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Katie: Hello and welcome to the “Wellness Mama Podcast.” I’m Katie from wellnessmama.com, and this episode is all about understanding metabolic dysfunction, how to move toward better metabolic health, and understanding, especially the differences that come into play with women versus men in this category. I’m here with Dr. Lauren Kelley-Chew, who is the head of clinical products at Levels. She’s also led strategy and bio ops for Fairly Life Sciences, and she previously founded a Y Combinator-backed digital therapeutic startup for digestive diseases, as well as working as a private equity investor.
She graduated from medical school at UPenn where she was a Gamble Scholar, and she really loves focusing on building products and businesses that solve system-level products and making health available to everyone. In this episode, we go deep on what metabolic dysfunction is, and why it’s so important to understand, as well as why it is so drastically on the rise, even though our calorie consumption has not changed that much in the last few decades.
We talk about the role of insulin in metabolic dysfunction, the personalization of the insulin response, and what we can all learn from it. The shocking amount of added sugar that most people are consuming daily, why walking is one of the most powerful tools for blood sugar regulation and how to get the most benefit, how light impacts our circadian response, and as a result, our glucose and metabolism.
And then we go deep on the topic of women’s health and how women differ from men metabolically, and what we need to understand to optimize our hormones and our health. And then how things change during our cycle, during pregnancy, and through menopause.
And we end by talking about the four pillars that are the framework for optimizing metabolic health and how to optimize each one, as well as then how to get personalized with your own body’s response beyond that very, very fact-packed episode. She is incredibly knowledgeable and was really, really fun to interview, and I know that you will enjoy it as much as I enjoyed recording it. So, let’s join Dr. Kelley-Chew. Dr. Lauren, welcome. Thanks so much for being here.
Dr. Lauren: Very excited to be here.
Katie: I’m excited to get to go deep with you on some, I think, really important topics that are only becoming increasingly more important in today’s world. We’re gonna get to talk about metabolic dysfunction, and what the inverse of metabolic regulation and adaptability looks like, with a special focus on women’s health, because, like we talked about off-air, before we started recording, this has been, I think, a drastically understudied area of research. And I know you’ve talked about this, women not just being little men, and that there are differences which we can use to our advantage, which is the part I’m super excited to get into today. But to start broad, maybe walk us through kind of what are the criteria of metabolic dysfunction? I know that this is massively on the rise, from the statistics I’ve seen. And I think you’ve called this the largest health crisis that’s facing us today. So, maybe just give us a broad overview of what is metabolic dysfunction?
Dr. Lauren: Absolutely. I think the best place to start is actually with what is metabolic health. And then we can talk about dysfunction and the impacts of that, and why it is such a global crisis. So, metabolic health really is just describing when our metabolisms are functioning optimally. Our body is made of about 37 trillion cells. And every cell needs energy in order to do its functions optimally. Metabolism is really just conversion of the food we eat into energy for those cells. So, when all of those biochemical processes that are happening smoothly, we call that good metabolic health.
Unfortunately, primarily due to lifestyle factors, like eating diets high in sugar and processed food, that process is often disrupted. As you mentioned, this impacts almost all of us, not just people with a diagnosis of prediabetes or diabetes. In the U.S. right now, 9 out of 10 Americans have some marker of metabolic dysfunction. And I know that’s certainly true for me. I was diagnosed with prediabetes when I was in my early-mid-20s. And I was actually in medical school at the time, and I thought I was doing everything for my health, or what I believed was for my health.
And so that’s really to say that this is something that is impacting almost everyone, not just in the U.S., but in many parts of the world. And we’ll come back to this, but specifically, because we will be diving into the topic of women, in developed countries, about half of women, it’s estimated right now, will die of completely preventable cardiometabolic conditions. So that’s just one reflection of how serious this is.
Katie: Absolutely. And I know there’s also the clinical definition of metabolic syndrome, which looks at things like I think blood pressure, triglycerides, high glucose, which we’re gonna talk about today, and also things like waist circumference. And I know the numbers are really staggering on, especially in America, the number of people who have at least a couple of those criteria, and it’s drastically on the rise. What I find interesting is, when we look at the data, our calorie consumption has actually gone down over the last 30 years. But metabolic syndrome is on the rise during that same time period. So is, of course, diabetes, a lot of these problems, the cardiometabolic ones you mentioned. What do you think are maybe some of the reasons we’re seeing this still very sharp rise in these?
Dr. Lauren: There’s so many reasons, and I think this reflects the complexity of the body. For so long, we thought it was calories in, calories out. And I think there’s so much evidence now that that doesn’t really makes sense, or that’s not the full picture. Certainly, energy is one part of the equation. I think a piece of it that is really important to me, that isn’t as well-known, is the role of insulin. And so, when we talk about high blood sugar, really, what we’re describing is that when we are constantly eating foods that spike our blood sugar high, and that is many more foods than most people think, we’re actually then triggering a release of insulin in the body, because insulin is the hormonal signal that tells our bodies to take sugar out of the blood and bring it into our cells.
So, when we’re having a diet that’s resulting in very high blood sugar, we’re also having a diet that’s resulting typically in very high insulin. And insulin is a signal to the body to create fat, by pulling sugar out of the blood rather, than to burn fat. So, when we’re in a situation where insulin is always high, even if we’re not eating that many calories, our body is actually being told not to burn fat. So we’re in a situation where we are actually prevented from fat burning. And I think this is the piece that gets so often confused when people think about calorie restriction, is that they’re doing calorie restriction, but the calories that they are eating are spiking their blood sugar, including insulin. So they’re in this somewhat bizarre and not physiologically typical state of being under-caloried but having high levels of insulin. So, I think that actually has a lot to do with why people are having trouble losing weight. But again, I mean, I think weight loss is one of the most humbling aspects of medicine and science, where it is just so incredibly complex, and really, we’re all still trying to understand it.
Katie: And, to your point, there’s, it seems a tremendous amount of personalization that goes into this, and almost no hard-and-fast rules of, like, this food universally is gonna cause this response in the body, because we are all so different. But I do think you’re right. If we look at the data, we’ve seen big shifts in not so much calorie consumption, but the type and makeup of those calories. And it’s certainly, I look at, like, micronutrient availability and nutrient density in those calories has declined, we know, pretty sharply, especially with the soil being depleted, and a lot of these factors that we talk about on the environmental side. But to your point, it’s maybe the first time we’re seeing at such a large scale, people who are sort of that overfed, undernourished cliche that we hear about so much. But it’s true. And you mentioned, you know, like, if you don’t have all these nutrients and cofactors, even if you’re getting the calories, you may not be absorbing, converting, and using them correctly, which is sort of putting, I’d use the analogy of, like, kinks in your hose, so your body’s just not functioning properly.
But I think the insulin piece is a big key that now we actually have the ability at home to have more of a picture of what’s happening inside of our bodies, which is really, really exciting. And because it’s so personalized, I know, with the company you work with, Levels, you guys give access to glucose monitors that we can wear at home. And for me, this was super eye-opening, because I could see in real time how my body was responding to certain foods. And it really illustrated for me that it’s not these hard-and-fast rules, where, you know, sweet potatoes wouldn’t cause a glucose spike for me, but something like berries, which are supposed to be low glycemic, could, and I wouldn’t have known that without that data. But let’s talk about maybe, are there any kind of hard-and-fast rules when it comes to glucose and insulin? Kind of any general principles we can build from? Or is it entirely personalized?
Dr. Lauren: I love that question, because I think, in general, it is much more personalized than people think. And people have probably even experienced this in their own lives, where they might find that they’re eating the same diet as a friend or a partner or a family member, but their response in their body, or even just the way they feel, if we just remove this from a discussion around weight, but even just to the way they feel in their body or their energy levels, they notice that’s very different than the other person following the exact same diet. So, intuitively, I think we have a lot of experiences where personalization is so key. There are a few things that I think are just not health-promoting, is the best way of putting it.
And so, one is, what you mentioned, which is essentially foods that are depleted of the nutrition. Right now, about 60% of American calories come from highly processed food. I think there’s no question that those foods are not nourishing for anyone, there’s not much personalization there, and if possible, should be reduced as much as possible. Likewise, foods that are very high in sugar. And this is especially added sugar. I saw an estimate recently that adults, not only adults, but also children in the U.S. right now, are eating on average 17 to 20 teaspoons of added sugar per day, which amounts to 60 to 65 pounds of added sugar per year. This is just a massive amount of sugar, that creates a very big burden on the body in terms of processing. I think sometimes we don’t realize how delicate, and resilient at the same time, our bodies are, which is to say that they are in this very balanced dance, where they have hormonal balance, they have metabolic balance. There’s so much going on. And while we can actually sustain a lot of stress, at some point, the stressors become more than we can sustain. And I think this is where some of these hard-and-fast rules around processed food, high-sugar foods, come into play. Because the stress that we’re putting on our body, it’s just much more than we were evolutionarily designed to sustain. So those are two that I think are kind of hard-and-fast.
And the other one, which isn’t directly related to food, in terms of what’s going in our mouths, but is related to the way that we process food, is the importance of movement and exercise. And we can get into that more. And there’s so much conversation around the details of that, right? Like, should you be doing high-intensity workout? Should you be doing zone two workouts, which is to say kind of low-level endurance workouts? But from my perspective, hard-and-fast rule is everyone should move their bodies as much as possible. And literally, every bit of movement counts, even if that’s the difference between sitting and standing. So, those are a few hard-and-fast rules that I think apply to everybody.
Katie: Yeah. I think that’s a really helpful paradigm to understand, looking at it that way. And I know with my kids, I don’t want to talk to them about calories. And I certainly don’t want them to develop a deprivation mindset around food. So we have a lot of conversation around nutrient density. And their targets are how can you get enough nutrients in all of these different categories from your food every day, not, you should be worried about how many calories you’re eating. And through that lens, it makes sense, very obviously, to avoid things like added sugar or really refined foods, because they don’t give you a good nutrient-density-to-calorie ratio, and they’re just not getting energy from it. But I think that same idea is really, really helpful to adults as well. And you mentioned the movement, which I think is a huge key as well. And maybe one thing you can explain is, if people are wearing a glucose monitor, I know I’ve seen mine go up at times, from intense workouts, from sauna, and that that’s obviously a different biological response than from food. Is there a difference in how the body responds to those, and, like, for instance, would spiking glucose a little bit from a workout be a negative like it would be from food, or are those things handled differently?
Dr. Lauren: Those are handled differently, and just going back to what you said, prior to that question around deprivation mindsets, I completely agree with you. And I think one of the misconceptions of diet, or let’s say, food guidance, is that it is about restriction, when in fact, from my perspective, it’s about learning and about freedom. It’s about getting through all the confusion that’s created by our medical system, and also by marketing and food companies, around what is actually health-promoting for our bodies. And so it’s really to expand, like you said, the range of nourishing options that we have, rather than to think about what we can’t eat. At least, that’s my approach to it.
In terms of exercise, it’s really interesting, because what you describe is definitely a physiologic phenomenon. And what it is, is that when you do a really intense workout, you’re actually triggering cortisol and the stress response in your system. This goes back to fight or flight, for animals. And what was really happening is, your body’s saying, okay, we’re working out really hard. We need sugar in the blood to be able to sustain this level of exercise, and really mount that response, to be able to meet that level of intensity. So this is actually a physiologically healthy response to intense exercise.
It is, as you pointed out, a very different pathway in terms of the health implications to spiking blood sugar through, for example, eating a very sugary food. When we eat really sugary foods, our body is actually in a situation where we have now created blood sugar through the food that we’ve eaten, and we have to now deal with it, versus in exercise, where our bodies have chosen to produce that sugar because we know we need it, and our muscles are going to use it. So, very different. But I agree, this is one of the areas of confusion when people first start wearing a continuous glucose monitor, is what’s really happening. Or, like you mentioned, something like sauna, where, again, you’re getting that stress response. But the goal is that the way that your body adapts to that stress is actually, in the long term, very health-promoting.
Katie: That makes sense. And I love that the Levels app lets me differentiate between this spike was from food, this spike was from exercise, and they’re handled, it seems, differently in how that score is calculated. I’m very, like, metric-driven, and I love data. And so I love that that gives you a number score. And it’s kind of like a game of beating the game and getting better scores. I know one thing I’ve seen mentioned a lot in the literature around this is, even the benefits of people just walking. And I know that sounds like a very simple, almost not exercise. But to your point about movement being so important. But there seems to be something special about walking, especially after meals, and what it can do for our glucose response, as well as, from what I’ve read, walking is actually unique, in that because it’s a low-level exercise, it seems to actually trigger fat-burning, versus that spike, from, we would need from the higher-intensity exercise. So that’s something I often mention to people. You know, even if you are new, and you don’t have a lot of tolerance to really intense exercise, almost everyone can walk, or, you know, move in some way that’s like walking. And that can have a really big, when you look at the monitor, it can actually have a really big impact on your glucose over the course of a day. But I know you’re much well-researched in this than I am, so what’s your take on just, you know, post-eating walks?
Dr. Lauren: Absolutely. I think post-eating walks are one of the easiest and most powerful things we can do to improve our metabolic health and our blood sugar. As you mentioned, I think there’s a lot of emerging research, and we’re actually looking into some of this, even internally as a team, looking on our own continuous glucose monitors, and running casual experiments around how to modulate the intensity of exercise, to change, essentially, what fuel source you’re using when you do that exercise. And again, this is an area where there’s so much complexity. Because you can imagine, for example, if you’re doing a fasted workout, you might not actually have very much glucose reserve, at which point you will tap into fat much more quickly than for example if you’re walking after a meal, but in both cases, I think walking, in general, you do see a decrease in blood sugar as you walk versus, for example, very high-intensity workout, where you’re going to see an increase. And what we’re experimenting with right now internally is modulating, actually, what is that threshold, of how slowly, so to speak, you need to run or walk in order to avoid that increase in glucose.
And again, not because that increase in glucose is harmful, but rather because it creates another tool for us to understand how we can modulate the energy system that we’re tapping into when we exercise. But I agree that, I think one thing that’s not recognized is just the power of walking, and that it doesn’t have to be a lot. It can literally be a two-minute walk. And of course, more is better. But for people who are really busy, or maybe don’t have a lot of safe places to walk, or any of these types of things, you can get benefit out of walking through your house after eating. Like, that actually…or walking up the stairs of your apartment building, or picking your kids up and down, anything that uses the muscles, because muscles are just glucose sinks, and they will suck that sugar out of your blood, just like a sponge would with water.
Katie: And you also mentioned the stress response link with this as well. And I know that sleep is also a component here, because, from the data, we see even one night of impaired sleep changes your glucose numbers the next day, it changes your stress response, makes a huge difference. So, I know one easy tip that I often recommend that’s entirely free is just, as soon as possible after waking up, going outside, getting light, which has a whole host of research that morning light and our cortisol rhythms, but also just, any kind of gentle movement, not high-intensity first thing in the morning. But, for me, things like mobility, I do a program called CARs, which is just controlled rotations of all the joints, which also helps then get nutrients into those joints after being still while sleeping. I feel like things like that are so underestimated in how big of an impact they can have. And like you said, it’s very gentle movement. I wouldn’t even categorize it as exercise at all. But it’s a way to get your blood flowing, to get your glucose response in the right range early on. But any other suggestions like that, especially related to, like, morning routine, that can help set someone up for good glucose throughout the day?
Dr. Lauren: I love that. There is increasing evidence around the importance of bright, natural light in the eyes in the morning. And I think the underlying theme here that is so interesting, that you’re alluding to, is the importance of our biologic clocks. And I think many people have heard of circadian rhythm. And certainly, there is a master clock in the brain, that is triggered by things like getting light in the early morning, where the light comes into the retina, and actually sends a signal to the area of the brain that is functioning as the master clock. But actually, every cell in our body also has an internal clock.
And so, part of what we’re trying to do during the day by moving through these different activities, and for example, eating not super late at night, what we’re trying to do is make sure that those peripheral clocks and the internal master clock are synced up. So, for example, if you do eat late at night, your master clock is already in a phase where it’s saying, “We’re getting ready to sleep. The sun has gone down, we’re releasing melatonin, we’re really getting ready to wind down.” But when you eat, the cells in your gut, and the related cells for digestion, say, “Wait a second. Now we’re eating. So is it an eating time, or is it a sleeping time?” And right there, you see a misalignment between the internal master clock and the more peripheral clocks in the other cells. So, I think, as research evolves, what we’ll see in what you’re describing is the increasing importance of trying to sync up all of the clocks in your body, so to speak, which sounds a little bit crazy. But if you look at the way that animals live, they do this naturally. They wake up, they’re in the sun, right? They eat in certain rhythms. And I think we have a lot to learn from that.
Katie: Are there any good general guidelines around the morning light routine, and around, you mentioned not eating at night, which is, I know, anecdotally, I’ve seen when I wear a monitor that those two factors seem to make a huge difference in my glucose response the next day. And so, as a general rule, for me, personally, I found I seem to sleep the best when I don’t eat for about three, or optimally even four hours before bedtime. I’m sure there’s some personalization there as well, as well as my glucose response is much stronger if I do get that morning sunlight. But are there any good general hard-and-fast rules for ways people can incorporate that?
Dr. Lauren: Research right now seems to suggest that most people have the highest level of insulin sensitivity, which means the most adaptability to carb loads, around mid-morning, so say 10 a.m. And that essentially decreases after that. And actually, as you get towards the nighttime, and you do start releasing melatonin, that actually further reduces insulin sensitivity, and increases insulin resistance. So, when you eat late at night, you are not only eating outside of, again, what your master clock would have thought was the time when your body would be eating, but you actually also have physiologic changes that are happening as you prepare for sleep, that make you less able to tolerate carbs.
So now, you’re going to sleep in a situation where your blood sugar is relatively high. And I think there’s a lot of evidence, just observationally looking at continuous glucose monitoring, that when people do eat later at night or closer to bedtime, they have a very difficult time actually getting their blood sugar down to normal levels and then stabilized at those levels for the rest of the night. I know for me, personally, when I eat late at night, what I see is essentially not a complete roller coaster of blood sugar overnight, but a lot of ups and downs during the night, where normally I’m completely stable. And I think that’s just one reflection of the likely disturbance in sleep quality that people experience when they eat really late at night. And, you know, as you mentioned, there’s personalization here. And there’s also just the practicality of living. Sometimes it happens. But I do think that what I try to focus on is that I feel best when I don’t eat late at night, and I focus on that rather than trying to say I’m not allowed to eat late at night or something like that. And I think, for me, that’s a very helpful mindset, where it’s all about tuning into how I feel at any given time.
Katie: Yeah, that’s I think such a good mental reframe of that, and it keeps us away from that sort of deprivation mindset, or, like, for me, the tendency to want to be rebellious when I feel like something is a hard-and-fast rule. But certainly, I notice the biggest difference in deep sleep as well, with not eating late at night, which research seems to show is a really important metric for the body being able to restore itself while we’re sleeping. I also seem to notice a difference, if I’m getting enough protein at meals, that actually seems to sort of help mitigate the glucose response, even if there’s, like, higher-carb foods in that meal. What does the research say about protein consumption and how it comes into play?
Dr. Lauren: Protein, fat, fiber, when paired with carbs, make a big difference in terms of the impact on your blood sugar spike. So, I think the classic example is around, for example, going to a restaurant, completely empty stomach, and starting with the bread. That is going to produce a much higher glucose response than if you start with, like you said, protein, fat, or fiber. So, let’s say you actually start with, if you’re eating meat that night, the chicken, and some salad, and some olive oil. By the time you get to that bread, the way that it’s digested, and the way that that converts into blood sugar, is much more muted than it would have been otherwise. So, I think food pairing, with protein or these other things, is one of the actually easiest and most powerful things you can do to reduce your blood sugar response. There is some interesting nuance when you think about the way the protein is processed, especially when it comes to keto diets.
And again, keto diets, the research there is still emerging, and certainly, it’s still emerging for women, because keto, like so many things, has been mostly studied in men, and we can get into the keto diet. But keto diets have very, very low protein loads. And that is because, in excess, protein can actually be converted into blood sugar. So there is some nuance there in terms of quantity of protein, but for the average person, we are eating much less protein than we would need to produce that response, and so I think it is a very metabolically healthy additive to almost any meal.
Katie: Yeah. I think that’s an important distinction, like, for the average person, because like you said, there’s a lot of research in things like what type of movement, and should it be zone two? Or, should we be hitting this heart rate for this amount of time? Or, you know, what is the optimal protein consumption? But for the average person, we’re not overconsuming protein, we’re not even probably hitting protein targets, we’re not moving enough, we’re not elite-level athletes, where it actually matters, those really nuanced specifics of what is actually the absolute best thing I can do for my body. It’s more of a, let’s get more movement, let’s adequately fuel our bodies with the right consumption of micronutrients and macros, before we need to start worrying about those more nuanced things.
And we’ve mentioned women’s health a couple times, and I think this is… I’m really excited to shift gears into this, because largely, women have not been included in medical research for a long time. In fact, if I’m remembering, I think it was 1993 when they actually first started even including women in research. And for often, it’s, you know, women are just thought of as, like, smaller men in these categories. And it’s so funny to me, because we have so much more hormone variation than men do. And so we might look entirely biologically different based on, you know, even just different parts of our cycle. So, to start broad, maybe just give us a rundown of some of the factors that come into play when we look at women versus men in these different categories.
Dr. Lauren: I’m so glad that we’re talking about this, because like you said, this has really been a neglected area of research, in my opinion. But, in reality, women are actually at higher risk of metabolic dysfunction and the downstream effects of that dysfunction. And this is due to sexual differences, but also gender differences, which is to say, the impact of genetic and physiologic differences, but also socially constructed differences, and differences in the lived experiences of men and women. And so, we know, for example, that by age 45, women are more likely than men to be overweight or obese, and women are more likely to struggle with blood sugar throughout their lives. In fact, I think, as we mentioned at the beginning of this, there is a very large percentage of women who, unfortunately, in developed countries, will die from completely preventable cardiometabolic disease. It comes out to essentially one woman every 80 seconds passing away from these preventable cardiometabolic conditions.
And so, I think what’s really important for us to understand, and we can dive into the hormonal causes, but also the importance of the experiences that women have living in day-to-day lives. For example, we know that women experience more trauma than men, they have higher levels of stress, and there’s disparities in quality and access of healthcare. One of those harrowing statistics of this, or kind of an example of this, is that when a woman is having a heart attack, if she goes to the emergency room and happens to be seen by a female physician, she’s two to three times more likely to survive than if she sees a male physician, which shows the impact of gender, completely separately from physiology or hormones. And you might wonder, well, what happens to a man if he goes and sees a female physician, actually men have equal survival rates when they see female or male physicians. So, this is just one of the many examples of where we have to underline the importance of the differences that we have physiologically and hormonally, but also the differences that we encounter as women living in society as it is today.
Katie: And on the hormonal side, I know that, obviously, our hormones shift at various points throughout our cycle each month. But how does this come into play when we’re talking about, for instance, glucose or metabolic health? Like, are there observed patterns based on different parts of the cycle?
Dr. Lauren: Absolutely, and I think this is one of the most fascinating important areas of emerging research. The menstrual cycle can be broken out into four main chapters, and this is following a typical 28-day cycle, but as many of us know, the cycle length can vary. So, this is just for kind of the simplicity of describing this, but the four main chapters are menstruation, which is the most famous phase of the cycle, where uterine lining is shedding, and we’re bleeding. The second phase is the follicular phase, when a follicle, or an egg, is being prepared to be released from the ovary. Then we hit ovulation, where the egg is released. And then we hit the luteal phase, in which that egg is available for possible fertilization and implantation.
At each of these phases, there are different hormonal characters. And so, I’ll talk about just two of them. And of course, there’s a lot of intricacy and complexity beneath this. But the two main characters that I’ll focus on are estrogen and progesterone. So, during the first phase of menstruation, which is approximately days one through five, estrogen and progesterone are both very low. But as we enter the follicular phase, estrogen begins to rise. And estrogen is the main hormonal player of the follicular phase. Estrogen, really interestingly, has been associated with increased insulin sensitivity. So, during this phase, we would expect that women will have a somewhat better tolerance for carb loads, and an easier time managing their blood sugar.
As we reach ovulation, estrogen peaks, and then it begins to fall. And as we enter the luteal phase, progesterone rises, and progesterone becomes the dominant player during that phase. In contrast to estrogen, progesterone is actually associated with increased insulin resistance. So during this part of the cycle, we would expect that women might notice a more difficult time controlling their blood sugar. And interestingly, in one of the fascinating aspects of human physiology, during the same time when it seems that our ability to be resilient to carb loads is decreasing, our carb cravings are also increasing. There was a really interesting observational study looking at eating patterns of women as they go into the luteal phase, and especially towards the end of the luteal phase, which is about days 14 through 28, with ovulation around day 14. And what they noticed is that these women, on average, ate 260% more refined carbs during the late luteal phase than during other phases of the cycle.
So, this is really to say that there’s complex biology happening here, where our resistance to carbs and sugar is changing, but also our cravings towards carbs and sugar are changing throughout the cycle. And then, of course, at the end of the luteal phase, the hormones drop, and, assuming that we’re not pregnant during that cycle, we then go back to menstruation, and it all starts again. So it’s beautifully complex and interesting.
Katie: So, understanding that, are there any ways that we can use that to our advantage when it comes to how we eat or how we work out in those different phases?
Dr. Lauren: Absolutely. There’s a few things. So, one, I think, is just being conscious of that timing around insulin sensitivity and insulin resistance. And especially as we go into that second phase, where we’re more insulin resistant, but we’re also craving more, to be especially aware, and, I think, kind to our bodies. But just, at least for me, I think, having that knowledge of saying, okay, I understand hormonally that I am experiencing different things now than I might have felt earlier on, that that creates a lot of compassion, and in some ways, the foresight to create strategy around, okay, if I know I’m going to crave this, maybe what’s a healthy substitute that I’m going to do to satisfy that craving, to keep my body feeling as good as it can, knowing that it’s not as resilient as it might have been? In terms of performance, there’s some interesting research that one of our advisors, Sara Gottfried, talks about, around the window around day 9 through 14, which is to say the end of the follicular period, and then going towards ovulation, when not only is estrogen peaking, not only do we have higher levels of insulin sensitivity, but also testosterone is peaking. Testosterone we think of as a male hormone, but it’s actually the most abundant hormone in the female body. And we’re exquisitely sensitive to it.
And so, when we have this peak in testosterone, as we near ovulation, it’s actually potentially a really good window to stress the body more, in terms of physical stressors. So, for example, a really hard workout, or if we’re going for strength gains in weight training, to try for them during that time, but also, potentially, to do stressors like intermittent fasting, if that’s something that someone is using for their health, that that window of days 9 through 14 could be a really interesting time to try those. It might actually be easier to try those things than later on, when the carb cravings increase and the body is changing.
Katie: That makes sense. And I’ve noticed that, with right now, I’m in a cycle of trying to increase strength. And it definitely feels easier. And I’m more likely to actually PR in that pre-ovulation phase than…and I pretty much now try to avoid those right before menstruation, just because it does feel much, much harder because my body’s not as ready for that. But understanding that, it’s great to be able to cycle that and plan for that kind of once a month, okay, this is when I’m gonna ramp up the strength training, and at the other times, I might focus more on, you know, mobility, or more gentle movements, or other goals than those, you know, specific strength goals.
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What about when it comes to weight gain? Because I know this is a big topic across the board, of course, and we see the stats about obesity on the rise. But it does seem like it affects women more than men, at least from the data I’ve seen, and I’m guessing there’s a hormonal component here as well. What are the intricacies there, and what can women understand that can help them if weight is an issue for them?
Dr. Lauren: There’s so many different ways of approaching this. And I think there are hormonal differences in women, just generally speaking. And then there’s also hormonal imbalances that are very common in women that can lead to weight gain. So, I’ll talk a little bit about both of them. On the first one, the role of estrogen, along with many other hormones, like growth hormone, play a role in weight. And I think an interesting way of looking at this is, as women approach menopause, and estrogen begins to drop, growth hormone begins to drop, and, of course, other hormones begin to drop as well, you often see a change in where the weight is distributed, an overall increase in weight, and also changes in lean muscle mass. And so, you know, for women who are having different estrogen levels, even prior to menopause, or outside of the window of menopause, it demonstrates the impact of hormones on those various factors. I think, when we begin to see lean muscle mass decrease, for example, that is so intricately related to weight and to blood sugar, because muscles are a really important glucose sink.
So, if lean muscle mass is decreasing, then you’re likely to be less resilient to blood sugar, which means you’re likely to have higher insulin, which means you’re likely to have more stored fat. Another window into understanding weight, and women, I think, is looking at hormonal imbalance, which is actually really, really common. And so, one of those common ones is polycystic ovarian syndrome, which impacts about up to one in four women. So, this is of reproductive age. This is extremely common. And it’s really a complex metabolic and hormonal imbalance. And what you see in those cases is that increased insulin, and again, if you have increased insulin, even without a PCOS diagnosis, this is the same physiology that is probably happening in your body. Increased insulin actually communicates to the ovaries, which are very sensitive to insulin, that they should pump out more hormones. And some of the hormones that they pump out are hormones like testosterone and other androgens, so, characteristically male hormones.
These directly result in a tendency towards weight gain. And then that weight gain further often creates more insulin resistance, because now you have higher levels of fat around the organs, and in other parts of the body. And that creates higher levels of insulin, which then signals back to the ovaries to create more hormones. And so you end up in this cycle, of essentially high insulin levels, and signals to the body to create fat. And again, even outside of a formal diagnosis, this is a process that can be happening in any woman’s body in response to high insulin. So, I think there are so many factors here, and a lot of it circles around metabolic balance, hormonal balance, and low levels or high levels of inflammation, which is what, really, high insulin is creating, is a state of inflammation, state of high cortisol, all of those things combined.
Katie: What are some of the steps then to breaking that cycle? Because it seems like a vicious cycle that will continue to perpetuate if we don’t interrupt it. So, what are some of the ways that women can interrupt that cycle with hormones and insulin?
Dr. Lauren: This is one of the reasons that I love talking about metabolic health, because…I think you said the word superpower at the beginning. We have so much, so much power in reversing this. And really, it comes down to diet, movement, stress management, sleep. And these are not easy for anyone, including me. So, it’s not an expectation that it should be so easy to do. But the solution really is in our day-to-day and moment-to-moment choices. So, the way you break the cycle is you break that high insulin level, being kind of the baseline physiologic way that your body is functioning. And the way that you bring that insulin down is by eating foods that will help to control your blood sugar. And we can talk about what those are, but a lot of it is what you described, which is focusing on protein, focusing on healthy fats, focusing on fiber, and then moving after meals, and moving in general, building up your lean muscle mass, through strength training, so that your muscles have more resilience when it comes to using the sugar that you do eat. Like you pointed out, getting high-quality sleep, starting the day in a state of low inflammation rather than high inflammation, telling your body it doesn’t need to be in fight-or-flight mode.
And then continuing that, through stress management throughout the day. All of those things combined will actually bring insulin levels down very quickly. And you can break that cycle very quickly. There’s been amazing research on how quickly these changes can occur. And I know for me, personally, within probably one week of making dietary changes, I saw my blood sugar completely stabilize, my fasting insulin dropped tremendously, and everything clicked into place, so I get so excited about this because there’s so much that we can do. We don’t need a magic pill. We have tools that we can use ourselves in our day-to-day lives.
Katie: Yeah, and I think having access to the data side of it, and being able to see that change happen, is very motivating and also helps you stick with it. Plus, it seems like for most people, there’s that first couple weeks can be a tough window, where there’s a lot more willpower that comes into play. But as the hormones start shifting and insulin starts changing, it actually gets much easier to maintain, so I think people, if they go into it with that expectation, it’s, like, the first two weeks might require some discipline and willpower, but then it gets easier. It’s helpful to get through that initial kind of transition phase.
And I love that you mentioned strength training and lean muscle mass as well, because I think this is another place we’ve seen disparity in the past, where guys have always sort of been encouraged to do strength training. That was always more socially acceptable for guys. But the data is really staggering, when I’ve looked at it, on the importance of those for so many aspects of longevity as well. Not even just our physique or what we may want to look like, but the data surrounding strength training, and maintaining lean muscle mass as we age, makes a huge difference. And it’s also an area where I think…I think about the idea of compounding a lot in my life, in business, and in work. But also, it really applies here, where you’re getting continual benefit over time.
So, even though building strength may be a slower process than just, you know, doing cardio to try to burn calories immediately, maintaining that muscle mass and growing it over time actually helps us to have a better metabolic response at rest, too, so there’s so much compounding.
Kind of peripheral to that, another thing I think that can maybe be a useful tool, you mentioned intermittent fasting. And I love that you brought it up in a context of cycles specific to women. But there does seem to be some really fascinating research, through people like Satchin Panda and others, around intermittent fasting, or what he calls time-restricted eating or feeding, and how that can influence our glucose response and hormones in many other ways. So I’d love to get your take on eating in a more time-restricted window, even for someone who isn’t going to necessarily do longer fasts, and also what blood sugar and insulin look like when we do longer fasts, to sort of reset those pathways.
Dr. Lauren: I think that the field of intermittent fasting is so fascinating, and it’s really, the research there is being published at a really exciting pace. So I think we’ll know much, much more about this as we go forward. But, to your point, I think there’s no question at this point that it is…can be very health-promoting. One thing that I think is interesting is when it comes to women, we actually are… We have, of course, as we do with everything else, much less information about the impact specific to female physiology. But there’s some early indications that intermittent fasting for women may need to be tweaked to match the physiology, especially for reproductive-age women who are actively cycling in terms of their hormones.
So, there’s this balance between the benefits of intermittent fasting and also the stressors that are created, and specifically the release of cortisol that some women seem to experience as they increase that fast beyond a certain amount of time. Our advisor, again, Sara Gottfried, has made the recommendation that for most women, actually, somewhere around a 14-hour fast looks like, according to the medical research, is the most healing. Versus, for example, pushing it beyond that, for example, to the classic 16 and 8, where you’re fasting for 16 hours and have an 8-hour feeding window, that for many women, that actually triggers cortisol.
And I think this links back to some of the research on keto diet, or even just observational research on keto diet for women, where that stress of the keto diet can actually have many downstream consequences from a hormonal perspective. So, for example, 45% of women who are doing keto, approximately, will have menstrual irregularities. Other women have impacts to thyroid, cortisol, sleep quality, and I think, my intuition is the same is true for, probably, for intermittent fasting. And this underlies the importance of personalization, and the importance of really being in tune with how it feels for your body, as we wait for larger-scale research telling us information about the impacts of different levels of intermittent fasting and frequency, and all the different ways of modulating how we do this, specific to female physiology.
Katie: Yeah, and I think, certainly, that’s why the data can be so helpful in understanding our own metabolic response to these things. But I’ve noticed the same thing, that the factors that seem for me to make the biggest difference is, on most days when I’m not doing anything specific, of eating in that, like, for me, a 13 to 14-hour window, but also being cognizant of feeding enough during the eating window. I think often, for women, you can fall into the trap of not actually consuming enough calories, and creating a stress response by undereating, if you’re eating in a more narrow window. So it’s something to be aware of there.
But also, when we look at the data, I know most people think, like, “Oh, I don’t wanna fast,” right? “And I probably already eat in that kind of a window anyway.” But if you actually track it, most people will be surprised to find that a lot of us are actually eating for, like, 17 or 18 hours a day. And that I noticed most people are eating continuously. Like, we think of, “Oh, I only eat three meals a day.” But if in between those meals, you’re having caloric consumption food, something you’re drinking, or just a handful of nuts or whatever it may be, your body still is in an eating window during that time.
So, for me, personally, one thing I’ve found helpful was to be aware of meal timing, and make sure I was getting enough food, but also giving my body a break in between meals. So I was actually not consuming calories for three or four hours in between meals, which also lets the body then finish digesting the previous meal, let the glucose response go back to normal, before consuming calories again. So, I think, for women, being aware of that, you can still make tweaks that make a big difference, even if you’re not trying to, like, eat in a very short window, or you don’t wanna push that too much hormonally.
Dr. Lauren: Absolutely. And I like a lot of the things that you pointed out. So, the first one being that taking breaks from eating is so important, because it comes back to that elevated level of insulin. If we’re constantly eating, we’re constantly essentially asking our bodies to process blood sugar, because even very low-carb meals, it will still increase your blood sugar a little bit unless you’re completely, completely keto. And that’s another story. But one of the keys to getting insulin down is having these periods when insulin does not need to be active. On the other point that you made around sleep, and kind of intermittent fasting, I think it’s also been noticed that when women under-calorie, as you’re describing, kind of undernourished, then they enter that window of fasting, really, in a state of hunger, essentially, and their bodies are not well-nourished, it can actually be very disruptive to good sleep. And high-quality sleep is so important for metabolic health. So, again, there’s a balancing factor there.
This is similar on the keto diet, where ketones can be very activating for some women. So, as they produce ketones going into the nighttime, if that level is higher than the threshold that works for them, they may find that actually, their sleep is quite disrupted, and they’re having insomnia-type symptoms, and then they start the next day with poor-quality sleep, and their metabolic health is already going to struggle because of that. So, there’s so much nuance there. And I know for me, I’m always trying to experiment with what seems to work and what doesn’t work, and what foods fuel me best if I am going to try intermittent fasting. I’m not someone who does long fasts, but I do try to give my body a break overnight. And I find that what I eat prior to that makes a big difference in terms of how I feel during that time period.
Katie: That makes sense. And two other categories specific to women, and not necessarily that even all the women listening right now, but I think that are important to touch on, are hormonal changes that are happening during pregnancy, and also during menopause. I know that from my reading at least, there are some hormonal and insulin-related changes that happen during pregnancy that are actually, they serve a very important biological purpose. But for a woman who’s pregnant, it might be important to understand how to think of that differently when she’s in the pregnancy phase versus normal. And also when it comes to menopause, and the statistics being really interesting, I know, I think I’ve read that, at menopause, women’s cardiovascular risk goes up to that of men. And so there’s obviously some changes happening here. But anything insulin and glucose-specific to the phases of pregnancy and menopause, that women can be aware of?
Dr. Lauren: Insulin is a growth signal. And so, insulin during pregnancy is actually a really important signal that helps with placental growth, growth of the fetus, and even also preparing the mother for what’s coming next. So, insulin plays a role in helping the mother’s breasts be prepared for breastfeeding, and helping the mom to store fat, to be able to go through this demanding process of pregnancy. So insulin is really critical during pregnancy, but sometimes it gets out of balance. And that’s where you start to see insulin and blood sugar levels that are too high for the body to sustain in a healthy way, and that’s when you enter down the pathway of gestational diabetes.
I think one thing that is really interesting, that demonstrates this physiology, is that mothers with insulin resistance typically have higher birth weight babies, and that shows the impact of the insulin-rich, and likely glucose-rich environment that the baby developed in, having a lot of this growth signal, leading to that higher birth weight. But interestingly, those babies that have higher birth weights have a higher increase or likelihood of being obese, and having metabolic issues as teenagers. In one study, it estimated that that increased risk is about 40% more likely. So it really underlies the importance of metabolic health during this very sensitive window, not just for the mother’s health, but also for the baby’s health. And then postpartum women who have gestational diabetes have an increased risk of developing diabetes down the road.
And so, I think this is a really interesting glimpse into, again, hormonal physiology and female physiology, but also sets the stage for the importance of developing habits before pregnancy, during pregnancy, and then after pregnancy, that try to keep insulin and blood sugar as regulated as possible. And then, in menopause, we see a whole different change, where, again, we see a drop in many hormones, like estrogen, but also growth hormone and progesterone and others. And this typically creates a whole constellation of impacts, including redistribution of fat. Many women will notice that their clothes just seem to fit a little differently, even if their weight itself hasn’t changed. Like we talked about, a reduced level of lean muscle mass, and then also just an increased overall likelihood of insulin resistance.
But I think something that’s not as well-acknowledged is that this increased risk of cardiometabolic health, and just metabolic health in general that you see at menopause, it’s actually not a drop-off or a cliff at menopause. There’s a lot of research now suggesting that, for example, the risk of heart attack, for which metabolic health plays a big role, is actually increasing from the ages of 35 to 54. And that we are becoming progressively less metabolically healthy, on average, as we approach menopause. And so, while there is this big shift in terms of risk at menopause, that shift is actually happening progressively over time. And I think this is really empowering knowledge. So, I hope it doesn’t make people feel afraid. Rather, it’s to say we can change that. That’s under our control to change. And if we know that it’s happening, maybe even silently, we can start taking steps at any age to prevent that.
Katie: Yeah, and I think those are really fascinating windows into kind of increased, like, what hormone response we might see normally, it seems to be intensified during those times with the hormone shifts, especially pregnancy-related. And so that was something I was always aware of while pregnant, was things like the nutrient bioavailability and food, and consuming enough nutrients and protein becomes even more important when you’re talking about nourishing a developing baby as well. But you get to see that response even more amplified in real time. So it can be a really fascinating window into understanding your own body, when you have that intensification happening.
And we’ve gotten through so many different topics, I would love to now sort of switch gears and talk about what are some of the key takeaways people can implement when it comes to understanding and improving metabolic health? Maybe if there’s a framework we can start with as just general good guidelines from which people can then tweak based on their individual body response.
Dr. Lauren: Absolutely. So, like I said, the power, to me, of metabolic health is that it all comes down to our day-to-day and moment-to-moment choices. Again, knowing that, not every day we’ll be able to make the choices that we might want to optimally, so we just try to do the best that we can. I think a good framework for thinking about it is the four pillars that we’ve discussed, which is diet, sleep, stress, and movement. And within those, a lot of the focus at Levels is on diet. But of course, there’s interplay between all of them. So, when it comes to diet, some of the main principles that people can follow is one, trying to avoid high-sugar, highly processed foods, and refined carbs. I think that is the blanket approach that will, for most people, get you to a much better state of health than you’re already in if you’re doing those things.
The second thing is to think about pairing your carbs with fat, protein, and fiber, as we talked about, to just slow down the rate of sugar absorption when you do eat carbs. Likewise, to think about timing. So, in addition to pairing foods, the timing of when you eat your carbs, with it being better to eat carbs after the fiber, fat, and protein than before. And then, layering onto that, nutrient density, as you described. So, the goal is not just to have a flat glucose line. In fact, I would say the goal is not to have a flat glucose line. The goal is to optimally nourish your body, with the highest nutrient-dense foods possible, while maintaining a relatively stable blood sugar. And so, what we’re really trying to do is lay the building blocks for metabolic health, rather than achieve just a metric on a continuous glucose monitor or a number on a scale. So, I think the way that I think about that is just trying to prime my body with the best signals for my metabolism as possible. So, that’s diet, and there’s so much more we could talk about there, but those are some main principles.
Movement. Any movement is beneficial. That’s my personal philosophy. Strength training, as you mentioned, has a lot, a lot of benefits for metabolic health. I think of strength training like you do, as an investment in the future of my metabolic health. It helps to use up blood sugar in the moment, while I’m doing it. But it also helps to build muscle mass for the future.
Getting high-quality sleep, in whatever ways possible. As you mentioned, there’s studies showing that even one night of interrupted sleep reduces insulin sensitivity, and really sets your body up for a much more stress-related and kind of inflammation-oriented approach to the day.
And then, along with that, just stress management, to the extent that’s possible, knowing that all of our lives are very busy. And as I mentioned, when it comes to women’s health, there’s so many stressors that are unique to women, that I think do not get acknowledged nearly enough. And so, just being conscious of those, and knowing that they impact us, and trying to manage them when possible, helps to be another puzzle piece in building an overall healthy metabolic picture.
Katie: Yeah. And then, beyond that, like we’ve mentioned in passing, that availability of being able to track some of these data points at home now is really, really fascinating. And I think it helps us to really dial in that personalized aspect. So I think you’re right. If you start with those four pillars, those are universal to everyone, with some variation amongst them. But then, having that data, I know I respond very well to seeing data in real time. And so, for a lot of people, this might be a new concept, to be able to actually see glucose response in real time. I know my advice when I started doing that, it was helpful to kind of follow a sort of a meal plan of my basic diet, and then tweak one or two variables at a time, so that I could see the response, and then sort of dial in from there. But any advice to people who are new to tracking or have never tried it, and how they can use this to even further tweak and personalize their own response?
Dr. Lauren: When I first started using a continuous glucose monitor, it was so eye-opening to me, because I think what you see, as you probably experienced, is that the foods that you’re eating may or may not actually be having the impact on blood sugar that you think. So, for me, one of the big ones was the oatmeal I was eating in the morning was massively spiking me out, and that’s how I was starting every single day. So, the way that I would approach it, if someone is trying continuous glucose monitoring for the first time, is to eat the foods that they typically eat when they first start, and see what the impact on their body is, and then really, to try to pair that with the sensation that they feel in their body at the same time.
There are so many things that we experience on a day-to-day basis that have been normalized, that I don’t think are actually physiologically normal, or that they don’t have to be any individual-specific normal. So, for example, mood swings, energy crashes, sleep disturbances, kind of unexplainable weight gain, all of these things, what you notice when you start using continuous glucose monitor is that many of those things are just glucose spikes and crashes. For example, I have a close friend who always thought that her personality was just to have a lot of mood swings. She was like, “I guess this is just what I am, this is what I have to manage in my life.” She started using Levels, and she noticed that actually, those mood swings were just blood sugar spikes and crashes.
And as soon as she leveled those out, those went away. And she was like, “Wow, I always thought this was me, but it was actually just my blood sugar.” So, I think what’s really powerful when you start using this is to make sure that you’re pairing the data that you’re seeing with what you’re experiencing, because that really lays the foundation, then, for the second phase, which is starting to make modifications. As you start to modify what you’re eating, you also start to feel different. And ultimately, the goal of all of this real-time feedback is that, down the road, you have such an understanding of your own body that you can always use a metric or monitor, and like you, I love data. But also that you have an internal biosensor, so to speak, that tells you when you eat something, “Wow, that really didn’t make me feel good. And I suspect that’s probably because it increased my blood sugar, and actually, I don’t want to feel like that, and I’m not going to make that choice again.” That’s the gold standard, to me, of all the excitement around technology and biosensors, is that ultimately, we’re training ourselves to be our own biosensors. And we’re just learning how to be more and more tuned into ourselves and the way that we want to feel.
Katie: It’s such an important point. And we’ve mentioned the monitors on and off throughout this, and the Levels app that shows you how to interpret that. I’ll make sure that’s linked, for all of you guys listening, wellnessmama.fm, we’ll have a link to… You guys have so much information on the blog side. I’ll link to that, as well as to the app and the availability of monitors and everything there as well. So, you guys can find those links at wellnessmama.fm, as well as a link to, I’ll link to your personal Instagram as well, because you share so much great information. People can continue to learn from you.
A couple questions, somewhat related, I love to ask at the end of interviews, the first being if there is a book or a number of books that have had a really profound impact on your life, and if so, what they are and why?
Dr. Lauren: I love poetry. And I especially love a compilation of poems by Mary Oliver, called “Devotions,” which I think is… I just think she does such a genius job of taking things that we see in our normal lives, that we might not think anything of, and completely changing the way that we’ll see those in the future, and kind of tying them to the universality of being alive. So, I just love that. That’s a book I’ve had since I was young. And I still read it, and refer to it often. And it actually does link back in many ways to health, and to the experience of being alive that we’re trying to achieve through metabolic health.
She has a quote that I love, that’s not from that book, but is from her essays, but I think it is seen in this book, which is, that “Attention without feeling is only a report.” And, to me, that links so closely to, even all this discussion on data and metrics, where there is an element of this which is about learning to pay attention to everything around us, to all the choices we’re making, and to the way our body is, but pairing that with feeling, and pairing that with the, like I said, the universal experience of being alive. Because ultimately, for me, health is really not about, as we’ve talked about, restriction and rules, and trying to achieve a certain physique or a certain, even length of life. To me, it’s really about being as alive as possible, and experiencing everything in our lives to the fullness of whatever it is that we want to experience. So, that’s what Mary Oliver reminds me of, and that book is always, always in my house.
Katie: That’s beautiful, and brings it sort of full circle. I love that it’s a new recommendation, and I’ll make sure that book is linked as well in the show notes. And lastly, any parting advice for the listeners today that could be related to one of the many things we’ve talked about, or entirely unrelated?
Dr. Lauren: On the theme of Mary Oliver, I’m going to go with one more thing that she says that I always think about when I think about my life, especially now, is, she says, “Keep some room in your heart for the unimaginable.” And I think, you know, I’ve spent so much of my life, especially during academic training, medical training, and I think creating this more scientific mindset, where a lot of it is about trying to control the unpredictable, right, like, trying to control what happens in our lives, trying to control all these things, when really, the experience of living is unpredictable. And that’s the beauty of it. And so, by remembering this, I remember both, everything that’s possible in life. But also, it helps to put into context I think a lot of this stuff around health, where it’s really not about, like we said, creating all this control. It’s about opening up the door for learning, opening up the door to have whatever life that we want. And so, I always just think about, yeah, the unimaginable, and all of the kind of magic of what’s possible.
Katie: That is a beautiful quote, and I think a perfect place to wrap up for today. But I have thoroughly enjoyed this interview, learned a lot from you. And I’m very grateful for the work that you do and the work that you guys are doing with so many thousands of people through Levels. Thank you so much for your time and being here.
Dr. Lauren: Oh, thank you for having me.
Katie: And thanks as always to all of you, for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did, and I hope that you will join me again on the next episode of “The Wellness Mama Podcast.”
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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