Episode 23 transcript

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Hi, good peeps. Welcome to the flexible neurotic podcast. You know that friend that you can call to ask anything? That's me. Dr. Sarah Milken. I'm known to my friends as the flexible, neurotic. What does flexible neurotic even mean? Let me be neurotic while I take out my golden shovel to dig deep for all the golden nuggets in the hottest topics, from parenting, to education to neuroscience, and maybe even some beauty secrets. So we can all start living more flexibly. Come join us for edgy conversations with rad moms. Innovative thought leaders and well being practitioners helping you find that sweet spot between chaotic and chill. If you're craving that sweet spot, grab your golden shovel with me. You will walk away with nuggets you can start using today.

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Hi, good peeps. This is the next episode of the flexible neurotic podcast. I'm Dr. Sarah Milken, the flexible neurotic. Today I have an awesome guest. She is a mother of three author and physician specializing in medical weight loss and nutrition. And I do want to mention that she's also the host of her own podcast called the health bite that is on all podcast platforms. Her private practice follows a holistic approach that blends lifestyle changes with evidence based medicine. She creates a customized treatment plan for each patient, whether for primary weight loss or to treat obesity related diseases. Her name is Adrian you deem she has a long standing reputation from her prestigious former position at Cedars Sinai where she was medical director of the Cedars Sinai Weight Loss Center. Dr. UDM wants people to empower patients to take ownership of their health and wellness through information and inspiration. In working with patients for over a decade, she has learned that people intuitively know how to achieve good health and well being. But even the most well intentioned people need tools. Hi. Hi. You sound good doing that. Can I just call you and be like, hey, sir, I need a little pickup. Yeah, totally. That's my radio voice. Do you want like a pep talk? Adrian, here we go. I like it. Okay, so as I told you, before we started recording, I somehow I have the air conditioning on 68. But I'm still sweating. Maybe I'll lose 50 pounds during this podcast. Who knows? Not that I 50 lose. But I sort of feel like that right now. Since I didn't work out all week I my excuse was I had the second vaccine. So I felt like, okay, I don't need to work out this week. No, it's good planning. Right? I just want to say how excited I am to have you here. I want to tell listeners that we're not necessarily going to like, dive into the exact way to lose weight or anything like that. It's really more of a deep conversation about larger issues. My intentions for this episode as it is for all my episodes of the flexible neurotic, is for us to dig deep with our golden shed shovels, and an edgy conversation about how we can and will find our sweet spots between neurotic and chill. In this case, we are going to find the sweet spot and learning about Dr. Hugh diems philosophy that she features in her book that is about to be released, hungry for more stories in the science to inspire weight loss from the inside out. And it's available when preorder is up next week and launches June 15. That's so exciting, super exciting. See, well, you had quite a pandemic project for yourself. You know, I'm always creating projects. That's my mo I kind of always if I think of something I'm in trouble, you know, Oh, here we go again. Because once I think it, I got to do it. I know I have to tell you in this case, it really was this. It was really organic how this happened because for the last few years, I've had this feeling when I'm in the office with patients where people come in with these stories and they feel so vulnerable, so much shame. There's so much you know, around our bodies and our weight and our relationship with food. And I felt this desire to like self disclose, you know, as a way, their feelings or even like disclosing other patients experiences as a way of validating their feelings. And of course, you can't do that right? Yeah, therapy session. It's it's their visit. And so when the pandemic happened, you know, I'm still zooming with patients from home and

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Everyone's stuff is coming out. And it's playing out in the relationship with food. And so while I had already written like 450 pages that I was having really a hard time mining I just left. It was in the pandemics that I felt really strongly that I just need to sit down and just get it out because the messaging that was coming, or the stories rather that were coming from the patients were so universal, and it felt so deeply needed that again, it didn't feel like a project, it felt like a colleague, you know, yeah, I totally understand that. That's sort of how my podcast came about in this pandemic. And we're gonna dive deep into your book it's probably the second half of this episode because I read it as you know, being the nerd I am you sent me the electronic copy? I was like the interest on enough Adrian, you gotta send me the whole fucking Hello. There you go. And you love the nerdiness. So the intention of this episode is to take a deep dive into how Dr. Your diems experiences with her patients as she just mentioned, and her medical expertise shed light on what our real hunger can be for other than food. We will not go deep into how exactly to lose weight. But of course, we're going to touch on tips, key stones and philosophies of weight loss. We're also going to talk to Dr. Yu Diem about how and why she gave up her highly coveted position as medical director of Cedars Sinai Weight Loss Center for more of a boutique and one to one practice to focus on her patients. This we could call her second half of life. REMAX right, Adrian. Yes. We talk about what happens to our bodies after 40 ish, or the second half of life. Yes, there are things that we can do. There's not one stop shop though, right? Absolutely. So we're gonna get our golden shovels and dig deep with Dr. Yu Diem. Here we go. You ready? I'm ready, sister. Cool. Well, you give us a brief snapshot of what you are known for in the weight loss world and about your highly coveted position, why you walked away from it and where you are now. This is major Second Life stuff. And I think it happened when I was 38. So I was kind of like edging into that mind space. So to back story is that I actually shifted my professional life a few times and was slated to go into a talk about coveted, a highly coveted fellowship in gastroenterology. This was while I was a resident at Cedars Sinai and having matched in this program as an intern. So it was my first year, I had a couple of years to get through before I would start this fellowship at county USC hospital, which was going to be you know, absolutely crazy and intense. And so I'd already been married for years at the time, and I thought, I'm just gonna, like pop out a child, right? And so I got pregnant, like, literally, we're sitting at Shabbat dinner at my husband's grandmother's house, we're like sitting at the table, we're sharing a chair, because there's so many people around the table and I whispered in his ear, and I'm like, I need to get pregnant. And he's like, you know, like, What are you talking about? And like, I think, I don't know, that week, it was done. And I was pregnant. And the moment I got pregnant, and I realized, oh my god, like, this is not I can't do this anymore. I can't go into this fellowship, where I'm going to be on call every third night and up all night and pagers, and, you know, I need to be a mom. And so that for me was a huge reckoning, right? Like balancing this Uber ambitious profession with my equal desire. And culturally, you know, I'm very much like the whole motherhood and, you know, family and cooking and all of that is so steeped in my, in my personal tradition. So that was like the first shift, right? And it was almost like a midlife shift. Because even though it happened in my 20s, late 20s These are the questions right like The Balancing Act, the the change in mindset and ideology and how we think we're going to live our lives and sometimes the hardest part of that is just accepting that it's okay to pivot. Right? Yeah, and it's also okay to like do things in seasons like sometimes you can like be a mom and then have a job then do this and sometimes you like you did you have to like combine it all at the same time and figure out what that hooker balances that feels good to you and not feel like you're being judged by yourself or by anyone else. Yeah, that's, I mean, that's a huge part of it. Right? Yeah. The judging by yourself. I had a lot of self judgment.

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About that, you know, giving that up. But I knew intuitively that it was the right thing to do. So even though I struggled with it for a year before I made the decision to quit the fellowship, I knew deeply that that was the right thing. So then I decided to go into, you know, some area of, of medicine, internal medicine, where I was being where I was trained. And at the time, you know, nutrition is always kind of very apropos, right? weight loss is always very topical. But we don't really learn about it in medical school, and or residency, we don't get trained. And so I kind of went out on a self fulfilling mission of teaching myself and I got a fellowship at cedars to do the self directed year, and did come to conferences all around the country and read books and went to clinics and, and basically developed my own program that I pitched to the medical center. And next thing I know, I graduated from my fellow my fellowship, and I'm, I'm named co director of the Center for weight loss. They already had a surgical weight loss program, but and you're a woman. Yes. And I'm a woman. And I can tell you that in those boardroom meetings with medical growers, there weren't that many of us, especially at my age. Yeah. And so yeah, so now I'm in it, and I killed it. I mean, I personally loved my work was very fulfilling. I wrote a textbook, I created an elective for residents. Some of my students went on into obesity medicine themselves, I became a question writer for the exams, I hosted regular conferences and meetings for colleagues to teach them about the science of weight loss and obesity, because we always talk about, I mean, there's so much misinformation right? so much. It's crazy. we're bombarded with it all day long. And that's part of the reason why I was so happy to have you on this podcast, because I'm like, Can you just break this shit down for us? And not only we've been boarded, but we're bombarded from like, all angles, right? So like, I have this practice. We're all spend now that I'm in private practice. So this is I'm, you know, deviating A little bit, yeah, the conversation, but I spend an hour to an hour and a half with my patients, right. So we get into everything talk about digging deep. I mean, dig Uber deep. And then there are times where patients come back after an hour and a half in conversation. And we've agreed to a plan. And they're like, you know, I was talking to my misuse. And, or my gardener, and this is what he thinks about our plan. And so yeah, not only is our ton of information, but it's coming from like, right, I mean, it's coming from everywhere. I now. So I really felt passionately about explaining the science to my colleagues and, and not only explaining the science, but I feel really deeply that doing that also addresses the bias. And that's what I'm equally passionate about. There's so much bias against weight, weight loss, even fat shaming. I mean, there's so we're gonna get into that way too. You see my list of questions, Adrian, we're gonna be like your

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chats.

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And I also do want to mention that you currently still hold the position as associate professor of medicine at UCLA David Geffen School of Medicine, and you are also a clinical associate professor of medicine at Cedars Sinai Medical Center. So like you're wearing 17 hats right now. You know, the part that I loved about my job as a faculty at cedars was the education piece. And so that was something that I really committed to maintaining, even though I transitioned out to private practice. So yeah, I I have maintained those positions. And yeah, I am wearing a lot of hats. It's exciting. It's daunting. And you also have three kids tell me how old they are again. Yeah, so I have a 16 year old almost 17 a 13 year old boy, my first is a girl, a 13 year old boy and a eight year old daughter. Oh, you're aware of it. We've got everything going on. We've got elementary school, middle school, you got high school. Oh my god, you're like in every age range. You're like in puberty, you're like in driving and hormones. I mean, I totally got it with my

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Oh, yeah. Oh, my God, I've a puberty episode. I probably will have played by the time years play. So that's like, that's a fun time. Okay, so I'm gonna ask some like specific questions. We don't have to go deep into all of them, but I can't do a weight loss episode topic with you and not ask some of the $10 million questions. So the first $10 million question I have is are carbs bad for you? You know, this is one of my pet.

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peeves is the vilification of carbs. First of all, let's talk about what carbs are. So carbs are like a super broad category. They include Twinkies. And they include asparagus. Right? Yeah. So like, Can we not like categorize all of those under the same umbrella? beans and legumes are carbohydrates, vegetables, and fruits are carbohydrates. Wonder Bread is carbohydrates. So I don't vilify carbs. And actually, there's a lot of data that talks about mortality benefit in people who consume things like beans and legumes is a big part of the Mediterranean diet, which is the most widely studied diet on the planet, in terms of cardiovascular outcomes, cancer kinds of beans. So, really like anything, right, so garbanzo beans are great, they are, again, their carbs, but they also have about nine grams of protein per half cup. So you're getting a lot of protein in that, especially if you want to, you know, go more plant based or no light on the animal protein, red beans, pinto beans, kidney beans, soy beans are a different class that goes under the legumes, lentils, which is the cousin, your cousin, these are all high fiber, they help stabilize blood sugar, they maintain your digestive tract, and digestive health. They're associated with reduced risk of colon cancer, heart disease. So like, why are we throwing everything under the bus? You want to control your like, I don't know, chips away addiction, by all means, right?

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But like if you're having lunch, and you're eating chicken tacos, like are you freaked out about corn tortilla versus flour tortilla? Or are you like just eat? Eat one? Or is it in moderation? Like what what's right last, so I don't like to. First of all, I meet the patient where the patient is at. So everyone's in a different place. They have different goals. And, you know, sometimes people want to be more restrictive, because they have a goal or they have a number, I try and work with that mindset and try and ease and manage people's expectations. But I also know that I have to meet them where they're at. So if they're having a really hard time with bread, you know, then I'll say, All right, let's just hold off on that right now. And and not consume it. If somebody really is consuming that on a regular basis and can't give it up. Let's limit the quantity, right? And in general, I like less processed, right? So if you can, because while process breads is actually a perfect example. like wheat bread gets processed, right. So all of the fiber content goes down, the whole wheat grain content goes down the vitamins and minerals get expelled in the processing, and then they enrich it, which means they add back vitamins and minerals. If we didn't like overly processed it, then we wouldn't have to like add it back in. Right. So I recommend things that are like as untouched as possible. If you're buying store brought bought bread, like the ones that like don't look homogenous, right, they're kind of ugly, they have lots of see, you know, because that's how it was made, right. As opposed to that beautifully uniform like mocha Brown, that you know, they're also more filling that way too. If you eat a piece of white bread, you're like you need 16 pieces if you eat she ugly piece of bread, you probably going to be a little bit more for somebody else to that too Sorry to interrupt. But you know, with that kind of the reason why people get hungry and if you want to get to like the really nuts. Yeah. Is that when we have super processed simple carbohydrates, we get a quick spike in our blood sugar. The way I consider it is like it's like already been chewed up for you. This process, right? Yeah, it's like the dopamine jackpot you like pull down the eye?

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Yes, exactly. You get a spike in blood sugar. And then what does your body do? Your body responds, your pancreas responds by pumping out insulin. Insulin is what helps manage your blood sugar. But when you get a rapid rise, you get a bolus of insulin and then you get a sharp decline. That drop is what gives you that hunger and craving like you know, 30 minutes after you have cereal in the morning. You're like what I'm hungry already. That's what's happening there. So not only are you not getting the fullness like you talked about with all the seeds and you know, stuff, but then you're getting this sugar and insulin response that actually is driving hunger. It's such a tough battle and I'll be honest, like I have bagels in my house that are I think they're made by thin slim and they're really high.

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high protein, a lot of fiber in them, and they don't they, I swear, I think at the end of the day, it has like two net carbs or something. And I'm like, Could these be bad for me? I just don't know. Because I mean, the ingredients don't look bad. But I'm like, Is this too good to be true that I could be eating a bagel with two net carbs? What are your thoughts on that? I mean, I think ingredients lists are really important, not labels, but ingredients lists, because we get duped by the label, right? Like low carb, low sugar, high fiber, zero trans fat, which actually doesn't mean zero trans fat. I mean, it's, as long as it's less than a certain percentage of the total content, you can say is zero, but zero doesn't mean zero, right? So I don't believe in low carb breads like do they exist? I think breads by virtue of what they are, are carbohydrates. And I worry in a lot of these things, like the low carb or the gluten free, for example, that it's overly processed, right. So then we equate it with health. I mean, gluten free is another major pet peeve. There are few categories of people that are truly need to be gluten free. And then the pushback I get or the or the comments that I get from people is, yeah, but when I stop eating, when I start eating gluten free, I feel better. Well, I wonder is that really the gluten that you're eliminating? You know, do you feel better? Because you're not eating gluten? Or do you feel better because you're not eating as much of the processed food? Her I think, for most people is the ladder, right? Yes. No, I mean, believe me, my carb, my really low carb bagel with the Philadelphia low fat whipped cream cheese. I'm like, Oh, this is too good to be true, but and it makes you fall for a while, but then you're like starving, like you said an hour later, and then you're back at the refrigerator back at the pantry. Okay, so my next $10 million question which we can go into briefly because these could be episodes unto themselves, keto and paleo. Let's start with keto. There's like a whole shebang around that. Fun fact, keto diet was actually created for epilepsy. Did you know that? I did not know that. Is it treatment for epilepsy because the ketone bodies, which is the energy source that gets broken down from fat can cross the blood brain barrier and does something to stabilize brain cells? Hmm. And then somehow that got extrapolated to weight loss? Yes, people lose weight because you're eliminating a ginormous category, right? You're eliminating carbohydrates. The American diet is 60 to 80% in carbohydrates is on average. So I mean, you eliminate that category, yes, you're gonna lose weight. In addition to that, as high protein and protein is very satiating. You know, I'm not I'm not a fan. I think it's okay. It's like a jumpstart or like an induction or you want to like, jumpstart yourself and eliminate all the carbs for a while just to get yourself going and off the dopamine hit. Yeah, fine. But long term, you're eliminating good sources of carbohydrate that we already discussed. You can get electrolyte issues, you can get bone density problems, you can get kidney stones, and it's not sustainable. I will say I in college, I've never been a big diet, or I've never had a huge weight issue, thankfully. But in college, I just got some stick up my butt where I was like, you know, I'm going to lose the last 10 pounds. And I guess because I was studying so much. I was like such a nerd. I had a boyfriend who's my husband at the time. Like, it didn't matter that much. So I basically gave up carbs. And I had like hard boiled eggs for breakfast Turkey for lunch. I mean, it's kind of like insane when I look back on it, because like, I could never do that now. But the whole point of that story is I got kidney stones. And let me tell you, they're painful. And once you cry once you're a kidney stone producer, you're kind of always a kidney stone producer. So if you're eating super high protein and not drinking enough water, just sort of be careful because you could end up like me. Yeah, they say it's like childbirth with

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epidural. It was so bad. But what do you think about the whole idea of keto and heart disease and cholesterol, you're eating so much fat? How could you possibly be keeping your heart and your cholesterol in check without much fat? Yeah, so the short term studies show that actually your cholesterol goes down which is so crazy, but it's a function of weight loss, right? So when people lose weight, blood sugar goes down. triglycerides go down cholesterol goes down. Fertility is an ovulation is increased. I mean, amazing thing that's happened with five to 10% of weight loss which is not ginormous, by the way, right? 10%

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Weight Loss or 180 pounds, that means nine pounds and you start achieving cardio metabolic benefit. That's amazing. So you got initially they do get that benefit. That's what the studies show, but the longer term studies are showing that actually cholesterol goes up, which is what we would expect, right with all of that fat. And then we don't have long, long term studies, like what's happening with like colon cancer risk, you know, or breast cancer as with such a high fat diet. Now, I'm not vilifying fats either. There are good fats, right, like, the poly and monounsaturated fats. But I still, I still believe that saturated fat is a risk factor and excessive amounts is a problem. Of course, like people massage data, you know, this is a scientist, right? Like, you can massage it anyway you have on? Yeah. So you know, people I rank the diets. I'm one of the people who helps rank diets for US News and World Report. And so every so often, I'll get hate mail from the keto lovers because you know, it wasn't ranked as high as you know, they thought it should be ranked. But I still, I'm still a believer in in, I don't know, decades of data that shows that saturated fat is not good for you in large quantities. You are the scientist, what about paleo? So I mean, paleo is similar but lighter, you know, it's not where you define it. For listeners, these are all like higher protein diets, right, and limit carbohydrates in various degrees. So keto diet is very restrictive carbohydrate, Paleo Diet does not restrict like the fruits and vegetables as much. It does restrict, like the good carbs that I was talking about, like the grains or the beans, for example. So it is lighter, but it's still, in my opinion, fairly restrictive. I am a proponent of limiting carbohydrates, because again, 60 to 80% of our diet comes from that. And it's usually the processed stuff. But I am not in favor of limiting the good carbohydrates. And in fact, when I asked people to augment their salad with a cup of garbanzo, beans, they find that they're satiated longer, they're full longer, they're not as likely to snack. So we really have to take into account like not only the meal, but what that looks like over the course of the day. And that's such a great point. Because it's not all about just that one moment in time. It's like you just think about it's like, Okay, I'm going out to an Italian restaurant tonight, I'm probably going to order pasta, because it's my one time a week that I eat like a full thing of pasta. So like maybe my breakfast and lunch are a little bit less carby. It doesn't mean I'm a terrible diet, or or I'm making bad food choices, or I should shame myself over the bowl of pasta, but it's sort of just adjusting the rest of the day to sort of fit with your plan. Yeah, I mean, there's so much there's so much there. And I don't know if you want to go in this direction, because there's so much to say about that. But the word diet is just the food we consume, right? We talk about diet, and it just sometimes it irks me, because my patients will come and they'll be like, I was perfect on your diet or I was perfect on your program. And I'm like, I don't have a diet or a program. That's really I you call it lifestyle. Yeah, I mean, I feel like these terms are all cliche now, right? Because they've been so overused, but I really focused on big principles like protein in every meal. We know that 20 grams of protein at your breakfast helps suppress hunger hormones all day long. half your plate green, right. So I don't tell people to have three ounces of protein. That's bullshit, but eat what you want. But then breakfast protein in that amount. Yeah, it's tough right? Breakfast is a tough one. So eggs will give you seven grams of protein per egg. The egg white, which is only 40 calories will give you four grams of protein that's a pretty high ratio calorie for protein ratio. You know, Greek yogurt is another great one, depending on the auger. Yes, you can get almost 18 to 20 grams in certain Greek yogurt. What brand of Greek yogurt do you like? Because I'm always on the search for it. So I like fiha yogurt. Yeah. Do you like the 5%? I think 5% is okay is good, too. Okay, I like oil coast, which is not Yeah, best, but I love their flavor profile. I liked the Trader Joe's Greek yogurts. But I basically look for something that it's in 120 to 140 calorie range and then has like at least 12 grams of protein. That's what I'm looking for. And then a food hack that I recommend I love tax. Kashi go cereal so it's the one in the red box. I don't get anything from Kashi. Maybe

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Tag costs you to this

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but I love that because it's it's got like this muesli it's got a lot of different stuff going on I can

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see cereal Adrian, it's an ugly cereal. That's right. So we should do we should

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ugly foods, you pull the carrots out of the ground you pull out, you know all the ugly things. We need to talk about that this could be like in business plan.

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Right red lipstick and ugly fruits.

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The other thing about that cereal is that it's also 12 grams of protein per serving. So you're it's actually a cereal, right? It's a card we're vilifying it because it's a carbohydrate, but it's high protein. And can I just say that it addresses my other pet peeve. I have a lot of food pet peeves, one of which is granola like this myths of granola being healthy. Oh, it's so much sugar and so karbi Whoo. It's I mean, the sugar is insane. So this is a good switcheroo. For the granola. It's such a good hack, because sometimes it's like, I mean, I don't know if it's a female thing, or it's just a me thing. But I want to have the yogurt. I want to have the creamy and I want to have the crunch. So maybe instead of like chocolate sprinkles or granola like maybe it's the Kashi jet, try it out and let me know.

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Like a tablespoon. You just need the texture. Yes, but you could also have like a full half a cup of it. Whoo, what a concept and then actually be like powered for your day, right? Yeah, exercising. If you're a regular exerciser, and I'm a regular exerciser, I run almost every day, I do something pretty much every day. I can't go zero carbohydrate, day after day after day. It affects my run and affects my performance. It affects my energy level. And it's not frickin necessary, right? Like, it's not necessary. I agree with you. If I don't eat something, I'm like running on empty, and then I wind up eating six times the amount later in the day or at night. Yes. And let me tell you that. I would guess that maybe 60% of my patients who come in for weight loss are eating one meal a day, well, I don't need I don't need all day. They are working, they're running after kids. And then they eat one meal a day. Then two things happen. To your point, you're like, way behind the eight ball, you've ignored your hunger cues. 100%. And then that's that feeling of like I could eat a cow. And yeah, get full. Right. The other thing is that we don't acknowledge how much snacking we do not because we don't want to report it. So when I tell my patients to like really be mindful about everything they're eating, they're like, I'm telling you, I'm not eating anything. You're not lying to me. I know you're not lying. We are just so mindless And so much of what we do, it doesn't even land we don't even acknowledge. And there have been studies that show that we underreport our calorie intake by up to 2000 calories a day. Oh, my lord. Does that mean that we're like, no, this is not lying. But we don't register it because it's like, oh, my sample? Yeah, like what's a hidden snack? Okay, so a lot of my mom's new moms, right, who are running around, they have no time to prepare food for themselves when they're cooking three different meals for their kids who are picky eaters. None of which gets consumed. Right. Right. Like who's eating the mac and cheese? Right? The leftover mac and cheese or who's you know, before? This is a really common one. I mean, my kids are not so young anymore, but like they're they take the food to the sink right? And they're clearing off the kids food. Oh my gosh, she right. Guilty. There's like a waiter taught there's four tater tots left I'm just gonna eat those. Yeah, but it's not I'm just gonna eat those it's not even landing it's not even registering you're doing the dishes and you're like shit the kid left like you know all this stuff on remit. You just like bites. You know? Take three big bites shovel into your mouth. You did it, enjoy it. It was cold. didn't taste good.

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But you're eating it. And here's another thing I don't advocate for wasting right like I'm all about I was raised with that whole people are dying in Africa. I'm not about wasting food. Right. But when you're consuming something for any reason other than your true hunger, you're being wasteful with your own house. That leads me to a really good question. Like, how do you know if you're hungry? So this is like such a I mean

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I wrote an entire book to address this issue. Yes, I know, we're gonna get to Yeah, we're gonna get to that. But my point is in bringing that up is that it's complicated. And so I'm going to try and just answer it briefly. Yeah. Because there's physiologic hunger, right? That hunger that you feel that nying in your stomach when you're truly hungry for food. But have you ever noticed Where? Well, I don't know about you. But most people hold their anxiety in their gut, a higher percent, right. And when you feel anxiety, you feel annoying sensation in your stomach. It's almost akin to physiologic hunger. And what's more of that is that when they stress animals, okay, and it's shown us in humans too, but they take these poor rats, right, and they like, I don't know, clog up their little water nozzle. So they're trying to suck on water, but they're not getting the water. So they're stressed, they noticed that hunger hormones that are usually modified by the food that you eat, and the nutrients that you eat, actually go up with stress. So there's a hunger hormone called ghrelin that's released by the stomach, you stress out that poor rat and grilling is going to go up. And so stress and emotions do also cause physiologic hunger when you're not hungry. And I can't blame all the weight gain during the pandemic on stress, right? Look, it I'm being trapped in our houses. No, I mean, that's real. And it is real. And so what I do with my patients is twofold. I'm super practical. I'll prescribe appetite suppressants. I'll give them meal replacements. I'll write out diet plans, right all the stuff that they want. But then I go in through the back door, because I know at the end of the day, we have to identify the true hunger. What are you truly hungry for? Is it lack of boundaries in your family life that's giving you zero time for self care? Are you in a job that's killing you? Where your boss is not seeing you, and you're hungry for autonomy, which is why I love these questions. And we're gonna get into those because I want to go through some specific examples from your book because I told you I read your book like page by page. But before we get there, I want to ask a few more $10 million questions. So we can dive into the book in depth. Let's talk about for one second. midlife and menopause. Why is it so hard to lose weight during this timeframe? What the fuck is going on? And everyone's calling it like the midlife middle like the muffin top for this that that what's going on in there? Or is that just an excuse? Yeah, no, totally not. I think I told you this at one point that I Oh, I felt like I've always channeled like a perimenopausal like a postmenopausal woman. Like I feel like

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my husband feels about that comment. But yeah, so a big part of my demographic is women in their 40s to 50s, perimenopausal which can start like Believe it or not 10 years before you actually know I did a whole matter pause episode. It's there's a lot there. There's a lot there. So in terms of weight gain, and the middle what what is happening. So let's think about how men gain weight. Right? And how women gain weight normally, so men are usually bellies, right? They gain all their weight or most of their weight in their bellies. Whereas women are accumulating waist subcutaneously or under their skin, right? So we get in our arms we get in our thighs, we're getting our buttocks we get in our bellies, too, but it's not like that protuberant belly like them, or like the extra gobbler underneath the chin, right, all that stuff everywhere, all of that. But what happens in menopause is that and we as women have estrogen, but we also have testosterone, which is the primary hormone sex hormone in men, but we also have it as women. And that relative amount of testosterone to estrogen changes as we go into perimenopause and menopause. testosterone is actually the hormone that helps target the excess weight into the midsection. And so yeah, people are experiencing weight gain in the middle. The other thing that happens is, patients will often come and tell me I'm eating the same thing I've been eating for the last 10 years. I do the same amount of exercise all the time I never exercised but so I never exercised right. Why am I gaining weight now when nothing has changed? Well, things have changed, right be changed. Everything's changed sister. But in terms of this, as we get older and it starts happening in

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Women in their 30s, I don't think it's a 30 something we thought we were old. But what starts to happen is body composition starts to change as muscle mass declines, muscle declines. So even if you're the same weight now that you were 10 years ago, the likelihood is that some of that muscle is now fat body composition has changed. And fat, we know burns more calories, it results in a higher metabolism. So if you're eating what you ate 10 years ago, and you haven't maintained a level of activity, and you're more fat for the same way, right? You're not seeing it, then you are muscle, then your metabolism is dropped, and you're gonna steadily gain way. That makes sense. Yeah, it makes complete sense. And it leads me to my next question in terms of exercise, you know, some people are like huge spinners and major cardio and huge sweat. And some people are no, no, no, I want to do Wait, where are you in all of that? So first of all, meet yourself where you're at, right? So like, I think the data is like 10% of people are exercising as much as is recommended. That means 90% of people are not, if you're not exercising, I'm not going to tell you to go lift weights 30 minutes, three times a week and do cardio, whatever. I'm not going to give people these lofty goals. Just do something like whatever gives you joy. You like jumping around your house to the beat of like Cyndi Lauper, you do your girlfriend, you want to go on a hike, you want to go swimming, you want to go walk by the just do something move. Right. But in terms of like our more seasoned exercisers who want to level out, yeah, and also thinking about like bone density. That's a huge issue for women in this age. It's like, yeah, are we should we be thinking like, okay, a certain portion of our week should be weight lifting depth in some capacity, right. So keep in mind, first of all, these categories cardio and strength training are not mutually exclusive. Right? You are doing some strength training when you're doing your cardio hike, for example, right. But yes, I do recommend the cardio piece. That's what helps cardiopulmonary fitness, stroke volume, which means like your heart rate drops, because your heart muscle gets so efficient at pumping out blood. That's when like heart rate, you know, the runner's heart, people's heart rates are like in the 50s, or the 40s. It's super efficient. But on the other hand, is strength training is what's helping build muscle or maintain and preserve muscle at the minimum, which also helps maintain your metabolism. In addition to that, to your point, we know the strength training not only strengthens our muscles, but it also strengthens bone density. Yeah, so it's, it's important in terms of maintaining muscle mass metabolism, healthy weight control, as well as other things like bone density. Yeah, you know, it's interesting, I, when I went to get my mammogram, I asked for a bone density scan, and the guy looked at me like, you don't need that you're not old enough. And I'm like, you know, the kind of runs in my family just do it. So he actually, you know, the doctor did the bone density. And he's like, you actually do have some bone density issues and your left hip and your lower back. And I was like, What can I do about it? And he said, Well, are you exercising? Are you doing strength training, and I was like, I'm doing all of those things. And I don't my weights not super high. But it goes back to your point of the exercise routine that was good for me 10 years ago, may not be 100% right now. And maybe I do need to like rethink like adding in more weights at a higher I don't know, higher weight and more reps or the opposite, or whatever it is doesn't even have to be you know, I feel like sometimes weights can be intimidating. Yeah. And I never did weights on my own I learned about it, you know, when I was doing, you know, whatever my orange theory classes, right, have you but it can also be bodyweight. You know, I'm a huge fan of the teawrex bands, you can buy them yeah. And so it can be a very easy start. It doesn't have to be like pumping heavy iron, in order for it to be strength training and certain types of yoga and pilates. Also are, I love my favorite. So as well as being restorative, which has other benefits. So I I kind of liked to talk about exercise the way I like to talk about veggies like you know how they see your colors, you know, antioxidant Yeah, it's like very your routine, and that's the best way to go about it. Okie dokie? What about women who are taking HRT or birth control pills? Are they less likely to gain weight? And this is whatever answer you have. Obviously, this is take this to your doctor. Get your own information based on your own body, but I just want to know generally speaking, I heard a chart

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And all of a sudden, I was like, Oh, all right. Cuz that's a whole can of worms, right? No, but I'm saying women who are adding estrogen back into their bodies in some form, do they have an easier time with wait? No, the data is all across the board. And even with like birth control pills, where most people anecdotally report weight gain when they go on birth control pills, the studies show that you may have a couple pounds, you know, two to three pounds gain, but most people go back to their baseline. There's so much individual variability here that I'm very hard pressed to make, you know, statement, okay. I mean, I know for me with birth control pills, I don't know if it's just me, but I've been able to like sort of stay within 10 pounds range the whole time. But that might just be my body, I don't know. 100%. And also, I think that when you take certain things like maybe birth control pills, or like evening out my mood or something, so maybe I'm not snacking as much certain times of the month, there's so many different variables and their mass. Yeah, sort of what you talk about in your book, and you talk about in your practice is that there isn't a one size fits all approach. It's like everybody has their own prescription for lifestyle change and commitment, and getting those changes that they want to see in their lives. Now, another thing that a lot of people talk about is intermittent fasting. As soon as someone says intermittent fasting to me, I like completely freeze and shut down as if I'm going to go into starvation if I don't eat for 16 hours. Tell me what you think about intermittent fasting and midlife from a medical perspective? Yeah, yeah. So first of all, let's just define it, because intermittent fasting means a lot of different things, there can be time restricted, intermittent fasting, which means you eat six hours out of the day, or you eat eight hours out of the day, and the remainder of that 24 hour period you're not eating. So that's one kind of fasting, there is the like five and too fast, where, you know, five days a week, you kind of eat what you want, two days a week, you're reducing your calories to like 500 calories per day. So there's different kinds of intermittent fasting, right? There's really good data in terms of like benefits in terms of like disease reduction, right? In the automation. Yes. And maybe longevity. Keep in mind that a lot of these studies were done in animals. right and right, and I mean, not to say they weren't done in humans, but a lot of them were done in animals. But there seems to be some benefits to like some kind of fast. And the truth is that, like, probably we should have a period of the day where we just don't eat, like I say, eight to eight or seven to seven, like, like, we probably shouldn't be up snacking at 11pm. While we're watching Netflix, right? Like, you know, there is, the idea is that it gives your body a break. Right? Do you want to explain that to us? Yeah, well, so what happens with intermittent fasting, once you're once you go into that timeframe of like, 10 plus hours of not consuming food, you do go into a slight ketosis, and basically what ketosis is, is, what it means is that you've utilized all the sugar in your body and sugar or is the primary source of energy, right? And then when you when you complete or exhaust your sugar stores, you turn to fat using fat and fat, however, it doesn't power your brain, which is like, kind of important organ, right? Yes. So what the body does is it converts fat into ketone bodies, so that it can be used by the brain as an energy source. So that's the whole thing behind ketosis and what happens in intermittent fasting? And for some people, it works. So yes, for some people, they will restrict their feeding time, and they lose weight. But this is where you got to know you, right? And this is what I find for a lot of people, myself included, when I skip out on my breakfast, and I may be eating a protein shake that was like 120 calories or two hard boiled eggs, which is 104. I mean, but I'm not talking about like a stack of pancakes. Right weekday that Right, right, right. So I skip out on that by the time I get to 12 or whatever that like Time to eat is, I'm famished. And then I have ignored my hunger cues so long that they're dysregulated Uh huh. And so if that happens for you notice, you know if that happens for you, then intermittent fasting is not the right strategy. You're much better off eating one or two eggs which are really calorically lean, right or a cup of yogurt with some coffee. And then being more mindful about your lunch. Yeah, and also leads me It's such a good point into another point.

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Part of this whole thing is the psychological part. Like you just said, like, I used to, like after I had kids, I ordered those food delivery programs, the zone, the best of that. And my husband's like, Why the fuck are you ordering that? You let it stack up in the refrigerator? As soon as someone tells you what to do, Sarah, you completely freeze over and and become like crazy. So instead of eating all the food that stacked in the fridge that was delivered, you're eating a bowl of cereal or you're eating the food that was delivered, and then you're eating the bowl of cereal after because you don't want to be deprived. Yeah. And I think it goes into this whole thing of the psychology of food and deprivation and mindset. Can you talk about that a little bit? Because I feel like it's such an interesting concept at this point in life. We talked to our friends and my, some of my friends are like, Weight Watchers is the best. It's amazing. And I'm like, how could Weight Watchers work if you're allowed to eat unlimited fruit and strawberries? Like isn't that sugar isn't that carbs? And then another friend like keto is the best. But what works for one person doesn't work for another? And is that because of the psychology of it, and that we are all different? I mean, there's a lot to be said there. And I think when it comes to weight loss, honestly, there's different strokes for different folks, right. So some people can calorie count, some people get triggered by calorie counting. Some people, you know, guys who like meat and potatoes can manage keto, because they get to eat their steak, you know, some women who are into like salads and fruit would die on keto, and all of these strategies in the short term are going to work. And if you maintain it long term, they're gonna work too. I mean, when you're restricting yourself to a certain category, or to a certain diet, it'll work for a certain period of time. But you know, it's that restriction piece, the concept of restriction. And, again, I may advocate for that for a short period of time to help people feel agency. So I think it is because it gives you that quick structure. Well, and I think it's important for people to know like that they can do this, they can manage their weight, they can have agency and a lot of times that's the conversation like, I can't, no, you can, and Fine, let's do keto for two weeks and just prove that you can. But over the long term, I do believe in a mindset of abundance. And so what I tell people is like, eat as much as you can have what serves you of what nourishes you. So you have less space, less desire less wanting for what doesn't serve you isn't that that's still may be eating lots of protein and veggies. But doesn't that shift in your mind? I mean, for me, it's like liberating eat as much as you want of what serves you. Yeah, that's

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right. As opposed to like three ounces of chicken, the palm of your hand. I mean, I'm sorry, like my palm is way smaller than most people.

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You're like doubling your palm, you're like, Well, my palm is smaller.

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Yeah.

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Big still freakin said, Oh, my gosh, I love that. No, because I think there's so much of this is the psychology of it. But I do like that you talk about this topic of make it matter. What do you mean by that? So for example, we come home from work, right? Tired or, or it's the end of the day, kids are finally out of our hair, and we plop on the couch, and there's a bag of chips next to us. And while we're like scrolling our Instagram or watching TV or whatever, or cooking dinner, we're snacking on these chips. We're not really chewing. We're not really tasting. We're not really savoring. I mean, it doesn't matter. We're not enjoying, right? It's like the calories don't matter. The food doesn't matter. Nothing matters. The experience doesn't matter. Hmm. So let's cut that out. But then it's like Shabbat dinner. Right? So that's obviously very important in my in my cultural heritage, or it's date night and you're out was here. You know, Thursday night is date night, my husband and I went to hillstone last night. I love their burgers. It matters. Um, did you eat the bread? part? Part of the bread? See? Yeah, you're like me, I'm like meet me halfway I go open face. Yeah, but I mean to me, sometimes I'll do like the burger without the bun because I don't really need the bun but fries 100%. That's what's so good about your program is like you're listening to your intuition. I know what I need. I know what I don't need. Maybe I need the bread today and not the fries but then like I'm getting my period or whatever. And I'm super hormonal. I need the fries but I don't need the bread. So I want to talk about the intuition in a second. But I just want to wrap up the the concept of make it matter if you really live by this and think about it in the

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way, right? If it matters, and you're really savoring and enjoying, like you, do you girl. But if it's just mindless crunching, and munching, it doesn't matter. So let's nip that in the bud. I like that. So there is this movement of intuitive eating, which I'm not a part of. And there's aspects I really love and are very similar to kind of my philosophy. But there's a point that I want to make, which is sometimes we confuse what we want, right. And that's grounded in some ways in our chemistry, because what I want sometimes in that moment, is to like sit on the couch and eat bonbons. That's what I want. I do want some chips, right? And then I finished like, whatever my portion and then I'm, I want more so then I get up to the pantry and I get more. And so if i confuse that what I'm craving with my intuition or with what my body wants, then I failed myself. That's a great point. Because that dopamine is like firing, and it's driving your desire. And that's physiologic and it's very real. What I want people to do is to kind of distinguish that short term desire was what my body really wants. What does my body really want? How do you feel after you've had I don't know like something Uber indulgent. Like I like donuts, right? Sometimes I get tempted. It's there, like I smell it. But invariably, if I decide to have it, my stomach feels terrible. 30 minutes later, hmm, is that what my body wants? Yeah, the minute I smell it, I'm like, whew, my body wants this. But if I really think about it, that's not what my body wants, because I feel like shit. 30 minutes later. Yeah. So I think we need to be a little bit more discerning when we talk about what our body wants, and recognize that, that that brain chemistry is driving us to consume a certain thing that may not be in our body's best interest in the long run. Yeah, no, I get that. But I do also get that whole idea of making the fries matter. No, because sometimes a fry is a fry, and you could bake it in an oven, oven big fryer, you can do all of these things. But it's not the same thing as eating a real french fry and the dopamine you get from that. Right? And so and so it is like, do we do that every day? three meals a day? No, no, that doesn't serve us right. Or, or when it's not like, intentional. So like, I know, I'm going out to dinner. And I'm like, I'm excited about meal I'm going to eat. But when I'm full and I walked past a, I don't know, Cookie shop and the smell of the coffee lowering me. I didn't really like what, like I didn't even want it right. Yeah. So we also have to, again, be discerning of like, the cues and the suggestions and what it is that really is making us think we want something. Yeah, no, I totally agree with that. And I also think that when you smell something, it's like, it's so hard to shut that craving down. Like you said, when you walk into someone's house, and they're baking cookies, it's like you can't stop thinking about it. It's just a, you know, there's a thing called, like, there's a thing about smell pollution. We'll talk about, about smell pollution, and it always takes me back to so I went to UC San Diego for medical school, I live in Los Angeles, or my family lives in Los Angeles. And so I would make that drive, you know, like come home to from San Diego to LA. And sometimes I would have my window down while I'm on the freeway. And even on the freeway, I could smell the McDonald's front like

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an exit that had McDonald's. Sudden, I'm like fixated right on McDonald's fries. And I'm like, I was minding my own. I know, I wasn't even thinking about I think I ate dinner or whatever. I'm for a book in my car on my drive. I was minding my own business. And then the french fries jumped out at me. Yeah. And that's like, and that's part of our food culture too, right? Like the marketing and the you know, all of that, which is a whole other can of worms. Now in terms of food, shame, can we go into that? Because I know it's a hugely important topic for us as adults. And for us who have kids, whether they're females or male teenagers, food shaming is a major thing. Like I know, like I was talking to my kids about it. And they were saying like, some of the kids don't eat at school because they don't want to be seen as eating. And I thought to myself, Oh my god, that never happened. When I went to school. Yes, there were the girls who went to the salad bar, instead of eating the burger in the cafeteria, but people weren't

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Not eating in front of other people. At least I didn't see it in my friend group, I think yeah, I think it was happening. And I think, you know, growing up, and I talked about this in my book, being a Middle Eastern background and how even though I was born in like beautiful La Jolla, Torrey Pines, right, overlooking the golf course, living in Dallas for a while, where everybody was very white and blonde, and here I am with my frizzy, you know, Middle Eastern hair, and like, you know, facial girl, I know, the list goes on. But anyways, I can tell you, I do think that at a very young age, I was very cognizant of everything, like, body size, body shape, hair color. So I think it does happen. And the shaming has always been there, too. I mean, there's food shaming, and there's fat shaming, right. And that is real, the American Medical Association several years ago called obesity, a disease. And part of that is because of the pathophysiology that occurs. So actually, there's hormonal changes that occur when people gain weight, and that promotes more weight gain. And when you lose weight, it promotes weight gain. So there is a whole Physiology or pathophysiology there. But it was also to take away the stigma, that is very big. And when it comes to our kids, it's a very hard thing to deal with. And I actually wrote about this in my newsletter this week. Just yesterday, I was writing about this, because I often will get parents who will bring in their kids to me, right? Yeah. And I, as a parent actually talked about that story. One of the stories in your book, I'm trying to remember who it was I have it in my notes later. Is it Lily? it Yeah, on who came in. And her mom was like, super dressed to the nines and was like, my daughter really needs to lose weight. And you were looking at her like, Oh, my God, what's happening here? Yeah. And then we talk about and then the parents will say, it's about their health, which is a physician, there's this movement of like, healthy at Every Size. And yes, you can be healthy at Every Size. But I also want to be cognizant of the fact that you are at risk for certain things when you gain weight. So I don't want these met this messaging to be mutually exclusive. Yeah, be compassionate. And yet mindful that yeah, it is something that can cause risk, right? And if you have diabetes in your family, right, and that's the thing, then if you gain weight, you have an increased likelihood for diabetes. So what do you say to these parents? So there is that right? But when a parent comes in and tells me that it's about health, I really want to challenge that notion. I may not challenge it upfront with the parent, but let's think about it. If your child has gained 1015 pounds over the year, because they've been cooped up at home, and sports have been eliminated, etc. are you really worried about that 12 year old getting diabetes? Or are you triggered by your own body issues? Are you worried that now they're going to face you know, social consequences or backlash? Are you like in your own fear, shame cycle? I challenge that notion that we're really worried about, yes, we're worried about their health, but I think it's like, some percentage 20% health, maybe an 80% our own shit that's get out there baggage, we carry the baggage market. And so we need to be super mindful of that baggage. And I will share a personal story because I have three kids very different. My first child is like almost 17. And until a few years ago, she would still ask me like, Mom, can I have a few m&ms? I'm like, Girl, like, you want to be a neurosurgeon. And you're asking me if you can have m&ms.

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Do you sister? Yeah. And then I have what do you think she was really asking you, Adrian? Well, you know, she has always been a rule follower. And she would ask me about everything. So I think in her mind, it really wasn't a food thing. Because she was just that child who wanted to be you know, first child and, and to do the right thing in every category, not just eating my first kids not like that.

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But my second child is a total he loves he's a foodie. And when he was three years old, and in preschool, they would, you know, pass out the graham crackers during snack. And then they would ask who wants more and then like a handful of kids would raise their hands and they give him more than who wants another round and, and at some point, like, I would have to tell the teacher like enough, right? Right. And my friends would make fun of me because they were like, Oh my god, she's three years old, and she's restricting the graham crackers and you're the weight loss doctor. What a nightmare. Yes, right. But when he started gaining weight, nine

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10 years old, helpful. Yeah, I was triggered, I was super triggered and I had to like bite my tongue bite my lips sit on my hands. But then something happened. You know, I tried to like, follow my own advice, I exercise, my husband exercises, we don't indulge all the time, but we try and eat healthy foods, etc, etc. And I had to wait and sit on my hands. It took a couple years. And then all of a sudden his own intrinsic motivation kicked in. Yeah. And we actually had a conversation about this a few months ago, and I said, I hope you don't know, you know, that. Like, even though I do this, this is my world. You know, I'm always talking to people about food, that this isn't something that I was pushing on you. And he's answered me a beautiful answer, which was, because you didn't push it on me. I was able to do it by myself. Yeah. And that's totally right. And I talked about this in this book, where, actually extrinsic motivation, which is parents pushing their kids is a de motivated. My kids say that to me all the time. If I, we have a gym in our house. And I'll say to my kids, because this whole year, we've all been together, I'd say to my daughter, are you working out? But I wasn't asking her? Are you working out? Because I'm monitoring you. It's like, are you working out? Is Jake working out because I want to get my ass in the gym before I lose my motivation. She goes, you know, when you told me to work out, I just automatically to new out and I don't want to work out and I'm like, but that's not what I'm asking. I'm just asking if it's my turn to use the gym. But it's exactly that it speaks to the point that no matter what you say, and how much you try, you're gonna have to pay for therapy later. Totally. I just did a post on that. By the way. I agree on that. Right now. I'm gonna be in therapy for something. So pick your poison. I think it's totally here or there. So I don't think when your child is three, and he wants like the eighth graham cracker, you should be like, Oh, honey, you do you like it's okay to set boundaries? Yes. But you do have to be really careful about what you say. And what you do. And the way I do it in my house is I really link all of these things to good mental health. And so in the pandemic, when they were cooped up inside, and they're experiencing all the feelings that we're all experiencing, I would say things like, you know, you really need to move your body. Yeah. And I would say it in the same vein of you really need to get out of your PHA pants, because all of those things are helpful for your mental well being. So what's good for our minds, what's good for our cognitive health for mood is also good for our bodies. And so I think we can reframe this conversation of weight loss, it really is a matter of well being like when you're treating your body, right? Mm hmm. Then you're doing well for your body. Yeah. And I also think it's important to know that you can be eating well, and you can be exercising and still not look like a supermodel. Oh, and that's very hard. It's a very hard pill to swallow. You're like I'm working my tail off. And I don't look like her. Yes, because that person typically is way underweight their weight, or BMI is not falling into their into the normal range. And there is people are always asking me like, what weight should I be? There's no magic number. It's a range because all bodies are different. And I can guarantee that the majority of the people that were looking at, you know, in magazines, or what have you are way below that range. And it takes a very restrictive approach, or a lot of luck and a great metabolism. Well, yeah, there is that to look like, I will never be the blonde girl that I used to go to school with in Dallas, like, I'm not blind, right? It's just not going to happen. And to the same point, like, I would never have that, you know, 110 pound body either. It's just the same way that I'm not going to be blonde. Right? Right. And the same way that someone else is not going to be a leading doctor in the world. I mean, everyone's got different things you bring to the table. And I talk about that with my kids all the time. It's like everyone has what they have, and you have to be comfortable in your own skin 100% it's just so hard to do. You know, I mean, my son, my son is almost 17 now but growing up he was never like chunky but like I'd say towards like six six through eighth grade. Like he gained weight. I wasn't monitor. I can't monitor what a middle schooler is eating going out for sushi all the time with his friends or whatever. And I was like God, I like so badly want to say something. What can I do? And it was interesting. He came to me and he was like, I'm done being the fat kid. I'm done with the fat jokes. I'm done with the fat, fat fat. I can't

1:10:00

Take it. And I was like, Okay, so what are you going to do? He goes, I'm going to cut out carbs. I'm like, are you sure about that? And he said, Yeah, I'm gonna, I'm gonna try he actually on his own by working out and cutting back the carbs, he lost 40 pounds. But he lost it because he wanted to do it and I wasn't involved in it at all. You know, I also speaking about the the shaming, you know, I, I get triggered by the F word. That's what we call it. You know, it's, but but but he was calling it what it was. He's like, Mom, they are fat jokes. It goes on all day, and it's hurtful. And I'm done with it. And the only way I can get rid of it is just by losing this weight. And he's so happy he did it. And he continues to this day, and now he eats pasta and all of those things. And he works out. And a lot of it was probably just Middle School, puberty, whatever. Yeah. But I think also in that in that kind of situation, we also have to be careful of that not drifting too far. 100% 100% intrinsic motivation doesn't mean that they're immune from eating disorders. And I know and boys too, because people think, Oh, well, boys are fine. They're not fine. I mean, I did monitor it in the back of my head, I was like, I think maybe we should like add this to dinner instead of just eating the chicken. And he was good about it. But like you said, he wanted to jumpstart himself in a very structured way to get immediate weight loss. Because when you get that taste of immediate weight loss, you want to stick with it. But again, it doesn't require keto, like you don't have to pee on a stick and not eat asparagus.

1:11:47

Right? That's not where it's coming from. Yeah, so limiting the caloric drinks for adults, the lattes in the, you know, frappuccinos, or the juices. He said that, yeah, he said that too. Because when you're with your friends, and you're drinking, like fantasy, and all this garbage, and like the fizzy drinks at school with your snack card, or whatever, all of that added up for him, his friends who could drink two of those can't besides the fact that I mean, it's not all about the weight. What about what that Santa is doing to cognition and

1:12:23

focus, right? We know that, like the sugary drinks are problematic when it comes to focus and attention and all of that. So, again, I really like to link the healthy behaviors to something that's other than the body because yeah, it's such a tricky place to be. And no matter what you say, you're going to run into trouble. And the reality is that if you have a studious child, their intention is to be studious. And that Santa or whatever the frappuccino is not on regular basis, not in line with their what they want for themselves. So that's so part of intrinsic motivation is aligning with what really matters. Yes. And at the end of the day, the two pounds on the scale, even though it's it's like noise, if that's not what matters, you know, there's deeper thing. Yeah. But that's a very hard thing to get away from. I mean, personally, I haven't weighed myself since college. And my friends laugh, and they're like, You're crazy. And I'm like, You know why? Because I would over focus on that. And I would penalize myself for it. And I think my kids see that. And they're like, she doesn't even have a scale. And I'm not advocating just free ride. I'm just saying, I know, for me, having a scale would be a disaster. So like, I go to the doctor, I'm like, Don't tell me my weight. I don't want to know, like, I went to my ob, when I was pregnant with my son. I was five months pregnant. He goes, Sarah, are you eating doughnuts all day? And I'm like, Oh, my God talk about shaming. I was like, shit, I became this small person who would I mean, I gained over 65 pounds with each pregnancy. And I'd never let them tell me my weight until after the fact after they were like you gained 65 pounds in that pregnancy. But it's a mental gymnastics. And I will tell patients, you know, I mean, we have this conversation because I used to be of the mindset and there was actually a new england journal article saying that if you weigh yourself every day, you're much more likely to lose weight. And so I was like, Yes, absolutely. You should be weighing I never said every day but at least once a week. Yeah. And then I realized for some people, it's really triggering and it's it backfires, right? They get into their head and then they they sabotage themselves. So I realized I had to really be personalized, like not everybody needs to weigh themselves all the time. But what I'd like to work on is the bigger issue I think, which is d identifying with that number. Like why can

1:15:00

We use that number as data and not be so intimately identified by an overselling what that number means, right? Yeah, completely. It's a shift in like you can be accountable by weighing yourself once a week or maybe once a month. Yeah. And then but what happens when you eat that Chinese food dinner the night before? And you're retaining four pounds of water that day? Is that a myth? don't weigh yourself after Chinese food. Okay, so that's not a myth. It's like a real thing. Because I'm also like, Can I take my shoes off? Can I take my sweater off? I'm glad you brought this point up. Because people often will be like, Oh, my God, I ate x y&z last night, and like, it's not translating to fat, like fat cells are not being created in that instance. You know, like, eight hours later, when you get on that scale, your fat cells have like, multiply, right? There is that. But there is also the point that sodium, like when they've done surveys, the average meal at a restaurant even like we're not talking fast food, we're talking about, like good for fine dining is about 2000 to 2200 milligrams. That's what the American Heart Association says we should be eating at a 24 hours.

1:16:14

So 100%, you're retaining sodium and water, and as a result, your weight is going to go up. So that's what I mean about not over identifying with the number, like it's a number, right? And if you can use it as data, then use it. If it's triggering, then lose it. Don't use that data. But I would still challenge you to redefine what that means for you. And how do you use body mass index indicators in your office versus the scale? And can you define that for everyone? So your weight is your weight, right? And then your weights can go into a calculation with your heights with like this coefficient that gives you your BMI or your body mass index. And body mass indexes are on the range of like 18.5, all the way to 60. a BMI of 18.5 to 25, or just under 25 is considered a normal range. 25 to 30 is considered overweight. And like every you know, I've tried to remember do you do you use those like, what's the word like clippers? Like, you know, where they like squeeze your fat roll? Yeah, no, I don't I don't do that. I do use bioelectric impedance, but which is a way of measuring body composition. But that's important, because BMI is just weight for height. So if you have someone who's super athletic and super muscular, they could have a high BMI in the obese range. But clearly, they're not obese, because their percent body fat is so low. So BMI is a good kind of general number. But there are a lot of limitations. Another limitation that people don't know about is ethnic limitation. So, for example, for Caucasian populations, those cut offs may be appropriate. But like Asian populations start to develop cardio metabolic stuff, like pre diabetes at much lower BMI. So that even the BMI is not one size fits all. Wow. So I take it, you know, I take a lot of other parameters in consideration, oh, we shouldn't be doing our BMI on Google.

1:18:24

I mean,

1:18:25

get people off of Google in general. I know. I know. Oh, my gosh, okay, what about I know sleep is really important to you. Explain to me that quickly, the function asleep, then we're gonna go into your book a little bit because I know sleep is like, so important. I actually talk about sleep as a nutrient as a vitamin. I know I love that I was waiting for you to say it. Or I was gonna say for you, it's so good. Because it's true that sleep is essential to not only cognitive and emotional well being, I think we all know that right? You're cranky when you don't sleep or you're not as focused. But it is critical to metabolic well being not only in terms of weight, but even in terms of like insulin resistance. So they've done studies where they've shown when people are sleep deprived, they can become insulin resistant within two days, which is crazy of sleep deprivation. So sleep it does a lot while you're sleeping. There's a lot of household items that get taken care of you know in your body that help promote well being overall. What happens when you don't get enough sleep in addition to a lot of other stuff is that hunger hormones actually go up? And so if you've ever pulled an all nighter, or you know like slept super late, you may notice like the next morning you're ravenous and unusually for like highly palatable foods, meaning like high fat foods or high sugar foods, and that's actually physiologic. When you don't get enough sleep, your hunger hormones go up.

1:20:00

Your predilection or your desire for palatable foods goes up as well. They've also done long term studies. So there's a something called the nurses health study where they took, like 44,000 nurses and followed them for 30 plus years, 40 plus years. And they tracked all these different health parameters. But they've tracked BMI as a function of sleep.

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And so they've shown these curves right of like weight gain over the ages. And the individuals who got eight plus hours of sleep, still kind of gain weight over time, people tend to gain weight over time. But the people who slept five hours or less gained much more precipitously. So we have physiologic data and epidemiologic data to show that sleep deprivation directly impacts weight, and metabolic health in general. Okay, so that leads me to another $10 million question in menopause, as we all know, we have a hard time sleeping. Yeah, it messes with our sleep. So what is artificial is artificial slept, say like taking melatonin, where you're not, you're getting a little extra outside help. Is that still the same type of restorative sleep as falling asleep on your own and staying asleep? Yes, but there's a caveat. So before we dive into, like, what we can take to improve our sleep, I want to talk about what we can take out to improve our sleep. And so for example, alcohol, which I enjoy my glass of wine, I used to enjoy it nightly. I no longer do I know I don't drink alcohol at all, because it's not worth losing the sleep. Yeah, for me, it's sleep over alcohol. Yeah. So So for me, it's become like my date night thing. And the reason for that is it started to impact my sleep. And when they look at sleep architecture, sometimes people say oh, no, but I but I fall asleep right away. 100% you fall asleep right away, because it's the sedative, but then it impacts your sleep architecture, it actually affects latency, sleep latency and REM sleep and all this others. Yeah, because your blood sugar goes crazy in the middle of the night. It's not only that, but it's actually what the alcohol is doing to neurotransmitters in the brain. And because it has a sedative effect, it affects the gamma nergic. I know you know, these neurons are like what adven or you know, does it like the dates, other parts of your brain compensate for that excited Tory neurotransmitters go up. So while you're sedated in the immediate timeframe, the bigger peak or the later peak is actually an increase in anxiety and excited Tory neurotransmitters, which wake you up. And sometimes you will notice people may notice they wake up at 3am and quote, can't go back to sleep. That's me. Sometimes they don't notice though. That doesn't mean that your sleep architecture and sleep quality is not being affected. So alcohol is one of them. Caffeine is another so I love my coffee. I used to drink coffee back in the day like round the clock. Now it's just my morning coffee. I don't drink anymore. Yeah, me too. And that can affect sleep. screens, of course can affect sleep circadian rhythm and how you're responding to it. So there's a lot of I mean, we could go into so many aspects of sleep. Melatonin is fine I'm not suggesting just melatonin I'm just saying sort of like a quote, artificial sleep like people are going to CBD supplements going to melatonin. Like is that is it better to have that kind of sleep than no sleep at all in terms of your way? Yeah, so So in terms of like CBD To be honest, I don't know the data on that and what that's doing to your sleep architecture. Hmm. I can tell you that Melatonin is small doses does help people go to sleep but higher doses may disrupt your own natural circadian rhythm. So you know usually they say three milligrams, which is on the lower end does Okay. And then the sleep aids which we used to be okay with have actually been demoted. And we recommend Yeah, so like sleep aids are now secondary to like CBT or cognitive behavioral therapy in all of our medical guidelines, because it actually does not have a restorative function of sleep. So you have to think about what category of sleeping right right That's what I'm saying. Like, quote, artificial sleep with a sleep aid just like not sleeping at all. No, but different sleep aids are doing different things. So yeah, has put them all into the same category. Okay, so now we are going to get to the book for a minute the reminders called hungry for more stories in science to inspire weight loss from the inside out. We talked at the beginning about how what the purpose of the book was

1:25:00

Right, you wanted to share stories, inspire people, educate people normalize a lot of the concerns that many of us have, is that a fair assessment? Well, I think, yes, I wanted to speak to the universal human experience or condition. And to remind people that, regardless of who you are, where you are these stories and these concerns, and the struggles and the losses, and the joys, they're universal, right, so let's de stigmatize and take kind of the shame out of what our experiences are. I also wanted to speak to the fact that like, while again, I have a very practical approach and can help with writing medications, I'm very comfortable with FDA approved drugs and you know, guidance that's practical. At the end of the day, I know that we have to address the underlying hunger. And so what I started doing, just in my practice, not really formally was, I was writing prescriptions for like puppies, you know, and someone who really was like, longing for connection or, you know, sometimes I was really, I had to, like control myself to tell someone to quit their job, but I would in lieu of telling them to outright quit, you know, I would bring up the question, you know, like, what, what is this job? Like, what is really the goal here? Like, what are we doing here? Right, what's the point? Well see what I think it's interesting, because what I took away from the book, as a reader is a 46 year old reader is, yes, we're all hungry for food, and we need to eat to live. But you're saying, Hey, you know what, yes, we all need to eat to live, but there's actually a hunger there for something deeper. Yes, that is leading us to eat more. And perhaps if we satisfied whatever hungers we have, that would make us more content happier. And ultimately, one, if one of our goals was to lose weight, perhaps we would lose weight, because we've satisfied another internal hunger that we have. And you took each chapter so brilliantly, and made each chapter on an example of hungers that come up in your practice. Correct. That was very well said.

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Thank you for that synopsis. So what were your favorite chapters? Like? Let's pick a few, like, I know that you talked about perfection, and you brought in a 20 year old girl who was struggling with her weight, and you sort of assess the situation? Can you give us sort of an over view of what happened there? I have to say, first of all that, and I say this in the intro or the prologue that everyone has been de identified, right. And so I still know that my patients are going to read this book and be like, Oh, she's talking about me. But it really you're really talking about so many of us? Well, exactly. It speaks to the universality of the stories because you could be a 50 year old man, or you could be a 25 year old girl. And you could have the same story. Yes. So in terms of hungry for perfection, this is a young adult who comes in and she is, you know, the first child and has been perfect in everything and has conditioned herself to do the right thing at home, do the right thing at school, do the right thing financially, take care of siblings, etc, etc. And the one area that she feels that she can't gain perfection is in her weight. She comes in for weight loss, but it turns out she's not actually overweight. She's just within the range, right? But she's looking at perfection. She grabs her tummy, you say yeah, pleases her tummy and shows you her fat roll as a sign of this kind of imperfection. And so there's so many things in that to address. But really, what needs to be addressed? Is this this desire or this hungry, hunger to be perfect? Which if we really define what perfection is, it's something that is, by definition, unattainable. Yes, perfection. And it's not cliche to say that so you look up the psychologists definition of perfection, by definition, it is something or a standard that is so high, and a goalpost that keeps moving, that you ultimately can never achieve that goalpost. And so what that does actually contrary to your intention, is it actually sabotage you. So not only do you not gain the perfection that's in your mind, but you don't even achieve your goals. You kind of shrink down because the fear of not achieving that goal is so shameful that you self sabotage. So how do you address that with her? What do you say to her? What is

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She needs she doesn't need a doughnut, she doesn't need to give the doughnut up. What does she really need in that? Well, you know, at the beginning in all of these stories, is really a lack of awareness. So, of course, people are like, No, you don't understand, like, I need to lose 20 pounds, you know, like, yeah, there's no like, there's no awareness of kind of what really is going on. And so the first step is really, to help people become aware. And there's various things that I may recommend depending on where the person is at. So sometimes I give them journaling exercises. Sometimes I give them mindfulness meditation exercises, sometimes I tell them to go color just because they need some mental space, right? And so I really try and promote awareness. The second thing is once they have that awareness, sometimes that triggers shame, right? It's like now more shame, right? And so when you think about like, mindful self compassion, the tenants are actually awareness. And the second one is self compassion. So in that moment, when you notice you're doing something, can you just like, give yourself a break? Can you just have compassion for yourself and be like, yeah, this is something I want to tell ourselves that we're enough. I mean, isn't that the sort of essence at the root of a lot of this is how do we convince ourselves that we are enough? Or I don't think it's a convincing, I think it's a practicing. That's a good point. I think it's a practicing. And I think it's something that requires reminding. So I may be in a, you know, I may wake up one morning, and like, my sunroof is open, and my windows are rolled down. And I'm like, Girl, having a flower day,

1:31:47

loving on myself.

1:31:50

And then shit, what happens the next day, I wake up, and I'm like,

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my hair is gray. Again, I got spots on my nose, Where the hell is these things come from, I didn't finish my to do list. And I'm being lazy. And so that's an important point two, right, because sometimes you get discouraged by that you're like, man, I had it what happened. But if the expectation is not being there all the time, if we know that this is a practice, that waxes and wanes, then we can even have more compassion for that we can have compassion for the times were, you know, down in the dumps, and having that compassion makes us more resilient to come back up. Now, in the case of this particular story, I didn't get there with her, she was too much in what she wanted to have a conversation about mindfulness and perfectionism. And it's not like I come out with all of this at once. But for those people who are actually open to it, I talk about the science behind a mindful self compassion practice that not only does that address, body image and weight loss, and make us more likely to achieve healthy habits, but it also addresses the perfectionism piece. Well, I also think you make a really good point, in that, you say, not everyone is open to it, like some people go to a weight loss doctor wanting a magic pill, but they don't realize that, like, you can give all the tools you want. But as long as if the person isn't open to it, or willing to do them, it's not gonna work. It's not even open or willing to do them. Because I feel like there's like judgment there, you know, willing to do it. And I just have a keen ear to this, because I've been talking to people about this for so many years that I just have really, for myself, try to find you find the way of saying the conversation. Yeah, yeah. So it's not that and I get it, I get that people want to lose weight, which is why I will provide the tools. But at some point, I have to be like, Look, this is ultimately going to undermine you, right? This thing that you're hungry for this perfection that you're seeking, is actually a hunger for something else is hunger for self compassion is the point that I make in that chapter. Yeah. And if we don't achieve that hunger, or if we don't address that hunger, you could be a size two, and you could still be hungering for that. Yeah. It's like you want this car you want this house, you get it? And that's still not enough. Unless you think you are enough, right? I actually had this conversation just yesterday with a patient who came in and told me she had gained like, 18 pounds over the pandemic. She's always been the same way. She never had a weight problem. We got the 18 pounds off. Now. She's 22 pounds lighter than she was when she came in. And now she's like, frustrated because she's stuck. And I'm like, how are we stuck? Because I I'm stuck. I'm not enough and a lot of us don't take into account those. Yeah, well

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wins and then they're never enough. So then I have to go back into the medical record because I write these I typed this stuff in. So I'm scrolling back six months ago, and I read to her, it says here that you gained 18 pounds. And the goal is to lose the 18 pounds you gained during COVID. Right? So how are we stuck? Right? So it requires, you know, it requires a lot of reminding, and in this case that I'm telling you, the woman was older, I'm not judging. I'm just demonstrating, I'm just illustrating that you could be 20, like Sophie was in Sha one, or you could be 46. And that's the speaks to the point of how do you convince yourself? It's a practice? Yeah, and I, what I find interesting about your work and your book is, it's almost like you're a cross between a life coach, and a weight loss doctor, because that's what a life coach does, like, even for me, I'm like, Okay, well, like, what can I do to grow this podcast bigger, and my life coach reminds me She's like, Sarah, six months ago, you didn't even know if you could make a podcast. And now you're like, how can I get this bigger? How do I get this here? And she did the same exact thing. She went back to the notes read to me things that I had said, and I was like, Oh, my God, thank you for reminding me. Yeah. It's funny because I've thought about taking up one of these life coaching courses. Yeah. But I realized in the last, you know, I used to be an avid reader. I loved reading as a child and I was a classics major in college. So I you know, how to read like classic mythologies, etc. And then I stopped reading for like, 20 years, right med school happened, kids happen, like, I just, you're also reading medical research all day long, like, how do you have time to write up other journals that were stacked? on my bed? Yeah. But in the last several years, I've done so much of reading in this in this realm, and just self educated on like, on mindfulness, and coloring, and you know, all these different creative pursuits. And I'm a big writer. So I don't mean book writer, but I'm journaling since I was six years old, but you have a creative expression and creative outlet in addition to your nerdiness. And I have processed it in this way, right? And so I've come to learn that is a lot of life coaching, because I think I have honed in my intuition in terms of what people need. And it's not just, it's not always a diet pill like they think. Right. And that leads me to my next chapter that you talk about, which is hunger for creativity. So you had a retired judge who realized that she was restless and bored. You told her that you asked her about hobbies, and she was like hobbies What are you talking about? hobbies are pointless. I hate hobbies. And you were like, no, no hobbies are not pointless. Tell us what happened. This is very personal. Well, they're all personal to me. And I share a lot of personal so all my talking about shoveling shit, all my shit is in this book. Haha. So if you're curious, right, that story was of a retired judge, she became a judge in a time of life where women were not in these positions. Clearly, she had to be a badass, very professional, very educated, very on it, you know, in order to achieve this high status, and she does it beautifully for her entire career. And then she decides to retire in part because her husband develop Parkinson's, and so she retires. And so she starts gaining weight in retirement. And the story line is, well, I'm home now not working anymore, so I must be eating more. But then she also describes this like restlessness, right? Like this restlessness. So I kind of hone in on that restlessness, like what is this restlessness? Are you missing work? Like, do you want to be back? And she's like, No, actually, I'm actually okay. Like, I love my job, but I'm okay. Not being in my profession or working anymore. But she's restless. And it it occurred to me that or it struck me that there was this energy that needed to be used in some way that wasn't being utilized. Right. And so she was eating because she felt like itchy, restless. You know, it's so funny that you say that because I'm about to say what I was about to say is that's how I felt when like right before the pandemic started when I turned 45 I was like, I have like second half of life. Ah, cheese. Yeah, my kids are teenagers. I have this PhD I haven't been working. I'm like itchy. And that's what I described like in my Instagram posts and the captions. I'm like, Are any of you is itchy as I am like, let's let's scratch our itches together. But we don't know what they are. You know what's so beautiful about that? That what was beautiful about That to me is that you experienced this at 45 and this judge was experiencing it.

1:40:00

In her 70s, right? Talk about the human condition talk about how the stories are universal. And it doesn't matter how old you are doesn't matter, right? And so, I recommend, so I asked her about hobby, she rolls her eyes at me, we just roll my eyes to Yes. Which is precisely what I did, right when, when I was offered up creative pursuits, right. And then in digging a little bit deeper, it turns out that she did have a creative past that she actually wanted to be an artist that her parents pushed her to do something like, you know, more sophisticated and money making. And so she ended up going into law school, but she loved art. And, yes, I told her to increase the protein or diet, I told her to clean out her pantry, yada, yada, yada. But I told her to start painting again. And the profound impact that this had in this person, I mean, she was exuding joy and the fact that she was doing what was always a hobby that she hadn't even quantified as a hobby in her mind. And then I go into like, the data around that right, and the benefits in terms of,

1:41:10

you know, neuro chemistry and things about creativity. And so what I also love about this is what feels good, is also what we intuitively know is good is also scientifically sound. Yeah, and that's what I try and the message that I try and promote. Yeah, and I think what's so great about all these chapters, it's like you talk about hunger for meaning hungry for connection, hungry for belonging, it doesn't matter exactly what it is, it's just knowing that and identifying what you're hungry for. And like you talked about a woman who, you know, felt like she didn't have a lot of friends and she moved to a new town or a new state. And you suggested like, maybe you should, you know, connect with, you know, an organization, you know, all of these things that, and it sounds like any of it is rocket science. It's like life coaches, like when people ask me about it, I'm like, it sounds like they're coming up with some innovative idea that you've never thought about before. But it's going back to what you said, they're reminding you of things that you already know, deep down inside, they're just calling them back up to the surface. And I think that that's what you're doing for so many people is you're calling up things that are in the onion layer, and you're peeling back all the layers, as you say, in your book. Yeah, sometimes we're so deep in our own shit. Yeah, we get shoveled out that the obvious things don't occur to us. And so I agree with you. There's nothing rocket sciency about any of this, but, but I think people welcome that that's allowed. And part of I think, Second Life work is permission, giving yourself permission 100, to have a hobby, or to have space, or to start a podcast or to go back to school and get that degree that you never got, because you got pregnant as a, you know, young woman, or it's permission and permission to start small. Because you may not, you know, as an esteem judge, you may be like, Oh, I'm going to paint randomly in my garage, like, Who's gonna care about that I'm not going to be you know, entered into a museum contest. And if you have a sort of performance based approach in your life of checking boxes and hitting goals, it's hard to go back to that nonlinear approach and say, Okay, I'm okay with starting small, I'm going to be scared. I'm going to do it anyway. And, you know, this is the two I kind of didn't answer your very first question about leaving this illustrious position that I loved. And I love that position. But I was itchy in that position towards the end and feeling like there was more I could do. And leaving because I knew there was more for me, even though that was such from a title perspective, so ambitious. There was more for me in terms of creativity, and it was more in terms of how I wanted to practice medicine. The other things I wanted to do, like write a book or my bar company that you know, I've launched, you know, soon after soon before COVID. Those are nutrition bars, and they're called del D h FL. Yes. Am I giving you any of those? No, no, oh my god, I have to send them to you. They're amazing. But anyways, that's a digression. But a lot of what cake, a lot of these wonderful things that are give they're wonderful because they're giving me so much joy came out a permission to just to to not be doing to not be hitting checkboxes, right? So when we're always in pursuit of checkboxes, and like attaining goals, we actually are blind to a whole category of potential checkboxes Yeah, that are in alignment with like our true

1:45:00

Joyce, and so for me, it was a really hard step to step back from that position. And then it was a really hard step to go from working five days a week in the office, what? Well, seven days once you know, right hospital, step back, step back step. And in each of these steps, I, I struggled with it, but I allowed myself just space to wonder to be curious to explore. And I want to encourage people that that's, even though there's this very scary, there's so much fear and stepping back. Yeah, that there's so much there to be uncovered if you just give yourself permission.

1:45:40

I love that because one of the themes that we talked about in this podcast that came up with Eve Brodsky was this idea of permission to be unavailable. And she talks about how it's not because you have to go into a manicure or get your hair colored because we all want to do those things. But it's permission to be unavailable to think about and do shit that you haven't done that you want to do. So I that makes me think of one of the chapters, which is hungry for boundaries. Mm hmm. Because the number one, well, now you're going to know what I'm going to say I was going to pimp you but the number one barrier to any of this work or to like weight loss or to like eating healthy or exercising, what is the number one barrier would you say or one barrier time time 100% I don't have time to cook, I don't have time to prep, I don't have time to exercise Time, time time, right. And the point I make is, time does not exist. Time is created. You create time based on your priorities. And then you set boundaries in order to make those priorities happen. When we become totally available to the people around us and look as a mother, Hel as a working mother, as a mother who is working 100 hour a week as a rest resident with my first child. Oh my god. I mean, I felt like I had to be up her ass 24 seven when I wasn't 100 hours a week in the hospital, and I needed to get the two hours you were home in the middle of the night.

1:47:16

salutely Yes. But what I also needed to hear was that I matter too, right? Yeah, I need to create boundaries. And what I was told, which I described in another shafter when I was struggling with this, I was given the homework assignment I went to saw therapist because I was really struggling with balancing my 100 hour work with with my motherly desires. And she told me I should start going out on a date night. I was like, coming back does it make sense like going to spend more time out it makes zero sense. And actually the that didn't happen during the 100 Hour Workweek was a few years later when I was out of the 100 Hour Workweek. But the point being that, creating that little space, it wasn't like we went on like vacation for a week, couple hours of eating,

1:48:09

and fries and rice. Not a lot just

1:48:13

right. But that boundary allowed me to like come into my own again, right. And so there's a lot there. But it ties in with the being super available to everyone and everything. And the time that we don't have for ourselves. It comes from priorities, and it comes from setting appropriate boundaries. Those are amazing points. And I hope everyone listening is resonating as much as I am. Because these are all the things that I talked about to what I want to do just to give people like sort of an overall view on the deeper questions that you think that we might be asking ourselves in terms of food and hunger, you list seven questions in your book, I'm just gonna read them quickly. They are how do we care for ourselves? Are we worthy of the time and attention required for that care? What boundaries are necessary to support healthy relationships with others and with ourselves? What true longing is our desire for food signaling? What do we seek to control? And what might we need to relinquish in order to achieve peace? Or have we abdicated our power? And how can we reclaim it? Is there a path for healing rather than numbing? I mean, do I need to say anything else? We I mean, that's a doozy. Right? Oh, my gosh, those are gonna have to live somewhere. You know, I think and again, I'm a huge fan of writing because of how it helps us process. I mean, I think taking one of reading that and taking the one question that kind of Yeah, pops out at you. That's the one that you need to take under a tree with your journal, and contemplate, you know, well, not you

1:50:00

But all of us, all of us, it's like the universal you, especially in the second half of life, it's like, it's our time, if we want to have do overs, it's our time to create things that we haven't created before, to pursue hobbies that we haven't pursued. And you say that most of us are looking for meaning in life. So and you say that there are three ways for us to find meaning, life achievements, how we love how we suffer. Yeah, so I was a late comer to to Victor Frankel's work, who talks about meaning and actually created a school of thought around that the psychology of that, and his major tenants, as someone who had lived through the Holocaust, was that our basic need is to create meaning in our life. And I think sometimes when we think about meaning, or purpose, which are not necessarily synonymous, we think of like, Oh, we need to be a doctor and save the world, or, oh, we need to, you know, go join the Peace Corps, or, you know, we have these kind of grandiose ideas of meaning, which I don't subscribe to. But the point in that what he says is that even our suffering, right, the way we handle our suffering, the way we sit with it, the way we live through it, that creates meaning to right. And I think that's so relevant right now to so many people who have been suffering, you know, because of personal loss, job loss, family losses, right? Like, how can we create meaning? I don't believe in things happen for a reason. You know, I kind of I mean, I think when somebody suffers a major loss, and you say things happen for a reason, you just want to give them the middle finger? What's the reason of like losing a family member to a virus that didn't exist a year ago? Like, there's no reason for that. But can we create meaning out of that? That's a different question, right? How do we sit with that? And can we create meaning out of that? And so, for me, this was really poignant, again, because redefining what meaning is, it's a very personal thing. It's not another checkbox, as we tend to define it. Yeah.

1:52:23

And what I came to realize in writing this book, and kind of reviewing my hundreds and hundreds of patients over the last 15 years, and reviewing my own life story, is that every experience I had an every hunger I experienced, really was necessary to get me to this point of my own personal fulfillment and meaning. It's a beautiful place to live, right? It's a nice place to be. I agree. I mean, this whole year has been crazy for everyone on so many levels. And I think that it also has given us more time fortunately, even though it seems harder to spotlight our own inner selves, and figure out what wasn't really working before what was working, how can we improve ourselves? How can we find more meaning, I mean, I just had an episode come out with with Rabbi Steve leader on trying to make meaning out of loss out of grief out of aging parents, and it's really hard. But he describes the inner beauty and sculpting it out. And it's like a beautiful sculpture that just kind of unravels itself over time. And I just want to say how much I have loved our conversation that we've done two hours now, which will be three episodes, for sure. Oh, wow. Um, but I think some of the episodes require that because there's a certain level of depth. And if I just came to you, and I'm like, okay, Adrian, give me the top 10 ways to lose weight and mid life. That wouldn't be me, as a person or me as my podcast. Like the whole purpose of this is to find meaning and a lot of these topics. And I think that weight loss, hunger, hunger for more things hunger for meaning. Those are big topics. And that's hard to cover in 30 minutes. 100% I just want to second your comment about just this time that we're in and, you know, a lot of people have spent this time kind of really reckoning with or redefining what matters to them, right people redefining their, their jobs, their relationships, where they live, how they want to live. There's a lot of reckoning happening there. And that's why I think this this book about hungers is so timely because that reckoning is exactly what's required to understanding and identify

1:55:00

Your own hunger. So I think it really ties in with what you were saying. And the last thing I want to say is that I appreciate your diligence, you do do a lot of due diligence in your podcasting. And it's a testament to the pride that you take in the work that you do. And it's also a big respect to the guests that you bring on. So thank you. I also feel like the people who are my listeners are the ones who are like, no, that's what we love about you, like, you're gonna get to the bottom of the situation, you're not going to just do the quick and dirty, like weight loss tips, you're gonna like, get to the bottom of like, why we're eating and the psychology behind it. So I really try to stick with the integrity of myself and the podcast, which is hopefully one in the same, yes. But like I do with all of my guests. I want to do a fun shit about Dr. UDM. So here we go. What's next on the bucket list? I definitely want to do a TED talk. At some point. I did write a letter to Oprah before I actually even bought

1:56:07

her story. I was driving to the Palisades from Beverly Hills to pick up my daughter from high school and I literally went and like went and parked on the curb. I mean, it's crazy, but I did it. Because I had this aha moment of what I wanted to say to Oprah and I took out my iPhone and I typed the letter This is way before the book. So Oprah if you're listening

1:56:28

I feel like oh, first part of everyone's plans is no funny. Oh, I have a few more in there. But those are those are on my on my to do list. Okay, anything that you have learned that is now on your bucket list after quarantine? Man, there's so much right yeah, I think for me, it was just like, like have grace. You know, I think what happened to me during quarantine was all these all the like the running and the scheduling and the you know, all of that, like

1:56:58

systems that I had I had implemented which I'm all about routine. I needed to let go a little bit I needed to like sourdough bread that your husband ate every day no bread. Yeah, I was very tight. In terms of my wakeup schedule, my workout schedule, my eating schedule, my everything schedule. And so while I like I say I believe in that routine, and I believe in a lot of what I have systemized in my life, it was a time in my life that I just needed to let go. I love that. Okay, secret pleasure. sour gummy worms. Is there a specific brand you like? It was funny I don't discriminate like it's not sour gummy worms like i like

1:57:42

i like sour gummy snakes. That's like my thing right now. Their portion sizes are loved you guys

1:57:49

go to the brown country Mart or Where do you buy? I ain't gonna lie sometimes. It's just a rundown to CBS you know?

1:57:58

I'm not gonna lie. It's so funny. I'm such a chocolate person versus sugar. interest. Yeah, I was when I was younger. I was when I was younger but something like that sour thing. Yeah, I get it as a dentist daughter just make sure you floss. Yes. favorite beauty treatment?

1:58:17

Well, we're talking about how my husband is a plastic surgeon. A facial plastic surgeon is incredible. But I'm really low budget like for me a beauty treatment is coloring my hair every two weeks with whatever was on sale and you know, CVS or target.

1:58:34

I go gray and lipstick you know for me, I try and keep it really simple. Got it. Okay, what about any woowoo things you do? Yeah, I mean, running is my religion. So it's for me that's partly woowoo because it's very much important to my mental health. I journal regularly almost daily. I write and I meditate when I can. Got it. Okay, favorite TV show from the past or one that you're watching now? Um, right now we're watching The Goldbergs which is a cute blog.

1:59:07

Yeah, that is cute. But my most favorite recent was shits Creek we saw

1:59:13

love loved that. Oh, good. Nice mental break from reality. What was the last thing you ordered from Amazon? I told you that I had to prepare for you. So you had some specifications?

1:59:26

But yeah, this specifications let's be clear word could you have corded earby so that my listeners get good sound? Yes. So I did buy that but my last real order was included a book Buddha and a badass which I haven't read yet. I haven't read that yet. But it's all my bookshelf socks for my son. And tumeric tea. Oh, is that something you drink on the regular or is that a new thing? I do drink. I mean I use tumeric in my in my cooking a lot.

2:00:00

But I like the flavor in my tea and coffee. So is there a brand new like, well the the tea you put me on the spot because I can't even remember what I bought but it's like that circular cylinder that comes Oh yeah, I know you're talking about and then the tumeric powder I use is actually my own on Dell nutrition calm and I use a I use a tease half a teaspoon in my coffee. And I kind of like I don't I don't like sweet coffees. I like it a little bit bitter. So I love the flavor of Oh, I'm like the worst. I'm like vanilla Hazel night. My daughter's like, Mom, I'm really sorry, but coffee made hazelnut creamer is like the worst thing you can put in your body. And she made me switch over to like non processed organic almond milk one It took me like a month to retrain my mind.

2:00:53

It's like a tablespoon of like Hazel nut, whatever, like gives you joy. I know. But I was like, okay, she's asking me nicely. I bug her about a lot of shit too. So I'm just gonna go with that. So, but now that I've switched over a like I'm okay with it. Yeah, we're adaptable. Yes, exactly. Was intuition natural? Or did you have to work at it? I think intuition is natural for everybody. That's what intuition is. Yeah, not everyone likes to do it. The question is if you allow it, yeah. So yes, it was it took work to allow it. Okay, but it is natural. What would your bottom line advice be on finding this sweet spot and the second half of life? I think we touched on it. Yeah, like permission and space. Yeah, me too. Okay, now that we have shoveled so much shit today. I hope you have loved Dr. Yu diems golden nuggets as much as I have. I have loved digging deep with you with our golden shed shovels today on this podcast. If listeners want to find you, where can they find you? So the best place to find me is Dr. Adrian you Diem calm. The podcast is there the the clinic information, some blog posts and tips. I'm also I do daily inspo at Dr. ager new Diem on Instagram. That's my one social media that I really enjoy. And if you guys want to hear more, learn more about the book we're launching soon pre orders up at hungry for more dotnet and spell your last name for us. It's y o u di M. Oh good. Okay, think about what shit you can start doing today. One small step. I want to thank Dr. UDM for explaining some of the weight loss strategies and philosophies. What we can do about weight and dig deep into ourselves to find out if we are hungry, not just for food. But for something else deeper meaning connection, relevance and creativity. We are all wanting to look and feel our best selves. This is all inspiration and ideas for the second half of life and hence this podcast Dr. Adrian you Diem. Thank you. Dr. Sarah, that was fun.

2:03:17

That was fun. Thank you so much for all of your time. Oh, sure. Sure.

2:03:25

Good peeps. Thank you so much for listening. If you enjoyed finding our sweet spot today, and digging through layers of shit with your golden shovel, subscribe, subscribe. Subscribe. DM me on Instagram at the flexible neurotic. Tell me which golden shit nuggets resonated with you. The ones that you're going to start using today to start getting your shit together to find our sweet spots. screenshot it, send it to a friend. This is Dr. Sarah Milken, the flexible neurotic, inspiring you to gather, curate, incorporate, maybe even meditate