Fix Your Metabolism with Lara Zakaria, PharmD, MS, CNS, CDN, IFMCP

[00:00:00] Dr. Lara Zakaria:  When people are given the right information, they make better decisions. We just said how when you tell somebody their weight and their efforts aren't good enough, they're more likely to give up than they are to keep going. But when you empower them with the right information at the right time, guided by a clinician who understands all the context right, that then helps them make better decisions and it actually informs better behavior change when it comes to sustainable lifestyle, habit changes.

 [00:00:27] Dr, Melinda Ring:  This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level

[00:00:58] Dr. Melinda Ring:  Today we are talking about tools and strategies you can start using right now to support your metabolism so you can get off that familiar rollercoaster of energy crashes, intense cravings, brain fog, and feeling like you're running on fumes. My guest today is Dr. Lara Zakaria. Lara is an integrative pharmacist, nutritionist, professor, and a public health professional specializing in functional medicine. Her work focuses on helping people make lifestyle changes that are sustainable, personalized, and grounded in evidence, especially when it comes to energy, mood, inflammation, and long-term metabolic resistance. Today we're gonna talk about things like biotech, like wearables, and the body composition scales, continuous glucose monitors, how that's changing, the way we understand metabolic health. And we'll go deeper than data 'cause the goal isn't just numbers. It's building a metabolism that's resilient, flexible, and works with your life. Lara, welcome. I am so glad to.

[00:01:58] Dr. Lara Zakaria:  Thank you so much for having me. I'm so excited. I always love chatting with you. It is such a privilege and I love this topic, so we're gonna have so much fun.

[00:02:07] Dr. Melinda Ring:  So I met you in person. I'd followed you for a long time. I met you in person recently at the American College of Lifestyle Medicine meeting where you were keynoting about these tech wearables and everything. But before we get to why they may be helpful, maybe let's step back a little bit and define these terms like good metabolic health or a healthy metabolism, because they can fairly vague and abstract.

So from your perspective, what does a healthy metabolism actually look like in real life? And are there signs that you look for that somebody's metabolism is working well or not?

[00:02:48] Dr. Lara Zakaria:  Yeah, I think if you're like me and you're a victim of the eighties and nineties diet, culture, your idea of metabolism is how well you can burn through calories, right? Like I have, I have vivid memories of people saying, oh, I've got a slow metabolism, I've got a fast metabolism. And that was sort of a depiction of, well, I can eat whatever I want and not gain weight, versus, you know, I have to be very careful and have to be really restrictive in what I eat in terms, and then otherwise I'm gonna end up gaining unwanted weight.

And I think I am, first of all, grateful that we have evolved this conversation and we're at a point where we can speak to it in more nuance and we could talk about something called metabolic flexibility underneath an umbrella term of what is weight health versus this sort of. Obsession over calories and you know, just calories in, calories out.

And what that means in terms of like what, how much you weigh on a scale or an even worse measurement of BMI. So kind of setting that as the foundation where we've evolved to now is understanding that metabolism is really what runs the entire show beyond whether or not it you gain weight, lose weight, metabolism.

At its core is how well your mitochondria are functioning and the entire name of the game, the entire name of life and survival is the production of a TP. It's what we learned in seventh grade biology, right? Like

[00:04:12] Dr. Melinda Ring:  Yeah. You got it.

[00:04:12] Dr. Lara Zakaria:  Simple and boring as that. And there are two fuel sources that we essentially use.

There's a bunch of co-factors, so I don't wanna oversimplify it, but there are two main macronutrient fuel sources, and those are gonna be your carbohydrates and your fats. And even our proteins get repurposed usually as carbohydrates for fuel.

Metabolic flexibility is essentially knowing when to flip from using glucose to using fat. What happens is in folks who are inflexible, it's stuck in one mode, usually in the glucose burning mode. Okay? And as a result of that, it's not burning down fat. When we stop burning down fat efficiently in those fasted states, that's where we have trouble losing weight.

That's where we increase our risk of fatty liver. That's where then you start to see that cascade of metabolic diseases like prediabetes, insulin resistance, and increased cholesterol, as well as that stubborn weight that just won't go away no matter how much calorically you're restricting.

[00:05:14] Dr. Melinda Ring:  If somebody's wondering, do I have metabolic inflexibility that might show up as they should be losing weight based on what they're doing in their life, but they're still not, um, carrying extra fat, especially maybe belly fat. Maybe they've been told they have hepatic steatosis fatty liver issues, or their glucose is running a little bit high. Even fasting glucose A1C level, those sorts of, they've been told they're in the pre-diabetic range. Are those the major things that are gonna tell somebody, Hey, your issue may not just be that you're eating. Too many Skittles. It might be that you you actually have a core issue with metabolic and flexibility.

[00:06:00] Dr. Lara Zakaria:  Yes, and there's one more.

[00:06:01] Dr. Melinda Ring:  One more. Oh, I'm

[00:06:02] Dr. Lara Zakaria:  And that is, and I believe this is the official term, being hangry all the time.

[00:06:08] Dr. Melinda Ring:  Oh, okay. Okay.

[00:06:10] Dr. Lara Zakaria:  And that we've all experienced that, that moment when you've gone just way too long in between meals and you're so hungry that you're starting to get cranky or angry.

And that is, to me, a really good sign that you are not switching from the Fed State to the fasted state. Most of the time when people experience that hanger you're like snapping at everybody around you. Everybody's telling you you need a snack. Like, you know, those kinds of things. That usually means that your body is overly relying on carbohydrates versus relying on fat, stored fat to help get you through to that next meal.

So if that's something that you experience along with some of the other signs and symptoms that you mentioned earlier that you usually is a pretty good indicator that you're metabolically inflexible, it's stuck in one mode, usually in the glucose burning mode.

[00:06:58] Dr. Melinda Ring:  

you've shared that openly about your own metabolic health challenges in the past, in the twenties, what was that like for you and how did that lead you to where you are now in terms of your understanding of all of the,

[00:07:13] Dr. Lara Zakaria:  Yeah.

[00:07:14] Dr. Melinda Ring:  Metabolism and all the work you're doing?

[00:07:17] Dr. Lara Zakaria:  So you make me think of, Speaking of hangry, you make me think of my first few years at a pharmacy school. Where I first started working was at a CVS and one of the busiest stores in the region. My ad,

I remember this, I'm in my mid to late twenties at this point.

 I was doing what at the time was considered healthy. I was watching calorically, how much I was eating. I was careful about making sure that I, my energy expenditure was more than what I was taking in. I was by all like intents and purposes, I was checking off all the correct boxes, but I was always hypoglycemic.

If I didn't regularly eat, if I didn't have a snack nearby, I was gonna crash out. I was going to be hangry, I was gonna get a little lightheaded. I was gonna need to sit down. And that in retrospect, is not healthy and anybody let alone like a 26-year-old. Feel like I was that perfect embodiment of the person that is trying to do all the things correctly, but.

I was by the standards overweight. My BMI was considered in the overweight category, or at my best. It was borderline. And it was always like very frustrating, especially like, again, coming from that nineties, two thousands era of super leanness, super thinness. I'm grateful. I was always in the gym, so I was building Musclele at that time.

And so I was aware that I was more Muscleular maybe than the average uh, woman my age. But there was always this sort of pushback against what my weight should be. I'd go to the doctor's office and I would be like, you need to lose some weight. And I'm like, I literally don't know how. Right. I, I, I don't know how.

The journey kind of in exploring metabolism was one that took a while. From there I had some other health issues. I had a lot of joint issues. I had GI issues again, 26, 27 years old, and I'm like popping Advil just to get through the day because I was. You know, standing all day and you know, work was very intense and very uh, stressful.

And I would just come home after a 12 hour shift and I would immediately have to put my legs up 'cause they were swollen, like tree trunks. And clearly something was wrong, clearly something was wrong. And I'd show up at the doctor's office and I'd go. It doesn't help that according to the charts you're overweight.

And I'm like, I literally, do you know how much I do spin? And I run and I lift weights. Like, Do you know how much I can bench.

Let's do this, let's do this. Right. And um, I think that that kind of as I was trying to explore how to kind of deal with the inflammation and how to fix my gut and I started to get really interested in the gut and the microbiome and that kind of opened the floodgates for me to learn about nutrition.

That took me down the path of getting my master's in nutrition, pursuing the board certification as a CNS and all those things. And my certification in functional medicine and discovering lifestyle medicine and all these, all these, other things that would come as a result of that.

Ultimately we think that we're doing our patients good when we give them that feedback, but again, when you're looking at the wrong metric, there's a much bigger chance that person will give up than that they

[00:10:23] Dr. Melinda Ring:  Yeah.

[00:10:23] Dr. Lara Zakaria:  going.

[00:10:24] Dr. Melinda Ring:  Yeah.

[00:10:24] Dr. Lara Zakaria:  That's, I think, dangerous, that, that puts us in a slippery slope.

[00:10:27] Dr. Melinda Ring:  The accessibility of biotech as a tool for insight into what's happening in our body is just exploding. We do have this ability to, talk, to find information out about our body, even on our own. I think it's always best if you have an integrated functional medicine provider who can help you interpret those. But, let's hear your take on what are the best ones out there?

What are the ones that you recommend to patients? And which ones do you think are like not ready for prime time, as I say.

[00:11:07] Dr. Lara Zakaria:  Okay, so first, let's preface this by saying the right tool depends on the person. So I can't say what the best is because I'm making general statements. I want a tool that is going to empower the individual to make better decisions. What we do know, what the research does tell us is that when. People are given the right information, they make better decisions.

We just said how when you tell somebody their weight and their efforts aren't good enough, they're more likely to give up than they are to keep going. But when you empower them with the right information at the right time, guided by a clinician who understands all the context right, that then helps them make better decisions and it actually informs better behavior change when it comes to sustainable lifestyle, habit changes, right? So ultimately the right tool is not only the right tool for the right data and the right information and the input, it's also the right tool that resonates with that individual and their goals at the end of the day. So, keep that in mind.

So I like to have a general idea of where we're going when we make those recommendations. I will also, like just an honorable mention to you, I'm focusing today on metabolic health tools. There are tools that you're probably already familiar with, potentially already using with your patients are technically considered as part of this health tech wearable space.

For example, blood pressure machines at home, blood pressure machines, underutilized. Tech, right? And they've advanced so much, even in the last two decades they've gotten much easier to use. There's so much more versatile for different bodies and different types and different people, right? We have monitoring capability dashboards where clinicians can check in and look at patients' data, and I don't know why we're not doing this more often with people who need consistent monitoring.

So that's like just one thing that's maybe metabolism adjacent, but an underutilized tool. Another one would be EKG monitors.

[00:13:05] Dr. Melinda Ring:  I know my son that was, it was, my son when he was a teenager, had an arrhythmia. And this device that could fit in the palm of your hand can be able to get an EKG in the moment with rhythm strips. It's just, it, blew my mind at

[00:13:22] Dr. Lara Zakaria:  It's so cool, right?

[00:13:24] Dr. Melinda Ring:  It's so cool.

[00:13:25] Dr. Lara Zakaria:  Yeah, my, my aunt has AFib and we got her one of these little machines. It's like literally this big, and she's.

It's and, her husband happens to be a physician and he's like, monitoring her. And I'm like, this is so cool. So there's a lot of different machines on there are at home hormone testing devices for people looking for fertility or perimenopause, menopause support.

So what I'm gonna focus on today are, things that are more in the metabolic space. So I'm gonna talk about. Glucose monitoring, metabolic flexibility, body composition. Um, we're gonna focus on those on those areas. So the first thing I'm gonna talk about are CGMs or consuming glucose monitors.

Those might be arguably the most controversial topic of all the tech that we're talking about. So just a little context, a little background. CGM machines have been on the market for a long time. They're not new. They used to be a little bit more cumbersome. They used to be a little bit more sensitive, and they historically have been used for folks who are insulin dependent, diabetics, either type one or type two diabetics, where we need to closely monitor their, blood sugar to avoid ketoacidosis or drops or significant fluctuations in their blood sugar levels. Over the years, they have gotten more sensitive, where some of the ones on the market now upload data every minute, sometimes even more frequently. They're much more sensitive to fluctuations.

And what we're really looking for in these devices when we're using them is what the overall pattern is. What is the response to food, movement, sleep, and stress that can be then viewed, assessed and then utilized to help that patient better understand how their habits are impacting their blood sugar fluctuations.

So I often will have people wear these for about two weeks, 14 days. Some of them give you a courtesy 15 days. And what I usually have them do is first pay attention, know how these habits are impacting the blood sugar. I teach 'em to monitor what time and range means how quickly their blood sugar rises and drops.

I teach them about what I call it a a boring roller coaster. And I say a, fun rollercoaster goes up really aggressively and then drops very aggressively. We don't want that on your blood sugar. What we want is a nice gradual up and a very boring, slow decline. And so I teach them about okay, how about we experiment and we change your breakfast?Maybe instead of just oatmeal, maybe we add some protein to your oatmeal and see how that impacts your blood sugar. And so it's a way for us to get them to reengage with what their habits are doing and how it's impacting their blood sugar in a way that I think without it, they wouldn't feel any different.

They wouldn't. Notice how their body feels necessarily as a response to that. You've probably had patients tell me if this sounds familiar, that tell you, you ask 'em how they handle stress, how's your stress?

Like, how would you rate it? Tell me a little bit about that. And they tell you like anybody, I have stress, but honestly I thrive. I thrive under stressful circumstances. I wait till the last minute 'cause my best work is under stress. You know, And there's sort of just like bragging about their ability to manage stress.

And again, there's no you know, if they're wearing an A ring or something like you, they could see their stress response, but there's no way, again, for them to realize what physiological impact that's having. What's cool is you can actually watch them. You could watch their stress level go up and then watch their blood sugar go up in response and help them make that connection physiologically between what's happening psychologically and what's happening in their body in response to that.

So those are really helpful to help make those connections. And I think most useful when used directly with a clinician that can guide them through that and help them first create awareness around those responses. And second, then help them implement experiments or ways to help adjust and bring those numbers into what goal ranges are.

[00:17:25] Dr. Melinda Ring:  I recommend CGMs for patients all the time, but I don't have the capacity to sit here and look at 24 7 data over two weeks and with their food logs and their sleep and stress logs telling them you need to either work with somebody or you need to journal and try to see what kinds of things come up for you. So it'll be interesting to see how these AI tools help somebody and with that interpretation, and I don't know if you've seen anything about that, but

[00:17:58] Dr. Lara Zakaria:  A hundred percent. There's a ton of tools now to bring in the data and to try to aggregate it in a way that's useful for clinicians. I don't think that's ready for prime time yet.

That said, this is my plug for collaborative practice, right? This is my plug for can we bring in a nutrition professional, a health coach? Can we create a program? Can we create educational material, interactive material that can then plug into these programs and to help support then that patient in that journey?

So it's not on the primary care physician, the nurse practitioner, the whoever that lead provider is to do all of it. I think this is where really like working collaboratively really shines.

[00:18:39] Dr. Melinda Ring:  I wanna make sure we get to some of the other

[00:18:41] Dr. Lara Zakaria:  Yeah.

[00:18:41] Dr. Melinda Ring:  'Cause CGMs, I think are the ones that people are most familiar with.

[00:18:45] Dr. Lara Zakaria:  I'm gonna go to what I call like the metabolic flexibility device, and I actually show you what it looks like. So, so don't laugh. It looks like a vape pen. So

it literally looks like a

[00:18:56] Dr. Melinda Ring:  Yes,

[00:18:57] Dr. Lara Zakaria:  Right. So anybody that's watching this is a lumen. Um, and basically, it's measuring carbon dioxide.

The idea here is that by measuring the amount of carbon dioxide that somebody is producing, we can tell if they're predominantly metabolizing and using car glucose versus fat, and this is old science, frankly, we could do this on A CMP but we're not gonna do CMPs every day, right? So this is a way for us to help measure that.

And I, you usually have people use it in the morning as a fasted measure. Then you can have them do it before and after meals, before and after exercise, and before bedtime. And so you're gathering that data all across, around the clock, and you're able to tell how often. They are in the correct mode at a specific time and use then that data to help inform the decisions.

What's great is the app itself gives the patient guidance and adjusts their targets, which is a good thing and a bad thing. If you have specific targets and goals with the patient that you're trying to really manage the, that may not be the best the best application there. But I have found that if you are just okay with letting that guidance, give them some general direction, increase your carbohydrates, lower your carbohydrates, increase your fat, increase your protein then, I think that's, it's a generally helpful and is again, very much patient guided.

The other bonus is that you have to breathe into it for 10 seconds, hold your breath and exhale, and you're watching this little bouncy ball on the app and it's 30 seconds of focused breathing.

So In my practice, what I often do is I start people on A CGM and when we feel like we're done with that, or if they wanna continue it, that's fine.

I move them into the lumen after, if they're still, if they're hitting a stall or if they're interested in doodads and gadgets, that we might move them into the lumen.

[00:20:47] Dr. Melinda Ring:  Other than changing the diet composition, stress management, are there other tools that you use with people to help improve their metabolic flexibility?

[00:20:59] Dr. Lara Zakaria:  Yeah, the obviously foundationally getting getting people to meet their protein goals. Not so much carbohydrates as much as this protein fiber. Those are usually the two things I'm aiming for. And then making sure they're getting good healthy fats in there. Making sure they're moving and they're increasing their muscle mass, meaning I need them to lift weights.

I need them to really stimulate muscle growth. And if I'm talking about somebody that's over the age of 30 or 35, that means I really need them to get proactive about building Musclele. Which usually means hooking 'em up with a personal trainer or a physical therapist to make sure that they're on the right track for recomposition in that direction.

Stress, obviously you've already mentioned, that is a really important piece. And then sleep is another really important microbiome gut health, making sure that there that is in check. We are learning so, so much about the impacts of the microbiome on not only metabolomics, but also on the way that the body is metabolizing bile acids, the way that it's utilizing carbohydrates to make things like short chain fatty acids and other compounds, neurotransmitters, TMAO.

So especially if we're talking about the overarching cardiometabolic risk, we can't skip that. There's also specific strains and species that are implicated in improved insulin sensitivity. The one that comes to mind is  Akkermansia. Yeah, of course.

[00:22:27] Dr. Melinda Ring:  Akkermansia these days.

[00:22:29] Dr. Lara Zakaria:  Absolutely. And it's not the only one for sure, it just right now has the best PR team. But it has opened up the door for our conversation about these keystone species that are absolutely instrumental in ensuring that we have good blood sugar control. So, you know, supporting the microbiome more directly is another important target. But all of these things, it's almost like it's all part of a stew.

And depending on who I'm working with and where the priorities lie with that individual, we might put a little bit more of one ingredient over another. And then I might use other data, other wearables, other labs to then help prioritize the way I'm gonna move forward.

[00:23:11] Dr. Melinda Ring:  Is there any data on the GLP ones and their impact on metabolic and flexibility?

[00:23:16] Dr. Lara Zakaria:  So there's a couple of interesting things about GLP ones I think that we're just starting to like. Scratch the surface of for example,

 That whole muscle loss thing. Apparently it's not an inevitable side effect of the use of glp. We just have to be more consistent in making sure that people are adequately eating enough protein and that they're lifting enough weight to build muscle and counter that impact.

Some recent studies have suggested that maybe part of the reason that people lose Muscle, and that's a common side effect, is because we have not been a. Properly managing their caloric intake and particularly their protein intake to offset that potential impact. Another really interesting thing about them is that we know that they're anti-inflammatory.

We've heard a lot of stories about people with autoimmune issues going into remission. We've heard about their use in low doses to help stabilize mast cell syndromes like MCAS. So there's something else happening on an immunological basis that I think also lends to this whole conversation. 'cause when we generally, when we lower inflammation, we generally also improve metabolic health.

And when there is a irregular inflammatory immune response happening, that's an expensive, going back to a TP currency, that's an expensive currency to maintain. And that often puts an added burden physiologically on the body. And then the other really interesting, this is one of my favorite kind of things, and I'm watching this closely, is that there's.

Likely what GLP have opened the door to is a conversation about the relevance of the vagal nerve and the relevance of the gut brain connection. Because what we're really doing here is stimulating that vagal nerve interface between the gut and the brain with glp. So this is still an early area of exploration, but is it possible that to a certain extent what's happening is by stimulating these peptides, what we're doing is awakening this gut brain interaction.

And by doing that, we are actually improving the part, that connection to the brain, the parts of the brain, the HPA access that then goes back and recommunicate back to the gut. And that's part of what's shifting metabolically and transitioning some of that conversation that's happening both on the microbial level in the gut and then on more of a hormonal cascade in the brain.

[00:25:41] Dr. Melinda Ring:  We talked about CGMs, we talked about the lumen, of course blood pressure, e, k, G. Are there other wearables that you think warrant, investigation or worth, worth, either practitioners who are listening, using or, or just listeners wanting to use for their own health? Any favorites out there?

[00:26:01] Dr. Lara Zakaria:  Considering how much we're learning about that interface with the gut and the brain and stress, and how all of these things play together from a hormonal perspective, neurological perspective, an inflammatory per perspective, we would be remiss not to call the like wearable recovery. Exercise collection, jewelry

[00:26:22] Dr. Melinda Ring:  Yeah.

[00:26:23] Dr. Lara Zakaria:  As part of it, right? Whether it be a watch or a ring or a bracelet or whatever, what have you, you know, things like ora rings, garments, whoops.Um, Fitbits, uh, these are first of all very consumer friendly. A lot of your patients are already walking in, wearing one of these devices.

What they are starting to get really good at is looking at some basic parameters like heart rate, heart rate variability. Some of them also will give us a really good sleep staging. Now is it as accurate as doing a sleep study? Not quite. We're not there yet. Maybe in a few years, but it does give us a much, much better picture of what somebody's sleep looks like, what their recovery looks like, and variables that help to then inform good recovery, good movement.

That then in tell us a little bit more about what their HPA access health looks like, what their hormonal balance is gonna look like, and it's a little bit predictive of their metabolic risks when I think about, for example monitoring, everybody knows what heart rate is. We wanna keep heart rate as low as possible.

That usually is cardioprotective. But we also want to look at what's called heart rate variability, which is the measure of in between those, rates and rhythms. And that is the opposite. We want that to be actually higher and that higher inti gates better, recovery and better resilience.

And so when we measure these data points on their own, they could be useful. And then depending on which tool you're using, the way that they interpret that within their algorithm to give us an overarching score can be really helpful for the patient then to see how the work that they're doing is advancing those metrics.

[00:28:02] Dr. Melinda Ring:  We're all decked out.

[00:28:04] Dr. Lara Zakaria:  Yeah.

At one point I did wear multiple devices, by the way, as I was exploring different ones. I had like a, a, a Whoop, and a Fitbit and a ring, and a, so, you know, you can you know, you, you don't necessarily have to do all that.

[00:28:21] Dr. Melinda Ring:  No, No, no. But, it's good to play with them. Um, and it and, and, they have cost associated with them. So, you know, They're certainly not accessible for everybody at this point. And, uh, and fortunately we always do go back to those same lifestyle foundational things as  there's

[00:28:40] Dr. Lara Zakaria:  such a thing as data overwhelm too, right? If the data's gonna stress them out more. I don't, I don't, need that to add to. I can just go to the foundations and we can stick to that and just do a really good assessment and make sure that we're connecting with our patient and qualitatively understanding how they're doing.

[00:28:59] Dr. Melinda Ring:  Absolutely. and now. From the, from those. How about some of the ones that we either get in or step on or, uh, some, of those devices that,

[00:29:12] Dr. Lara Zakaria:  I wanted to save, I wanted to save my soap box for last, so if you made it,

[00:29:17] Dr. Melinda Ring:  Okay.

[00:29:19] Dr. Lara Zakaria:  Congratulations. I wanna talk about how I want everybody to throw away their dumb scale, right? I, want everybody to move away from just focusing on weights and pounds or kilos or BMI throw it away. We all need to embrace body composition as a.

As a better marker of not only metabolic health, but also of body composition, right? We know you've got two people, one person who might be five two and might be super fit, right? Going to the gym, lifting weights, super Muscleular, right? And I can have somebody that's six two and in a, different body, in a larger body th those y you are looking at their weight alone.

It's not gonna tell you anything. I might guess that person that's six two weighs as much as the person that's five two. But that person that's six two doesn't have Musclele, right? And so these are vague numbers and we could do better now. So we could use weight to measure changes in fluid volume, right?

There's other reasons why we might use weight, but if you're trying to track metabolic health and body composition, we need a better tool. So there are in-office devices you certainly can invest in that will measure muscle mass. And in my opinion, visceral fat is really important to track. The other option is to have your patients have something at home that they can use.

And so there are definitely consumer products that they can have consumer grade products that they can keep at home that they can use to track their body composition prices range anywhere from $80 to $500. What you want is a machine that is going to be consistent in the data that it's spitting out and is going to be something that they're gonna be able to use.

And ideally, if you are tracking alongside them of, there's a professional dashboard where you can grab the data. So for example, Withing has that, and Body has that where there's a professional dashboard where you can track their data alongside with them. That's the ideal situation. But I feel very strongly about us measuring muscle mass as a marker of their metabolic health and then visceral fat as the other marker

[00:31:31] Dr. Melinda Ring:  And and how do those compare for you to say, the DEXA scans that are

[00:31:37] Dr. Lara Zakaria:  Yeah.

Yeah. Great question. So DEXA is gonna be the gold standard because DEXA is going to be the most sensitive way for us to track changes, not only in bone density, but in Musclele comp and visceral fat. Visceral fat is the hardest one to replicate because all of the devices that aren't a dxa are essentially estimating visceral fat using A BIA or bioness analysis technology.

And so it just depends on the accuracy of their technology. And there's different levels, different wavelengths that they're using and depends how they're breaking.

[00:32:06] Dr. Melinda Ring:  makes such a difference

[00:32:07] Dr. Lara Zakaria:  Correct? Correct. Yeah, exactly.

[00:32:10] Dr. Melinda Ring:  it at the same time every day.

[00:32:11] Dr. Lara Zakaria:  Exactly. So a big part of this, and this is why I usually advocate for a, machine that has been established where there's reproducible data and that there is as much patient education inherent in the way that they're testing and consistency in that data to help keep it level.

The other piece is that DEXA is a good baseline, so have them do it. You're not gonna be able to do that at every visit, necessarily every day. Month, every year, every week however often they're able to get that DEXA is fine. That could be your baseline. Then the at-home device can be in between sessions to monitor and progress.

The other thing is that when I'm looking at that body composition data, I'm not looking at one measurement. I'm looking at it over time. I'm collecting the data just like anything else honestly we've talked about today. We don't wanna hone in on one measure, one abnormality, one win. What we wanna see is the overarching pattern.

So it's more helpful to have four measurements in a month than one measurement in a month to track that progress and to see where we're moving if we're moving the needle in the right direction.

[00:33:12] Dr. Melinda Ring:  Is there an ideal target people should aim for? Or do you just go by the standard for women, this body fat percentage, et cetera. This for men,

[00:33:22] Dr. Lara Zakaria:  I don't go for body fat percentage, I go for Muscle mass or Muscle percentage. And then we try to go for, and it depends on the, again, individual goals, what their starting points are. I try to avoid huge, huge, uh. jumps. So usually we go, okay, in the next three months we wanna inch towards this. But what I want to do is, one, get their brain out of thinking The scale is evil. I don't wanna step on the scale. Every time I step on it, the weight goes up. I want them to, start forgetting about what the weight actually says, and to just hone in on the Muscle and on the visceral fat. I want them to also notice that their body is actually feeling stronger and to dismiss any stagnations or any fluctuations in the wrong direction, and just rely on how they feel in their body.

So if they feel good, but the scale is not reflecting that, it's another opportunity to, to um, kind of disconnect. Uh, That uh, the abstract data from how they feel in their body, visceral fat, there is a more of a goal because that we want it to be under 10. Ideally for both men and women, there's some variations on the data depending on how we're collecting the data, but generally speaking, if you're in the single digits, that's the healthiest, visceral fat. You can also measure, I will mention, hip to waist ratio. The problem with hip to waist ratio is that in certain individuals there are certain body types. They can have a favorable hip to waist ratio and still be carrying visceral fat. They may not be very obvious depending on their body type. So somebody who's naturally curvy, who naturally might have a thinner waist, we might be not able to spot that they actually have increased visceral fat. So it's not a perfect way to measure, but a useful alternative if for whatever reason you can't.

[00:35:06] Dr. Melinda Ring:  just takes a tape measure.

[00:35:08] Dr. Lara Zakaria:  Exactly. Exactly. Exactly.

[00:35:11] Dr. Melinda Ring:  Okay. Well we've covered so much. Uh, I always like to end with this question, which is if you could share one piece of personal wisdom or one small doable practice that listeners could start this week to support their metabolism and reach their own next level of health, what would that be?

[00:35:33] Dr. Lara Zakaria:  Challenge yourself to lift something a little bit heavier this week

[00:35:37] Dr. Melinda Ring:  Nice.

[00:35:38] Dr. Lara Zakaria:  Yeah. Just,

[00:35:39] Dr. Melinda Ring:  Love it.

[00:35:40] Dr. Lara Zakaria:  Add an extra couple pounds on the weights that you're already doing. Learn how to do a couple of sets of squats with a little bit of added weight. Uh, get a weighted vest for your walk, but just do something that adds just a little bit of weight towards that goal.

[00:35:55] Dr. Melinda Ring:  Right. I love that. Thank you so much. I've enjoyed our conversation. It's been empowering. You've helped reframe metabolic health, not as something that's fragile or we need to moralize, but something that we can understand and support and actually strengthen over time. And now we have tools to help us measure that we're doing that.

[00:36:19] Dr. Lara Zakaria:  Thank you for having me.

[00:36:20] Dr. Melinda Ring:  As always, remember your health isn't about doing more about being perfect. It's about understanding your body, responding with curiosity and building resilience, one small step at a time. for listening, and I'll see you next time on Next Level Health. Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring as we continue exploring the path to healthier, happier lives together.