"The Skinny-Fat Crisis" — Dr. Amy Shah on South Asian Genetics & The Cortisol Reset

How does somebody know if they actually need a supplement versus just a food? Okay, so great question. Women in today's society are so chronically inflamed and stressed, which is why we're having more health issues. So many expectations that are placed in us. We have to look a certain way. We have to be in our feminine. We have to do this. We have to do that. And our bodies are just like, what do you want from me? Yes. What is my role here? My mom, South Asian, huge community of women. I interviewed her and I said, what did you learn about menopause? She was like, we didn't talk about it. I mean, we didn't know. People start doing 30-33, and they will feel better within a week. This should be in our textbooks, given to every woman, because, well, fecal transplants stopped, only allowed for one condition. They were concerned, like, people are going to, I mean, you could change people's personalities. There's a conspiracy theory that a lot of people think that drug companies didn't want it because... Dr. Amy Shaw, welcome to Biohack It. I'm so excited to be here. I love that I'm sitting down with a South Asian woman. Yes. And we can also talk about all the South Asian health issues that we have as a race that other people can't, you know, kind of relate to at times. Yeah, it's really crazy because people look thin, they look healthy, but then they have all this metabolic disease. It's insane. I wanted to go straight into it. You and I were just speaking about this before we got on the show. Why are South Asians, even though we're built so petite and we look thin, have a higher risk than a lot of other populations to diabetes, Alzheimer's, and heart disease? Okay. So let me tell you a really quick story. um we moved to the united states when i was five years old and um my parents were working really really hard and my dad about a year into moving to the u.s um was diagnosed with type 2 diabetes and all of his five brothers the five got diagnosed all at the same time all thin look seemingly you know healthy of course you know the immigrant struggle uh had like changed his diet from tradition and then probably wasn't as active as he was back there. So there was definitely like a, maybe that was a stimulus, but I remember thinking back then that was actually the reason that I went into nutrition before med school, because I thought to myself, like, that doesn't make sense. Like, how is it that someone can eat all the sugar and they're fine? And then other people, um, you know, get diabetes from eating what seemed to me at the time, Like a healthy diet. A healthy-ish diet. And it's just now I understand that a lot of it is genetics. And we talked about like some of the theories about why our genetics are different from all the famines that we had to survive. So we have more thrifty genes, meaning like we are just survival. the survival of the people who could live through a famine makes us just much more likely to hold on to sugar and to process it in a different way. Because we're like really good at fasting and being a part of a famine. And then of course, the dietary changes that have happened over the last 50 years, like actually, when I was, I'm sure you're the same. When I was talking to my family, just, it's only been one generation really that this has changed so much. Their grandparents were not eating as much processed sugar. Absolutely. We're not eating as much processed carbohydrates. They were walking a ton using a bicycle or whatever. So it's very, very recent. So it's a combination of genetics and lifestyle change that has happened, but it's really kind of tragic. I will go even a step further and say, if you just look at the oil that we, our grandparents used to cook in, which was like desicchi, which is now known as butter. And the processed seed oils that now everybody's starting to cook with because they've tried to commercialize everything, make it for profit. Just the fact the amount of oil that we use in our food has made such a difference. And it's so inflammatory now to ourselves. Absolutely. And the amount, even for me growing up as an immigrant, the lack of protein in my diet was so crazy because, So my parents were vegetarian when they brought us. And then we incorporated, like I incorporate eggs, but dairy, we had dairy anyways. But the lack of protein in that diet and the amount of sugar and starches is insane. And also like the kind of oils, like I remember my grandmother, the way she learned, they had very little oil. So they would reuse it multiple times. And that is so bad because every time it's basically turning into trans fats. So, yeah, there's a lot going on there. How much do you think someone's environment and culture can shape their long term health? Oh, it's like, I mean, study after study says it's like 80 percent. Your lifestyle. So let me give you an example. There's a study on twins and their gut microbiome, which basically shapes your body. and they found that the twins, once they had been separated, living in different houses, their microbiomes looked nothing like each other. They looked more like the people they spent the most time with and ate with than each other. And this is genetically identical twins. So it just tells you how much your environment, the people you spend time with, and your food you're eating really shapes the inside of you. 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So if you're around someone who's really toxic and negative and has a horrible personality, You don't want to be around that person because they will inadvertently get your back chair and you will get theirs. And so the more time you spend with someone who is positive and happy and optimistic, not only mentally, but your microbiome will conform to that. Yeah. There are now studies that show even athleticism. So elite athletes have a different microbiome than just people who are just like randomly playing the sport, like tennis, for example. And so there's a company out there that actually sells the microbiome of elite athletes. It's like fecal pills. I think I heard about this. Yes. They've stopped doing that now, though, right? Or they're still doing it? Well, fecal transplants are now stopped, only allowed for one condition in the U.S. because they were concerned. Like people are going to, I mean, you could change people's personalities. You can change their hormonal status. You can change you know like it a little crazy what can happen if you give someone microbiome to someone else And then there a conspiracy theory that a lot of people think that drug companies didn want it because what if you could like cure people Absolutely And so it very interesting the whole microbiome world. But yeah, I think it's so important to spend time and share food and space with the people you actually want to be like. And it's not just I mean, it's, we've known this for 1000s of years, They're written in books, but the science is coming out now. That's insane to see how much influence the people and the organisms that they carry within themselves can have around you. Yeah. And those organisms, let's put it this way, Maude, they're louder than our own brain. So, for example, the dopamine and the signals that the bacteria send are louder than our own brain chemicals. So they can override it. Override. And that's why the gut-brain axis is so important because it can really affect how you make decisions, your mental health. Do you have anxiety? Do you not? How do you regulate your nervous system? And then we wonder why everyone is so depressed and anxious. It's because our microbiome is trashed. Right. How does somebody know if they actually need a supplement versus just a food? Okay, so great question. I think most people, you know, in the ideal world, we could eat it all through food, but we can't. Like there's, we know for a fact that vitamin D, for example, we can eat, I could eat all the vitamin D in the world, but I'm not going to like be able to fix my deficiency through just eating it. I have to take a supplement. So there's definitely cases, B12, you know, there's iron deficiency. Minerals even. Yeah, like some people have iron deficiency and like their diet does not correct it. So it's like you have to, it's personal. Obviously, there's people who have no deficiencies and their diet's fine. And then there's this new thing about certain minerals like magnesium, for example, that people who eat the most magnesium in their diet or get it from supplemental sources, if you get up to 550 milligrams a day, which is a lot, they have slower brain aging. and so figuring out how to get that much through food and it's hard yeah so like it's overwhelming it's another thing on our plate that we don't need exactly and so I feel like magnesium omega-3 and vitamin d those are the three that I can say for sure that we have good data on that actually could help especially for women and what's the best way to take in common nutrients so they're most effective? Is it a certain time of the day? Is it a certain type of supplement, liposomal, liquid, pill? Like what's the way? The worst, okay. Our body has a circadian rhythm, meaning that day and night matters. So there are certain medications that are twice as effective if they're taking it at night versus morning. So we really do need to pay attention to when we're taking these things. It's not like, of course, you know, people will say like, you should take it. It's better than not taking it. But ideally, you really want to take certain vitamins. For example, B vitamins are best taken in the morning. Iron is best taken with in the morning. You want to take the melatonin or anything that it's like chamomile in the evening. So fat soluble and water soluble as well, right? Exactly. Fat-soluble, you want to take it with food. So vitamin D, omega-3s, you want to take it with food because they're fat-soluble. And so I feel like that kind of education needs to be given to people because a lot of people are just taking vitamins and not really understanding any of that. If you want to live longer and heal naturally, you are going to love the Dr. Josh Axe Show, hosted by my dear friend, Dr. Axe. Every week, he shares how to balance your hormones, restore your gut, boost your energy, and slow down aging without relying on harsh medications or quick fixes. He shares both ancient biblical practices and the latest breakthroughs in nutrition, herbal remedies, and lifestyle medicine. And he sits down with world-renowned experts to have a real unfiltered conversation you won't hear anywhere else. If you're ready to take control of your health, renew your energy, and transform your body, mind and spirit. Tune into the Dr. Josh Ack show every Monday and Thursday, wherever you get your podcasts. Why, especially in this part of the world, and I remember Gary was saying this on stage, or it was at the YPO dinner. I don't think you were there yet, though. But he said, the Middle East population and South Asians, this part of the world is about 80% deficient in vitamin D, considering we are exposed to so much sunlight. Yeah. And we also have darker skin tone. Why is that? Yeah, it's so crazy. I mean, this part of the world and in general, I think women tend to have this issue a lot, even more, especially women in perimenopause. And we think part of it is because our gut lining, our absorption of vitamin D is lower. And then part of it is, I think we didn't understand that vitamin D is hard to, so we don't spend as much time outside anymore as we used to. And the amount of time you have to be outdoors with a darker skin tone to get adequate vitamin D is a lot more. And so, you know, back in the day when people were farming or biking or walking a lot, you know, you would get a lot more sun exposure. So I always say, actually for my female clients and especially for my South Asian or Middle Eastern is get that sunlight early in the morning before it's so harsh. Okay. So that you are getting it through your eyes to reset your hormones or kidney rhythms, and you're getting a little bit of natural vitamin D from your skin. But don't do it between the peak hours, 12 to three. Yeah, exactly. Is it true or not? Because I experienced this this summer and you're the expert, so you will tell me. So I obviously had a really stressful summer. A lot was going on with work. And even though I spent a ton of time outside in the morning, was getting in natural light, obviously got a ton of color. The summer finishes, I come back three months later and I'm really badly vitamin D deficient and it's messed up because vitamin D is a master hormone, messed up all of my other hormones. And I sat there and thought to myself, here I am spending a ton of time in sun, getting in my morning light, all of that. But because my nervous system was dysregulated. And my body could not absorb even from the sun the vitamin D that I was actually getting. Think about it. Our whole gut is like a nervous, you know, you know, when you get really nervous, you totally feel it in your gut. It's because there's so much of your nervous system that's there and you can't absorb the things you need to absorb when that, that nervous system is always on. Correct. And I honestly, I would suggest this for you or anyone who's listening or watching that is a woman, especially like in the age range of like 30s all the way to 50s, is you have to prioritize the cortisol. Because I call it, you have to do a cortisol reset every time you come back from a trip, every time you come back from a hard work event, because your body needs recovery for it to function better. And what is a cortisol reset? Okay, so it's going to be like three to five days of actually doing everything you can to calm that nervous system. So it's like sunlight in the morning. Maybe it's not the aggressive high-intensity workouts. Maybe it's yoga. Maybe it's walking, you know, in nature. And then you're going to cut your caffeine in half. Okay. For people who drink alcohol, you're going to cut your alcohol out. you're going to eat foods that really support your gut more soups and protein rich foods and you're going to do things like in the evening you can take ashwagandha rhodiola things to calm your nervous system okay and then you're going to spend a few minutes every day during this cortisol reset really taking that time to do your meditation or mindfulness so the goal is not just what you actually do. The goal is what you don't do. So you're really going to manage your nervous system. Almost like imagine you going on a beach vacation and you have no responsibilities Like you going to do that for yourself even though you home Okay That mindset of like I in relaxed mode not going to get into any you know like big arguments or do everything you can to kind of calm your nervous system. So that goes with food but also the workouts maybe not doing that like high intensity and doing like more nature-based because that brings down your cortisol. Also increasing your sleep by at least 20 minutes. Really? So even just 20 minutes makes a difference? Even just 20 minutes because what happens in mind is like if I told you to go to bed at eight o'clock tonight and you usually go to midnight go to bed at midnight like there's no way you're gonna go to bed. Right. But if I tell you instead of midnight go to sleep at 11 40. Yeah. You know like you could do it. Yeah. That's how you can increase the amount of, that's the best de-stressor there is, is getting adequate sleep and getting some sunlight in the morning. And just those two things by themselves can really help reset your cortisol response in your body. Let me tell you, after doing that for three to five days, I usually ask people how they feel and they're like, I want to do this all the time. So it's kind of like, so when you see elite athletes, right, or NBA players, they spend as much time, if not more, in recovery than they do. And what you're doing for your work and what a lot of women are doing is like an elite athlete. Absolutely. You need that recovery to function. Yeah. I think women in today's society are so chronically inflamed and stressed out, which is why we're having more health issues. And I said this on a podcast earlier this week because we're living so out of design of what we're actually able to withstand in terms of stress. Yes. Because we have so many expectations that are placed in us. We have to look a certain way. We have to be in our feminine. We have to do this. We have to do this. And our bodies are just like, what do you want from me? Yes. What is my role here? One of the best tips I've ever gotten is that after you do the cortisol, what you said, is keep 20% of your day free. And let me tell you why. When you are booked back to back to back to back to back, not only are you not present, you know, because you're like, oh, next thing, you know. Correct. You are not getting time to process the information. Correct. And recover from whatever it is you did. And sometimes you're having a great conversation, say, and you can't finish it because you're on to the next, right? So one of the biggest thing I learned is like in medical school, we were told to pack your schedule back to back. And when I started to leave 20% of my day free, I found so much growth because big things don't come to overwhelm people. You need time to like process your nervous system. If it's in fight or flight, it cannot make a good decision. But most of us are living in fight or flight constantly. And I was too. And that's why this changed my life because I'm like, oh, cortisol reset. Amazing. I would do that for three to five days and then you would come back to your crazy life. And so then I started to add in a few like little breaks throughout the day and it made the biggest difference in the world. A little nature walk. You know, it's so funny you were saying that. So today I was having a really hard conversation with somebody I really care about. And normally I'm such a reactive person. I'm like, that's it. Cut blank. I made my decision. because I'm like, I made up my mind. I thought to myself, but maybe where I'm coming from is because I'm tired, I'm stressed. Maybe I'm not in the right with what I'm thinking. That's right. Maybe I need time and space to really sit, calm my nervous system and feel safe in my body before I can actually come to a decision, you know? That's right. Because I'm like, maybe this isn't the time to ask me anything serious right now because I don't know what I'm going to feel, right? And I started the conversation with saying, where I'm coming from, I don't know if this is my final take on things, right? Because I don't know how I feel right now. I'm telling you, like, if you think of animals, very easy to see in animals, right? Yeah. When they're in fight or flight. Correct. They're only thinking about survival. Correct. And they're not thinking like planning for next year. You know, like, it is so innate in us when we're in survival mode to pick the answer. Yes. That is just the easiest right now. To protect just you. and sometimes just protecting us and just keeping ourselves safe is not what's meant to be that's right and like the biggest answers I've ever gotten is because after I had the call or the meeting or the trip I kept that 20 and like when you're walking in nature and you don't have to rush that next thing that's when it comes to you and you're like wait yeah and sometimes I think to myself, the threat that we're feeling, is it really external or is it internal? And if it's internal, where is it internal coming from? Where is a lack of safety and security coming from? And my nervous system is just so heightened right now. It maybe is not what I think it is. Yeah. And Niman, this is why I think religion and meditation, mindfulness, I think, you know, when you're growing up, a lot of people are like, oh, whatever, you know, but it's a time for people to kind of slow down and maybe go inwards. Because oftentimes when you do that, you come out, you have the answer. It's the same thing. You're getting yourself out of that fight or flight. You're getting yourself in a different realm. And then you can come back and make a better decision. Absolutely. And that's what I was thinking about today. It's like if we just had more regulated nervous system and we could create safety and security in our bodies, then if we're in a position that we're having a hard conversation or something that normally would trigger us, maybe we could have a different response to it because we're able to see things as the observer versus the person who's in the reaction moment. Well, and you know, women especially, not only are we more sensitive to stress, but as we move through perimenopause, 30s, 40s, 50s, and beyond, you become more sensitive to stress. So the same amount that it used to take you to feel overwhelmed, it happens sooner with less overall. Amy, I'm at this event, and obviously we planned everything, put this together, but I have to be talented, I have to moderate and stuff. And I was like, man, I used to back in the day run like seven days worth of fashion week, do art basal events back to back to back. And I'm feeling exhausted even faster. I'm just feeling depleted. Exactly. And that's partially because our hormones are changing and our ability to kind of buffer that cortisol response is lower. Okay. And so you need to do even more to recover. Correct. Than you used to. Right. And that's why perimenopause ends up being a time of major anxiety and mental health challenges. Oh, totally. I was, I just had to put myself on hormone replacement therapy because I was like, I'm not feeling like myself, guys. Yeah. I mean, this is like, this is happening. I just think that for women especially, I think we need to be conscious of that. It's so funny. I work with a couple of patients and one of them is a OBGYN and she still delivers babies. And, you know, and we always laugh because her life outside of the hospital is constant cortisol reset. And that's kind of like you probably. Yeah, yeah. Like every time you're not doing what you need to do, you should be working on your nervous system to kind of like calm yourself to get ready for that next hit. Because otherwise you're going to be like burned out, anxious, stressed all the time. Exhaust. I have a question for you, though. being that we are South Asian, in our culture, there's no such thing as slowing down. And people have all these like, I mean, I grew up like this, everything is, you have to be the best at everything. You have to always be an overachiever, being mediocre. There's no space to being mediocre. There's no such thing. And so we grow up not only highly competitive with ourselves, but we always are trying to push ourselves to the max. When our genetics are wired to be this way, how do we create that space? Okay. So, um, if you think about it, um, this is so beautiful, but a lot of us came to a different part of the world. Like my parents brought, came from a small village to the U S because they wanted us to have the opportunity. They wanted their daughters to have the opportunity to share something with the world that maybe their moms and their family did not get a chance to do. There's a lot of people where I grew up that wanted to do really big things but couldn't because either they got married and pregnant or things changed in their lives. They moved to their in-laws' house or whatever it is. So you have this amazing opportunity to share your gifts in a way that your ancestors never did Were not able to do And so it a big responsibility And I think that's what we're feeling is that big responsibility on our shoulders to be like, we need to take advantage of this. But at the same time, you are a pro athlete and a pro athlete to go out there on the field. They have to have recovery. I mean, they're not going to make it if they didn't. If they didn't have the moments to slow down, rethink, calibrate, and reset their bodies. Yeah. And that's the hard part for me and you, I'm sure, is that we don't have a lot of role models, right? I know. That we can say, oh, it's like aunt this or like mom that. You know, most of us are the first in our generation to be doing what we're doing. Yeah. I was going to also ask you, what is 3033 and does it work for all body types and people? Yes. So here's the thing. I when I was really diving into nutrition for women I noticed something none of the textbooks had a chapter on nutrition I mean there was we get so little training in medicine I think it's 80 percent of people patients don't feel like they're getting enough guidance around you know diet nutrition lifestyle and so I thought to myself well that's so silly like we need to arm people, my mom, South Asian, huge community of women. I interviewed her and I said, what did you learn about menopause? She's like, what do you mean? She was like, we didn't talk about it. I mean, we didn't know. And I'm like, after all those generations, nobody thought to bring it up. No, but they didn't. She just thought she was going crazy. And all of them thought they were going crazy, like the mind, body, whatever. And so it's just such a shame that you couldn't even just say, Hey, you know what? Change your diet. Maybe like, you know, you need a little more recovery. And so I thought to myself, what is what from everything I know, what is the best kind of advice I would give to any woman who comes to me and asked me, Hey, I'm going through these hormonal changes. I'm working on, you know, my hormones, whatever the getting hormone therapy, but like, what can I do now? That's going to make a difference. And gut health changes within days. I mean, people start doing 30-33, and I'll explain what it is in a second, and they will feel better within a week. And so I feel like this should be in our textbooks. This should be given to every woman. And it's just a framework. It's 30 grams of protein in your first meal, 30 grams of fiber throughout the day, and three probiotic foods. I'll explain each one. 30 grams of protein in the morning is because not only are you setting yourself up to get adequate protein, but studies have shown that you will be more satiated. Your blood sugars will be better controlled. You have better choices throughout the day. So that's 30 grams of protein, 30 grams of fiber. That is what we need to feed our gut. Our gut is starving. 90% of people don't get enough fiber for our gut. So even things like berries and avocados, surprising things have high fiber, chia seeds. And then the three probiotic foods, that's a hard one because all traditional societies all over the world, especially Middle East, Asia, had fermented foods as part of their diet. But over the years, as things got more processed, sometimes they're not fermented, they're just pickled and put in the fridge. So the old way of making it, the fermented way, before we had refrigerators and processing and all that stuff. That's actually the best way. Right. So we still have yogurts. That's a great example of something easy that you can do for probiotics. But a lot of people are not eating any probiotics in a day. Not, I mean, three is like a stretch for most people, even if it's one spoon. Right. It's crazy that so much of our health issues would be fixed and not be where they are if we stuck to an ancestral diet. 100%. And how we are ancestrally meant to eat and operate. And each one of us is different, right? Even just you look at some countries like India and Pakistan, whether you're from the north or the south, depending on how much meat you're exposed to or you're vegetarian, that can also make a massive difference. 100%. And, you know, like they found that people who lived on the coast, like people in Kerala in India, had much better brain health, you know, because they're eating fish a lot. And so it's like, yeah, it depends on how you grew up. But because of the South Asian kind of thrifty genes and the diet and then the lack of exercise, it's like a death nail. I'm telling you, being South Asian, every time I gain even a little bit of muscle mass, I'm like, man, I'm killing it. Because I know I have to work so much harder than a friend who's Brazilian or African-American. It kills me to gain that muscle mass. A hundred percent. I have to push myself 10 times harder at the gym than somebody else with different genes. Most South Asians have an issue of being skinny fat or having fat deposition in places that are really dangerous, like visceral fat. Yeah, exactly. And that's like something I was even thinking with my family with the diabetes, there's heart disease. And a lot of them, a lot of people in my family have a lot of visceral fat. It's kind of like, yeah, very, very common thing. And it's very, I mean, it's true with many different cultures, South Asians, also Latina, yeah, Middle Eastern, all of them. I want to ask you, approximately 80% of women experience some form of menstrual pain. That's really insanely high. But I had heard a doctor, a really great MD that I know, saying that we should not be experiencing period cramps if we're properly taking care of ourselves. Let me tell you this, okay. Okay. When I'll give you an example, I see this in myself all the time. If you have a very stressful month with terrible food choices, like bad sleep, pretty much guaranteed that your period this month, that month is going to be awful. The PMS will be awful. It's just like your hormonal reserve is going to be depleted. Yeah. And so that makes sense that when you actually eat good food, you're eating. Like I noticed that when I started to add, like fix my vitamin D deficiency, I added more magnesium to my diet, added more omega threes, added more fiber and built up my gut. My PMS almost is like non-existent. Absolutely. And I think also when you are hydrating correctly, a lot of us are walking up chronically dehydrated. Our cells is not just, and I want you to tell the audience over here. It's not just about drinking water. Yeah. I mean, I honestly feel like, especially when you're in a hot place or sweating a lot, you need to replenish electrolytes. Especially if you're sweating a lot or you're doing a lot of sauna therapy. I mean, I love sauna therapy for longevity, but you need to replace your electrolytes after you do that. Leaving our audience and the women on the show that obviously dive in and dive in for people like you and for me to bring people like you on the show and your expertise, what is the one piece of advice that you think all women need to implement into their life? The one piece of advice I would give is give yourself that space that like we talked about, like give yourself space and permission to be able to think and to process and to be the best version of yourself. Don't worry about what the world is saying to you. Um, keep that way. You can step into who you really are and do the things that you're meant to do. I am so grateful. I've been trying to get you on my show for 18 months, by the way. I'm so happy. I'm so excited. It happened finally, even though Saudi Arabia, Riyadh, we're all here experiencing this region together and I'm so grateful. I got to sit down with you. I heard you speak today on a panel and I was like, you're such an inspiration. And the fact that you're South Asian, I'm so passionate about looking into our history and what our women especially go through. So thank you so much, Dr. Shah. Thank you for having me. This was so great.