Episode 388: Special Guest: Dr. Naomi Parrella, Weight Loss, Fat Loss, Semaglutide And GLP-1 Inhibitors, Fasting With An App, Muscle Loss, High Protein Diets, And More!
Welcome to Episode 388 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Vanessa Spina, author of Keto Essentials: 150 Ketogenic Recipes to Revitalize, Heal, and Shed Weight.
Today's episode of The Intermittent Fasting Podcast is brought to you by:
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To submit your own questions, email questions@ifpodcast.com, or submit your questions here!!
SHOW NOTES
LMNT: Go to drinklmnt.com/ifpodcast to get a free sample pack with any purchase! Learn all about electrolytes in Episode 237 - our interview with Robb Rolf!
Naomi's background
Exercise doesn't drive weight loss
Hormonal fluctuations affecting fat loss
Fasting for women
Semaglutide and GLP-1 inhibitors
Developing the Zero App
Data collection and sharing with other wearables
Diet mindset and tracking a fast
Fasting studies
Caloric reduction
Our content does not constitute an attempt to practice medicine and does not establish a doctor-patient relationship. Please consult a qualified healthcare provider for medical advice and answers to personal health questions.
TRANSCRIPT
(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)
Melanie Avalon:
Welcome to Episode 388 of The Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat, not what you eat with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker, author of "What, When, Wine" and creator of the supplement line AvalonX. And I'm here with my co-host, Vanessa Spina, sports nutrition specialist, author of "Keto Essentials" and creator of the Tone Breath Ketone Analyzer and Tone Lux Red Light Therapy Panels. For more on us, check out ifpodcast.com, melanieavalon.com, and ketogenicgirl.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment. To be featured on the show, email us your questions to questions@ifpodcast.com. We would love to hear from you. So pour yourself a mug of black coffee, a cup of tea, or even a glass of wine, if it's that time, and get ready for The Intermittent Fasting Podcast.
Melanie Avalon:
Hi, friends. Welcome to episode 388 of the Intermittent Fasting Podcast. I'm Melanie Avalon, and I am here today with a very special guest that I am very excited about. So the backstory on today's conversation a while ago now, quite a while ago now, I tried an app called Zero, which I'm sure a lot of you guys are probably familiar with because it actually helps you track your fasting. So something really near and dear to the heart of this community. So I tried it a while ago. I haven't used it recently, but I did sort of recently, a few months ago, got reached out to by the app, because they wanted to have their chief medical officer come on the show and share more about the app and everything that she's doing in her work with health and weight loss and all the things. And so I was obviously over the moon thrilled at this idea, because I know the app is so valuable for people in their fasting journey. I knew it would be of such an interest to everybody. And then I was talking with Dr. Parela before this, but I dive deep into some of the other work that she's doing in her in her past working with, you know, thousands and thousands of patients. And she is really a wealth of knowledge when it comes to finding the diet that works for you weight loss resistance, really making metabolic changes for people in an often confusing and disempowering world, especially when it comes to just knowing what to do and doctor patient relationships and all the things and has worked on a pretty cool study about Ozempic. And I know we get a lot of questions about that as well. So there is so much that we can talk about here. I am so, so excited about about this opportunity. And I will say before we even jump in France, because we're going to talk all about the app, but if you go to ifpodcast.com/zero, you can get a free seven day trial of that app. So definitely go to that link. But in any case, I'm here with Dr. Naomi Parela. Dr. Parela, thank you so much for being here.
Dr. Naomi Parrella:
Melanie, thank you so much for having me. I'm super excited, especially with your audience.
Melanie Avalon:
So a little bit about you, so you are the medical director at Rush Center for weight loss. And you've done a ton with speaking and for people like United Airlines and Google and all the different things. And now, like we were talking about, you work at zero as well. So questions for you. Your personal story, like what led you to what you're doing today? Did you always want to be a doctor? When did the interest in weight loss in particular come into your life? What happened there?
Dr. Naomi Parrella:
Yeah, great question. Hard to answer. So I am not somebody who knew I wanted to be a doctor very young. As a matter of fact, I was pretty sure I didn't want to do that. You know, I was born in Japan and grew up in Japan, moved to the US when I was in high school and had this experience of different kinds of health experiences and perspectives across different cultures. So already, you know, that was just kind of interesting. And then, you know, did undergrad and, you know, started a family after graduating. And during the time that I was taking care of my little guy, I really became super interested in the medical profession, just what they were doing, what they were advising, because I had so many doctor's appointments for a newborn baby for all the prenatal care. So I started just, you know, being around much more with the medical providers and became very curious about the different recommendations they made and how things were very different hearing, you know, how people were talking to each other in the health care that I was receiving. So long story short, I got excited about all the different things related to lifestyle. And this was actually even before because as an undergrad, I had been an aerobics instructor and a personal trainer and was very interested in building communities around health. And so I was doing that actually after I had my babies. And along the way, I decided I would see if I could get into med school. So I took some classes, I studied while my kids were sleeping, went to med school and became a doctor. So it was kind of a roundabout sort of way that this occurred. And my practice has also evolved organically as well. So that's how I kind of got to this current space.
Melanie Avalon:
Oh, first of all, that is an extremely inspiring starting becoming a doctor after having kids and all the things. So it is never too late and no excuses for not, for not doing what you want to do. That's amazing. And so with your work as a doctor, so you said that you, you know, were initially having all of these appointments for your child and becoming intrigued with that. Where did the switch or the focus on weight loss in particular come in?
Dr. Naomi Parrella:
Yeah, that's a great question. So actually, while I was at the University of Wisconsin-Madison, I, like I said, I was a personal trainer and aerobics instructor, and I noticed that in the rural communities outside of the city, there were no gyms. And in those days, people were using VHS exercise videos. And I thought, wow, you know, I wonder if I could bring exercise out to the farms and see if I could build a community and get buy-in for it because people would be a thing to do together instead of in your own living room, you know, watching a video and doing exercise. I thought, I want to go out into the community and see if I can build interest and build a community around that. So that's what I did. And it was actually quite fun. I started with two students, and we were in elementary school gymnasium. So you can imagine how awkward that is when you're the instructor and you don't know which one to look at, right? Because you don't want to, like, look too intensely at one and not the other. And so they were so fantastic. And sure enough, word of mouth, right? Communities develop and they talk to each other and friends share really good information. And so while I was teaching, I would be, you know, sharing what I was learning in school on campus. Slowly, my classes grew. And so they grew so fast and so large that we had to move into a high school gymnasium, which was pretty awesome. So I saw that just by having fun exercising together, you could actually bring a community together and inspire others to get active as well. So along that way, people started asking me a lot of questions and I was not involved in medicine. I had no idea what a normal blood pressure was. They started asking me all sorts of questions in the class. So I started hanging out in the medical school bookstore when we had bookstores before on campus and reading a lot about the different, you know, questions they were asking me about. So just learning on my own. And this was, you know, obviously before having kids. Then once I had kids and started play groups and started health conversations for our children, you know, a bunch of parents getting together, then parents started asking me about losing weight after having been pregnant because they had gained a lot of weight during pregnancy. And so I started really studying and working on that and we created groups and worked on weight loss with small children, not for the children, but for the parents. You know, from there, like I said, I went off to med school and during medical school, we didn't talk about nutrition at all. We didn't talk about weight back at that time either. Not very much. Once I went into residency and I started making recommendations to individuals about their weight and seeing that disease processes were reversing. Patients were having great outcomes. I started getting referrals from specialists who would say, I don't know what she's doing, but if you need a primary, go see Dr. Perala. She'll take care of it. And so slowly I just turned into the weight loss doctor over time and it's, you know, been great fun. And this is pretty much what I was meant to be doing, I guess.
Melanie Avalon:
with the start with the focus on exercise. So what were you finding that was working? Was it, was there a common theme that worked for everybody or was it pretty unique to people when it comes to exercise versus counting calories versus changing macros? Like was there a magic formula?
Dr. Naomi Parrella:
Well, so what's interesting is when I first started, so as an undergrad, I, you know, obviously having lived in Japan and then moving to the US and seeing sort of the different shapes and lifestyles, I really thought I would teach people to exercise. And so it was really exercise more to help people achieve their weight goals. And what ended up happening was I had like a 0% success rate in helping people lose weight by teaching them how to exercise. They had a great time, they got physically fit, they were more active, they engaged in their world more, but long-term weight loss success was pretty much a big fat zero. And so, you know, I realized I have to do something different here. And that's when through, you know, the postpartum period and, you know, after having children, I really started diving into the diet and paying attention to different things about diet. So first, I really did believe calories in, calories out. I did believe that was the driver and that I needed to make sure, you know, people were eating less calories. And the strangest thing happened, people would come in and they would say, I'm eating less calories, but I'm not losing any weight. So of course I'm asking all my other trainers and other people I know, and they say, oh, they're probably just lying. They're probably really eating more than they say they're eating. So of course, you know, you start kind of questioning yourself because everybody was being unsuccessful. And here I am giving this supposed amazing advice. So I had to really go back to the books and it wasn't until I became a physician and had enough patients that I started realizing what my advice was, was completely wrong. It is not calories in, calories out. Calories are not the answer. So, and exercise clearly wasn't the answer. And what I found was by changing how people signal their body and the hormone response to that, then I could achieve amazing results that everybody told me was not possible. And that was the first moment I started seeing, my patients showed me, you can reverse type two diabetes. You can reverse the need for blood pressure medicines. That blew my mind because of course in med school I had not been taught that in residency. I never saw that. And so my patients showed me through their quote, miraculous recoveries that I had it all wrong early on. And so I started seeing, it really is about what you put in your body, how you take care of your body, what you do with your body, causes a change in the hormone responses, hormone signal to the body, what to do with fuel, whether you have access to certain fuel. And that is the secret to weight loss.
Melanie Avalon:
So I think about the calories in calories out piece quite a lot. And subtle nuance question about it, because you're saying that you know, it's not calories in calories out. Is it that it's not calories in calories out? Or is it that the way we perceive calories and calories out is not what actually ends up being the calories and calories out? What I mean by that is, you know, we think that we can just count the calories that we are taking in and that we can somehow magically also count the calories that we're expending. When maybe there's like a lot of other factors that are affecting, you know, how calories are actually burned or not. I guess the question is, in the end, is it still calories in calories out? It's just that we, you know, set up a metabolic system that led to more calories going out than they otherwise would have because of the metabolic setup.
Dr. Naomi Parrella:
Melanie, that's a genius question and insight. And I just love that you asked this because I think it is one of the most misunderstood. So the calories in, calories out, you're right. If we were a robot or a machine in a vacuum where the environment doesn't change, then yes, you can calculate what goes in and you know exactly what the burn rate is and then that is a calories in, calories out approach and that follows laws of physics. But we're not in a vacuum, our environment changes and the body changes and adapts. So you're right, metabolic rate can change from day to day. So just because right now my metabolic rate might be a certain amount, tomorrow it could be different and it could be dependent on multiple factors and the environment and what I'm putting in my body. Did I get enough sleep? How are my hormones? What time of the month is it, right? All of those things. So you're right. So ultimately, calories in, calories out sort of works but you can't use that to calculate what's appropriate for you and you're right. The kind of calories also matter. So if you have a bag of some candy or cookies and or you have a potato and or you have a piece of meat, fish, chicken or you have a salad, those are all gonna impact the body very, very differently. And the hormone response to those different foods and macronutrients will result in whether you're burning fats, whether you up-regulate your metabolism, whether you are storing fat. And so you're right, it's way more complex than I'm just gonna count the calories I'm eating and I'm gonna watch what I'm burning, using my various biosensors or getting my metabolic rate tested. So it's way more complex than that because the body keeps adapting and different calorie inputs have different metabolic responses, meaning the hormones are different.
Melanie Avalon:
Okay, I'm so glad you got what I was asking. I was like, okay, yeah, I love this so much. It's so important, because I think people so often, they just want to make it simple. It's not simple at all.
Dr. Naomi Parrella:
There is a way to make it more simple, to think about it a little bit more simply. So we know all living beings have to have fuel and energy, right, the fuel to burn so that you can do things and stay alive. And so if you have infinite sources of fuel, your metabolism runs nicely, you're good to go, you can heal, you can play, you can do all the things. But if you don't have enough fuel, your body is gonna slow down its metabolism and it's going to shut things off and it's not gonna repair as well. And it's going to have to pick and choose and prioritize where it's gonna put its energy and where it's gonna use the energy. And so this is one of the biggest challenges with when people do a calorie restriction approach. If you force your body to have less calories, then it needs to do its daily functions, then it's gonna do less. If you, on the other hand, change the hormone balance so that you can burn fat, which we all have enough fat on the body to basically keep us going for months on end, if we can tap into the fat burning, then whatever you don't, for example, eat or take in as calories, you burn off your body. So that's a point where you might not be that hungry because your body's getting enough fuel. And so then you would end up eating less, which means you have less calories coming in, but not because you're forcing your body to try to function with less calories. It's because your body has access to the stored calories on your body, the fat cells.
Melanie Avalon:
And I think that's one of the biggest, you know, paradigm shifts I had historically, and this was forever ago because I've been doing intermittent fasting for so long, which by the way, do you do intermittent fasting daily or.
Dr. Naomi Parrella:
Absolutely. I'm post-menopausal. If I don't do intermittent fasting, I can't fit into my pants, for sure.
Melanie Avalon:
or how do you approach it?
Dr. Naomi Parrella:
Yeah, so I approach it, I had to change it up because I have different kinds of days. And so one of the things I've learned over the years is the body adapts and you want it to be able to adapt. So there was a period of time when I was very strict and I was doing 16-8s. And after a while, it wasn't as effective for me. It wasn't that it wasn't effective, it just didn't have a noticeable change. I sort of, I don't want to say stalled, but sort of stayed the same. And I was really interested in optimizing further. So I realized if I change things up and respond to the season, my sleep, my stress, if I pay attention to more factors than just the clock, it makes a big difference. And so this is why I like actually tracking, because then I can see the patterns and I can start connecting the dots and actually ask my patients to keep track as well so that we can see what's that pattern you need like right after the holidays or after a celebration. What do you need when you haven't been eating and you now need to replenish because you were sick and you didn't feel like eating, right? So I change it up.
Melanie Avalon:
Do you find, because this is probably one of the main questions we get all the time, is fasting good for women? Is it detrimental for them? Is it too stressful? Is it going to affect their fertility or their cycle? What do you find working with women in particular in fasting?
Dr. Naomi Parrella:
Yeah. So fasting is really, really individual dependent. So I hate those kind of answers where you're like, well, that doesn't really tell me what to do. But the bottom line is if you have metabolic dysfunction, even just early on, so that means your waistline is increasing or larger than it was before and you're not pregnant. If you have abnormal blood work, like your triglycerides are high or your A1c, which measures your blood sugars over the past three months, things like that. If there's markers that are elevated, that would also be blood pressure, if that's high, then you would want to use fasting to help with those conditions. And it would be something that even a 12-hour fast would make a difference. If somebody has PCOS, polycystic ovarian syndrome, then they might need to do a little bit longer fast, depending on the type of cycle. For women, if you're in your follicular stage, which is right after your period until the time of ovulation, you have a different fasting profile than premenstrual, right before your period when you're ravenous and having cravings. So it kind of depends. It's not awful. I hate that answer.
Melanie Avalon:
No, I mean, it's basically the answer, though. So I guess what we can do with that answer is how, how intuitive is that for women? So can they just go based on how they feel? Or do they need to be taking metrics, you know, tracking things? How can they, how can they find what works for them?
Dr. Naomi Parrella:
Yeah, I think actually you can be a little bit intuitive, but there are some rules that I recommend just because if you're very dysregulated, for example, you have an irregular sleep cycle or work schedule or you're studying weird hours, whatever, I think it's helpful to just know, number one, regardless of what you're doing or what stage of life you're in, you probably will benefit from making sure you have 12 hours out of 24 hours that you do not eat. And you can drink water, you can have black coffee, you can have unsweet tea, but pretty much if you do that at a bare minimum, that should be okay pretty much at all times unless you have a problem with maintaining weight, that would be the only time. So in other words, if your weight is very, very low and you're trying to increase your weight. So I think that's something that's very straightforward. Intuitive from there is if you had certain reasons that you wanted to extend your fast, like I said, different medical conditions or chronic disease, and you wanted to extend your fast, then you may want to extend it slowly. So for example, somebody says, I'm going to do 14 hours or I'm going to do 16 hours. If they're sitting there at the 15th hour, staring at their watch being like, oh my gosh, if I don't eat for another hour, I hit the 16 hour mark, but oh my gosh, I'm starving. Their body's cortisol stress hormone level is sky high, right? And if you're watching the clock like that, it's no longer effective. So yes, you can choose to extend the fast, but just pay attention. It might have to go a little bit slower if your body is screaming at you to eat. The other thing would be if you are feeling super hungry, you want to reflect back, are you getting enough water, salts, and proteins? Those would be the things that drive hunger. And it's really, really important to pay attention to that because if you're not getting enough of those, your hormones will get screwed up. You will lose muscle mass, right? Those are things that aren't very beneficial. So I think there's a little bit of a nuance. And again, paying attention. If you start getting hungry before you want to end your fast, take notes, pay attention. Were you getting the nutrients you need? Are you maybe under more stress than you expected? Did you not get enough sleep? Your body signals to you and it's important to pay attention. And then if you're like, oh no, I'm just wanting a cookie, then that's really not true hunger, right? If you couldn't satisfy it with a chicken or egg or something.
Melanie Avalon:
We talk about protein all the time on this podcast. We are major, major protein fans. And actually, and that's another question we get is women seem to often struggle to get enough protein in their eating window. So I eat a short, like a four hour eating window every night. And I don't have, I'm a bad person to ask about how to eat protein because I, um, I eat so much and it's like so natural to me that I forget people struggle to, I'm like, how do you struggle to fit it in? And I eat like pounds in my like four hours. Do you find that that's a common theme where women struggle to get enough protein in their window or how do you handle that?
Dr. Naomi Parrella:
Yeah. I mean, Melanie, kudos to you that you are talking about protein and that you're saying you can do this in a four hour window because a lot of people don't believe that's possible, right? And in the past, we used to... Oh, it's possible. Oh, totally. Totally. And in the past, we used to tell people, oh, you can only absorb 30 to 40 grams at a time, blah, blah, blah. Totally not true. And recent research has demonstrated, actually, your body can absorb what you put in if your body needs it and it's bioavailable. So I do hear a lot of people struggling with getting adequate protein because it's something that's not in a vending machine. It's hard to get really quickly. You have to kind of plan for it. So this is where it starts getting difficult. Also, individuals who don't like to cook or who don't have someone to cook for in their house, for example, if you don't have children that you're cooking for, then it also becomes easy to not, quote, prep or prepare proteins. And then if you go out, it can be challenging because your plate's going to be piled high with cards, you're going to have bread baskets brought to the table, right? It's not necessarily like they're bringing meatballs as the...
Melanie Avalon:
When I, this is a true statement. When I go out, I order for dessert a savory dessert. So I'll order like another appetizer or another steak. You have to tell the kitchen though, ahead of time.
Dr. Naomi Parrella:
That is so funny.
Melanie Avalon:
So I tell them like early in the entree, I'm like, I might order another entree for dessert. So and I do.
Dr. Naomi Parrella:
I love it. Oh my gosh. I've never even thought of doing that. That's so genius because they only bring you the dessert menu, right? At the end, they never bring back the menu with the appetizers on it. It's brilliant.
Melanie Avalon:
You know it's so fun the first time i did it i felt really like awkward and weird but then once i realize that you can do that it's like the world is your oyster like there's so much potential.
Dr. Naomi Parrella:
Totally. Oh my gosh, Melanie, I'm totally feeling that. That's brilliant. Love it.
Melanie Avalon:
And I even asked the waiter one time, I was like, do people do this? And he's like, yeah, sometimes people order savory desserts. So that's where I got that phrase from. So then I was like, okay, this is a thing. This is a thing.
Dr. Naomi Parrella:
That would be a really cool cookbook. I have like a million cookbooks and that would be a really good one.
Melanie Avalon:
Oh, it would be. Yes, I love it. I love it so much so many ideas. So thank you for focusing on protein as well. And I actually this is actually a really quick rabbit hole tangent question. But as I have heard you talk a lot about is it semi-glutide is how you say it. I thought that's how you say it. But then I was listening to your interview and
Dr. Naomi Parrella:
I say semaglutide, but some people call it semaglutide, so either one is this. Yeah, fine. I'll know what you're talking about.
Melanie Avalon:
I'm super curious that the studies that show, you know, these negative changes in body composition with the weight loss, so loss of muscle mass and such, do you think if the participants were actually eating a high protein diet that they would preserve muscle or do you think it's something else going on?
Dr. Naomi Parrella:
Oh my gosh, I love this question. Melanie, this is too fun. Well, okay, so let's talk about this because so many people misunderstand. So the GLP-1 receptor agonists and the GLP-1 GIP, which, so those would be semaglutide and terzepatide, brand names Ozempic, Wigovi is semaglutide, and then Manjaro and Zepbond are terzepatide. Those medications work in two places, right? They work in the brain and in the gut. And in the brain, it tells the brain you're satisfied, you don't really need to eat, and you're basically the drive is gone. So people love that because they're like, the food noise is gone, I'm not having cravings. And interestingly, it's also seeming to be helpful for addiction. So it just kind of kills that drive. And then it works on the gut by just slowing the movement of food through the gut, and also causing an insulin surge if you eat foods that have that digest down into glucose. All right, so this is important because what happens when you spike that insulin when you have an insulin surge is you turn off fat burning, you turn off access to your fat cells, right? So that's a massive energy source that you shut off access to. Okay, so now you don't want to eat, and your blood sugars look great because the insulin took care of whatever it was that you ate. And so basically, what happens is if you start running out of fuel, instead of burning the fat on your body, because the insulin is so high, it actually forces your body to start melting down a little bit of the muscle, right? So that's a very, very not helpful thing because it's so hard to keep our muscle and build muscle. Now fasting also causes people to not eat, right? Insulin is low, exactly. And so it has a fabulous effect turns on autophagy, which is the body recycling cells, it maintains the lean tissue because when insulin is low, you burn fat for fuel. So this is like a complete game changer, right? Yes, people are losing weight. And you are right, if they eat enough protein, that will stimulate muscle synthesis. And so you might be able to maintain more the muscle. And that's what we do in our clinics. So any of my patients that choose to be on one of these medications, we first make sure they're getting adequate protein before we prescribe these medications, because we want to make sure they get in the habit of doing that before they no longer care if they're eating enough, right? So you're right, we have been monitoring body comps, and they seem to be better maintained if the individual when they do eat, they prioritize protein. If they start with a piece of bread, it's over because they get full so fast, they don't eat their protein. Now they don't have enough protein to maintain their muscles, and they've probably spiked their insulin. And there we go.
Melanie Avalon:
Wow, okay. Do you find that if they pair exercise with it that that helps maintain the muscle?
Dr. Naomi Parrella:
Yeah, it does, but they still need to eat enough protein, right? If your body turns over between 2 and 400 grams of protein a day and you're eating like 30 grams of protein, hello. You know, that's a problem.
Melanie Avalon:
Are you concerned about long-term effects that we might not be aware of?
Dr. Naomi Parrella:
Absolutely. Yeah. So there's so many, that's like a whole other topic. But the most important thing I think is if people are not prioritizing protein, not staying active, not drinking enough fluids, eating late at night, it's going to create problems. Absolutely. There's going to be, and that's long term. So you can lose weight in multiple different ways and some is good and some is bad. If you lose weight, like with cancer, you're losing muscle mass, right? That's terrible. And so same thing with these medications. If you do it right and you get appropriate counseling so that you know that you're getting adequate protein, you're doing all the things so that you can maintain your muscle and you can lose fat mass, then these medications can be very helpful. But if you don't have anybody teaching you how to do that or making sure you're doing that okay, it can create a huge problem. So we monitor multiple things, but a person can even look in the mirror. And if you look in the mirror and you look at your face and you notice that around your temples, you know, the parts right at your temples on the sides of your eyes, if that starts indenting dramatically, that's not what's supposed to happen, right? That's a loss of the wrong kind of tissues. So that's what we define as cockexia, losing more than 5% of body weight and really losing it in an unhealthy way.
Melanie Avalon:
have this study where you talk about the effects of these drugs and the effects they might have on people with plastic surgery and just the actual surgical procedure and such. But it was saying in the study that some of the, like the stomachs of those patients on these drugs, they could have food in their stomach after 18 hours of fasting. This is a really random question and I don't know if you know the answer, but I was just thinking about that and I was like, so does that mean that if you're 18 hours, you're 18 hours fasted, but there's food in your stomach. So is your body not going to like, will that food be signaling something to your body to not make adaptations into the actual fasted state?
Dr. Naomi Parrella:
You know, that's a really good question. And I don't know that that's been studied. That's a super brilliant question, Melanie. I don't know the answer to that. What I do know is because the food moves through so slowly and in different people, it's different, right? So some people, their stomach stops moving entirely and that's what all the problems with these meds are about, or some of the problems. But yeah, it's a huge problem because it could be signaling continuously, right? And we don't really know what exactly is happening with regards to the signaling there. And if, I mean, it might be published. I haven't seen it.
Melanie Avalon:
Yeah, so fascinating. And speaking of signaling, just a comment on something you were talking about earlier with the absorption of protein in a small window. We recently talked on this show about a study that came out pretty recently, and it was looking at the post absorption window of protein and muscle protein synthesis. And I have to find it, but basically the takeaway was that they only had really looked up until a certain point and just assumed that it wasn't really absorbing. So that was really nice to hear.
Dr. Naomi Parrella:
Yeah, and this is one of the things, Melanie, you've probably already figured this out too. Many of us have started recognizing or appreciating the human body is designed to thrive. It's not designed to always be the same. It's designed to adapt and thrive. So if your body needs something, we know, for example, iron is very hard to absorb. And if you have enough iron in the body, and you don't have a condition that causes excessive iron absorption, you won't absorb as much iron. But at times when your body needs iron, it will do better with the absorption of iron than at times when it doesn't need as much. So, you know, again, with the protein, if you need the protein, it's very unlikely that your body is going to ignore it as it goes by, right, just because it's hit a certain threshold that we have decided is the threshold or the time, right. So, yeah.
Melanie Avalon:
It reminds me of, have you heard of, I think it's called hepcidin, which is basically like the insulin equivalent for iron, like it regulates iron absorption. And when I first found out about that, it's just a good example of, you know, things are being regulated. Like you were saying, the body has this natural intuition and desire to thrive. And so we could be thinking we're doing something, but it might not actually be what manifests because of these hormones at play. I tried to get my doctor to order that and he hadn't even heard of it and said he couldn't order it.
Dr. Naomi Parrella:
Yeah. Well, it is interesting because some tests that we do that people will come in and say things like, can you test my cortisol? Yes, I can test your cortisol and I can tell you what your cortisol is, but it tells you one moment in time, right? And are you going to change all of your behaviors because of a one moment cortisol test? Meaning at that moment, the stress hormone, where was it? Your life changes on a minute to minute basis. And this is one of the challenges is many people get caught up in one specific lab and they freak out. And understandably, I mean, I was one of those people too. I had to go to med school so I could feel better about it. But I think the most important thing is starting to recognize and appreciate the body changes and adapts to what it's trying to survive. It's trying to make it better for you. And that's why we adapt and get stronger. That's why we adapt and have better immune systems and so on. So yeah, it is hard because we don't know what to do with some of the labs that we get.
Melanie Avalon:
And so speaking of broader picture and, you know, tracking things beyond a single moment, how did you get acquainted with zero?
Dr. Naomi Parrella:
Oh yeah. So like I said, seeing so many patients, they teach you, right? So I remember, gosh, I don't even know how many years ago, but it was actually pre-COVID several years. I had a patient come in and we were doing instrument fasting for this patient's protocol, and they were having wild success. And I said, what's helping with your success? I'm always so curious. They said, oh, you know, there's this new app and it's called Zero. So I, of course, promptly had to download it and try it out. So since then, I have recommended and used it with patients over the years and through COVID, it was particularly helpful, especially when there were times of, you know, food shortages or concerns with the safety of different foods, you know, does the groceries have bugs, you know, whatever. And so it turned out to be really, really useful because there's a way to anchor and stay okay. And so then, you know, a little over a year ago, a year ago, the leadership team at Zero reached out and we connected. And so that was, you know, when I decided to join on and I've been super thrilled to see all these brilliant people both at the company and all of our users who have continued to give great feedback and inform us. And so it's really wonderful to have empowered individuals altogether, you know, sharing their information, sharing their data, and being excited about it.
Melanie Avalon:
Okay, I have questions. I'm fascinated by app development and everything. So, because now that you're mentioning that, I can see where I was in my life when I first used it. And it was in the beginning of COVID, I believe. So I, you know, looked at it recently in preparation for our interview. And it's changed a lot since I used it. It was a lot simpler. So your role in the company, how much of it is you informing the company versus you analyzing the data and learning? Like, what's the relationship there?
Dr. Naomi Parrella:
Yeah. So, I mean, it's actually quite a brilliant team. And so everybody's been really diving deep into the research, each individual person, you know, as far as I can tell, everybody lives what we preach, right? So that's really, really cool. So I am actually probably doing more of the science review. And, you know, when possible, I try to give some feedback with regards to different content that we might consider in the future or whatever, based on what my patients are saying. So it's actually really more around the science. I'm not looking at any of the data unless somebody sends it to us, right? So that's really, right now, I'm more involved in the science end and understanding how to best help people and provide the information in a simplified way. I just like to make it really easy. You know, I know there's some people who want to use big words and make it really complex. It's just not that complex, right? We want to make it simple and easy so that you can live your life and enjoy.
Melanie Avalon:
Okay, awesome. So yeah, that was one of the things I was thrilled to see was, you know, all of these articles and so do you actually part? Okay, because you're my favorite person ever you have a there's a right now on the homepage, there's something from Peter to yet, like, does that actually partnering with him to create content for
Dr. Naomi Parrella:
So he was one of the brilliant people who at the start of Zero, I'm not sure how exactly he got involved or if he was one of the original individuals, but he obviously created fabulous content and knew there was a need. So currently he's not communicating with us about the app, he's got many more things to do.
Melanie Avalon:
Okay, so he was though in partnership, yeah.
Dr. Naomi Parrella:
Yeah, yes, absolutely.
Melanie Avalon:
Yeah, that's amazing. I'm super curious the app, because it says it'll indicate sort of your fat burning status. What are your thoughts on that, especially when we're talking earlier about how people are all individual, like do people enter the fat burning state at the same time? How can we how can we know what's actually happening in a person's metabolism?
Dr. Naomi Parrella:
Yeah, this is what I mean by like genius people at the company. So they have over time, you know, put together both with the research and data analytics and so on been able to create a formula that really takes your information. So in the app, you can have it so that let's say your Apple health kit automatically feeds information into the app, any data that you are willing to share with yourself in the app and put in one place, then a mathematical formula calculates and helps determine that. So, you know, it'll take into account like if you had an aura ring, it'll take into account your physical activity and so on. So that's how that's done. That's how it's individualized.
Melanie Avalon:
Yeah, I was wondering, when you sign up, you ask your age and sex and everything. So I'm guessing it takes that into account to figure out as well.
Dr. Naomi Parrella:
Absolutely. Yep. And I think, you know, now that we have more and more sensors that are becoming available, over time, I think the information is going to get even better and better. Right. So right now, yes, you can get continuous glucose monitor, but there's continuous lactate monitors coming, right? There's so many, like, new measurements that can help us more finally figure out, okay, this is what's going on for you. Oh, your ketones are up. Okay, you are burning fat, you know what I mean?
Melanie Avalon:
Yeah, awesome. We love cgms on this show. We talk about them all the time. Oh good me too big fans
Dr. Naomi Parrella:
Yes, they're so useful for so many people for learning.
Melanie Avalon:
I know if everybody, I honestly think if everybody did a CGM at least just once, it would just open the eyes. I think it would change the metabolic health of, you know, at least the US if everybody just did it once, you know.
Dr. Naomi Parrella:
Yeah. Yeah. You just really only need that two-week window to just kind of check it out and see how your behaviors are. And it is pretty interesting. But I, you know, I don't know if you found this, but I find some people, their sugars are pretty solid, like they're like a line, right? So they're not fluctuating that much. And when that happens, you know, then I'll have people come in and say, well, that wasn't very useful for me. Like, oh my gosh, but you're metabolically so healthy.
Melanie Avalon:
Oh, that's, you know, that's true. So with all the people, metabolically unhealthy people did it at least once. And so, so the actual content that you are reviewing in the app, have you seen any content that you have felt the need to update or change based on the science or how does it evolve?
Dr. Naomi Parrella:
Yeah, we're definitely constantly updating and I think that's part of the fun of the whole team. So we'll post different research or we'll talk about what, you know, if people are struggling. This is why feedback is so helpful. So, you know, ask zero and send a note or question or comment. It helps us to fine tune and figure out, oh, okay. Because there's so much content now that, you know, sometimes we forget what's out there already. And so we have to like pull it in review and adjust. But so far, you know, other than things like, you know, protein dosing, right, that you don't need to have, you know, so many times of eating protein, you could do it in a short window, that type of stuff. Yeah, we definitely have to keep up to date on all of that. And of course, with these new medications, which are really changing the scene, I particularly interested in individuals who've been on or are on these injectable weight loss medications. We want to make sure, you know, we could help those individuals, for example, if they can't get their medicine or they're starting to have weight regain after they come off or something to that effect. I want to make sure we provide content around that and keep that up to date as well.
Melanie Avalon:
Awesome. Yeah. Do you experience with your clients and patients weight regame issues or are they able to maintain after semi-glutide and osympic and things?
Dr. Naomi Parrella:
Yeah. So, so far, you know, the literature has been pretty clear and patient experiences are that most people will regain the weight if they come off the medicine. So, you know, there's different things people are trying. Do you use different medicines? Do you do a medication vacation and then restart? Do you sort of wean down? And then if the weight regain happens, you go back up. So, there's lots of different things happening. But what we're finding is it really, really matters if you've lost mostly fat or if you've also lost muscle. If you've lost muscle, we're in trouble, right? We are going to need to really be very careful about how we replenish nutrients. You know, again, this gets to the mTOR, the AMP kinase, like, you know, there's like a whole thing there. So, but we want to make sure we take care of people and help them, you know, stay as healthy as possible wherever they're at.
Melanie Avalon:
Awesome. Well, when I'm, um, when I was in the app and it prompts you to subscribe and get the, the plus version, which gives you more access to more of the information or like the science information and everything it says, I mean, I'm assuming this is true. It says that the people who are in plus reach their goals two times faster. Do you think that's because of the exposure to all of the, like the information in the app or is there something else going on there?
Dr. Naomi Parrella:
Absolutely. So there's two things, right? One is that commitment to yourself. And, you know, sometimes that's enough. Tracking, we know that tracking makes a massive difference, right? That's also super important. And then thirdly, education and knowledge, the more you understand, you can't like unknow something once you know it, right? So if you learn something, and it is like fundamentally different than what you understood before, it changes how you approach, let's say, eating, or your physical activity, or, you know, your life. And it has this wonderful effect of just keeping it in your forebrain, right? So just by engaging, you're already making a commitment to yourself, you're already carving out a second of your time to just take care of you. And so I think there's multiple factors in there. But it is really impressive how responsive just making that decision is.
Melanie Avalon:
I know I love that so much and honestly, I'm going to start recommending this a lot because we talk on the show a lot about the role of tracking because a lot of people, especially with diet people, sometimes they don't want to get into diet mindset and they don't want to track and all of that, which I completely understand and want to support as well. And so something I like to say to people is you can actually, in a way, divorce the tracking of calories from the actually monitoring of calories and what I, or sorry, from actually changing what you eat. And what I mean by that is we know there's this observer effect where like you just said, just the act of tracking tends to make people lose weight and eat less without even meaning to. So instead, you know, like with the, and it's one of the, you know, issues with studies like and controlling them because yeah, that's exactly right. So I'll talk about that, but I haven't, honestly, in the seven years of this show, I don't think I've talked a lot about having an actual intense accountability tracker for the actual fasting aspect of it. So yeah, this is, this is really, really great. So do you use it daily?
Dr. Naomi Parrella:
Yeah. So I go through cycles. It's my most favorite reset tool. So if I've been off track or my life is just a little bit crazy, then it's really helpful to ground me and to make sure I'm paying attention to myself and the signals I'm giving to my body. So it's super, super helpful. Are there times I'm not using it? Absolutely. When I'm crushing it, I'm already in a good space. You know, I'm not having a scheduled disruption for sure. But what I like about it is I can track so many different things. But even just with the fasting timer, I can use that for example, like I might already have my fasting, you know, window and I'm doing that fine. But I might notice, you know what, I'm starting to eat a little bit not so great. You know, a little bit of these, you know, sweets have entered or salty, salty is usually my thing. And I want to get back on track. And, you know, since I had a celebration weekend, you know, I'm a little bit not focused, I'm still doing the fasting time, but I'm not eating what I want in that eating window. So then I'll use the fasting timer to for example, fast from fried foods or sweets or whatever it is. And I use it that way for that time period. Yeah. And so it helps me reset and just recalibrate. And if I didn't have that, you know, I could do it, but it would take up brain space. And I don't want to use my brain space for that. I want to, you know, do my life. And so that's how I'll use that as well.
Melanie Avalon:
Can you, so if you're doing that where you're accounting the fasting from a certain food, can you tell it that's what you're doing or does it think that you are fasting, fasting?
Dr. Naomi Parrella:
Right now you can't tell it what you're doing. It will think you're fasting. And so I will know what I'm trying to do in that time period.
Melanie Avalon:
Okay. Gotcha.
Dr. Naomi Parrella:
I'll put a little marker for you can write little notes.
Melanie Avalon:
Okay, very, very cool.
Dr. Naomi Parrella:
Because I'll already know, for example, that I'm doing a 16 .8, right? Most of the time, that's what I'm doing. And then there'll be times when I go down to 12 and times when I extend it longer. That's awesome.
Melanie Avalon:
And then the powerful, I love that there's the calendar for the streaks, because there's something really powerful about streaks. I mean, I do that like old school for some things, like with like a calendar and stickers. Me too.
Dr. Naomi Parrella:
I do. I'm totally into that. It's so fun. I'm like, oh my gosh, I'm in first grade again.
Melanie Avalon:
You get to put the sticker every night. It's so exciting. And what I did is I got this sheet of stickers, and every single one is a quote about abundance. And so it's like a meditation moment every night or a mindfulness moment where I like, yeah, it's a whole thing. I highly recommend.
Dr. Naomi Parrella:
Well that's so great especially if you're doing that at night because of course if you do something like mine fall it boost that btnf right that brain derived neurotrophic factor so you're and then you go to bed that's like so what a bonus.
Melanie Avalon:
I love this. This is amazing. So what are you most excited about with the future of this app?
Dr. Naomi Parrella:
You know, I'm really excited about we're continuing to modify this experience for people so that we can meet them where they are and give them an experience of wild success with their own body, right? So again, personalizing it, figuring out what's going to make the difference and simplifying it as much as possible. Life is busy, right? Everybody's got other things they want to do. So we want to make it so, so easy to take great care of yourself and make it. Like, you know, just a little thing, but have a powerful impact, you know, helping the gut, the brain, the metabolism, the waistline, you know, all those things. So I think that's what I'm really excited about is trying to find better and better ways to make this possible for more people because that's our ultimate goal, right? Help as many people as possible live, you know, their life with, you know, health, longevity, this vitality that we all love.
Melanie Avalon:
I love this. Well, I'm just so, so grateful for this resource for people. So for listeners, again, you can go to ifpodcast.com/zero, and you can get a seven day free trial of zero of the plus version. And then you can always keep using it, not the plus version, or you can upgrade and get that version to stay. Okay, two really last quick questions for you. One is if you could design if you had unlimited funds and resources and all the things and you could design any study about fasting, what would you do or test?
Dr. Naomi Parrella:
Oh wow, I want to ask you, what would you want tested?
Melanie Avalon:
I don't know if this is like the thing I would do if I had more time to think about it, but something I would love to do is I think I've come up with a way to test sort of like the placebo effect with fasting. Basically, I think they should do some trials where they tell the people they're testing a pill and the pill is not a sugar pill because I would mess things up. It has to be like a cellulose pill. And then they would tell the people that this pill can't be taken with food and you can't eat a certain amount of time before or after. So, then it would make people fast without realizing that they're testing fasting. I would just like some studies to use that setup because it would kind of like trick people into fasting and I think there's a lot of like potential there for looking at placebo effects and stuff.
Dr. Naomi Parrella:
Oh, wow. Yeah, that is super. That's a very interesting thought.
Melanie Avalon:
Like you could say it has to be taken in the morning and then you can't eat for X amount of hours and so that would you could force people into a long fast.
Dr. Naomi Parrella:
That's true. That's true. Although I'm curious because a lot of people won't follow the rules. So we'd have to monitor.
Melanie Avalon:
You have to have them on like on like cgms on them and stuff. I know
Dr. Naomi Parrella:
that is a really interesting study and I'm very curious about that. That's a great idea.
Melanie Avalon:
Yeah, that's more a mechanism of study, but I don't know what I would do for like, actually testings. There's so many things. I think one of the things I'm haunted by is I really want to know, because I know speaking of Peter, I don't know if he's changed his mind, but he'll often say that effects of fasting are due to calorie restriction. And I would like more comparisons of calorie restriction and fasting to see if that is the sole reason or if it's something else.
Dr. Naomi Parrella:
That's interesting because fasting does cause decrease in calorie intake, right? So is in it, I think it depends on what you're eating in your eating window, because if you are tapping into fat burning because your insulin comes down because you're fasting, yeah, you're gonna end up eating less and not wanting to eat more. That's the key, right? So or is it that you're not tapping into fat burning and you're starving and you want to eat something, but you're starving your body because the time's not up, right? This is exactly, that's exactly the point. So, you know, why is somebody eating that amount of calories? Whether it's a lot or a little, if it's because their body's hormone setup is set up that way, then that's in alignment with the body. But it's not in alignment if you're forcing the calorie restriction by force. That's why the fasting is so interesting because some people do it where they force themselves and some people actually, after a while, they're like, oh, no, I actually am fine. And it's because the body can actually fuel off the fat cells.
Melanie Avalon:
Yeah, exactly. We didn't even talk about it. I know in your, in the input form, but you had something about cracking the circadian code. I would love more studies on, cause I'm such a late night eater. Are you, are you a late night or earlier when do you
Dr. Naomi Parrella:
I'm definitely not a morning person for sure. I'm with you.
Melanie Avalon:
So I would love more studies, like really controlled studies on actual fasting with late night eating because I have controversial thoughts on this.
Dr. Naomi Parrella:
Well, you know, what's interesting is there are studies that show when people eat at a certain time and then they change it. So let's say you do eat late at night, but then you go into a new fasting pattern where you don't eat at night and you actually eat early in the day. So you shift your fasting time. It does have a metabolic effect. And so, you know, that's really, really interesting because it goes both ways. So I think, again, the human body is designed to, you know, make you be the best you. And first it's about survival. So if it has to protect you, it's going to start storing everything. If it feels like there's abundance and it can tap into all the fuels, then it can burn freely and give you all the energy you want and be able to do all of that.
Melanie Avalon:
So this is the last question that I ask actually on my other show, but I'm gonna bring it into this show because we don't normally have guests on this show. And it's just because I realize more and more each day how important mindset is. So what is something that you're grateful for?
Dr. Naomi Parrella:
Oh gosh, there's so many things. I'm grateful, actually, that you're running this podcast and that you're sharing information for the world to hear. I'm grateful that we actually have opportunities to share this information broader with all the new technologies available. And I'm grateful that people are curious and seeking this knowledge and that they're able to access some very, very new ideas and that we're learning. It's not that we just didn't have enough discipline, right? It's actually much more complicated than that and the body is super fabulous and it's able to take care of you.
Melanie Avalon:
Well, thank you so much, Dr. Perilla. I am so, so grateful for what you're doing. It was so thrilling to be introduced to you, and it's really nice to know there's somebody like you. And it sounds like, from what you're saying, the rest of the company is amazing as well. But it's great to know that this is the team behind this app. It makes me feel really grateful and so excited to recommend it to everybody. So everybody, again, go to ifpodcast.com/zero. Get this app now. And yeah, thank you so much for everything. I really, really enjoyed this. This was so delightful. Is there anything else you want to say, any links you want to put out there, anything else for the listeners?
Dr. Naomi Parrella:
Melanie, I'm so grateful, like I said, for what you're doing and the messaging that you're giving to people to empower them. So thank you so much. I think the most wonderful gift is seeing the ripple effect. So you talk to one person, their lives change, and then it goes on and they spread that. And so I'm super grateful about that. And I think right now, I'm learning how to do Instagram. I'm really late to the show here. So I'm going to try to also start developing ripples like that. And I'm really grateful for this opportunity to talk with you. Thank you so much.
Melanie Avalon:
No, I'll just say really quickly, I was late to the Instagram game too and I was like really intimidated. It's awesome. You got this. It'll be great. Thank you for that. Thank you. Thank you. Yeah. All right. Awesome. We'll have a good rest of your evening and I will talk to you later. Bye. All right. Thank you so much, Melanie. Bye-bye.
Melanie Avalon:
Thank you so much for listening to the Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing a review on iTunes. We couldn't do this without our amazing team. Editing by Podcast Doctors, show notes and artwork by Brianna Joyner, and original theme composed by Leland Cox and recomposed by Steve Saunders.
Check out the Stuff We Like page for links to any of the books/supplements/products etc. mentioned on the podcast that we like!
LINKS
BUY:
Melanie's What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine
Vanessa's Keto Essentials: 150 Ketogenic Recipes to Revitalize, Heal, and Shed Weight
The Tone Device Breath Ketone Analyzer
The Melanie Avalon Biohacking Podcast
More on Melanie: MelanieAvalon.com
More on Vanessa: ketogenicgirl.com
Original theme composed by Leland Cox and recomposed by Steve Saunders.
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