Coffee with Dr Geoff #1 - Janine Thornton, nutritional therapist

GLP-1, the gut and the real work of metabolic repair

GLP-1 has quickly become part of the public conversation around weight loss. But weight is only the visible layer of a much deeper metabolic story.

In this episode of Coffee with Dr Geoff, he is joined by nutritional therapist Janine to explore what is really happening beneath the surface. Together, they discuss visceral fat as an inflammatory driver, the role of the gut microbiome in regulating metabolism, and why GLP-1 should be viewed as a catalyst rather than a cure.

When used correctly, GLP-1 can create a window of opportunity. Appetite quietens. Insulin stabilises. Inflammation begins to fall. The question then becomes what we do with that window.

This conversation focuses on rebuilding, protecting muscle, nourishing the microbiome, and supporting the body so that long-term metabolic stability becomes possible. It is a clinical, considered look at metabolic medicine grounded in physiology, not trends.

For full transcript, see below:

Welcome to Coffee with Dr. Geoff. So I'm Dr. Geoff Mullan and, this is where we really pull back the curtain on a lot of the messy and complex fascinating science that's really around how our body turns fuel into energy, into power. That's really what we're talking about, metabolic medicine.

And we're gonna look at some of the latest evidence, and science and ... This is very much not about quick fixes. It's about biology, it's about data, and, yeah, we're gonna do it over a coffee. And in the next 30 minutes, we're going to go deep into what possibly may be a longevity drug of our generation, GLP-1s, Wegovy, Ozempic, et cetera, and probably change the way you think about these medications.

And coming up, we're breaking down a brand new 2025 paper that reveals how these drugs are literally reshaping your gut microbiome, both for better and for worse, and we're gonna discuss why your visceral fat, your belly fat, can act like inflammatory pump, and the landmark science that shows that it drops these inflammatory markers into your bloodstream, which gets to your liver as well.

stay with us till the end. we're also going to talk about a case study that... with a patient who was able to walk away successfully from lifelong use of a biological drug, Humira, simply by changing their metabolic architecture.

So I'm sitting down today with someone for whom I've got immense clinical respect and Janine Thornton's a highly regarded functional nutritional therapist. Not only does she have her diploma from CNM, she also lectures there as well and doesn't look at just what you eat, but how your body actually functions at a deep cellular level.

Um, what truly makes her perspective vital for our discussion today is her focus on probably one of the most challenging aspects of health, and that's the immune metabolic axis. And for over five years, Janine has been the person many practitioners turn to for the hard-to-solve cases. That's the ones that fall through the cracks with traditional medicine often, and we're talking about the complex autoimmune conditions, be it rheumatoid, lupus, the lingering challenge of long COVID, and the intricate nervous system challenges of POTS and MCAS.

So Janine, welcome. It's fantastic to have you to join me for a coffee today.

Thanks so much, Geoff. I'm very excited to, to have a chat about all this.

Fantastic. So look, before we jump into chatting about GLPs and metabolic health, et cetera, I'd love to hear a little bit more about you, how you got to where you are today, 'cause I know you've got some fascinating stories behind ... You're a driver behind what you do.

Yes, absolutely.

I became a nutritional therapist for very personal reasons. my daughter ... So historically, I actually worked in HR and financial services, so nothing to do with nutrition. but my daughter, up until the age of three, was extremely healthy, but at age three, she,

was exposed to E. coli, a very nasty strain of, E. coli, and was diagnosed with an E. coli infection, which, really caused a lot of gut health ... some horrible gut health symptoms, and resulted in her ... she had to have a long, strong course of antibiotics. Now, within just a couple of months, she then developed horrendous eczema.

and there was a family history of eczema, but the eczema literally took over her whole body. we had to take her to see a top skin specialist, but, there was very little that could be done. she ... We had to, treat it with a very strong steroid, topical steroid cream.

but the inflammation, which I now know was driving that, eczema, and that was the inflammation from within,

carried on. And at age 11, she was diagnosed with type 1 diabetes, which is an autoimmune condition where, her own immune system destroyed all the beta cells in her pancreas, and those are the cells which make insulin. So, at age 11, she was having to inject herself, about five times a day with insulin and really closely manage her blood sugars, which is not an easy task.

and then

the

autoimmune immune system journey carried on, where at age 12, she was, diagnosed with Guillain-Barré syndrome. this is when your immune system attacks your nervous system, and she actually became completely paralyzed, stopped breathing. It was very dramatic.

and, this actually was in response to the HPV vaccine, so it was the trigger that,

Yeah.

her immune system to respond in that way. and at that point,

I didn't know an awful lot about how the body worked and why these things were happening, and nobody could really answer my questions. And I thought, "Right, I have to learn more, and I have to learn what's going on with her immune system and why these things are happening." So I retrained, and,

just started this fascinating journey into functional medicine and nutrition, and

a few years down the track, she was also diagnosed with Hashimoto's, which is, when your immune system attacks your thyroid, and she had an underactive thyroid. And at that point, I knew enough that we were able to look at her overall gut health, the food that she was eating, and, within a year, we had completely reduced all her thyroid antibodies without the need for any medication.

So, that was such a win.

Amazing.

and so now, I've taken all those things, I've learnt the importance of identifying the root cause of immune system imbalances, their link to gut health and the gut microbiome, and, the key drivers of inflammation to help many clients,

and support them on their own health journeys, to, have better health outcomes. So, that's my story.

Wow, that's quite a story. And I think it ties quite neatly into a lot of what we're talking about today, and that is the fact that generalized inflammation can manifest its way in different ways, at different times in different people. And as doctors, sometimes we get a little bit stuck on where it has manifested and possibly have forgotten to go upstream, like we like to do in functional medicine, and try to understand, okay, sure we can block that inflammation, we can give steroids, we can block it, but have we really worked out why that's happening in the first place?

and there's many different causes for that.

one of the ones that maybe we can segue into a little bit is looking at ... Well maybe let, let's start off with gut health and microbiome because I know it's a particular passion of yours.

I'd be interested to know, maybe you could give us a quick summary of, how you approached that with your daughter, for improving gut health.

Yeah. So, with my daughter, we did do, a stool test to analyze the different microbes that were in her gut microbiome, and make sure that there weren't any imbalances or more pathogenic strains that could be driving,

her immune system inflammation. the gut microbiome is

a whole range of different,

living organisms that live within our gut. And I think they outnumber the number of cells that are actually in our body. We have, you

times, yeah.

yeah, a huge array.

looking at those, they give us a lot of health benefits, but they can also negatively impact our health. one of the very important jobs that these microbes do is maintain the health of our intestinal lining, to prevent something called intestinal permeability, or leaky gut as it's commonly known. that, is because they release, something called short-chain fatty acids, which help us maintain a healthy, mucin layer for our gut microbiome

and for our gut lining, and reduce any inflammatory response there that might be pulling these cells apart and leading to leaky gut. Now, leaky gut has definitely been found to be very much in place for things, related to systemic inflammation.

Absolutely.

autoimmune disease conditions, and leaky gut go hand in hand. So, if I look at my daughter, she had intestinal permeability, so foods that she was eating would, get through into her bloodstream very simply, her body would make antibodies against those, and that would switch on an inflammatory response. she permanently had a switched on, inflammatory,

reaction to things. And then those, because that went a little bit rogue, her immune system got way too carried away, it then started attacking her own body. So it looked at the beta cells in her pancreas and went, "Right, they're not good. We're gonna attack it and kill them off," to put it simply.

making sure that that immune response doesn't get carried away and there isn't high levels of inflammation in the body is really key. So with her, that was very important to go right the beginning, rebalance her gut microbiome, take away the foods that were, driving inflammation for her, and basically make sure that we healed and sealed her gut at the same time, and had those beneficial microbes in there that helped with that.

Yeah, I think, I'm just gonna focus on the leaky gut question a little bit because I think both in the general public and amongst, my colleagues and some of your colleagues, probably less of your colleagues, there's a skepticism around leaky gut and, intestinal permeability. And it's probably a little bit of a lack of education.

that question has been well and truly put to bed. there is what we're talking about, you often, with these bacteria, you get fragments off the walls of bacteria like the polysaccharide -bacteria. So they leak across and they're particularly potent at causing this inflammation. Not only do we know that happens, we even have commercial blood tests to measure the body's reaction to it as well.

So, this is something that we can measure. we know that it's happening. So, I think for those people that dismiss it, I would say, look, have a look in ... literature, there's a lot of evidence out there and it's something that we know happens, we know to the extent, that it happens.

And there's also, I know you treat a lot of MCAS, the link between the gut lining and also histamine because people talk, "Oh, I'll, I need to eat low histamine foods." They're maybe looking at that question. Do, you to talk a little bit about, the gut lining link with histamine?

Yes, absolutely.

so, you most people just think of histamine as being causing hay fever or, you

Yeah.

you get stung by a bee and

you get a histamine reaction to that. And they don't realize that there is a really strong link between sort of histamine in our gut, um, and actually quite a lot of symptoms that we might experience digestively as well. So there are certain foods that contain histamine, um, and also things like fermented foods or foods that

Yeah.

started to spoil a little have higher levels of histamine. But we also have bacteria in our gut that are very good at converting histidine into histamine, so that's another aspect of it why we need to look at... they might not even be necessarily bad bacteria as it were, but this is an action that they have.

And that histamine in our gut, needs to be degraded by an enzyme called diamine oxidase, and it's, commonly known as DAO. And DAO is made in a healthy gut lining, so again, if we

Mm-hmm.

inflammation in our gut lining, that could lead to lower levels of DAO, and then we might end up with higher levels of histamine which again

Histamine is an inflammatory driver so, we need it, it plays a very important our inflammatory cascade. But again, it's when we have too much of it and then it can lead to mast cells which contain histamine degranulating more quickly and then we can get some of those more widespread histamine symptoms as well.

So just helping maintain that mucin lining of the gut so we produce more DAO enzyme ourselves is really important, and there actually are also foods that contain some DAO enzyme. So, nature can also give us a helping hand with things like that, So I try and look at a broad approach and use lots of different things to help with that.

So, you touched on the foods, so which foods do you like to use and practice for lowering histamine? And I know you've got some probiotics that decrease histamine, some of them increase it, so you

Yes.

to be careful what strains you're actually using.

Absolutely. yes, you have to be very careful and, and

there has been a big drive towards adding more fermented foods into our diet because they boost our gut microbiome, so they have a probiotic effect. But of course, that, for someone that might be struggling with a histamine issue, that might,

be a food that needs to be excluded for a while We talk about a histamine bucket, so we need to make sure that we, lower the amount of histamine in that histamine bucket. So for those clients, for a certain amount of time, we might look at reducing those, fermented foods.

But actually, certain, beans, like chickpeas, pulses, they can contain some levels of DAO that are

Yeah.

so you can combine those with foods to help degrade that. And then yes, going in with perhaps a probiotic that

isn't going to add to that histamine load that also helps with that degradation,

can be helpful but there's never a really, a one-size-fits-all approach, People have their own unique profile for these things, so ...

Yeah. I think I'm I think someone's told me, said that, yeah, if we, if we were all the same, medicine would be less of a or less of a more of a, what was it? Less of a science, more of an art, but yeah, I think we, we know what we're saying.

But

we'd... Before the call we'd been discussing a few papers and actually I think it leads in quite nicely, with certain gut bacteria. And, GLP-1 medications, everyone thinks about weight loss but actually,

in practice they, when we're treating patients or doing patients together, we're, we look at very much beyond the weight loss aspect and we will come to that later. But, one of the interesting papers you had kind of shared was the effect on some of these gut bacteria because there's so many of people in the population using them.

And there's one in particular that, Akkermansia, that, maybe we can dive into in a little bit more detail.

Yeah, absolutely. so there is, and it's a, what we call a commensal bacteria, group that are called Akkermansia. And we like to have them in a really good abundance in our gut microbiome,

and sadly I'm one of the people that doesn't have them in very good abundance, so I've had to work very hard at boosting my own, Akkermansia.

and it, and it's not an easy, species to, give as a probiotic either. They're, they're, you know, they're not very stable and so the best way, to sort of boost your Akkermansia is through giving them the right foods,

that they want to feed on to help them grow in abundance. But the paper, that we were looking at showed that GLP-1s, there's been some research, that shows that they...... mechanism of the GLP-1s has helped when they reviewed the gut microbiome to really boost

Yeah.

And they have some, that has some really wonderful health benefits, because Akkermansia produce some really important short chain fatty acids that help support that mucin layer. So,

that has been such a positive. I was, really interested to read

that this is like, hey, we can't even get this as a probiotic but,

Yeah.

... the GLP-1 mechanism has been found to increase that.

Yeah. and we'll put the link to that paper in the show notes. it's The Effects of GLP-1 on Gut Microbiota was published, last year by Gofron et al. And, Akkermansia, I suppose has been called the skinny bug, because we know, or lots of studies have shown that high levels of Akkermansia seem to match up with a healthier kind of body composition, as well.

And so, hence there's been so much interest in how we can balance it. And there's also interesting studies that have shown that Akkermansia seems to have an effect on our own natural production of GLP as well, so it's a bidirectional,

effect going on as well.

absolutely. And I think that's what's really important, um, when we look at GLP medications, is that, you know, there's not something that we want to be taking long term.

Mm-hmm.

what we want to do is use them as a tool to get the body to be in a position where the action of the GLP-1 is happening, within our We've got We've managed to boost our own GLP-1,

through something like Akkermansia, so that then when you start, titrating off the actual medication, your body has, We've given our own bodies the tools that it needs to manage, those metabolic health markers ourselves going forwards.

So look, I just think it might be a good time to talk about GLP-1s. in practice, we tend to use it in a different way from, I think, the standard,

pharmacy pill mill route of starting on a drug, going up very quickly onto high doses.

in practice what we do is we stay on micro doses, very low doses, and we manage the nutrition side of things. People stay on very low doses. And it's also something that people don't talk about is an exit strategy.

No one wants to be on a drug for a long term. We want to create a window where we can change habits, create, new,

ways of eating and our approaches to food so that we can change that fuel energy par metabolic pattern into something that's healthier, that's going to stay longer term. And, maybe, I think you're better placed to, talk more about a lot of ... I've had patients come to me eating two almond croissants a day, diet.

And, they go, "But the GLP just fixes everything, doesn't it?" And, that's absolutely not the case.

so maybe talk a little bit about GLP-1s and the way that, I use them practice when we work together, that our approach is using micro doses. we rarely go beyond the second-lowest dose, and there's a number of reasons for that. If you get the nutrition right, if you can switch on the ability to burn fat a little bit better, then these drugs will work at a much lower dose than is currently used.

And that's really important for a couple of reasons. It doesn't cause the stomach issues, but also it allows you to exit them. if you're on a very high dosing, it take a long time to come off these. No one wants to be on them for a long term.

as was saying beforehand I've had patients come to me on the almond croissant diet, which is, the drugs are gonna take care of everything, I can eat whatever I want, two almond croissants a day. And there's one thing to leave from here is that absolutely not the case. This is a window to allow you to change how you eat and to eat mindfully.

I'd love if, at the end of this we could educate people a little bit more about, look, if you're cutting down on your calories a little bit, what should that look like? what work should you be doing? And maybe you can talk a little bit more about that, Janine.

Yeah. So I really, feel this is such an important point that is missed.

Absolutely.

I also have had a client that has come that was just having Diet Coke, literally

And

I think if you understand the importance of something like the gut microbiome to health, you realize

that Diet Coke and almond croissants alone are not going to give those beneficial gut bacteria the fuel that they need to, be in healthy abundance. we want

diversity and richness in our gut microbiome. That's really key to our health. and you achieve that with eating a diverse range of the rainbow-colored vegetables, but making sure that have, you good quality, food that is, really high in protein. We want good, decent sources of protein, really good healthy fats, because,

fats, essential fatty acids like omega-3,

are really important for some of our anti-inflammatory pathways as well. And then we want that diversity and richness of fiber, and those beautiful polyphenols and flavonoids to also

Absolutely.

reduce that inflammation. those are the kind of key things that we need to be, using this window of opportunity to change our eating habits to add those in and, throw the Diet Coke and the almond croissant bin.

I think one of the fascinating things is that I've had patients

and actually the part of using the GLPs that they have liked the most is control. So they can actually... They're not under the spell of thinking about, the crisps, the Pringles, the, the chocolate, but

they still get, the nudge, the craving but actually, It allows them to be in a window where they can make the right decision. And so it's that, can we help them get that pattern into place, of making the right decision more and more often? And so that when they're titrating off these, it's just the natural thing, and the body's used to it.

Coming off sugar, if you're somebody who likes a lot of sugar, can be difficult and, I tend to find it takes patients six to eight weeks before those cravings settle.

Yeah. Yeah. I would, totally agree. And that's why

making sure that you add in things like protein, healthy fat, and fiber is so important to

keep blood sugar levels nice and regulated as well because that's what often drives, some of those cravings. and also we mustn't forget the nervous system in this. So, I do work a lot with clients to help them understand the impact of stress and cortisol, on, those pathways as well.

So, if we keep our blood sugar nice and balanced without the food that we're eating, and our body doesn't feel like it's under threat or, those sorts of things, then we can really help manage our levels of cortisol at the same time, and build our own stress resilience which, is also helped by that all important axis as well.

Yep. So when we're talking about diets, I think there's been a lot of talk about protein and, I would also reiterate with people, yes, protein's important for preservation of muscle. Protein without resistance training really won't do very much for your muscle. It doesn't initiate muscle protein synthesis. So

yes, the high levels of protein are important, the fats, that anti-inflammatories of good fats, again, good fats and bad fats.

obviously carbohydrates are not a villain, of the nutritional world. And again that doesn't... That's not true as well. yes, the beige, sugars, starchy foods are but, maybe we can talk a little bit more about, the good carbs that you should be focusing on, with those good polyphenols and what are the type of foods that, we should really be telling people to double down on during this time?

Yeah. So obviously, we've got, to start with, our root veg, which, are quite h-... have got starchy carbs in them, but, provide lots of fiber and lots of polyphenols, flavonoids, that are really important for health. So, and again, this is where, I love linking it back to nature. So nature provides those root vegetables in the winter when we probably have a higher need for some of those more starchy carbs.

So, focusing on those root veg are really good and also whole grains, and the quality of the grains that we eat.

Yeah.

I think that's where things have come very unstuck. So things like wheat have been really refined and grown and, you know, they're... It's not recognizable to wheat as it was,

quite a long time ago. So as such, it's very difficult for us to digest now, and gluten is notoriously, tough on our digestion and there's a massive link between gluten and autoimmune disease. So, you know, it might be focusing on some of those more ancient grains, for example, and building those into our diet.

women sometimes rea-... Particularly for their cycle and things, you know, do need a little bit of carb.

Yep.

it can be really important and, you know, there are certain pathways of detoxification like glucuronidation that are glucose dependent that again we need to, have some carb. And some of us actually just burn glucose more efficiently than fat anyway, so knowing that about ourselves genetically, and, you know, trying to understand when we might need the carb, when we need to make sure we, don't have it during our day, you know, just understanding some of those variances that are unique to us and how we work can be really important as well.

It might be a good time to also talk about insulin resistance and linking all this to fat and why we care about it. one of the... We all think about insulin and glucose control but we could also look at it in a different way. We could look at as a fat storage hormone

the higher your insulin, it's pushing this glucose to be converted into, lipogenesis, produce new lipids and also inhibit those fat cells from breaking down the fat as well. if you're constantly having fast release carbs, the starchy sugars, that's spiking your glucose, spiking your insulin, so you're stuck in fat storage

if you then drop into a calorie deficit with the medication too quickly, you've not reversed that insulin resistance. that's a key thing that we focusing on is at the start trying to reverse that insulin resistance and through diet, using supplements like inositol or chromium, even medication like metformin. why I tell patients it's very important to not try to lose weight at the start if you're on any journey, if it's GLP or otherwise.

It's trying to fix the insulin resistance, so you can get into fat burning mode a little bit more and, proteins and fats don't spike insulin, it's the carbohydrates do. But maybe talk about the, sort of, the glycemic index, which type of foods spike that insulin more than others and how can we prevent it from spiking?

Yes. So foods that are high in refined sugar, or even things like juices, people think that juices are really healthy, but they can... So my daughter will

Yeah.

... sometimes to treat, an episode of low blood sugar being a type one diabetic that, so that's a lot of sugar that goes in, one, all in one

A really good point, yeah.

will really spike. So,

yes, we want to avoid those sort of, sugars that are not combined with lots of starch that are what we call simple sugars. So in their molecular structure, they don't have lots of bonds and so they're digested very quickly and absorbed very quickly into our blood and then cause, a massive, blood sugar spike and insulin spikes.

So eating, so that's why snacking on

sweets and chocolates and cakes and biscuits that are all very delicious, but are very high in those refined sugars,

is what's so damaging to our sort of blood sugar regulation. But combining some of those with, protein, fat, and fiber or also just having times in the day where we make sure we are not having those sugars is really important. So I'd say, really, cutting out those refined sugars, but you can focus on some of those more starchy carbohydrates when you do eat a meal, but avoiding them as snacks and things.

I think one of the fascinating things is that I've had patients

Coming off sugar, if you're somebody who likes a lot of sugar, can be difficult and, I tend to find it takes patients six to eight weeks before those cravings settle.

So I think actually something else we said we were gonna talk a little bit about was inflammation. So we're talking about, you know, this insulin resistance, it pushes up into fat storage mode, but the fat we store is different and where we store it is different as well. And I think it's might be important to help the listeners understand that.

Say when you've got subcutaneous fat, it's the fat that kind of sits under your skin. but we can also have mental fat or fat around the belly, the gut, that's a very different animal altogether and that fat

causes more inflammation. So we're talking about, this insulin resistance, it pushes up into fat storage mode, but the fat we store is different and where we store it is different as well. And I think might be important to help the listeners understand that. Say when you've got subcutaneous fat, it's the fat that sits under your skin.

but we can also have mental fat or fat around the belly, the gut, that's a very different animal altogether and that fat

causes more inflammation. And there's, a couple of very good studies like Fontana et al, and it was one of the first people to show that this fat produces much higher levels of things like interleukin-6 and TNF-alpha and anything that comes from that fat is directly by the hepatic portal event into the liver.

So the liver is getting these high inflammatory markers very quickly. And, is this something you see in practice a lot that visceral fat causing issues? I think you were talking a very interesting story about someone who was very skinny who actually had this issue. And there's, a couple of very good studies like Fontana et al, and it was one of the first people to show that this fat produces much higher levels of things like interleukin-6 and TNF-alpha and anything that comes from that fat is directly by the hepatic portal event into the liver.

So the liver is getting these high inflammatory markers very quickly.

is this something you see in, in practice a lot that visceral fat causing issues? I think you were talking a very interesting story about someone who was very skinny who actually had this issue.

Yes, absolutely. Yes, absolutely. So I have had a client who, actually,

was under eight stone, had a,

on the surface of it,

not your stereotypical person, but was always on the go and, had quite high, quite a high stressful lifestyle, so quite high levels of

Yes.

and we know cortisol also puts us into that mechanism where we lay down fat. But yes, on the surface of it, actually quite underweight, which again might have been a driver for laying down some of that fat. And,

she had a absolute metabolic syndrome picture. She was type two diabetic, had very high cholesterol, fatty liver. So she, we know she was laying down fat around those organs, that you were saying around her middle.

Mm-hmm.

and unfortunately the only advice that she was given was to stop eating cakes and biscuits and sweets, none of which, because she was a dancer, none of which she ate anyway. So she was really quite desperate to work out how,

to solve that. And I think you were saying, Geoff, that it is possible to lay down fat in your muscles as well.

that's a

Yeah.

important thing to bear in mind.

Yeah. There's a lot of study coming out, especially in women with PCOS, and we know there's two phenotypes. There's women who, have a high BMI and then patients or people that don't, and there's been interesting studies done with Stener et al who did where they were doing MRIs using radio-labeled markers to actually look at the fat within muscle.

And this is the fat that's often missed by DEXA scan. The DEXA scan will look at the muscle and count everything, fats and or intramuscular fat as well. And it appears that this intramuscular fat is particularly lipotoxic. It causes significant insulin resistance and it may be that we're missing a lot of this and when people do lose weight, and it looks like on a DEXA scan they have lost muscle, we also see the pattern of they have increased muscle strength, which doesn't make sense.

So it may be that some of that so-called muscle loss is not muscle loss at all. It's actually the intramuscular fat going, which is actually driving some of the insulin resistance, which could easily be the picture, in the ballet dancer about. ... about.

Yeah. And,

muscle is metabolically active, isn't it?

So important.

that's part of our burning.

so helping her to reduce that fat in the... was in her muscle, by helping the insulin resistance was key,

she remains sort of the same weight, really, overall. she does a lot of exercise. But was able to completely reverse her insulin resistance. So, that was a good win. So I have had a client who, actually,

was under eight stone, so had a, you know, on the surface of it,

not your stereotypical person, but was always on the go and, had quite high, quite a high stressful lifestyle, so quite high levels of

Yes.

she had absolute metabolic syndrome picture. She was type two diabetic, had very high cholesterol, fatty liver.

And could you give us a little summary exactly, of what's, what was your,

strategy for helping her to reduce that inflammatory fat?

Yeah. with her, we used, some of those, nutrients and herbs that really do help with, insulin resistance. So I did use some berberine, which, for her was, really important. It has the same sort of effect as metformin in, that pathway.

Yeah.

and also, things like chromium, which is a metal, which was,

Big fan of as well, yeah.

really, helpful again, in just improving her insulin sensitivity. I also used some medicinal mushrooms in my practice as well, so things like reishi and maitake. and also with her, I worked a lot on her nervous system. Because in recognition that cortisol was one of the drivers for her,

I just made her take time in the evening to have a bath and relax, which she found really hard to do.

it's not just about nutrition is it? It's about that whole lifestyle, sleep, stress. all those things play their part. So, it was like making it acceptable for her to relax, So, yeah, that

I think what you've touched on is a great point. The stress, people, you know, lambast stress. We need stress. We need stress to get up and do stuff. We need stress to live our lives. We need... the villain is not recovering from stress.

Yeah.

And that stress needs to come back down again. And so, if you're in a life full of a lot of stress, you need to be very mindful making that happen. And so, the strategy you mentioned, it's getting back down to baseline. If that baseline never hits at night, you wake up a slightly raised level, your body's just never recovering, is it?

No, not at all. And, you know, she'd got so into the habit of not ever taking that time to

Yeah.

... that she couldn't even... She found it very difficult to do. So, it was like if there's one thing you're doing, you are going to, have a... She said, "I don't, I, I don't have long in my bath. I literally have 10, 15 minutes, and then I... while I'm doing that, I'm listening to the news or something." And I'm like, "No, no.

This is all wrong." Yeah, so really important. You know, it's,

And that's how we, we learn about our bodies and what our body needs to, you know,

the effects that that can have. And, you know, when she realized, she actually then went, "I'm actually really enjoying this time in the bath when I'm not rushing around doing things for, you know, other people." And, yeah.

Giving herself permission. Yeah, no, absolutely.

Um, so at the, the start of this talk, um, I promised to come and talk about a really interesting paper that had, had a great name to the paper. I think one of the fascinating things is that I've had patients

Coming off sugar, if you're somebody who likes a lot of sugar, can be difficult and, I tend to find it takes patients six to eight weeks before those cravings settle.

so at the, the start of this talk, um, I promised to come and talk about a really interesting paper that had, had a great name to the paper. Two Birds One Stone, and semaglutide's high effect against severe psoriasis in a type 2 diabetic patient which was published by Costanzo et al.

And, we were talking about this impact of visceral fat, how it increases the inflammatory markers. And it can all sound a bit abstract and theoretical. But actually, I've seen this in practice, inflammation going down as people lose this visceral fat. there's a lovely example of somebody who not only had crippling psoriasis and type 2 diabetes.

And the strong Humira anti-biologic drugs that they were on wouldn't even work. It couldn't even dampen that TNF-alpha. And they went on a course of weight-loss medication, and we got that weight down, that visceral fat down. Not only did all the symptoms improve over the course of eight, nine months, stopped the medication completely.

Amazing, amazing. In fact, I think that paper should be called Three Birds with, One Stone because it was the obesity, the diabetes, and the, the psoriasis sort of win, wasn't it? So, yeah. And I, I think that,

supports what is the underlying principle of my practice. Which is that if you can get on top of chronic systemic inflammation, that's what drives most health conditions. And so, it's identifying ways to reduce that within the body. And, you know, reducing obesity, and, you know, we know that adipose fat, you know, produces those inflammatory sort of cytokines and drivers which are so damaging for other things.

So obviously, we've got, to start with, our root veg, which,

have got starchy carbs in them, but, provide lots of fiber and lots of polyphenols, flavonoids, that are really important for health. So, and again, this is where, I love linking it back to nature. So nature provides those root vegetables in the winter when we probably have a higher need for some of those more starchy carbs.

So, focusing on those root veg are really good and also whole grains, and the quality of the grains that we eat.

So as we can see that, that obesity was driving the,

you know, arthritis, the autoimmunity

link to psoriatic arthritis. So, it... To come off,

all medications, incredible, isn't it? So, yeah, unfortunately.

incredible, yeah. You know, Humira, the biologic, is the most expensive,

drug bill, for the NHS.

Right.

So that, that blocker of TNF-alpha is the biggest bill that, they spend. I think it's £16,000 per person per year, is what it costs. And so, if you go upstream and you can look to, to fix this. And I might touch on, the mechanism by which this visceral fat causes it.

And certainly, the hypothesis is that as these fat cells in the belly become bigger and bigger, they've got a very poor blood supply. And over time, they start to become hypoxic. And as they become hypoxic-... you get these M1 macrophages attacking it and they release these inflammatory mediators. So, that whole pathway from start to finish has been well mapped and, and well understood.

And there's, a couple of very good studies like Fontana et al, and it was one of the first people to show that this fat produces much higher levels of things like interleukin-6 and TNF-alpha and anything that comes from that fat is directly by the hepatic portal event into the liver.

So the liver is getting these high inflammatory markers very quickly.

is this something you see in, in practice a lot that visceral fat causing issues? I think you were talking a very interesting story about someone who was very skinny who actually had this issue.

Yes, absolutely.

but it's not the case with everyone. It's not everyone with psoriasis, it's

causing this. And as you said, you explained your daughter, you know, she had a different cause of inflammation.

Yeah.

So sometimes, you know, there's a bit of detective work to understanding the underlying cause.

Yes, exactly. I always describe myself as the Sherlock Holmes of well, Agatha Christie, Miss Marple, you know? But yeah, you sometimes do have to really,

explore a lot of different avenues. And sometimes it's not just one. So obesity might be playing a part, but there could be some other, you know, things going on as well. So, you sort of have to unpick all of, of that. but, you know, helping reduce that fire get, through getting on top of obesity is going to help.

Everything's going to play its part, isn't it? So,

amazing.

if you do in a careful

Very careful,

and that is not rapid weight loss where you lose this fat quickly

and you rebind and put it on afterwards. So, I think there's a lot of use or misuse goes on and it... I think one of the fascinating things is that I've had patients

Coming off sugar, if you're somebody who likes a lot of sugar, can be difficult and, I tend to find it takes patients six to eight weeks before those cravings settle.

Indeed. And I think there is some research coming out now that does show that the, the rebound weight gain is... can be quite significant when the, the GLP-1s are not used in the right way.

Yeah. absolutely right. but in practice, we do DEXA scans before and afterwards. We also, most of our patients don't lose any muscle at or it's very modest the amount of muscle and, actually a lot of that down to potentially that intramuscular fat. and that's where working with a nutritionist like you to get your diet right during that time, working with very low doses, going, low and slow, not...

most people, when you explain the why, and hopefully this will help explain the why, we have the ability to use... We got two storage tanks in our nutrition practitioner, we've got a fat tank and we've got a muscle tank. if you can't access the fat stores, because your insulin is high, and you're in a high calorie deficit, the body needs energy from somewhere, it needs to keep the heart and the brain going, and it will break down that muscle.

So, it's so important to unlock that fat burning mode before you start going into these calorie deficits.

Absolutely. And otherwise, you're in the... you run the risk of just creating more of an inflammatory response, So,

doing the things to get on top of the insulin resistance first and doing that lovely slow,

safe pathway is definitely the way to proceed.

Fantastic. So look, we've covered a lot and I think, you know, two big areas. One is, the microbiome, the importance ... the health of the microbiome. And some of that interesting studies with the, the GLPs. Actually was interesting, that paper, wasn't it, that the Akkermansia increased but the diversity, didn't increase.

Yeah.

So it actually decreased,

Yeah. So, you know, the diversity and richness of the microbiome decreased, so we think that the Akkermansia increased due to the actual mechanism of the GLP-1 medication. But obviously the lack of eating lots of, diverse

Yeah.

... fibers and things did have a knock-on effect, on that microbial diversity. So, the way to sort of, mitigate that would be to making sure that you are eating a good range of, you know, lovely fruit and veggies

Exactly. So, fantastic. and just to wrap up, any final thoughts on, what people can take away from what we're talking about today?

Well, I think, as I've experienced personally with my clients,

the road to better health is not always, simple, and is rarely a quick fix.

Yeah.

So doing things in a safe, controlled way, and making changes that,

will be something that you're going to put into practice for the rest of your life, is you can't really put any value on that. It's just, going to transform your health. so I think, trying to do it the... There's... I always say there's a right way and the easy way, and the right way is never the easy way.

Exactly not.

it's just to... So, but doing things in the right way, the safe way, and the sustainable way is going to be the way to really effect long term positive change. And that's what I think this Human PEPAL program with the GLP-1s is going to give clients. So, that's why I'm delighted to be working with you, Geoff, and, hopefully helping people with the nutritional therapy element.

Yeah, no, absolutely. and thanks to Janine. the goal of setting a window, working with, a nutritional therapist like you to make those long term changes, I often say to people, "Look, you have the chance to change your timeline. where you're gonna be healthy, how long you're gonna be healthy for." And I don't know if there's any better investment that you could make than doing it properly.

Completely agree, Geoff. Completely agree.

Fantastic. Well, thank you very much, Janine. And look forward to speaking to you all on the next Coffee with Dr. Geoff.

Indeed. Thanks, Geoff. Thanks for having me.

Pleasure.

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