Episode 142: Vyvyane Loh on weight management, ketogenic diet, and the treatment of metabolic diseases
STEM-Talk
Ise, Can You Talk About Normal Weight Obesity?
Vivian Ise: Most people think of obesity as an increase in fat mass. But we should be looking at fat function, she says. If the fat is sick, so to speak, then that person could well have metabolic disfunction in the fat tissue. These people tend to be missed interms of risk stratification just because by the eyeball test, they look normal and they look healthy. i much prefer using body composition by dexa.
Our interview today is with Dr. Vyvyane Loh, a board-certified physician in obesity and internal medicine. She is the founder and leader of Transform Alliance for Health, a Boston preventive-care practice that specializes in weight management and the treatment of chronic metabolic diseases such as diabetes, hypertension and dyslipidemia.
She and her staff are known for helping people lose 50 pounds or more and getting their type-2 diabetic patients off their many medications. Vyvyane has spent her medical career developing expertise in immunology, metabolic syndrome, fat metabolism, clinical nutrition, and preventive medicine.
In today’s interview, we discuss how abdominal, or visceral, fat is linked to a wide range of metabolic disorders. Vyvyane goes on to explain how there’s a clearcut association between obesity and decreased brain volume that rarely gets discussed. When her overweight patients complain about their behavior around food and how they consistently give in to snacks that patients know are bad for them, Vyvyane explains how the challenges they are facing is often a result of the brain struggling with decreased blood flow and the shrinkage of neurons.
Vyvyane also shares how a patient asked Vyvyane if she knew anything about the Atkins diet, and although she didn’t, Vyvyane ended up doing the diet along with her patient. This led Vyvyane to start seriously researching whether a ketogenic diet could help people not only lose weight, but also reverse chronic disease.
Toward the end of today’s interview, we explore Vyvyane’s interest in macrophages, which are specialized cells involved in the detection and destruction of bacteria and other harmful organisms.
We also have a nice discussion about how Vyvyane took some time off from practicing medicine to enroll in the writing program at Warren Wilson College in North Carolina in 1999. She spent the next two years writing a novel, “Breaking the Tongue.” Set in Singapore during World War II, her book was nominated for the prestigious International IMPAC Award in fiction and was selected by the New York Public Library as one of its top 25 books of 2004.
If you are interested in finding out more about Vyvyane, check out her website, vyvyanelohmd.com. Also, Vyvyane launched a podcast this week, which you also can find on her website. Episode one looks at “Metabolism: What It Is, And How It Affects Your Health.”
If you enjoy today’s interview with Vyvyane and the many other interviews we’ve had on STEM-Talk discussing the treatment and prevention of chronic metabolic diseases, you may want to check out the upcoming virtual conference on Targeting Metabesity.
Our cohost Dr. Ken Ford will be one of nearly 70 speakers, including many former guests on STEM-Talk, talking about the growing evidence that the major chronic diseases of the day share common metabolic roots and as a result may also share common solutions.
To find out more about the conference, follow this link to the Targeting Metabestiy home page where you find a program guide and list of speakers. If you would like a free ticket to the conference, click on this link where you will find instructions on how to receive a code for complimentary admission that is being offered to STEM-Talk listeners.
Ken will be moderating a session on emerging research related to endogenous and exogenous ketosis in health and disease as well as the role of ketones in mild traumatic brain injury and the prevention and treatment of cancer.
If you have enjoyed the interviews we’ve had on STEM-Talk with Drs Steven Austad, Colin Champ, James Kirkland, John Newman, Brianna Stubbs, Jeff Volek and Morley Stone, who are all speaking at the conference as well, you should find the talks by the over 70 speakers quite interesting and beneficial.
So, click here to request a free registration and we will make sure to send a you a code for a complimentary ticket.
Show notes
[00:04:45] Dawn mentions that, based on the interviews she’s listened to with Vyvyane, that writing and dance have been passions of hers since she was a child. Dawn then asks Vyvyane at what point did she become interested in science.
[00:05:25] Dawn asks Vyvyane how she ended up in the states attending Boston University.
[00:06:25] Ken asks why Vyvyane decided to double major in biology and classics.
[00:08:14] Ken mentions that Vyvyane’s classics advisor has a connection to the town of Seaside, near where IHMC is located.
[00:09:01] Dawn shifts topics to talk about Vyvyane’s research, and asks about TOFI, which stands for “Thin Outside, Fat Inside.” It refers to people who outwardly appear thin, but have a disproportionate amount of adipose tissue in their abdomen, as well as “normal weight obesity.”
[00:10:58] Ken mentions that the TOFI phenomenon helps to highlight the relative lack of utility of BMI, which is just a function of the relationship between a person’s height and weight, meaning that people with TOFI will look fine in terms of BMI, and someone who is lean and muscular may be categorized as obese by BMI, particularly if they are not very tall. Ken asks Vyvyane to elaborate on this.
[00:12:26] Dawn explains that abdominal, or visceral, fat is of particular concern because it’s a key player in a variety of health problems, more so than subcutaneous fat. She goes on to explain that visceral fat is found deep within the abdominal cavity, where it pads the spaces between our organs. Dawn asks Vyvyane to talk about how visceral fat is linked to a wide range of metabolic disorders.
[00:14:37] Ken explains that obesity often causes endothelial dysfunction, which results in the vasculature being inflamed and damaged, resulting often in decreased blood flow to the brain. Ken asks Vyvyane to talk about her frustration with the fact that this clearcut association between obesity and decreased brain volume rarely gets discussed.
[00:17:22] Dawn mentions that it is estimated that just 12 percent of Americans are categorized as metabolically healthy. She goes on to mention that researchers at the University of North Carolina published a study that found that just one in eight American adults have optimal metabolic health.
[00:18:22] Ken asks Vyvyane what she has learned about metabolic disease in her practice that she didn’t learn in medical school or her residency.
[00:19:10] Dawn asks about the prevalence of using food to relieve stress in the wake of the COVID-19 pandemic, and what effects of this trend Vyvyane has seen in her practice.
[00:20:13] Ken asks about Vyvyane’s practice, which she started in 2015 because she had been working in the medical system and came to the realization that she couldn’t develop a new way of providing preventive care from within the system.
[00:21:53] Dawn mentions that Vyvyane’s practice is called the Transform Alliance for Health, and the website is quoted as saying: “Chronic stress and emotional issues commonly lead to using food to self-medicate or self-soothe. The visible result, the patient’s weight, becomes the focal issue for their healthcare providers. For us, however, it is merely the physical manifestation of the patient’s internal struggle with his/her real problem. From this starting point, we work with our patients to uncover their deeper and often more complex reasons for overeating and to take charge of their lives.” Vyvyane elaborates on this approach to her practice.
[00:23:29] Dawn mentions that she listened to an interview with Vyvyane where she talked about how a ketogenic diet can often reduce inflammation and reverse metabolic disease, but that it can be hard to get people to stick to a ketogenic diet. Dawn asks if this is why Vyvyane emphasizes going on a low carb diet for her patients rather than a strict ketogenic diet.
[00:25:07] Ken asks about the struggles of having to convince patients to give up carbs.
[00:27:17] Dawn explains that non-alcoholic fatty liver disease is today one of the most common maladies in the United States, with a remarkable 30 to 40 percent of adults in this country having it. Dawn asks Vyvyane to discuss NAFLD and what she sees as its causes and the most efficacious treatments.
[00:29:07] Dawn asks about the markers Vyvyane uses in evaluating a patient’s metabolic health, including insulin resistance scores and advanced lipid panels.
[00:31:45] Ken asks about the curriculums Vyvyane offers for her patients, which explain to them the importance of sleep and mobility and strength training as a way of pressing the body’s “the reset button.”
[00:34:00] Dawn mentions that we recently had Greg Potter and Jeff Iliff on the podcast to talk about the importance of sleep and particularly how a lack of sleep can lead to many negative health outcomes. Dawn goes on to mention that something Vyvyane has emphasized in the past is the role of nocturnal blood pressure dipping during sleep. Dawn asks Vyvyane to explain what she means by that, and how a lack of it increases a person’s risk for silent strokes and kidney dysfunction.
[00:35:45] Ken asks Vyvyane to talk about her recommendations for protein intake as it relates to body composition and sarcopenia.
[00:39:18] Ken asks Vyvyane to talk about some of the immune cells that are involved in regulating metabolic health.
[00:41:34] Dawn mentions Vyvyane’s recent lecture at IHMC, titled “On the Magical Mystery Macrophage Tour, where she refers to macrophages as mysterious, specialized cells of innate immunity that play significant roles in some of our most common medical conditions ranging from cardiovascular disease to gastrointestinal disorders to obesity to osteoarthritis. Vyvyane elaborates on what these cells are and their various functions.
[00:43:02] Ken asks how and when Vyvyane first became interested in macrophages.
[00:43:41] Ken mentions that macrophages also stand out because they possess the unique ability to become polarized in response to different environmental stimuli and asks Vyvyane to explain how this works.
[00:46:22] Dawn explains that macrophages can detect products of bacteria and other microorganisms using a system of recognition receptors such as toll-like receptors or TLRs. Vyvyane explains the role and significance of these receptors.
[00:48:13] Dawn mentions that tissue-resident macrophages, or TRMs, are heterogeneous populations originating either from monocytes or embryonic progenitors and distribute in lymphoid and non-lymphoid tissues. Dawn asks Vyvyane to talk about the diverse roles that TRMs play in many physiological processes, including metabolic function.
[00:50:46] Ken mentions that current medical practice still looks at obesity through the lens of caloric balance. Ken asks what new discoveries in obesity research challenge that dogma.
[00:54:39] Dawn asks about the aspects of Vyvyane’s life outside of her medical practice such as writing, dance, and choreography.
[00:55:47] Ken mentions that Vyvyane’s novel, “Breaking the Tongue,” was selected as one of the Top 25 Books of 2004 by the New York Public Library and in 2006 was nominated for an International IMPAC Award, which is the world’s richest prize for a single work of fiction published in English. Ken explains that the novel chronicles the fall of Singapore to the Japanese in World War II, and asks Vyvyane to talk about the book and how it deals with issues of race and class.
[00:58:08] Ken mentions that Vyvyane has another novel she is working on, but that it, and her fiction writing as a whole, is on hold because she is working on a nonfiction book. Ken asks Vyvyane to talk about this new book.
[00:59:47] Dawn closes the interview asking about Vyvyane’s morning routine, which incorporates an hour of meditation. Dawn also asks what else Vyvyane does on a regular basis.
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