ONe Th 1
About our guest:
Dr. Geoff Lecovin
Episode 1: Our guest Dr. Lecovin speaks
Episode 1: Metabolic Flexibility with Dr. Geoff Lecovin
About this episode
We speak with Geoff Lecovin, DC, ND, LaC, MS, CSCS (Yes thats a lot of initials!). He is a Kirkland, Washington based physician who specializes in performance. He is very involved with researching the latest on metabolism and sports medicine. In this episode, we talk about metabolic flexibility and the different trendy diets that are directed at changing our metabolism. So many people feel like their metabolism is stuck in place. If they avoid carbohydrates, they don't feel right and if they eat carbohydrates they crave even more. This gives us a clue that the body has become metabolically inflexible. Have you ever driven a hybrid car? Do you admire how it can run on either gas or electricity? That is similar to someone who is metabolically flexible. If they decide to fast, they feel fine for the 16-24 hours without food. If they decide to enjoy carbohydrates, they don't become inflamed. Staying metabolically flexible is easier then restoring metabolic flexibility. Thankfully, through current research, we are learning approaches to sleep, lifestyle, and exercise and nutritional strategies that might help.
A quick plug for my podcast. Support this episode by becoming a member of my Patreon page or shopping through Fullscript where you get a 15% discount on nutritional supplements. I intend to otherwise always keep this free. It cost a lot to bring this to you and I hope to make it tremendously valuable.
Definition of Metabolic Flexibility
The term metabolic flexibility was coined by Kelley et al. (8) in 1999 when they studied fuel selection in skeletal muscle in lean and obese individuals after an overnight fast.
It is typically assessed by the increase in respiratory quotient (RQ) from fasting to glucose/insulin-stimulated conditions (1). During the overnight transition from the fed to the fasting state, metabolic inflexibility can also be evident by a higher fasting RQ (2). Finally, the lower capacity to adapt fat oxidation to a fat overload is another feature of metabolic inflexibility. Meaning after fasting the less metabolically flexible folks did not burn fat as well.
My favorite definition”metabolic flexibility can be understood as an adaptive response of an organism’s metabolism to maintain energy homeostasis by matching fuel availability and demand to periodic fasting, varying meal composition, physical activity, and environmental fluctuations”. (Smith. Et. al 2018).
Meaning you are flexibly able to eat and adapt based on your level of activity, stress, etc. Your body generally runs on what is most readily available for the lowest cost. A pretty wise survival strategy. Going to the liver for extra glucose is fairly economically inexpensive for the liver and going to fat stores is a little more expensive. Meaning the pathway is more biochemically challenging. So what happens when your body is inflexible. Is that it doesn't do a good job of switching based on supply and demand.
Symptoms of Metabolic Inflexibility
This not a complete list of symptoms of metabolic inflexibility but it might give you some clues as to why you may be having challenges with your metabolism:
You get sleepy after eating carbs.
You can’t go five hours between feedings.
You refer to meals as “feedings.”
You get the midday crash every day after lunch.
You must snack to sustain your energy levels.
Fasting is difficult, and if you manage to power through the discomfort, you get worse results than you were expecting (muscle loss, very little fat loss).
You can’t function without a steady stream of stimulants, like coffee, tea, or worse.
What to Do if you think you are metabolically inflexible.
A good approach to metabolic flexibility is holistic. A functional evaluation does not preclude a standard screening for Diabetes, thyroid disorder, hypogonadism, and hypothyroidism. Those conditions may be a cause or consequence of metabolic inflexibility. Onc A well rounded approach may include the following evaluation.
Fasting insulin and Hemoglobin A1C
Testosterone and DHEA-S evaluation
2 hour postprandial glucose levels. Measured with insulin.
Beta-hydroxybutyrate levels after fasting
Organic Acid Testing looking at mitochondrial markers
You may do a trial of medically supervised Intermittent fasting program
We are now also looking at microbiome imbalances that could lead to metabolic inflexibility.
Listen in below as we discuss this topic. Make sure to see the show transcript and resource section below.
Episode 1 show transcript on Metabolic Flexibility with Dr. Geoff Lecovin
This is episode One of ‘One Thing’. We speak to Dr. Geoff Lecovin about metabolic flexibility. Welcome to one thing. I’m your host Dr. Adam Rinde. I’m a licensed naturopathic physician in the Seattle area and I’m the host of One Thing. We are a podcast that brings together thoughts leaders in the field of medicine, science, fitness, psychology, and performance. We speak about one core thing that these thought leaders have learned, applied, and integrated into their life and practice, in the last three to six months. Today’s guest is Dr. Geoff Lecovin, he’s a Kirkland (WA) based licensed naturopathic physician, chiropractic physician, acupuncturist and Master of Nutrition.
He’s been practicing medicine for over 25 years. Dr. Lecovin is someone I met early in my training and became one of my first mentors. I was drawn to his ability to simplify complex concepts in a digestible and applicable manner. Our relationship grew to a friendship over the years. Later we found out we were distant cousins from 23andme testing. Please join me in welcoming our guest Dr. Geoff Lecovin.
Welcome to the show.
Dr . Lecovin: Thank you for having me. It’s a pleasure to be here.
AR: Yeah it’s great to connect with you. I’m honored to have you as my first guest on One Thing. Why don’t we catch up and you tell me a little bit where you’ve been up to professionally?
Dr. Lecovin: Gosh. So over the years, I’ve kind of taken my training and I found that I had all these different tools and just felt like I needed to kind of hone in and specialize. So over the past I would say five years or so, it’s kind of gone into the direction of sports performance, sports nutrition and injury prevention and injury treatment.
And so my practice focus and my focus in general has been to establish relationships with personal trainers, psychiatrists or physical medicine doctors, orthopedists and just get them to know what I do, refer them patients and in turn they refer me patients. So get those relationships going and then also continue on with my passion and my education. So that led me to International Olympic Committee, sports nutrition certification which has been the focus or was the focus over the last two years. I just completed the program in December.
AR: Wow congratulations. You’ve always been one of these people that I just associate with this insatiable desire to learn and you seem like you’re always gaining more knowledge and you don’t only apply it to your practice, you apply it to your own life.
Dr. Lecovin: Yeah it’s a passion for me so I just like of like every day I go to work, I’m living my passion, my dream. I think as a practitioner, if you really enjoy what you do and it’s part of who you are, part of your life, it’s just going to work, is this like you’re practicing life.
I’ve gone through a number of these sports nutrition certifications and it’s just kind of an insatiable quest for learning and each of them brings something different to the table.
In the last one that I just completed through the International Olympic committee, one of the final projects was to write a paper that could be potentially published in one of the sports nutrition journals.
And what I did is I tried to take what bodybuilders and physique athletes do in order to attain the physique that they want and try to apply it to the general population of people who come into my clinic.
That’s not to say that I want to train my clients and patients to become physique athletes. But I did find that a lot of the strategies that the physique athletes and bodybuilders use in terms of their nutrition and exercise recommendation can be applied and used very successfully for weight management in general population.
AR: That makes sense to me. I mean if we can study and understand people who’ve really excelled in an area or have really learned how to adapt their bodies and to nutrition and fitness for certain outcomes and to learn from them and study them and apply it to the general public seems like a really good way to learn.
Dr. Lecovin: What particularly draws me to these associations like the International Olympic Committee or there’s another one called Guru Performance that’s out of the UK that was and still affiliated with the International Society Of Sports Nutrition (ISSN), is that it’s evidence based, it’s not based on trends.
It looks at what’s the evidence and how do we bridge the gap between science and practice. So I really like that idea of like, how can I take this science, bring it into my clinic and apply to the patients that I see in order to help them with weight loss, weight gain, performance or wellness.
AR: So yeah we’re going to dive into this a little bit deeper in just a moment here. If you could just share with the listeners like when you show up at your office from the day like what’s a typical day, I mean where do you practice, what’s the facility like and just kind of tell us a little bit about that?
Dr. Lecovin: I start my day at about 4:30 a.m.. I get up and just maybe do a little meditation and then go to the gym and do my exercise at about five in the morning. I need that release and just kind of need to start my day with some kind of activity and then come home and have a huge breakfast and then I’m off to work and usually get to work by seven and spend about 20 minutes or so just kind of reviewing my day, the charts.
The patients I’m going to see, and maybe kind of go through some treatment plans and then start to see patients at 7:30. And so the clinic that I’m at is a fairly integrated, well there’s myself, there’s another Chiropractor, there’s a psychologist, a physical therapist, and several massage therapists.
AR: It’s kind of like a multi integrative practice. How many patients do you see on a daily basis?
Dr. Lecovin: So I have two long days where I’m there until about 6:30 p.m. on Monday and Wednesday and then Tuesday, Thursday, and Friday, I’m usually there until 3 p.m and then I can take off and spend some time with my kids.
So anywhere between 15 to 20 patients a day would be my typical schedule. Then generally I’m seeing patients for about 30 minutes on a typical type of interaction.
Would be either some hands on thing where I’m doing some trigger point dry kneeling which is a neuroanatomical form of acupuncture combined with manual therapies and corrective exercise.
Or I might see people who are coming in for nutrition based consult to address co-morbidities of obesity or there might be an athlete that’s coming in and wants to know what they can do to perform better.
AR: I think one of the things like when I have patients that’s looking for someone in your area of expertise and I’m talking about you it’s like someone I might refer to. I always describe you as really dynamic in your approach and you actually have multiple tools to use based on whatever the patient is dealing with verses sort of just one tool.
Dr. Lecovin: People come in and say, “Are we going to do chiropractic or are we going to do naturopathic or acupuncture, how do you decide and I really don't compartmentalize like that. I just kind of see like I have these different tools and it affords me a larger scope of practice and I will use it based on what I would recommend to a patient. And then I’ll meet them where they are at. Some patients they want to do acupuncture or they don’t want to do a more high velocity type of manipulation so kind of meet them where they’re at and what they’re comfortable doing.
AR: That’s great. So you and I talk a lot maybe like once every week, every two week. We’ll share various general articles and the new things that we’re learning from time to time and s I really enjoy that. And so the nature of the show is we want to kind of zero in on one thing over the last three to six months that has sort of opened your eyes, changed the way your practice, changed the way you live your life or changed the way you implement new previous tools and previous learnings. I just want to go in that direction.
Dr. Lecovin Gosh it’s kind of hard for me to say like just one thing because as with you, I am constantly looking at the research and what the evidence is showing and I would say like kind of like the biggest thing for me is just staying at the foundation of things. There’s a buzz term that people call functional medicine that we spoke about earlier and I would just say like for me it’s just getting to the basics like diet, exercise, lifestyle types of things, and just applying those.
Every now and then you’ll see this kind of new things that come out or there’s a new trendy diet and my eyes will open up a little bit and my eyes will open up a little bit and kind of see what the research shows on those things.
And then I’ll see, a lot of times I have access now to journals and to the researchers and educators from the programs that I’ve gone through.
And I look at their comments like for example with the Ketogenic diet, which we’ve talked about a lot and just look to see, how do athletes and what is the research showing and try and look and kind of see like is there a place for that in my practice or is there a place for this in somebody’s healthcare. So it’s an evolving thing.
AR: Let me stop you there so that brings up a really interesting point. I think this is something that I’ve noticed with you is that you don’t get rocked off your foundation very easily.
Like you have a way of discerning information that I don’t see very often like when I’m talking to other providers or y listening to people and how they’re growing professionally.
Can you share, how have you hanged onto to not getting thrown off by the latest and greatest?
Dr. Lecovin: Probably there are people that I really respect in the fields of nutrition exercise science and I look to them and I look to their comments because you can get really caught up on social media and see people saying things that kind of appear to be extreme.
And I just kind of again just kind of come back to where the research is at. So for example when the whole Ketogenic diet came out and athletes were using it and making claims of performance enhancements and more people were talking about using for weight management.
I started looking at some of the physician stands form these large organizations like in the international Olympic committee or the ISSN and they just kind of seemed to synthesis the full body of literature that is out there. Say, “Okay this is what the body of literature shows.” And so for me it’s like okay you can get excited about some of this things because like people make a big stink out of things and get excited.
And it’s really easy to kind of you find somebody who’s very dynamic and say, “Well this must be like a cool thing”... This keto diet or whatever it might be and people want to kind of jump on that bandwagon and follow a leader especially if they’re very dynamic. For me I want to jump on the bandwagon and follow the researchers. I look for example Louise Burke, PhD is a name that comes to mind and she’s one of the tutors in the International Olympic committee.
Dr, Burke is probably one of the most respected sports nutritionists in the field and I look at her comments and her way of looking at what is happening biochemically, physiologically and so on and then what happens when we apply these principles to athletes.
I guess what kind of brings me back to the foundation again is the literature, what is the research showing.
AR: It sounds like in your practice of learning with some of these extensions of diet, nutrition and lifestyle have kind of strengthened your resole in the foundations of good athletic performance and sort of nutrition that’s ideal for metabolic flexibility. Is that fair to say?
Dr. Lecovin: Exactly, it’s just understanding the basic biochemistry and the physiology and the needs of a sport for example or the needs of a person in their general life kind of helps me to figure out what the best program is for them.
N=1 in general. Right?. Everyone has their own biochemical individuality but when it comes down to it, if you can apply these general principles then most people are going to get results.
AR: Right. So I guess one of the things that I’ve noticed is; you’re trying to save the carbohydrate from extinction.
Dr. Lecovin: Yeah I think the carb gets a bad rap for sure. I mean if we want to go down that pathway for a second, I think that carbohydrate is one of those nutrients that needs to be periodized, meaning that it needs to be taken based on somebody’s activity level.
So let’s say somebody says well they’re going to go on a low carb diet. If they’re going to be a sedentary person, they don’t need the carbohydrates. They can get away with having more of a higher fat diet because based on physiology and biochemistry that’s the type of substrate they’re using for energy.
Now somebody like myself or you or an athlete that’s going to go out there and do some more high intensity needs to have the carbohydrate because that’s the main substrate for fueling their performance. Then that’s a different story and there’s also recovery, things that you need to consider to the carbohydrate help to provide in terms of adrenals and the immune system.
AR: Yeah good point.
So I really have appreciated that inside I think that’s an individualized the approach to nutrition and to work with the individual and their needs based on how much movement they’re getting, how much exercise, and sort of their general lifestyle. I guess teaching people to learn their own needs and adapt rather than kind of stick to some type of template.
Dr. Lecovin: In the sports industry , personal trainers do this a lot. They come up with what’s called a needs analysis .. When your patient or your client comes in, what are their needs, like what are they trying to accomplish?
And then you need to figure out; where are they at now? and then you need to come up with a timeline or some kind of like path or route that’s in a reasonable way take them from where they are to where they need to be . I’ll give them the tools with diet, exercise, and lifestyle modification. In generally that’s seems to be the most effective way that I found to help people.
AR: Great. This really helped me a lot and I’m sure will help a lot of the listener just o be discerning and learn how to kind of come back to the foundation.
And to make sure that whatever recommendations they’re following, they are thinking out what their individual needs and to discuss that with a practitioner so that they have the best outcomes.
So Geoff, if people wanted to learn more about you or more about this kind of approach, what would you guide them?
Dr. Lecovin: So for me my practice is in Washington and my website is www.drgeofflecovin.com.
If you went to my website, I’ve got a lot of blog posts that I’ve written over the years on this topics that we’ve discussed and also if you were to google my name and NASM Geoff Lecovin | NASM Blog. There’re also quite a few posts that I’ve written for the online national medicine blog that has to do with nutrition and exercise and health management types of things.
AR: Okay great. Let’s see I’ve a question when’s your book coming out? I’ve been after you for years.
Dr. Lecovin: Yeah I know. To be determined.
AR Okay I’m going to keep after you on that. So thanks for coming on, it was great connecting with you, I always learn a lot from you and we’ll catch up another time.
Dr. Lecovin Sounds great, thanks for having me.
AR. Thank you for tuning in to the first episode of One Thing with Doctor Geoff Lecovin. This is Doctor Adam Rinde, he’s going to share some concluding thoughts on the episode. What I learned most about talking to Doctor Lecovin is continued emphasis on the foundation.
He is repeatedly stated over the course of his career about the importance of good sleep, consistent exercise, and making good nutritional choices.
And I think everything on top of that seems to be beneficial only on the context of how well you’re doing the foundational lifestyle choices. This doctor is not away from this, I’ve known him close to 15 or 16 years now and I’ve not seen him waiver on this.
He lives that lifestyle and I think more people who do listen to him and follow his guidance see the benefits of this approach. And they seem basic but we’re so often caught up in the latest supplement, the latest dietary strategy to tweak the metabolism of doing something that is not currently doing.
However if we’re consistently working on caloric balance, also working on restful sleep and also implementing an exercise program, that is far head and shoulders above most people and if we look at healthy populations, this is a consistent part of their lives.
And so I think skipping over that and trying to go on an extreme diet doesn’t make a whole lot of sense for the long term success of that lifestyle change.
So I really appreciate that he has stayed true to himself in his career. Metabolic flexibility is a big topic and I’m going to share more on that on the page for the show on my website.