The Surprising Secrets of Your Metabolism
The metabolism may seem like a magical concept: some people eat whatever they want and don’t gain weight. Others so much as look at a dessert and feel the pounds creeping on. But what do we know about our metabolism? Can it speed up? Can it slow down? Does yo-yo dieting damage our metabolisms? On this episode, Juna and Eddie talk to Dr. Herman Pontzer, Associate Professor of Evolutionary Anthropology at Duke University all about the ins and outs of human energy expenditure, and what hunter gatherer tribes can teach us about how our metabolism works.
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Guests
Dr. Herman Pontzer is a professor of evolutionary biology and global health at Duke University. His work focuses on the Hadza tribe of Tanzania to investigate how evolution has shaped metabolism and health. Take a look at his work below.
Read Dr. Pontzer’s latest book Burn: New Research Blows the Lid Off How We Really Burn Calories, Lose Weight, and Stay Healthy.
Components of Total Daily Energy Expenditure (AKA “Metabolism”)
BMR - Basal Metabolic Rate - The amount of calories your body needs just to stay alive: keep lungs breathing, blood pumping etc.
NEAT - Non-Exercise Activity Thermogenesis - The calories you burn doing non-exercise tasks: walking, standing, going grocery shopping, cleaning, fidgeting, etc.
TEF - Thermic Effect of Food - The calories you burn digesting and absorbing food.
EAT - Exercise Activity Thermogenesis - The calories you burn during exercise.
REE - Resting Energy Expenditure - Calories burned at rest.
NREE - Non-Resting Energy Expenditure - Calories burned from activity.
Other Stuff We Talked About
Law of Thermodynamics - Energy is neither created nor destroyed, therefore all calories either must be used or stored as new tissue.
Adaptive Thermogenesis or Metabolic Adaptation - The process of down regulating or up regulating metabolism in response to higher activity level or diet change.
Boston Police Study - Exercise as an adjunct to weight loss and maintenance in moderately obese subjects
Constrained Total Energy Expenditure Model - The model posits that total energy expenditure is homeostatically constrained within a narrow range. According to the model, low to moderate physical activity increases overall energy expenditure, but higher physical activity stops having an effect on total energy expenditure. Instead, other non-essential physiological processes are down-regulated to account for the increased energy costs of high activity.
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Juna: Food We Need to Talk is funded by the Ardmore Institute of Health, home of Full Plate Living.
Juna: So when I was growing up, metabolism was a magical way to explain almost everything. Why can my sister eat so much more than I can and stay skinny? It's because of her metabolism. Why do men not struggle as much with their weight? It's their metabolism. Why do I have so much trouble losing weight? It's my metabolism.
Eddie: I hear my friends say things like, "Oh, the reason I'm putting on some weight? Well, it's my metabolism. You know how it is as you get older."
Juna: But how much do we actually know about metabolism and how much of our problems can we blame on metabolism? Can we speed it up? Can we slow it down? This, and much more, will be all the topics we are talking about on today's episode. I'm Juna Gjata.
Eddie: And I'm Dr. Eddie Phillips.
Juna: And you're listening to Food, We Need To Talk, the only podcast that has been scientifically proven to counteract the effects of aging on your metabolism just by listening. So, Eddie, we kind of introduced the topic of metabolism in our last episode, but can you give us a quick recap?
Eddie: Sure. Here's the cliff notes. When scientists talk about metabolism, they usually call it energy expenditure or total daily energy expenditure, TDEE. And the traditional model of metabolism includes four components. Let's go through them.
Juna: OK.
Eddie: The first and largest, making up about 60 percent of your metabolism, is your basal metabolic rate.
Juna: Your BMR is the calories that you burn, just keeping your body baseline functioning. So doing things like your heart pumping, your lungs breathing. To give you a concrete picture of how scientists measure BMR, they basically have you lying down in the lab, eyes closed, no food in your stomach, not moving. And the calories you burn just lying there existing, that's your BMR.
Eddie: So the no food part here is important because the next portion of your metabolism is the thermic effect of food or TEF, which are the calories you burn just to digest. It's kind of like getting a discount on the calories you eat. If you eat 100 calories, then you need to burn about 10 calories just to digest and absorb. And the last two components are,
Juna: The calories you burn from activity. So we break this up into two portions: your exercise calories and your non-exercise calories. And guys, if you want to see an illustration of the metabolism, you can go on our website foodweneedtotalk.com to the shownotes.
Eddie: It's important to note here that exercise calories would be zero if you don't actually do formal exercise. And even for those that do exercise, unfortunately, it's the smallest portion of your metabolism. Meanwhile, your non exercise movements, those can come in a huge range.
Juna: Think about people's different jobs. You can see why calories that come from non exercise activity thermogenesis or NEAT, as we snazzily call it, can range up to 2000 calories. So people like my dad who do a lot of construction and contracting, he is moving all day long, carrying things, walking around with heavy objects and compare that to all the movement I have to do: 20 steps to my kitchen, 20 steps back to my bedroom. Sometimes I'll take a walk to Starbucks, OK, even if you add in the one or two hours I spend at the gym, it just does not compare to moving all day long.
Eddie: Before we get into the details of metabolism, I think we have to recap one more thing, which is our favorite physics equation the first law of thermodynamics. And for that, let's bring in our guest for today's episode Dr. Herman Pontzer, associate professor of evolutionary anthropology and global health at Duke University.
Herman Pontzer: So the law of thermodynamics says that you can't create energy or destroy energy, and that every calorie that you eat has to either be burned off or is it gets stored as new tissue.
Juna: So Professor Pontzer is being kind of coy here, OK? When we're talking about new tissue, we're talking about fat, OK? That's what we're talking about. So if you eat less than you burn, then you are going to tap into your energy stores, a.k.a. your fat stores. And if you're eating exactly as much as you burn, then your weight is basically going to stay the same. Dr. Pontzer studies energy expenditure, but not in the usual way by bringing people into the lab and having them put on a mask, et cetera, et cetera. He actually went to study energy expenditure of the Hadza tribe in northern Tanzania.
Herman Pontzer: The Hadza are one of the last hunting and gathering populations on the planet. Of course, we all used to be hunting and gathering just a few generations ago, right before the advent of farming, but only a handful of cultures today still hold on to that way of life. They live in northern Tanzania, they live in grass houses.
Eddie: Wait, so living in a grass house, they can throw stones.
Juna: Oh my god, Eddie. That's not even worthy of a groan, moving on.
Herman Pontzer: They don't have any domesticated animals or plants or guns or machines or vehicles or anything like that. Electricity or plumbing? No, nothing like that. And every day they get up in the morning and they go out and then they get wild. Plant foods and animal foods and honey from their landscape to eat.
Juna: Before Dr. Pontzer and his colleagues went to Tanzania, no one had studied energy expenditure in hunter gatherer societies, so we had no idea how many calories they would burn. And this is a huge hole in our knowledge.
Herman Pontzer: We really wanted to know that for two reasons. One is from the sort of evolutionary or ecological reason humans are a hunting and gathering species. That's how we evolved. And so if you want to know something really fundamental about any species, like how many calories it burns every day, you want to go and understand that in a context that's sort of ecologically and evolutionarily relevant. But then there's also this sort of public health aspect to it, too, which is that one of the reasons that we have this obesity crisis in the U.S. and other industrialized countries is that we're not burning enough calories. And you know, if we were hunting and gathering and really physically active like we know hunter-gatherers are, then surely we'd be burning a lot more calories and that would be easier for us to stay at our healthy weight, but to know kind of what that gap is, we have to have a reference point.
Juna: So Dr. Pontzer and his colleagues went to the National Science Foundation with a grant proposal completely centered around this hypothesis. The Hadza tribe is going to burn a lot more calories than we are, and we need to find out how much.
Eddie: Juna, I've worked in an exercise lab and I could tell you that even in a lab, it's complicated to do it in a free living group of humans. That's got to be crazy.
Herman Pontzer: You can't just estimate it -- that doesn't work very well. So if you go to like an online estimator for how many calories you burn every day, you know, they ask you how much you weigh, they'll ask you about your lifestyle, they'll estimate your calories. But those kind of estimates are actually quite poor. They're just basically a little bit better than random number generators.
Juna: OK, guys, you heard it here first. The online metabolism calculators are not good. So instead, the researchers decided to use something called the doubly labeled water method. And this involves enriching water with hydrogen and oxygen isotopes.
Herman Pontzer: And you drink this water that's enriched in these two isotopes, and we can use then those isotopes to sort of track the flow of hydrogen and oxygen through your body. And by doing that, we can calculate, very precisely, over about a week or so, how much carbon dioxide your body produces. And you can't burn calories without making carbon dioxide, and you can't make carbon dioxide of that burning calories. That's a really nice, precise measurement of how many calories you burn on average over the measurement period. And again, we usually measure it over about 7 to 10 days
Eddie: Before we talk about the Hadza's energy expenditures, we should probably just do a quick summary of their overall health.
Herman Pontzer: So like a lot of, I guess, you call them traditional populations, they are models in public health. They don't get heart disease. They don't get diabetes. They're never overweight.
Eddie: In other words, they don't have the chronic diseases that we see in industrialized countries like the U.S.
Juna: But by the way, guys, none of the Hadza are dieting or going to the gym to try to obtain these optimal health outcomes.
Herman Pontzer: They're happy to eat whatever they can get, and they don't intentionally go out to exercise.
Eddie: Well, no one is moving with the intention of exercise, but one of the things that sets the Hadza apart from us, is that they are extremely active.
Herman Pontzer: Americans and other folks in industrialized countries, you know, if you get five thousand steps a day, you're doing pretty well compared to the average. Most people get a lot less.
Eddie: And that's only like a few minutes a day of moderate or vigorous exercise.
Herman Pontzer: In the Hadza community, men and women get 13,000 to 19,000 steps a day on average, and they get about two hours, 120 minutes or so of moderate vigorous activity every day.
Eddie: Depending on how you measure it, that's about four times more activity than the average American every single day.
Juna: OK, that's a lot of moving and a lot of energy being spent on non exercise activity thermogenesis. So what would you expect their metabolisms to be?
Eddie: Raging! It's on fire. It's got to be like super high, right?
Juna: Oh Eddie, oh Eddie, you silly, silly rabbit. If only that were the case, that would actually make sense.
Herman Pontzer: So we use this doubly labeled water technique and got the urine samples and trucked them all back to the United States and sent them to one of the best labs in the world for this kind of work. And we get the numbers back for I think in the first study, we had 30 men and women, so 30 adults. And I compared those daily energy expenditures to similar data from the U.S. and Europe and other industrialized countries. And I was completely shocked because it's the same.There's no difference in total daily energy expenditure between Hadza men and women and adults here in the U.S.
Eddie: Wait, what? What do you mean? Are you sure there wasn't a mistake?
Juna: Well, that's what Dr. Pontzer and his colleagues thought.
Herman Pontzer: If you're a good scientist and we all try to be, then when you get a really surprising result, your first response has to be-- I screwed up.
Juna: So they went back to do the exact same experiment with a completely different method using heart rate monitors.
Herman Pontzer: So we calibrated heart rate monitors. We had people in a sort of a set of tests where they walked around the camp with a mask on, a mask based respiratory system to measure calories very precisely while they walked. And we could calibrate their heart rate while they're walking against how many calories they burn. Then they would wear the heart rate monitor alone, just like a chest strap heart rate monitor that might go jogging with. They wear just that for a week, and it was the same numbers as we got with the doubly labeled water method. So two different techniques, completely the same results.
Eddie: OK, woah, let's just recap here for a second. The Hadza are much more physically active, but they're not burning more calories? So something else must be going on here.
Juna: Well, the researchers even tried to study their walking to see if maybe their muscles were more efficient than ours are.
Herman Pontzer: So we've actually measured how many calories they spend to walk around camp, and they spend the same number of calories to walk a kilometer as you or I do. So they aren't moving more efficiently. There's nothing magic about how they move. You know, their muscles are working the same way as any other people's muscles work.
Juna: So if they're definitely spending a ton of calories moving, that must mean they're saving calories somewhere else. And we're going to find out exactly where after this break.
Eddie: We're back and we are in northern Tanzania with the Hadza hunter gatherer tribe, people who are much, much more active than we are, but they don't seem to be burning any more calories than us.
Juna: Eddie, as you can imagine, this raises a lot of questions for researchers.
Herman Pontzer: Where are they saving all that other energy and what does that mean for the way their bodies work? What does that mean for the way that exercise affects us here in the U.S.?
Juna: One possibility is that the Hadza are reducing their other movements throughout the day, so, for example, they might be fidgeting less or standing less, and all that lowers their energy costs.
Herman Pontzer: That's possible, but we've measured their activity with accelerometers, so we get every time they move, not just when they're walking out of camp to go get food, but we get every time they stand up to walk across camp to be able to talk to a neighbor. So we're getting all of that movement, and we don't see any obvious sort of reductions in that other stuff.
Eddie: Maybe it could be their sleep?
Herman Pontzer: That was another hypothesis that came up early. You know, maybe they sleep more and by spending more time sleeping, they have more time to rest, they spend less energy, etc. That was a hypothesis, but that's not true. They sleep at the same number of hours as people do in the U.S.
Eddie: Basically, it's not their behaviors. They're not reducing other movements. No, they're not sleeping more. Now, instead, the real thing that's going on may be more subtle.
Herman Pontzer: What we think is happening is there are these physiological changes that there are others, you know, the immune system, reproductive system, all the other systems that you know, we're only vaguely aware of because they all kind of happen subconsciously for us are suppressed in some way. They're down regulated so that you spend less energy, for example, on immune function and you add up all the functions that are spending a bit less and you make room for that physical activity.
Eddie: The problem is that this is really hard to study, especially again in a hunter gatherer tribe. Hmm. You're not going to just disrupt their lives and say, "come on over to the lab and go through all these tests so we can see what's going on". But there must be some other evidence of physiologic downregulation in other populations that have been studied.
Herman Pontzer: If you look for example, in published work, not from my lab looking at people who exercise a lot versus who don't, but who exercise a lot have lower levels of inflammation, and that's immune function that's energetically costly. People who exercise have lower stress reactivity. They produce less cortisol and less epinephrine over the course of a day, and that will save you calories. There is some evidence that people who exercise more have lower levels of testosterone and estrogen, not not to where it's unhealthy, but just perhaps a more kind of moderated level of reproductive activity.
Eddie: This is so fascinating because a lot of these changes we're talking about are actually good for your health, like reducing inflammation, reducing stress hormones. And yet, in a world where we probably want to have a slightly higher metabolism, the human body may be just putting a limit on how much you can increase your caloric burn just by moving more.
Juna: So even though we may see this as something that we don't want, your body is just doing its job. Our body is constantly adapting to the stimuli that we're throwing at it, and it looks like the metabolism is no different. So the whole process of down regulating your BMR in response to your higher activity is called metabolic adaptation or adaptive thermogenesis.
Eddie: And you know, Juna, metabolic adaptation doesn't just happen in response to the higher activity like we've been talking about. It can also happen in response to the opposite-- crash dieting. We're going to talk a lot more about that in the next episode, but here's a sneak peek. If you don't give your body as many calories as it needs to try to lose weight, your body will adapt.
Herman Pontzer: You really cut how many calories you eat, and you're eating far fewer calories than your body needs every day to balance the books, you know your body will respond by reducing basal metabolic rate that kind of energy spent on all your other non activity tasks.
Juna: How exactly this process is happening in response to dieting? We're not exactly sure because it's just really hard to study in a lab. But there are studies, for example, in mice.
Herman Pontzer: We know in mouse studies that if you starve a mouse, mice respond in a really kind of predictable way, I guess. Immune function is jettisoned. Other aspects of their body kind of shrink and spend less energy as you basically starve them. But male mice don't shrink their testicles, and they don't drink their brains, right? Because if you're a mouse, you're evolved to never give up, you know, reproduce all you can.
Juna: So that's how mice respond, OK? They respond in a way that makes sense, given their very short lifespan. But in humans, we've actually seen something different.
Herman Pontzer: When people are starved, either in experiments or, you know, tragically through some kind of horrible famine or are starved. We know that actually sex drive is one of the first things to go, right? So humans seem to prioritize differently.
Eddie: Even though we may not know the details or the exact mechanisms here Juna, I think the important takeaway is that metabolism is not a fixed thing. It's adaptable. It's pliable. It responds in a way that optimizes our survival. It's not as simple as those four components that just add up in a linear way.
Juna: The study of the Hadza has led to a new theory of metabolism called the constrained energy expenditure model.
Herman Pontzer: This idea that your total energy budget is somehow constrained and your body wants to keep it within some narrow range, we call that either energy compensation or constrained daily energy expenditure view of things. And what it says, is that your metabolism is really responsive to lifestyle so you can respond to changes in activity level or, for that matter, can change to respond to changes in diet. If you crash diet, it can respond to that too.
Juna: And a key part of this adaptation response is we don't really know it's happening.
Herman Pontzer: If you stop exercising or if you start exercising for that matter, you know that because you can feel yourself move and you can feel your heart rate go up and you're aware of those calories. But most of the calories you burn every day you're not aware of, right? You're not aware of all the background housekeeping stuff that your body does. And so those adjustments, which we think are the key adjustments here in energy compensation, make it really hard to keep track of the calories that you burn every day.
Eddie: This is one of the reasons why people feel like calories don't matter. You think that when you change your behavior, you can just measure how it's affecting you. But there are effects that are just much harder for us to see. That doesn't mean that the law of thermodynamics isn't working, but it does mean some aspects of the energy out part-- the expenditure-- are just much more complicated than a fitness tracker or an online metabolism calculator may make it seem.
Juna: One interpretation of these findings, a tempting interpretation, I might add, might be "Oh my God. Exercise doesn't work. I'm just not going to do it because it doesn't burn as many calories as I thought it does."
Herman Pontzer: When you actually put people into exercise programs, they don't lose much weight. The most recent review of the says you lose about five pounds, two kilograms of weight, after a year of exercise. On average, it's way less than you'd expect. If you think about all the calories you're burning on that all the exercise you're doing. You add up all those calories. Well, how many pounds should you lose? Well, a lot more than five pounds.
Eddie: So we've talked about this before. The benefits of exercise are not just about the calorie burn, it's everything else, including the fact that it's one of the key features of maintaining lost weight.
Juna: One of the classic studies done in this field of research was actually done right here in Boston. It's called the Boston Police Study.
Herman Pontzer: They took a bunch of men on the Boston Police Force, and these are men who needed to lose a little weight so they either were assigned to the diet only or diet plus exercise. And it didn't matter which group you were in diet plus exercise or diet alone, you lost the amount of weight because exercise doesn't do a whole lot to weight loss.
Juna: After the weight loss, the groups got reassigned. So in the diet only group, half got assigned to start exercising, while the other half got assigned to nothing. And the diet + exercise group have got assigned to continue exercising. And the other half got assigned to stop. And the key finding,
Herman Pontzer: It didn't matter what group you started in, it mattered what group you got assigned to for the second half. If you got assigned to the exercise group in the second half, you kept the weight off. If you didn't get assigned to an exercise group in the second half, you tended to gain the weight back and exactly what's going on. Mechanistically there, we're not sure, but it seems to be really clearly true that exercise helps you keep the weight off.
Eddie: Aha-- you see, I never get tired of hearing about the benefits of exercise.
Juna: I know you don't.
Eddie: Speaking of benefits, I believe that one of the things we promised our listeners is something to actually speed up your metabolism. Now the bad news, it's not a powder, it's not a pill. But the good news is you can do it, and the way you can do it is with resistance training. You know, when I first heard that term, I had toddlers at home and I thought resistance training was like, No, no, no. It's actually the scientific way of describing lifting weights, getting stronger or building muscle that actually helps us increase the largest component of our metabolisms. The BMR.
Herman Pontzer: The evidence I see, says that if you gain muscle mass, then your metabolic rate will go up to match that because those cells are burning calories and they're burning more calories than they were before. Because they're new, the cells, those muscle cells are new.
Eddie: This may be part of the reason that exercise helps us to maintain weight loss. But another place where keeping muscle mass is absolutely crucial, and near and dear to my heart, is aging.
Herman Pontzer: Throughout middle age, but especially you get into your sort of 50s and 60s, and especially after age 60. We see metabolic changes, where metabolism slows down.
Eddie: OK. There may be some natural slowing because of hormones, but the vast majority of the slow down that people notice as they age is actually volitional. It's because they've reduced their activity. And most importantly, it's because they've lost muscle mass.
Herman Pontzer: One strategy to try to keep that from happening would be to keep your muscle mass up, stay strong. And so I think that there's a lot of sense to the modern push to get people who are older into resistance exercise.
Juna: Guys, last year, Dr. Pontzer was part of one of the biggest studies looking at human energy expenditure over the entire lifespan. They looked at over 6000 subjects that ranged in age from eight days to 95 years. And the key finding was there was no metabolic slowdown from ages 20 to 60. Once you accounted for people's body weight and the reduced activity, and I just want to give another plug for exercise here, because Dr. Pontzer's work often gets interpreted as because exercise does not have as large of an effect on weight loss, there's no reason to exercise, but exercise is good for so many other things.
Herman Pontzer: Exercise, we know is really important for —we can do the list— heart health, immune health, brain health, preventing yourself from getting frail as you age prevents diabetes or other non-communicable diseases. So there are so many good reasons to exercise.
Eddie: OK, I'm sold.
Juna: Yeah, well, you're not the person you're trying to sell here, but OK,
Eddie: But back to metabolism. I know something we all wonder about. Why do certain people seem to just have a faster metabolism than others?
Juna: OK, Eddie, I just want to jump in here because I grew up with a sister who had the biggest sweet tooth ever and she never, ever struggled with her weight. So this is something I was dying to ask Dr. Pontzer about.
Herman Pontzer: The real answer is we don't know. We'd love to know. Some of it is differences in like proportions, like the percentage of you that is high energy organs like your brain and your liver versus lower energy organs like your skeleton and your skin.
Juna: But even after accounting for that, there's still another 10 to 20 percent variation, which Dr. Pontzer says might just be genetic. And finally, something that he's studying in his lab right now is that there may be a developmental component to all this.
Herman Pontzer: If you grow up in an environment that perhaps encourages physical activity and has plenty of good nutrition for you, your body might respond to that by saying, OK, I can have a faster metabolism here. If you are in a nutrient poor environment, maybe you have a slower metabolism.
Eddie: To wrap this all up, metabolism is a dynamic aspect of human physiology. It is constantly adapting to the things that you're doing, and ways to support a healthy metabolism are firstly, not crash dieting and also maintaining or even increasing your muscle mass, especially as we age.
Juna: And one thing I was really curious to ask Dr. Pontzer about is, what lessons we can learn from the Hadza tribe?
Herman Pontzer: Get active every day. I think that's an obvious one. They are active every day, and because of that, they stay active and healthy and hearty into their 60s, 70s, 80s. Two is, We focus on diet and exercise. But I suspect a big part of their quality of life and quality of health has to do with things like being outside, right? Americans spend 90 percent of their lives indoors. We know that getting outside in real sunshine makes people healthier and happier. It has good mood effects. It has health effects beyond just the activity. And then the last thing they do that, I think is really important is they have a real strong community that they're part of from the moment they're born and through their old age. We know that when people are lonely here in the U.S., disconnected, that there are real, severe health consequences to that. And they're same kind of health consequences that we often attribute to exercise and diet, you know, heart disease and these kind of things.
Eddie: Our homework assignment from Dr. Pontzer. Yeah. Go on a walk.
Juna: OK.
Eddie: Outside.
Juna: OK.
Eddie: With a friend.
Juna: All right, we can do. It might be a little hard in New England, but we can, definitely, we can, definitely try. Guys, that is it for today's episode. If you are interested in our show notes, you can go to foodweneedtotalk.com. You can find us @foodweneedtotalk on Instagram. You can find me @theofficialjuna on Instagram and @JunaGjata on YouTube and TikTok. You can find Eddie walking around outside, taking his walking meetings to increase his needs. And you can read all about Dr. Pontzer's fascinating research in his book Burn. New research blows the lid off how we really burn calories, lose weight and stay healthy. Find links to his book on our website. Food We Need to Talk is produced by PRX.
Eddie: Our producer is Morgan Flannery.
Juna: Clair Carlander is our associate producer, and Tommy Bazarian is our mixing engineer.
Eddie: Jocelyn Gonzales is executive producer for PRX Productions.
Juna: Food We Need to Talk was co-created by Carey Goldberg, George Hicks, Eddie Phillips and Me, Juna Gjata.
Eddie: Always remember, consult with your personal health professional for your health questions. To find out more, go to foodweneedtotalk.com.
Juna and Eddie: Thanks for listening!
Eddie: Food We Need to Talk is funded by a grant from Ardmore Institute of Health. The home of Full Plate Living. Full Plate Living helps you add more whole plant-based foods to meals you're already eating. These are foods you're familiar with --apples, beans, strawberries and avocados. It's a small step approach that can lead to big health outcomes. Full Plate Living includes weekly recipes and programs for weight loss, meal makeovers and better blood sugar management. Best of all -- Full Plate Living is a free service of the Ardmore Institute of Health. Sign up for free at fullplateliving.org.
