self-care rituals, easy mattar paneer, and 5 health tips

from Dr. Sethi, plus answers to 10 reader questions

I am thrilled to introduce you to

Tanmeet Sethi, MD

today. I met Dr. Sethi right here on Substack, where we connected over our shared passion for everything metabolic health. Dr. Sethi is a physician, activist, author, and speaker, and she has kindly agreed to a Q + A for Nest Wellness. Thank you to all of you who submitted questions, and a huge thank you to Dr. Tanmeet Sethi!

Mark your calendars!

Dr. Sethi will be the metabolic health expert answering your questions inside The Blood Sugar Method course on July 10th at 10:00 am PST. If you are already a member, RSVP inside the course to get the Zoom link. If you would like to be a part of the course, sign up here!

Dr. Tanmeet Sethi

Welcome to Nest Wellness, Dr. Sethi!

When did you know you wanted to be a doctor?

This was a challenging decision for me. I knew I wanted to impact people’s lives in an intimate and profound way but was undecided between medicine and teaching. I pursued my pre-medical requirements but majored in African History. I then took time off after college and taught in China while I decided. In the end, I decided medicine would be the most flexible and powerful way to make change and ironically, I have spent my 27 years in medicine both caring for patients and teaching—in the academic setting with resident physicians, speaking globally, and through my Substack publication! I got to do both in the end!

How did you choose your specialty?

I knew when I went into medicine that I did not want to be a ‘typical’ doctor. I grew up with Ayurvedic treatments in my home passed down through my mother. These treatments included changes in food, routines and ways of thinking. So, I knew from a young age that there was more than just conventional Western medicine. I just didn’t know the science behind it all.

There wasn’t a term like Integrative or Functional Medicine when I went to medical school, that came later. But I knew I wanted to do just that, pull from the most evidence-based treatments through the world and teach patients how to find the root cause of their symptoms instead of just using band-aid medications or procedures. Now I integrate all the best of nutrition, functional medicine, mind-body medicine and the understanding that there is so much to do before you even go to the doctor. Family medicine was the best way to integrate my holistic philosophy and take care of patients in the context of their family, environment and socioeconomic challenges.

How has your personal journey shaped the way you practice medicine?

Two big things have shaped my practice of medicine: One is the integrative philosophy I described above. It has shaped everything I do in medicine, even my most recent foray into psychedelic medicine which has brought my work in spirituality, trauma work, plant medicine and social justice full circle. And the second massive part of my journey is my second child receiving a degenerative and fatal diagnosis (It’s like an ALS in kids), when I was pregnant with my third child. It was a nightmare to think of how to navigate this new reality. It has shaped everything for me personally and professionally. I now have a very intimate superpower to sit with the most profound tragedies and suffering in ways that patients need. I also went on to write my first book, Joy Is My Justice, based on my and other patients’ experiences in trying to thrive after tragedy and finding that Joy is very different than happiness and much more sustainable and nourishing. I now am on a mission to change the mental health conversation.

What do you think are the superpowers that women bring to doctoring, and how have you used them in your own business?

Women have too many superpowers to list! ☺ But when it comes to medicine, I think some of our biggest ones are fine-tuned empathy and the capacity to make decisions from a balance of data and intuition. That is really important in medicine where you don’t always have all the labs or test results available in a moment, but you need to make split second decisions to triage patients to the right level of care. There’s a reason women make up more than half of all medical students!

What keeps you fired up and passionate about your work, even when things get tough?

For sure for me, it’s the deeper why. You might guess my why is to help others but that just skims the surface. What I found when I really explored my deeper layers of why I do what I do, I realized that it was so difficult for me to feel safe growing up as a brown girl in the south and constantly being targeted as a family. I take care of and advocate for others to make them feel safer, so that I know the world is safer for all of us. That keeps me going, always.

Is there a particular project or moment in your business that you’re super proud of?

There are so many but the one I think about often is the publication of my book, Joy Is My Justice in 2023 with a Big 5 publisher, Hachette. I had no platform or social media fan base at all, had no clout behind my name, and yet, the book went to auction and I got a book deal with a top publisher. I know it is because that book is needed, well written, and so compelling. I feel so proud of the work, and it impacts lives daily. I am eternally grateful I went for that dream.

How do you juggle running a business and living your life? Any favorite self-care rituals you swear by?

I will be honest, balance is elusive, day to day. Some days it’s elegant and others a mess!

I always, no matter what, get some movement. What I focus more on is the journey and the process. I navigate that with a practice of daily, profound gratitude to the earth and those who support me as well as humility to the fact that I am only human, and cannot always do everything I wanted to.

On those days, I lay down to bed at night and do a meditation I created to the “gods of the river of balance.” I ask for grace if I worked against them that day and resisted what is, or I express gratitude for flow with them that day. But either way I welcome in the river the next day and hope that I can try once again to flow with smoothness and grace.

Do you have a favorite go-to dinner recipe?

In our house, we do meal prep and menu planning every Sunday for the week. It not only keeps us sane and eating healthier, but it also is better for the earth. You waste less when you shop with intention for the week. We think out menus week to week and they usually contain a mix of Indian, Asian, and Mediterranean meals. But my quickest go-to when I am in a hurry and still need to feed my house of mixed omnivore/vegetarian eaters is mattar paneer (peas and paneer, Indian style) with rice. It packs in the protein and vegetables, is comforting and satisfying and makes everyone happy!

Photo by Kalyani Akella on Unsplash

What would your perfect day look like?

My perfect day would be starting in the peaceful dawn hours of the day with some sketching or reading and brewing a perfect cup of coffee with my husband. Then sitting with him and checking in before the house wakes up. I relish when we get alone time with our busy schedules. Then we would spend the day with our kids, either taking a long walk in nature, playing games, cooking good food, dancing, or some combination of all of that. And always, a perfect day includes laughing so hard that my belly hurts!

What’s got you excited about medicine right now?

The awakening to the Indigenous healing medicine of psychedelics. I pursued certification and training in this field several years ago and now practice with ketamine in my clinical practice and conduct research on psilocybin at the University of Washington. I have worked in communities traumatized by addiction, manmade and natural disasters and personal grief for decades and these medicines are not a one size fits all solution. But they are one of the most exciting tools I have learned to work with to shift consciousness and perspective. I explain them to patients this way, “Psychedelic medicine can rearrange the material of your mind so the unseen can be seen.”

What kind of legacy are you hoping to build with your business, and how do you want to influence the next generation?

I think we all want to do business that serves the greater good so that goes without saying. But in addition to that, I also want to create a legacy of how to do business in a compassionate and sustainable way and still make profit. Making a living does not have to mean compromising on your values and two of mine are compassion and reciprocity. There is always someone else also responsible for my success. It’s my responsibility to give back to them whether it’s financially or by giving credit and acknowledgment to those who paved a path for me.

5 tips for better metabolic health:

1. Try not to snack at nighttime. Finish dinner and be done so that you have at least 12-13 hours between dinner and breakfast.

2. Eat your protein first with every meal, don’t load up on carbs first. (Those darn bread baskets should come last ☺)

3. Avoid sugary drinks, they wreak havoc with your insulin levels.

4. Move your body as often as possible, and throughout the day. Work it into your schedule so that it’s not only in bursts of exercise.

5. Get good amounts of fiber every day. It promotes satiety, balances blood sugar levels, and feeds your gut microbiome well.

3 things you would never do or eat:

1. I would never smoke.

2. I would avoid sugary drinks at all costs.

3. I would never ride my bike or ski without a helmet.

Audience questions:

1. Is there a reliable way to measure/ascertain that one has Insulin Resistance?

There is not one definitive test. It’s a combination of clinical judgment, history and lab tests which may include fasting blood glucose, hemoglobin A1C and/or fasting insulin. In some patients you may even need a glucose tolerance test.

2. How to lower insulin resistance and keep it down.

Anything you can do to keep glucose levels stable and less erratic will help maintain insulin sensitivity. This means eating low glycemic foods, pairing food with adequate fiber, fat and protein, exercising regularly, and some level of intermittent fasting which depends on your age and health profile in terms of how long to fast each day. As well, insulin sensitivity improves in the 48-72 hours after exercise so regular exercise each week is paramount.

3. How to combat the onslaught of hormonal disruption and up-regulating insulin resistance in the cells even when your eating low gi food, exercising and. Fasting. Is the only answer push spaghetti uphill till post menopause or take hrt. I've been working on it for over a year and still my IR is intransigent...and I'm def Peri menopausal

It sounds like you are working so hard, so first I want to give you kudos for that. And yet, it can be so frustrating. All the things you are doing do matter. On top of that, HRT, you are right, can be very beneficial and I would talk to your doctor about taking it earlier rather than later, depending on how your lab tests look.

4. Best foods to eat to fight insulin resistance. Any supplements that help?

There is really no supplement that can beat food as medicine. And that means eating low glycemic foods, avoiding processed foods and high carbohydrate packaged foods, as well as getting adequate fiber, protein and healthy fats. I do use cinnamon and berberine often in my practice as well as magnesium and think all of these can be helpful, but nothing beats the food we eat.

5. What can be done pre-menopause to help offset the future impact? How to prepare the body for perimenopause.

My number one advice is to maintain and increase lean muscle mass pre-menopause. Muscle is your number one organ for metabolic health later.

6. Why does Insulin Resistance increase with peri/menopause? Is it due to decreasing hormones, and if so do they recommend HRT to reduce IR? What about GLP1’s to reduce IR?

Love this question! I am doing an article on it on April 25^th if you’re interested (Free to all subscribers) But yes, you are right. Estrogen is a key hormone to maintain insulin sensitivity and when it decreases, we increase our risk of insulin resistance. HRT, especially when started early in menopause can be very helpful for decreasing this risk. GLP1’s are an entire subject in of themselves and my short answer is yes, they can be helpful. But I plan on writing more on this soon as well.

7. I've heard conflicting recommendations about HRT. 1. No need for HRT if you do not have noticeable symptoms, i.e. hot flashes, mood swings, etc. 2. Must use HRT no matter what to help avoid possible Alzheimer's, heart attacks, and osteoporosis. What do you recommend?

I don’t think anything is ever a must do. In this case, I think it involves a comprehensive discussion between physician and patient of the risks and benefits and of course making sure there are no contraindications. Here’s a simplified way that I see it, knowing all the science of its benefits and as well, an understanding of the physiology. It’s really not that different than replacing a woman’s thyroid hormone if it is not being secreted in sufficient amounts. There is a reason we make estrogen and when it ends, we feel the effects on our heart, bones, and brain. So while I do not think all women must do this, I think it’s important that every woman has the opportunity to review their choice and the risks/benefits. It’s an important women’s health issue that has been overlooked for far too long.

8. Also, how does your recommendation change for women with endometriosis, who are primarily estrogen dominant? Estrogen can cause endometriosis to worsen.

This is such a good question. And the science is not clear, the evidence is really limited in how to manage women post menopause with a history of endometriosis. What I can tell you is that it is a nuanced decision and I take into account many factors, including how well the inflammatory cellular environment is managed for the patient -ie in any women with endometriosis, I work hard with them on gut health, anti-inflammatory eating patterns, supplements, weight control as fat tissue secretes endocrine hormones that can increase this inflammation and estrogen effect. And I work with women to explore their unique menopausal symptoms and quality of life to make decisions with them. It’s not clear cut. But transdermal forms of estrogen are better to use and always, always need to be balanced with progesterone. As well, some women do better with bioidentical forms. So, there are many factors to consider. And I am hoping the science gets better on this.

9. What can take away the sugar cravings? I am post menopause and cannot work out like I use to. I am diabetic also but the sugar cravings are just crazy.

This is such a good and important question. I can tell you this is complex and nuanced for each person but I will give you the general approaches I consider in this situation. For one, intense sugar cravings indicate to me gut dysbiosis, i.e. imbalances in the gut microbiome and I work with patients to rebalance that. As well, I work with patients to do a 10 day to two week sugar detox, it takes 10 days for the taste buds to reacclimate and I swear to you, every time you do this, the cravings decrease. I also use breath work in tandem with this. Both of these have scientific basis and my clinical experience is they make a big difference, especially when combined with the work on gut health.

10. I am curious about the timing of beginning HRT and menopause. I have heard and read conflicting information about when you must start it to gain the benefits for metabolism/cardiovascular health/and IR. Curious to have the opinion of a doctor with these specialities.

What we know so far from the literature is the earlier during menopause you start HRT, the better the cardiometabolic effects. That being said, the data also does show that in the first ten years after menopause starts, HRT has the potential to be helpful so I would not count anyone out who had not started earlier. The reason you probably have heard conflicting information is because there is clear science about the benefits but not clear science on when the plateau of these benefits occurs.

5 things Dr. Sethi is loving!

1. My new pour-over Hario V60 with olive wood is so beautiful to look at and use that it has elevated my morning coffee ritual.

2. Springtime gardening! I think of food as medicine, and it starts in the garden. There is something so wonderful about growing from seed for me. It’s a way of connecting to nature that lights me up!

3. For my birthday, a friend gifted me Wilderton Citrus Apertivo, which I’m loving. I love cocktails, but gave up alcohol two years ago, and this Non Alcoholic spirit is so delightful.

4. The Flecks of Gold journal, which was designed for moms to use over 3 years, but I recommend it to all patients and use it myself. Each day you log your gratitude, you can see your ‘fleck of gold’ from the year before. It’s a beautiful way of soaking in the gratitude and teaching your brain to look for AND remember the good!

5. I am loving the conversations I am having in the world around my book, Joy Is My Justice (Hachette, 2023). The content has never been more timely with the challenging world we live in, and my readers remind me every day why it’s important to understand Joy, not as a destination or contrived positivity, but as a tool for thriving in a complex world.

Dr. Sethi and her book: “Joy Is My Justice”

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