Podcast Drop Date: 3/8/23
Amber Warren, PA-C has an in-depth conversation with internationally recognized hormone & cardiometabolic expert, Dr. Mark Holthouse, MD. Get ready for an informative episode with Dr. Holthouse as he reveals why the battle against weight is a struggle for most Americans, and unveils a functional and sustainable approach to achieving a healthy weight. Get ahead of the game with the latest and greatest research on effective weight loss that will leave you feeling informed, inspired, and ready to take on your weight loss journey! Don't miss out on this must-listen episode!
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Transcript:
Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.
Amber Warren, PA-C: Welcome back. I'm Amber Warren here, your host, back here with Dr. Mark Holthouse. Dr. Holthouse trained. He did his medical training at Loma Linda, where he now teaches preventative cardiology and he has for the last decade. He also did training within the Air Force and did training at UC Davis as well. He teaches for the Institute for Functional Medicine. He's part of the teaching faculty where he teaches on hormones. And he also is going to be teaching for a national compounding associating conference here in Vegas in a few weeks. Yes. So he is internationally recognized for both cardiometabolic medicine and hormones. And we are just honored to have him. So we're here today talking about really a functional approach to weight loss. Two thirds of our country is either obese or overweight. And we want to change that statistic because with that comes a whole host of medical issues and issues with longevity and cardiovascular disease, which is by far the number one killer in our country. So it's actually really exciting. As a group of practitioners with functional medicine foundations, we put together essentially a weight loss program and package in a way that we feel like is going to offer the most success for these patients that are really interested in in just decreasing inflammation, decreasing the risk of chronic disease. And let's be honest, improving body composition, right, because that's something we all want as well. So what are some of your favorite approaches to getting some of your patients that have this goal saying, Doc, I just I need to lose weight?
Dr. Mark Holthouse, MD: Yeah. You know, first of all, I try to get them to give themselves a break and often it's the self sabotage and people get down on themselves. They do. And so we start there and say, okay, this is day one of your new life. Stop blaming yourself. Stop getting down on yourself for past failures. What is failures? It's trying something until you win. Yeah. So reframing. Yeah. Is there going to be an instant magic bullet? No. Right, Right. And we've got some things that are we're going to be talking about that folks are the latest and greatest, newest, bright, shiny toy, thinking of it that way. And it doesn't work that way either. Yeah. Surprise, surprise. Yeah. Intermittent fasting is probably my go to. And you know, if they're premenopausal females that are single moms stressed out. Yeah, I'm not going to tell them to do intermittent fasting and raise cortisol and antagonize their stress that they already have. Yeah, we might modify that in some way, but the idea is that we just eat too often and we're always keeping our insulin high when we do that. Yeah. And we can't burn fat when our insulin is high, right? It just doesn't happen. We can't go out into the proverbial deep freeze, you know, the garage, you know, to access the fat and burn it easily like we can. The refrigerator in the kitchen, which is carbs. Yeah. 1977 NHANES government study looked at frequency of meals in the United States and we were at three meals a day.
Dr. Mark Holthouse, MD: Yeah. Fast forward 2005, same group, US population six meals a day on average. You know, this is in addition to the timing of of introduction of things like high fructose corn sirup and video games and a whole lot of other things. But there's no doubt that the frequency of meals, having a insulins that are constantly elevated in a post Fed state, which make it very difficult for us to burn our peripheral stored energy, we call that fat. So intermittent fasting or time restricted eating has become vogue. It's not new. It's been around for millennia, for religious purposes and whatnot. We're not really talking, though, about prolonged water fasts. We're talking about taking the same number of calories, what we call an isocaloric diet. Save for an average female 16 to 1800 calories, depending on how active they are being their basal metabolic rate and saying, hey, we want to make sure you get at least that amount that you're not eating under your BMR. Over eight hours, maybe two meals instead of over a 12 hour window. Three hours. The data out of USC has shown that if we take those people and we combine, we compare them to folks that are getting that same number of calories over 12 versus over an eight hour eating window, there's a difference in weight loss, even though there's no difference in calorie intake.
Amber Warren, PA-C: Yeah. I'm curious your thoughts and approach to that, that that eating window, that feeding window that we're recommending for our patients. I've been playing with, I'll be honest for myself, but also some some of my patients that are in my same age range on a more what they're now calling reverse intermittent, where instead of, you know, the skip breakfast because we're all in a hurry getting our kids off to school, not eat till lunch, and that's your two meal a day, lunch and dinner, but instead saying, wait a second, I know what cortisol is doing in the morning. I don't want to make it spike more. I work out in the morning, I'm fasted. I'm rushing to work, rushing my kids to school. Do I want to make that cortisol spike more than it already is? And then I now know what insulin like growth factor growth hormone is doing at night. So do I want to be eating close to when that's trying to rise? So I've actually started shifting my window. Do you do you agree with that?
Dr. Mark Holthouse, MD: It's the optimal way to do it. Okay. Especially if people have prediabetes or insulin resistance, what we call a lack of metabolic flexibility where they can't really shift easily between glucose as their primary way of maintaining blood sugar versus other other macronutrients. So I try to get my pre-diabetic patients and certainly my diabetic patients that we monitor very closely doing this type twos only to front load the day. Yeah, I like reverse. That's cool. I use that.
Amber Warren, PA-C: I know I'm using that term.
Dr. Mark Holthouse, MD: But it's it's probably superior to do a 6:00 breakfast, 10:00 lunch and be done eating by 233 in the afternoon. Right. We know that that's physiologically more, more it's preferable. Yeah. The problem is for people like me, I'm seeing patients at 10:00 in the morning and at two. And so it's more of a pragmatic compromise.
Amber Warren, PA-C: Well, and it is difficult when you're eating dinner with your family. It's like my family can't eat dinner at three and we're working.
Dr. Mark Holthouse, MD: So it's that's the other thing.
Amber Warren, PA-C: Disruptive to eating it is family and that's family time and that's important.
Dr. Mark Holthouse, MD: The biggest the biggest thing is, I think, to avoid eating after dinner late at night. You know, I'm guilty watching TV. I'm relaxing. And, you know, I'm just not quite satisfied. And you just start that thing back and forth to the pantry and, oh, my gosh, if it's carbs, it's like putting gas on a fire. You know? So I know I'm in trouble. I'll go grab a piece of celery, load it with as much peanut butter as I can get in my mouth. Oh, you're so lame.
Amber Warren, PA-C: Or I'll put.
Dr. Mark Holthouse, MD: Or I'll put an avocado with with, you know, you know, a good oil in it and down that the the things that have satiating power. We know carbs don't have a satiating ability and things.
Amber Warren, PA-C: That aren't going to spike blood sugar at night when your body doesn't have anything to do. Exactly.
Dr. Mark Holthouse, MD: Yeah. So I try to get them to eat their last meal or the last thing they put in their mouth other than toothpaste three hours before they go to bed.
Amber Warren, PA-C: That's great. Yeah, that's great. Um, I knew you were going to want to start there, because that's your jam. I just know that, um. I'd like to go next towards the. I mean, let's just be honest. It's the Hollywood weight loss drug right now. I mean, everybody's talking about it, right? The Semaglutide. Yeah. Um, we're using it. It's actually part of our weight loss package because it does work and it does more than just get people to lose weight, honestly, right? When you look at the data and now that we've been using it for a while, um, it's what's called a GLP one agonist. So let's break that down so we can say, how does it work? Yeah. And how does it function within the pancreas and what it does for blood sugar postprandial.
Dr. Mark Holthouse, MD: Exactly. Yeah. These are not, this is not a new drug class, right? Peptides in general are I said the word naturally occurring protein like structures that our body makes. Semaglutide is a peptide one of 7000 that we know of. Semaglutide being a GLP one agonist, glucagon like peptide agonist has been used for years with type two diabetics to lower blood sugar, and it does that by delaying gastric emptying how fast your stomach lets things through. It pops insulin just a little bit to cover glucose and it suppresses something called glucagon, which raises our blood sugar. So it's only been recently 2021 FDA approved these drugs for weight loss. And so now everybody's gone crazy thinking there's this magic bullet and they don't have to worry about changing their diet, exercising, managing their stress, getting good sleep, good gut health. They just can take a shot once a week. Yeah. Endocrinology clinics are giving this stuff out like water. There was back orders on it a couple of weeks ago. People couldn't get it so incredibly helpful. My experience has been the sustained benefits require doing these other things.
Amber Warren, PA-C: I'm always telling my patients. And when I explain the mechanism of action and what it does for these hormones postprandial and how it just really works to stabilize blood sugar, guess what? So does a ten minute walk after you eat? So does making sure you're eating carbohydrates with a protein. And let's talk about what kind of carbohydrates they are and the kinds of foods. Oh, my goodness. High fructose corn sirup or even some of these sugar substitutes. And what those are doing to to blood sugar postprandial. So, yeah, I think there's or even I guess it's appropriate to to go here next in this package. We've we've laid out really a pretty pretty beautiful list of supplements that can work synergistically with Semaglutide or other peptides that we choose to use for weight loss purposes. But but Berberine is one that has the same effects on some of these, not only on on microbiome and gut health, but on some of what these hormones do after you eat. So it's.
Dr. Mark Holthouse, MD: Amazing. Yeah. You know, Berberine being a plant that was kind of it was used to treat dysentery, you know, and they accidentally noticed that the diabetics didn't need their, their diabetic medications as much when they took berberine for their diarrhea. And so now we know quite accidentally, kind of like we discovered penicillin, right. That berberine worked to help lower blood sugar, help lower lipids and are incredibly helpful for managing energy metabolism. But this gut connection that you allude to in probiotics, low testosterone, you know, being associated with a gut that's out of alignment, fatty liver disease and and abdominal obesity being related to gut microflora. And this leading to hormone imbalances, low progesterone and women, low T and guys. These are not theories anymore. These are like hard science. So it's phenomenal to me that we can add probiotics to help people lose weight.
Amber Warren, PA-C: Yeah, I was reviewing a study that was sent to me late last year and it was two cohorts of people and one was given obviously a placebo. The other one was given a combination pre and probiotic, and 90 days later it was pretty significant the loss of visceral, adipose tissue in the individuals that were given the pre and probiotics. Incredible. It was. It's pretty.
Dr. Mark Holthouse, MD: Cool. It's the fat loss we're all wanting. It's the bad fat, the white fat, the inflammatory fat, the dangerous fat, the fat that we were just talking about last session makes the type of estrogen that can stimulate bone cancer or breast cancer estrogen. So, yeah, visceral fat belly fat is kind of evil.
Amber Warren, PA-C: Yeah, definitely. Definitely. So. So another thing that we're doing in clinic is doing body composition testing. I know you do a lot of it. In fact, when you started with us, you said, I can't do what I need to do if we don't buy this machine, right? I was like, okay, we need to get it.
Dr. Mark Holthouse, MD: Right off the bat.
Amber Warren, PA-C: Ultimatums. Yeah, you did. You did. What are what are some of the most important things that you're seeing when you do body composition testing on your patients?
Dr. Mark Holthouse, MD: It's great whether we're doing DEXA scanning, whether we're doing because we have the BIA machine, which is great, kind of on par with the underwater fat dunk tank. As far as validity, Yeah, looking at percent body fat, looking at fat free mass, looking at visceral fat, looking at body water, how much is in the cell versus how much is outside of the cell and what that means. People come in with a weight. Means nothing to me. I don't know what that means. Like my dad used to say, I want to know what you're made of. I want to know what they're made of. Yeah, How much? How much of that is metabolically active and how much of that is inflammatory fat? So monitoring weight, even body mass index, BMI, I think is great for insurance salesman, but it has no real place in a medical practice. Yeah. Bmis, don't take into account your lean muscle or your frame size, which are huge. So all of my football players that are cut that are 15% body fat are obese by their BMI. Right? Yeah. So really you have to use that as a baseline to see if the fat, the weight they're losing isn't just water and that it's not losing muscle, it's actually losing fat.
Amber Warren, PA-C: It's this whole term Sarcopenia, Right.
Dr. Mark Holthouse, MD: Sarcopenia is part of aging. It is. You know, we.
Amber Warren, PA-C: Talk so much about losing bone health, but if you keep the muscle mass, which I think is really our organ of longevity, the bone will follow. Yeah, right.
Dr. Mark Holthouse, MD: I agree.
Amber Warren, PA-C: That's how we should be approaching this.
Dr. Mark Holthouse, MD: The two biggest priorities for anti-aging internally. You know, not thinking about the crow's feet and everything else which follows sometimes. But unless you get too much sun from skiing, right, farm kid or loss of lean muscle and our immune cells becoming inflamed. And developing into these zombie cells, which is another discussion.
Amber Warren, PA-C: A whole nother discussion. Yeah. So when we're trying to think about longevity and as it relates to to lean muscle mass, what are you recommending nutrition wise? I'm assuming macronutrients push the protein, I'm assuming.
Dr. Mark Holthouse, MD: Yeah, not high protein, but adequate protein. You know, again, depending again on their activity level, if these guys are guys or gals are doing strength training 4 or 5 days a week for an hour, you know, they're going to be on the higher end of that recommendation. You know, 1.2, 1.3, 1.5mg per grams per kilogram. Ideal body weight. Good. Yeah. Versus somebody who's a little bit more sedentary, I'm really careful not to over push protein because I don't want to put that load of acidity. Yeah. That's amino acids right in the body.
Amber Warren, PA-C: Yeah.
Dr. Mark Holthouse, MD: Nor do I want to put that much load on their kidney. I think the most important thing is to realize that if you avoid simple, simple carbs, focus on complex. Go crazy with the plants of all different colors. Get the fiber. Get those phyto pigments in you. We know they're uncoupling your mitochondria, which is involved with thermogenic weight loss. There's the whole issue of what we got wrong about ketosis. You know, how does how do ketones actually work? Are they really better, more efficient fuel molecules over glucose? Not buying it anymore. Ketones at best supply about 20% of our body's energy supply. I think what's happening is that these ketones are uncoupling mitochondria which actually allow our mitochondria to multiply and to detox themselves and to clean out all the worn out cell parts.
Amber Warren, PA-C: I mean, I think you could have a whole episode talking about mitochondrial health and weight loss and decreasing risk of chronic disease. Yeah. So we've picked out one of the supplements actually is, is to help improve mitochondrial health. It's really important. And then of course, the detoxification aspect of everything and what that's going to do for your mitochondria.
Dr. Mark Holthouse, MD: We talk about these kind of super nutrients, right, for weight loss and it's based on physiology. Your B vitamins instrumental in the Krebs cycle, magnesium, alpha lipoic acid, some of these things that are just indispensable for burning energy, burning food.
Amber Warren, PA-C: And that's where it's important to look at labs, right? Not everyone fits in a box. Not everyone's going to get this this nonspecific package for themselves, or they eat perfectly.
Dr. Mark Holthouse, MD: And they've been in the gym an hour a day. Doc, I'm not moving the needle. What's going wrong? So true, you know. Well, well, let's look at thyroid. Yeah. A lot of times that's already been done. What about hormones? Hormones? Yeah. What about. Peptides. What about GLP one Agonists? And there's so many more that are out there now.
Amber Warren, PA-C: We're learning more and more about new ones coming.
Dr. Mark Holthouse, MD: Out. Exactly. They work through different mechanisms and they're synergistic with each other. With growth hormone, releasing peptides and things that help us sleep, regenerate our tissues.
Amber Warren, PA-C: Which then in turn helps way less you get somebody sleeping, their cortisol levels come down, that visceral, adipose tissue, the belly fat goes away. It's all related. It's amazing.
Dr. Mark Holthouse, MD: So that's the fun part, is that you're using cell signaling molecules that your body's evolved with. It understands, yeah, these are not new to nature. Synthetic patented medications necessarily know Now some of them are patented, some of them are not. Yeah, the FDA approval process is a whole nother discussion.
Amber Warren, PA-C: Yeah. What's interesting to me on how they're kind of marketing and advertising the semaglutide is that they don't always say and sometimes they hide the fact that what is it? 15% body weight, right. Using this, which is really impressive. 10 to 15%. 10 to 15%. Yeah. But what they don't always share is that that's with caloric restriction and movement. Yes. So they don't always include that part.
Dr. Mark Holthouse, MD: And those are the folks that that just give themself the shot. Right. Once a week for three months, six months that are losing 3 pounds and gravely disappointed and kind of sheepishly come in and say, well, I didn't do the time restricted eating. I didn't do anything you said about the right kind of exercise or or managing my stress. My job is still killing me. It's toxic, right?
Amber Warren, PA-C: So let's talk about. Right can exercise. What are you telling patients?
Dr. Mark Holthouse, MD: So two things for cardio. I have them do hit high intensity interval training 2 to 3 times a week, making sure they get cleared by somebody that knows that they're safe to do that first from a cardiac perspective and that they don't injure themselves, but that, you know, that's the idea of going all out for 30 seconds, 45 seconds a minute. Tabata drills, kind of a synonymous term and then recovering for the same or maybe a little longer. As you get more fit, these intervals can change. We're talking seven minutes. 15 minutes? Yeah. Max. Yeah, two, three times a week. Max, You don't want to do this every day. You know you want to recover. And then, of course, strength training would be the second thing that's incredibly four days a week minimum. I think to really move the needle, you know, 45 minutes is enough. Okay. But using a trainer group, group training classes are wonderful because they're going to have somebody to watch your form so you don't blow your disc out or blow a shoulder out because you think you're 20 still. And yeah, so I think those are the two. You know, I don't recommend slogging away on a treadmill, you know, at the old 220 minus your age, 75% necessarily is the most effective way. And we know weight loss really pitiful. With exercise, it's all about food. Yeah, it really is about food. Nutrition.
Amber Warren, PA-C: Absolutely. Yeah. No, I was looking at some of that data. Actually. I'm looking at it in this peptide training course I'm doing on just how four minutes a day of that type of exercise increases your VO2 max and when you increase your VO2 max, what that does for mitochondrial health and just longevity. And it's like that's pretty impressive. Like there's almost no excuse to not be doing that high intensity type training.
Dr. Mark Holthouse, MD: The plants do the same thing. They can't move. Think about 107, middle of Boise, summer, July. They've got all this stress. So they develop these same adaptive things that keep their oxidative stress levels low. You know, their mitochondrial equivalents do the same thing when we eat them. It's not just the fiber helping make our short chain fatty acids, our butyrate and our acetates to make ketones. It's those pigments, those phytonutrients that have these antioxidative and anti stress molecules that are genetically helping us to turn on genes like sirtuin ones. And so with some of these peptides are doing as well that are anti-aging antioxidative. So it's pretty exciting to see how hormones. Toxins. Some of these natural protein cell signaling molecules and good old therapeutic lifestyle. Are all connected. It's incredible. And they're a jealous mistress. They don't want to be separated.
Amber Warren, PA-C: Yeah. For each other. Yeah, it's pretty it's pretty amazing when we look at it as a whole. Um, sleep. I don't think any weight loss conversation is complete without talking about sleep because it's so important. And regulating hormones and cortisol and and the growth hormone at night.
Dr. Mark Holthouse, MD: Right, Right. We know shift workers that have circadian that are out of whack, circadian rhythms, biological clocks have more cancers. We know that they have a lot more cortisol. We really screw up our cortisol and our melatonin at night when we're we're not getting quality sleep. I'm not talking about being. Excuse me. Unconscious from drinking too much wine. That gives you kind of crappy sleep. Sleep architecture or a sleeping pill? Yeah, I'm talking about good natural sleep where you got adequate REM cycles and stage three, four deep cycle sleep where you're going to do testosterone and growth hormone, respectively. These are the areas where you're going to see cortisol modulated. It's going to allow you to be less inflamed, less stressed, your blood pressure, blood glucose, all those things do the right thing. So many people are waking up at night not because they have low estrogen with hot flashes, but because their cortisol spiking, because their blood sugar is dropping. And there's this obligatory response that the insulin has to come out of the pancreas to respond to that or glucagon. So in sleep, it's really about what happens at night that you're missing out on. And what happens when you've got excess cortisol because you're not sleeping well, what it does to the gut.
Amber Warren, PA-C: One of one of the peptides I know you and I are using a lot of is really good at increasing the stage three for sleep and it's the stressed out inflamed patients that and also patients with autoimmunity that can't get that stage three. I guess I guess stage four is now not a thing. I guess it's now just stage three. So maybe I should just say Delta. Yeah, yeah, yeah. So they can't get that phase of sleep. Well, that stage of sleep is when our brain takes out the trash. It's when our brain detoxes. So no wonder everyone's got brain fog because who's not stressed, inflamed or dealing with some kind of autoimmunity. Exactly. So I'm really impressed. I mean, I think we love the anti-aging benefits of this this peptide. We're using this this growth hormone analog. But I'm impressed with the sleep changes I'm seeing in some of these patients. It's awesome.
Dr. Mark Holthouse, MD: What a lot of them will do is just drink too much. And we saw that, you know, And what does that do? It suppresses t production both at the brain and the testicle causes leaky gut carcinogen. It screws up sleep architecture. You think you're sleeping.
Amber Warren, PA-C: But you're not not getting that deep sleep.
Dr. Mark Holthouse, MD: So I always tell people, hey, enjoy your occasional wine or whatnot, but for gosh sakes, let's do other things to go root cause on disrupted sleep so you get good architecture and.
Amber Warren, PA-C: Then the alcohol, what it does to the microbiome. We know it pretty much destroys the pretty much, pretty much. So then you're just back in that vicious cycle with a healthy gut.
Dr. Mark Holthouse, MD: I know. It's just so it's so wrong.
Amber Warren, PA-C: Well, I know you and I are both doing consults right now in this this weight loss program we're launching. And it's it's just exciting. And we're it's just, you know, we're it's another aspect to kind of us personalizing medicine and just really trying to hear our patients and try and reach some of their goals. Yeah. So we're really excited about it. I always end each conversation with if with in relation to this discussion, what's one piece of advice that you give your patients that moves the needle the most?
Dr. Mark Holthouse, MD: Yeah, you know, it's really hard for me to get off of this bandwagon and that is. You need to. You need to cut yourself some slack. Yeah. I think the biggest self-saboteur. Is around this topic. Both men and women.
Amber Warren, PA-C: It's true. Both sexes. Yeah.
Dr. Mark Holthouse, MD: There's a lot of shame. And all that does is raise cortisol and prevent you from taking intentional steps towards a solution.
Amber Warren, PA-C: Yeah. And there's no perfection here. No, you and I, we do functional medicine every day. I don't eat perfect. Right, Right. This whole concept of eating hygiene, we didn't even go there. But what that does for postprandial hormones that are released. Yeah. I mean, you eat on the go that that's not doing anything good, but it's being mindful. Yeah. Mindful eating. Yes.
Dr. Mark Holthouse, MD: After all, Rest and Digest is a vagal nerve function. And we can't do that when we're sympathetically fight or flight. And that's where a lot of us live. So we try to eat that way. Yeah. So how much are we really extracting from the wonderful, expensive organic foods that we're buying? So true.
Amber Warren, PA-C: So and then what is our blood sugar doing after those foods? It's not very stable. Yeah, well, thank you, Dr. Holthouse. I love, love having these kind of conversations with you. Thank you, everybody.
Dr. Mark Holthouse, MD: Thank you.
Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at FMF and the highest quality of supplements and more. Go to Fun Med Foundations dot com.