Updated: 4 days ago
Podcast Drop Date: 10/19/22
Amber Warren, PA-C has an in-depth conversation with internationally recognized hormone & cardiometabolic expert, Dr. Mark Holthouse, MD. In this episode they discuss:
Connection between inflammation, gut health and hormone imbalances
Central obesity leading to systemic inflammation leading to insulin resistance and hormone dysregulation
Stress, cortisol, hormone dysfunction
Cell signaling protein treatment for supporting improved body fat/lean muscle composition, aging, repair
Resistance training and HIIT- Not just any movement but the right movement
Time Restricted eating- more than weight loss
Toxicants and hormone dysregulation
Learn more about our Radiant Woman program
EPISODE 2 | TRANSCRIPT
Host 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. Welcome back to our podcast, Amber Warren here again, and I have the privilege to introduce one of my favorite humans. This is Dr. Mark Holthouse. He is our has been our acting medical director at Functional Medicine of Idaho since 2020 and now medical director for Functional Medicine Foundations. He graduated from Loma Linda School of Medicine and did his family practice training at UC Davis. He currently and has spent the last ten years teaching at the Loma Linda University School of Medicine, where he teaches in cardio metabolic preventative medicine. He's also on teaching faculty at the Institute for Functional Medicine, where he also teaches cardiometabolic preventative medicine and teaches their advanced hormone modules. He owned his own functional medicine practice for 28 years before moving to the great state of Idaho, where he loves the outdoors, he enjoys photography, mountain biking and really anything on water or snow. And we are just so honored to have him as a part of our team. So today we're talking about one of the areas of expertise we offer with within functional medicine foundations and essentially how to be a radiant woman. So we're really excited to dig into this today. So, Dr. Holthouse, first of all, welcome. We're so glad to have you.
Dr. Mark Holthouse, MD: Happy to be here.
Host Amber Warren, PA-C: I know you get this question probably more often than I do. Okay, Doc, fix my hormones. Check my hormones, test my hormones, put me on hormones, fix them. I am in a bad place. So how do you approach that?
Dr. Mark Holthouse, MD: Probably the most common question I get right and we try to kind of back people up a little bit because they're usually coming in and they're really not desperate, but kind of they've been on the Internet, they've heard a lot of rumble out in the community about what they should be doing, what what fad they should be chasing, what new podcast might be the thing, right And so we try to get them to kind of back up, take a deep breath and say, Hey, let's hear about your story, let's hear your symptoms. When did they start? And let's look at you as a whole person that you are. You're not a peptide, you're not a molecule, you're not a neurotransmitter, you're not a type of diet. You're not defined by what you've tried and failed. Let's talk about what's making you a less than optimal feeling person right now. And often it comes into this kind of this this taking a breath, a sigh of relief phase where they realize I'm going to be listened to. Right. And they want to know more than just what hormones have I tried and failed. And then suddenly you get this this sacred opportunity to enter into this space with a person where they share with you relationships, where they share with you what's going on with their digestive tract, what's going on with their sleep, what's going on with their energetics, what is missing that they, when they were 20, always thought they would Have.
Dr. Mark Holthouse, MD: Now that they're 30 or 40 or 50 years of age. So, yeah, I get that question a lot. And the first thing we do is kind of take a check, take a deep breath, get their story, and that's where the fun begins.
Host Amber Warren, PA-C: And our patients want to they want to feel heard. They have spent so much time not feeling heard, not no one's ever asked them, How do you sleep? What are your stressors? When did these symptoms start or what happened the 6 to 12 months leading up to these symptoms. I still ask those questions and people are baffled that we even care to go there.
Dr. Mark Holthouse, MD: Exactly.
Dr. Mark Holthouse, MD: So where I've always been impressed with you in what you teach us as a group of practitioners and what you teach on the grand stage is how you make this connection between gut health, which is so commonly talked about nowadays and thankfully so recognized, so gut health, hormonal imbalances and inflammation, and so digging into more root cause of hormone imbalances. I just I love your teaching there, so I really want to go there first.
Dr. Mark Holthouse, MD: Great. I like to go there.
Host Amber Warren, PA-C: I know you do. I know you do.
Dr. Mark Holthouse, MD: But so we always we always talk about gut first when in doubt, any good naturopathic practitioner or any good integrative practitioner that's looking at root cause medicine is always going to start with the gut. And it's funny because we get these these great looks when they walk in. It's like, you know, maybe you're getting me confused with someone else that you have in your schedule today. I'm here for hormones. Yeah. Your your intestinal patient is next after me, possibly because I'm not following you. And it leads into this this kind of playful banter where we can say, I get it. But did you know that most of your hormones are largely metabolized within your intestinal tract? Estrogen in particular, talking about the context of female patient, hugely impacted by constipation, by the health of the lining of the intestinal track. So then we have to talk about everything that affects the gut. You know, Yes, it's the standard American sad diet. Yes, it's stress. We know we know that cortisol, the stress hormone, impacts how the intestine works. Yes. It's your diet. Yes. It's those prescriptions that you're taking, those antacids that are making your heartburn go away magically. But now you can't digest protein, absorb B vitamins or your calcium. And zinc is a problem as well. So you kind of connect the dots. And by the end of the discussion, you know, they're kind of saying things like, well, what do I do for my gut to fix my hormone, my hot flashes, my my libido problems, my whatever they're coming in with. And and so making these connections is so powerful. The intestinal tract is affected by all the other areas that we talk about the nodes, the imbalances, the seven core imbalances in functional medicine. And it really is foundational to understanding not just hormones, but so many other things regarding communication within our bodies, whether they be neurotransmitters or things like peptides. So the gut is always first.
Host Amber Warren, PA-C: I'm always I'm always so surprised how patient's kind of like you touched on this, but they kind of just blow off GI symptoms. Like all know I'm fine and then it's like, are you having 1 to 2 bowel movements a day? Oh I. No, I actually I actually go days without a bowel movement or I don't feel like I completely eliminate. Right. And that's where we we can have those conversations and just bring more awareness to what is appropriate healthy gut health. And maybe we have to start there. Maybe it's not even appropriate to check serum hormone levels, Right. Hormone levels in the blood. That's that's probably not an appropriate starting place.
Dr. Mark Holthouse, MD: Right. Right. It's one of the selling points that we kind of have to educate on. A lot of them come in saying, you know, I'm here for a hormone discussion. Obviously, you're going to check my serum hormones or my salary hormones or what have you. And in the pre-menopausal age group, it's it's always kind of a gut check, no pun intended, where we say, you know, that might not be as helpful because those things are going to be kind of all over the map by definition. Sometimes we do looking at certain phases of the cycle. So we have reference ranges to know what's what's going on, but it's certainly not the first priority. We always start with looking at things like digestion, absorption, assimilation. How is the gallbladder doing? Is the pancreatic enzyme secretion adequate? Is the intestinal heal, the hydrochloric acid that we so desperately need to digest proteins being formed? Are you sending the right messages down with the foods you're eating, not just calories, but what are the messages to your cell saying, hey, alarm, inflammation or anti inflammation or aging or anti-aging? Yeah, And the hormones are just part of that story, right? The metabolism piece is huge because of the direct connection with metabolizing things like estrogen and testosterone there. However, all of these other networking ideas have to kind of fit and they're overlaying like the layers of an onion when you have this conversation. So we try to kind of move them away from just focusing on the hormone levels themselves to these other areas, the gut being foundational.
Host Amber Warren, PA-C: And when you approach a patient. So yes, gut is foundational, but we also call ourselves informed allergists, right? We're casting a wide net to look at all the sources of inflammation. So how do you see inflammation, inflammation impacting hormonal imbalances?
Dr. Mark Holthouse, MD: Great question. Boy, we could talk about this all morning. Yeah, the the effects on allergies choose testosterone and progesterone for today. The effects on progesterone are fairly dramatic with inflammation. We know in the context of the gut where you've got a leaky gut barrier, there are things on the linings of our gram negative bacteria that come in with our food that can get across the gut barrier that directly stimulate inflammation systemically. And it's that systemic inflammation that mediates a kind of a real static turning down of progesterone production in the ovary, ironically, also testosterone production. And that's a big issue on guys, which we'll talk about in the next episode. But so so now you've got this gut connection mediated by inflammation from a from a compromised intestinal barrier that's producing what we call estrogen dominance. Why not? Because you have extra estrogen necessarily, but the dance has been disrupted and the dance being that now there's less progesterone. And as women age, as they move into their mid thirties, early forties, progesterone starts to drop a little bit earlier often than estrogen. And with that becomes this tendency for an estrogen dominant picture, PCOS being an extreme version of that polycystic ovarian syndrome. So inflammation directly with the context of gut health can impact progesterone and testosterone.
Dr. Mark Holthouse, MD: I'm always surprised how women kind of underestimate or maybe there's just this lack of knowledge. We talk so much about estrogens, but you're honing in on progesterone, how important progesterone is for our well being as women, as we age.
Dr. Mark Holthouse, MD: It is it is progesterone is actually more of an androgenic male type hormone that both men and women have. And it is it's the consummate balancer of estrogen. And and there's this change in the ratio that occurs with both men and women as they move from puberty through their mid middle ages. And it's a little different. You guys go through it a little bit more abruptly. Ours tends to be a little bit more of a progressive change after mid twenties.
Host Amber Warren, PA-C: It's just so much harder to be a woman, let's just be honest. But we don't have time for that today.
Dr. Mark Holthouse, MD: Well, you know, we refer to hormone optimization in the in the Radiant Woman program as opposed to the optimal meds as really the Ferrari program versus the Chevy Chevelle. You know. Guys are just they're simple that way. And you guys, when things are running well, it's there's nothing better. It's a fine tuned machine and there's so many other points of of leverage. The guys tend to be a little bit easier overall.
Host Amber Warren, PA-C: Yeah. I find when we can and you know, we don't always have to give progesterone. There's a lot of different really great herbs and a lot of different natural modalities to stimulate progesterone production and just the impact on sleep. Yes. I mean, how many women are struggling to sleep? Their brains are on fire at night. They're they can't stop thinking these these kind of these ongoing thoughts. So do you see a lot when you can get a woman's ratio improved, how much better they sleep and therefore how much better they feel the next day?
Dr. Mark Holthouse, MD: Absolutely. You know, there are botanicals like Chaste Tree Berry and black cohosh that can act as progesterone agonists. They they support progesterone like effects. And so you can kind of combat some of this estrogen dominance that way. Naturally, sleep is hugely affected by both estrogen levels and progesterone with sleep initiation and sleep maintenance both. What's interesting about what you're saying is that when you don't sleep optimally, often your cortisol levels at night, which are supposed to be at a very low level kind of a trough while things like testosterone are are being pulsed and peaking. So you can kind of take out the garbage and detox and regenerate the damage from the day before when that's not happening and cortisol is are high. Instead, that cortisol is directly competing for cholesterol, which is that mother hormone that becomes pregnant alone, that becomes either cortisol or the sex steroids that we're talking about. So I always say, hey, the baby making machinery gets turned off or the normal steroid hormones, estrogen and progesterone when you're stressed out, cortisol.
Host Amber Warren, PA-C: Fight or flight. Right. Exactly. You don't need to reproduce when we're running from the tiger.
Dr. Mark Holthouse, MD: That's right. Yeah. Right. It's kind of one or the other. And so my heart really goes out to countries where women are living in constant stress.
Host Amber Warren, PA-C: Yes.
Dr. Mark Holthouse, MD: Anywhere in the world. You just you look at what's happening to them, what's happening to their unborn children, just being bathed in these high levels of cortisol. Yeah, we know that their sex steroid ratios are being messed with. But yes, premenopausal women who are living in chronic stress, literally your body will support cortisol adaptation to stress every time over making sex steroid hormones that's seen as kind of not frivolous but extra if you've got the bandwidth.
Host Amber Warren, PA-C: So what's your approach to these women that are like, I can't fall asleep, I can't stay asleep, I have that classic 1 to 2 a.m. awakening. I get up to go to the bathroom, I can't fall asleep. My brain starts, starts going. How do you how do you approach? What's your advice? Where do you start?
Dr. Mark Holthouse, MD: I always sleep deprivation and insomnia is the bane of any primary care practitioner, and certainly that's true also for us that are doing integrative route coursework. I always start with trying to figure out the secondary reason. I mean, there are a few people that have true primary insomnia, but most people we see you and I see every day are going to have some secondary reason. Are you not sleeping because of pain? You know, Are you not sleeping because of what we call monkey mind? You know, you're doing the Rolodex and and you can't fall asleep because you're a business owner and you've got financial worries or, you know, you see what's happening to your 401k with the way the stock market's going or what have you, the way the world is going right now.
Host Amber Warren, PA-C: You're a mom of young kids. What is the future of my children's lives look like? What do I do? I don't keep them in school. Do I pull them home? What do I do?
Dr. Mark Holthouse, MD: So many of my my young moms, when you really get down to it, are are worried about the world that their kids and grandchildren are going to grow up in and the maternal hardwiring instincts that that women have are fascinating to me because that becomes paramount to them. The future and where there's a lot of my guys tend to be worried more about money and supporting and being there for their family, which is.Huge as. Well, providing am I an adequate provider or am I an inadequate person. They're defining their own identity through those kinds of things. So I always start with the possible causes. Is it pain? Is it emotional pain? Is it your bladder? So many people, they're waking up because they've got to go pee in the middle of the night and especially with guys, but also with women is their sleep apnea that's been undiagnosed.
Host Amber Warren, PA-C: I'm blown away. How many young, thin trim women have sleep? Have apnea. Yeah, right. It's wild. And how much that's contributing to cortisol imbalances and therefore hormonal dysfunction.
Dr. Mark Holthouse, MD: Exactly. So I always start with trying to find the why.
Host Amber Warren, PA-C: Yep.
Dr. Mark Holthouse, MD: I tell my patients, look, if we can't get you sleeping well. Pretty much everything else that we're doing is going to is going to have a half effect. It's just going to be really hard to move the needle. And and so we always go there first with kind of looking at that. We use sleep counselors, folks that are really good at cognitive behavioral sleep therapy, that are specialists in that we get them involved with that try to get processing out those issues because it's usually emotional. Yeah, it's usually emotional trauma. They have one of these high ACE scores adverse childhood events. Yep. That that is still living with them or their current situation. Yeah. So we'll always start with that. We use homeopathic, we'll use other natural things to kind of help them. Melatonin sometimes will work for sleep and things like Valerian, but yes, you've got to get them sleeping and I'll even use some of the non habituated pharmaceuticals initially if they're really sleep deprived just to buy us time because I know it's going to be hard to move the needle if if they're trying to get through life on 4 hours of sleep chronically. And we know that if you get six or less hours of sleep a night, your brain is like inflamed for the next four days.
Host Amber Warren, PA-C: It's crazy. Data. Yeah, Yeah, it's pretty wild. What are your favorite ways specifically to tackle cortisol imbalances that are driving that early wakening in the morning? What are modalities that you use and our women to get that cortisol down so that they can fall asleep? More importantly, stay asleep?
Dr. Mark Holthouse, MD: Right? Right. There's some adaptogenic types of botanicals and herbs that we can use with things like ashwagandha and phosphatidylserine and rhodiola that we know and even St John's words, things that blunt cortisol response. I don't use a lot of St John's Wart anymore really because of the interactions with metabolism and the liver enzyme systems with meds and other supplements. But we're not. We know that those products can have a blunting effect. The other things that I'll try to do is kind of consider what might be raising cortisol in the middle of the night. We refer to cortisol as kryptonite to sex steroid hormones. Yeah, it's certainly kryptonite to testosterone and guys. And it is also a problem for hormones for for women. So if it's low blood sugar, you know, the body has this obligate need to keep the blood serum sugar levels stable. And the brain senses that at night when it's dropping. And the response that it has is to raise cortisol from the adrenal, which then goes to the liver and wrings out the glucose from glycogen stores to raise it back up so the brain can go back to sleep and chill. So often we'll try to figure out if they're having what's called reactive hypo low glycemic problems.
Speaker2: And sometimes they are. And it's interesting because one of the first things we see with women that are becoming pre-diabetic on their way to diabetes is they become unstable in the way they really metabolize insulin and sugar. And so they'll get low sugar readings and what we call a lack of metabolic flexibility where they can't use various forms of nutrition for energy and adapt and go back and forth between them very easily. So they get hypoglycemic at night and here comes the cortisol surge. So we'll often look at salivary cortisol levels at night. Typically we do a few readings during the day, but I'll have them do a tube of their own saliva around 2 a.m. and we'll look at cortisol and other adrenal hormones, DHEA, kind of the yin and the yang of the cortisol adrenal story and see where it is. And often we find that indeed it's spiking at 2 a.m.. So no one's going to sleep through that. Not even prescription medications often are effective against Mother Nature's onslaught of increase in cortisol. So looking for things like stress, looking for things like chronic infection, inflammation, sleep deprivation, problems with low sugar are the areas we look at to kind of address high PM and nocturnal cortisol.
Speaker1: And then we've got those cortisol spikes that's going to, as women especially well men to allow us to hold on more, more, more adipose tissue specifically in our bellies, which leads to more inflammation, which just further perpetuates the cycle. So it's just a it is a very damaging cycle we can get into. So obviously, talk about blood sugar per day, Betty. Pre-diabetes will lead us into a conversation about intermittent fasting. And that's a really hot topic for menopausal women right now. Right? We want to stay trim. We want to build muscle. We want to lose lose fat. And I know there's a lot of different approaches. Is. And that's where an individualized approach is really important. But what's your take on maybe someone like me, late thirties, looking to keep my metabolism nice and high, not knowing where I stand from a cortisol, adrenal functioning standpoint, throwing myself into intermittent fasting. What's your advice there?
Speaker2: It's a great question and there's been a lot of really questioning the safety and efficacy of time restricted eating or intermittent fasting where you're going 16 hours and then eating in a fasting and then eating all of your same calories that you might eat over a 12 hour period during the day in an eight hour window. So that's the so called 68 protocol raising cortisol, right? Because we know that there is when you fast for a period of time that it's not only lower your insulin, which we think is probably the keys to the kingdom as far as burning peripheral fat stores. But you're raising some of these counter regulatory hormones as well, like glucagon, like cortisol, like growth hormone growth hormone being the one that kind of maintains your lean muscle and promotes fat burning lipolysis we call it the cortisol is is the interesting character in that story. As as in the context we've been discussing, the cortisol can promote abdominal obesity. It tends to decrease lean muscle mass and and yes, it raises sugar. So it's kind of flies in the face of people that are pre-diabetic, that are trying to deal with high fasting sugars. Is this really a good practice? What we look at in intermittent fasting is really what it's doing to metabolism in general. And we see in the thyroid labs the fruits of what happens with intermittent fasting. You have kind of this temporary pulling back of the metabolic rate as the body suspends itself from being overly catabolic a fast metabolic rate when it perceives a threat.
Speaker2: This is what happens when we get a bit of the ICU with heart attack or pneumonia. Our thyroid reflects this. So we know that we've got a slowing that's associated with a perceived threat that the body has overall. So in the context of a premenopausal female who's trying to gain muscle and what we call fat free mass losing central adiposity, spot reducing, as we used to say, and intermittent fasting. With this conversation, we really need to consider the individual. Okay, is this a single mom who's barely making ends meet, who's just bathed in cortisol? They're a little stress ball. And here we come along and say, Hey, we want you to do intermittent fasting six, seven days a week where we know we're going to yank your cortisol up probably more than it is already not a good idea. So we will often modulate the way we make that recommendation where it's a lot less abrupt. We might just do a 12 hour fasting period. We might not, during certain stages of the menstrual cycle, have them fast at all. So it needs to be modified in that demographic for sure. And there's other ways to get at that goal outside of intermittent fasting with other programs.
Speaker1: And so once we fix the cortisol imbalances, they probably will have success later, right? Like let's Yeah, because it offers so many metabolic benefits, it's so much more than just weight loss. As for what it does for the body's at a cellular level, so we'd love to get them there and you'd be able to use that as a tool, but you can't put the cart in front of the horse.
Speaker2: Exactly. That's why it's so frustrating when I hear, you know, advertisements for weight loss and hormones and quick fixes. Because when you really look at the true physiology, it doesn't exist in a bubble where those are the only two variables.
Speaker1: Not for everyone.
Speaker2: Yeah, you know, you can see where there's monetary motivation possibly to oversimplify things. I'd rather educate my patients so that they can go the whole distance and really understand. You know, I think our job creates such a unique niche for what we're trying to do at fMRI and fMRI is that we really are trying to empower the patients to be smart and be an informed consumer. They'll be able to recognize that if something sounds too good to be true or something's oversimplified.
Speaker1: It probably.
Speaker2: Is. It probably is. And you know, the arrogance of thinking that there's only one or two.
Speaker1: Variables in.
Speaker2: Any of these outcomes is just.
Speaker1: That. Well, and that's where the benefit of testing comes in, right? Like we do these really awesome functional tests, like the salivary cortisol curve and we can say, Yes, that's you. We don't have to make a bunch of educated guesses. We can say, Oh, look, your cortisol looks great, or Oh, you are sky high at night, or stop waking up at five and trying to go to the gym in the morning, sleep deprived with a high cortisol. You are you are taking one step forward but three steps back. Knock it off. I tell a lot of my women that this whole there's this whole like, I don't know if you've heard of it, but it's this whole 5 a.m. club. I hear about it from a lot of my mom friends. Like it's this I don't know if it's being followed on social media or whatever, and I'm like, Knock it off. You're going to bed at 11, you're waking up at five to do this really hard core CrossFit workout. You're not helping yourself, especially as a premenopausal woman. So I love that. I love that advice. I love that approach because we also know in functional medicine we're trained to treat cortisol first and then the thyroid and then the sex hormones. And our patients want the opposite. Yes, makes my hormones. Then I'll figure out my thyroid later and then whatever, like the stress hormone thing you're talking about. But we're constantly trying to get people to think think in a different way.
Speaker1: Let's take a quick break to learn more about our Radiant Woman program. A high priority for women is to age beautifully, naturally and gracefully. At Fun Med Foundations. We use the best approaches in functional medicine to establish root cause of hormonal imbalances and help ladies become the best version of themselves. This leads to improved body composition, diabetes reversal, blood sugar optimization, age reversal through improved cell signaling and hormone optimization, pre-diabetes reversal banishing that stubborn belly and back fat lean muscle mass optimization and more. Simply put, our experts are the very best at helping women look and feel absolutely radiant. To learn more about the brand new Radiant Women program and book a one on one consult, go to funmedfoundations.com/radiant. All right. So let's touch on exercise and how exercise can can fix or be part of the fix for hormones.
Speaker2: Great question. So exercise is kind of that deceptive variable where people have often just really beaten themselves into the ground with guilt. I've been in the gym, I've been doing CrossFit, I've been doing high intensity interval training, I've been doing weight resistance training. And I'm not I'm not getting the goals I want. What is what is wrong with me? What am I not doing right? I've hired a trainer and the first thing we say is kind of setting the ground rules to say, first of all, love yourself, give yourself permission to look at you and and at your current state and literally love yourself unconditionally.
Speaker1: And be in tune with your body. Yes. Learn to listen because it's so good at sending messages when it needs to.
Speaker2: Women more than men, at least the verbalization that I've received the last 30 something years just really they can really get down on themselves with body image. And I'm not talking about people with bulimia or anorexia or diagnosed body image distortion diseases I'm talking at as a whole. Many, many of them will come in and they have this disgust, you know, just this this loathing self-loathing when they look at themselves. And so it sounds like kind of a why would you put so much emphasis on this doctor? But it's huge. You really have to make them face the music that until they unconditionally can be okay with themselves where they are, none of this matters. So sleep and body image and and loving yourself unconditionally huge. But exercise, I always tell them is is is a rotten way to try to lose weight. Yes. I mean, the data is clear.
Speaker2: We really lose weight with the way we what we eat in the way we eat. And and exercise is great for things like neurotransmitters and how we feel and our our depression.
Speaker1: Or lack enough.
Speaker2: Yes. Yeah, yeah. The brain derived neurotrophic factors that are kind of the miracle grow for our our neuroplasticity certainly for muscle mass for flexibility and tissue develop and preventing osteoporosis.
Speaker1: Anti-aging in general.
Speaker2: Anti-aging in general. So it's it's not to minimize exercise at all, but it's to kind of put it in its place. It is not the way you lose weight. It's the way you feel good and it's the way that you kind of help what you've done with your eating habits, maintaining it.
Speaker1: And it keeps you motivated as a woman. There is there are very few things that feel as good as like a really awesome weightlifting workout where I leave that gym or that space feeling stronger and empowered. And that's that's, I think, a really cool part of, you know, Sammy asked me, what does our marketing director, what does Radiant Woman mean to you when we were marketing it and it's like, I just keep coming back to strong, you know, I don't know if men feel that way, but as women like we do, we want to feel and look strong. It's important.
Speaker2: Yeah. You know, I tell both the female and male patients that I see that it matters the type of exercise you do.
Speaker1: Yeah. So what's wrong with pounding the pavement for 45 minutes with you? With your Nike's on? What's wrong with that? At a steady state?
Speaker2: I mean, we were all brought up in the, you know, the Ken Cooper era, the aerobic heart rate zone of 20 minus your age, 75, where you slog away there for 45 minutes. And I still go to the gym now. And, you know, you'll see folks on stair steppers, they look completely miserable. You know, some of them have a TV on just so they can bare the.
Speaker1: Agony or checking Instagram just to make the time go faster. Exactly.
Speaker2: But I'm going to get my hour in and I'm going to do that. And I'm going to I'm going to I'm going to do this range, which is is entirely inefficient as opposed to doing, you know, maybe something of a shorter duration, that's a more high intensity interval where you're going all out for a certain amount of time. You're recovering for a minute or so and you're repeating that like like these Tabata drills that we do, and you might do this two or three days a week, you're not going to be doing this every day. You've got to let yourself recover, combining that with good strength training so that you're with a group of people, somebody hopefully, that can monitor your form so you're not going to injure your back, your shoulders by lifting incorrectly and kind of looking at your technique. So I love cardio. That's been my bias. My whole.
Speaker1: Feels good. It just feels.
Speaker2: Good. It feels good. I hate resistance training and I do it sporadically. Full disclosure. But I know that it's probably one of the best ways to raise t. I'd much rather be out on a two mile or two hour mountain bike ride with with you and Sam or somebody else seeing God's nature out there, good earth. So we really have to combine. You know, so if you can get those anaerobic bursts and some joyful recreation of exercise combined with some high intensity interval cardio a few days a week with four days of resistance training, ideally this is the kind of exercise that regulates hormones. And I tell my guys and my women, it's not it's not doing this with a dumbbell. You know, it's not a single joint one muscle issue. You've got to have multiple joints involved, lots of muscle mass mass that you're recruiting in order to really get the stimulation that you're looking at for hormone.
Speaker1: Balance and the metabolic benefits and the.
Speaker1: Benefits as well. Yeah. Where do things like I know a lot of my girlfriends and my patients love yoga, you know, or Pilates, some of the more gentle stuff. Does that play a role in balancing hormones?
Speaker2: You know, it's a great question, and I can actually speak to that experience lately because my wife's gotten me to finally go with her.
Speaker2: I love it. It's it's wonderful. I love I love the gal that teaches it. I can't do half the stuff she does, but I try. The yoga aspect of this is just amazing because of what it does. I feel for the mind body. In addition to just overall conditioning, the stretching, the holding of the poses that are not necessarily something you do in an everyday activity and the learning how to use your breath.
Speaker1: Yes. Cortisol. Breathwork.
Speaker2: Oh my goodness.
Speaker1: Oh man. Meditation. So you're forced to do it? Yeah. Doing yoga? Yeah.
Speaker2: It's kind of a moving yoga. It's moving meditation, right? It's say it's an opportunity to increase this vagal tone. Get out of our heads. I love going there at 530 or six after work.
Speaker1: Oh, yeah.
Speaker2: Because by the time you get home, you're just like, you feel like you've had a massage. You just in la la land. It's wonderful.
Speaker1: Yeah, well, the mobility aspect of injury prevention, when we are doing our mountain biking and our lifting of weights and stuff too, there's there's good data there that how much that prevents us as we age, especially from overuse injuries. Yes, it's huge. I kind of would like to shift a little in and nerd out a little bit with some of the cell signals. Cell signaling protein treatment for supporting cortisol, hormonal dysfunction, recovery, libido, that's, you know, improving lean muscle mass. Right. Again, as a woman in our late thirties, trying to just age gracefully. Yes. So what what are we learning in functional medicine? What are we implementing?
Speaker2: Yeah. So there's there's all kinds of buzz out there. And the endocrinologists, it hasn't gotten lost on them. They're using a lot of prescription peptide type cell signaling molecules. This has been a concept that's not new in integrative medicine and even in functional circles where we can really kind of help along with all this great lifestyle discussion that we're having regarding sleep and stress management and diet and exercise, understanding the person's role in community, do they feel supported? Are they isolated? We're not meant to be isolated beings. We're like ants. We're like bees that way. We're very social and we get sick when we're isolated. Boy, if we didn't know that before COVID, we know it now, and we've seen all the ramifications. So yes, there are naturally occurring cell signaling molecules that we can utilize in, in really therapeutic models now for anti-aging, really slowing down what's happening, not preventing aging. I mean, give me a break. But if we can slow down some of the natural cell cycle processes that are occurring that are creating premature aging, not just from the hormonal influences, but from these peptide cell signaling molecular pathways, it's pretty powerful. And now we've got things that are supporting our natural hormones that we know take a dive in middle age that can help slow those processes down, whether it be promoting autophagy. And helping take that proverbial trash out.
Speaker1: So can you define really briefly autophagy? Yeah, I think a lot of our listeners are. Listeners would love to. Yeah.
Speaker2: Autophagy. Really. Faggy means eating and it's it's the process of recycling worn out cell parts, whether they're organelles, which are elements within the cell or parts of metabolism, things that really need to be recycled and gotten rid of so that new fresh mechanisms can come in. This is what we're talking about. And it's part of the balance of anti aging, which we'll talk about more in some future episodes. Really what you're looking at with hormones and peptide types of therapy are is a balance between promoting growth and on one side and on the other side promoting an anti-aging growth. And and topics such as mTOR and autophagy are really looking at this yin and yang experience. We can have the same analogy with things like peptides and hormones and promoting anti-aging with everything else that we do. Promoting and pushing just one narrative tends to promote too much growth. Be pro cancer, it's pro-inflammatory. Some of my patients that are really, really passionate about not eating anything green or any plants are a great example of that, where I see the most inflammation on labs that I see in any of my other patients in the clinic. And then you start adding in in the plants and the phytonutrients and the polyphenols and these things that we know promote autophagy and anti-aging to balance out the pro growth effects of things like testosterone and growth hormone support and some of the things that we're doing with peptides, you see a less inflamed balance.
Speaker2: So it's not really an either or discussion. You can have both. It should be an and and I want to be feeling strong. I want the best lean muscle mass I can have. I want to support all that growth hormone did for me when it was peaking in my twenties. And like the sex steroid hormones, it also declines and we think is related to aging. But I don't want to get cancers either. I don't want to be inflamed and I want to promote an anti oxidative, anti inflammatory state within my body. So I think what's unique about our clinic is that we're looking at both aspects of this dance, right? Again, here's the dance paradigm. You have things that can tell the cell to regenerate, to grow, to promote lean muscle mass, to get rid of body fat and at the same time not squander the anti-aging, the autophagy, the inflammatory message in the same efforts.
Speaker1: So these peptides that we're talking about is peptide therapy. That's it's not really new, but some of them are actually directly impacts autophagy.
Speaker2: Yes, Yes, there are FDA approved peptide molecules that we can give in many different ways. Some of these are topical, some of them are oral, some of these are given as a simple subcu injection.
Speaker1: I was reading about one that even for hair loss, you can rub on your scalp.
Speaker2: Yes. Yes. There's lotions, nasal sprays.
Speaker2: And what's fascinating is that what was once thought of is something that was going to help decrease blood sugar and decrease body fat. Now we're finding can do all these other kinds of regenerative. Things in our.
Speaker2: Know and promote really a decrease in in premature aging. And really aging is the process of what we call cellular senescence, which is just the cells kicking out of their division, their cell cycle, and just hanging out. They're even called zombie cells for that reason. They just kind of hang out. They're not dying, which they should be doing. If they're not lifting, they're carrying their own weight.
Speaker2: And they're not really actively contributing. They're in fact creating a source of inflammation and oxidative stress that accelerates aging these zombie cells. So we can affect these things in addition to tissue repair and so many other things. Cognitive and and detox behaviors.
Speaker1: Yeah, body even just the recovery sleep. I was reading about the benefits of these peptide therapies that we're starting to implement on just getting your deep sleep and what a what a powerful impact that can make on everything we're just talking about, right? Hormonal regulation, cortisol balancing. What else are you seeing as you start to implement peptide therapy into your practice, other other symptoms that are that are being benefited, not just the weight loss or sleep, but what else are you seeing?
Speaker2: You know, the the big issue is helping regulate pre-diabetes, which is such an epidemic.
Speaker2: We see improved glycemic control, as you said. We see improved body composition, which is such a touch tough thing for people to move the ball, move the needle that way.
Speaker2: I would say that one of the other biggest areas is in that of recovery, certainly in that of detoxification and aiding us in using things like glutathione and acetyl cysteine and master antioxidants.
Speaker1: Yeah. We live in a toxic soup. Right. We all need an estrogens and antioxidant too. That's on the topic of hormone balancing. So awesome. I guess I didn't realize that that we're really seeing antioxidant boost from some of these peptides. Mm hmm.
Speaker2: Yeah, it's it's really just an exploding. Science. And, you know, we've lost some of them. We've we've had some of these taken away. We don't have access to them.
Speaker2: But having really quality compounding pharmacies that are dedicated to developing good sterile products that we can use in injectable forms that are tolerated well, that are customized in formulations that minimize side effects such as nausea, which you tend to see in some of the pharmaceutical mainstream drugs that are available in regular pharmacies.
Speaker1: And we're not talking thousands of dollars.
Speaker2: No, these are things.
Speaker2: Are reasonable, you know, in the $100 range per month. And the neat thing is that we're using these short.
Speaker1: Term, you know, a lot.
Speaker2: Of these things are used cyclically when I think about growth hormone hormone releasing peptides and and. Particles that really are without much of the risk of what's been seen with using things like growth hormone in the past, which in my mind is unsafe. The effects that we're having just with short pulse dosing for very short periods of time, it's really bringing personalized medicine to another level, using some of these things to have a 10 to 15% reduction in weight.
Speaker1: In a three.
Speaker2: 3 to 6 month period and then they're off of them. It's not making these patients an annuity where they're on these things forever, ever. And, you know, that's it just brings the point home that if you started well and done the foundational work with diet and exercise and therapeutic lifestyle, when they stopped doing the injection, they're not going to immediately rebound. And yo yo, it's so important. I tell my patients that come in for peptide work that are often the same ones I'm seeing for hormone optimization, right? Hey, my goal is to not have you lose this same £50 five times in the next five years. I don't want the yo yo thing.
Speaker1: We're not putting you on The Biggest Loser. That's not what this is about.
Speaker2: We know that The Biggest Loser program, We know what not to do right after eight seasons of TV. So we want to start with the end in mind and set you up for long term success. And it's not about just hormones. It's not about just a.
Speaker1: Shot or.
Speaker2: Whatever they're taking. It's all of these things we're talking about.
Speaker1: Yeah. So something that is really significant in my practice and the more I do functional medicine, the more I learn how much of what I do is environmental medicine. I want to really touch on toxins specifically as it relates to the concept of estrogen dominance in women.
Speaker2: Yes. Yes. Great question. One of the things that we do in all of these workshops is we discuss with our female patients, hey, did you know you're exposed to hundreds of known toxins, chemicals every day before you leave the house, especially women, even more so than guys. What's this statistic that you guys swallow? £4 of lipstick over the course of a life? It's unbelievable the things you have to put up to. You know, you're all beautiful already. This is part of that. You know, love yourself.
Speaker1: As you are message.
Speaker2: But don't get me wrong, we like the way you guys look when you're.
Speaker1: All dolled up.
Speaker2: All that's wonderful, right? So no toxins is foundational. It's right in there with gut health.
Speaker2: We have a term that we use called Zino Estrogens, Zino Ming, foreign estrogens. Obviously, estrogens. Zino estrogens are things as innocent as as the head lettuce that you're having spread on your your sandwich at the deli. We know that often head lettuce has more water and toxins in it that has nutrients. So I'll always go for the spinach and I'm hoping it's organic, right? Usually shop for those things. Those pesticide and insecticides and herbicide residues often have these so called zino estrogen, estrogen mimicking molecules in them. So we take these things in their passing through our breast milk and in our babies. They're going across the placenta into the unborn child. They're affecting all of our cells. They're binding to our estrogen receptors and our and our cells in our nuclei respond to them as if it's the real thing. And it's it's making things happen within the body. So looking for urinary levels of herbicides, pesticides.
Speaker1: We have really cool tests that can do that now. Great, awesome test.
Speaker2: Functional medicine, specialty kits, which you can't get through your regular physician's offices necessarily, where we can look at these things. Yeah, we believe in testing, not guessing.
Speaker2: And you can have objective data of before and after treatment as to what's been happening, what's working. So you can look at petroleum based chemicals and plastic metabolites. You know, we talk about websites where we really get people eating clean things that we can use the barcode scanners in the store to choose the safe household cleansers and the safe sunscreen every spring.
Speaker2: For your family, based on some of these findings.
Speaker1: I tell my patients because it's really overwhelming and I've gotten caught up in the trap of you almost like try and make it your God. Like how clean can you make your home? How, how, how much can you detox your family? Right. So I tell my patients, hey, it's really overwhelming. Here are some resources. Let's start with what you are breathing or what's being absorbed through your skin every single day. Right? What what are your kids sleeping on? The laundry detergent that you wash your sheets in and wash? Your close in, right? What are you cleaning your home with? What are you wiping your kitchen counter with or using candles that your your kids and your family are breathing in every day? Those are really toxic, those perfumes. We know what's in those. So I just, you know, don't freak out about the you getting your hair done every three months or going and getting a pedicure every three or four months. Let's start start small. And as your knowledge grows, then you become more comfortable changing things. You know you don't. This is not an overnight change that we're asking you to make because really small changes can make huge, huge differences on on your body.
Speaker2: I used to tell you that my wife would ask me when I'd come back from a conference, okay, what am I going to have to throw out in the pantry this time? And it's no joke. And my families feel the same way. And the guys come in, you know, like, Oh, you know, you've ruined my life, You know, that lays potato chips are gone. Yeah, I can't have any more Splenda. Yeah, You know, the crystal lights evil. The white bread is gone. Yeah. And yes, you're right. I always start by saying, you know what one of the biggest stressors are to the body, and that is stress. And if if you're fanatical about your lifestyle. Yes. Number one, no one wants to be around you. You're not very much fun.
Speaker2: And number two, you lose your joy. And if anything is is is a buzzkill. And functional medicine is being around someone who's so serious. Yeah. You know, we have jokes about going out and ordering with friends and hearing how they order at restaurants. But, you know, it's interesting. You do what you can. Yeah, In a toxic world, my wife and I right now are buying some furniture. And you know this the the simple act of of looking at the product to see is there formaldehyde in this stuff.
Speaker1: It's everywhere.
Speaker2: It's everywhere. It's in the couch. We're buying. It's in the mattress. What what is what is in a flame retardant. And, you know, there's all these governmental requirements that everything that sold has this thing underneath it that says it's been treated with poly brominated by phenols, which are endocrine disrupting chemicals that keep our pajamas from lighting up at night if we catch on fire. I guess so, yes, the toxins are huge. The World Health Organization has acknowledged that endocrine disrupting chemicals now are a huge contributing factor, not just to birth defects, but to things like PCOS and premature ovarian failure. And so many of the things that pre-menopausal women are.
Speaker1: Seeing with.
Speaker2: Hormone dysregulation. So even non. Integrative practitioners and our own governing bodies are acknowledging this is a huge problem.
Speaker1: Yeah, and I'm so thankful. And that's where functional medicine really shines, not just in exposing those things, but also we can't live in a bubble, right? As much as I want to think I can put my kids in a little bubble and not have them have glyphosate in their urine or be exposed to EMFs or these things. Yeah, but we are focused on just keeping the body detoxifying, right? Opening up those pathways, making sure that that our liver is working optimally, our kidneys are working optimally to cycle things out. So that's where I think that's we I think we bring together the best of both of those worlds. I love these conversations. I love these topics. I love the science. You're I love I've talked to a couple of practitioners this week who are just like, he's just a walking textbook. And so we're so we're so honored to have you. I like to end each each interview with with one question, if you and this might be difficult, but if you can think of one recommendation or piece of advice you give your patients that that improves their health the most, moves the needle the most, what would it be?
Speaker2: Mm hmm. You know, I'm going to say I'm going to say that the number one I'm going to answer that with two answers.
Speaker1: I'm not sure that's allowed. I'm just.
Speaker2: Going to break your rule.
Speaker2: I'm going to say the number one thing that I think has the strongest therapeutic effect is the relationship with your provider. Mm hmm. I think there's a lot of studies that validate that. But after 34 years of doing this, my experience is that the number one thing that I do with my patients, my team mate in the room, is is to. Instill in them that they've been heard. That what they're going through is they're not alone.
Speaker2: And that what they're trying to get across to me matters. As as three pillars I. And then your question that you actually answered me or asked of me was.
Speaker1: What moves the needle the most.
Speaker1: So a piece of advice which you just answered. So I just answered that.