For listeners out there feeling frustrated by rebound, weight gain, brain fog, or fatigue, what's the first practical step that they can take? That's a great question.

First practical step, number one, let's have a mindset shift so that our stress levels aren't going up. The weight gain is not your fault. There are a lot of factors that are working against us as we're approaching 30s, 40s, 50s.

So if we have that mindset, it's easier for our cortisol to not spike. And then number two, let's make sure that our protein intake is adequate to start revving up the metabolism as well as adding on some resistance training to build those muscles so that we can bump that thermostat up.

And then if we're still not seeing results, Get your labs checked. Let's do a comprehensive panel to unlock the underlying causes. Your health is shaped by more than symptoms.

Through real stories and expert insights, we explore how your genetics, environment, and daily choices affect your well-being. We uncover root causes and share practical tools to help you find the healing you need.

Welcome to the Forum Health Integrative Medicine Podcast. Thanks for tuning back in. This is Amanda, your host with the Integrative Functional Medicine podcast.

I'm joined with Margot, our PA in Knoxville. We're here at our Forum Health Summit, and today we're going to be talking about perimenopause, thyroid, and GLP-1s.

Hi, Margo. Thanks for joining us. Hey, I'm so excited to be here. How are you doing today? I'm doing great. How are you? Wonderful, wonderful. So excited to have you with us today.

Margo, you are in our Knoxville location. Yes. I would love to know, how did you get into functional medicine? What got you coming to Forum Health? So my journey into functional medicine was actually personal.

I started off on the patient side. So in my early college years, I developed Hashimoto's thyroiditis that went undiagnosed for many years, and I had all the classic symptoms that you might imagine.

Fatigue, weight gain, increased stress, that actually led to me being hospitalized for some heart issues. And I spent a year bouncing around to different conventional medicine specialists, and I was not getting better.

I got another prescription from each specialist. And eventually, I was tired of taking prescriptions. I felt really ill. Even though my lab somewhat improved, I did not feel great.

So I ordered a book. I thought, what is the root cause of this? The only thing I know I have is Hashimoto's. So I looked it up and I found a book called The Root Cause of Hashimoto's, and it suggested that I find a functional medicine provider.

And so that led me here. I found a functional medicine provider. Within six months, I was off all the prescriptions except for thyroid support. They had switched me to a more natural thyroid support.

They were working on lowering my auto-antibodies with, you've probably heard a lot about luteosanitrexone or LDN, supported my stress management diet, and that was so impactful for me that I thought, this is what I have to go into.

Wow, that's wonderful. And Knoxville, what do you guys do? Who do you guys serve in Knoxville? So we serve a mix of women and men. I would say that the majority of our office, at least 75%, are women.

And I see a lot of women in the perimenopause, menopausal age range. But lately I'm seeing more and more females in their 20s and 30s that also have underlying hormone imbalance, PCOS, endometriosis, as well as, we're in Tennessee, so ticks are present.

So there's also a growing number of patients that are being treated for chronic infection, like Lyme disease. Wonderful. How do perimetopause, thyroid, and GLP-1 medication intersect, and what's the root cause approach to help women achieve sustainable weight loss?

Yes. So many women in their 30s, 40s, and 50s are coming into the clinic and they're struggling with achieving sustainable weight loss. Some of them are coming in and they're already on a GLP-1, but maybe they've hit a plateau or they're having fatigue or they're just not seeing the results they would like.

So we need to look a step deeper because a GLP-1 can be helpful, but it doesn't really address the root cause in some situations. So there is an overlap.

It's almost like three overlapping puzzle pieces between struggling to lose weight, thyroid, and hormone changes and perimenopause. Wow. That's a lot to consider just for like, I want to lose weight.

Right. It's difficult for women to have the knowledge that that is going on. Yeah. But that's why we're here to help with the testing and to uncover those root causes.

Absolutely. Absolutely. So many patients regain weight after stopping GLP-1s. From your root cause perspective, why does this happen? Sure. In functional medicine, we have something called the tach theory.

I don't know if you've heard of that. And it's a really simple way, that's funny to me, to describe how overlapping conditions, the effect they have. So let's imagine that you're sitting on two tacks.

If you take one tach out, the pain in your backside is not going to improve by 50%. So if you're on a GLP-1 and it's only a band-aid, then when you come off, it hasn't fixed that root cause and that weight is just going to come back on.

Yeah. But if we start the GLP-1 and we are addressing those underlying causes, we can then titrate you off the GLP-1 after we fix those things so that we have sustainable weight loss.

That's amazing. So Margo, how does perimetapause, with its shifting hormones, change how women store fat and burn calories? That's a great question. So in perimenopause, your estrogen and progesterone levels are changing, and that can cause a change in where the fat is distributed in the body.

So a lot of women come in and they're calling it the menopause belly, so especially around the midsection. So if women in their 30s, 40s, 50s are noticing weight gain, especially in the midsection, that's normally because your hormones are not balanced.

So we need to take a deeper look and help to balance those hormones. So then when we do start to shift the metabolism, you know, those results are long lasting.

Yeah, absolutely. That sounds a lot like the stress belly, right? Like the cortisol belly. Yes, stress is another huge part of it. Yeah, it's another like under looked factor in the whole like puzzle of weight loss.

But you definitely hit it while you're talking about the thyroid and the GLP ones and stuff like that and all those hormones. And as progesterone declines, your body's capability of appropriately responding to stress is diminished.

So it can exacerbate underlying stress. So then we have, you know, it's almost a twofold increase. Yeah, absolutely. I mean, just naturally, as we age, things compound.

One plus one doesn't equal two anymore. The stress resilience declines. We've been going through 30, 40 years of stress. And let's be honest, life doesn't get less stressful with more and more responsibility.

And as we get older, right, there's just more and more. So we get more stress. and our stress resilience is going down. Yes. And now entering challenges with weight gain, maintaining weight loss, all those things.

So balancing hormones and perimenopause actually helps increase resilience to stress. Oh, I love that. At Forum Health, we uncover the why behind your symptoms.

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Learn more at forumhealth.com and explore supplements at shopforumhealth.com. Yes. So the thyroid is an underlying common cause of why a GLP-1 might not be giving you the results that you would like to see.

So you can have subclinical hypothyroidism. You can have underlying Hashimoto's. So there are a lot of things that aren't conventionally tested that we need to go ahead and check that data to screen you for.

So instead of just checking, let's say, for instance, a TSH and a T4, we're looking at six markers of thyroid health. We're looking at TSH, T4, your conversion to T3, which actually controls the thermostat of your body because the thyroid is your metabolic thermostat.

Yeah. We're also looking to see if reverse T3 is high. That is a sign that your body's not responding to stress appropriately and also screening for markers of Hashimoto's, which is an autoimmune attack on the thyroid.

Oh, wow. All right. And so if that is not, if the thyroid isn't optimal, it's almost like your thermostat is not running at the right temperature. Yeah.

So you can eat all of the right things, but your metabolism is sluggish. And so you're not going to see those results that you'd like. Yeah. When you get off the GLP-1s, Is it, you know, people have been reducing their caloric intake naturally.

How does that play a role coming off GLP-1s? So the whole model of calories in, calories out, and counting calories doesn't work as well for females because muscle mass is something that we need to maintain because muscle is revving up your metabolism.

So women need to be focusing more on protein and less on counting the calories. So if we can make sure that your metabolism is optimized, so the thermostat is set to the right temperature as we come off the GLP one, then we don't have to worry about that rebound weight gain and counting calories when you come off.

And I think that's really important, too, while you're on these GLP ones is the protein and maintaining muscle. Naturally, when you lose weight, you do lose a small percentage of muscle.

Sure. But we're testing with our in-body scales and things like that to make sure that you're maintaining your muscle mass while you're losing weight and identifying and treating the root cause of your weight gain and your weight loss resistance.

Yes, that's a great point. And you need that muscle too when you get off of this because the muscle is what also increases your metabolism as well. Right.

So that when you get off, it's not you don't have as much fear of am I eating too much because my appetite's coming back. I think a big piece that people miss while they're either titrating off of the GLP ones if they titrate at all or if they just stop is one.

And then two is they didn't work with anybody either on their relationship with food or they haven't worked with anybody on the appropriate food and nutrition that they need during and post.

Right. That's why so many patients come to me and they've already been on a GLP-1, but they're coming because they're not seeing the results that they would like because they need a more comprehensive program.

We have a great support system so that these GLP-1s are more effective and we don't need them long term forever. We have health coaches that can work with patients to make sure that their nutrient intake is where it needs to be to help their metabolic function.

You mentioned the in-body. So for people that don't know, that is a scale that can test your biometric. So we're looking at percent of fat and muscle to make sure that we're doing everything we can to maintain muscle mass on the GLP-1.

And if we start to notice that muscle mass is slipping, then we know, let's follow up with a health coach. Let's increase our protein intake. We might need to layer on another peptide to help with muscle.

Like CJC. Exactly. CJC 1295. And we can also refer out to Personal trainers or physical therapists even just like backing down on the dose too so that you can get in the appropriate amount of protein I know I've done I have a coaching background and I coached some GLP ones and Scaling off the dose isn't right for everybody either.

I don't need to always go up and up either low and slow in weight loss really is importantness, like so slow that you're not satisfied with your results.

But, you know, seven to 10, you know, some of these people who are losing a pound a day and stuff like that. Right. You know, if you have a high amount to lose, yes, you're going to lose a lot in the beginning or at least more, but you really should be getting to that one to two pounds a week.

Yes, exactly. So that you're still maintaining your muscle and hopefully building some muscle there. Right. So pairing it with, again, you know, a nutritionist, a health coach to make sure that everything is on point there and then increasing resistance training.

because not only does that help your metabolism, but when we're dealing in the perimenopause and menopausal age range, that's also protective for your bones to increase muscle mass.

So it's looking, it's not just looking at losing weight so that you feel great and look great, but it's also about how can we make sure that your health is optimized decades to come?

Well, and that's another thing too, like it's got kind of have some cards stacked against us when it comes to like menopause and perimenopause, because not only you know, if we're on this weight loss journey and stuff like that and we're losing weight and we have to be in tune with our muscle mass and things like that and muscle protects our bones and stuff like that.

But we're also about like we're entering an era where it is harder for us to build muscle. And it is easier for us and our bodies to lose muscle as well as our bone mineral density.

And we need that nutrition. We need all that good stuff coming in. Nutrition gets so much more important when GLPs come into play because you need to prioritize the fuel your body needs to keep everything going.

Right. And if we're focusing on nutrition, it also helps to minimize side effects. So it's well known that GLPs can cause nausea, GI changes, constipation.

So if we're focusing on nutrition, that helps to minimize those side effects as well. And you mentioned the muscle mass and bone mass. So in this age range of, you know, most women that are coming into the clinic are 30s, 40s, 50s.

So we're approaching perimenopause and menopause. And I mentioned earlier about estrogen and progesterone, how that affects metabolism, but your testosterone is also declining.

And testosterone fuels your muscle strength. So that is why optimizing those hormones can help the metabolism as well. Yeah, absolutely, absolutely. Talking about optimizing our hormones and things like that, if patients come to you in our Knoxville Clinic, and they're already on a GLP-1.

and they wanna make sure that they're getting to the root cause, what labs and assessments would you prioritize to help them uncover those hidden drivers of weight gain so that they are successful?

That's a great question. So I check a weight loss panel for most females that's more comprehensive. So we're doing a deep dive into thyroid health. We're screening for Hashimoto's.

We're checking the free T3 and reverse T3 ratio to make sure that Stress management is appropriate because we all know that stress can inhibit our weight loss.

So that shows me how stress is impacting the thyroid, uncovering any hidden thyroid issues. We're also looking at the hormones, so checking your estrogen, progesterone, testosterone levels to make sure everything is optimized there.

And then also checking up fasting insulin to screen for insulin resistance. Because if you have underlying insulin resistance, we'll probably need to tweak that dose of the GLP-1 or the GIP that you're on to help make sure that that has been completely resolved.

So again, if we go back to the TAC theory, if we're not seeing results, it might be because you still have some TACs there that we need to pull out. Absolutely.

It just sounds like GLP-1s, it's so wonderful that they're here and that they're a tool for us. I know Form Health, we've been using peptides and GLP-1s since they've really become available in this space.

And we were hungry for it also because the GLP-1s originally were actually discovered and researched for Alzheimer's patients. and dementia patients, but because of the side effects of appetite suppression, it started becoming a more widely used drug for diabetes.

So it's great to start seeing this tool back in our toolbox, but that's what it is. It's a tool. And I think that's a big missing piece for people to understand that this is a tool that's going to put one of those screws in place, but when you're building the table, when you're, you know, building the house, what about the thermostat?

What about the plumbing? What about, you know, like speaking of plumbing, you know, detoxification is so important. A lot of people, when they start GLP ones, even on low doses can have, you know, some side effects where they're feeling a little fluey and congested or headache-y and stuff like that.

Right. And we know it's a Hirschheimer's reaction. You've got less coming into your body, and so your body's able to release some of that stuff that's in storage.

our fat cells are what store toxins. Our toxins, because our body's trying to protect ourselves. So I mean, even somebody considering going on a GLP-1, doing a detox to prep yourself beforehand so you minimize those side effects when you start it.

If you're hitting a plateau on your GLP-1s or on your weight loss journey, a detox can really just clear out some of those cells that are holding on to those toxins.

Yes. Our body can't get rid of fat cells, but it can create them. So if we keep on pumping in the bad stuff and we want to lose weight, it's contradiction from each other.

Right. Because the body… Some people, there's a mindset shift that needs to happen when we're looking at weight loss. A lot of women are hard on themselves about gaining weight, but if you have toxin exposure, the body's trying to protect you by storing those toxins away in your fat.

So number one, I want to encourage, especially women, to not be stressed about that. And number two, we can help with detox. We have great programs that help with detoxification, like the GDRx program.

And those are great. I've tried GLP ones in the past too. They're a tool in my toolbox. And when I was on those, even taking a detox support shake, it gave me the nutrition I was looking for.

Yes. It had like so many micro and macro nutrients that my body needed plus the protein and how it's supporting my liver, getting that stuff out of my system.

Yes. So, I mean, Even gentle detoxes or just daily support for your body while you're going on a weight loss journey can make a huge difference for people.

So you mentioned tools in the toolbox and I did not create this analogy, but I think it's great that a provider once was explaining something to a patient and they said that losing weight is like hiking a mountain and a GLP-1 is like having on a really great pair of hiking boots.

And then if we add on detox support, it's like adding some hiking poles. So the patient is still going through the steps and they're still putting the work in to lose weight.

We're just giving you some support to make that journey easier. And what I love about our detox support, you know, Forum Health, we have GDRX, and that's really popular.

I think why it's so popular is because not only is it helping with detox, but it has a lot of protein in there. So it's helping to maintain that muscle mass so that we don't lose anything.

Yes, absolutely. For listeners out there feeling frustrated by rebound, weight gain, brain fog, or fatigue, what's the first practical step that they can take?

That's a great question. First practical step, number one, let's have a mindset shift so that our stress levels aren't going up. The weight gain is not your fault.

There are a lot of factors that are working against us as we're approaching 30s, 40s, 50s. So if we have that mindset, it's easier for our cortisol to not spike.

And then number two, let's make sure that our protein intake is adequate to start revving up the metabolism. as well as adding on some resistance training to build those muscles so that we can bump that thermostat up.

And then if we're still not seeing results, get your labs checked. Let's do a comprehensive panel to unlock the underlying causes. Exactly. Yes, absolutely.

Inflammation, another one. I mean, there's so many, that's the thing is that weight loss, your weight loss journey is unique to you. Yes. It is unique to everybody, right?

It could be estrogen for one person, testosterone or combo of both for another. It could be thyroid for somebody else. It could be an underlying infection that has a low grade inflammation going on throughout the body.

And if you've got consistent chronic levels of inflammation, losing weight is so hard. Yes, it could be so there's just so many things there are so many underlying and not that that has to be something that scares people like oh my gosh i can't do it no because we've got you and we've got resources and tools and you just have to find the right person in your corner to walk that journey with you and guide you through it i totally agree we just need some some direction absolutely yes margo It was such an honor speaking with you today.

I can't wait to invite you back and keep going further with this. If you had to give your listeners one wisdom of Pearl, one takeaway that you want them to remember if they're going through a weight loss journey, what would it be?

Okay. One pearl that I would give patience. Hmm, let me think about that. Sounds good. I know, I put you on the spot there. We didn't prep for this one.

Gotta throw you guys a curve ball. So one pearl I would give patients is that hormones matter. So many patients that I check that are here for weight loss, their hormones need to be optimized.

And these aren't necessarily big glaring issues, but it's about tweaking a lot of small things to see great results. Yes, absolutely. Yes. Small changes that are consistent have big impacts.

Yes. We see that every day. Every day. Every day. Thank you so much for joining us today. Thanks, Amanda. Before we leave, how can people contact you if they want to see you?

Sure. So I am Margot, the lead provider of the Knoxville, Tennessee Forum Health Clinic. And you can find me on Instagram at Knoxville Functional Medicine, as well as our website.

Wonderful. Thank you so much. Thank you. Thank you for joining us on the Forum Health Integrative Medicine podcast. Each episode, we help you understand your health from every angle and inspire your lifelong wellness journey.

Follow the show, share it with someone who needs hope, leave a review, and take the next step toward feeling your best at forumhealth.com.

Margaux Cousturian, PA-C, MMSc

Optimizing Hormones for Women in Their 30s, 40s & 50s