Full Transcript Reconsidering GLP-1 Medications 0:00 Welcome back to Menopause Mastery. If 0:02 you've been listening to this show for a 0:04 while, you know that I pride myself on 0:06 foundational pillars, bringing you 0:08 unbiased evidence-based bioy. 0:11 And secondly, being willing to say the 0:13 quiet parts out loud. Today, I'm 0:15 actually making a confession that I've 0:17 changed my mind about something big. If 0:20 you go back to my original podcast 0:22 episodes a couple years ago and read my 0:24 commentary or listen to my commentary 0:26 about Ozimpic, WGO, Zepbound, GLPS, GIPs 0:31 when they first exploded onto the scene 0:33 into mainstream culture, you probably 0:36 heard me express some pretty deep 0:38 skepticism. And let me be clear, I was 0:40 not really skeptical of the underlying 0:43 science about how these medications 0:44 work. I was really worried more about 0:48 and frankly what still sort of angers me 0:50 is the wild west of prescribing and when 0:55 it's being used inappropriately and the 0:57 and the guidance that should go along 0:59 with these medications isn't actually 1:00 being given. 1:05 You know, we created a culture where 1:06 women in pmenopause, you know, could log 1:09 into and fasttrack a tele medicine 1:11 company, fabricate height and weight, 1:13 and get a high dose of GLP1 1:16 on a prescription sitting in her 1:19 doorstep within 30 minutes with no blood 1:22 work, with no actual verification of the 1:26 data, without even a visit to confirm 1:30 and have conversations about how to use 1:32 these medications safely. and then also 1:35 how to make sure that you're getting the 1:38 right medication and the right guidance 1:40 for you to have the actual outcome you 1:42 deserve. And especially when we're not 1:45 ne giving good dietary recommendations 1:48 and things like resistance training and 1:50 evaluation of your ovarian and hormone 1:53 status, we now a couple years later have 1:56 a lot more data about how these 1:57 medications work, how to utilize them 2:00 prop appropriately, and how to 2:02 especially use them in midlife women 2:04 because you know what, the most common 2:07 uh people being prescribed these 2:09 medications are midlife women. And so I 2:12 was vocal and I called it out. But you 2:14 know, science is not a static dogma. 2:16 It's always evolving and it's the 2:18 conversation's always evolving. And over 2:20 the last few years, some clinical trials 2:22 have really expanded exponentially. And 2:25 now we have more robust long-term data 2:28 on cardiovascular protection, chronic 2:30 kidney disease, systemic inflammation, 2:33 hypertension, neuroinflammation, 2:36 even addiction. And simultaneously, we 2:40 have more forward-looking clinicians 2:42 that have completely shifted how we 2:44 really are using these medications as 2:45 tools. So, today I want to set the 2:47 record straight. I want to help 2:49 vindicate these medications and where 2:50 they're being used correctly. We're 2:52 going to talk a little bit about uh why 2:55 semigloid tepatide and the new to come 2:58 to the market retreatide can be used and
Midlife Hormones and Metabolic Change 3:02 dosed and where are all the little sort 3:05 of uh caveats coming in about dosing and 3:08 what do we know and what do we not know 3:10 and especially what does the most recent 3:12 research say about using it with hormone 3:14 replacement therapy in the midlife woman 3:17 and how these instruments can be used 3:19 for longevity. So grab your notework 3:22 notebook. So grab your notebook. Let's 3:24 dive in and let's dig in. All right. To 3:27 understand why GLPS matter in midlife, 3:30 first we have to talk about what's 3:31 actually happening in your body in 3:34 midlife between the ages of 40 and 60. 3:37 For decades, women have been told, "Hey, 3:40 you're gaining weight in midlife. You're 3:41 eating too much. You're moving too 3:42 little." And I think we need to put a 3:44 kaibos on that whole idea. It's 3:46 patronizing, medically inaccurate, and 3:48 ignores fundamental changes to the 3:50 endocrine system. When you enter 3:52 pmenopause, your ovarian production of 3:55 estradiol begins to fluctuate wildly 3:57 before ultimately dropping. And that 3:59 dropping is even before you actually hit 4:02 where your periods stop. You're actually 4:04 still having cycles, but your overall 4:06 estrogen level is either highly variable 4:09 or actually lower than what it was. And 4:12 when that happens, estradiol isn't just 4:14 a reproductive protective hormone. It's 4:17 a master metabolic regulator. And 4:19 estrogen sensitizes your cells to 4:21 insulin, protects your blood vessels, 4:23 maintains mitochondrial function, and 4:26 also regulates how and where your body 4:28 stores fat. And as estrogen declines, we 4:31 know that it causes more insulin 4:33 resistance. Even if your diet hasn't 4:34 changed, your cells become less 4:36 efficient at utilizing and clearing 4:38 glucose from the bloodstream. fat 4:40 distribution shifts. It's not only on 4:42 your butt and thighs and abdomen. It 4:44 actually shifts to visceral fat deposits 4:46 where you get a widening of the of the 4:49 actual waistline. But that visceral fat 4:52 tissue, the deep fat surrounding your 4:54 organs is more pro-inflammatory. 4:56 And because of this we get inflammatory 4:59 systemic inflammation inflammaging a 5:02 steady lowgrade 5:04 elevation of inflammation and 5:06 inflammation signaling with molecules 5:08 like TNF alpha and interlucan 6 that 5:11 increases our overall systemic 5:13 inflammation and that's why we also see 5:15 the increased risk for cardiovascular 5:17 aging neuroinflammation and and and 5:20 degeneration and even bone loss and 5:23 that's why you can do everything right 5:25 and run that extra mile, cut out carbs, 5:28 fast for 16 hours, and it still feels 5:31 like your metabolism has put on the 5:32 parking brake. Mainstream medicine 5:35 offered really two terrible solutions. 5:37 They either tell you to accept aging and 5:40 hand you a max dose GLP 5:43 um and they might titrate you, but they 5:45 might just hand you that medication, say 5:46 go um and in many cases that medication 5:49 makes you so nauseated that you live on 5:52 bone broth and crackers. I know because 5:54 I hear it all the time in our clinic um 5:57 as people come in on these medications 5:59 and they're struggling and it also can 6:02 destroy your remaining amount of muscle 6:03 mass if you're taking these medications 6:05 without being able to maintain enough 6:08 protein and exercise in the diet. And so 6:12 neither of those options are really 6:14 acceptable and it's where precision 6:16 really is required. So, let's talk about 6:19 what these drugs actually do. Because 6:22 calling GLP a weight loss drug is like 6:24 calling a smartphone a pocket 6:26 calculator. It severely understates what 6:28 these actual peptide hormones do. So, 6:32 GLP-1 is glucagon like peptide 1. It is 6:35 a naturally incurring hormone called an 6:38 incretin produced in your gut and your 6:40 brain. And we've known about these 6:42 hormones since the late 1800s. And we 6:46 have receptors for GLP-1 that exist 6:48 throughout your entire body. Your 6:50 hypothalammus in your brain, your 6:51 mioardium around your heart, your renal 6:54 tubules, which are in your kidneys, your 6:56 liver, your blood vessels, and your 6:58 immune cells. And here's what the 7:00 research shows beyond the scale. 7:03 Systemic inflammatory actions are 7:05 actually part of the mechanism of this 7:07 drug. In major clinical trials including 7:10 outcome studies looking at semaglutide 7:13 and proceepide researchers notice that 7:16 something remarkable happens. Markers of 7:18 systemic inflammation specifically 7:21 highly sensitive C reactive protein drop 7:24 significantly. 7:25 And here's the critical detail. The 7:27 inflammation drop occurs independent of 7:30 weight loss. So that's really important. 7:33 It is not a side effect of weight loss 7:36 which a lot of people were proposing 7:37 early on. It is independent to weight 7:40 loss. So the GLP-1 receptor activates 7:44 directly the down reggulation of 7:46 inflammatory cytoines NFCappa B which is 7:49 the central switchbox for chronic 7:52 cellular inflammation. It cools down the 7:54 vascular walls. So it actually slows 7:57 vascular inflammation and aging and 8:00 reduces neuroinflammation in the brain 8:02 and reduces inflammatory signals in your 8:05 fat tissues which makes you more insulin 8:08 sensitive. So when we look at the 8:10 cardiovascular and kidney renal 8:13 protection, the data confirm that GLP-1 8:16 agonists reduce major adverse 8:18 cardiovascular events, heart attacks, 8:21 strokes, cardiovascular death while 8:24 slowing the progression of chronic 8:26 kidney disease. for midlife women whose 8:29 risk of cardiovascular disease rises 8:31 sharply like an uphill you know hike 8:35 after menopause due to the loss of 8:36 estrogen and estrogen's vascular uh 8:40 protection this organ protective benefit 8:43 is a gamecher right so GLP1s act 8:47 independent and reduce these other 8:49 chronic uh cardiovascular risks that 8:52 coincide with the loss of estrogen in 8:54 midlife women Now, here's what I think 8:57 is even more important. The powerful 8:59 combination of GLP1s plus hormone
How GLP-1s Work Beyond Weight Loss 9:02 replacement therapy for pmenopause and 9:04 menopause. This is where the magic can 9:06 really happen. Estrogen and GLP1s work 9:10 synergistically in the central nervous 9:13 system to regulate satiety, 9:16 regulate energy expenditure and glucose 9:19 handling. And retrospective and clinical 9:22 data, including recent observational 9:24 data from institutions like Mayo Clinic, 9:27 demonstrate that post-menopausal women 9:30 taking both hormone replacement therapy 9:32 and a GLP-1 receptor agonist like Ozepic 9:36 or Wagobi, Semaglutide throughpatide 9:40 show a higher loss of body fat mass and 9:44 maintained better metabolic stability 9:47 than women taking a GLP1 alone. Why? 9:51 Because bioididentical hormone 9:52 replacement, specifically estrogen, 9:55 helps preserve muscle protein synthesis, 9:58 supports bone mineral metabolism and 10:01 bone mineral density and keeps baseline 10:03 metabolic rate intact while the GLP1 10:07 addresses insulin resistance, visceral 10:09 atyposity, and central food noise. And 10:12 I'm going to tell you estrogen also when 10:15 used appropriately in a pmenopause par 10:18 and menopausal woman helps with insulin 10:20 resistance too because it increases 10:22 insulin sensitivity and it reduces 10:24 visceral adiposity because it also 10:26 reduces the inflammatory response of 10:29 atapost tissue and can be so very 10:32 helpful. So when you combine these 10:34 together you're not starving the body 10:36 you're actually restoring youthful 10:39 cellular signaling. So here's some 10:42 things too that are very very 10:44 interesting. 10:46 In many clinical practices, a lot of 10:48 doctors and prescribers have been using 10:50 these GLP and GIP1s 10:53 off label at different doses. Right? So 10:56 we know from the research data from the 10:59 actual clinical trials that for many 11:01 people there are GI distress symptoms 11:04 everything from nausea vomiting to 11:07 gastroparesis 11:09 to a host of different symptoms and for 11:12 some people taking these medications 11:14 even at the lower approved doses prove 11:17 to be symptomatic and and unattainable. 11:22 Right? So there's a distinct group of 11:24 people where women are actually using 11:26 these in a different dose escalation 11:30 therapy off label through 11:32 compoundingies. 11:34 Now this is not what the FDA approved 11:36 them for. This is not how the drugs were 11:38 actually delivered through the brand 11:39 names. However, what do we know 11:43 anecdotally from the data of people that 11:45 are doing a different dosing? Okay, so 11:49 the commercial dose escalation world, 11:51 right, where these medications from the 11:53 approved studies, they usually start on 11:56 a standard pharmaceutical titration 11:58 schedule where they scale up every four 12:00 weeks to a maximal dose of like a 2.5 12:02 milligrams of semiglutide or 15 12:05 milligrams of 12:08 um so what we see is depending on the 12:10 study and depending on the feedback a 12:13 lot of times this is where we start to 12:14 see exhaustion, chronic nausea, or it's 12:19 really hard to choke down 800 calories a 12:21 day because you've lost every bit of 12:24 hunger and this is where we start to see 12:27 a loss of significant muscle tone when 12:29 we sometimes hit these higher doses. Um, 12:32 but this is where the weight loss really 12:34 occurs. And so for a lot of women, we 12:36 start to see hair loss. And long term, 12:39 we see metabolic rate that can be 12:40 changed, right? And so for many women, 12:43 this is when we get into the caveat of, 12:45 hey, I can't handle these medications, 12:47 but I want these medications because 12:50 it's killing the food noise for the 12:52 first time. And I was seeing really 12:53 weight loss, 12:56 but the ever escalation of dosing causes 12:59 too many symptoms, right? So this is 13:02 where a lot of practitioners have 13:03 started micro doing or lowd dose 13:06 targeted therapy instead of pushing the 13:08 dose to cause this severe appetite 13:11 suppression or or you know all the 13:14 symptoms many are actually doing sub 13:16 therapeutic minimum effective dose. So 13:19 what does a micro dose do? 13:22 A micro dose is a dose significantly 13:24 below those starting doses of turseptide 13:28 saglutide and what it is intended to do 13:32 in most cases I don't prescribe I'm just 13:34 talking about the either the anecdotal 13:36 data and what has been reported is what 13:40 they're doing is getting a therapeutic 13:42 level to turn off the intrusive food 13:45 noise. This is probably one of the most 13:47 significant things that we see in the 13:49 research on these drugs is the turning 13:52 off of the addictive patterns that 13:55 happen in our brain. We know that they 13:57 are there. This is hypothalamic control 13:59 that have to do with satiety and hunger
GLP-1s, Hormone Therapy, and Microdosing 14:01 signals. Well, what's really interesting 14:03 is when we look at these drugs, they 14:05 also do that with alcohol and other 14:07 addictive substances. So, one of the 14:08 most powerful effects of these 14:10 medications is this food noise and 14:12 craving, right? So for the people that 14:16 get that effect, but the medication at 14:18 the standard doses cause nausea and 14:21 vomiting 14:23 when when a micro dose is used, it can 14:25 be used to shut off the food noise but 14:27 maybe not induce that appetite activity 14:31 entirely. Um, so what ends up happening 14:34 is we get a suppression of that food 14:36 noise, a better appetite control, an 14:39 improved post-eing blood sugar spikes 14:42 and enhanced insulin sensitivity without 14:44 the nausea, vomiting, and fatigue. And 14:48 it can deliver [clears throat] an 14:49 anti-inflammatory benefit that might 14:51 help with vascular tone and things like 14:54 overall inflammation, and even joint 14:56 pain. We don't have clinical data that's 14:58 proved by the FDA to say that, but we're 14:59 hearing that anecdotally from the 15:01 individuals that are prescribing in 15:03 these lowd dose arena. And what it does 15:06 is also allow women to 15:09 eat a little bit more food, but still 15:12 see the positive effects of these 15:14 medications and especially getting to 15:17 that 120 gram minimum of protein a day 15:21 because this is the part that even two 15:23 years ago I was very concerned about. It 15:25 was the um just overall 15:29 loss of hunger. And even I did it. I 15:32 mean, I did an entire podcast saying, 15:34 "Okay, I'm going to try these 15:35 medications and see how it feels." Cuz 15:36 Dr. Amy Hornman, a good friend of mine, 15:38 was like, "Betty, you haven't taken 15:40 these meds, but you're lambasting them." 15:41 So, I did. And the first dose, I didn't 15:44 really feel anything, right? That first 15:45 level dose. But as soon as I titrated to 15:47 that next kind of therapeutic dose at 15:50 the pharmaceutical level, I was so 15:52 nauseated. And I could promise you 15:54 whenever I put a piece of animal protein 15:57 in my mouth, it was everything I had to 16:00 actually choke down a couple ounces. It 16:03 for me it was very very difficult. And I 16:05 was like, this is unattainable. I can't 16:07 I can't take these medications and also 16:10 fight through a piece of chicken breast, 16:13 right? And so my concern always back 16:15 then was how do you get in that protein 16:17 amount that you need when that's the one 16:20 food you absolutely don't want? And so 16:22 for a lot of practitioners that have 16:24 been micro doing over the last two 16:26 years, what they're finding is they can 16:27 get that sort of benefit without 16:30 actually moving the dose so high that it 16:33 starts to impair the intake of protein, 16:36 right? And it also allows women to still 16:39 hit the gym and hit the weights. Because 16:42 the other thing is is if we're 16:43 undereating calories so bad that we're 16:46 losing weight rapidly, which is a lot of 16:48 what's driving the significant kind of 16:50 skinny talk and the other things that 16:52 we're seeing, we're also losing muscle 16:54 mass if we're not hitting the gym, 16:56 right? And that's already an uphill 16:58 battle in midlife. And so, you know, we 17:01 had a a woman that I talked to last 17:03 week, which is really what prompted me 17:04 to talk about this medications and kind 17:07 of how I feel about it today. And she 17:10 was 52 years old, permenopausal, and she 17:12 had all the things, all the inflammatory 17:15 things, elevated, highly sensitive C 17:17 reactive protein. You know, her in 17:19 fasting insulin was getting higher. Her 17:21 ceptide, which is the precursor that 17:23 kind of holds on to insulin before it 17:25 hits the bloodstream, was elevated. and 17:28 she picked up a steady 20 pound gain 17:30 around her waist mostly and was 17:32 experiencing joint pain which is part of 17:34 that muscularkeeletal syndrome of 17:36 menopause. when we looked at her lab 17:39 work at the clinic, what we noticed um 17:41 is that you know there's a lot going on 17:44 and medically our medical team here put 17:47 her on a lower dose of GLP and we 17:52 optimized her her estradile and oral 17:55 progesterone and used a lower dose of 17:58 tzepatide and then adjusted a protein 18:01 target to 1.2 g per pound of lean body 18:04 mass. Right? So in that case where we're 18:07 looking at, you know, 100 to 120 grams 18:10 along with 3 days of heavy heavy ins uh 18:13 resistance training, you know, so here's 18:16 the thing that was a great plan for her, 18:19 right? And we're going to see 6 months 18:20 from now to, you know, what her relative 18:23 joint pain was. We know that joint pain 18:25 actually improves with hormone 18:26 replacement therapy. It improves 18:28 actually with weight training. Oddly 18:30 enough, the thing that you're most 18:31 worried about, weight training, 18:33 increasing uh joint pain actually 18:34 reverses joint pain. And we also have 18:37 arthritic studies that show that more 18:39 physical activity and especially more 18:41 weight and resistance training makes the 18:43 pain better. And then you add the 18:45 anti-inflammatory effects of turepide 18:47 and what we're going to probably see is 18:49 that her fasting insulin is going to get 18:50 better. She's going to have weight loss 18:53 and we're going to see especially 18:54 visceral fat loss because we've seen it 18:56 before, right? This is part of metabolic 19:00 engineering, right? Metabolic 19:02 engineering looks at not just adding to 19:05 weight loss because everybody's worried 19:07 about what's on the scale. It's actually 19:09 turning back and turning on the things 19:11 that are changing in midlife like the 19:13 hormones and improving glucodon type one 19:16 peptide and the receptor activity so we 19:19 can kind of engineer the metabolism to 19:22 work as if it did several decades ago, 19:24 you know. So if what's the PLA practical 19:27 translation of this? What's the advocacy 19:30 you could do? So and and if you're 19:32 thinking about it and you're like, 19:33 "Okay, maybe I'm not on hormones and 19:35 maybe I should be on hormones or maybe 19:38 I'm not on a GLP1 or one of those 19:40 medications or maybe I tried them and 19:42 they made me feel that crap and I 19:44 couldn't do them, but I I also am 19:47 envious or andor sad that I can't take 19:49 them." So here's some of your framework 19:51 for your own self- advocacy. So how to 19:53 think about that? So, first I always I 19:56 you know even yes like if you're 19:58 permenopausal and you're symptomatic 20:00 that enough warrants getting treatment, 20:04 right? You don't you don't have to have 20:05 labs. However, I really like knowing 20:08 where I'm starting, right? It's kind of 20:10 like a map. You can't get to where 20:11 you're going if you don't know the first 20:13 left or right that you have to take. So, 20:14 I do like getting data. So, what data 20:17 would be helpful for you if you're if 20:19 you're thinking about sort of 20:21 re-engineering your metabolism? First 20:23 and foremost, it's I recommend getting a 20:26 DEXA. So, a DEXA does your body 20:28 composition and your bone mineral 20:30 density. Now, some places may only do 20:33 bone mineral density. Some places can do 20:35 both. And what I recommend is if you can 20:38 get to one that does both, that would be 20:40 advantageous. That's what we do is we 20:43 look at both because DEX is going to 20:45 have a much more accurate assessment of 20:48 your body fat, visceral fat, and lean 20:52 muscle mass and where it's distributed. 20:54 And then obviously the DEXA scan, if 20:56 you've never had one done, you should 20:57 have one done because that tells you
Labs, Protein, and Resistance Training 21:00 your lumbar and and femur level of bone 21:04 mineral density, which is extremely 21:05 important. we lose bone mineral density 21:08 through pmenopause and menopause and we 21:10 don't want to do that. But it's a very 21:13 important part of establishing 21:15 particularly your lean muscle mass and 21:17 fat mass so you can pay attention to 21:19 where you're losing it from. I also 21:21 think it's really important to get a 21:23 full metabolic panel on your blood work. 21:26 That also includes things like your 21:28 fasting glucose, your fasting insulin, 21:31 your hemoglobin A1C, your lipids, and 21:36 your lipoprotein, apo lipoprotein B, and 21:39 apol lipoprotein A1. That tells us along 21:43 with your triglycerides kind of what 21:45 your cardiovascular risks are too. And 21:47 are you brewing insulin resistance? Are 21:50 you having glucose management problems? 21:53 What's going on there? because a fasting 21:55 glucose is not enough to understand 21:56 that. And I think it's really valuable 21:59 to get inflammatory markers, things like 22:01 HSCP 22:03 to understand what's your general level 22:05 of inflammation, particularly from a 22:07 cardiovascular risk. And even if you're 22:10 in pmenopause, 22:11 I also like to see an estradiol, a 22:14 progesterone, a total and free 22:16 testosterone, and a full thyroid panel. 22:19 TSH, T4, T3, free T3, free T4. your 22:24 thyroid antibodies and reverse T3 if you 22:26 can get it because thyroid is often 22:29 along for the ride on this situation and 22:31 we want to understand it and if you can 22:33 get a DHEA sulfate and cortisol now we 22:36 have a much fuller picture of your 22:38 metabolic hormones that have a lot to do 22:40 with what's going on along with your sex 22:42 hormones and your thyroid. All [snorts] 22:45 right so when you have that that gives 22:46 you your first stop sign what's going on 22:49 with your body. Now we have to really 22:52 look at a muscle centric protocol, 22:55 right? You know, Gabrielle Lion talks 22:57 about muscle centric medicine. Um, you 22:59 know, everybody under the sun is talking 23:01 about it, Stacy Sims. But when you're 23:05 looking at putting in a GLP-1, we have 23:08 to anchor that GLP-1 therapy with 23:12 protein minimums, right? And protein 23:14 minimums are 1 to two grams per pound of 23:17 targeted lean body mass, right? So that 23:20 puts most women squarely in that 100 to 23:22 120 grams is the low end of the scale, 23:25 right? We had a study that came out last 23:27 year that looked at protein intake and 23:31 showing just having more protein intake 23:34 in a woman in midlife improves muscle 23:38 protein synthesis. However, that can be 23:41 lost when there's not resistance 23:43 training. So we got to make sure we get 23:45 enough. If you're going to the gym, you 23:46 got to make sure you get the protein to 23:48 actually make the muscle, right? So, 23:50 your protein minimums are that one to 23:52 two one to 1.2 grams per pound of 23:56 targeted lean body mass. And our target 23:58 lean body mass is at least 100. And we 24:00 need to do progressive resistance 24:02 training. You know, lifting three to 24:05 four times a week. And you can you can 24:07 create harder lift mechanics by either 24:11 raising the weight and reducing the 24:13 number of repetitions you do or by 24:16 increasing the number of repetitions and 24:19 keeping the weight lighter. Here's how 24:21 you know which one to do. Number one, 24:24 don't lift heavy weights if you don't 24:25 have people spotting you. You don't want 24:27 to be doing this on your own where you 24:29 might cause injury because that sets you 24:31 back. Now, you can increase the number 24:34 of repetitions, add a lower weight, and 24:36 make it harder. How do you know whether 24:38 those weights are at the right amount? 24:41 The last two reps should be really 24:43 difficult because that's where all the 24:45 growth grows, right? And if you can add, 24:48 you know, once a week or once every 10 24:50 days, a weight training session that is 24:52 lower repetitions, heavier weight, big 24:55 compound movements, squats, deadlifts, 24:58 you're going to get more muscle growth 24:59 that comes from that. Both will increase 25:02 strength gains, but muscle growth 25:04 actually is slightly improved with those 25:07 lower repetitions and heavier weight. 25:10 But what you want is that mechanical 25:11 signal for muscle protein synthesis and 25:14 muscle tissue growth along with your 25:17 osteoblasts that tell your bones to 25:19 grow. Right? So, we have to make sure 25:21 that we're playing paying attention to 25:23 that before we put in GLP ones, right? 25:26 That that's part of the picture. And if 25:29 you're looking at can I do these right 25:31 so first and foremost hormones have to 25:34 be part of the picture GOP ones GIPS 25:38 absolutely can help with food noise 25:40 reduce inflammation and help with the 25:43 weight loss picture. However, hormone 25:45 replacement therapy not only gets rid of 25:48 hot flashes and night sweats and might 25:50 help with your mood, depression, 25:51 anxiety, brain fog, 25:54 palpitations. 25:56 Menopause has a stiff arc of aging and 26:00 we know that there is this kind of 26:02 increase that we see that's exponential 26:04 when we hit 40 and a lot of that is the 26:07 hormone chaos and probably the most 26:10 powerful longevity thing we can do is 26:12 replace the hormones that are missing 26:13 because of loss of ovarian function and 26:16 so when we put those hormones in and we 26:17 stack a GLP and especially for somebody 26:20 that might need a GLP that is um micro 26:24 do so we get the anti-inflammatory 26:26 effects, but we don't induce some of the 26:27 digestive and nausea related symptoms. 26:31 You want to make sure you're working 26:32 with somebody that can see both. So, you 26:35 want to ask your do your provider if 26:37 you've tried the medications before and 26:39 they're too much. Ask if you can start a 26:41 low dose. Ask if we can evaluate my 26:44 inflammatory glucose levels, my appetite 26:47 response before escalating the dose. 26:50 Because what you may find is that you're 26:51 getting metabolic improvement without 26:53 having starvation. 26:55 And like I said, this is this is not the 26:57 FDA cleared doses, but lots and lots of
Self-Advocacy and Longevity in Midlife 27:00 functional medicine practitioners are 27:02 using these lower doses to help out. But 27:04 I what I would say is that the GLP1s 27:07 help when we have all of that other 27:09 stuff dialed in. And they are 27:11 exponentially better when we have the 27:13 hormones on board to actually improve 27:15 all of those other activities of aging. 27:19 And you know this entire conversation is 27:22 kind of how I came full circle to 27:24 creating the Manurva project because the 27:27 Manurva project is not only Manurva Tele 27:29 medicine which is providing hormone 27:31 replacement therapy and thyroid support 27:33 in all 50 states but it's also my 27:37 research and my own experience 27:39 navigating perry menopause. If you've 27:42 heard my story before, I gained like 30 27:44 pounds as I went into pmenopause from a 27:47 tubal. And it was kind of this 27:49 acceleration that happened. And it 27:51 wasn't until I went back and started 27:53 digging through the research and 27:54 understanding the impact of these 27:56 hormones on our actual metabolism that I 27:59 was able to sort of reverse gears. And 28:01 it was really as I embarked on actual 28:03 menopause that I was able to kind of get 28:05 this under control, lose the 30 lbs, and 28:07 I been able to keep it off for over 28:09 eight years. But the reality is is for 28:12 many many women and generations, women's 28:15 health has been plagued by this binary 28:16 thinking. We either given no options or 28:20 told that our symptoms are just part of 28:22 aging and we are handed either quick fix 28:25 pharmaceut pharmaceutical band-aids that 28:27 are stacks of medications that 28:29 completely ignore female biology 28:33 or we've been under under reppresented 28:35 even in the brosphere longevity research 28:38 and metabolic research for far too long. 28:40 And so either we're applying men's doses 28:43 or doses that don't really work in a 28:46 combined therapy sort of way or we're 28:50 just driving without instructions. And 28:53 that's really where Manurva, the data 28:55 and technology and research side is 28:57 coming. It's coming. It's coming ladies. 29:00 I promise you because the reality is is 29:02 we have decades of gap in women's 29:04 research from the women's health 29:06 initiative. But we have over a hundred 29:08 years of ignoring women's health to 29:10 begin with. And it really requires us 29:12 understanding not only what's happening 29:15 in imperry menopause and menopause, but 29:17 capturing data and applying more 29:20 research directly to women today and not 29:23 waiting decades for double blind placebo 29:26 control trials of every single thing. 29:27 Because if that's the case, I'm sorry, 29:29 the boomers and the Gen Xers will be 29:31 dead long before we ever get there. And 29:34 so we don't have to apologize for 29:36 wanting to feel great and energetic and 29:40 also lean in midlife. And you don't have 29:42 to choose between having all natural 29:45 solutions. Yeah, I said that too that I 29:48 was just going to handle my pmenopause 29:50 and menopause with nutrition and good 29:52 lifestyle, which is complete and utter 29:54 because you can't replace the 29:55 hormones that are missing when your 29:57 ovaries stop making them. And so we can 29:59 be natural and there's nothing more 30:01 natural than replacing the hormone that 30:03 your body is no longer making because 30:04 our body hasn't caught up to our 30:06 longevity yet. And we can use modern 30:09 biochemistry to do that. True Healthspan 30:12 architecture uses every validated 30:16 validated evidence-based informed tool 30:20 available. Even if that evidence isn't 30:22 double blind placebo control trials, 30:25 when they're done intelligently, safely 30:28 with a care team that is listening to 30:31 you and also capturing data, utilizing 30:35 data, and utilizing emerging research, 30:38 we can do that respectfully and we can 30:40 also do that while we actually make a 30:43 difference in the science of longevity 30:45 for women. So, as we wrap up today's 30:48 episode, 30:50 I want to leave you with three questions 30:51 to reflect on this week. Number one, are 30:54 you measuring your health progress by 30:56 arbitrary numbers on a bathroom scale? 30:59 Are you trying to get back to the woman 31:02 you used to be? What we need to do is 31:04 get to the woman you're supposed to be 31:06 right now. Right? If we're having that 31:08 conversation about who you used to be, 31:10 we're still playing in an arena where 31:11 we're not recognizing that the game has 31:13 changed. Right? or are we looking at our 31:16 muscle strength and our strength overall 31:20 and our cellular inflammation and our 31:22 overall longevity health? That's that's 31:25 where we want to put our focus on. Is 31:28 our medical provider working with us as 31:31 an intelligent partner or handing you 31:34 cook cookie cutter solutions or being 31:36 dismissive of what you need, right? and 31:39 being willing to maybe go into the gray 31:42 sometimes to help you navigate your 31:44 health. And I'm not talking gray market, 31:47 right? I'm not talking gray market. What 31:48 I am talking about is that they're 31:50 willing to sit in the emerging science 31:52 because we cannot, in my estimations, 31:55 this is my opinion, we cannot let the 31:57 boomers and the Xanaxers of which I'm a 32:00 part struggle because we want pharma and 32:04 NIH to fund a study. We get less than 1% 32:07 of all fundable research dollars in 32:10 midlife. If we wait for that, we'll all 32:12 be dead. And what would happen if you 32:16 stopped viewing metabolic support of a 32:18 failure of willpower and started viewing 32:21 it as an opportunity of proactive 32:23 longevity care? Because it isn't a loss 32:27 of willpower. It isn't your lack of 32:28 willpower. It is a biological, 32:31 biochemical, physiological change to 32:33 your body of which you're trying to 32:35 navigate. And in most cases, your 32:37 medical providers are navigating with 32:39 old technology or crap that was made for 32:41 men. So if this episode has changed the 32:44 way you think about metabolic health in 32:46 midlife, I know I have created a lot 32:49 more opportunity for these weight loss 32:51 drugs in a broader scope because I've 32:54 been watching the emerging research and 32:56 watching patients within our clinic and 32:58 within tele medicine navigate this 33:01 experience. 33:02 You know, think about this. If this has 33:05 really changed how you think about 33:06 metabolic health in midlife, please 33:08 share it with a friend, share it with a 33:10 sister, share it with somebody who needs 33:12 to hear it because you don't want to 33:16 navigate this alone and you don't want 33:18 to let your good friends navigate it 33:20 without help. And I want to thank you 33:23 for listening to Menopause Mastery. You 33:25 know, it's literally why I do what I do. 33:28 I want to make sure that we're all 33:30 having the most amazing midlife 33:33 possible. 33:35 And you know what? If you're listening 33:36 to us on your favorite podcast platform, 33:39 don't forget to leave us a review. 33:40 That's how we get found. And if you 33:43 happen to be watching this on YouTube, 33:45 don't forget to subscribe and leave a 33:47 comment. And until next time, keep 33:50 asking better questions, demand better 33:52 data, and own your midlife mastery. 33:56 See you next week. 33:59 >> [music]
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