Ep 129 | Metabolism & Menopause: Thyroid, HRT, and the Muscle Connection w/ Dr. Christine Maren

Addressing the root cause is a really big deal. If you go on HRT but you still have some underlying gut infection or a microbiome imbalance, like gut health is also really important on how you do on HRT and so is thyroid. Hey guys and welcome back to the show. I am your host Megan Hardy and today I'm joined by Dr. Christine Marin, a board certified physician and functional medicine expert who helps women navigate parimenopause, menopause and thyroid health. In this episode we're going to talk about the importance of muscle for hormone health, blood sugar and metabolism, especially for women over 40 and we're going to touch on thyroid health and its impact on HRT, hormone replacement therapy. Dr. Marin brings both her expertise and practical strategies to help women in parimenopause and menopause take charge of their health. I am really looking forward to this conversation. Dr. Marin, thank you so much for being here and welcome to the show. Thank you. Thanks for having me. Yes, absolutely. Would you just share with our listeners a little bit about you to get a started, anything I left out in that intro, your expertise and also just a little bit personal about you? Yeah, so I mean on the personal side, I'm a mom of three, I mean my 40s. Most of what I practice is because I've been through my own health journey and I figured out a lot along the way and of course I've seen women for the last decade in my functional medicine practice and learned a lot from my patients, things we have gone and in my practice I really focus on root cause medicine, that's that whole piece that's like this functional medicine lens and I focus on hormone optimization and so that is for a lot of women in parimenopause and menopause, estrogen, progesterone, also testosterone and thyroid. I talk a lot about thyroid health and also stress and chronic stress and how that really layers into our lives as women, which I think is really common and prevalent. So I've got that framework and then I've got my five foundational health habits. One of those is strength training and movement as well as nutrition, low-tox living, sleep, stress and mindset. And so from a professional standpoint, my functional medicine training was started about a decade ago and really was born out of fertility, really fertility issues that I had, I had recurrent miscarriages and I knew there was something going on with me, I didn't get a lot of answers in the conventional, you know, from a conventional standpoint. But I'm born certified by the American Board of Family Medicine, Institute for Femish Medicine, certified and I'm also certified by the menopause society. I did not realize that about you. I had my own miscarriage so I can, it's like you don't realize how big that that tribe is until you're in it. And you're like, oh, okay. And I also can really appreciate that you're like, okay, what is some of the root cause here? Because it's common but not normal. Yeah, exactly. We're told it's normal, but really you're like, no, it's not, it's common, but what's going on here? So that's really what fueled you to kind of get into the functional health side. Yeah, I mean, I had a lot of things going on at that time. As most of us do, it's usually that not one little thing. It's like gut health and thyroid issues and hormone imbalances and mold exposure and, you know, it's just a big soup. So kind of unpacking all that took years. And also, you know, got me a lot of good experience and helps me take care of women who have complicated issues. I mean, I think we're all truly complex, right? Like our health just isn't super simple. Like it just isn't. Yeah, I actually, I'm going to reuse what you said. I'm going to use that now and call it a soup because it definitely feels like soup a lot of time. It's just like, what is going on and what is in here, you know? So being able to peel back the layers of that and like figure out what the ingredients are in the soup. And actually, so with our topics today, I like, I reached out to you on social media because I saw a post of yours. I don't even remember how I came across your page to be honest. I think it might have been another podcast you were on possibly. And I was like, Oh, let me follow this person. And then you posted about muscle and how it's so underrated for hormone therapy. And for women in their 40s. And I was like, this she sounds like my people. Yeah, but with that was a big fan of muscle. Yeah. So I was like, I need to have her on the show. I did some stalking. And then I was like, I would love to have her on. And I just want to I mentioned this before we start recording. But give, you know, Dr. Marion props to when I reached out, she was like, Yeah, let's do it. And I just always appreciate who were like, Yeah, let's go. You know, why not? And that's how I try to be too if people approach me for podcasts. So really excited for this conversation. And I would love if you could just kind of touch on that post first. And then we'll jump more into thyroid and how it impacts HRT. But the post said, I have it written here. You said muscle is the most underrated form of hormone therapy. And one of the best things you can do for metabolism, blood sugar, and body composition after 40. And if you could just from your own lens, like, I feel like my audience gets to hear me talk about some of these things, but he's just hearing it from someone else and an expert in the space can be really helpful. So would you just kind of give your lens on muscle and its impact on metabolism, blood sugar and body comp for when? Yeah. I mean, skeletal muscle is, it does a lot of things, and they're all good. You're all good. I mean, there's a lot of like, where do I even start? I mean, from a blood sugar standpoint, muscle is really important for insulin sensitivity. And as women go through menopause and parimenopause, and they have a decrease in estrogen, often it's accompanied by something called sarcopenia, which is aged related muscle loss. And we can prevent that, but we have to be ready for it. You know, we have to be proactive about that and maintaining our muscle often requires some hormone therapy to help, but muscle itself is like the number one thing that we can do for longevity, for blood sugar and insulin. It is anti-inflammatory. There's even studies looking at how patients who are post cancer have done with recurrence after chemotherapy and they do better if they have more muscle, if they're lifting weights. And so strength training doesn't just help the blood sugar piece and the metabolic piece. It also helps the immune system piece. It's also really important for women with autoimmune disease. I mean, I think it's just, it's like, it's underrated. There's so many patients I have who are doing all the things. They're often like un-alimited or restrictive diet. And sometimes they are, I mean, they're taking like 5 million supplements. You know, they're doing a lot for their health, but they're missing this one really critical aspect, which is lifting weights and preserving muscle mass. And I appreciate you that you mentioned the autoimmune piece as well, because a lot of the, so I like, I work with clients and nutrition and fitness. And I would say almost half or have hypothyroid or even Hashimoto's. And it's like, oh my gosh, it's like, was this always a thing or just not realizing it or more and more women, getting this, and having this. Yeah. It's more and more women getting it and having it. The rates of autoimmune disease, especially autoimmune disease among women, is really huge. And I think part of that reason is women are so overextended. We are just, we take on a lot. There's a lot of cultural background to it. And again, it's like the soup. It's like we're, we take on a lot. Women tend to be really overly, I shouldn't say overly, but women tend to be really productive and are often very capable and highly responsible. And those are the women who end up often with autoimmune disease. I've seen this pattern over and over in my clinic. I've seen it with myself. I mean, I had autoimmune disease. This is like a pattern I've, I've played out in my own life. And there's a lot of good that comes from it. We're really capable resilient. You can depend on us, but like ultimately, it adds up and it creates health issues. And so the downstream effects are often autoimmune. Gosh, it's so real. I don't know if you've seen the, is it real? That's like, I wish that relaxing could be more productive or something like that. You know, just speaking to the woman who's not good at relaxing, you know, we're just always trying to be productive, but then it kind of comes at a cost to, you know, yeah. So as far as muscle, it can even, so impacting metabolism and then the blood sugar component, but then even like immune health and autoimmunities too. Yeah. And I think this is a good, important misconception to sort of bring up to because a lot of women who have autoimmune disease are under the pressure that shouldn't exercise. Now they've been, they've got this message like, oh, my cortisol's messed up. I shouldn't lift weights or I shouldn't exercise. And while I agree that they probably shouldn't like run a marathon or train for like an iron man, lifting weights is one of the best things they can do, you know, it is one of the best things we can do if we have autoimmune disease. It also just helps with cortisol actually. Like it gives us, you know this, like when you lift weights, it gives you this different source of strength. And sometimes I have a hard time like putting the science on it exactly, but it helps with stress and it helps with emotional resilience and strength. There is something about lifting weights. So does that, am I right? Oh, you're right. You're so right. I'm like, yeah, my drop. Yeah. No, and it's like, it's like the acute stress of lifting weights. And it's like, it's that stress in the moment, but it then it really does make you stronger not only physically, but then also translates to other aspects and areas of of life so much, such a firm believer in that. That's so, so good. Well, if we could jump into our topic 'cause I think this can be like a very meaty conversation about thyroid health and its impact and link to HRT as well. If a woman is, you know, contemplating or on hormone replacement therapy, that I will tell you that's a lot of our listeners or paramedicolism and appausal ladies, either on HRT thinking about it, have been on it, it didn't go as planned, all the things. Yeah. So one thing to kind of open up this conversation and I'll open the floor to you, but a lot of women who have tried HRT, they tend to still feel like, they're still feeling tired and foggy or they're still struggling with their weight and could that be a thyroid health link as the missing piece? If you could, yeah. I think there's a lot of missing pieces. Like HRT is not a panacea, it's helpful. That's why when I talk about this framework I have in my clinic, it's like address the root cause and optimize hormones and work on these five foundational lifestyle habits, but addressing the root cause is a really big deal. So thyroid is a little complicated because it just suboptimal thyroid levels and/or is it Hashimoto's. So if it's Hashimoto's, that's a really common underlying autoimmune condition that over time causes hypothyroidism. It's very much under-treated. Well, I should say it's under-diagnosed. A lot of women aren't tested for it. They have no idea that they know that they have Hashimoto's. And so there's a lot of overlapping symptoms between women who are in paramanopause and women who have hypothyroidism in Hashimoto's. Like a ton, it's really hard to differentiate. And so that's where labs come in. I mean, that's where yes, we can walk through symptoms and there's some things like thinning of the outer third of the eyebrows more common with hypothyroidism than it is with paramanopause. But like thinning hair is common with both, right? So it's hard. It's fatigue, it's common with both. Irregular periods could be both. Like there's a lot of overlapping symptoms. So labs are important and if you start HRT and your symptoms are not any better, like even more reason to get more labs. - Mm, well that was one of my questions for you actually was like why do so many thyroid problems get missed with standard lab testing? And then what labs should women really be asking for when they are? - Most doctors, when I did my family medicine residency, most physicians are checking just a TSH. And TSH is a good lab, but we need a lot more than that. Some physicians will check a TSH and a free T4. So free T4 is gonna be really important. Sometimes people have a normal TSH, but it's a low free T4. That's another condition, but that's a problem. That's a type of hypothyroidism. So for women in my practice, I'm checking a TSH, I'm checking a free T4, also a free T3. So you convert T4 to T3 and T3 is your active hormone. I also like to check a reverse T3. So for women who are under fueled, which if you're lifting weights and you're not fueling appropriately, you're not gonna have been a good, you know, anabolic state, you're not gonna gain muscle, you're under fueled, often we'll see a high reverse T3. And that's a good sign that there's just too much stress. Like there's too much stress on the organism, you're under fueled, like there's a lot of inflammation, there's other things going on. And then to identify Hashimoto's, we can check TPO or thyroid proxidase, as well as TG, thyroid glabulin antibodies. So those are usually common in patients who have Hashimoto's, not always. We can also do a thyroid ultrasound. There's other kinds of investigation we can do, but that full thyroid panel is TSH, free T4, free T3, reverse T3, thyroid proxidase, and thyroid glabulin antibodies. - Do you wanna win some free supplements, like protein powder, creatin, or pre-workout, then keep listening. I'm partnering with Legion and giving away free supplements to you podcast listeners, just for being a listener of the show. All you have to do to enter the giveaway is subscribe to the muscle makeover, click that little plus icon so that you're following the show, and leave a review if you listen on Apple podcasts or leave a comment on one of the episodes if you listen on Spotify. And that's it. If you win, you can pick from any of Legion supplements, and one of my personal favorites is Legion's protein powders. I put the cinnamon cereal flavor protein and just about anything I can. I put it in my oats, in my cereal, Greek yogurt, baked goods, you name it. It is so delicious and so creamy, and on top of the flavor is being absolutely on point. All of Legion's products are 100% natural. They don't use artificial sweeteners, flavors, or dies, and they're a third party tested for quality assurance. So if you wanna give Legion a try, the link is in the show notes, so you can easily shop around, and for being a listener of the muscle makeover, you'll get 20% off your first order, and cash back on all future orders, by using the code TMM, as in the muscle makeover. Now, if you want those free supplements, don't forget to subscribe to the show, and leave a comment or review, so you can be entered into the next giveaway. I can't tell you how many clients I've had who are like, "Yeah, I got my thyroid tested, "and I'm like, what did they test?" And they're like, "TSH." And all is normal. Could you kind of speak to that too? And I've even had clients who have gone in and said, "Can I get a full thyroid panel?" And then, you know, they just get, they just get "TSH tested." - Yeah. - Coming from a doctor and someone, you know, practices functional health. Why is that? - Yeah. - Yeah, I mean, doctors, so a lot of times how it's ordered is a TSH with a reflex to free T4. And that means the labs only gonna check your free T4 if your TSH is outside of the reference range. There's some controversy behind the reference range, American Thyroid Association, American Academy of Family Physician. Like, everybody stands behind it now, behind that reference range, but the reference range is based on sick population. It's based on people who have hypothyroidism. And so there's optimal, and then there is the normal reference range. And so the reference range usually goes up to around four and a half depending on the lab. And so, unless your TSH is above four and a half, you're not gonna be identified. Even if it is above that number, so if you're between five and 10, that's subclinical hypothyroidism, assuming your free T4 is normal and so you wouldn't be treated in most cases. Sometimes they'll treat you if you have signs of Hashimoto's, which just isn't checked enough. Like it just missed so often. So part of the reason it's not checked, I mean, I think a lot of it is honestly financial. Also, when you see a primary care doctor, they know a lot, but they know a little bit about all this stuff, right? They're not, they're not as special as they don't do thyroid. They don't do Hashimoto's. They don't know they're always like the preconception lab where they're just like, they're good doctors a lot of times. Like they've got a lot of training and there's, they don't know everything and sometimes they miss some things, you know? It's just, it is what it is. Also there's, there's not, there's no big certifying body that's pushing, but nobody knows what a full thyroid panel. Like if you say that to a normal conventional doctor, like that, I don't even know what they know what they're doing. I mean, - 3T3 is just really under-checked and even if it is checked, if you have an open-minded doctor who's like, sure, I'll check it for you. A lot of times they don't know what to do with the information because it's not something they do a lot and the reference range for a free T3 goes really low. And so you're not gonna be flagged as having a low free T3 unless you're really, really low, like in the pits. So kind of that's the thing with thyroid. It's like unless you're really in the pits, like it's not flagged on your lab. - Yeah. - So you kind of have to understand what is, what are these optimal lab ranges look like? And then, you know, make some decisions from there. As a, just like a broad kind of one, I'd say free T4 and free T3 should be in the upper side of that reference range. But my optimal range would be to get TSH, like somewhere between one and two, to get free T4, at least above like 1.2, 1.3, 1.4, 1.5, that is good. Sometimes I see it at like 0.8 or 0.9, which is low. And then free T3 in the threes, like 3.2 to 3.8, it's like the sweet spot. - I love that you mentioned the optimal range versus normal range. And that point of like that's looking at like a sick population or you know, people struggling with their thyroid and so really what we should be looking at, the optimal range because it just gets, they get thyroid issues, get missed so much. - Yeah. - Actually, I have a family member who's not, someone who's working with me, but who was asking for advice. And I like told her over and over, and I was like, please go get labs and see a functional health practitioner like, like I really think there's an underlying thyroid issue here. And she's like, I had my thyroid test, and I'm like, no, you didn't. Yeah. And I'm like, just out all the symptoms point towards that. And I actually was wondering if you could address some of those even thyroid issues that you see commonly show up in, especially in pariaminent and pausing in a paus, so women might know what to look for. You already mentioned some that can be, you know, between your menopause or thyroid, like thinning eyebrows, things like that. But what would be some things that would be like, maybe thyroid issues? - Yeah. So sometimes women will experience cold intolerance. So like, it's like a cold to the bone. Like you can't warm up constipation sometimes, but sometimes it's just like, IBS kind of symptoms. There's a big feedback between thyroid and gut. And so sometimes it's just this dysmotility. Sometimes it's like bloating or belching or low stomach acid, something like that. Fatigue, you know, just being tired, not getting enough sleep or not feeling like you get enough sleep is a really common one. Dry skin, hair loss, thinning hair, thinning out, thinning out or third of the eyebrows. Infertilities, another really common one. recurrent pregnancy loss is really common. Changes in the menstrual cycle could be related to thyroid for sure. What else? Depression, anxiety, kind of mood-related issues can be thyroid-related also. I see a lot of people, it's different. Some people are more sensitive to thyroid perturbations with their brain health and their mood than others, but it can be a really huge impact for some women. They'll struggle a lot with mood. What am I missing? You can just listen to you, you know, rattle all of these off. It's easy to see how it can be very confusing for someone in parimenopause. Totally. There's not much people overlap. Parimenopause is this time of unmasking. I call parimenopause, I say it's the unmasking effect. What I mean by that is, as we lose hormones, we lose some resilience and any underlying issues become more obvious. So maybe you have some subclinical hypothyroidism and you will refine in your 30s and then you hit parimenopause and things get worse because we're not as resilient when we don't have as many hormones or when we have these fluctuating hormones. It just is harder for us. There is this element of that and we know that parimenopause and menopause is a big risk factor for developing autoimmune disease. Just like postpartum is. So when women are postpartum, we know that's one big huge time when women experience a lot of autoimmune issues and onset. Everything happens as we go through parimenopause and menopause. There can be a lot more increased autoimmune activity happening. So just knowing too, like, okay, well, all the more reason to get good comprehensive laps in my opinion. So good. Also, could you speak to or I guess I'll ask the question, as far as estrogen progesterone and especially in parimenopause and things, it was kind of like, whoa, all over the place, can fluctuating estrogen and progesterone levels impact thyroid function and if so, how? Yeah, that's a great question. And one to just kind of like backtrack a little bit because with lab testing, thyroid labs are, I would say more reliable than hormone testing because hormone tests are so variable, right? So if we go check estrogen, I still check those labs in patients, but it really does depend if you're in parimenopause, what part of your cycle was this drawn? Like did we, you know, check it out at a time when it was really high and then a time when we were really low. So I like to get multiple data points. And then when it's really high, can increase things like thyroid binding, glibulin and sex hormone binding glibulin, it's a similar effect is when we're pregnant, but less. So when a woman is pregnant, let me just back up. So when a woman's pregnant, she checks thyroid, like we have to monitor really closely because your estrogen levels go really high when you're pregnant, like into the thousands. So they are much higher than when you're in parimenopause. But if you have that spike, you know, but so when that happens, women make more SHBG, sex hormone binding glibulin and TBG, thyroid binding glibulin. Those are proteins that bind up hormones. And so in pregnancy, we know a woman is more likely to be hypothyroid because she has more SHBG and TBG and so she'll need more thyroid medication or more support. The same thing can happen in parimenopause, but it's less of an effect. I don't see it as much, but high levels of estrogen can cause more SHBG and bind up more thyroid hormone. So making it less bioavailable. On the other hand, estrogen is really important for thyroid hormone receptor sensitivity. So your thyroid hormone is going to work better if you have estrogen. So if you have really low levels of estrogen, less of an effect on SHBG and TBG, but your thyroid doesn't work as well. Muscle, by the way, influences that thyroid hormone receptor sensitivity too. Muscle. And T4 and T3. So like remember, T4 is the kind of raw material T3s. The gas interacts with your receptor. And so muscle is helpful there. Estrogen is helpful there. Gut health is really important there. So thyroid itself is like, it's a lot more complicated than, you know, just check out that. Like, yeah, it's just, it's, there's a lot. There's a lot that goes behind like, how do we optimize thyroid function? Like gut health, muscle, stress, hormones, nutrients, you know, there's a bunch of nutrients that can affect thyroid conversion and, and our ability to make thyroid hormones. So it's, it's complicated. There's a lot that's in there, but just to like keep it simple, yes, your hormones will influence your thyroid hormone receptor sensitivity, but usually estrogen is favorable, I would say overall, it's just you have to be more careful when you're taking oral. So I think that the times to be the most cognizant of our birth control pills, that's a huge one and pregnancy. Outside of that, if you're taking oral estrogen, like for paramedicol, some women will take oral estradiol. That could influence transdermal estradiol, doesn't generally cause an issue like where you would need more thyroid hormone. Oral versus green. So transdermal, like most women in paramedicol are using transdermal estradiol. And so if they're on transdermal, like a patch or cream or gel or whatever, it's not usually going to affect thyroid hormone as much or if at all. I still check their thyroid labs always after we start HRT for sure. But mostly favorable with estrogen, but it's still kind of like a Goldilocks effect of like, you don't want too much, but don't want too little. Yeah, I mean too much of a good thing is about thing. Yeah, yeah. So so good. Well, and also you kind of touched on this a little bit, but as far as gut health and the tie to thyroid function, could you speak to that just a little bit more? Like how does gut health tie into thyroid function and then also like hormone balancing? Yeah, it's super bi-directional. So gut health and thyroid hormones and sex hormones are bi-directional meaning they influence each other. So so it's a big one. So when we talk about thyroid and gut health, so gut health is one of the main points of interest in any patient who have autoimmune disease. It's often this issue with intestinal permeability. So patients with Hashimoto's like the gut health piece is going to be really big deal because of the autoimmune component. But health is also going to determine how we're absorbing nutrients and those nutrients are really important for making thyroid hormone. So things like iron, vitamin A, B complex vitamins, D, zinc, selenium, all of those are important for either making thyroid hormone T4 or converting it between T4, T3. I didn't even mention iodine. Ida is important though it's very goldy locks. You have to be careful with that one and protein. So amino acids are really important for making a thyroid hormone. So carbohydrates, so this is a really big one and interesting for probably your community. I'm a big fan of really good healthy complex carbs. I think a lot of women are trying to lose weight and they're on a low carb diet to try to lose weight. Now it's very individual. Some people have blood sugar issues. They have to be low carb. But like the more muscle you have, the more carb you're going to tolerate. And the carbohydrates really important for thyroid conversion. When you give your body more carbs, you're usually signaling like abundance. Like hey, I'm good here. I've got enough resources. I'm not under fueled. And so your body does a better job of converting T4 to T3 versus diverting it to reverse T3, which is going to be like the metabolic breaks. Oh, that's so great. Let me back up because I told you like, okay, so gut health is important for thyroid, but then thyroid is also important for gut health. Thyroid determines things like motility. We know patients with hypothyroidism are often constipated, but like I mentioned also, they sometimes have this dysmotility or issues with like sometimes it's IBS kind of symptoms like a lot of there's a lot of overlap with a gut infection called CBO. And so that's a big one too. So it's it's also going to influence like your digestive enzyme secretion, how's your stomach acid? Even saliva can be influenced by thyroid. So patients with hypothyroidism often struggle with good digestive enzyme function overall. Oh my gosh. There's so many things there. Still to impact the soup. Well, and so like and you you get this information back and it's like, whoa, these things are off, but I think I know how you might answer this, but like when when you're addressing these things and you're like, okay, thyroid markers are off or like you have all these symptoms too. Like you're also basing off the patient or the client symptoms as well. What are you attacking first or are you like attacking all of these areas kind of at once? How are you approaching it when it's like, oh, there's might be some gut permeability, thyroid's off, sex hormones are all get above. Yeah. And I don't ever like we take things in a stepwise approach. You know, I don't. There's been a time when I'm like, let's start estrogen and progesterone testosterone. A G will be one and get right like that's too much here. All right. So we've got to like sort of pace ourselves. And so in my clinic, how we do it is like, let's get the lab. So we've got some data. We'll start to start trickling things in. So if I've got like somebody who I know is impairment of pauses and just got some symptoms suggestive of low progesterone, I mean, starter on that so that the next visit I can layer in estrogen. Or if we see that her labs are really off, then I'll layer in thyroid medication. And so we just kind of layer things in one at a time. And then I check labs like every six to eight weeks. And that's when when I work with patients, new patients, we see them, we check labs every six to eight weeks and you know, kind of build up to like, what else, what else do we need to layer in? And it's sort of like this unraveling, but we can't just do it all at one time, right? But simultaneously, as I'm working on optimizing those hormones, I'm also treating underlying gut infections. So there's an underlying gut infection like, okay, that's part of the percol. We're going to start treating this and replacing some nutrients. So you know, it just depends on the patient. We try not to do things that are overwhelming. I always tell patients like, this is your plan. It's not mine. So let's talk through like, what does this look like and how quickly do we want to do this? Like, I can throw the kitchen sink at you. The risk is we're not going to know if you have a side effect what it's from, but sometimes that's already answered. Somebody's feeling really bad. And so we just kind of talk through like, like kind of this layered approach. Like let's, and then we decide how quickly can we go? So it depends. I mean, it's, I wish there was like this simple answer because I get that question all the time. Like, what do you do first? I don't, I don't know. It's hard. I would just be staying as encouraged people to show up for themselves. Oh gosh. Well, and I can appreciate that because like if you're throwing too many things in at once, then you don't know what's maybe there's a side effects. You don't know what it was that caused it. If something's working, we don't really know what it was the lever that we pulled to do that. Yeah. So I usually like, if I'm adding multiple things, I'll have them add this, you know, add this first. If you have side effects, let us know if there's positive effects, take note. Like, I want to know what's, what's helping and what's not because it does help when we have data, because it's not like we're throwing mud at the wall, like at least we have data. We know what we're doing and why. But, you know, if you try something that you haven't tried before, it can, yeah, it can be tricky sometimes. Yeah. What, what testing are you doing for to identify underlying gut infections? So I do organic acid testing in the urine. I like to look at all those fungal markers, material markers, I also do breath testing, lots of like a seabot breath test. And then I'll do stool testing as well, like a PCR stool analysis. So that's, those are kind of my favorite three when patients are struggling with gut issues or they have autoimmune disease. Yeah. How often do you see overlap with someone who comes in thinking they maybe have thyroid issues going on who also has those underlying gut, like how much overlap do you see? So much overlap. I mean, I would say the gut issues are really, really, really common. And so any patient who has Hashimoto's, I would say 90% of them have some underlying gut issues going on. And the patient who has hypothyroidism, that's hard to say, like you can have hypothyroidism without Hashimoto's of course, right? And so I would say there's probably last but I don't know. I just like I'm just guessing 70%, 60%, I don't know, the majority. The majority, yeah. But I would say the majority of patients, even without hypothyroidism, have some sort of underlying gut issue going on. I mean, in our modern day world, we're exposed to things, pesticides, antibiotics, stress. Most of us have an imbalance with our gut microbiome. And just to accompany that, we didn't really get to this part yet. But as you go through parimenopause, parimenopause itself and the withdrawal hormones will affect the gut microbiome and shape the gut microbiome in a really distinct way. So we see in studies sexual dimorphism, men and women have very different gut microbiome. A woman's gut microbiome starts to plateau around age 40 and she begins to lose diversity after that. And I would, I mean, studies would attribute that to parimenopause or menopause and the change in hormones. So, you know, that in and of itself, just those hormonal shifts and changes are going to affect our gut microbiome as well. And what is that super interesting and what is your, what's some of your recommendations for as far as helping with gut diversity for women in parimenopause and the pulse. Yeah, exercise. Here's another one. Got microbiome benefits from movement and exercise in a huge way. So cool. So like workout that's super important to get my problem. And I think really underappreciated right? I'm taking probiotics, but like actually I think what's more effective is exercise. So I do also use probiotics and recommend specifically, like, sport form probiotics for my patients for sure. So it's another way diet super important and getting fiber. So this is another place where complex carbs come in. You know, you can get a lot of great fiber from different kinds of fruits and things like oats and, you know, all sorts of complex carbs. You also get fiber from things like avocados, but having diversity in our diet and eating a good amount of fiber is really important for good gut microbiome and diversity avoidance of antibiotics as much as possible. Of course, sometimes you need them, but I always work on upstream factors. So if my patients are getting recurrent, you're in a tract infections or recurrent sinus infections like, let's go upstream and figure out how to stop those. So you don't keep needing to use antibiotics over and over being outside in nature is really important, figuring out how to minimize stress. I mean, I think a lot of us are living in this like stress and survival mode and don't always know it. It's not good on your gut microbiome. It's another one. Like I said nature pets are really important. I love my dog so much. She's the cutest. Oh gosh, I love that one. That's great for your gut microbiome. Avoiding crappy food like ultra processed food that's bad for your gut microbiome. So it's sort of like adding more of the good things, removing some of the bad things. I didn't even mention alcohol that alcohol is terrible for your gut microbiome. So, you know, removing antibiotics and pesticides and alcohol and ultra processed foods and adding fiber and nature and stress relief and being outside and walking. Also say in those like pots is birth control pills like birth control pills are not great for the gut microbiome. There's other medications as well that can be negative to the gut microbiome. Whereas like HR team might actually help the gut microbiome. There's some like pretty early studies on that, but they would suggest that and I've seen clinically that it's helpful for gut health. Wow, which would be very cool to see that as well. That's really helpful to you. Okay, there's things that we can minimize at things to add more of to help with our gut diversity for it. Also, as far as like thyroid and HRT. If you're optimizing your thyroid health, is that going to also make your HRT more effective? Maybe, maybe. I would say actually your HRT is probably going to make your thyroid more effective. But I wonder if the opposite is true and I would suspect like it probably is. So here's an interesting one to test a stosterone might mean like if you go on testosterone, you might need less thyroid medication. So I'm just trying to think if you want a thyroid, would you maybe need less estrogen or less thyroid or less testosterone? I haven't seen that clinically, but I mean, it's definitely a part of the puzzle. Yeah, because you're like everything so synergistic. You can't go on estrogen and progesterone and like have poor thyroid function. Like that's not going to get you very far. Right. Well, and also like on the flip side of that is there is there be any risk in starting HRT if a thyroid dysfunction is on address. Yes, that's a great question. And clinically, I've seen this come up. Okay. So I've had a few patients who were like they started HRT and they're like, oh, they were expecting like they had high hopes and they were like didn't do well with it. And so we got a step back and like, okay, well, what went wrong? And I think it's usually because estrogen isn't well tolerated if you have hypothyroidism. You've got to fix the thyroid piece first, fix the hypothyroidism first and then layer back in estrogen. Okay. And you're like clinically, I've seen this happen where it's like, oh, HRT wasn't the magic pill that I thought it would be, but there's really probably some underlying thyroid issues. Like also for women already on a thyroid medication, you know, how might HRT also affect their dosing. I know you said you're having clients come in or patients come in every like six, eight weeks for testing. But how might that affect their HRT dose. So transdermal estrogen is probably not going to affect it, but I would check it. And then the less like if you're going to, if you're on thyroid medication, you start transdermal estrogen, I'd always recheck your thyroid hormone after, but no transdermal is going to have less effect than oral. And oral estradiol is going to have less effect than birth control pills. And birth control pills and pregnancy are both going to be like on that top kind of, you know, we know they're going to very likely affect thyroid. Estosterone is going to also check your labs again. It's like it's, it might warrant less thyroid medication might be able to reduce your dose of thyroid meds if you start testosterone. So good. That's really, really helpful. And it's like that's where I'm actually recently did an interview with Sam Miller. I'm not sure if you're familiar with him, but he we talked about. And Vince Pizzic as far as birth control pills and it's like just hears the information like I know for lifestyle factors, sometimes the pros outweigh the cons, you know benefits outweigh the rest. But also it's like it's such a sad piece of information that like the effect it can have on so many things, including your like you shared today or got, you know, your good health. Like you said, that's kind of top tier that in pregnancy, the way it can impact impact things. So good information to have and then do with it what we will. Right. So good. Well, also, could you share to like what are some common symptoms that women might attribute to just getting older, you know, or like that might actually be like thyroid related. Yeah, fatigue, weight gain, hair loss, a little bit of not feeling like myself anymore. Anxiety depression. I mean, so much, I think this is the message that a lot of women get as they as they get older is like, well, you're getting older. I mean, I don't blame them. They're told they're literally told, well, you're getting older. This is just normal. Like your five or 10 or 20 pounds of extra weight that you want to lose is not going anywhere because you're just getting older. And I have a lot to say about that, but none of it is confirmed or like, I don't I think we get we go through paramedic pausing, menopause and we need different things. Just like our daughters go through puberty. They need different things or bodies change. - You need to know how to support our bodies in a different sort of way as we get to this phase of life. - Oh, man, that is such a good parallel to make. Like how we support our bodies going transitioning through puberty and those things, but then like this stage of life has been very over. - You're just throwing the towel. - Yeah, it's fine. - It's fine. - Don't know. That's the craziest. I mean, that makes me, it gives me a lot of fire. Honestly, like it is why I do what I do because I see women who are sort of dismissed all the time and gaslit for symptoms. And so many women just are really encouraged to give up on themselves. I mean, there's a movement right now suggesting we should not care. And it's funny, there's humor behind it. But it's part of the, there's like some underlying thread culturally that women should care less about themselves and care more about everybody else. And give up on themselves ultimately. And I very much disagree with that. - Me too, very much so. Oh, yes. Yeah, and I see that like I know exactly what you're referencing. It's like almost just like a humor of like, well, oh well, you know. - Yeah, like like. - Have the extra glass of wine, whatever. That's the way I'm going to care for myself now. It's fine. You know, and there's so much better to be had. Actually, a part of your post as well in reference to the body composition piece, the initial post that had me reaching out to you is you were also just sharing, you're like, you do not need your shrink, you need more muscle. You know, that's like where, you know, so many women are trying to lose weight. And they think that's the answer. It's like, no, you need more muscle. And I think you said something like, if you're trying to lose weight in your 40s by more cardio eating less, like here's your sign to stop that. - Yeah, and they eat it in less. That's a big piece of it. So so many women are restricting their food. And that can backfire. Like I mentioned with the thyroid conversion. Like, you know how it works? Like how's your metabolism gonna adapt if you're not eating enough food? Like not very well. It's gonna protect you. Like our bodies love us. Are this contrary to what people think? Like your body loves you and is trying to protect you. And we have to step back and think like, okay, well, you're not feeding your body. Your body's gonna try to protect you by slowing down your metabolism. And that's just how it goes to stay alive. We're prioritizing survival above staying skinny or survival above even reproduction or having children. We're prioritizing survival above digestion sometimes. And so we just have to remember that. And yeah, your body is not like, we're not designed for 600 calories a day. Like we really have to nourish our body. Yes, there's like, it's again, it's like too much and too little are both a problem for a woman who want to lose weight. You got to get like in that sweet spot where you're eating enough to fuel your workouts and to fuel muscle growth and you're in a good catabolic state or rather anabolic state. Not a catabolic state, really breaking stuff down. So it really is that sweet spot for each. It is. It's like you got to get in that sweet spot. I see it all the time because we focus on certain parameters in our labs. So like if somebody has low leptin in a high reverse T3, I know they're under fueled. Either you're not absorbing what you're eating or you're not eating enough of it. And often it's like women are eating enough of it. And so we just have to change some habits there. - So good, so so good. And if you would share anything else you would like to add to this conversation too, I think one of my last questions for you is just like what, someone listening to this, like what practical steps can they take what the woman listening to this right now? Like if she suspects that her thyroid is not optimized and even if her labs look normal or what she's gotten so far, like where would you practically lead her next? - Yeah, I mean I think that getting a more comprehensive thyroid panel is really important and also understand it's hard to know what to do with it. Because if your doctor doesn't really practice through that lens and let's just say like this person doesn't have access to seeing a functional medicine doctor. I think part of it is listening to podcasts like this, go read my article on Hashimoto's and hypothyroidism, my outline, all the normal parameters. I do think it's important for women to educate themselves and learn as much as they can. And you're not your own doctor, you're not even a doctor. You can't prescribe medication, it's not your job to know all of this. But it does sometimes take you advocating for yourself and finding the right doctor who can help you. So I do think there are a lot of doctors out there who can help, but unfortunately where we are right now, it requires women to really like advocate and ask around. I think if you go on certain like Facebook groups or something, you can ask around in your community to try to find somebody like who can help you, who knows. Sometimes endocrinologists can be a little bit more helpful honestly and sometimes not. It really depends on the specialists that you're seeing. But I think the biggest deal is don't give up on yourself. Don't quit. If you know something's wrong, keep looking for it and advocating for yourself and finding somebody who can help because at the end of the day sometimes it's not thyroid. But if you have symptoms suggesting that it's thyroid and you were like certain something's wrong, something is wrong, it just might not be that. It might not be, there might be something else. And so really it's just like finding somebody who can help you navigate this stuff because it is complex. And I wish I could see like everybody, but I just can. Then I, like it's part of it, but I try to get on podcasts like this and educate because that is where women start to understand like, oh, okay, they can kind of put the puzzle together. And hopefully, get some data. I will say too, there's, you can go get this data on your own. You need a doctor to order it. Like Mark Kymons got function health labs. You can get that whole panel done. You can go through other, you know, third parties and get a full thyroid lab check. It's not that expensive, 100 bucks or so. Function health is more like 500 bucks, but. - But that there is it's like very, very. - Get a lot more parameters. - Yeah, it's not just thyroid. You're looking at your car, cardiovascular risk factors, bunch of auto-mean risk factors. So it's a really good comprehensive panel, but. Yeah, it's okay. I wish there was easy answers, but I know. - I know. - And it's. - Show it for yourself. - Yes. Well, it's something too. It's at that point like, you know, it's like, yes, it's nice when things are covered by insurance and that kind of stuff, but also it's like for something that's been plaguing a woman for so long, you were worth that 500 bucks or whatever it is to go get some answers, you know, like this has been plaguing you for years or whatever. And I'm gonna ask you a question that I always say it depends when people ask me in my field of practice for like how long is this gonna take? And they're like, you know, as far as results, right? Like so for me, and that's a very big sliding scale depending on the person, but if you were to kind of just give like, an idea of parameters when someone, if they started dressing these things with their thyroid and HRT, like when could they expect to see improvement and then also like the results? - Yeah. So I think in my practice, six to nine months, like three months is when people start to get all that state of back and we can start to like see some improvements and move things in the right direction. So like we're moving in the right direction, but six to nine months is like when the magic happens. That's when people are like, oh my God, I feel like myself again, like I had no idea how good I could feel. And you know, we keep building on that. But that's in my practice where we're addressing gut health and hormones and autoimmune disease and all the lifestyle factors. And so I think it depends on how much you're addressing, right? Like if it depends if you're just starting on thyroid medication or just starting on HRT, like it depends if you have other underlying risk factors or other underlying issues and if those are being addressed or not. I think ultimately you're not gonna get very far if you're not addressing these underlying issues if you've got, you know, an imbalance with your gut or autoimmune disease that's unaddressed and things like that. But I think the big goal is like moving things in the right direction, you know, small improvements at a bovertime. And yeah, it's like that factor of, yeah, how much are you doing? How much are you addressing? - Yep, how much are you addressing? How diligent are you being like what puzzle pieces are you putting into play versus the next person? And I think like for some people it can sound like, oh my gosh, daunting six to nine months. But it's like two things. While you're probably gonna already start to see improvements like you said, even around three months, like, oh, I'm feeling a little different, you know, things. But like also it's like how long have you been struggling with this too, you know, for years for a lot of people. So in the grand scheme, it's really not that much time for your body, you know, gotta be like gracious with our bodies to change too. So that's so good. Well, thank you so much for your time. And I just appreciate you. Like you said, you can't work with everyone, but doing podcasts like these is just so helpful. And I know there's gonna be women listening to this who are probably gonna go take action 'cause they're like, oh, okay, that's me. I should go. I should go get help. So thank you so much. And where can everyone find you? What's up? - Yeah, my website is drkristinemarin.com. So it's a M-A-R-E-N and I'm on Instagram at the same handle, Dr. Christine Marin. - Perfect. I will put that in the show notes for everyone as well, but thank you so, so much for your time today. We appreciate it. - Thanks for having me. (upbeat music) - Thank you so much for tuning into another episode of The Muscle Makeover. I hope you're getting so much better. value out of it. If you enjoyed this show, please rate, review, and share this podcast so we can reach more people and impact more lives. Also, take a screenshot of this episode, upload it to your stories, and tag me in my guests so we can be sure to say thank you. If you ever have a question or comment about the show, feel free to message me. My social media handles are in the show notes. Make it an amazing day, you guys, and remember, you are loved and you are worthy, just as you are.