Weight Loss Resistance and Insulin Resistance After 40: The Lab Test Nobody Ran (EP 65)

Welcome back to the becoming her podcast. You guys, I'm so genuinely excited for today's episode because number one, we're gonna be talking about something that I know 99.9% of you are dealing with right now if you're listening to this podcast. And number two, I can promise you that we're gonna drop more value than your doctor probably, in the next 45 to 60 minutes in your doctor probably has in the like last 30 years. So I want you to grab your pen, grab your pad, take some notes because episode is gonna be so freaking fire and I quite literally could not think of up better person to have this conversation with than our guest today. So Matt Casino is with us. He is the clinical director of rise, which happens to be team becoming hers in house hormone optimization team. And generally one of the smartest people that I have the pleasure of working with. So Matt, can I just take a second, get the people up to speed. Let's hear a little bit about you before we dive in. - Sure, thank you so much for your kind words. I truly appreciate it. I've been an online nutritionist and fitness coach, I guess you could say, for about 14 years. For the majority of my time, I was working with high level competitive athletes, physique competitors, CrossFit Games competitors, strength and conditioning competitors. And then in about 2017, 2018, I really started to lean into metabolic dysfunction and stress and understanding the root drivers to metabolic adaptations and gut health and inflammation. And my father actually got diagnosed with stage four of softwares cancer in 2018, which didn't last long. And that was my big wake up call. And that's where the final straw that broke the camel's back in terms of distrust in our healthcare system really played in. And it really drove my passion to fix my own GI issues. And in the process of seeking out functional medicine specialists to help me with my own GI issues, I just gained this whole new passion to help others. And since then, for the past seven years now, I've really been fixated and passionate about functional health. In 2020, I completed my FDMP program. And that's where I really got fully involved into servicing the population with functional medicine services. I then started, you know, obviously working with a couple of different hormone therapy clinics and recognized some big mistakes they were making right off the bat, particularly with female TRT, whether that was pellet therapy or just utilizing male applications for females and significantly overdosing them, causing a lot of symptoms. And started, you know, communicating with these compounding pharmacies, finding a better approach to offer the female population. And then as things transpired with those clinics, I just kind of still felt avoid in the space, which is what led to me with my partner at the time, opening our own clinic. And so we opened Rise together at the end of 2022. And it's just been a full send ever since. We now work with a little over 5,000 patients across the nation. We service all 50 states via telehealth and, you know, not to to our own horn, but I do feel that we're one of those, one of the few clinics that really has a root cause functional medicine scope when we're reviewing people's labs and offering them different approaches to remediating their issues. I absolutely agree. I've worked with a lot of providers in the space. And I can tell you right now you are absolutely one of the best. So not asking not to to your horn. I mean, the amount of care that you take and the deep dives that you do because it is, it is multifaceted. It's never just one thing and that's something that we're going to be chatting about today. So let's set the scene here because I know for at least the majority of women that we work with. And I'm certain the majority of women that you work with outside of team becoming her chances are she's been eating clean for months. She mill preps every week. She tracks her macro. She goes to the gym four times a week. She's doing everything that by traditional standards is the quote unquote right thing. But yet the scale isn't moving. And if it is moving, it's typically not in the direction that she wants it to move. And so I would love for you to walk me through or walk, I guess the listeners through what's happening when a woman is genuinely doing everything right and the scale is not moving. I would like to hear like from the clinical side of things what's going on here as a woman over 40. Well, and that's a great question. And the answer is a lot, a lot of possibilities. So one big topic I think in modern day is weight loss resistance. And I think the missing piece that everyone is missing from the conversation of weight loss resistance is inflammation. Because for the most part, dying, dieting in the calorie deficits and exercising more, neither of those get rid of inflammation. So if you have, it works, it's going to be honest. Like it can make it. Yeah, it's going to make it. It's going to make it. Yeah. So if you already have 10, 15, 20, 30 pounds of inflammation on your body, which some people absolutely have, then none of that is going to go away through diet or exercise. In fact, it could get worse. So that's number one is a lot of people are trying to lose the wrong weight. And that's why nothing is happening. You can't get rid of inflammation through calorie deficits and exercise. Number two, the conversation around metabolism. Everyone kind of assumes that our metabolism is located in our stomach and has to do with something to do with processing food. You know, calories inverse calories out. The actual definition of a metabolism is the communication between our brain and the glands that produce hormones. End of definition. And so therefore, if we're not producing hormones or producing hormones improperly or there's an imbalance of hormones, we don't have proper metabolic function. And so what this can mean? And when we say hormones, everyone immediately goes to sex hormones. But we're talking about the trilogy of adrenals, thyroid and sex hormones. And these three systems work synergistically together. So when one is off, it's very likely that others are off. And so, you know, they do studies that majority of men who have hypothyroid also have low T. Well, duh, they're both related to stress, you know, same thing. Most women with hypothyroid also have low progesterone stress response. It's all correlated here. And so when we're looking at metabolic adaptation, again, let's think about these terms adaptation. So what's happening in the body? Most of the time hormone decline is a survival adaptation, whether that's related to under eating and being in a starvation state, or it's due to chronically high psychological stress, physiological stress, internal inflammation, whatever those stress responses are. A good way to understand it for women specifically is, you know, thinking in caveman times, women were put on this planet for procreation. So that's how our women's bodies think. Every action and reaction is related to procreation in one way or another. A high stress environment is not a good place to have babies. And your bodies know that. And so the body is going to say, Hey, right now it's not a great time to have babies. We're going to shift energy focus away from fertility and move it towards survival. This is a layman's explanation to as when cortisol goes up, sex hormones go down. We're prioritizing energy towards survival and not fertility. That same concept of fertility, as we just said, also controls metabolic function, mental health, sleep, cycle regulation, all the symptoms we see women experiencing relate back to stress adaptations. And of course, to your point, the more you diet, the more you exercise, the more stress you're causing, leading to more adaptations of those hormones that control metabolic function. So yes, is the conversation between calories and calories out valid? Sure. If you're constantly eating low calories, you're not producing hormones, which then affects your metabolism. But to argue that it's only calories and that hormones mean nothing shows that you don't understand physiology. Gives me crazy. You have these influencers that want to preach that, you know, menopause doesn't change fat loss. And well, at the 10,000 of you, it is, like you said, it's calories and calories that will always drive that for sure. But it does reduce our margin for error. And as these hormones decline, I mean, our hormones are responsible at how our body performs, how our body feels, how our body functions. So if you're anxious, you're irritable, you're not sleeping, you're overwhelmed. Everything about fat loss becomes 10 times more challenging. Absolutely everything. And the influencers in the space that want to, again, just preach calories and calories out at the high level, they're not wrong. But there's just so much more nuance that goes into this, especially for a woman over 40 and hormones are declining. I do want to address this piece of it. And I would love to get your feedback here because while yes, everything you said is valid. It is a 100% valid. I know that we're going to have some women next here this and I know when I was in the thick of my journey, I wanted to point the finger to everything else, except for the lack of accountability on my end of, I always say the calories of your freeze to track, the protein you refuse to eat, the weight that you refuse to lift kind of things. So give me an idea here, 'cause I know that again, there's a version of the woman who hears this and they understand that, but then again, there's the version of the woman that wants to say, oh no, it's only my hormones. How do you separate between these two things? Because I think for most women, it's actually both. - Yeah, it typically is. It's a combination of things and so, well, number one, get comprehensive blood work. If you want to be validated in your feelings that it's hormones, how about we check our hormones? The problem is that if you're trying to go through conventional healthcare and ignorance, you're set up for failure because insurance's job is to not pay for you. And so they're gonna get the most minimalist labs possible to make you assume everything's okay so that they don't have to pay for your treatment. And so it can be pulling teeth just to even get sex hormone labs. I don't know how many women have come to me over the year saying, hey, I got my hormones checked and it's TSH. (mimics sound) That's all they got checked, worthless. And so they don't even know the doctors that everything looks normal. They thought their sex hormones were checked. All they got was a minimal thyroid marker. And so the biggest issue I think is not enough is real education and understanding. But it's very difficult to get the right labs tested through your PCP, OB/GYN and stuff. And that's where so many people end up becoming their own health advocates and paying out of pocket, going elsewhere, places like myself to get their labs done. But yeah, if there's a feeling in your mind that all of these symptoms could be related to stress, hormone decline, age-related hormone decline, you name it, let's get some labs in C. To your point, it's typically a multitude of things. You know, hormone therapy is not this quick fix that, oh, we just start shedding weight afterwards. - Yeah, so you can't just slap a patch on an expected drop 20 pounds overnight, but there still is that misconception. And I have a lot of women in my DMs every single day. I mean, 10, 15, 20 conversations a day and I started hormone replacement therapy, help Nicole, I'm still not losing weight. It's because yeah, hormone replacement therapy is not and will never be a fat loss strategy. That's not what hormone replacement therapy is for. And again, there's still that, well, there's a lot of misconceptions around hormone replacement therapy, but that is absolutely still high up on the list as one of them. And I would even argue to say, and I'd love to hear your thoughts about this, but I preach this all of the time is, we can replace all of your hormones, all of them. We can give you all of the hormones. But if you're not doing what you need to do on your end, lifestyle drives that, drives your body responding to those hormones. And so again, it is the cherry on top of the Sunday. You cannot have, you can't just replace your hormones without the lifestyle. Your body won't respond as well. Purely from the inflammation piece of it, right? You're eating like dog do do, you're not moving your body, you're not sleeping, it's in flamed AF, your body just isn't going to respond to those hormones as well. - Right. Well yeah, and again, the hormones are facilitating metabolic function. You still have to use that healthy metabolism. So it's healthy hormones, healthy activities, healthy diet choices, and the trilogy combined will eventually lead to body composition changes and fat loss. It's also important to discern weight loss from fat loss. Because going back to the calories and calories out, zealots, it's true. If you starve yourself enough, you will lose weight, but you're losing bone and muscle density. And so these diets that I've seen over the years, you know, way back in the day, you probably remember, this is the HCG diet. - Oh yeah. - They gave you HCG and one apple for the entire day. That's starvation. So of course, yes, you've lost weight, but most of it was bone and muscle, not fat. And so when we're talking about fueling ourselves properly, an exercise, it's a much different conversation when we say weight loss and fat loss. With fat loss, hormones are much more important. An exercise is much more important. And that's where we get into the conversation of GLB1s and stuff. We want to separate weight loss and fat loss. Those are two separate conversations, you know? - You're speaking my love language and this kind of preps me for my next question and talking about the muscle piece of this because it's the key and I will die on this hill, but it's the key to everything that is good in life for you, especially as a woman over 40. We're naturally starting to lose muscle mass. So if you're not doing everything in your power at bare minimum to sustain what you have, if not, you should be trying to add more of it to your frame. Everything about life is gonna be harder, right? Muscles are key to longevity. It's your anti-aging key. It's the key to health. It's the key to combating falls, breaks, tears, osteoporosis. It's the key to like Matt said in Metabolism, that is on mother-epping fire. And as hormones start to, so menopause is hormone deficiency, we know this, our hormones pack up, they exit, they leave the building. We're no longer producing them like we were in our 20s and 30s. And as hormones are starting to decline through menopause and you are losing muscle on top of that, that's just like a whole shit storm. And so this breeds me into the conversation we talk about weight loss resistance, which is directly tied to for a lot of women insulin resistance. And this is, especially as estrogen starts to decline, it impacts how we store body fat. Let's talk about insulin resistance. Let's talk to the woman who's heard that term a thousand times online, but she doesn't even necessarily quite understand or grasp what that means. - Sure, yeah. So insulin is the hormone that controls blood sugar. The overall concept of insulin resistance is that very similar to an alcohol tolerance, our cells are becoming more tolerance or insensitive to insulin, which makes it less effective at controlling or managing our blood sugar. If this continues over a long period of time, the body gets, just like an alcohol tolerance, gets less and less efficient using that insulin, which then translates into type 2 diabetes. Our body stops responding to natural insulin and now we have to inject exogenous or synthetic insulin into the body. So insulin resistance in many ways is a precursor to type 2 diabetes. It's our body sending us a check-in to light that things are wrong. And the thing is we have to have a preventionary healthcare model to catch this and not just wait for the disease to fully take effect before we start helping people. Now, the conversation around diabetes, insulin resistance, high blood sugar is always fixated around food and carbs and sugar. And of course, that does play a part, but there are so many people out there who have already changed their dietary habits. Maybe they've tried keto or carnivore, whether it is zero carbs and zero sugar and yet they still have constantly high blood sugar and elevated insulin resistance. Maybe they're taking things like metformin or a GLP1 drug, intentionally to reduce insulin, yet they still have insulin resistance. In these situations, it actually has far less to do with food and everything to do with stress and inflammation. Then we have to understand is just like those sex hormone adaptations, there's other survival adaptations happening in the body. So once again, when that body's in that stressful survival state, it's saying to itself, "We need fuel to fight-or-flee situations." So what the body does is it takes glucose and pulls it out of our muscles and maintains it in the bloodstream in case we need it. So stress leads to higher blood sugar as a survival adaptation. But if the stress never goes down, the blood sugar never goes down, mid-creating insulin resistance. And as long as that stress stays high, that insulin cannot work and that creates that cascade over 5, 10, 15 years, leading to type 2 diabetes. Now again, I want to be clear that I'm not saying, don't change your diet, don't change your habits. What I'm saying is there's a select population that already done those things and they still have prediabetes and insulin resistance. Typically, it's going to be related to inflammation, infections, toxic burden, chronic internal stress, driving that. - Yeah, 100% now. - To your point, in terms of metabolic function, how do we ever get into a fat burning zone if we're always in a blood sugar burning zone? The whole idea of fasted workouts or cardio post exercise is our blood sugar is lower, so we get into a fat burning zone faster. If our blood sugar is constantly high, there is no fat burning zone. We just keep burning sugar. And like you said, as well, higher insulin means we're more likely to store fat than build muscle. So our bodies are working against us in so many different ways when we're in a very inflamed stress state, basically. - 100%. And when we talk about again, that when we speak to the muscle piece, 'cause I'm so passionate about this for women over 40, there's still this misconception that, so many women are, if they are strength training, they're not lifting weights heavier than their purse, they're not really challenging themselves. And muscle is a sponge for glucose. More muscle you have, more place glucose has to go. And so when it comes to insulin resistance, and if you're looking to lose body fat, [BLANK_AUDIO] I always say it's going to be like trying to climb out Everest and a pair of stilettos. If you're trying to lose weight, you know, with working through insulin resistance, we need to tackle the root of what's really going on. So we need to work through your insulin resistance first. And then fat loss becomes a byproduct of that. And that's the part that gets, yep, 100%. And that's the part that gets overshadowed. And especially for women over 40, it's like menopause is, again, the hormone deficiency state, but it's a massive stressor on a female's body. When we speak to inflammation, it acts in mimics so much of these symptoms of insulin resistance of autoimmune. You know, it's going to mimic a lot of those same symptoms as your hormones are starting to climb because it is. It is a huge stressor. These hormones kept female's bodies like vital and taking for the first 30 plus years of our life. Right. And, you know, as they decline, your body starts to respond appropriately to that. And there's this whole period of, you know, my, just the more I serve women in this space, like I see women who have lost myself and before I, and I interjected quicker than most do, but who have lost decades of their life to paramanopausal symptoms and hormones declining and just providers who just don't know what they don't know. And I don't think providers gas a lot of providers, gaslit on purpose, but women are basically just told to accept that this is what aging is, right? And just because something is common, doesn't necessarily mean that it's normal, but women are gaslit to believe that, you know, your zero sex drive, can't sleep, hot flashes, mood swings, you know, cravings all over the place. Your inflammation, just that that's just what aging is. And it's crazy to me because if a male were to go into his, you know, primary care provider with the same symptoms that a female has, that providers, what, writing a prescription for testosterone before he can even finish spitting out what he's saying. A female has these same symptoms and it's like, well, it sounds like you might be slightly depressed, you know, you know, stress hits you differently at this age. They're able to help. Here's something to take the edge off and the amount of women, I'm sure you, I mean, Matt, you see it working with the woman we serve, the amount of women on SSRIs and birth control in their fifties. It just like, it drives me absolutely crazy. It's like, it's already a hormone deficient state. Birth control suppresses your natural ability. Like why? Why are we having women in their fifties on birth control? Nothing about it makes sense. It's crazy to me. And so let's talk a little bit about common sense to call is it's not that common, especially in our healthcare system. Yeah. You know, there's so much backend business model talk with big pharma and insurance companies. And the providers don't know this. The providers are set up for failure because who's writing the med school curriculum? Big pharma. So the providers learn two things, pharmacology and pharmaconetics, not root cause, not inflammation, not infections, not lifestyle, nutrition. None of those aren't concepts that they're learning or deductive reasoning to connecting dots. They're learning this patient presents the symptom. We provide them this medication. And they see so many pharmaceutical reps every week that it just seems so easy to say, "Make this birth control pill." And most doctors, 9 out of 10, don't even know the mechanism of action of birth control, meaning they don't actually know what birth control is doing to a woman's body. Guarantee 9 out of 10 physicians couldn't explain the mechanism of action of birth control and how it works. And so to your point, there's a vast misunderstanding around female physiology. I think for a while in American healthcare research, it's just been assumed that male physiology research will translate over to female physiology research. And particularly with female sex hormones, there's a lot of misunderstanding, lack of information, too much focus around certain fertility concepts and not enough focus around, "Hey, sex hormones do a lot more than just fertility, cardiovascular health, neurological health, mental health, sleep, metabolic function." All the things that most American women are dealing with these days, but all they want to say is, "Well, you're not worried about getting pregnant, so you're fine." You know? It's a closed-minded approach around female hormones. We also have to understand what our primary care physician's job is. It's not to optimize our metabolic function. It's not to do any of that. It's to look at your labs and see whether or not you're in a current state of disease. Yep, they're trying to treat disease. And if you're not in a current state of disease, your labs look normal. And what does your labs look normal means? It means you're not ready for me yet. Once you're in a state of disease, I can help you with a symptom management medication. But that's what we have to understand. There is no preventionary care model. If you're not trying to optimize your health, they're trying to mitigate your disease once it's already there. Yeah, they're basically just saying, "You're not sick enough to support." Yeah, is what they're saying. And I don't know what it is, but I saw the amount of women we work with. It's like, "Well, my provider said that I'll be on birth control until I'm 55." It's like the magical age of 55. And then once I hit 55, then we can look at hormone replacement therapy. And again, it makes me want to pull my hair out because hormone replacement is preventative. Care. Sure. That's what this is. I'm sure there are pharmaceutical reps who have said that to them that this is a low estrogen pill and women can take this till they're 55 and slowly transitioned into menopause. An uneducated doctor is going to trust that pharmaceutical rep and say, "That makes sense. That's how I'm going to approach things going forward." Never doing further research. Never trying to actually understand it because they see 100 people a day, female hormone regulation isn't their passion project. Even though they're symptomatic AF symptoms are just through the roof. And it's just like, "Well, we can band-aid the symptoms." Yeah, we can do that. We can do even SSRI, a GLP1 and birth control and an immunosuppressant for your autoimmune. We fixed you. Yep. You can start with medications for the rest of your life. I love that you brought up GLP1 as a band-aid because I want to dive into that here in a second because that is something. I mean, I know that you're. I mean, I see it every single day and that's what a lot of women are using this as a band-aid. And then it's like when the band-aid gets pulled out, they're going to start hemorrhaging. And we're going to see a lot of that coming to fruition. I think as, you know, with just with the rise of GLP1s, let's talk about the lab piece of this though because I would love to talk about the markers that are not being ran. I know on our team, we run like 22 or 23 comprehensive markers, a lot of women go into the providers and like you said, they're getting their T4 and their TSH. Maybe they'll run, you know, testosterone, but it's not free until like it's just very, very incomplete. So dive into what it looks like an incomplete lab and what it's saying versus a comprehensive lab giving the whole picture. Yeah, absolutely. So an analogy that I used to do back when I was having to basically convince people or buy them into getting comprehensive labs done is an analogy around your first home purchase. Okay. And so when we think about our very first home purchase, you have two options. Option A, you can peek through the living room window before making that purchase decision. Option B, you can go room to room, closet to closet, door to door of that house before making that decision. Which one do you think is going to lead to a more educated decision about a home purchase? The same thing as comprehensive labs. If you don't get all the markers checked, how can you possibly use any type of deductive reasoning or educated approach towards treatments? Because they don't want to do an educated approach because they want to manage your symptoms, they check individual markers. In fact, why do they check TSH and T4? It's not because those are effective thyroid markers. It's because they prescribe synthoid, which is synthetic T4. In order to legally prescribe synthoid, they need a TSH and a T4 test. They're testing based on what they can medicate. They're not testing based off of patient needs. That is how crooked our model is. And so we need the full picture to understand. When we're talking about hormone dysfunction, there's actually two separate categories of conversation. There's production of hormones and then metabolism and conversion of hormones. Every single hormone in their body, adrenal hormones, sex hormones, thyroid hormones, they all metabolize and convert through our GI track and through our liver. So if we have any type of GI dysfunction, sluggish liver function, inflammation, microbiome and balances, we're basically guaranteed some type of hormone dysfunction. And so when we get limited labs, we're barely able to tell, is this a production issue, a metabolism issue, an imbalanced ratio issue? There's so many details there. And so with a thyroid panel, we want to see a full thyroid panel. There's a dramatic difference between TSH and T4 and then TSH, T4, T3, reverse T3, T4, T3 uptake, TPOAB antibodies, full picture, minimal picture. TSH and T4 only show us production. But that T4 has to go through our gut liver and convert into T3, which is the metabolism side of things. T3 is the end. important factor there, and most people don't even test for that. So that's just one example of a thyroid marker. When it comes to women's sex hormones, DHEA, estrogen, progesterone, antistosterone, equally important, it's not just looking at the individual markers though, it's looking at the balanced ratio or the harmony of those hormones working together in a woman's body. She can have Androgen dominance, which is a precursor to PCLS, high testosterone, high DHEA. She can have estrogen dominance, which I would argue 80% of American women are, do the birth control and high stress. So there's imbalances there and technically they can look normal in individual reference ranges, but you need nuanced understanding of hormonal harmony to see those imbalances. Other factors are understanding that majority of women's hormones stem from the adrenal gland, not from the ovaries. So if you're not checking cortisol and adrenal function, you don't have the answer as to why hormones are off. Progesterone converts into cortisol. And so if a woman has very high cortisol, that will explain why she has very low progesterone. And this is very important that we get into treatments because even as we treat her with progesterone therapy, it's still going to all convert to cortisol if her body is stuck in a fight or flight state. This is where we start hearing women gain weights and gain anxiety and have sleep issues from progesterone therapy. That's not progesterone therapies, that's your body utilizing it wrong because we never got to the root cause problem. So there's so many factors that go into hormone imbalances and how to approach those hormone imbalances. And if you don't have that full picture, you're never really going to understand. And I think, you know, your group, your avatar or community of women is in that interesting period of their lives where yes, it could very well be age induced hormone dysfunction. But it also could be stress induced hormone dysfunction. So a lot of women 35 to 45 actually have perfectly functioning age related. It's not hormone decline. It's all cortisol. Cortisol is crashing their progesterone, pushing more testosterone to DHT, reducing their estrogen. So it's not metapause related at all. It's all stress related. And so a lot of women are in this midway point where they're not getting any help. And even if they start hormone therapy, it's not working because their body is still just too stressed. So I know that was long winded, but there's a lot of reasons as to getting comprehensive labs to have the full picture. You need to know why your body is doing certain things and why it's not doing certain things. And I love that you brought this up because I talk about this all of the time and you just nailed it. It's like, well, I started hormone replacement therapy and I started gaining weight. It's I can't take hormones. My body is it's not the hormones. There's something deeper rooted going on here. There's not a single female that you replenish hormones to where they're, you know, you know, at ample amounts to where they're vital and taking where their bodies like, oh, nope. I know we operated this way for 30 years and you're like deficient. Now we're going to re-induce them with a bio identical version. And I just don't like them anymore. Nobody's that your body telling something much deeper. And we're going to do a whole podcast episode talking about gut because this is like Matt's like love language. And he's so godly good at what he does. But I'm going to use myself for example, we just pulled my labs. I've been running through or I've been experienced a lot of exhaustion, a lot of inflammation. I packed on on this and again, I don't use the scale as a metric of thinking I'm getting fat, but I packed on eight 10 pounds on the scale. And I knew I wasn't gaining weight. Absolutely knew something was off. So we ran labs and labs showed my estrogen. And I don't even replace my estrogen. You guys my estrogen was sky high. And so therefore which led to GI mapping, which then led to a whole host of issues as to why I feel the way that I do. So having a provider that understands how to diagnose who understands how to connect the dots who understands how to dig deeper than just well, you know, it's is what it is kind of thing. And that is just the approach for so many. And again, not me throwing stones to your PCP or your OBGYN, but just honestly they don't know what they don't know. Yeah, well, I mean, when we think about our typical appointment at our PCP or GP's office or even OBGYN, those meetings are never more than 10 or 15 minutes long. Our calls are 60 to 90 minutes long. And again, that's that's the healthcare design. The typical physician is seeing 100 plus people a day. They can't spend 90 minutes with you going over your entire life, all of your choices, things like that. They're turn them in burn them. What are symptoms? How can I help get out of my office? And so we and then there's also other conversations. Again, they're handcuffed by big pharma and insurance. They literally get in trouble for prescribing to comprehensive of labs. They get in trouble for prescribing certain medications. Any providers who are listening to this podcast know what what prior authorizations are. Prior authorizations is your insurance, your doctor wrote a prescription. The insurance is coming back saying, are you sure? Have you tried X, Y and Z first? They're doing everything possible to stop the patient from getting what the doctor prescribed. So the insurance is constantly fighting against you guys getting good healthcare one way or another and unfortunately the provider stuck in the middle. The final piece of that is medical malpractice lawsuits in their entire school curriculum. They are hammered. If you go against the grain, you risk medical malpractice lawsuit. You risk losing your license, you risk everything. So of course they're going to put their head down and do their job. There's a lot of things working against providers in the system. So we need to be very cautious to not blame providers. Don't get me wrong. There's some bad ones. But it's it's the system and it's it's shifting our expectations of what we are going to get and what we're not going to get from our healthcare system. It's disappointing. But at least we need to know the truth so that we can shift our expectations. Yeah, you just nailed it. You literally just nailed it on the head there. So let's talk about let's say a woman knows that you know she's she's menopausal. She's parry menopausal. She knows hormones play a role in this. She you know at this point probably listening to this podcast working through probably some insulin resistance stress high cortisol inflammation. Where does she start with her provider then like if it's like she goes to her provider and they refuse to run you know the lab work that we need. Yes, and I'm going we're going to talk about what you've offered at the end of this podcast. But if if she's in her provider's chair and she's trying to demand a higher level of support. Where does she start? Is it. I need you to run X labs. I need you to how could how can we maybe move that needle a little bit more. Is that in a sense? No, it does. I mean definitely pressing for a full sex hormone panel DHA testosterone estrogen progesterone and keeping in mind for women who are still having regular cycles. That there's actually an important time for accurate labs and that's in your luteal phase that is when progesterone will actually rise. So that is the only time that you're going to get an accurate portrayal of is progesterone low or is this healthy. That any other time it's going to be low and so checking in that luteal phase which by the way is seven to 10 days before your cycle starts. That's when you can accurately gauge that estrogen progesterone ratio and see if things are off. So that's important. I always recommend getting labs tested in the morning versus in the afternoon hormones are always higher in the morning. So you're going to have more accuracy there. If you're lucky enough to get a doctor willing to test cortisol that is a huge benefit with those sex hormones to again deductive root cause. But cortisol needs to be tested in the morning typically before 9 30 a.m. So generally speaking fasted first thing in the morning in your luteal phase is when we want these labs done. You don't have a cycle then disregard the luteal phase conversation but early morning is always preferred for labs. So I would say sex hormones and adrenal function is big cortisol believe it or not there's there's no research or treatment or understanding around high cortisol and stress in our health care system. But in fact what when we typically go into a doctor's office and complain about brain fog fatigue sluggishness slow memory trouble waking up in the morning what do they do thyroid. Because they can prescribe you thyroid meds there's nothing to prescribe you for adrenal dysfunction. So though to slap someone on level of thyroxen or synthroid and it doesn't help because they have high cortisol and adrenal issues. So you actually have to push for cortisol to be tested and checked. But it would also be wise to look at the thyroid because these three synergistic systems work together if one is off very likely we're going to see compensation or dysfunction in the other arenas. And so, really trying to push for those items. as well as your general health markers, a CBC, a complete blood count, things of that nature. Now, if they continue to give you pushback and you're just not seeing any compromise with them, the next place to go is probably just out of pocket labs. And there's a lot of resources for ordering labs online, but there's also a lot of clinic resources like myself that we work with Quest Agnostic, so we work with all 50 states, and we have a lot of different panels that we can run. But we typically do when someone enrolls is look through their medical form and help them decide based on their symptoms, based on their goals, we do what we call a needs analysis, and help them decide what the best labs for their situation are. And so, generally speaking, if you've tried for several months to get your general doctor or provider to do that for you and you're not getting anywhere, I would say, you know, start going elsewhere. In the meantime, though, let's start thinking back to some low-hanging fruit items that you can potentially do while you wait. So if we know that we have all the symptoms of stress, and what are these symptoms? Trouble sleeping, anxiety, mental health issues, low sex drive, weight gain, these are all survival responses, these are all stress responses. What can we start doing to reduce that stress in our daily lives? Reduce caffeine and stimulants. Shut off our phones earlier. Stop paying attention to politics and people gaslighting us on TikTok and stuff. Get seven to eight hours of sleep every night. Take some rest days from the gym. You know, find a balance there with recovery and exercise and maybe finally get out of a calorie deficit for the first time in time. I know. I just need enough food and the healthy food. If you're noticing loading and reactions to foods, even though that's your favorite food and you're emotionally attached to it, your body's telling you otherwise. That could be signs of other testing. If you're having digestive symptoms, you probably should look into GI testing because that's rooted into everything that we're talking about here. Always low-hanging fruit items. See what adjustments you can make to your diet. I don't mean this the wrong way, but use some common sense in regards to reducing stress. Better sleep, less caffeine and stimulants, and potentially more rest days, potentially boundaries with certain people in your life. Those are just inexpensive, actually free. Low-hanging fruit. I'm trying to get out and get some fresh air. Get off your phone and get out in the sun. These are free things that you can do while we wait on those lab results to come back. Yeah, that's great advice. I also think it's pushing for labs as one thing, but making sure that you have a provider who understands how to read those labs. That's the other one. That's because that's death too. That's a portal number two. Yeah, because you can have all the labs. If they don't understand how to connect the dots, it's just, you know, I'll use again myself for an example. You look at my labs and as my labs came back, they came back fine. As my estrogen was high, but my metabolic markers were phenomenal. By traditional standards looked great, but I obviously had symptoms and it trails back to GI issues that I'm having and there's just a lot more going on underneath that needs to be healed before, you know what I mean? I can feel the best again. This is nothing to even do about just how my body, and that's the part again too. I think for a lot of women, they're so desperate to look better. They overshadows that I want to feel better. Yeah, and, you know, they go hand in hand. I run. Oh, they do with a hand. They absolutely do. Healthy bodies are responsive bodies. And that was a saying I really got into it in my final years of working with athletes is helping them understand. If we get you healthy, you have to do less cardio, you have to diet less, you know, it's become easier for you. So yeah, I mean, totally agree with you. And, you know, I lost my chain of thought there. Sorry. Oh, no, you're fine. No, I think you nailed it though. It is one of those things that, you know, a body that is well rested, a body that feels good wants to show up to do the damn thing. And I as women, especially, I'm sure men struggle with this too, but as women, we're just taught to drive our body into the ground. If it doesn't hurt, if we're not miserable, we're not quote unquote working hard enough. But it's just like, and I think women, I don't think I know for a fact, they attach their worth to they love coming in telling me they're only eating 1200 calories a day. They love and they wear it like a badge of honor. They love to say that I do six days a week working out and X amount of cardio and, you know, I'm doing two days two days. I work out six days a week two or three of those days or two days. I work out twice a day and I'm eating 1200 calories as if this is just something that's cool. Like that's what the cool kids do. And I just, it hurts my heart because I just, nothing about that's cool. You're just body hurts. It's miserable. It's and I've been there. I've been in the, and I've been in that situation. I'm understanding when you're so desperate for an outcome that you will quite literally do anything to achieve it. And in the process, this is where you end up, you know, at the end of the day in a place where your body is starving for nutrients and just for you to feed and fuel and, you know, give it what it needs is, you know, at the end of the day, when you give your body what it needs, it always gives back to you. It does. And while that goes back, they're pride in wearing that with a badge of honor, goes back to our influencers in our society and the people who gas let them into thinking it's their fault. Yeah. So they're prefacing the conversation with you of they're in defensive mode. It's not my fault. I'm eating low calories. I'm doing all the exercise. They're letting you know like it's not me, you know, but they're they're wearing as a badge of honor because they're proud of these things that I'm doing all the things I'm supposed to be doing. It's actually the opposite of what you're supposed to be doing. No one should be exercising six to seven days a week. The best athletes in the world only exercise four times a week. That's because we actually build muscle when we recover, not when we train. And so by constantly taxing your nervous system and never giving your body the ability to recover, you're actually hindering progress. And so there's always a difference between emotional drive and rational drive. And as you know, as a coach, sometimes we have to like speak rationally and take away some of the emotional desires and help them understand better what's going on in the body and what they need to do to to compromise. I think a lot of people think of like fitness and stuff as I'm going to force my body to do what I want. And that's that's starved, you know, dieting exercise, forcing our body to lose weight. But that's actually not what we should be doing. We should be working with our body, listening to biofeedback and making choices as a compromise, as a team to reach a common goal. So if we're exhausted all the time, that's your body saying get more sleep, dude. Almost like we speak the same leveling, which I talk about this all the time, but posting about your rest and your recovery isn't a sexy. So it's just not sexy to post about online and say like, oh, I spent the day and you know, I you know, put in some self-care and you know, it's much, it's much sexier to talk about how you, you know, did work out for the day and you hit 25,000 steps. And you know, it just it's one of those things that the real flex, the ultimate glow up is, you know, it's in the recovery piece. That's that's and and being able to eat as much food as humanly possible too. I just I remember this video I did on TikTok and it blew up. I talked about how you had 150 grams of protein a day as a woman. And I never in my life have had, I mean, it went make a buyer. It has like millions of views. And never in my life have I heard more people say how it's too much food they can never possibly and I'm not even kidding, that is like 1900 calories for the day. But I give you 1900 calories of whole food and it looks like a lot more than that, you know, the pasta and the breadsticks and the wine that you're consuming. But people lost their mind. And it's just like this. I and I just want to like, I just want to shake them. It's just like, you know, it's better you would feel if as a society we talked and preached about just abundance when it comes to nutrition. And whenever I speak of abundance with nutrition, I'm talking cold foods, right? I'm talking fuel in your body. I'm not talking abundance of donuts and bond bonds. I'm talking abundance of whole quality foods. But people see volume and it's just like, that's too much food. And it's just like it's almost like it's a it's cool to talk about how, you know, the whole skinny talk took over. It's so cool to talk about how little you eat and then you have somebody coming on here and showing you what a normal day a fueling for an average woman looks like. I'm not, I'm just talking average. I'm not talking and later somebody who is just, you know, moves more than the average female. It's just like all of a sudden, it's just like, oh, no, no, like there's just so much scarcity around food. It's just absolutely crazy to me. It's crazy. But before we dive into, you know, you made a really great offer. Do you have anything else you want to add before we wrap up here? There's been such a great podcast and there's so many valuable nuggets here. Anything else you want to add? The one thing I'll add going back to, you know, talking with your provider, getting labs reviewed. But bodies are complex systems. But actually, it's not that complex. And so there's a lot of just common sense missing. And so don't be scared to ask questions. If your doctor says something is off or you see something off, off, ask why? And if they don't have a good answer for you, That should be a red flag. If they can't explain to you why something is going on in your body, and they can't give you any type of, well, let's do more testing. Let's do this. Let's do that. It just doesn't seem to make sense to you. You should probably be looking elsewhere for solutions. Or there's solutions in SSRI or birth control. Yeah, no band-aid solutions. If all they have-- Or GLP1 even, and we use GLP1. They can be powerful in the right context, but if that's just their go-to without digging deeper, running further, it has become a band-aid solution. And we will start to see-- there's going to be a rise of women who pay for that. Here in the next slide. I mean, I think our entire society is going to pay for it. One snippet, I'll say about that, is one thing that we're learning over the years about GLP1s is on top of the appetite control, insulin resistance control, it also impacts neurotransmitters and excitatory hormones. So what they found is that it really reduces addictive personality. So it's really helped people with alcohol addiction, smoking, even gambling and stuff. And that's because it's impacting dopamine and your excitatory neurotransmitters. That sounds great. The caveat to that is what we're also seeing is people are losing interest in sex with their loved ones. So for the first time ever, we are becoming a much-number society. And we are seeing sex drives from couples, single individuals, you name it, just slowly decline. We have to be cautious about this. With all these new drugs coming out, we are going to be a very numb society in the next few years. And it's going to be interesting to watch. And that's a little scary to think about on top of the band-aiding of disease. The only other thing I'll say about GLP1s is one of the other great benefits that it can have is reducing gastrointestinal inflammation. So the people who lose a ton of weight quickly-- that's not a fat. You didn't lose fat. You dropped insulin levels. You dropped blood sugar, and you dropped inflammation. But something's causing that inflammation. And so if you are one of those people who loses a bunch of weight, stops the GLP1, gains it all back instantly, that's not fat. That is inflammation. And there is a bigger root problem there that you need to address. And that'll be my final point about GLP1s, because I know we're going to talk about them one another episode. Yeah, we'll definitely dive into them. I think there's just so many amazing podcast episodes here between gut health, beauty, and just GLP1s peptide. I mean, there's just so many spin-offs of just this conversation alone. But I know Matt has a hard stop here pretty quick. So I want to respect your time. But just to let everybody know, he has made a really generous offer. So for anyone listening to this podcast, I'm going to drop an application link below in this specific podcast. In the show notes, "For this specific podcast." I'll also drop Matt's Instagram. You should go follow him. He's a wealth of knowledge. He's absolutely phenomenal. But anybody who applies for coaching with that specific link is going to get comprehensive lab work, as well as a lab review with Matt specifically. That is in combination with coaching the owner. And make that very clear, because labs without a plan, you guys, it's just a really expensive piece of paper. So if you have a lab work, but you don't have the way to connect the dots and you don't have the protocol outside of just hormone replacement there, because again, it's never going to get you from A to Z. You can take all of the hormones. But if the lifestyle doesn't support it, I promise you you're going to spin your wheels. And so that's something that you're interested in. I am going to, like I said, drop the application link below, fill that bad boy out. And yeah, any feedback from the podcast if you guys enjoyed this, anything you'd like us to chat about, I mean, you can always, my DMs are always open, shoot me a message. And we can definitely think about putting together podcasts related to just things specifically that you guys want to know more about. But again, thank you so much for your time. I mean, this has just been amazing. And I know it's just been super, super impactful for so many of these women who just are just in the thick of what menopause is and just the broken health care system that we have. So but there's going to be some many more episodes. And we'll see you in the next, we'll see you in the next show. Ciao.