33: Why Muscle Power Is Essential for Hormone Balance in Perimenopause with Dr. Christine Maren

(upbeat music) - Welcome to the Driving Mama, the podcast that teaches you not just how to survive, but to drive in motherhood. I'm your host, Dr. Stephanie Davis. Two of the most common issues women bring up in their late 30s and early 40s in my practice is that they gain weight seemingly out of nowhere and the inability to get that weight off. The truth is is that we are hormonally and metabolically changing during this time. And we have less what we term metabolic flexibility. So your body just doesn't have that agility that it used to have, went to kind of switch gears into like car burning or fat burning or to be able to take some of the insults that it used to if you had a crazy weekend or something of that nature. Increasing this metabolic flexibility and resilience is the key to having a healthy body composition or monon mood health and longevity as we age. But how do we do this? Muscle. Muscle is the key. Today I'm talking with my friend, Dr. Christine Marin, who is a women's health expert in parimenopause and menopause. We're gonna dive deeply into all aspects of this topic, ranging from diet and weight training, all the way to hormones and microdosing, GLP ones like semi-glutide. Some of the highlights include why muscle is essential to having optimal hormone balance, body composition and vitality in your 30s and 40s and beyond. What labs and metrics you can track to both identify underlying issues and progress on your journey? And why low calories and fasting might not be your friend during this stage of life? Dr. Christine Marin is a board certified position in the founder of our virtual functional medicine practice in Colorado, Michigan and Texas. Her practice specializes in women's health and hormones specifically parimenopause, menopause and preconception health. She is a compassionate clinician, speaker and wellness advocate. If you're confused about where to start on your own health journey, I'm offering podcast listeners of free health check-in. We're all evaluate your physical, mental and emotional health and provide you with useful resources to help you on your journey. You will find that link in the show note. Hey everyone, I'm here with my friend, Dr. Christine Marin, who is a hormon goddess. She is so brilliant at all of the things that she does. And one of her newer components is talking about body composition and just being strong and vibrant in your kind of second half of life, parimenopause, menopause and beyond. And so I really, I've wanted to have her on for a while and I'm so glad you're here. I'm so glad to be here. I'm so glad to catch up with you too. - Been a while. - I know. It had been a while, so it was so good to talk. So what I wanted you to do first is kind of talk to people about your journey to how you got here. Because this is, it's not like, for most of us, you just kind of like wake up when you're like something's not right. And a lot of us ignore the signs building up. So if you could kind of share with that, look like for you, I would love that. - Yeah, I mean, you know, I got 44 years to cover here. So I'll just make it really fast and tell you, I mean, I was pretty healthy when I was younger into probably like around bed school started having digestive issues, some hormone issues, pregnancy sort of uncovered a lot of things as it tends to. And women, you know, it's like a stress test for us. I had gestational diabetes, I had recurrent miscarriage and really started taking my health seriously after pregnancy loss. And, you know, throw some old exposure in there and Hashimoto's and, you know, all the things. Fast forward to where I am today. My health is much better, but I'm also 44 and started experiencing symptoms of paramedics a couple of years ago. And also with that, like five pounds or 10 pounds or whatever the annoying thing is that I just didn't want anymore 'cause I didn't fit into my clothes. And I didn't feel all super awesome. But I, you know, it was like, was I overweight? No, did I want to buy new jeans also no? And it was a little, it was frustrating 'cause all the things I did didn't, you know, the things I used to do didn't work anymore. So I really sort of started that journey and, you know, as things go, like our personal interest coincide with what we see professionally. And I see a lot of women in the paramedic pausing metapostime frame and really started diving into like HRT. And, you know, so right now I'm just on this journey of like helping women feel really vibrant and alive and beautiful and confident and sexy and metaboply healthy. And I love it. It's just my new favorite thing to talk about. Now I love that because like we talked about before, so much of the messaging throughout a woman's life, let's be honest, like we are given messages that we need to act a certain way or look a certain way. But it really ramps up in those like paramedic pausing and pausing years. You know, you're constantly told that, oh, you're wrinkly. You've got your body isn't shaped the right way, you know, all of these things, you know, all of the get ready first swimsuits is that there's so much messaging out there. And I really want, yeah, I want to flip that script. And I feel like the work that we do, but especially like you're focusing on right now is really hitting that head on, which I really, really appreciate. It's because that messaging is so destructive and it makes women feel less than and invisible. And, you know, like we said before, we don't want to look like Twiggy and the latter half of life. And muscle, you know, we talk about muscle. Muscle is the organ of longevity and vitality. And I feel like that's a reasonably new concept. So if you could explain what that actually means, I think that would, you know, kind of clear the air for a lot of people. Yeah, I want to back up because I think this weight loss conversation, first of all, it's not about weight loss. That's just what we call it because everybody's familiar with it. It's about losing sat and gaining muscle. And that is, you know, like you just said, organ, it's muscles and organ of longevity. Like we need more of it. It helps us stay young and able and fit. And do the things we want to do. It also surprisingly, one of the side effects for me, gaining a lot of muscle in my legs is just struggle with IT band friction syndrome, which was like, my legs were always like super tight and achy. And now like I have stronger glutes and stronger quads and my musculoskeletal system is different. I mean, I'm married to an orthopedic surgeon. Like we had this conversation last night. And he is like, no, it's because you're, you know, your patellar tracks differently, like all these things. I mean, I'm not rolling out my IT band anymore. So, point is it just helps with some of like the body structural issues. But this conversation about weight loss, I have shied away from four years because I hate the message that women are supposed to look a certain way or be a certain way. I love the message that you be you, be more of who you are and do more of what makes you feel beautiful and confident and vibrant. And most importantly, like show up for yourself. Show up for yourself in the way that, I mean, I wasn't showing up for myself in the way I thought I was. So for so many years, I mean, I literally had a therapy session about this because I hired a trainer and she wanted me to track my protein and weigh my protein on a scale. And I'm like, that sounds like way too high maintenance for me. And so I had to unpack a lot with that. Like it really gets into like unpacking mindset around this, you know? Are women who have disorder eating of which I see a ton? I don't recommend doing that probably, you know? But for me, I was like, well, I don't have disorder eating. I'm not really going to get an eating disorder in my 40s. And you know, as my therapist said, what if you just allow yourself? Like, what if you just let yourself do that? What's going to happen? And I'm like, well, all right. Like I sort of just, I realized for me, I was like, oh, yeah, I've been really conditioned to think I have to be low maintenance and be highly capable and take care of everybody else, but I might not be able to take care of myself. You know, it's just, there's a lot around that and everybody's going to be different, right? Like I don't know what everybody else feels, but that's what was going on for me. And that's why I couldn't really get serious about like, hey, I'm going to the gym. Like I'm sorry that, you know, you're going to have to miss your ride or whatever. Like whatever it is, I figured out a way to show up for myself. So I could consistently do the things I wanted to do to reach my goals. But really like when I'm at the gym and working hard, my mantra is like self-respect, self-respect. Like last rep, it's self-respect. This is not being hard on yourself. This is not like, oh, keep going. Don't be such like, whatever it is. It's just, it really has an under-chone. Like the mindset piece, I think is critical. So it's huge. You're right, 100%. That's like in the program that I do with, because I focus on mom's, mom's of all kinds. It's not like we're just targeting hormones or anything, but that is it. I start off the program with intention and mindset, because that's what needs to change in order for the changes to occur in all the positive things to happen. Because we tell ourselves so many different stories. You know, like you said, you know, I need to be low maintenance. You know what? You do not need to be low maintenance. You know, you need to take care of yourself. And that's a concept that so many women can't grasp anymore, because they've always put themselves, that's the one thing I always say, like you put yourself in the back seat for too long. You need to put yourself in the front seat and take care of yourself. Almost done. So now that we've covered that part, do you want to talk about muscles and organ of longevity and vitality and just, it does so much and I don't think people get how much it does. - Yeah, I mean, muscle, having good muscle mass, not only important for your musculoskeletal system and for joint pain and things like that, it takes the stress off your knees and your hips and whatever. It also helps a ton with insulin resistance. As we age and as we go through paramedics, [BLANK_AUDIO] to have changes in body composition that leads to more visceral adiposity or fat around the mid-life. And those changes cause issues and cause increased risk with all the things we don't want. Type 2 diabetes, cardiovascular disease, or an attack. Tients are even. And so muscle helps offset that. Muscle is metabolically active, so it's going to improve insulin resistance and also help as you work on the body composition changes, it's going to improve your metabolism. So help with the fat loss. Like the more muscle you have, the better your metabolism. Right, exactly. Yeah, that's awesome. And I love how you, some people go off on a tangent on that. So I like how you kind of condensed it. It's short and sweet because it really is. It's complex. It's a very complex metabolic organ. And it doesn't, most people think about muscles and they think about like working out and they think about the way you physically look. They don't think about it as an endocrine organ, something that really does signal to the rest of your body and really helps in pyrimenopause and menopause because so many women are not aware of the fact that those pyrimenopausal changes are happening in your 30s. Nobody really, you know, you don't talk about it and those changes might be so slight and significant until you wake up one day in your 40s and you're like, what's happening? You're like, I'm gaining fat. Yep, I'm gaining fat and I'm irritable. And you know, all of these things are happening. My sleep is disrupted, right? So we've got all of these not fun things, but now we have so much information and the tools to to deal with them. So that's really like, I feel like we're we're living in a good time to be going through this. So let's talk about, you know, like body composition because like before you and I talked about like, I really hate, I don't want to say hate scales, but the scale doesn't tell the whole picture. And we really need to be focusing on body composition and more of your lean mass rather than, you know, the number on the scale. So if you want to talk a little bit about how you approach that and when you're working with people, what that looks like. Yeah. So initially, you know, I like to know, what's your starting weight, but like we have to remember, you might not lose weight. You might actually gain weight. The goal here is to get you warm muscle and less fat. And so we recommend, there's an at home scale. People can buy it called in body. And so we recommend that for people, or if you can do like one of the dexab body composition, like fitnessity and some other companies will do that and actually tell you like, you know, percent body fat, percent muscle mass. But the overall goal is increase your muscle mass and decrease your fat mass, especially around the middle. Absolutely. Yeah. That's a big one because we've been so programmed to be looking at the scale. And, you know, that's your weight. And I love that you mentioned you might actually not lose weight. Because it's true. I mean, some of us, even though you look really thin, may not have a lot of muscle. So that's in putting on the muscle is the important piece of the puzzle there. Yeah. And an inexpensive, sort of old school way that is still pretty accurate is to just check your waist to hip ratio. What is it? Because as you get older, we tend to have a higher waist to hip ratio. You want to reverse that? Yes. That's a good one. Yeah. It's funny. My husband and I actually got out this bad boy the other day just because we wanted to look at that. It's sitting on my desk from the other day. I mean, it's like, it's cheap. It's easy. Like, it's a good thing to track. So I like patients to give me their starting waist to hip ratio. And then, you know, we can go back and look and see what kind of changes we've made. But a higher waist to hip ratios is this you with cardiovascular health and poor cardiovascular health and insulin resistance. So yeah. Exactly. And I feel like, you know, we were talking about before you were talking about having to weigh your protein on a scale. I, for the same reasons, I'm not always like keen on that. Just I'm very sensitive to if that person has added eating disorder, if they or if they're prone to going down that pathway, even if they haven't yet. But I think it's a good idea of metrics being able to measure things like, I don't, I usually only have people do it for about a week because if you do it for a week, you can see what a portion of protein looks like, right? You can see what a portion of fat looks like. It's like all of those things. So it's like, once you get it in your mind, you don't have to weigh it out anymore. But tracking your body composition in different ways is really helpful. It gives you points, you know, points to actually start from. It gives you an endpoint. It gives you, you know, different targets to hit. And then you know how to tweak things from there as well. Is there anything else that you look at when you're tracking besides ways to hit ratio or or what's happening with the like the in body or dexa? No, I mean, outside of like labs, I mean, we're looking at all the metabolic markers. So, you know, things like insulin fasting insulin insulin resistance score, even below anyone see fasting blood sugar liver function test because as TALT can show a pilot things like fatty liver disease, which is really metabolic. I don't know if I mentioned fasting lipid panel. If I didn't say that out loud, you know, we check that. So HSCRP, you're a acid, you know. So we look at those metabolic markers before and like at that three month mark and have some idea of, you know, progress. And that's really the end goal here is like, we want to be insulin sensitive. We want to have low triglyceride levels. We don't want high blood sugar. Like that's super oxidative. And you know, in talk, we talk about lipids or LDL cholesterol, like honestly, more concerned with high blood sugar than I am with a high LDL. So like, let's work on that piece first. And ultimately, they usually they'll turn in the same direction. So is your program set up to be three months at first or is it is three months just where you check it? Yeah, three months is just where I check. And I mean, for me, specifically when patients start working with us, they'll sign up for either a three or 12 month program, but a 12 month program is really like what most patients do to see big changes. I mean, most of our patients are also, you know, it's like sometimes it's just, I mean, they're all different, right? Like sometimes it's just because they want to lose weight, but often it's because there's other kind of health conditions going on. I mean, that's also part of like why I shared away from weight loss for a long time is because when you address the other underlying issues, like it often comes off when we address the inflammation, you know, it's like when you take out the super inflammatory foods, like my mom took out gluten and lost like 25 pounds, you know, it's like we have to address all those issues. And so typically, any word looking at the whole picture with patients, not just weight, obviously, but, but it's something I acknowledge at this point is like if your goal is weight loss, I'm super excited to help you with that. Yeah. Yeah. Awesome. So let's talk about you touched on insulin resistance. And that as you, it seems, this is what I've observed in practice for many years, the closer you get to menopause, if you're not addressing your hormones, the insulin resistance piece just goes through the roof. Can you talk about that from a hormonal standpoint? Like what's happening with like the sex hormones and the thyroid in what? Yeah, it's estrogen. I mean, thyroid, thyroid's important. We do get triggered to have more thyroid issues through paramanopause, menopause, just like we do a postpartone. You know, so it's always something to look at. Like if you're having trouble losing weight, but as you know, like not all people who have hypothyroidism are overweight. Like it's really things that they're often cold and sort of like, you know, metabolism is a little bit slow, but they're really not all overweight. You know, sometimes they're stric skin, sometimes there's constipation, sometimes of loading, sometimes there's a list of all of them. So thyroid is for sure something we look at. But as we reach paramanopause and menopause, and you have this decline in estrogen, estrogen effects are blood sugar sensitivity. And so less estrogen means we're more likely to put on the visceral adiposity, meaning like belly fat. And we're more likely to have this trend in insulin resistance and higher blood sugar over time. I mean, I've seen it and you, I know you've seen it too in labs, you know, and you have a patient who's like, she eats really well. Like, you know, she's eating like whole food diet, eating lots of fiber, lots of vegetables. I'm like, like why is your blood sugar off? Like I'm just surprised sometimes that they're hemoglobin A1C, but now I understood it in a different way. Just from the perspective of like, oh yeah, this is called menopause or paramanopause. And estrogen plays a big role there. I mean, they all, all the hormones play a role testosterone, progesterone, I mean, progesterone less so when I'm talking about like the weight loss stuff more so when I'm talking about sleep. But yeah, the estrogen deficiency is for sure a factor. I feel like that's a topic that's finally again, starting to gain some some traction, because I always feel like when you hear about paramanopause or menopause, you hear about progesterone. And progesterone for me did not move the needle. I do bioidenticals. And I was like, you know, the young main version of me is like, oh, I'm going to be all natural. I'm not going to have to do all this stuff. But then, but then I couldn't sleep. And I was super irritable. And all these changes were happening. And I first added in progesterone. And that did help with the sleep, but it didn't help with anything else. So I was like, what else do we have to do? And then we added in the estrogen. And that was the game changer for me. It was huge. Like night and day, night and day. I mean, I think for women who have like crazy heavy periods and stuff like, yeah, you need some progesterone. But for me, I mean, you know, for some people, progesterone is like a game to your for sleeping irritability. But like for me, it was more, I was more at the low estrogen state for a long time, probably. Like in retrospect, I look back at them like, oh, yeah, probably been kind of low estrogen for a really long time. And you know, even if you look at like the Women's Health Initiative data. So like this big study published in 2002 that made everybody think HRT cause breast cancer. What it showed is a way decreased risk of type 2 diabetes, along with other things like the increased risk of colon cancer. But the type 2 diabetes piece is huge. Like that was pronounced in both arms of the study that estrogen progesterone and the estrogen only arm. So I mean, for the people listening like the WHO I was looking at can conjugate equine estrogen this synthetic progestin, which is not what we use anymore. It was almost like looking at what happens when you get almost like a birth control pill, you know, like these synthetic estrogen and progesterone. And now what we use is safer works better. It's body identical, you know, but nonetheless it improves insulin sensitivity and decreases your risk for things like tattoo diabetes or just insulin resistance. Yeah, I feel like probably 10, because I've been practicing for a really long time. 10 to 15 years ago, I feel like I would see women because that was still like where that estrogen fear was peak. And you were seeing so many women transition into menopause and their cardiovascular risk went through the roof, right? It was like first those blood sugar changes were happening. And then they were having heart attacks and they were having, you know, also high blood pressure and all of the things happening. And now it's like we're finally trying to see, you know, we're starting to see the tides turn where people are starting to become more educated and embrace, you know, the bioidentical hormones. It's really interesting, though. And I know you can speak to this too. It's like when you go to some of the functional medicine education, you know, places like IFM or A4M, there are still, we still have colleagues that are like super opposed to using estrogen or estrogen in certain forms. Like there's one person that I interviewed and she was talking about the research on oral estradiol going through liver metabolism and that being the one that actually shows the strongest benefit for cardiovascular disease risk. Yeah, I have heard this before. Most of the time I prescribed transdermal, but I am like, I am curious about that data because that's I think still a little bit controversial, you know, because you increase clotting factors and it's like, yeah, yeah, exactly. She I'll say that she doesn't do it lightly. We'll say I'll say that like she doesn't the most of those research papers showed two milligrams per day were the dose and she will do it anywhere from 0.5 to two. She tries to use the lowest amount to get the benefit. So I know it is, it's like it's a big conversation in the, you know, kind of functional and integrative medicine world on on the forms of estrogen now. Now that we're embracing estrogen, do you use when you do it? Do you do the transdermal patch? Is that your favorite form? Most of the time. Yeah, most of the time I just took a course with a urologist and a sexual medicine expert. So I've really started looking more at other kinds of estradiol as well outside just the patch. The patch and oral progesterone has always been like, oh, two, but there is an estradiol ring you can use. So genitow urinary syndrome of menopause is huge and like for women who want to preserve sexual health, who want to prevent you to use, you to eyes like, we need to have estrogen, badger, estrogen, super important. And so you can use that topic, like super low risk, but there's also like the ring, the estradiol ring that you can use, which is if you use the femurring, it's estrogen topically to, you know, for a vaginal tissue to prevent GSM, genitow urinary syndrome of menopause, but it also is systemic. So it's like, I've been prescribing a little bit of that. I'll prescribe gel sometimes for people who can't use adhesive. Yeah, but I mean, in general, I'm transdermal estrogen. Although there, I have a few patients who have come to me who have been on oral estrogen. I'm not opposed to keeping them on it if they've been doing well. It's like the first year of initiation where it's like a little bit higher risk. But I think that little bit higher risk is also like really a little bit. And just for anybody listening, like looking at the literature is so complicated because when we look at the data, like most of the data we talk about comes from the WHOI, which was using conjugated equine estrogen, which is a, it's not actually synthetic. It's not synthetic because it comes from a horse's urine, but it is not body identical to a human. It's body identical to a horse, right? To a horse. Yeah. Right. I know. That's like us doing studies to determine what's going on. And then you've got the progestin, which yeah, kind of complicates things. I mean, it's like if we were to study blood pressure medicine and we're like all the blood pressure medicine does this. And you're like, well, it's like a beta blocker and hydrochlorothyside work totally differently. Yep. Exactly. Yeah, it is very complicated. I still feel like in general, in the realm of research, there just hasn't been a lot of good research done on a women in general and women's specific issues, but we look back retrospectively at all of this information. And it's like, yeah, what truth can you glean from it? There's not a lot. We need to do a lot more current relevant research. That's a very, a very, very big thing. Awesome. Yeah. And I love the oral progesterone because I was one who liked it. The topical for a really long time. And I was like, I think I actually have to put like a whole bottle on myself to actually get a benefit. So I'm going to do the oral because it's that and then worried about like, I used to recommend it. And now I'm like, forget it. Just use the oral progesterone. Like it works great. It's easy and it's cheap. It's not an expensive, you know, medication. So it's like, it's super easy. And for those of us who are moms, I've always concerned about like, transfer to kids and like, you know, how long is it taking for your kid to absorb, I mean, you're too absorbing your skin. It's just, it's crazy stuff. Awesome. So we, you know, while we're talking on the, you know, kind of the idea of hormones, before we got on, we talked about microdosing the GLP ones. And so for those of you who are not familiar with the, you know, the GLP ones, I'm going to let her give you guys a little overview of what they are and how, when you microdose, it's different than the dose that you're giving to somebody who has metabolic issues. Yeah. And talk about the research, like, we don't really have it. So let's just be like, right up, like, clear from the, we have research on high dose, which I just have to like, bring this analogy back to like testosterone too. Like if we give a woman testosterone, we actually have research on giving people really high doses and what happens. Those are people who are transgender, who are transitioning from female to male. They get these very high doses of testosterone. So we actually do have that data. So I think with the same thing and like with GLP ones, we have this data for what happens when we give people really high doses. And those are morbidly obese diabetics. And, you know, what might happen. So when you go for, so traditional GLP ones are things like ozempic and wogo-bi. And they're FDA approved for obesity and diabetes, high-titude diabetes. However, sometimes you have somebody who has some insulin resistance. She's not morbidly obese and she doesn't have diabetes. Can we use it preventatively? What happens if we use it at a really low dose? Can we reduce the side effects? And we can definitely reduce the side effects. I mean, I can say from just, from seeing this clinically, people who go on a full dose of those medications often do experience a lot of side effects. Namely nausea, appetite suppression, they will eat. But if you use a really, really, really little dose, they still have benefit without as many side effects. And so they're just better tolerated. I do counsel patients like when you start this, we can work on titrating the dose up slowly if you experience appetite suppression, food aversion, nausea, gastrointestinal side effects. You know, we should back off the dose. The other thing to watch for is I tell people like don't like watch your fat intake because it can increase your risk of gallbladder disease. So like don't be a bunch of potato chips. I mean, it's really important to, I also have a sort of requirement in our clinic. If we're gonna start these medications, like you have to build muscle. Because if you don't work on building muscle and you're not in the routine of listing weights, lifting heavy weights, not like a five pound weight, but like getting into like listing heavy, that's my always, I always encourage this first. Like start first with lifestyle. That's not like what I jump to, right? But start first with lifestyle. Lift weights, eat a lot of protein. Once you can do those things, we can later in a GLP one at a really low dose, I think safely. But you have to, that's where tracking the protein can be helpful. And eyeballing it or at least making sure like every meal you're getting, at least there are minimum like 30 grams of protein, especially in the morning meal. Yeah, but I mean, I think in general, they're really well tolerated. We have a lot of patients do really well on them. Yeah, not only that, but it, you know, on a cellular level, I'm even seeing people who post COVID or long haulers or other kind of non-traditional uses of those medications. It really is helping change the, you know, cell function. And that's something that I probably beat like a dead horse. My patients probably get sick of it because I'm always talking about them. Like the cell is the key. I'm like, if you don't have fluid cell membranes and you can't get your nutrients in and out of the cell and oxygen into the cell, it's like everything else we're doing is a mood point, you know, we need to get the cells healthy. So that's another place where I think we're seeing it too is just get improving cellular health. Yeah, I mean, it's being used for like psoriasis and fatty liver disease. And I mean, there's a lot of indications for it. Well, should say there's not a lot of indications for it. There's a lot of people using it clinically in practice and seeing improvements. It's just not approved for all those things. But we use things off label all the time, you know, like testosterone for women and see used off label. Yeah. Do you speaking of testosterone? Do you tend to use a lot of testosterone? Are you using more of like estrogen and progesterone first? I start with that. estrogen and progesterone first. And then I layer in testosterone when women need it. I always say like measure testosterone 'cause we don't always need it, like not every woman needs it, you know? Sometimes people's testosterone is fine and they feel great. Once they start estrogen and progesterone and some people don't tolerate testosterone, they get hair loss or acne, it's not as common, but yeah, I just, I layered in kind of one thing at a time. I don't like to start all, all like spy, like thyroid estrogen, progesterone, testosterone, do a P1, like, let's say. - Yeah, yeah, say it one step at a time and let's see how. - Yeah, it's a lot. - I know, I'm always suspicious of that too. - Which is why a three month program is like, not enough. - Yeah, truly, it's truly, when you're making, I always feel like this is like radical lifestyle change, right? It's like we talked about like talking about the minds, like getting mindset and intention and all of that dial then and then working on your diet and working on exercise and prioritizing sleep. That takes time, like you can't do that overnight, very rare. Every once in a while I come across a person who's like, okay, I'm doing this and it's done like tomorrow, but that's like 0.001% of the population. Most of us can't do that, right? So it's a process. So yeah, three months is not a lot of time. It's like you can lay the foundation, but you need to keep going. You need to keep building on that foundation. - And I think it's important too for people to give themselves a lot of grace. Like when I first started kind of change, I'm not like a super, I don't have to be really rigid must myself. I'm just not. I've never been super rigid about alcohol is like an example. People somebody asked me the other day, do you drink? And I'm like, if I want to, which the answer is no, not really. I don't want to because it makes me feel like crap and my or a ring data goes to hell and like I just worked out. Like why am I going to like screw myself over with a glass of wine that doesn't even help me in any way, you know? But nonetheless, like if I wanted to have a glass of champagne while in Paris, I might like I don't have any rigid rules, right? So I just, I don't know, everybody's different. Some people need that, some people don't. But I think the whole point of this like aside is be gentle with yourself, move the needle in the right direction, don't expect perfection. Just sort of like build on habits one thing at a time and you know eventually things change, but give yourself time. Yeah. My mantra with all the people I work with is progress over perfection. Because I think so many of us are programmed, you know, right? It's, you know, perfection is a progress over perfection. Yeah, yeah, yes. Progress over perfection. And I'm like one, small changes in the right direction add up over time. My patients know I see this all the time. They really do. It's like one like you don't even have to take a full step. Like one, one baby step, you know, in front of the other every day adds up. And it's like so we're so programmed to like want everything especially now. We, you know, we want everything like yesterday. We want all the benefits. And it's like that's that does not happen with our bodies. It took our bodies of really, really long time to get to this place. And it's going to take our bodies a long time to get out. And so it's like, yeah, giving yourself grace is absolutely huge. Because it's like it's so interesting. One of the whole reasons I started like focusing on working with moms is because in my practice, it's mostly, it's like family practice, it's moms and kids. And the moms would like, they would go on vacation or a holiday would happen. And they would get their kids back on track on their plans. And then they themselves would not. And it was so fascinating to me. I'm like, why is this happening? And it's like because they're prioritizing their kids and their kids' health over their own, you know? And like they're not, you know, there's all the, you know, mindset. I'm not good enough. I'm not worthy. I don't deserve it. All of those things. So it's like getting beyond all of them. Yeah, totally. I love the, yeah. I love the worthiness talk. Like you're worth it. What is your worthiness, you know? And I love really like drilling down to like, what's under there? Yeah. Oh, we talk about that a lot. That's what spurred me on my, you know, like, it's funny how like a lot of us who are in functional medicine, integrative medicine, we, it's a lifelong learning process. Like you can't ever really stop learning. And like you said, you're just working with a urologist. And like for me, like I, like dove headfirst into like trauma and emotions and mindset and all that. So all of my like certifications and education and that the last like five, six years have come in that realm. So and that's something that I do a lot with because yeah. Oh, yeah. It's awesome doing that a lot. I gotta learn more about that. Because that's new, that's sort of like my new jam in the last several years too. It's like, and it's part of why I'm here doing what I'm doing now. You know, it's like I started with that. But not so much in the patient realm, just more in the personal realm. Yeah. My transition from personal to patient, you know, is like mold trauma and then you're like, I gotta address this. Yeah. Yeah. That's exactly what happened for me. It was like I had the aha moment for myself, like 12 years ago. I literally like sat up in bed one day and I was like, the change has to come from within me, not anywhere else. So it was like, I just, I knew that I needed, I had stuff I had to work on and I did it for myself. And then I started noticing that all my patients who said they did that kind of work in or work with whenever it was, you know, whether it was like talk therapy or EMDR or any of the myriad of things out there right now. Like they were the ones who did better. And I was like, there's something to this. So that's like why I started incorporating it into practice too. Because it's huge, such a huge piece of the puzzle. It's so huge. It's so huge. And I told like this one of the things I talk about a lot is like stress. You know, I used to think like stress is the straw that breaks the camel's back. And now I'm like, no, that like childhood conditioning sets us up for things like autoimmune disease and cancer. I mean, it just does like with it gabbermote's work. That's where I send my patients a lot of times. So yes, a lot of times in our inner and inner patient visit, I'm like telling about your childhood, what was your, like what was your personality like? And I'll say like 95% literally 95% of my patients are like super high achievers. Were really capable when they were children because they often put their own sort of needs on the back burner or they had to put their own. Nobody was there. Like they didn't have their emotional needs met. It usually wasn't like big trauma, big T trauma. It was like some little trauma. Their emotional needs were maybe not met. They were, you know, the oldest and had to take care of other siblings or one of their siblings was like severely disabled and they had to like really show up and sort of fend for themselves. Whenever it is, that is definitely the trend. And then they end up is these like high achieving sort of badass women who it's not so obvious all the time, but they're like, their needs are sort of on a back burner. And I can relate because I'm that person too. Like, I'm like, oh, I know you. Yeah, we're coming from the same class. Why are we all here in the same room? Exactly. That is the truth. One of the very, I think when I recorded like the first five podcasts, that was one that I did. I talked about from like zero, like, you know, basically conception to the age of five. You know, those are the critical years. And then everything else is built on that. And what you said is so true. It's like 95% of the women we work with are in that realm. You know, they're accomplished. They're high achievers. It's, you know, it's a trauma response. Yeah. It's a trauma response. Yeah. Everybody goes to them because they're like, I know if I have you do this, it's going to get done right. Yeah. Do you even like, I even think back to like being in school, like when we were in school and you have to have to do projects, everyone would want to work with me because they knew that I would get it done and I would do it right. And I wouldn't, you know, be like all the, I hate to say the guys in the corner, but it was. It was always like, there was always this like group of guys who were like, oh, I don't want to do it. I'm going to work with her because I know she'll do it. You know, it's like they didn't want to part. Nobody wanted to partner with them. So it's like, it was really interesting when I looked back and I was like, yeah, I had been the go to person for so long. And I'm like, now I need to be the go to person for myself. For me. Yeah. It's just like back to show up for yourself. I haven't shown up for everybody else for like four years. I'm like, what the hell? I know. I know. I know. And being the oldest definitely adds a layer. I'm going to the gym for an hour. Like what? Yeah. Exactly. I'm going to make myself some chicken. Exactly. Exactly. It really, I think this for me, this whole process has been transformative, not just in the physical body and feeling more confident and sexy and whatever, but it's like really realizing, like, oh, that's what that looks like to show up for yourself. And damn, that feels good. Like, all right. I'm going to do more of that. And I think it just, it influences people in lots of different ways. And just like, you know, when you work with moms, it's cool because you get to influence their whole family and then the whole family gets healthier. And like, if mom can, you know, sleep better and she feels better, all those things, we know this. But I think it's, you know, it's like the same way when you help her feel more like herself, when you help her feel more radiant, when you help her feel more confident. And you know, she shows up for herself. I think the family sort of sees this like, and especially your daughters, you know, they see like a different kind of way to be. Yeah. That's a big thing with me. Like how, how am I showing up for my daughter? What am I modeling? How am I speaking? How am I acting? All of those things. And it's funny because like, if I do something, I'm not, not pretty, you know, we all have bad days, right? And if I have a bad day and I like snap at them or something like that, I apologize because I'm like, you know, I did not mean that. I'm like, I'm, I don't, I tell them I'm like, I'm having a bad day. I'm like, I'm sorry that I, you know, stepped out. You were whatever it is. It's like that. And like, I would have been unheard of for our parents to do. know it's like it's crazy but yeah I mean it's like trying to my what I want her to have when she's older, because life was different. Life was different for us. So I would love for you to share if a woman is in that contemplation state, and she wants to start this journey. What's the first thing you would recommend that she do? - Mindset. I think mindset and get clear on like, what are your goals and why? Like, what's your why? What are you trying to achieve here? Is it because for me, actually, you know, we haven't even talked about this, but for me, my why was having migraines and it turned out that I have a cervical, a herniated disc in my cervical spine that I found on a Pernovo MRI. And so I started going to physical therapy and eventually got an MRI, a Mary Dospine surgeon. I mean, basically, what you need to do is strengthen your upper back muscles and strengthen your lats and serratus interior and all these things. And so I realized like, oh, damn, I mean, I'm not gonna have surgery on my neck. Like, I'm gonna do everything. I can't avoid that, right? And also, these headaches are really annoying. Like, I can't, I gotta figure something out. And so I started lifting weights and then it just sort of progressed from there. So I think like for me, it was like, I like to, I want to be able to do whatever I want. Like, I like to go outside and ski and wakeboard and, you know, like I'm pretty stinking active and I have no intention of stopping that at any point in my life, you know? When I get to be older, I want to be able to do all those fun things. And also my husband is a freaking animal and I want to keep up with him to some degree, you know? Like, I'm not gonna be like, I can't go hike with you or ski with you or something like that because my neck or because they don't have muscles, you know, so for me, it was really like, that was my why. But then it morphed into something else. So I think the first thing to do is just like, figure out what is your why? Sit down and really think about it. Like, what's the why? And then from there, you've got like, okay, yeah, the honest why, like it really honest with yourself. And then picture yourself like, what would look differently for you in your life if you were stronger, if you had more muscles? If you had a great metabolism, like how does it feel? What activities do you do? What are your relationships like? Do relationships change? What are stresses like all that kind of stuff? So I think really just like getting your head around that mindset piece, what you want to achieve and why? And then you start. But everybody needs, you know, everybody needs like to, and it's different for everybody. Like as we see in health, it's like people, sometimes they come see me because they're like, I am losing here. And like that is the straw that broke the camel's back. This is not acceptable. Like they were okay with having a hemoglobin, and see if six. But once they started losing here for a lot of women, it's like, all right, that's not going to fly anymore. So I mean, you know, for some people, it's just like, you know, they don't sleep as well or their relationships are not as good because they're irritable or whatever it might be. You know, we all have our different kind of challenges and they're different. Why? But I think it's important to identify that. Yeah, exactly. My was kind of similar. I was having headaches and it was hormonal. It's interesting that you had a herniated disc at C7. Do you have any idea where that, where it might have happened? It's four or five, I think four or five and five six. Oh, no, and I don't, which is really bizarre. I have no idea. Like I didn't have any like significant injuries that I can remember. I mean, I've always been like active and who knows? I know. I think if at some point, there's some things. Oh yeah. Yeah. I mean, at some point, something changed and these, I've been getting these, I mean, I, you know, I think 2023, I was like, I'm I'm with these are for, like what's going on here? So I went down this like journey of trying to figure out like, where is this coming from? And then, you know, then it was like 2024. I was like, I'm going to get fit. And now, you know, it's like every year, I sort of have the school, but it evolves. Yeah, it evolves. Yeah, it is. And that's, it's important because I always bring this up to people. I'm like, this isn't something that really has an end point. And like, it's a journey. Your health and your life are an evolution in a journey. So it's like, there are going to be some changes. There are going to be some ups and downs. And it's like, what we're doing truly is building resilience. We're building emotional and physical resilience, you know? And so the more resilience you have, the better you are going to be when you weather these storms, you know, it's like, it's, it's interesting. It's like, it's like, that is what we're doing. We're literally trying to build a resilient foundation so that we have longevity and we can do the things we want to do in life, in later in life. And it's like, I want to see, you know, I want to see my kids grow up and I want to see them have kids and I want to see all of those things. And I also have a husband who's like yours who's like beast and can do anything and is better than everybody at everything and like fast like when we're snowboarding, he's like the first one down the mountain. And I'm like, I will, I'll never be as fascist and just because I'm much more cautious. I had one, one time we were snowboarding and I hit my head and I didn't totally black out. But I had like a brown out moment. And I was just like, yeah, it was like, I want to say like six or seven years ago. So I'm just like, I'm super cautious now instead of bombing down. I'm like, let's do some nice big esterns and get down upright and with a solid head. So yeah, I mean, I want to be able to do all that stuff too. Still, you know, I want to be able to go hiking and do all the things that we do. If just so the audience knows Christine also lives in Colorado too. So we have a lot of opportunity for outdoor activity and outdoor recreation here. So awesome. So that's great. That's, I mean, I agree with mindset being a really a really good place to start. One other piece I wanted to ask you about was if a woman is in the program and or just, you know, working on all of this stuff. And she is not seeing the progress that you think she should be making and she thinks she should be making, even though she's following what you're doing. What, what are you looking at next? Like, what are your next thoughts? I mean, that's always where I like stepping back. Like, are we missing something? Like, this happens with posh motives, you know, if you're like, your antibodies aren't coming down, we don't see improvement. Like, what are we missing? Is there something else here going on like wool toxicity or heavy metals or like, why? I mean, now what else are we missing? And so I think we generally kind of evaluate all that stuff at the onset and get like a really good picture of some these health, but they don't always do all the testing, you know? So yeah, I mean, generally, it's, I would stay there. I think that other important piece is like, we got to look at the nutritional piece. Like, I find a lot of women, I mean, I was saying most of my women who are in menopause, who are struggling with weight, are restricting food a lot because they're like, I can't eat, like I used to eat. If I do, I'm going to be overweight and I'm not going to let that happen. So I don't eat that much. And so we, I have to go through that with them and really sort of restructure their relationship with food to some degree where it's like, okay, you actually have your metabolism needs to see that you're safe and you can eat food. I eat more food than I used to eat. And that's how you really like condition your metabolism to say, like, oh, I'm safe. Like, I got to keep going, bird the things off. Like, that doesn't mean eat potato chips and like, I don't know, actually, but I learned through this journey is like, I was eating a really high fat. And there's all healthy fat, but I was eating a lot of fat. And fat has calories. And by no means low fat, but I think for a lot of women, what I end up doing is sort of flipping. Like, okay, first prairie is protein. Like, eat a lot of protein. Most of my patients are not eating like heavily processed foods and drinking diet coke and things that would mess with their satiety and their signaling. But some of it too around food is like, sit down, really mindfully eat your food. chew your food. Don't try not to be on social media. Eat three meals a day. We have a lot of recommendations around nutrition and that sort of thing. But it really is something we usually do it front. But nonetheless, it's like really focus on protein with carbs. Think of carbs as fiber. So high fiber carbs. I eat rice and potatoes and fruit. I'm not like occasionally. I might have some gluten free pasta. I just don't have that much of it. Is this much gluten free pasta or this much potatoes? You know, it's like a really tiny amount or a really big amount of potatoes. So, you know, generally I think working around that can be helpful. And then sometimes it's like really looking at like what's the diet really look like? I think this is where I think there is a time and place for that one week of trekking. And like, let's figure out, I don't do this with everybody. It's certainly not with people who have disorder eating or, you know, teetering on that. But if I have somebody who's in a spot where she can do that in a healthy way, it's like, okay, let's track your food. Let's see what you're actually eating here. And then take another look at like, how do we need to adjust this? I mean, the reality is if you do want to lose weight, you should be to some degree of a calorie deficit. But you also, it's like this trick where you have to remind your body like, I've got enough food. I got a burn's food. I got a burnt seuel. Fuel your body, you know, focus on protein. And yeah, so trekking can I think teach us a lot actually? Yeah. Speaking of tracking, do you ever have people use like a CGM or for people who don't know? For sure. Yeah, totally. Okay. Yeah. That's like one of the first things we do. Yeah. I mean, generally I'll meet with a patient and then they'll meet with my nutritionist. She'll go through all that stuff. I just talked about, talk about sleep, stress, lifestyle stuff. And, and we'll get patients started with the CGM. So continuous glucometer. So they can really like focus on that. Yeah, totally. Because I feel like it's, it can also show if you're having an inflammatory response to healthy foods too, which was what of the things that I have found most interesting is like persons like, oh, I just ate, you know, broccoli or I ate sweet potatoes and my insulin spiked, I mean, with, you know, it's really, I just think it's so interesting. I find, I think that that is one of our, our most valuable tools. Like it's super, super interesting. So you are tracking that too as well. That's cool. Okay. Yeah. And it is interesting. That's sort of like, that was my first sort of like dive into this world was because I had gestational diabetes. And so I didn't, we didn't have continuous kilometer effect that, but I was very determined in my first pregnancy. There's no way you're going to put me on medication when I was pregnant. And I monitored my blood sugar four times a day for like nine months, maybe not nine months, but whenever I found out about the stagnosis and it was like surprising because I was, didn't have any of the traditional risk factors around that. But I learned a lot and wow, that a z-kiel bread I was eating was really spiking my blood sugar. And you know, later I'm like, Oh, I'm super gluten intolerant. Like I can't do gluten. It does not work with me. Yeah. And that's probably why, right? It's like, was causing a lot of inflammation. Did you know about your Hashimoto's that, but at that point or was your Hashimoto's diagnosis after that? No, I didn't have it then. I don't think. Yeah. I don't, I don't, I don't know that I had it back then. I think the Hashimoto's is probably triggered from mold. Maybe at least trigger postpartum because, you know, autoimmune stuff happens postpartum. And I mean, my oldest daughter's 13 years old. So, yeah, 13, 14 years ago, I just like thyroid was on my radar. You know, I was like checking TSH, but if I, I've gone back and looked and I can see my TSH was like maybe your own two and a half or three, like, which is too high when you're trying to conceive and have a baby. But there was, yeah, there was nothing like super obvious or over at that time. But, you know, as it goes, like, regular doctors don't usually check those antibodies. I have a family history of it. So, I was, honestly, I don't remember, was they asking me to check it back then? Or, probably not. Yeah. So, who, and your family, is it like a first degree relatives that have Hashimoto's? Oh, yeah. Yeah, my sister, because Hashimoto's and my other sister had graves, has graves disease. Yeah, it's really interesting. I find, I've got a couple of families that have the prevalence. It's like, it's, it's really interesting. The difference between people who have, like, the family history of Hashimoto's versus people who get it, you know, and don't really have the family history, the family history people I take with, when I get them into my practice, I handle very differently because they, that likelihood seems like it's so much greater, you know, with all of the root causes with those people end up manifesting it. If you don't catch it before and start doing all the things before, my husband's family is like that too. Like, everybody, he has it. His sister, all of his mom, like, they all ants, like, they all have it. It's, it's kind of crazy. It's really interesting. And then, like I said, I've got a couple of families. I've got one, one mama who has it, and she's got seven kiddos. And when I started working with them, the older ones were in their late teens and early 20s, and they have all the way down her youngest one now is, I want to say, 11 or 9. And the older ones had already been diagnosed, but like, we've been trying to prevent the diagnosis and the younger ones. So it's like, it's really interesting to look back at all of this. And like, it's, I love that, like, you, you've kind of watched yourself over time because I've done the same thing too. And every once in a while, I'll go back and like, look at my labs from like 15 years ago. And I'm like, oh my gosh, I'm like, I can see we're certain changes started happening. And then, now that you know what you know, you're like, oh, I would have done something differently completely differently, right? Awesome. So last question I wanted to ask you was, if you were honest on a desert island and stranded, and you only had three things you could bring with you, and this is not people, not be like, obviously, we'll say the given is our family with us, the like things, like, fake objects or things that would support your life. What would you have with you? Oh my gosh. Seriously, this is like such a hard question. I mean, my cell phone, like, so I could call somebody and get some food. Oh my gosh. What would I bring with me? Like, this is a hard question. I would bring, oh, well, actually, I have, I have a real answer to this question. So we had a huge fire in my neighborhood. So I lived just outside of Boulder. And this was like two years ago, or maybe two and a half years ago. And there was a huge fire, which was like crazy because I live in the suburbs. I'm not up against the foothills. I was in my office and saw this like crazy cloud. And I called my friend who's married to a firefighter. And I was like, do you know what's going on? Like, it looks like there's a fire. And she said, yeah, Billy said we should be evacuating. You should leave your house right now. And I was like, what are you talking about? And my kids were at home. My very awesome babysitter, like, saw some stuff and she brought them to my parents house out. Meary. So literally I brought my contacts. So 100% my contacts, my contact lenses, and my thyroid medication and my nut pods, because I really like coffee and I don't do dairy. And so I'm like, I'm good. I got nut pods in contacts. And my thyroid meds, like, we're good. And I went to my parents house. So I guess that's my answer. That's awesome. Now I love that. I know those kind of questions make you think, right? Because like occasionally I'll be interviewed on a podcast and they'll ask you something like that. And I'm like, huh, what would I do? That's kind of that's for me. I'm like, my, yeah, oh, me too. I have to wear my contacts or glasses. Yeah. My hormones, my hormones are coming with me. But I like the coffee. The nut pods. That's awesome. I mean, the nut pods is just ridiculous. I'm like, for real, I didn't actually think it was going to get that close to the homes. Like, I know, I know. That was, that was a, that was a crazy thing that happened. I don't know. You know, photos, I bring my photos, my kids photos. And they were little, but you know what? We've got the one our phone mostly now, right? I know. I mean, no, I told you my phone. I'm going to bring my phone in my contacts and my hormones. That's it. Nut pods are getting left behind. I know, right? I know. Exactly. Oh, awesome. I can live without coffee for a minute, but I don't like to. I know. Neither do I. Oh gosh. Well, let me ask you one more thing. So when you're working with women, do you make them get off of coffee because so many practitioners do and I don't anymore. I don't either. No, I do not. I am like, is there super anxious and are having a really hard time? I recommend that they eat before they drink coffee because just like alcohol, if you have alcohol on it and de-stem, it's going to make you drunk. Like, if you have coffee on it and just die of it, it's going to give you that caffeine buzz and might contribute to some anxiety. So there are some times when I'm like, hey, I might want to like cut back or switch to see, or something. But that is definitely not my rule by any means. I think, yeah, I think usually it's like eat more food and eat breakfast and stop fasting is what I'm usually telling women. Eat breakfast, stop fasting. You can have your coffee. I tell people that I can take away gluten. Like, you can ask me to be gluten free. I'm fine. Dairy fight, but do not take away my coffee. Come on. Yeah, save. Same totally. I love that. Oh, but thank you so much. I know it is. I just like it. I like the warmth. I like the ritual of it. The warmth. There's so many things I love about it. It's awesome. Well, thank you so, so much for sharing everything with the audience. And is there a place that if they're looking, you know, looking to work with you or want to know more about you where they can find you? Yeah, my website's a great place to start. It's start your Christine Marin dot com. So DR Christine and then Marin's like, Karen with an M and I am pretty active on Instagram. So you'll find me in my face and in whatever I'm doing there. But yeah, website's a good place to start. And then is there anything that you would like to share with the audience like a free gift or anything? Yeah, we have a free gift. So it's 12 ways to detox your home and really the goal being like better hormone health. We didn't talk about this much, but endocrine disrupting chemicals can definitely affect hormones can lead to really menopause for infertility issues, you know, cross-sport. And so I have a 12 month guide to sort of how to clean up your home all the products that I use at home progress or perfection. That's a big of that book is like, you know, one step at a time, progress or reproduction. You don't have to be perfect, but the things you do every day do matter. Awesome. Yeah, thank you so much. And again, just thank you so much for being out here. Awesome. If you made it this far, I truly appreciate you. Remember, knowledge is just the beginning, taking action is what truly sparks change. If you're overwhelmed and don't have enough energy to make it through the day, I invite you to book a free 20 minute coaching call with me. It's a no obligation chat where we can discuss your health goals and how I might be able to help you achieve them. Is it the link in the episode description to book that call? Until next time, keep striving for wellness and remember, you have the power to not just survive, but thrive in motherhood.