transcript

Speaker 1:
[00:02] Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week, and impact over a million lives. This is the start of a new Thursday series called The Midlife Minute that is really designed to address listeners' questions in a little bit longer length of time and or deeper dive into topics. Ideally, we're going to keep these podcasts under 20 minutes. Occasionally, we make over to 30, but I'm trying to reinforce some key concepts and ensure that I'm addressing listeners' questions in a way that's really helpful. So the questions that I will be addressing topics are going to be items that I'm being asked over and over and over again. I hope you enjoy this series. Please share with your friends. And as you know, you can always send your questions to support at cynthiathurlow.com. I appreciate each and every listener. Latest episode of the Midlife Minute, lots of questions around GLP-1. So we're going to unpack these. I have quite a few questions. I'm going to try to get through a compilation of them during the course of this short but sweet Midlife Minute. Question number one, I got this multiple times. Are GLP-1 medications fixing the root cause of midlife weight gain or just suppressing our appetite? Number one, we know that we start losing some degree of insulin sensitivity in perimenopause with alterations in estradiol, which is our predominant form of estrogen that our bodies make prior to menopause. And so depending on your degree of muscle mass, depending on your health habits, depending on your sleep, your stress management, gut health, et cetera, can really impact whether or not you're just becoming less insulin sensitive or if you are slip sliding into insulin resistance. This is why I think checking fasting insulins, looking at A1C, looking at uric acid, looking at triglycerides, HDL, really, really important to get a sense of what your insulin sensitivity is, plus or minus a glucometer or a CGM if that's appropriate for you. We know with the loss of estrogen, we also have an increase in visceral fat, which will also exacerbate underlying glucose dysregulation, hyperinsulinemia, which is a fancy way of saying your blood sugar gets dysregulated, your insulin levels go up in the setting of high glucose, and that can lead to worsening insulin resistance. We know that with alterations in hormones, we also get dysregulation in our appetite and satiety hormones. Ask any woman in perimenopause and menopause why they're standing in their pantry at the end of the day, when they've eaten several meals during the day, and a lot of that has to do with this loss of estrogen and how estrogen impacts appetite regulation. We know that that protein leverage hypothesis really becomes paramount if you're not getting enough protein into your diet, your body will look to make up for the lack of calories, namely in the fats and carbohydrates, generally in the process varieties. That's why you're standing in your pantry as opposed to sitting down and having chicken breasts and broccoli, right? Muscle mass preservation becomes critically important as we get older. Sarcopenic obesity is not at all in common. Even people being toffee, thin on the outside, fat on the inside. So really honing in on bioimpedance readings before we even start talking about GLP-1. So I think GLP-1s as a tool, they are like any other strategy. It's not a cure for a lot of women. And I've heard women say this, like, I'm never going off them. It's the first time I don't have food noise. I think that these are life changing drugs. But on the other hand, you have to be maintaining muscle mass or and or building it and you have to hit your protein macros. And I think depending on where people are having these drugs, they may or may not be having those conversations with licensed medical providers, which is why I think it's so important. They're not inherently good or bad. They're not a crutch. In fact, I get really frustrated and frankly, really upset when I hear anyone on social media pointing a finger and judging people. People need options and I think they're a great option for a lot of individuals. I've heard people telling me for the first time in their adult lives, they feel like they have control over food and that's huge. That's a win. So with all that being said, I think they need to be prescribed responsibly. I think patients need to take them responsibly. They should not be utilized just to make you thinner. I think that we're starting to see, in fact, I don't even want to name the actress that I saw in social media video recently, and she was so cacactic, which is a medical term used for someone who is frighteningly thin, like frighteningly thin. When you can see someone's clavicles and their scapula, they are very, very thin. I do not think this person is anorexic. I suspect they're just not eating and they're probably taking a GLP-1. In fact, a lot of people were commenting, and I just don't want to be part of that narrative. I just think it's very unhealthy. I think many women are judged for their weight at both extremes, and I don't want to be part of that narrative. So I think that you need to be thinking about GLP-1s as a tool. You need to think of them in the context of why you might need them and why you would benefit from them. You must lift weights. Maybe you start off doing bodyweight exercise. Really important that you're strength training. And that's why I'm a fan of bioimpedance ratings and getting those done every quarter. I'm doing them probably every three or four months. I'm maintaining my muscle mass, and so I feel very comfortable saying, as a middle-aged person, muscle mass is really, really important. I think many people think about the physicality piece, and I would be the first person to tell you that if you're not thinking about muscle mass as your fall prevention strategy, then you're missing the boat. Yes, when you have lean muscle on your body, you look better enclosed, you probably feel stronger, you probably have a different outlook on life. Versus very, very thin women that I see. And there's another actress, different actress, who was in a very form-fitted outfit, and a colleague of mine said, what do you think about this photo and this video of this person? And privately, I sent her a message and I said, she looks sarcopenic and frail. And that is sad. I think this actress is 60 years old. Sarcopenia, muscle loss with aging, is not a question of if but when, but what leads to muscle loss and bone loss is frailty leads to falls. And if nothing else, remember this, that leads to a loss of independence. I don't think there's anyone listening who wants to be dependent on anybody. I think all of us want to live as independently as we can for as long as possible. Okay, next question. What do GLP1 medications do to the gut microbiome? Such a great question. Okay, we know physiologically, so there's the first generation, that's a semi-glutide, a zempic. We know that they slow gastric emptying, so they help with satiety, right? They can alter gut motility. So food will not move as quickly through your digestive system. Obviously, some of this is dose dependent. If you're starting off on a teeny tiny dose, very different than a maximized dose. There is a risk for constipation, which is why I think fiber becomes important. Fiber is very bio-individual. I will probably get hate for saying this, but I think fiber is critically important, especially when we look at how the gut microbiome is changing with these alterations in progesterone and estrogen in particular. So the constipation risk goes up. So you have to make sure you're hydrated. You have to make sure you're moving your body, and you have to eat some fiber. Notice I'm saying some. I'm not saying you have to have a certain amount. We know based on research that the average American is consuming five to 10 grams a day. That coincides with the standard American diet. My listeners know more is going to be better. I think it is very bioindividual. I think for every person listening, it's finding what types of fiber work well for you. I talk very openly that for me, fresh ground flax and chia seeds together, they are like perfection. For me, I can tolerate a lot of vegetables, like cooked vegetables, salad I do fine with. There are certain things like inulin, which is a fiber. Do not do well with it. It bloats me horribly. It doesn't matter how small the serving size is or how large it is, I get the same effects. But that is what works for me. But I find for a lot of patients, adding in a tablespoon of fresh ground flax and fresh ground chia is a good way to boost a little bit of fiber and boost a little bit of protein and very well tolerated. In a lot of instances, you can throw it in a smoothie and forget about it. Okay. Also thinking about how some people, especially with this first generations, have a degree of nausea. Not as much of an issue with terzapotite, which is a little bit different. That's the second generation. And so nausea can be problematic. Sometimes it's dosage dependent. Sometimes it's people that are going too high up on doses too quickly. I think if nausea is a problem, you stay at the dose you're on or reduce it. Easy peasy. We're watching emerging research on the microbiome effects. I suspect that it will alter insulin sensitivity and glucose metabolism because we know in the setting of alterations in the microbiome contents, we can have better profiles for metabolic stability or we can have worsening profiles. I think it's going to help with insulin sensitivity. I think we're going to see better utilization of estradiol, especially if we're on hormone replacement therapy. Emerging research right now is suggesting that women that are concurrently taking HRT and a GLP-1 have much more favorable body composition. I'm not talking about we're getting on a stage and doing like a bodybuilding show, but these are people that tend to have healthier body composition, more lean mass, less fat-free mass. And the other thing is you have to think about this strategically when you slow digestion pharmacologically. So that means when we slow our digestion due to taking a medication, you have to support the microbiome intentionally. If you're in midlife and you've started to notice that your energy, your strength, or even your recovery just isn't what it used to be, I want to share something I've been thinking more and more about lately. For many women, we assume it's all about hormones, and hormones are absolutely part of the story. But there's another layer that often gets overlooked, and that's about cellular energy. As we get older, our mitochondria, the energy engines of ourselves become less efficient. They accumulate damage over time, and when that happens, it can show up as a very specific kind of fatigue. You're doing all the right things, you're eating well, you're strength training, you're prioritizing sleep, and yet, something still feels off. That's why I've been incorporating timelines might appear into my routine for the last five years. What I appreciate might appear is that it works at the level of the mitochondria, helping your body clear out damaged ones so your cells can function more efficiently. And clinically, this matters because mitochondrial health is tied directly to energy, muscle strength, and resilience. For me, this has been a foundational part of my routine as well as my husband's, not something extra because something that supports everything else I'm already doing. And for women in perimenopause and menopause, this is an important part of the conversation because supporting your energy at the cellular level can make a meaningful difference in how you feel day to day. And my friends at Mitopure are doing a big price cut. There's a one-time purchase is going from $125 per month to $99 with subscriptions. It will now start as low as $75 a month. The hope is that this will make timeline more accessible to folks in my community who've been on the fence or tried it and lapsed. You can go to timeline.com/cynthia to learn more. You can go to timeline.com/cynthia to learn more. That's going to be my new phrase. I think it's really important that you are getting lots of brightly pigmented fruits and vegetables into your diet. Those polyphenols have, which are the bright pigments, have a lot of signaling molecules. Green tea, black tea, just getting really strategic, adding in fermented foods. I don't care if you have a teaspoon of apple cider vinegar tossed in some water and you can consume that as like a digestive enzyme before you eat a meal. But hydration, making sure you're moving your body, strength training, protein, all really important. I think it's the responsible thing to do if you are also taking a GLP-1. And I know the experts I've interviewed on the podcast that prescribed GLP-1s talk about this very, very, very openly. Okay, who should and who should not consider GLP-1s in midlife? This is clinical decision making, right? I think there are now pill mills, we used to call them weight loss mills, where you have a provider in a box that does a quick assessment of whether or not you meet certain criteria for taking a GLP-1. I think that if we think about proper screening, so anyone that is not metabolically healthy, so if you are diabetic, have high blood pressure, have abnormal lipids, have heart disease, are obese or overweight, we know that that meets criteria in most instances for insurance coverage. So, women with metabolic syndrome, if you are someone that is struggling with weight loss resistance and you have PCOS, if you have a history of gestational diabetes, you should be having conversations to see if you are eligible. We know that people with gestational diabetes or had preeclampsia or eclampsia during pregnancies or even PCOS for that matter, are at greater risk for developing insulin resistance and having poor metabolic health. If you have significant visceral adiposity, which is a fancy way of saying, if you carry all of your belly fat like an apple, that is different than a pear-shaped person. So again, like that visceral fat around your major organs is concerning. And then, you know, the other side of that is people who are sarcopenic. And trust me, you don't have to be older to see this. I see this in 30 year olds, 40 year olds, 50 year olds, 60 year olds and older. This person who doesn't have a pancake butt. That's something that my mother used to comment on because she has a little bit of a flat rear end. People that have poor muscle tone. I think about who I would be hesitant. Someone that has a distorted relationship with food already. I think this could fuel it. Those with chronic GI issues, unless they are getting a sign off by their gastroenterologist. Yeah, people are using it predominantly for cosmetic weight loss. Now, I'm not talking about the autoimmune effects. I think a lot of women have shared with me transparently that it's put their autoimmune conditions in remission. And we know women are four to five times more likely to develop autoimmune conditions and perimenopause and menopause. So certainly a population that is at risk for this, really dropping inflammation in the body can be helpful. Those are the people that I think about. It's probably not a great idea, but this is where clinical decision making really comes in. So those are my thoughts about those questions. I have a couple more. I have questions on my computer and questions here. Many perimenopausal patients as well as menopausal patients are on Metformin or GLP-1 for weight management. What are simple, practical ways we can support microbiome health and these patients thinking quick and dirty tips that make life easier for women? This is easy. Number one, got to hydrate your body. At least half your body weight now is a day. If you're more active, you're sweating, you live in a hot part of the world or the country, you might need more. I would probably consider adding electrolytes. I'm a huge fan of electrolytes. Adding fiber with each meal. Remember, I've already talked about how I think fiber is really very bioindividual. The experts talk about 25 to 30 grams. I know people that tolerate 50 grams, 40 grams. I have others that barely tolerate 20 grams. A lot of it has to do with the health of the microbiome and how well your body tolerates a bolus of fiber. So you may start off with 5 to 10 grams in a meal and then buffer that based on your response. I mentioned earlier that my cheat is a tablespoon of fresh ground flax and chia seeds together. It's also great for people who struggle with constipation. You know, I think also about a little bit of aloe vera juice. It doesn't taste good, but can be very helpful. You know, especially if someone's struggling with slowed gut motility, which can be bloating and constipating and not fun. Adding in those polyphenol-rich foods, as I already mentioned, green and black tea, coffee, a quarter cup of berries. Adding spices to meals like turmeric or clove has also been helpful. And one to two tablespoons of extra virgin olive oil to a salad dressing. So anything that has a little bit of a bite. Like good quality extra virgin olive oil should not be bland. It should have a little bite on your tongue, which is why you generally pay more for high quality extra virgin olive oil. It's generally not the stuff you find generally, not the stuff you find in the grocery store. I also think it's important to get your body into a parasympathetic state. So four to five deep breaths before you take a meal. Dr. Jason Fung, who I interviewed earlier this year, talked about how oftentimes families say grace before a meal. That's a great time if you're taking a pause before eating to kind of get your brain in the right frame of mind. We know that digestion starts in the brain. It's not the mechanical action of chewing, although most adults and kids think that. It is really trying to prime your body so that when you're in the parasympathetic state, you can digest, break down, assimilate your food, absorb nutrients, detoxify. No, this is not the stuff in a box. We're talking about actually detoxification, really priming everything. The other thing I think is helpful just from a down and dirty perspective is walking after meals. Walking five or 10 minutes, we know can help with glucose disposal. We have these Glut4 transporters in our muscles that will help scavenge up glucose. Great thing to do after your largest meal of the day, really easy to do. You don't need anything special. In fact, most of these things that I'm mentioning are actually quite affordable, which leads me to a question that's tangentially connected to this, which was, is there an affordable extra virgin olive oil brand, one at high in polyphenols with that characteristic bite? So talk about serendipitous. There's a couple of brands. I like the Fresh Pressed Olive Oil Club, and I actually had the opportunity to meet the owners. They're absolutely lovely and they really do source from all over the world. But in terms of really affordable California olive oil, which is found in dark glass bottles, you want first press, single ingredient. I've been told that Trader Joe's Premium Extra Virgin Olive Oil as well as Costco. Again, dark glass bottles, not plastic, single ingredient. Those can be nice options for patients. You know, I think about just how challenging it can be in general when wellness influencers that are well-meaning, including myself, you know, I have a large platform and a podcast. I try to be sensitive to that. You buy the best quality that your budget permits. So don't get too caught up. I would say the California brand that I mentioned, California Olive Oil, I bought that brand before and my family likes it. It's, I would say in terms of polyphenol count, it's probably mid-range. Obviously, I've got fancy olive oils that have been gifted to me. I think it just depends. I mean, and I share that transparently just to say, you know, my husband who does the bulk of our cooking would not want to be spending $25 or $30 on olive oil every month. Like that would nest, that wouldn't make him very happy. He's a pretty frugal guy. So I think we have to make decisions based on our budget and what's going to keep us same. So really great conversation today about GLP-1s. Keep your questions coming. I am now pulling questions from my free group as well as questions that are submitted. And today was a compilation of GLP-1 type questions because I'm getting so many questions. And I think that what that tells me is that everyone is listening and kind of absorbing what we're talking about and trying to figure out like what is right for them. And that's why I love this community. So free Facebook group, Midlife Pause, backslash my name. You could submit questions for the podcast directly on our podcast page. We're trying to push away from my support at inbox because my poor admin is overwhelmed with emails. I was in there this afternoon trying to help her out. But that's a great place where you can just fill out a form. It'll send the questions directly to a spreadsheet and then we can organize them that way. Have a great rest of your day. If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.