Dr. Rocio Salas-Whalen
Appearances
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And when a patient hears this, I can almost physically see it how they feel relieved. I've had grown men in my office cry when they hear this for the first time because they've lived decades thinking that it was their failure.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So when we talk about genetics, we're talking about family history, right? If your parents struggle with weight, if your grandparents struggle with weight, then you are at higher risk of also struggling with weight. Again, we know the preconception weight of your parents impact. Even the food that they eat, consume highly palatable food that can be transmitted to you. What's palatable food mean?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
food, processed food, ultra processed food that will lead to wanting to consume more. Right. Then when we talk about also there's some mutations that may also cause obesity. Right. And then when we talk about hormonal, so through a person's life, there could be hormonal changes, shifts, imbalances that is going to promote waking.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
We can talk about hypothyroidism, right, which thyroid hormone controls your metabolism. Then we can talk about PCOS, polycystic ovarian syndrome, when there's hyperinsulinemia, insulin resistance, and this promotes visceral fat. Visceral fat promotes insulin resistance, insulinemia, and it goes into a vicious cycle.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
We also talk about perimenopause and menopause with the changes of fluctuations or the drop of estrogen. This promotes visceral fat. The subcutaneous fat that you had in your fertile years in your hips and your breasts goes intra-abdominally. This visceral fat promotes insulin resistance, and then you go into that vicious cycle again.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Also, because of the drop of estrogen, we see a decrease in lean muscle mass. Muscle mass is your burning calorie machine. If you lose it, then your metabolism slows down. Then we go into aging. Aging also, as we age, we tend to lose muscle mass. It's harder to build muscle. And also it promotes waking. And then we go into environmental factors.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
As we talk, the food industry, industrialization, plastic, pesticides, all of those things disrupt your endocrine system. We call them endocrine disrupting chemicals because they disrupt the function, the normal function of your hormones. They mimic your hormones. So they occupy the receptors where your hormones should go and do a function. And this can promote obesity and fertility.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So they're real things that are impacting people's life on the day-to-day basis.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Knowing this and understanding this, you move away of anxiety. putting the pressure on the patient, right? You move away of being a one participant in this equation. It goes more into a team, what you can do for the patient and educating the patient. It becomes a team. Let's talk about, as an example, diabetes, type 2 diabetes.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
We know it's a chronic multifactorial disease, but we have no trouble prescribing and treating medications for it, right? It's widely accepted from the patient side, from the physician side. Let's talk about hypertension. Same thing, right? We know that lifestyle can help it or make it worse. but that is not causing the disease.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Therefore, we feel comfortable treating it and the patients accepting treatment. And when we provide treatment for type two diabetes, hypertension, high cholesterol, we always talk about eating healthier and exercising, but it doesn't replace the treatment. So if we see obesity as a disease, we can act the same way.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Understand and support the patient and their lifestyle, but also provide a medical treatment.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
But also there's other things like medications that patients may take for certain particular disease that can promote waking, right? There's a lot of antidepressants that can promote waking, blood pressure medications that can promote waking, right? And many times there's no other option for the patient. And this can also lead to obesity.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
The first FDA-approved GLP-1 was in 2005.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes. The FDA name, it was by Eli Lilly. It was called Bayera. And this was twice a day subcutaneous injection. So it was a daily, twice a day injection that patients had to do. Okay. And the first indication was for type 2 diabetes because GLP-1 is a hormone.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Glucagon-like peptide. And it's a peptide or a hormone.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
No, peptide is... what we call a short chain of amino acids. A long chain of amino acid is a protein. So before protein, it's a peptide. Peptides can help to produce or inhibit the secretion of hormones. The most important finding of this drug, and I actually met the person, the doctor, the researcher who isolated this, the GLP-1 outside the human body. It was in a lizard.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
called the Gila monster. And the lizard, the venom of this lizard, caused pancreatitis on its victims. So Dr. Eng, John Eng, being an endocrinologist and researcher at the VA hospital in the Bronx, wondered what in the venom affected the pancreas. And he isolated GLP-1.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It causes pancreatitis, so the prey dies from pancreatitis.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So it stimulates to produce insulin. The problem in type 2 diabetes is insulin-resistant and hyperinsulinemia. So with time, with frequent stimulation of the pancreas, every time you eat, every time you eat anything that has glucose, your pancreas produces insulin. But with time, it overworks. Your body stops responding the same way to the insulin that you make.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So you become resistant to your own insulin. The pancreas in response tries to overcompensate and make more insulin overworked. but your body is resistant to it. So you have hyperinsulinemia and insulin resistance. So these are the two main pathologic factors that lead to somebody to develop type 2 diabetes.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And this is the beauty of medicine, right? One thing is made or developed for a particular disease or reason. We find out later that it has other benefits like GLP-1.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I've seen people's lives change. I've seen more acceptance to the medication. The drugs are becoming safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone 1, the iPhone 10, and now we have the iPhone 16. Same is happening with this class of drugs. Their versions are newer, safer, less side effects, and more effective.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Okay. So I feel like people are getting the message one or accepting the message that obesity is a disease. They feel like giving up. For many patients, I'm the last stop of the journey. And when I talk about a journey, I'm talking decades of journey. I'm talking about doing diets that I've never even heard about. I always learn about a new diet from my patients.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
being with nutritionists, being in fat camps that they call them. So I've seen patients struggle through their life and how this medication are changing their lives and giving them their life back, basically.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
First of all, the initial versions of this drug, they cause more side effects. And they were more cumbersome for somebody. People had to inject themselves twice a day, every day. So even for many patients with type 2 diabetes, it was hard to accept because patients with diabetes... They think and feel that once they're on insulin, they're failed, right? Or it's just more severe.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So having a medication that is injectable, it was hard to dissociate them with insulin. Got it. Or with failure.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So patients didn't like to inject themselves. And it was a twice a day injection and there were a lot of nausea. So it was harder to tolerate back then.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It stimulates your pancreas to make more insulin when your sugar goes above normal. But if somebody who doesn't have diabetes and their glucose is normal, it doesn't touch the pancreas. Interesting.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Again, as with any drug we see, we have off-label uses. And what's happening is when we started somebody with type 2 diabetes on these drugs, when they were coming back to their follow-ups, not only was their glucose improved because they're great anti-diabetic drugs, but they were losing weight.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And to have that as a diabetes treatment, a drug that lowers your sugar and also helps with weight loss, it was unseen because most medications for diabetes promote weight gain.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It is fantastic, especially for type 2 diabetes, that weight gain or obesity goes hand in hand with diabetes. And before, with the medications that we had, we had to choose. Either we help with the glucose or we help with the weight. And many times we wanted to bring the glucose and that's what we had available.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
They started back in 2000. So, I mean, even for 2005, for the FDA approval, they're starting in the 90s. right, with the first one. But in regards for weight loss, it started around 2005, 2006. Gotcha. And then the first one approved for weight loss was in 2012, named Saxenda, also a daily injection.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So we moved from the twice a day injection to the once a day injection, but it's still severe side effects where we're nausea or vomiting. And it was hard to get to higher doses where we see most of the weight loss because of the side effects. Then eventually in 2017, we have the poster child of these drugs, which is Osempek. That was when it was approved for type 2 diabetes.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
In 2021, Osempek became also approved for weight loss independent of diabetes and then renamed it as Wegovii. Wait, what, Gove and Ozempic are the same thing? It's the same drug, yeah. When a GLP-1 gets approved initially for type 2 diabetes and then eventually gets approved separate exclusively for weight loss, they're rebranded.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
They just changed the name, but it's the same drug, same pharmaceutical, same dosing.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Well, if you don't have diabetes... you don't want to take a medication that is for diabetes and also for insurance purposes, right? Got it. Insurance will approve one drug for type 2 diabetes and will approve one drug for obesity, but unlikely that it's going to approve one for both things.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
GLP-1, I like to explain to my patients, target the two reasons that humans eat. We eat for fuel, survival. And we eat also for reward, for a reward. And the fuel part or the survival part, what this medication does, it suppresses your appetite hormones and it increases your satiety hormones.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So if for somebody who's on this drug and you're going to start eating, you get fully satisfied with a third or half of what you normally would need to feel full. And then in between meals, it suppresses your hunger hormones. So for most patients, it looks like two small meals a day, feeling physically content. That's for the survival part.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Now, for the reward part, we have receptors for this hormone in our brain in the hedonistic eating and drinking area of our brain where we anticipate or associate our reward either with food or beverages like alcohol. And it blocks that reward response. So let's say if somebody's anticipating having a meal that they know is going to relieve or a certain reward.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Once you're on these medications, you see that meal and you don't get the same feedback. So their behavior change. You enjoy your food when you're hungry and eating. Once you're full and satisfied, it's out of your mind.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It doesn't touch your pancreas if your glucose is normal.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
First, I think we need to backtrack a little bit before we dive into that answer. Sure. We as a society tend to associate being thin as being healthy. So whenever we see somebody that you can think they're slim, they're thin, they don't need this medication, we're assuming that they're healthy. Yep. That they're metabolically healthy. Yep. Yep.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
But we don't know by just looking at somebody, right? When I do body compositions on my patients, and this should be done on every patient. And basically, I would say even patients that don't need weight loss medications, just to know what's your body composition. Because whenever we're talking about weight loss, we're really talking about fat loss, right? We're not talking about a bulk number.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
We're talking specifically, we want to reduce what can cause disease or increase your risk of disease, which is Fat, not muscle. So by doing a body composition, we can see what's the percentage of somebody, right? What's their visceral fat and what's the muscle mass?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So many patients that we may see slim or thin, they could be what we call a skinny fat or sarcopenic obesity, that they may have a very low muscle mass. and high body fat, there's still a risk of disease. They're still in a pro-inflammatory chronic state, right? There can still develop type 2 diabetes or even be a risk of developing cancer.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So just by looking at somebody, we cannot say what the body composition is and what they need or don't need to lose. Got it, right? So we first need to stop associating thinness with health, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Many times when I see patients that think they need to lose 10 pounds or 5 pounds, when we do a body composition, surprise, surprise, they actually have to lose 20 or 25 because they're under muscle, right? So to really say who needs this medication or not, we cannot assume by looking at somebody that they do or they do not.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So we have machines, right? So the gold standard for a body composition is an MRI, but we're not going to do MRI on every patient on every visit. The second is DEXA. And then the third, which is the more accessible, is body impedance, also known as InBody. There's different versions of it. So those are the ones that are more easy, accessible, and they offer no radiation to the patient.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And we do body compositions on initial visit and every visit when somebody starts on a weight loss journey.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
No. No. Most patients that come is because they need them and because they've done their work and it's just not working. It's just not happening.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So first, starting with a very thorough weight assessment. So I need to know at what age were they conscious about their weight, at what age were they trying or being consciously about the eat or they were told they need to lose weight. For many patients, they tell me nine, ten. Also, I need to know their medical history.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Are there comorbidities that can contribute to obesity or medications that they're taking that can contribute to obesity? Then I go into a deep family history. I need to know up to two generations before. What was your parents', your grandparents' weight, your uncles' weight? If they have children, how is your children's weight? I need to see if there's a familial factor contributing to obesity.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And then I look at their gynecological history, right? Are they in perimenopause, menopause? Do they have PCOS? And then we move to the physical exam. And in that, also, we do the body composition. And there, we can really target what is it that needs to be improved or doesn't.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So what we consider obesity and percentage body fat is 32 and above. Normal in women is 18 to 28 percent, in men is 10 to 20 percent. So anything above those numbers, we either fall in the overweight range or in the obesity range.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Definitely. What we see in perimenopause and menopause with the drop of estrogen is that your body composition changes. You tend to store more body fat, central visceral body fat, and then you drop more your muscle mass. There's less lean muscle mass.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Also, in this stage of life, when somebody, let's say, that didn't struggle with weight in their 20s or in their 30s, anything that they were doing to maintain a weight once they enter midlife, perimenopause and menopause, is not going to help because of that hormonal fluctuation or drop of estrogen.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So in this time of a woman's life, and we hear it all the time, everything that I'm doing is not working. I used to do it before and the weight used to come off, but now I even have to work harder and it's still not happening. Yes, because of aging and the changes in estrogen or the drop of estrogen. So here, GLP-1s have a huge place for...
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
for patients that need or that have gained weight doing perimenopause and that it's just going to become even harder to lose it and easier to gain weight.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
The only absolute contraindication that we have for this medication is a personal or first-degree family history of medullary thyroid carcinoma, which is a very rare and aggressive type of cancer. Now, if somebody has other versions of thyroid cancer, papillary, follicular, that's not a contraindication. Exclusively medullary thyroid carcinoma.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Above that, patients that are pregnant and breastfeeding is not recommended.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Or how does this work? So we have to remember what is obesity, right? What causes a patient to require this medication? It's a chronic disease. multifactorial disease, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So if we assume that we can use this medication to take them to a goal and then we stop it, we didn't fix, we didn't cure the other things, the familial history, the genetics, the hormonal changes, the aging, the environmental factors, those factors are still there. Chronic diseases, we don't cure, we control. So that's why these medications were designed to be used long term.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Now, that can change. If somebody has history of obesity since childhood in their midlife or later decades of their life, then most likely they will require this medication long term.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
But if it's somebody, as an example, who gained weight after pregnancy and hit midlife and they gained 30 pounds, but they never struggled with their weight, then maybe those patients will not need to use them long term. Huh. That's interesting. But you have this patient that had children late in life, and then they hit midlife.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Then, yes, they didn't struggle with weight in the past, but now their surrounding is not going to be helpful for them to maintain the weight loss. So they may benefit from long-term use.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes, I have a very personal family member myself. I used this medication after I had my kids. I didn't struggle with weight growing up. I always used to lift weights since my early 20s. I fell in love with weightlifting, but I had my children late in life. I had my first one at 38 and my second at 39. After that, I hit my 40s. I started with perimenopause.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So what I was doing before, it didn't help me. I ended up with 30 pounds that I couldn't lose. I used the medication. I used for six months. I got back to my weight, and I have not needed it since then. I take back exercising and all of that, and I've been able to maintain my weight with that. It was just a combination of late pregnancy hitting midlife at the same time.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Mm-hmm. To not worry about your weight or punish yourself for not getting back on track so soon. I always tell women, give yourself one or two years before you start doing that because just having a child at that age is hard enough. After that, I think when us doctors go through certain situations, it does makes us a better doctor or more empathetic doctors, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Because it's very hard to identify with something that you don't know necessarily. It made me more understandable. I was better to relate possible side effects and what to do about it and definitely to be more empathetic. Beautiful. How long ago was that? I was 42, so seven years ago, I'm 49.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I know what causes waking. I knew in what place I was in my life. And I knew that I didn't want to exhaust every other possible situation that at the end was not going to help me. I'm a very proactive person personally and professionally. So I really wanted to be very proactive at that time.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So as with any diet or anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always a risk of muscle loss, right? Because it's hard to just exclusively lose body fat without lowering muscle mass.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So one of the risks of using this medication is muscle loss. And there's no direct effect of the drug towards the muscle mass. It's an indirect effect of you eating less that you may lose muscle.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes. Got it. But it's not a dead sentence. So by informing the patient and teaching them about what is it that they need to consume while they are on this treatment can prevent muscle loss and even gain muscle for those that need to gain muscle.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Before we go into that, I just want to explain why we're talking about muscle. Why is so important muscle? It's not because we want to see all people bulked up and Arnold Schwarzenegger-like, right? Muscle is your biggest metabolic organ.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It's your calorie-burning machine.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Muscle.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Muscles burn calories and muscle regulate your glucose. Because every time a muscle contracts, it's physically being used, it sucks sugar from the bloodstream to provide its energy.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
For your glucose? Yes.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yeah, whenever we hear, oh, if you lose weight, your metabolism slows down. One of the reasons is because you lost muscle along the way and that's slowing your metabolism. You're burning less calories. And I see that all the time with body compositions. When patients lose muscle... They don't lose significant amount of fat. It's harder for them to lose fat.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
When patients maintain muscle or gain muscle while on these medications, the body fat drops rapidly and significantly. So really your muscle is going to determine how you lose the body fat. And that's why we need to have that conversation of muscle on day one.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
On your first appointment, your doctor needs to discuss with you what exercise you should be doing, which is strength training, hitting the weights, and increasing your protein in your diet. Because you can lift as heavy as anybody and you will still lose muscle if the protein is not there.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
One gram of protein per pound for ideal body weight. That's what they should aim. So I would say the sweet spot that I've seen for most patients is between 90 to 100 grams of protein a day, which without a weight loss medication, without a medication that is suppressing your appetite, it's hard enough to eat that amount of protein.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I mean, it's very hard to, it becomes mission impossible when you're giving somebody a medication to suppress their appetite. Oh, that's true. But then you want them to eat 100 and more grams of protein, right? So we have to find a medium point to patients to not lose muscle, and that's around 100 grams of protein a day in their diet.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Twice a week, we can do this. One day upper body, one day lower body. I love a formula that I actually feel like I could actually achieve. But I would say for many patients at the beginning, my main, main baby steps, right? Baby steps. If I want them to do one thing is to increase their protein in their diet, because at least with increasing the protein in their diet, they won't lose muscle.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Then we can, once the patient starts losing weight, feels a little bit more stimulated or more encouraged or physically able, then we can start incorporating exercise.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Well, it's not the GLP-1 is the drop of rapid weight loss or significant weight loss. And why is this? Because of not eating enough protein. So if you're losing muscle because you don't have enough protein in your diet while on this medication, you're not only going to lose muscle, you're going to lose hair.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
You're going to lose elasticity in your skin because we need protein to make collagen, elastin, right? Also, you need muscle to fill the gaps of the fat loss, right? The goal here is not skinny. It's strong. It's fit. So you need to fill those pockets with muscle. Now, if you're not losing muscle by increasing your protein intake, then you're going to make enough collagen.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
You're losing weight slowly, so you're allowing your skin to adapt to the changes. But if you lose weight rapidly, it means that you're also losing muscle. It means that you don't have enough protein in your diet, so you're not making collagen and elastin.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So I'm going to, there's a phrase that I use a lot and I'm going to repeat it until I don't have to, but the efficacy and the safety of this medication is going to depend on the expertise on who is prescribing it to you.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes. It means that it's a medication. It's a medical treatment. And you need medical supervision to decrease side effects and to achieve weight loss to have the most results from this medication, right? I've never had to stop the medication for any of those symptoms that you mentioned. It's very important to take the time to explain to the patient.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
To have this conversation, to talk about weight with a patient, you need time. It's very hard to have such a vulnerable conversation with somebody in 15 minutes, let alone then explain to them about medications and how they work. Okay. You need to build trust, right? And you can only achieve that if you take your time to talk to a patient.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And that's one of the reasons that I decided to do private practices because I knew I could offer more patients if I had the time. To decrease the possibility of side effects, you really need to make your research, do your research, do your due diligence before you go to somebody to get this medication done. And they should be a medical doctor.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Ideally, they should be a medical doctor, but it could be a nurse practitioner, it could be a PA that they're specialized in obesity.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes. So every patient should come into a visit every eight to 10 weeks. when they are taking these medications, right? Because to see if it's working, what's not working, how is your muscle mass? Are you losing mass? Do we need to slow down the medication? Do we need to decrease for the greater good of muscle?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So every patient is individual and we try to adjust their lifestyle, but we need to see those frequent visits to see where the patient is, right? Are they tolerating it? Can we go up? Do we need to go up or do we need to come down on the dose?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
That obesity, that weight gain is complex. It's not as straight line as we used to think. And that most importantly, that weight loss is should not be a full-time job. Weight loss should not consume your life mentally or physically.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So the first thing to look is that we, as medical doctors, we don't sell FDA-approved medications in our offices. We send a prescription to your local pharmacy. It could be a commercial pharmacy, but we don't sell it in our office. If you encounter somebody who does, they're not, they're selling you the compounded version, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Also, many of those med spas or mail order or telemedicine platforms, what they're offering you is the compounded version of the drug.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
The FDA-approved medications are evidence-based. They're from the clinical trials. They're heavily, heavily regulated. For a drug to be FDA-approved, they sometimes have to show 10 years of research, right? Efficacy and safety to get FDA approval. Compounded medications are not regulated. They're not FDA-approved.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So many times what you're getting, it may not be exactly what they're promising, right? Many times they put fillers on the medications. So safety should always be above anything. Granted, these medications, the FDA versions are expensive, right? But I always tell people safety should not be jeopardized by cost. And second, because there's always the risk of self-administrating more medication.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Oh. The current FDA versions, they're pre-dose medications. So there's no way that a patient can inject themselves more or less. With the compounded medications and what we've seen and there's studies showing that most of the hospital visits for severe side effects of GLP-1s are from compounded medications from overdosing.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So you leave it to the patient many times to figure out the dosing or to run the risk of underdose or overdose, right? And this can lead to severe side effects.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So we have to understand how a medication or how the doses are recommended, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Medications go through clinical trials, clinical studies, where many doses are tried. Then we reach a therapeutic dose, which is a dose that exerts an effect. That's what we call therapeutic doses. That's what, when medication is approved, they come with therapeutic doses.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It exists. It is possible and reachable.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
If we think about microdosing or using less amount of the actual therapeutic dose, well, we're not going to get the effects that the drug was designed for, right? Number one. Second, if you do need this medication and you have obesity, then you need the therapeutic doses, not the soup therapeutic doses. Now, the other thinking is, well, I don't need to lose weight.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I just want the positive effects of the medication. Well, if you don't need to lose weight, then if you are already in a healthy metabolic weight, then you don't need the, you're already getting the benefits, right? You're already, just by being fit, you have that. You don't need another medication.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And third, the problem with microdosing is that it's based on compounded medication. Oh. Currently, the FDA approved drug, they come pre-dose. So there's no an easy way to give yourself a lower dose. It's a single-use pen for most of them, pre-dose, so you cannot really play around with the dosing.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Now, when Eli Lilly came with the bile of the lowest dose, that may potentially have a use for patients that reach a healthy weight goal that don't require higher doses, that can maintain a weight with a small dose, then we can do a lower dose. But currently, we only have terceptide in a bile, right? Got it. Another reason of the microdosing was to avoid the side effects that people were having.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
What are the big side effects? The problem with those side effects... were that they were initially created by people using compounded medication and that didn't have expertise on that. So their thinking was, well, maybe if you use less, you'll have less of the side effects. But that's not a problem of the actual drug of itself, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It's an actual problem of who was prescribing it and also using compounded medication.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
If you're using the FDA-approved drug the right way by somebody who knows how these medications work, you won't have those side effects that will make you use a microdose. Wow.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
They're not heavily regulated. We don't know exactly what you're getting in the medication. There's the risk of overdosing yourself. There's higher risk of side effects, one, from not knowing what it is in the medication and not doing the right dose. And third, there's no evidence-based research that says that microdosing is effective.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
That they're easy way out, that is cheating, that you can sit back and not worry about how you eat and if your exercise or not.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
patients are more involved in exercising. They're eating better. They're increasing their protein intake. They're working out. Because when you explain to a patient the possibility of muscle loss, and when they see it physically, when they come and do their body compositions and they think, oh, I lost three pounds. Great.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And then they go into the body composition and they saw that half of it was muscle. They get it. They understand.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And they become part of the treatment. They start working out. They start lifting weights. They start eating better. And then halfway the journey, which for me is what drives me of what I do every day, is there's a switch. There's a switch from when the patient comes thinking of something externally, physically, and then halfway it becomes something internally. They like how they feel strong.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
They start to worry more about muscle in every visit than weight loss. How did I do on my muscle? Did I gain muscle? Once a patient feels strong, understands on how to eat, there's no turning back. When a patient comes to me, they struggle through decades. exercise program, personal trainers. Some have personal chefs. They're doing what we're recommending. They've been doing it.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
They've been listening to us. Also, when somebody says, oh, if they wanted to lose weight, if they really wanted, they would have done it. They want it. They know. But unfortunately, it was not their sole responsibility. I have yet to meet the couch potato that is just eating, sitting, and not doing anything. And that's why they gain weight.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And I learned this through my patients and not in my medical training. I learned through my patients how they... I've seen how they struggle through decades for many. I have patients all ranges of age. I have from teenagers to 70, 80-year-old patients, how they've struggled through since childhood for many of them, and it consumes their life. And every plate in front of them
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It's, I think there's no, anything I say is not going to be comparable to what a patient experiences. You have to understand patients with obesity, they think about their weight 24 seven, how everything that they do or put in their mouth is going to impact their weight or feel guilty about it later. When you remove that from a person, it changes their life. They feel liberated.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
The possibilities are endless. That's incredible.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It's liberating. Some patients tell me, oh, so this is how it's supposed to be. This is what is normal. And then it opens your eyes, right? It's like removing a blindfold when you're on these medications and you go out with somebody who's not on this medication and you think about like, whoa, We were overeating. You don't really need to eat that much to feel physically satisfied, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And then it has a rippling effect too, right? I mean, you can discuss this with family members or family members see the effect, see the positive effect, and then it's just... They want it too.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And people say, well, some people with exercise and diet, they lose weight. The key is how much, how restrictive does it have to become to reach that goal? And can it be sustainable long term?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
could be causing guilt, anxiety, shame. And this is 24-7, seven days a week, 365 days in a year.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
It's a difficult conversation to have, even for us doctors, that that may be the sole reason a patient is coming to see us. Some patients are not ready to have that conversation. It could be the same with a family member, with a friend. I would say if it comes from a place of love, in authentic care, people perceive that, people feel that and don't feel attacked.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I think the most important thing that we have to remember with patients with obesity is that they've learned to feel blame and to feel attacked. So you have to be very, have a lot of tact on how you're going to bring the subjects with that feeling or putting more blame into the situation.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Both pharmaceuticals that produce these medications, they have manufacturing coupons. Okay. Meaning that if your insurance, if your commercial insurance didn't approve it, you can use a coupon that cuts the cost about 50 to 60%. So they become a bit more accessible. Now, one of the current pharmaceuticals just came out with a vial of the medication.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Currently, we have injections that are pre-filled pens. And this drives the cost very high. But now the medication is coming in a vial, like an insulin vial, but it's not insulin. And it had cost the price significantly more. So that's another option.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And then also going to a specialist, right, that is going to do and take the proper measurements to make the diagnosis and to be able to justify the need of the use of the medication.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
To share what impacted you the most about this conversation, right? I think our duty and our responsibility is to share the information.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I would add to what you say that one, it's not your fault. And two, it's okay to receive help. It's okay to ask for help. That doesn't make you a failure. Doesn't mean that you're cheating. It means that you understand and that you are human and that for the first time, we actually have help beyond exercise work and eat less.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I am originally from Mexico, and that's where I studied medicine. I graduated from medical school. And once I graduated from medical school, I decided to venture to the United States by myself. wanting to become a doctor in New York City. And then after nine years of training, residency, fellowship, I completed my specialty in endocrinology and then the following year in obesity medicine.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And originally, endocrinology takes over what's metabolism and obesity. But we've learned that obesity is complex and it requires its own specialty just to be solely dedicated for obesity. And endocrinology is the management of hormones. And yes, hormones impact weight, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
I want to say that I'm sorry on behalf of the healthcare providers. We didn't know better and we failed you and I've been humbled by my patients. I've learned and hear their stories and we got it wrong. We got it all wrong, but there is help. We're learning more. Science advances like everything, right? Medicine is an evolving science and we are aware and we will do everything we can to fix it.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
obesity increases your risk of mortality. There's more than 15 cancers that obesity is their biggest risk, including breast cancer. You have more risk of developing breast cancer than alcohol, hormone replacement therapy, or genetics. It's obesity. Obesity is the number one cause of pancreatic cancer, colon cancer, prostate cancer, thyroid cancer. The number one cause?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
The highest risk for developing, yes.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So... By reducing obesity, by treating obesity, we are going to have less chronic diseases. We've built specialists. We created medical specialties from the complications of obesity. So we will have less diabetes, less hypertension, less cardiovascular disease. If we treat obesity now, we will have less incidence of the cancers that I mentioned.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And this is a very interesting thing because you as a non-medical professional have felt like that, judging and assuming we as a healthcare providers, as doctors, we did the same, right? When patients were coming to us for help and to play devil's advocate, we didn't have the training. We didn't have the knowledge that obesity is not a self-inflicted disease, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So what we've learned is that obesity is a multifactorial chronic disease. And I'll deconstruct that. Multifactorial, meaning that there's more than one cause leading to somebody to struggle with weight or have obesity. I like to break them into five pieces. One, lifestyle, exercise, sedentarism, diet. but that's one piece of the five. The other one is genetics, right?
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
You can have a genetic mutation, but also it can run in the family. So it's two different, right? Then the third one, hormonal changes. We have PCOS, perimenopause, menopause in women. Then we have aging. That's unchangeable. Nothing that we can do about it yet. But as we age, our metabolism slows down. We lose muscle mass. We tend to store more body fat. And then we have environmental factors.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
And those are on its own. We can deconstruct that too, because in environmental factors, we can talk about the food industry. Right. We can talk about obesogenic environments. So meaning places where the walking is not available or accessible or easy, where people have to drive everywhere or even working from home now. Right. So there's less opportunities to being active.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
That leads to more sedentarism. So we call that obesogenic factors, things that promote obesity in how we live. Also, we can talk about endocrine disrupting chemicals. Like BPA, what's found in plastics, pesticides, right? We live in an industrialized world that really promotes obesity.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
So if you think of all those five factors and you think of what the patient has control, pretty much only on one, right? What we're talking about lifestyle, exercise and eating healthy. And before or when we do that, we tried or we put a lot of pressure on the patient to overcome all the other factors that are not in their control. Let's talk about genetics.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
We know now there's research showing that the parent's preconception weight can impact the weight of their child.
The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Yes.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Also, ich möchte anfangen mit dem Verständnis von allem und dem, was wir gerade wissen. Aber du hast ein Buch geschrieben. Was hat dich dazu gebracht, ein Buch zu schreiben?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
You know, there's a lot of criticism about them being vanity drugs. And obviously there's people that might not need them that are taking them and say like, this is the fast and easy way to do it. What do you say to that? And are there other side effects to be aware of?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Let's go back to GLP-1s and hormone therapy. Is that something that we're seeing more and more of now with women who are coming in with perimenopause or menopause symptoms of taking both those things? Is there something good about doing that together?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Sie können GLP-1s verwenden, wenn ihre Hormone nicht gut sind.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Is there a philosophy of whether hormones should come first? Do you regulate your hormones or GLP-1s or does it matter which way you do it? Do you do them all together? I don't know.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Okay, yeah, I was wondering about that because I guess it's really the symptoms of which symptom is really going to be the… The more pressing symptoms. Yeah, the more pressing one, right? If it's brain fog, it might not be that the GLP-1 comes first. Wir sprechen immer über Belly Fat in der Zwischenzeit und wir haben es vorhin mit dir besprochen.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Kann es ohne GLP-1s oder Hormontherapie verloren werden?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Findest du es schwierig, Patienten zu erzählen, dass sie nicht schwach sind, weil sie es nicht tun konnten ohne GLP-1 oder Hormontherapie? Ich fühle mich, dass es einen echten Bias dazu gibt. Oh, du hast nicht genug hart gearbeitet oder du hast nicht gegessen. Deine Diät ist nicht perfekt und vielleicht ist das der Grund.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Fühlst du, dass du die Patienten fast überzeugen musst, dass es nicht du bist? Ich höre mich das oft sagen.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
I'm sure it does. I'm sure you've seen all sorts of emotions all different ways and people coming in there with a different type of confidence afterwards if there's weight loss and then that. oder ich bin mir sicher, es ist nur ein Zyklus mit all dem, oder?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Ich denke, das ergibt viel Sinn. Ich denke, es ergibt viel Sinn. Und vielleicht schlafen sie besser jetzt. Können Sie aus GLP-1 kommen, ohne all das Gewicht zurückzuhalten?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
So they can really understand it. I mean, it really is almost what we're doing with hormone therapy as well, right? It's like trying to understand it and trying to give people the knowledge about this.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
A hundred percent. But you're right about that. I never thought about all those things. Es ist eine andere Person in vielen Fällen, abhängig davon, wie groß der Gewicht ist. Wir sprechen nicht von fünf oder zehn Kilo.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Gibt es andere Auswirkungen? Ist Haarverlust eine Auswirkung? Gibt es andere Auswirkungen, die die Leute wissen sollten?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
So how much are you usually losing depending on, what is it, by the weeks or the months or what do you go by?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Okay, more than a pound.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
What do you think the future looks like for GLP-1s? I know when the book comes out, people are going to really be educated on it, be able to take that book into a doctor and say, here's what I know, which is my hope for you, because it sounds like that's where that's going.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Wow, I didn't know that.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
You have to be seeing such change come in and out of your office now, really on all different levels. Where can people find you?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
You're going to get to them somehow. Exactly. Thank you so much for the time. I really, really appreciate it. Thank you. I hope this episode cleared some things up for you or made you think differently. You can pre-order Dr. Salas Whalen's new book. It is out soon and it goes even deeper into everything we talked about today.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
If you haven't already, make sure and follow the show on socials at The Tamsen Show and please leave a review. We are figuring this out together, one conversation at a time. And I'm so glad you're here for it. I'll see you next week. The Tamsin Show is an original production by Authentic Wave. Executive Producers Scott Weinberger, Kevin Bennett and Rebecca Grierson. Brand Director Johanna Ofsnick.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Our line producer is Sabrina Saray. Editing by Zach Smith and Marquis Harris. Musik Musik Musik Musik Musik
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Es ist so, so wichtig. Okay, also um Patienten zu beruhigen und was sie aus dem Buch bekommen werden, worüber ich sehr begeistert bin, weil ich denke, dass es eine Menge Verwirrung gibt. Was ist ein GLP-1?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
If you listen to our episode with Dr. Rocio Salas-Whalen on belly fat in midlife, you'll know why part two of this conversation is going to be a game changer.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
So I didn't even realize, I don't think, I didn't understand that. So we're seeing them everywhere right now. There's all different types, right? All different measurements of them, all different ways to take them. I guess maybe not different ways. Well, I guess so. I guess there's drops and there's shots and there's all sorts of things.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Okay, also was tun sie eigentlich im Körper?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
GLP-1s, Ozemphic, Rogovi, Manjaro. We're talking about weight loss meds that have been marketed as miracle solutions, but then also criticized as vanity drugs. But what's actually the truth?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Also was ist der Punkt? Genau.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
And you learn to do it without feeling like I'm deprived or I want to sneak in there and go get something again.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Ist es nur für Gewichtsschmerzen oder ist es mehr dazu, was wir jetzt lernen?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Feel better just about their body?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Unglaublich. Ich weiß, dass es Fragen zu diesem Thema gibt. Ich weiß, dass es viel über dieses Thema diskutiert wurde. Können wir zurückgehen zu dem, was die GLP-1s für Jahre und Jahre verwendet wurden? 20 Jahre oder mehr? Das ist eine tolle Geschichte, die ich liebe zu erzählen.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Dr. Salas Whalen is a triple board certified endocrinologist, an expert in obesity medicine and the person I went to when I was struggling.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
That is fascinating. Your eyes lit up when you were telling the story.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
In this part of the conversation, we're going to get into the reality of what these medicines can do and what they can't do for women in midlife.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Und was war das 2010 für?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Unabhängig von Diabetes und was war das Produkt?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
What percentage of the country would you say are on GLP-1s now? Oh my goodness. I think it's not enough. Okay, ich wusste es einfach nicht. Ich wusste nicht, wie viele es sind. Ich war nicht sicher. Ich sehe immer mehr und mehr Veranstaltungen. Aber ich weiß, dass es in verschiedenen Formen kommt. Es gibt auch Mikrodosen. Ist das richtig? Was ist Mikrodosen?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Ich bin gespannt, dass wir Sie in dieser Konversation wiedersehen. Ich weiß, dass es eine in-depthere Konversation über GLP-1s wird. Wir haben über sie gesprochen, als Sie hier für Teil 1 waren. Und dann haben wir aufgehört und gesagt, warte mal, wir haben viel zu erforschen für GLP-1s. Sie sind also eine leitende Stimme für GLP-1s und Obstmedizin.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Okay, because I feel like some of these words are thrown around and they can be confusing.
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Wenn du nicht fühlst, dass du die Art von Person bist, die sich injizieren möchte, du hast Angst, das zu tun, gibt es andere Wege, GLP-1 zu nehmen?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Oh wow, also was sind die Auswirkungen?
The Tamsen Show
GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters
Is there a right and wrong way to take them? Like, is there a right foods to eat if you're taking GLP-1s? I mean, if we're, you know, I mean, obviously regular, you know, if you're eating something greasy or eating something fat, is that a problem? Yeah. And do you have to, I don't know, do you have to have different habits? Ja, definitiv.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
That's why we call it the bad fat.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Viszeralfett. Viszeralfett ist ein proinflammatorisches Tissue. In diesem Fett-Tissue, in dem Adipose-Tissue, gibt es Zytokine, die inflammatorische Zellen sind. Sie fördern die Inflammation in deinem Körper. Dies ist das Fett, das verschiedene Arten von Krankheiten fördern kann. Wegen der konstanten Inflammation der viszeralen Fette.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Wenn es sich um deine Organe befindet, kann es in deinem Blut, deinem fettigen Blut, in deinem Blut, in deinem Pancreas, Insulinversorgung verursachen. Das ist also das Fett, das wir targetieren wollen, wenn wir über Gewichtsschmerzen sprechen. Wir targetieren wirklich viszerales Fett.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Das ist der Grund, warum jemand, sagen wir, mit diesem Übergewicht, und sie haben hohe Subcutaneous- und hohe viszerales Fett, wenn sie mit Plastikschirurgie gehen, und sie haben Liposuktion, wird das viszerales Fett nicht anstecken. Also sind sie immer noch vor Krankheiten.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Exactly, the cosmetic external part, but the metabolic part is not touch.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Yeah, so two easy changes that don't require any medication and we want to talk about that first. It's going to be strength training, building muscle. The more muscle you have, the more fat you burn for energy. Irgendwo in deinem Körper, ob du deine Arme, deine Beine machst, irgendwo. Du musst Muskel- und Krafttraining bauen. Das ist das eine. Und das Zweite ist deine Diät.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Also erhöhte Proteine in deiner Diät sind ein Muss. Und das ist für jedes Alter, aber besonders in der Zwischenzeit, wo wir mehr Muskelmasse verlieren, müssen wir unsere Proteinintake in der Zwischenzeit erhöhen. Ich spreche auch von lehnen Tierproteinen oder Wehrproteinen. Warum diese beiden? Weil sie komplette Proteine sind, das heißt, sie haben alle Aminoasen für Muskelproteinsynthese.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Die aktuellen US-Grundlagen erzählen uns über 1 Gramm pro Kilo pro Tag. Aber das ist wirklich niedrig. Was wir als Endokrinologen wirklich sagen wollen, ist, dass es 1 Gramm Protein pro Kilo für euren idealen Körpergewicht ist. And to know your ideal body weight, we really need to do a body composition.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
But what I've seen through thousands of patients that I do body composition, the sweet spot is anywhere around 90 to 100 grams of protein for a woman in midlife. Und das ist schwierig, 100 Gramm Protein pro Tag zu bekommen. Du musst es einfach durch den Tag strukturieren. Unser Körper verwendet nur ca. 30 Gramm pro Mahlzeit für Muskelproteinsynthese.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Es ist nicht so, dass wir nicht die extra Menge an Protein absorbieren. Es ist nicht so, dass wir es verbrauchen. Das extra Protein geht für andere Funktionen in unserem Körper, um Collagen zu machen, um Elastin zu machen. But to actually for muscle protein synthesis, our body only utilizes about 30 grams per meal.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So then you have to space between three or four portions a day of 25 to 30 grams of protein a day.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Because when I, growing up and during my training of medicine, my early years in medical school and in my internship, I saw how women's symptoms were gaslighted, number one. But second, it was that we were just misunderstood. I remember my male attendings saying, Oh, sie muss nur ein Hobby bekommen. Oh, du wirst einen davon bekommen. Oh, sie muss nur spät werden.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
That's the problem. That's the message here is that don't count 50 for your muscle. Count 30 grams for your muscle. Because then we overestimate how much protein we're eating because we're eating large amounts in one meal. But it's not going for our muscle.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, ich weiß, wir können Bücher darüber schreiben. Ich habe alles gemacht, ich kann 100 Bücher darüber machen. Fasten, das empfehle ich nicht, weil es schwer ist, so viel Protein in einem zwölf- oder sechzehntstündigen Zeitraum zu essen, und zwar in einem acht-Stunden-Zeitraum.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Also, wir verlieren den vitalen Zeitraum des Tages durch Fasten, um genug Protein in einem Tag zu bekommen, weil Protein auch sehr füllig ist. Darum musst du es auch auswählen, damit du mehr Protein in deiner nächsten Mahlzeit hast. Aber wenn du es nur ein paar Stunden pro Tag condensierst, du wirst nicht die Menge, die Gramm Proteine, die du in einem Tag essen musst.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ich denke, sie sind überrascht, dass Fasten nicht empfohlen wird, dass Fasten kein Gewichtsschaden erzeugen wird, weil ich denke, es war sehr berücksichtigt, und auch die Menge an Protein, die Leute konsumieren müssen. Und was ich finde, ist, dass wir oft zu überstatten sind, wie viel Protein wir essen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Also wenn ich Patienten für Follower-Ups sehe und sie immer noch Muskeln verlieren, und sie mir sagen, ich esse viel Protein. Und dann, wenn wir zurückgehen, sage ich, schau mir einen Tag von deinem Protein an. Und ich sehe immer, dass sie 25-30 Gramm Protein pro Tag verlieren, weil sie dachten, dass sie so viel Protein pro Tag haben.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So it's an impedance machine. So the gold standard for body composition is an MRI. But it's expensive and it has radiation. So we're not going to do that on every patient or in every visit. Der zweite Beste ist ein DEXA-Scan, wie wir es für den Bein machen. Auch ein bisschen Radiation und auch etwas teurer.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Die dritte beste Option ist eine Impedance-Maschine und das ist ein bio-elektrisches Strom, das von der Basis deines Fußes nach oben geht und das Tissue separiert. Es separiert Fetttissue, Wasser und Muskeln. Das ist das, was wir von den meisten Doktoren in unseren Offices haben. Und die Biokomposition wird deine skelettische Muskelmasse messen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Eskalettal Muscle Mass ist ein Muskel, den du kontrollierst, um zu wachsen. Das ist ein Prozent des Körperfadens und dann dein visueller Fad.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Das ist das, was wir benutzen, um deine Bohnen zu sehen. Aber es ist auch hilfreich, um Körperkomposition zu sehen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So DEXA scans or bone scans, I mean really after the age of 50 every woman should have one, but for body composition at any age.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Definitely hormone replacement therapy will help we change body composition. We never promote estrogen as a weight loss hormone, but it will help change, recomposite your body again, right? So remember in perimenopause, there's a drop of estradiol and an increase in visceral fat, decrease in muscle mass. So by giving you back
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
What you're not making, we intend to see less visceral fat and more muscle mass. So that's an option. And then we have GLP-1 medications, which are a great tool. And really to have the optimal results, which is body recomposition, increasing muscle mass, decreasing visceral fat, GLP-1s have to be along the side of strength training and protein in your diet.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Es ist relativ neu, dass wir, ich denke, es ist mehr neu, dass wir mehr Hormonreplacement-Therapie benutzen als GLP-1.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Also ich würde sagen, es ist neu, dass wir sie zusammen nutzen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Testosteron für Gewichtsschmerzen, wir promotieren es auch nicht als solches. Testosteron ist ein anabolisches Hormon, also es promotiert Wachstum. Es kann den Appetit erhöhen, wenn er nicht unter Überwachung verwendet wird. Es hilft also, Muskelmasse zu bauen, wenn es um Strengetraining geht. Man wird nur nicht Muskel bauen, weil man Testosteron nimmt. Man braucht Strengetraining.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Oh, sie hat nichts mehr zu tun, jetzt, dass die Kinder... Was hast du gemacht?
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Und die Bauung von Muskeln wird helfen, visuelles Fett und Körpergewicht zu reduzieren.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So stress, chronic stress, puts our body in a chronic flight response phase. und das kann chronisch deine Kortisoleben erhöhen. Wir haben eine pathologische Krankheit, die Cushing-Krankheit heißt, wo unser Körper zu viel Kortisol macht. Das wird meistens mit Arzt behandelt. Das ist sehr anders, als wenn ich von chronisch erhöhten Kortisoleben spreche, von chronischem Stress.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
But it still can have effects in our body. So chronic stress with chronic elevated cortisol can promote waking.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
More centrally again. So if you're not sleeping, you're going to gain weight. If you're not sleeping, You're not going to build muscle. So everything that you do, even if you're eating properly, if you're exercising properly, even if you're taking a GLP-1, your hormones, if you're not sleeping, that can promote waking anyhow.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, ich war am Boden der Ladder, in der Bürokratie des Trainings. Und ich erinnere mich sogar an eine Frau, die aufwuchs. Sie war eine Frau aufwuchs. Sie machte eine Frau, die geboren werden wird, und sie checkte, in ihrer Vagina, um zu sehen, ob sie bereit war, geboren zu werden. Sie kontrollierten die Abweichung des Cervix.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
It is shocking and for many people it's still not. It's not, right? Many people accept that, oh no, I don't sleep or a lot of stuff is going on in my life and I don't need to sleep or like they take it and accepted it. But it can spill into every aspect of your life. So for me, priority for all my patients, for whatever reason they're coming to see me, is that they sleep. Und wie viele Stunden?
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Neun Stunden sind ziemlich hart. Sieben bis acht Stunden sind genug. Aber die Qualität des Schlafens ist auch wichtig. Das ist ein kontinuierliches Schlaf. Und das ist nicht unterbrochen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
If you can lower your stress. Do you have a plan for that? Definitely. I mean, exercise is one. With exercise, your stress levels decrease. Sleeping better, meditation, yoga, Pilates. And then trying to see what in your life you can modify to decrease the level of stress.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ich denke, wir vertreten viele Dinge an den Therapeuten. Ich fühle mich, als ob wir jetzt über Hormonvergleichstherapie sprechen, jetzt, dass wir GLP-1 haben, der Gland, der einen Ball hat, ist wahrscheinlich ein Therapeuten, der sich wie ein Therapeuten befindet. Finally, they're leaving me alone. Because everything that happens is a thyroid, right? You gain weight, it's a thyroid.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
I don't feel great, I feel tired, the thyroid. I think we attribute too many things to the thyroid that can be easily explained and that they're true, being caused by other things. Such as? Such as midlife, waking, life itself. Oder etwas anderes.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ich denke, wenn wir uns nur auf das Gehirn konzentrieren, denken wir, dass wir etwas anderes vermissen können, das zu behandeln ist und das in der Gesundheit sehr wichtig ist.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Definitiv. Und bevor wir dazu eingehen, möchte ich sagen, dass neun aus zehn Mal nicht der Thyroid ist. Wirklich? So it's stress and we're trying to... It's life. It's the environment, genetics, hormones, aging. That's amazing. 9 out of 10. 9 out of 10 times that I see patients coming, attributing symptoms to the thyroid. It's not the thyroid. And it's okay.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
It's okay because we have health for other things, right? If you're perimenopausal, we have hormones. If it's waking, we have GLP-1, right? Right. Es ist also nicht so, dass es eine Verletzung ist, wenn es nicht der Thyreoid ist. Eigentlich haben wir die Mittel, wenn es nicht der Thyreoid ist.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Und ich erinnere mich, ich war in einem Lehrhospital, und Frauen werden von den Anwesenden, den Residenzern, den Internen, den medizinischen Studenten getäuscht. Jeder lernt. Diese Frau war in Schmerzen von so vielen digitalen Examen, die sie hatte.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Wenn wir etwas zu viel machen, dann sind wir in Schwierigkeiten. Ich denke, dass wir mehr Balance in unserer Diät haben, nicht schwarz und weiß, wie komplett ohne Gluten, oder wie in deinem Fall, dass du das Gegenteil gemacht hast, nur um die Proteine zu bekommen, und du hast es zu dem Punkt übernommen, dass du dein Glukos erhöht hast und dich in einem prädiabatischen Zustand gesetzt hast.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So anytime that we tip the scale from one side, it's bad. So we need to find the medium, right? We need to find the balance because that's also more sustainable long term than something extreme.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Das ist es. Okay, warum? Weil Sie wissen müssen, was Ihre Muskelmasse ist. Longevität ist direkt proportional zur Muskelmasse. A low muscle mass increases all-cause mortality. We don't say that with high body fat. We say you're going to develop osteoarthritis. We know chronic diseases can come out of high body fat mass. But we don't say it increases all-cause mortality.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
As we say, low muscle mass, and the studies are there that show that patients that have sarcopenia or low muscle mass, their mortality is increased, all-cause mortality is increased. Why is that? Because then we're more prone to falls, right? If you don't have muscle mass, it means that you're lacking protein in your diet and we need protein for our bones too, right?
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Then you're going to be more prone for fractures, right? Es wird dir einfach nicht die Independence geben. Und auch Muskel ist anti-inflammatorisch, richtig? Also mehr Muskelmasse zu haben, ist wirklich die Gesundheit gleich. Also für jede Frau in der Zwischenzeit oder vor der Zwischenzeit,
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Und ich erinnere mich an die Frau, die anwesend war, die sagte, na gut, ich bin sicher, dass du nicht gezwungen warst, als er es in die Hand gestellt hat. Und es hat mich bis heute gesteckt und das ist mehr als 30 Jahre her. Und ich erinnere mich an einen Punkt in meiner Karriere, als ich zu Beginn dachte, Gott, lass mich nicht einer dieser Frauen werden.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Du musst wissen, was deine Muskelmasse ist, weil das dein größtes Waffen ist, um lange Jahre zu leben und unabhängige lange Jahre, richtig? Das ist das, was dir helfen wird, aus der Toilette selbst zu kommen, aus dem Bett selbst zu kommen, wenn du schlägst, um dich aufzunehmen, richtig? Also definitiv, denke ich, ist es sehr wichtig, dass wir wissen, was deine Muskelmasse ist.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Yeah, they can do waist circumference. But really, I mean, body composition machines are pretty much everywhere now. I don't think there's a reason why not to have one. Even in your gym, you can have one.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Yeah, definitely. So cardiovascular exercise is good for two things. Mental health, right? And the second is for cardiovascular health. But it's not important for fat loss. Got it. Okay. And I feel that's a lot of... A mistake that women in midlife make, thinking that cardiovascular exercise will make them or help them lose body fat.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
For my patients, I tell them, if it's good for your mental health, then keep it. But if the goal is fat loss, then really we need to concentrate more on strength training.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, und auch, wenn du das Druck des Gewicht-Losses, des Fett-Losses mit Kardio entfernt hast, kannst du es mehr genießen, oder wenn du es wirklich nicht magst, dann kannst du etwas tun, was du eigentlich magst, in Bezug auf Übungen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Genau.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Was ist es? Cortisol-Face ist das, was wir Cushing-Syndrom nennen. Das ist eine echte Krankheit. In dieser Krankheit, wenn wir die Diagnose bestätigen, sehen wir Cushingoid-Faces oder eine große, rote Face. But just simple stress is not going to give us that round cushionoid face that you're mentioning.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
False. It burns muscle, right? So you need the energy, the fuel to support when you're exercising, when you're doing cardio. But if there's no food, then the muscle starts to break down to produce that energy that you need.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
That one panicked me. There is no reason not to eat carbs after 40. Ist Osempic Butt real, wahr oder falsch? Irgendwo zwischen. Osempic doesn't cause muscle loss and Osempic Butt is referring to the drooping of the gluteus. And that's because you're losing muscle, but not just in your butt everywhere, right? So it could be the Osempic arm, the Osempic leg.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
It can happen if you don't have the right supervision in this medication.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
False. We really, endocrinologists, don't use the word balance so much. You can lose weight even in perimenopause if you're not using hormone replacement therapy. You can still potentially lose weight.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Very, very true. So visceral fat increases insulin resistance, insulin resistance increases visceral fat, and then you get into this vicious cycle.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Very true. Definitely. And we talked about elevated cortisol from not sleeping, right? So that's going to promote waking. And if you're not sleeping, you're going to be tired during the day and you may be less prone to want to exercise and eat healthy.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
False. We need the same amount of protein.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
False. It works for nobody, but many people do it. But really, if we're talking about high protein in your diet, building muscle, intermittent fasting is going to make it very complicated for you to meet that amount of protein.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
True, very true, because you can rebuild muscle at any age.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
And through my journey as a doctor, I've learned to believe women. Nicht nur, weil ich in dieser Phase meines Lebens bin, sondern weil ich durch meine Reise und Training gelernt habe, dass Frauen Symptome glauben. Ich denke, das ist der Missverlängerung zwischen Gaslighting und Frauen Symptomen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Weil ich denke, das ist falsch verstanden. Ich denke, die Wissenschaft hat die Frauen nicht komplett verstanden, richtig? Ich meine, wir verletzen so viele Jahre der Forschung in Frauen, insbesondere in der Pregnanz. So we really have not enough knowledge as we do in men and we don't know what to do about it, right?
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
And we question if it's real, what they're feeling, what they're going through, because we haven't been educated on it, right? And especially the WHI study, I think, after that. colleges, residencies, we stop talking about hormone replacement therapy. So we forgot how to do it. We don't know even how to approach it, right?
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So I think doctors, that's what they encounter is that the lack of knowledge. But the lack of knowledge should not mean, no treatment should mean I refer you to somebody who will know.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Definitiv. Und du hast gesagt, dass nichts verändert hat, was sie tun. Aber alles hat sich um sie herum verändert, richtig? Also die Umgebung, die sich um sie herum befindet, ist nicht das gleiche, wie es vorher war. Und nicht unbedingt wir, die etwas anderes tun, mehr essen oder weniger exercizieren. Es ist nur das Umfeld, in dem wir sind, physiologisch und sozial auch.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
In der Mittellinie erleben wir viele Veränderungen in unserer Leben und hormonale Veränderungen passieren parallel zu soziokulturellen Veränderungen gleichzeitig. Es ist also die Kombination dieser Dinge, die ich fühle, die uns in einem Ort befindet, in dem wir fast zur Verletzung geraten sind.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
In der Perimenopause sehen wir die Veränderung der Hormone, die chaotischen hormonale Veränderungen, die wir durchgehen, die viszerales Fett ermöglichen. Das Fett, das wir in unseren frühen Jahren hatten, wo sie meistens mehr in den Hüften und den Brüsten sind, geht zentral. Unsere Körperkomposition verändert sich und außerdem verlieren wir die Muskelmasse einfacher.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
When you lose muscle mass, you're losing your burning calorie machine, right? So then it promotes also the accumulation of body fat. And because of perimenopause, the accumulation happens centrally. And then also if we're symptomatic for perimenopause, we're not sleeping. The lack of sleep has a lot of rippling effect.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
The not sleeping is going to make us tired, irritable, we won't want to work out, we may not be nach einer heiligeren Nahrungsdiät. Der Lack des Schlafes kann die Insulinresistenz erhöhen. Die Insulinresistenz erhöht die Nahrung von Carb, Nahrung von Zucker. Es ist also nur in einem visuellen Zyklus. Und auf der anderen Seite sind soziale Dinge oder familiale Dinge passiert.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Unsere Eltern werden älter. Wir verlieren unsere Eltern. Unsere Kinder wachsen professionell. Wir sind vielleicht professionell in Veränderungen oder an der Ecke unserer Karriere. All of this is multifactorial, really, what is happening in a woman's life in midlife.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Definitely. The drop of estrogen causes us to change our body composition. We lose muscle mass easier to gain body fat. So it just becomes a little bit more difficult. And I hear women saying, everything I did is not working. Or even some say, I'm doing more. I'm exercising more. I'm being more cautious about my diet. And it's just not happening.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, also ich denke, das ist eine Missverständlichkeit, dass wir es in deinem Blutwerk sehen werden, aber viele Male, wie zum Beispiel Perimenopause, wissen wir, dass der Druck von Estrogen von Prämenopause bis Menopause nicht von 500 bis 0 geht. Es ist mehr ein fluttuierender Zeitraum von acht bis zehn Jahren.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So depending where we check in that time of the month, your levels may be at a different level, right? So let's say your estradiol level is normal. That doesn't mean that you're not in perimenopause. That doesn't mean that you're not symptomatic. It only means that at that time, that period of time that we check, the one point, Your levels were normal.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
They're clinical diagnosis and not chemical diagnosis. So any woman that they tell them, no, your symptoms are not real because your blood work shows something different. They really have no knowledge of what the hormone physiology is in midlife.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Nothing has changed of what they do, but everything has changed around them. It can spill into every aspect of your life.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Wir haben den verbalen Vertrag gerade. Dein A1c, das ist ein 3-Monats-Average deines Zuckers, der von dem Tag zurückgeht, an dem du dein Blut entdeckt hast. So that's a measurement that it tells us your average of your glucose in the last three months. And how that test works is because glucose attaches to the red blood cell and the red blood cell lives for 90 days.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So that's why we get a three month average of your glucose looking back. Der normale A1c ist 5,6 oder weniger. Die prädiabetische Größe ist 5,7 bis 6,4 und ein A1c von 6,5 und höher macht die Diagnose von Typ 2 Diabetes. Dein A1c von sechs Wochen her war 5,8, was dich in die prädiabetische Größe befindet.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Definitely. And then we did a family history and there's no type 2 diabetes in your family, right? Even your body composition didn't show high visceral fat. High visceral fat will tell me that there's insulin resistance. If there's insulin resistance, then prediabetes can start to lurk on. In your case, your visceral fat was not elevated and you don't have any family history of type 2 diabetes.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So then we went dig in further and you had mentioned to me that you had recently in the last few months changed your diet, that you went from more of a lean animal protein diet into more of a vegetarian diet. Sie basieren den Protein-Eintrag auf Lentillen, Beinen, Zwiebeln, die Stärken sind. Wenn wir sie in unserem Körper essen, werden sie in Glucose verwendet.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
I hear women say, everything I did is not working. Or even some say, I'm doing more and it's just not happening.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, sie haben Fiber und sie haben andere Nutriente als ein Snickerbar, aber es erhöht auch unseren Glucose.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ja, und auch Ihre TPO Antibiotika wurden erhöht. Diese Antibiotika sind das, was Hashimoto-Bedrohung verursacht. Hashimoto-Bedrohung ist eine Autoimmun-Bedrohung mit der Präsenz dieser Antibiotika. Diese Antibiotika, wie alle Antibiotika in unserem Körper, sie attackieren. Und sie attackieren insbesondere Ihren Therapeuten.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
With time, the antibodies can attack it to the point that it destroys and stops functioning. Then hypothyroidism comes in, right? In your case, your thyroid function was still normal. The antibodies are elevated, meaning that they're doing some work there, right? And it could be in your lifetime or not. You may develop hypothyroidism and that will show in your blood work.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Hashimoto ist eine Antibiotika. Im Grunde genommen sind wir mit Antibiotika geboren. Antibiotika attackieren normalerweise etwas Außerirdisches in unserem Körper. Aber Antibiotika sind eine Misskommunikation. Sie attackieren unseren eigenen Körper. Also Hashimoto ist... Antibodies against your own thyroid that they can complicate with hypothyroidism, meaning an underactive thyroid.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Now, having present or elevated antibodies for your thyroid doesn't mean that you need thyroid replacement at that moment. It doesn't mean that your thyroid is not working. It just means that it may happen with time or it may not.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Ich denke, während der Perimenopause, was passiert ist, dass es viel Stress in unserem Körper gibt und viel von nicht schlafen, richtig? Das ist eines der meisten gemeinsamen Symptome. Also nicht schlafen, Angst, all diese Änderungen in unserem Körper verursachen Stress. Stress reduziert dein Immunsystem.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Das ist der Grund, warum du, wenn du sehr gestresst bist, mehr versorgt bist, eine Infektion zu bekommen, eine Kälte, ein Virus, weil dein Immunsystem droht, wenn es Stress in deinem Körper gibt. Also in diesen Situationen, wenn das Immunsystem reduziert wird, werden alle Antibiotika, die dort flirten, die Vorteile nehmen und ihre Arbeit machen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Es ist also normal, dass wir in Stressperioden, dass Immunsysteme auftauchen.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
I've learned to believe women's symptoms.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
Und es ist ein rippelndes Effekt während der Mittagszeit.
The Tamsen Show
The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue
So we have subcutaneous fat that is basically what's under our skin. So if somebody has liposuction, what they're going to remove is subcutaneous fat, right? That is not a bad fat. That is not a pro-inflammatory type of fat. Then we have intra-abdominal fat, which is inside our abdomen that attaches to your internal organs, to your liver, to your gut, to your pancreas.