Mind Pump: Raw Fitness Truth - 2447: The Keys to Visceral Fat Loss & Muscle Gain With Dr. Tyna Moore

Episode Date: October 17, 2024

The Key to Visceral Fat Loss & Muscle Gain With Dr. Tyna Moore Her thoughts on Hormone Replacement Therapy (HRT) for women. (1:41) What do her patients notice when they go on HRT? (6:22) Explaining Regenerative Injection Therapy. (11:12) What age are women going into perimenopause? (13:45) Estrogen and adipose tissue. (17:02) Get healthy FIRST! (21:48) Context matters. (26:40) Defining metabolic health. (30:06) Why she is a BIG advocate of strength training. (33:29) Not all muscle is the same. (37:14) Metabolic warning signs. (41:10) Cautioning the audience when taking peptides. (48:28) Her thoughts on protein for metabolic health. (51:09) Is HRT becoming more necessary? (54:39) The triad for perimenopausal women.  (58:34) Her thoughts on metformin. (1:03:42) How to find a good doctor. (1:04:49) Related Links/Products Mentioned Visit Legion Athletics for the exclusive offer for Mind Pump listeners! ** Code MINDPUMP for 20% off your first order (new customers) and double rewards points for existing customers. ** October Promotion: MAPS Muscle Mommy 50% off! ** Code OCTOBER50 at checkout ** Ozempic Uncovered Course Mind Pump #2360: What You Need to Know About GLP-1 With Dr. Tyna Moore Suicide rates in women of menopausal age rise | ITV News Mind Pump #1547: The Hidden Benefits of Lifting Weights How Botox Injections May Reduce Depression - Psychology Today Mind Pump #2187: Why Building Muscle Is More Important Than Losing Fat With Dr. Gabrielle Lyon Mind Pump #2232: Age-Proof Your Muscles, Bones & Brain With Dr. Gabrielle Lyon Mind Pump #2442: How Strong Should You Be? The Fastest Way to Get Bigger & Stronger at the Same Time Androgen receptors and testosterone in men—Effects of protein ingestion, resistance exercise and fiber type Dr. Tyna – How to Find a Good Doctor Mind Pump Podcast – YouTube Mind Pump Free Resources Features Guest/People Mentioned Dr. Tyna Moore (@drtyna) Instagram   Website The Dr. Tyna Show Podcast Dr. Gabrielle Lyon (@drgabriellelyon) Instagram  

If you want to pump your body and expand your mind, there's only one place to go. Mind pump with your hosts Sal DeStefano, Adam Schaefer and Justin Andrews. You just found the world's most downloaded fitness health and entertainment podcast. This is mind pump. Today we had Dr. Tina back on. She was so popular last time we brought her back on. Remember, she's a metabolic health expert. She works with hormone therapy and peptide therapy. In fact, today's episode we talk about hormone therapy, who it's for, who it's not for, why it's valuable, what it does to the body. Talk about metabolic health, visceral body fat. We do talk a little bit about peptides as well. We know you're

gonna love this episode. This episode, oh by the way, you can find Dr. Tina. You got to check her out. She's on Instagram at Dr. Tina, Tina spelled T-Y-N-A and then she also offers a free course on GLP-1s like Ozempic, breaks it all down for you. It's at Dr. Tina, so Dr. Tina.com, so Dr. Tina.com forward slash Ozempic uncovered. Go get it, it's super rad we've had people get it already they love it go check it out also we have this episode being sponsored by Legion Legion is a company that offers supplements for performance for muscle gain for fat loss and if you go through our link you'll

get a discount so go to buy Legion calm that's be why legi o n calm forward slash mind pump use the code mind pump, you'll get 20% off. We also have a sale on a workout program this month. MAPS Muscle Mommy is 50% off. If you're interested, you go to MAPSfitnessproducts.com and then use the code October50 for that discount. All right, here comes the show.

Dr. Tina, welcome back to the show. Yeah, thanks for having me. It's always a lot of fun having you on. All right, I wanted to start by, you have some really interesting thoughts on HRT for women. I've heard you say a couple things like you think it's a really good thing, it's great for quality of life, longevity. It's a bit of a, maybe a little bit of a controversial topic these days, HRT in general.

Tell me about that. Why is this such a good thing or why is this something that maybe people should pursue or should they? Well my mentor always, always, always drilled into me the benefits of HRT as I was coming up and practicing medicine and I have personally been on HRT since I was in my mid thirties and we've always, the way I've been taught and the way that I have treated patients is always just with physiologic dosing. I'm not ever trying to go into pharmacologic high doses or crazy high doses. I'm not trying to turn a 65-year-old man into a 25-year-old man.

It's really just meeting the patient where they're at and meeting the deficiencies where they're at and similar to the way last time I was here when I talked about GLP-1s, you know, I've done the same thing with thyroid, estrogen, testosterone, progesterone for sure, and in the end patients always felt much better. My background is that I specialize in regenerative injection therapies, that's predominantly what I did in clinical practice for well over a decade. So hormones were a huge part of that because you can't regenerate tissues and you can't get good healing

and you can't decrease inflammation appropriately if you don't have enough hormone on board. So a lot of folks would come into me in middle age with issues and I'd say, you know, I know you think it's your knee, but it's not your knee. It's your hormones first and foremost. We got to get those dialed in and people would look at me like I had two heads.

Like, what does my, you know, what does my estrogen have to do with my chronic knee pain? But excitingly, in the last few years, really good data has come out to support the way that I have been treating clinically for decades. And it got vilified about 20 years ago or so the Women's Health Initiative came out and said that bioidentical hormone or just hormone replacement therapy in general was dangerous and that women should stop taking it and the women that were on it were calling clinics saying why do you have me on this poison?

I'm going to die. And those of us who understood how to read studies, you know, looked at the data and they were using estrogen with progestins, which are artificial progesterones. It's not progesterone, it's progestins. You said bioidentical earlier. Sorry. So, okay, so tell me. You said bioidentical earlier. Sorry. So tell me the difference, bioidentical versus synthetic. Well allopathically, this is what always gets me in trouble

is when I talk about the allopathic system. Allopathically, the standard is to give Premarin or PremPro and that's a bioidentical estrogen, but with a progestin. And a progestin is a fake version of progesterone. It sits on the receptor just like progesterone would, but it doesn't do, it doesn't make the cell do what progesterone will make it do. And that's a bad combination.

And so we knew that reading that study, so those of us who were doing bioidentical hormone replacement with bioidentical progesterone were like, yeah, we're fine, we're going to just keep giving it. And I'm glad we did because it's decades of women who got the hormones they needed versus most of the women in the United States and probably the world who, I mean, an entire generation of women were denied hormone replacement because of this poorly done study. And recently they've come out and reanalyze that data and said we were wrong and that HRT is not dangerous and that it does not cause all these terrible things we said it caused.

And a lot of women quite frankly have just been fucked over by this whole problem. So I've been using it successfully. I've been using it personally. It does great. It has really helped with pain. It helps with healing. It helps with helped with pain. It helps with healing. It helps with women feeling better. It helps with anxiety. It helps with crippling depression. There is a crippling depression that occurs in women as they're hitting that perimenopausal phase,

as they're further into it. In fact, a study came out in 2023 showing that women aged 45 to 49 in the UK, that's the highest age range for suicide in women. So it's something to do with that precipitous drop in estrogen. So anyway, I've been knee deep in it because I really believe that GLP-1 solo monotherapy aren't it. I think you need the HRT, especially in that. I really think GLP-1s are just so phenomenal

in that perimenopausal, menopausal woman, that age group. It's such a nice adjunctive, and the way that I've always treated was, strength training and HRT, and now I have this third component, which is this potential, adding in the peptides and varieties, but the HRT is really important

for the back and forth success of this, I believe. What do you see when you put a woman on HRT? What are the experience? What do you notice in their lab work? Do you see changes in, because I hear this from my aunts. In fact, I just saw my aunts recently and my aunts said, oh my God,

like all of a sudden I'm gaining body fat on my midsection. I never ever did that before. I'm not sure nothing changed. And then my other aunt pipes in and says, oh yeah, when I hit the same age, the same thing happened. Are you, like what are you noticing, or what are your patients noticing when they go on HRT? So what they usually come in reporting when they need it

is brain fog, they, you probably saw your moms do this. A lot of people will, once I describe this, they're like, oh my mom went through that. Um, their moms get kind of ding baddy or they start forgetting things or, you know, where did I leave my keys? Where it's like, it looks like this sort of pre early dementia.

And that's the drop of estrogen in the brain. And work by Dr. Moscone, I don't know if you've talked to her yet, but she's an Italian researcher and she, a brilliant lady and her and her team found that the brain itself will start up regulating estrogen receptors as estrogen drops because it's thirsty for the estrogen.

So it's trying to compensate. It's wanting, yeah, it's looking for the estrogen. So brain fog, but a big symptom is depression and sometimes suicidal ideation. And so women who, particularly women who, this happened to me actually, women who had struggled with depression in younger years had seemingly come out of it for however long.

And then all of a sudden you're like, I mean, I was feeling a lowness in my mood that I hadn't experienced since I was a teenager. And I was like, what is going on? You know, I chalked it up to all the stress of pushing back against the narrative during the last few years, but it was really pronounced.

And then also what I would see in clinic is all of a sudden just really pronounced joint pain out of nowhere. I mean, who gets frozen shoulder? Perimenopausal and menopausal women. Oh, that's quite true. Whose knees fall apart? Perimenopausal and menopausal women. All of a sudden their joints start melting on them.

Frozen shoulder, knees, plantar fasciitis is another one, or fasciosis, hips, hips are a big issue. Anytime you see bilateral in the joints, especially in a woman, you should get concerned. That's usually hormonal in its presentation. So any variety of that, and then hurting, just hurting. Now you've got low libido potentially, they might have trouble with lubrication

in their vaginal tissues, or their vaginal tissues might start to atrophy, and they just, they won't tell you that, they just will sort of start rejecting your advances, they are not so interested anymore because their brain isn't interested, but also their tissues aren't working the way that they want them to,

and yes, the weight gain, but that might be later. And then we always think with menopause like, oh, the hot flashes and the vasomotor stuff, that's way later and not always there. Same with men. Men, with men, everybody, when I'd have a male patient come in and I'd go to check out his knees, I'd pull up his pants and I'd be doing an evaluation of his knee and he would be missing shin hair. And that to me was really indicative of low testosterone. And I've seen it time and time again. And I'd say, how's your testosterone levels?

And they'd always say, oh, everything's fine. Like they'd assume I meant, you know, erectile dysfunction. And I'm like, no, dude, like how are your gains in the gym? How are you feeling overall? Are you moodier than usual? Are you, how's your stamina? Like mentally and physically? How is your presence with your family?

Men usually will get pretty grumpy and they get kind of aggressive and kind of, I hate to use this word, but kind of bitchy. They're irritable. Yeah. What's, the shin hair, never heard that. Yeah, I've never heard it. It was just something I correlated.

Like no one ever taught me that. I just kept seeing it and then I put them on testosterone. I almost feel like I've seen that. I feel like I have too. That's why I'm so curious right now because I'm almost positive I've seen this before. What about where the socks are? Yeah, because they-

Right, well they would want to chalk it up to that. So I've seen this so many times and I've treated it so many times successfully that, and you have to have, the thing is is for me, I have to have testosterone and estrogen and progesterone and thyroid on board if I'm gonna do regenerative injections because I'm using their own tissues often.

I'll be pulling their own blood or their fat to get what I need to re-inject and if those aren't worth a damn and they're not hormonally optimized, they won't have a robust healing response. So to me it's almost unethical to try to put these people through expensive procedures if they're not going to have a regenerative response, right? Right, right. So the testosterone was really key. Even if it was just short term, a lot of guys didn't want to go on it long term. I'm like, we'll just do it for now for, you know, these many months so that we can at

least do the injections and know that they're going to take and work for you. And then you can decide what to do later. But I'm promising you, you're going to want to stay on it. Anyway, my husband comes to me about a year ago and he's like, babe, why is all the shin hair gone?

Like, where's all my shin hair? And I was like, ah, have you been using your testosterone? He's like, no. So, and then we treated him and boom, he's, it's back. Now explain what you were just explaining about. So you actually pull, you pull from our own tissue to then re-inject us. Explain that, break that down. Like that's. So there's the baby version of regenerative injection therapy, which nobody really does anymore because it requires a lot of talent and it requires a lot of tactile skill.

It requires really good palpation skills and it's called prolo therapy. And that's where we use dextrose, sugar water. And that actually regenerates the tissues and turns down the pain. It's amazing. And it recruits and activates the stem cells. Just the sugar water does that? Just the sugar water. But you got to be good with a needle and you have to have good technique.

Because you gotta hit the right site in order for that to happen. Yes, and most doctors don't know their anatomy nor do they know how to palpate to save their life. I've trained like hundreds of doctors in this technique and most of them do not know how to palpate to save their lives. So they use ultrasound, they give you one shot,

they call it good and I'm like, dude, I've got 40 spots I wanna hit, not one. Yeah. And then you can grow that up into something different in the syringe, same technique, and that would be platelet-rich plasma, so you're pulling their blood. And then you can grow that up,

and you can actually harvest either bone marrow or adipose tissue, and there's stem cells there. And so you concentrate these tissues down and you- And what you're saying is without a good hormone profile, then it's like you're not able to maximize the benefits of any of that. Right, and also if the person's really inflamed, I think these treatments get a bad rap,

one, because patients expect a miracle, and number two, doctors are not being ethical in screening their patients very well, because if you take, I would tell patients these exact words, like if I take your hot mess of inflammatory blood, and I concentrate it down, and I shoot it into your hot mess of an inflamed shoulder, it's going to be a disaster, right?

And it could cause a lot more harm than good. Like inflamed fat is really bad and we don't necessarily want to be utilizing that tissue in a concentrated form into an inflamed knee. So the second one you described was PRP, correct? Now, so if I understood you correctly, if you're taking that from somebody who is out of balance or out of whack hormonally, then is that why some people seem to have like all amazing responses with PRP

and other people are like, I didn't really notice anything from it. Is that why? That's one of the reasons. And then I would say it's the technique of the person. Because I've had that as clients. I've been around it for a long time. I had a client that actually sent to do it for her.

It was a miracle for her. She was also a pretty healthy woman. So, and I didn't know that. Good substrate. Yeah, and I've had other clients after that say, oh yeah, I tried PRP, it didn't do anything for me. So it could be either one, a person who's injecting it, not very good at that, or two,

because they're pulling from somebody who's hormonally all out of balance and it's not gonna do any good that way. Is that right? Potentially, yeah. What age range are women going into perimenopause typically? Younger and younger and younger. And I suspect, honestly, some women are just running low hormone for years and years without knowing it.

So for instance, I'll have women go on estrogen and anxiety, crippling anxiety that they've had since their twenties resolves. And so I wonder if they weren't just running low hormone profile for a long time and their mental emotional issues were being blamed on mental emotional stuff when in reality, I mean, it's

obviously multitudes of factors. I mean, are they exercising? Are they eating well? Are they sleeping? I mean, there's a lot of reasons why people have anxiety, but there's this, just this incredible anxiety that overcomes you. And this is why I think you see, that's why I said, you might see, remember seeing this in your

mothers, all of a sudden your very calm, happy, balanced mother gets a bit neurotic during that middle age period. A lot of people will say, yeah, my mom went crazy for a while. I think that's really testament to what dropping during that middle age period, a lot of people will say, yeah, my mom went crazy for a while. I think that's really testament to what dropping estrogen levels can do to the brain.

So you're saying younger and younger, so like women in their 30s are starting to see this, like mid 30s? Unfortunately, yes. There's a lower and lower threshold, it seems. And I don't know if that's just poor health and, or we've got generational issues happening. I mean, I talked to you guys, I think last time

about Pottinger's cats. I think I mentioned that, you know? I mean, we're several generations into some bad stuff. And so I'm not sure reproductively if ovaries are working optimally anymore as they should, or maybe that they were generations prior. So I think that, yeah, we're seeing, and there's

just other toxins in the environment. Less of Xenoesthetics. Yeah. Puberty has been shown like to happen a bit earlier as well. And now what, what would you attribute like, so like birth control having some kind of role in this in terms of how the hormones have, you know, led towards pre-menopausal situations? I think birth control is given out so readily,

especially in young women, because you can take a young woman, even a teenage girl who is seemingly losing her mind for whatever reason, and you can put her on birth control and a couple of things can happen. One is she'll get crazier and can't tolerate it at all, which is not uncommon. Two, she'll feel better.

It'll calm her down. And it's that substitution of hormones that she was missing. And all of a sudden her brain's like, oh, thank you, I can relax. A lot of women get, or three, you know, she'll just balance out and everything's fine. She's seemingly fine. A lot of women stay on these for decades

until they get to my age. And then they're like, okay, I'm going to go through menopause naturally. And their ovaries have never been functioning without this properly. And so they try to go through menopause or perimenopause without the oral contraceptive pill and it's a train rack for them. So they come into my clinic and they're like, yeah, I've been on the pill for decades. I went off it to have babies and then went back on it. it's a train wreck for them. So they come into my clinic and they're like, yeah, I've been on the pill for decades. I went off it to have babies and then went back on it.

And I'm like, oh no, we don't even know your ovaries if they know how to work. So there's not a nice transition into menopause. It's just like a. Abrupt. Eee. Boom. And we gotta sort out what normal feels like for them.

When you talk about hormones too, there's far more complex than just like progesterone, estrogen or testosterone. It's how they interact with each other, work together, and then there's individual variances. What does that look like working with someone? You obviously look at the labs, you look at their symptoms, and then what do you do? You just work with them and start to titrate

based off of symptoms? That's exactly it. And it works so much easier in somebody who is metabolically sound and fit. So if a woman my age walks in the door and she's got decent muscle and she's decently active and she's decently lean and doesn't have a lot of excess adipose on her and she says, I want to start HRT or I think I need it or I'm having these symptoms, you know, waking up in the middle of the night, the forgetfulness, like I said, she'll come in with a myriad of symptoms.

That is such an easy patient to treat. We just titrate the doses and we kind of, you know, we work closely together until we get them feeling optimized. That optimization is going to shift a little bit with the seasons, it's going to shift a little bit as the age, it's going to shift a little bit with the seasons, it's gonna shift a little bit as the age, it's gonna shift a little bit with different levels of stress that they go through, but for the most part, it's pretty clean and easy. A woman comes in who is inflamed, metabolically compromised

and carrying a lot of adipose tissue around is like trying to hit a moving target. And the studies that have been coming out in the past couple of years that I've been reading really confirmed for me what I saw clinically because that was such a hard patient to deal with. They'd come in and say, yeah, you tuned up my friend Danielle. I want you to do the same for me.

And I'd be like, oh no, this woman doesn't exercise. She's super inflamed. She's super metabolically unsound. Maybe she's a couple of years post menopausal. So she stopped ovulating completely. You know, it's maybe there's a window of opportunity here and she's passed it and cleaning that up and trying to get that dialed in enough

so that the hormones work adequately and make her feel good and not all over the place is truly like trying to hit a moving target. And it is one of the reasons I quit doing so much HRT in my practice was because I didn't know what to do for that group of women. This is where I got really excited about GLP-1s. Because you can handle the obesity.

You clean it up and then give them the hormones they so desperately need. But I will say the data is showing when it comes to estrogen and adiposity, there's a big interplay there because adipose tissue is really an endocrine organ. It's estrogen sensitive, right? Yeah. I mean, it's an endocrine organ at the end of the day and it really is so important that it's working properly and it's not in an inflamed state because as you pack those adipocytes full, the more full they get, the more pissed off and inflamed they get. They start bringing in the macrophages of your immune system and now you've got a hot mess there and this is going to really impact the immune system. It's going to impact everything, but it's really going to impact how estrogen behaves.

So if you start applying estrogen to that body, that's like a whole different ballgame. It's preventatively, if you apply estrogen to a premenopausal woman, even if she is dealing with some of that, estrogen is protective. It's going to help keep adipose laying down in the right places, the hips and the thighs less in the gut area, less in the visceral fat area. And it's going to be protective on the cardiovascular system. It's going to be protective to the brain.

It's going to be protective to the joints and pain. Your pain levels are associated with your estrogen levels. But over here on this side, if they've crested the hill and they're way over here, estrogen can actually be pretty bad. It can cause vasoconstriction in an inflamed body, whereas over here it helps with vasodilation. It can make joint pain worse. It can make spinal pain worse. So this has got to make studies on this impossible because, not impossible, but confusing because if your sample size are unhealthy overweight women. Or a mix of the two.

Estrogen's a mess. Then it's like, oh, estrogen's bad for you. Yes. Look what it's causing here, versus the sample size of healthy individuals. So I always say, get started sooner than you think you need to. Get tested and get started sooner

than you think you need to and use it preventatively. And so we, the estrogen I took when I was 40 was intermittent and it was a much lower dose than what I'm needing now, but I'm 50 now and I've got different ovarian function, right? And our stress levels are going to impact our ovarian function. So going through a major stressor

while you're in perimenopause is maybe going to throw you over the edge. COVID seemed to throw a lot of people over the edge of whatever they were sitting on. You know, how your thyroid's working, how everything's working. So our adrenal glands are what make our testosterone in women once our ovaries go offline.

So if women go into perimenopause and menopause adrenally compromised, which most women are, or stress the F out, then this is going to be a really difficult process. If they go in under-muscled, it's going to be a really difficult process. Well, if they go in undermuscled It's gonna be a really difficult process and sticking to this this avatar of a woman that we're talking about Which is actually really common in our clients that we used to change we a lot of times Hiring us was the last resort. They've already tried to do it on their own. They come to you

Here's the other challenge too Is that you have somebody who has got all this metabolic dysfunction, hormones are all over the place. They now have reached a place where they recognize, oh my God, I need to lose all this weight. I need to get in shape. But then the approach of fasting, cutting calories, bootcamp classes, that applied, that type of exercise and diet restriction is a recipe for even more of a disaster. So so much empathy for my female clients that are experiencing this. They know that they're motivated to make a change. They know they have to make a change. And then they come in to try and try, or they try this on their own and they sign up for the Barry's Bootcamp or the Orange Theory.

And then they start eating salads every day. and then it just gets worse and it's like You have to speak to that. I was just literally having this conversation with my sister-in-law and my niece They're both inspired by my whole docu series to get kicked up again doing their thing They went saw their nature path both and told them that there's got issues with their their hormones and they have They went and saw their nature path and told them that there's got issues with their hormones and they have adrenal fatigue and all this stuff going on. And I'm explaining to them, like in this position that you guys are in, before you think burn body fat build muscle, it's got to be get healthy first. And thinking you need to go cut a bunch of calories and do a bunch of crazy activity

that's really stressful on your body is not going to be the recipe. We need to build muscle. You need to give yourself recover. We need to feed the body nutritionally. And I'm like, it seems counter to what you think you need to do to lose all that weight, but you've got to do that. Otherwise, you're just going to be in a worse situation. Yeah, it's a hundred percent. You got to go slow and low. And here's the real caveat. This is what made me realize that the little bits of estrogen I was taking was not cutting it. I kept tearing everything. I kept injuring myself over and over again,

because estrogen keeps you elastic. It keeps you juicy. And so when that plummets out out of nowhere, mine just dropped very suddenly. I mean, I was fine. I was fine. I was fine. And then it was gone and it was, you know,

Achilles rupture, back injury, back injury. And then right before I flew out to London for that podcast, we were talking about, I herniated a disc, picking up a doormat. I mean, it was like classic, you hear in chiropractic college, they teach us, you know, I'm a naturopathic doctor too, that's why I can prescribe. But in chiropractic college, like, yeah, people just lean over and pick up something light and they herniated a disc. And I had to get on a plane in five days for a great opportunity.

And I was like, oh, my God, this is ridiculous. And I had to get on a plane in five days for a great opportunity and I was like, oh my God, this is ridiculous and I'm slapping the estrogen patch on after that. I wasn't messing around anymore. I learned that the hard way also. I remember, I think it was Sal who made the connection for me about, was it five years ago when I went natural and tried to go,

so I obviously did all kinds of steroids in my 20s, then I got into bodybuilding, so obviously taking large doses of it. Then decided, okay, I'm gonna point my life, I'm gonna try and get off everything and try and, and I did that for like three years, trying everything under the sun to try and naturally bring it up.

And what I didn't realize, I mean, I was just flooding the floor. And hormones were all over the place, went through the whole depression thing, but I was on a mission to try and fix it. And I blew my Achilles and had no idea that it was connected to the estrogen. And I thought that was so wild

that no one had ever said that to me. And it was out of nowhere. I was playing basketball, which I played basketball my whole life, all by myself, just running up and down the court and just out of nowhere. And then he's like, dude, you know that that's connected to low estrogen levels.

Did you look up? And I looked it up and I was like, son of a bitch, I had no idea, I had no business doing that. And they, some scientists think that testosterone is actually a pre-hormone to estrogen. So it's really not its own, I mean, it's in the pathway with estrogen being the last in line of production. If you go down the hormonal pathway of the sex steroids, you know, it starts with cholesterol.

So- I mean, it kind of makes sense because one way to make a man's body naturally raise his testosterone is to make him think it has no estrogen. You put them on a CIRM like Novadex or what do they use now, Enclomaphene, and their testosterone levels go up

because their body is trying to produce more estrogen. Yep. So it's, and you guys need estrogen too. So when you're doing HRT with women, you're not just working with one hormone, right? You're using- All of them. Okay, is it almost always that way?

Where you're like, okay, we're gonna do progesterone, estrogen, okay, never just the one, because- It depends on their age. If they're young, you know, a lot of young women just need progesterone and they're great. They might need a little thyroid. Usually it's like adrenal support progesterone. That's like the young woman's cocktail.

And then as they age, you know, actually I will sometimes use testosterone. If testosterone's low and I know they need estrogen, I'll use a little bit of, that's how I functioned for about a good decade. It was a little bit of testosterone because it would convert into enough estrogen. But then you hit a certain point and you're like,

just give me the estradiol and please. You said body fat on the body is an endocrine tissue. Endocrine tissue. Yeah. Explain that to me. So is it just because it's estrogen sensitive? Does it produce hormones? It produces hormones, but more importantly,

it has aromatase enzyme in it. So we've got aromatase enzyme in our brain. So aromatase enzyme is just as important to our estrogen receptors as the hormone it is. First explain romatase. It's an enzyme that converts testosterone into estrogen. And so, it's an important enzyme. But I used to know it for like, you know, you put a guy on testosterone and he's got a lot of belly fat.

He's going to convert a lot of that into estrogen. You might have a mess. That's where those TRT studies actually showed all those decades ago that that was dangerous. They weren't looking at their estrogen levels, they weren't looking at their diet, they weren't looking at their belly fat levels. Some of these guys were smoking,

they're just cranking tea. And not considering any of the other downstream effects. And they're like, well, they're having heart attacks and strokes. And I'm like, yeah, not a good stuff. Testosterone's bad. Yeah, yeah, testosterone's bad. So estrogen got wiped out, testosterone got wiped out

and a whole generation, all the poor Gen Xers, I feel so bad for them, you know, and a little bit older. Anyway, aromatase enzyme's important in the brain, in the bones, in the fat tissue predominantly, that's where it's most active. And in the fat tissue predominantly, that's where it's most active. And in the fat tissue, it turns our, it turns a precursor. So if you take DHEA, it goes down the pathway potentially to testosterone, but it also goes to one molecule that readily converts into estrone.

And I don't, I think, and I can't find the data yet to really put it all together, but I think estrone's the problem. Estrone's the main estrogen when you are postmenopausal. So when you're younger, it's estradiol. When you're older, it's estrone. I think estrone in the presence of metabolic dysfunction

is a real problem. And your fat, in the fat fat aromatase converts your testosterone and all your other androgens into estrone and the fatter you get the more estrone you make and it becomes this and estrone can convert into estradiol I think in a healthy body so they used to think well women don't need estrogen replacement because they're getting fatter as they get older because as your estrogen drops you become more insulin resistant you put on more fat you're getting fatter as they get older because as your estrogen drops you become more insulin resistant, you put on more fat, you're getting fatter, you're collecting more adipose tissue, therefore, and your aromatase enzyme gets more activated because there's more of it, because there's more fat cells.

So now they're fine, they've got enough estrone, they should be fine, but estrone just doesn't do the same thing as estradiol. And I think a lot of estrone in that post-menopausal body, especially if there's obesity involved in metabolic dysfunction, which it's most women in that age group, I think a lot of estrone in that post-menopausal body, especially if there's obesity involved in metabolic dysfunction, which it's most women in that age group, I think that's a real problem. You mentioned, what about these inhibitors like Arimidex that inhibit the aromatase enzyme? I've heard those are really bad

for your brain and your psyche. Yeah, yeah, I don't think they're great. I used to put some men on really low doses, but those were the men that were screwing around and not strength training and not regulating their alcohol intake and not being serious about the lifestyle modifications that are necessary when you take TRT.

You can't just take TRT, you can't just take estrogen, you can't just take all these things and keep living a frivolous lifestyle and assuming that everything will be fine. Context really does matter with a person's life. So explain metabolic health then. Okay, so we keep talking about somebody who's metabolically unhealthy or healthy.

So umbrella, metabolic health. Like what are we talking about? It is, in its most simplistic form, it's the ability of the foods that you ingest to be turned into fuel. It's the ability of your mitochondria to function and make ATP. Obesity ability of your mitochondria to function and make ATP. Obesity really destroys your mitochondrial function. It really screws up your aromatase activity

and it really screws up your estrogen receptor activity too. So like this is all one big soup and it starts with metabolic dysfunction, which I think gets sequestered into insulin resistance. Everybody understands insulin resistance leading to metabolic dysfunction where insulin is the lock and key mechanism that gets glucose into the cell

so that the cell can use the glucose for fuel. The mitochondria can use it to make fuel ATP at the end of the day. And if there's too much blood sugar, the pancreas starts cranking out insulin, the insulin gets high and the cells start cleaving off the receptors. You need that insulin to bind the insulin gets high and the cells start cleaving off the receptors. You need that insulin to bind the insulin receptor in order for this other

receptor called a Glut4 receptor to translocate to the membrane, open up and let the glucose in. If there's too much glucose and there's too much insulin out here, the cells gonna be like, yo, we are overdone in here, we don't need all this and it's gonna start cleaving off receptors. That's insulin resistance. That's where most Americans are sitting. But what people don't realize is there's a myriad of other ways to get that Glut4 receptor to translocate to the membrane and open and get the glucose in. Exercise.

Strength training in particular. Strength, just squeezing the muscle, the actual act of squeezing the muscle up regulates the Glut4 receptor. Yes. By the way, this was the theory behind eating, carbohydrates post workout. Oh, it upregulates gluten for, let's just throw some carbs at you and I absorb them faster. Which it does. You do, you do, you do intake glycogen quicker,

faster post workout. That doesn't mean you won't necessarily do it later, but that's where it all came from was the whole gluten for receptor. Caloric restriction will do it. So intermittent fasting, I think, is a nice tool when done appropriately. Depends on the woman or the man as to how many hours I stay to fast, but just not eating all day long.

Don't be grazing the six meals a day that we all were taught to teach our clients is not probably the best. GLP-1s do it. If you can stimulate that AMP case or one pathway, you can get the Glut4 receptor up to the membrane. And just squeezing a muscle, just actually contracting the muscle will do it,

which I think is so cool. So we're all focused over here on insulin, and this is where that low carb fanaticism, but if you low carb yourself for decades, you can actually become insulin resistant. I've heard of this. In fact, I know that the Atkins diet, I remember, I think it was Atkins himself came out

and said, oh, you might need to throw some carbohydrates at yourself every once in a while because we're seeing insulin resistance because people are so low carb for so long, like their cells almost forget how to utilize. Is that the case? That's how I explain it to people. It's just the body kind of forgets how to do it right and it's not being called upon. You know, it's a hormetic response. Cellular

receptors are a hormetic response. If you don't ever ask them to be used, they won't. And if you bombard them, like if we flood people with hormones all day, if we flood them with high doses of GLP-1s or whatever, I mean anything that we just throw at people, eventually the receptors will start to down regulate. And so we don't want receptor resistance. Now you're a big advocate of strength training. Is this because it's one of the best forms, if not the best form of exercise for metabolic health?

Yes. And time for time basis? Yes, I would say. I think just the tension, just learning to tension your body appropriately and then the squeezing of the muscle has so many benefits beyond what the actual muscle is doing. So muscle itself is also an endocrine organ, in my opinion, and it secretes myokines. And myokines are so critical for so many, there's anti-inflammatory impacts of myokines, there's important signaling

molecules that are myokines. It's the balance and the force, right? So if we have interleukin-6 being secreted by the fat, it's pro-inflammatory. If we had it, and it's a cytokine, if we have it being excreted by the muscle, it's a myokine, it's anti-inflammatory. So there's the muscle itself, but what muscle does, like actually activating muscle,

what other organ can we activate? Like what, you can't squeeze your liver. I mean, you might be able to wiggle your ears, but we can use our brain, we can use our heart, but you can actually move and you can feed, move, squeeze and amplify your muscle. And you're basically amplifying your anti-inflammatory effects.

It's going to feed back to the fat and calm it down and keep it from being in such a pro-inflammatory state. I mean, there's just on and on in the Glut4 receptor thing alone. Everyone's over here like, I'm just going to low carb until I turn into a melted candle. You know, I'm going to keto myself into, you see all these people, these, it's so cute because

you get these older couples, they're like, we went on a keto cruise and they're big and heavy and then they keto cruise themselves until they're. Is that really a thing? Is that really a thing? Yes. And they're, they come out so skinny,

or they'll GLP one themselves into the same thing and they look like melted candles. And I'm like, you guys did it wrong. You should have started with the muscle part. That's the step one. Do you think- Not to mention, what we didn't mention is muscle is this, you increase your storage capacity.

So, I mean, talk about also setting you up for the future to enjoy that glass of wine every once in a while or enjoy that dessert that you can now have because you now have this bigger storage and you don't overspill and then get stored as fat. So- Did you see the study that there was a study that showed that calf raises seeded with nothing.

This right here. Post-prandial. That's why I'm always doing that. Right after you eat reduced blood sugar. Just this right here. So literally the way I've explained it is like your muscles are like sponges. So you're contracting, relaxing,

and it's sucking up glycogen. So post meal, going for a walk, it's so beneficial. Not because the walk is this crazy workout, but you're just making the muscles move. It's stimulating the AMP K-CERT1 pathway. So you're stimulating the pathways that get the mitochondria to turn on. It's not just the muscle absorbing.

Right. Like it's not just the muscle itself doing what muscle does. It's actually the stimulation of these different metabolic pathways. They get your mitochondria supercharged. That's the fuel. It's like supercharging your engine.

And so I do think like in studies where they showed Botox would reduce depression. It's not just that there's an impact of freezing the muscles, it's the muscles of smiling or frowning that change feedback to the brain. There's a mechanism, I think the soleus muscle, which is the muscle you were talking about, same thing, it's ambulation and gait.

And so the body is potentially being signaled to do what it's supposed to do which is like let's burn the fuel. What a great observation. I forgot about that study on Botox. I also want to shout out the bodybuilder bros that had that figured out a long time ago and have been doing that forever post meal. I mean we never communicated it correctly. We never broke the science down right. But we all did it. You know what I'm saying? Like you after every meal you carry little bands around

you got a little pump with all the arms and the shoulders and all that. That's been a hack in bodybuilding for a long time. You know we know how healthy muscle is Dr. Tina. Do you think in many cases with GLP-1s with how effective they are just for for weight loss, do you think in some cases we may be fixing one problem and creating another? In other words, I don't remember how long ago it was. I want to say maybe 20 years ago, I remember there was,

they had these images of people who are normal weight versus obese and they were trying to show that overweight people don't have more muscle. In fact, many times they have less muscle. So sarcopenia is actually more common in people who are obese. And I think about the average person I trained who was overweight and also very weak. And if they just ate less, didn't strength train, that they would lose body fat, but they would also lose muscle. They didn't have much to lose to begin with. Do you think we may be causing other problems with some people? I think if it's done too high and too fast, yes.

Okay. You know, you've had Dr. Gabrielle Lyon on several times and I'm sure she's discussed how not all muscle is the same. Yes. You know, metabolically compromised muscle is really pathologic and it's marbled and it's secreting its own, it's like a little cytokine factory itself

because it's got this marbling, the type two fibers are not firing appropriately. This is why people fall down. This is why people have balance issues. It's not feeding back up to the brain appropriately. It's not doing all the awesome things we were just talking about muscle can do. And in fact, it might be doing, you know, bad things down the line. So, we don't want marbled. We don't want prime rib. It's definitely who the aliens will eat first. Just want to point that out. It's the tasty stuff, but it's not what we want. The problem is reversing that strength training will, when you start strength training, from what I understand, the muscle and the fat and the liver

start to preferentially get burned up first. And so we want to add strength training on first. I think of GLP-1s as the sweetener. I don't think you get to have this unless you're doing all this. I did the same, I used to make men sign contracts when they went on testosterone replacement therapy. Like they had literally had to sign a contract. I have to lift weights.

Yeah, you will lift weights three times a week. You will not drink more than this. I mean, I obviously couldn't, you know, I could tell when they came in if they were abiding by it or not, right? Just by the look of them. And I would pull the prescription because I'm like, you have one of two choices when you take this, you're going to go this way or this way. And I think of the same with GLP-1s. It's just not,

it's non-negotiable. It's so critical. It's non-negotiable whether you're on GLP-1s or not. Like you have to strength train if you want to survive. Yeah. And it just makes all of these interventions far more effective to say the least. And in some cases, like you're saying, can make some of these interventions not good. I mean, raising hormone levels while being unhealthy, you raise your testosterone when you're inflamed, you could cause problems in some individuals.

I just don't understand why a man would go on testosterone lift weights, that's such a dumb, doesn't make any sense. I don't know why someone won GLP ones and not lift weights. You could make the case for if a man was suffering from low libido, a drive in depression and just the testosterone started to improve that in itself, you could see somebody, I could see that. I could see somebody.

Yeah, an immediate elevation. Yeah. There's been periods of time when I'm taking HRT where I've been not training. Now the thing that's interesting, I love having this conversation, is that my body feels weird when I'm on HRT and I'm not training. And it's weird, as soon as I start lifting the weights again, it's like, I can feel it like balancing out. My estrogen levels go off,

I feel my nipples get sensitive if I'm on testosterone and I'm not training. Like it's literally, the training balances out that hormone therapy, it's wild. I've actually noticed a significant difference. Now I've just stayed consistent, but hearing that now I'm going like, you know, what I probably should have done was really tamp the dose down. If I was going through a period of not training for like, and like,

cause you're not using it all the time. Yeah. That's correct. And I, I 100% have noticed a significant difference. And I've always like, it's like a constant reminder myself, like all I gotta do is get in there and lift a little, once I start lifting it, I feel it balances right out. And if I'm not lifting, I feel, I can feel the estrogen shift in my body.

It's wild. Are there like metabolic warning signs that'll help someone identify like, okay, I'm going down the wrong path. Cause we have the loud ones, right? Like, oh, you're pre-diabetic or, you know, you go to the doctor and they're noticing these big things, but are there earlier warning signs that someone can say,

that can point them in the direction of, okay, I might need to change course here? One that's not so obvious is brain fog, but you know, well, it's waist circumference. First off, it comes down to waist circumference. And I think as Americans, we've really accepted just widening and widening of waists. And I see this in the vanity sizing of all the clothing,

even men's clothing now is vanity size. So, you know, just that wider waste acceptance that we've had, but we really can't. Like keeping, my mentor always taught me, keep your waist in check. That's key. So an easy way to do this, you can get into measurements.

I think, you know, the red flags is 35 inches for women. It's about 40 inches for men, But easier is just take your height in centimeters or inches and divide that in half. And that is your red flag. You want it below that. That's a cool little, I've never heard that. Yeah, so just take your height, divide it in half

by whatever, it could just be string. You don't have to even, it doesn't have to be inches or centimeters. And that's my red flag. I'm well below that, but that's the red flag. We don't want that. When we have the, that's why when women come in and they say, you know, I am strength training,

I am eating well, I am doing all the things, and they've got that 15, 20 pounds around their waist out of nowhere, I'm like, honey, you need hormones and let me get some GLP-1s in here to clean it up. Because going back to your muscle, the pathologic muscle may not be as obvious to people, but they'll just start getting weaker and weaker and weaker. Or they won't be able to catch themselves or right the ship as well.

So, meaning when they go to get up from a table or from a seat, it just takes a minute. I feel this too when I'm not strength training a lot. I'm just not, things are not firing. The muscles are not firing the way I want. So, I'll go to get up and I'm just not, I don't right the ship as quickly. That's that marbled muscle and that's the insulin resistance happening. GLP-1s clean that up really well too. So going back to what you were saying,

I do think giving people, don't put the cart before the horse, but sometimes we gotta give them the hormone or the peptide before they start taking action with the understanding that they will agree to be taking action. Kind of help them get off the couch essentially. Yes, get them going.

Some other ones are, and you know that's a symptom of low estrogen too, is just not wanting to move. When they cut the ovaries out of mice and rats, they go in the corner and they get visceral fat and they stop moving. So, you know, when we have our middle-aged clients and you're like, honey, I need you to do all this exercise,

I guess you don't call them honey, but you know, I need you to get going, I call them honey. Okay, honey or doll. They don't you to get going. I call him honey. They don't want to get going. It's not just because they're being lazy. It's the low estrogen is actually making them want to stop moving. GLP ones seem to help people want to get moving again

for some mechanism of it. So that's exciting. I'm not trying to sell the GLP ones. I'm just, this is where I use them in consumption. I also want to make it very clear as you're talking about them, because you talk about them and use them totally different than almost anybody else I have which I appreciate because one of the things that we're wreck we're going through this whole thing with this glp1 group and they're all using different doctors and It's very clear to me that there's this generic dose that a lot of these doctors are just prescribing

Yeah, and you have a very low and slow process that you do that I think is completely different, which is like, we can always go up, but let's start with a tiny bit. And I think, I don't want anyone to hear this, hear you doing that, we're nodding our head yes in an ingriance of like, yeah. And then they go out and just get some doctor who gives them and puts them on a radical dose

right out the gates, because I don't think that's a good idea. And there's a lot of doctors now saying they're microdosing, and a lot of clinics saying they're microdosing, and they're just starting people on the standard starting dose. Yes. And then they're doubling it. I just talked to somebody, really thin, tiny, very fit woman,

who's my age, and she's like, hey, can you, you know, check out my, what they sent me? And I was like, oh my God, are they trying to kill you on this dose? Like, that's insane. Anyway, there's a lot of folks now jumping on that word and they're not doing it the way that I'm talking about doing it. The way that I lay it out in my course is very different.

Anyway, signs of insulin resistance though, goes back to that. GLP-1s have a hard time working. Weight loss in general is difficult in the insulin resistant person. So they'll say, everything I used to do to drop the five pounds is not working anymore. Nothing's working.

So that tells me, okay, you're probably looking at some insulin resistance. There's skin signs. You'll start to get enlarged pores, which my daughter the other day, she said, you know, since you've been on the GLP-1s, your pore size is so much smaller, mom. And I was like, yeah, that's because I'm not

as insulin resistant, you know? And I was thin and fit. I was just hitting insulin resistance because my estrogen was dropping and my stress was through the roof. So different things will induce insulin resistance. Um.

Aren't skin tags? I was just going to say skin tags are another one. Some people even notice some darkening, kind of a darkening on the neck or even the ankles. We'll see that, especially people of color will start to notice it a bit more. And so the darker your skin tone, the more

obvious this may be. It's called acanthosis nigricans and they'll start to get this and they'll want to wash it off. I see this in kids. It makes me sad because I see it in kids and their moms are like, your neck is dirty. And I'm like, no, he's insulin resistant. He's going to have diabetes.

Oh my God. He has a pre-diabetic. You see that in kids? Yeah. Damn. Yeah. I'll just see it like, you know, when my daughter was younger, we'd be at soccer practice or whatever and I'd see, I kids? Damn. I'll just see it like, you know, when my daughter was younger, we'd be at soccer practice or

whatever and I'd see it. So those are some of the big ones that I notice in people. I would say that's it. And then obviously we run labs and we'll start to see, of course, serum insulins going up, blood sugars going up, their lipids get all wonky, their doctor wants to put them on statins. And I'm like, that's not the root problem here. The root problem, your hormones being low and your thyroid being low will also make your lipids crazy. So everyone's getting thrown statins and none of

the root causes being addressed at all, which is probably low hormone. And then the insulin resistance will cause further hormonal disruption. It makes me crazy when I see people online talking about either microdosing GLP-1s or balancing your hormones naturally and nobody's addressing the big elephant in the room,

which is the metabolic dysfunction. And their big solution for it is keto. And I'm like, this is not it. Do you work with growth hormone as well as part of this protocol for people? Well, we can't give growth hormone anymore, really legally. Really?

Not even longevity clinics? No, my mentor told me a long time ago, don't do it if you don't want the FDA in your office. So I listened to him. I never have prescribed it. He prescribed it back in the day, but I got licensed in 2008 and he was like, it's not the climate, don't do it. So I know some docs do and that's their risk tolerance, but I'm not. What about the growth hormone releasing peptides and stuff? I think those are great. Again, I think those are really, the dose varies for the person, for their size, for their gender, for their age, and for what our goals are,

what our short and long-term goals are, because those can quickly, you know, you can quickly overdose people on those too, and they'll blow up. They'll just puff right up and feel terrible. And so, these are, I'm really not a fan of these being thrown around and being sold just randomly on the internet

because I think that people can really screw themselves up with it. But I do understand that there's not a lot of doctors out there who are versed in this and are good at it, you know, so it's hard for the consumer to find someone to work with, but also this is, and this is just not stuff we throw mamsy-pamsy around. You know? I think that was our stance for a very long time.

And I remember when we first started hearing about peptides and things like that, we were really cautious about what we would say about or what we thought about it. And I do, and I obviously where we're at now is like, I think they're incredible used correctly under the right, our right supervision for the right person. They can be incredible, but like anything else it can be abused. But you know, you guys are bodily aware. My patients, so my, like I said, I did regenerative injection therapies. I'd have patients on the table who just had no bodily awareness.

They, I would say does that hurt? Because if I could hit it with my needle, if I could hit the pain generator with my needle, I could treat it effectively. And I'd say am I on it? And they'd be like, I don't know. I mean, they just had no clue. And so I think that when you're fit and you're active and you have an athletic lifestyle, you have more bodily awareness. You notice when a one capsule of that adrenal support versus two, whereas when someone's

really metabolically compromised or really, really down in the dumps or has a lot of way to lose, they just aren't usually as bodily aware and so they don't know. Listen, we train people for years, okay? And so we know exactly what you're talking about. Exercise in particular puts you in your body. When we would get clients, new clients,

I could talk to any trainer who's been a trainer for a long time, they've all had this experience, they'd be doing an exercise and they would say, where am I supposed to feel this? Yeah, where, yeah, yeah. Yeah, they don't know. Where am I supposed, while they're doing it with difficulty, where am I supposed to feel this? Yeah, where are they? Yeah, they don't know. Where am I supposed, while they're doing it with difficulty,

where am I supposed to feel this? I'm like, you don't feel this in the area you're working right now? This is driving me crazy. No, because they had no idea. Or I had one woman drop the, let go of the bar. Oh, hurts. Yeah, because she thought she hurt herself, but she had never felt her tricep burn.

And they don't have the ability to create tension in the body and they don't have the, the CNS isn't working with the muscles, you know? So there's just, and I think I say all this because I think that folks who are really bodily aware are better at figuring out, at least I saw this with my patients, like they know when little tiny changes in dosages of anything.

When I change something, they really feel it or not and they can give me good feedback. Whereas people who are not, are just like, I don't know, what am I supposed to feel? Whereas I take a touch of estrogen and then I take a touch more and I'm like, Oh, there goes the anxiety relief. You know, that's what I was looking for versus not having a clue and you're just slathering stuff on you or injecting stuff and not knowing. So I don't know. I say that because people who are bodily aware tend to be better at giving feedback. You also think too, it also probably, I mean, those are the same

people too, who tend to be a little more consistent with their diet, more consistent with training, more and so, and all those factors play a role too. If your diet is up and down and you intake all kinds of stuff, I mean, it's hard to tell. It's like, Oh, is that because of that thing I took? Or was it because I got shitty sleep last night or was it because the cheeseburger and french fries that I just crushed, it's really tough. Speaking of diet, you've brought up keto, low carb, and how people can abuse that.

How about protein? So we typically advocate for very high protein, whether someone wants to lose weight, gain weight. What are your thoughts on protein for metabolic health and for maybe the people that you work with? I think it's critical. I think it's really hard for some people to for maybe the people that you work with? I think it's critical. I think it's really hard for some people to get in the high protein. You know, I think that can be a challenge and I think it, not everybody has the

digestion to support high doses of protein. And so working with people who have compromised guts, that can be hard. Working with people who are older, that can be hard. They just don't have the digestive milieu to break it down. They might not even have the dentition to break it down. And so I found, I have a really cool audience of people aged anywhere between like 30 and 80. And I get messages from a lot of little old ladies

and they're just the coolest ladies and they want to strength train. They love you guys. I introduced them to guys like you through shows and they're like, I just love those mind pump guys. They're so cute. They're like, I'm 75, I'm gonna get strong. And they're so cute, but they just can't crush the fluids

and the protein and all that. And so I really try to meet everyone where they're at. And my goal always though is just start your meal with a protein and get as full as you can on that before you start stuffing in the carbs. If you fill up the gut with carbs, you're going to not get, it just all comes down to malnourishment. I just don't want people malnourished and malnourished in anything and I think a lot of people get themselves malnourished. I've been carnivore

and I malnourished myself on other things and it started to show in my face. So really, I'm all for a balanced diet, food that looks like the way God presented it, how it came off the farm, and eat a variety of it, and eat a variety of colors, and make sure that you're getting animal, I really do prefer animal protein over, I'm just not a fan of plant protein at all, I think it's, I don't know, I can't even, I just thumbs down on that.

So. Yeah, well that's what the data shows too, it's just not the easiest to assimilate, it's not as bioavailable. Right. And it's just gram per gram, it doesn't have the same effect. It's difficult.

And there's lactins, and I'm just not a fan of like beans and legumes and things like, yeah, we run into anti-nutrients, we run into autoimmune triggers. I just, yeah, just eat the meat. My whole, what I seriously tell people is like, just go for Tan and Jacked. If Tan and Jacked is your goal,

everything will fall into place. Justin's got Jacked out. You gotta get the Tan and Jacked out. Yeah, I don't have that other section. If you go for Tan and jacked is your goal. Everything will fall into place. If you go for tan and jacked, you'll spend enough time outside. You'll lift the weights, you'll drink the water, you'll get the electrolytes in, you'll get the protein in, you'll get your sleep dialed in. If you're, if you're just strength training

focused and you're just, I mean, look, I am not jacked by any means. In fact, I'm probably thinner than last time you saw just, I mean, look, I am not Jack by any means. In fact, I'm probably thinner than last time you saw me because I've been injured so many times. I, this disc herniation in June was like really, really threw me off for a minute, but that's always the goal in my head because then every other lifestyle I choice I make revolves around that. And then it all falls into line.

It's true. Jim tan laundry. Now do you? It's true. Jim Tan laundry. Yes, Jim Tan laundry. Oh my God. I think about all the time though. Jersey Shore had it right. You know why?

Because laundry is really cathartic and I love folding it. It's weird. I love the smell. It calms me down. Well you're probably using stuff that's screwing up your hormones. Oh. Just kidding. Those are testosterone blockers.

Great. He needs a little block testosterone. It smells so good. Your testicles won't like that. But like, you know, but I, I joke because anything that's cathartic and repetitive that will get people. So that's the mindfulness piece that the tan and Jacked is missing. As long as there's a mind, that's where the laundry.

So it makes sense. Do you think that hormone replacement therapy is becoming more important because we're noticing these drops in fertility and testosterone and it's just, you know, because you hear people say, well, we didn't need it back then or we didn't want to, is it becoming more necessary? Am I saying that right? Is that a good observation? I think that's fair. I also think that people are just becoming more savvy and realizing that they did need it back then and medicine was really patriarchal and it was like, you don't need, you know, just tough it out, this whole,

same thing with the GLP-1s. People just want everyone to white knuckle it. I'm like, why are we white knuckling anything? Give me the hormones, give me the peptides, give me anything that's gonna make this easier. I'm just trying to hang in there. We always play this game of trying, I don't know if there's like a silver bullet in this.

I think there's like, it's just a bunch of different things. And I would think the things that are most alarming to me is when you read the studies that show how weak we are today compared to what we were 20 years ago. And when you talk about how important muscle is and the role it plays with being metabolic healthy, I would think that that has some of the biggest impact. And then of course, the Xenoestrogens. That's the silver bullet. Yeah, I feel like that has to be it.

Muscle is it. When you think about what's going on hormonally with everybody, and that's kind of back to talking to our friend, Dr. Gabriel Lyon, like we're under-muscled. We are just under-muscled as a nation, and we're just, we're getting worse faster. And I think that has a lot to do with why HR,

it's just becoming necessary because we're not doing enough. We're not, we're not lifting weights. We're not strong or weak. We are really in a fertility crisis though, too. We are really, I mean, we are, we are not generations away from not being able to have children. We are not populated repopulating ourselves the way that we need to be, to be sustainable. And I mean, the stats are really terrifying. Oh, sperm counts are like half what they were on. I was a three or four decades ago, to be sustainable. And I mean, the stats are really terrifying. Oh, sperm counts are like half what they were,

I don't know, was it three or four decades ago? Just sperm counts. Young people just aren't even having sex. I mean, it's just, it's bad. And then I saw, speaking of fitness levels, I put something on my Instagram stories yesterday. It might still be up. It said, uh, it takes a child nowadays.

It takes them 90 seconds longer to run a mile than when we were kids. 90 seconds? 90 seconds, nine zero. I mean that's significant. That's a huge difference. Yeah. Wow. I mean that was the difference between the slow kids, the outshakes, and the fast kids in class. That's why that's a big deal. That's the difference between the kid who came in first and the kid who came in last. It's like everyone's coming in last now. Yeah, yeah. So it's last and last-er I guess. It's just bad. So we're in a pickle for sure. And I think that they're malnourished though,

you know, they're malnourished, they're under-muscled, they're just under act. It's just under activity. I love to, I used to really say like, you know, it's the strength training and that is critical, but I want people to have fun too. Like I just want people to have a spinal mobility and movement and, and eat enough to

feel juicy and have enough hormones to feel juicy and stretchy and elastic and be able to feel juicy and have enough hormones to feel juicy and stretchy and elastic and be able to do the fun things. I look at 70 year olds that are, I look at like Mick Jagger and I'm like, I want, I don't care that he's a skinny little dude, he's not well muscled, but everything he has on him is muscle and he's got great mobility.

He's so mobile, like that's what we want. We want great mobility. That's a lot of cocaine. Well, he's got a little kid too. I just saw him, his little son was dancing on the stage Like that's what we want. We want great mobility. Well, he's got a little kid too. I just saw him, his little son was dancing. No, they can still tour. They can still tour and get down like that. The fact that he has a seven year old son still that was healthy. You know what I'm saying? Like he's got some mobility. I feel like the quality or presidential physical fitness that was like the standard then you see over the years each president I know I feel like our health and our presidents

Seven or eight Wow, I used to crush the presidential physical fitness Used to be a sense of pride when I was just I'd be like, I'm going to pull up all of you. Yeah. I always feel- I'll sit and reach. Sitting and reach is what screwed me up every time. All my dude friends crushed them.

On everybody. Well, so, I mean, talk about the results someone gets when they do all of that. They come in, OK, I'm going to start strength training appropriately. I'm going to start watching my diet, which by itself, just from a trainer's perspective, has profound effects. But you combine that with balancing your hormones

with hormone therapy, that's gotta be like a turbocharger. Oh, it is, and it's so much harder without it. And then again, the potential for injury. I had so many patients that refused HRT but would start strength training, and they kept coming back getting hurt, needing injections, and I'm like, I'd really like to stop injecting every single joint

in your body. You need some estrogen. I'm not gonna inject'd really like to stop injecting every single joint in your body. You need some estrogen. I'm not going to inject you again until you agree to take some estrogen because you're just tearing everything over and over again. It's almost unethical for me to continue with these expensive injections that sometimes hold high liability and risk, you know, because they're sensitive areas like the neck and they maybe just needed some thyroid or they maybe just needed some estrogen or testosterone. So yes, it's the triad. I really think the triad for the menopausal woman, or even the perimenopause, I mean, honey,

start in perimenopause, is strength training, HRT, and then I do think that there is a place for appropriate dosing of GLP-1s in a lot of women in particular, just to keep that insulin resistance down, and maybe even men too. Men tend to, so the reason we see heart disease in men earlier than women is because you guys have that, what they call the android shape,

where you get the belly fat. Yeah, visceral in particular. Yeah, you turn into little apples first. Women, if you notice, get that shape post-menopausal, right, they go from the gynoid shape, which is the hips and the waist, and the little waist, big hips and boobs, to filling out in the middle,

and they get the male gynoid shape, I'm sorry, android shape post-menopausal-y, that's when their cardiovascular disease hits. So that's the shape we don't want. That's why you gotta get tan and jacked. You need the V. Yeah, it's funny too, you brought up waist circumference because there's like two measurements you could take

that would predict all-cause mortality really well, grip strength and waist circumference. I also read a study that correlated waist circumference with cognitive function. Oh yeah. They say like every centimeter your waist grows or every inch your waist grows and girth your brain shrinks a centimeter is kind of the… Interesting. I don't know how accurate that is. It's something I've seen thrown around at different conferences, but I would add in blood pressure though. So if a patient came in and they said, this is how I knew someone was insulin resistant. First, I would look at them and not to be judgy,

but you can just tell by looking at them. How do we look? Are we all right? When you guys all came in the door, I wish I had my camera, because you all came waltzing in. It was like that moment in Monsters Inc. when they all come in. I was like, this is it. It must have been the day. Today must be a day. We just took our walk, and we got stopped twice.

I would just be standing there like, can I just take your pictures? We attribute to Sal. Sal looks so crazy jack right now for all of us. That's because I put on Doug's shirt. That's the key, right? So my buddy always said, he's like, I just wear size mediums.

Extra medium. But if they came in and they had filled out their intake form and they said they were not strength training or they were not, I would ask like how many days, what do you do? So they weren't strength training. They had a waist circumference that was bigger than half their height. And then their blood pressure even mildly elevated.

I just knew they were, they had metabolic dysfunction, period. And of course, if they're 45 or older, they probably need some hormones. So going back to what you were saying about your testosterone, like, we just dose what they need. We just meet the patient, as I said in the beginning, you know, you meet the patient where they're at, they might need baby doses, but they need something.

And my gauge was always symptom relief. I cared less about labs. I just wanted to know their symptoms were resolved. I used labs to track and to make sure we weren't hurting anybody and to be compliant and to make sure, you know, I covered my ass and the patients, you know, we had something objective to look at,

but more important was symptom relief. And a lot of doctors, I think, follow labs and don't care as much about symptom relief, but because I specialized in pain, that's a pretty good symptom. So if I could get rid of whatever their pain was, whether it be migraines or whatever, I knew I was on the right track.

Yeah, and along those lines, there was a study that was done maybe a decade ago where they compared men and strength gains to strength training all within what would be considered normal testosterone. And what they were looking at was, was high total testosterone connected to better gains in strength? And what they found was androgen receptor density was a much better predictor. So just kind of backing you up, you could have a man with a total testosterone that's really high, but he has low

androgen receptor density compared to someone else who might have lower testosterone, but has high androgen receptor density. So it's testosterone is much more effective. So in other words, just basing off the labs isn't really good enough because they may respond well or not as well, may need more or less. Obesity crushes your receptor density.

Yeah, yeah. So, yeah, it's bad. It really messes with your estrogen receptors. So that's again why sometimes we have to get that adiposity off the body before we can safely apply the hormones or expect them to work in any way that's predictive. How do you feel about metformin?

I haven't used it much. I have not used that much. I don't know why it is. I keep hearing wonderful things about it. And then I run into- I hear both good and bad. People just, I have not found people who, the people I've treated with it

and myself personally, I've used it on and off. I just don't like it. I don't feel great, different enough on it. So I've tried it and it felt like garbage. Yeah. I just keep running into people who say that and I've had patients say that and they say, I want to try Metformin. We say, okay, we dose. And then there's other people who swear it is the Holy grail. So I know there's something to it. I really can't speak to it because I just haven't had enough experience with it

to have an opinion. But I, I just not finding people to be like, what did you try? I had a client, I tried it maybe a year ago, and I had a client who went on metformin gut neuropathy and found, because it can cause deficiency in B vitamins. I think that's why I didn't like it, because I tend to run low anyway. Okay, okay, and so they had to go off. And maybe if they've got methylation issues.

Yeah, like with the MTHFR, you know, whatever. I mean, I just think there's factors there. I tend to go really hypothyroid on it for some reason. I get really hypothyroid. Just goes to show you, you wanna work with a good practitioner. You wanna work with a good doctor because that makes all the difference in the world.

So, awesome. It's true. Like you. I'm not taking any patients. You're not. Are you done? I'm done. That's it, no more new patients?

Well, if it's by referral, that's so very cool. Okay, so if we bring you somebody, okay. I'm not taking any patients. You're not. Are you done? I'm done. That's it? No more new patients? Well, if it's by referral, that's somebody cool. Okay, so if we bring you somebody, okay. All right, good, because I might have someone to bring you. But generally, generally no. I have enough people to keep me busy. I've kept some of my favorites.

I have a big family on both sides. I have enough people to keep me active and I'm still, they call it the practice of medicine for a reason because you get to apply different things and work with people. But, you know, just, I have a whole video on my website about how to find a good doctor. And really it comes down to like, you have to find somebody who's going to listen to you

and somebody who, when you bring them in, you know, your approach as a patient matters, but bringing in the literature and being educated. And that's what my whole platform is about. That's what my Ozempic done right course is about. It's like, if you're educated, you can have a conversation with your doctor and the two of you can work together to guide the treatment. It's not just coming in

demand and not have any insight about it. You have to come with some knowledge and also you have to find a doctor who's open to wanting to learn. That's a big key to me because I think what this is really tough for a lot of consumers that like hear this and then they just go to their doctor and a lot of consumers that like hear this. And then they just go to their doctor. And a lot of MDs are only treat labs. I mean, they just look at your labs. And if your lab say that this, even though you're complaining of all these symptoms,

you're fine. Yeah. And then, and that there's, so there's a divide in the medical community. There's definitely a divide here where you have people like yourself who are like, I'm going to, you know, yes, I'm going to take it in account of the labs, but I'm really going to listen to the patient. And I'm gonna take it into account of the labs, but I'm really gonna listen

to the patient and I'm gonna try and get to- Even worse, labs look fine, let's put you on an SSRI or an Enzyolytic, because that's maybe what'll fix ya. You gotta find a doctor who lifts weights. Ooh, good one. Yeah, I like that. That's it. That's a good quality.

If they don't lift, I'm out. I mean, I'll listen to them. That's actually really good. That's a pretty good qualifier right there. That's true. It's actually true who you bring on the show. All the doctors that we have on. That's actually true.

Have we ever had a doctor that, no, we've never had a doctor who doesn't lift. No, no, never, no. I feel like the skinniest doctor on your show. You're doing all right. I lost my shoulders as my coach calls me. I don't know why I've never said that. I'm gonna start saying that to my family.

That makes for a specific qualifier. When I send them, because sometimes I get that right, I'll get pushback from family or friends like, well, my doctor said this and you told me, I'm like, well, yeah, for now I'll go, is your doctor Lyft? I don't give a shit then. You talk to a doctor that lifts and see if he disagrees with what I said. It's so true. I ended up in the ER a couple of years ago. I had pneumonia and I had like months of walking pneumonia and I was so sick and I was so skinny. And I ended up, I was so confused and tired and worn out from the coughing. I ended up taking like two different over the counter cold, I never usually take over

the counter cold meds, but I was desperate for the coughing to stop. And I took two things that I think conflicted and I ended up feeling like I was having a heart attack. And I was right at that age where like they just for women out there, if you're 40 years old plus and you feel like you're having a heart attack, go to the ER, just don't ever mess with that. And I knew that was the right thing to do and I went in and the doctor standing there was like,

my age and he was so fit, I mean he was like filling out his scrubs and I audibly said, oh thank God. Like I was so tired and out of it and I was like, oh thank God, everything's been fine. I'm in good hands. Yeah. I'm was so tired and out of it. And I was like, oh thank God, everything's been fine. I'm using good hands. I'm so using that. I don't know why.

I mean, I think that's such a great. Yeah, you jacked it down. We're fine. Well, I just, there's a sixth sense. And there's an operation system in your brain that is working when you're strength training that is not working when you're not strength training. And it's like a superpower.

And you really want your doctor to have that superpower. That's a clip right there. We're going to put that on there. I love that. Awesome. Well, it's great having you back on. Yeah, thanks for having me. Thank you so much.

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