unPAUSED with Dr. Mary Claire Haver - GLP-1s, Hormones, and Why You Can't Calorie-Count Your Way Out of Menopause with Dr. Michelle Gordon

Episode Date: June 2, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Michelle Gordon, a board certified obesity medicine physician and diplomate of the American College of Lifestyle Medicine, with surgical fellowships from the American College of Surgeons and the American College of Osteopathic Surgeons. Through her practice Thrive Span Medical, she works with midlife women across 39 states whose metabolic and hormonal symptoms have been dismissed as normal aging. Dr. Gordon opens by dismantling the calories in, calories out framework, not as a vague wellness talking point but on a physiological level. She explains why biology determines the burn rate, why fat oxidation drops by 32% in perimenopause, why visceral fat accumulation accelerates when estrogen declines, and why insulin resistance and leptin resistance make it nearly impossible for midlife women to lose weight through willpower alone. She also covers how sleep deprivation compounds all of it, creating a cycle of cravings, brain fog, and weight gain that most women are navigating without any clinical support. Guest links: Michelle E. Gordon, DO (LinkedIn) Dr. Michelle Gordon (Instagram) Dr. Gordon, Obesity Medicine (Substack) Dr. Michelle Gordon (Facebook) Dr. Michelle Gordon Dr. Michelle Gordon (TikTok) Dr. Michelle Gordon Dr. Michelle Gordon (YouTube) Books: “The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again,” by Dr. Mary Claire Haver “The New Menopause,” by Dr. Mary Claire HaverWeightless: A Doctor's Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve,” by Dr. Rocio Salas-Whalen For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Weight gain in midlife women is physiological and predictable. We know this now. The burn rate goes down and you can't out calorie, count yourself out of it. It's going to happen. It's predictable. We can work on it. Resistance training. I mean, that's the number one longevity hack and sleep and fiber.

You don't have to white knuckle through it. If you start gaining weight and rapidly the weight comes on and all you're doing is thinking about food and you're craving food. We have medication that can help now. And the other thing I want to say to the women is that if your doctor dismisses, you go get another doctor. There's a million doctors in this country. You don't have to go to a doctor that makes you feel like crap.

The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related. materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Today's guest is someone I found the way I find many of the best medical communicators. I was scrolling on social media and came across a video where she was explaining why calories in, calories out, does not work for many midlife women. Not in the vague, wellnessy way. In a physiological, mechanistic, this is what's actually happening in your body way. And I thought,

This is someone who gets it. I was watching her dismantle a medical myth in plain, precise, clinical language, and I thought she has got to be a guest on Unpaused. Dr. Michelle Gordon is board certified in three disciplines, general surgery, obesity medicine, and lifestyle medicine. She spent 15 years building and running a multimillion-dollar surgical practice, and she was good at it. Then she walked away from it because she kept seeing the same thing over and over.

women arriving for surgical intervention after years of being dismissed, minimized, and told their symptoms were stress or aging or their own fault. By the time the system paid attention, the damage was already done. She left this thriving surgical practice because she was tired of seeing women arrive already broken. She wanted to intervene earlier. Her practice focuses on weight, hormones, metabolism, sleep, and brain health in midlife women. She works with high performing women who cannot afford to lose their edge and need clinical clarity without judgment. Today we're doing a deep dive into why midlife weight gain happens, why eat less, move more, stops working,

and what GLP1 therapy actually looks like when it's done right for a perimenopausal or menopausal woman, the connection between metabolism and brain health, and what the future of obesity medicine and menopause should look like. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and a certified menopause practitioner. I'm also an adjunct professor of obstetrics in gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Why does blow drying your hair always feel like it takes way longer than it should? For most people, it's time-consuming, a little tiring, and honestly, not always worth the effort, but the right tools can completely change that.

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not like a chore. Go to launchhair.com and use the code unpause to get 20% off your first order. That's LAN. G-E-H-A-I-R.com and use the code unpaused for 20% off at checkout. So Dr. Michelle Gordon, welcome to Unpaused. Thanks for having me. I'm very excited to be here. More and more information about weight management, G-L-P-1s, and how that can all incorporate successfully into a clinical practice is one of the top requests that we get.

So our audience is super excited to have you here. Yay. But you didn't start out doing this. No. No. I didn't. You were a general surgeon? General surgeon. I like to say it was a general surgeon for 20 years because it was five years of residency, yeah. Residency. But yeah, no, I did acute care of general surgery. That's what I found I liked. And then in the pandemic, things got really weird. Yeah. And I didn't like it anymore. And I just stopped all of it and started looking at other things. So I took this time off. I was really unsure of where I wanted to be thinking I was going to leave medicine altogether. Yeah. I'm a surgeon.

Okay, we forget medicine. So I had to learn a lot. And that was probably one of the harder board exams I've ever taken. But I passed it in 2023 and then I started practicing and learning about obesity as a chronic disease was eye-opening for me. Yeah. When I was learning about obesity as a chronic disease, that was such a kind of a mind-blowing, you know, concept to me because what I had been taught in all of my training was this was a willpower issue. This was a personality disorder. This was a thermodynamics problem. My first video I saw of you that really got, maybe I've seen something before, but like the one was you debunking the thermodynamics equation to the Jimbrose on your page.

You had a quote from somebody up there and I was like, and you did it in such a great way and you used science. The problem, I think, with the thermodynamics argument is, yes, you are not going to lose weight if you're not in a calorie deficit. I have never, ever, ever said that that wasn't true. The issue is that all thermodynamics experiments, for the most part, are based on static engines. And biology determines the burn rate. And that's the difference. And a perimenopausal woman, which, you know, of course, the research hasn't really been given to women. health, so we don't really know a whole lot. But what we do know is that women are not small men.

Exactly. Very, very different biology. You talked about women showing up in your office when you were a surgeon and they were already broken. They'd missed all these windows of opportunity for intervention. What did already broken look like? Well, I was an acute care general surgeon. So people come to the ER, they're already broken for the most part. But the best example of that was a woman in her 60s who came to the ER with belly pain and septic shock. She'd lost her granddaughter about a week before. And it was obvious that something was very broken inside of her. And when I got her to the operating room, there was a clean hole in the sigmoid colon and the belly was full of stool. And she just sat there and endured it. She was obese. And she endured it because women put themselves

last. We're taught that from the beginning. And she might have survived if she, she had come earlier, right? But by the time we got her to the O-R, it was too late, that's what already broken looks like. You have a phrase that I love. I mentioned in the opening, you help women who cannot afford to lose their edge. I have the same subset of patients, I think, coming to see me.

A lot of them are very high-functioning, you know, in their jobs, in their day-to-day lives. Not all of them are employed, but they are literally managing multiple things and all of a sudden, they've lost that ability. Are you seeing the same thing in your clinic? I do. What's happening is the women who come to me are high-powered leaders, CEOs or entrepreneurs.

A lot of entrepreneurs come to me. And they're women who have always met their goals. And all of a sudden, either they're not able to think the way they used to or they're really upset because they've always met their goals and they can't lose weight. Or they lead a team. and they can't get to the edge of their brains, and their team is noticing, and they wonder if there's something wrong with them.

And we'll get into some of the specifics, but what happens with the majority of those patients in your practice? Well, usually we treat them with estrogen. Estrogen is amazing. That will help. I have one patient in my practice now who had a TBI. And for our listeners of TBI. Traumatic brain injury that she's recovering from,

and it's been a while. But I put her on estrogen within a week, I said to her just, I think yesterday I saw her, and I said, are you able to get closer to the edge of your brain now? Because that's a big problem. People who've had traumatic brain injuries just feel like everything's just right there, but they just can't get there. And she's like, you know, my thinking has cleared up a little bit. Amazing. I have another one that I saw yesterday as well who I had just started her on testosterone involved in 0.5 milligrams, really small dose, like lowest dose. She said this the first time in years, I didn't take any Advil for a week.

Wow. No pain. I was like, this is miraculous. Yeah. Because when you take hormones, when you feel crappy and you just take hormones, it does feel like a miracle. It's a, you know, estrogen in its natural state pumped out of the ovaries has this amazing anti-inflammatory property. And then when you outlive the life of your ovary, that goes away and it just unmasks so much musculoskeletal pain. inflammation, et cetera. So being able to ameliorate that in part with hormone therapy is one of my

favorite parts of my job. It's so nice to see women come back to themselves. And I don't know if you know this, but I've got survey data from over 16,000 women. And one of the things that they've said over and over is I feel like an alien is being down taking control of my body, mind, emotion, and mood. Why do I just not feel like myself? Yeah. Did you see that paper? last year. It was presented at Menopause Society meeting, which I did virtually. And it was a woman who wrote a paper called, I just don't feel like myself in perimenopause and really quantified it. Like, now we can use that as a medical term. And now I like use that all the time on social media because it's now considered a medical term that a woman has just, she doesn't feel like herself.

And that often is the first sign. Right. Let's talk about calories in calories out. Is that the biggest thing you had to kind of rethink through once you left surgical practice and got into lifestyle and obesity medicine? I wouldn't say it's the biggest thing I had to work through. I think what really brought that on for me was posting on social media and seeing the pushback from Jimbrose more than anything else. I've been through this exact arc. You know, talking talking about lipotoxicity and how obesity is a disease of inflammation. And when I was on TikTok and posting, I would post like a text post. and I had to turn off comments. They were so awful.

Just put down the fork, bra, thermodynamics, bra. And so it makes for a real easy way to attack the standard that men think about. And then when I start to get into the conversations with the people who actually watch my videos, this is for the women. Women are not small men. And we've been treated like small men our whole lives. or like we are a servant to men or they're for men's pleasure only and what we think and who we are doesn't matter.

Right. I also had to learn how to really believe women and get out of the bias and that was kind of built into the system of women tend to just be emotional. I mean, and I was taught that women tend to somatize psychological problems. It's not clear if it's not on the checklist that we gave you, then, well, she's... just a little bit crazy.

Now, what did you say on Mel Robbins, a whiny woman? Wynie woman. I mean, that was my intern year. The W.W., well, she was Caucasian, so it was a W.W. Wynie White woman. And so they'd coded in it, because we still had handwritten charts, that's how old I am. Right. It was like a little W.W. And that was like a little signal that she's midlife. She has multiple vague complaints. You can't put your finger on it. Labs look okay. She's still having a few periods. Like, she's not menopausal. We did not have a framework in how to treat this woman.

Right. And it didn't matter. It didn't matter because it was a woman. Yeah, exactly. And I think the biggest problem is that women dismiss other women as well. They do. They do. I see, you know, in the comments in social media a lot, there's a lot of blaming of male clinicians. We've got some great male clinicians out there. And this is not a gender issue. You know, sadly, I was one of those females who did tend to dismiss when I couldn't figure it out. Well, it must be something. psychological, I'm missing, until my patients and I all got to that age and I'm like, all these women I hang out with outside of the office are not crazy. Like, I know them. I shop with them. We run together. We have mommy groups. You know, they pick up my kids when I'm running late at the hospital. Like, she's not crazy. Like, this is real. Yeah. And she's not gaining weight because she's constantly going through the drive-through. Right. And I think women are not believed. Like it's a, it, women and girls are not believed. I mean, it's more of a systemic problem than just in medicine.

Oh, totally. You're in there fighting, fighting the good fight in the clinics across from the patients, day to day, seeing the success, seeing the new tools available to patients, you know, and really helping change your patient's lives. Right. But, you know, you don't have to fight this battle on social media. No, but I, I'm trying to reach the woman who has been dieting since she was eight. What do you want to tell her?

If she can't drive to northern New York and come find you. Well, I have a virtual clinic. And I have 39 licenses so I can treat a lot of people. So here's the thing. The metabolic chaos that goes on in women is just very different. And obesity has its own set of inflammatory markers, inflammation. And the woman who has been to the doctor and the doctor just says, eat less move more.

Yeah. Why does this fail her? Because she's already got so much inflammation that fat oxidation isn't happening the way that we would expect. I mean, even in pari menopause, you must know this because you just wrote the book, but in pari menopause, fat oxidation goes down by 32%. Right? So a woman who does the same things, exercises the same, or even starts doing more, will

gain weight because hormones. Right. And that's where put down the fork bra doesn't work. We have to work on the resistance. We have to work on insulin resistance and leptin resistance. And the brain will pathologically cause someone to feel more hungry through parimenopause. Yeah. So what is insulin resistance?

For our listeners who may not understand, it's a term being tossed about quite a bit now. Yeah. So it's a really interesting problem. It's not something that you're born with, although there are some genetic predispositions. But in midlife women, estrogen is responsible for how the body responds to insulin, right? And I can't imagine because you just wrote that book. And you must have read so many papers on how insulin and estrogen interact. Yes, less than you would think because when you look at the volume of research around perimenopause,

I have to kind of look at the postmenopausal data and make inferences backwards. Wow. that's frustrating. But maybe we'll get some more than 11% of the NIH budget for women's health. We'll see. We'll see. Maybe. So what happens when estrogen declines is there's more visceral fat accumulation. So fat moves from around the hips to visceral, right? And that becomes. And for our listeners, visceral intra-abdomal cavity. So inside our tummy or what we call belly fat. Right. Well, we also have, remember, we have the omenum. Yeah. Right? And the omentum's job is to clean up in the abdomen. And I can't. I can't tell you how many times I took out an appendix and had to do a partial omenectomy just because the momentum was doing its job. And that gets bigger. The momentum gets bigger, the mezzanitary, which is the fat. Between our bowels. Right. Well, it's where the blood vessels are living. That gets bigger. And then, of course, anything around the organs.

But when we talk about visceral fat, I think we're mostly talking about increased volume of momentum and mesentary. But that's active endocrine organ, right? And so it starts releasing some information. inflammatory cytokines, and then with that, the fatty acids go up. Fatty acids go through the portal vein in the liver, which is where most of our blood comes back, right? And there's a reaction there that causes us to have less sensitivity to insulin because of the increase in the fatty acids. It's not all sugar.

You think it would be all sugar, but it's not. And that's where, you know, the biology is just so complex. as the pancreas tries to adapt. As the sugar goes up, it puts up more and more, but the body doesn't react as well, and that's insulin resistance. And then you mentioned leptin. So what is leptin's a hormone? Yeah. And what does leptin do? It is responsible for satiety. And satiety is feeling full.

Feeling full. Yeah, it's the thing that makes you full. And we know from bariatric surgery studies, right, that leptin resistance goes down with bariatric surgery. And Grellin sensitivity goes. Grellin is the one that makes you feel hungry. Yeah. And that sensitivity goes up in bariatric surgery. We have lots of data on bariatric surgery. But we don't have enough on weight loss.

In people who lose weight, the hormonal changes don't last. We don't have the data. We think that maybe five years staying at a lower weight, maybe. But the body always tries to go back. Yeah. That is survival. And so we're fighting against survival and the way that we evolved. In bariatric surgery, yeah. And not just bariatric surgery in any time you want to lose weight, right? Bariatric surgery is really interesting. I almost became a bariatric surgeon. I studied bariatric surgery and decided I didn't want to do it because I thought the relapse rate was too high. And now I understand why. I never understood why until I started studying obesity medicine. And bariatric surgery, about 25 to 35% of patients will regain.

Yeah. Most won't because there is a permanent hormonal change that happens when you permanently change the anatomy. But bariatric surgery comes with its own problems. Yeah. I've had a lot of post-bariatric surgery pregnancy patients and they were complicated. We managed them, but it was, you know, it creates a different body. Right. And that creates its own set of complications to deal with, especially when you're dealing with

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That's just the way it is. So when somebody loses weight, right, it's a patient who loses weight will lose about 10 to 15% of what they lose will be muscle. The data show that a patient on GLP1 will lose just maybe a little bit more, 20 to 25% max. Now, we have, if you watch social media, oh, 40 to 60% of the weight you lose is muscle. that's not true as long as you make sure that the patient is eating enough protein. And weightlifting is an adjunct. Protein is the number one, which I was really surprised about. I was at Obesity Week 2025 and there was a paper that was presented about weight muscle loss specifically with somaglite. And that was for every 10 kilogram of weight loss, it was 2 to 2.5 kilograms. So it's not as much as we thought.

Yeah, up to 25%. You know, our patients in perimenopause and menopause, we see a doubling, sometimes tripling of sleep disruption. Sure. Of sleep disorders across the transition. How is that affecting her weight potentially? Well, as you know, in perimenopause follicle stimulating hormone increase, right? And that disrupts sleep. But I hear from these women in my practice who are waking up 10, 12 times a night. I have a woman who, she had an elective hysterectomy, total hysterectomy because her mother had breast cancer. It was never given hormones. And she didn't have breast cancer. And I've just put her on hormones. and her sleep is improving, which is crazy because she's never had a good night's sleep since that time.

But what happens with sleep deprivation is it leads to brain fog. Then there's worsening insulin sensitivity. Okay. And this, then because of loss of sleep, there's cravings. Yeah. Right? You don't have a choice. This is all like subconsciously wired.

And the brain will preferentially go toward high, calorie foods. Comfort foods. It could be fats. It could be carbs. But a lot of times the brain runs more on carbs, so it can, you know, chips or whatever. But the cycle with the cravings can lead to weight gain. But then you also, when you throw perimenopause in the mix and the decreased fat oxidation, you know, it's with decreased sleep, decreased sleep leads to brain fog. Okay. I mean, it's just. You just end up in a negative feedback cycle. Oh, it's terrible. I describe it as a traffic circle going the wrong way around, you know, where where you've got sleep, got loss of hormones is kind of in the middle and then that affects your sleep, which affects

how you store fat, which affects your hunger. It is nearly impossible to break. Like, if a peri-menopausal woman eats the same and works out the same, her visceral fat level will double to triple with doing nothing different just from the hormone changes and all the downstream dominoes that fall. Right, but it's calories and calories out. Yeah. Calories are important, bra. You know, it's not the only thing. It's not the only thing. I have a daughter in medical school, so I'm seeing what the new kids are being taught. They're definitely treating obesity as a chronic disease. Great. Yes. They are, they are not stigmatizing patients with, you know, high fat levels nearly as much as I was kind of taught to do. But I think we have a whole generation of physicians still practicing who are struggling to get that

message. Were you seeing this in your clinical practice? By the time my patients get to us, you know, and they're primarily coming for a menopause, but many of them are struggling with weight. And so once we kind of tend to their menopause, then we'll start introducing GOP ones into practice. So, I mean, women who come to me are women who have either been mismanaged or have gone to an online place and gotten medicine and then, you know, weren't really just kind of left to their. No body composition. Yeah, yeah. And so when they come to me, they, most of them are usually on a GLP one and have been since they were eight. So it's a much more difficult metabolic picture when I'm dealing with. Let's talk specifically about GLP1 therapy. Okay. And I get this question all the time on social

media. Is it okay? Like they're asking for permission for me to use a GLP1 for my menopause waking. Depends. So who's a good candidate? Who's not? So the guidelines are as follows. BMI. I know BMI's trash, but that's what we have, of 27 with a comorbidity, comorbidity, including high cholesterol, sleep apnea, high blood pressure, pre-diabetes, diabetes, for the most part. So that's BMI or BMI of 30 or higher. Okay. Those are all candidates for GLP. 21. Right. Or 30 plus. There are some guidelines to say 25 plus one. For me, it really depends on the patient. Same. Let me tell you who GLP1s are not for. Please. Okay. They're not for. They are. They are. are not for someone who wants to lose 10 or 15 pounds for a wedding. They're not a temporary fix.

Obesity is a chronic relapsing disease. There's no world where we would tell someone, hey, you know, you can take this asthma inhaler for two times and then you've got to get off it. We've got to get you off it. And so the biggest issue is changing the narrative around what obesity really is. And even if it was behavior that caused it, it's still there. It's still active endocrine organ that is causing inflammation throughout your body. And so what I love about GLP1 is it makes it so that you're not hungry when you're trying to starve. I mean, you don't have to fight against your biology to get to a normal weight. I'm a GOP1 patient. Yeah, yeah. My patients talk about when they go on a GOP1, something unlocks in their brain. Did you feel that?

I don't know because I had been on a weight loss journey. I mean, at my highest, I was over to 20, okay? I'm 5'6. I gained weight with pregnancy, was never able to lose it, right? So I gave birth in 1993. My son's going to be 33 next month. And I was never able to lose it. I would exercise my butt off and get down to maybe 15 pounds,

everything where I am now. But then I just couldn't maintain it because it was, you know, it was restrictive and so much exercise. And then I went into surgical residency for getting it. Right. So for me, I was on a journey working with a coach, losing weight, doing great, tracking my food. And then I got bored in obesity medicine and started treating patients. Six months into treating patients, I went to Obesity Week.

And one of the presenters said this about terseppatide specifically. It prevents diabetes. It prevents 10 types of obesity-related cancers. It prevents, we think, Alzheimer's. It has longevity benefits. And for me, that was the click. It's like, oh, I don't have to really fight with my body. I'm going to try this.

I'm going to try it as an experiment and see. And so I started in December of 2024. I mean, I didn't lose that much. I also didn't go to the max dose. So I stayed at 5 milligrams for a long time and went up to maybe 8.5, 9. But I got down. And is this is smaglutide or? No, Toursupit.

30-ish pounds. Okay. I'm my pre-pregnacy weight. I haven't seen this weight since 1992. too. So for me, the biggest thing is I don't have to worry about what I eat. Yeah. Other than the protein. Like I got to make sure I get into protein. You clear the brain space. Yeah. I mean, I still track. I still make sure I eat enough or don't eat too much. So you have a patient coming in, decide she's a good candidate. Yeah. You know, for her, GLP1. Walk us through what the options are.

What's available commercially right now for you to prescribe to a patient? What are the differences in them? How are they given? Okay. What is currently available? We have laryglotide. I don't prescribe it. It's a daily injection. It's sexenda. Same thing, right? It's GLP1, but it's daily. Decent weight loss, 12 to 15%. Not bad, but it's a daily injection and that will cause needle fatigue fast. Okay. We have somaglite. Good drug, high side effect profile. For example, what are the side effects? Nausea, gastrointestinal. That's the biggest one. That's what we see in our clinical practice. to a very, very high side effect profile. I do find, though, that men tolerate somagletyde better than women. You don't treat men, right? No. Yeah. So in the men, men, I will always start on somaglite first.

And then if they don't tolerate it, I'll switch them. But women don't tolerate it as well. Because we're different. We're not small men. Turns out, right? We just through trial and error have now pretty much exclusively do tersephotide. Yeah, yeah. Just to avoid the side effects.

Our patients tolerate it better in general. There's a few that come in on it, want better management. They're happy with it. We keep them on it. But if we're doing a new start, we're pretty much doing terzapetat. Yeah, I really like terzapitide. I started with terzapitide. I never had any major side effects.

I get a little bit of nausea. I'm very careful about constipation as a surgeon especially. So my cocktail for constipation is magnesium oxide. Some people do better with magnesium citrate. But for the most part, if I have a patient, patient who says that they're constipated, it's magnesium oxide. And it works. It's great. It might cause some diarrhea in the morning, but it's a lot better than being constipated in my opinion. So somaglotide will come in 0.25 and now up to 7.2 milligrams. I haven't prescribed 7.2 yet,

but it's like a huge jump. It's from 2.4 to 7.2, which I don't know how I would never want to do that. I would want to step somebody up. Yeah, start slow. But I don't know. I haven't talked to Norvo, so I don't know how to step somebody up to that, but I'm pretty sure you can go from 2.4 to 7.2, which seems scary to me. Wow. Yeah. What about terseptide? How do you dose that?

So terseptitide is 2.5 to 15 milligrams. Another big jump. Yeah, yeah, but you dose it small and slow. I love using vials. So do we. Okay. I like having that ability to control the dose. Yeah.

So there might be somebody who can't take it. get 2.5, they just get too sick from it, and we'll start them on a much lower dose. The Zetbound vials come in 50 units per vial, and so we might start them on 20 units or 30 units instead, and work that way. I have very few patients who are on max dose of terse appetite. It is never my goal to take somebody to the max dose. I want to get somebody to the dose that works where they're feeling good, able to live their life and losing weight, of course, but we don't want to lose weight too fast. Right. What happens? The data tell us that if you lose weight too fast, you're at risk, especially for women, more osteoporosis and muscle mass loss. I mean, we know that from bariatric studies,

that there's a lot more muscle mass loss in rapid weight loss, so we don't want that. And also, with rapid weight loss, there's the gallbladder risk. Yeah. Galstones, acute colisestitis. So how do you count? So you get these patients and we decided to use a good, good candidate, you pick the medication, you start her on the dose. What other counseling are you giving her? Oh, well, about the medicine specifically? Well, about lifestyle. Lifestyle. I'm your patient. Walk me through this. So we're going to talk. So I have my shots. I'm ready. Yeah, no, you don't have your shots yet. We're going to find out what your history is first. What is your relationship to food? What is your lifestyle like? Why is that important? Well, because if you're somebody who has always been

afraid to eat a carb, we're going to talk about eating carbs. That's really important. I'm really big on understanding what somebody's relationship is to food. You know, some patients in my practice who won't step on a scale. They just want to base it on how they're close fit. That's fine. I think it's very important to meet patients where they are. We're going to talk about how your sleep is. What's your sex drive like?

What's your mood and motivation? How willing are you to partner with me in helping you reach your goals? Right. And then what are your goals? What do you want? And how fast do you want it? because is it realistic to think that you're going to lose 20 pounds in a month? Those are really important things. So I need to get to know you. And we're going to talk about protein.

I say the only thing you have to track is protein. That's all I care about to start. Okay. How much protein? The data say one gram per pound of ideal body weight. Almost nobody can get that. So yeah, like that's a lot. For example, if you're 120 pounds ideal body weight, 140 pounds, that's 140 grams of protein. Every single day. And most women are in reality eating 50 to 60. Yeah. Maybe. Yeah. And that is so like more than doubling, that is a lot of protein. How do you, how do you teach them to scale or do you teach them to scale? Well, we, again, you have to start people where they are and we start finding high protein foods, right? The only thing I care about is getting 30 grams of protein in the morning. I don't care about timing, but I want you to get 30 grams

of protein in the morning. Why? Because that's going to keep you full and it's going to fuel your brain and it's going to help you get through the day. That's the number one thing. And it's funny because when I have patients who start doing that, they're like, oh, I feel so much better during the day when I do that. Yeah. Right. And I've seen videos that you did where you're like getting 50, 60 grams of protein first thing in the morning. I like efficiency and I'm a very busy girl. And so I've concocted the shake that I make that hits so many of my nutritional goals at once. So we tell patients to track their protein and their fiber, okay, for satiety and all the health benefits. So the shake has a scoop of protein powder, of course. It has Greek yogurt. I have no dairy issues, and that gives me

another 20 grams there. I have a, like, hemp chia flax, you know, mix that I throw in there for omega-3s. The Greek yogurt also has probiotics. You know, I put an extra scoop of fiber, and I do put a little collagen that's a specific for skin and bone, which we create. And so, you know, I put frozen berries for anthocyanes and, you know, vitamins, minerals, nutrients, and fiber, and shake that whole thing up and add a little water because the berries are frozen. And it's delicious. It's probably 700 calories. And it is 700 calories. And but it has 50 grams of protein-ish and probably 20 grams of fiber. And it takes me three, four hours to get through it. So I take it down to the gym. I get my workout in. And then I work on the treadmill on my walking desk and take all my Zoom calls for business

there. And, you know, that's my morning. That gets me till noon 1 o'clock. And that is how I start my day usually when I'm at home. That's great. I usually tell patients that, you know, they have to start tracking their protein. I do tell them 25 to 45 grams of fiber, but that's, that's hard. It's hard if you've not done it. So I, but you have to really ramp up the fiber slowly. Oh, yeah. If you wrap the fiber too fast, you're going to have, you're going to have the scoots. So we don't, we don't want that. But what, what I do is, is if they really have a hard time eating food and getting protein in from real food, then I say, let's say, let's, let's, you know, Let's find a powder that you like.

There's some clear protein powders you can put in water. There's just a lot of options out there. And there's more coming. Yeah. I like Greek yogurt. I do too. I like the Oikos protein shots, the 10 grams of protein and 60 calories. I usually have a couple of those in the morning.

And I'm also a big sourdough bread fan. So I make my own sourdough. Oh, for probiotics. Every morning I'll have a slice of sourdough bread and some and some like kefir kind of thing. And that'll get me to 25 or 30 grams of protein. Awesome. Okay. So what about do you prescribe hormone therapy?

Yeah. I do. Yeah. The combination seems to be magical for my patients, GLP1 and HRT. And the data backs it up. There are good studies now showing both for some agglutide and transepatide that the patients on HRT plus one or the other will lose more weight than on the medication alone. Well, yes.

On a GLP one alone. And women lose more weight. on a GLP1. When they pulled a couple of metal analysis and the data show us that women lose more weight than men on GLP1s. Probably we're thinking because of estrogen. But yeah, I do prescribe them together. But not always. Some women come to me and just want to see if they feel better and see if they can lose weight on hormones. I think it's very important to meet patients where they are, like I said, and we have to know what their goals are, right? So part of evidence-based care is based on the patient's wishes.

And if the patient isn't ready to start, that's fine. Yeah, we don't start them together. We almost always start hormones because we're a menopause clinic. And then see how they do. And there are a few patients who, that's all they needed. And that with lifestyle, they're doing great. Why add something else? That leads me to the next question.

This is all controversy, but I see it constantly on social media. Microdosing, giving GLP-1s to patients who don't have a weight, problem for the anti-inflammatory benefits? Where do you stand on that? Well, it's not something I practice. I think that it's an area of study. I think that there's a lot of benefit for people with say rheumatoid arthritis, for example, who would take a small dose, maybe a one milligram of tersepatide and find that it really helps. It's we just, it's like, it's like any other drug. Let's say you were going to take surmoralin, for example, right? We have no data. And so I can't in good conscience And for our listeners, Marlon, is the growth hormone.

Yeah, it's a growth hormone analog. You can get at, you know, functional medicine clinics and that sort of thing. There's a lot of untested peptides that are kind of getting hawked by people on social media, BP 157 and the CHU. We don't do any of that. No, no, no. I don't either. I have worked for, you know, some big telehealth clinics that do sell that stuff. And I won't prescribe it because I have not seen the data for.

for it. Yeah. There's just no data. So why would I want to be a party to an experiment that isn't being controlled? There's no human data. There's none. It's very, very, very sparse. But to be clear, GLP-1s are a peptide. Insulin is a peptide. Yeah. Like we use peptides that are studied in humans and show benefits. Absolutely. I'm not against peptides. I'm against unstudied peptides that haven't been FDA approved. This episode of Unpaused is brought to you by Alloy Health. We talk a lot about hormones affecting mood and energy, but they also play a major role in your skin. Collagen, hydration, elasticity. And in midlife, when hormone levels start to shift, your skin changes too. I first heard about Alloy through a close friend who is a dermatologist.

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Do you have a general panel? Do you wait until they get there? Yeah, I do, but I don't delay treatment. for labs. I usually will, you know, meet with the patient. I'll see what their needs are. Again, remember, most of them are already on a GLP1. Some of them may not be on hormones, but they're on a GLP1. So I get baseline labs. So a good portion of my patients have had bariatric surgery. Okay. And I've had regained. And the problem with bariatric surgery is many patients forget that they had it and get lost to follow up. And anyone who's had bariatric surgery is not matter which kind, right? You had a VSG or

you've had a Rui or a duodenal switch, you are at risk for iron, thiamen, all the bees, and if you get tingling limbs, you probably have a B vitamin deficiency. And so it's really common for somebody who's had a regain to come to me and say, you know, I want a GLP1 and I'm like, but are you taking your bariatric multivitamin? And they're like, no. So that's important. So I test for micronutrients. I only do that once.

I'll do cholesterol, you know, basic stuff. And then usually... CBC, so blood count. Basic metabolic canal. Fasting insulin. The other thing I do is inflammatory markers. Which ones? CRP, HomoIR, that kind of thing.

And then we work on it. Yeah. And of course, DeXA, but I don't require, usually the labs and the DeXA. And so for our listeners, DeXA, is a bone density scan, the DeXA scan. Yeah. Do you do any body composition measurements? In the office? Well, you do a lot of virtual.

Yeah. So how do you do West. No, I use DeXA. You use Dexa. I think it's the gold standard. It's a gold standard, yeah. So I use Dexa, and that I do within three months. Some patients that come to me have already had it, and then we just follow.

And then I'll do one every three to six months, depending on the patient. We try to standardize it, so they all come in fasting and do their bladder before. You know, we try to get them in eight-hour fast. They have a similar baseline status between scans. Sure. And we don't, like, hang a solid number on it. We're just looking for trends. What does inform consent look like?

Well, I have a big contract I sent to the patients that I paid a lawyer to make, right? Yeah, I mean, we have to, right? But informed consent for GLP1 specifically. So we talk about a few things. The number one thing I tell patients is that we're treating a chronic disease and that this chronic disease is something that we have to treat for life. So I look at GLP1 as a forever medication. Not something that we're going to talk about coming off of, not that I won't talk to you about it. but if you do decide you want to come off it,

we're going to monitor very, very closely. It's not going to be like, you know, I'm going to let you come off and send you off into the void by yourself. But we talk about common side effects, nausea, vomiting, diarrhea, constipation, abdominal pain. It usually happens when you titrate too fast or if somebody's like a super responder and doesn't tolerate the starting dose, which can happen.

Yeah. Then there's some other things that we have to be careful for. about and explain if somebody's had a history of pancreatitis and not gallstone pancreatitis because usually gallstone pancreatitis is resolved after surgery. Yeah, once you get rid of that gallstones. But for somebody who's had an idiopathic pancreatitis, then we have to be cautious. Somebody who's had gastroporosis, cautious, right? And then I do warn patients that if they get blurry vision to discontinue use and go see an

ophthalmologist right away because there is. is a type of neuritis that's been linked. I'm not sure, but enough, enough that I've had a couple of patients with blurry vision that I sent to ophthalmology. They were fine, but just to be careful. Right. So those are the things I really talk about. bowel obstruction is something else that can happen.

And I haven't had a patient with any of the major side effects, but the rodent studies showed that bowel obstruction can happen. And then we have some absolute contraindications. Pregnancy, breastfeeding, absolute contraindications. We don't know what this does to a fetus. Yeah. Right. So, I mean, I've had plenty of patients who got pregnant while they were on it,

but it's not a fertility tool that I would recommend. We just don't have data. So we want to never do it. And if you're breastfeeding, it's a big no-no. If somebody wants to get pregnant, I tell them stop two months before. It's got to be out of your system. Because the half-lip is five days. That means it's still in your system 30 days later.

Yeah. Right? So we want to make sure that it's discontinued. And then when you're done breastfeeding, if you want to get back on it, then come on back. Most of my patients are done having children. I mean, let's face it. Right. So we're mine.

Yeah. But then other absolute contraindications include family history of multiple endocrinealasia type 2. With that comes something called medullary thyroid carcinoma. Other thyroid carcinomas. not a contradiction. It's the medullary thyroid carcinoma, and that only showed in rat studies or rodent studies. We have not seen it in humans, but it's enough to make it, and MEN 2 is really rare. Yeah, I've never seen a patient with it, but I've read about it. I know how to answer the question on the test. Right. That's why longitudinal care and having a relationship with a physician

makes a huge difference. So somebody who's willing to look at the big picture, and make sure that you're eating enough protein and that you're going to the gym. Or, you know, it doesn't necessarily have, some people hate lifting weights. And I've had some patients say, every time I go to the gym, I get angry, right? So we have to find something that you will like to do because the best exercise is one you'll do. If you hate it, you're not going to keep doing it. You're just going to be fighting yourself. Do you counsel someone differently if they have low bone density versus neural bone density?

You know, it's not something I've had to treat yet. So I will say that, you know, somebody with low bone density, I mean, I usually send them off to a specialist. That's not my area of specialty. It's rare, you know, sarcopenic obesity. I don't see a lot in my clinic because we do the body scans, but it's the thinner patients that are struggling because the heavier body that they had, that was actually protective because their bones and muscles were working harder for the heavier weight that they were carrying around.

So I don't see so much of that in the obese patient. There's a few things you have to work on from a lifestyle perspective. Okay. Right. You've got to work on the diet. you've got to work on the movement. You've got to work on the self-concept. Self-concept is huge when it comes to obesity.

Remember, a lot of women will gain weight because they don't want to be noticed. And then what happens is they realize that it's not healthy anymore for them to do that and they want to lose weight, but then they start to get noticed again. And if they've had any sort of trauma in their life, that can be triggering. So getting the self-concept, and usually I'll tell a woman who, is at the beginning of her journey to get used to how you look in the mirror and start really loving who you are now. There's a lot to that,

working with not hating the person in the mirror. It's a lot easier to get yourself to do something when you're not hating yourself. Yeah. The number one patient stop is gastrointestinal side effects. So we talked a little bit about constipation and magnesium oxide, you know, to help manage that. What are you backing off on?

dose, like how are you managing some of these other symptoms? Well, I use your appetite first of all. That's the number one thing. But I usually find that if somebody has a lot of nausea, that's usually acute to back off on the dose a little bit. Most of the time, if it's really bad, we can't give them zofran. Just remember the zofran's going to make any constipation worse. You're going to be careful. But also, ginger.

Ginger works. It's the nausea, anti-n nausea, natural. For nausea. And so I usually say, start with ginger. Let's see how you do. and kind of move from there. And when I was working for the big telehealth clinic, I probably had 15,000 some odd interactions,

and I wrote maybe 20 Zofran prescriptions. How often are you following up on your patients? Like how often are you monitoring? What does that look like? So you get them started, off they go. When do you see them back? It's a medical partnership, right? So in the beginning, I see them a lot.

Okay. About weekly. And then as things start to stabilize, it'll be every other week, but never less than once a month. So once they reach their goal weight, what do you do? Do you take them off? No. It's a chronic disease. Do you back up on the dose? It depends. My philosophy about these medications is they're a lever, right? If you're a woman who wants to gain muscle,

then we've got to back your dose off so you can eat. Because if you don't eat, you're not going to build muscle. It's really hard to build muscle when you're in a caloric deficit. That's almost impossible. It's really hard. And so I tell women, look, here's what we're going to do now. I'm going to drop you down to a lower dose. You're going to be hungry or maybe, and you're going to lift heavy. And then once we've done that build phase, maybe three months, let's do a cut and we'll raise your dose and watch. This is exactly what potty builders do without it. Yeah, that's how they get ready for competition. Yeah. For patients who are not losing weight on a GLP one, does that ever happen? It can. About 20% of patients lose less than 5%. Wow. That's what the data

show. The thing is, is that that doesn't mean that it's not working, that it's not doing things behind the scenes to regulate blood sugar or even, even give you cardiovascular benefits. I mean, that was the biggest takeaway from the select trial, but it's just what came to my mind is that regardless of weight loss, there's cardioprotective benefit. So you mentioned the select trial. Tell us, tell our listeners in lay terms, please, a little bit about it, and why it was important. Yeah, so they looked at cardiovascular benefits with somaglite in particular. And I think the biggest takeaway is that cardiovascular benefits are there regardless of weight loss. Wow.

That was my biggest takeaway from it. Cardioprotective, regardless of weight loss, patients in the trial with less than 5% weight loss still benefited. Wow. That's huge. What are those benefits? Like what would that look like? Were they measuring, I don't know, cholesterol? No, 20% lower major adverse cardiovascular events.

Oh, so they were just looking for heart attacks. Yeah, but they only enrolled people who already had cardiovascular disease. Okay. So we don't know what it's going to be. be like in terms of cardio protection. So someone who had had a heart attack or had died, you know. Yeah, somebody, anybody that already had it, and it was a 20% reduction in major adverse cardiovascular events. And so because of this trial, this is when the American College of Cardiology said we have to treat obesity first. That is what brought them around.

That's amazing. That's what brought them around to saying that obesity is a chronic disease. Because before that, it was all, you know, bro science. But I think, I think also it's really important to going back to select is that we don't know what all of the anti-inflammatory benefits are of this medication. I give you that. And so what we can say is that obesity is inflammatory disease, hypertension is and inflammatory disease, diabetes. So if we can mitigate that inflammation, we may see a decrease in chronic disease across the board. I agree.

Okay. Let's talk about weight regain data. So people stop JLP once, they gain the weight back. They do. In the first year, it's two-thirds of the weight they lost. So that's why we don't stop. Just like any other medicine, what happens when you stop taking insulin when you're diabetic and you're insulin dependent? The reason why I love this data is because it is the biggest evidence we have for obesity is a chronic disease, a chronic relapsing disease, that when you stop the stimulus, the weight comes back. And some people are able to stop and maintain. Yeah, I have, but not many. No, I don't know what the data are, but I can say that for the most part, the brain will take you back. Because GLP1 works not just on, you know, not just on the stomach, but it works on the brain. Let's talk about that because I think our listeners are really curious. How does this medicine work?

So where in the brain is it working? It works on dopamine signaling. Okay. So there's this thing that can happen with it that's not truly a side effect because it hasn't been described enough called anhedonia. Yeah. Have you seen that? A couple of times. Yeah.

Yeah. So I call it the I Don't Give a Shits. Loss of joy and daily things. Yeah. So like a patient's complain, you know, I've lost my libido. I don't want to go shopping. I'm not depressed, but things aren't making me happy anymore. Right.

This is where I think that there's a good amount of research potential in addiction for these medications, especially at higher doses because of dopamine signaling. But if somebody. gets all of their dopamine from food. And I was like that. So when I first started, I was like, why do I feel so crappy? Why do I just like, ugh? I don't know how else to explain.

It was just very blah. And I realized that it was because I wasn't able to get that hit from food. I just had to change the story about it. And then I was okay. That was fine for me. But that's not going to work for everyone. I'm somebody who spends a lot of time constructing stories to make my life mean something. And so when I changed the meaning,

because I knew the medicine was working. I had to work for me, so I had to change that story. But there is that problem that some people just really feel crappy on it. And that, to me, is a signal that we just got to dial it down. And when it comes to weight loss, you didn't gain weight in three months. Why expect that you're going to lose all the weight you gained in three months? I think it's very important to remember that we are treating a chronic disease and we have to be patient.

It all takes time. Let's move on to sleep. Okay. So my patients complain so much. And for me, I have to protect my sleep with my life. Sleep is important. With my life. I can't take it for granted.

I can't expect to be able to have alcohol and sleep the same. And my little mean ring tells me, you know, like there are things like when I have caffeine, when I work out, like all of this will affect not just the hours I'm sleeping. but, you know, we had a couple of sleep medicine specialist on recently who really talk about the architecture of sleep. So what are you seeing in your clinical practice for sleep and your patients? Well, oftentimes I'll see patients who have not, you know, they're perimenopausal and they're not sleeping. And, you know, those patients are usually pretty easy to treat because we give them progesterone and they can sleep through the night, right? Again, it's increased in

follicle stimulating hormone and then the sex hormones decrease and the sleep architecture just gets all messed up. But, you know, again, one to 12 times per night, the sleep deprivation then leads to the brain fog where difficulty finding words and then cravings and then weight gain, and then it's all back to that whole cycle again. Yeah. Are you finding that GLP-1s are helping with sleep at all? Some patients find that they help with sleep, but some paradoxically find that they don't sleep well if they take it before bed. It's so individualized. Right. So if you have a patient coming in and her main complaint is brain fog. what are you thinking?

Is she obese? Sure. Okay. So we're going to treat the obesity with a GLP1. And I'm going to find out what other symptoms are going on. Okay. She's 43, right? She's waking up at 3 a.m.

Progesterone. All right. Progesterone and maybe even low dose estrogen depending on her mood. True. The data out of Australia is clear, you know, new onset. mental health with anxiety, your transdermal estrogens are going to be. It's like a miracle. Your best bet.

But also, we've got to look at the thyroid. True. I mean, somebody with brain fog. That's standard on my panel. Like, they get that before they even come through the door. I had one patient who had had a progester and IUD placed and she was really tired, really tired, really tired. And I said, well, maybe it's that IUD. And then I looked at her TSA, which was 50.

I was like, oh, we need to treat your thyroid. Let's do that first. So we talked about somaglutide, the main gulpate. the main GLP1 that's being used. Trezepatide is different because it's the GLP1 plus. Yeah, it's got insulinotropic polypeptide. Yeah. And then there's something new on the horizon.

Are you excited about? I am so excited. Retachetriotide. Retachretide, okay. GLP1, GIP, and glucagon. Okay, so it's like terseptide plus glucagon. Plus glucagon. Basically.

And glucagon. Why would that? Glucigon ups your fatty acid oxidation. Okay. So fatty acid oxidation with more muscle, preservation. Okay. And the phase two trials look amazing. They're still enrolling for phase three. And what's really interesting for me, because I'm on Reddit, there's a subreddit called Reda. And the results that people are getting, and it's amazing. So when you say results, is this just

weight loss? What are we talking about? Oh, weight loss, body composition, you know. Muscle preservation. But it's, it's mostly men. And remember, if you're taking, if you're taking red at two tide now, retoucher tied now, you're using. something that is not FDA approved, that is gray market, that is, that is, people are taking it? Oh, yeah. I had no idea. Oh, yeah. And it's, and it's, and it's, and it's, and it's, and it's just waiting for it to drop.

No, no, no, no, it's, no, research grade is available. You could take it now, just like all the other peptides. I really want to make, use caution there because it's, it's, you don't know what's in it. No. You don't know what's in it. As opposed to my friends in the compounding world, who will compound terseptide and will compound semagliteite. And if you're using a reputable compounding pharmacy, then I don't necessarily have a problem with that, as long as the pharmacy is good.

And usually it's because of cost. But I haven't seen appreciable differences. In outcomes? Between the compound and the name brand. Right. I haven't. Okay. So I can't say anything bad about it.

Injection barrier. What if a woman won't inject yourself? Do you have patients? I don't. They will not get an IV. They will have a baby at home. They will, but they will inject themselves with a G. That is how strong the pull to lose weight is. There's a greater conversation to be had about the standards of beauty for women. Like what are they really based on? 14-year-old, 12-year-old, 10-year-old, not even post-adolescent. I mean, pubescent. But I think it's important. So we've got to. We've got strong social pull to be thin, but at what cost? And that's the problem.

And, you know, seeing some of the celebrities that are really emaciated now, going back to that 90s, heroin chic is scary. So the question was needle fatigue, right? Or being willing to give yourself a shot. I've had a couple patients who are really afraid. They'll find auto injectors. So they'll get their compound or they get their vials from Eli Lilly, and they'll use an auto injector. They're just afraid to put a needle in themselves. I'm a surgeon and I'm afraid of needles.

Really? Man, when I needed to get a shot, I would run the other way. So I took Deppo Barbera for a little while. And my nurse was going to give it to me and I just ran to the other side. I am afraid of needles. But I inject myself every week. It's slow. Now, what about the new oral therapies that are coming down the pipe right now?

I haven't had to prescribe those yet. I mean either. So we have Wagovi now that's at 25 milligrams, 15% body mass reduction. okay, wrapped in snack. Okay, don't ask me what that means, but it's wrapped in a special molecule so it won't get destroyed by the liver. Yeah, that's proprietary.

And I think it's very important that anyone who is offering a compounded version of oral wagovi, the coating is patented, and you're not going to get that. And so what we found is that there's, oral forms don't work, but this one does.

Okay, because it's coded. to basically make it through without being destroyed by the gastric juices. But then we have a couple interesting ones coming down the pike, right? Or for Glypron and the R1, what is that? Or for Glypron is really exciting because it has almost equal weight loss

to somagletide without having to worry about eating around it. So that's going to be an interesting one when it gets approved. We might see that a lot more frequently. And then the other one, what is that other one? Danu Glypron. Oh, more side effects, colorability challenges.

These agents are really interesting because anything oral, you know, remember, everything goes to the liver, right? Right, right. It's destroyed by the liver and the stomach. These agents actually kind of permeate the barrier and go into the bloodstream that way. So they're really interesting agents. Wow. So they're kind of skipping that first pass effect of the liver?

They're not peptides. They're these small molecules that resist. enzymatic degradation. Okay. That's cool. Well, we'll see. You know, my patients are super happy on their injections and do not want to stop. I haven't had anybody like ask for an or, I mean, they're like, it's working. I'm tolerating this. Like, why would I stop this? Exactly. You know, I'm very happy with my results and I don't want to switch to anything else. Giving myself an injection is not a problem. Now, if the cost came down significantly, that may tempt some patients. Well, cost is coming down or somaglite is off. Oh, since we've been

prescribing it. It's down like 80%. Right. But also the patents are expired in Asia. Oh, wow. Let's say you go to India, you can get it for 30 bucks now. Amazing. Maybe 15. Okay. So, I mean, I'm not going to make a trip to India like every month, but I'm just saying it's going to get cheaper. So the studies were not powered to look at menopause, but we're doing it, you're doing it. You know, the whole menopausee, most of them are prescribing it to some degree, HRT plus. And it's a game changer. I think it is, yeah. A total game changer on multiple levels, not just on what she weighs, but her inflammation, her sleep, her joint pain, her, you know, the combination really seems to be unlocking something and really giving her her life back. I agree. It's, to me, I mean, my personal

feeling when I started taking this, I was right into my coach every week, I say, this drug's a freaking miracle. Yeah. Because it really has helped me. And it helps my patience. And one, time I did a 10-day fast because I was a surgeon. I had to fast people all the time. I was like, let me see what it feels like to fast. And I like to have experience so that I can relate back to patients. And you know what happens after about five days without food? You start to feel really sad. And the reason I bring this up is that my experience with this medication, I understand. I struggle with obesity for 30 years plus. And understanding that it wasn't something broken in me that I didn't have willpower,

it was my metabolism that had changed was a game changer. Yeah, giving you back. Yeah, exactly. That's your best self. Do you see a future? I mean, I'm doing it now where GLP1 and menopausal hormone therapy kind of go hand in hand for a menopausal patient? I do, but not yet.

Probably, you know, we need more research money. We need more data. We need to find out what's actually happening. We need to understand why the ovaries fail. People are looking at that, but only from a fertility standpoint, you know, or extending the life of the ovaries, simply so she can stay pregnant or get pregnant later. I just want enough estrogen to keep my bones strong, lower my risk of heart disease, you know, and do keep my cognition humming the way it should be, you know, keep my general urinary system on

point and let me go live my life. Exactly. I would love to understand why it is, I mean, it's, it can't just be because of fertility. There's got to be an evolutionary reason, but I intentionally didn't have a period all throughout my, through my residency. But then when I stopped the pill, I had, I got a fiber right up to here and had to have a uterinarity ablation. So it was, it was crazy. I thought, I thought, well, I want to lose weight now because I was perimenopausal. Didn't know I was paramedopausal. And, and so I stopped the pill. And then all of a sudden I was like, what is this mass in my house? It's like, oh my God, I have cancer. Okay, so the question was more along the lines of, is it going to be standard care? Probably. But we need data. And for that. Before the

society step up and make guidelines. They're going to need the studies. Yeah, we're not going to do that. And I think that the studies need to be, you know, free of commercial bias. True. And, you know, the problem is, is that there's no money in that. So how, you know, how, you know, how. How do you get it done? Yeah. That's hard. So let's talk about the system and the fix and social media. There is a very loud contingent out there on social telling women that GLP-1s are a crutch, the easy way out, that they're cheating and you just need to try harder.

Let's say that about Viagra. What do you say to that? No, really. I mean, would you say that about Viagra? Because Viagra was intentionally, the first intention was to treat Angina. Mm-hmm. Right? GLP ones were first intended for diabetes.

We found another use for them to treat a chronic disease that wasn't a moral failing. The problem is that the residency system all by itself is broken. We destroy our doctors through residency. And it's almost like this same feeling when it comes to weight loss. I had to suffer to lose weight. So because of that, so must you. Is it cheating? Not if you look at it as a chronic disease.

and you understand that it's chronic disease, it's not for five pounds, it's not for 10 pounds, it's not to fit into a smaller clothes. You have to understand. We're looking at somebody who's had weight loss and weight regain and weight loss and weight regain over and over and over. By the time somebody's come to me, they've tried and failed, tried and failed, tried and failed 20, 30, 40 times. This time it's going to be different. This time it's going to be different. And then inevitably it all comes back. if there's a clinician out there listening, you have this really unique background of, you know,

15 years as a practicing general surgeon. And then, you know, several years now, lifestyle, obesity medicine, totally just, you know, bringing women back their game medically, psychologically, you know, you're part-time therapist probably as well. But if there's a clinician out there who is traditionally trained, the way we were trained, right, and is hearing all this noise right now about how women are different than men, what actually menopause is doing? What message do you want them to hear?

Well, I think it's important that you understand that women navigate hormonal chaos from puberty to pregnancy and then through the perimenopause and menopause transitions. Our hormones are never stable. Men have stable hormones for the most part. They'll lose a little testosterone and we give it back to them, right? It's our hormones fluctuate because we 3D print humans. It's very important to remember that. We have this magical ability to create life.

It's really cool. Doctors don't understand that women are not small men. And I think that's an important fact. Any woman who is presented to the doctor for weight loss has tried calories and calories out, eat less, move more. They've really, they've really exhausted that. and a woman who continues to come back to the doctor in a system where she's been dismissed is persistent because she wants help. And I think that's important.

And that woman who's sitting across from you as a person who hasn't, you know, maybe hasn't studied menopause or is starting to understand, you know, she's starved herself. She's counted her calories. She's exercised into oblivion. And she's probably being explained something by. a man that she already knows more times than she's tried those things. So it's important that you meet her where she is and meet her with compassion and curiosity. Is there anything else you want to let to the women listening out there who just feel like they've just been gaslit, dismissed,

and they're giving up. You know, this is what it is. What do you want to say to her? You're not broken. Midlife changes everything. Everything changes. It's your. your biology. No one told you it was coming either. Yeah. I mean, how many women have you spoken to that said, what the hell is happening to me? Thousands. Right? All of a sudden, I'm embarrassed, but I'm not embarrassed. It's a hot flash, right? But weight gain in midlife women is physiological and predictable. We know this now. The burn rate goes down and you can't out calorie, count yourself out of it. It's going to happen. It's predictable. We can work. We can work on it, resistance training. I mean, that's the number one longevity hack and sleep. Yeah. And fiber.

You don't have to white knuckle through it. If you start gaining weight and rapidly the weight comes on and all you're doing is thinking about food and you're craving food, we have medication that can help now. And the other thing I want to say to the women is that if your doctor dismisses, you go get another doctor. There's a million doctors in this country. You don't have to go to a doctor that makes you feel like crab. Yeah. It's okay to fire them and find someone else. Absolutely. So if someone's starting a new start for GLP1 and say she gets it from someone who hasn't given her a lot of information, what are your top three tips for her? So first one is don't go up too fast. Okay. It's not something that you want to race to the top. It's never a race to the top. It's a race to effectiveness,

first of all. So when your appetite and your cravings are managed, then stay at that dose as long as you can. Let's milk as much out of it as we possibly can. And then we'll step it up slowly. Good advice. Eat protein. Eat more protein than you think you can tolerate. It's the magic sauce for menpaws and midlife. It's very important. One of the most important to me findings from the women's health initiative, because they followed these women after they were off hormones for decades, right? And we're still collecting data. Was when they looked at frailty scores, amount of protein in their diet was the most predictive measure of her chance of being frail was how much protein. So the women in the highest quartile of protein intake had the lowest frailty scores. Well then regardless of their weight.

Even more reason to eat more protein. Yeah. Gram a protein propounded by ideal body weight. And that's the start. That's really the start. And there's a lot you can learn from bodybuilders. Not the guys who are like doing tea, but but they do understand weight loss. They do. The problem is is that, Most of them don't understand female biology. Yeah. So we have to take the good with the bad. But the third tip I would say is it's got to be a slow process. You didn't get here overnight.

You're not going to get there overnight. Enjoy every second of this journey and love yourself through it because no one shamed themselves into weight loss and felt good about it. Awesome. Well, Dr. Michelle Gordon, thank you for coming on on pause. Thanks for having me. You can find Dr. Gordon through her website at Dr. Michelle Gordon or on Instagram at Dr. Michelle Gordon. I'd love to hear from you about this topic and anything else that's on your mind.

You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click for you. follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes

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