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Beek on being AN ENDOCRINOLOGIST · Beek on being

• 0:00
  Melissa Shere Beek: Hi, I hope you're well. This podcast is a place for people to share personal and professional perspectives to talk openly and to ask questions. From serious to silly to sublime, it's all about communication and connections, Always coming from a place of kindness and curiosity, we talk about shared humanity, discuss ideas, and highlight people creating a better world. We've got to keep learning, keep growing, keep being. I'm Melissa Shere Beek and this is Beek on Being.
• 0:28
  Today's episode is Beek on being an endocrinologist. Hormones, hormones, hormones. The endocrine system controls the hormones which control us. Everything from diabetes to thyroid, osteoporosis, growth, reproduction, cholesterol, obesity, and more. In studio today, we have board certified endocrinologist Doctor.
• 0:47
  Laura Paraskos to explain it all and to help keep us healthy. So initially, I had like a million questions that I thought we'd have to do like a three parter. But today, we're going to touch a little bit on a lot of it. Is that good? Sounds great.
• 1:01
  Okay. I'm so honored you're here.
• 1:02
  Dr. Lara Paraskos: Happy to be here.
• 1:03
  Melissa Shere Beek: Oh, I'm thrilled. So can you just start by telling our listeners a little bit about you and how you got into endocrinology?
• 1:11
  Dr. Lara Paraskos: Sure. Absolutely. So I grew up in Miami. And I started thinking about being a doctor actually starting in in seventh grade. My English teacher asked us to start thinking about what you wanna be when you grow up and I never really thought about it and so I had this idea that I wanted to be a doctor.
• 1:30
  And so then I kind of ran with it. And it it you know, I in way went to Emory University in Atlanta for college, studied biology. And then from there, I I went to I came back home to the University of Miami for medical school. Wow. And in medical school is really where I started my introduction to endocrinology.
• 1:51
  Right. And in school, they have different modules where you're exposed to different organ systems. And the endocrine system always spoke to me because to me it made a lot of sense. It was very organized. I really it just didn't take any effort for me to learn it.
• 2:09
  So I really kind of took to it immediately. And that's kind of how I ended up going into endocrinology because I loved it. I loved learning about it and it just seemed like such a great place to be.
• 2:20
  Melissa Shere Beek: Wow. That's amazing. So hormones are important. So can you can you sort of break down why hormones are so important?
• 2:27
  Dr. Lara Paraskos: Oh, sure. Absolutely. It's interesting because, you know, when you're going into endocrinology, you kind of have this idea of what it is. But until you actually start to practice it, you don't realize like how much our whole body is, know, relying Yeah. On Absolutely.
• 2:40
  It's crazy. And so hormones are just essentially little I'd like to think about them as like little messengers Okay. That are released from the organs into the bloodstream and it tells our body what to do.
• 2:54
  Melissa Shere Beek: Okay.
• 2:54
  Dr. Lara Paraskos: And it controls almost everything in the body. You had mentioned in the introduction, it controls growth, it controls metabolism. So weight, even mood, how you respond to stress with cortisol, diabetes, how you respond to foods, digestion. So it's so important in
• 3:12
  Melissa Shere Beek: control of everything.
• 3:14
  Dr. Lara Paraskos: Every aspect of our bodies are in some way related to some sort of hormone.
• 3:18
  Melissa Shere Beek: All right. So I like how you said that they're messengers for the body. So can you tell a little bit about how these message systems work in the endocrine system?
• 3:27
  Dr. Lara Paraskos: Yeah, I think that there's a very like a one kind of overriding theme with endocrinology and hormones is that they are typically released in a feedback loop. Okay. So you have, kind of the the one controller. Most of the time it's the pituitary gland which is the kind of a little gland in the brain kind of right behind the eyes. And that we call it the master gland.
• 3:52
  It controls most of the hormones in the body. And it reads the levels of the other hormones in the body and it kind of keeps things in balance. So when one thing is low, the pituitary hormones increase.
• 4:06
  Melissa Shere Beek: Right.
• 4:06
  Dr. Lara Paraskos: And vice versa when one thing is high, the levels in the pituitary decrease in an effort to keep everything in balance.
• 4:12
  Melissa Shere Beek: So they send messages back and forth Back to
• 4:14
  Dr. Lara Paraskos: each and forth and they communicate.
• 4:16
  Melissa Shere Beek: Okay. Yeah. So it's like a whole control panel. I can visualize this in my head Exactly. Okay.
• 4:20
  Dr. Lara Paraskos: And so they should, when everything works properly, the loop is completed and everything is balanced. And when there's something wrong, that's when the issues arise.
• 4:30
  Melissa Shere Beek: Okay. So that's what I wanted to ask. What happens when the endocosystem goes wrong?
• 4:34
  Dr. Lara Paraskos: Yeah. I mean, depends on what where the problem is. And I think that's one of the the keys is to try to figure out where is the primary problem and then how is the body reacting to it. So for instance, with thyroid which is probably one of the more common endocrine issues is that typically it's an issue with the thyroid gland itself where it just doesn't work properly. And in those cases, the thyroid hormone, the circulating levels are gonna decrease.
• 5:01
  And that's what's hypothyroid is the most common. And that feeds back to the brain to the TSH which is the pituitary hormone. And then that increases The thyroid stimulating But when there's an issue, sometimes it can't fix itself. Because if there's a problem in the thyroid for instance even though the pituitary gland is trying to signal it to work more.
• 5:23
  Melissa Shere Beek: It can't produce enough the right amount of hormone to help you balance. So what happens when that goes wrong? Like what, how does how does a person know, let's say specifically with the thyroid issue that something's not working properly?
• 5:34
  Dr. Lara Paraskos: Yeah, it's really about just how you're feeling. You know, the way I like to think about the thyroid is that it controls how fast or how slow things are going in the body. And so, when everything is working well, everything is great. And everything is, you know, you're going average speed. You know, when things are slower in the body and you're hypothyroid and you're not getting enough thyroid hormone, everything's a little slower.
• 5:57
  You feel tired. You can have dry skin, brittle nails, your hair is falling out, constipation, weight gain because that's another thing that decreases is the metabolism. And so that's, you can feel cold also. That's another common complaint from patients that we see. And the opposite is the case in hyperthyroid.
• 6:19
  Everything is going really fast. So people can't sit still, they're jittery, their hands are shaking, their heart is racing, they're sweating, they're hot. They're losing weight without trying. And they generally can't sleep. They feel very miserable.
• 6:33
  Melissa Shere Beek: Okay. So when we talk about thyroid disease, these are the symptoms. So someone comes and presents to you and says, I'm either having these symptoms which would be hypo or these symptoms that would be hyper. What are the treatments?
• 6:47
  Dr. Lara Paraskos: Well, it depends on what the underlying issue is. So there are some cases of thyroid disease that are self limiting that will fix themselves. For instance, sometimes after a pregnancy you can have postpartum thyroid disease.
• 7:02
  Melissa Shere Beek: Oh really?
• 7:03
  Dr. Lara Paraskos: And or sometimes even after an illness, the flu we've seen it after COVID where you can have this postpartum thyroiditis called and it's kind of like an acute inflammation in the thyroid and it causes all sorts of havoc in the thyroid. It high and then low and then eventually if everything is working properly, it should kind of self regulate and go back to normal. That we don't do anything about because it's gonna fix itself.
• 7:26
  Melissa Shere Beek: How do you determine that it's just that
• 7:28
  Dr. Lara Paraskos: and not?
• 7:29
  Melissa Shere Beek: Because like I'm thinking, okay, but if you're having symptomology, how do we know that this is just short term, like an acute situation or longer and we need like medication or something?
• 7:39
  Dr. Lara Paraskos: That's a great question. Yeah, it really depends on the history. So we try to take a good history. When did it start? What was going on?
• 7:46
  Had you been sick? You recently postpartum? Also family history. Right? That's also very important because those kind of self limiting situations of thyroiditis that's not familial.
• 8:00
  So it doesn't really run-in families. But the most common type of thyroid issue is autoimmune, Hashimoto's and Graves' disease. And those are very hereditary. So those typically run-in families. So you'll see, you know, when you take somebody's history, you know, everybody on the mother's side has thyroid disease.
• 8:19
  And then also other autoimmune diseases as well kind of come together.
• 8:25
  Melissa Shere Beek: Do they?
• 8:25
  Dr. Lara Paraskos: They run together.
• 8:26
  Melissa Shere Beek: They can affect thyroid disease as well if you have a different sort of autoimmune It
• 8:29
  Dr. Lara Paraskos: can increase your risk for having thyroid disease. Having one. And even in the family, you may have somebody that has rheumatoid arthritis or psoriatic arthritis, inflammatory bowel disease. Those are all autoimmune conditions. And so having one in the family increases the risk of any autoimmune disease.
• 8:46
  Melissa Shere Beek: Okay, I know there isn't a BRCA test, let's say, for thyroid, but I I know that you will find it.
• 8:52
  Dr. Lara Paraskos: Yes. I wish.
• 8:53
  Melissa Shere Beek: Yeah. It's definitely a familial thing. Definitely. Okay. So that's one of the endocrine like you said, that's one of the most common endocrine disorders.
• 9:01
  Okay. So we broke all that down, but I wanna talk about diabetes because that's another big one too.
• 9:05
  Dr. Lara Paraskos: Oh, Huge.
• 9:06
  Melissa Shere Beek: So can we talk about the signs, the symptoms, diagnosis, treatment? I know that I threw a lot at you. Yeah, that's
• 9:12
  Dr. Lara Paraskos: a lot. You know, there's really two big groups of diabetes. You have type one diabetes and you have type two diabetes. And the presentation is different. Type one diabetes used to be called juvenile diabetes because it used to be diagnosed only in
• 9:29
  Melissa Shere Beek: Primarily for children.
• 9:31
  Dr. Lara Paraskos: Children. Now that is an autoimmune disease as well. So in that case, you have kind of an autoimmune destruction of the pancreas which is what causes or which is what creates insulin. And so if the pancreas is destroyed, it doesn't make insulin. And so you have an insulin deficiency in type one diabetes.
• 9:49
  Nowadays, what's very interesting is that we're seeing more and more type one or autoimmune diabetes even in the adult population. We've had people in the 20s and 30s. Even I think I diagnosed somebody in this, he was in his 70s. And then a partner. Diagnosed somebody even older.
• 10:07
  So it's very interesting that we're seeing it pop up more. I read an article just yesterday that was saying that the incidence of diabetes type one is increasing about twenty six percent. That's Has increased. Yeah, in the last ten or fifteen years. Why?
• 10:22
  We don't know. We don't know why. And that's the interesting thing is there are, know, we're talking about family history increases your risk. But that's only accounts for a part of it. It's very interesting that autoimmune diseases are kind of this big gray area in medicine that we don't really understand a lot of it.
• 10:43
  Why does somebody get it? If you're at risk some people will develop autoimmune diseases, some people won't. We're thinking that it has to be something maybe environmental that there's
• 10:53
  Melissa Shere Beek: a That's lot of different one of my questions later about the uptick and increase in a lot of these autoimmune disorders. And we'll get that in
• 11:02
  Dr. Lara Paraskos: a minute.
• 11:02
  Melissa Shere Beek: Okay. So then the difference between the type one and type two.
• 11:05
  Dr. Lara Paraskos: So type one, you don't have any insulin. And then type two is the opposite. You actually have You make too much insulin. Not really too much. But you get what's called insulin resistance.
• 11:17
  So to keep your blood sugars normal, you need more insulin to keep the sugars normal. And that's driven by lifestyle.
• 11:26
  Melissa Shere Beek: Okay.
• 11:27
  Dr. Lara Paraskos: Diet, exercise, you know, or lack of diet, right, and lack of exercise. So too much sugar or too many carbohydrates, that definitely increases your As
• 11:36
  Melissa Shere Beek: I offered you cookies and
• 11:37
  Dr. Lara Paraskos: had candy in my mouth
• 11:38
  Melissa Shere Beek: when you came into the studio. Hey, I didn't say anything. I was just thinking about all those things. I was like, ding ding ding. Just did all of those bad things.
• 11:47
  Dr. Lara Paraskos: Everything in moderation. And I think that's really the key to life. Right? Oh, that's so funny. Yeah.
• 11:53
  So so in type two though, it's that, you know, just can't, you know, really too much. And then the weight goes up and then that causes the diabetes. And symptoms really, so it's interesting because type one is gonna be more symptomatic. So those type one patients are when it kind of presents more, acutely. And they're gonna present with, they're gonna be very thirsty.
• 12:20
  They're gonna be peeing a lot, losing weight, very fatigued because their sugars are very high. And it happens very quickly. And then they can have, they can present, oftentimes with something called diabetic ketoacidosis which is, where your body becomes acidotic because of the lack of insulin and the high sugars. Got it. So that's actually a very dangerous situation.
• 12:41
  That's what drives a lot of them to the hospital for diagnosis. Type two diabetes is interesting because it's more of an insidious process. So patients, because it doesn't happen so quickly, they're really not gonna have those symptoms. Or if it happens, it happens very slowly. Gradually.
• 12:57
  And you don't notice it. And it's very interesting. They may have where they're thirsty a lot and they're peeing more often but it happens so slowly and over time that they don't really notice it.
• 13:07
  Melissa Shere Beek: It sort of becomes their norm and they And accept
• 13:10
  Dr. Lara Paraskos: then only once you start to treat it and improve the numbers they come back and they tell me, oh my gosh, I can't believe it. I'm not peeing as much. I'm not waking up in the middle of the night to go to the bathroom. And so it's a slower process that they may not actually have symptoms. Or they're not aware
• 13:26
  Melissa Shere Beek: of because like you said
• 13:26
  Dr. Lara Paraskos: it Oftentimes was they're not. What about gestational diabetes? Gestational diabetes doesn't always have symptoms because that is something that just it's diagnosed in pregnancy. And a lot of times, they'll screen for it. Right?
• 13:39
  Actually, people screen all
• 13:40
  Melissa Shere Beek: this stuff they made us drink was gonna give me diabetes.
• 13:43
  Dr. Lara Paraskos: Horrible. Right?
• 13:44
  Melissa Shere Beek: And they kept making me drink so much of that. I was like like, you're gonna give me
• 13:48
  Dr. Lara Paraskos: diabetes. Exactly.
• 13:49
  Melissa Shere Beek: It's terrible.
• 13:50
  Dr. Lara Paraskos: Yeah. Yeah. Yeah. That's a horrible screening test. Yeah.
• 13:53
  What you have to do is you it's it's essentially your it's like a stress test for your pancreas and your sugars. And so they give you this very concentrated Oh, yeah. I think it's like seventy five grams of glucose, which, oh my gosh, is so much. Like 10 of these cookies.
• 14:09
  Melissa Shere Beek: Yeah. No. It was
• 14:10
  Dr. Lara Paraskos: like bacon, bro.
• 14:11
  Melissa Shere Beek: And I don't drink sodas or anything like that. So this was like
• 14:14
  Dr. Lara Paraskos: Carbo pure sugar and and they see what happens.
• 14:17
  Melissa Shere Beek: The baby liked it.
• 14:17
  Dr. Lara Paraskos: It's For kicking all the sure. Yeah.
• 14:21
  Melissa Shere Beek: Okay. So those are more acute situations. So how are those treated?
• 14:24
  Dr. Lara Paraskos: In gestational diabetes, a lot of it can be treated with diet, really very intense diet. Because obviously in a pregnancy you only have so many months until the baby is born. And so you really have to be very strict with the diet in gestational diabetes. And their goals for the sugar levels are much stricter. Because higher sugars can have consequences on the pregnancy, the fetal development, increased risk of preterm labor and a lot of other issues.
• 14:56
  Okay. They're very strict with that. And if you can't control it with diet, usually we use insulin. You do. That's
• 15:04
  Melissa Shere Beek: okay during pregnancy
• 15:05
  Dr. Lara Paraskos: Very, and stuff yes. Like Okay.
• 15:06
  Melissa Shere Beek: Got it. Yes. So I wanna talk about because we touched a little bit upon it about the uptick of some things. Have you been seeing an uptick in because you said a little bit with the diabetes type one. Have you been seeing an uptick in thyroid disease?
• 15:21
  Dr. Lara Paraskos: I have. I don't know if it's as documented as, as type one diabetes. It's interesting because in a thyroid, we treat all thyroid the same. Right. Right?
• 15:37
  If it's you had thyroid surgery and that's why you're hypothyroid or if you have autoimmune thyroiditis or autoimmune thyroid issues or congenital, you can actually be born without a functioning thyroid. And they're all treated the same. We give thyroid synthetic
• 15:52
  Melissa Shere Beek: thyroid Everybody becomes hypo and then they get Synthroid.
• 15:54
  Dr. Lara Paraskos: Thyroid medication. Exactly. So they're all treated the same. So we don't always investigate why. Cause.
• 16:01
  I like to know why. Yeah. Right? I it's funny. I think that's something that's very common in endocrinologists.
• 16:06
  I always like to joke to patients that we were that kid that's asking at the dinner table, why? Why? Because that's always what we wanna well, that's okay. This is the case. But why?
• 16:16
  That's why? I wanna know.
• 16:18
  Melissa Shere Beek: You know? I wanna know. I wanna know if it's a genetic thing. I wanna know if it's environment. Is it because science has better studies or tests now?
• 16:25
  We're like seeing more?
• 16:26
  Dr. Lara Paraskos: And it could be all of that.
• 16:27
  Melissa Shere Beek: Okay.
• 16:27
  Dr. Lara Paraskos: Right? And that's the the thing that we don't really know is like, why is the why is it increasing? You know? Is it that we're testing more for, you know, for for Hashimoto's for instance? Or is it like a testing bias?
• 16:41
  Or is it really something that's taking up? I think it's probably a combination of all of that Because, know, it's just I've seen it more often, you know.
• 16:52
  Melissa Shere Beek: Right.
• 16:53
  Dr. Lara Paraskos: And I don't know why. You know, I have a feeling it has to be something Right. That we're exposed to, whether it's something environmental and the diet. You know?
• 17:03
  Melissa Shere Beek: So for a million years, I always thought genetics, genetics, genetics. Yeah. And then the computers came around. And then there was like this uptick. Yeah.
• 17:12
  And then I thought when the computers initially because now everybody has like iPads and different things. Yeah. For sure. They were huge And you were level. Like, throat was sort of level with all of that coming at you.
• 17:24
  And I thought, well, maybe the uptake is environmental. Yeah. But maybe there's something in the water. But I think, like you said No. I think it's a bit of everything.
• 17:32
  Dr. Lara Paraskos: I think it's probably a bit of everything. You know, I think sometimes people ask me this and it's nice to, I think, have a conversation about it and and kind of, you know, brainstorm different ideas. It's hard though because where I think sometimes people get a little too yeah. Don't know the right word to say. Narrowly focused?
• 17:55
  Maybe that's the right way.
• 17:56
  Melissa Shere Beek: It's not going like this.
• 17:59
  Dr. Lara Paraskos: You know, is where they they say, oh, I know exactly what the problem is. I know how to fix it. If you just follow this protocol, you're gonna fix your thyroid issue. And you're gonna fix your Hashimoto's. And and and the the real no.
• 18:12
  I wish that was the case.
• 18:13
  Melissa Shere Beek: That would be wonderful. But there's also no one size fits all for thyroid diseases.
• 18:16
  Dr. Lara Paraskos: Exactly. And so I think that's one of the things that's like, okay, we know we're already here. Let's address it and let's treat it. And there are things that maybe we can do differently to help you feel a little bit better, maybe some dietary changes, you know, obviously adjusting medications if you're on medications and optimizing that. But, you know, there's really because we don't know the why really.
• 18:39
  There's
• 18:39
  Melissa Shere Beek: not Is there enough research being done about that?
• 18:41
  Dr. Lara Paraskos: No. I don't think there is. Yeah.
• 18:43
  Melissa Shere Beek: I don't think so either.
• 18:44
  Dr. Lara Paraskos: And I I think maybe I'm a little bit cynical, but I think one of the reasons is that with that why, you know, a lot of it we're talking about maybe something environmental, is it dietary? Is it something related to maybe infections? Or what's the like how who's gonna make the money off of that? Right? And that's what I'm saying.
• 19:10
  So it's interesting because trials, clinical trials and studies are really funded by somebody. Their goal is to get a return on their investment. They wanna make money at the end of the day. They wanna be able to find a cure or sell something. And if it has to do with avoiding gluten or, you know, doing this supplement, there's nobody They're
• 19:30
  Melissa Shere Beek: not gonna put the money in.
• 19:31
  Dr. Lara Paraskos: Who's gonna make the money off of that because you're just not eating something. Right? Right. Or you're avoiding something else. Right.
• 19:36
  So, you know, I feel like I don't know. I don't know if they're ever going to do that study. I think a lot of it is just more investigational kind of theoretical. You can do that and of make some assumptions based on observations.
• 19:52
  Melissa Shere Beek: I always thought that they point about not doing the research on it, but also because thank god it wasn't what you would consider a life threatening disease.
• 20:01
  Dr. Lara Paraskos: Yeah. And that's part of it too is that, okay, you have hypothyroid. We have many things. It's manageable. Exactly.
• 20:07
  Now, of course, not everybody Well, there's there's an easy course with it.
• 20:11
  Melissa Shere Beek: Different circumstances for each situation. But I just thought, like, because that's not something that is life threatening at that moment that and it is manageable. Yeah. That maybe the research wasn't behind it. But I am still curious.
• 20:24
  Oh, me too. One day you and I are gonna get to the bottom We of should. All right. So let's talk about what are pituitary and adrenal disorders. So you talked about like pituitary was controlling everything.
• 20:36
  Dr. Lara Paraskos: Yeah. The pituitary gland is, like I was saying before, it's the master gland and it controls most of the hormones in the body. So it releases, growth hormone. Well, doesn't release controls growth hormone. It controls the thyroid.
• 20:51
  It controls cortisol levels. And then also it controls the adrenal glands. Okay. Well, that's the cortisol. Yeah.
• 20:59
  Writing this
• 21:00
  Melissa Shere Beek: down because I wanna talk
• 21:00
  Dr. Lara Paraskos: about cortisol levels later. Yeah. Yeah. That's a hot topic. Think a lot of people come in talking about that.
• 21:10
  Melissa Shere Beek: So Pituitary and adrenal disorders.
• 21:12
  Dr. Lara Paraskos: They're connected, right? So the pituitary gland, especially for cortisol. So it it secrete it it controls cortisol levels. And the cortisol comes from the adrenal gland.
• 21:21
  Melissa Shere Beek: Got
• 21:21
  Dr. Lara Paraskos: it. And the adrenal glands are these little like triangle shaped glands like sitting on top of the kidneys. And so the pituitary is in the brain and then the adrenal is in the abdomen on top of the kidneys. And so they communicate kind of in that feedback loop we were talking about. That the pituitary releases a hormone called ACTH and that is what stimulates cortisol production in the adrenal glands.
• 21:43
  So they can be related. You can have an issue in the adrenal glands that can affect cortisol. There's also some other hormones in the adrenal glands as well Okay. That are not regulated by the pituitary. One is, actually like epinephrine levels.
• 21:56
  Melissa Shere Beek: Oh, yeah.
• 21:56
  Dr. Lara Paraskos: That fight or flight reflex is secreted from the adrenal glands. And then another hormone called aldosterone, which is actually regulated by something in the kidneys. What's that? Aldosterone can affect blood pressure
• 22:08
  Melissa Shere Beek: Oh, okay.
• 22:08
  Dr. Lara Paraskos: And potassium levels. Oh, yes. Interesting. Yes.
• 22:12
  Melissa Shere Beek: I didn't know that. No. I will have an off camera discussion
• 22:14
  Dr. Lara Paraskos: about that later. Okay.
• 22:16
  Melissa Shere Beek: So tell us a little bit about cortisol levels.
• 22:18
  Dr. Lara Paraskos: Yeah. So cortisol is I like to refer to it as like the stress hormone. So we always have cortisol. It's important to keep your blood pressure normal. That's really the main focus of it.
• 22:29
  But if you are stressed in any way, whether it's an emotional stress or a physical stress, like an illness
• 22:35
  Melissa Shere Beek: Right.
• 22:37
  Dr. Lara Paraskos: Your cortisol levels are going to go up. And the levels are fluctuating throughout the day. They're up and down kind of throughout the day depending on the circumstances.
• 22:45
  Melissa Shere Beek: If we're sleeping, if we're awake, moving, sitting.
• 22:48
  Dr. Lara Paraskos: Exactly. It's fluctuating. Now typically it is released more in a, like a circadian rhythm. So that's why actually daylight and making sure you're getting enough sleep is so important for cortisol levels because it is released in a circadian rhythm. Right.
• 23:02
  So when you're awake and if the sun is out, the cortisol levels are gonna be higher. And then when you're sleeping and it's dark out, the cortisol levels are gonna be lower.
• 23:11
  Melissa Shere Beek: So don't stay up late. Don't look at your phone.
• 23:13
  Dr. Lara Paraskos: Exactly. Well, let me tell you, it can affect it. So when we're testing cortisol levels, it can be very tricky because depending on what you're looking for, you have to test it at different times of the day. Okay. And so a morning cortisol doesn't tell you about excess.
• 23:31
  The morning cortisol actually is telling you more about a deficiency in cortisol. And, actually we like to test it at nighttime to look for excess. Because at nighttime it should be the lowest. And so you wanna test for an excess when it should be low. Because if it's not low, that's abnormal.
• 23:48
  Melissa Shere Beek: Okay. So if you test and you see someone has an excess in the nighttime, what does that mean? What is it saying?
• 23:54
  Dr. Lara Paraskos: Well, it could be a lot of different things. But what we are looking for with that is something called Cushing's. And Cushing's is higher cortisol levels.
• 24:02
  Melissa Shere Beek: Okay.
• 24:03
  Dr. Lara Paraskos: And so that we look for the cortisol at nighttime. We can also do a twenty four hour urine collection for cortisol.
• 24:11
  Melissa Shere Beek: Oh, fun.
• 24:11
  Dr. Lara Paraskos: That's the best test. And then there's a special test that sounds fancy, but it's really not. It's called the dexamethasone suppression test. So those are the tests that we look for for Cushing's.
• 24:21
  Melissa Shere Beek: And what is Cushing's?
• 24:22
  Dr. Lara Paraskos: So Cushing's is an excess cortisol. And so if you can think about it, it's like your body is always making extra cortisol. It's never, coming down. So when you're sleeping, you still have higher cortisol levels. So if you've ever seen somebody that is on steroids, extra steroids for like for instance, a transplant, an organ transplant.
• 24:41
  They've had a kidney transplant. You know, you've noticed there I don't know if you've never noticed the face is a little bit roundish. They can get that like a bigger belly. But higher cortisol levels can cause physical changes. It can cause the round face, belly fat, these kind of darker purple stretch marks.
• 25:01
  The skin can get very thin. They bruise very easily. But also it can cause other issues. High blood pressure can cause diabetes, osteoporosis, Oh, increased risk of High cortisol is not great.
• 25:16
  Melissa Shere Beek: Not good. Yeah. Okay. Yeah. We don't want that.
• 25:18
  No. All right. So when you talk about inflammation and we talked about swelling and different stuff, I wanna talk about staying healthy because being overweight plays a role in your body's health.
• 25:31
  Dr. Lara Paraskos: Oh, sure.
• 25:32
  Melissa Shere Beek: So can we talk about all of those things
• 25:34
  Dr. Lara Paraskos: Yeah.
• 25:35
  Melissa Shere Beek: Going into it?
• 25:35
  Dr. Lara Paraskos: Yeah. Absolutely. So, you know, I think that weight listen, weight, I mean, is is obviously a big issue in the world in The United States. And obesity, believe it or not, has been linked to I think over 200 medical conditions. You know, including we we know about like diabetes and high blood pressure, high cholesterol.
• 25:59
  But then also other things like rheumatoid arthritis, sleep apnea, fatty liver. Actually certain cancers are driven by or increased by fat and obesity. So it can have so much effect on the body. And so staying healthy and just trying to maintain a more healthy body mass index is so important because it can touch so many different things.
• 26:24
  Melissa Shere Beek: Yeah. It affects all of those things. I was thinking like you said, cardiac and cholesterol and cancer and all of these things.
• 26:31
  Dr. Lara Paraskos: Okay. So
• 26:33
  Melissa Shere Beek: for someone who's trying to eat healthy, who is not being sedentary and they're working out regularly and all of these things, but they can't lose the weight, we now have GLP-1s, which is a hot discussion. I've heard doctors say it is the best thing that has ever happened to getting people healthy. And I've had other people say, well that's a cheat, you can't do it, it's not good. What is your advice?
• 27:00
  Dr. Lara Paraskos: Let me tell you, it is something I talk about this every day with patients. I mean probably at least half of my patients we have this Yeah because it's so and even if I'm out to dinner with, you know, friends or, you know, my daughter's family or, you know, my daughter's friends' families, they all ask me about it. Everybody asks about
• 27:22
  Melissa Shere Beek: Right. It. Everybody wants Because there's there and I'm gonna take this off the table right There are populations that are abusing things.
• 27:29
  Dr. Lara Paraskos: Yeah. Sure.
• 27:30
  Melissa Shere Beek: So I'm not we're not discussing Yeah. The people who are abusing it Yeah. Who maybe deal with body dysmorphia and all of those things. So, like, I'm talking about the people who are obese Yeah. Who need to do it Sure.
• 27:42
  Or want to talk about it in order to make sure that they don't have cardiac issues, cholesterol, lose cancer issues, all the things that being overweight can do.
• 27:51
  Dr. Lara Paraskos: Yeah. So, you know, I think that the first thing that usually will start when I talk to my patients about this is just talking about weight in general. Because everybody's journey is different, right? And I think, you know, we were mentioning before about autoimmune diseases and so we don't understand a lot about autoimmune diseases. Believe it or not, the same thing goes for weight.
• 28:15
  We don't really understand a lot of the biology when it comes to weight. Why
• 28:20
  Melissa Shere Beek: Wait. Before you even continue, do autoimmune diseases because I wanna make do autoimmune diseases play into someone they overweight? Can.
• 28:29
  Dr. Lara Paraskos: If there's a thyroid issue, you can that can affect weight.
• 28:33
  Melissa Shere Beek: Got it.
• 28:34
  Dr. Lara Paraskos: Yeah but weight like maintenance and management is such a poorly understood topic. And I think for a lot of years it was really not seen as a medical condition. And so it was not something that was studied or they didn't really look into it. And so now that obesity is actually like a medical diagnosis that we can diagnose somebody with obesity and treat it now is when we're really starting to look into it. And it's tough because you have some patients and this is the hard thing.
• 29:09
  You have some patients who never have any problems with their weight. They never have any issues and they can eat whatever they want.
• 29:19
  Melissa Shere Beek: Metabolism is totally different.
• 29:21
  Dr. Lara Paraskos: And then you have other patients like you mentioned that, listen, they're exercising and they're eating right and they're doing everything and it just does not work. And part of what I do when I see a patient like that is I try to, again, take a history and dig into that. What are they at risk for? Like you were mentioning about autoimmune. Are they at risk for thyroid disorders?
• 29:41
  Could there be an issue with cortisol? Because all of those can affect the weight. So I always like to look into that and just see, is there something else that could be contributing? A lot of times there is not. And there's no good reason.
• 29:53
  I think that's one of the frustrating things when I talk to patients and they go, well, why? I don't understand.
• 29:57
  Melissa Shere Beek: They don't have anything concrete to say, okay, I can work with that.
• 30:01
  Dr. Lara Paraskos: Exactly. And unfortunately I don't really have an answer for them. But I always tell them this. So I always start with before we start before we talk about any medications, we have to really make sure that we're optimizing lifestyle. Right.
• 30:15
  And that includes diet and exercise. Exercising, the recommendation is one hundred and fifty minutes a week. Which seems like a lot. But when you break
• 30:24
  Melissa Shere Beek: I it didn't think it sounded
• 30:25
  Dr. Lara Paraskos: like a lot at all. Okay. Yeah, I know. Well, when you break it down-
• 30:29
  Melissa Shere Beek: It's a whole week.
• 30:30
  Dr. Lara Paraskos: I know. Yeah, per week. Exactly. Which is about if you break it down like thirty minutes, five times a week, you can even do it in like twenty minute increments. And so I think it's definitely doable.
• 30:39
  I think sometimes we have to be creative with the exercising. It doesn't always have to be at the gym. Right. You know, it could be just walking around your block at lunch time, going up and down the stairs. Walking in place, you know, doing a twenty minute video on YouTube or something like that.
• 30:54
  Know, so there's different It creative makes a difference. It really, really does.
• 30:57
  Melissa Shere Beek: It makes a huge difference.
• 30:58
  Dr. Lara Paraskos: Yeah. And then with diet, I encourage patients to use like apps that will help them kind of count calories and just kind of keep them on target And with their I think that's one of the issues sometimes is people don't know. Don't know. It's like, well, I'm eating a salad but listen, the salad has the cheese and the croutons and the creamy dressing. And by the end of it, it's 1,200 calories.
• 31:25
  Right. At not a
• 31:26
  Melissa Shere Beek: big mac at this point.
• 31:28
  Dr. Lara Paraskos: Sometimes you can get away with like making those changes. Right? But even then, sometimes some patients do have a hard time. And that's when I think these medications honestly are really they can be life changing. And I have a lot of patients that are on these medications that they come back and they tell me, I can't thank you enough.
• 31:48
  Like you have changed my life.
• 31:49
  Melissa Shere Beek: Restores everything for me.
• 31:51
  Dr. Lara Paraskos: It's really like remarkable honestly to see some patients response. And do
• 31:57
  Melissa Shere Beek: And not just from a physical sense. Oh, yeah. A mental and emotional
• 32:01
  Dr. Lara Paraskos: Oh my sense gosh, as absolutely. Yeah, absolutely. It's tied. One of the things also that's tied to obesity is depression, anxiety. So sometimes by treating it, it kind of treats there's other aspects It's that are
• 32:15
  Melissa Shere Beek: all connected.
• 32:16
  Dr. Lara Paraskos: Yeah. So I do think that's something that, you know, I use these medications, I think, quite often. I'm probably biased because, you know, I've we've been using these medications interest like the Ozempic and the Mounjaros and stuff for diabetes for so many years. So we are so comfortable with
• 32:30
  Melissa Shere Beek: our brand. Comfortable. Know every new ones of them.
• 32:32
  Dr. Lara Paraskos: Yeah. It's interesting. So they were first released I don't know the exact date, but I think it was like 2018 maybe. Even maybe a little bit It's before been
• 32:42
  Melissa Shere Beek: long time.
• 32:42
  Dr. Lara Paraskos: It's like
• 32:43
  Melissa Shere Beek: over eight years.
• 32:43
  Dr. Lara Paraskos: The first one yeah. Well, actually for 2018, I think was the first one for obese that was a proof for obesity. Oh, okay. So we were the diabetes used
• 32:53
  Melissa Shere Beek: for that.
• 32:53
  Dr. Lara Paraskos: Almost twenty years. Yeah. It's interesting. So the first version was a twice a day injection. And I know.
• 33:01
  Melissa Shere Beek: How did they discover this?
• 33:02
  Dr. Lara Paraskos: You know, it's very interesting.
• 33:03
  Melissa Shere Beek: I'm fascinated
• 33:04
  Dr. Lara Paraskos: with I would love to know who thought about this because it came from, like a lizard in the desert. I know, right?
• 33:13
  Melissa Shere Beek: Oh, this is fascinating.
• 33:14
  Dr. Lara Paraskos: I need to
• 33:15
  Melissa Shere Beek: know how this started.
• 33:16
  Dr. Lara Paraskos: Know, right? And then
• 33:17
  Melissa Shere Beek: not only how did they find it, but then how did they find out, oh, it just doesn't work for diabetes. It works
• 33:21
  Dr. Lara Paraskos: for obesity. Well, it's interesting. You know So, It's fascinating. With the I know with these so the medications, like who first thought of it, right? Yeah.
• 33:29
  Like, let me look at this lizard in Let me
• 33:30
  Melissa Shere Beek: just check out this lizard in
• 33:31
  Dr. Lara Paraskos: the desert. That first was That called was the first one. And then came out with Victoza, which was a once a day. Now so Victoza These are
• 33:41
  Melissa Shere Beek: all injections.
• 33:42
  Dr. Lara Paraskos: Injections, all injections. And then there were the weekly versions. And then it kind of transitioned into like the Ozempic and the Mounjaro is kind of a
• 33:50
  Melissa Shere Beek: Why injections instead of a tablet
• 33:52
  Dr. Lara Paraskos: So or it's interesting and I hate to use the word peptide but they're peptides. And some of a lot of these peptides actually are not chemically stable in a pill. So it actually took them so many years to actually develop the pill version. The first pill version of these peptides was, it's called Rybelsus. It's a semaglutide, in a pill.
• 34:16
  Melissa Shere Beek: And that's controlled. That's like And that is
• 34:19
  Dr. Lara Paraskos: they were able to stabilize it. And I don't know how they worked it with the molecules or what they did to it but they were able to stabilize it so that it can be used as
• 34:26
  Melissa Shere Beek: As effectively as an injection.
• 34:28
  Dr. Lara Paraskos: Exactly. Exactly.
• 34:29
  Melissa Shere Beek: Because when I think of injections, I think like, know, the human growth hormone injections and things like that.
• 34:35
  Dr. Lara Paraskos: So I'm thinking about Well, are other peptides.
• 34:36
  Melissa Shere Beek: Those are other peptides. All stabilized
• 34:38
  Dr. Lara Paraskos: like a growth hormone. That's one of the reasons why they have to be injected is because it's very difficult to stabilize these these peptides and, pill forms. Interesting.
• 34:48
  Melissa Shere Beek: Fascinating. Yeah. So fascinating.
• 34:49
  Dr. Lara Paraskos: So yeah. So I don't don't know what we were talking about, the GLP ones. We were
• 34:53
  Melissa Shere Beek: talking about, yeah, having
• 34:54
  Dr. Lara Paraskos: The weight, right?
• 34:55
  Melissa Shere Beek: The obesity.
• 34:55
  Dr. Lara Paraskos: Yeah. So, yeah. Anyway, so I, you know, so I do, I use them as a tool. And I always tell patients like, listen, you have to make sure that you're working on the lifestyle because you're not gonna get the results that you want. And it's not gonna be It's not
• 35:12
  Melissa Shere Beek: a replacement. It has to go hand in hand.
• 35:15
  Dr. Lara Paraskos: Exactly. And so my patients that really have such a drastic response are the ones that are gonna be working on the lifestyle, making those changes, increasing their exercising.
• 35:26
  Melissa Shere Beek: They wanna live healthy lives.
• 35:27
  Dr. Lara Paraskos: Yeah, of course. And let me tell you, it's really interesting. Well, not interesting, but I mean, and it makes a lot of sense, right? That their cholesterol gets better, their blood pressure improves. They come off blood pressure medications.
• 35:39
  The sleep apnea improves, the knee pains improve.
• 35:42
  Melissa Shere Beek: I was gonna say joints and bone and cardiac because carrying around extra weight, the risk of cancer
• 35:49
  Dr. Lara Paraskos: goes down. They've seen so the cardiac risk is it's been proven actually especially with the Ozempic is the one Ozempic and Wegovy are both the semaglutide. And the data on that there is a twenty six percent reduction in the risk of heart disease and stroke.
• 36:05
  Melissa Shere Beek: Right? I mean, is brilliant.
• 36:07
  Dr. Lara Paraskos: I know. And they just published the data now with the Mounjaro, which is maybe not as strong but it's still really excellent that there's a reduction in the risk of cardiovascular disease. But the interesting thing is that they don't think that it's solely related to the weight loss. Really? The weight loss is a part of it.
• 36:22
  But even when they look at the studies, even before somebody reaches the maximum dose and starts losing a significant amount of weight, they start to see that curve separating the survival curve and separating a little bit earlier on.
• 36:35
  Melissa Shere Beek: Really?
• 36:35
  Dr. Lara Paraskos: They think there's something in the molecule that maybe is changing, you know, fat composition or
• 36:42
  Melissa Shere Beek: I don't know. They're still doing Body chemistry molecules.
• 36:45
  Dr. Lara Paraskos: That's what they think. Yeah. It's interesting.
• 36:47
  Melissa Shere Beek: But I would also think brain chemistry molecules too. Because once you're feeling healthier, less pain, less risk, I feel like that changes your mindset too. And then again, there's that loop
• 37:03
  Dr. Lara Paraskos: Absolutely. Between the brain and
• 37:04
  Melissa Shere Beek: the body. You're feeling more confident. You're feeling better about yourself. You're feeling better about your longevity and your health, and that makes you stay online with taking care of your body. I feel like
• 37:14
  Dr. Lara Paraskos: Yeah.
• 37:14
  Melissa Shere Beek: Of course. Oh. So it it kind of is a wonder drug.
• 37:17
  Dr. Lara Paraskos: It can be. Yeah. Yeah. Of course.
• 37:18
  Melissa Shere Beek: I mean, for like, we're not talking about No. Like I
• 37:21
  Dr. Lara Paraskos: said No. But they know, who are using
• 37:23
  Melissa Shere Beek: these things.
• 37:24
  Dr. Lara Paraskos: For everybody. Right? Because, of course, there are side effects. And I think that's something that you always, no matter what medication you're doing, what Yeah. Risks and anything you always have to look at the risks.
• 37:35
  And I do have patients that can't tolerate it or can't take the medications because of certain things. So the biggest risk factors can Well, the side effects, it can cause nausea and constipation. Those are the two biggest things that I usually tell patients. And that's part of the way that the medication works because it works in a lot of different ways. One of the big ways that it works though is that it's slowing down the emptying of the stomach and it slows down the intestines.
• 38:01
  So food sits in the stomach longer, you stay you get fuller faster.
• 38:05
  Melissa Shere Beek: Does it help the brain feel full?
• 38:07
  Dr. Lara Paraskos: Yes, it can. So it's interesting. So there are kind of sensors in the stomach based on like how full it is that will send signals to the brain. So once that gets signaled, the brain signals senses that you're full. But interestingly, the medications also, there are receptors in the brain.
• 38:25
  Direct receptors for these GLP ones and these GLP one molecules that are in the brain that actually is helps once they're kind of signaled and stimulated by the medications that they give you a sense of fullness, satiety. You know, people talk about that
• 38:44
  Melissa Shere Beek: The noise.
• 38:45
  Dr. Lara Paraskos: It's really interesting. Let me tell you all the time. Okay. Not all the time. But a lot of the times, I have patients come to me and they say, I never realized how much I thought about food.
• 38:54
  Yeah. And I can't believe what these medications have been doing to
• 38:58
  Melissa Shere Beek: me. I
• 38:59
  Dr. Lara Paraskos: can think. I can think about other things. I'm so much more productive. Right? It's really
• 39:04
  Melissa Shere Beek: it's really
• 39:05
  Dr. Lara Paraskos: remarkable. Yeah.
• 39:06
  Melissa Shere Beek: Oh, see. That's great.
• 39:07
  Dr. Lara Paraskos: I hear it a lot. You know?
• 39:09
  Melissa Shere Beek: This is a fascinating conversation
• 39:11
  Dr. Lara Paraskos: Yeah. About So Because
• 39:12
  Melissa Shere Beek: I don't really hear people give the full story that you've given. Yeah. No.
• 39:16
  Dr. Lara Paraskos: Well, thank you.
• 39:16
  Melissa Shere Beek: No. Seriously, from an endocrinology, but just talking about, like like you said that feedback loop, think it's a brilliant conversation. For the right people.
• 39:25
  Dr. Lara Paraskos: For the right people. Yeah. Exactly. You know? And so I think that so with the the the GI side effects, I mean, those are really expected.
• 39:31
  And usually we can manage it. We can manage it with, you know, eating smaller portions, making sure you're drinking water for the constipation and increasing your fiber and, you know, having kind of an aggressive like stool regimen, like a bowel regimen in case you're getting constipated. So those are things that we can usually manage. As long as you're aware of. It Okay.
• 39:51
  Other side effects they gave me were severe. It can increase the risk of pancreatitis. And that can actually be very severe. And so if somebody has a history of pancreatitis or experiences pancreatitis on these medications, probably not gonna wanna give it to them again. Because that can be something that can end up being very, very Yeah.
• 40:10
  Serious and So that's really one of the biggest contraindications. There's also a very rare cases of a certain eye condition that's popping up now. As more people are using the medication, we're seeing more of these. It's not a very large percentage, a very, very small risk. It's called nylon where it's like an of like an embolization of the optic artery and it can actually cause vision changes and blindness.
• 40:41
  And that could be irreversible. It's happened in, like I said, a handful of patients. Typically, it's in more of an uncontrolled diabetic. Those are the patients that are typically gonna have this. And again, it's very rare.
• 40:55
  But it can happen. And so, things I think that we have to think about it, You have to kind of be aware of all the risks of the medications because if something happens to you, obviously we're trying to make you healthier
• 41:10
  Melissa Shere Beek: Right, work we're on your way. Way. But
• 41:14
  Dr. Lara Paraskos: I think we have to be aware of that. And then people always ask me about the thyroid cancer risk. To me, that's one of the lowest risk. I'm really not worried about that.
• 41:23
  Melissa Shere Beek: Okay. So you said with the I risk, that's usually someone with uncontrolled diabetes.
• 41:27
  Dr. Lara Paraskos: Basically.
• 41:28
  Melissa Shere Beek: If someone has a thyroid disorder or something like that, should they it's okay for them to take the GLP-one and stuff like that.
• 41:34
  Dr. Lara Paraskos: Yeah. Should be. So the the the really the only contraindication in the thyroid realm is if they have a personal history or a family history or risk factor for a certain type of thyroid cancer called medullary thyroid cancer, which is not very common.
• 41:49
  Melissa Shere Beek: Right. Another rare kind of
• 41:51
  Dr. Lara Paraskos: It's a rare kind of And that is very genetic familial. Right. You'd know. Yeah. That would be something you would typically know.
• 42:00
  You would have that risk factor. So those would That would really be my only contraindication. Even if somebody that has a history of papillary thyroid cancer or follicular cancer,
• 42:10
  Melissa Shere Beek: not Not be
• 42:11
  Dr. Lara Paraskos: at all.
• 42:11
  Melissa Shere Beek: Not at all.
• 42:12
  Dr. Lara Paraskos: We can still use it. Thyroid nodules, we can still use it. We just monitor them. Maybe have a lower risk to do a biopsy. But for the most part, there's I have no concerns over thyroid issues.
• 42:23
  Melissa Shere Beek: Good. Good to know. Yeah. Alright. So we talked a little bit about we were talking about bones with obesity and joints and stuff.
• 42:29
  Can we go into the realm of osteoporosis? Sure. Yeah. Okay. Bone loss, bone density.
• 42:34
  Is it just older population? Is it just after menopause? Is it like what Tell us about it.
• 42:41
  Dr. Lara Paraskos: I think that I don't know why, but I feel like osteoporosis is probably one of the hardest things that we do. And I'll tell you why. So in postmenopausal women, that's when we see the most patients that have osteoporosis. And the reason is that estrogen is such an important part of bone health. And postmenopausal the estrogen levels drop.
• 43:04
  And so we tend to lose bone faster because of that.
• 43:08
  Melissa Shere Beek: And if you can't take like a hormone patch and stuff like that?
• 43:10
  Dr. Lara Paraskos: Exactly. You're gonna see more bone loss, more accelerated bone loss. But even then, we still see osteoporosis in patients that are perimenopausal. So it's not only menopause that's a contributing factor. Are other things, you know, exercise, lack of exercise that can affect both.
• 43:29
  Melissa Shere Beek: Weight bearing exercise.
• 43:29
  Dr. Lara Paraskos: You wanna make sure you're doing weight bearing exercises, exactly. Because that's so important. Making sure you're getting enough calcium in your diet. So calcium deficiency, vitamin D deficiency.
• 43:38
  Melissa Shere Beek: On calcium. Yeah. I was once told that you need to like load up before you're 35. Is that still true? Or if you're perimenopause or postmenopause and you're doing calcium, does it just not matter anymore?
• 43:51
  Or does it like
• 43:52
  Dr. Lara Paraskos: That's interesting. I don't think I've ever heard that before to load up before you're 35. But it kinda makes a little bit of sense. And the reason is that, believe it or not, you're still actually building your skeleton
• 44:03
  Melissa Shere Beek: Uh-huh.
• 44:04
  Dr. Lara Paraskos: Until you're about 35. So you don't reach your peak bone mass until your mid thirties.
• 44:09
  Melissa Shere Beek: Oh, okay.
• 44:10
  Dr. Lara Paraskos: So you're constantly, you're still building your skeleton. It's interesting. You think you're done growing. I think
• 44:13
  Melissa Shere Beek: that was pretty much done at like 12. Right? Exactly. The same height You're
• 44:18
  Dr. Lara Paraskos: still building your bone. It's interesting. And so that is one of the risk factors actually for osteoporosis later on in life. If you are, you know, even growing up like having a lower calcium diet as a, you know.
• 44:31
  Melissa Shere Beek: Oh really?
• 44:32
  Dr. Lara Paraskos: Yeah. Both, yeah. So that makes sense. You don't have to load up. But you
• 44:35
  Melissa Shere Beek: just have
• 44:35
  Dr. Lara Paraskos: to make sure that you're eating Getting enough. Amount.
• 44:38
  Melissa Shere Beek: Yeah. If you're perimenopause or post menopause, should you do extra calcium supplements? Should it be from food only or both?
• 44:48
  Dr. Lara Paraskos: Or No. My answer to most things is it depends.
• 44:53
  Melissa Shere Beek: Okay.
• 44:53
  Dr. Lara Paraskos: And it depends on on on your what what you're eating. Uh-huh. So the in in I don't know when they changed it. Maybe like ten or fifteen years ago. But I remember at the beginning of my training, it was that everybody no matter what postmenopausal should be taking like a thousand, twelve hundred, fifteen hundred milligrams of calcium, two thousand milligrams, kind of the more the better, No matter what you're doing with your diet.
• 45:17
  But what they found was that patients who were taking more calcium, extra calcium, especially with this in supplements, they actually had more cardiac calcifications. Now I'm
• 45:30
  Melissa Shere Beek: glad I didn't follow
• 45:31
  Dr. Lara Paraskos: that order. I know, right? So, so the recommendation is you wanna get about, especially post menopausal, about twelve hundred milligrams of calcium per day.
• 45:42
  Melissa Shere Beek: So is that supplement or food?
• 45:44
  Dr. Lara Paraskos: A combination total. And so typically I'll tell people to kind of look at what they're doing in their diet. They have online calculators. You can also jot it down and add up at the end of the day. But the online calculators are just much easier, right?
• 45:57
  Melissa Shere Beek: My gynecologist told me chew extra Tums.
• 46:00
  Dr. Lara Paraskos: Yeah. Well, yeah. So that's an option. Tums is calcium. Right.
• 46:05
  It's calcium carbonate. So it's an easy source of calcium. Okay. But what you wanna do is take a look at what you're doing in your diet. Honestly, it is very tough to get twelve hundred milligrams in
• 46:15
  Melissa Shere Beek: your Because
• 46:17
  Dr. Lara Paraskos: also what has calcium? Dairy products, cheese, you know? So we don't wanna eat that much. I love cheese.
• 46:24
  Melissa Shere Beek: I'm laughing because this week my body must have been saying you don't have enough calcium because I have been on a cheese fest.
• 46:32
  Dr. Lara Paraskos: Oh my gosh. Oh my gosh. So yeah. So why? You know.
• 46:37
  Melissa Shere Beek: Lack of calcium, I guess.
• 46:39
  Dr. Lara Paraskos: Yeah. Right.
• 46:39
  Melissa Shere Beek: Because I don't take supplements.
• 46:40
  Dr. Lara Paraskos: Yeah. So clearly, I needed cheese. So what what else has calcium? Like, cheese. I love cottage cheese.
• 46:47
  I think it's very polarizing because you either hate it or you love it. Yeah. That's very funny. Right? I think it's the texture.
• 46:53
  But I've had patients let me it's funny story.
• 46:56
  Melissa Shere Beek: No. Think you're right about
• 46:57
  Dr. Lara Paraskos: the Tell me. It's really funny. Everybody says, ugh, I hate it. Or they go, oh, I love cottage cheese.
• 47:02
  Melissa Shere Beek: My grandmother used to give it to me with pineapple.
• 47:04
  Dr. Lara Paraskos: Yeah. So
• 47:04
  Melissa Shere Beek: pineapple That was so good.
• 47:05
  Dr. Lara Paraskos: Right? A patient of mine, I still have not tried it and maybe I should. She tells me she gets plain cottage cheese, cinnamon, and a little bit of vanilla. Oh. And she's like, it tastes like a Pudding.
• 47:17
  Like rice pudding. Yeah. And I go, oh my gosh. I don't know.
• 47:19
  Melissa Shere Beek: I would try that too.
• 47:20
  Dr. Lara Paraskos: I don't know. It's a little strange, but then she swears by it.
• 47:23
  Melissa Shere Beek: Yeah. But it's the same thing. It's kinda got that sweetness to it that the pineapple gives it. Yeah. So
• 47:27
  Dr. Lara Paraskos: So, yeah. So cottage cheese, think is a great option because it's it's you can get a low fat version, right? So it's not gonna have all that extra cholesterol. So then your cardiologist isn't gonna hit me because your cholesterol is going up. Right?
• 47:40
  So I think that's good. You can do yogurt, like a Greek yogurt, a plain yogurt.
• 47:43
  Melissa Shere Beek: I love a Greek yogurt.
• 47:44
  Dr. Lara Paraskos: Like that, you know, adding some fruit to it. So there's definitely some healthy ways to get calcium. But even then it's actually very tough to get That much. Hundred milligrams is a lot. And I would say probably on average, my patients are getting maybe like five to eight hundred milligrams of calcium.
• 47:59
  Know, it's not enough. Yeah. And so typically then adding a supplement is gonna be useful to get to that twelve hundred. Now way you have to be careful about is with the supplements when you buy it over the counter and you look at the back, it'll tell you, oh, the daily, the recommendation for the dose is two capsules a day or two tablets or whatever it tells you. But that is probably to get about a thousand or twelve hundred milligrams.
• 48:23
  Melissa Shere Beek: Was feeling you to that if you're eating properly.
• 48:26
  Dr. Lara Paraskos: Yeah. You just have to kind of take a look and see how much is it in the capsule and do
• 48:31
  Melissa Shere Beek: And you feel that we're really absorbing from the supplements. We're really getting what we need from them.
• 48:36
  Dr. Lara Paraskos: That's a great question. And so it again, it depends. Right? So if you're gonna take more than one a day, you actually wanna split it up because you're not gonna absorb all that calcium all at once.
• 48:49
  Melissa Shere Beek: At one time.
• 48:50
  Dr. Lara Paraskos: Right? You will not, really. And so anytime somebody's taking calcium, I usually and if they need to take extra calcium, I tell people to take it twice a day. Morning If at you're taking like two times at nighttime, you're only absorbing a part of it. Then you
• 49:03
  Melissa Shere Beek: get stone.
• 49:06
  Dr. Lara Paraskos: And then we
• 49:07
  Melissa Shere Beek: don't want that.
• 49:07
  Dr. Lara Paraskos: So yeah, you're right. Then you're just gonna have more expensive pee. That's what we say. More expensive
• 49:14
  Melissa Shere Beek: pee. I like that.
• 49:15
  Dr. Lara Paraskos: That's what it is.
• 49:15
  Melissa Shere Beek: That's a good one. So how is osteoporosis or bone loss, bone density issues diagnosed?
• 49:21
  Dr. Lara Paraskos: Bone density. So what we do is it's like an and they're looking at the spine and the hips. Sometimes we'll look at the forearm depending. But we like to look at the spine and the hips mostly. And then we look at the, like the lucency essentially of the bones.
• 49:39
  And that's how we diagnose osteoporosis.
• 49:41
  Melissa Shere Beek: How often should that be done?
• 49:43
  Dr. Lara Paraskos: It's interesting. So the recommendation is to do your first bone density at age 65. I know. I How many people have osteoporosis? So typically I'll recommend around menopause to do your So first you can get a good screening, like a good baseline.
• 50:00
  Melissa Shere Beek: Baseline,
• 50:00
  Dr. Lara Paraskos: yeah. Bone density. And then from there, if it's normal, maybe every five years or so, something If like it's abnormal and you have some bone loss already, which is actually very common, I usually recommend every two years to do a bone density.
• 50:15
  Melissa Shere Beek: Got it. All right. What should we be doing?
• 50:19
  Dr. Lara Paraskos: Well, okay. The most So
• 50:20
  Melissa Shere Beek: we talked about calcium, we talked about weight bearing.
• 50:23
  Dr. Lara Paraskos: Yeah. So the most important things that you can do, anybody can do for bone health, that making sure you're getting the calcium, making sure you're getting in a vitamin D. Because vitamin D is important to absorb
• 50:33
  Melissa Shere Beek: Vitamin D as a supplement or also like hang out in
• 50:36
  Dr. Lara Paraskos: the sun? It's such a hard question.
• 50:39
  Melissa Shere Beek: Well, have my big sombrero
• 50:40
  Dr. Lara Paraskos: over here because
• 50:41
  Melissa Shere Beek: I never go on
• 50:42
  Dr. Lara Paraskos: the sun. We don't wanna be out in the sun. So the sun is actually the most efficient way to get vitamin D. So we make vitamin D from the sun exposure and the UV exposure. Right.
• 50:52
  So when we're out in the sun, a lot of times or most times, right, we are, we should be wearing hats and sunblock. And actually that's blocking the UV rays. So even if you're out and you have a full thing of sunblock on, you're not gonna make vitamin D.
• 51:04
  Melissa Shere Beek: Right.
• 51:04
  Dr. Lara Paraskos: So some people will tell you to go out like early in the morning and later at night. The sun is not as strong. That's probably okay. But the supplements in that case are okay. It's they're very they're very effective.
• 51:20
  The vitamin D supplement They're is efficient.
• 51:23
  Melissa Shere Beek: Yeah. Okay.
• 51:24
  Dr. Lara Paraskos: And you just wanna check your levels and make sure. And then you were mentioning about exercising. So you wanna make sure the weight bearing exercises, impact exercises. And that doesn't mean CrossFit. Right.
• 51:34
  Was just gonna say
• 51:35
  Melissa Shere Beek: we're not flipping like 18 wheeler tire truck things
• 51:38
  Dr. Lara Paraskos: It where we great. Right. So walking lightweight And
• 51:41
  Melissa Shere Beek: like the little vest.
• 51:42
  Dr. Lara Paraskos: Weighted vests and stuff like that. Stuff like that. You know, it doesn't have to be really like heavy impact. It can be I like lightweights. Those exercise bands I think are great.
• 51:52
  You know, any kind of strength training is really, really good. Also, like exercising and strength training too because it's helpful for balance too. And it's so important to make sure you have enough core strength. And that's one of the things with osteoporosis that we always talk to patients about is trying to reduce the risk of falling. Yeah.
• 52:09
  Sometimes we don't think about that in terms of treatment but you have to make sure that you're like steady on your feet because if you're already at a high risk for having a fracture and then you fall, oh my That's downhill. It's a problem. Yeah.
• 52:22
  Melissa Shere Beek: Okay. So let's talk about reproductive hormones and issues.
• 52:25
  Dr. Lara Paraskos: Oh, sure.
• 52:26
  Melissa Shere Beek: Because that's we didn't get there yet.
• 52:31
  Dr. Lara Paraskos: Go ahead. Have more questions. Yeah. Tell me your question.
• 52:34
  Melissa Shere Beek: Just how it's all being controlled with reproductive hormones and stuff like that. When we talked about the pituitary gland and things like that. How does it show up? What are the symptomologies? When does somebody be concerned?
• 52:46
  How are they treated? How do we handle that?
• 52:49
  Dr. Lara Paraskos: Well, you know, I think, again, there I go. It depends. It depends on what the issue is. So, the reproductive hormones are controlled by the pituitary gland. So the pituitary secretes two hormones, the FSH and the LH.
• 53:04
  And in women, that controls the menstrual cycle. And in men, it actually controls testosterone levels and sperm production. So it's the same cycle just different end organ. And so if there's an issue like in men, it could affect sperm production or it can affect testosterone levels. Right.
• 53:22
  And in the testosterone, it's tough because a lot of the symptoms for low testosterone in men, overlap with, you know, life symptoms, fatigue, weight gain, you know. And so sometimes it's tough. People come in thinking, oh, maybe I have a low testosterone. Right. The levels look normal and it's not that.
• 53:41
  Right? Right. But I think it's important to kind of, you know, listen. What I tell people is listen to your body.
• 53:47
  Melissa Shere Beek: Right?
• 53:47
  Dr. Lara Paraskos: Right. If you don't feel well, say something. We can check these levels. We can see where it is. Okay.
• 53:53
  If it's not the testosterone or it's not your thyroid or it's not something else, okay. You have to dig a little bit deeper and say, what is A little more homework. Is lifestyle? It I'm not getting enough sleep or I'm not eating healthy? Or is there something else going on?
• 54:05
  So it's always a good thing to check your hormones and talk to somebody about it Always. So yeah, in men, it can present more with like the fatigue and the weight gain, decreased muscle mass. Women is, I don't wanna say a little bit easier to diagnose, but the menstrual cycle, I don't know if you remember from like seventh grade. Yeah. Looking at this chart.
• 54:28
  Right. And you see the it's like, it's like a so delicate. Somebody when I was in my I think it was in med school. It's like, you know, the menstrual cycle is like a delicate dance, you know? And if one thing is off, you're not gonna get your period.
• 54:43
  Right. Right. And so that's a very easy way in women to tell. Like if there's something going on.
• 54:48
  Melissa Shere Beek: Exactly where the chain Exactly.
• 54:51
  Dr. Lara Paraskos: So you're like, okay. You know? So that's really how women will present typically with issues is with irregular periods. Okay. And so that's an easier way to to to know in women.
• 55:01
  But then we still have to dig into it and figure out, okay, where is
• 55:04
  Melissa Shere Beek: the cause
• 55:04
  Dr. Lara Paraskos: coming from? Like what's happening here? Is it a problem with the pituitary gland? Which can happen. Is it a problem with prolactin?
• 55:13
  Which is another pituitary hormone. That's actually the breastfeeding hormone. And so sometimes you can have cases where the prolactin levels are high because of a growth in the pituitary gland. And that can affect the periods. Or could it be PCOS, which is a polycystic ovarian syndrome.
• 55:31
  And the interesting thing with that is like that.
• 55:34
  Melissa Shere Beek: That was one of my next questions. I'm glad we led into this.
• 55:37
  Dr. Lara Paraskos: Go ahead. So the and that can present with irregular periods and other symptoms like acne, hair loss, hair growth, weight gain. So it's very it can be very tricky to treat because it has so many components. In terms of diagnosis Diagnosable. Yeah.
• 55:56
  Oh, very diagnosable. You just have to to know what you're looking for. Right? And ask the right questions to make the diagnosis.
• 56:03
  Melissa Shere Beek: And have the right doctor. Well, so we talk about PCOS. How come they change it to PMOS?
• 56:10
  Dr. Lara Paraskos: Yeah, exactly. Well, okay.
• 56:11
  Melissa Shere Beek: And tell our listeners the difference. Yeah. Okay. Polycystic ovarian syndrome and then PMOS.
• 56:16
  Dr. Lara Paraskos: Is I think
• 56:18
  Melissa Shere Beek: It's polyendocrine metabolic
• 56:20
  Dr. Lara Paraskos: ovarian Ovarian syndrome. Yeah. So they just changed it.
• 56:23
  Melissa Shere Beek: So why did they change it?
• 56:25
  Dr. Lara Paraskos: Well, so I think it's the same thing. Right? So they just changed the name. But I'm glad they changed it because it really reflects more of like what the underlying So etiology when we diagnose this, it's a constellation of symptoms. So there's not one blood test that's diagnostic diagnostic for this condition.
• 56:46
  You have to have certain conditions. You have to have irregular. It's two out of three, right? It has to be irregular periods, signs of high testosterone or symptoms of like, or blood work that shows high testosterone and then cyst on the ovaries. But the interesting thing is you can have a cyst on the ovaries and not have PCOS.
• 57:07
  Melissa Shere Beek: And you
• 57:08
  Dr. Lara Paraskos: can have PCOS and not have cyst on the ovaries. So as an endocrinologist, that was a kind of like a toss away.
• 57:14
  Melissa Shere Beek: I
• 57:14
  Dr. Lara Paraskos: mean, if somebody comes to me and they have an ultrasound that shows cysts, you're okay, great. I think I know what you have. But, know, I can kinda take it or leave it because it didn't really help me very much. Right. Because typically it's those, you know, the irregular and the other things.
• 57:28
  But to me, I love that they changed the name because one of the the root causes of most cases of PCOS is insulin resistance. Right? And that's that metabolic syndrome. So we see, and this is something that we talk about and we One of the things that we really focus as an endocrinologist when we're treating our patients with this condition is treating that underlying metabolic risk. Because you see higher risk of insulin resistance, diabetes, high cholesterol, high blood pressure, weight gain.
• 57:59
  It's all connected. You know? And so and and and the hard part is that they kind of feed off of each other. You know? Like the the weight gain and the insulin resistance that can make the testosterone levels higher and the periods more irregular.
• 58:11
  And then that makes the insulin levels And just it's a spiral and it's very It can be very, very tricky to treat it. Yeah. So I'm glad they changed it because to me it makes it It's more succinct. I think sometimes if you just kind of treat it on the surface with irregular periods, think a lot of times people missing. Yeah, exactly.
• 58:33
  They're missing that root cause. And really focusing on that I think is tough because we can we can treat a lot of it. It's it's tough. But it can be treated But treatable. And managed.
• 58:45
  Right. And birth control can help, you know. But it's not the answer because it's just kind of treating the
• 58:51
  Melissa Shere Beek: A band aid.
• 58:52
  Dr. Lara Paraskos: Exactly. It's a Band Aid. It's just, you know, treating the the the irregular periods where you're not touching the cause. Underlying cause. I'm glad they changed it.
• 59:00
  Melissa Shere Beek: Okay. Good. Yeah. Alright. So are with all of these things, are there annual tests that we should have to make sure our endocrine system is working properly?
• 59:11
  Dr. Lara Paraskos: Well, yes. Yes and no. Okay. You know, the recommendation in terms of screening, I would tell you, it depends on family history. So for instance, diabetes, you know, the recommendation on your annual screening every few years, you get an a one c.
• 59:28
  But based on body mass index, weight, circumference, family history, they'll screen every year, usually. Right. And most people are gonna get screened every year for diabetes. Thyroid, same thing in women. If you have a family history, you screen more often.
• 59:42
  Melissa Shere Beek: Right. More frequently.
• 59:43
  Dr. Lara Paraskos: Always have to. And if somebody comes in and they're really feeling great and they have no symptoms and no family history at all
• 59:50
  Melissa Shere Beek: Right.
• 59:50
  Dr. Lara Paraskos: You probably don't have to do it every maybe more than every five years or something like that.
• 59:53
  Melissa Shere Beek: Oh, really? Okay. Unless something changes.
• 59:55
  Dr. Lara Paraskos: Unless something changes. I think the hard thing is that when you ask somebody, are you tired? Are you having trouble with your weight?
• 1:00:03
  Melissa Shere Beek: Again, it depends.
• 1:00:04
  Dr. Lara Paraskos: It's Everybody's gonna say, yes, I am tired.
• 1:00:08
  Melissa Shere Beek: I'm exhausted.
• 1:00:09
  Dr. Lara Paraskos: I'm I don't know what it is. I think that's so sometimes when you just kind of do a screening, it's not necessary in
• 1:00:16
  Melissa Shere Beek: a lot
• 1:00:16
  Dr. Lara Paraskos: But of the I think it just is nice to kind of throw it in because I think a lot of these symptoms overlap with so many things. And really to tell the difference is the blood work.
• 1:00:29
  Melissa Shere Beek: Also to just get a baseline too while you're feeling okay. Then you can say, okay, that was what my norm was. And here I'm having symptoms and now we see the difference between Exactly. My Okay. So how do we know the difference between regular aging and, like you said, tiredness, exhaustion, stuff like that, and when to be concerned.
• 1:00:50
  Dr. Lara Paraskos: Mhmm.
• 1:00:51
  Melissa Shere Beek: Is it just like a temporary acute situation? Or if it's prolonged, then we know, okay, I've gotta go see an endocrinologist. Yeah. At what point do we become concerned?
• 1:01:01
  Dr. Lara Paraskos: That's a a really great question. And I think that patients, they have different thresholds.
• 1:01:08
  Melissa Shere Beek: Uh-huh.
• 1:01:08
  Dr. Lara Paraskos: You know, as to when they have symptoms for things. And I have some patients that will come and their thyroid levels, for instance, will be just like a little bit off. And they'll feel really bad. Know? And then I have other patients that come and they go, what?
• 1:01:22
  Melissa Shere Beek: I have no idea.
• 1:01:23
  Dr. Lara Paraskos: How is this possible? I don't have this. And their their thyroid levels are like through the roof.
• 1:01:27
  Melissa Shere Beek: Like, I
• 1:01:28
  Dr. Lara Paraskos: got call from Quest in the middle of the night. Like, oh
• 1:01:30
  Melissa Shere Beek: my god. I'm so You need to call them now.
• 1:01:32
  Dr. Lara Paraskos: Exactly. And I called them and I like, no, I'm fine. I was just skydiving. And I was like, what? Okay.
• 1:01:38
  Melissa Shere Beek: Yeah. Threshold. A 100%.
• 1:01:40
  Dr. Lara Paraskos: It's very interesting how people, everybody kind of manifest their issues differently. Yeah. But I really, you know, something that I'll tell patients is that, and I hate to sound cliche. Right? But like listen to your body.
• 1:01:55
  And if something doesn't feel right, speak And up about talk to somebody. And have an evaluation. And really, you know, try
• 1:02:04
  Melissa Shere Beek: and And know yourself.
• 1:02:05
  Dr. Lara Paraskos: Yeah. And know yourself. Because I I do feel like patients kind of they they know what is normal for them and when something is abnormal. So if something is changing, if something doesn't feel right, if something if you're tired but it doesn't match the situation. Same thing with your weight.
• 1:02:20
  If your weight has changed and nothing has changed. Something's up. Something may be off. I mean, it may be something like
• 1:02:26
  Melissa Shere Beek: But also, you're a remarkably incredible physician. So, you also not only have to know yourself, but you have to have a great physician who listens, who says, Oh, okay. If this patient's coming to me and saying something, then I realize I've to investigate them. Because not every doctor has the love and care that you have with your patients.
• 1:02:50
  Dr. Lara Paraskos: Well, I appreciate that. I appreciate that. I think my approach is when I talk to a patient, it's just trying to get the whole history. What's going on? What's going on in your life?
• 1:03:05
  What are you feeling? When did things start? And really try to dig into it. And actually a lot of my conversations are not even about like the endocrine system. It's like, okay, what's happening in your life?
• 1:03:14
  Like, what's going on? Or is there any stress in your life? Just trying to see like what else could be going on. Right. Because if it's Which not is you part of the picture.
• 1:03:24
  Sure. Absolutely. And I think sometimes too, I also like to think about other things that could present just like some of these endocrine disorders because I try to, again, I kinda go back to that. Why? Why are
• 1:03:39
  Melissa Shere Beek: you feeling like your investigative
• 1:03:41
  Dr. Lara Paraskos: services. And so if it's not the thyroid or it's not something endocrine, what could it be? Could there be something else? And so I always try to do that with patients. And sometimes I can't figure it out.
• 1:03:56
  But I try to kind of figure out like, if it's not me, what else is it? I may not be able to diagnose you, but we're
• 1:04:02
  Melissa Shere Beek: gonna be able in the right direction.
• 1:04:04
  Dr. Lara Paraskos: Yeah. And that's something that I will encourage patients. Like, if they come to me and they have all these symptoms and you can tell they're not feeling well. Right? You can tell there's something going on.
• 1:04:13
  You know, and you do everything. Everything is totally normal. You know, I say it's kind of one of those good news, bad news situations. It's like, okay, great news. Everything But is there, you know, there's still something going on because you should not be feeling that way.
• 1:04:26
  Right. And then what is it? And then trying to get them to get to the right next step, whether it be circling back to your primary care doctor and just kind of discussing the symptoms again and seeing if they can come up with some other ideas. Think another thing too like psychiatry, mood, kind of mental health That's affected. Such an important aspect to talk about as well because, you know, I think a lot of these symptoms like we talk about with the thyroid, it can affect the mood.
• 1:04:55
  Cortisol can also affect mood.
• 1:04:56
  Melissa Shere Beek: A 100%.
• 1:04:57
  Dr. Lara Paraskos: You know, and so these are things that I look for in patients that have issues. But sometimes if everything looks normal and okay, it's not that. But well maybe like we need to address that. And there's such a stigma associated with mental And sometimes it's hard to kind of approach that. But
• 1:05:19
  Melissa Shere Beek: if you had a broken arm, go to a doctor and you get it set. So if you have something's helped with your mental health, you need to go to a doctor and
• 1:05:27
  Dr. Lara Paraskos: get help.
• 1:05:28
  Melissa Shere Beek: Okay. What myths are there with endocrinology and hormones and everything? Like big myths you wanna debunk?
• 1:05:36
  Dr. Lara Paraskos: Big myths. Okay. So I think there's the
• 1:05:40
  Melissa Shere Beek: What do you want your patients Okay. To
• 1:05:43
  Dr. Lara Paraskos: One of them is about, and so I get this a lot with patients that sometimes when they, I don't wanna say fight back or when they're a little bit Defensive? Yeah, defensive about when you're having conversations with them. I mentioned it before that some people will talk about because now, I mean, listen, online you can find
• 1:06:02
  Melissa Shere Beek: Oh, yeah. A wealth of information. Why is it coming from the right sources?
• 1:06:05
  Dr. Lara Paraskos: That's the question. And I always tell patients, they go, well, listen, it depends on how you ask the question. You can put the question into chat one way and get one answer. You can put
• 1:06:13
  Melissa Shere Beek: it in another Don't use that.
• 1:06:15
  Dr. Lara Paraskos: And get a completely different answer. Right? So it's like, how do you phrase it? You just call your interest in it. So, you know, but also then, you know, you have social media and people on TikTok and Instagram And saying these I think that's really the biggest myth is like, you know, check your source, right?
• 1:06:35
  Because one person is gonna tell you one thing. Right. And, you know, it's You can use the example of like thyroid for instance. Because patients come to me sometimes and they have all these questions. Like where do you hear that from?
• 1:06:49
  And they ask me things that I've never heard of before. For instance, somebody came to me and go, oh, heard I'm not eating nightshades. I go, what is a nightshade? I don't know. It's like a type
• 1:06:59
  Melissa Shere Beek: of vegetable. It's yeah. Right?
• 1:07:00
  Dr. Lara Paraskos: Like I'm like, what? That's not really gonna affect I'm your
• 1:07:04
  Melissa Shere Beek: a physician.
• 1:07:05
  Dr. Lara Paraskos: You know, I know. It's like, what? Nightshades? I've never heard of that before. No.
• 1:07:09
  And this is my specialty. So, you know, it's interesting that when you when you go and if you start doing research, you know, for thyroid for instance, some patients will come to me and say, oh, I I think I have to avoid everything with iodine because iodine is so bad for my thyroid. So I'm not eating kaolin. I'm not eating this and I'm not eating this and I'm avoiding everything with iodine. And then some people come and they have the opposite information.
• 1:07:31
  I need more of they're taking iodine supplements And then it's overloading that with iodine. And you know what? The truth is they're both wrong. Right? And too much is bad and too little is bad.
• 1:07:42
  Right? So it's kind of that, you know, you have to kind of look at who, what the source is.
• 1:07:48
  Melissa Shere Beek: Right.
• 1:07:48
  Dr. Lara Paraskos: And I think that's one of And listen
• 1:07:49
  Melissa Shere Beek: to your body.
• 1:07:50
  Dr. Lara Paraskos: Yeah. And listen to your body and look at what the source is.
• 1:07:52
  Melissa Shere Beek: And call your doctor.
• 1:07:54
  Dr. Lara Paraskos: Yeah. And yeah, for sure. You know, I think that's one of the big things because there's so much out there. Yeah. It's an overload.
• 1:08:02
  And in some people, oh, I heard so and so. If you take this supplement, like, oh, you're gonna cure the Hashimoto's. Okay. Well, are they That
• 1:08:11
  Melissa Shere Beek: would have been brilliant if Where it was
• 1:08:13
  Dr. Lara Paraskos: is their data? I tell them, what is the data? If you show me the paper and you show me the data, we can talk. And listen, there there is some data and I'm not against kind of like a
• 1:08:26
  Melissa Shere Beek: Wish there was a cure like that.
• 1:08:27
  Dr. Lara Paraskos: Eastern medicine and like, you know, kind of functional medicine. I definitely think there's a And go hand in hand. I do. I think that they go hand in hand and I'm not opposed to it. You know, and I think that there's some stuff that has some weight behind it.
• 1:08:42
  Right. There's some studies, there's some clinical trials, you know. But not a cure all. Exactly. You know, in medicine and science, and we like to look at big clinical trials, right?
• 1:08:54
  We like to look at, they're called double blind, randomized double blinded clinical trials. Where it's like, you are trying as much as possible to eliminate extra factors that may be- A of variables. Exactly affecting the results. And so by blinding the study, the researchers and the patients and everybody involved, they don't know it's, you know, removing some of that bias. And by, randomizing people, it's a complete, you know, there's no extra factors.
• 1:09:22
  So those are the trials that we like to look at. And then there's like different layers of like strength of different types of trials. There's a case control observational, you know, case reports. And so depending on kind of what kind of evidence is out there, it's like the strength of the study, how much validity you put in it. And there, and so there are studies, right?
• 1:09:45
  Looking at certain things. But if somebody's just saying it based on, I don't even know where they come up with it or it was like a random case report. Like there's a case report of this lady. And I don't know why she started doing this, but she decided she was gonna like change her diet and only eat bok choy. And that's how like a lot of where this iodine thing came with the thyroid.
• 1:10:06
  It's like, oh my god, iodine is so bad. Because this lady was eating like pounds of bok choy a day. And she caused like all sorts of damage in her thyroid and her thyroid levels were crazy. Because she was getting all this extra iodine from this bok choy it was causing problems. And it her case, it wasn't the bok choy.
• 1:10:22
  I mean, it was the bok choy, but it was something when you take too much iodine. There's a condition that can happen where actually you like shut off the thyroid. It's something called the Wolf Chaikov effect. But you can really like shut the You thyroid know? And sometimes the opposite happens and you get it's called the jod based out where it can go crazy and it gets really hyper.
• 1:10:41
  Right. Yeah. And so it's interesting. So you kinda have to know what are the source source. And I think that's really the biggest myth because there's so much information out
• 1:10:49
  Melissa Shere Beek: But it's not all correct information.
• 1:10:51
  Dr. Lara Paraskos: Correct. Yeah.
• 1:10:52
  Melissa Shere Beek: What should we implement daily? Like give us one or two things that you think like everybody should be doing daily.
• 1:10:57
  Dr. Lara Paraskos: Exercise. Exercise. Yeah. Exercise. I think diet and exercise is so important.
• 1:11:02
  Really, mean a lot of what we talk about, especially like circling back to diabetes, you know, I think that and weight, you know, I think that having a good solid foundation, lifestyle, good sleep is Critical. When we were talking about cortisol, were mentioning about the circadian rhythms. And I'll see in patients that have trouble with their sleep and they're not getting enough sleep, their levels are off. And sometimes it can be very tough and it can be difficult to interpret the blood work and the levels because they're high and they're low and you're not really sure like
• 1:11:35
  Melissa Shere Beek: Their sleep is messed of
• 1:11:36
  Dr. Lara Paraskos: the sleep and the circadian rhythms. And so making sure you're getting good sleep, eating healthy, it's so important. I like to tell people to try to as much as possible avoiding a lot of processed foods and preservatives whenever you can. I mean, it's sometimes it's unavoidable.
• 1:11:54
  Melissa Shere Beek: But not every day.
• 1:11:55
  Dr. Lara Paraskos: But as much as you can. Trying to eat healthy and exercise. And like we said, the exercise doesn't have to be gym. It can just be in the morning, I'm gonna wake up and I'm gonna do some jumping jacks and a few squats
• 1:12:11
  Melissa Shere Beek: and call
• 1:12:12
  Dr. Lara Paraskos: it a day.
• 1:12:12
  Melissa Shere Beek: Yeah. Move. Move more.
• 1:12:14
  Dr. Lara Paraskos: Move more. And eat better. Yeah. And get good sleep. I think to me those are the most important things.
• 1:12:18
  Melissa Shere Beek: Critical for everything. Absolutely. Okay, good. Is there anything new on the horizon in the endocrinology field?
• 1:12:24
  Dr. Lara Paraskos: There's a lot of stuff. I mean, it's interesting. For me, diabetes is I think where the biggest gains have come in endocrinology. When I first started my training, there was so little the medications that we had for diabetes were so little. It was like Metformin, older medication called agglipizide, amphetose, which we never use anymore.
• 1:12:48
  And then it was insulin. And then it that was it. And so, oh my gosh. Diabetes used to be something I think that we all kind of dreaded
• 1:12:55
  Melissa Shere Beek: Afraid of.
• 1:12:55
  Dr. Lara Paraskos: To treat because we didn't have good options. And then now we have so many new medications, you know, we were talking about the GLP-1s for weight loss, but we have Ozempic and Mounjaro for diabetes,
• 1:13:07
  Melissa Shere Beek: which are
• 1:13:08
  Dr. Lara Paraskos: amazing medications. That's awesome. That have other benefits as well. Cardiac benefits, renal benefits is good for the liver. And then there's another class also Jardiance and Farxiga.
• 1:13:23
  They work kind of at the level of the kidneys. Those are also excellent medications that have other benefits. So there's so much kind of new things that And are coming there's new new medications that are on the horizon. Probably very soon, we're gonna have them approved kind of piggybacking. It's like the next step from the Ozempic and the Mondradiopy ones.
• 1:13:43
  It's there's one called Kagrisema that's coming out very soon. And then Retrutide is another one Okay. That is like Monjaro but extra, you know. And so I think that those are very promising for diabetes and also weight weight Maintenance. Management.
• 1:13:58
  And I think those are kind of the newest things that are kind of really very close around the corner. Oh, that's exciting. The other thing I like to mention too is like Definitely. Me, in type one diabetes, autoimmune diabetes, one of the coolest things is all the implementation of technology in the treatment of diabetes in type one and insulin delivery systems, insulin pumps, automated pumps. It's so the same thing from when I started to now is
• 1:14:29
  Melissa Shere Beek: The technology is totally different.
• 1:14:31
  Dr. Lara Paraskos: Oh my gosh. It's The difference and the difference that it makes in patients' lives. So I'm very excited about that going forward as well. Oh, that's so cool. Well, this has
• 1:14:39
  Melissa Shere Beek: been did we leave anything out?
• 1:14:41
  Dr. Lara Paraskos: Probably. I don't know.
• 1:14:43
  Melissa Shere Beek: I told you. I had so many questions. It could be part two, three, four.
• 1:14:46
  Dr. Lara Paraskos: I know. Right?
• 1:14:47
  Melissa Shere Beek: This has been one of the most brilliant and educational and fun episodes. Oh, no. I'm so honored that you've been here. Thank you so much.
• 1:14:56
  Dr. Lara Paraskos: Oh, it's my pleasure.
• 1:14:57
  Melissa Shere Beek: Oh, no. It's mine. Before I let you go, I do something with my guest called Quickie Questions. Are you game?
• 1:15:02
  Dr. Lara Paraskos: Sure.
• 1:15:03
  Melissa Shere Beek: Okay. Let's do it. I'm a little nervous. No. That's okay.
• 1:15:05
  Do you have a daily ritual? Like, maybe something you do in the morning or the evening or
• 1:15:11
  Dr. Lara Paraskos: Not really. Well, okay. So I I wake up. And before everybody wakes up, I exercise. That's what I do in the morning.
• 1:15:17
  Melissa Shere Beek: That's brilliant.
• 1:15:18
  Dr. Lara Paraskos: I exercise. Good. Yeah.
• 1:15:19
  Melissa Shere Beek: Do you have a favorite book or movie or concert?
• 1:15:23
  Dr. Lara Paraskos: Well, so probably my favorite concert was the Taylor Swift concert.
• 1:15:28
  Melissa Shere Beek: Oh, yeah.
• 1:15:29
  Dr. Lara Paraskos: That was really epic. So that was great. We went with our kids. And it was this unforgettable Yeah.
• 1:15:34
  Melissa Shere Beek: She's brilliant. Yeah.
• 1:15:36
  Dr. Lara Paraskos: Just something I think we'll all remember forever. It was amazing. Oh, that's
• 1:15:41
  Melissa Shere Beek: so good. Okay. Do you have a favorite journey?
• 1:15:44
  Dr. Lara Paraskos: Journey in terms of vacation
• 1:15:46
  Melissa Shere Beek: or It could
• 1:15:46
  Dr. Lara Paraskos: be Oh, gosh. A
• 1:15:47
  Melissa Shere Beek: personal journey or it could be a vacation with your family. It could be any kind of any whatever your interpretation of Journey journey
• 1:15:53
  Dr. Lara Paraskos: for me, at least for now, is vacations with my family. So we've been kind of focusing on really trying to create kind of those core memories with the kids. And whether it's just like this weekend we're going to Naples. And, you know, so we just try to do a lot with the family and just spend as much time together as possible. Those are the always looking for that new journey and that new new experience Those are the best.
• 1:16:21
  Melissa Shere Beek: That's forever. Those are forever memories. I like that. Do you have a skill you wanna learn?
• 1:16:25
  Dr. Lara Paraskos: I wanna learn so many things.
• 1:16:29
  Melissa Shere Beek: Well, you have one in particular that came to head into your mind?
• 1:16:31
  Dr. Lara Paraskos: Well, from in endocrinology, the there's something that we the kind of a new new procedure for that's to treat thyroid nodules. It's called thyroid radiofrequency ablation. That's what I want to learn right now. But, you
• 1:16:46
  Melissa Shere Beek: know, this what wanna
• 1:16:47
  Dr. Lara Paraskos: ask you too. Okay.
• 1:16:49
  Melissa Shere Beek: Where and when are you happiest?
• 1:16:51
  Dr. Lara Paraskos: Probably on vacation with my family.
• 1:16:52
  Melissa Shere Beek: For sure. And last one, little known fact about you.
• 1:16:58
  Dr. Lara Paraskos: Oh my gosh. You know, okay. I'll tell you. One and it's it's not it's embarrassing, but not really embarrassing. That I was a child model, actually.
• 1:17:08
  Really? Yes. Oh, that's so cool. Who
• 1:17:10
  Melissa Shere Beek: did you
• 1:17:10
  Dr. Lara Paraskos: model for? Well, I so I don't know how it my sister did it and then I kinda got into it. But I was in a lot of like children's vogue, think. Did a lot of that's so fabulous. I did a lot like from I think I stopped around like eighth grade because it got a little bit like too
• 1:17:31
  Melissa Shere Beek: Too stressful.
• 1:17:32
  Dr. Lara Paraskos: Too stressful. Yeah. With everything. And then school and it was a lot.
• 1:17:36
  Melissa Shere Beek: I love that. That's a great little known fact. That's a really great fact. Oh, thank you. Thank you again for coming in.
• 1:17:42
  My pleasure. I was really thrilled that you said yes, and I'm so excited to talk about all these things. I could talk to you forever about all of this.
• 1:17:48
  Dr. Lara Paraskos: I know. Right?
• 1:17:49
  Melissa Shere Beek: Oh my god. I'm gonna do my outro, and then we can talk afterwards. To our listeners, thank you so much. So grateful you're here. Keep listening.
• 1:17:56
  Keep learning. Keep laughing. Keep up with Beek on being. Listen to Beek on being wherever you get your podcast. All episodes are automatically transcribed.
• 1:18:03
  DM us to share thoughts, ideas, or to nominate a guest. A big shout out and a huge thank you to Steven Chen at Penthouse Studios. Woo hoo. Beek on being was recorded at Penthouse Studios and is a proud member of the Penthouse Podcast Network. Thank you.
• 1:18:20
  Was your first podcast.
• 1:18:21
  Dr. Lara Paraskos: That was great.
• 1:18:21
  Melissa Shere Beek: Did you enjoy it?
• 1:18:22
  Dr. Lara Paraskos: I love it.