Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / GLP-1 Medications: Are They the Answer? with Dr. Taz MD
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- GLP-1 Medications: Are They the Answer? with Dr. Taz MD === dr. taz: We are spending 427 billion a year managing metabolic disease. There's gotta be a better way to do this. Everybody has their own normal and normal does not mean disease free. So this is a conversation for all of us. And no, I'm not going to tell you to eat better and to move more because that's too simplistic and doesn't work. dr. taz: So medications, there's a sweet spot. If you come off of it, you're going to gain all the weight back. Well, then that's not a solution because staying on something forever should not be the way we think about medicine. All right, guys, we got to get honest. Are you on a GLP one medication? Have you thought about being on a GLP one medication? dr. taz: You know what I'm talking about? terazapatides, the Majorna, the Wegovy, the alphabet soup of medications out there right now that everybody is talking about. All right, we're going to break it all down in just a second. Just a second. Hello and welcome to the whole plus podcast with me, Dr. Taz MD, where science and spirit converge, create healthy and whole families, communities, and individuals. dr. taz: And a part of that conversation is your metabolic health. And we've got to talk about the state of metabolic health and what that means for you and really what it means in a family unit or a family structure as well. We know our current healthcare system is broken. We know that people are not getting answers. dr. taz: I've got some mixed feelings about these medications, but stay tuned. I'm going to talk about it, but first we got to talk about metabolic health in general, because I think there's a lot of confusion about what metabolic health is. Is it just about your weight? And the answer of course is no. Metabolic health is now a global public health issue. dr. taz: We have every country in the world struggling and dealing with the diseases of metabolism. And if you're curious as to what those diseases might be, we're talking about everything from yes, obesity and weight management, but also high cholesterol, high blood pressure, sleep disorders, joint pain and inflammatory disorders, and so much more. dr. taz: So the family of metabolic health disorders encompasses everything from cholesterol, blood pressure, heart health, to issues with weight as well. And so it's really important, again, where we take a holistic approach. This is a classic example of where just taking a singular approach is failing and is not working. dr. taz: And again, I've got the data and the statistics to talk about that. So when we look just at the U S we are spending about 427 billion a year on managing metabolic disease. That money is going towards medications and pharmaceuticals, doctor's visits. surgeries, secondary diagnoses, meaning that you might have a metabolic health issue, but because of that, you're now more prone to all these different illnesses, including autoimmune diseases, cancer, mental health disorders, and more. dr. taz: So the burden of metabolic health upon our healthcare system is huge. It's massive and is bankrupting healthcare systems across the globe. Now let's bring that back to you and what it really means for you. At the end of the day, this is the journey that we've seen and, you know, I deal with this right here in our house, but we see patients go through over and over again. dr. taz: Usually one of the markers of their metabolic health will start to shift. Could be cholesterol. Could be blood pressure. It could be weight. It could be any one of those. And you typically go into the doctor and they might find that on an exam, or you may notice it as you're monitoring your own weight and how your clothes fit and so much more, but typically you end up on a medication and that first medication may treat one of those issues, right? dr. taz: It might treat the cholesterol. It might treat the blood pressure. But it's not treating the entire picture. So then sure enough, a few years go down and you're on a second medication. Maybe this time it's for blood pressure. And a few more years go by and you're on a third medication. This time it might be for diabetes. dr. taz: And a few more years go by and you have a new diagnosis. This is the pattern that we want to stop. And I know firsthand that it can stop. Understanding and identifying metabolic disease in you very early on will save you this journey of medication after medication, but more importantly, will save you just from just feeling bad and not feeling like your best self. dr. taz: Currently, we think about metabolic health and metabolic disease in silos. And that's it. Ultimately what's happening for every patient out there is not only are they ending up with a lot of different medications, they're also ending up with a lot of different specialists. So you may have a cardiologist in the picture. dr. taz: You may have a rheumatologist in the picture. You may have an endocrinologist in the picture and it goes on and on. Well, when we think about metabolic disease from a holistic perspective, we actually approach it in a very different way. And that's where this conversation around GLP 1s needs to really be framed. dr. taz: Many people are coming in to my exam rooms or you're asking me on social media or even right here on the podcast, should I or should I not go on one of these GLP 1 medications? Well, let's talk for a second about these medications. So the mechanism of action of these medications is fairly interesting. dr. taz: So it is acting on blood sugar and it is helping to bring average blood sugar levels down, but it's doing it by really increasing your satiety or how full you feel in any given moment that in turn is impacting gut health, meaning it is cutting down the amount of food you're eating for sure. And it's absolutely a game changer for people with a lot of weight to lose. dr. taz: But the flip side of that, as we're about to learn, is that when we impact or manipulate gut health, we are changing the microbiome, which is all those bacteria that live in the gut. And then in turn, we are influencing the expression of many other diseases and disease patterns. Patterns. So that includes increasing inflammation and directly improving or worsening hormone balance. dr. taz: And then of course, impacting your overall nutrient load. So the decision to go on a GLP one has to be weighted in science, but also has to look more closely at your whole health picture. So let's start with just you. And hopefully this is helpful, not only for you, but maybe for somebody in your family. I know that when I look at. dr. taz: But my own personal family or my husband's family, there's a long history of metabolic disease on both sides of the family. Both families have different burdens of cardiovascular disease, diabetes, you know, hypertension. That's the legacy that both my husband and I are gifted and we've unfortunately probably are also gifting it to our children. dr. taz: But neither one of us are expressing those diseases at the same ages. As our parents did. And that's because we do take into account different aspects of our health and are much more proactive when it comes to health than the generation before us. And hopefully you as well are more proactive about your health than your, maybe your parents or even your grandparents. dr. taz: So when we think about metabolic health, here is what we need to really be thinking about. Metabolic health can shift as early. As childhood, and there are a lot of different reasons for that. We're going to get into it in just a minute, but it does exaggerate as we go into our teen years, then into your twenties, then into your thirties. dr. taz: And that that golden age of somewhere between 40 and 45, there is a massive shift metabolically that then exaggerates even further as you hit 50. In fact, in a recent study, they said there are two key ages where aging is experienced in a more dramatic way. And I know exactly why one is at the age of 44 at 44, that's where both men and women are experiencing significant hormone shifts. dr. taz: That's then the impetus for shifting metabolic rates. At the age of 60, which is the second one, that's where we really see the effects of losing muscle mass or sarcopenia as it's commonly called. That loss of muscle mass in turn triggers more metabolic disease. So when I think about the metabolic timeline. dr. taz: I'm thinking about kids and are we setting them up in the right way to prevent metabolic disease? I'm thinking about our teenagers. Are they set up appropriately to prevent metabolic disease? And then again, going into these critical ages of your forties and then of course, post 60. So this is a conversation for all of us. dr. taz: And there are a lot of things at play and a lot of forces at play that are triggering this crisis in metabolic health. In fact, in a recent study, it said that only one in eight adults have optimal. metabolic health. That is horrific. And that again, can explain the cost and the disease burden of really managing this that we're seeing on the other end. dr. taz: Okay. So what do we need to be thinking about when it comes to metabolic health? Well, the first thing is just to scan yourself. So let's get a gauge and understanding of what's going on with you. In my experience, I really, truly feel like the earliest signs of a metabolic shift Show up in your waistline, seeing an expanding waist circumference, which is a hallmark of metabolic shifting is something we need to pay attention to across the ages. dr. taz: This is actually happening in our children as well. We are seeing more and more young children with expanding waistlines. In addition to that, we definitely see that shift as we cross 35, 40, and then definitely as we cross 50. So if you're wondering if you have metabolic disease and you haven't heard anything in your exam rooms, if your waistline is expanding, then the answer is yes, you are sort of in that spectrum of having an increased metabolic burden. dr. taz: The next marker that we often see shift is cholesterol and blood pressure. Both of those numbers gradually going up over time as these metabolic shifts are happening. Now, again, let's dial all the way back to the pediatric population. What we're seeing with them is that the increased waist circumference shortly thereafter leads to higher total cholesterol and higher LDL levels in children. dr. taz: That's why a part of routine pediatrics right now is to check those numbers in kids and. to measure their waist circumference, moving into the adults. What we're seeing is higher cholesterol levels as well. This becomes really dramatic, especially as the hormone shift. In fact, for many women, and I experienced this personally, by the way, always had low cholesterol, low hemoglobin A1Cs, which is the average, by the way, of your blood sugar over three months. dr. taz: And sure enough, that crossover. From perimenopause into maybe a pseudo menopausal state, cholesterol numbers go up. A1c goes up. And again, you're starting to see as well, more of the belly fat. So those are some of the ways, you know, if you are dealing with a metabolic issue, again, it's waist circumference, looking at blood pressure, looking at your blood sugar, looking at your cholesterol levels and tracking that over time. dr. taz: Now, one of the things that I'm really advocating for before, you know, we get too much deeper into all of this is that you actually have a way of tracking this on yourself. I think it's too late, honestly, to wait year to year to year and keep getting told these numbers are normal and they're okay, but they may not be normal for you. dr. taz: Let's go back to me. For example, my A1C pre hormone shifting was always a 4. 8 to a 4. 9. Again, remember that hemoglobin A1C is something you can check in routine blood work. And it's the average of your blood sugar over three months. Now, as my hormone shifted, guess what happened? That number went to 5. 2, 5. dr. taz: 3, somewhere in that range. That's still quote unquote, normal. But that's high for me. That's the type of information I think is really important for you to have and to understand about yourself. And I almost want you to keep to a certain extent, like a health diary or a health journal where you're tracking these numbers every six months to a year so that you can catch when you start to have those metabolic shifts. dr. taz: Now, for the majority of us, we don't catch those, right? Life gets in the way. You're busy. You're running around. You have 20 things you're doing. And before you know it, it sneaks up on you and you have that medical visit where your cholesterol is out of control or your blood pressure is out of control. dr. taz: Or, you know, because you've gained 10 pounds, 15 pounds, 20 pounds, and didn't even realize it was happening. Or there's an event that takes place, whether it's a heart attack, stroke, more of those type of extreme events that sort of shock you into understanding that this is an issue. Now, when we think the holistic way, we think preventively, we think fully, and we want these numbers to be caught earlier, before they happen. dr. taz: Rather than later. And we want to accept that premise that everybody has their own normal. And normal does not mean disease free, right? We don't want to confuse those terms. We want to understand what your optimal values are. Now, while there is the entire conversation of recognizing when you get. dr. taz: Metabolic disease, or when you more importantly metabolically shift, there's also the conversation of actually having a metabolic disease. And this is now defined in a couple of different ways, and I'm going to break it down for you. Please don't roll your eyes, but it's important to kind of know what the guidelines are. dr. taz: Okay. First of all, everyone with a BMI over 25 is considered overweight and BMI over 30 considered obese. Now, I don't think that's really fair because BMI is calculated looking at your height against your weight. And there are many ethnicities that have, you know, different proportions of height and weight. dr. taz: And so that number can be skewed and cause a lot of panic and sort of a lot of mental drain for sometimes no real reason. I think a better number to look at Is visceral fat and body fat, and those can be measured on many different machines that are out there today or at your doctor's office. There's also the caliper test where you can kind of pinch a fold of your fat and it will give you a measurement, but by understanding where your visceral fat is. dr. taz: And where your percent body fat is, we have a better gauge of where you're doing metabolically. Visceral fat, remember is the fat that's stored around your organs, your liver, your colon, even your heart. That is the fat that is of greatest concern and of greatest risk. So in the ideal exam room, we're tracking and measuring visceral fat in addition to the numbers that I just gave you. dr. taz: And not just looking at this blanket. kind of weight that everybody gets fixated on. I think percent body fat and percent skeletal muscle is equally important. Remember, there's a relationship between losing muscle and gaining body fat. We know that muscle is also an endocrine organ, helps to regulate blood sugar and helps to keep the metabolism humming. dr. taz: So these are additional things that I feel like really need to be checked if we're going to diagnose somebody with metabolic disease. Not just BMI moving on from there, looking at cholesterol numbers. Most people are looking nowadays at an LDL level or a small LDL P level, which is looking at small particles that typically impact the heart and the state of cardiovascular health. dr. taz: And then definitely looking at your blood pressure numbers as well, not going over about one 20 over 80 for cholesterol, not going over a fasting level of about 200. So those are the common ones, right? That's kind of what everybody's talking about, medicating, treating, kind of moving forward on there. Now, when somebody has crossed over, you know, when you have a patient or a loved one that's crossed over into very high amounts of visceral fat and very high amounts of body fat, that's when you're going to have a problem. dr. taz: They're in a state of what we call insulin resistance, meaning the pancreas just kind of can't keep up. Blood sugar levels stay elevated. Insulin stays elevated or quits responding. And then in turn, we're just gaining more and more weight. And again, it's typically belly weight. So it's almost like a cycle that perpetuates itself. dr. taz: It just keeps rolling around and around and around and people start gaining more and more weight. Now, in research and in the different studies, looking at all the different interventions that we have, here's what they found. And this may be maybe slightly encouraging or, or just discouraging as well. dr. taz: Diet interventions for people that have crossed over into a metabolic disease pattern only seem to help about five to 10 percent of the population. That's not a lot for all the conversation around diet and for all the like emotional wear and tear. Well, I was good and I was bad and I ate sugar and I didn't and I did this and I did that. dr. taz: 5 to 10 percent impact is really what they're finding with diet. And I think I know why from being in practice, because diet changes and implementing diet changes takes a really long time to see a result. It's not something that happens overnight. So for the majority of patients that have a lot of weight to lose, a lot of body fat, they're deep in the throes of metabolic disease. dr. taz: It's demotivating because it takes so long. to see those numbers change. The next intervention is often medications. These medications are things like metformin, cholesterol medications, blood prep, blood pressure medications. For example, they do impact the state of metabolic disease. They do improve it somewhere between 10 and 15%. dr. taz: So again, we've talked about diet. Now we've talked about medications. It's still not driving it home. What about movement? I'm sure you're thinking movement helps too. But again, the research is showing that movement helps only a small percentage of the people who are caught in the deep throes of metabolic disease. dr. taz: This is exactly why a medication like GLP one entered the scene. It's also why therapies like bariatric surgery entered the scene. Bariatric surgery actually had better statistics. It showed that close to 25 to 35 percent of the population can improve their metabolic disease post bariatric surgery. So here's this toolbox. dr. taz: That hasn't been super effective. And here comes GOP one medications, and they're still relatively new. So we still can't call it in terms of how effective they've been, but I can speak to what the research says, and I can speak to what we see in practice. What we're seeing in practice is that folks with a lot of visceral fat. dr. taz: And a lot of body fat, especially the percentage of body fat that crosses over into that 35, 40, 50 percent body fat, which usually correlates to those visceral fat numbers around 16, 17, 18, 20, you know, very high numbers. They know it because they have a very large waist circumference, usually crossing over 30 in women and crossing over about 40, 42 in men. dr. taz: So for that group of Patients because diet is only making a small impact because they're so deep in and medications are only making a small impact. It's not unreasonable to use a GLP one medication, like an Ozempic, like a Wegovy, like a terazapeptide. Now the side effects of those medications are real and they have to be used cautiously. dr. taz: Here's where. Those medications and I start to diverge, and this is exactly why we need a holistic strategy to GLP 1 medications. We have seen them work in practice at their standard conventional doses, 0. 25, 0. 5, 1, all the different numbers that exist out there. Patients do indeed lose weight, but we have also firsthand seen. dr. taz: How they lose skeletal muscle, how they lose facial fat. So the quote unquote Ozempic face, and more importantly, how their digestive health becomes disturbed and remember the gut is ground zero for your health. It's where inflammation begins when things are not healthy. So what are we supposed to do? dr. taz: This is where medicine. Needs creativity, needs a different way to think even about the pharmaceutical medications that have so much value. In practice, there are a couple of things that we have seen work. First of all, we know that microdosing the GLP one medications, So we might start one of these medications, but at a quarter of the dose, enough to blunt the blood sugar rise or the insulin rise, but not enough to cause the side effects that in turn helps people to acclimate and helps them to still maintain a healthy digestive system. dr. taz: Some people don't respond at those low doses. So what do we do next? Well, then we may go to a conventional dose of one of these medications, but now we're supporting the gut. Okay. And gut support involves everything from taking digestive enzymes, using something called glutamine that rebuilds the gut lining, and even taking probiotics to keep the microbiome intact. dr. taz: In this way, we are able to incorporate something like a GLP 1 pharmaceutical into a holistic strategy around weight loss and around metabolic health, rather than just saying, this is the only way, this is the only thing to take. Now, the research around GLP 1 medications is fascinating, and we can go back and forth a little bit, because again, like many things, I think there's a sweet spot. dr. taz: When GLP 1 medications are prescribed in the right amount for the right patient, there's a reduction in visceral fat, in body fat. And inflammation, because remember excessive fat, excessive visceral fat and body fat actually triggers inflammation. And so it helps in that inflammatory process. And we know that everything from cancer incidents, autoimmune incidents, infertility, mental health disorders, they're all tied to inflammation. dr. taz: So when we use GLP 1 medications in standard dosing for the population that needs it, we see a reduction in inflammation, inflammatory disorders, and improvement even in hormone based symptoms and mental health symptoms. But here's the catch. When it's not used in the right way, and it's dosed for somebody, That does not have that high amount of visceral fat or body fat than the GLP 1 medications actually promote inflammation. dr. taz: They become pro inflammatory because again, they're impacting gut health and the microbiome and they're disrupting hormone balance. So medications. Just like supplements, just like diet, just like everything, there's a sweet spot and we have to make sure you, the patient are matched to the right medication at the right time. dr. taz: One of the things that I think bothers me the most is this idea that we have to be on the medication forever. And I hear that all the time from patients. If you come off of it, you're going to gain all the weight back. Well, then that's not a solution because staying on something forever should not be the way we think about medicine. dr. taz: We should be thinking about bringing people to a healing state. And from there, the body, which is so incredible and so capable of its own self healing should be able to take over. One of these studies, this study Study in particular is from advanced therapeutics is showing two clinical trials, GLP 1 agonists help to lower A1C, decrease weight and improve the obesity comorbidities. dr. taz: That's the right use, correct? Here's another one talking about the link between using these GLP 1 medications and the reduction of alcoholism because it's taking away that impulse. And the reason Why it works that way is because as we manage leptin and ghrelin, these are satiety and hunger hormones, they are also caught up in cravings for alcohol and cravings for other substances. dr. taz: So again, somebody on the extreme end will benefit in other ways from these GLP 1 medications. The flip side of this, of course, is do these GLP 1 medications actually contribute to to cardiovascular dysfunction. We've got a lot of different studies talking about how in a cardiac patient who may already have metabolic disease, a GLP one medication can make anxiety worse and can make the heart overall a little bit worse by stimulating something we call the SA node or the sinoatrial node. dr. taz: That's not such a great use of that medication. That's a negative implication of that medication. In addition to that, we've also seen where the GLP one medications cause. really bad gut and GI side effects, and also impact just overall feelings of wellness and vitality. So the medications have a place, but they should not be the first step. dr. taz: And this is where I want to take you on a journey, thinking about metabolic health, the holistic way, or why. And overall kind of strategic plan when it comes to your metabolic health is so important. We know that metabolic health is an issue. We've seen the dollars, we've seen the diagnoses, we've definitely seen the pharmaceuticals. dr. taz: Here's a fun fact, by the way, the U S is actually responsible for 40 to 45 percent of the world's consumption of pharmaceutical medications. Most of those on diseases of metabolic health, no big surprise. There's gotta be a better way to do this. Right. And one of the things I'm very passionate about is really helping to paint that holistic plan, that strategic plan for reversing metabolic health. dr. taz: And by the way, this is at every age, just because we're talking about weight and metabolism. This is a conversation for our children as well, because they are definitely at every Risk, but what we need to do before we think about a GLP one medication, or before we think about any medication, honestly, beyond tracking and staying kind of on top of our health in a more proactive way is thinking first around that central concept of inflammation. dr. taz: Now inflammation is a word that everyone's gotten a lot more comfortable with, but it is an integral word, a critical word. For the practice of medicine that we do, and especially important when we're talking about a holistic plan, let me tell you why inflammation impacts every system of the body. It is not limited to an organ, to an area, but instead seeps throughout the entire body, really impacting every chemical process there is. dr. taz: That means inflammation can show up. As joint pain, as a rash, as hair loss, as a hormone issue, as mental health issues, and so much more. One of the critical issues facing us today is the epidemic of inflammation, which I actually believe is triggering the epidemic of metabolic disorders. We are susceptible to inflammation. dr. taz: For a variety of different reasons, but let's talk about what's happening. When we say the word inflammation, essentially it's the body reacting against itself. There are a couple of different pathways in the body. When we see a foreigner or an invader, the immune system is programmed to react in a couple of ways. dr. taz: One way it reacts is to go after it, kill it, get rid of it. Right. That's what most of us. Want to do the other pathway though, starts to Peter out and the body starts to turn against itself. It's almost like there's an internal riot instead of everybody getting together to push this enemy out, that acting out upon itself is in turn what triggers inflammation. dr. taz: And I can use a big, lots of big scientific words. There's a flood of inflammatory cytokines, different mediators that get released. Those in turn trigger damage to different areas of the body. Now, winding it all the way back to metabolic disease, chronic inflammation leads to disorders in metabolism and severe metabolic disease leads to more inflammation. dr. taz: So it's kind of like a catch 22. The beauty of starting early in this conversation and proactively in this conversation, and I can keep screaming about this, is that we have to track inflammation. And understand what's happening in your body. When it comes to that particular concept, that means all of us, our children included should be tracking some of the key markers of inflammation besides the symptoms, which include just to repeat myself, joint pain, rashes, cognitive disturbances, feeling achy, having trouble sleeping, hormone imbalances, and so much more. dr. taz: In addition to that, we can actually look at it in lab values. And that includes looking at a number called a CRP or C reactive protein, looking at a homocysteine, looking at a erythrocyte sedimentation rate. These are all things we can do routinely in practice using conventional labs, and we should be doing them even in our children. dr. taz: And our seniors, oftentimes we're not, and diseases sneak up on us by surprise. Sometimes I've had patients come in and all those numbers are beautifully normal, but their symptoms check off as symptoms of inflammation. What's happening there? Well, those numbers are not telling the whole story. I would say in addition to that, if your white count is low, if something like a TGF beta or a C4a is high, or even an IL 6, which is a pro inflammatory cytokine. dr. taz: You've got inflammation. So those are some additional numbers you can check. If you're wanting to go a little bit deeper, we've got study after study talking about the role of inflammation and metabolic disease. This study in particular is from 2004. It's an older one, but it's talking about all the different causes of chronic inflammation that can be a triggering factor for inflammation. dr. taz: for metabolic syndrome, overnutrition, inactivity, being sedentary, all of which is leading to insulin resistance and diabetes. We also have another study here coming out now, more recent 2019, talking about the link between inflammation and adipose tissue, that even your fat cells are pro inflammatory and make that inflammatory cycle worse. dr. taz: Here again is the correlation between your hormones and what's happening with inflammation. That's linked as well. So as you can see, inflammation is a concept to really sink your teeth in, grasp and understand how it's playing into this conversation around metabolic health. Okay, let's move on from there hormones I have alluded to, but I think this one is so important because remember those critical ages of 44 and 60. dr. taz: They're not just random numbers. Those are critical numbers when it comes to hormone shifting. And so if we can know that and act five or six years ahead of that, we can save us a lot of metabolic pain. What's happening with the hormone system? Well, here's what we understand, and I can paint the spectrum of hormone imbalances and metabolic disease, starting as young as our kids and going all the way through our seniors. dr. taz: Let's talk about our kids for just a second with our children, if they have experienced trauma. Poor nutrition, a lot of stress, they will have issues and disruption. And what is called the hypothalamus, it's an area that sits right in the brain and really regulates a hormone called leptin, which decides how full we are. dr. taz: And if we're satisfied, if we are eating more than we need, well, we produce more fat cells, which also produce more leptin and kids stay in this vicious cycle of wanting to eat all the time, wanting to snack all the time and in turn develop more inflammation and of course more weight. So the. The two cycle together. dr. taz: If we move that conversation around hormones a little bit older, what we're seeing in our adolescence is that with the environmental load of toxins, many of them are skewing to a high estrogen profile. Not just high estrogen, but high estrogen across both genders and high androgens in our young girls. dr. taz: Androgens are those male derivatives of hormones like DHT, testosterone, free testosterone, estrogen we can measure in boys as circulating estradiol, and we can even look at an estrone, which is a stored form of estrogen. One of the greatest challenges of our time today is that those numbers are high in our kids. dr. taz: So even before they get to adulthood, where we typically see maybe some metabolic disease show up, they're already at a disadvantage. These are things we change when we think about metabolism and metabolic health, the holistic way. All right, let's keep moving it through. Now we're getting into, uh, pregnancy years, postpartum years, men are starting to have, uh, declining levels of testosterone that definitely impacts their metabolic health. dr. taz: And for women that decline in estrogen triggers a rise in blood sugar, which then triggers a rise in insulin, which then triggers a whole sequence. Of metabolic issues. Remember at the start of this conversation, I talked about women who all of a sudden, even myself started seeing that a, when C go up, started to see those cholesterol numbers go up as they were in their mid forties and early fifties and had no other change that they possibly could put their finger on. dr. taz: It's the hormone shift. And that's something that's very real when it comes to metabolic health. Study after study talks about the link between hormones and metabolic syndrome in women and in men and the link between testosterone and metabolic health as well. So when we're going to think about metabolism holistically, the hormones become a part of that conversation too. dr. taz: All right. I have just a couple more, I promise, but they're all equally important in this grand landscape of metabolism as we're trying to put the pieces together. The other thing we have to talk about here is gut health. I've written about gut health. I've talked a lot about gut health and I measure gut health in our practices. dr. taz: And here's what we're seeing over and over again. The microbial shifts. that are being triggered by food quality, by stress, by hormone shifts, by toxins in the environment are lending and driving themselves towards a pattern that is inflammatory and triggers metabolic disease. For example, we know that there is also an epidemic of candida overgrowth across all ages. dr. taz: Candida is a yeast and we all have it. It's normal, but in certain people it overgrows and in turn triggers a rise in androgens and a rise in insulin. Triggering more metabolic disease. There are other bacteria that we found actually connect to why metabolism gets slower or more sluggish, or people present with more metabolic disease. dr. taz: We know that acromantia, the bifidobacteria, lactobacillus family can all start to alter and change, especially in men and women as they hit their forties and then going into their fifties. And the decline of these particular bacteria are linked to the rise in cholesterol, blood sugar, blood pressure, and metabolic disease. dr. taz: So again, it's all connected. It's almost like we can't have a conversation of one without the other. And even as I'm talking, you can see how I'm like tripping over and interconnecting all these different ideas. So the gut becomes paramount in the conversation around metabolic health and its sister or brother, the liver is equally important. dr. taz: In Chinese medicine, you couldn't have a conversation around gut health without having a conversation around the liver or liver health. The two were so combined. The liver is responsible for the production and the management of blood sugar. But if that liver is heavy and boggy and not able to process things very well. dr. taz: Well, blood sugar levels get higher and it results in more fat around that liver. Again, another cycle, right? More fat around the liver, more of a boggy liver. Can't do its thing. Blood sugar levels are going higher and higher and higher. Well, one of the things that really impacts liver health, and we are concerned, worried in fact, that this is happening in utero. dr. taz: This might be even happening at conception is that the toxic load. That we are all experiencing and carrying around in our systems might be driving that liver pattern of metabolic disease that could show up in childhood or could actually show up later in adolescence as well. We know that the last few generations have been exposed to more endocrine disrupting chemicals than ever before. dr. taz: This is everything from our pesticides, our plastics, our heavy metals, and so much more. Toxins consume us, they surround us, but it's not just about the stuff that we're eating or putting on our bodies or any of that. It's also about the air we're breathing and the water we're drinking. And it may even be about how many people are around us in the population density. dr. taz: This toxic load in turn is disrupting hormone balance is altering the hypothalamus that is then raising leptin levels. Which then changes appetite, which then changes blood sugar, which then results in visceral fat. You guys see where I'm going with all this. It is so, so intricately connected. I do want to share a couple of studies that talk about the impact of the environment on, uh, metabolism in general. dr. taz: Here in particular, this is one from the international journal of molecular science. This is from 2023 and it talks about really how the landscape has changed. It's saying to meet the increased need for food and energy because of economic shifts brought about by the industrial revolution, there has been an increase in persistent organic Transcribed pollutants in our atmosphere and more heavy metals in our environment. dr. taz: All of this has had an impact on metabolic health. Metals impact glucose regulation by disrupting pancreatic beta cells, causing hyperglycemia and impaired insulin signaling. In addition to that, there's been a positive association between the concentration of endocrine disrupting chemicals in the 12 weeks prior to conception. dr. taz: And fasting glucose levels. And does that bother you or what? We have a major issue with what's happening, not just with what we're doing, but even with what we're passing on to our children. And I think this is something that we all have to be aware of and have to pay attention to. So we know that toxins in turn are linked to it, but let's talk about you. dr. taz: The last and final piece of this holistic puzzle when it comes to your metabolic health. And then we're going to try to build a mini metabolic treatment plan just for you. This next one's a big one, which is probably why I saved it for last, because we can't diminish it. We know that we are living in a stressful time, and I don't want to just throw the word stress out there and for everybody to overuse it and oversimplify it. dr. taz: But here is what I'm referring to. That hypothalamus, right, we talked about it, sits in the brain, buried deep in, it's like your shark fin is the way I like to think about it. Feeling and sensing and almost like tasting your environment. Well, think about what we're doing nowadays. We're sitting a lot. We have a lot of blue light that surrounds us. dr. taz: We don't sleep. Our circadian rhythms are disrupted. There's a lot of stress and deadlines for women and for men. We live in nuclear families, not an extended family. So we have limited support and help when it comes to childcare or family rearing. We are all in a state of chronic cortisol overload. It's almost like we're vibrating at that level. dr. taz: And then we enter our relationships, our careers and the like in that vibratory state. And we continue to perpetuate almost this cortisol overload. As cortisol continues to be high and blood sugar levels continue to respond. to that cortisol level. At some point, the hypothalamus activates the autonomic nervous system, pouring out more cortisol, adrenaline, and all of these different neurotransmitters, making us anxious. dr. taz: In addition to that, all this activity is crashing your HPA axis, right? Your hypothalamic pituitary axis. So there's an earlier decline in progesterone and earlier decline in testosterone and earlier drop in estrogen, all the while an earlier rise in insulin and blood sugar. So, again, we talk about stress, but we need to be thinking about it more so in terms of what is it doing to your hypothalamus? dr. taz: And that's where the lifestyle means of bringing this metabolic conversation home really matters. Because if we can dial down the cortisol and rest the hypothalamus, we can stay in a metabolically healthy state. From childhood all the way through our senior years. But if we can't manage that, we keep band aiding, kind of poking our holes in a bleeding dam and not really getting a solution that works for the long term. dr. taz: I've been honest with you that even I and my practice providers have prescribed GLP 1 medications, but we think about it holistically. We think about it in context of this puzzle and how to build a plan that's going to work not just while you're on a medication, but a plan that's going to work for the long haul. dr. taz: All right, if you're still with me, let's build that metabolically active, holistic plan. I'm going to give you some of the starting steps so that you can at least start to have this conversation with yourself. But I'm going to lay out for you what really needs to happen if you're trying to reverse and change your metabolic health. dr. taz: And no, I'm not going to tell you to eat better and to move more because that's too simplistic and doesn't work in the context of chronic inflammation and high blood sugar. The starting point for all of us needs to be around two central ideas, the reduction of cortisol and the reduction of inflammation. dr. taz: And that's really where you need to focus. That means taking a step back. Looking at your life and seeing where it is that you can sort of insert stress, relieving modalities, or maybe even alter your structure of your day so that you're able to manage it a little bit better. Reducing cortisol can look like many different things. dr. taz: It can look like eating consistently, meaning you're getting the right amount of protein, 20 grams or so every four hours, which keeps the blood sugar stable and prevents you from experiencing the stress of erratic blood sugar. It can look like consistent sleep where you make sure you sleep from at least 10 PM to five or six o'clock in the morning. dr. taz: And it can also look like changing your life. Do you need to come home earlier? Go to bed earlier. Do you need to change your environment in your job? Or is it more, you just need to get off the computer or the cell phone and have blue light free times throughout your day. All of these are factors that worsen cortisol. dr. taz: Now for women, and even for men, if you've had a massive drop in estrogen, progesterone, or testosterone, the Those cortisol levels are higher on average. So understanding where your hormones are may be helpful as you're trying to accomplish some of these other things. The other part of this is reducing inflammation. dr. taz: And one of the key ways to reduce inflammation is to protect the gut and to really adopt an anti inflammatory diet. Your starting point. Let's eliminate sugar and alcohol. Those are probably the two most fundamentally inflammatory foods that we eat on a consistent basis. Removing those will help to bring the load of inflammation down and the added bonus of bringing your blood sugar levels and even your insulin levels down as well. dr. taz: Just by tackling those two concepts, your cortisol and your inflammatory load, you in turn can start to see metabolic shifting Transcribed A little faster than you would, if you just took a singular medication or a singular supplement. Now there are supplements and herbs that help with both cortisol reduction and inflammation reduction, but I really want you to build the life that's going to allow those things to happen. dr. taz: Everything from ashwagandha and magnesium to using curcumin for inflammation and even omega 3 fish oils, vitamin D. These are all things that become critical in that starting step. So for me, a holistic strategy is first, where are you with these two central concepts and what do we need to do to get those lined out? dr. taz: Let's assume that you've already accomplished that your next step is then to get into hormone balancing because as you've seen, if the hormones are not where they need to be, you're going to constantly be dealing with cortisol and blood sugar levels might mean some bioidentical progesterone or estrogen, or even testosterone, depending on who you are. dr. taz: It may even mean some herbs or supplements for blood sugar balancing, whether it's berberine or some of the other natural herbs like gymnamina and Ayurvedic medicine that help to balance blood sugar. Moving on from hormones, the next place is gut health. What's happening with your gut? Are you going to the bathroom every single day? dr. taz: Do you have a healthy microbiome? Would you benefit from more good gut bacteria, whether through food and fermented foods or whether through a supplement? Have Digesting fat and making sure you're aiding your pancreas with digestive enzymes can support the gut and a metabolically healthy plan moving on from the gut. dr. taz: Finally, and sometimes that's enough work to do. And if you want to stop there, so be it. But then the next place to go is to look at that toxic load. Where are you with your toxins? Are you using products that might be contributing? Are you in an environment that might be contributing? Are you exposed either at work or at home to a lot of these endocrine disrupting chemicals and microplastics? dr. taz: Well, if you are slowly removing them and cleaning up the liver is going to help you become metabolically more active. As I've worked through this sort of diagram here, notice how I have not yet talked about calories in and calories out. And I have also not talked about how much you need to burn on a given day. dr. taz: And there's a distinct reason why it actually works against us until you bring things like inflammation and cortisol down. And until you get your hormones and your gut balanced, these extremes of watching calories and burning calories only will get you so far. And then you'll find yourself having to do it all over again. dr. taz: But once you walk through this plan. And you've also looked at yourself from an emotional standpoint and made sure you're in a life pattern that matches the vibration of nurturing and caring for yourself. Then you can start to think about additional medications. Whether it's a GLP 1 or any of the other medications that we've talked about today. dr. taz: But that idea that you have a rhythm, that you have a vibration, and that vibration drives you to certain behaviors that sometimes work against you and land you in the sea of metabolic disease is something I really want you to wrap your head around. Because while I can give you a linear path of different things you need to do, I don't The harder part is making sure you built a life and a plan that works for you. dr. taz: So when we think about healing the holistic way and becoming whole, these are the elements that play everything from how you build your life and your schedule. how you sleep, how you eat, who you're around, what your gut, what your liver, what your toxic load is, and even where inflammation is in your body. dr. taz: And the key to being successful with this strategy is to enter the conversation earlier and earlier and earlier, even helping your children with this plan, helping yourself and the people around you. And by doing so, we avoid the disease burden, the heartache, right? And the expense of metabolic disease, which is an epidemic across the globe. dr. taz: This is how we become whole. This is how we heal our families. This is how we heal our communities. Thank you for joining me for this episode of Whole Plus. If you enjoy this conversation, be sure to share this episode with your friends and family and subscribe wherever you get your podcasts. Don't forget to follow me on all social channels at DrTazND. dr. taz: Thank you for joining and I'll see you next time.