Latest / Clearly Hormonal / Ep 22: Reclaiming Your Body in Midlife with Dr. Caissa Troutman

Transcript

Ep 22: Reclaiming Your Body in Midlife with Dr. Caissa Troutman · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health.
• 0:18
  Dr. Komal Patil-Sisodia: And recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:40
  Dr. Komal Patil-Sisodia: Hi everyone.
• 0:41
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge for today's episode.
• 0:44
  Dr. Komal Patil-Sisodia: I'm excited to announce that Dr.
• 0:47
  Dr. Komal Patil-Sisodia: Case Troutman from Midlife Remedy will be joining us.
• 0:50
  Dr. Komal Patil-Sisodia: Dr.
• 0:50
  Dr. Komal Patil-Sisodia: Troutman is a, is an obesity medicine physician as well as a menopause certified practitioner, and she has been running her own practice now for about.
• 1:00
  Dr. Komal Patil-Sisodia: Two years and is passionate about all things perimenopause and menopause related, especially how that ties into weight management.
• 1:08
  Dr. Komal Patil-Sisodia: So excited to have you here today so that we can discuss the shame and the stigma around midlife weight changes.
• 1:15
  Dr. Komal Patil-Sisodia: So welcome Dr.
• 1:16
  Dr. Komal Patil-Sisodia: Troutman.
• 1:17
  Dr. Komal Patil-Sisodia: Thank you so much for joining us.
• 1:19
  Dr. Case Troutman: Yes.
• 1:19
  Dr. Case Troutman: Thank you so much for having me, Komal.
• 1:21
  Dr. Case Troutman: Super happy to be here and ready to chat about everything and anything.
• 1:26
  Dr. Komal Patil-Sisodia: Thank you.
• 1:26
  Dr. Komal Patil-Sisodia: I appreciate that and I am a longtime admirer of the work that you're doing.
• 1:30
  Dr. Komal Patil-Sisodia: You're located in central Pennsylvania, correct?
• 1:32
  Dr. Komal Patil-Sisodia: I.
• 1:33
  Dr. Case Troutman: Yes, that's correct.
• 1:34
  Dr. Case Troutman: Yep.
• 1:34
  Dr. Komal Patil-Sisodia: That's great.
• 1:35
  Dr. Komal Patil-Sisodia: That's great.
• 1:35
  Dr. Komal Patil-Sisodia: So for any of our lucky listeners who are out in Pennsylvania, Dr.
• 1:38
  Dr. Komal Patil-Sisodia: Troutman is gonna be a great resource for you.
• 1:41
  Dr. Komal Patil-Sisodia: So I just wanted to kick off today hearing a little bit about how you got to where you are in your current practice and what inspired you to move towards your own practice focusing on these topics.
• 1:54
  Dr. Case Troutman: What a great question.
• 1:55
  Dr. Case Troutman: When I talk about my practice and my professional expertise, I always really start by saying it was me search.
• 2:02
  Dr. Komal Patil-Sisodia: I love that.
• 2:03
  Dr. Komal Patil-Sisodia: That's so good.
• 2:06
  Dr. Case Troutman: It was me.
• 2:06
  Dr. Case Troutman: I am the patient, I am a person with obesity.
• 2:09
  Dr. Case Troutman: I've struggled with obesity my entire life.
• 2:11
  Dr. Case Troutman: I would always be able to lose weight when I, my head was on and I'm on point, and whenever there's any life disruptors, I would always regain the weight back or when, and I would always feel bad about myself.
• 2:23
  Dr. Case Troutman: I always felt like I was broken.
• 2:24
  Dr. Case Troutman: I always felt that there was something wrong with me and I should have more willpower.
• 2:28
  Dr. Case Troutman: So that's when I dove into the science of obesity medicine and really understood the modern science of weight, that it wasn't really my fault.
• 2:35
  Dr. Case Troutman: And also, I'm a woman in perimenopause.
• 2:37
  Dr. Case Troutman: And just like many other women in midlife, I had a lot of symptoms.
• 2:41
  Dr. Case Troutman: I attributed to stress, air coats and just push it away because, we're women and we're strong and we were just told to just really yeah, suck it up and put up with it.
• 2:50
  Dr. Case Troutman: And really, as a physician, I didn't even, I didn't even tie it in that the symptoms I was experiencing were from.
• 2:56
  Dr. Case Troutman: Hormonal changes to perimenopause.
• 2:58
  Dr. Case Troutman: So I became a board certified menopause society practitioner and also prescribe FDA approve hormones to my patients.
• 3:04
  Dr. Case Troutman: So again, research, right?
• 3:06
  Dr. Case Troutman: So my, my pain points became my professional expertise and I just love this field I'm in where we fuse both'cause it is, apparently I'm not that uncommon.
• 3:18
  Dr. Komal Patil-Sisodia: It's so funny you're talking about this and you know how you're personalizing it.
• 3:24
  Dr. Komal Patil-Sisodia: And I have had similar struggles like my whole life.
• 3:27
  Dr. Komal Patil-Sisodia: And it is something that as women, we downplay, what is the term head down power through where we are just pushing through anything and everything we can to make sure we're checking off our list and doing all the things we're expected to manage.
• 3:40
  Dr. Komal Patil-Sisodia: And then on top of that, I think being female physicians.
• 3:44
  Dr. Komal Patil-Sisodia: We almost gaslight ourselves into being like, oh, it's not that.
• 3:47
  Dr. Komal Patil-Sisodia: It's just stress.
• 3:48
  Dr. Komal Patil-Sisodia: There's nothing wrong with me.
• 3:49
  Dr. Komal Patil-Sisodia: It's just stress.
• 3:50
  Dr. Komal Patil-Sisodia: And then you really start getting walloped by perimenopause and life changes and you realize you need to make some changes.
• 3:57
  Dr. Komal Patil-Sisodia: So that resonates so much with me, and I'm sure with our listeners who are trying to hold it together.
• 4:03
  Dr. Komal Patil-Sisodia: And I interviewed another physician on the podcast.
• 4:05
  Dr. Komal Patil-Sisodia: It was actually on a sleep topic, but she said, women come ask for help when their compensatory mechanisms fail.
• 4:11
  Dr. Komal Patil-Sisodia: And that was in context of.
• 4:13
  Dr. Komal Patil-Sisodia: Sleep, but I think it applies here as well.
• 4:15
  Dr. Komal Patil-Sisodia: You can be doing all the right things and still have things go off the rails or go sideways.
• 4:21
  Dr. Komal Patil-Sisodia: So I'm so excited to talk to you and hear your thoughts on how our listeners can best manage this.
• 4:27
  Dr. Case Troutman: Yeah,
• 4:27
  Dr. Komal Patil-Sisodia: let's go.
• 4:28
  Dr. Komal Patil-Sisodia: All right,
• 4:28
  Dr. Case Troutman: let, what shall we talk about?
• 4:29
  Dr. Komal Patil-Sisodia: So let's start with the elephant in the room.
• 4:32
  Dr. Komal Patil-Sisodia: Why is talking about weight in midlife often loaded with so much shame, especially for women?
• 4:39
  Dr. Komal Patil-Sisodia: I think we talked about personally, what that was for us, but I would love to hear your experience and your practice and what you're seeing in your patients.
• 4:47
  Dr. Case Troutman: I think the.
• 4:49
  Dr. Case Troutman: I think it has to do with what is the prevailing theory on why we gain weight.
• 4:54
  Dr. Case Troutman: It is the calorie in calorie out model, hence, and it's so mathematically perfect, just eat less and move more and you'll lose weight.
• 5:02
  Dr. Case Troutman: And if it doesn't work, it means something's wrong with you.
• 5:05
  Dr. Case Troutman: So I think if we start with that understanding, and I know you shared this with your own patients, if we disrupt that thought for a second and recognize that it's actually a little bit more complicated than that.
• 5:15
  Dr. Case Troutman: Then we recognize that all the other sleeps, how we handle stress, how we and then again, the hormonal disruptions that happen in midlife, that is all like the perfect storm for women who are doing 10,000 things.
• 5:28
  Dr. Case Troutman: They're taking care of their family, they're taking care of their careers, they're taking care of their kids, they're taking care of their parents.
• 5:33
  Dr. Case Troutman: It's like the perfect storm for it to happen.
• 5:36
  Dr. Case Troutman: And in a way it's like a failure, oh you let yourself go or you're again, you don't have any more will, you don't have any willpower.
• 5:43
  Dr. Case Troutman: Yeah.
• 5:43
  Dr. Case Troutman: That old story of willpower being the reason Yeah.
• 5:46
  Dr. Case Troutman: The way to lose weight.
• 5:47
  Dr. Case Troutman: It does.
• 5:48
  Dr. Case Troutman: It has to die.
• 5:49
  Dr. Komal Patil-Sisodia: I totally agree with you.
• 5:51
  Dr. Komal Patil-Sisodia: And it's so hard because when you've been in the shoes, we've personalized this for ourselves.
• 5:56
  Dr. Komal Patil-Sisodia: When you've been in that space of wanting to try anything and everything and gritting your teeth and trying the willpower way, it is just so demoralizing when you find that things aren't working well.
• 6:07
  Dr. Komal Patil-Sisodia: So that, that's a great, that's a great, and
• 6:09
  Dr. Case Troutman: I think to a certain extent, it might work.
• 6:11
  Dr. Case Troutman: But the question is how long it's gonna work for two weeks, one month, six months, three months, and then what happens?
• 6:17
  Dr. Case Troutman: Then your brain recognizes like, oh, this is not what I want.
• 6:20
  Dr. Case Troutman: It ramps up all the hormonal changes that make it much harder to maintain what we do.
• 6:25
  Dr. Case Troutman: Yeah.
• 6:25
  Dr. Case Troutman: So yeah, I think it's the stigma of what weight.
• 6:28
  Dr. Case Troutman: Gain is and what obesity is or just what weight gain is.
• 6:32
  Dr. Case Troutman: And then the fact that we carry a lot, and I think societal picture, like women should have a certain size, women should look a certain way.
• 6:40
  Dr. Case Troutman: Yeah.
• 6:40
  Dr. Case Troutman: Dress a certain way.
• 6:42
  Dr. Case Troutman: Yeah.
• 6:42
  Dr. Komal Patil-Sisodia: Yeah.
• 6:43
  Dr. Komal Patil-Sisodia: And I think you're absolutely right.
• 6:45
  Dr. Komal Patil-Sisodia: That is the societal expectation.
• 6:47
  Dr. Komal Patil-Sisodia: That's the weight stigma that shows up there.
• 6:49
  Dr. Komal Patil-Sisodia: And then, it translates to how we look at ourselves in the mirror and how we start talking about our bodies.
• 6:54
  Dr. Komal Patil-Sisodia: What do you see with that, with your patients?
• 6:56
  Dr. Komal Patil-Sisodia: Are they coming in, beating themselves up?
• 6:58
  Dr. Komal Patil-Sisodia: Are they, is it just like defeat and acceptance?
• 7:02
  Dr. Komal Patil-Sisodia: Where, what are the patterns and the common complaints and?
• 7:07
  Dr. Komal Patil-Sisodia: Things that we're seeing in our, I think it's
• 7:09
  Dr. Case Troutman: a combination.
• 7:09
  Dr. Case Troutman: I've definitely seen the spectrum.
• 7:11
  Dr. Case Troutman: I've seen the spectrum of where they've tried everything and they just want any, and any kind of help to help them.
• 7:19
  Dr. Case Troutman: Which I, that is all both great, but also there's a lot of negative default thoughts that they've already formed, but I'm a failure, et cetera, et cetera.
• 7:28
  Dr. Case Troutman: That sometimes it's hard to break that.
• 7:31
  Dr. Case Troutman: And I think it's also let's see.
• 7:34
  Dr. Case Troutman: Patients that want certain way of doing it, they, I think just a variety of things.
• 7:40
  Dr. Komal Patil-Sisodia: Okay.
• 7:42
  Dr. Case Troutman: That was a hard question.
• 7:43
  Dr. Komal Patil-Sisodia: That is a hard question.
• 7:44
  Dr. Komal Patil-Sisodia: I think you did a good job answering it though.
• 7:47
  Dr. Komal Patil-Sisodia: And I think that's true in all aspects of medicine.
• 7:50
  Dr. Komal Patil-Sisodia: Everybody's story is slightly different when they come in.
• 7:52
  Dr. Komal Patil-Sisodia: And as physicians, we have to be aware of where that stigma is hitting them the most and how it's coming out in their story.
• 8:00
  Dr. Case Troutman: I.
• 8:01
  Dr. Case Troutman: You know what's interesting?
• 8:02
  Dr. Case Troutman: Like I've seen a different, every patient come in.
• 8:05
  Dr. Case Troutman: Yeah.
• 8:06
  Dr. Case Troutman: For the initial consult in different ways.
• 8:07
  Dr. Case Troutman: I've definitely had people that come in to see me now.
• 8:10
  Dr. Case Troutman: I always espouse the data the comprehensive approach, which is, looking at what your nutrition, physical activity, behavior, change in meds.
• 8:18
  Dr. Case Troutman: I think all of them together really create that comprehensive approach to treat the biology as well as the habits.
• 8:23
  Dr. Case Troutman: But I, it's interesting how I have a lot of patients that come to me and say, I don't want any meds.
• 8:28
  Dr. Case Troutman: I just want.
• 8:29
  Dr. Komal Patil-Sisodia: Yeah.
• 8:30
  Dr. Case Troutman: So has that ever happened to you?
• 8:32
  Dr. Komal Patil-Sisodia: Absolutely.
• 8:33
  Dr. Komal Patil-Sisodia: And I think that is interesting because a lot of times, and this is a nice segue into the next several questions that I have, a lot of times people don't understand the biology of their body.
• 8:44
  Dr. Komal Patil-Sisodia: And while you may not want something, it may be what your body needs.
• 8:48
  Dr. Komal Patil-Sisodia: And I think a lot of times that conversation really starts shifting around how do we get people to understand that they're doing all of these different things?
• 8:56
  Dr. Komal Patil-Sisodia: And if something isn't working, how do you.
• 8:58
  Dr. Komal Patil-Sisodia: Start accepting that you may need to take another step to, to work on yourself.
• 9:03
  Dr. Komal Patil-Sisodia: Would you say that you see something similar?
• 9:05
  Dr. Case Troutman: Yeah, and I think that's where the art of medicine comes in.
• 9:08
  Dr. Case Troutman: 'cause we meet them where they're at and definitely support them in the nutrition part.
• 9:13
  Dr. Case Troutman: Physical activity and behavior change.
• 9:15
  Dr. Case Troutman: And then get, give them like, okay, let's see if this doesn't work or, let's level up or something like that.
• 9:21
  Dr. Case Troutman: But I and again, that's where I think, battling the calorie and calorie out model, which has been there for so long, and even me, I know that I still sometimes have that.
• 9:31
  Dr. Case Troutman: Yeah, sometimes default thought of oh, but no wait, no, this is actually science.
• 9:36
  Dr. Komal Patil-Sisodia: It's hard not to go down that road.
• 9:38
  Dr. Komal Patil-Sisodia: I was looking at my own diet the other day and I realized that while I thought I was hitting all of my protein goals, I wasn't, I was also not eating enough carbs, which sounds like an oxymoron to a lot of people who are trying to lose weight.
• 9:51
  Dr. Komal Patil-Sisodia: And I realized that it wasn't, feeling my muscles.
• 9:54
  Dr. Komal Patil-Sisodia: And with that.
• 9:55
  Dr. Komal Patil-Sisodia: All of these things start shifting, but if I can get blind to that, everybody else can too.
• 10:01
  Dr. Komal Patil-Sisodia: We have a background in doing this and it, it's very hard to maintain.
• 10:06
  Dr. Case Troutman: Yes, totally.
• 10:06
  Dr. Case Troutman: I was telling my husband the other day, yeah or, and I was sharing this to my patient too, like I know all the right things to do.
• 10:13
  Dr. Case Troutman: I teach it every day.
• 10:14
  Dr. Case Troutman: I know all the right things, but it doesn't always translate to.
• 10:18
  Dr. Case Troutman: Ability to apply it to my own life.
• 10:21
  Dr. Case Troutman: Yes.
• 10:21
  Dr. Case Troutman: For a, for the most part I do.
• 10:23
  Dr. Case Troutman: And then again, without the tool of medicine, oh my God, that applying it to real life is just so much harder.
• 10:28
  Dr. Case Troutman: Let's make it.
• 10:29
  Dr. Case Troutman: Let's, and again, what, and maybe we, you do this too with your patients, I always say weight loss is not natural.
• 10:34
  Dr. Case Troutman: We're literally fighting biology.
• 10:36
  Dr. Case Troutman: So let's arm you with all the tools in the toolbox to help you, change that dysregulation.
• 10:42
  Dr. Case Troutman: I.
• 10:42
  Dr. Case Troutman: Yeah,
• 10:43
  Dr. Komal Patil-Sisodia: and I love that because when we do, start like at least when I was studying for my obesity medicine boards and looking at all of the data, there was really this big concept of, what are the pillars behind obesity care?
• 10:55
  Dr. Komal Patil-Sisodia: I think we have similar pillars that we try and apply to menopause care, and it's amazing how many of them overlap and how many things you have to pay attention to.
• 11:04
  Dr. Komal Patil-Sisodia: I'm sure you've.
• 11:04
  Dr. Komal Patil-Sisodia: Seen like all those memes on social media.
• 11:06
  Dr. Komal Patil-Sisodia: It's like I'm eating my protein, taking my creatine, taking my magnesium, intermittent fasting, lifting weights, but then not intermittent.
• 11:13
  Dr. Komal Patil-Sisodia: It's all over the place with all the different things that you have to do, and it gets very overwhelming, I think for patients.
• 11:20
  Dr. Case Troutman: Yeah, in midlife for sure.
• 11:22
  Dr. Case Troutman: Yeah.
• 11:22
  Dr. Case Troutman: Plus, if you already are in brain fog, tired and having joint pain and then you have to deal with that, right?
• 11:27
  Dr. Case Troutman: So it's all of that.
• 11:28
  Dr. Case Troutman: So in my practice, what I always tell my patients that are interested in helping with both kind of aspects, yeah.
• 11:34
  Dr. Case Troutman: I say let's start with hormone therapy'cause I wanna make you feel better.
• 11:38
  Dr. Komal Patil-Sisodia: Yes.
• 11:38
  Dr. Case Troutman: And I wanna have you just feel, be less, have better sleep, no hot flashes, less joint pain, better mood.
• 11:46
  Dr. Case Troutman: And then when we're in that better.
• 11:48
  Dr. Case Troutman: Place.
• 11:48
  Dr. Case Troutman: I hate the word hormone balance, but I know that keeps throwing around.
• 11:52
  Dr. Case Troutman: I don't know.
• 11:52
  Dr. Case Troutman: What's a better word?
• 11:53
  Dr. Case Troutman: Better.
• 11:53
  Dr. Komal Patil-Sisodia: I don't know.
• 11:54
  Dr. Komal Patil-Sisodia: I feel like so many things are buzzwords, but I know exactly what you mean.
• 11:57
  Dr. Komal Patil-Sisodia: You want people to feel physically well from their symptoms so that they can then go on and do all of the things that they need to Changes for, yeah.
• 12:06
  Dr. Komal Patil-Sisodia: Yeah.
• 12:06
  Dr. Case Troutman: Exactly.
• 12:07
  Dr. Case Troutman: And you
• 12:07
  Dr. Komal Patil-Sisodia: can't do it if you feel crummy.
• 12:09
  Dr. Case Troutman: So it's interesting, I was had my, one of my patients for a follow up.
• 12:12
  Dr. Case Troutman: This is a kickass woman.
• 12:14
  Dr. Case Troutman: Yeah.
• 12:14
  Dr. Case Troutman: Doing tremendous things in her work.
• 12:17
  Dr. Case Troutman: And when I saw her for follow up, she said, I just thought I was lazy before in terms of why she wasn't doing physical activity.
• 12:25
  Dr. Case Troutman: 'cause again, she's, yeah, she knows what to do, but she was just tired.
• 12:29
  Dr. Case Troutman: So that's why I said.
• 12:30
  Dr. Case Troutman: This is why we're doing it this way.
• 12:33
  Dr. Case Troutman: Let's make you feel better.
• 12:34
  Dr. Case Troutman: 'cause then she was telling me, oh, I did this, I did that.
• 12:37
  Dr. Case Troutman: Yeah.
• 12:37
  Dr. Case Troutman: This is what happens when you feel better and we give you estrogen that was not there anymore.
• 12:42
  Dr. Komal Patil-Sisodia: Exactly.
• 12:43
  Dr. Komal Patil-Sisodia: It's, oh yeah.
• 12:44
  Dr. Komal Patil-Sisodia: It's amazing how much change that can bring to people in terms, in their ability to function.
• 12:50
  Dr. Komal Patil-Sisodia: Yes.
• 12:50
  Dr. Komal Patil-Sisodia: I think I always worry about my patients who.
• 12:54
  Dr. Komal Patil-Sisodia: Can't have hormone replacement for, a multitude of reasons that exist in terms including like blood clots that were unprovoked or history, personal history of breast cancer, ovarian cancer, things like that for systemic hormone replacement.
• 13:07
  Dr. Komal Patil-Sisodia: I'm not talking about vaginal estrogen treatment, but systemic hormonal replacement.
• 13:11
  Dr. Komal Patil-Sisodia: Sometimes people, they feel like they're left behind if they can't have that, but I find that there are other pillars that of menopause care that can also help them, namely that.
• 13:21
  Dr. Komal Patil-Sisodia: That non-hormonal treatment.
• 13:22
  Dr. Komal Patil-Sisodia: And then really, I think that's where the overlap with the obesity medicine pillars also comes in between like diet, lifestyle, sleep, stress, all of those things that you're trying to, has to
• 13:33
  Dr. Case Troutman: be all of that, right?
• 13:34
  Dr. Case Troutman: Yeah.
• 13:34
  Dr. Case Troutman: It can't just be here's a patch, you'll feel better automatically.
• 13:38
  Dr. Case Troutman: No.
• 13:38
  Dr. Case Troutman: Yeah,
• 13:39
  Dr. Komal Patil-Sisodia: exactly.
• 13:39
  Dr. Case Troutman: It's a tool in the toolbox so that you live a better life, which is ultimately the role.
• 13:44
  Dr. Case Troutman: That's why we do what we do.
• 13:46
  Dr. Case Troutman: This is why we prescribe.
• 13:47
  Dr. Case Troutman: These meds for either along, improving their quality of life.
• 13:51
  Dr. Komal Patil-Sisodia: Yeah, absolutely.
• 13:53
  Dr. Komal Patil-Sisodia: And so it's interesting because so many women will hit like 40 and then all of a sudden feel like things are changing overnight.
• 14:00
  Dr. Komal Patil-Sisodia: I, let's talk a little bit about what in your practice and how you are trying to explain to them, like what is happening to them biologically during perimenopause and menopause.
• 14:08
  Dr. Komal Patil-Sisodia: What are the things that you're trying to educate your patients on?
• 14:11
  Dr. Komal Patil-Sisodia: Yeah,
• 14:11
  Dr. Case Troutman: so the first thing I always do is validate.
• 14:14
  Dr. Case Troutman: What they're feeling.
• 14:15
  Dr. Case Troutman: Yeah, because, I know that sounds so simple, but before that patient comes to me, she's told other doctors, other providers that, and they would usually meet it with you're just eat less, move more, just ex, all the disbelief, all the gaslighting.
• 14:27
  Dr. Case Troutman: So really the first thing I just tell them is girl, yes, I hear you.
• 14:31
  Dr. Case Troutman: It's real.
• 14:32
  Dr. Case Troutman: I get it.
• 14:34
  Dr. Case Troutman: This is why.
• 14:35
  Dr. Case Troutman: So I, I explained like the four metabolic hormones that are affected which is not necessarily, we're not even talking about estrogen, progesterone, and disarm.
• 14:45
  Dr. Case Troutman: I'm just talking about ghrelin, leptin, insulin, and cortisol, which are, the four metabolic hormones that affect weight.
• 14:52
  Dr. Case Troutman: And then a and then introduce the concept of, yeah.
• 14:55
  Dr. Case Troutman: When we're in perimenopause or menopause, yeah.
• 14:57
  Dr. Case Troutman: We lose estrogen.
• 14:58
  Dr. Case Troutman: That affects our body composition.
• 15:01
  Dr. Case Troutman: And then with age, so that's one.
• 15:03
  Dr. Case Troutman: So it's usually lean body mat sorry.
• 15:05
  Dr. Case Troutman: Body composition.
• 15:06
  Dr. Case Troutman: So instead of having fat deposition in our.
• 15:09
  Dr. Case Troutman: The OID or in the hips.
• 15:12
  Dr. Case Troutman: Now it's in the central adiposity or in our belly, which we really don't like, which that fuels something called insulin resistance.
• 15:19
  Dr. Case Troutman: Which makes it harder for people to lose weight.
• 15:22
  Dr. Case Troutman: And then the second thing I talk about is that lean body mass or muscle mass that goes down mostly with age.
• 15:28
  Dr. Komal Patil-Sisodia: Yeah.
• 15:28
  Dr. Case Troutman: Again, this is increased when we're not moving as much.
• 15:32
  Dr. Case Troutman: 'cause a lot of us are working in offices, have minimal time for exercise.
• 15:36
  Dr. Case Troutman: Going back to what you said earlier about how it's not just about medicine.
• 15:39
  Dr. Case Troutman: It's about how are you moving your body?
• 15:41
  Dr. Case Troutman: How are you eating?
• 15:42
  Dr. Case Troutman: They're probably not sleeping a lot of the times, whether they have hot flashes or not.
• 15:46
  Dr. Case Troutman: That's, and then again, that's why I always start with.
• 15:49
  Dr. Case Troutman: Cortisol and insulin.
• 15:51
  Dr. Case Troutman: 'cause those are what drives those body changes.
• 15:53
  Dr. Case Troutman: Also an
• 15:53
  Dr. Komal Patil-Sisodia: endocrinologist that makes me so happy
• 15:55
  Dr. Case Troutman: because I think they don't get their due when we
• 15:57
  Dr. Komal Patil-Sisodia: talk about all of this in context.
• 15:59
  Dr. Case Troutman: Yeah.
• 16:00
  Dr. Case Troutman: But I think the key is, again, number one, validation.
• 16:02
  Dr. Case Troutman: 'cause I really feel that when patients or women.
• 16:07
  Dr. Case Troutman: Know that you are on their side, like you understand like then it's not an adversarial relationship, and then they're more, even if they had held on to different beliefs before, like calorie and calorie out, then they're more likely to have an open mind to what is this insulin resistance, what is this?
• 16:24
  Dr. Case Troutman: Cortisol is a relationship that you develop.
• 16:26
  Dr. Case Troutman: But yeah, so I go through all of that, which is a lot.
• 16:29
  Dr. Case Troutman: Yeah,
• 16:30
  Dr. Komal Patil-Sisodia: But necessary.
• 16:31
  Dr. Komal Patil-Sisodia: I've been using the Green CLI TERIC scale, which I think is a, the best tool we have, but incomplete because it doesn't talk about all of these other things.
• 16:40
  Dr. Komal Patil-Sisodia: But I find that it provides patients with a lot of education just in terms of what the potential difference symptoms of perimenopause and menopause can be.
• 16:49
  Dr. Komal Patil-Sisodia: I was meeting with.
• 16:50
  Dr. Komal Patil-Sisodia: A patient a few weeks ago, and we were going through their responses on that, and it was like, I didn't know that could be a symptom of menopause.
• 16:57
  Dr. Komal Patil-Sisodia: I didn't know we could do this.
• 16:58
  Dr. Komal Patil-Sisodia: Is that really?
• 16:59
  Dr. Komal Patil-Sisodia: Oh my gosh, I've had that for a while.
• 17:01
  Dr. Komal Patil-Sisodia: And it goes back and forth.
• 17:02
  Dr. Komal Patil-Sisodia: And so there's so many different things that, we're starting from such a deficit of knowledge.
• 17:08
  Dr. Komal Patil-Sisodia: I totally agree with you that we need to do all of that education upfront, so your patients are lucky that you're validating that for them.
• 17:16
  Dr. Case Troutman: Yeah.
• 17:16
  Dr. Case Troutman: Yeah.
• 17:17
  Dr. Case Troutman: I love that.
• 17:18
  Dr. Case Troutman: By the way, when we go over the questionnaires yeah.
• 17:20
  Dr. Case Troutman: And you're like, what is my peeing all the time related to estrogen?
• 17:24
  Dr. Case Troutman: Related to hormones, or, yes.
• 17:27
  Dr. Case Troutman: Mind blown, right?
• 17:28
  Dr. Case Troutman: Yeah.
• 17:28
  Dr. Case Troutman: And then they always think it's just because they drank more water, which again, it's very possible that's part of it.
• 17:33
  Dr. Case Troutman: What's much more fun is when a lot of the symptoms improve.
• 17:37
  Dr. Case Troutman: Yeah.
• 17:37
  Dr. Case Troutman: You're like, oh my God, this is so different.
• 17:39
  Dr. Case Troutman: But yes.
• 17:40
  Dr. Case Troutman: Love it.
• 17:41
  Dr. Komal Patil-Sisodia: I think you and I have a lot of similar approaches there.
• 17:44
  Dr. Komal Patil-Sisodia: When you are talking to your patients about the shift in their symptoms, like they're starting to notice mood changes or hunger or cravings, we see that as estrogen levels.
• 17:55
  Dr. Komal Patil-Sisodia: Can drop.
• 17:56
  Dr. Komal Patil-Sisodia: So you start with talking about the insulin, the cortisol, the leptin, the ghrelin as like those metabolic hormones.
• 18:04
  Dr. Komal Patil-Sisodia: How do you approach the conversation about the reproductive hormones?
• 18:07
  Dr. Case Troutman: Yeah, so the reproductive hormones, I actually put it.
• 18:12
  Dr. Case Troutman: In context just with their entire body, and not just with weight.
• 18:16
  Dr. Case Troutman: I tell this all the time to my patients.
• 18:18
  Dr. Case Troutman: Hormone therapy is not a weight loss medicine.
• 18:21
  Dr. Case Troutman: Now, if you are having trouble with sleep and we improve your sleep because we improve your hot flashes, or just just improve your sleep and now you're sleeping better, your corsol will go down and you know you're gonna lose weight.
• 18:32
  Dr. Case Troutman: But the reason I do that is because you'll see that on social media all the time, can't get.
• 18:36
  Dr. Case Troutman: This medication get on hormone therapy.
• 18:38
  Dr. Case Troutman: And I'm just so annoyed at that because it's so false.
• 18:41
  Dr. Case Troutman: When I talk about the, estrogen, progesterone, testosterone, I start with just the whole body, how it affects all the receptors in different body parts.
• 18:49
  Dr. Case Troutman: And then, if they do say, yeah, I've noticed some weight gain, et cetera, then kinda circle back to how that affects the metabolic hormones in a way.
• 18:59
  Dr. Case Troutman: Yeah.
• 18:59
  Dr. Case Troutman: It's like my approach and then still approaching treatment.
• 19:03
  Dr. Case Troutman: Four Weight in midlife with the four pillars at nutrition, physical activity, changing behavior, and medications as a tool.
• 19:11
  Dr. Komal Patil-Sisodia: I really appreciate your approach of starting the hormone replacement therapy first, because I am equally annoyed when I see the things online about, you need to be on hormones to help you lose weight.
• 19:22
  Dr. Komal Patil-Sisodia: I've actually had people gain weight on hormones when you're giving them back.
• 19:26
  Dr. Komal Patil-Sisodia: Some people do have a little bit of weight gain and abdominal bloating and fluid retention, and putting that out there as a weight.
• 19:33
  Dr. Komal Patil-Sisodia: Loss tool is inaccurate and can be very demoralizing for people when they start gaining weight on them.
• 19:39
  Dr. Komal Patil-Sisodia: So I love that you optimize that first, and then you have that baseline of where you're going to lose weight from that point.
• 19:45
  Dr. Komal Patil-Sisodia: But I think that approach needs to be adopted more because I'm with you.
• 19:48
  Dr. Komal Patil-Sisodia: I get super annoyed when I hear that online.
• 19:51
  Dr. Case Troutman: Yeah.
• 19:52
  Dr. Case Troutman: And again it's also about setting expectations.
• 19:54
  Dr. Case Troutman: Yeah.
• 19:54
  Dr. Case Troutman: Because if they think that this is gonna make them lose weight and then.
• 19:57
  Dr. Case Troutman: Their weight is the same or whatever yeah, because it's not supposed to make you lose weight, yeah.
• 20:02
  Dr. Case Troutman: But they feel fantastic.
• 20:03
  Dr. Case Troutman: So it's, it is, again, it's one of those things, they need to know why, what this med does, why, and just like anything in medicine, expectations and realistic goals.
• 20:12
  Dr. Case Troutman: And expectations.
• 20:13
  Dr. Komal Patil-Sisodia: Let's talk about how you start leveraging tools for people when they're coming to see you.
• 20:18
  Dr. Komal Patil-Sisodia: And there's a woman in midlife who wants to feel better in her body.
• 20:22
  Dr. Komal Patil-Sisodia: What are the top priorities that you are trying to address with her when she comes into your office?
• 20:29
  Dr. Case Troutman: So in my practice, I have two tracks.
• 20:32
  Dr. Case Troutman: One would be if they don't have a weight gain as a concern, but they have more like just the hot flashes, joint pains, et cetera, and they just want hormone therapy.
• 20:43
  Dr. Case Troutman: If they approve hormone therapy, then they can be in that track.
• 20:47
  Dr. Case Troutman: And then the other track is where I call it the Uplevel midlife, where they get the benefit or guidance on both aspects.
• 20:55
  Dr. Case Troutman: Yeah, the weight or obesity care.
• 20:57
  Dr. Case Troutman: And hormone therapy.
• 20:58
  Dr. Case Troutman: So I meet them where they're at basically.
• 21:00
  Dr. Case Troutman: If they're in that phase where they would like help with meals, movement in mind.
• 21:07
  Dr. Case Troutman: And again, if they are in that appropriate category for meds, then we start with hormone therapy.
• 21:12
  Dr. Case Troutman: 'cause we make them feel better, and then usually the, usually again, the next topic, next visit, I talk about the science of weight.
• 21:19
  Dr. Komal Patil-Sisodia: Yeah.
• 21:20
  Dr. Case Troutman: Because I really truly believe that when we understand why it happens, it's so much easier to create strategies.
• 21:28
  Dr. Komal Patil-Sisodia: Yeah.
• 21:29
  Dr. Case Troutman: For treatment, the buy in for them to do the movement.
• 21:32
  Dr. Komal Patil-Sisodia: And one of the things that I've noticed is sometimes people come in with goals.
• 21:37
  Dr. Komal Patil-Sisodia: That are probably not best suited for their wellbeing or not attainable.
• 21:42
  Dr. Komal Patil-Sisodia: So how do you help women separate what their health goals look like from like years of indoctrination, from diet, culture, and society?
• 21:50
  Dr. Komal Patil-Sisodia: I feel like that is such a hard thing to navigate.
• 21:53
  Dr. Case Troutman: Yeah, I, it's very, it is hard.
• 21:56
  Dr. Case Troutman: I talked, so in my questionnaire and things I ask my patients routinely is ask Yeah.
• 22:02
  Dr. Case Troutman: Identifying their non-scale wins and non-scale goals, or if they tell me like, I wanna be, let's, I'm gonna just, 160 pounds, let's say that's their goal weight.
• 22:13
  Dr. Case Troutman: I usually use a little bit of motivational interviewing and say, what happens at 160 pounds?
• 22:19
  Dr. Case Troutman: Again, trying to get that why?
• 22:22
  Dr. Case Troutman: Because maybe, because at that, what they remember when they were that weight before is they were able to hike, the appellation trail.
• 22:29
  Dr. Case Troutman: So actually that's the reason why, and not.
• 22:31
  Dr. Case Troutman: The number on the scale or that age, that weight, they felt more confident in front of the camera or taking pictures.
• 22:38
  Dr. Case Troutman: So if that was the real driver, then I asked them, so what if you weigh 170 pounds?
• 22:44
  Dr. Case Troutman: So 10 pounds higher, but you're more toned and look great in pictures.
• 22:49
  Dr. Case Troutman: So it's a little bit of like really digging in and finding what really motivates them and, and then tying it to that result as opposed to a number on the scale.
• 22:59
  Dr. Case Troutman: But it's, again, it's not a one time conversation.
• 23:01
  Dr. Case Troutman: It is about really developing that trust and kinda
• 23:07
  Dr. Komal Patil-Sisodia: building that relationship.
• 23:08
  Dr. Case Troutman: Yeah.
• 23:08
  Dr. Case Troutman: Yeah.
• 23:08
  Dr. Case Troutman: I really think it's about, so this is why I love what I do now is, yeah, I get to build relationships with my patients because I have the time to spend with them and just get to know them and figure out how to help them the best way.
• 23:21
  Dr. Komal Patil-Sisodia: That is such a compassionate way to care for people, and I think that's what I.
• 23:27
  Dr. Komal Patil-Sisodia: A lot of women struggle with is showing themselves that compassion.
• 23:31
  Dr. Komal Patil-Sisodia: So how do you cultivate that for them?
• 23:32
  Dr. Komal Patil-Sisodia: Like how do you I was gonna
• 23:33
  Dr. Case Troutman: ask you how do you do it?
• 23:34
  Dr. Case Troutman: Yeah.
• 23:34
  Dr. Case Troutman: I wanna learn from you too.
• 23:35
  Dr. Case Troutman: How do you, I'm gonna give you your, an, your question back.
• 23:38
  Dr. Case Troutman: How do you handle this?
• 23:39
  Dr. Case Troutman: I would say,
• 23:40
  Dr. Komal Patil-Sisodia: It's similar.
• 23:41
  Dr. Komal Patil-Sisodia: What is it that we are trying to achieve?
• 23:43
  Dr. Komal Patil-Sisodia: What is realistic?
• 23:44
  Dr. Komal Patil-Sisodia: I've had a few patients come in here and say I want to get back to doing what I was doing in my twenties and thirties.
• 23:51
  Dr. Komal Patil-Sisodia: And while that would be nice, like I always joke with my girlfriends if I could have my.
• 23:55
  Dr. Komal Patil-Sisodia: 45-year-old mind in my 25-year-old body, I would be like the happiest person for, because the body felt good.
• 24:01
  Dr. Komal Patil-Sisodia: The mind feels good right now, but it's really trying to, help people.
• 24:06
  Dr. Komal Patil-Sisodia: Get to a place where they can understand what is probably safest for them and best for them to keep staying healthy in the long term.
• 24:15
  Dr. Komal Patil-Sisodia: And that's a different type of conversation.
• 24:17
  Dr. Komal Patil-Sisodia: I employ a lot of the same techniques in terms of really trying to get to the why behind why they're doing this.
• 24:23
  Dr. Komal Patil-Sisodia: Everybody's why is different and it's.
• 24:25
  Dr. Komal Patil-Sisodia: Colored by what their past experiences have been, either within their family of origin or what society has told them about themselves and their body.
• 24:33
  Dr. Komal Patil-Sisodia: And a lot of that takes a lot of conversation and yes, almost deprogramming over time.
• 24:38
  Dr. Komal Patil-Sisodia: Yeah.
• 24:38
  Dr. Komal Patil-Sisodia: That you don't need to believe the hype around what you're seeing.
• 24:42
  Dr. Komal Patil-Sisodia: And you see all this questionable stuff on the internet.
• 24:46
  Dr. Case Troutman: Yes.
• 24:47
  Dr. Case Troutman: Oh my God.
• 24:47
  Dr. Case Troutman: There's this one that pops up on my Facebook like.
• 24:51
  Dr. Case Troutman: You don't need to have obesity for this medicine anyway.
• 24:55
  Dr. Komal Patil-Sisodia: What?
• 24:55
  Dr. Komal Patil-Sisodia: Yeah, exactly.
• 24:57
  Dr. Komal Patil-Sisodia: It's that and then I think it's, like the supplements, this is a natural GLP one.
• 25:02
  Dr. Komal Patil-Sisodia: There's no such thing as that.
• 25:03
  Dr. Komal Patil-Sisodia: No such thing.
• 25:04
  Dr. Komal Patil-Sisodia: Yes.
• 25:04
  Dr. Komal Patil-Sisodia: There's no such thing.
• 25:05
  Dr. Komal Patil-Sisodia: And it's hard because I'll see that with my own parents sometimes.
• 25:09
  Dr. Komal Patil-Sisodia: I'm an endocrinologist.
• 25:10
  Dr. Komal Patil-Sisodia: We have a strong family history of diabetes and.
• 25:12
  Dr. Komal Patil-Sisodia: There will be things where they'll find articles online or, my dad will forward me some outrageous claim about Metformin causing cancer, and he'll send it to me and ask me to review it, and there'll be a PayPal link at the bottom of the page asking you to buy their supplement.
• 25:28
  Dr. Komal Patil-Sisodia: And the website is, metformin causes cancer.com or something ridiculous.
• 25:31
  Dr. Komal Patil-Sisodia: I'm making that up.
• 25:32
  Dr. Komal Patil-Sisodia: I don't know that website exists, but something along those lines.
• 25:35
  Dr. Komal Patil-Sisodia: Yeah.
• 25:36
  Dr. Komal Patil-Sisodia: Where it's instilling this fear into people and they're having these fear-based reactions and then going out and buying and doing stuff when it's not well regulated.
• 25:44
  Dr. Komal Patil-Sisodia: But I think a lot of it is just trying to make sure people are getting good information.
• 25:49
  Dr. Komal Patil-Sisodia: But one of the things I've been finding myself doing is like looking at everybody's supplements.
• 25:53
  Dr. Komal Patil-Sisodia: 'cause the supplement game is wild out there right now, and it's always been in the endocrine space.
• 25:58
  Dr. Komal Patil-Sisodia: I used to routinely have people come in and they'd be like, oh, I'm on this adrenal support.
• 26:02
  Dr. Komal Patil-Sisodia: And I'd look at it and it would have a ground up.
• 26:04
  Dr. Komal Patil-Sisodia: Cow or pig's adrenal gland.
• 26:06
  Dr. Komal Patil-Sisodia: And so they were inadvertently taking steroids and then gaining weight and I was like I don't think this is what you should be taking.
• 26:13
  Dr. Komal Patil-Sisodia: So it's a lot of dissecting out what it is they're doing and seeing if I can find something to connect with them on and help guide them towards something that will be helpful and not harmful.
• 26:22
  Dr. Case Troutman: Yeah.
• 26:23
  Dr. Case Troutman: Helpful.
• 26:23
  Dr. Case Troutman: Helpful.
• 26:24
  Dr. Case Troutman: Not harmful.
• 26:24
  Dr. Case Troutman: Yes.
• 26:25
  Dr. Case Troutman: Evidence-based as much as possible.
• 26:27
  Dr. Komal Patil-Sisodia: Yes.
• 26:27
  Dr. Case Troutman: Yes.
• 26:29
  Dr. Komal Patil-Sisodia: It's a hard thing to do.
• 26:30
  Dr. Komal Patil-Sisodia: One of the things, and I don't know if this is your experience.
• 26:32
  Dr. Komal Patil-Sisodia: Experience is that this deep distrust of medicine I think has developed because.
• 26:38
  Dr. Komal Patil-Sisodia: We don't do a great job of explaining what scientific process and investigation looks like.
• 26:44
  Dr. Komal Patil-Sisodia: I always tell my patients we know a fraction of what our creator intended.
• 26:47
  Dr. Komal Patil-Sisodia: It is the most humbling job on the planet to be a physician or other type of healthcare provider because.
• 26:55
  Dr. Komal Patil-Sisodia: We only know a fraction of what there is to know and the information will change.
• 26:58
  Dr. Komal Patil-Sisodia: So what we know now could be different five years from now, but the advice I'm giving you now is based on the information we have now.
• 27:05
  Dr. Komal Patil-Sisodia: So fast forward five years, if I change my mind based on new evidence, it's not that I was lying to you five years ago, it's that the information has changed and we're innovating and we're progressing with new information.
• 27:16
  Dr. Komal Patil-Sisodia: I think that can be hard because we are taught to think in absolute.
• 27:21
  Dr. Case Troutman: Yeah.
• 27:21
  Dr. Case Troutman: And there is so much information.
• 27:23
  Dr. Case Troutman: Kudos to primary care doctors'cause I don't know how Yeah.
• 27:27
  Dr. Case Troutman: They keep up with everything that's, in a poor patient in 10 minutes.
• 27:33
  Dr. Komal Patil-Sisodia: I know.
• 27:33
  Dr. Komal Patil-Sisodia: It's amazing work they do.
• 27:35
  Dr. Komal Patil-Sisodia: And I am deeply appreciative for them every day.
• 27:38
  Dr. Case Troutman: Yes.
• 27:39
  Dr. Case Troutman: Yes.
• 27:39
  Dr. Case Troutman: Yeah.
• 27:41
  Dr. Komal Patil-Sisodia: Now that, we've talked about what our approach is, how are you getting your patients to define success then when they're hitting these goals?
• 27:50
  Dr. Komal Patil-Sisodia: Does that take additional conversation from you where you're pointing it out to them because they may not realize it's happened?
• 27:55
  Dr. Komal Patil-Sisodia: Oh yeah.
• 27:56
  Dr. Komal Patil-Sisodia: Are they, yeah.
• 27:57
  Dr. Case Troutman: Yes.
• 27:57
  Dr. Case Troutman: Okay.
• 27:58
  Dr. Case Troutman: I actually always start my visits with non-scale wins.
• 28:04
  Dr. Case Troutman: Or things, so start so what are your non-scale wins today?
• 28:07
  Dr. Case Troutman: My patients always tell me.
• 28:08
  Dr. Case Troutman: Yeah, I was thinking about that before I came over.
• 28:10
  Dr. Case Troutman: So again, I'm, they're practicing the skill.
• 28:13
  Dr. Case Troutman: Yeah.
• 28:13
  Dr. Case Troutman: And I call I call everything that I teach my patients a skill I.
• 28:17
  Dr. Case Troutman: Knowing how to, eat, what's your protein, what's your fiber, et cetera.
• 28:21
  Dr. Case Troutman: Drinking more water, lessening the cognitive negative, cognitive bias.
• 28:24
  Dr. Case Troutman: The, this is all, these are all skills and sometimes we just, we didn't practice the skills for the longest time, but it doesn't mean that we can't.
• 28:31
  Dr. Case Troutman: Anyway, so I always start that with the non-scale wins.
• 28:34
  Dr. Case Troutman: And then for my patients that are on, also on hormone therapy I always ask what has changed?
• 28:39
  Dr. Case Troutman: Yeah.
• 28:39
  Dr. Case Troutman: And so it's just an amazing way to.
• 28:43
  Dr. Case Troutman: See their progress.
• 28:44
  Dr. Case Troutman: Yeah.
• 28:44
  Dr. Komal Patil-Sisodia: I love.
• 28:45
  Dr. Komal Patil-Sisodia: How about you?
• 28:45
  Dr. Case Troutman: What do you normally do?
• 28:46
  Dr. Komal Patil-Sisodia: I would say it's similar.
• 28:47
  Dr. Komal Patil-Sisodia: I think that really trying to find what the positive changes have been.
• 28:52
  Dr. Komal Patil-Sisodia: That's how I phrase it, which is basically non-scale wins.
• 28:55
  Dr. Komal Patil-Sisodia: Yeah.
• 28:55
  Dr. Komal Patil-Sisodia: What are, it's the same, it's the same type of approach is like what has gotten better?
• 28:59
  Dr. Komal Patil-Sisodia: And let's move from there.
• 29:01
  Dr. Komal Patil-Sisodia: And then what has not changed?
• 29:02
  Dr. Komal Patil-Sisodia: And then what do you think has potentially gotten worse?
• 29:05
  Dr. Komal Patil-Sisodia: And then trying to draw correlations.
• 29:07
  Dr. Komal Patil-Sisodia: Between what we're impacting and I think the other thing that I, I struggled with when I was purely in an endocrine practice alone is people wanting.
• 29:16
  Dr. Komal Patil-Sisodia: A single fix for a problem that's multifactorial.
• 29:20
  Dr. Komal Patil-Sisodia: So I would adjust somebody's thyroid medication.
• 29:22
  Dr. Komal Patil-Sisodia: Their thyroid numbers would look great, and they're like I still feel tired.
• 29:25
  Dr. Komal Patil-Sisodia: I still feel crummy.
• 29:26
  Dr. Komal Patil-Sisodia: I still feel this.
• 29:27
  Dr. Komal Patil-Sisodia: It might be that there's something else that we need to look into.
• 29:30
  Dr. Komal Patil-Sisodia: So really understanding that.
• 29:32
  Dr. Komal Patil-Sisodia: There could be multiple things that are affecting one symptom that you're having or one spectrum of symptoms that you're having.
• 29:38
  Dr. Komal Patil-Sisodia: And when you incrementally improve each one, you'll see a little bit of change, but you may not see a big boom change until you address all of those things.
• 29:46
  Dr. Case Troutman: Yep.
• 29:47
  Dr. Case Troutman: Multifactorial for sure.
• 29:48
  Dr. Komal Patil-Sisodia: Yeah so I think a lot of it comes down to that because they think there's disappointment too, right?
• 29:53
  Dr. Komal Patil-Sisodia: When people feel like something is not working for them right away or fast.
• 29:58
  Dr. Komal Patil-Sisodia: Enough.
• 29:58
  Dr. Komal Patil-Sisodia: It's trying to get people to slow down and realize that rapid weight loss is not actually going to do them favors.
• 30:04
  Dr. Komal Patil-Sisodia: It needs to be long-term and sustainable and something that they work towards slowly.
• 30:11
  Dr. Komal Patil-Sisodia: Some patients get it right away.
• 30:12
  Dr. Komal Patil-Sisodia: I had, I saw somebody earlier who said to me I don't wanna lose weight too fast because I don't want, would you say Ozempic face or ozempic butt or something like that?
• 30:22
  Dr. Komal Patil-Sisodia: Because people are starting to notice when you do get that rapid weight loss, it can affect your appearance.
• 30:27
  Dr. Komal Patil-Sisodia: It can affect a lot of different things if you're not doing it sustainably, if it's too fast.
• 30:32
  Dr. Komal Patil-Sisodia: So I think really trying to piece those things together is important as well.
• 30:36
  Dr. Komal Patil-Sisodia: What about you?
• 30:37
  Dr. Case Troutman: Yes.
• 30:38
  Dr. Case Troutman: Same thing with hormones?
• 30:39
  Dr. Case Troutman: Yes.
• 30:40
  Dr. Case Troutman: Hormone therapy.
• 30:40
  Dr. Case Troutman: Yes.
• 30:41
  Dr. Case Troutman: Patients that they're specifically interested in a particular result.
• 30:46
  Dr. Case Troutman: And then we've tried X, Y, Z, and some things are better, but the one result is not better.
• 30:51
  Dr. Case Troutman: And I just thought, I'm like hormones don't fix everything.
• 30:54
  Dr. Case Troutman: I'm a hormone specialist, so you need to see somebody else that specializes in that.
• 30:58
  Dr. Case Troutman: Particular symptom, or something to that effect.
• 31:00
  Dr. Komal Patil-Sisodia: Yeah, I think that's fair.
• 31:02
  Dr. Komal Patil-Sisodia: My sister is a TMJ specialist and there are so many things that kind of almost like the reverse of what we're talking about, that people don't attribute enough to TMJ.
• 31:11
  Dr. Komal Patil-Sisodia: She was telling me that you don't need like the clicking popping joint noises, that it can be like the loss of musculature in the airway that causes.
• 31:19
  Dr. Komal Patil-Sisodia: Sleep apnea.
• 31:20
  Dr. Komal Patil-Sisodia: In somebody who's thin and then that can contribute to TMJ symptoms.
• 31:24
  Dr. Komal Patil-Sisodia: And it, to me, it was like, oh my gosh.
• 31:26
  Dr. Komal Patil-Sisodia: Wow.
• 31:26
  Dr. Komal Patil-Sisodia: Like that boom, I learned something new.
• 31:29
  Dr. Komal Patil-Sisodia: Yeah.
• 31:29
  Dr. Komal Patil-Sisodia: But it's almost like the reverse, like where we're not attributing enough to something else, and we may need to, to your point, send them somewhere else to investigate it.
• 31:38
  Dr. Komal Patil-Sisodia: Sometimes just having that knowledge is hard.
• 31:40
  Dr. Komal Patil-Sisodia: It's hard to come by because, oh yeah.
• 31:42
  Dr. Komal Patil-Sisodia: There hasn't been enough discussion around women's health.
• 31:44
  Dr. Komal Patil-Sisodia: Obesity is just.
• 31:45
  Dr. Komal Patil-Sisodia: Now getting its due after how many decades of being ignored it's going to be the same uphill climb, I think, for midlife care.
• 31:54
  Dr. Case Troutman: But it's so much fun, right?
• 31:56
  Dr. Case Troutman: It's so gratifying, so much fun.
• 31:58
  Dr. Case Troutman: I don't wanna be anywhere else but where I am right now,
• 32:00
  Dr. Komal Patil-Sisodia: I totally agree with you.
• 32:01
  Dr. Komal Patil-Sisodia: I think it has been the encounters where I have.
• 32:05
  Dr. Komal Patil-Sisodia: Seen women reach out to me and say, oh my gosh, I'm feeling significantly better, or understand my body better.
• 32:12
  Dr. Komal Patil-Sisodia: Actually, I think that one is almost higher for me than the feeling better part, like the understanding of the body better.
• 32:18
  Dr. Komal Patil-Sisodia: It, to me, is just so fulfilling at the end of the day.
• 32:22
  Dr. Case Troutman: Yes.
• 32:22
  Dr. Case Troutman: Yeah.
• 32:23
  Dr. Komal Patil-Sisodia: Yeah.
• 32:23
  Dr. Komal Patil-Sisodia: So'cause then
• 32:24
  Dr. Case Troutman: you're equipped for the rest of their life ex.
• 32:26
  Dr. Komal Patil-Sisodia: Exactly.
• 32:27
  Dr. Komal Patil-Sisodia: Exactly.
• 32:28
  Dr. Komal Patil-Sisodia: Thank you for this conversation.
• 32:29
  Dr. Komal Patil-Sisodia: As we close out this episode.
• 32:31
  Dr. Komal Patil-Sisodia: If a woman is listening right now and she's feeling defeated by her changing body, what do you want her to hear?
• 32:38
  Dr. Komal Patil-Sisodia: Hard to heart like what would you say to her as she's on the cusp of taking the next step to get her health better?
• 32:45
  Dr. Case Troutman: Yeah, so what I would say to that woman is that you're not broken.
• 32:49
  Dr. Case Troutman: This is really happening.
• 32:51
  Dr. Case Troutman: It's not your fault.
• 32:52
  Dr. Case Troutman: Are biological reasons why this happens.
• 32:56
  Dr. Case Troutman: Both the metabolic hormones and depending on the age the rep like estrogen and progesterone, testosterone hormones they're, this is happening and it's real.
• 33:05
  Dr. Case Troutman: And don't give up.
• 33:06
  Dr. Case Troutman: Advocate for yourself.
• 33:08
  Dr. Case Troutman: Get help.
• 33:09
  Dr. Komal Patil-Sisodia: Yeah.
• 33:10
  Dr. Case Troutman: And if you're in Pennsylvania, I would love to help you.
• 33:12
  Dr. Komal Patil-Sisodia: Yes.
• 33:13
  Dr. Komal Patil-Sisodia: And so where can people learn more about your work at Midlife Remedy?
• 33:16
  Dr. Komal Patil-Sisodia: Do you have a website?
• 33:17
  Dr. Case Troutman: Yeah, I do.
• 33:18
  Dr. Case Troutman: So it's Weight Remedy and Midlife Remedy.
• 33:20
  Dr. Case Troutman: So it's weight, W-E-I-G-H-T-R-E-M-D-Y.
• 33:24
  Dr. Case Troutman: I'm also on Facebook.
• 33:25
  Dr. Case Troutman: I love posting a lot, sharing information.
• 33:29
  Dr. Case Troutman: So same name, weight, remedy.
• 33:32
  Dr. Case Troutman: But yeah it's so much fun.
• 33:34
  Dr. Case Troutman: Love to help everybody.
• 33:35
  Dr. Komal Patil-Sisodia: Wonderful.
• 33:35
  Dr. Komal Patil-Sisodia: So all of our lucky listeners out in Central Pennsylvania, if you are looking for a kind, compassionate, well-educated doctor in these areas of your life, go look up Dr.
• 33:45
  Dr. Komal Patil-Sisodia: Troutman.
• 33:45
  Dr. Komal Patil-Sisodia: You will not be disappointed.
• 33:47
  Dr. Komal Patil-Sisodia: She's an incredible lady I've known you for a few years now.
• 33:49
  Dr. Komal Patil-Sisodia: Yes.
• 33:50
  Dr. Komal Patil-Sisodia: We were just chatting about that.
• 33:52
  Dr. Case Troutman: Yeah,
• 33:52
  Dr. Komal Patil-Sisodia: and we've run in the same circles, and so it's so lovely to be able to reconnect.
• 33:56
  Dr. Komal Patil-Sisodia: Thank you again for your time today.
• 33:58
  Dr. Komal Patil-Sisodia: I really appreciate it.
• 33:59
  Dr. Case Troutman: Thank you for having me.
• 34:00
  Dr. Komal Patil-Sisodia: Of course.