Stay Off My Operating Table

How Hormone Imbalances Affect Heart Health: Dr Jay Wrigley #2 170

• Dr. Philip Ovadia • Episode 170

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While most people focus on cholesterol numbers, the real cardiovascular risk comes from hormone imbalances triggering inflammation. The body actually increases cholesterol production during menopause to try to make more hormones - but it's the underlying hormone deficiency, not the cholesterol, that raises heart disease risk.

EPISODE SUMMARY

Dr. Jay Wrigley, a functional medicine physician with 29 years of experience in hormonal biochemistry, shares groundbreaking insights about the connection between hormone balance, metabolic health, and heart disease risk. He explains how the dramatic hormonal changes during menopause can trigger inflammation and increase cardiovascular risk if not properly managed. The episode explores why traditional hormone replacement therapy using synthetic hormones can be problematic, while bioidentical hormones in physiological doses may be protective. Dr. Wrigley emphasizes that metabolic health through proper diet and lifestyle is crucial - especially during hormonal transitions. He challenges conventional wisdom about cholesterol and discusses why common blood tests like TSH may not tell the full story. The conversation provides practical strategies for optimizing hormone balance naturally through stress management, proper nutrition, and metabolic health, potentially helping listeners avoid serious health issues as they age.

NOTABLE QUOTE

"If you want to increase your quality of life into your seventies or eighties, what's clear is that what's keeping most people from that is rock bottom levels of the hormones we've been talking about."

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Written & Performed by Logan Gritton & Colin Gailey
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Speaker 1:

Hey folks, thanks for joining us. It's the Stay Up Operating Table podcast with Dr Philip Ovedia, and we are rejoined with a guest we've had here in the past, dr Jay Wrigley. I was just telling Phil that I had been thinking about Jay's episode talking to a new friend this week who's dealing with some hormonal issues, and I wish I could remember what it was that Jay had talked about. Then I come home and I look at my schedule and here we've got Jay on the show this week. Phil, I'll throw it over to you.

Speaker 2:

Yeah, really excited to have Dr Jay Wrigley back with us. If anyone's not familiar with him, certainly go back find our first episode. It's actually a little kind of scary to think how long it's been.

Speaker 2:

I think it's been two years maybe, and I do remember we had some difficulty getting that episode Finally recorded some technical issues around it. Glad to get Jay back for a second conversation and Jay just give us a little bit of an idea about what you've been up to since we spoke last and I think we have a lot of great topics to talk about.

Speaker 3:

Sure, you know, for those of you who don't know me, I'm a functional medicine doctor who also has a master's in biochemistry, and mainly what my practice has been for about 29 years now is working with hormonal biochemistry with both men and women, but their large percentage of that certainly would be women who are going through anything from the transition of perimenopause into menopause or thyroid disorders or infertility or whatnot. And along the way, a couple of years probably, maybe more than that, but a number of years before me and Philip met, I had kind of changed. Let's put it this way. I found myself being a overweight doctor, fat doctor, who was giving a lot of bad dietary advice to people and had a wake-up call and through my own due diligence and deep diving or whatnot, I put together that I had been fed a bunch of bad information. From all of the schooling that I had been through of what is a healthy human diet and through using my specialty in hormonal biochemistry, I began to look at what I needed to do for myself and it became really clear that so much of what's going on with everybody today, with the obesity epidemic and the diabetes or whatnot, is so much related to hormones and because every food that you eat has a hormonal response to it. To give an end of the story is I pieced together a way of eating that would keep me full and happy and energetic and drive fat burning, and I lost a hundred pounds and I've kept that off now for about eight years, and this is okay. Leading back to what I was saying is you know, and then eventually I started meeting doctors like you know, dr Avadi here and who were interested also in that.

Speaker 3:

The next step in this piece puzzle of health care, and maybe the remedy for the disease management system, is this focus on metabolic health, because it really seems to be at the key of just about everything that that physicians deal with no-transcript driving, far more of a glucose model fuel burning system that more than their body can keep up with, and all of that extra sugar, basically, that gets transferred into triglycerides is then got to be stored away somewhere and that's going to be put in fat tissue.

Speaker 3:

So what I've been up to I'm trying to get to, you know, what I've been up to is just furthering how I mirror my, the things that are already my wheelhouse, which is really working with hormonal balancing, and then to match that with what I have learned about metabolic health and trying to build protocols and models for both women and men who reach the age of 40 or beyond and have hormonal declines and things going on, and try to teach them about methods of how to repair that balance, that ways of eating to structure themselves, to decrease inflammation and keep that stress off their cardiovascular vessels and things like that. That's what I've been doing and what we'll keep doing and that's what's led me to kind of enjoy kind of pairing with both Jack and Philip here is to continue to talk about this until people understand that there's answers and we got to get away from kind of a model that was not working very well.

Speaker 1:

Okay, I'm thinking and, phil, I know you're going to dig in from the scientific side, but I'm thinking about this guy I talked to earlier this week who's, I guess, roughly my age, overweight, type 2 diabetic, and his physician has got him on one of these GLP-1 type drugs to help him lose weight. With what little. I've told you. What would you say to a guy like this If he said you know what? I want to do it the right way. I don't want to get myself, don't want to paint myself into a corner in terms of of my health choices. I want to do the things that are best for my body. What would you say? What would you do?

Speaker 3:

are you asking me or philip?

Speaker 1:

I'm going to start with you, jay, okay um, remember, the name of the show is stay off my operating table. We're trying to keep him from getting to phil exactly.

Speaker 3:

It's a tricky. It's a tricky question because it's you have to look at so many. You know what's the circumstance that this person is in the we. I would. You know right off the bat I'm going to go. That's not great decision, because what we see with these types of medicines, which can be very effective in a period of time of dropping weight, but what we see here is that it is not addressing the root cause of this problem at all. And once they come off of these meds, there is a rapid weight gain.

Speaker 1:

Okay, hold on, I'm going to ask you to go slowly. Root cause of the problem Root cause of the problem. So what's the root cause?

Speaker 3:

Well, again, that's my job and what I do is to find out in each individual what's the root cause. So, in one person, it might be insulin resistance and that's causing the problem, because they can't get glucose inside the cells of their body and they keep producing more and more insulin, which we know is a storage hormone which is going to put the brakes on weight loss and store fat rapidly. So if that's the case, there's you know that's, you know the root cause so hold on.

Speaker 1:

This is something new that just occurred to me. So if he's insulin resistant and he's a type 2 diabetic and he's supplementing with insulin, which is a fat storage hormone, am I hearing you right like yeah?

Speaker 2:

you've got it right yeah you got it right. The fact that you're going.

Speaker 3:

why would that be happening? Yeah, that's good, that's. You got that right, because you know that happens daily and it doesn't make really metabolic sense whatsoever if you've gotten to a stage in type two diabetes where you Jack, I love it that you're like deep diving right into the heart of some serious stuff, because when you get to the point where you're making your insulin resistance and you're still making a lot of insulin, but you actually need even more insulin given to you by a physician to get glucose into the cells of your body, you've got a real big problem. And you've also got a physician who is not thinking putting the whole picture together, because the answer is never going to be that we're going to be able to give you enough insulin to solve this problem.

Speaker 3:

The problem is that insulin, your cells have lost their sensitivity to insulin and your body's already trying to make more insulin to overcome this and then to throw more insulin on it is just an absolute nightmare and almost kind of like malpractice to me, because it's like you're, if you don't deal with addressing getting this person back to being sensitive to insulin, which is not that hard, I mean it's I would you know, I want to say, and I think Philip would agree, is that in theory and what we've studied now, it's not a hard thing to do at all. Now is it hard to practice for a lot of people, because what's going to have to happen is they need to really, really get rid of a lot of carbohydrate in their diet.

Speaker 1:

Okay, I want to clear something up. Yeah, it's not. Would you say it's not hard to fix? Do you mean that it is actually a relatively simple fix? It's simple, but it's hard to implement. That's what I mean. It's painful to implement.

Speaker 3:

Yeah, yeah, and it's about compliance and it's about discipline and whatnot. It's a simple, absolutely simple thing to fix. I mean, all you'd have to do is get rid of all the carbohydrates in your diet for a period of time and force your body to have to start burning body fat for fuel, and what would happen is your insulin receptors would become sensitive again and it would fix this problem. Now, I'm not a huge fan of a zero-carbohydrate diet not at all but there are periods of time where I see that it could be beneficial for a person to eat a carnivore diet for a period of time if they've got an autoimmune disorder or something that is driving inflammation and we really want to get that down. But anyway, let's get back to the point.

Speaker 3:

Point is that, yeah, it's super easy to fix because all you have to do is shut down the body's ability to have glucose or something that gets broken down into glucose, which would be any carbohydrate, whether it be a starch or a vegetable or a fruit or whatnot. If you eliminate that, the body has to go after fat for fuel and when it does that, it's happy about that and it increases insulin sensitivity and it correct reverses people's a1c drop from 12 down to 5.4, and so it's not hard. In theory it's, but a lot of it's hard for a lot of people it's hard in practice absolutely sugar addicted.

Speaker 3:

Yeah, it can be very tough to even convince somebody that's a healthy thing to do, but it's not. I mean it's almost like physics If you do this, automatically happens.

Speaker 1:

So I think I've got the mechanism. So the reason you're insulin resistant is because you've basically overstimulated the insulin receptors and they're kind of worn out. And if you stop stimulating them for a period of time or at least dramatically reduce the stimulus, it gives them a chance to recover gives them a chance to recover.

Speaker 3:

Yeah, but to take that a step further, there are huge benefits just from having low insulin levels. We want, for the most part, to have pretty low insulin levels because if we look at the evolutionary model of our diet, there wasn't a whole lot of food 20,000 years ago that was going to spike your insulin quickly. So we live through most of our evolving as human beings eating a diet that was definitely not hyperinsulinogenic. So if you just drop the insulin levels, a lot of good things begin to happen, including the increasing of the sensitivity of the receptor sites to insulin or whatnot. But a lot of times the goal is just this get your insulin levels down. This is why a lot of us will go.

Speaker 3:

You know, when I'm looking at a patient and they're asking me what blood numbers do I want to see?

Speaker 3:

There are so many things out there that now I feel like are just a waste of time and money.

Speaker 3:

But if you give me some things like, I want to know your fasting insulin, I want to know what your triglycerides and HDL levels are, I want to know what your T3 thyroid level is and a couple of others those are going to tell us into in the metabolic health world of where are we?

Speaker 3:

And most of the time that points to you're eating far too much carbohydrate for your body to be able to get through in a day, and so that gets turned into triglycerides stored away in fat tissue, and then you start your day over again the next day and do the same thing, and eventually you're going to do toothache, you're going to gain a bunch of weight, you're going to spike an inflammatory response which Philip would tell you that eventually, if you're prone to it, is going to show up in your arterial walls and that's going to be spinning out of control. And it's probably a much bigger reason. I'm going to go out on a limb but I'm talking to a heart surgeon here but I would think that there's a. There is much more to this chronic inflammation that gets into the arterial walls through being metabolically unhealthy than there is this idea that your cholesterol levels are too high and that's why you're going to have a heart attack. I think it anyway.

Speaker 2:

I'll wait for you know Philip can tell us about that, but yeah, we can. I certainly want to get some of your thoughts on some of the influences of heart disease, but before we get there, you just said you know you just mentioned that you see a lot of blood work done that you don't think is useful. What are some of those common blood tests that people get that you don't find to be useful? Because I think that will be interesting for people to hear about.

Speaker 3:

Oh, yeah, yeah. I don't care if I get pushback from this, from comments or whatnot. I'll just be honest with you. The majority, the majority of the metabolic panel that we all run on people at this point I find you know what is that telling me? That's the running of what your blood protein levels and your blood calcium levels and everything that pretty much has to be bound to a protein in order to even pick up on a blood test, is very suspect to me Because it's not telling us anything about your true reserve levels of this or how well they're functioning, or are they getting into receptor sites. So probably the biggest one at the top of the list is the TSH. The gold standard, so to speak, for your thyroid function is to go out and run this test called thyroid stimulating hormone, which is kind of the way that to explain this to people is. It's like the gas pedal in your car. So it comes from the pituitary gland and what it sent out from the pituitary to the thyroid in response of you're not doing your job effectively enough, so we need you to step it up, so there will be a higher TSH level If your thyroid is doing pretty good and it's pumping out enough hormone, that TSH level will usually be in some kind of normal reference range, but it's again. It gives you so little information.

Speaker 3:

I work with women every single day who here's what happens they develop. I take you through this, walk you down this pathway. I'll try to do it quickly. So a woman who's transitioning let's say she's 47 years old, her estrogen and progesterone are beginning to drop, but estrogen is not dropping nearly as fast as progesterone. So the gap between those two hormones is getting bigger and bigger. What will happen there is that estrogen competes against thyroid hormone for receptor site bondage and being in what we call an estrogen-dominant state increases a hormone called thyroid-binding globulin. So what ends up happening is that you've got a woman here who is developing all kinds of symptoms of hypothyroidism she's gaining weight, her skin's getting dry, she doesn't sleep well, she's got mood swings, tendency towards constipation, tendency towards edema, retaining fluid and all of this.

Speaker 3:

But if you go look at her thyroid test, especially if you're just looking at a TSH, it'll look normal because the woman is producing thyroid hormone. Problem is it's not getting into the cells where it needs to get into the mitochondria to set up this whole oxygenation for burning fat, for producing ATP and all of this stuff. So that is a useless test to me. When somebody comes in and goes, hey, my TSH level came back in the normal range, so I definitely don't have a thyroid problem. Really, that doesn't mean to me you don't have a thyroid problem. It means that your thyroid can make thyroid hormone, but it doesn't tell me that it's getting to where it needs to go and that's why you're having all of these complications and none of your doctors want to take it a little bit further and start looking at other numbers free T3 levels, reverse T3 levels, thyroid hormone uptake. There's better ways to evaluate this, but we've gotten ourself in a situation where so that's one, all right, and then the other ones I mentioned blood protein levels are really not all of that going to tell you whether you have a problem of any kind.

Speaker 3:

Calcium is something again that looking at blood calcium tells you. Unless this person's got a parathyroid problem, which usually you can pick that up on either a physical exam or other ways your calcium levels aren't telling you much. And then you go down and you just look at the list of a bunch of stuff that I found that's not really all that valuable and then we can get into blood lipid profiles and you know Philip can tell us all about this. I don't find it to be all that interesting when somebody tells me that they have, you know, a cholesterol level of 220. Okay, let's look at. But your triglycerides are 90 and your HDL is 60. I'm not really concerned about your 220 total cholesterol at all. So cholesterol isolated, your total cholesterol isolated, I really provides really little information and I'd love to hear Philip talk about that because I don't know if he would disagree. But in and of itself, just a total cholesterol level doesn't seem to hold a lot of weight to tell somebody that, oh, you've got a big risk factor here for cardiovascular disease for cardiovascular disease.

Speaker 2:

Yeah, certainly, as I've talked about many times, we really want to know about the quality of your cholesterol and we want to know what is the environment that cholesterol is in, because that's what really is determining whether or not the problem that cholesterol gets involved in heart disease is going to occur. It really has very little to do with the cholesterol, it has to do with everything around the cholesterol and, you know, one of the reasons we wanted to have you back on to talk about was you know your expertise, your understanding around the hormones, specifically kind of the sex hormones and the thyroid hormones, and how those interact, how those contribute to the risk of heart disease.

Speaker 3:

Yeah, definitely so. Again, we had kind of mentioned this earlier, maybe before we started recording. But something that still doesn't get as much press as I thought it would is that, you know, heart disease still is the number one killer of females and males, I believe Unless that's been replaced now with cancer, but you can tell me that. But in females, the number one, females, the number one cause of death is some kind of cardiovascular problem, and it usually takes place right around menopause. And so if you start thinking about why would that be okay? So you've got in menopause. So you've got in menopause. And for those of you who need to know what that really means, menopause really medically means that a woman has gone 12 months without having a menstrual cycle, but even earlier than that, when a woman has skipped three or four periods and is on her way to that. So what's happening here is you've got three primary hormones that are dropping, and at this point they're dropping fairly quickly, although progesterone has already dropped and outpaced the other two. But now your estrogen levels are dropping and your testosterone levels are dropping. Okay, so these three sex hormones, sex steroid hormones, are all manufactured through a pathway that starts with cholesterol. So your liver produces cholesterol. It turns that into a precursor hormone called pregnenolone. And then, from pregnenolone, your body chooses to shunt that precursor into. Does it need more progesterone? Does it need more estrogen? Does it need more testosterone through androgenostione? So these three metabolic hormones are beginning to drop and cholesterol was the building block to make all of them so.

Speaker 3:

Naturally, what happens is menopausal women start stockpiling cholesterol. You know, take any woman who is going through menopause who has chosen not to do any kind of hormonal replacement therapy, and you're going to see that their cholesterol levels are higher than they used to be before they started going, before they started being in menopause. And that's just the body saying we're trying to hoard the building block to make the hormones that are deficient in your body. Now this is where it gets confusing. It's not that your body's stockpiling cholesterol. That has anything to do with their increased risk in heart disease. Really, it's the fact that they, when the body has this decline in these hormones, it views it internally, even though it's a natural process. That's been going on in women and it also goes on in men too. We can talk about that later. But it's a natural process.

Speaker 3:

But internally the body views this as a stress. It's okay, this has to be dealt with. We don't have the amount of progesterone, testosterone, estrogen that we used to do. That is a stress to the body because the body's always looking for homeostasis. So the body is looking for how do we make up and shift the keep the body in homeostasis with the deficiency of this, these hormones.

Speaker 3:

The first mechanism is it's going to call upon the adrenal glands to produce more cortisol, because cortisol is our stress hormone. That is used to, you know, do all kinds of good things. We die without it. But what you don't want is this chronic low level of elevated cortisol, because this is sending an inflammatory marker through your body all the time and with that elevated that mildly elevated cortisol will end up doing is it will interfere with the thyroid function, which is the. We talked a little bit about this, but I would love people to know that what the people have this tendency to think about thyroid all about. You know metabolism it is, but probably better to know the mechanism of why it gets tagged that way.

Speaker 3:

What the thyroid is all about is oxygenation. It's about getting oxygen inside the cells of your body and we know from looking at. Think about a fire. You know you can't burn. You can't have a fire burn without oxygen. So if you can't get oxygenation inside the cell, and mainly to the mitochondria, then the suffocation of the inside of this cell is going to be really crappy at being good at many different things, one would be producing ATP. One would be producing. You're just not good at lipolysis, you're not good at fat burning.

Speaker 3:

If you can't get oxygen into your cells, now this begins to cause a challenge because you cascade that leads to the inside of the vessels to become inflamed. And then there's so many things that are added to this. People are eating a diet that doesn't have enough magnesium in it, so their muscle, the smooth muscle fiber around their arteries and whatnot don't relax very well and so they become rigid. Now you've got inflamed tissue inside and your diet is really deficient in magnesium and it sets this whole cascade up for. And it sets this whole cascade up for placing an unnecessary stress on heart function, and it's a shame because it doesn't have to be that way.

Speaker 3:

So much of that can be addressed with diet. So much of the taking the stress off of the adrenals producing too much cortisol. So much of what you can do to eat a nutrient-rich diet that improves thyroid function and decrease inflammation is all going to be very helpful for you. But if you don't get on it and you don't take care of eating an anti-inflammatory diet, you don't take care of trying to do what you can do to balance your hormones and keep your cortisol levels low and to keep some of the other hormones a better level. You know, aerobic exercise, high intensity, interval training, strength training all of these things help increase back testosterone levels to some extent, bring estrogen levels up and put a woman back into a case where she's not at such a risk for this cascade that can lead to eventually heart failure or whatever and really it's through inflammation is the way that I see it more than it.

Speaker 2:

Yeah, so do you think that really all women would benefit from keeping their hormone levels higher, counteracting sort of what tends to naturally happen during menopause? How do you view which women will benefit? Or do you think kind of almost all women should be on some sort of hormone replacement therapy as they're approaching or going through this transition?

Speaker 3:

That's a super question and it's a tough one because, you know, I deal with this every day, 25 times a day, it seems and the things are that, if I think that what has to be brought up first to answer that question, philip, is the understanding, and what I try to get women to understand first is this If we were to look at the life expectancy range a hundred years ago and I don't know exactly what it was, but it certainly wasn't what it is today the natural course of the declining of hormones, which has been going on since we were a species or whatnot you know kind of takes care of itself and I don't think that it would have needed to be thought about or manipulated Because, number two, things were happening back then they were eating a really nutrient-dense diet and, number two, they certainly were not sedentary.

Speaker 3:

So they were doing things that helped them out, both hormonally better nutrition, better decreased inflammation. Where I'm trying to get at is now when I'm having a conversation with a woman and I'm saying listen, there's a good chance, especially in women who are outliving men by the average of four more or five more years, there's a good chance that you're going to live to be 90 years old. So now where hormone replacement therapy or how you have a conversation with a woman about hormones and what do you do about that, is a whole nother thing, because if you're looking for quality of life throughout all the way into your 70s or 80s, what's clear is that what's keeping most people from that is a rock bottom level of the hormones that we've been talking about.

Speaker 1:

Oh, hold on. I want to make sure I understand what you just said. Okay, I think I heard you say the reason people are having crappy qualities of life if they live a longer time can definitely be attributed to screwed up hormone situation. Not solely, but certainly. I would have to agree with that.

Speaker 3:

I would probably shift that to a different paradigm and say if you want to increase your quality of life, then you might want to think about I mean, we know this about. Let's just take estrogen and testosterone. Those are two of the. I think progesterone is the most important of all of these, but so many people don't even kind of we can talk about that later they don't recognize that as much as they've heard the words estrogen and testosterone. So you take a. We'll stay with the with females right now.

Speaker 3:

You take a woman who has been in menopause for 10 years and is rock bottom in both estrogen and testosterone. Here's what you're going to see. She might be healthy I mean to the point where she doesn't have any huge risk factors or something. But here's what you're going to see Clearly, signs of aging of the skin, of the hair, of the strength of her muscle strength and her bone density, her quality of cognitive thinking, motivation to take on new activities or whatnot. They all begin to decline naturally through a longer period of time of being in this hormonal demise. You take that woman and you put her on natural estrogen and bioidentical testosterone. You're going to see some pretty amazing things happen. You're going to see her skin look 10 years younger. You're going to see that her vitality is so much better. Her bone density is better, Her muscle mass and strength is better. Her moods are better. She is better, her muscle mass and strength is better, her moods are better, she sleeps better. Now I kind of feel like I'm pigeonholing myself, because I am not an advocate for every woman whose menopausal should be taking hormonal therapy, for is that there's somewhere in here that we're beginning to see that, if we're going to keep living longer and longer through you know what medical science has done for us and some of the removal of some of the diseases that we used to have to deal with that we don't anymore, this is going to become more of a. It's going to become more of a conversation, because you want to have the best quality you can into later life and, if done correctly, what I can clearly see after 29 years is that hormones got a bad rap, and for a bad reason.

Speaker 3:

The idea of bioidentical hormone replacement therapy in small amounts, physiological amounts, is not only not harmful, it's actually protective of many things, including cardiovascular problems. Road, somebody very quickly decided that let's see how we can first take horse urine and then synthesize that into a synthetic version in a laboratory and give that to a woman and expect that we just took care of her estrogen deficiency, only to come to find out that, wow, you know, that's like lighting a fire for reproductive cancer, breast cancer or whatnot. It's not the estrogen, so to speak, that did that. It's the synthetic version of a version of an estrogen that your body does not recognize at all, of an estrogen that your body does not recognize at all, and this happens all the time, and it's a real problem.

Speaker 3:

The biggest one is with birth control pills and some of the other hormonal replacement therapies that I see where doctors are handing out. What they tell patients is progesterone, and it's not. It's a progestin, and it's a totally different thing. Your body's never seen a progesterone, and it's not. It's a progestin, and it's a totally different thing. Your body's never seen a progesterone in its life, but it knows what bioidentical progesterone is because the woman's ovaries have made it all her life.

Speaker 3:

So if you feed back the same estrogen that she's always made, in its identical form and only in the amount that a woman would have made on a daily basis when she was a healthy 38-year-old woman. Amazing things can happen there, but try to put her on a synthetic progestin at a ridiculously high dose which is what I see all the time and you're asking for really big problems, including, I think, it promotes things like arterial inflammation and heart disease. So, and you know, as Philip would tell you too you know there's always been a complication with women who are taking estrogen, whether it be in birth control form or some kind of other form, who are not well-suited for it or they're using a synthetic form of estrogen as being problematic, as a blood clotter and all kinds of things that could be a problem with cardiovascular issues. All right, that's a lot, but that's my thoughts about that.

Speaker 1:

So I want to try to put it in in plain english for a simple folks, okay, we're living longer. If our hormones are out of whack, you might not be happy about how long you're living, so let's get the hormone situation straightened out. However, be aware that there are two big classes of hormones. There are the artificial ones, the ones that are manufactured in a lab and patented by some drug company, and there are the bio-identical ones.

Speaker 1:

And just because you say this is a progesterone replacement doesn't mean that it's something your body recognizes. We're far better off with the bioidentical than the patented stuff.

Speaker 3:

Absolutely. I mean 100%, and again, I don't want people to draw the conclusion that's a first step. There are so many things that I would rather start with a patient about of how to improve hormonal balance by, like it was a huge one I see every day. Is that again? Let's go back to the people with chronically low elevations of cortisol. Is a real problem because we live I mean, the Western world is just everybody's stressed out anyway. So most people have chronic low level, but in but higher levels of cortisol.

Speaker 1:

Now what that means in both chronic low but higher. I'm confused.

Speaker 3:

Yeah, I mean. What I mean is chronically low level.

Speaker 3:

They're elevated, but they're elevated, but they're not like yeah they're like you know, let's say, on a scale of, you know, one to 10, and your cortisol levels are should be at a four. Most people are running around with their at a seven. Okay, now when it gets to 10, we've got a big problem and we need to look at what's going on. Do they have Addison's disease? I don't know, but most people are at a seven when they should be at a four In years of that mildly elevated cortisol, and what we're talking about is and how it would relate to a woman that I see Jack would be this. Here's what we're current to fix that we want to be aware of two things. One is what's cortisol made out of? Cortisol is made out of progesterone. This woman already has her progesterone levels declining, naturally, so the little bit of progesterone that she's still making is being robbed to make cortisol out of. So now she basically has no progesterone, right?

Speaker 1:

Because she's stressed out, or it's probably a chicken and an egg kind of situation.

Speaker 3:

Yeah, it goes both ways. But if the body needs to maintain homeostasis and keep things in balance, it has to be made out of progesterone. So it's going to rob the progesterone that could have been used for something else, like antagonizing estrogen to keep a woman from having endometriosis, or a whole other story. But so what we're talking about is this is, before we get to hormone replacement, therapy we could talk about okay. So what we know is stress management, which, again, is a hard thing because you're asking somebody to do something that requires that they got to be compliant to this. But stress management through things like meditation, yoga, long walks, you know prayer, you know anything that is designed to kind of just put you in a state of more of a relaxed state it's going to lower cortisol right Now. That's going to have a direct effect on now. You have more progesterone available.

Speaker 3:

Now, if you were to take that and practice that stress management and then pay attention to the things that we know that encourage your body to be able to produce more estrogen I mean more progesterone and that would be a diet that is well-represented in protein, a diet that is well-represented in vitamin B6, particularly the active form of B6 called pyridoxal 5-phosphate, or they might want to supplement that.

Speaker 3:

You might want to simply put that patient on a B6 supplement, because we're going to nudge the ovaries to produce a little bit more progesterone. We've dropped the cortisol levels down. Now we're getting back closer to a normal balance of hormones and we haven't had to go into actual hormone therapy, right. So there's a lot of ways to address this and we want to first start out as natural as possible, without having to use things that until you get to that point where, hey, honey, you need to be put on progesterone. Let's try a couple of things here and get your progesterone levels up and your cortisol levels down without actually having to use hormonal therapy. And you know, I think that's the best choice first, and then, if that you know, does that answer the question.

Speaker 1:

Joe, we're getting there. It's clear to me that it's a complicated system. We're getting there. It's clear to me that it's a complicated system, and I mean traditional Western medicine is treating it with less than delicate tools. We're kind of using sledgehammers when we should be using tweezers. It kind of sounds like to mix my metaphors.

Speaker 2:

So I want to dig in on the impact rate that the metabolic you know health or metabolic disease might have on this. Maybe the best way is to sort of contrast right, a woman who's metabolically healthy, right, she's been eating the whole real food, she's been, you know, doing the activity and she manages her stress, you know, and she goes through this perimenopause versus the woman who is metabolically unhealthy, like the majority of women unfortunately in this country, eating the processed food and not doing the right activities and they go into menopause. What are the differences that you see there? Night?

Speaker 3:

and day, night and day, night and day. It's the metabolic piece of so. Being metabolically healthy, so to speak and certainly being able to adapt to your body can easily fluctuate back and forth between using glucose for fuel or fat for fuel has a profound impact on keeping your body uninflamed, supports hormonal balance by keeping cortisol levels down, improves thyroid function, for sure. And if you're doing those things and you're metabolically healthy, you're going to find that going through menopause is it can be. I haven't seen this in so long, philip, to tell you the truth, but I know that it can be kind of a smooth sailing. If you're really taking care of your health, you're doing the right diet, exercise, sleeping, taking time to make sure that you're managing sleep well, and stuff like that, it can be a fairly smooth ride. Now, even in those people I still see usually some little blurbs that things aren't. You know I'm not sleeping as well as I used to. That's not that big a deal. We can fix that with, you know, in what I do's.

Speaker 3:

Now, on the other hand, you take a woman who has, you know, completely wrecked her metabolic health, has become ins, you know, super insulin resistant and which has already started the inflammatory cascade which is already, which has already started the inflammatory cascade which is already soaking up all of her progesterone and cortisol. This is the woman who is going to in mid to late period menopause is going to have. I'm going to see her and first thing is she's going to be anxious and she doesn't know where it came from because she's never been an anxious person. Now she's got anxiety. She's gained 15 pounds without changing anything about her diet. She cannot stay asleep between one and three o'clock at night. She has terrible mood swings completely, has lost her libido and I mean irregular periods. If she's still having periods, they're getting really out of control. They're starting to come every two weeks with really heavy bleeding for the first two or three days, for the first two or three days. And this is all caused by not paying attention to being metabolically healthy.

Speaker 3:

As you're getting ready to go through this hormonal change and it's sad to see, but again, there's such an answer there. If somebody really wants to go, I see this now. I believe I've heard enough from you docs like you and Philip and whatnot that there's an answer here to approach the root cause of these issues, as opposed to putting band-aids on these issues, then you know they can turn this around for themselves. But it's night and day and I encourage every woman to, you know, really take this seriously of getting yourself metabolically healthy and because you don't want to see what it's like to have a severe hormonal drop at 49 and you're already pre-diabetic and need to lose 75 pounds and having migraines and you don't sleep well already and watch how that just gets worse and worse and the work gets harder to turn around, even though it's always they can always do something about it to turn around, but it gets harder and harder the more they've let it go.

Speaker 3:

And again, I want to just bring up men too, because one of the things that this is happening in men so much, but nobody really is talking about, the biochemistry of it, of the typical man is not understanding that if you are, if your diet looks like pizza and beer and you're playing video games and you're sedentary and you're stressed out at work, then what's happening, what you're going to see here is and I put this out on Twitter a lot because I'm trying to get guys' attentions, and so you'll hear me talk about things like man boobs, because I feel like maybe that'll wake them up, because the ones that they don't want, that they don't want man boobs, and so what's happening here is this concoction that I just put together of the poor diet and beer drinking and video games and stressed out, and they don't sleep well. So what they're doing is they're creating a ton of an enzyme in their body called aromatase, right? So aromatase is what converts testosterone into estrogen, into estrogen. So these men are out here making the primary amount of testosterone that they have in their body is getting converted into the female hormone, estrogen. Now we need some estrogen as men, but not very much of it.

Speaker 3:

But if you've got this aromatase just cranked up, they're just turning this into estrogen. So they're going to get all kinds of estrogen characteristics, like they're going to grow fatty tissue on their boobs and they're going to have their abdomens are going to blow up, because that's where they're going to store all their fat, and they're going to have issues with no libido, no motivation to do anything, they're going to be fatigued all the time and they might even start getting, you know, issues with hot flashes and night sweats and certainly insomnia and all that kind of stuff. So it's, uh, it affects men too, and and you know, that's my, my, my goal is to try to get people to understand that there's a lot going on here, and a lot of it's related to biochemistry of hormones and enzymes or whatnot, and let's get that straightened out so in a situation like that.

Speaker 2:

You know, if you give testosterone replacement which again, uh, is a maybe a bit of a default reaction these days to these problems it sounds like you may make that worse. Right? Because if you have this high aromatase and you're giving more testosterone, more of it's going to get converted to estrogen.

Speaker 3:

It's going to be a disaster. It's going to be a disaster. It's going to be a disaster, but but you know, here's how modern medicine unfortunately deals with that. They will take that man and they will put them on testosterone, but they will require them to take an aromatase inhibitor. And now you're talking about all kinds of issues, because aromatase inhibitor are not friendly to our biochemistry at all. They come with all kinds of side effects that you don't want. But the doctors who practice that type of hormonal therapy go. You know it's better that we want to keep your testosterone being testosterone. So you've got to take this aromatase inhibitor along with the testosterone. So you've got to take this aromatase inhibitor along with the testosterone, and it's.

Speaker 1:

You know, I think they're playing around with stuff you don't really want to be playing around with Wow.

Speaker 3:

Yeah, okay.

Speaker 1:

And people are lining up for it too. They're lining up for it too. They're lining up for it. Superficial results very quickly, and I guess that's what these other things do as well. So we're trying to keep people off of Phil's operating table by making sure that they're, rather than just being superficial and again you brought that up, jack, in the beginning, and so now let's kind of add another.

Speaker 3:

I think you can see that it's a very individual thing when you're working with a patient and we're trying't know make up. A 46 years old male has got himself to the point where he weighs 485 pounds. Right yeah, is there a? And here's what we're looking at is there a way that you could build a protocol for this man to use one of these new medicines for a period of time? But it came with that they absolutely have to be engaged in the education of learning how to get themselves metabolically healthy, because there's going to be a time where they have to come off of this medicine and if they haven't done anything but the medicine, they're just going to blow right back up. But if they learned how to utilize things like maybe a.

Speaker 3:

You know I kind of promote what's called a lower carbohydrate, higher protein, moderate fat diet Because, again, it's really because of the wheelhouse that I work within. In menopause, once these hormones have begun to decline, the idea of a woman being on a true ketogenic diet absolutely makes zero sense whatsoever. And again, I just kind of went off, but I'm going to try to bring it back around.

Speaker 1:

That'd be cool to hear more about that.

Speaker 3:

yeah, yeah, I got to explain that if I'm going to throw it out there, and here's why that is. The hormones we've been talking about in the three in a woman that's going through perimenopause and now endomenopause estrogen, progesterone, testosterone all are part of a younger woman's, a big part of their metabolism. Each one of these has a role in body composition, burning fat and keeping people from being obese. So when these levels begin to drop and they drop significantly the idea of putting this woman on a low-carbohydrate with a moderate to 80 percent of her calories coming from fat is ludicrous, because there's no way, without that metabolic power of those hormones, that you could ever burn enough of that fat. Yet you just took in, even though that you're thinking that this is going to be great because I'm going to produce a bunch of ketones, which you might, but you're not going to burn through all of that energy toxicity that you took in with 80% of calories from fat one day, before you get up the next day and you start this over again and it's you know, it's something I deal with every day of I you know, I'm so faithful to the ketogenic diet and now I'm 49 or 50 and I'm beginning menopause and all I do is seem to gain weight. Yeah, you cannot sit around adding butter to your coffee and cooking ribeyes with another stick of butter and all of this and lose weight at that age.

Speaker 3:

Now, a healthy 28-year-old male who's an athlete absolutely, he can get ripped doing a ketogenic diet, ripped doing a ketogenic diet, but this is not the diet. For once, you've reached the stage of life where your hormones are starting to drop. You want to moderate that fat, and in no way am I talking about a low-fat diet. I'm just talking about get rid of the idea of the ketogenic high-fat diet, but focus on protein, because protein is the most satiating of the macronutrients by far and anyway. So Can't even remember where we started this whole thing. Oh, that's OK. The problem it all leads back to protein, ultimately, absolutely.

Speaker 2:

I think that's where we all keep coming back to.

Speaker 1:

You're so dang interesting that I just want to keep talking, but I don't want to wear our listeners out. I'm about half inclined to edit this episode and drop it as three separate episodes, because there's so much that you've given us. Um, we're gonna wrap it up.

Speaker 3:

Yeah, you figure out what you want to do, so I love you guys so, so I'm available anytime.

Speaker 1:

I love talking with you At least once a year. Yeah, more than every two, right, so tell our listeners how to find out more.

Speaker 3:

Okay, if you're interested in my work at all, the two things. One is you're going to find me on most social media platforms. Primarily, I do most of my work on Twitter, but Instagram, facebook as well to a lesser extent, but everything is at the at hormone diet doc, so that's where you're going to find me. And then my website is drjrigleycom. And those are the two places you can get educated on what I do, how I kind of work with people and I try to put out as much as I can to help people. Just keep people educated.

Speaker 3:

I think our job right now and Philip does a great job of this is right now what we've got to do is just get people educated, because people still it blows my mind, people so many people are still like I find every day I'll put up, you know, a tweet about something and somebody will come back and go something like are you sure that I can eat eggs? Because I know eggs have cholesterol in them and won't that give me a heart attack? And I'm going, man, I thought we were way past that. I thought we were past that.

Speaker 2:

Every time you think we get past the eggs, they release another study of some sort trying to bring them back in. Absolutely, it's crazy.

Speaker 3:

Hey guys, thank you so much for inviting me back on, and this is great. It's been fun to watch Philip, it's been fun to watch you grow and you're really making an impact, and good for you, man.

Speaker 2:

Thank you, jay, and keep up all the great work that you've been doing.

Speaker 1:

All right, we appreciate it. This has been Dr Jay Wrigley For Dr Philip Ovadia. This has been the Stay Off my Operating Table podcast. Thanks for joining us. We'll talk to you next time, all right, ciao, guys.

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Dr. Philip Ovadia

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Jack Heald

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