Quick Minisode: Midlife Metabolic Health & Weight Loss Drugs

Rocio Salas-Whalen (00:00:00) - A drop of estrogen promotes visceral fat. When a natural fat promotes insulin resistance and insulin resistance promotes visceral fat, and then it goes into that vicious cycle.

Sarah Milken (00:00:18) - Hey peeps, welcome to the Flexible Neurotic Podcast. I'm your host, doctor Sarah Milken. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago, like last fucking year, I was sitting in the midlife funk wondering, was this it for me? That day, I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD, wiped the menopause sweat off my forehead, grabbed my golden shit shovel, and started digging deep to all my midlife bitches. It's not just luck, coffee, and hormones that get you through your midlife remix. It's action steps. Let's do this. Hi peeps, it's me, Doctor Sarah Milkman with a new episode of the Flexible Neurotic Podcast. This is a mini. So as all of you know, I love researching so much. I'm a fucking nerd.

Sarah Milken (00:01:13) - My whole podcast is built based off of digging into the research with experts related to midlife, menopause and all the things, and bringing us all the golden nuggets so that we can take action steps today or tomorrow, or maybe even a fucking year from now. I'm hoping today, though, I'm going into my research library, and I'm reminding you and picking out some of the golden nuggets from the top episodes, because they were just that good. We need a little mini refresh for the midlife brain fog. So in regular, flexible, neurotic fashion, I'm getting my golden shit shovel digging deeper, bringing you along with me as we reconnect with the golden nuggets you may have forgotten about in your midlife to do list. So today, we're circling back to an episode with midlife weight loss that was filled with so much information. This episode was crazy. Downloads. Last year, I interviewed Doctor Rocio Salas Whalen, a triple board certified physician with vast experience in all areas of endocrinology and weight loss. You name it.

Sarah Milken (00:02:22) - She has that degree in this golden nugget mini sode. We're getting into everything that she said about metabolic health in midlife visceral fat, insulin, how weight loss drugs even work. She's sharing with us information from her evidence based practice. So we're getting information and real research data formulated from real women in her practice and studies. And they're our age. The more you know, the more empowered you can be on your midlife journey and metabolic health. Let's get into that episode.

Rocio Salas-Whalen (00:02:54) - So what is.

Sarah Milken (00:02:56) - Visceral.

Rocio Salas-Whalen (00:02:56) - Fat. So this low fat is the accumulation of fat. And it's domino right. It's not what we're pinching outside with the pinch with our hand that's more subcutaneous. It's entrapped on the side is the what we call the bad fat is the fact that attaches or adheres to your internal organs, including your liver, your pancreas, and your gut. Right. And as that level accumulation of fat that can, uh, take you to have insulin resistance and hyperinsulinemia, there's a miscommunication in the insulin signal when there's accumulation of fat in the liver and the internal organs, that leads to hyperinsulinemia insulin resistance, and that can lead to diabetes or type two diabetes.

Rocio Salas-Whalen (00:03:43) - Right. So why are.

Sarah Milken (00:03:45) - So many women in midlife in this menopausal like perimenopausal to postmenopausal zone? Why is this insulin resistance becoming such a hot topic right now? Is it sort of just that we're focusing more attention on it, but it's always in there. We have more tools like what's the deal?

Rocio Salas-Whalen (00:04:04) - It's the drop of estrogen, right? It drops a vast region promotes visceral fat. On a visceral fat, promotes insulin resistance and insulin resistance promotes visceral fat, and then it goes into that vicious cycle. What happens in menopause? Perimenopause with the drop of Estragon. There's redistribution of fat. So in our fertile years where we have our fat for fertility, which is our hips, our breasts, Wednesday, when the estrogen starts to fluctuate down or to drop that body fat redistributes centrally necessarily so that we're more risk of insulin resistance. And so resistance causes weight gain. So then we get into that cycle. So that's why we're seeing that in midlife. And perimenopause and menopausal women specifically we're talking about the changes in estrogen is promoting visceral fat.

Rocio Salas-Whalen (00:05:02) - Added to that all the other factors that I mentioned. So it's again, it's not one source. It's different. Many factors contributing to that. So visceral fat it's an inflammatory organ. Right. Um, and it releases cytokines and that's what promotes inflammation. Right. So that's why we know that in obesity it's a chronic inflammatory process. And that's why that explains Covid right. When Covid enters your body. If your body is already occupied or preoccupied in a chronic inflammatory process, using all your cytokines and inflammatory things that can protect you from when something comes in your antibodies, they're already preoccupied with the inflammation from obesity or visceral fat. Then comes the virus and can have a party, right? Because there's no one to body's to protect you. So that's what's happening with inflammation and obesity. Um, and we know that dementia, it can be an inflammatory process, cardiovascular disease, type two diabetes. I mean, there's inflammation is pretty much the basis of many of our chronic diseases that we have. Okay.

Sarah Milken (00:06:10) - Let's get into the pharmaceutical drugs. They're in a class called incursions. And I'm sure many listeners have seen it all over the news and Instagram and social media everywhere. Can you tell us what they are and what categories they are?

Rocio Salas-Whalen (00:06:27) - So there are a class of medications called ingredients. And they're hormones. They're synthetic hormones. We make these hormones in our gut. In the small intestine there is GLP one uh glucose like peptide one and GIP glucose inhibitory peptide. So these are the two, uh, ingredients that we humans we make. But the problem with our endogenous inheritance is that they have a very short life from from an enzyme called DPP four. In this enzyme breaks down this hormone within three minutes that is released. Right. So we do make them, but unfortunately they don't live long enough to give us all these benefits that we're seeing with the synthetic forms of this, of these drugs and what they do. We have receptors all over our body for this type of hormones. Um, but the more studies are the ones in the gut and in brain and heart and now even in kidney.

Rocio Salas-Whalen (00:07:23) - So again, we have different organs receptors for this. And so we don't know even what other potential benefits, uh, multi-organ they can have. Right. Um, but in regards to weight, uh, the way that they work, it's in our, in our stomach with our, uh, hunger and satiety hormones. This, this ingredients, what they do, they increase your satiety hormones, uh, when you start eating their release and they start working to release your fullness hormone. So you start eating and you feel fuller with smaller portions of food. And in between meals, they decrease your hunger hormones. So you really have more control. Way of in a almost. I like to say that it gives you a similar effect as bariatric surgery. That is a restricted way of eating that you you don't you cannot eat more than what you can put in. Um, and that's more like a mechanical restriction. But in the amygdala and the head on a stick eating area. We have receptors for these hormones too.

Rocio Salas-Whalen (00:08:27) - And what they do is they dissociate any positive feedback or positive reinforcement from food in regards to comfort, emotion, anxiety. Right. So many, many people that are emotional eaters, anxiety eaters, it takes it away. You're not getting that response back from food and more so it really changes your behavior with food. You enjoy your food when you're hungry, then you get satisfied with smaller amounts and then that's it. You're not thinking of food or anticipating food for certain types of relief or comfort.

Sarah Milken (00:09:06) - But I know a lot of people are probably thinking like me. But what about like when you're looking forward to going to that Italian dinner date night with your husband? Like, are you going to lose your kind of intrigue in food? Or are you still going to have it? But maybe it's less.

Rocio Salas-Whalen (00:09:25) - See, it depends if you I mean, if you if you're looking to enjoy, you're going to go out with your husband, another with a friend. Enjoy. And that's not going to take it away.

Rocio Salas-Whalen (00:09:34) - Right. But if you are feeling, if you're expecting your food that you're eating to to give you a certain type of comfort or release. Right? Right is two different things, right? Then this is going to take that away. Right. But you know what happens? Something wonderful happens for those patients that do have that reach for food for that anticipation. Suddenly they have so much more mental space to pursue and create other things and not consume a food. Right. That's beautiful. Because when you have unless I see all the time there's patients that are struggling decades right now, we can talk more broadly about obesity. And another way. Yeah, something like that. Decades with their weight, it consumes 90% of their brain, their meal in front of them. Right. How is this going to impact my weight? Am I doing the right thing? Am I eating the wrong thing three times a day? Four times a day? It runs into their head for decades. Suddenly they don't have to worry about that.

Rocio Salas-Whalen (00:10:43) - It's like they let go of the control. Something wonderful really happens with those drugs, and it's very hard sometimes. I tell my patients is very hard to understand once you're on them. And when I see you again, we're going to be having a completely different.

Speaker 3 (00:10:56) - Aha!

Sarah Milken (00:10:56) - Hey, peeps, it's me again. And I'm here to summarize what we just heard about metabolic health, visceral fat, insulin resistance, menopause hormones, weight loss, drugs. I mean, I'm so glad that we revisited this long episode with Doctor Rocio Salas when she explained what visceral fat even is, why it's such a huge topic for us in midlife women. I mean, it's literally caused by the decrease in estrogen that we see in midlife. She describes this as a cycle where a lack of estrogen leads to visceral fat, which leads to insulin resistance, which leads us back to visceral fat ugly. But like I said earlier, the more we understand what is going on in our bodies as we age, the more that we can work with the imbalances that are occurring.

Sarah Milken (00:11:44) - We have agency. There's shit we can do about it. Learning about this stuff, taking action, and working with our hormones are going to make all the difference in the world. We have to find doctors who don't just say it's part of midlife, just accept it. Just work around it. Eat fewer calories. That's not what's working. So what the heck is insulin resistance and why is it part of this weight cycle? Insulin resistance means that your body is resistant to the hormone insulin, which results in an increase of blood sugar, which leads to a redistribution of our fat. Again. But like I say all the time, midlife is all about the Uggs and fabulosity. And unfortunately, the midlife muffin top is part of the Uggs. The more we understand the Uggs, the more we can work around them and create some more fabulosity, whatever that means for you. It's all hard and good. We want our blood sugar to be right. We don't want the muffin top. We want to be in good shape.

Sarah Milken (00:12:43) - We want to do the strength training, so we have to do the dumb weights. Doctor Rocio Salas Whalen said that when someone takes a weight loss drug, it works with the receptors in the gut to communicate with our emotions. She said that these drugs actually work to change your interaction with food and behaviors around how you consume. This is fascinating. Emotional eating is real, and addressing the triggers associated with this behavior is actually the root of changing our eating habits. Wow. It doesn't mean that weight loss medications are for everyone and you have to. Check this out with your doctor. Everyone's situation is different. Mid lifers. Don't worry about digging through your old notes from the amazing information we received from last year's episode, because I'm doing it for you. Stay tuned for more golden nuggets that you probably forgot in the midst of mid-life parenting. Careering, sweating, and all the things we're doing in midlife. Hope you enjoyed this mini sode! There are three things you can do. First, fucking subscribe to the podcast.

Sarah Milken (00:13:47) - Don't just listen to it one off second, share it with some friends who like midlife shit. And third, write an Apple review. Yes, it's annoying. It's an extra step, but guess what? It really helps a podcast grow. DM me. You know, I always respond. And of course follow my Instagram at the flexible neurotic love you by.