← BETTER! Muscle, Metabolism, Meals, & Mindset in (Peri) Menopause with Dr. Stephanie Estima
BETTER! Muscle, Metabolism, Meals, & Mindset in (Peri) Menopause with Dr. Stephanie Estima
Menopause Weight Gain: Why 'It's Genetic' Is a Lie (And What Actually Works)
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Buckle up, because we're diving into the controversial topic of weight loss, genetics, and why the growing claim that obesity is primarily genetic is not just scientifically questionable—it's potentially stripping you of your power to change your health. Watch the full episode at https://youtu.be/LgoytCUbsHw
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If it's a genetic disease, well, then she can't do anything, right? She just has to take the medication. But she can sit on the couch and eat all the foods that she wants and there's no solution for that. There's nothing that she can actually do because the medication is the first and primary mode of treatment. So I'm just going to call bullshit here, okay? I'm all for getting people out of the obese category. Right? Like you are much better not obese than you are. However, this idea that obesity is a genetic first disease is not only prepostero, it's also insulting. Hello. Hello, my friends. Welcome back to another episode of better with Dr. Stephanie. It's me, your host, Dr. Stephanie Estima. And this month's episode, the solo episode, where it's just you and me. I wanted to talk a little bit about something I've been thinking about deeply lately. It's actually something that's been bothering me. And so I've been thinking about it a little bit. I've been working to articulate my thoughts on it and I'm ready to share it with you. But it has to do with weight loss, fat loss, body composition, and the relationship to genetics. And I've been seeing this more and more online lately. Many endocrinologists, many doctors who are sort of dabbling in the lifestyle medicine space. And I use. If you're listening to this and you're not watching the video, like lifestyle air quotes, lifestyle medicine usually means a medical doctor who prescribes Ozempic. I say that tongue in cheek, of course, but it does seem that there is this push from that camp to suggest that weight loss, particularly in menopause and perimenopause, but just generally is more than half, you know, 50% of like more than 50% of your results. Maybe the reason why you gain weight or don't gain weight is due to your genetics. There was this Instagram post that irked me, sort of in tandem with two other doctors who shall remain nameless. It doesn't matter who they are, but they had posted these articles that were talking about how Ozempic and GLP1s have always been and always will be more effective than diet and exercise because so many people fail on diet and exercise programs. And this one particular Instagram account, menopausematters, which I follow and generally think they put good content out. But they basically talked about this idea that more than 50% of the reason why people become obese or why, you know, the proper way to talk about obesity is as a, as, as a disease. So people with obesity is genetic. So more than 50% of the reason why someone is, is obese is, is genetic. And 15% of how you look, only 15% of how you look is attributed to diet and exercise. And not 15% diet, 15% exercise equaling 30%, 15% in total for diet and exercise. Hydration isn't just about how much water you're drinking, but it is how well your body is holding on to that water. And this is especially true in perimenopause and menopause because as our estrogen declines, so does our ability to retain key electrolytes like sodium. And then you add in exercise sessions and hot flashes and night sweats. And women in midlife can very easily get dehydrated and disrupt our mineral balance. This is one of the reasons why I love Peak's deep hydration protocol. It is a synchronized day to night electrolyte protocol to restore your nervous system to keep you hydrated. And it has the added bonus of being drinkable skincare. It strengthens your skin barrier and helps to unlock a luminescent youthful glow from the inside out. It's a two part electrolyte ritual. The first one is BT fountain. You take this in the morning to deeply hydrate smooth skin and fuel all day energy. And this electrolyte electrolyte has clinically proven ceramides visibly to improve skin elasticity and reduce fine lines. 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This irks me for several reasons, but before I get into that, I do wanna say that I absolutely Recognize that there are genetic differences and genetic predispositions for some individuals that put them at a greater risk for obesity. First and foremost, obviously, is that we know that individuals with obesity typically have a different reward cascade in the brain. So someone who is obese might have, I don't know, like, pick your favorite fruit, like a chocolate chip cookie or something, and have that. And someone who's not obese may have the same chocolate chip cookie. So same stimulus, but the reward cascade in the brain, meaning that the neurochemicals that are released as a result of consuming that, you know, chocolate chip cookie is basically a fat and sugar bomb, right? So like, and we know that carbs and fat together, that's like bliss point food, right? We typically over consume them. But what that does to a person who has a genetic predisposition to over release serotonin, to over release dopamine is gonna put them at a greater risk for obesity. Because what the brain does is like, oh, my God, look at all this dopamine. I feel great. What was I doing immediately before all of this dopamine was around? Oh, I was eating the chocolate chip cookie. Okay. So if I have like five more, I'm gonna have, you know, so you can. The brain will basically say what preceded the event, like, what caused this greatly increased dopamine or like this dopamine secretion. And that would be the chocolate chip cookie in this case. And not to say that in a person who doesn't have obesity, you don't get that same cascade, but the. The amplitude, like the amount of neurotransmitters, like dopamine, for example, that are released in response to that stimulus in someone who has a predisposition to obesity is gonna be much greater. So there's that we have this neurochemical cascade that is amplified in individuals who have a genetic predisposition to obesity. We know that. The other thing, of course, that we know is that there. There also seems to be a altered glucose retrieval and disposal in the muscle. So, meaning that the quality. So someone who is obese has trouble actually taking the glycogen that is stored in the muscle and actually utilizing it. And it's ess. In many cases, the obese person might have energy stored, but they can't actually access that energy. So in some respects, their bodies are actually starving, which is why they eat more. And then, of course, that puts an imbalance to that reward center, that calories in, calories out. So there's that. And then, of course, in midlife, we also have this Obviously declining hormone situation. So we have declining estrogen if that's left untreated. So if a woman doesn't go on HRT in some form, we will also see this preferential shift from her where she's gonna have the subcutaneous fat shift to visceral fat, which then of course puts her at risk for some of these lifestyle diseases, the cardiovascular disease, the cerebrovascular disease, the diabetes, the Alzheimer's, the metabolic diseases, all the things how the eff ever, okay? However, so there are these genetic predispositions. I wanna say that. I'm not discounting that. Okay? But when we approach obesity and other diseases, frankly, as genetic in nature, right? Primarily a genetic disease, right? Like no one's saying with sickle cell anemia that you can modify that with diet and exercise, okay? We know that that is a medication first. Like you need medication for sickle cell, okay? It is a genetic disease. And any genetic disease, what we are essentially saying is that the first line of treatment is medication, right? It is. If it's genetic, then lifestyle doesn't mean anything. Then lifestyle is just like. It's just like I just said, if you have sickle cell anemia and your doctor said, well, if you just change your diet and exercise, that should help the stickiness of your platelets. Like, no one is saying that, right? Like you need to take medication. But with obesity, it's a little different. If we look at obesity as a genetic disease, then what we are essentially saying is that this can. The first line of treatment for it is medication, aka GLP1s, G I P1s, you know, the ozempics, the mounjaros, the tirzepatides, et cetera. The other problem which is related to a medication first approach is that we are taking power away from the patient to actually affect and control her destiny, right? If it's a genetic disease, well, then she can't do anything, right? She just has to take the medication. But she can sit on the couch and eat all the foods that she wants and there's no solution for that. There's no. There's nothing that she can actually do because the medication is the first and primary mode of treatment. Your midlife lack of energy isn't a caffeine deficiency problem. It's a mitochondrial efficiency one. If you're finding your energy dips between meetings and workouts and those perimenopausal ups and downs, I want you to think more about optimizing your energy production rather than having more coffee. Meet TROSCRIPTION'S just blue. This is a precision dosed methylene blue buccal trochee and methylene blue works like a tiny electron shuttle for your mitochondria. It supports ATP production which is the energy currency that our cells run on and we are after cleaner, steadier energy and focus without the jitters. Early human brain imaging even shows that low dose methylene blue can improve attention and memory networks, which is exactly the circuits that suffer the most in midl and that we lean on the most in our midlife transition. 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Take the Just Thrive, Feel Better challenge today and save 20% on your first gut essentials bundle. Visit justthrivehealth.com better and save 20% with promo code better at checkout and see the difference for yourself or get a full product refund, no questions asked. That's justthrive health.com forward/better. So I'm just going to call bullshit here, okay? I'm all for getting people out of the obese category, right? If you need to go on medica like, you are much better not obese than you are. However. However, this idea that obesity is a genetic first disease is not only preposterous, it's also insulting. All you have to do is look at society 20 years, 30 years, 50 years ago, and you know, a hundred years ago, if you want to put a little bit more time around it and you know that these societies were not generally obese. They were typically quite. Not. You might make the argument a fit, but like, there was, it wasn't an obese, obesogenic society. People were not obese there. And that is certainly not enough time. Like, if it truly was a genetic issue, this would be consistent over a very long course of time because our genetics don't actually really change over time. What has changed is the epigenetics, the environment in which our genes live in, right? So we live in this, like, Wall E that, you know, the Disney movie Wall E. We live in this sort of Wall E type of world now where everything is available to us at our fingertips, right? We can order food and it's at our door in 30 minutes. We can order whatever we want from Amazon or whatever, whatever, right? We go to fast food and we have fast food on our plate within, you know, minutes. So there are, you know, even in our, in our current environment, right? There's, like I said, we have the uber eats. We have rabid, rabid consumption of foods with rancid oils, right? Anytime you go to any type of fast food restaurant, like, they're not changing the oil that they, that they fry those fries in, right? So you can go down the seed oil route if you, you don't even. Who cares about seed oils? Like, it's like just rancid oil. It doesn't, if it, it doesn't matter if it's olive oil. It doesn't matter if it's, you know, tallow. Although tallow does have a better heat resistance profile, of course, than, than olive oil does. But this is trans Fats essentially that are causing systemic inflammation in the body. We have chemicals sprayed on our vegetables, we have medications that are fed to the animals that we consume. We have medications that, you know, that we don't have long term data and studies on. There's personal care products that women use. Like I think the average woman uses like something nuts, like 40 products, you know, if you include like skin care and hair care and soap and toothpaste paste and whatever, like 30 to 40 to 50 products a day. And we have sort of these endocrine disrupting chemicals. So my, my whole point here is to disregard food and exercise as the primary models of treating obesity. To be British for a moment, absolute bollocks, like barking mad. You are wrong. This is wrong. But I'm seeing this narrative adopted. And what I worry about is that women in midlife, and of course I know that there are women, there are a certain subset of women who go through perimenopause and menopause who just, you know, just have the, you know, the shit kicked out of them by, by this transition. And it doesn't matter how much they calorically restrict, they still can't seem to lose weight. So there is, I'm not suggesting that this is a universal principle, but for like 90% of the world, 90% of the population, including women in perimenopause and menopause, it absolutely is. So exercise, one of the biggest levers, okay, for the, when we think about calories in versus calories out on the calories out piece. I am certainly a resistant train, you know, resistance training first kind of gal. I'm a muscle, muscle mommy, if you, if you want to say it that way. But like, you know, I take more of a longer term view to body recomposition. Not just like the calories that I burned on the elliptical machine, but how can I build more quads, how can I build more lats, how can I build more glutes so that my resting metabolic rate, which is a sort of a percentage of our total, you know, sort of maintenance calories or caloric expenditure of the day, how can I have more metabolically healthy tissue? Resistance training is a huge part of that and so is what you put in your mouth. So, you know, in midlife. I mean, we've talked about this so much on the show, it's like kind of bordering on like being, you know, ad nauseam at this point. But we need to have a protein forward or a protein first approach to our food selection as women in midlife. We need to be Prioritizing protein not just for the muscle building properties that it has, but also to just prevent, for the, for the satiating factors that it has. As our stomach lining degrades, as our naturally occurring amounts of GLP1s degrades, having protein actually helps to correct for that. Yes. So I, I have, I, I have this like problem and I'm trying to, I, I haven't quite figured out how I want to tackle it publicly, but I'm, I'm sharing it with you and maybe you can post your thoughts on this as well. If getting a good night's sleep feels like it is a second job, then this is for you. I have been building a simple night ritual with AGZ. This is the melatonin free nighttime drink from AG1 that's designed to support restful restorative sleep so you can actually wake up feeling refreshed. It's an easy mix that you can sip it cold, room temperature or as I like to do, warm. I like to think of it as cocoa with benefits. 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We know, for example resistance training doesn't have any immediate benefits on caloric deficit, but of course it's a mechanical stimulus. You're improving the quality of your muscle tissue. Right? So an obese individual, like I mentioned before, has muscle, but the quality of that muscle is actually quite poor because they're not able to extract the glycogen, the stored food, let's say in the muscle in order to use it in Many ways the muscle itself is starving. That can. Because there is lack of mechanical tension and contraction of those muscles on a regular basis. The expression of some of the GL, the glucose molecules. So the GLUT4 receptor is the one I'm thinking of. That one has to be expressed on the cell, on the myocyte surface through contraction of the muscle. Like it doesn't come out otherwise. Right. There's some, there's like glucose dependent and independent ways that the muscle takes up glucose. But GLUT4, you need to squeeze those muscles in order for that receptor site to kind of express itself on the surface. So the quality of the tissue is really important. Now, I'm not against Ozempic. Like I said, you're obese, you need to not be obese. Okay. So if taking Ozempic in tandem with learning how to eat and learning how to move again, which is fundamental to our design as human beings, which of course is hard in a modern society where we sit all the time. If you need to use Ozempic, no problem. Like you do, you boo, like get not obese. Right? Eat more protein, lift weights, start some type of program. Right? But while you're using the Ozempic to help you don't for a moment think that it's because it's a genetic. For the, for the vast majority of people that it's a genetic problem. Like for some people. Yes. Okay. There are outliers. There are exceptions to the rule all the time. The vast majority of us, just like the vast majority of us, you can lift all the weight you want. You're not getting bulky. There's, there's some outliers. There are some females who naturally always very lean, always have a six pack, no matter, you know, how much they eat and what they do, and can get really jacked and lean without doing much. Okay. Certainly outliers to the norm, the same is true here. There's going to be people who have these like strong genetic predictors that, you know, you can say, okay, maybe they are going to end up obese. Or you know, when you look at some of the. I believe it was the, it was the Nederlands in the world, Second World War, the. I don't remember. My son is going to be horrified that I don't know all of these details because he's really into World War, all the world wars. But there was this bombing. The Nazis closed off passages or the. I think it was the ports. They'd bombed all the ports, something like that. The, the end point of this, the end result was that the. The people of the Danes were starving, right? They couldn't get food in. They couldn't get food. They couldn't get food into the country. So what they noticed in these subsequent generations, particularly women who suffered through, survived that. So there was like this vast famine in the Netherlands. And what happened were the women who were pregnant and survived that gave birth to these children had these epigenetic changes where they just had a really high disposition to put on everything as adipose tissue, because in utero there was such stress because these women were famine. They didn't have food to feed their wombs, they didn't have food to feed their babies while they were pregnant. These babies sort of switched gears, if you will. Like, they had these epigenetic changes where they had a very high propensity to being obese, and that lasted several generations. So, of course, we see outliers like that. We have markers, we have, you know, you know, historical examples of that. But for the vast majority of us living in North America, where food is plentiful and abundant, maybe we live in obesogenic environments where we are fighting harder against becoming obese. But that is not to say that diet and exercise should not be the primary tools for fighting this war. And I think it honestly starts in the home. I think it starts with our children. Far too easy to put our kids in front of, you know, in front of a screen and feed them chips and all the crap that they see their, their peers eating. We see school food programs like, it's all. That's. It's a whole thing. Okay? But if we can start teaching our children from a young age, like, hey, chicken is a protein. Broccoli is a carb. Avocado is primarily a fat. What are some other examples? I don't know. Cheese is primarily a fat. It's got some protein, got some carbs, but primarily fat. Nuts, primarily a fat, and actually quite a bit of carbs. So berries, primarily a carb, that kind of thing. If we can start teaching our children that, we can start slowly making improvements into the choices that they make, and 100% they are gonna copy exactly what you're doing. So if you are working out, they are gonna work out. If you are making healthy choices, they are gonna make healthy choices. And I know that that's a truth that's, like, uncomfortable because it. The onus, the responsibility falls on us. We can't abdicate our responsibility by saying, oh, it's a genetic thing, so I can just take a drug and I'M sorry if this is upsetting, but it needs to be said. And you probably don't follow me because I sugarcoat things like you follow me because I tell it too straight and I maybe make things uncomfortable for you in the short term with the goal of helping you love yourself in the long term. It's not easy to learn how to work out voluntarily putting yourself in, you know, what can be described as pain. It's also not easy to continuously fight against an obesogenic environment where we see these endocrine disrupting chemicals and the personal care products and the, you know, like our food's sprayed with all this crap. It's not easy, but that doesn't mean it's not worth it. And that doesn't mean that it's still not the first line of defense. I don't care about. I mean, I care about feelings, but in this case, I don't care about feelings. This is the truth. You can use the pharmacology to help you get out of a bad situation. Of course you can. But you need to develop life skills and lifestyle habits. All right, friends, how many of these symptoms are you currently dealing with? Bloating, indigestion or reflux? New food sensitivities that's popped out of nowhere? Leaky gut? Autoimmune flares, post antibiotic issues, or mold exposure? Or just gut problems that never fully go away? Now ask yourself, did these symptoms get worse around perimenopause? If they did, I promise you are not imagining it as estrogen and progesterone decline. They will affect profoundly gut health like motility, microbiome, balance, and your gut barrier. That is why so many women in perimenopause suddenly struggle with gut issues that didn't bother them before. When your gut lining is weakened or it's inflamed, it disrupts nutrient absorption, it ramps up inflammation and even worsens hormonal symptoms. Because gut health is directly tied to hormone detoxification, your ability to produce energy, your mood, and your immunity. So that's the bad news. The good news is that you can totally repair your gut with peptides. Level Up Health has formulated the most powerful gastrointestinal healing product, Ultimate GI Repair. It is a clinical grade formula designed to rebuild your gut barrier and calm inflammation from the inside out, using peptides like BPC157 and GHK Copper. These are very powerful peptides that rapidly repair the gut lining. Lorazatide, which is another peptide that seals leaky gut, improves barrier integrity. Then you have Other compounds like zinc, l, carnosine and truterine. These are things that will soothe inflammation and support digestion. And then quercetin and sodium bicarbonate. These will enhance nutrient absorption and gut resilience. This product, Ultimate GI Repair, is designed to target the root cause of gut issues and it will help heal and protect your digestive system so that you can feel your best whether your symptoms are tied to perimenopause, chronic stress. Hello, that would be me. Or past gut issues. Ultimate GI Repair will give your body the ingredients it needs to finally heal. Head over to leveluphealth.com that's L V L U P H E-A-L-T-H.com and use code Dr. Stephanie to get 15 off of the entire website. That's LVL U P H E A L T H.com and use code Dr. STEPHANIE at checkout. I share this with you because I want you to be maybe aware of some of this messaging and maybe how it. We might just start to see this in more and more frequency. But if we can really start with metabolic health and diet and exercise as the primary, primary tools for intervention, I think that we will be. You know, it's a difficult thing to do, but the paradox of life is that, right, it's like nothing worth having is usually easy. And if it is too easy, you know, you've given up something, something has been sacrificed in order for it to be easy. And this is the hack part of biohacking that just drives me insane. You cannot shortcut like Ozempic is not gonna lift the weights for you. Ozempic is not gonna build your plate for you. It's gonna make you not wanna eat a lot of things on your plate. And this is why you absolutely must give your muscles a mechanical stimulus in order to prevent yourself from losing the muscle mass that we. That it's been shown, shown to do. If you're not. If you're not weight training and prioritizing protein. So those are my thoughts. Um, honestly, I've been sitting with these thoughts for a week, maybe more. Actually, I think I've been sitting on this for like two weeks. I saw this meme and I was just beside myself for four days. And I finally went to my team and I was like, this is really bothering me. And one of my team members was like, you should probably put that in the solo. It was like, oh, yeah, maybe I should. All right, there you go. So there you are. Interested in your thoughts and your feedback on this. Would love to hear what you think about it. And I also just want to sort of safeguard your mind because sometimes the, you know, the old adage like, you know, a lie is something that you've said to yourself so many times that. And you can start to believe that lie, right? You can start to believe that obesity is a genetic, you know, primarily for most of us, a genetic disease. And it absolutely effing lutely is not. So there you are. I will leave you with love in January as we all embark on our New Year's resolutions. I hope that you found this helpful and love to hear your feedback as always.
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All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.