The Belly Fat Episode: The Truth About Muscle Loss, Menopause, and Midlife Fatigue

Summary

The Tamsen Show: The Belly Fat Episode – A Comprehensive Summary

Date of Release: May 21, 2025

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Introduction

In this enlightening episode of The Tamsen Show, host Tamsen Fadal delves deep into the perplexing issues of belly fat, muscle loss, menopause, and midlife fatigue. Recognizing that midlife health journeys are highly individualized, the conversation emphasizes the inadequacy of one-size-fits-all weight loss plans and the necessity for personalized approaches that consider hormones, stress, routines, and lived experiences.

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Guest Introduction: Dr. Rocio Salas Whelan

Joining Tamsen is Dr. Rocio Salas Whelan, a triple board-certified endocrinologist and an expert in obesity medicine. Dr. Whelan shares her personal and professional journey, highlighting her commitment to believing and validating women's symptoms—a response to the widespread gaslighting and misunderstanding women often face in medical settings.

Notable Quote:

Dr. Rocio Salas Whelan [04:00]: “Through my journey as a doctor, I've learned to believe women. It’s the missing link between gaslighting and women’s symptoms.”

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Understanding Belly Fat in Midlife

The discussion begins with the prevalence of stubborn belly fat among midlife women, a condition that often appears despite maintaining healthy lifestyles. Dr. Whelan explains that this issue is multifactorial, stemming from both physiological and sociocultural changes.

Key Points:

• Hormonal Shifts: Perimenopause triggers chaotic hormonal changes, particularly a drop in estrogen, which promotes visceral fat accumulation.
• Muscle Loss: Concurrently, muscle mass decreases, reducing the body's calorie-burning capacity.
• Sleep and Stress: Menopausal symptoms like sleeplessness exacerbate fatigue, irritability, and insulin resistance, creating a vicious cycle that impedes weight loss.

Notable Quote:

Dr. Rocio Salas Whelan [07:14]: “In midlife, hormonal changes happen parallel to sociocultural changes, setting us almost up for failure.”

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Insulin Resistance and Pre-Diabetes

Tamsen shares her personal health revelation of being pre-diabetic despite adhering to a mostly plant-based diet. Dr. Whelan elucidates how dietary changes, particularly increased intake of plant-based proteins like lentils and beans, can inadvertently raise glucose levels, leading to pre-diabetes.

Key Points:

• A1C Levels: An A1C of 5.8 indicates pre-diabetes, even in the absence of high visceral fat or a family history of type 2 diabetes.
• Dietary Missteps: Excessive consumption of starch-based proteins can contribute to elevated blood sugar levels.

Notable Quote:

Dr. Rocio Salas Whelan [12:32]: “Increasing protein in your diet is a must, especially in midlife where we tend to lose more muscle mass.”

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Hashimoto's and Thyroid Health

The conversation shifts to thyroid health, particularly Hashimoto’s thyroiditis, an autoimmune disease where antibodies attack the thyroid gland, potentially leading to hypothyroidism. Dr. Whelan emphasizes that elevated thyroid antibodies do not immediately necessitate thyroid replacement but warrant close monitoring.

Key Points:

• Autoimmune Impact: Stress and hormonal fluctuations during perimenopause can trigger or exacerbate autoimmune conditions.
• Thyroid Misattribution: Many symptoms attributed to thyroid dysfunction may stem from other midlife physiological changes.

Notable Quote:

Dr. Rocio Salas Whelan [32:45]: “Nine out of ten times, it's not the thyroid that’s the issue.”

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Types of Fat and Their Health Implications

Dr. Whelan differentiates between subcutaneous fat (beneath the skin) and visceral fat (around internal organs). While subcutaneous fat is generally harmless, visceral fat is pro-inflammatory and linked to various health risks, including insulin resistance and certain cancers.

Key Points:

• Health Risks: Visceral fat promotes inflammation and is metabolically active, increasing the risk of chronic diseases.
• Cosmetic vs. Metabolic Fat: Treatments like liposuction target subcutaneous fat but do not address the harmful visceral fat.

Notable Quote:

Dr. Rocio Salas Whelan [17:07]: “Visceral fat is pro-inflammatory tissue, promoting different types of cancer and insulin resistance.”

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Dietary Strategies: Emphasizing Protein Intake

A central theme is the critical role of protein in midlife health. Dr. Whelan advises increasing protein intake to support muscle mass, which is essential for metabolism and overall health.

Key Points:

• Optimal Protein Consumption: Aim for approximately 90-100 grams of protein daily, spaced across multiple meals to maximize muscle protein synthesis.
• Debunking Myths: Intermittent fasting is discouraged as it complicates achieving adequate protein intake.

Notable Quote:

Dr. Rocio Salas Whelan [19:51]: “Our body only utilizes about 30 grams per meal for muscle protein synthesis.”

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Exercise: Strength Training Over Cardio

The importance of strength training is highlighted as the most effective exercise for reducing visceral fat and maintaining muscle mass, compared to cardiovascular exercises, which primarily benefit mental and cardiovascular health but are less effective for fat loss.

Key Points:

• Muscle Building: Engaging in resistance training helps burn more fat by increasing muscle mass.
• Cardio’s Role: While beneficial for mental health, cardio alone is insufficient for targeted fat loss.

Notable Quote:

Dr. Rocio Salas Whelan [38:19]: “Cardiovascular exercise is not important for fat loss. For fat loss, we need to concentrate more on strength training.”

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Managing Stress and Sleep for Weight Control

Chronic stress and inadequate sleep are significant factors contributing to weight gain and metabolic disturbances. Elevated cortisol levels from persistent stress affect metabolism and fat storage.

Key Points:

• Cortisol Impact: Chronic stress leads to sustained high cortisol levels, promoting visceral fat accumulation.
• Sleep Hygiene: Prioritizing 7-8 hours of uninterrupted, quality sleep is crucial for metabolic health and stress reduction.

Notable Quote:

Dr. Rocio Salas Whelan [29:24]: “Chronic stress with elevated cortisol can promote visceral fat accumulation.”

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Hormone Therapies and Medications

Dr. Whelan discusses medical interventions that can support body recomposition in midlife women, including hormone replacement therapy (HRT) and GLP-1 medications.

Key Points:

• Hormone Replacement Therapy: Helps mitigate the drop in estrogen, aiding in reducing visceral fat and preserving muscle mass.
• GLP-1 Medications: Assist in weight loss and improving metabolic health but should complement strength training and adequate protein intake.
• Testosterone Therapy: Can build muscle mass but requires supervision due to potential side effects like increased appetite.

Notable Quote:

Dr. Rocio Salas Whelan [27:35]: “GLP-1s have to be alongside strength training and protein in your diet for optimal body recomposition.”

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Body Composition Testing: A Vital Tool

Understanding one’s body composition is essential for effective health management. Dr. Whelan advocates for regular body composition assessments to monitor muscle mass and visceral fat.

Key Points:

• Testing Methods: Impedance machines are a practical alternative to expensive MRI and DEXA scans for measuring body composition.
• Importance: Low muscle mass is directly linked to increased mortality and decreased independence in later life.

Notable Quote:

Dr. Rocio Salas Whelan [35:37]: “Longevity is directly proportional to muscle mass. A low muscle mass increases all-cause mortality.”

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Rapid Fire: True or False Segment

To engage listeners, Tamsen and Dr. Whelan participate in a rapid-fire true or false segment, addressing common misconceptions:

1. Cortisol Face Is Real: False. Only in Cushing’s disease does one develop a true Cushingoid face.
2. Fasting Cardio Burns More Fat: False. It burns muscle.
3. You Can’t Eat Carbs After 40: False. Carbs can be consumed at any age.
4. Ozempic Butt Is Real: Partially True. It can cause muscle loss if not supervised.
5. You Have to Balance Your Hormones to Lose Weight: False. Weight loss is possible without hormone balancing.
6. Midsection Weight Gain Means You Have Insulin Resistance: True.
7. Sleep Affects Your Metabolism: True.
8. Women Need Less Protein Than Men: False. Women require as much protein as men.
9. Intermittent Fasting Works for Everyone: False.
10. You Can Reset Your Metabolism at Any Age: True.
11. Detox Teas Help with Blood: False.

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Conclusion and Tease for Part Two

As the episode wraps up, Tamsen expresses her enthusiasm for the profound insights shared and hints at a forthcoming second part focused on GLP-1s and obesity medications. She encourages listeners to subscribe and follow the show for more expert discussions aimed at empowering women to take control of their health and well-being.

Final Note:

Tamsen Fadal [39:26]: “We have part two coming up soon, where we'll dive deeper into GLP-1s and obesity meds.”

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About The Tamsen Show

Hosted by Emmy-winning journalist and New York Times best-selling author Tamsen Fadal, The Tamsen Show offers real talk and real solutions for women seeking to understand their bodies and lives better. With new episodes every Wednesday, the show features conversations with top doctors, leading voices, and women redefining health and wellness.

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Follow The Tamsen Show:

• Instagram: @thetamsenshow

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Disclaimer: The information provided in this summary is for informational purposes only and is not a substitute for professional medical advice.

Transcript

[Tamsen Fadal]

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[Dr. Rocio Salas Whelan]

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[Tamsen Fadal]

Today we're talking about something I know. So many of us are struggling with belly fat, that stubborn weight around our middle that shows up seemingly overnight.

[Dr. Rocio Salas Whelan]

Nothing has changed of what they do, but everything has changed around them. It can spill into every aspect of your life.

[Tamsen Fadal]

If that sounds like you, I need you to hear this. First off, it's not your fault. You're not being lazy. You're not imagining it.

[Dr. Rocio Salas Whelan]

I hear women saying everything I did is not working. Or even some say I'm doing more and it's just not happening.

[Tamsen Fadal]

Today I'm joined by Dr. Rocio Salas Whelan. She is a triple board certified endocrinologist, an expert in obesity medicine, and the person I went to when I was doing everything quote right and still not losing weight.

[Dr. Rocio Salas Whelan]

I've learned to believe women symptoms.

[Tamsen Fadal]

We're gonna talk about the real reasons why your belly fat won't budge and what actually works. This conversation is so layered, we have two parts. The first part's gonna get into the science and the truth. Sharing the tools you need to start making a difference in your body.

[Dr. Rocio Salas Whelan]

Two easy changes that don't require any medication.

[Tamsen Fadal]

So let's get started. What made you care so deeply about helping women?

[Dr. Rocio Salas Whelan]

Because when I growing up, during my training of medicine, my early years in medical school and in my Internship, I saw how women's symptoms were gaslighted, number one. But second, we were just misunderstood. I remember my male attendings saying, oh, she just needs to get a hobby, or you're gonna get one of those. Oh, she just needs to get laid. Oh, she has nothing else to do now that the kid.

[Tamsen Fadal]

What did you do? I mean, I don't know if you could say anything you probably feel intimidated by.

[Dr. Rocio Salas Whelan]

Yeah, I was like, in the bottom of the. I was in the bottom of the ladder, right. In the bureaucracy of. Of training. And I remember even seeing a female attending. If she was a female attending, she was doing a woman who was going to give birth, and she was checking her. In her vagina to see what was the. If she was ready to give birth. Right. You check the dilatation of the cervix. And I remember I was in a teaching hospital, and women get touched by the attending, the resident, the intern, the medical student. Everybody's learning. Right. So this woman was in pain from so many digital exams that she was having. Right. And I remember the female attending saying, well, I'm sure you were not complaining when he was putting it in. And it stuck to me till this day. And that's more. That's 30 years ago. And I remember at one point in my career, early on, I remember thinking, God, don't let me become one of those women.

[Tamsen Fadal]

Well, you certainly aren't. Thank you so much for being here. I'm so excited to see you. Yeah, I, you know, you and I have known each other now for a little while, and I just so respect what you do, and I know that so many women had so many questions when I said that you were going to be coming on the show. So we're going to get to a lot of those, because I think that there's a lot of shame wrapped up in even having these conversations about our bodies and how we feel and belly fat and solutions to it. So thanks for sharing that story, because that is, you know, you hear something like that when you're so young, I can't even imagine. But that. That framed you to make sure that you never, 100%, never were even close to feeling.

[Dr. Rocio Salas Whelan]

And through my journey as a doctor, I've learned to believe women. Right. Not just necessarily because I'm in that stage of my life, but because through my journey in training, I've learned to believe women's symptoms. Right. I think that is the missing link in between gaslighting and women's symptoms.

[Tamsen Fadal]

Why do you think many doctors don't.

[Dr. Rocio Salas Whelan]

Believe Women's symptoms because I think it's misunderstood. I think we science hasn't understand completely women. Right. I mean, we're lacking, lagging so many years of research in women in particular, even in pregnancy. So we really have not enough knowledge as we do in men, and we don't know what to do about it. Right. And we question if it's real, what they're feeling, what they're going through, because we haven't been educated on it. Right. And especially the WHI study, I think after that, colleges, residencies, we stopped talking about hormone replacement therapy. So we forgot how to do it. We don't know even how to approach it. Right. So I think doctors, that's what they encounter is that the lack of knowledge. But the lack of knowledge should not mean no treatment, should mean I refer you to somebody who will know or.

[Tamsen Fadal]

At least listen and say, maybe I should look into that a little bit more. The WHI study you mentioned being the Women's Health Initiative of 2002. And we've talked about it quite a bit on this show because it really has informed where we are today in terms of so many women feeling confused. So I want to talk in particular about one symptom that shows up in midlife. I won't even say perimenopause or menopause yet, but belly fat, it comes at a time when we have a lot going on. Maybe nothing that we're doing has changed yet we feel this tremendous change. We see it in our bodies, then we don't know what to do about it. And anything we try to do doesn't really seem to work. Can we talk about belly fat? Because I have to imagine with the work that you do, that has got to be one of the top symptoms. Women come in, they're very emotionally about.

[Dr. Rocio Salas Whelan]

Definitely. And you said nothing has changed of what they do, but everything has changed around them. Right. So the surrounding, the environment is not the same as it was before. Not necessarily us doing something different, eating more or exercising less. It's just the environment that we are on physiologically and socially also. Right?

[Tamsen Fadal]

Right.

[Dr. Rocio Salas Whelan]

So in midlife we encounter many changes in our life. And hormonal changes happen parallel to socio cultural changes at the same time. Right. So it's the combination of those things that I feel puts us in a place that we're almost set to failure. Right? Definitely. In perimenopause, we are seeing the shifting of hormones, the chaotic hormonal changes that we're going through that promotes visceral fat. Right. So the fat that we had in our fertile years, where they tend to be more in the hip and the breast goes centrally, so our body composition changes. And then in top of that, we start losing muscle mass easier. When you lose muscle mass, you're losing your burning calorie machine. Right. So then it promotes also the accumulation of body fat. And because of perimenopause, the accumulation happens centrally. And then also if we're symptomatic for perimenopause, we're not sleeping. The lack of sleep has a lot of rippling effect. That not sleeping is going to make us tired, irritable, we won't want to work out. We may not be following a healthier nutrition diet. Right. The lack of sleep can increase insulin resistance. The insulin resistance is going to increase carb craving, sugar craving. Right. So it's just in a vicious cycle. And on top of that, socially, things or familial things are happening. Our parents are aging. We're losing our parents, Our kids are growing. Professionally, we may be in changes professionally or a peak of our career. So it's. All of this is multifactorial really what is happening in a woman's life in.

[Tamsen Fadal]

Midlife, as you're saying that, I'm like, yes, okay. And then that happened. And I can really remember those different times in my life and how it just kind of one thing layered on top of the other. Things have changed in all different areas. It's not just the hormones. But hormones do play a big role in all of that, right?

[Dr. Rocio Salas Whelan]

Definitely. The drop of estrogen causes us to change our body composition. We lose muscle mass, easier to gain body fat. So it just becomes a little bit more difficult. And I hear women saying everything I did is not working. Or even some say, I'm doing more, I'm exercising more, I'm being more cautious about my diet, and it's just not happening.

[Tamsen Fadal]

I mean, I want to give women solutions by the end of this so they can really feel like there are actionables that they can take. Because it is this thing where we're like, well, move more and change your lifestyle. Well, that sounds great, but if that's not working after a month or two months, you just kind of give up. A lot of women feel like they're being told like, their levels are normal, they're pretty normal, but they're not feeling normal at all. How do we define that?

[Dr. Rocio Salas Whelan]

Yeah, so I think that's a misconception that we going to see it in your blood work. Right. But many times, like, let's just as an example, perimenopause. We know that the drop of estrogen from premenopause to menopause doesn't go from 500 to zero. It's more of a fluctuating period of eight to 10 years. So depending where we check in that time of the month, your levels may be at a different level. Right? So let's say your estradiol level is normal. That doesn't mean that you're not in perimenopause. That doesn't mean that you're not symptomatic. It only means that at that time, that period of time that we checked at one point, your levels were normal. They're, they're clinical diagnosis and not chemical diagnosis.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

So any woman that they tell them, no, your symptoms are not real because your blood work shows something different. They really have no knowledge of what the hormone physiology is in midlife.

[Tamsen Fadal]

Because we know going in there how we feel. And that's what you listen to.

[Dr. Rocio Salas Whelan]

Exactly.

[Tamsen Fadal]

That's what you listen to.

[Dr. Rocio Salas Whelan]

Exactly.

[Tamsen Fadal]

Okay, so full disclosure. I came to see you maybe, maybe a month ago, maybe maybe six weeks ago, and I found out something that shocked me when you, you looked at my work and we, we did my, my analysis. So can you explain what I have going on? I know that I heard it and then I don't really understand, know that I comprehended at all. But I'm pre diabetic, is that right? Which shocked me, yes, because I couldn't even imagine how that happened because I feel like I'm eating right, I'm working out. Right. And can you explain what my level showed you when you, when you saw them?

[Dr. Rocio Salas Whelan]

Yes, definitely. So with your permission.

[Tamsen Fadal]

Yes, you have my full permission. I didn't know what you. I didn't know. It was like I said to my producer. Does she need my consent? You have my full consent.

[Dr. Rocio Salas Whelan]

Well, we have the verbal consent. Right now your A1C, which is a three month average of your sugar going back from the day that we draw your blood. Okay, so that's a measurement that it tells us your average of your glucose in the last three months. And how that test works is because glucose attaches to the red blood cell and the red blood cell lives for 90 days. So that' we get a three month average of your glucose. Looking back normal, A1C is 5.6 or below. Pre diabetic range is 5.7 to 6.4 and an A1C of 6.5 and above. It makes a diagnosis of type 2 diabetes. So your A1C six weeks ago was 5.8, which puts you in the pre diabetic range.

[Tamsen Fadal]

So I was stunned by that. We talked a little bit through it. Can you explain how that happens or what's going on diet wise? You know, it's mostly plant based. Vegetarian. Yeah, with some, some fish. But I'm not a. I'm not a meat eater, definitely.

[Dr. Rocio Salas Whelan]

And then we did, we did a family history. And there's no type 2 diabetes in your family. Right. Even your body composition didn't show high visceral fat. So high visceral fat will tell me that there's insulin resistance. Right. And if there's insulin resistance that prediabetes can start to lurk on, in your case, your visce fat was not elevated and you don't have any family history of type 2 diabetes. So then we went dig in further and you had mentioned to me that you had recently, in the last few months, changed your diet, that you went from more of a lean animal protein diet into more of a vegetarian diet. Right. You were basing your protein intake in lentils, beans, chickpeas, which are starches. So when we eat them in our body, they convert into glucose. Yes. They have fiber and they have other nutrients compared to a snicker bar, but it also raises our glucose.

[Tamsen Fadal]

Can I go back to the Snicker bar? But I felt like I was doing that too. And I told you this because I was trying to get protein right. And I thought, well, if I put, you know, if I go really heavy, I mean, I was eating quinoa. And also you overdid it. I overdid it. And so we see those levels. So what else did it show? I know that it was pre diabetic. And then we also talked a little bit about Hashimoto's and thyroid.

[Dr. Rocio Salas Whelan]

Yeah. And also your TPO thyroid peroxidase antibodies were elevated. These antibodies are what causes Hashimoto disease. Hashimoto is an autoimmune disease. With the presence of these antibodies, these antibodies, as any antibodies in our body, they attack. And they attack in particular your thyroid gland. With time, the antibodies can attack it to the point that it destroys and stops functioning. Then hypothyroidism comes in. Right. In your case, your thyroid function was still normal. The antibodies are elevated, meaning that they're doing some work there. Right. And it could be in your lifetime or not, you may develop hypothyroidism and that will show in your blood work.

[Tamsen Fadal]

And so what is Hashimoto's? Because I've heard it, I've Read about it. I try to understand it, but I'm not quite sure I understand it or understand what to do about it.

[Dr. Rocio Salas Whelan]

So Hashimoto is an autoimmune disease. Basically, we're born with antibodies. Antibodies normally will attack something foreign in our body, but autoimmune diseases, it's a miscommunication. They attack our own body. So Hashimoto is the antibodies against your own thyroid that it can complicate with hypothyroidism, meaning our underactive thyroid. Now, having present or elevated antibodies for your thyroid doesn't mean that you need thyroid replacement at that moment. Doesn't mean that your thyroid is not working. It just means that may happen with time or it may not.

[Tamsen Fadal]

Is that. Is that a menopause thing? Because I know there's so many weird things that have happened since I hit menopause. Cholesterol was weird. You know, the word thyroid even is weird. That I have pre diabetic blew me away, I think.

[Dr. Rocio Salas Whelan]

During perimenopause, what happens? There's a lot of stress in our body and a lot from not sleeping. Right. That's one of the most common symptoms. So the not sleeping, anxiety, all of those changes in our body cause stress. Stress decreases your immune system. That's why when you're very stressed, you're more prone getting an infection, getting a cold, a virus, because your immune system drops when there's stress in your body. So in those situations when the immune system decreases, any antibodies that are lurking there will take advantage and do their work. Right. So it's common that we see in periods of stress, autoimmune diseases pop up.

[Tamsen Fadal]

I'm so glad you said that, because I feel like a lot of women are saying, oh, my gosh, okay, so I just hit menopause or perimenopause, and now this and this and this, and all these things happen. But they're not alone. I mean, you're. You're consistently seeing this with people.

[Dr. Rocio Salas Whelan]

Yeah, definitely. And it's a rippling effect right. During midlife.

[Tamsen Fadal]

Yeah, there's no question about that. I want to go back to fat and inflammation and some of the other dangerous kinds of fat. I know you mentioned visceral already. When we talk about fat and we talk about inflammation, can we talk about the difference between those two and how they show up in the body?

[Dr. Rocio Salas Whelan]

So we have subcutaneous fat that is basically what's under our skin. So if somebody has liposuction, what they're going to remove is subcutaneous fat. Right. That is not a Bad fat that is not a pro inflammatory type of fat. Then we have intra abdominal fat, which is inside or abdomen that attaches to your internal organs, to your liver, to your gut, to your pancreas. That's what we call the bad fat.

[Tamsen Fadal]

And what was that one called again?

[Dr. Rocio Salas Whelan]

That's visceral fat.

[Tamsen Fadal]

Visceral fat.

[Dr. Rocio Salas Whelan]

So this can cause invisceral fat is up pro inflammatory tissue. So in that fat tissue, in the adipose tissue, there's cytokines which are inflammatory cells. Right. So they promote inflammation in your body. This is the fat that can promote different types of cancer because of the constant state of inflammation that the visceral fat is on. Now if it surrounds your organs, it can lead to in your liver, fatty liver. Right. In your gut, in your pancreas can cause insulin resistan. So that's the fat that we want to target. Whenever we're talking about weight loss, we're really targeting visceral fat. That's why somebody, let's say with that overweight and they have high subcutaneous and high visceral fat, if they go with plastic surgery and they have liposuction, it's not going to touch the visceral fat. So they're still at risk of disease.

[Tamsen Fadal]

So they'll have. The vanity part might be.

[Dr. Rocio Salas Whelan]

Exactly. The cosmetic external part, but the metabolic part is not touch.

[Tamsen Fadal]

So how do you target both of those things? Because I know there are a couple of different ways. I know there's some new way, there's a lot to discuss with it. But what are some of the ways to start targeting that if you're a woman, that whether you're on hormone therapy, I guess or not.

[Dr. Rocio Salas Whelan]

Yeah. So two easy changes that don't require any medication and we want to talk about that first is going to be strength training. Right. Building muscle. The more muscle you have, the more fat you burn for energy anywhere in.

[Tamsen Fadal]

Your body, whether you're doing your arms.

[Dr. Rocio Salas Whelan]

Your legs, anywhere you need to build muscle resistant training and then strength training. That's one. And the second is your diet. So increasing protein in your diet is a must. And this is for any age, but especially in midlife where we tend to lose more muscle mass. We need to up our protein intake in midlife. Right. Also and I'm talking about lean animal protein or whey protein. Why these two? Because they're complete protein, meaning it has all the amino acids for muscle protein synthesis.

[Tamsen Fadal]

You gave me the whey protein, I put it in my coffee like my creamer now. I mean that's where I, that's literally where I start my day because of.

[Dr. Rocio Salas Whelan]

You sneak it in and I think.

[Tamsen Fadal]

Of you every morning. Every morning I'm having coffee with you.

[Dr. Rocio Salas Whelan]

Well, cheers.

[Tamsen Fadal]

You're right though. You have to find some ways to sneak that in. So let's talk about some of the different ways to do that when it comes to eating, because I think that that's probably the, the hardest one. And how much protein is the right amount of protein? If you're 145 pound woman, how much protein should you have?

[Dr. Rocio Salas Whelan]

The current US guidelines tell us about 1 gram per kilo per day, but that's really low.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

What we want to say, really, endocrinologists, we agree that is 1 gram of protein per pound for your ideal body weight. And to know your ideal body weight, we really need to do a body composition. But what I've seen through thousands of patients that I do, body composition, the sweet spot is anywhere around 90 to 100, 100 grams of protein for a woman in midlife.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

And that is difficult to get 100 grams of protein a day. Right. You just have to structure it through the day. Our body utilizes only about 30 grams per meal for muscle protein synthesis. It's not that we're not absorbing the extra amount of protein, it's not that we're wasting it. That extra protein goes for other functions in our body to make collagen, to make elastin. But to actually, for muscle protein synthesis, our body only utilizes about 30 grams per meal. So then you have to space, be in between three or four portions a day of 25 to 30 grams of protein a day.

[Tamsen Fadal]

So it's got to be more than just, I did 1, 2, 3 meals, 30 grams. It's not going to be possible. It's going to be 20 in the morning, maybe 30 for lunch. Because if you're doing, if you're, if you think you're going to do 50 at lunch, that's not going to be helpful.

[Dr. Rocio Salas Whelan]

Exactly. That's the problem. That's, that's the message here is that that don't count. 50 for your muscle count, 30 grams for your muscle. Right? Because then we overestimate how much protein we're eating because we're eating large amounts in one meal, but it's not going for our muscle.

[Tamsen Fadal]

Okay. So that I think that's so important because I think we think we can just jam it all in there at some point. Like I ate pasta at this point, so I'll just eat just protein at the end. And that's all I can do.

[Dr. Rocio Salas Whelan]

Yeah, it doesn't work like that, unfortunately.

[Tamsen Fadal]

Anything else with diet that we should focus on in terms of fasting or eating better at different times a day because there's so many. I mean, my goodness, if I look back at the diets I've done.

[Dr. Rocio Salas Whelan]

Yeah, I know there's. You can write books on that.

[Tamsen Fadal]

I've done all I've done. I could do 100 books on that.

[Dr. Rocio Salas Whelan]

Fasting, I don't recommend it because it's, it's hard to eat that amount of protein in a 12 hour period, in a 16 hour period, let alone in an 8 hour period. Right. So we're missing vital time of the day by fasting to get enough protein in a day. Because protein is also very filling. That's why you have to space it out. Also is so you have room for more protein in your next meal. But if you just try to condense it in a few hours a day, you're not going to meet the number of the grams of protein that you need to eat in a day.

[Tamsen Fadal]

Do you feel people get shocked with that advice of eating more? Because basically that's the advice. Eating more of the right thing, but eating more.

[Dr. Rocio Salas Whelan]

I think they're shocked to know that fasting is not recommended, that fasting is not going to cause weight loss. Because I think it was promoting, very promoted. And also the amount of protein that people have to consume. And what I find is that we tend to overestimate how much protein we're eating. So when I see patients for follow ups and they're still losing muscle and they tell me, but I'm eating a lot of protein. And then when we go back, I say, walk me through a day of your protein. And I always see that they're missing or skipping 25 to 30 grams of protein a day because they thought they were having that amount of protein a.

[Tamsen Fadal]

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[Dr. Rocio Salas Whelan]

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[Tamsen Fadal]

How do you do the body composition? Is that a machine that you get on? Is that the mach? I think I was on the machine. Right.

[Dr. Rocio Salas Whelan]

So it's an impedance machine. So the gold standard for body composition is an mri, but it's expensive and it has radiation, so we're not going to do that on every patient or in every visit. The second best is a DEXA scan like we do for the bone. Also a little bit of radiation and also more expensive. So the third best option is an impedance machine. And this is bioelectrical current that goes from the base of your feet up and it separates the tissue, it separates fat tissue, water and muscle. So that's what we have most doctors in our offices. And the body composition is going to measure your skeletal muscle mass. A skeletal muscle mass is a muscle that you have control to grow percentage body fat and then your visceral fat.

[Tamsen Fadal]

What is a DEXA scan? Mention that.

[Dr. Rocio Salas Whelan]

So that's what we use to see your bone mass.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

But it also, it's helpful to see body composition.

[Tamsen Fadal]

Okay. So you can see both and you can measure both those things with the DEXA scan. Are those recommended at a certain age.

[Dr. Rocio Salas Whelan]

Or so DEXA scans or bone scans, I mean really after the age of 50, every woman should have one. But for body composition at any age.

[Tamsen Fadal]

Okay, you talked about non meds. What are some of the ways you can do that with meds?

[Dr. Rocio Salas Whelan]

Definitely hormone replacement therapy will help rechange body composition. We never promote estrogen as a weight loss hormone, but it will help change recompensate your body again. Right. So remember, in perimenopause there's a drop of estradiol and an increase in visceral fat, decrease in muscle mass. So by giving you back what you're not making, we intend to see less visceral fat and more muscle mass. Right. So that's an option. And then we have GLP1 medications which are great tool and really to have the optimal results, which is body recomposition. Right. Increasing muscle mass, decreasing visceral fat. GLP1s have to be along the side of strength training and protein in your diet.

[Tamsen Fadal]

And I know we want to go go hard into that one because I think that there's a lot of questions about it. I think we're seeing a lot of it with hormone therapy. And GLP1 is doing a combination of those now, right?

[Dr. Rocio Salas Whelan]

Yeah.

[Tamsen Fadal]

Is that relatively new?

[Dr. Rocio Salas Whelan]

It's relatively new that we're you. I think it's more new that we're using more hormone replacement therapy, thank goodness, than GLV1.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

So I would say it's new the using them together, the combination of it.

[Tamsen Fadal]

And what about testosterone for weight loss?

[Dr. Rocio Salas Whelan]

Testosterone for weight loss also we don't promote it as such. Right. Testosterone is an anabolic hormone, so it promotes growth. It can increase appetite if it's not used under supervision. So it will help build muscle mass. If there's strength training, you just won't build muscle because you're taking testosterone. Right. You need to strength train. And building muscle will help you decrease visceral fat and body weight.

[Tamsen Fadal]

I know you mentioned this time of life and A lot of things all happening at the same time. And I think we talked about lack of sleep causing weight changes, but also stress. How does stress affect our weight?

[Dr. Rocio Salas Whelan]

So stress, chronic stress puts our body in a chronic flight response, mood or moment. And this can increase your cortisol levels chronically. Right. We have a pathological disease called Cushing's disease or Cushing's disorder, where our body is making too much cortisol. Right. That is usually treated with surgery. This is very different than from what I'm talking of just chronic elevated levels of cortisol from chronic stress, but it still can have effects in our body. So chronic stress with chronic elevated cortisol can promote waking. Right.

[Tamsen Fadal]

Where do you see that all?

[Dr. Rocio Salas Whelan]

Is that all over or is that more centrally again? Yeah. So if you're not sleeping, you're going to gain weight. If you're not sleeping, you're not going to build muscle. So everything that you do, even if you're eating properly, if you're exercising properly, even if you're taking a GLP one your hormones, if you're not sleeping, sleeping, that can promote waking.

[Tamsen Fadal]

Any how it's so shocking that sleep was never a priority ever. Like, like never.

[Dr. Rocio Salas Whelan]

It is shocking and for many people it's still not right. Many people accept that, oh no, I don't sleep, or a lot of stuff is going on my life and I don't need to sleep or like they take it and accepted it, but it can spill into every aspect of your life. So for me, priority for all my patients, for whatever reason they're coming to see me, is that they sleep.

[Tamsen Fadal]

And how many hours is that?

[Dr. Rocio Salas Whelan]

Eight plus seven to eight hours. Seven days, nine hours is kind of hard. Seven to eight hours is more enough. But the quality of the sleep too, right? That is continuous sleep and that is.

[Tamsen Fadal]

Not interrupted, not getting up sleep, naps and all that stuff. Cortisol. Can you lower your cortisol?

[Dr. Rocio Salas Whelan]

If you can lower your stress. Right. So that's.

[Tamsen Fadal]

Do you have a plan for that?

[Dr. Rocio Salas Whelan]

Definitely. I mean, exercise is one.

[Tamsen Fadal]

Why?

[Dr. Rocio Salas Whelan]

With exercise, your stress levels decrease. Sleeping better, right? Meditation, yoga, Pilates, and then trying to see what in your life you can modify to decrease the level of stress.

[Tamsen Fadal]

I think that, you know, we go, we sometimes go and we learn about all these things and they feel like more stress to us because we know we have to tackle them. But it's funny that most of it comes back to the basics at the end of the day. But it's whether it's, you know, insulin resistance or thyroid I do want to talk about the thyroid quickly. And I know we touched on it just a little bit. It's little butterfly shape right in here somewhere. I'm trying not to look for it just in case I have something. What do doctors miss when it comes to thyroid? Is there something in particular they miss when looking at that, or are those traditionally just blood levels?

[Dr. Rocio Salas Whelan]

I think, to be honest, I think it's quite the opposite. I think we tend to attribute many things to the thyroid. I feel like now that we're talking about hormone replacement therapy, now that we have GLP1, the gland that is having a ball is a thyroid. Probably that is like, finally they're leaving me alone. Because everything that happens is a thyroid, right? You gain weight, it's a thyroid. I'm not. I don't feel great. I feel tired. The thyroid. I think we attribute too many things to the thyroid that. That are. That can be easily explained and that they're true. Being caused by other things. Right.

[Tamsen Fadal]

Such as?

[Dr. Rocio Salas Whelan]

Such as midlife, waking life itself. Right. Or something else. I think if we concentrate just on the thigh, we're thinking we may be missing something else that is treatable and that it may be very important in health. Right.

[Tamsen Fadal]

Because I feel like a lot of women in midlife seem to. I mean, I mean, obviously, you know, have autoimmune, have never. I don't think I've ever had an autoimmune. I never even heard the word before. Now all of a sudden, it's right. You know, it's right upon me. Is that normal in midlife? Is that something that changes?

[Dr. Rocio Salas Whelan]

Definitely. And before we go into that, I want to say that. That nine out of 10 times, it's not the thyroid, really.

[Tamsen Fadal]

So it's stress, and we're trying to.

[Dr. Rocio Salas Whelan]

It's life, it's the environment, genetics, hormones, aging.

[Tamsen Fadal]

That's amazing. Nine out of ten.

[Dr. Rocio Salas Whelan]

Nine out of ten times that I see patients coming attributing symptoms to the thyroid. It's not the thyroid. And it's okay.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

It's okay because we have health for other things. Right. If you're permanent pusill, we have hormones. If it's waking, we have GLP1. Right. It's not that it's doom if it's not the thyroid. Actually, we have the tools if it's not the thyroid.

[Tamsen Fadal]

This episode is brought to you by Progressive Insurance. You chose to hit play on this podcast today. Smart choice. Make another smart choice with Auto Quote Explorer to compare rates from multiple car insurance companies all at once. Try [e-mail] Progressive Casualty Insurance Company and affiliates. Not available in all states or situations. Prices vary based on how you buy. This episode is brought to you by. Hay Day. Feeling stressed? Take a moment for yourself with Hay Day. Stroll through rows of golden wheat, tend to cute Barnard animals and discover the joys of a digital farm retreat. You don't have to hop in a car or catch a plane. Escape to the farm at the tap of a finger. With Hay Day, you're not just tending to a farm, you're tending to yourself. Hay Day Search Hay Day. That's H a Y space D A Y in your favorite app store. Hay Day is a free to play mobile game and offers optional in app purchases and random rewards. You know, I know we talked about some of the things you have to change with diet. Gluten, dairy, alcohol. Alcohol's getting like a bad rap, obviously in a very big way. But gluten and dairy are those things that we have to avoid.

[Dr. Rocio Salas Whelan]

I mean, I just, I get so.

[Tamsen Fadal]

Confused nowadays days if we do anything.

[Dr. Rocio Salas Whelan]

In excess, that's when we run into trouble. Right. I think having more of a balance in our diet, not comp. Not being black and white, like completely off gluten or like in your case. Right. That you went opposite. Just trying to get the protein and you overdid it to the point that it increased your glucose and it put you in a pre diabetic state. So anytime that we tip the scale from one side, it's. It's bad. So we need to find the medium. Right. We need to find the balance because that's also more sustainable long term than something extreme.

[Tamsen Fadal]

Yeah. You know, I, I went. I was very non dairy for a very, very long time and I've now gone back to that with, you know, yogurt and some of the different things. And it actually is, it's helped give me more options because I think that's what was going on is I, I ran out of. I ran out of options really. And I'd look at a menu and I'm like, oh, I can't, I can't have any of that.

[Dr. Rocio Salas Whelan]

Yeah.

[Tamsen Fadal]

And then I, you know, I put that. I ended up in your office. Okay. If there is one thing that every woman should know right now or one test that she should do right now, if she is in midlife or peri. Perimenopause or premenopause and trying to figure out what she should ask her doctor for. Is there one test that she should look at that you think is really important?

[Dr. Rocio Salas Whelan]

Yes. And it's not what you're going to think.

[Tamsen Fadal]

Okay, go ahead. I'm not going to, I'm not going.

[Dr. Rocio Salas Whelan]

To say a body composition.

[Tamsen Fadal]

That's the one.

[Dr. Rocio Salas Whelan]

That's the one.

[Tamsen Fadal]

Okay. Why?

[Dr. Rocio Salas Whelan]

Because you need to know what your muscle mass is. Longevity is directly proportional to muscle mass. A low muscle mass increases all cause mortality. We don't say that with high body fat. Right. We say you're going to develop osteoarthritis. We know chronic diseases can come out of high body fat mass, but we don't say it increases all cause mortality as we say low muscle mass. And the studies are there that show that patients that have low, that have sarcopenia or lower muscle mass, their mortality is increased. All cause mortality is increased.

[Tamsen Fadal]

Why is that?

[Dr. Rocio Salas Whelan]

Because then we're more prone to falls. Right. If you don't have muscle mass, it means that you're lacking protein in your diet. And we need protein for our bones too. Right. Then you're going to be more prone for fractures. It's just not going to give you the independence dependence. And also muscle is anti inflammatory. Right. So having more muscle mass, it's really equals to health. So for any woman in midlife or before midlife, you need to know what's your muscle mass because that's your biggest weapon. To live long years and independent. Long years. Right. That's what's going to help you get out of the toilet by yourself, to get out of the bed by yourself if you fall, to pick up yourself up. Right. So definitely, I think very important that we know in midline life what's your muscle mass.

[Tamsen Fadal]

And we don't. We. I've never, never think like that. I would never think like that. It's not what I thought you were going to say.

[Dr. Rocio Salas Whelan]

I know, that's what I said.

[Tamsen Fadal]

Well, I'm glad. But I'm glad. I'm glad I did mine. Thank goodness. I can't wait to do it again because I'm hoping that I see some changes because I, I do remember it was very borderline on everything. And it wasn't. It wasn't what I expected. Yeah, yeah, it wasn't. And I didn't even understand how the test worked. I really didn't. Is there another way for people to figure out their body composition aside from the machine? Machine?

[Dr. Rocio Salas Whelan]

Yeah. They can do waist circumference.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

But really, I mean, body composition machines are pretty much everywhere now.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salas Whelan]

I don't think there's a reason why not to have one. Even in your gym. You can have One.

[Tamsen Fadal]

Okay. Okay. So they're, they're accessible. Okay. So you mentioned strength training, and we know how important that is for muscle building. Cardio. We can't ignore cardio. It's in there. But that's not really what is going to burn that belly fat. Right. Or remove the belly fat.

[Dr. Rocio Salas Whelan]

Yeah, definitely. So. So cardiovascular exercise is good for two things. Mental health. Right. And the second is for cardiovascular health, but it's not important for fat loss.

[Tamsen Fadal]

Got it.

[Dr. Rocio Salas Whelan]

Okay. And I feel that's a lot of a mistake that women in midlife make, thinking that cardiovascular exercise will make them or help them lose body fat. For my patients, I tell them, if it's good for your mental health, then keep it. But if the goal is fat loss, then really we need to concentrate more on strength training.

[Tamsen Fadal]

I love that. I love when you told me that too. I was very happy. I grew up, you know, constantly in aerobics, constantly on the Stairmaster, constantly sweating it off. I mean, you know, that I, I battled an eating disorder. So I, I have a lot of things that I have, you know, in the past. So cardio was one of those ones where I thought I had to do it. And so it's almost a relief that I understand that, you know, when I go for my walk in the morning, that is what I do. I love it. I'll do, do some cardio. But it's really the strength training, I think, that is making a huge difference.

[Dr. Rocio Salas Whelan]

Yeah. And also when you remove that pressure of weight loss, fat loss with cardio, you may enjoy it more. Or if you really didn't even like it, then you can do something that you actually like in regards to exercise. Right.

[Tamsen Fadal]

I so agree with that. It makes you not dread it. And count, count the minutes down.

[Dr. Rocio Salas Whelan]

Exactly.

[Tamsen Fadal]

All right, so we're going to do some rapid fire. True or false. Cortisol face is real.

[Dr. Rocio Salas Whelan]

False.

[Tamsen Fadal]

What isn't?

[Dr. Rocio Salas Whelan]

So. So cortisol phase, what we call Cushing syndrome, that's a true disease. Right. So in that disease, when we diagnose, confirm the diagnosis there, we see Cushingoid facies or a large round face. But just simple stress is not going to give us that round Cushinoid face that you're mentioning.

[Tamsen Fadal]

Fasting cardio burns more fat.

[Dr. Rocio Salas Whelan]

False. It burns muscle. Right. So you need the energy, the fuel to support when you're exercising, when you're doing cardio. But if there's no food, then the muscle starts to break down to produce that energy that you need.

[Tamsen Fadal]

You can't eat carbs after 40. False.

[Dr. Rocio Salas Whelan]

You can eat carbs at 40, 50, 60, 80.

[Tamsen Fadal]

That one panicked me.

[Dr. Rocio Salas Whelan]

There is no reason not to eat carbs up to 40.

[Tamsen Fadal]

Is Ozempic butt real? True or false?

[Dr. Rocio Salas Whelan]

Somewhere in between. Ozempic doesn't cause muscle loss. And Ozempic butt is referring to the drooping of the gluteus. And it's because you're losing muscle, but not just in your butt, everywhere. Right. So it could be the ozempic arm, the ozempic leg. It can happen if you don't have the right supervision in this medication.

[Tamsen Fadal]

All right. True or false? You have to balance your hormones to lose weight.

[Dr. Rocio Salas Whelan]

False. We really endocrinologists don't use the word balance so much. You can lose weight even in perimenopause. If you're not using hormone replacement therapy, you can still potentially lose weight.

[Tamsen Fadal]

Midsection weight gain means you have insulin resistance. True or false?

[Dr. Rocio Salas Whelan]

Very, very true. So visceral fat increases insulin resistant. Insulin resistant increases visceral fat, and then you get into this vicious acid cycle.

[Tamsen Fadal]

True or false? Sleep affects your metabolism.

[Dr. Rocio Salas Whelan]

Very true. Definitely. And we talked about elevated cortisol from not sleeping. Right. So that's going to promote waking. And if you're not sleeping, you're going to be tired during the day and you may be less prone to want to exercise and eat healthy.

[Tamsen Fadal]

True or false. Women need less protein than men.

[Dr. Rocio Salas Whelan]

False. We need as the same amount of protein.

[Tamsen Fadal]

True or false. Intermittent fasting works for everyone. 1.

[Dr. Rocio Salas Whelan]

False. It works for nobody, but many people do it. But really, if we're talking about high protein in your diet building muscle, intermittent fasting going to make it very complicated for you to meet that. That amount of protein to get that goal.

[Tamsen Fadal]

Yeah. True or false. You can reset your metabolism at any age.

[Dr. Rocio Salas Whelan]

True. Very true. Because you can rebuild muscle at any age.

[Tamsen Fadal]

True or false. Detox teas help with blood.

[Dr. Rocio Salas Whelan]

False.

[Tamsen Fadal]

All right, there's so much more I want to ask you about GLP1s. And so we're going to stop this one here and we're going to be back with part two talking all about GLP1s. That was so fascinating. I am still shocked by some of the things she said about my lab results. I'll tell you. Well, if you've been struggling with belly fat issues, you are not alone. It is one of the number one issues you have reached out to me about. We have part two coming up soon. We're going to get into GLP1s. We're going to talk obesity meds and then also what's really working for women right now. Make sure you're following the show and you're subscribed. It really helps us to interview more experts and provide more answers for our amazing community. You can follow us on socials at the Tamsen show and I'll see you back here next week. The Tamsen show is an original production by Authentic Waves executive producers Scott Weinberger, Kevin Bennett and Rebecca Grierson brand director Johanna Ofzenik. Our line producer is Sabrina Sarre editing by Zach Smith and Marquis Harris. The views and opinions and information shared by guests on the Tamsen show are their own and do not necessarily reflect the views of Tamsen Fadal or the production team. This podcast is for informational purposes only and is not a substitute institute for professional, medical, legal or financial advice. You just realized your business needed to hire someone yesterday. How can you find amazing candidates fast? Easy. Just use Indeed. Stop struggling to get your job posts seen on other job sites with Indeed sponsored jobs. Your post jumps to the top of the page for your relevant candidates so you can reach the people you want faster. According to Indeed data, sponsored jobs posted directly on indeed have 45% more applications than non sponsored jobs. Don't wait any longer. Speed up your hiring right now with Indeed and listeners of this show will get a $75 sponsored job credit. To get your jobs more visibility at Indeed.com Arts, just go to Indeed.com Arts right now and support our show by saying you heard about Indeed on this podcast. Past terms and conditions apply. Hiring Indeed is all you need.