How Hormone Balancing Keeps Weight Off with Dr. Franchell Hamilton, MD

If you're finding that no matter what diet or lifestyle changes you make, the weight keeps piling up, this episode is for you! Dr. Franchell Hamilton, MD and Dr. Carrie Lam, MD do a dive into the hormones and neuroscience of behavioral change to help you create permanent healthier habits and get the weight off for good.

4:48 - How hormones are related to weight gain
8:35 - Stress response and storage of fat
10:35 - Dealing with emotional and mental baggage to help obesity
12:15 - Long term motivation
15:35 - How Hormone Therapy Helps weight loss
16:50 - Estrogen Dominance and Cortisol imbalance with obesity
18:35 - Is it only the thyroid?

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Transcript

Dr. Carrie Lam, MD: 0:06

Welcome to the Dr. Lam Show. I'm Dr. Carrie Lam, and we're going to be talking about how to keep your weight off. We have Dr. Franchelle Hamilton, who is actually a bariatric surgeon and is board certified in obesity medicine. And now she takes an integrative functional approach to obesity instead of trying to do surgery to keep the weight off. She's an author of the books Transformation is a

Mindset: 0:33

The Journey to Changing Your Input and Your World and The Best Diet is. She is the founder of the four pillars of Transformation Program and the Chief Medical Officer at FreshTri a digital mobile app that uses neuroscience for behavioral change. So we're very excited to have you here, Dr. Franchelle Hamilton. We have a lot of patients that are dealing with weight gain, because of their stress response. A lot of them also deal with hormone issues. So we'd love to talk to you today about that. But you know, first of all, why don't you just tell us about your journey of how you came into this integrative and functional medicine?

Dr Franchelle Hamilton: 1:13

Thank you so much for having me. So essentially, as a bariatric surgeon, when I first started, my private practice in Texas and started doing weight loss and bariatric surgery, that's pretty much all I was doing, because that's what I was taught. I came straight out of fellowship, because you have to do extra training for it. Then I set up my practice was doing predominantly surgeries. I would also talk to my patients about nutrition and exercise, we have nutritionist and psychologist in the office. The patients would initially do well after their surgery but I noticed several years in, I started doing more revision surgery. So revision surgery, for those who don't know is essentially another one after they've already had a surgery. They have regained their weight, which means a lot of their medical problems, relapse, ie hypertension, diabetes, obstructive sleep apnea, and they needed another surgery. So probably about five years into my private practice, I somehow started doing more revision surgery than primary surgery. And I had to ask myself, these surgeries are the most powerful tool like anybody in the medical field was told the surgery is like the Taj Mahal to treat these this obesity. And I wondered why is this not working? Despite doing the most powerful tools and yet I'm getting more revisions. And everybody was doing revisions. We were seeing weight regain after maybe two years, mostly, like they would do good for the first year, maybe two, and then it slowly started coming back. And then they wanted to do a revision. So I started thinking because of my scientific side, why is my surgery not working. And so coming to find out, it wasn't just the surgery, it was all these other aspects that was left untreated, or unidentified. So we told them about their nutrition, we told them about an exercise regimen, we told them about some of the mental aspects of getting the surgery. We did not talk like some of the family support they needed or the resources they had or did not have or some of their fears with other issues that would prevent them from getting successful. And so kind of at the midway point, I took a step back. I was not trained this way. So I started looking at social aspects of weight regain obesity, I started looking at other medical contributors, and not just by what we all know about thyroid. That's when I started introducing hormonal treatments. I've had people will lose like 15 pounds just by adding that in. There were so many other things going on, besides what was right in front of me. And I just had to view it from a wider scope. So that's when I started taking a more integrative approach. Because I didn't want to do revisions, which are more complicated with greater risk. I didn't want to be known as this revision Queen of Texas.

Dr. Carrie Lam, MD: 4:18

Yes, that means it didn't work the first time, right? You're right, in that when we look at health, it shouldn't just be the physical health, which is what surgery is. Just you have a structural issue, we're going to do that. But like you said, there's a lot of behavioral, emotional, mental, hormonal, underlying causes that cause a weight gain to come back. It's also what do you think? I love that you talk about hormones, if you can explain a little about how hormones are related to weight gain.

Dr Franchelle Hamilton: 4:57

I realized hormones are related around that midway point, when I started expanding my scope and checking everything. Stuff that people typically don't look at, normally we consider medical problems, hypertension, and diabetes, but a lot of people don't look at hormones. They often don't look at the stress responses and how they affect weights and hormones.

Dr. Carrie Lam, MD: 5:27

I love those words.

Dr Franchelle Hamilton: 5:29

I had to learn this almost like on my own, because I was like, I have to do better for my patient, like this person sitting in front of me. The patients didn't even know. So I started expanding my panel, and realized a lot of their hormones were way off. And so I thought before we do weight loss, let's start fixing these things first, and that's how it started. I noticed if we could fix some of their stress response to their environment, or their mental health and other stuff first. The hormone levels were abnormal, they're low, or almost zero. And I noticed when we started fixing these first patients, they started losing weight. I had given them a timeframe, like three months, we're gonna start doing all these other things first, and they were losing weight and maintaining it. Because we were fixing some of the roots, not just banned, ending it with a surgery, or even a medication. I have since expanded to do medical weight loss also. And so that would include different medications. But none of those tools will work without training some of these underlying tools. And that became so clear to me and so evident to me that I'm like, we need to start focusing on this stuff. First, we need to educate the patient on other factors that they don't even know what's going on, that's affecting their well being. All of this stuff affecting their well being depletes their hormones, it makes them gain weight. How they respond to an environment, all that kind of interacts. I realized this is where education needs to be focused, because then once they get a handle on this, they won't have the fatigue anymore. Now they're depleted in their adrenal, adrenal fatigue, right, or their hormones will be better if they don't run through them. And so we started doing all of that first, and we saw great results. Then for those who still needed surgery, they still got the surgery. But they did better, they maintained their weight, because they were aware of the other things that needed to be fixed. They knew what was going on and they still came in for their hormone replacement. Like stuff like that doesn't go away, that will need to constantly be repleted. And so we started monitoring that. When people have these other tools, their vitamin deficiencies got completed better ways to handle stress, their depression was better, their hormones were better, which affects all of those things, right? Yeah. And then they just did better with their weight loss. So that definitely has to be one of the things that you look at when you have somebody who's weight gaining. You can't just give them medication, and do this diet or nutrition plan. There's other stuff that's contributing to that weight, and hence, that's where my four pillars.

Dr. Carrie Lam, MD: 8:37

You do a lot of very similar things that what we do and you say all the right things, adrenal fatigue, hormone imbalance. I like the analogy where let's say, the people are polar bears and the stress response is they have to go through winter. Bears usually have to hibernate in the winters and they store under stress, right? Unless you get rid of the stress, for the bear, it's summertime, they're not going to come out of hibernation, and they're going to feel fatigued. They're going to keep storing all their weight until you get rid of the stress response. You deal with the emotional factor, deal with the underlying hormone issues, then the weight will come off naturally. Even after you can keep it off. So that's, that's really great. I love to hear what you're saying.

Dr Franchelle Hamilton: 9:25

The current issue is that there's not enough people who see it this way. I don't know if any bariatric surgeon actually will look at it this way. We have to send a different message like there were not as a provider gonna treat the end result without taking it back to where some of these other causes. Even if they have the stress, if you don't teach them how to manage or that this is affecting their body. It's like going into this hibernation mode where they're just piling on, and then they get metabolic syndrome. If you're not telling them that this is what's going on and this is how you treat it, patients aren't going to know. We can't just give them Metformin and wish for the best but not know what's going on.

Dr. Carrie Lam, MD: 10:17

You use the term is to do surgery on the mind. What does that mean?

Dr Franchelle Hamilton: 10:25

Yeah, essentially, that's what I was finding out during this whole journey, and trying to not just treat but really heal my patients and help them overcome, My obesity patients didn't come in with just obesity, they came in with all their medical problems. But then they also came in with traumatic experiences that needed to be treated. You have to be able to identify those as a provider and know that they're there. So even if you can't provide that treatment, you need to be able to get that treatment to them. Without that being resolved or healed, it just manifests into more medical problems. So even if you give them a pill, or treat one or two of their medical problems without treating some of this within the mental aspects of health and well being, they relapse into their medical problems. And so I noticed specifically, I had a patient who I gave the Taj Mahal of surgeries. Soon she was a revision, she had all the medical problems, chronic kidney disease, for high blood pressure, medications, insulin, for diabetes. She knew she could die from her medical problems, it was that bad. And so she got this surgery, she did well, for two years. Then she had almost like a trigger, I call them triggers. And people have to know what those triggers are. That, sent her on this spiral, and she went back into her unhealthy habits. I didn't get to see her during this period of time for about five or six months. When I saw her again, she gained 60 pounds back that quickly, and was back on hypertension meds. And at that moment, I was like, what was it and it was the mental she knew what to do? Or what to do, right? A lot of patients I know how to eat, I know what I should be doing. But then why aren't you doing it? So then in order to get through that, why aren't you doing it? You have to ask other questions. That's when you start getting into the mindset, you have to start bringing this out of them, what is their Why? What is their goals, and it has to be something that they can hold on to, because motivation can come and go. And it has to be something they can latch on to. So when my patients came in, wanting to lose weight, I have to dig deeper and figure out why. And we also together had to figure out what will be holding them back in the event, they get a trigger. So they had to learn what their triggers are, whether it was work environment, because they go through different things, discrimination in the workplace, etc that really doesn't go answered in a doctor's office. A lot of my patients were hearing, you've lost so much weight, you're too skinny and now it's all back on. So there's so many things that you have to take into account, you almost have to make them mentally strong. And that's where surgery on the mind comes in. Once they become mentally strong then you can educate them on everything that's going on with them in a functional integrative way. And then almost push them out to be able to handle this surgery or treatment. So when a trigger comes whatever it may be, they don't relapse. They're strong enough to get through that and they have self control. They develop new healthy habits. That's what I've learned I had to do with my patient population. Like, it couldn't just be the surgery. There's so many other things that they go through, that they have to almost be mentally strong. You have to as a provider, walk through that with them, and then help them understand why the stress over here interacts and how that affects them.

Dr. Carrie Lam, MD: 14:11

Yeah, that's great. I love it. You know, going back to the hormones, and how would you use hormones to help people lose the weight?

Dr Franchelle Hamilton: 14:21

So when patients come in, and after learning about their extensive history and physical and extensive lab bloodwork, I always tell my patients we have like a pie in different pieces weight is in the middle. And on the outside, you have these different things that are contributing, pointing in to your weight. For a lot of patients, abnormal hormones or hormonal deficiency was one of those contributors. So then the way that I would tell them is, even if we fix some of these other things, if you don't fix in these individual pieces around the pie, you're gonna have something that's ontributing to your weight ain. For my patients, the ormones once we corrected that, hat was at least 10 to 15 ounds, right. But if we never orrected that first, and then hroughout their weight loss ourney, that would be 10 to 15 ounds, they would still be olding on to. Then they're ike, I can't keep up. There may e behaviors there. But efinitely, we have to be able o treat this, and the hormonal herapy. I think why the weight oss was so much with fixing hat is because just treating heir hormones made them feel etter, it made them less tired, t made them sleep better, it ade them look better. That in urn, help them have more onfidence and help with maybe ome of their hair loss. It did ike all these different things. o I think that's why we got uch a significant weight loss ith hormone treatment versus ust switch to this diet or tart exercising. Treating the ormones does so many other ifferent optimal health, like ecause sleep by itself is a ontributor to weight gain, ight, like an independent risk actor for weight gain. That's hy I always say you got to find ut where it's rooted. If it's ue to your hormones being bnormal, you need to fix that. nd then that fix your sleep, hich in turn will fix the eight.

Dr. Carrie Lam, MD: 16:34

When you say hormones, we're talking about the adrenals and its hormones. The cortisol is very important to also weight gain, in the fat cells. And do you find that a lot of overweight people actually are estrogen dominant, like the phrase where they hav a lot more estrogen compared to progesterone. Because heir fat cells are producin more estrogen?

Dr Franchelle Hamilton: 17:04

Yeah, I have seen that almost 100%. It's funny because another physician asks what am I seeing on my hormone panels, and they're usually always deficient, like zero progesterone. And then all these usually more estrogen, and then minimal testosterone, you know, and cortisol too. Their cortisol is way off. And believe it or not, people always want the belly fat gone. Well, you got to fix your cortisol, you know, and you got to permanently fix that and fixing them will fix a lot of the belly fat. Obviously, some about what you eat and inflammatory markers. So I usually see most of my patients, both men and women, actually, estrogen dominant, and even I have to put men on aromatase inhibitor to make their estrogen produce testosterone.

Dr. Carrie Lam, MD: 17:58

I find also that you can't really put people on hormones unless you also fix their adrenals because they can overstimulate some people to go on hormones, they can overdose on hormones. So you have to make sure that the cortisol looks good. And then also the reproductive hormones all at the same time plus the thyroid, right? Yeah.

Dr Franchelle Hamilton: 18:17

I was gonna say plus the thyroid. So our panel includes all of that and they all go together. And that's integrative. Many people who just treat thyroid, and say well, I thought it was my thyroid. Yeah, but have they checked your cortisol or your hormones, and they say, no.

Dr. Carrie Lam, MD: 18:42

Three legs to the stool.

Unknown: 18:44

Exactly, as a lot of the symptoms are very similar, right especially thyroid and the reproductive symptoms are very similar. And so you can't really do one without the other in my opinion.

Dr. Carrie Lam, MD: 18:58

So what can you just quickly go through what the four pillars or transformation are, how you are helping people or where they can find you?

Dr Franchelle Hamilton: 19:10

My four pillars, essentially, you have to find where it's rooted. They includes mental which we've talked about and gave examples, environment, which already talked about behavioral and medical. So the way I do it is I make sure that when a patient comes in with a certain complaint, chief complaint is what we call it. I go through all these different areas because every medical condition is rooted in one of these areas. So if their adrenal levels or their cortisol is off, I've noticed a lot of times it's from environment. Triggers that's making them produce the stress free. I was like overproduced, the stress reaction that's depleting their cortisol. So instead of me just giving them treatment for their adrenal fatigue or whatever, we have to go to the environment, like where it's rooted in their environment and say, what are the things that we can do to kind of make adjustments in this area. Patients come in with a presenting problem. And then I go to one of the, it's always in one of those four, I've noticed always in one of those four. We figure out the mind part, the treatment in that part, that's where the mind comes in. So we have to give them tools to be able to fix that. Then we can give them the treatment. Otherwise, they'll just keep depleting or keep just doing this recycling. Medical conditions is, is pretty obvious but you can't just check reproductive hormones without looking at cortisol and thyroid, like, you have to get the whole picture in all these areas. So that's what I do. And that's the end when I started kind of implementing this. And now when my patients say I had a really bad craving and I gave in, and then they'll realize that they were upset. So that's in the mental. They automatically go to where the root is. And we discuss, okay how can we combat this next time? So once you implement looking at it from a different lens, like automatically when they come in, like, where is it rooted? And then we do other things, too, but that's the broad of the pillars, you have to find the root.

Dr. Carrie Lam, MD: 21:20

That's really great. So Dr. Hamilton, how do people find you? Are you seeing patients?

Dr Franchelle Hamilton: 21:26

I am seeing some clinical patients, but I have recently transitioned to join a wonderful company called Fresh Try. That's where I spend most of my time. We're trying to make this whole mindset training for better behaviors on a bigger scale. I'm hoping to make a bigger impact. All that information can be found on my website, as well as my podcasts and books. It's www.drfhamilton.com All of my social media is either Dr. F. Hamilton or Dr. Franchelle

Dr. Carrie Lam, MD: 22:00

I will put all the links. Great to talk to Hamilton. you about how to use the four pillars of transformation to lose the weight more permanently, especially also dealing with hormones on the medical side. We definitely en oyed having you on our Dr. Lam how. If people have loved this pisode, make sure you like it nd share it and subscribe. And lso check out Dr. Hamilton's odcasts. So we're so glad to ave you. Thank you.

Unknown: 22:39

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