How to Maintain Vital Hormone Balance While Losing or Regaining Weight Artwork

Dr. Pepper....Really?

Welcome to "Dr. Pepper...Really," where Dr. Gary Pepper—a board-certified endocrinologist and Associate Professor at a major U.S. medical school—delves into the world of metabolic health. Join him as he interviews individuals sharing their personal journeys with metabolic issues and chats with experts in metabolism, nutrition, thyroid disease, diabetes, hormone imbalances, weight management, and more. The show aims to provide you with valuable insights and perspectives from top professionals on common yet critical issues affecting your health and well-being.

All Episodes

Dr. Pepper....Really?

How to Maintain Vital Hormone Balance While Losing or Regaining Weight

October 10, 2024 • Gary Pepper, M.D. • Season 4 • Episode 4

Join Dr. Gary Pepper, board certified endocrinologist, who, with the help of two chatty chat bot assistants, focuses on how rapid weight loss or gain can alter levels of vital hormones such as estrogen and testosterone.In a pleasant conversational style the trio makes sense of hormone imbalance accompanying rapid weight changes, often overlooked when thinking about using weight loss drugs such as Ozempic, Wegovy, and Mounjaro. These chemical changes are critical to your health, mood and energy when on these medications. And please stick around until the end of this podcast to hear some simple steps to help avoid the surprisingly harmful Refeeding Syndrome, the unwanted effects of regaining weight too rapidly once the medication has stopped. So as Doja Cat says, let’s get into it…ya!

Visit our website at Metabolism.com and our YouTube channel metabolism123

#Ozempic # Wegovy #Tirzepatide #rapidweightloss #Refeedingsyndrome

Disclaimer:
This podcast is for educational purposes only and is not intended as medical advice or treatment. Consult with your own qualified healthcare professional before embarking on any new medications or diet programs.

Gary Pepper, M.D., an associate professor at a prominent medical school and endocrinologist with 40 years of experience, brings clarity to numerous topics within the field of metabolic health. His view points are unhindered by corporate interests, unlike many other current "thought leaders" in medicine. Dr. Pepper, a dedicated educator, established his homebase website www.metabolism.com in 1996 and has blogged on important topics since then. Not one to be left behind by technology he began podcasting in 2020 with the onset of the pandemic and continues publishing vlogs on YouTube at his channel metabolism123. So whatever your choice in media, you will be gaining fresh insights by tuning in to his opinionated shows or reading his blogs on critical health topics.

0:00

Talk about mixed signals. Yeah, it's likethe body is an overdrive trying to figureout what's going on. And that's whyunderstanding these hormonal changes isso important. They're not just numbers ona lab report. They have real consequencesfor how we feel, how our bodies functionand ultimately our health in the longrun. Yeah, it's easy to get caught up inthose numbers on the scale. But like youwere saying, those visible changes, thoseare important, too. Solet's talk about those.Hey there, everyone.This is Dr. Pepper, really.And in today's podcast, we're going to betalking about a subject which I think issomewhat overlooked when discussingthings like ozimpic, Wagave and manjaroand how it creates rapid weight loss.My concern is that during rapid weightloss, there are other changes going on inour body other than our physicalappearance, particularly inthe realm of our hormones.And this can have a great impact on howwe feel and how our body functions.We'll be talking about that in a minute.And towards the end of the podcast, I'dalso like to examine something even lessknown. And that is the effect of rapidweight gain afterstopping the medication.This could be a tricky time for the bodyand can lead to a condition known as therefeeding syndrome, which can be ratherserious. There are a number of somewhatsimple nutritional approaches that we candiscuss to prevent such an outcome.So it's going to beworthwhile to hang around and listen.As Doge Cat says,let's get into it, y'all.All right, buckle up, because today we'retaking a deep dive into the fascinatingand often confusing worldof estrogen and obesity,and we're adding another layer to thiswhole thing. What happens when you throwrapid weight loss into the mix? Yeah,it's definitely not as simple as justcalories in calories out, right?Absolutely not. We're talking hormoneshere, people. And from the looks of it,you've really been digging into this.Research papers, chatbot conversations.You've gone down quite the rabbit hole.But what really stood out to me was yourfascination with rapid weight loss andhow it impacts our reproductive hormones.I mean, you mentioned things likeintermittent fasting and even moreextreme situations like anorexia.It's hard to interrupt, butlet's not forget, of course,the effect of the use of medications likezempic, wagave, tearsof peptide and manjaro.OK, so let's keep going.It's pretty clear you're eager to get tothe bottom of this. It's prettyfascinating stuff. I mean, we're talkingabout how these hormones, especially whenthey're all over the place, affect somuch more than just our reproductivesystems, right? Mood swings, energycrashes, bone hell. Even our metabolismgets thrown for a loop. Right, right.It's all connected. It's like this crazyhormonal symphony orchestra.And rapid weight loss is like theconductor who's lost their sheet music.Yeah. So so where do we even begin tounpack all of this? OK, so let's break itdown. We've got our all star players,testosterone and estrogen, the classicsex hormones, but they don't just operatein isolation, right? We have a motherhormones like S.H.B.G. that's sex hormonebinding globulin, by the way. And itessentially acts as a chaperone for thesehormones. It determines how much of themare actually free to, you know, do theirthing and interact with our cells. SoS.H.B.G. is kind of like the bouncer atthe hormone party, letting some in andturning others away. Exactly. And thenwe've got growth hormone and IGF-1, whichare obviously essential for growth anddevelopment. And they're also part ofthis intricate dance. But here's thething. Weight, especially when itfluctuates rapidly, can really throw thiswhole system out of whack. OK, so thatmakes sense. But what actually happens toour hormone levels when we lose weightquickly? Does everything just sort ofplummet? Well, not quite. It's not alwaysso black and white. Taketestosterone, for instance.You know, you sent over some researchabout how rapid weight loss affects it,particularly in men whoare dealing with obesity.There is that one study impact of weightloss on reproductive hormones in obesemen. And it found that for men with ahigher BMI, losing weight quicklyactually led to a bigger drop intestosterone compared to gradual weightloss. Kind of counterintuitive, right? Itreally is. You'd think that losingweight, especially a lot of it, would bea good thing for those hormone levels,not the other wayaround. Yeah, it's surprising.It's me again.I'm thinking that the effect is probablyrelated to the rate at which the bodyweight is changing, since in nature,rapid weight changes are very stressful.Let's keep going.But it just goes to show how incrediblycomplex this whole system is. Hormones,you know, they don't always follow therules. We think they should. That's forsure. OK, so what about estrogen?I mean, your research on estrogen andobesity was really interesting. Yeah,estrogen is a bit of a double edged swordwhen it comes to obesity. On one hand, itcan actually help protect against obesityand even problems with how our bodies useglucose. But on the other hand, it canalso promote fatstorage, especially in women.There was that interesting study youfound about how estrogen effects wheremice store fat mainly in their bellies.So it's almost like estrogen has thisregulatory role kind of influencing wherewe pack on the pounds. But when it's outof balance, it can actually increase therisk of weight gain and even potentiallylead to more serious issues down the linelike diabetes. You got it.A special note here is thatas estrogen levels decline duringmenopause, it can also cause a shift inthe way fat isdistributed to the abdomen,causing what we refer to as a beer belly.And also it can enhance theoverall weight gain effect.And when we add rapid weight loss intothe mix, it gets even more complex.Remember that excerpt you share from theeffects of diet and exercise onendogenous estrogens. It suggested thatrapid weight loss could significantlyimpact estrogen levels in women who havealready gone through menopause. Wow,that's huge. And what about S.H.B.G. ourhormonal bouncer? Does dropping weightquickly affect how it does its job?Definitely. You know, that chatbotconversation you mentioned was on tosomething. Rapid weight loss usuallyleads to an increase in S.H.B.G. levels.And remember, S.H.B.G. binds to keyhormones, which makes them less availableto the body. So even if your body isproducing what seems like a normal amountof testosterone or estrogen, havinghigher S.H.B.G. means less of thosehormones are actually active in doingtheir thing. So even though someone islosing weight, which we usually think ofas positive, their hormone levels mightbe telling a verydifferent story. That's wild.Exactly. And it's one of the things thatmakes hormones so fascinating. They don'talways play by the rules. And, you know,we haven't even touched on growth hormoneand IGF-1 yet. These guys are especiallyimpacted by extreme weight loss, like wesee in anorexia. Right. Right. Thechatbot mentioned that anorexia canactually lead to higher levels of growthhormone, but suppressed IGF-1. Talk aboutmixed signals. Yeah, it's like the bodyis an overdrive trying to figure outwhat's going on. And that's whyunderstanding these hormonal changes isso important. They're not just numbers ona lab report. They have real consequencesfor how we feel, how our bodies functionand ultimately our health in the longrun. Yeah, it's easy to get caught up inthose numbers on the scale. But like youwere saying, those visible changes, thoseare important, too. So let's talk aboutthose. How does rapid weight lossactually show up in our bodies? You know,what's happening on the outside? Right.Those visible changes are often ourbody's way of trying totell us something's up.OK, at this point, let's shift our focusto the effect of the rapid weight loss onbone density with complications ofosteoporosis. Which issevere forms of weight loss.Let's start with bone density, which isso important for our overall health,especially as we get older. And this isespecially important for women. You foundsome really interesting research aboutpostmenopausal women.Estrogen actually plays a big role inkeeping our bones strong, right? Right.So when estrogen levels drop, which canhappen with rapid weight loss, it canlead to a big decrease in bone density,which can make someone more likely todevelop osteoporosis. And fractures. Wow.It's a good reminder that it's not justabout looking thin. It's about the healthof our bones,especially as we age. Absolutely.OK, now it's time for us to change focusagain on how rapid weight loss can affectour sex lives in terms of libido or sexdrive and also bodily function changes,such as disruption of the menstrual cycleand in men erectile dysfunction.And then there's libido or sex drive,which is, of course, very much connectedto those hormonal ups and downs we'vebeen talking about. When testosterone islow, estrogen is low, SHBG is high. Thosecan all contribute to a lower sex drivein both men and women. Makes sense. Likeif your body's in survival mode becauseof the rapid weight loss, it's probablynot going to be too concerned with, youknow, romance or making babies. Exactly.Reproduction just isn't a top prioritywhen your body thinks it's in a famine.And speaking of which, for women, thesehormonal imbalances can really mess withtheir menstrual cycles. You mentionedanorexia, and it's super common to seeirregular periods or even a menorrhea,which is when your period stopsaltogether in those cases. It's like ourbodies hit the pause button on certainfunctions to save energy when they thinkwe're in trouble. Exactly. It's afascinating evolutionary adaptation.But let's talk about some other visiblethings that can change, like our hair,skin and even where we store fat. Thesemight seem kind of superficial, but theycan be really upsetting for people. Andthey usually point to thosesame hormonal shifts. Absolutely.What causes those changes? Is it justbecause we're not getting enoughnutrients or is there more to it? It's alittle of both. Nutrient deficienciesdefinitely play a role, especially ifsomeone's really cutting back on theircalories. But those hormonal changeswe've been discussing are reallyimportant, too. Thinning hair, dry skin,brittle nails, all of those can be linkedto hormonal imbalances. Hormones affecteverything from collagen production,which keeps our skin looking young andhealthy, to how our hair follicles work,which determines hair growth. And when itcomes to fab distribution, our hormoneskind of tell our bodies where to storefat. So as hormone levels change withrapid weight loss, you might see changesin body shape, even if you are losingweight overall. So even if you're losingweight, you might not be losing it fromthe places you want to, all because ofthese complex hormonal interactions.That's right. It can be frustrating, butit shows how important it is to thinkabout weight loss in a holistic way. It'snot just about the number on the scale.It's about understanding how our hormonesand metabolism work together and findinga sustainable way to lose weight that'sgood for both our physicaland mental health. Absolutely.OK, now, as I mentioned atthe beginning of the podcast,it's time to look at what happens to us,our bodies, our hormones,when we start to regain weight, which iscommon when you stop theweight loss medications.OK, so let's say someone has gone througha period of rapid weight loss and they'veexperienced some of these hormonal andphysical changes we've been discussing.What happens when they start eatingnormally again? Does everything justmagically go back to normal? Well, it'snot always that simple. It's not always areset button, unfortunately. Refeeding,especially after a period of reallysevere restriction, like we see withanorexia nervosa, can be tricky. It's notjust about upping your calories again. Infact, doing that too quickly can lead tosomething called refeeding syndrome,which can be really dangerous. Refeedingsyndrome, that sounds serious. What makesit so risky and what's actually happeningin the body? So imagine your body hasbeen in starvation mode, right?Conserving energy, holding on to thoseessential nutrients just to survive. Andthen suddenly it's flooded withnutrients. This can overwhelm yourmetabolism and lead to a bunch of changesin your body. One of the biggest thingsto worry about is a sudden drop inphosphate levels in the blood, which isan important electrolyte. Why isphosphate so important during refeeding?Well, phosphate is essential for a wholebunch of bodily functions, producingenergy, muscle functions, cell signaling,even pH balance. When you start eatingagain after not eating enough for awhile, your body wants to use those newnutrients to rebuild and repair tissues.This process needs a lot of phosphate. Ifyour body has been low on phosphate for along time, it can't keep up with thissudden increase in demand, which cancause serious problems. You could seemuscle weakness, heart problems,breathing difficulties, even seizures.It's really important to manage itcarefully. It's important to add at thispoint that with the refeeding syndrome,there can also be prominent fluid shiftsin our body and fluid retention with thedevelopment of swelling inthe legs and even in the face.And there's a form of severe fluidretention, which affects the whole body,which is known as anisarka. Butfortunately, that's quite rare.This is really important information,especially for anyone dealing with asituation where refeeding is necessary.So how do you prevent refeeding syndrome?Is it just a matter of slowly increasinghow much you eat or are there otherthings to keep in mind? Wow, it's amazinghow much goes on in our bodies that wedon't even think about this. Refeedingthing sounds really delicate. It is. It'sdefinitely not as simple as just goingback to your regular meals. You have toreintroduce calories very gradually. Andit's not just about the calories you haveto keep a close eye on electrolytes to,especially phosphorus, potassium andmagnesium, making sure the person isgetting enough of those, either from foodor sometimes supplements. Right. So it'sabout replenishing all those importantnutrients that were depleted. Yeah.Right. Could you give us some examples offoods that are especially good sources ofthese electrolytes? You know, just somepractical tips for our listeners. Sure.For phosphorus, dairy products are greatthings like milk, yogurt, cheese,lentils, beans, nuts and seeds are goodtoo. For potassium, bananas, avocados,sweet potatoes, spinach, beans, those areall good sources. And when it comes tomagnesium, almonds, spinach, darkchocolate, those are your friends. Oh,and avocados for magnesium as well.Awesome. Those specific examples make itso much easier to see how this all worksin real life. Exactly. It's all aboutgiving people the information they needto make gooddecisions about their health.Well, we've covered a lot of groundtoday, haven't we? From the ins and outsof our hormones to the visible changes wesee and the complexities of refeeding. Ifyou had to leave our listener with justone key takeaway messagetoday, what would it be?That's a tough one. But I think the mostimportant message is that our bodies areincredibly complex and resilient andhormones play a much bigger role than weoften give them credit for. Rapid weightloss, even though it's often seen as thisquick fix, can actually disrupt thatdelicate hormonal balance. And that canhave all sorts of unintended consequencesthat go way beyond just the number on thescale. It's a good reminder that weightloss is not just about willpower. It'sabout listening to our bodies and findinga sustainable approach that supports ouroverall health, both mentally andphysically. Absolutely. And while someups and downs in our hormones are totallynormal, really rapid weight loss can setoff a chain reaction that we might noteven realize is happening until we seethose changes in our bodies or evenworse, run into health problems down theline. So important. It's all about makingsmart choices thatbenefit us in the long run.I'd like to interject a word of cautionhere because handling of the refeedingsyndrome in this period of time canresult in serious medical complications.And should be done under the supervisionof qualified physicianand nutrition specialists.The information that we're providing hereat this time is for educational purposesonly and not meant asmedical advice or treatment.Well, we've covered a lot of groundtoday, haven't we? From the ins and outsof our hormones to the visible changes wesee and the complexities of refeeding. Ifyou had to leave our listener with justone key takeaway messagetoday, what would it be?That's a tough one. But I think the mostimportant message is that our bodies areincredibly complex and resilient andhormones play a much bigger role than weoften give them credit for.Rapid weight loss, even though it's oftenseen as this quick fix, can actuallydisrupt that delicate hormonal balanceand that can have all sorts of unintendedconsequences that go way beyond just thenumber on the scale. It's a good reminderthat weight loss is not just aboutwillpower, it's about listening to ourbodies and finding a sustainable approachthat supports our overall health, bothmentally and physically. Absolutely. Andwhile some ups and downs in our hormonesare totally normal, really rapid weightloss can set off a chain reaction that wemight not even realize is happening untilwe see those changes in our bodies or,even worse, run into health problems downthe line. So important. It's all aboutmaking smart choices thatbenefit us in the long run.Well, you've really given us a lot tothink about today and a huge thank you toyou, our listener, for bringing up thisincredibly important topic. And as youcontinue to learn about all this, here'ssomething else to consider. We've beentalking about the immediate effects ofrapid weight loss. But what about thelong-term effects, especially for peoplewho go through cycles of losing andgaining weight, you know, yo-yo dieting?How do these constant changes in weightand therefore hormones affect ourmetabolism and reproductive health overtime? There's no easy answer, but it'sdefinitely something to think about as wetry to navigate the confusing world ofweight management and figure out what itreally means to be healthy. Absolutely.Okay, so that wraps up the podcast fortoday and I hope you got some usefulinformation out of it.If you have any suggestions for futurepodcasts, I'm always eagerto hear from our listeners.So please feel free to email info atmetabolism.com. And as always, we reallyneed the support of our listeners bysubscribing and putting likes on thepodcast so that we can continue toprovide this kind of useful information.Okay, stay well andthanks again for listening.The contents of this podcast are foreducational purposes only. And if youreally have some concerns about yourhealth or medical issues, please consultwith your own health care provider.