GLP-1 & PCOS: Why So Many Women Were Misdiagnosed

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What if millions of women with PCOS were misunderstood for years because the condition was treated mainly as a reproductive disorder instead of a metabolic disease tied to insulin resistance, obesity, hormones, and fertility?

In this episode of The Plus SideZ Podcast, Dr. Melanie Cree, a pediatric endocrinologist, obesity researcher, and PCOS/PMOS expert, explains the recent global consensus to rename PCOS to PMOS, or Polyendocrine Metabolic Ovarian Syndrome, to better reflect the condition’s metabolic and hormonal impact.

Dr. Cree breaks down how delayed diagnosis and outdated understanding may have prevented many patients from getting earlier metabolic treatment and intervention.

We discuss:
Why so many women with PCOS were misunderstood or dismissed
The connection between PCOS, PMOS, insulin resistance, obesity, and fertility

• Why weight gain is not just about willpower
• Adolescent PCOS and why early intervention matters
• GLP-1 medications like semaglutide for PCOS/PMOS
• Emerging research focused on ovulation, fertility, and metabolic health
• How hormones, appetite, and metabolism are connected
• Why the PMOS name change could improve diagnosis and treatment

Dr. Cree also shares information about her ongoing research and studies exploring how GLP-1 medications may help improve metabolic and reproductive health in people with PCOS/PMOS.

Learn more about studies 
https://medschool.cuanschutz.edu/pediatrics/sections/endocrinology/endocrinology-research/cree-lab/Cree-Melanie-UCD4665?utm_source=chatgpt.com

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Transcript

SPEAKER_03 0:00

Hey Plus Science Community, before we jump into the podcast, do me a favor, like, subscribe, and share if you haven't already. This helps us get referred up in the algorithm so we can find more people that need our help and guidance from our doctors. Thanks so much for supporting the show. Let's jump in. If you're like most of us, you've been denied a GLP1 at least once. But did you know that less than one percent of denied claims are ever even appealed? Even though the data suggests that over 60% of appeals are often approved, that means that people who should be paying $25 a month are instead paying thousands of dollars a year out of pocket. Not necessarily because appeals don't work, but because the process is confusing and time consuming. But that's where Honest Care comes in. You go to their site and then you just start with a quick assessment. And then Honest Care will build your appeal with the clinical and medical arguments that your insurer needs to hear and then guide you through submitting it. If you've been denied, don't stop there because most appeals must be filed within 90 days. So don't wait. Go to findhonestcare.com slash Kim to get your free assessment today. That's findhonestcare.com slash Kim.

SPEAKER_01 1:08

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SPEAKER_03 1:38

Are you interested in understanding geoblood medications like a synthesis of Foodie or Mandaro? Then join us on the Plus Side, tracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time.

SPEAKER_00 1:52

The Plus X podcast is Destructor.

SPEAKER_03 1:54

We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that will leave you feeling enforced and empowered. Join us every week to learn from doctor to a specialist around GLP1 medications like obesity of Governor Manjaro. We'll provide you with science and facts to validate this incredible story. But that's not all. We'll also bring you the voices of the GLP1 Manjaro TikTok community, real people who face the challenges of obesity related diseases and disorders and discover the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides cracking the obesity code. And together, we'll change the narrative around obesity and the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The Plus Sides Podcast. You're not alone. It's not your fault. Welcome, welcome to the Plus Sides Podcast. Hey Kat.

SPEAKER_04 3:16

Welcome to my Dark Mysterious Dungeon.

SPEAKER_03 3:19

Dark Mysterious Dungeon. You can't see a listening audience. The cat. Boy sound very like Elvira there. Do it. Yeah, yes.

SPEAKER_04 3:26

No, you are doing the quiet storm where we're playing lessons but love songs. She says Delilah. I say quiet storm because I was an RB child. Kim was a top 40 child. Although we grew up listening to Prince and Rick names.

SPEAKER_03 3:42

Also, my favorite yelling everybody's like, oh, what was your first concert? My first concert was the ultimate oldies concert because I am a straight nerd and I liked oldies. I was like my favorite. And if that was my first concert, it was like Paul Revere and the Raiders, and like they were all like old and everything. I don't care. I loved it. It was fantastic. The music is fantastic.

SPEAKER_04 4:01

I don't care what you say. You you want to know what my first concert was? What was it? What was it? I'm not no, it was not. I did not see Prince until I was 21. It was it was MC Hammer. Oh, I love MC Hammer. What's wrong with that? I love M Cammer. Any fender. Well, you uh yeah. Yeah, MC Hammer. Oaktown 357. Is that bad? Is he bad? I don't know. No, I mean that was like MC Hammer.

SPEAKER_05 4:27

What's wrong with Mm?

SPEAKER_04 4:29

Hammer Pick. Yeah. Okay, we have Oh uh. We're gonna turn anyway.

SPEAKER_03 4:37

So yes. That is our diversion. Important, very important things uh today. Actually, we're going to talk a lot about um PCOS today and GLP ones. So the new name. Yeah. Um we're gonna do our very best. Um, we're just now kind of getting back into it. I've been out for quite quite a while with my family loss, and so just trying to get back into it. But cat may be leading us a lot because I'm the squirreliest squirrel right now.

SPEAKER_04 5:06

And so I'm in a dark corner because my computer, um, the camera adjusts. Yeah. So it'll be light and then it comes right in and it says, hey, you face.

SPEAKER_03 5:18

It must be like it must be like a a new like update or something. Because I think I think it was.

SPEAKER_04 5:23

It didn't used to be like this. So we need to get your husband to look at it one more. I was gonna say, I my geek squad is taking a nap in the other room. So yeah, yeah, and I don't that mind when he's asleep either.

SPEAKER_03 5:33

It's it's like when you're when you're when you're and they're married or you have kids and they're napping. That's my mom's hilarious. I'm gonna live for that nap.

SPEAKER_05 5:42

She was right.

SPEAKER_03 5:44

Anyway, speaking of females and reproductive things, let's talk about PCOS and GLP ones and learn all about it. Because there have been some juice, there have been some changes going on in this year's very recent changes. Yep. Yes. That's all did. Oh, I should probably tell you who are open for intro. Oh, see, I told you guys. Who are you, Kim? My name's Kim. This is the Plus Sides Podcast, and we are a multi-award-winning podcast. I'm telling you this because it's reputable, and I know you know a lot of places you can go. We're also on the trip ranking to the top 1% of all podcasts in the world and in the world. In the world. Kat always goes, in the world. And we talk about metabolic disease, and we have on researchers and scientists and doctors and experts and dietitians and all these different people so that you can learn everything you can about your body and your health when you have metabolic disease because it's just different, y'all. It's just different. Okay. And you're equipped with the data. Yeah, and you just deserve to know, you know. And um, I've struggled with obesity the majority of my life. Um, I have lost a bazillion pounds over and over and over again. Um, I am now 46, maybe 47 this year, and going going getting closer to the pause. Uh, and so we're going through all the chains. And we talk about that here too. Kat and I've been on GOP1 for almost four years. Um, and I lost 110 pounds, and I've gained back 20. And I'm on it. Because menopause, and because of metabolic disease, and it's because and cause uh uh what do we call it? Uh uh metabolic adaptation. What about it, you know? And grief. Jeez, it's not a matter. Well, here's what's crazy. I always could be straight up honest. Like, um, I have not been overeating, but I'm gaining weight. It's the weirdest thing. I and I'm not. And I my body's just doing that thing. It's like anything I do eat, restore it. You know, it's crazy.

SPEAKER_04 7:31

Well, I'm CAD. We're we we would we are what we would consider the OGs of the GLP community. We are the OGs. I have been on the MJs, the Manjiro, like a good Midwestern accent. I'm on the Manjaro, um, the whole time since 2020. So it has been about four years. Um, I am not somebody who counts the days, the weeks, and all I've never have ever, ever, ever done any of that. In fact, I always I estimate I lost about 70, 65, blah, blah, blah. Um, but the days on program, the days on Monjaro, because there are people, if you cruise through TikTok and Instagram, um, this is my second week. This is my 52nd week. This is my 300th week. And I'm like, wow. Absolutely not. Me either. Absolutely not. No. Started July 4th. Fourth. This this July. It'll be July. I don't. I think it was a Labor Day weekend. That's all I remember. So maybe I'm not gonna do that now. But yeah, so finally it got to a hundred pounds, but I teeter, I creep. This is and it's always how even like when I lost weight, the white knuckled way.

SPEAKER_05 8:40

Yeah.

SPEAKER_04 8:40

Um, down and up, down and up, down, up, up, up, up, up, up, down, down, up. You know, just it, yeah. So right now I am working with a few pounds on top, but you know, well, you don't you don't see the text that be there are between Kim and I, but I don't give a uh you know what. I don't I try to, and some days when I can't listen. When I catch myself carrying, I was like, you need let's yeah. So um, but yeah, it's definitely it's it's a it's a crazy journey. Um, but there's it's exciting to watch people when they get on it. Oh and I have to tell you real quick it's happening.

SPEAKER_03 9:20

Um John and I ordered um we're going to strength train. That's amazing. I know. It's a that's amazing. Amazing. That's always telling me because stronger.

SPEAKER_05 9:30

Yay.

SPEAKER_04 9:31

Well, muscle, yeah. I mean, well, I'm a cardio bunny, but I still do muscle. I still do um weights. Oh, yeah. I've always lifted, always done fitness when I was 320 and down to you know 220, 21, 23, 24. That's what I'm playing with right now. I get it.

unknown 9:48

Dang.

SPEAKER_03 9:48

I'm jealous.

SPEAKER_04 9:50

And that's it.

SPEAKER_03 9:51

All right, let's talk about why this sucks and what we can do about it, if anything.

SPEAKER_04 9:56

And there's a lot of people in the community that yeah, that are dealing with PCOS. So this is a listen up. Yes. All right. We got derailed. MC Hammer and Paul Revere.

SPEAKER_03 10:08

Paul Revere and the Raiders. Don't forget the Raiders.

SPEAKER_04 10:11

And then Dr. Dr. Melanie Creek put Violet Family was your first concert.

SPEAKER_02 10:16

Violet Family. Wow. Yeah, that was. It was a lot of fun. I think I floated on the crowd, you know.

SPEAKER_04 10:24

Crowd surfed. That is amazing. I was too big to smile. I was too big to do any of that kind of stuff.

SPEAKER_03 10:31

I get that. Oh, well, whatever. That's our thing. Listen, whatever. There are plenty of small people that don't have a lot of things that I have, so I'm just gonna focus on those.

SPEAKER_02 10:41

There you go. Perfect. Well, I'm not I would not crowd surf now. So I guess who would?

SPEAKER_03 10:47

I'm probably brick a hip at this point, you know. Exactly.

SPEAKER_02 10:50

Exactly. Exactly the same age, Kim.

SPEAKER_04 10:54

So maybe we're telling me I'm like, I'm going down, something's cracking. You know?

SPEAKER_05 10:59

Yes, exactly.

SPEAKER_04 11:01

Well, I'm about to be, what is it? I'm I'm Sally O'Malley. If you're ever watched that skin, Sally O'Malley. I'm I'm hitting 50 this year. I'm Sally O'Malley. Oh my gosh, amazing video. I expected anything. I'm gonna do a 5K. I'm gonna do a 5k the weekend of my my my birthday. Awesome.

SPEAKER_03 11:20

Maybe I should try it for that cat.

SPEAKER_04 11:22

Do it for the March of Times. I was thinking it's something to shoot for. And let's do it. You don't have to run it, you can walk it.

SPEAKER_03 11:30

I'm just gonna say I wouldn't be ready for run, but I could probably walk it with a little jog. We'll see anyway. This is gonna be too fast. Nine minutes in. Sorry guys, we love you. I'll try to edit this out. I'm sorry.

SPEAKER_04 11:44

No, and you know what, listeners, if you're listening to us, let us know in the comments. What was your first concert? Let's engage. Yes, look at you, cat.

SPEAKER_03 11:51

At a girl, at a girl.

SPEAKER_04 11:52

See, let's engage. Let me know. I want to see all your first first concert.

unknown 11:57

Okay.

SPEAKER_03 11:58

So um, Dr. Melanie Cree. Um, um, I was looking at to meet you in front of the downsize booth at Obesity Week. And you were like, hey, you heard you got this podcast? I was like, yes I do. And you were like, hey, I want to come on. And I was like, that sounds great. And you were like, I'm not here to talk about PCOS. You were like, and I'm a childhood obesity expert, and this is what I talk about, and they're doing trials around this, and you should know about it. And I was like, You're daggum right. I should, I can't even tell you how many PCOS listeners I have. So I'm so excited to have you here. We've got a set of questions, but it's meant to be very like conversational roundtable. Um, and uh, we're so glad to have you. But it would be wonderful if you could just tell people a little bit about who you are and how you help people.

SPEAKER_02 12:37

Yeah, for sure. So, yes, my name is Dr. Melanie Cree, and I'm a pediatric endocrinologist. So I take care of teenagers and we stay till about 2021. I say, you know, you don't need a new doctor, right, when you graduate from high school and are making big life changes. Um, and I specialize in um conditions related to excess weight, so PCOS and type 2 diabetes. And if you want to talk about OG for GOP1s, I've been using them since 2011 when I first started prescribing them.

SPEAKER_03 13:11

Um what Victosa? Or is it Victosa you're prescribed?

SPEAKER_02 13:15

Um by durion, before it was Bieta.

SPEAKER_03 13:19

Whoa, Bietta. Wow. That really is that's a twice a day one, right? Yep. Dang. What is it like to see science right now? Be in someone else. Oh, it's phenomenal. Literally, like, are you freaking out? I would be like, if I had been prescribing this, it's why they're exactly where they are now and where they're going, I'd be like, oh, crazy.

SPEAKER_02 13:36

Yeah. It has been an amazing, it has been an amazing journey for sure. Yeah, yeah. Yeah. So that's my clinical practice. And I'm very passionate about women's health. I went to an all-women's college and you know, from the very beginning. I went to Brainmark College in Philadelphia. And um, yeah, have always focused on women's health. I'll admit I wanted to be a gynecologist, but I decided they worked too hard. That's do they work hard? I don't know. I feel like they all work hard. Well, that's what I realized is I don't do quite as much overnight call, but I still work. See, I figured you were gonna be like, be really literal, like, I don't want my head in the vagina every day.

SPEAKER_05 14:19

I gotta I cannot leave that in.

SPEAKER_02 14:24

Yeah, no, these are if you made me look at I would freak out. I cannot do teeth, broken mouths. No, I can look at crotches. So I only take care of um, I only take care of patients 15% of the time. And I also have a PhD, um, so a research degree in learning how insulin works. And insulin is a huge part of PCOS. So that kind of research I've done for over 20 years. So it's been really fun to bring these different research techniques that we use in people with type 2 diabetes and bring them into the PCOS space. And so that's really what I've my research program focuses on. And first we were trying to figure out how does it work in teenagers, and now we're figuring out how to try to treat it uh in teenagers.

unknown 15:22

Yeah.

SPEAKER_04 15:22

Wow. Yeah. You gave us a great segue.

unknown 15:25

Yeah.

SPEAKER_04 15:26

PCOS changed to PMOS and insulin resistance. Let's just let's give us all the things. Um, what is what is PCOS, which is now PMOS? I'm gonna let you describe uh the acronym. Um what is it at its core? And let's let's nerd on the everything.

SPEAKER_02 15:44

Yeah. So in terms of the diagnostic criteria, it is um irregular periods, so not every month, and too high of testosterone, so our male hormone. So in teenagers, you have to have abnormal periods. And in teenagers, that's less than 21 days or greater than 45 days between cycles, and then clinical or lab-based high androgens, and that means um primarily testosterone, clinical-based high androgens. This is what I think gets all women, growing a beard, and we're not talking about the five postmenopausal hairs. We are talking, I've got patients with full beards that shave every day, and growing hair on the chest um and all the way down on the on the stomach. Also, really severe acne in our teenagers, and then just acne in in older women. Some of the times we see um people starting to go bald, just like men do. So it's called androgenic, that is male hormone um balding. So those are the clinical stars.

SPEAKER_05 17:02

Is that what androgen?

SPEAKER_02 17:03

Male everybody has the same hormones, right? So women primarily should have more estrogen and a little bit of testosterone. Um, and then men have a lot of testosterone and a little bit of estrogen.

SPEAKER_04 17:19

Yeah.

SPEAKER_02 17:19

But what happens in this condition is the testosterone is a little bit high. It's nowhere near men's high. So men are around 500. Okay. Women without PCOS PMOS are typically under 45. And most women with PCOS PMOS sit between 45 and 100. Okay. So and then in adult women, we also look at the ovaries and we see are their ovaries big and are they filled with uh eggs that are starting to mature? There are no cysts in polycystic ovary syndrome. Interesting. They're called follicles. Yes, yes, and that's and that is part of that's part of why we went to the name change. But in order to be diagnosed, teenagers, you have to have the irregular periods or the the high androgens either in your skin or um by blood work. And in adult women, or eight years past your first period, you have to have two of the three, and that can include then the ovary findings. So that's how we made the diagnosis. Yeah, and that's why the name was originally polycystic ovary syndrome. And the cyst is now it's different, probably crine metabolic ovarian syndrome.

unknown 18:52

Wow.

SPEAKER_03 18:54

Right. Well, I mean, I get that though. I mean, like I would say like the biggest thing I had were the actual cysts, and they were very painful, um, and especially when they burst and stuff. But um my cycles were short. So they were like, um, and so nobody did anything. And then I I had a really hard time. Um, I I miscarried twice. And um when we all go, they would be like, it's fine, you just need to lose weight. And I'd be like, okay, you know, like they're like, you just just need to lose weight, you need to lose weight, and you'll be fine, you'll be fine. And then oddly, sorry, weird, weird squirrel story. Sorry, brief brain. Um I went on um, I won this trip at work after my miscarriage, and I took a break. I had to take a break. It was called a um for some type I haven't forgotten. Anyway, you won the Fred Linux Club. You went to the city.

SPEAKER_05 19:44

We used to work together.

SPEAKER_03 19:45

Yes, that's great, Kat. I went to Hawaii and when I was there, because of the time teacher something, my cycle got off. So I had like a 30-something day cycle and I got pregnant and I had my son. I've never been able to get pregnant since.

SPEAKER_02 19:57

Isn't that weird?

unknown 19:58

I know.

SPEAKER_02 19:59

You ever brought the word luteal face defect up to you?

SPEAKER_04 20:02

No, nobody gave a shit. Like I know about luteal phase because I I read the woman code. No, I was just fat and needed to lose weight. That's what I got.

SPEAKER_02 20:11

No, well, luteal phase defect is where eggs are like eggs, like chicken eggs. So in PCOS, you know, most women have kind of two to four eggs that start maturing. Um, in PCOS, you've got anywhere from like 11 to 20. But when you ovulate, the the egg that can be fertilized, and I kind of think of that as the yolk, is released. And that's what goes down the fallopian tube to get fertilized. What's left behind is called the corpus luteum. Okay, that releases well, no, the shell.

SPEAKER_04 20:50

The shell. Oh, the shell, okay. Okay.

SPEAKER_02 20:58

So the shell is left behind, and it's called the corpus luteum, and it secretes progesterone. And what progesterone does is it fluffs the blankets of the endometrium, the lining of your uterus, so that that fertilized egg has a nice little place to implant in. And so many women that are having shorter cycles, they ovulate and then their corpus luteum goes away too fast. And when you have a drop in progesterone, and we actually copy this to make people have a period, when you have a drop in progesterone, it makes you um have a period. So you could have been getting pregnant, but then instead of getting to implant into the nice, you know, fluffy bed, yeah, it's been thrown in the washing machine. So that cycle that you had in Hawaii would be represented. Representative of your corpus luteum staying intact. Wow. So then you had enough progesterone.

SPEAKER_05 22:06

A baby.

SPEAKER_02 22:07

It was a startup postropedic, is what perfect, right?

SPEAKER_03 22:12

There you go. Oh my gosh. Isn't that crazy that nobody told me that? Don't like, don't you find this? And then I had two miscarriages and went to a specialist and had them look at all my business and them to be like, you're fine. There's there was no pill. And I I hated that because I was like, wait, I don't understand. There should be a thing wrong, and then you give me medicine for the thing. And they were like, no, just go ahead. You know?

SPEAKER_02 22:35

No, you start taking progesterone. You watch when you ovulate, you have sex when you ovulate. Assume that you've gotten pregnant, and then you take progesterone to maintain the endometrial lining.

SPEAKER_04 22:44

It's pretty fine. But my gynecologist told me to, she said I would not qualify for fertility drugs until I lost about 40, 50 pounds.

SPEAKER_05 22:54

That's what they told me to just win.

SPEAKER_04 22:56

It didn't happen, but everything works out just fine for a reason. But yeah. But yeah.

SPEAKER_03 23:02

But it's crazy that nobody like tells you these things. Like it's like, you know, I just, if you're within kind of like a window, right, of probably okay, right? And you're and you and you're overweight, that's this is what they're gonna say every time. Is it and it's not that I deny that losing weight doesn't help. Losing weight does help, right? But why am I still overweight? Right. Like that was the question that nobody was like, and I think it's probably for reasons that we all know, right, that I don't think people really understood it, right?

SPEAKER_02 23:31

Metabolic disease until the past, I don't know, 10, 15 years in terms of like I think it's also, I think it's also this really extreme body size bias in particular from the health professions. But, you know, I have to tell you, that's been uh, you know, that's been a uh, you know, um, you know, really up for discussion in the United States. I would say at least for the last 15 years, really, and treating people for who they are and what conditions and symptoms they're presenting with, not just looking at their body size and dismissing them. Yeah. And I have to tell you that they just approved uh semaglutide for use in teenagers in Australia. And it was approved, it was approved in August. And I went over there in September to teach their adolescent doctors how to use these medications in teenagers and everything, the the body size bias overwhelming. And you know, you you vaguely remember, and I'm sure you guys have experienced more, so you'll remember more. But, you know, I remember when this was, you know, we really started talking about it and thinking about it and evaluating people for who they are and their symptoms.

SPEAKER_05 24:52

Yeah.

SPEAKER_02 24:53

And I would say we still have a long way to go in the United States. Oh, but I was blown away. These teenagers, they just need to exercise more and stop going out to eat with their friends. They don't need a weight loss medication. We shouldn't have to do this. Why are we putting our children on medications? And I'm like, well, because they're getting type 2 diabetes. And when you get type 2 diabetes as a teenager, they type 2 diabetes in teenagers, it's really aggressive. They're starting to lose kittens and have heart attacks and strokes at the age of 30. Oh my god. But we're not gonna put them on, we're not gonna treat their extra weight.

SPEAKER_03 25:33

And not like everything I've ever thought is out the door now that I know that. I mean, I always was like, we should really consider it, but now I'm like, do it. Yeah. So it's really aggressive when it starts in child in adolescence?

SPEAKER_02 25:47

When it starts in teenagers, it's super aggressive. And um, you know, my my boss just retired, Dr. Zeitler, but um, he actually wrote the first case report of type 2 diabetes in kids way back in the day. And then he led this very first trial looking at can we treat kids with type 2 diabetes like adults with type 2 diabetes? Absolutely not. Um, and then they followed all of those, you know, kids in that first trial all the way out. Um, and fatty liver disease, you know, um fatty liver disease is now the leading cause of liver transplant in women with an average age at the end of the uh end of the 20s, early 30s, and you get fatty liver disease, you get mass old, metabolic associated steatotic liver disease.

SPEAKER_03 26:42

You see that we see that in five-year-olds. Have you been on our friends podcasts yet? Have you been on our have you been on downsize? Okay. No, you you're the first.

SPEAKER_02 26:51

I talked to you, used to be, and you're the first ones. You guys are the first one to follow me up on my uh comment.

SPEAKER_03 26:58

I know everybody. We win the prize. Time to cycle around. So we'll get you with we're gonna get you with our friend Dave on the pen. We'll get you a downsize if you haven't got one of them yet. Um, we have some of the friends too, but those are like the two like real big ones. And Mike and Zach. Yeah, and oh yeah, Mike. Oh, for sure. Mike's on Dave's show. We could do both, yeah. No, Mike and Zack out something. I did a dude. They have their own show on Dave's show.

unknown 27:21

Yeah.

SPEAKER_02 27:21

For for downsize, they were doing little clips there at yes, they were I did a clip for downsize at the meeting.

SPEAKER_04 27:28

Okay, so we don't technically win, but you know.

SPEAKER_05 27:31

Well that was pretty easy. Yeah, you hear me, Christopher.

SPEAKER_04 27:37

Christopher and Lorraine, we love you. Yes.

SPEAKER_02 27:42

Um, we love that. So we Lorraine is. So we yeah, they were super funny. Yeah.

SPEAKER_04 27:47

They are great.

SPEAKER_02 27:47

Okay. So we've got these individual conditions happening in teenagers, right? Yes. Yeah. But what happens in our teenage girls is they get this little bit of extra testosterone. So we've got extra testosterone and we're a teenager. So when we go through puberty, we need to grow, right? Yeah. Grow taller, things like that. So where insulin works in our body, in particular our muscle cells, it comes into the same what we call receptor. So it comes into the same place in our muscle, and it can either go to using and storing sugar, or it can it can turn on making protein and growth. And so what happens is our our bodies are amazing. So when we go through puberty, we need to grow, and we say to these receptors, hey, when you see insulin coming up, we're not going to pay attention to sugar as much. We're going to take this and make more muscle and growth. And so what happens is that's called insulin resistance. So the insulin comes to where it's supposed to work, but it doesn't work. So in puberty, kids are very insulin resistant. Yeah. So if a kid drinks that nasty sugary drink when you're pregnant, the oral glucose tolerance test. Yeah.

unknown 29:17

Yeah.

SPEAKER_02 29:17

So we did this. So we did the next study trying to see if we could prevent two diabetes. Yeah. And the kids make three times as much insulin just because of puberty.

SPEAKER_03 29:28

Mm-hmm. You know, yeah. It's gonna be weird real quick. My sister is wrote this book before she passed, and she had a liver transplant. She had no obesity, she had this whole other thing. Um, but this um this this part of her book talks about the doctor that invented insulin or that came up. Oh, yes. Right. And she talks about like how he he kind of comes from like nowhere nowhere, and how he came up with this and how they were treating children with this, and how when they would go and treat the children with the insulin, right? And they would just like come back to life, you know? What like massive, amazing discovery was and like just what that meant, like for just the future of everything. Like it's it really is fascinating how important it is, you know.

SPEAKER_02 30:14

Yeah, exactly, exactly. Super important. Yeah. So we've got teenagers who have high insulin, and then what happens when we struggle with weight? Um, then our insulin goes up as well. Our insulin doesn't work as well when we struggle with weight. Um, and in particular, if we're struggling with weight because we're drinking liquid carbs. Humans aren't designed. Our bodies do not know what to do with liquid carbs, right? They go carbs. No, well, think about it. Think of did hunters and gatherers have juice? That's regular catering. That's yep. There you go. Give yourself an insulin spike. So our bodies don't know what to do with liquid carbs. So what they do is they chase them with these massive amounts of insulin. But then we're struggling with weight, so our insulin doesn't work very well. So now you've got this teenager who's a teenager with extra insulin, who's struggling with weight with extra insulin. And then what can happen is in some people, not everybody obviously, but in some women and teenagers, their ovaries are a little too sensitive to insulin. And so the insulin, the way I explain it is the insulin confuses the ovary and it makes the ovary make extra testosterone. And this is so the old name, PCOS, is focused on the ovaries and focused on testosterone. And people are told to go lose weight, and they're like, why on earth would I lose weight for an ovary condition? What is wrong with you? And this makes no sense.

SPEAKER_04 31:55

But it's like a chicken and an egg thing, like, because if you have PCOS, you have to lose weight, but PCOS is preventing you because you have that insulin resistance. So what the hell?

SPEAKER_02 32:06

So that's where it's exactly, and so that's where it needs to be much more specific. And so, you know, those are some of the things that we're really trying to work on with our research and really with this explanation and name change as well. So the first word, poly means many, endocrine is hormones. Yeah. So we've now talked about testosterone and insulin, and I'll talk about the other hormone that plays a big role, cortisol. So we've got three hormones that play a big role, right? So polyendocrine. Yep. Metabolic. Well, what happens? What happens when you have testosterone and insulin? So let's think about the difference between men and women. Okay. Men snore more. Men have a lot more diabetes, men have more diabetes, men have a lot more fatty liver disease. Yeah. Men have worse heart disease because they have worse high blood pressure and worse high cholesterol.

SPEAKER_05 33:12

Yeah.

SPEAKER_02 33:12

Insulin, testosterone, bad. So what happens when we have females who have high insulin compared to females who have high insulin and high testosterone? All those metabolic risks that are worse in men are also worse in women with PM metabolic OS. And what's been happening is they come up as a teenager, they don't have normal periods. The doctor says, take this birth control, go lose weight, come back when you want to get pregnant. Yes. They can't get pregnant, they have miscarriages, they go to the doctor, they get told to lose weight, you know, finally get into IVF, get pregnant. IVF doctor is not your gynecologist, that's not who delivers you.

SPEAKER_05 34:02

Right.

SPEAKER_02 34:03

You go to a different doctor who doesn't know that you have PMOS and that you are a high-risk pregnancy, that you are much more likely to get diabetes in pregnancy if you haven't already gotten diabetes. You're much more likely to have a preterm birth. So baby comes out early, you have high blood pressure in pregnancy, right? Well, it's just an ovary syndrome. Why would I say anything to my delivering doctor? Because I'm pregnant. So who cares about the ovary? So you've got all these pregnancy complications. This medical information isn't passing on, right? Well, then we go through the pause, as you said. Yeah, the pause. And we're like, oh, our ovaries don't work anymore. We don't care, it doesn't matter. Yeah. After menopause, women who had PMOS still have that increased risk of all of that cardiometabolic disease. They need to be tested more often. It needs to be a high-risk cardiovascular risk. And the American Heart Association put PCOS in their guidelines three years ago. So really they did.

SPEAKER_03 35:17

And so having that isn't that interesting. GLP1 treatments were exploding. I'm just saying.

SPEAKER_02 35:26

Well, yes, but it's just an exploder. You need to be put on statins earlier. Or you can get a GLP one. So all of this, and because of this old ovary name, yeah. True. This was being missed across the board. So it took 14 years to get this name. I was at the initial meeting in 2012 at the NIH when we started talking about it. Um, the Australian government has paid for this entire thing. And no, and it has been led by Monash University and um mostly patient-driven. This is not coming from the doctors. This is us providing the platform and having the patients say what they want. And so that inspires me. 86%, 86% of patients picked this final name.

SPEAKER_03 36:24

Wow. I love that. That's that's really great. I think um, you know, one thing we we've we've been doing the show a few years now, and we had on one of the first doctors was um Dr. Salis Whelan. I don't know if you know her, but she's an chronologist, and um, and she came on to talk about PCOS with us, and um, and she was like, Oh, yeah, like PCOS is insulin resistance. And yeah, she was like and obesity insulin resistance most of the time, right? And then diabetes insulin resistance. She like made this connection and we were like, like, yeah, exactly. You know, like it's crazy. It it it plays such a big role. And I can't even tell you how many times on this platform I've had people say to me, oh no, no, my A1C is okay. And I'm like, that does not mean that you don't have insulin resistance, but we didn't we didn't know and we didn't know when the doctors don't over. I I don't really know why, but they don't, you know, so but it it is insane, like the connection between it, you know. Can I just teach? Yeah, yeah.

SPEAKER_04 37:24

Yeah, just that just makes me think, um, where where does this put us? Like, does this tee us off to like obviously for like future treatments um or the shift in earlier diagnosis, better treatment, maybe, um, changing the way women and adolescents are treated. Um, how is all that that you see forecasting moving forward?

SPEAKER_02 37:48

Yeah, so in a lot of different ways. Um, and so like I said, the diagnostic criteria have not changed. Where we're hoping it's going to um the name change process, not the name per se, but the name change process is going to help is through the efforts of folks like you. And just getting this condition out in the media and saying, hey, you know, what I say is is vi is periods are a vital sign for women. If you are sick or there is something wrong with your body, if you're not taking hormones or something else that's messing with your periods, you need to go see your doctor because something's wrong. And so hopefully getting this message out that if you are having abnormal periods or growing hair and really trying to disseminate even just what this condition is, that's where we're hoping that we'll improve the diagnosis. Not through the name change itself, but through this really active process, right? Where we're hoping that we're going to see um really immediately is better metabolic screening. So um I I run a 19-center um group of PCOS physicians across, so across the country. So um we've got, you know, Children's Hospital of Philadelphia, Children's Hospital of Los Angeles, um, we've got Boston, so hospitals all over the place. And we have been putting in all of the data that we have on our patients with PMOS. And so we've got 1,100 patients in there. And in addition to looking at, you know, what does PMOS look like in a teenager when they first get diagnosed? We also said who diagnosed them, how were they diagnosed, and did they have metabolic screening within three months of diagnosis per guidelines that have existed since 2013?

SPEAKER_05 39:56

Wow.

SPEAKER_02 39:56

So that's been in the guidelines for over a decade. And the screening rates for cardiometabolic disease in our girls with PMOS within three months of diagnosis are horrible. And in our girls who don't struggle with extra weight, it is less than 50%. Yeah, but what our data showed, 7% of girls who don't struggle with weight and have PMOS have high blood sugars. 20% of them have markers of liver inflammation. So, you know, we need to be starting this right now. We don't just sitting there with it.

SPEAKER_05 40:38

Yeah.

SPEAKER_02 40:38

It's just sitting there and they're not being checked. They're at risk for all of these conditions. There's a huge weight bias. You know, the the people in bigger bodies are getting checked more often, but it's still less than 70 to 80 percent for most of the measures.

SPEAKER_05 40:52

Yeah.

SPEAKER_02 40:52

And yet they're at really high risk for this diabetes, right? That that could kill them.

SPEAKER_03 40:58

So yeah, on meds that have been on them and struggled with obesity for a long time, like whether it was adolescence or whether it was later in life. I think all of us, uh women, and this can be for me, too. I'm just being very specific about my women audience right now, female. Um, is that we have been like, wait a second, what the fuck? Like, do you want to like look back? Like exactly what Kathy said, like, yeah, right. Like we've been, we're like, what's what's happening? And then I think that we're also seeing our bodies respond this way and being like, but what about my daughter? What about my granddaughter? What about my niece? Like, because you see them going through the same things and you're like, is it genetic? What do we do? You know, and it's like, okay, well, if that's what's happening and it's happening this early, and we we don't want our kids to have to get to right the the level that we're at, right? Like we don't want them to farm, right? If we could possibly stop, and everybody feels that way. Like, I think everybody ultimately, I mean for the most part, and don't get me wrong, I'm in my pharma era. Okay, I I take it all. I don't give a crap. Like, I this way at this help, I take it all. I don't care, you know, like no. So anyway, but sorry, that got really squirrely. But there are a lot of us that think like we don't want to give our kids like medicine. Like, I don't give my kids medicine. He only just now started taking uh Anvil and he's 13. Like he's that's pretty much all I've ever done. If they've ever recommended anything, it's only been like bare minimum, like because his great brain is still developing and stuff. But if I thought I saw signs in him, when I know I have obesity, I know his dad has obesity, right? I would oh there's sorry that thing, that I would probably be like, okay, like what do we need to consider, right? Because I know that it's a progressive disease. Like I know that, you know, and I don't think people, one, think about it as a disease, and two, think about it as progressive, and also don't understand sort of this underlying dysfunction that you're talking about, right? That kind of leads there, right? So I think what would be really interesting is to understand when we see these things and our children, grandchildren, nieces, right? Um, how do we advocate for them and what treatments are available? And how do we know? I think too, like when are we being dismissed and they're just going to sell it or sign the mama, right? And when do we need to do that and something else? You know?

SPEAKER_02 43:15

Yeah, exactly. So, you know, lifestyle is not food and activity. And I think that's the other thing that we really need to think about. So if if we come, you know, coming back to PMOS, but any any child who's struggling with excess weight, remember I said excess weight causes you to have more insulin, right? And then you have a kiddo with excess weight, and then you go into puberty. Well, now we've got two causes of of excess weight, right? So it's not losing the weight per se. The goal should be to lower the insulin. And things that lower insulin often lead to weight loss. But what I found in one of our Our studies, so we looked at oral semaglutide, oral GLP1 versus diet, um, and uh primarily cutting carbs in teenagers with PMOS and excess weight. And our girls who were cutting the carbs had improvements in their PMOS symptoms, their testosterone came down, they got more periods, their insulin came down, the same as the girls at the beginning of the GLP1 treatment. So, what I think is amazing about that message is food changes, cutting the carbs in the absence of weight loss.

SPEAKER_03 44:42

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SPEAKER_02 45:36

Yeah. Made them healthier. So it's really important and that's why I think we need to get away from this weight loss message. It is lowering the insulin. And I also happen to lose weight. Awesome.

SPEAKER_03 45:48

Yes. So true. Let me just tell you. We had this doctor on our show, it's a good friend of ours now that is um a bariatric surgeon. And it was like our first season. They talked about childhood obesity, and he said this thing that blew my friggin' mind. He goes, Literally, we used to do bariatric surgery on people, and we started noticing that they would be in remission from their diabetes type two before they left the hospital and lost any weight. Yeah. And they were like, and I was like, I was like, what happened? And he goes, because we were taking GLP1 at the bottom of the intestine and bringing up higher, and it was bursting up higher. And then so we were like, let's let's reverse engineer that. Obviously, I'm very much oversimplifying, right? But that blew my mind. Like nobody, nobody knows this. Still, I make videos all the time about this thing, that because this is understanding that it's not your fault and it's a disease disorder and you deserve treatment. That thing right there. But people don't know. They don't know, they think it's a weight loss. Drives me crazy. Well, the only thing they make is make videos.

SPEAKER_02 46:47

You know, I mean, so you know, I I originally said this about antidepressants and mood medications, and now I say it about the GLP ones. If it wasn't a chemical problem, why would a chemical fix it?

SPEAKER_03 47:02

Wow. Yeah. Right? So true. Yeah. Like that's it really does blow my mind. Like, but it's so weird because it's just, it's against everything we've ever been taught, right? So it's very difficult to unwind that and understand that even now, like I'm telling you, like, even now when I look, like my activity is lower for sure. Like since uh since I've been going through the grief, I am not eating more. I'm not eating different, and I'm gaining weight. Like I'm telling you, like, I but I've I've had metabolic disease forever, right? We've talked about this, right? So I mean, it's just like people don't understand that either. They don't understand that your body starts to burn differently in certain like phases and times, like when stuff happens. Nobody knows that. And even I, knowing this, am all like, I guess I got this and I guess I gotta, which I do gotta have those because that's about my health. But it shouldn't be I got this and that because of my weight, because that's not it's about health.

SPEAKER_02 47:58

It's about it and it's about health. And I think it's always a better conversation about health. And it is so this comes back to lifestyle. Some of the things, you know, so what else makes insulin work? What else makes insulin not work and raise insulin levels? Cortisol. So let's talk about cortisol. We're grieving, we're stressed out, yeah, our cortisol's higher. What does cortisol do? It goes to the energy sensing part in our brain called the hypothalamus, and it makes the energy sensing part in our brain say, feed me sugar and feed me fat and give me a lot right now.

SPEAKER_04 48:36

So when you're sad, depressed, um, stressed, and when you have those sugar and the fat cravings, or like okay, or it can be related to so lifestyle is not just cutting carbs, it's not just increasing activity.

SPEAKER_02 48:51

So activity, when you're active, you can take sugar out of your blood without insulin. So you need less insulin. So, you know, go lose weight and chill out, very poor language.

SPEAKER_05 49:05

Yeah.

SPEAKER_02 49:06

Actually, you know, partially medically correct. If you do the things to lower the insulin and they lose and you lose weight, great. Seeing a therapist, managing depression, lowering your daily cortisol can help with some of those food cravings.

SPEAKER_03 49:23

Like I feel like under exactly meditation.

SPEAKER_04 49:26

That's like I makes me think of it's the opposite end for you, Kim. So when I lost my dad a couple of years ago, I went and I think you know, um, cycling, indoor cycling is one of my favorite things. Well, at this one cycle bar, right? Um, and I put up crazy high numbers um because there are points in in class where I would start to like try to, you know, I'd start crying, but then I was like, I can't breathe. I can't breathe. But like I it became addictive. Like I I had I had to go ride. I had to ride every freaking morning. Like uh it was it was you know, some people when they grieve, they they they don't move, they stop. But I I just had to, oh my gosh.

SPEAKER_02 50:10

Um well that's a dopamine addict. So that's that means your brain really likes dopamine. So if you exercise hard enough to cross your exercise threshold, you know, people describe it as runners high. Right, right, you work hard enough, you know. Some people, and you know, back when I was very young, and you know, I played college and soccer, and I've run one marathon, and I will never run another one. Um but when you hit that, when you hit that runner's high, that those hormones, like some people have them big enough for the runner's high, but it's dopamine and it's those pleasurable hormones, and your brain gets addicted to it. So that's I had to do it. This is why I love the hormones. It's weird.

SPEAKER_05 50:59

Yeah.

SPEAKER_04 51:00

Wow. Okay. I mean, I would go to my car and do like an ugly cry on the way home, but like it was like such a release.

SPEAKER_03 51:07

And then exercising is a release. Like, she's not wrong about that. Like, I'm but I think I'm only just now getting where like I think I'm gonna, you know, like I need to be able to handle it in different ways.

SPEAKER_04 51:16

You don't you don't have to be like gung-ho, like the next person. You can yeah.

SPEAKER_03 51:21

I've been on one walk since I died and I cried the whole time. Like it's just it's one of those things. And I also think ex and cat knows me, exercise induces some emotions for me and like release and some crying. And so this is also the mat. It's something about my brain being like, Danny's safe when you're doing that right now, because we'll lose it. Like something's going on in my brain. And so now I'm like, I'm I'm getting that's why I was like, I'm gonna order some weights and this, like, you know, so like I'm taking steps, it's just they're very, very tiny, you know, like, but I'm head of there and I can do it because I've done it 850,000 to a million times, right? And and now I have GLP1, so I'll be fine, you know, but it's still frustrating, you know.

SPEAKER_04 51:57

Could I mean this may be an obvious well duh, yeah. But so like say um stress and life events could exacerbate your PMOS, right? Because it's the cortisol, right? Okay.

SPEAKER_02 52:10

And the the the last big piece to this that relates to cortisol is sleep. So if we have a nice night's sleep, your cortisol drops. Cortisol has what's called a diurinal rhythm. Dye means, you know, just that it varies and through the day. So your cortisol is highest in the morning, gets you revved up, out of bed, getting going, and then it slowly drops through the day. We feel kind of crummy in the afternoon. And then if you go to sleep before midnight, if you're not a shift worker, if you stay asleep for at least seven hours, and you don't have obstructive sleep apnea, then exactly, then your parabenopause will drop down. Well, yes, exactly. That's part of the reason that that is part of the reason that women going through menopause gain weight, is they lose, you get the hot flashes at night, yes, and you lose your core your overnight cortisol drop because you're awake. See, aren't aren't hormones cool? So anyway, they're very powerful. They are so there's so there's your last, there's your last piece. So this is where I'm saying it's not you don't go lose weight. It it it is a comprehensive lifestyle to figure out to lower.

SPEAKER_03 53:35

It's a management, right? Like it's not even a lifestyle changes, it's like a management. Like you're you're managing your disease with all of these different things, like medicine, movement, right, meditation. Oh, they're all imps. Like, right. Oh uh. But like seriously, like that's kind of what it is, right? It's like you know you were in this state, you have this thing, yeah. And so you're just doing these things to treat it. Like, I wonder if people saw it that way instead of seeing it as because I think when people, in my opinion, who have been in big bodies most of their lives, especially if they were young and distressed, right? When you say lifestyle changes, just in there, we're thinking about name changes. I'm just saying, um, lifestyle changes, they hear diet culture and they hear it's their fault. Like there's some there's some emotional mental stuff there that's very deep. And I'm like, we gotta call it something else.

SPEAKER_04 54:19

Like I told Kat, I was like, Lifestyle change can be going to therapy, you know?

SPEAKER_03 54:23

Yeah, like but lifestyle changes is what we consider dismissive because that's what happened, right? So I can't, I feel like there's gotta be a different way for us to communicate. This isn't about yeah. This is about health. You know, there's about how right, it's about the health. Yeah, it is exactly you're just treating the health, and then weight loss follows. And guess what? It's probably only gonna hit a certain amount. Some people gonna go all the way down, somebody going a little bit, like, but you can only do what you can do. You do the pieces you can do, and the rest just has to be worked at God or medicine or whatever, you know?

SPEAKER_02 54:54

Like that's just and it uh it also has to be what is right for you and your your body. So the what I really like about the the PCOS guidelines that I actually feel have really helped me as a physician is with the exception of making sure that somebody's uterus is healthy, if we don't have periods, we increase the risk for endometrial cancer. Um, it is six to eight times higher in women with PMOS. Um, with the exception of making sure that we're doing something to make the endometrium, keep the endometrium healthy and medications for type two. Whatever the patient wants to do and wherever they want to start is where they start. And what I say is my job is to open the buffet and make sure you know what everything is. And you start with what feels right for you, your family. So, you know, for one person, it may be getting them into therapy, treating their depression. Now they have the energy to have activity, they're sleeping through the night, right? Another girl that I had snoring like a freight train, woke up in the middle of the night, went downstairs, ate blocks of cheese. We did a sleep study on her. She had these massive tonsils, took her tonsils out. She lost over 50 pounds in six months because we're sleeping through the night. We don't have we're we now get cortisol, and we're not going down. We're we have the energy to exercise during the day, we're not coming home and going to sleep after school, and we're not eating cheese at midnight. So and then all her periods came back. And her PCOS was completely managed. But so for her, it was tons and sleep. She just needed her tounsils out so she could sleep. Louise 14 years.

SPEAKER_03 56:51

Oh my god.

SPEAKER_02 56:51

Exactly. So that's where you kind of have to look at the big picture and see, you know, where where are we where are we gonna start? So these are some of the things that were, you know, one, I've been really trying to understand what is the insulin status in girls with PMOS, and is it the same in girls with excess weight or girls without excess weight? And that was some of the very early work that I did when I came to Colorado. And teenagers with PMOS, regardless of weight, have high insulin. And I call it pre-bre pre-pre diabetes. Coming back to what you said before. Well, I have normal blood sugars. Yeah, because they do and once you have normal blood sugars because you're hemo because you're making a ton of insulin. So then you say, Well, why don't you uh measure my insulin level? We don't have norms and we don't have a good reliable test. This is why we don't have consistent insulin measuring. If we had consistent insulin measuring, it would be so helpful, right? Because if your doctor is saying, hey, you've got high insulin, let's bring your insulin down, yeah, you're like, okay, well, you know, give me that level. The same as hemoglobinal and C, right? Oh, that level's too high. I need to do X, Y, and Z to bring it down.

unknown 58:16

Yeah.

SPEAKER_02 58:16

Well, we don't have a good test. So if we can get a good test, then we could start using it medically. And I think then the message of decreasing insulin. So what about type 1 diabetics? How do they measure it? We don't. We measure their sugars. They don't have insulin. Sugars. We just treat yourself.

SPEAKER_04 58:35

Yes. So we so we need uh an insulin level test, right? That's the one of the missing pieces that because we're bringing this all together.

SPEAKER_03 58:47

But but it was for a long time.

SPEAKER_02 58:50

Um so we don't, I mean, you know, some physicians, you know, they they may order it all the time and they may be going to the same lab and they have a large amount of patients that they order it on. And so they may have a sense of, well, in my lab, if you don't struggle with weight and you exercise your insulin and you're an adult, your insulin is going to be nine or less. If you exercise, struggle with weight, exercise makes a huge difference to insulin levels. If you exercise, struggle with weight, don't have obstructive sleep apnea, you know, maybe you're going to be 10 to 16. And that's what I just expect about your physiology. So that's where we just don't, we don't know what's one, we don't know what's normal, and then two, the tests vary so much. But you know, if your doctor's checking your insulin.

SPEAKER_03 59:43

Do they do studies on this? Like, we're going to change this thing and see how it affects insulin? Like, absolutely. So those are the studies that I do. Oh, you do? So does when you exercise and it helps manage insulin, is that what is the reason for that? Like, what's the what's happening in the body that it's happen it's helping manage insulin levels?

SPEAKER_02 1:00:03

So one, when you're actively exercising, um when it's happening is when you mean actively. Yes, when you're when you're actively exercising, yeah, the process of exercise um brings the sugar receptors to the blood. So normally you need insulin to bring the sugar receptors to the blood so that your muscle or your fat can take the sugar out of the blood. So that's how insulin works. And when insulin doesn't work well enough, you need super high levels of insulin to bring those insulin receptors to the surface.

SPEAKER_05 1:00:44

Wow.

SPEAKER_02 1:00:44

When you exercise, the process of exercise brings those um brings those sugar receptors to the surface without insulin. So this is why when people run marathons and they don't take goop and they're exercising for a long time, their muscles are pulling the sugar out of the blood, even though there's no insulin, and they end up with a low blood sugar.

SPEAKER_03 1:01:11

You explained the muscle in the beginning. It's all connecting now. Okay, wow. And so that makes you process it better, but that's only happening, let's say, one, if we're lucky, like 30 minutes to an hour, let's just say a day. So that's if you do seven days a week. So, but over time, like something's going on within your body that's helping like kind of maintain that, not while the active exercise is going on, right? Yep.

SPEAKER_02 1:01:34

So there it helps. Um it's like turning your body from a VW bug into Ferrari, right? So even if you're cruising along, not doing very much, that bug is gonna use is gonna be way less efficient, right? And you know, that Ferrari is just gonna be super efficient. So what it does over time, so now we're talking a training effect, right? So over time, you make all of the machinery in your muscle and in your fat use sugar better. And so over time, then when you use sugar better, you need less insulin.

SPEAKER_04 1:02:19

But how permanent is it with just life lifestyle, with with just exercising? You know, like you detrained very quickly, so yeah, because I I was very heavy um and still exercised. So I actually did too.

SPEAKER_03 1:02:36

And I think we're different, but I did all the sports, I did dancing, like I was still there, yeah. I've always been like this forever.

SPEAKER_02 1:02:42

Yeah, but I could never did you get poor, were you stressed? Were you getting poor sleep? Were you doing your liquid calories? And then this is what really and then there's our entire name.

SPEAKER_03 1:02:55

I was never drinker or anything like that. I just drink because I get I get the hunger and the thirst signals get mixed with the GLB1 in the brain, right? So like sometimes I'm like, I gotta drink something, and so I drink a Gatorade. But like, no, I've never, and it's even easier to say no to sugar drinks now than it ever has been. But I didn't. I was I was like cat, I did sports.

SPEAKER_04 1:03:16

Like, but I was about like adulthood, like in my well into like my 40s now. Like I still I always exercise.

SPEAKER_03 1:03:23

I was I was into it wasn't until I was out of college that I wasn't doing those things. Like, you know what I mean? And and um, and then it was always like, okay, it's been six months time trying to try to lose weight again. Okay, lost some, it's back. I give up. Okay, fine. And then six months later, all right, I gotta lose weight again. That's been my entire existence.

SPEAKER_04 1:03:40

Like, you know, no, it this makes me think of something because it was at Dr. Gordon.

SPEAKER_03 1:03:44

You're getting on a GLP one, right? Life's got it.

SPEAKER_04 1:03:49

Dr. Gordon was talking about the biggest loser, and it wasn't really like the starving that they were doing, it was the massive amounts of activity that they had them do. That was that makes me think that's the insulin connection where they were working out like athletes eight hours a day, and that's what was yeah.

SPEAKER_02 1:04:11

So have you ever read of like affecting change? You want now? Oh, I was just gonna say if uh Michael Phelps needed he found eating to be a chore, the amount of the he had to eat 9,500 calories a day to maintain his weight because of how of of what it takes. So I you are it is it is absolutely both. But I think it's very important to realize, again, we need to come back to this message of health. Yeah. So exercise in the absence of weight loss is still fabulous for your heart, for your brain, significantly decreases cardiovascular disease risk, decreases heart attacks, decreases strokes, even if you don't lose weight. Yeah. So again, coming back to that message of health that you're talking about, you know, and it but you're not failing if you're not losing weight and you're doing one of these activities. You are still doing good for your body.

SPEAKER_03 1:05:18

And I think that's really important to get away from telling people or failing at all when it comes to this. I really do. Like it because the things that we're talking about, plus you add in, right, life, like losing your job, losing your sister, losing what, like whatever. Like there are so many things that affect sleep, cortisol, hormones, like time stages of life. Like it's at the point where we're like, if you're not, if you don't have this every moment, having this like super Herculean effort, right? Where you are whatever, whatever, and whatever, all together at the same time, and you're a Ferrari or whatever. And if you're not doing those things, because that is exactly what we think, you know? Especially Actually, been like this forever, right? And then why does this concern me? And I'll tell you. This is and I want I just want you to let you know. This concerns me because what happens is eventually people on these treatments hit, they're doing everything. Okay. They stop, they're done. They lower and lower and lower. And then they get to the point where they're like, what do I do? Eat a thousand calories a day and they're an adult. And the answer is that's what that is what they think they need to do. I've seen people in my comments say they're eating 500 calories a day to try to get the goal weight because that that size equals success, right? So, and I and I'm I've always been a big body. So even me at a size 14, size 14, 16, 12, like this area for me, that's fine, right? But there are people who feel like that equals I've done everything right. And they will, because of this mindset, restrict themselves so significantly that they're gonna starve themselves, they're gonna hurt their muscles and their organs and all and I know it does and the brain. You would not believe the stuff that people do in my comments too, because they think the answer is to continually lower calories and know how no matter how much it low it takes, right? And we and you and I also both know there's gonna be a point where the body's gonna be like, mm-mm, right? And I think like, or you know, you're starving yourself, you have these horrible things that you're doing to your organs. And I it's I don't know if doctors know about it. As I mean, I think they know like it exists or whatever, but it lives in my comment section.

SPEAKER_02 1:07:28

Like, well, I I treat, you know, teenagers have lots of disordered disorders. Yeah. So you know, and that's actually one of that's actually a really big topic right now. Um with so much disordered eating, you know, some of my colleagues won't you many colleagues and many recommendations say don't use any GLP1s in anybody with disordered eating.

SPEAKER_03 1:07:54

Everybody has disordered eating.

SPEAKER_02 1:07:57

I actually, you know, in there are certainly people who really need to deal with how things always a place and a time, but it is being applied way too broadly.

SPEAKER_04 1:08:09

Yeah. Right.

SPEAKER_03 1:08:11

Disordered part where you have to be like Kat has been busy forever, and she's like, you would not believe how much disorder eating is like it is not on body size, it's just not, you know, and I can't look at one to two. What's the driver of that? Like, it's not that there aren't other things that affect disorder eating. We know that there are, but we also, and a lot of that happens when you're young and you're trying to control things, right? And we also have the same three standards, right?

SPEAKER_02 1:08:37

I was gonna say we were all kids during Cosmo, right? Weren't you looking at Cosmo when that was when Schiffer came out and it was all about the supermodels?

SPEAKER_04 1:08:46

Cindy Crawford. We were in the era of the supermodels, Cindy Crawford, Nick Homey.

SPEAKER_03 1:08:51

I mean, it's really started coming in. I guess like 15, and I bought this book to help me lose weight. And the book advised me that whenever I hear my stomach growling, that I should be happy for that because my body's eating itself and I'm going to get skinny.

SPEAKER_02 1:09:09

That's the kind of shit. I heard that too. Whatever you, I mean, whatever problem. So yeah, but it comes back to really focusing on this message of health and weight loss or weight gain is is not a is not is not failure or success. It is a byproduct of taking care of yourself.

SPEAKER_03 1:09:29

And I think that's and I think there's always readjustment too, right? Like, hey, Kim's gone through, I'm just giving me an example because I but like Kim's gone through, and Kat give a really good example with the menopause, right? But like Kim's gone through loss, right? Shape, she hasn't been moving. She hasn't, I'm not eating, I'm not overeating, but I'm I'm also not really moving and not really sleeping. And you know what I mean? Like all of those things are affected, would have which have caused Cortisol, yeah. Cortisol, right? All those things we just talked about. So does Kim equal fail, or does Kim go to a doctor and say, you know, okay, this is where I'm at? And we go, okay, then we need to adjust your treatments, right? Is it we add another GLP one? Is it that we um, you know, consider like what are we eating right now? Like, is is it more carb heavy? Like, okay, let's look at that. Okay, let's just adjust it. Like, I think that people think that it's set it and forget it. And I will just say for most people, that's not the case because of all of these things we've talked about, the complexities are complete, right? And like you're gonna have ups and downs. I can't even tell you my mama is 70 and she's on GLP. And she will go, you know, we just traveled. She just came home the other day. We just traveled, we went up there, and you know, dad lost five pounds and I gained three. And I was like, Mom, do you really think that you gained three pounds of fat in a weekend?

SPEAKER_02 1:10:45

Because I because that's no, she ate a ton of she she ate and hasn't pooped yet. I mean, it's early.

SPEAKER_03 1:10:52

But I'm telling you, that it's that disordered, like in in the like if doctors ever wonder what's really going on, you go on the comment section because they will come to us or they come to you.

SPEAKER_02 1:11:04

I do go, I do go look.

SPEAKER_04 1:11:07

Oh, you know what? I got a question for you. Now think about it too. So mothers, that's certain narration, almonds, the almond moms. Um, do you have to kind of sometimes toggle the road between the almond mom parent and the child and where is it intersect? Sometimes maybe a parent might be a little too like, well, they just need the same thing, dismissive. You just need to start moving and yeah, um, how do you navigate that interception?

SPEAKER_02 1:11:38

Absolutely. And I mean that's that's really we don't just have a patient like adult doctors. We, you know, and you know, everybody's within their family circle, but within the scope of a child, they're not in control of their diet. I think the ones, to be honest, the ones that bother me more are she should just have control. And I don't have to change my eating ways. And her younger brothers are skinny, so I'm not gonna take away their soda and I'm not gonna take away their chips. She just has to have the control to not eat it. So there's that that I feel is you know, but you're right. There, I mean, so it's kind of going along those lines of what you're saying, like it's just their fault. I think that's that's where I struggle the most, yeah, is when as a child they are not being supported and in no way, shape, or form are being set up for any kind of success. Being singled out. I don't keep desserts in my house, they're gone. Right? The kids got pissed at me. I finished their uh I ate their Easter treats because they didn't hide them. I can't like I cannot control myself around. I just can't have candy.

SPEAKER_04 1:13:00

I love it.

SPEAKER_02 1:13:01

Yeah, you don't need it on eating it. Get it out of this house. Exactly. So, yeah, so certainly in our adolescence, it's it's definitely challenging. And um, you know, I've I've one of the things I really like about taking care of patients to 18, 19, 20 is I do see some of them getting out of unhealthy homes.

SPEAKER_05 1:13:22

Yeah.

SPEAKER_02 1:13:23

And, you know, getting control getting their own control of their diet and their stress management or getting away from a stressful situation and just seeing them be able to take ownership, yeah, um full ownership of their lives and just blossoming. That's great. Yeah, yeah.

SPEAKER_03 1:13:39

I love that. Well, that must be that was very rewarding work. I can imagine. Like, you know, I I didn't I didn't know any of those things about that early onset piece. It makes actually a lot more sense now. Cause I I kept thinking, even to myself, even know all that I know about this, right? Only from a patient perspective, right? But um, but all that I know about this, and even then I would be like, God, it'd be really hard for me to choose to put my 12-year-old right on it. Like I'm like if we had tried all the things and they hadn't worked, like something like that. Like, but I get it. Like I get it because because the whole goal, it sounds like, and it also sounds like we're still learning, is to try to get it in the control now before it progresses. Right. Exactly. And I think that's right, what you're saying. Like they're the way it's being diagnosed, what they're calling it, and hopefully, I guess the extension of telling, you know, um, I would say I think like pediatricians as well as you know, regular like PCPs, what to look for.

SPEAKER_02 1:14:29

Well, and our geriatricians and making sure, I mean, I think the the two areas we really need to focus are the areas where we don't think about the ovary as much, right? Yeah. We really need to be focusing on our teenagers, and everybody who's in menopause now needs to think back and say, well, gosh, did I have PMOS and I haven't talked to my doctor about my increased risk status? Or did I have symptoms that maybe would have supported this diagnosis and I wasn't diagnosed, but I may have this increased risk. But I, you know, everything in medicine comes down to the risk-benefit ratio for the individual. And this is where we are so shortchanged in American medicine by the time constraints of our appointments. I am amazingly fortunate in endocrinology that my appointments are 30 or 40 minutes. We can actually talk about risk and ratios, right? So it may be that you need to, you know, and so they say that if you really want to be successful with losing weight, you need to see a patient every three to four weeks. Yeah, I get it. Wow. I have to wonder if that's be I have to think that's because our contacts are so short. Um, but you know, think about it. You your doctor's like, you you go in, you get all energized, you go home, you're doing it for two weeks, and they're like, oh, just kind of something happens, right? You stop doing it, and then you're like, oh, my doctor's appointment's coming up in two weeks. I've been let me get it together. Right? So if you don't go longer than six weeks, sustained, right? Like, I mean, it's a big thing. Yep. So if if you do four to six weeks, your slack is less.

SPEAKER_05 1:16:17

Yeah.

SPEAKER_02 1:16:17

If if you are the kind of person who responds to how to, and it doesn't have to be a doctor, it could be a dietitian or um, but I also think that's because of the short the short context.

SPEAKER_03 1:16:28

A good opportunity there, I think, with dietitians. We've had a couple on our show to be the person PCP to possibly be there to ask more questions about GLP. Like there's and then disease and management, all things, right? Like, but um there I think there is opportunity there because they actually have, I think, a little more space, right? And to be with because if not, they come like I hate to say that they come on the they come on the internet and they ask me. And like, so my response to them is this is what I learned from doctors. Here is the language to go talk to yours because I am a mercy on the internet. You know what I'm saying? Like, so they come to me because they are desperate, because they don't trust doctors. Like, it is a it's a massive problem. And like, even I tell you all the time, even me who have friends that are doctors because of the show, right? I still, when I have a question, will go to my community and make a video and ask them what it's been like for them before I will ask my doctor. Isn't that crazy?

SPEAKER_02 1:17:20

Like that I've fired doctors, I'm a doctor who's fired doctors, and I'm a doctor who's sued doctors. So you know, I mean, it's I don't know the jokes that we have.

SPEAKER_03 1:17:38

What's the joke?

SPEAKER_02 1:17:39

What's the name of the person who got the lowest grade in medical school?

SPEAKER_03 1:17:44

Uh I don't know. A doctor?

SPEAKER_02 1:17:46

Doctor.

SPEAKER_05 1:17:48

Right? Like, there's a threshold.

unknown 1:17:51

I get that.

SPEAKER_05 1:17:52

Yeah.

SPEAKER_02 1:17:52

Love it. I love it. Yeah.

SPEAKER_03 1:17:54

Um, I think before we go, if you would tell us a little bit about what you've maybe seen in the trials, because I know, you know, there's not, from what I understand, there's not like um it's our last one. Um, but there's not like a medicine that's been like, yes, this is an indication for PCOS, right? Or now we write PCOS, right? There's a because I know a lot of my friends took metformin, right? Um, with PCOS. And they were like, some of them were like, yeah, how you lose a little bit of weight, maybe get pregnant. Like some people are thinking it's great, but most people I talk to are like it's garbage, right? And I'm curious, like, is there one? Is this a possibility of one, maybe with studies? Like, do we think there's a possibility of that, or is that are they always going to kind of be like, eh, it's obesity, you know, and it's diabetes.

SPEAKER_02 1:18:37

No, so metformin makes insulin work better.

unknown 1:18:41

Yeah.

SPEAKER_02 1:18:42

It's not the headache. If you don't do lifestyle changes with metformin, you're not going to see much change. It's not actually a weight loss medication. It makes you a little bit nauseous, so you don't eat as much because you feel crummy and you don't have as much in your stomach. And sometimes when you get huge insulin spikes and then your insulin drops, you get food cravings. And metformin helps smooth out those insulin curves. So it helps those food cravings go away. So metformin is for the high insulin in PMOS. Birth control pills bring down that testosterone really fast. They get rid of the androgens, they help clean up the skin, they're gonna give you a period, and especially for teenagers, they have a period like their friends every month, but they and this is this is research that we're doing right now. What, and we just did this with our statistician on Tuesday, so you're gonna have to wait a little bit for this to be presented. But in our girls, it'd be wonderful. Yep, part two, there you go. In in our girls with PMOS who don't struggle with weight, they're not gaining weight with birth control pills, which is what our gynecologists keep saying. Interesting. Birth control makes insulin work less. So maybe in our people who don't struggle with weight, it doesn't matter. But in our people who do struggle with weight, and now we've got PMOS, in our individuals who have a bigger body size and PMOS, and when we put them on birth control pills, they gain weight. And that is what all of the endocrinologists have been saying. So we are showing this in our US teenagers. Those are the two treatments for PMOS and comprehensive lifestyle. Then there's specific things for certain symptoms. So to your next question, are we going to have a medication approved for PMOS? Yeah. Not anytime soon. Um, PCOS Challenge has been the major advocacy group um in the United States. And Sasha OT, who runs it, is absolutely amazing. And I've been an advisor with them for a long time. Um, they do um meetings with our senators. PMOS was not a condition that you could look up, or and well, as PCOS, the former name, you couldn't look it up because it wasn't a listed diagnosis within our NIH grants to even see how much funding went through to it. It wasn't a nameable condition within all of the government registries. They made that happen. And um, it wasn't part of the FDA in any way, shape, or form. So PCOS Challenge, along with some of my um colleagues who also do a lot of advocacy work, um, colleague physicians, Anuja Dokris from uh the University of Pennsylvania and uh Sasha with PCOS Challenge led the very first listening tour of the FDA on the condition of PCOS in December of 2023 to even get them to think about that it is a condition that needs to be uh treated. This again our hoping is influenced by the name change. Yeah. So because it's a what can what exactly crisis, you know? So what uh what endpoints can you treat?

SPEAKER_05 1:22:22

Yeah.

SPEAKER_02 1:22:23

Well you can treat infertility. So some of the studies, and um we will have a study published within the next month. It's just a very small study showing that injectable GLP1s, so this is now here there is a role of weight loss in here, but what we found is that women who lost more than 10% of their body weight, six of the eight, their PMOS got way better. One had no change, and one, her body thought she was starving and shut her periods down. Oh god, like somebody with disordered eating. Oh wow. So this is where we really need to do the research when we're looking at it for reproduction, but their testosterone dropped by 50%.

SPEAKER_03 1:23:20

Oh my god. When they lost 10%?

SPEAKER_02 1:23:23

When they lost 10%. We haven't analyzed the rest of the data. I'm I'm guessing that their insulin came way down. My primary endpoint for that is rates of ovulation. Rates of ovulation and infertility have defined endpoints within the FDA. So if we're gonna get, if we're gonna get any indication for a GLP1, it is going to be for infertility that women with PMOS can take advantage of. The other thing is they're approved for obstructive sleep apnea, fatty liver disease, and type 2 diabetes. And if our adults with PMOS aren't being screened for obstructive sleep apnea or Mass hold the fatty liver disease, they may be eligible to get on a GLP1 covered by insurance, but they're not getting the metabolic screening. So that is actually the last point where I see this name change with improved metabolic screening could make an immediate difference to women with PMOS who struggle with health, have these metabolic conditions, and don't realize that they could be eligible for a GLP one under one of these metabolic conditions.

SPEAKER_05 1:24:40

Yeah. Wow, fascinating.

SPEAKER_03 1:24:43

Oh my gosh. What to do?

unknown 1:24:46

Yeah.

SPEAKER_03 1:24:50

Like that, that we have had many Oh, we know we're doing a research trial on it. We'll have to come back and have me talk more about that had that had PCOS that started these meds, lost weight, and not even all their weight, just lost weight, pregnant. Like it's like that, you know what I mean? And couldn't PCOS could not infertility couldn't be pregnant, you know? It's crazy. I mean, I'm just telling you, like it's like never could have kids, you know? It's it's insane. But um, I can't wait to hear all about it. So when when you're when you're published, we have to come back for part two.

SPEAKER_02 1:25:22

Oh, I yes. So maybe next maybe next fall I should have a good four or five out that I can actually love it.

SPEAKER_03 1:25:30

And that would be wonderful. Well, where can people find you if they want to follow your research or anything like that? Or if you're not on the tell us all the things. We'll put it in the show notes as well.

SPEAKER_02 1:25:39

So I have all of my research on my lab website. So um, and I also explain what PMOS is. Um, we have one PMOS trial that's currently enrolling. Everybody gets semaglutide. Um, get out of bed. So yep, so um we're just looking for the women now who have PMOS and are taking metformin, and it hasn't fixed metformin has not fixed their periods. Okay. So I have never enrolled for a research trial so fast in the group that didn't need to be taking other any other meds, and they got 10 months of free semaglutide. That's something to consider. Yeah. So I can give you the link to post or Google, if they just Google Cree um C R E C R E E, and then um uh you can put um University of Colorado and then lab. And then Google should pop it up pretty close to the top. And then um, there's lots more information on my lab website. Um I do we do one-time medical consults for adolescents, um, and how to do that for people living in other states um is there, and then we actually have a multidisciplinary clinic for adults. I'll go to DMOS at the University of Colorado, and that that clinic and that lab group is easy to find.

SPEAKER_03 1:27:10

I love that software. We will put, we'll get all those links, friends. We'll put them in the show notes. Um, make sure uh that you like and subscribe and comment and share and reviews and all those different things help us keep our work going here because it takes a lot of time and energy, and we love you, but it's hard. Okay, so let's engage, just engage, it's free. It's peace. Um, and I this been a wonderful conversation. I learned so much, you know. I think the big takeaway is friends is that if you struggle with this growing up, you probably had a dysfunction and weren't given the attention that you needed. And if you love someone who's struggling with this, then push to get some metabolic testing. Like have all these things considered now and see if there are options, you know. And let's stop calling them lifestyle changes. That's my take.

SPEAKER_04 1:28:15

Absolutely.

SPEAKER_03 1:28:16

How do we have a good measurement for influence? I like it. All right. All right, guys. Thanks so much. We love you. We will see you next week. If you're like most of us, you've been denied a GLP1 at least once. But did you know that less than one percent of denied claims are ever even appealed? Even though the data suggests that over 60% of appeals are often approved, that means that people who should be paying $25 a month are instead paying thousands of dollars a year out of pocket. Not necessarily because appeals don't work, but because the process is confusing and time consuming. But that's where Honest Care comes in. You go to their site and then you just start with a quick assessment. And then Honest Care will build your appeal with the clinical and medical arguments that your insurer needs to hear, and then guide you through submitting it. If you've been denied, don't stop there because most appeals must be filed within 90 days. So don't wait. Go to findhonestcare.com slash Kim to get your free assessment today. That's findhonistcare.com slash Kim. Are you interested in understanding GOP1 medications like Osimpic, Wokovi, or Minjaro? Then join us on the Plus Sides, cracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time.

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