Ep 22: Reclaiming Your Body in Midlife with Dr. Caissa Troutman

When women hit midlife, it can feel like their bodies start to betray them overnight. Weight creeps on despite doing "all the right things," energy plummets, and those tried-and-true habits suddenly stop making a difference. Society blames willpower, leaving women feeling broken and ashamed. But what if it’s not your fault—and biology holds the real answer?

This week, I’m joined by Dr. Caissa Troutman, an obesity medicine physician and menopause specialist, who runs Midlife reMDy/WEIGHT reMDy, a Direct Care Wellness practice in central Pennsylvania. In this episode, she shares her personal story, unpacks the four key metabolic hormones, and explains why the “eat less, move more” model completely ignores the complex hormonal disruptions of perimenopause and menopause. Together, we explore a compassionate, science-based path to feeling better in your body.

If you're tired of fighting your changing body and ready to understand what's really happening during this life stage, this conversation will transform how you think about midlife health.

References

Climacteric Scale

Connect with Dr. Troutman

WEIGHT reMDy website

Facebook

Connect with me:

TikTok

Instagram

Eastside Menopause & Metabolism

Audio Stamps

00:40 - Today’s guest, Dr. Caissa Troutman, shares how her personal struggles led her to create a practice focused on midlife, weight, and hormone health.

04:30 - We unpack the deep-rooted shame around midlife weight gain and why the 'eat less, move more' myth is failing so many women.

08:40 - Understanding your midlife biology means recognizing when willpower isn’t enough and knowing how to use every tool available to support your body and brain.

13:53 - The importance of validating women’s experiences and how metabolic hormones change during perimenopause and menopause.

17:56 - Hormone therapy improves overall health, not weight loss, and realistic expectations are key.

20:13 - Dr. Troutman focuses on hormone therapy, weight management, and realistic health goals for midlife women seeking to feel better.

27:44 - Dr. Troutman helps patients define success through non-scale wins, steady progress, and greater body awareness for sustainable health.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:01

Welcome to the Reset Recharge podcast with your host, Dr. Komal Patil-Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist. This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health. And recharge the conversations you are having with your healthcare providers. While I am a physician, this podcast is purely for educational purposes. No individualized medical advice is being given on this podcast. If you do find information that is helpful, please discuss it with your healthcare provider at your next visit. Hi everyone. Welcome back to Reset Recharge for today's episode. I'm excited to announce that Dr. Case Troutman from Midlife Remedy will be joining us. Dr. Troutman is a, is an obesity medicine physician as well as a menopause certified practitioner, and she has been running her own practice now for about. Two years and is passionate about all things perimenopause and menopause related, especially how that ties into weight management. So excited to have you here today so that we can discuss the shame and the stigma around midlife weight changes. So welcome Dr. Troutman. Thank you so much for joining us.

Dr. Case Troutman 1:19

Yes. Thank you so much for having me, Komal. Super happy to be here and ready to chat about everything and anything.

Dr. Komal Patil-Sisodia 1:26

Thank you. I appreciate that and I am a longtime admirer of the work that you're doing. You're located in central Pennsylvania, correct? I.

Dr. Case Troutman 1:33

Yes, that's correct. Yep.

Dr. Komal Patil-Sisodia 1:34

That's great. That's great. So for any of our lucky listeners who are out in Pennsylvania, Dr. Troutman is gonna be a great resource for you. So I just wanted to kick off today hearing a little bit about how you got to where you are in your current practice and what inspired you to move towards your own practice focusing on these topics.

Dr. Case Troutman 1:54

What a great question. When I talk about my practice and my professional expertise, I always really start by saying it was me search.

Dr. Komal Patil-Sisodia 2:02

I love that. That's so good.

Dr. Case Troutman 2:06

It was me. I am the patient, I am a person with obesity. I've struggled with obesity my entire life. I would always be able to lose weight when I, my head was on and I'm on point, and whenever there's any life disruptors, I would always regain the weight back or when, and I would always feel bad about myself. I always felt like I was broken. I always felt that there was something wrong with me and I should have more willpower. So that's when I dove into the science of obesity medicine and really understood the modern science of weight, that it wasn't really my fault. And also, I'm a woman in perimenopause. And just like many other women in midlife, I had a lot of symptoms. I attributed to stress, air coats and just push it away because, we're women and we're strong and we were just told to just really yeah, suck it up and put up with it. And really, as a physician, I didn't even, I didn't even tie it in that the symptoms I was experiencing were from. Hormonal changes to perimenopause. So I became a board certified menopause society practitioner and also prescribe FDA approve hormones to my patients. So again, research, right? So my, my pain points became my professional expertise and I just love this field I'm in where we fuse both'cause it is, apparently I'm not that uncommon.

Dr. Komal Patil-Sisodia 3:18

It's so funny you're talking about this and you know how you're personalizing it. And I have had similar struggles like my whole life. And it is something that as women, we downplay, what is the term head down power through where we are just pushing through anything and everything we can to make sure we're checking off our list and doing all the things we're expected to manage. And then on top of that, I think being female physicians. We almost gaslight ourselves into being like, oh, it's not that. It's just stress. There's nothing wrong with me. It's just stress. And then you really start getting walloped by perimenopause and life changes and you realize you need to make some changes. So that resonates so much with me, and I'm sure with our listeners who are trying to hold it together. And I interviewed another physician on the podcast. It was actually on a sleep topic, but she said, women come ask for help when their compensatory mechanisms fail. And that was in context of. Sleep, but I think it applies here as well. You can be doing all the right things and still have things go off the rails or go sideways. So I'm so excited to talk to you and hear your thoughts on how our listeners can best manage this.

Dr. Case Troutman 4:27

Yeah,

Dr. Komal Patil-Sisodia 4:27

let's go. All right,

Dr. Case Troutman 4:28

let, what shall we talk about?

Dr. Komal Patil-Sisodia 4:29

So let's start with the elephant in the room. Why is talking about weight in midlife often loaded with so much shame, especially for women? I think we talked about personally, what that was for us, but I would love to hear your experience and your practice and what you're seeing in your patients.

Dr. Case Troutman 4:47

I think the. I think it has to do with what is the prevailing theory on why we gain weight. It is the calorie in calorie out model, hence, and it's so mathematically perfect, just eat less and move more and you'll lose weight. And if it doesn't work, it means something's wrong with you. So I think if we start with that understanding, and I know you shared this with your own patients, if we disrupt that thought for a second and recognize that it's actually a little bit more complicated than that. Then we recognize that all the other sleeps, how we handle stress, how we and then again, the hormonal disruptions that happen in midlife, that is all like the perfect storm for women who are doing 10,000 things. They're taking care of their family, they're taking care of their careers, they're taking care of their kids, they're taking care of their parents. It's like the perfect storm for it to happen. And in a way it's like a failure, oh you let yourself go or you're again, you don't have any more will, you don't have any willpower. Yeah. That old story of willpower being the reason Yeah. The way to lose weight. It does. It has to die.

Dr. Komal Patil-Sisodia 5:49

I totally agree with you. And it's so hard because when you've been in the shoes, we've personalized this for ourselves. When you've been in that space of wanting to try anything and everything and gritting your teeth and trying the willpower way, it is just so demoralizing when you find that things aren't working well. So that, that's a great, that's a great, and

Dr. Case Troutman 6:09

I think to a certain extent, it might work. But the question is how long it's gonna work for two weeks, one month, six months, three months, and then what happens? Then your brain recognizes like, oh, this is not what I want. It ramps up all the hormonal changes that make it much harder to maintain what we do. Yeah. So yeah, I think it's the stigma of what weight. Gain is and what obesity is or just what weight gain is. And then the fact that we carry a lot, and I think societal picture, like women should have a certain size, women should look a certain way. Yeah. Dress a certain way. Yeah.

Dr. Komal Patil-Sisodia 6:42

Yeah. And I think you're absolutely right. That is the societal expectation. That's the weight stigma that shows up there. And then, it translates to how we look at ourselves in the mirror and how we start talking about our bodies. What do you see with that, with your patients? Are they coming in, beating themselves up? Are they, is it just like defeat and acceptance? Where, what are the patterns and the common complaints and? Things that we're seeing in our, I think it's

Dr. Case Troutman 7:09

a combination. I've definitely seen the spectrum. I've seen the spectrum of where they've tried everything and they just want any, and any kind of help to help them. Which I, that is all both great, but also there's a lot of negative default thoughts that they've already formed, but I'm a failure, et cetera, et cetera. That sometimes it's hard to break that. And I think it's also let's see. Patients that want certain way of doing it, they, I think just a variety of things.

Dr. Komal Patil-Sisodia 7:40

Okay.

Dr. Case Troutman 7:42

That was a hard question.

Dr. Komal Patil-Sisodia 7:43

That is a hard question. I think you did a good job answering it though. And I think that's true in all aspects of medicine. Everybody's story is slightly different when they come in. And as physicians, we have to be aware of where that stigma is hitting them the most and how it's coming out in their story.

Dr. Case Troutman 8:00

I. You know what's interesting? Like I've seen a different, every patient come in. Yeah. For the initial consult in different ways. I've definitely had people that come in to see me now. I always espouse the data the comprehensive approach, which is, looking at what your nutrition, physical activity, behavior, change in meds. I think all of them together really create that comprehensive approach to treat the biology as well as the habits. But I, it's interesting how I have a lot of patients that come to me and say, I don't want any meds. I just want.

Dr. Komal Patil-Sisodia 8:29

Yeah.

Dr. Case Troutman 8:30

So has that ever happened to you?

Dr. Komal Patil-Sisodia 8:32

Absolutely. And I think that is interesting because a lot of times, and this is a nice segue into the next several questions that I have, a lot of times people don't understand the biology of their body. And while you may not want something, it may be what your body needs. And I think a lot of times that conversation really starts shifting around how do we get people to understand that they're doing all of these different things? And if something isn't working, how do you. Start accepting that you may need to take another step to, to work on yourself. Would you say that you see something similar?

Dr. Case Troutman 9:05

Yeah, and I think that's where the art of medicine comes in.'cause we meet them where they're at and definitely support them in the nutrition part. Physical activity and behavior change. And then get, give them like, okay, let's see if this doesn't work or, let's level up or something like that. But I and again, that's where I think, battling the calorie and calorie out model, which has been there for so long, and even me, I know that I still sometimes have that. Yeah, sometimes default thought of oh, but no wait, no, this is actually science.

Dr. Komal Patil-Sisodia 9:36

It's hard not to go down that road. I was looking at my own diet the other day and I realized that while I thought I was hitting all of my protein goals, I wasn't, I was also not eating enough carbs, which sounds like an oxymoron to a lot of people who are trying to lose weight. And I realized that it wasn't, feeling my muscles. And with that. All of these things start shifting, but if I can get blind to that, everybody else can too. We have a background in doing this and it, it's very hard to maintain.

Dr. Case Troutman 10:06

Yes, totally. I was telling my husband the other day, yeah or, and I was sharing this to my patient too, like I know all the right things to do. I teach it every day. I know all the right things, but it doesn't always translate to. Ability to apply it to my own life. Yes. For a, for the most part I do. And then again, without the tool of medicine, oh my God, that applying it to real life is just so much harder. Let's make it. Let's, and again, what, and maybe we, you do this too with your patients, I always say weight loss is not natural. We're literally fighting biology. So let's arm you with all the tools in the toolbox to help you, change that dysregulation. I. Yeah,

Dr. Komal Patil-Sisodia 10:43

and I love that because when we do, start like at least when I was studying for my obesity medicine boards and looking at all of the data, there was really this big concept of, what are the pillars behind obesity care? I think we have similar pillars that we try and apply to menopause care, and it's amazing how many of them overlap and how many things you have to pay attention to. I'm sure you've. Seen like all those memes on social media. It's like I'm eating my protein, taking my creatine, taking my magnesium, intermittent fasting, lifting weights, but then not intermittent. It's all over the place with all the different things that you have to do, and it gets very overwhelming, I think for patients.

Dr. Case Troutman 11:20

Yeah, in midlife for sure. Yeah. Plus, if you already are in brain fog, tired and having joint pain and then you have to deal with that, right? So it's all of that. So in my practice, what I always tell my patients that are interested in helping with both kind of aspects, yeah. I say let's start with hormone therapy'cause I wanna make you feel better.

Dr. Komal Patil-Sisodia 11:38

Yes.

Dr. Case Troutman 11:38

And I wanna have you just feel, be less, have better sleep, no hot flashes, less joint pain, better mood. And then when we're in that better. Place. I hate the word hormone balance, but I know that keeps throwing around. I don't know. What's a better word? Better.

Dr. Komal Patil-Sisodia 11:53

I don't know. I feel like so many things are buzzwords, but I know exactly what you mean. You want people to feel physically well from their symptoms so that they can then go on and do all of the things that they need to Changes for, yeah. Yeah.

Dr. Case Troutman 12:06

Exactly. And you

Dr. Komal Patil-Sisodia 12:07

can't do it if you feel crummy.

Dr. Case Troutman 12:09

So it's interesting, I was had my, one of my patients for a follow up. This is a kickass woman. Yeah. Doing tremendous things in her work. And when I saw her for follow up, she said, I just thought I was lazy before in terms of why she wasn't doing physical activity.'cause again, she's, yeah, she knows what to do, but she was just tired. So that's why I said. This is why we're doing it this way. Let's make you feel better.'cause then she was telling me, oh, I did this, I did that. Yeah. This is what happens when you feel better and we give you estrogen that was not there anymore.

Dr. Komal Patil-Sisodia 12:42

Exactly. It's, oh yeah. It's amazing how much change that can bring to people in terms, in their ability to function. Yes. I think I always worry about my patients who. Can't have hormone replacement for, a multitude of reasons that exist in terms including like blood clots that were unprovoked or history, personal history of breast cancer, ovarian cancer, things like that for systemic hormone replacement. I'm not talking about vaginal estrogen treatment, but systemic hormonal replacement. Sometimes people, they feel like they're left behind if they can't have that, but I find that there are other pillars that of menopause care that can also help them, namely that. That non-hormonal treatment. And then really, I think that's where the overlap with the obesity medicine pillars also comes in between like diet, lifestyle, sleep, stress, all of those things that you're trying to, has to

Dr. Case Troutman 13:33

be all of that, right? Yeah. It can't just be here's a patch, you'll feel better automatically. No. Yeah,

Dr. Komal Patil-Sisodia 13:39

exactly.

Dr. Case Troutman 13:39

It's a tool in the toolbox so that you live a better life, which is ultimately the role. That's why we do what we do. This is why we prescribe. These meds for either along, improving their quality of life.

Dr. Komal Patil-Sisodia 13:51

Yeah, absolutely. And so it's interesting because so many women will hit like 40 and then all of a sudden feel like things are changing overnight. I, let's talk a little bit about what in your practice and how you are trying to explain to them, like what is happening to them biologically during perimenopause and menopause. What are the things that you're trying to educate your patients on? Yeah,

Dr. Case Troutman 14:11

so the first thing I always do is validate. What they're feeling. Yeah, because, I know that sounds so simple, but before that patient comes to me, she's told other doctors, other providers that, and they would usually meet it with you're just eat less, move more, just ex, all the disbelief, all the gaslighting. So really the first thing I just tell them is girl, yes, I hear you. It's real. I get it. This is why. So I, I explained like the four metabolic hormones that are affected which is not necessarily, we're not even talking about estrogen, progesterone, and disarm. I'm just talking about ghrelin, leptin, insulin, and cortisol, which are, the four metabolic hormones that affect weight. And then a and then introduce the concept of, yeah. When we're in perimenopause or menopause, yeah. We lose estrogen. That affects our body composition. And then with age, so that's one. So it's usually lean body mat sorry. Body composition. So instead of having fat deposition in our. The OID or in the hips. Now it's in the central adiposity or in our belly, which we really don't like, which that fuels something called insulin resistance. Which makes it harder for people to lose weight. And then the second thing I talk about is that lean body mass or muscle mass that goes down mostly with age.

Dr. Komal Patil-Sisodia 15:28

Yeah.

Dr. Case Troutman 15:28

Again, this is increased when we're not moving as much.'cause a lot of us are working in offices, have minimal time for exercise. Going back to what you said earlier about how it's not just about medicine. It's about how are you moving your body? How are you eating? They're probably not sleeping a lot of the times, whether they have hot flashes or not. That's, and then again, that's why I always start with. Cortisol and insulin.'cause those are what drives those body changes. Also an

Dr. Komal Patil-Sisodia 15:53

endocrinologist that makes me so happy

Dr. Case Troutman 15:55

because I think they don't get their due when we

Dr. Komal Patil-Sisodia 15:57

talk about all of this in context.

Dr. Case Troutman 15:59

Yeah. But I think the key is, again, number one, validation.'cause I really feel that when patients or women. Know that you are on their side, like you understand like then it's not an adversarial relationship, and then they're more, even if they had held on to different beliefs before, like calorie and calorie out, then they're more likely to have an open mind to what is this insulin resistance, what is this? Cortisol is a relationship that you develop. But yeah, so I go through all of that, which is a lot. Yeah,

Dr. Komal Patil-Sisodia 16:30

But necessary. I've been using the Green CLI TERIC scale, which I think is a, the best tool we have, but incomplete because it doesn't talk about all of these other things. But I find that it provides patients with a lot of education just in terms of what the potential difference symptoms of perimenopause and menopause can be. I was meeting with. A patient a few weeks ago, and we were going through their responses on that, and it was like, I didn't know that could be a symptom of menopause. I didn't know we could do this. Is that really? Oh my gosh, I've had that for a while. And it goes back and forth. And so there's so many different things that, we're starting from such a deficit of knowledge. I totally agree with you that we need to do all of that education upfront, so your patients are lucky that you're validating that for them.

Dr. Case Troutman 17:16

Yeah. Yeah. I love that. By the way, when we go over the questionnaires yeah. And you're like, what is my peeing all the time related to estrogen? Related to hormones, or, yes. Mind blown, right? Yeah. And then they always think it's just because they drank more water, which again, it's very possible that's part of it. What's much more fun is when a lot of the symptoms improve. Yeah. You're like, oh my God, this is so different. But yes. Love it.

Dr. Komal Patil-Sisodia 17:41

I think you and I have a lot of similar approaches there. When you are talking to your patients about the shift in their symptoms, like they're starting to notice mood changes or hunger or cravings, we see that as estrogen levels. Can drop. So you start with talking about the insulin, the cortisol, the leptin, the ghrelin as like those metabolic hormones. How do you approach the conversation about the reproductive hormones?

Dr. Case Troutman 18:07

Yeah, so the reproductive hormones, I actually put it. In context just with their entire body, and not just with weight. I tell this all the time to my patients. Hormone therapy is not a weight loss medicine. Now, if you are having trouble with sleep and we improve your sleep because we improve your hot flashes, or just just improve your sleep and now you're sleeping better, your corsol will go down and you know you're gonna lose weight. But the reason I do that is because you'll see that on social media all the time, can't get. This medication get on hormone therapy. And I'm just so annoyed at that because it's so false. When I talk about the, estrogen, progesterone, testosterone, I start with just the whole body, how it affects all the receptors in different body parts. And then, if they do say, yeah, I've noticed some weight gain, et cetera, then kinda circle back to how that affects the metabolic hormones in a way. Yeah. It's like my approach and then still approaching treatment. Four Weight in midlife with the four pillars at nutrition, physical activity, changing behavior, and medications as a tool.

Dr. Komal Patil-Sisodia 19:11

I really appreciate your approach of starting the hormone replacement therapy first, because I am equally annoyed when I see the things online about, you need to be on hormones to help you lose weight. I've actually had people gain weight on hormones when you're giving them back. Some people do have a little bit of weight gain and abdominal bloating and fluid retention, and putting that out there as a weight. Loss tool is inaccurate and can be very demoralizing for people when they start gaining weight on them. So I love that you optimize that first, and then you have that baseline of where you're going to lose weight from that point. But I think that approach needs to be adopted more because I'm with you. I get super annoyed when I hear that online.

Dr. Case Troutman 19:51

Yeah. And again it's also about setting expectations. Yeah. Because if they think that this is gonna make them lose weight and then. Their weight is the same or whatever yeah, because it's not supposed to make you lose weight, yeah. But they feel fantastic. So it's, it is, again, it's one of those things, they need to know why, what this med does, why, and just like anything in medicine, expectations and realistic goals. And expectations.

Dr. Komal Patil-Sisodia 20:13

Let's talk about how you start leveraging tools for people when they're coming to see you. And there's a woman in midlife who wants to feel better in her body. What are the top priorities that you are trying to address with her when she comes into your office?

Dr. Case Troutman 20:29

So in my practice, I have two tracks. One would be if they don't have a weight gain as a concern, but they have more like just the hot flashes, joint pains, et cetera, and they just want hormone therapy. If they approve hormone therapy, then they can be in that track. And then the other track is where I call it the Uplevel midlife, where they get the benefit or guidance on both aspects. Yeah, the weight or obesity care. And hormone therapy. So I meet them where they're at basically. If they're in that phase where they would like help with meals, movement in mind. And again, if they are in that appropriate category for meds, then we start with hormone therapy.'cause we make them feel better, and then usually the, usually again, the next topic, next visit, I talk about the science of weight.

Dr. Komal Patil-Sisodia 21:19

Yeah.

Dr. Case Troutman 21:20

Because I really truly believe that when we understand why it happens, it's so much easier to create strategies.

Dr. Komal Patil-Sisodia 21:28

Yeah.

Dr. Case Troutman 21:29

For treatment, the buy in for them to do the movement.

Dr. Komal Patil-Sisodia 21:32

And one of the things that I've noticed is sometimes people come in with goals. That are probably not best suited for their wellbeing or not attainable. So how do you help women separate what their health goals look like from like years of indoctrination, from diet, culture, and society? I feel like that is such a hard thing to navigate.

Dr. Case Troutman 21:53

Yeah, I, it's very, it is hard. I talked, so in my questionnaire and things I ask my patients routinely is ask Yeah. Identifying their non-scale wins and non-scale goals, or if they tell me like, I wanna be, let's, I'm gonna just, 160 pounds, let's say that's their goal weight. I usually use a little bit of motivational interviewing and say, what happens at 160 pounds? Again, trying to get that why? Because maybe, because at that, what they remember when they were that weight before is they were able to hike, the appellation trail. So actually that's the reason why, and not. The number on the scale or that age, that weight, they felt more confident in front of the camera or taking pictures. So if that was the real driver, then I asked them, so what if you weigh 170 pounds? So 10 pounds higher, but you're more toned and look great in pictures. So it's a little bit of like really digging in and finding what really motivates them and, and then tying it to that result as opposed to a number on the scale. But it's, again, it's not a one time conversation. It is about really developing that trust and kinda

Dr. Komal Patil-Sisodia 23:07

building that relationship.

Dr. Case Troutman 23:08

Yeah. Yeah. I really think it's about, so this is why I love what I do now is, yeah, I get to build relationships with my patients because I have the time to spend with them and just get to know them and figure out how to help them the best way.

Dr. Komal Patil-Sisodia 23:21

That is such a compassionate way to care for people, and I think that's what I. A lot of women struggle with is showing themselves that compassion. So how do you cultivate that for them? Like how do you I was gonna

Dr. Case Troutman 23:33

ask you how do you do it? Yeah. I wanna learn from you too. How do you, I'm gonna give you your, an, your question back. How do you handle this? I would say,

Dr. Komal Patil-Sisodia 23:40

It's similar. What is it that we are trying to achieve? What is realistic? I've had a few patients come in here and say I want to get back to doing what I was doing in my twenties and thirties. And while that would be nice, like I always joke with my girlfriends if I could have my. 45-year-old mind in my 25-year-old body, I would be like the happiest person for, because the body felt good. The mind feels good right now, but it's really trying to, help people. Get to a place where they can understand what is probably safest for them and best for them to keep staying healthy in the long term. And that's a different type of conversation. I employ a lot of the same techniques in terms of really trying to get to the why behind why they're doing this. Everybody's why is different and it's. Colored by what their past experiences have been, either within their family of origin or what society has told them about themselves and their body. And a lot of that takes a lot of conversation and yes, almost deprogramming over time. Yeah. That you don't need to believe the hype around what you're seeing. And you see all this questionable stuff on the internet.

Dr. Case Troutman 24:46

Yes. Oh my God. There's this one that pops up on my Facebook like. You don't need to have obesity for this medicine anyway.

Dr. Komal Patil-Sisodia 24:55

What? Yeah, exactly. It's that and then I think it's, like the supplements, this is a natural GLP one. There's no such thing as that. No such thing. Yes. There's no such thing. And it's hard because I'll see that with my own parents sometimes. I'm an endocrinologist. We have a strong family history of diabetes and. There will be things where they'll find articles online or, my dad will forward me some outrageous claim about Metformin causing cancer, and he'll send it to me and ask me to review it, and there'll be a PayPal link at the bottom of the page asking you to buy their supplement. And the website is, metformin causes cancer.com or something ridiculous. I'm making that up. I don't know that website exists, but something along those lines. Yeah. Where it's instilling this fear into people and they're having these fear-based reactions and then going out and buying and doing stuff when it's not well regulated. But I think a lot of it is just trying to make sure people are getting good information. But one of the things I've been finding myself doing is like looking at everybody's supplements.'cause the supplement game is wild out there right now, and it's always been in the endocrine space. I used to routinely have people come in and they'd be like, oh, I'm on this adrenal support. And I'd look at it and it would have a ground up. Cow or pig's adrenal gland. And so they were inadvertently taking steroids and then gaining weight and I was like I don't think this is what you should be taking. So it's a lot of dissecting out what it is they're doing and seeing if I can find something to connect with them on and help guide them towards something that will be helpful and not harmful.

Dr. Case Troutman 26:22

Yeah. Helpful. Helpful. Not harmful. Yes. Evidence-based as much as possible.

Dr. Komal Patil-Sisodia 26:27

Yes.

Dr. Case Troutman 26:27

Yes.

Dr. Komal Patil-Sisodia 26:29

It's a hard thing to do. One of the things, and I don't know if this is your experience. Experience is that this deep distrust of medicine I think has developed because. We don't do a great job of explaining what scientific process and investigation looks like. I always tell my patients we know a fraction of what our creator intended. It is the most humbling job on the planet to be a physician or other type of healthcare provider because. We only know a fraction of what there is to know and the information will change. So what we know now could be different five years from now, but the advice I'm giving you now is based on the information we have now. So fast forward five years, if I change my mind based on new evidence, it's not that I was lying to you five years ago, it's that the information has changed and we're innovating and we're progressing with new information. I think that can be hard because we are taught to think in absolute.

Dr. Case Troutman 27:21

Yeah. And there is so much information. Kudos to primary care doctors'cause I don't know how Yeah. They keep up with everything that's, in a poor patient in 10 minutes.

Dr. Komal Patil-Sisodia 27:33

I know. It's amazing work they do. And I am deeply appreciative for them every day.

Dr. Case Troutman 27:38

Yes. Yes. Yeah.

Dr. Komal Patil-Sisodia 27:41

Now that, we've talked about what our approach is, how are you getting your patients to define success then when they're hitting these goals? Does that take additional conversation from you where you're pointing it out to them because they may not realize it's happened? Oh yeah. Are they, yeah.

Dr. Case Troutman 27:57

Yes. Okay. I actually always start my visits with non-scale wins. Or things, so start so what are your non-scale wins today? My patients always tell me. Yeah, I was thinking about that before I came over. So again, I'm, they're practicing the skill. Yeah. And I call I call everything that I teach my patients a skill I. Knowing how to, eat, what's your protein, what's your fiber, et cetera. Drinking more water, lessening the cognitive negative, cognitive bias. The, this is all, these are all skills and sometimes we just, we didn't practice the skills for the longest time, but it doesn't mean that we can't. Anyway, so I always start that with the non-scale wins. And then for my patients that are on, also on hormone therapy I always ask what has changed? Yeah. And so it's just an amazing way to. See their progress. Yeah.

Dr. Komal Patil-Sisodia 28:44

I love. How about you?

Dr. Case Troutman 28:45

What do you normally do?

Dr. Komal Patil-Sisodia 28:46

I would say it's similar. I think that really trying to find what the positive changes have been. That's how I phrase it, which is basically non-scale wins. Yeah. What are, it's the same, it's the same type of approach is like what has gotten better? And let's move from there. And then what has not changed? And then what do you think has potentially gotten worse? And then trying to draw correlations. Between what we're impacting and I think the other thing that I, I struggled with when I was purely in an endocrine practice alone is people wanting. A single fix for a problem that's multifactorial. So I would adjust somebody's thyroid medication. Their thyroid numbers would look great, and they're like I still feel tired. I still feel crummy. I still feel this. It might be that there's something else that we need to look into. So really understanding that. There could be multiple things that are affecting one symptom that you're having or one spectrum of symptoms that you're having. And when you incrementally improve each one, you'll see a little bit of change, but you may not see a big boom change until you address all of those things.

Dr. Case Troutman 29:46

Yep. Multifactorial for sure.

Dr. Komal Patil-Sisodia 29:48

Yeah so I think a lot of it comes down to that because they think there's disappointment too, right? When people feel like something is not working for them right away or fast. Enough. It's trying to get people to slow down and realize that rapid weight loss is not actually going to do them favors. It needs to be long-term and sustainable and something that they work towards slowly. Some patients get it right away. I had, I saw somebody earlier who said to me I don't wanna lose weight too fast because I don't want, would you say Ozempic face or ozempic butt or something like that? Because people are starting to notice when you do get that rapid weight loss, it can affect your appearance. It can affect a lot of different things if you're not doing it sustainably, if it's too fast. So I think really trying to piece those things together is important as well. What about you?

Dr. Case Troutman 30:37

Yes. Same thing with hormones? Yes. Hormone therapy. Yes. Patients that they're specifically interested in a particular result. And then we've tried X, Y, Z, and some things are better, but the one result is not better. And I just thought, I'm like hormones don't fix everything. I'm a hormone specialist, so you need to see somebody else that specializes in that. Particular symptom, or something to that effect.

Dr. Komal Patil-Sisodia 31:00

Yeah, I think that's fair. My sister is a TMJ specialist and there are so many things that kind of almost like the reverse of what we're talking about, that people don't attribute enough to TMJ. She was telling me that you don't need like the clicking popping joint noises, that it can be like the loss of musculature in the airway that causes. Sleep apnea. In somebody who's thin and then that can contribute to TMJ symptoms. And it, to me, it was like, oh my gosh. Wow. Like that boom, I learned something new. Yeah. But it's almost like the reverse, like where we're not attributing enough to something else, and we may need to, to your point, send them somewhere else to investigate it. Sometimes just having that knowledge is hard. It's hard to come by because, oh yeah. There hasn't been enough discussion around women's health. Obesity is just. Now getting its due after how many decades of being ignored it's going to be the same uphill climb, I think, for midlife care.

Dr. Case Troutman 31:54

But it's so much fun, right? It's so gratifying, so much fun. I don't wanna be anywhere else but where I am right now,

Dr. Komal Patil-Sisodia 32:00

I totally agree with you. I think it has been the encounters where I have. Seen women reach out to me and say, oh my gosh, I'm feeling significantly better, or understand my body better. Actually, I think that one is almost higher for me than the feeling better part, like the understanding of the body better. It, to me, is just so fulfilling at the end of the day.

Dr. Case Troutman 32:22

Yes. Yeah.

Dr. Komal Patil-Sisodia 32:23

Yeah. So'cause then

Dr. Case Troutman 32:24

you're equipped for the rest of their life ex.

Dr. Komal Patil-Sisodia 32:26

Exactly. Exactly. Thank you for this conversation. As we close out this episode. If a woman is listening right now and she's feeling defeated by her changing body, what do you want her to hear? Hard to heart like what would you say to her as she's on the cusp of taking the next step to get her health better?

Dr. Case Troutman 32:45

Yeah, so what I would say to that woman is that you're not broken. This is really happening. It's not your fault. Are biological reasons why this happens. Both the metabolic hormones and depending on the age the rep like estrogen and progesterone, testosterone hormones they're, this is happening and it's real. And don't give up. Advocate for yourself. Get help.

Dr. Komal Patil-Sisodia 33:09

Yeah.

Dr. Case Troutman 33:10

And if you're in Pennsylvania, I would love to help you.

Dr. Komal Patil-Sisodia 33:12

Yes. And so where can people learn more about your work at Midlife Remedy? Do you have a website?

Dr. Case Troutman 33:17

Yeah, I do. So it's Weight Remedy and Midlife Remedy. So it's weight, W-E-I-G-H-T-R-E-M-D-Y. I'm also on Facebook. I love posting a lot, sharing information. So same name, weight, remedy. But yeah it's so much fun. Love to help everybody.

Dr. Komal Patil-Sisodia 33:35

Wonderful. So all of our lucky listeners out in Central Pennsylvania, if you are looking for a kind, compassionate, well-educated doctor in these areas of your life, go look up Dr. Troutman. You will not be disappointed. She's an incredible lady I've known you for a few years now. Yes. We were just chatting about that.

Dr. Case Troutman 33:52

Yeah,

Dr. Komal Patil-Sisodia 33:52

and we've run in the same circles, and so it's so lovely to be able to reconnect. Thank you again for your time today. I really appreciate it.

Dr. Case Troutman 33:59

Thank you for having me.

Dr. Komal Patil-Sisodia 34:00

Of course.