8. Can Obesity Cause Infertility? | Courtney Younglove, MD

Jollie talks with Courtney Younglove, MD about the connections between obesity, polycystic ovarian syndrome (PCOS), and infertility.  Dr. Younglove is one of a handful of physicians in the country dual-board certified in OB/GYN & Obesity Medicine, so she is the perfect expert for this discussion.

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Email: CourtneyYoungloveMD.com

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Transcript

Transcript

0:00

You see less metabolic dysfunction in people that are 20 they just haven't gotten it yet so they're more fertile

0:06

even though they're probably on that path with the environment we live in they're just it's not affecting them yet

0:12

so because you see more metabol dysfunction as people

0:20

age more than 73% of Americans have overweight or obesity while more than 12% have food insecurity America is

0:27

getting heavier sicker and more isolated from each other every day our motto move

0:32

e give reflects our belief that virtually every problem in America could be fixed if we took better care of

0:37

ourselves and took better care of each other welcome to interrupt hunger movie give podcast where we talk with experts

0:44

in exercises medicine food is medicine and food in security and understanding that knowledge isn't always enough to

0:50

help you lose weight every other episode showcases someone who's lost at least 10% body weight to share exactly how

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interrup hunger. org to show your support 50 meals are donated for every item sold to the nation's largest hunger

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relief Network so you get to look good while feeling good now on to today's

1:25

episode Courtney Young Love is a physician dual board certified in a OB medicine Obstetrics and Gynecology she's

1:32

one of only about a 100 clinicians in the US that has earned her Oma Fellowship in the field of obesity

1:38

medicine one of the highest honors bestowed upon clinicians who demonstrate dedication and commitment to the

1:44

clinical treatment of obesity and obesity related diseases and was recently elected to the Board of

1:49

Trustees for the Obesity medicine Association Dr younglo is the founder and medical director of Heartland weight

1:56

loss and obesity medicine practice with clinics in Overland Park Kansas and LA Kansas the chief medical officer at

2:02

Journeys metabolic a digital therapeutic solution for value-based organizations impacted by a current metabolic Health

2:09

crisis and she is currently building Welly a company providing tools to self-funded employers struggling with

2:14

obesity in their Workforce Dr younglo thanks so much for joining us today

2:19

thanks for having me there's just not a lot of people who are experts in both

2:26

obstetric Gynecology and obesity medicine so it's a treat to get to to learn from

2:33

your experiences today so I um I've been married for 30 years I have three

2:38

daughters and I have heard about PCOS from time to time but I never really

2:46

understood it too much until after after seeing that post on LinkedIn with you

2:51

and really diving in and and talking to my wife and girls about it um I had no

2:57

idea the interplay between PCOS and infertility and obesity so we we before

3:03

we go down that road why don't you just uh tell us a little bit about you and and your practice that good stuff yeah

3:08

sure yeah so I practiced OBGYN for 15

3:13

years it was a long time um I was a women's Studies major in college went into obj and right out of med school um

3:21

and loved that field I absolutely loved it um and dealt with a lot of patients

3:27

with PCOS I mean I entered the field in the early as this obesity epidemic was really

3:32

skyrocketing and it really became a big focus of my practice as we'll dive into a PCOS there's a huge overlap with

3:39

metabolic disease and obesity which seemed to be the thing that was also what my patients ask me about all the

3:44

time so in early 2010ish I went and got

3:50

uh I went to a conference on Obesity medicine trying to figure out can I can I figure out this piece of that that

3:55

seems to be lacking in my education and really got HED to the field of OB medicine and dove into that field and

4:02

the rest is history I mean I I I got bored in OB medicine in 2014 at which point I became the OBG

4:08

Wayan in Kansas City that saw patience with obesity I mean it just kind of naturally went that way of I you know I

4:16

was very inclusive to patients with OBC which wasn't normal at the time quite a

4:21

few years ago sure that was a long time ago yeah and it you know I mean for a long time obesity was really looked at

4:26

as this thing of sloth and gluttony and people didn't want to treat patients with obesity they were labeled as

4:32

non-compliant or lazy and it really just never felt that way to me and so my

4:37

practice very quickly shift into a practice that would heavily focus on patients with

4:43

obesity um which meant a lot of pus which meant a lot of infertility which meant a lot of complicated pregnancies

4:49

because women with obesity tend to have a much higher rate of pregnancies Complicated by gestational diabetes and

4:55

gestational hypertension and preclampsia and C-section and and is it just evolved that way um without me really meaning

5:02

for it to do so and eventually I said I need to treat this obesity like I don't have those space in a OB clinic to

5:10

really treat obesity the way it needs to be treated I grapple with a lot of Ethics in my own world of what do I do

5:16

and how do I do this right and I finally just said I'm going to go practice OBC medicine hang a shingle do this thing

5:23

that really nobody else is doing in town and let the Obstetricians do the obstetrics and the gynecologist do

5:29

Gynecology and I'm just going to do the Obesity piece which has been wonderful but that meant I had to leave that obgy

5:36

piece behind um so I've just been solely obesity medicine now the past five years

5:42

is or so I think for a while I was doing both which really hard to do as a position um and as a mom um and so it's

5:50

I kind of siloed that direction now but it's still my love I still was a women Studies major I still am a gynecologist

5:57

and so there's probably a place where that to really take off someday but you

6:02

know with the Obesity World we've been in the last year now obesity medicine's booming and we're trying to figure out

6:07

how to do that realm so I wear a lot of hats but you know women's health is a passion of mine and obesity medicine is

6:13

a passion of mine and yes that's where PC and pry complications really come in

6:18

so well it's fantastic whenever you have uh you have multiple passions in your life and and you're lucky enough to to

6:24

get to do both of them so yeah that's pretty cool what I just need is more time

6:30

yeah don't we all lots of your so lips still so so the

6:35

uh you know it's really neat so the the noise level for uh for folks with

6:41

obesity and overweight it's it it's it's really growing the I think the it's

6:47

taken a while it's very slow but the the the bias and the stigma that comes along

6:53

with that is finally yes starting to crack and it just it feels so refreshing

6:58

and and and this is kind of my world now but uh when I do when I am confronted by

7:05

it still I'm just kind of thrown off like oh my gosh we we still have so much work to do but but it the other part of

7:11

this is um you know there's so much overlap obviously as you know with with uh with folks with obesity and and and

7:18

other comorbidities uh where you know whether it be mental health issues or or cancer

7:25

or just a whole host of diseases so I I think Physicians are just gradually

7:30

going to become are going to be forced to become like you know have some type

7:35

of component of obesity medicine and then you know the flip side of that is like I think most Physicians are going

7:41

to have to you know kind of become lifestyle medicine ohome physicians as

7:47

well so that's you know that's good news we're going to the right direction yes I think we're going the right direction then it's going to be a messy trip to

7:53

get there but I think we will get there it's just going to be the mess before we get there that's okay

8:00

position I mean truly at the heart of what we do we really do want to help people and I think if you look at

8:05

position burnout I I hate that term but the reason Physicians are leaving medicine and droves is because we don't

8:11

feel like the current healthare system is really helping patients very much we're just becoming prescribers and I

8:17

think if we had the capacity and the space and the system of set to let us do a lot of Lifestyle medicine we would I

8:23

mean I think a heart of our hearts we do want to help people so we just have to get there yeah all right

8:30

all right so let's dive into this what is PCOS so PCOS stands for polycystic ovarian syndrome so it's a syndrome

8:38

which is which just means it's a constellation of things that occur under an umbrella versus a diagnostic disease

8:46

like you have to have this lat test kind of thing um it is the most common endocrine disorder of reproductive age

8:51

women which says a lot we hear about thyroid diseases all the time in women but PCOS is the most common disease or

8:58

disorder of rejective women um and it it depends on which criteria you use before

9:04

you can say the prevalence so I just saying it affects a lot of women is probably worthwhile right now because

9:10

there's a a couple different buckets of how you define it the most common is

9:16

called the rdam criteria um that was thrown out there in about 2003 a bunch of experts came together and said how do

9:22

we Define this thing how do we say yes you have it or no you do not um and so

9:28

the rdam C IIA means you have to two of three things one of them is in medicine

9:35

what we call oligo oligo ovulation or an ulation which means ovulation is the the

9:41

making an egg when we have a a ferle cycle we make an egg and that egg either creates a fetus or it doesn't and

9:49

anovulation means that doesn't happen and oligo means it happens less than it

9:54

should so that's the fancy Latin overlap of medicine so the Aver menstrual cycle

10:00

in women lasts about 28 days so normals 21 to 35 there's obviously a range but

10:05

but it's about every month you have a menstrual cycle and so to have less than

10:11

normal it means you need to have Cycles more than 35 days apart or less than

10:17

eight Cycles a year so women with pcus tend to not ovulate very much they don't

10:23

have that cycle where they release the egg so that's one criteria a second criteria is excess

10:30

Ence or excess what we call male hormones although women have testosterone we all do through all of

10:36

our life it's actually our most dominant hormone but Having excess testosterone relative to our other sex hormones and

10:43

that can either be diagnosed on a lab test and you can say yes the testosterone is high or it can be

10:49

diagnosed clinically and you can have features of excess androgens um which

10:55

for women typically is abnormal hair growth so here's to which is having kind

11:00

of a male pattern of hair growth so hair on the chin on the cheeks on the chest

11:07

in places that women are not traditionally thought of having hair growth so that's her taism it can also

11:14

show up as acne or uh female pattern hair loss those are not actually

11:19

technically criteria of PCOS but we see them in that realm so one is that

11:25

ovulation having less of it than you should two is having excess androgens

11:31

and then three the third criteria PCS remember you have two of three is having

11:37

this visual appearance of the ovaries of having lots of tiny little cysts within

11:43

the ovaries that's why the the term came up of polycystic ovaries is you have all these tiny little follicles these things

11:49

that are supposed to become eggs that are bigger than they should and so obviously most people can't see their

11:55

ovaries they're buried way inside of us so we as gynecologists can see the ovaries by doing an ultrasound or by

12:01

looking at the ovaries if we're inside the the pelvis for some other reason so if you put a laparoscope inside of

12:08

somebody to tie their tubes and you look at their ovaries you go oh wow there's lots of little cysts all over them um

12:13

most common is obviously ultrasound because it doesn't involve anesthesia and that kind of thing but so that the

12:18

third criteria is having these tiny little cysts all over the ovaries that usually makes them bigger I mean you

12:24

know if you have tiny little cyst all over your ring finger that finger is going to get bigger than your other fingers so

12:29

and it's not just having one cyst on the ovary or an ovulation cyst on the ovary it's having these tiny little cysts all

12:35

over the ovaries um that we see when we're looking for that so with PC you have to

12:43

have two of those three things um and because one of them doesn't necessarily

12:48

mean you have PCOS so a lot of women especially when they first start menstruating have polycystic ovaries

12:54

that they don't have the other things so that doesn't mean they have polycystic OV and syndrome they just have lots of on their ovaries it's okay that's fine

13:01

that in and of itself is not anything it's just a thing um and some women have

13:08

excess androgens especially as they're going through puberty that doesn't mean they have PCOS it just means they have

13:13

the extra andrens at the time so PCS is having two of the three criteria okay I

13:18

got it medicine's complicated that way but you know there's lots of reasons to have all kinds of other things there's

13:24

you know other reasons to not ovulate so that's that and then what's the section with obesity nobody to go there yeah

13:31

sure that was my next question yeah so not all women with pcis have obesity and

13:37

not all women with obesity have P us so they're they're different things it's just like not all people with high blood

13:43

pressure have obesity and not all people with obesity have high blood pressure so they are different

13:50

manifestations of a problem um and so and this takes us back to how do we

13:56

Define obesity which is really kind of where I'm kind of backtrack in my career of I don't understand this we used to

14:02

call it atypical PCOS if they presented with pcus and not obesity and I was like

14:07

well God like a third of those people have atypical PCOS which means it's kind of common um and so if you really look

14:14

at the ideology of obesity or the ideology of pcus the ideology of these

14:19

things that we call comorbidities of obesity they're not all the same right

14:25

they're all different but they all arise from the same common mechanistic problem

14:30

which as medicine's evolved we're starting to see that and we knew it but we Haven put pieces together in medicine

14:35

but so all of these things obesity PCOS hypertension H high cholesterol these

14:43

kinds of things are all a result of metabolic dysfunction so somewhere within the body the

14:49

metabolism the metabolic switch these things is breaking and the manifestation for many

14:56

people is obesity but not all of them and the the manifestation for REM reproductive age is pcus sometimes with

15:02

obesity sometimes without sometimes the manifestation is high cholesterol sometimes it's fty liver sometimes it's

15:08

ovarian cancer sometimes it's you know that it's common ideology is this

15:14

metabolic dysfunction and in women we predictive age a lot of times we see obesity and

15:20

pcus as that manifestation so at the core of it pcus is being caused by this

15:28

metabolic AB nality which is usually caused by insulin resistance which is typically caused by

15:35

F not always sometimes we have insulin resistance because of chronic high levels of stress that raise our

15:41

insulin sometimes and this is where it's really getting gray is we have high

15:47

testosterone levels as the primary problem with this pcus which then causes insulin resist so it's it's it is

15:54

complicated I mean medicine's just not super straightforward like a lot of people would like to believe but

15:59

this this metabolic abnormality is driving pcus which then often puts

16:06

people into a spiral and so insulin resistance raises testosterone and guess what testosterone

16:13

in women worsens insulin resistance which then increases testosterone which then increases the chicken of the egg

16:19

cycle yeah sure yeah and so if we get there we get there and then it's really hard to pull ourselves out of it because

16:26

it's complicated and so can is so is it safe to say that that PCOS is is the

16:33

leading cause of infertility in I would imagine today it probably is

16:42

um and that's probably recent I mean 253 years ago I would say the leading

16:50

cause of infertility was probably you this is where I'm not a reproductive endocrinologist or

16:57

specialist in infertility problems but I mean there's a lot of reasons for infertility um sometimes the tubes are

17:04

there's there's other reasons but I would say today it's probably has to do with pcus yes wow and also Advanced

17:12

maternal age which is also going along with that is the older women get the more likely they are to develop

17:17

metabolic disease so we kind of pushed those two things down the road together

17:23

so it's there's probably that combination too you see less metabolic dysfunction in people that are Twi just

17:29

haven't yeah gotten it yet so they're more fertile even though they're probably on that path with the

17:35

environment we live in they're just it's not affecting them yet so you see people age because you see more metabolic

17:41

dysfunction as people age yeah so we're we're seeing more so we're seeing more

17:47

PCOS or yeah and what so like you said

17:52

just because you have PCOS or just because you have obesity doesn't mean you're necessarily going to have infertility problems there's all a whole

17:59

a host of other yes disorders conditions that come along with that like just like

18:05

how what percentage of of infertility problems I mean it's not

18:10

that common it's more common than most people think it's such a complicated stat

18:16

because it's do you know you have it if you're not trying to get pregnant right good point Y I mean um

18:23

and there's a lot of people and this is where it just gets so gray I mean I run into people all the time that say I

18:30

can't get pregnant so I don't take birth control but that's kind a load statement right you're not are you trying or you

18:36

not trying are you having sex during that point of the month when you should be fertile and so I don't know it's it's

18:42

very great it depends on how you define it of the people that step back and say right now I'm going to start trying to

18:48

get pregnant on purpose how many of those people are successful that's probably a much

18:54

more accurate statistic that I could probably find if I'm really nailed it

19:00

down um and and what age are we talking about yeah sure there's a lot of what

19:05

ifs a lot of variables that's okay that's okay yeah I know it's

19:11

um yeah I mean nine out of the ten top causes of death right now are nutrition

19:16

related and we're just finding more and more that that that so much comes back to this and sedentary lifestyle and yeah

19:23

so we just we just got to work to get healthy okay so so okay so you're trying

19:28

to get pregnant you uh you find out you have PCOS then

19:35

what you probably goes back to a lot of people don't know they have PCOS because they start birth control to prevent

19:42

pregnancy and so one of the treatments for pcus is oral ctive pill so a lot of people don't even know they have it

19:48

because they can't diagnose the ovulation piece because you're on a thing suppressing ovulation and then

19:54

you're inadvertently out of treatment for it so so like let's say Ario somebody comes in who has been up bir

20:01

control pills for five or six years or had an IUD or something to you know so that they haven't really thought about

20:08

their ovulation issues so they decide okay I want to start deliberately

20:13

ovulating and letting my body you this thing and I want to get pregnant so then they have to see what happens and so

20:20

they stop birth control and they start seeing what their natural cycle is and it'll take a few months to

20:26

reestablish that natural Rhythm that we have as women and guess what we're not perfect so bodies get thrown off all the

20:32

time by illness or stress and so it's normal to have an anovulatory cycle here and there but let's say you do that for

20:39

six or nine months and you come back in and you say hey Doc I don't know my Cycles aren't regular anymore and we say

20:45

okay well now you're off your kills now we now we're establishing your normal Rhythm guess what it's not a normal Rhythm it's an abnormal rhythm of

20:53

Cycles maybe we should look into this idea of PCOS and so then you have to do that work work up and you say do you

20:59

have high Androgen levels clinically or or by labs and should we look at your ovaries to see if you have polycystic

21:07

looking ovaries and then you do this work up and and let's see you get diagnosed which is going to be some but

21:12

not all you know so let's say you have this diagnosis PCS you say okay now I want to get pregnant and I have this

21:18

diagnosis then we have to go down that path of what do we do for you and there things that we do in medicine and then

21:24

there's things we do in lifestyle and hopefully those are one of the same but most of the time they're not as somebody with a background in in lifestyle

21:32

medicine in metabolic Health the first thing I would say and the first thing I said to my patience is okay let's get the insulin down because then that

21:39

solves most of the problems and and that's usually by lifestyle so that's get the insulin down that's what I do

21:46

for a living in my clinic is get the insulin down that's dietary modifications it's better sleep it's

21:53

managing stress because that raises cortisol which then raises insulin so it's all this lifestyle stuff so let me

21:59

ask you real quick so so um just be clear so insulin goes up testosterone goes up and if you already have PCOS

22:07

does that just make it that makes it worse so do on an open wound yes yep

22:12

that makes sense so getting getting the insulin down gets the testosterone down gets gets the resulting problems from

22:20

PCOS impr he okay okay now sometimes it's not enough but but yes when you fix

22:27

the insulin you fix what's called sex hormone binding globuline which carries around the testosterone and so yeah you

22:34

have to kind of fix that problem so what the easiest lever to turn to bring that testosterone down is to lower the

22:40

insulin got it and the easiest way to lower insulin is to not stimulate it in the first place and so and that goes

22:47

back to that obesity medicine piece of you know certain things that we eat raise insulin and if we have syic called

22:52

insulin resistance then that insulin stays up for a lot longer than it should so just not bringing it up in the first

22:58

place is ideal which it's hard to heal the insulin resistance piece if you're con

23:03

constantly being bombarded by insulin so that's that dietary beginning how how

23:09

before we get into you know what your approach is to to the lifestyle and and trying to get that insulin down like how

23:15

long of a of a process how how much how much do you need to get that insulin

23:20

down how much how much weight do you need to lose to affect change here and

23:26

and make things start working again I mean it depends on how how advanced

23:31

the disease is and we in medicine do a terrible job of quantifying that in

23:37

medicine we just say you're fine or you have pre-diabetes or you have

23:42

diabetes um and diabetes would be end stage insulin disease insulin resistance

23:48

it's when the body can no longer no matter what it does get the glucose down

23:54

before that you have pre-diabetes meaning it's struggling meaning it's still a able to crank out enough insulin

24:00

to keep the blood sugar in what we deemed the normal range but for about 10 years before di pre-diabetes is when we

24:07

have high insulin levels and and so it depends on where you are in that Continuum I mean for some people you

24:13

just stop stimula insulin and wow the body heals and for some people especially those ones they have

24:18

pre-diabetes or diabetes they have much further Advanced disease you probably have to do it a lot longer before the

24:25

body really fixes things I knowes so hard yeah it's like looking at a lawn

24:31

right like if the lawn's been sick for 10 years you can throw grass seed on there but it's going to take a whole lot

24:36

more than grassy of water you know I like it I like it Y and then if you keep

24:41

throwing Roundup on it periodically because that's what happens you're really not going to get anywhere you're

24:46

going to be stuck in that cycle and so I kind of look at insulin's kind of like that Roundup like and now if it's coming

24:52

down here and there in the rain okay you know but if it's a bursts of it here and there and then if you turn off the

24:59

watering for a while cuz you don't want to put the water on there then have you backslid and so it's it's such a process

25:05

yeah and it's such I mean there's such generalizations here but like yeah we hear it it really doesn't matter what

25:12

the what the disease is but you hear if you lose like 5 to 10% body weight you

25:18

start to have some fairly significant improvements in health so I'm assuming

25:24

that's kind of the range that we're we're hopeful for so it doesn't yeah it doesn't doesn't take a whole lot to get

25:30

improvements and especially in really Young News yeah you lower that insulin you don't even have to lower the body weight I

25:35

mean the the body weight might not even be the problem and especially in women that don't have a ton of excess weight

25:42

you might not have to lower the weight at all you probably just need to get the metabolic Health fixed so gotcha now

25:47

this is fascinating okay yeah it's it's just the way you frame it right like if you can get if you if you have a

25:54

significant amount of excess weight but you can fix the metabolic problem that cause excess weight yes that Outpost

25:59

tissue is still there in those fat cells but the problem that put it there is solved you might be

26:06

ovulatory which is kind of cool yeah yeah this is neat okay

26:12

so all right so like walk us through um how you might uh put in your

26:20

your your obesity medicine specialist hat on now yeah so

26:26

like walk us through walk us through a journey how are you going to support uh

26:32

these these women uh on their journey and and and try to help them in their

26:38

goal getting getting pregnant if the goal is to get pregnant then you kind of

26:43

have to put a timeline on there so if it's as soon as possible then I'm going to lower their insulin and hope their

26:49

testosterone comes behind with it because I don't want to we'll go down

26:54

the other path but uh met foran which is a really old drug that's around for a long time can help lower that

27:01

insulin um so I would put them on Metformin metformin we use in pregnancy

27:07

to treat gational diabetes so it's a very safe drug to help lower insulin if we want to move that along as fast as

27:13

possible and meor is a great drug for helping with insulin resistance so I I use that very liberally it's a very safe

27:19

drug it's a very cheap drug has it's got a few side effects but guess what the side effects really only come if you're

27:25

eating the stuff that raises insulin and which is which you're not wanting to do anyway so in in that category in a low

27:30

insulin stimulating diet formon is usually very tolerable um and so to me it would be let's work on insulin let's

27:37

work on dietary modifications to keep our insulin down let's work on good sleep to keep our cortisol down let's

27:44

work on movement because when you move the body you make the muscles activate and the muscles soak up glucose really

27:51

quickly which then means we need less andle so I work on movement I work on sleep I work on stress because stress

27:58

raises cortisol and I work on nutrition and then probably some metform in there

28:04

and then hopefully that's enough now if you have a longer timeline of hey I want to get pregnant in a year or I want to

28:10

fix this PCOS and get a lot healthier before I become pregnant putting somebody on birth control pills if

28:17

they're a candidate will lower that testosterone so it's an additional tool in the toolbx that obviously advents

28:23

pregnancy um there is an anti-androgen medication called spironolactone that lowers the testosterone so that would

28:30

lower the testosterone piece but that can cause birth effects in somebody who gets pregnant so you wouldn't want to do

28:35

that with pregnancy Lumen and so you know it's kind of two different Pathways so those are kind your Pathways now if

28:43

it's not enough in a woman who says no I want to be pregnant right now I don't want to take birth control I don't want

28:48

to take spaone like I I'm doing everything I can do to lower my insulin

28:53

I'm taking my met hormon I'm moving I'm you know doing all these things and it's not enough then there's

29:01

medications that we give in Gynecology to stimulate ovulation to really just

29:06

push past the problem um fertility drugs we we call them Clomid we call them

29:13

LOL you know you take them for a few days is certain point tining in the cycle to try to prompt that ovulation

29:21

piece um and we do those that that's nothing you would do as a DIY you do that along with the gynecologist and

29:26

then usually you check to see if the the progesterone level rises at the right time to see is it effective or do I need

29:32

a different dose I mean that's that's definitely a further path down there that you would need to work with a gynecologist but that's what we do you

29:38

try to stimulate ovulation and if that's not enough then you go to a specialist

29:43

who then gives you a whole slew of hormonal cocktails throughout the month

29:49

to you know level it up to say okay we need we need lots of help with ovulation and then we need the support since we

29:55

haven't ovulated we're going to fertilize that egg and then put it back inside of you and then hormonally support that process

30:01

so it's different levels yeah so it it was interesting uh last time we spoke it

30:08

it was neat you said that uh you get you get referrals from the fertility clinic

30:13

yes and and and there's yeah and there's a there's quite a large chunk of patients that that actually don't have

30:20

to go back to the fertility yes clinic right yes and thankfully they they're okay with that you keep thinking they're

30:27

my referral sources dry up but they're so busy I mean the fertility clinics that are saying here on like a year long

30:33

wait so happy as a clam if we can just take that off and say hey now we're

30:38

pregnant right problem solved and they look like hero for just sending them our way so I think did that and it works out

30:44

for everybody and then somebody doesn't have to go through IVF or have that long conversation so yeah no we love the and

30:51

those are the best patients because they want something so badly that you know when you want something that's t able

30:58

and you say okay so yes changing your diet's hard I mean it's hard for everybody but if you say oh my gosh I want a baby more than I want to eat the

31:05

way I've been eating for 25 years oh hey that's it's just a great population in general yeah we I I interviewed some

31:12

some folks to like just share their their weight loss Journey on here as well if they lost 10% body weight or

31:19

more and there there's always a trigger for the folks that have you know lost

31:24

you know we're talking like 30 pounds or more you know that's that's that's a lot so you know yeah I I think there the

31:30

studies show that you you have uh like a 95% failure rate if you're trying to

31:36

lose 20% body weight or more so like the human body was not built to lose weight

31:42

so yeah but if you also think about it most of the recommendations for losing body weight are just restrict your

31:47

intake so you Haven it six the metabolic disease in the first place which it's like pulling a rubber band you can only

31:53

pull it so far and it's miserable to restrict your intake so of course of course it's not going to be a durable

32:00

intervention so this is where in obes we go back to the problem of why are you storing that fat

32:05

abnormally and why is the intake higher than it should be and it's usually because something's striving so yeah

32:11

like for a different day but like if you actually fix the root cause the problem which is that insulin resistance you can

32:17

do that it stays off and definitely as long as that insulin lowering

32:22

intervention is more durable so I think we when we attack the problem wrong it's the failure really high yeah that makes

32:29

sense which is what we've done for very long time eat less like not struggle

32:34

with weight since I was 12 and eating less doesn't work very long it's miserable I don't do well with it but

32:39

guess what if I just eat low insulin I can eat as much as I want and inadvertently I actually probably eat less then I would have but there's no

32:45

misery associated with it so you move on that's that's a neat concept so I think

32:50

people could get their head heads around that so like what's that mean to eat low

32:56

insulin well well also if you look at what stimulates insulin M beside sleep you know poor sleep and stress and all

33:03

of that things that raise blood glucose quickly result in an insulin rise so

33:10

dietary fats don't raise insulin so olive oil coconut oil butter but we don't tend to eat those things by

33:16

themselves Whole Food proteins like eggs and chicken and fish and those things don't raise insulin so eat those eat

33:22

them with the fats they taste better if you put some butter on them or some olive oil on them um then vegetables

33:28

don't really raise insulin because they're high fiber content so non-starchy vegetables don't raise insulin so you eat lots and lots and

33:33

lots of those whole fruits don't raise insulin very much they definitely more so than the other Foods we just talked

33:39

about but like eat an apple it doesn't raise insulin very much and it's a much slower so it's a gentle it's like a soft

33:45

rise so foods like that beans and legumes don't raise insulin very much so

33:50

Whole Foods Mother Nature Foods those don't raise insulin much so when you eat that stuff you don't now then you start

33:56

getting into Mother Nature foods that do raise insulin more like potatoes and rice um so some of those whole grains do

34:03

now again if you're metabolically healthy you can raise your insulin here and there no big deal but if you're not then that insulin stays up for a long

34:10

time so there that's where those can become harmful but when we get into foods that really raise insulin it's it's Ultra

34:16

processed foods it's the addition of flour it's the creation of flour it's taking a whole grain and pulverizing it

34:23

into a powder that then gets absorbed rapidly through the small intestine no matter what the powder is made out of

34:29

anything powdered just goes right into the bloodstream quickly which then causes a rise in blood glucose quickly

34:35

which then stimulates AR rise in insulin um ironically artificial sweeteners or non-nutritive sweeteners

34:42

because of the the taste of something sweet on the tongue they raise insulin

34:47

so Diet Coke I probably shouldn't say products on here but diet sodas you know

34:53

sweetened yogurt that tastes like strawberries or blueberries or lemons those sweeteners raise insulin simply by

34:59

being sweet and activating the sweet receptors on the top and so it's not really the calories that raise the

35:06

insulin it's the type of food that we eat yeah I get you so how so so just

35:13

changing the diet not restricting like you said and I think we all know that doesn't work changing the the the the

35:21

type of food you're eating is that how often is that enough or you know how how

35:27

often often does physical activity go with it um and then throwing medication

35:33

on top of that a loaded question because a lot of people when their insulin's High have a lot of inflammation and

35:40

physical activity is miserable so asking them to do that is also really hard but I will tell you when people lower their

35:46

insulin and that inflammation tanks they want to move so I think it's it's hard to say you need 10% of this

35:53

and 20% of this and that kind of thing uh we typically in our Clinic start start with nutrition because it's such a

35:59

big lever to pull and in my experience most people can then pull the physical activity they just pull it automatically

36:05

they don't even need us to say hey it's time to move they go you know I'm walk to my dog all the time I'm G to join a gym I think this feels really good I'm

36:12

gonna done it's fun yes because most human beings like you remember being a

36:17

kid it's fun it's fun to move your body when your body feels good it's miserable

36:22

to move your body when the body feels bad and so you kind of have to work up Dre of the problem so you know when I

36:30

was not met AAL healthy it was miserable to go to exercise but now I thoroughly enjoy it it's it's it's a piece of my

36:37

day that feels really good you know when I take I live out in the country when I take the trash cans down it's fun to

36:42

just jog up the hill back to the house because it's kind of this little burst of I kind of feel like a kid again U but

36:49

when I had excess weight and didn't feel good that would have absolutely been a

36:55

no and I looked at people when they said I like exercising they had two heads right I didn't think that was fun so it

37:01

it kind of all works together yeah it's I think for a long time this has been a a huge obstacle that that we uh we still

37:09

have ways to go but getting folks to to realize because there's always been a huge swath of folks who love to exercise

37:15

they get the runners high or dance or hiking or whatever their physical activity is and then there's this other

37:21

group that like they don't understand because they they don't get it but maybe it's because of all that inflammation

37:28

and some other stuff going on so you take care of the diet not diet you know restricted but yeah yeah yeah the way

37:36

you eat reduce the insulin reduce the stress reduce the um the cortisol and

37:42

and inflammation and then everything just gradually starts to get better and you get to you get to live to your full

37:50

potential when you watch people become vibrant you know and it's it's so it's so ironic it this where I can talk about

37:56

this forever but like people come into the clinic thinking this 25 lbs is what's weighing me down once I lose the

38:03

25 lbs I will be vibrant again and you kind of go well I don't

38:08

know I mean right it's the the loss of vibrancy is is not necessarily the pound

38:13

it's that underlying inflammation metabolic dysfunction now if getting the weight off lowers the inflammation and

38:19

that's the nidus and that's where we begin and that's usually where people begin you know but I had you know I had

38:26

a family member who got really and she lost 60 lb accidentally I mean she was very ill but she didn't feel

38:32

vibrant it wasn't the 60 lb that were the the problem it was the underlying illness you know so we might package

38:40

that solution up but they but most people and they put it in terms of words of weight but they do want to feel good

38:47

yeah and it's it's amazing when you don't think about your body all day long how much better you feel about yourself

38:53

about your daily productivity you know so everybody just wants to not be so tired not be so stressed not be so sick

39:00

yeah yeah just yeah not be constantly thinking about the aches and pains they don't want to think about their knees every time they get up to pee they just

39:06

want to pee just smile La yeah well this has been fantastic you've taken us down

39:12

a path that that I didn't even know was was was a thing and um until I started

39:17

diving into it so uh this has been really interesting so wow thank you so much um what I do right yeah yeah what I

39:25

can do to make the world a better place now this wonderful it's it's going to take these kind of conversations and hearing these for you know people to

39:32

change their mindset and you change your mindset and you look at you know a problem a different way a different

39:37

angle and all of a sudden it's it's so much easier to tackle because because you you know your path forward so you

39:43

know your why yeah kind of know yeah understand it yeah and you say I mean I

39:48

but I like chocolate well I do too I certainly love chocolate I'm not saying I don't right like I don't live in this

39:54

la la world where I just love brussel sprouts but I actually do like a lot but you know it's not that I dislike eating

40:00

those other things but I also have a very big why of I really want to be very productive with my day and feel good

40:06

yeah and so when I look at it and say I could do that thing that feels really good but then I lose all the momentum for all those other things I want to do

40:13

all day yeah I got it I got it makes sense so um all right so why don't we

40:18

take uh just these last few minutes to tell us you know about your your practice or anything exciting you're

40:23

working on right now or just anything you want to share I mean I'm working on so many things at once I mean to me one of my

40:31

bigger things is the healthcare system is not set up to implement a way of

40:36

making this accessible to everybody we we as clinicians don't get to talk about

40:42

these things very much because we're in a churn through so we have to fix the Health Care system as a whole to really

40:47

get support people as they want to do this and so I think that's that's my biggest what do I want to do in this

40:53

world now how do you do that I don't know the whole Healthcare System is still up against that so you know that's

40:59

it's hard and so I think to me the place we start is self-funded employers that

41:05

are that they have the ability to create a healthcare ecosystem within their

41:10

population especially those that already utilize direct primary primary care or onset clinics or nearsight clinics where

41:17

they have a little bit of control over that can we can we get those clinicians to really approach Healthcare that way

41:23

and we set up those benefit plans to say if you want to do this let's do let's not pize you for going to your doctor to

41:29

talk about nutrition or make that come out of your co-pay you know so I think we have to shift the incentives to align

41:37

with a healthcare ecosystem that that helps with this it's actually very cheap to treat with nutrition compared to

41:42

medications but the the alignment needs to happen there so that's kind of what I'm working on that's kind of a

41:48

gathering of a lot of fragmented people out there that are working on it in different ways and I think we're

41:53

starting to come together together really fun yeah that's NE and and once we get Corporate America and you know

42:01

small and mediumsized companies to come on board I think we have to get them to realize they have that power like

42:07

Shifting the government Medicare Medicaid it's not going to happen like they're going to be the last months to shift I wish they weren't the best just

42:14

it's such a behemoth it's like turning a cruise ship they just don't they're Nimble enough to turn you know but these

42:21

smaller employers and they're the ones taking it so hard right now financially with this Healthcare System so I think we have to get to them so I've been

42:27

speaking at coalitions more trying to consult with these small employers saying here's here's ways we can do it I

42:32

don't know that we all have it figured out but it's not a prively expensive process at all that's reassuring to hear

42:38

yeah exactly like I think it just takes thought yeah and it takes you know thinking outside the box a little bit

42:44

and it takes some being willing to to throw yourself out there and try this thing and you know um so I'm writing a

42:50

book about that right now because I think I don't know it'll touch me thing but then since something I always want to do so I'm doing that title for it

42:58

yeah when it comes out like I just want people that create benefit plans to read that and say let's talk about it you

43:03

know and I think obesity medicine is then the kind of the way in because that's the words people use and it's the

43:10

a thing that people anchor onto so I think we have an opportunity to say okay rather than just spending $20,000 a year

43:17

on all your employees for an injectable medicine that's not treating the the problem could we could we find a do

43:22

something different a medium yeah so I think I think the world has shifted right I don't know what it's going to look like but I think you know I think

43:29

the employers have more power than they realize and I think they're paying for it more than they realize so just

43:35

talking yeah yeah clinic but it's only for people in Kansas so you know aren in

43:41

Kansas then it probably doesn't help but this is what we do all day long in the clinic is we really we have an INF luring Clinic which is really fun oh

43:48

that's cool to hear you say it's fun it is neat cuz you get to yeah change lives so if somebody listening wanted to shift

43:55

the direction of their company and we're interested in this kind of stuff how how can they find you how can

44:00

they get a hold of you I mean probably the easiest way is Courtney md.com that'll get you to that yeah I me kind

44:08

of all the little buckets yeah Court md.com um I'm working for joury

44:13

metabolic which is working just on value based Care Health Systems it's kind of its own little niche out there that's

44:18

those are big entities so you know small mid siiz employers really have to get in the other way that's yeah that makes

44:24

sense in and you know I think it's it's have Brave conversations and see you know see if we can all align ourselves

44:31

in One Direction we talking about it like keep saying keep having podcast talking about this stuff I think getting

44:38

out of the mindset that we just are all on a pathway to poor health is a it's a terrible mindset there there's all these

44:44

different components but it all comes back to the same thing fixing fixing our our our metabolic fix our metabolic

44:50

health and it's going to take Physicians and I want that's the Physicians that's they're hard to get to CU they're all just you know cowering in the corner

44:58

being bombarded by so much that doing everything they can to keep their head above water yeah helping as many people

45:03

as they can so well mayor's need some help yeah Dr Young love thank you so much for for shedding light on this and

45:11

uh and hopefully somebody listening will uh you know you'll be able to touch them and and uh just make things a little bit

45:17

easier for them so appreciate it well thanks for having the five pass and how the conversations people need to hear

45:22

them yeah and we'll put your uh your contact information in the in the show notes so if anybody wants to get a hold of you but uh again thanks appreciate it

45:36

thanks thanks so much for listening please rate and review the podcast on the platform of your choice so we can

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45:52

views and opinion expressed in this program are those of the speakers and do not necessarily reflect the views or position of any entities they represent

45:59

for my day job I'm an employee of ABV and appear on this podcast on my own accord and not in the professional

46:04

capacity as an ABV employee all viewpoints provided are my personal opinions and not intended to reflect

46:09

those of my employer if you have any questions or comments please shoot me an email at Jolly interrupt hunger. org

46:16

let's go spread some Joy people