Well Woman Podcast - Dealing with Midriff Weight gain

Dr. Frances Pitsilis hosted an episode of the Well Woman podcast focused on addressing midriff weight gain, particularly in women over 40 and after menopause. She discussed how hormonal imbalances, particularly declining progesterone levels, can contribute to weight gain and metabolic issues. Dr. Pitsilis explained her approach to treating weight gain, which includes testing for hormone imbalances, thyroid function, and metabolic syndrome, as well as addressing potential toxic exposures to chemicals and heavy metals. She outlined a comprehensive treatment plan involving lifestyle changes, dietary modifications, supplements, and medications like metformin and low-dose naltrexone, emphasizing the importance of addressing underlying causes rather than just using appetite suppressants.

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Transcript

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Hello and welcome to the Well Woman podcast with me, Dr. Francis Pitsillis. This podcast is for education and entertainment. Always consult your healthcare professional. Please like, share, and subscribe. Now, today I would like to discuss the serious and very frustrating problem of midriff weight gain. It is such a source of intense worry that many people are resorting to paying money for appetite-suppressing drugs that can have mixed benefits. Quite a few benefits in weight loss, but some of that weight loss is muscle and bone, some side effects that are unwanted, and some of them serious. And of course, you've got the cost. Well, we've seen it in others, and some of us are having problems with watching our weight steadily go up, especially around the waist. And women from their 40s onwards, and especially after menopause, start to gain weight around their trunk. And this can happen to men as well. It becomes very stubborn to get rid of even when you're starving yourself and exercising a lot. So, what is going on here and what can be done? In this podcast, I want to talk to you about what I've observed in my practice and what I think is going on from what I've seen, what I've researched, and from the results I've noticed. Now, of course, there's a genetic component, look at families, but this genetic component doesn't need to play out. I think it's also got to do with the changes in the areas of hormones, thyroid and metabolism that seem to occur with aging, and of course, some of the vitamins and minerals that help to support these hormones, the thyroid and the metabolism, start to become drained or lost as you age as well. And when I correct these, I find that the person loses weight. When it comes to hormones, we have a gradual decline that can start from mid-30s and even earlier in some women who are very stressed because it drains their progesterone. The youngest woman I've had to give progesterone to was 20. But generally from about mid-30s, women can start losing their progesterone, and of course, you see this in conditions like premenstrual syndrome, polycystic ovarian syndrome, endometriosis, those with heavy or painful periods, as well as premenstrual dysphoria syndrome. So that's the severe emotional, mental health, depression and anxiety that women get. Now in these women, they're partly particularly low in progesterone, and that's called estrogen dominance. So they start gaining weight because progesterone reduces fluid retention, increases the metabolism, lowers blood sugar, helps the thyroid. So also because thyroid can be associated with some of these conditions, they then have this double problem. They're low in progesterone, but they might also be low in thyroid at the same time. Now, when you approach menopause and you start to eventually lose as well as progesterone, your estrogen, DHEA, and testosterone, that also has an effect. So harmonising all the hormones helps to maintain the metabolism and to some degree weight control. Yes, progesterone helps to stimulate the thyroid, but so does DHEA and testosterone. An underactive thyroid runs in families and tends to affect women far more than men. An underactive thyroid also tends to manifest itself more after menopause. And this is a situation that's difficult to diagnose because the tests are unreliable. And you can listen to my podcast about an underactive thyroid. And family doctors don't have time to listen to all the symptoms and examine the patient, which becomes really important. They just look at a blood test, which is unreliable. So making the diagnosis of an underactive thyroid is really important because it increases the metabolism, it helps everything to run properly. Then, of course, we're looking also at metabolic issues within which, yes, include an underactive thyroid, but also include diabetes pre-diabetes. Polycystic ovarian syndrome is associated with prediabetes and diabetes, but also an underactive thyroid. And this profile runs in families. You only need to look at families and look at whether they have certain things that run in the family, which means that then the younger generations are at risk of some of these. Now, along with diabetes and prediabetes, they can have fatty liver, and fatty liver is the fatty infiltration of the liver, but but fatty liver also has an underlying problem, which is the underactive thyroid. So, how do I approach the patients who come to me and tell me they haven't been able to lose weight? And some of them want to go on the new GLP1 agonist drugs like Wagovy and Manjaro. Well, my first thought is to make sure that I don't forget to check that they haven't been poisoned with chemical sprays, pesticides, and heavy metals, because some of these are kept stored in the fat of the body, and you must get rid of the toxin first to get rid of the fat. This involves testing heavy metals. If you're high risk, like a dentist or a dental nurse or a hospital worker, so I'm thinking about mercury here. It's also about knowing someone's occupation and understanding what they might be exposed to, which is important, because then you can start thinking about what they could be poisoned with, especially if they don't take any precautions in their occupation. Special doctors who understand this use swallowed chelating agents for mercury and arsenic, etc. But until recently, it's tended to be that if you're poisoned with lead, you have intravenous chelation, although a doctor I know in here in New Zealand has identified a good oral chelating agent for lead. So that can be looked into and researched. If you think you've got lead poisoning. If the person has had a lot of exposure to pesticides, there's no medicine that I know of that you can take to clean it up. In this situation, I would suggest looking at taking oral antioxidants like vitamin C, melatonin, coenzyme Q10, and Nacetylcysteine, and then to these you add sauna. So the prescription for sauna is to sit in the sauna for 30 minutes three times a week. The heat makes you sweat, and the sweat carries out some of the toxin. So the next thing to consider is lifestyle diet and sleep. It's important to get enough sleep at the right time so your natural melatonin will work properly. If you're not in bed and asleep by 10:30, you won't make melatonin. And on top of that, we are deluged with blue light everywhere. Now we have LED lights to save money, we have computers, TVs, and devices. So I end up giving a lot of my patients melatonin for this reason and for its benefits. Now, on top of that, there are a large population of shift workers in our community, retail shift workers, not going to bed early enough because you're working late, even if you're not a night shift worker. And then these people don't make their own melatonin. So what's important about melatonin is that it restores the natural circadian rhythm, which then helps the body to work properly, as well as it being an antioxidant, anti-inflammatory, and it has some anti-cancer actions. Diet, we all think about diet, don't we? Well, it should be highly plant-based so that you can get all the colours of the rainbow and all the different antioxidants and adequate protein. Very often we talk about a ketogenic diet or a paleo diet or a Mediterranean diet so that the person gets adequate nutrition. The trick here is to keep the sugar and starch very low. And I find some of my patients, actually, many of them have to look at avoiding gluten, and some patients have to avoid dairy, and then a small percentage of people have to look at histamine foods. Now, this latter group are the people that have more autoimmune diseases, allergy, asthma, underactive thyroid, migraine, lots of conditions, about uh one in five people. Now I like to suggest that people take a good multivitamin containing methylated folic acid in it, two to four thousand milligrams of fish oil if it's safe to do so. So check with your family doctor, and some vitamin C. These three things are my foundational things that I think everyone should take. After that, I like to test zinc, copper, vitamin D, B vitamins, thyroid function tests along with thyroid antibodies. I also like to do the cholesterol or lipid panel as well as renal and liver function, because the liver function and the renal function and the cholesterol tests give me side door indicators as to what the thyroid's doing. So, for example, if the triglycerides, the LDL are high, one of the causes is an underactive thyroid. If the ALP test within the liver function tests is low, that can be associated with an underactive thyroid. And if filtering in the kidney is low, that can be related to an underactive thyroid. I've also noticed that the uric acid test can be raised, that can be related to diabetes or prediabetes, but it can also be related to an underactive thyroid. So once the tests are with me and the patient comes along, I can review everything, look at the questionnaires, and correct all the deficiencies. Now, metabolic syndrome can include diabetes, hypertension, raised uric acid, as I've already mentioned, abnormal lipid tests, and a large waist circumference. It runs in families. But I've observed that as men and women age, it becomes more apparent. And I think it's because, in part, people are losing the vitamins and the minerals that are keeping the glucose and insulin low and also supporting the hormones. But on top of that, they're starting to lose the hormones that keep the metabolism under control. So an important set of tests that are related to the metabolic syndrome or pre-diabetes includes fasting insulin and hemoglobin A1C. Sometimes I'll do the glucose as a side indicator of an underactive thyroid. But I get valuable information from the triglycerides, the LDL cholesterol, the liver function, and the uric acid test. When the fasting insulin is raised, I know that giving the patient metformin is going to be useful. It's going to reduce the insulin, the glucose, help any diabetes, but it also reduces appetite and helps weight loss, along with protecting the brain, heart, and having some anti-cancer and other properties. I'll often give this to non-diabetics as well because of its many helpfulness. Please see my podcast on Metformin for details on metformin. Now, once I've corrected all the biochemical imbalances, the hormone imbalances and the thyroid imbalances and treated any metabolic issues, I can then, especially if there's not good enough weight loss, and especially if the patient wants to get more weight loss and get help, I can give them a few other things. Now, one of the things that I do that I've found is successful is that I give them a course of fluconazole, which is an anti-yeast and fungal, because the gut and the brain are connected. And I've got that as a video in my YouTube channel and as an article on my website about the gut and brain connection. But if you can get rid of sugar for long enough and the fluconazole uh kills off the yeasts and the funguses, and then the microbiome isn't sending messages to the brain to say, give me sugar. So I do a course of fluconazole to help with that. And people who have terrible sugar cravings. Now, in addition to that, the other things that I can give include chromium, Nacetylcysteine, and low dose naltrixone. Chromium burns fat and reduces cravings and can help increase DHEA, as well as chromium helping to absorb minerals into the body. Now, N-acetylcysteine is the precursor of glutathione, which is the body's master antioxidant. It works well in diabetes, it protects the brain and reduces sugar cravings and food cravings and helps with weight loss. Low-dose naltrexone has been used in normal doses of 50 to 100 milligrams for alcoholics and drug addicts, but in smaller doses it's used for autoimmune disease, as an anti-cancer agent, as an anti-inflammatory, and it's used for reducing pain. The doses for these types of areas start at a half or one milligram, and the maximum dose is 12 milligrams. Now, when it comes to weight loss, I've noticed that as the low-dose naltrexone dose goes up, it starts to suppress the appetite. This is a different dose for each person. Separately to this, I've noticed that there's a product on the New Zealand market called Contrave, and you'll probably see it in other international markets. And this contrave contains 8 milligrams of low-dose naltrixone plus an antidepressant. So I think the average person with low-dose naltrixone could start with one milligram of no low-dose naltrixone and slowly increase it. And I would prefer that to the contrave because that may have more side effects. You're meant to take the low-dose naltrixone at night, but because it can disturb your sleep, I ask my patients to take it in the morning and increase it every third night until they get the desired effect. A small percentage of people don't tolerate low-dose naltrixone. Well, now you can see that it's not just about taking an appetite-suppressing drug to lose weight, because you can lose muscle and bone with it. We need to address the underlying causes of weight gain, which are multi-layered, as I've just explained. Using the process I've just described to you, a person can start to obtain control of their weight. And eventually, if they are on these medicines, they might be able to reduce their dose of GLP1 agonists drugs as well. Now I hope this information has been helpful, especially for people who've been very frustrated with their weight gain and have felt that they didn't know where to start. This is a good place to start. Please share this with someone who you think would benefit. Always remember to involve your healthcare provider, and that this information is for education and entertainment. Bye for now, and I'll see you in the next one.