Dr. Jade Teta is a naturopathic doctor, author, entrepreneur, and educator specializing in functional endocrinology, transpersonal psychology, and strength and conditioning—what he terms mind, muscle, & metabolism. As a renowned expert in physical and personal development, Dr. Teta has also created educational health programs that focus on a range of personalized lifestyle components, from optimizing nutrition and eating habits to self-development and building healthy relationships. Learn more about his work at www.metabolic.com and www.nextlevelhuman.com and on his popular podcast Next Level Human.
Kalea Wattles, ND:
Maintaining optimal metabolic function is vital for overall wellness, and poor metabolic health may lead to an increased risk for a range of acute and chronic diseases. Reports indicate that the prevalence of metabolically healthy adults is alarmingly low in the United States, even for those within a normal BMI range.1 So how can healthcare practitioners help patients maximize their metabolic health?
Jade Teta, ND:
So, from my perspective, when we are looking at individualized metabolism, we take these four p’s—physiology, psychology, preferences, and practical circumstances—and we combine them with the current reality of these four m’s, right? The mindfulness, the meals, the movement, and the metabolics. And then we start looking for the disconnects between these two. And this is how I begin unpacking this individualized medicine.
I’m your host, Dr. Kalea Wattles, and on this episode of Pathways to Well-Being, we welcome Dr. Jade Teta, a naturopathic physician and renowned expert in physical and personal development. We’ll discuss the intricate relationship between metabolic health, personalized nutrition, hormonal balance, and physical fitness. Dr. Teta, we’re thrilled to have you on today. We’re so excited for this conversation about igniting metabolism. Welcome to the show.
Thank you so much for having me, Kalea, I’m excited to be here. It’s gonna be a fun conversation.
This is going to be really fun, and I’m really looking forward to hearing all of your clinical insights. I know this is a real area of passion for you. So let’s start with a brief overview of metabolic health in relation to disease prevention, optimal health, optimal wellness. For an individual, I know you’re all about personalized medicine and finding what our kind of metabolic profiles are. So I would just love to begin this conversation with understanding a little bit about how an individual’s unique metabolism helps you to create personalized treatment plans so that we can do some preventive medicine.
Well, thanks for that question. And honestly, to me, and you’ll have to forgive me here, but when I think about metabolism, one of the things I think about that I think that we have to cover before we start talking about the individual, which is critical, is we have to talk about sort of our understanding of metabolism. Now, of course, this is The Institute for Functional Medicine. So you all do an incredible job, in my mind, the best in the business, in terms of helping us understand how to integrate all the metabolic processes. I also think that we have to point out, and Institute for Functional Medicine does this, that we have been dealing with wrong models about metabolism in the conventional medical world. And I even think in the alternative complimentary world, we sometimes get this wrong. So, from my perspective, if we’re gonna talk about individualized metabolic medicine and health, we need to first just unpack what we really mean by metabolism, at least the way that I’m looking at it, and we’ll see what the clinicians here think.
From my perspective, when we look at metabolism, it is very simply a sensing and responding apparatus. And the thing that it is sensing and responding to is stress. Now, of course, all of us understand that when we hear the word stress, it means a lot more than emotional stress. I mean inflammatory signals. I mean toxins in the environment. I mean eating too much or too little calories. I mean exercising too much or too little. I mean everything that is sort of impacting this metabolic software system. So what we have to understand is once we understand that very simple dynamic, that the metabolism is looking in the outside world, sensing what’s going on out there in terms of temperature, in terms of food availability, in terms of viral insult and bacterial insult and inflammatory insults, it’s taking all that information in, then it’s also gathering information from inside, and it’s essentially integrating those two messages from inside and outside and plotting a path back to homeostasis.
So I think we’re probably all clear on that, I hope, but here’s ultimately where the individual gets in, because what we tend to do in medicine, in my mind, both conventional and alternative and complementary medicine, functional medicine obviously is the best at this, but there still might be some need to sort of break this down, is that what we tend to do is we tend to say, okay, well, all the things out there in the environment are the same things for everybody. And all the internal sort of things going on inside the body are sort of the same thing for everybody, and so we can essentially start saying, if someone has insulin resistance, for example, we’re gonna prescribe a particular diet, a particular set of nutrients, maybe alpha lipoic acid, inositol, and berberine, certain things like that. And what you end up having is you end up having sort of a natural medicine prescription that looks very similar from practitioner to practitioner and patient to patient in the same way in conventional medicine, you have a similar sort of prescription from the pharmaceutical side. So the way I try to break this down is I essentially go, look, everyone is unique, and that’s the starting point.
So the idea is then, how are they unique? They are unique, in my mind, in four specific ways. They are unique in their physiology, they are unique in their psychology, they’re unique in their personal preferences, and they’re unique in their practical circumstances. Now, physiology wise, we know, Kalea and I were talking offline, and she’s wearing a continuous glucose monitor. So am I, right? So we know that if we each have the same piece of white bread, that this is gonna impact each of us very differently. That’s the physiological differences, right? We also know that if we are under stress or under a deadline at work or something like that, I might respond to that with appetite suppression. Kalea might respond to that with appetite increases. That’s the psychological differences. We also know we have practical sort of circumstances. Some people live in food deserts. I’m here in Asheville, North Carolina, there’s a Whole Foods a block away. I have the resources to eat those foods. That’s the practical circumstances that we have. And then, perhaps most importantly, is personal preference, which I think tend to be thrown under the rug. Some people like beers and Brussels sprouts, other people like chocolate and coffee, and we need to incorporate all of these aspects of the individual into this understanding of the sensing and responding apparatus that is the metabolism.
And from there, I’ll say one more thing, and then I’ll see where you want to go with this, Kalea. So, from there, we have this individual, I would call the four p’s, physiology, psychology, personal preferences, practical circumstances. And then from there, I can go in and look and say, what are the different attributes of the lifestyle? Well, there’s the mindfulness and mindset, the way I perceive the world, the way I handle stress, how I rest and recover, what’s going on with sleep. There are the meals that I eat, right? There are the movements that I do, and there’s sort of the metabolics. And by movement, I mean not necessarily exercise, but just moving throughout the day, activities of daily living. And then there’s the metabolics, everything I do to move the metabolism. This would be things like exercise, supplements, drugs, et cetera. So, from my perspective, when we are looking at individualized metabolism, we take these four p’s, physiology, psychology, preferences, and practical circumstances, and we combine them with the current reality of these four m’s, right? The mindfulness, the meals, the movement, and the metabolics. And then we start looking for the disconnects between these two. And this is how I begin unpacking this individualized medicine, realizing what we’re really talking about here, these four p’s that make me unique and then these four choices I have around lifestyle, which is around mindfulness, meals, movement, and metabolics. And from my perspective, if we just break it down to that simple four-part process on either side of this equation, we can begin simplifying this for our patients a little bit better.
So hopefully I didn’t ramble on and make that unclear, but that’s the way that I like to impact, that we need to have an understanding of metabolism, we need to have an understanding of that person’s individual metabolism, and we need to have an understanding of that person’s individual lifestyle choices.
That was beautifully said. And as you’re speaking, I’m picturing all of these components within the functional medicine framework. So here at IFM, we use a tool that’s called the functional medicine matrix. At the foundation of this matrix are our modifiable lifestyle factors, sleep, nutrition, stress, relationships, and then we have this map of our body systems that we call core clinical imbalance areas. And it’s so much of what you just mentioned, hormones, cellular energy production, our ability to biotransform and excrete environmental toxicants, our gut health, the structural integrity of our body, and then at the center of that is our mental, emotional, spiritual component. And it sounds like you’re actually just inherently in your process touching on all of those pieces. When we look to sustainable behavior change and how we can realistically take bite-size chunks from a treatment plan, how are you looking at all of these various contributors to metabolic health and creating a hierarchy so that you know what you want to address first?
Yeah, it’s a really, really good question. Well, first of all, to me, this is why functional medicine is so important and been doing such amazing work for all of us, because they do make this clinical reality an easier sort of process. And that’s all I’m trying to do. Just as you said, I’m basically trying to take the same kind of mindset and breaking it down in a way that sort of makes sense for me and my sort of clinical reality that I see on a day-to-day basis. So how this starts to translate for me in the real world with a patient is, for me, rather than going in with my own bias and my own dogmatic view of what people should be doing, I am looking and talking to this person about A, maybe what they should be doing based on my clinical experience, but also what they’re ready to do and what they’re interested in.
We hear a lot about evidence-based medicine, right? And what most people take that to mean, of course, I’m speaking to the choir here, but I just think it’s good to cover these things so we’re all on the same page. I think most people who listen to this show and pay attention to functional medicine have a deeper understanding of what evidence-based medicine means. It’s not simply just looking at the research. That’s a big piece of it. That’s one piece of it. So we’ve got to look at the research and sort of understand what that’s saying, but we also have to take into account our own clinical experience. And then most importantly, we have to go and see, what are the realities of this particular patient?
So, from my perspective, I’m always starting at, what’s the realities for this particular patient? And this is gonna perhaps get us in a direction that might seem a little esoteric, new age, or woo-woo, but from my perspective, I tend to look at, what can this person actually do? Oftentimes in clinic, we will say, well, this is the ideal thing for them to do. An example might be this. We would all know that someone is, let’s say who’s insulin resistant, metabolically inflexible, dealing with something like metabolic syndrome, which I use that because we know almost every patient we see has some degree of this, we might say, well, the best thing for them to do, if all things were perfect, would just be to abstain from food for a period of time. Maybe fasting would be the fastest way to get them back to metabolic flexibility and insulin sensitivity. However, we know that in the real world, when there’s food around everywhere and these people are gonna have very real appetite and craving consequences from going on a fast, we can’t necessarily just jump right to that, that we know that that might end up making this person overeat, get into a binge/starvation cycle. Obviously, if we could just throw them out into the wilderness and tell them to fend for themselves, they probably would fix this out really quickly, right? The metabolism would heal really fast, but they live in the real world.
So what I’m essentially doing is saying, what can they do? So what I do is I have them rank where they think their biggest struggles are on this four-m matrix. What is going on with their mindfulness? How in touch and in tune and aware are they of stress-reducing techniques? What’s going on with their meals? How are they eating? So I’m doing sort of an evaluation there, and I’m also getting their input there. And the reason why is because I can look at their diet recall and maybe say, oh, I see problems there, but I ask them, because I want to know, what are your struggles here? Is that gonna be the easiest place to attack? Even though it might be the place where we’ll get the most clinical, relevant sort of results, it might not be the place that they’re ready to tackle. I do the same thing with movement, and I do the same thing with metabolics, my four m’s. And then I take my clinical judgment along with where they think they can start and start there. So I’m not using myself as the guide. I’m acting more as a coach and essentially saying, here’s all the things that I essentially see. What are the things that you think you need to tackle first?
And a clinical pearl that I often could give people that I have found, and we’ll see what you think about this, Kalea, because you may have found something different in your practice, is that almost always, when it’s left just to my judgment, even then I usually start with mindfulness and mindset and stress-reducing techniques. From my perspective, that to me is what tends to be the greatest bang for your buck and the easiest approachable ways and enjoyable things to do things for patients who are struggling metabolically. But there is this sort of back and forth between my clinical judgment, understanding what the research says, but most importantly, letting that patient guide me.
And I’ll give you just a quick example of this in case that didn’t make sense. Let’s say a patient comes in and they want to lose weight and they’re dealing with thyroid issues and metabolic syndrome, something we all tend to see. What I’m going to essentially do is I have an idea of where to start if they don’t have one in their head. But what oftentimes happens is someone will say, you know, I was reading about the keto diet, or I was reading about the paleo diet, or I was reading about intermittent fasting, or I heard about this or that. And from my perspective, rather than try to steer them away from that, or maybe they’re thinking, I’m moving towards a vegan/vegetarian diet, and I want to try that. Rather than steering them away from that, I seize on that as a clinician and I say, perfect, cool. And then from there, I start to teach them and say, you know, there’s not a one size fits all diet out there. The only rule in this whole thing is to do what works for you. So that’s what we’re gonna do. We’re gonna act as metabolic detectives, you and me, instead of dieters or people who are just trying to follow a cookbook sort of dietary regime, and we’re gonna see if it works. And what we’re gonna do is we’re gonna see how your biofeedback, things like sleep and hunger and mood and energy and cravings, responds to this. We’re gonna see how your body composition, whether you’re losing fat or not, attaining or maintaining optimal body composition, responds to this. And we’re gonna see how well you can adhere to this, how consistent can you be with it, and we’re gonna see what’s going on with your vitals and your blood labs and things like that. And that’s gonna tell us whether this regime that you’re choosing is going to work for you or not, and then we’ll tweak and then we’ll adjust. Now, I call this the “aim” process. So we’re assessing what they’re doing, we’re investigating the response that they had through biofeedback, and then we’re modifying our approach like a detective, slowly but surely homing in on what is going to work best for them rather than starting with my bias as the clinician. Now, if they don’t have a plan, I certainly have an off the shelf plan that I would use in this case, which we could talk about if you like. But this is the way I begin this process.
All right, metabolic detectives, I’m gonna remember that one and call upon it. It’s almost like a choose your own metabolic adventure, we’re in it together. Words matter, and I think the way you phrase that really helps the patient understand that this is a therapeutic partnership, that you’re there to investigate with them, and I wholeheartedly agree. I also always start with modifiable lifestyle factors. And I think we hear all the time, oh, meet the patient where they’re at. But it’s hard to figure out what that means, but you’re doing real assessment of their readiness for change, which I’m sure plays out in great adherence to the treatment plan, so really appreciate that insight.
You mentioned thyroid, and I imagine you have many, many patients coming to you saying, I think I have something going on with my thyroid. I know you specialize in integrative endocrinology, and we know that metabolic health and hormonal health are intricately related. So can you talk to us a little bit about how you start to tease apart the hormonal component when someone’s struggling with their metabolic health?
From my perspective as a clinician, and of course I’ve written books on this and everything else, the old way I would approach this is I would name out all these hormones, right? I would say, oh, it’s an insulin issue or it’s a thyroid issue, or a GIP and GLP and leptin and all these myokines and cytokines, and I would speak that language. Now, even when I’m talking to clinicians, I no longer speak that language. I speak the language of biofeedback, because these hormonals, the hormonal system, the endocrine system, is either directly contributing to and/or causing many of the biofeedback sensations that we as clinicians would call signs and symptoms. I call them biofeedback to the patient. We call them signs and symptoms. And to me, the signs and symptoms are illustrating to me what is going on with the hormonal system.
And to me, there are a few really big ones here. Sleep, difficult sleep, fragmented sleep. This is a sign that we are dealing with something going on in the hormone system, right? Hunger, dramatically impacted by hormones. Cravings, dramatically impacted by hormones, especially things like cortisol. Mood, dramatically impacted by hormones. Estrogen and progesterone we know have effects on dopamine and serotonin and GABA, et cetera. Not to mention sleep, hunger, mood, energy, and cravings, but also things like exercise performance, exercise recovery, libido, erections, menses, digestive function and signs and symptoms, headaches, joint pains, et cetera. So what I typically am doing is I’m looking at, and again, you guys do an incredible job with these matrices that you have that we can go in and look and see and go, okay, here’s the different biofeedback signs and symptoms that we’re looking at. What I’m doing is I’m relating those to potential hormonal issues. What might be different about the way that I do this is rather than focusing just on the hormones themselves, I look at this from either a top-down or bottom-up approach. And I’ll explain sort of how I look at that.
So let’s say I began to see that I’ve got foggy brain, some depression, a little bit of constipation, cold intolerance, all the sort of signs and symptoms of some thyroid dysfunction. From my perspective, the way that most people might do this is they might go, okay, there’s some thyroid stuff going on, let’s go and look at the thyroid, right? Which I certainly do. But right away, I also go, well, what is impacting thyroid function? The top-down approach would be we’ve got the hypothalamus, the pituitary, the adrenal, thyroid, and gonadal axis. If we look at metabolism as a stress sensing and responding apparatus, and we look at the hypothalamus as this major satellite that has two heads, one focusing into the body, picking up all those signals, and the other head focusing outside of the body, picking up all those signals, I’m asking what is going on with the hypothalamus first. Hypothalamus, pituitary, adrenal, gonadal axis. Now, even before I start putting in any thyroid treatments, I’m looking at those signs and symptoms, those biofeedback sensations, especially sleep, hunger, mood, energy, and cravings, and by the way, when I’m talking to my clients, I call this “shmec.” “Shmec in check” means hormones are probably in balance. “Shmec out of check” means hormones are likely out of balance. So, when I’m talking to them, I’m not talking hormones, I’m talking this sleep hunger mood, S-H-M-E-C, shmec effect.
If this shmec effect is off, what I want to do is I want to work the top-down approach and start working on the hypothalamus. From my perspective, this is really all the lifestyle stuff we mentioned, but then putting in adaptogens. So, at this point, I’m not using ashwagandha, let’s say, simply because I think there’s something wrong with the thyroid and we know it does some things with TSH, et cetera. I’m using ashwagandha because I’m trying to get the hypothalamus to respond appropriately again.
I also could take the bottom-up approach and say, well, what’s going on with the mitochondria? We know that the mitochondria are essentially in direct communication with the sarcoplasmic reticulum in the cell, and this is making all of the hormones. So we don’t necessarily know that mitochondria are integral in making hormones as well as integral in making energy. And from my perspective, we also know that each cell in the body and each tissue is essentially regulating its own thyroid production. So then what I am essentially doing is I’m looking at that as well and saying, what can I do to support the mitochondria? So maybe now I’m not necessarily adding in things like CoQ10 and acetyl-L-carnitine and alpha-lipoic acid from the perspective of, because I’m giving alpha-lipoic acid because of insulin resistance, I’m giving it to begin to support the underlying mitochondrial structure.
So now I have a top-down effect where I’m really looking after the hypothalamus and the endocrine system functioning that way from the top-down approach, and I’m also supporting the mitochondria from the bottom-up approach. Now, once I do that, now we’re assuming first comes the diet and exercise piece, right? But I can do all of this at the same time. So let’s say adaptogens and things like that and maybe lifestyle adaptogens like sauna and contrast therapy and walking and interval training and things like that, and I’m putting all those pieces in place. Now I’m ready to actually go and look at, now what’s going on with the thyroid? At this point, we may have already seen shmec get back in check. I may have already seen some of the stuff happen. Now, of course I’m getting those blood labs first. For me, it would be TSH, free T3, free T4, thyroid antibodies, all these kinds of things, but I’m putting all this stuff into effect because I may not need to support the thyroid directly. And doing so, supporting the thyroid directly right away as a clinician and not taking care of this top-down, bottom-up sort of idea of the endocrine system, I may actually end up missing something along the way.
So this is the way I began to approach this. It’s like this whole lifestyle effect, then taking care of the top-down approach to the endocrine system, taking care of the bottom-up approach to the endocrine system, and then and only then beginning to target the actual system that might be struggling. And at that point, we may not even need to do that, if that makes sense.
Well, I have to make this observation that these acronyms and these talking points I think are so helpful for our listeners, and I can tell that you really value this philosophy of docere, which is doctor as teacher, I think we both highly value that. So as you’re doing your education with patients, do you set some expectations for how long it might take one to get shmec back in check?
100%, right? And by the way, when working at it this way, it used to be, before I started doing things this way, I would have to wait whatever it was, three months or maybe a month. And the truth of the matter is, let’s face it, running blood labs, we would all like to get blood labs probably every two weeks when the person comes back. We can’t because we have limitations in terms of the money that is spent here. Now, of course we all run lots of different specialty tests, but most patients cannot run all these tests, so we need a way to evaluate what’s happening week to week or every two weeks when a patient comes in.
So this is where the sort of shmec in check piece comes in. And by the way, when I say “shmec” to a patient, I make it very clear to them that, ah, that’s a euphemism or a catchall phrase for all biofeedback. So it’s not just sleep, hunger, mood, energy, and cravings. It might be the joint pain that they’re having. So when they feed back to me, they’re saying my joint pain is less or more, my gut function is less or more, and then I’m making my adjustments based on that. So that is happening week to week. Now, I usually don’t let more than two weeks go by. Let’s just use this as a… I work mainly with weight loss and metabolic dysfunction and resistance in terms of that. More than two weeks goes by, and I don’t have shmec in check, I’m making some adjustments. So, in that “aim” process, assess, investigate, modify, my patients know, matter of fact they come in once they’re with me for a little while and they’ll immediately just say, my shmec is this, it’s in check, out of check, my body composition is this, and hopefully then I have different things that I can use.
I really like, for example, you’re wearing the continuous glucose monitor. That’s something we now have available to us that I can have real data daily. I’m wearing an Oura ring. That’s something we now have available to us that we can get HRV, we can get sleep numbers. So it’s a really fun, fun time to be a clinician, isn’t it? Because we have lots of different tools that we can now pull from real world data. So I’m using this subjective shmec every week or every two weeks when the patient comes in, and I’m also using this objective sort of data from devices and biofeedback and stuff like that to augment the labs that I wish I had every week that I can only get once a month or every quarter.
And from my perspective, at least as it pertains to weight loss, and I’ll say something pretty controversial here, it’s on purpose just to make a point to all of us, from my perspective, if I have a patient whose shmec is in check, who’s attaining and maintaining optimal body composition and whose blood labs and vitals are all moving in optimal directions, I really don’t care if they’re eating cotton candy and burgers all day. Now, the reason I phrase it that way is we all know that no one’s gonna be able to eat cotton candy and burgers all day and get all three things that I talked about in order. However, I have seen people having various diets and lifestyles that some of us might not find that healthy who are actually getting healthier from looking at it this way versus trying to become something that is not doable for them. I think we get into this very weird thing, and I think us clinicians fall prey to it as well, when we jump on the bandwagon of the latest, greatest things. We’re not immune to the novelty that is out there either. But we have to understand that there are various ways to achieve health, and we can’t make that popular phrase, we can’t make perfect the enemy of good enough. Most of my patients who get the best results are patients who make little tiny changes and end up having better health, shmec in check, optimal body composition, blood labs and vitals, and they’re still drinking their wine with dinner and they’re still having some sugar on occasion and they’re still doing some of the things that in the clinical world, a lot of us would be like, you can’t do that. And I do think that’s important for us as clinicians to teach that to patients that this is a journey. I want you to take the first step, maybe walking and just cutting out junk food with some of these nutrients is enough for you, and then we’ll take the next step. But this is how I like to look at this.
Super approachable, and I appreciate you throwing these perhaps controversial tidbits into the conversation. It’s gonna get the audience thinking. So I think that’s really valuable. Before we move on from this hormonal topic, I have to ask. Do you experience an added challenge treating metabolic dysfunction in women who have some hormonal cyclicity? Is that an obstacle for you, or your experience now that that’s no issue and you have your methods?
No, it’s a huge obstacle, and of course you know that. That’s why you asked the question. It’s a huge obstacle, and I think we need to just speak a couple things here. So, in a very funny way, I have become an expert in female endocrinology. I’m known for helping female patients lose weight. That’s how I sort of, I guess made my name and became known in this field. And one of the things that was shocking to me… So I graduated back in 2004, and prior to that, since the age of 15, so back in high school, which I graduated back in 1992, I started personal training. So I’ve been working with mainly women on weight loss issues since the mid-80s, basically, right? And what I saw, especially back then, 90s, early 2000s, that there was literally, when I went to look and see this, and by the way, I have to be honest here, I was dragged kicking and screaming. In those years, I was embarrassingly an ignorant, arrogant, meathead clinician who was like, if you’re not getting results, it’s because you’re just a glutton and you’re lazy. And most of the people I was working with were women and women in the age range of 35 to 65, first having children, big hormonal changes, perimenopause, menopause, and I was treating them all like young athletic men, embarrassingly. And part of the reason for that was I was just not well educated and open-minded at the time, but another big reason is it was in none of our textbooks, it was in none of the education that we got. It still isn’t.
As a matter of fact, just a few years ago, I think the American Heart Association came out and said, this is the leading killer of women too. Came out and said we have women underrepresented in the area of research in strokes and heart attacks. Back in 2001, they said the same thing. So it’s still not being fixed. We have a huge issue here in the research on women and metabolism. And part of it is, let’s be fair to the research community, part of it has to do with the female metabolism is, how should we put it, more sensitive and refined than a man’s. It just is. And we know it is because they are the gender of childbearing. They’re also still primarily the gender of child rearing. So, if the metabolism is a stress sensing and responding apparatus and you are the gender that has to take care of a baby for nine months and know when it’s appropriate to get pregnant, stay pregnant, and then support that child after they’re born, you better be looking and paying very close attention to the way the environment is, and you better have some mechanisms in your metabolism that are very in tune to the environment.
And we see that estrogen and progesterone are just these beautiful hormones that are very, very responsive to the environment. I like to describe them as the two nonidentical twin sisters. To me, they’re nonidentical because they don’t do exactly the same thing, but they’re twin sisters because they’re incredibly reliant on each other. And we know that post-ovulation, during the luteal phase, when progesterone kicks off, the body becomes more insulin resistant, right? It becomes a little bit more stress reactive as well. People might say, well, why is that? Well, the female metabolism is incredibly brilliant. It essentially goes, look, a baby might be coming along, so let’s make sure we’ve got some blood fats, triglycerides, extra blood fats, triglycerides, and extra blood sugar to feed this extra baby that we might have to support. This is what progesterone does. Estrogen, on the other hand, is the sister that is more adventurous, athletic. She’s the entrepreneur, she’s the go-getter, right? Progesterone is more the worrier, the artist, the musicians, and these two sisters work together. So this would make sense that at certain times of the menstrual cycle, let’s say during the follicular phase when estrogen is dominating, the brain chemistry, serotonin, and dopamine are better regulated. The body is more insulin sensitive. You can handle stress better, everything feels better. This might be a time when a woman can get away with too many calories or too few calories without reacting so harshly. It might be a time where she can burn the candles at both ends without getting in too much trouble. However, in the luteal phase, when progesterone starts to dominate, that might not be such a good idea.
And I’m oversimplifying things here a little bit because we all know you can look at this from an estrogen/progesterone ratio, relatively speaking, or you can look at it from an estrogen absolute perspective. So all we need to know is that when estrogen is high, the female metabolism is operating differently, more functionally, more flexible than when progesterone is dominating, when it becomes more rigid, and for good reason. And we have to be looking at this. This goes into the four p’s we talked about earlier, right? The physiology and the psychology of a female is different than the physiology and psychology of a male, and a young female who’s cycling month to month versus a more mature female who’s in perimenopause or menopause who’s having slightly different hormonal realities is gonna influence every aspect of their endocrine system. And we have to be able to begin to address that.
And just a couple other things here, because I love this here. When you get into perimenopause, now all of a sudden, guess what happens? Progesterone goes to sleep. What does the twin sister do? Well, she doesn’t have her progesterone sister to rely on anymore, so she starts going crazy. She one day, minute, she’s high, next minute she’s low. This has ramifications for the female metabolism and ramifications for our ability to treat the female metabolism. At menopause, same thing. Now estrogen has fallen. Now this woman is more insulin resistant, and progesterone’s not there. So they’re also more stress reactive. At this point, maybe they need to start taking more of a carbohydrate-reductive approach versus just a calorie approach. Maybe they need to realize that doubling down on diet and exercise where that may not have stressed out the system before is now stressing out the system.
So rightly said, Kalea, like this is profound. And no one is really talking about this except people like Institute for Functional Medicine, people like me, people like you. This is critical. Women are still being drastically underserved because we don’t understand it. And the final thing I’ll say here is that the research is difficult to do on women, because how do you control for this in research studies? Which brings us back to the primary reason you all do the work that you do, which is in the end, when we’re looking at evidence-based medicine, sometimes the evidence is not there or not good. And we have to come back to our clinical judgment and the reality of the woman that we’re dealing with. And so us clinicians right now are still largely driving the ship in terms of the information that we have on female metabolism. Now, hopefully that’s gonna change, but that’s still the reality that we’re in.
Well, I have to say selfishly, I’m so pleased to hear the female metabolism described as brilliant, sensitive, refined. So thank you for using this beautiful language. In someone who is having a regular menstrual cycle, there’s perhaps, as you described, metabolic changes that are happening every two weeks or so. Are you talking to patients about this? Are they doing some adjustments to their nutrition every few weeks?
100%. Now certainly, again, it comes down to some women do just fine, right? Their metabolism is flexible enough that these hormonal changes, they don’t really need to have a separate sort of diet and exercise programs. But many do, and absolutely. So, of course, we don’t like to do off-the-shelf cookbook medicine, but I’ll just give you sort of a general rule. There’s sort of two ways to approach this. At least if we’re talking about just what I tend to do, which is weight loss, weight loss–oriented stuff and metabolic sort of optimization from that point of view. The first two weeks of the menstrual cycle, now, this would depend, right? Because remember, first day of the menstrual cycle, first day of bleeding, some women feel great during that week and have plenty of energy, others don’t. So again, this is where the practical circumstances and personal preferences come in. Some women do not feel like training during their menstrual cycle while they’re bleeding, for many reasons. Other women feel great during this time and absolutely want to work out.
So what I tend to do is I tend to let the female patient guide me, this young woman who’s cycling, still cycling. I tend to say, when do you feel your best? Right? How do you feel? Do you feel motivated? Is your shmec in check or not in check typically during the pre-menstrual period and the menstrual period? And what you’ll find is, in my experience, I would say about 60:40, 60% of women say, I really don’t want to work out at that time, about 40% of my clinical population says they do.
So, for me, then I take a relative approach, estrogen to progesterone. I go, estrogen’s more dominating here in the first two weeks, so I’m going to give them more exercise. This might be three to five workouts per week. I tend to use very short duration, high intensity, mixed metabolic conditioning. This would be weights lifted faster. Not faster in the set, but shorter rest periods. Plenty of walking, about 10,000 steps sort of per day. Again, just keep in mind this is an off the shelf average woman, no one’s average, but I’m just giving you sort of the basics here. So there’s more exercise. Typically weight trainings involve lots of movement and a diet that is more amenable to her likes and probably relatively isocaloric. So we’re in an eat more, exercise more phase, right? More of an athletic type of program. Remember, estrogen is the athletic sister. So we’re using that to our advantage. Here we go, hey, we’re gonna do eat more, exercise more. Notice that I did not say eat less, exercise more, even though this would be the better time to do that because it’s a more stressful dietary regime and it would be better if estrogen is high if you’re gonna do eat less, exercise more. But I like eat more, exercise more during this time. Now if someone says they don’t like to work out during the week of menses, then I just shift that over to the week before and after ovulation where estrogen is still high in both of those states. So I just shift that eat more, exercise more over one week. And then as you move into the latter half after ovulation, the luteal phase, I essentially move into what’s more of an eat less, exercise less approach. So this would be lots of walking, less than three workouts a week, very gentle, more time at the spa, more meditation, more sex and physical affection, more like woosah-type stuff, more time with pets, more connection-oriented stuff, take it easy, eat less, exercise less. And then I switch it again.
So eat more, exercise more followed by eat less, exercise less followed by eat more, exercise more followed by eat less, exercise less. And this tends to do very well for the vast majority of my female patients. Now, once they get into perimenopause at this point, it’s a lot of stress going on, right? Estrogen can be high at sometimes, low at other times. I tend to stay with an eat less, start shifting more into eat less, exercise less at that period of time. And same into menopause as well. But you can see how looking at the endocrine system, this way might guide sort of your approach here. One other thing that you can begin to do is when progesterone is dominating as well and the body is more insulin resistant at this time, you certainly could be using more insulin-sensitizing supplements and other things like that as well. So I’ll shut up there, but that’s sort of how I would look at this.
This is excellent. We’ve covered so many of our modifiable lifestyle factors. We’ve talked nutrition, we’ve talked exercise, some relationships. I cannot let this time pass with you without talking about the mindfulness aspect, because I’ve heard you talk about mind, muscle, metabolism, so I don’t want to let the mind piece pass us. Just briefly, I know we don’t have a lot of time, but would you be willing to share maybe your top two or three strategies for helping your patients with the mindset piece of making these behavior changes?
Well, to me, like the bottom line here is, we hear a lot about purpose, and purpose is a very overused word, a lot like stress. However, purpose is the thing that I think is really important here, and I’ll tell you, without getting into a big discussion about everyone’s got to find their purpose, it doesn’t actually have to be that.
To me, the thing that we know about humans, we know a couple things, we know we all suffer, right? We wouldn’t be human if we didn’t. We also know that we want to matter and make a difference. So one of the things that I like to tell my patients and get them to understand is that they’re not making these changes for themselves. They’re not making these changes just for themselves. They’re making it for every single person who watches them, at the gym, at their house, their coworkers, their peers, et cetera. And when they start seeing it this way, that they are a teacher, they are an experience and an example for the world, they start looking at things a little bit differently. They start feeling that the changes that I make and the battle that I am fighting is a battle that everybody is fighting. And that my little way of figuring this out and my struggle can teach someone else about their struggle.
So one of the things that I try to do to get people to tap into this purpose potential is to understand that we are each unique. I mean, think about it. So there’s never been another Jade, there’s never been another Kalea in the history of humanity, nor will there ever be again. It’s the same for all of our patients. That means that they can teach exactly the same thing that someone else is teaching, but certain people will hear them where they won’t hear someone else. So what I get them to begin to think about is that their journey is a journey for themselves, but it’s also for their little boy or their little girl. It’s also for their husband or significant other. It’s also for every single person that’s watching it.
Now I know a lot of us hate where we are in the world right now with social media and everything else. The good side… By the way, I don’t necessarily love it either, but the great side of that is it is a platform for people to begin telling their stories. Telling their stories means teaching their journeys. Teaching their journeys means inspiring and touching people. And when someone internalizes that and a patient internalizes that, they now have an energizer bunny behind the changes they’re making. It’s no longer just about beating themselves up, I did it or I didn’t do it, it’s basically this hidden idea that whenever I mess up, that’s an insight, a lesson that I could pass on, and I need to get back up because I can teach people.
And when you start looking at it from this perspective, it’s what every human actually wants. They want to make a difference to their fellow humans. And as clinicians, when we drop that breadcrumb, and by the way, I think it’s our job, they may never hear this from anyone else. It’s our job to drop those breadcrumbs. We teach them so they can teach others. And by teaching others, they end up enacting this purpose. And that’s what ignites the mindset and that’s what puts them on the trajectory to not stopping, because we know once you start this process, it’s a process that lasts forever. So what are we gonna do to make sure there’s an engine, a reason for them doing this? We get them to begin to share this journey and integrate it into their larger purpose. And that to me is where a lot of the rubber meets the road here. And that’s a conversation that I think not a whole lot of us are having and we need to have.
Well, we’re gonna do it now. That was really powerful, Jade. Inquiring minds want to know, what are you doing today to support your healthy metabolism? We want to know it, a day in the life.
Well, so I just built a sauna downstairs with a cold plunge, and it’s funny, just before I got on with you guys, it takes about an hour to heat up, so I put that on, and I’m gonna go down and get in the cold plunge and sort of, I’m not working out today, so I’m using that as sort of my recovery stress reducing day. And that’s what I love. And by the way, I think each of us have to find the things that really make the difference, because I’ll be honest with you, if I wasn’t doing that, I’m an Italian guy, so I love wine and I love pasta, I love all that. And I’m looking at the time now, right? And it’s gonna be four o’clock soon my time. So I’m like, hey, I do that so that I’m more likely to make the right choices later.
And one thing I’ll say here just briefly is that I do think as clinicians we need to look at stuff like this where it’s not what we’re doing in the moment, the health benefits of the meal in the moment, or the workout in the moment, or the sauna cold plunge in the moment. It’s the endocrine effects that those things change that make us eat better and less later that make us less stressed later. We tend to think about what we’re doing as a singular moment in time and the health benefits of just that thing when we should be looking at it as when I do this thing, what does it do to my shmec for the next six to 10 hours? Does it keep it in check or not? And so, for me, the sauna is one of those things that I know keeps me in check, which is why I built one and invested in that for my health.
Very good. Well, time to go get our shmec in check. Jade, I wanted to thank you so much for this really approachable, intentional conversation. It’s been such a joy to glean all of these lessons from your clinical experience. Thank you so much for your time. A pleasure to speak with you.
Yeah, I loved talking to you, Kalea, and thank you to the institute for all that you do. I really appreciate you all so much.
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1. Araújo J, Cai J, Stevens J. Prevalence of optimal metabolic health in American adults: National Health and Nutrition Examination Survey 2009-2016.?Metab Syndr Relat Disord. 2019;17(1):46-52. doi:10.1089/met.2018.0105