How to Navigate Complex Female Clients with PCOS, Hormonal Imbalance & Gut Dysfunction with Dr. Ashley Dwyer

Beyond macros, how to navigate complex female clients with pcos, hormonal imbalance, and gut dysfunction.

Hi, I'm Beverly Simpson, former fitness manager turned online personal training business owner. And this podcast is where smart fitness professionals, including trainers and clinicians, discover how to increase client performance in movement, package and position their products and services, and get out of their own way so that they can increase their revenue to live a life that they love without sleazy sales. Welcome to the PT Profit Podcast.

Welcome back to the PT Profit Podcast. My name is Chris and I'm giving you your intro today. And today's guest is no stranger to the show. Dr. Ashley Dwire, a former clinical pharmacist turned functional health coach is back and going beyond macros in a way that every coach and client needs to hear. Ashley is the founder of Team BDN Coaching, where she specializes in helping women with pcos, hormonal imbalances, and gut dysfunction finally get results, especially when they've already been told they're doing everything right. In this episode, we're unpacking the frameworks Ashley uses to solve the unsolvable cases, from when to suspect complexity to how she assesses lifestyle stressors, to interpreting labs and building individualized protocols that actually work it. If you've ever had a client who trained hard, tracked everything, but still didn't get the outcome they wanted, this one is for you. Let's dive in.

Ashley, welcome back to the show. I'm super pumped to have you. How are you?

I am great. It's so good to be back. Hello.

I. I mean, listen, we were just chitty chatting for the last seven minutes before I pressed record. I think it was actually 10 minutes. So I was like, okay, we gotta hit record because we've got some genius already coming through you. And you're like my brain. But you're your. Your brain is so genius. So I' super glad that you're back and pumped and I'm excited to dive in. Okay, so with that said, let's talk a little bit about. So you were starting to talk about how you are really focusing your career right now on complex cases in terms of hormones, pcos and really and gut health. And you're doing it through the lens of two facets, meaning you're essentially creating your own. Your own control study in terms of helping women with these, with these complex cases. And then you're going to, after essentially is communicate this in for coaches and help coaches really look at labs, look at, look at it, look at their complex cases and help, you know, raise industry standards. So if you're going to bring us back to the basics and to the beginnings, can you just walk me through a little bit of your thought process when you are taking a client and helping them uncover what their complex cases are? And you know, how do they know it's complex? Or rather how do you know it's complex and just kind of give me the skeleton of your process.

Yeah, of course. So, I mean, when I first started coaching, we were coaching women just on diet and exercise, right? Like, it wasn't new macros and fitness plans and maybe some mindset. And then we see, we have women see results, we have people see fat loss, and it was just like a weight loss coaching. With my pharmaceutical background and my health issue background with hypothyroidism and functional medicine and testing, I always was like a nerd in the functional space. So I was putting out messaging that was bringing in more women with thyroid issues, hormone issues, PCOS just dysregulated everything. High cortisol, insulin resistance. And so I like those cases a little more because they're more like puzzles. And those patients, those clients are not going to respond to just simple diet and exercise. They need more, more unique tweaks. They need an individualized approach. Right. The one size fits all isn't going to work. And even if we're doing macros, they still need more than just what macros and typical exercise, like prescription exercise is going to give them. So this is what I mean when it's complex. If you have a client who is doing all the right things but they're not seeing results, like, then we may need to pull some blood work and see what's going on. And you need to dive deeper into gut health.

And you unpack real quick. Sorry, I didn't mean to interrupt, but can you unpack all the right things? Like, what is the checklist that you really think of from a practitioner coach perspective? When a client comes to you and says, I'm doing all the right things, and then you look closer and you're like, well, are you? So, you know, I'd like to hear your thoughts on that.

So a client pre coaches right things versus like a coach's actual right things are gonna differ severely. So when I say doing the right things, I mean like actually tracking your intake and knowing how much you're eating. And you're accurate with tracking, you're getting in adequate protein throughout the day fiber, you're hitting your exercise at least. You know, strength training two to four times a week. Maybe we Have a day or two of cardio in there. We're getting in at least seven hours of sleep a night and we're working on increasing steps in neat activity. So steps over 6k, at least depending on where the client came from in the beginning. Like if they were very sedentary, getting them up to 6k would be a big jump. Other clients, 10. So if we're doing all of that, we're working on stress management as well, and we're still not seeing the results that we want, then we need to dive a little deeper. And that would be more of like a complex case.

Got it. So now what is the time container that you usually use as a practitioner for yourself to assess whether or not we need to go deeper.

So for us now, we are already getting like the diagnosed complex cases. Like we already know what's going on from the get go. But if I was back working with someone else or speaking to a coach who maybe didn't know, I would give.

It.

I would give it at least eight to 12 weeks.

Okay, great.

Now is that like two to three months of consistent.

Okay, great. So that, that brings up like, is there any flexibility in terms of your, your baseline metrics? Like, here's what, for example, someone who has a complex case, they might be trying to sleep eight hours a night, but then their ring is showing that, you know, they're only sleeping five or they're only showing six. So what's, you know, which can be a sign of a complex case. Like someone who's got an imbalance in their hormones or their hormones are shifting or whatever, you know, so, so when you're looking at your control, your control metrics, is there any flexibility in like, okay, well they're semi consistent, meaning, okay, they're training two times a week and not three, but they're still pretty good. And they're tracking their intake. Like, do like, where's your, your flexibility, if any?

Yeah, this, it's, it's going to be persons person dependent, right? Like you can't compare a client who's doing two days a week versus four days a week and giving them the same protocol. Everyone's going to have a different protocol. Their macros are going to be specific to their energy output. Whether they work out two days a week or four days a week, we're going to calculate it in the way that they need for their goals. So it should mathematically work out. Now if we have the case of like a new mom who's not getting any sleep, right? Like, you can't really control some of those factors. So what we do on our end, which other coaches may not even be registering as, like, something they need to do, is, for women especially, it's all a balance of stressors. Like, if you picture, like, the two scales with, like, the weights on the other side, you have to be able to balance the scale so that stress is not taking over. And so if we don't have enough sleep, if that's an area that we just cannot maximize no matter what we're doing, because it's kind of out of our control, we put a greater emphasis on the things we can control, and maybe that's backing down activity a little bit or taking off some volume. We increase calories maybe a little bit. If we can't get into such a deep deficit, we focus on meal pairing and meal timing a little better, because sleep is gonna throw off, like, hunger hormones and cravings. So we work on, like, decreasing some of the stressors that we can while balancing the others. Like, it's all a juggling act. I play a barter system with my clients.

Yeah, for sure.

For sure.

Okay, great. So now that we've got that kind of clear in terms of, like, how we're discussing it now, you are already taking people that are at a complex stage. So now that you're like, okay, now my client. Now, if you're listening to this and you're a coach and you're like, oh, my gosh, my clients might be a complex case, what's the first next step that you would recommend them to do.

Once they've established that, like, yeah, we're not seeing results where we should after, like, eight to 12 weeks, then we get into. I would recommend some lab testing. If the client has labs, you know, from the past six months, you could take a look at those, But I would always run new ones. So I would run a new panel and just kind of see what's going on under the hood? We may have some. Yeah, we may have some stubborn and foreign resistance. We may have some low iron and ferritin issues. We may have some thyroid issues, gut health issues. We can't really see that in a lab, but you can definitely address that with bowel movements and just how regular they are, their digestion, things like that.

Okay, got it. So now, is this when you would recommend someone to, like, partner with you or partner with, like, another. Like, someone else or. What are some of your favorite places to get labs and then have those labs read?

Yeah, it definitely. That's a great question. It depends on your level of coaching expertise too. Because sometimes this is out of someone's wheelhouse. Right. So I would maybe refer to someone who's more comfortable addressing these complex cases instead of sometimes taking it on your own if you don't really know. Because if you don't know what you're doing and you try something that's not correct, you can really mess up the patient further or the client. I always, like, use them interchangeably. Stupid pharmacist brain. But otherwise there are a bunch of different places you can order labs for clients. I specifically have a partnership. I at this moment do not order labs for other coaches, but I do order labs for our clients. I can refer other coaches to places to order labs if they'd like to for their clients. But again, they would have to know how to interpret them and read them and understand, like, what they mean. So this is where I would refer out or try and link up with like a mentor, like you asked if I, if they could come to me, like, eventually. I am trying to do a mentorship for coaches where we would have calls and where I could do all of this for coaches. That would be like a dream in the future. But at that point it's going to be a test and assess versus like, guessing.

So, okay, coach is tuning in. You know what to do, right? You're going to go and DM her and be like, I'm interested in this mentorship is created for me.

We're doing some beta testing for sure. It's. It's funny, I don't even order labs. Like, I have a bunch of clients in my DMs or non clients who are like, hey, can you order labs for me? And just out of like, liability, but also, like, I find it irresponsible to just order labs for someone when I don't know their history. And then I'm also not following up with them. Like, I'm not just gonna, like, give them protocols to follow and then no follow up. Like, I think that would be a bunch of supplements to take.

Yeah, lack of integrity. Totally. I get that.

Feels icky.

Yeah. Yeah. Okay, great. So now look for you. Like, let's. I'd love to unpack. Like, I know you're going to be specifically really going, like, helping people who are suffering from pcos. So I'm curious, when you're reviewing, I was going to say ads. Oh, my gosh, my brain. When you are reviewing labs, what. And you're dealing with a client who has pcos, what are you looking for? And then typically, how do you guess? Test and assess?

Yeah. So first I look at their symptoms and I will, I will, on the off chance, ask the client if they know what type of PCOS they have, because there's four types and normally women don't know what they have. So I like to assume that they have insulin resistant PCOS because that's 70% of cases. So in order to make sure, like if they have this diagnosis already, I assume it's insulin resistant. And then we will look at labs. And when I'm looking at labs, I will look at fasting glucose, I will look at hemoglobin A1C, I will look at fasting insulin, and those will give me a really good picture of if we have insulin resistance or, you know, what we have going on there. The other labs I will look at for PCOS will be HDL and triglycerides. That ratio there. If it's three to one, like triglycerides or three times hdl, we usually have a lot of metabolic issues, which is also indicative of pcos. So we'll look at those cholesterol labs. I'll look at HSDRP and inflammatory markers because inflammatory PCOS is also another type of PCOS that we have. And then adrenal PCOS, we're going to be pulling fasting cortisol and DHEAs sometimes. We're also pulling sex hormones to see if we have more androgens. Most PCOS clients do have higher testosterone and higher androgens than they do, than they do estrogen and progesterone. And usually they have irregular cycles. So we can't even really get a correct estrogen and progesterone lab value sometimes in these clients. So I don't even funny. But like, I don't even worry about that with PCOS patients until we get back to like regular periods. I'm looking at inflammation, insulin resistance and metabolic syndrome. And then correcting those will then correct hormones.

What are the other three types of pcos? If you've got insulin resistance, there's insulin.

Resistant, inflammatory, adrenal and post pill.

Okay, so. And then I realized that I just kind of jumped the gun and assumed that people knew what PCOS was. So can you also just kind of unpack what that is and what the symptoms actually look like? And how do clients typically know that they have it?

Sure. So it is polycystic ovarian syndrome is what PCOS stands for. It is becoming more and more widely popular. If you go to the gynecologist and you get tested a lot of women will think that they have PCOS or assume they do because we have irregular periods. We have maybe some, like, hair thinning and then hair growth in other places that, you know, we don't want, like, chin face. That's from high testosterone, acne, just having a really difficult time. So, like, the way that doctors will diagnose this is the Rotterdam criteria, which means hyperandrogenism. So, like, high testosterone, like we spoke about, no ovulation or just random ovulation. So you could go, like, three or four months without a period. They're just like, random irregular cycles. And then when they do an ultrasound, you will have usually, like, a bunch of cysts in your ovaries. So cystic. You know, there are PCOS cases where women haven't had cysts, but majority of the time they have cystic ovaries, so.

I see. Okay. So, you know, the other thing, just out of curiosity, when you're dealing with pcos, do you have women that also complain of, like, really, like, miserable periods? Like, it's not just. It's not just like, skipping periods. It's like, I'm on the bathroom dying periods?

Yeah, I mean, it's. It's a whole metabolic syndrome. So, again, we have really high testosterone, but we also will have dysregulated estrogen and progesterone. So if we do have some estrogen dominance along with that, we'll have a lot of painful period. We can have even more symptoms like pcos. There may even be underlying endometriosis that makes things really worse. So it. It, you know, never say never in the case of what these women are experiencing.

Got it. Now, just also out of curiosity, you know, sometimes. Sometimes a lot of the. The hormonal shifts that you're talking about in PCOS can sometimes be present with women as they age and they go into perimenopause and also menopause. So curious. Like, is it the cystic component that separates it? Like, how do you know? How will one know what's where the level of complexity is.

So PCOS is generally diagnosed in women of childbearing age. So when we start reaching menopause and perimenopause, we're kind of out of that diagnostic criteria. But also what sets them apart is the hyperandrogenism. When you're going through perimenopause, your testosterone is usually lowering. When you're going through menopause, all of that is pretty much bottoming out, like the estrogen and progesterone does. So you wouldn't really have as much high elevated testosterone levels either.

Got it, got it. That's why you have to look at hormones as well.

Yes. Okay.

Okay, thank you. I realized they jumped the gun on there. So if you were tuning in and like, wait, what's pcos? Then I just, we just unpack that. Okay, cool. So now when, so now that you're looking at these labs, also out of curiosity, do you recommend someone go to like a functional medicine doctor, or is this something that, that, that usually gynecologists, they can go to their gynecologist and have their labs looked at. Like, is this a controversial topic that I'm about to bring up? Give me your best answer.

Like, it's not controversial. It's, it's the problem that you're, you're not going to get the full picture by going to Western medicine, which is awful because my experience with clients and even myself with different hormonal issues going to Western medicine is, yes, you can go to the gynecologist, they will test you, they will diagnose you. And then their answers are, here's birth control to regulate your hormones and to get everything back on track. And here's metformin to handle the insulin resistance. They're not really addressing the lifestyle factors. And when they do address the lifestyle factors, it's more like cut out all carbs because you're insulin resistant and drop your calories super low for weight loss. Loss because you need to lose weight is generally the recommendation. And none of that is helpful to a client with pcos.

Okay, got it.

Great.

Which leads me to my next question, which is like, well, what's the protocol? Right. And then now that you know this, how do you build out your protocol for your patients?

Yeah. So for our patients specifically, if we have a PCOS client who's coming in to work with us, we have every single client do a five day log of what they're already eating and drinking. So I want to see their baseline because we, we still get the, I'm not eating a lot. Like, I'm eating very little. And then we see their log and we're like, you're actually not, like, are you surprised by how much you tracked? Right. Like, you know, we, we get them tracking, we ask for their lab, that they have labs within the last six months, or we run fresh new labs and kind of get a baseline of what is going on inside. And then we look at stress and gut health. Like I said, it's a metabolic systemic issue. So we're going to have to really control cortisol and stress, which also regulates insulin and blood glucose. And then we're going to really want to control gut health because if we're not pooping dairy, we're not detoxing estrogen. That is where inflammatory PCOS makes its grand debut is with food intolerances and gut mishap and inflammation and digestive upset. So by really getting these things moving more smoothly and getting insulin regulated, we see a lot of success. So we put clients on, you know, in a calorie deficit for the most part. The only. I don't want to get too nuanced, but like, the only PCOS type that I maybe wouldn't put in a calorie deficit right away would be adrenal pcos. And that's because their stress is so high that we don't want to make it worse by putting them. Those clients generally aren't even overweight. That can be like a fit person with adrenal PCOS just because of the metabolic stuff that's going on. So that might be someone I don't put into a calorie deficit. But other than that, with the insulin resistant, for sure, we go for calorie deficit because that's the best way to increase insulin sensitivity. We work on perhaps giving them more fat than carbs, but never cutting carbs. We need carbs for hormone health. We do need carbs for fiber. We work on getting their fiber up to 25 to 30 grams a day. So we're teaching them how to choose more whole foods. We're teaching them how to do more meals instead of snacking all day. Like, how many women do, you know, kind of just like, go about the day grazing me.

Guilty. Guilty as charged. Listen, this is me.

Right? So we focus on, like, protein in every meal is especially breakfast. We focus on, sure, you can have a snack, but you're going to have breakfast in the morning, then you're going to have a snack three hours later. Then you're going to have lunch like two and a half, three hours later. We're not just going to be picking on stuff all day and grazing. We're going to have full meal. She's like, damn, this is like, this is.

I hate that.

I don't think, you know, unless you're dealing with some type of hormonal issue. I don't know, you're probably. But in this client population, it is not something they want to do and make a habit of.

Yeah, no, I mean, listen, I've been working on it this year. I have been doing well okay. But I have like, that is my go to. My go to is like, I'm just gonna graze. But you know, I'm always surprised. I'm not. Oh, I'm not surprised. I'm not always surprised. But it, it is pretty eye opening when you're like, I'm not eating that much. And then you're realizing that you are eating little food. But the density of calories is usually really high and then there's low micronut and so you're actually not, you know, it's. That can be very eye openening for coaches and for, for every.

Yeah, yeah, totally. I mean, my favorite is when people are like, oh, I love, like snacking on nuts. And I'm like. And you think you're in a calorie deficit snacking on nuts? Yeah. Let me tell you how dense they are.

Totally, Totally.

Yeah. Yeah. So, I mean, there, the protocols are going to be patient specific, but then we obviously have to get them into exercise and depths and you know, get them off of being out of being sedentary. The dhea, the adrenal PCOS clients, we might have to slow down activity. So that's going to be like the complete opposite of the rest of them. But strength training for. For sure. You know how important muscle mass is. We need those extra stores for blood glucose and to get insulin sensitivity up walking, especially after meals. I rarely have a client ever do a cgm. Like, I know there's a lot of people who love like continuous glucose monitors and tracking blood sugar. I don't do that with my clients. Even with pcos. I don't. I don't see the bend, the benefit. I think it causes more stress.

So, speaking of stress, because I do. I am curious about this because. Listen, and I also know for the record that the Internet is the wild, wild west. Okay? So, like, listen, I know.

Yeah.

I just want to throw that context out there, however, you know, with this, you know, because you have one camp that are like, cortisol is bullshit, and then you have another camp that's like your cortisol and stress is gonna kill you. So I'm just curious, right, with knowing that these extremes are in place and it's always. There's three sides to every story. I'm curious your take on really identifying levels of stress that are appropriate. So, you know, for example, you've got some people, like, maybe your adrenal pcos people that they're just doing hits so hard that there's. Their stress level is like through the roof. And then they're never activating that parasympathetic nervous system and coming back down. So they're not balancing out. And I know that, like, naturally your cortisol is going to spike in the morning. Like, what is your perspective around appropriate levels of cortisol usage and stress managed?

Yes. I love this question because I think it all reverts back to stress and stress management. So we have to think of, like, what we're throwing in the stress box. And what a lot of people don't understand is that it's not only like. If I were to ask you, Beverly, like, on a normal day from 1 to 10, how stressed do you feel on an average day, what would you say?

My mental or physical stress. But I would.

Mental.

Yeah, my mental stress. And like. But okay, to be fair, I want to give context. I'm going to answer it, I swear. I swear. Actually, I'm going to answer it. But I've really done a lot of nervous system work. Okay. So right now, that's amazing. Right now I would say my stress level is like a three or a three or four. Maybe, like my mental load is.

Okay, that's perfect. But it hasn't always. You could. You're going to need to do a podcast just on how to teach women how to control their nervous system, because I think that's super important. But the example I was getting at was we asked that and I asked that on console calls. And when people think of that, they immediately jump to work, family, deadlines, finances, like, all the things in their life that are just like pulling them in, in multiple directions. Right. What we don't think about is how much we're eating. Calorie deficit, calorie surplus over training, under training, sleep. We don't think about toxic load. We don't think about other things that are going on in our body when we think of stress. And those things also need to be put into the bucket. So if we're going to talk about balancing stress, cortisol, like you said, it does not need to be demonized. It is very necessary. If we didn't have cortisol, we would all die because we have no, like, fight or flight instinct. Right. We would. There would be no running away, no nothing. So cortisol is absolutely necessary. The problem now is that it's just staying too high and too elevated for too long because a lot of us do have dysregulated nervous systems. We think sitting in traffic is the end of the world. Or, you know, financial thing is like causing all of the cortisol to be released instead of just it being used to like chase saber, like run away from saber tooth tigers back in the day. Right. So now it's just these little things that are causing all of the spike and never allowing us to come back down. And then we have training stress, which is good for our body. Like we want that stress adaptation. But if we are not allowing time to recover, that is again helping it stay elevated. And we're not recovering appropriately. Muscles aren't recovering appropriately. If we're under eating, that puts us in a stress state. The body does not like being in famine mode. Right. And it starts to downregulate all of our other important hormones. So there needs to be that level of like, okay, if I want to train like I do this, I had a client who did CrossFit. And CrossFit is like a fancy hint. Yeah. And she, she was doing it. Yep. She was doing it five days a week and she's like eating nothing and she's like, I don't understand, I'm not seeing any results. I feel like crap like all this. And I was like, listen it, we gotta, we gotta tone that down. Like your stressors are out of. So I did a barter system. I was like, if you can hit these macros and you can eat this much food, I will let you keep four days of CrossFit, not five. And if you promise me we can get this much sleep, I can let you keep this many days of CrossFit. So it's kind of like a barter system. If you take care of your body, you feel well, you recover well, you can continue doing that activity that stresses out your body a lot. But the main key with women especially is going to be nervous system regulation from a psychological standpoint, like the mental load that we carry, the things that we remember, the kids, the work, like women are doing it all. You know, working 40 hours a week, taking care of households, taking care of kids. Yeah. Doing it all. And we're not meant to do it all. There is no rest or digest time, which is why we all have stomach issues. For real.

Or graze all day, girls have IDs.

Or grazing all day long.

But yeah, sure.

That's it in a nutshell.

Yeah. Okay, great. So now when you're. Okay, so now you're. I'm also curious, like speaking of the mental load and how you help your clients with the management of stress, especially PCOS clients, because this is likely not the first time by the time they get to you, this is not the first Time. They've tried to get healthy events. So they, their mental load in their health is just probably through the roof. So how are you cultivating and coaching and creating buy in and buy in fast?

Yeah. So they have never been seen or heard in a way that their symptoms or what they're struggling with haven't been dismissed or they haven't been gaslit. So when you're now speaking to a coach who's like, there's no need for you to lower your calories that low. There's no need to get rid of carbs. Like, there's a way where you can create balanced meals. There's a way where you can get off birth control. They're like, no freaking way. How, you know, like, like, show me. Right? And then we do. And the way to help with mental load especially is you have to find an outlet. Like us women need to find an outlet. For example, you hear like the yoga, the meditation, the journaling, the whatever. Meditation does not work for me. I've tried it millions of times. I probably need it more than I know because I can't meditate. So I need to spend time with it. But I also need something efficient that's gonna work with me in the moment. And I found journaling really works for me. So, like, dumping the thoughts and just like, putting it on paper helps me chill. So women need like that type of outlet as well as like even three minutes of breath work. I had a conversation with one of my PCOS clients last week or two weeks ago, and I made her. When her, she had like a Keurig. When her pot of coffee is brewing, she's like. I told her, I go, just stay there. Like, just stay there and wait for it to brew and breathe. And she's like, that was so freaking hard. I'm usually unloading the dishwasher, doing like a million other things while my coffee's brewing. And I was like, she doesn't know. Like, we don't know how to relax. We don't know how to just breathe. So kind of showing them the example, educating a ton of and proving, you know, showing social proof like, this has worked for such and such other clients. Like, we know it's going to work for you. Gets them to be like, very excited about it. And we're not telling them anything that's fluffy or gimmicky. It's not like, I'm going to put you on this supplement. You have to buy this. You have to, you know, it's basic lifestyle shifts and adjustments. Nothing cure all Right. Like, no fancy, sparkly fish.

Yeah. Yeah. Okay, great. So, I mean, I. I was just curious, like, what's that level of fear around them where you're gonna be like, no, no, you're gonna eat more. This is. You're gonna eat more. What's that level of fear? Or, like, oh, you need to actually pull back on some of your exercise. Or, like, hey, you're not moving enough. Or you're. You're doing this really well, but we need to add more. Like, how does that. You know, what happens to your clients, and how do you navigate it?

Oh, yeah, it goes one of two ways. It goes. I'm not eating a lot. There's no way I can eat that much food. And then we have them log, and I'm like, you're already eating way more than this, so you actually can eat that much food. We're just. Now, because you know how it is. Women like to go in diets for, like, four days out of the week, five days out of the week, and then the weekend either blows them out of the water and no longer puts them in a calorie deficit, or they come home from work and they're, like, snapping, binging. And then that puts them out of a calorie deficit. So when you have someone who's, like, trying to hit 1300 and then they're binging, by giving them 1800, which is what their sustained deficit should be, they're able to feel more satisfied and put more meals together, and they don't have those cravings or those binging behaviors, so they start to see that pattern. So we're like, okay, you can eat this much. The other ones who are very afraid to eat more, we go slow. Like, I know there's no data behind reverse dieting, but psychologically, there is a benefit to reverse dieting. So we increase it slow and over time to get them comfortable with it, and then they will trust the. You know, they understand the process and start to trust it more as they see the results, and we build momentum.

So this actually leads me to that question, question about metabolic adaptation. And I'm curious in terms of, like, you know, you hear people say starvation mode's not a thing, and, you know, we've talked about that before. But, you know, I'm curious just in term, you know, when you're looking at this through the lens of, like, are we dealing with someone who's not tracking correctly, or are we dealing with a metabolic adaptation, especially for complex clients who have gone potentially years of eating 1200 calories or, or, you know, you know, so on and so forth. But how long do you typically see people get into like a, like a re. How long does it take for people to get into a real metabolic adaptation where they start to like, really see.

Where it starts to downregulate?

Yes, downregulate.

Thank you. It's going to be person specific and depending on how much body fat they have to lose and how deep their deficit is, the body's main goal is to stay alive, right? So if you're in a 10% deficit over a longer period of time, we can experience, you know, it'll take longer for the body to register. Like we need to down regulate our set point. But if we're in a really steep deficit, which is what women love to do, like, let's say your maintenance is 2000 and you jump right to 1200, it's going to be a lot shorter and you're going to go into more of a survival mechanism than you would doing a 10% deficit. Starvation mode does not exist, like we like to say. I know a lot of people like to say it does. But even if your body has slowed down, your metabolism has adapted to a lower set point, it's not as low as you think, to be honest. But if it has, a calorie deficit will still work. The problem is nobody is going to want to sustain 800 to a thousand calories a day to lose weight, nor would I ever recommend it. So calorie deficit is always going to win, but that doesn't mean it's always the best idea. Then we need to reshift, reverse diet, get back up to maintenance, readapt the metabolism to a higher set point. So obviously, just because science rules and law of thermodynamics rules everything, doesn't mean it's the best idea for the clock.

I'm also curious, right, because calories are cumulative and you're not a calculator. So, you know, this is also why, like, people will be like, eat a thousand calories, but then they'll eat 7,000 on the weekend. What is your container of time in terms of accumulation? Like when, when we're dealing with the law of thermodynamics.

What is my, I'm like, what is that?

So what is your container of time that you're looking at? Is it a week, is it a month? Like, let's say you eat, you know, for three weeks at a thousand, and then for the last week you eat a million calories. Right? I mean, I know it's not necessarily Possible. Yeah, but it, I mean, God, it could be, you know, so I'm just curious, like, especially when we're dealing with metabolic adaptation and when we're dealing with, you know, weekend and, and weekday eating, what is your control set point that you're looking at? A week generally?

Yeah, because we do weekly check ins with our clients, we're looking week to week and especially because we have clients who are very particular about the scale and they want to know why it went down and went up. We're looking at a week set of time. Sometimes with bi weekly clients, we're looking at two weeks of time and just averages. We will even zoom out and take a month in time or 90 days and be like, listen, you're wondering why your cut didn't go well. And we'll zoom out for the last 12 weeks. Let me like look at how many days you consecutively hit your macros. Like 70%. That's giving you a C grade. Like we can't expect a result with a C grade. Yeah. So it'll depend on the client situation, but it's, it can be as little as a week just to see kind of what your habits are. But I think if we're looking at the grand scheme of things, it would probably be more beneficial to look at a month of data because everyone's going to have social outings or something that may happen on one weekend and not another. So the more data points the better. That's my theory always.

Yes. That answers the question perfectly. Now out of curiosity, is it different and do you look at it differently for your complex PCOS clients than you would someone who isn't?

I don't look at it differently, but I do put a bigger emphasis on it. Just like women in perimenopause and menopause, these type of more complex clients need to be more dialed in than like the average fat loss client. So we do put a bigger emphasis on it. I do go through the logs more efficiently and look at how they're pairing their meals together to see if we have like, you know, protein, fiber, healthy fats. Like if we're building balanced meals or if we're girl dinner in it, you know.

Yes, yes, yes. Or we're just mind mentally we're, we're, we're pretending, we're pretending that we're hitting, but we're not really.

Yeah. Another thing we'll do with these, with these clients too is a carb consistent diet. So I will go through their logs and see if we're hitting the same around the same amount of carbs per meal to just keep insulin as predictable as possible. We'll do that. So that'll be a different thing that I look at where I don't look at that. And regular fat loss clients.

So what I'm also curious about is do some of these symptoms reverse for people?

Yes. Okay, absolutely.

So they do reverse. So it's not something someone gets and then is stuck with.

So pcos, there's a lot of controversy on the Internet of whether it's in remission or whether it's reversible. I personally think it is remission versus remiss versus reversible because it is a metabolic syndrome. It is something that is. Has a genetic predisposition. So some women are just more prone to it than others. And you have to sustain these lifestyle habits to sustain the disease state, but you can reverse all symptoms. So it kind of goes hand in hand. Like, I have a handful of clients who have come in. We've gotten, you know, their A1Cs back down to optimal range. We've gotten regular cycles off of birth control, which is almost sometimes unheard of with pcos. We've gotten them pregnant when fertility was not something they were doing. We've gone through healthy pregnancies without gestational diabetes, which they're at increased risk for. We've had regular healthy babies. So these are things that women with PCOS don't have the luxury of just like doing or having. Like, fertility is much harder. Healthy pregnancies are much harder. Low birth weight babies or normal birth weight babies are harder for PCOS women. So I think as long as they maintain these practices that we're teaching them, they can be in remission for ever. It's just going to come down to lifestyle. And that's why you hear me on Instagram all the time saying it's not your hormones, it's your lifestyle. And then people hate me.

They're like, no, I just want to take this green detox liver and I'm. Coffee enema. Yeah.

Oh, no, please don't listen.

Some people will drink their urine. And I'm like, not even joking.

Don't sign me up for that algorithm. Okay, Beverly, my phone is listening. If I get, I'm sending it to you. If I get it 100%, I agree. We see a lot of food intolerances, namely dairy, sometimes gluten with PCOS women. So we do work on elimination diets with them to get the inflammation down. We can also see like poor bowel movements, not pooping every day not detoxing properly. So we do see some digestive upset. But it is, I feel, in my opinion, more easily fixable than say, someone with like hypothyroidism or like a deeper gut issue like Sibo, obviously, or something like that.

Okay, so now how does someone know if they're inflamed or if they have intolerances to food?

The easiest way is to keep a food journal, which, if you're already tracking macros, you basically have one. If you eat a meal and you are extremely bloated or crampy or gassy or any. You have to rush to the bathroom after eating a meal, stop taking that meal your body does not like. We need to keep an eye on that and we need to experiment a little bit more or eliminate it for at least two to three weeks and introduce it back to see if we get those same digestive upset issues with that.

What about skin irritation?

So skin issues, love that question because a lot of them are from the gut. So eczema, psoriasis, things like that really stem from the gut. Acne can really stem from the gut. That is a bigger issue that can boil down to potentially needing like a GI map to see what is actually going on in the stool, what the bacteria looks like. If we have any, any issues there, if we have any autoimmune triggers, we perhaps have like a decreased or increased permeability of the gut, which causes a lot of the autoimmune triggers like psoriasis and things like that. So that's going to be a different protocol than say, like a pcos.

Okay, so. So autoimmune gi. Now you had mentioned that like pcos, for example, is a. Has genetic components. Do they. Are they ever married in terms of like autoimmune? Like, do you see them? You know, people who have PCOS also have autoimmune or they're prone to autoimmunes. Like, do you see these relate. Like, I feel like PCOS and Hashimoto's are something that often is put together or married.

That's interesting because I, like, don't. I'm trying to rack my brain of all my clients and I'm like, I don't know a client that has Hashimoto's or pcos. PCOS is not autoimmune, so that I generally don't see them linked. I do see hypothyroidism and PCOS linked, but not always the autoimmune component. But if someone does have Hashimoto's, I do see Celiac which is another autoimmune. We do see sometimes rheumatoid arthritis or, you know, psoriasis or things like that that pop up. Because if you have one autoimmune, you can have a bunch of other ones. But with pcos, I don't see a lot of autoimmune.

They're not really.

It's autoimmune. Yeah. Together. That just doesn't mean. Just because I don't see it doesn't mean it exists. But not a lot we treat and.

It can be hard to find. But like, sure you do. People. When do. When do these kinds of symptoms start to show up in people's lives?

Ooh, it could be as early as teenage years when you start getting your menstrual cycle. You could have irregularities and get diagnosed with PCOS or hypothyroidism or something as early as teenage. You can also get it after getting off of birth control, which, you know, could be in your 20s, could be in your 30s, could be in your 40s. That's when we have post pill PCOS. But that's also when, if you think about it, when you were young and you were put on birth control at like 14, 13, 14, you never actually let your cycle do what it was supposed to. So now you're getting off of it and now you're like seeing what your body is doing. And that could have masked a lot of things for 15 years. Right. So that's when we see it when we're trying to get pregnant, that's when we start noticing it. So it's really 20s and 30s, even as early as teenage years.

Health is from birth. My daughter had a lot of this stuff.

Yeah, yeah. Gut health can be from birth.

Yeah, yeah. Interesting. Okay, great. So I want to be mindful of your time. So for. Thank you so much. I love, I love hanging out with you and chatting with you and. And sharing your genius. Your genius. You are just so smart and you help simplify these really complex concepts for coaches and people and clients at the same time. So for those of you tuning in and want to go deeper with you, where are some of the best places that I can send them?

Yeah, the best place is instagram. So at Dr. Dwyer. At Dr. Dwyer, that is the best place. Slide in my DMs follow along chit chat. It's me in there. I really don't like, generally send people anywhere else because, like, Instagram is my.

Okay, cool. We'll definitely link it up. We'll also link up the show that we did together. I don't know, it feels like yeah 10 years ago but it wasn't. But I'll link that up too so that you can. Also we talked a lot about like getting client client buy in in that episode. So like if you've got fat fat loss plans like definitely check that one out as well.

I was like I need a refresher on what we talked about last time.

I know all those Internet months ago. So thank you so much for hanging out with me. I really appreciate it.

Thank you and I'm looking forward to listening to this one.

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