EPISODE #904 Hacking Menopausal Weight Gain – Interventions With Dave Cheryl Fraser, Ph.D.

Today is going to be really interesting because it's one of the most challenging cases I.e. a perimenopausal or a menopausal woman who has a hard time losing weight. So we're going to jump right in and see if we can think about this in a way that's helpful for you. So even if you're saying, well, I'm not a paramenopausal guy, because I'm a guy, you're going to learn some stuff in here. So this is how to think about your own health. And if there's anything that is medical, I will refer whoever's on here say, you should talk to your doctor about that. But here's what to ask, right? So this is how to prep for meeting with a functional medicine physician. And I am not one. On that note, Dr. Cheryl Fraser, welcome.

Hello, Dave. Great to be here. I'm excited to get some hacks and help all the other women out there with what I'm calling personally menopausal metabolic mayhem. It's like, what the hell, Come on, Mother Nature. It's not fair.

Well, it's kind of intimidating because, you know, I saw your request. I'm like, oh, it's a doctor. Great. We're going to go go nerdy on this. But you're a, you're a sex therapist. Psychologist, kind of doctor.

Yeah. That is correct. I work with couples. Yep. And help them biohack their sex lives, which I know is something you're very interested in as well.

Yep. It matters. We just had a big panel on that at the biohacking conference. Now, what's the deal? What are you trying to hack?

Well, very simply, weight loss. That is stubborn. Since menopause. I'm 57. I hit menopause right on. Canadian female, average right at 52. Not a bad menopause. Pretty graceful. I do use bioidentical hormones. A functional medicine doctor years ago put me on those. But to, to cut to the chase very quickly, premenopause, if I would get lazy and sloppy and have an extra 8, 10 pounds, if I would use a wise eating program for about a month, six, six weeks, two months, boom, seven, eight pounds off, you know, a pound, pound and a half a week. I'm £154 now. Pretty much the fattest I've ever been. I'd say I've put on £15 in the last five years. And what has changed is when I do a wise eating program, whether that's bulletproof eating. When you first debuted, fastest way and did the course the first 14 day fast. I did it to the letter. And I think I, you know, lost maybe one pound. And that's a radical change. So when I do it right, quote unquote, and when I do a plan, I'm very methodical. I do everything that is. I don't cheat. Let's cut to the chase. I don't cheat. So doing a plan correctly and not seeing results is the issue. And what kind of hacks or like, what's going on? That when I'm doing things right, I exercise well, I train with a trainer three times a week. When I do a plan, I do it exactly as it's laid out. I don't cheat, I don't muck about. I've got great discipline.

Hold on a second here. Oh, you have to lose weight on the fastest way challenge. And since you didn't lose weight, therefore you were eating Snickers bars all day every day. Right.

Was not, not true. I would, I would confess if I had cheated. Hence the frustration.

That's how the doctors talk to me when I'm like, look, Yeah, I weigh 300 pounds, but I've been working out an hour and a half a day, six days a week, I'm on a low fat diet. And they literally look at you like you're crazy and say, no, you didn't, because that can't be.

Yeah, you big fat liar. You're nocturnal. Driving to McDonald's and eating fries.

Right, Right. Okay, so you've been compliant. I totally believe you.

Thank you.

And for listeners, if you go to a doctor, functional or not, and they simply don't believe what you're saying, it's because they've been trained that if you have five or 10 symptoms, then you're crazy. Because real patients only have one or two symptoms. And that's not actually how biology works. The symptoms are all intertwined. And this is just a deficiency in older medical training. Functional should be ahead of that. So keep that in mind as you're going through this. You can actually do something that's supposed to work. And when it doesn't work, it's not you. Well, actually it is you. It's that you're different than others, and that's okay.

And can I confess one thing, which is I generally have a very positive mind state. I'm a hard worker. I'm used to achieving. But after multiple quote, unquote failures, doing the correct things from wise guidance and doing them to the letter and having them not yield a result in terms of Weight loss and fat loss, inches loss. I got discouraged. And that's not something that is a Cheryl thing very much. I was kind of like, well, maybe this is just the new body, you know, and I can adapt to the new body. But I don't think that's it because I don't think that's it.

There's a name for what you described. You're a psychologist. Do you know what it is?

A really intelligent person who doesn't want to give up. So she asked Dave for help.

Well, that's what's happening right now. But the feeling of discouragement you talked about is learned helplessness.

Exactly. Yeah. You do things and you don't get results. You try them again. You do. You don't get results. And eventually even someone with kind of the tenacity of myself feels like, well, it's not working. I guess things have changed and I need to accept it.

Things have changed, but you never need to accept it. There's always a way. It just might not be the way you thought it was. Right. And you've shared a great amount of information now just in describing the situation, like, all right, I've got more weight than I want. I am diligent. Tell me about your exercise habits, though. What are you doing there?

I go to a personal trainer three times a week for a 45 minute sort of high intensity training, and he's really focusing on metabolism and doing the sorts of things that can help with this issue. And then I live like you do on beautiful Vancouver island, so I hike a lot. Just kind of relaxed 90 minute hikes in the woods with my dogs.

Wow, so you're barely doing anything right?

I'm a big lazy bum and it's all my fault.

You're a classical example of why I started writing my blog. Because you would be where I was when I was in my mid-20s going, what the heck? I'm doing everything. And it just keeps going the wrong way and I don't know what to do. So you're in a very common circumstance. And the people have the hardest time losing weight usually are menopausal or perimenopausal women. And perimenopause, it goes all over the place and it just requires a lot of lab testing order to see what's happening this month and eventually go, oh, maybe when I'm hitting this feeling and this is happening in my body, I need to take more progesterone or less. But to get there can be unacceptably expensive. Right now that isn't covered in a lot of medical plans in Canada, even. It's hard to get any good labs because it's government stuff. So I just want to put that out there that if you're having a rough time with perimenopause, that that is an issue. Right. And if you don't have labs, it's okay to say, I'm going to try taking more progesterone for this month without the labs and see if you get the results. That's what I did in my 20s when I didn't have enough money. People like, oh, do you know Dave was born a billionaire? Whatever the heck they think. No, I actually scooped Baskin Robbins ice cream to help pay for my college. So. Right. I. I definitely was on a budget for a lot of my early biohacking out of necessity. So what's going on with you? When we look at your. At your labs here? I'm seeing. And this is a Dutch test that you had done. And again, you're okay with talking about all these numbers in public and all of that?

100%, because I think it's going to help a lot of other women, which is very motivating because I know there's a lot of us out there in the same situation. So go for it.

Awesome. And so anyone on earth, at least in any country that I'm aware of, you have a right to take any of your medical information and publish it however you want. It's that your doctor cannot publish your medical information, even your name, without it, under HIPAA in the US or the equivalent thing in Canada. So we're not under that because you've released your information. And so if someone tells you you can't talk about medical. No, you can talk about whatever you want. It's your body, it's your biology. And you can put up pictures of whatever surgery you had done on Twitter, if you want to want to see it, can see it, but your doctor can't do that. So that's. That's just like a cool setup here where we have the right to talk about stuff. Now, when we look at your Dutch test, which is one of the many ways you can look at your. Your sex hormones and some other things, your DHEA is at the very low end of the range. Well, not quite very, but it's the low end. It goes from 20 to 750, and you're at 75, which is very, very low. And the way it works is there's pregnenolone, which is the mother hormone, and then it turns into dhea, which then turns into all of your various sex hormones. So if you're low in dhea, then you're going to have a hard time making sex hormones. And because you are menopausal, that means that you're already not making some sex hormones in your ovaries the way you would have before. So what happens is if you're low in either pregnenolone or dhea, then you're likely to be low in all of your other sex hormones, and especially menopausal. You aren't making as many of them in your ovaries as you were before. That's okay because they are made in other parts of the body, especially adrenals. And people don't know this, but your mitochondria themselves can make sex hormones, and they're distributed throughout the body. They just make smaller amounts of them. So I see that your DHEA is at the low end of the range. Your androne, one of the male hormones, so to speak. You know, the, the, the more testosterone family hormones, it is below range. And your Testosterone itself is 2.9 on a scale of 2.3 to 14. And that's not ideal at all. So what I'm seeing is you have low testosterone. And is it any wonder that the hormone that makes it easy to lose weight and put on muscle, if it's low, in fact, it's quite low, 2.9 on a scale of going up to 14. And this is for women who are in their luteal range, in other words, when you're not menopausal. So when you're postmenopausal, there isn't even a range, provided they're saying, oh, you shouldn't have that. So there's a reason that women, when they're in menopause, almost universally put on substantial amounts of weight. And the few who don't work their asses off, they're gifted with good metabolisms and they're exercising all the time. They're eating very little, and it's a major focus of life. It's very difficult, if it even works at all. So one strategy now that we know you're low on DHEA would be for you to try taking DHEA. I want to caution listeners, when I was 18, oh, DHEA is good for you. I'll take DHEA. And I took it. And two days later I'm like, I have no sex drive at all, and I'm 18. This doesn't seem natural. And taking DHEA when you don't need it is not good for you. It is a full on hormone and it is available over the counter in the us. You can just get it at any health food store. I like that. Everything you can buy should be available at a health store. You shouldn't have to have a permission slip for it. DHEA is a very powerful thing. Don't mess with it unless you already know that it's low like we do here with Cheryl. So that would be kind of step one and I don't see a number on here. But pregnenolone would also be another potential thing you could take. Pregnenolone is one of the other precursors and see if it raises your levels. I will tell you it probably doesn't. Although you're training, I'm assuming you're doing some lifting with your trainer. Yep, yep.

Weight bearing as well.

Yeah, you're probably not going to get a lot of testosterone out of that, but that's about as good as you're going to get. So I'd start with dhea, but if I was lazy and wanted to get results quicker, I would talk with your functional medicine practitioner who's working with you on bioidentical hormones and say, look, my testosterone is at the very low end of the range. I have symptoms of low testosterone in the Canadian scales that go from 2.3 to 14. I don't remember off the top of me how to convert those to American scales. But as long as you guys know the range, she's at the very bottom of it. What you say is, I want to be in the middle or maybe three quarters of the way up the range. And when you do that, you may find, wow, my energy in the morning comes back. But I don't think testosterone's energy in the morning. Your sunny outlook is good that you still have that because if your testosterone drops low enough, it actually is correlated with depression. I don't feel that good. I just don't have a zest for life. So I don't want you on testosterone for a sex drive, although you might find benefits from that. I want you on testosterone for drive. They're just different things. And you already have lots of drive, but you might find there's a little spark that you remember when you go.

Back on, like the energy to support the natural drive I have. The energy is lacking. It's like the gas tank is low. Although the mental emotional focus is really strong and the attitude is strong, the body's not supporting it.

Got it. So that may not be testosterone. That may be the other thing that Stood out in your labs here when we were going through them. Let's talk about drive. So we're going to assume that your testosterone helps with your fat loss to a certain extent and some of that vibe, but you've got to have electricity to make that happen. Since we've already talked about dhea, which is an adrenal hormone, there's also cortisol, which is an adrenal hormone. There is an epidemic of cortisol problems with people, what would have been called adrenal dysfunction in the 90s or adrenal burnout. I have dealt with this personally. I've had low adrenal function probably my whole life. There's a genetic thing for that. I've had low blood pressure and my cortisol levels are always low. People say cortisol is the bad hormone, but if you have no cortisol, you will get sick, or if it's low, you won't be able to fight off infection, you will hate your life. You won't have enough blood pressure in your brain to power you. It's a really big thing and it happens all over the place. So when someone says I'm really low on energy, especially if DHEA is low, you look at their cortisol. And fortunately for you, you're one of the few people I talk to who has a 24 hour test of cortisol. And the way this works, this was a urine test, which is the most expensive and annoying to do because you have to pee in a cup sort of thing, but it's also the most accurate. There is a 24 hour salivary test, which is pretty cool because it's less work and it's generally accurate for cortisol from what I've heard from the functional medicine doctors I speak to a lot. So what we're finding here is you're at the low end of range when you wake up. So waking cortisol, this is important because if your body's working right, right when you start getting a little bit of light in the room, maybe, or right when it's just time to wake up, there should be a surge of cortisol. This is really important because if you sit up or stand up without cortisol, you won't have enough blood pressure to keep blood in your head. You'll pass out and then a tiger will eat you. So your body has very carefully made sure that you will have cortisol in the morning because it's mission critical. And barring that, it'll also do it with adrenaline, which is another way to do that. And adrenaline can feel good. So does cortisol. Cortisol is incredibly energizing. So you describe that you wake up in the morning feeling pretty much like crap, right?

Yeah. At the time those tests were taken, which is about a year ago, like, I felt like I had the flu for the first two hours of the day, just really crappy. And at that time, I hadn't discovered bulletproof coffee tea. And when I did, I'm a tea drinker, so I make it with black organic tea. That started helping along with beginning to address some of the things you're identifying today to get some mental clarity and a bit more juice in the tank in the morning.

Okay. One thing that a cup of coffee, or in your case, tea, will do, but coffee more so than tea, is it will create a small increase in cortisol. Oh, no.

Right.

When you need it in the morning, when there's a circadian rise in cortisol. But I thought you had weak adrenals. You can't have coffee. Okay. If you're a functional medicine doctor listening to this, you want your patients to feel good as they're recovering from adrenal dysfunction. I was in stage four adrenal dysfunction, like, no DHEA and cortisol, Very, very low, all that kind of stuff. If you're going to go to work and you're going to feel good, do a clean cup of coffee, one cup or tea, maybe two cups in the morning, and see if you feel different. Now you have enough energy to actually do what your doctor tells you to do. It's a compliance thing and a quality of life thing as you're on the road to healing. If you need five cups, especially with sugar and other stuff in it other than butter and mct, okay, then you're probably doing it wrong. And there's blood sugar issues, et cetera. But it is something that helps people. It's an adaptogenic herb when taken in the morning. So in your case, low cortisol at the low end of the range when you wake up. And then in the morning it was normal. Within range is at 70 on a scale of 30 to 1 30. And then in the afternoon you had a crash even to lower than when you woke up. So in the middle of the afternoon you must have felt really bad, Right? It was below seven.

It was incredibly hard to stay awake.

Yeah.

Yeah.

That's because you had no oxygen in.

Your brain from about 2 to 4. It was just a washout.

Okay.

Yeah.

What did you do to fix that.

At that time I rested, I would, I would basically rest because I, the brain wasn't working well. Everything I do is highly intellectual. So I, I adapted sort of in the way you don't want to have to adapt to what the body was not capable of doing in the afternoons. And then I would tend to get brighter around 4 or 5pm and finish off my workload.

Even at 4 or 5pm in the afternoon your cortisol would go up, but it was still below the normal end of the range.

Yeah. My practitioner at the time said, how the hell are you getting through the, the day, Cheryl? And I said, sure bloody minded. Willpower.

Yeah, you're not supposed to get through the day with willpower. You're supposed to surf through the day and use willpower to do things like big things. And so I feel you greatly here because this was exactly the situation that I was in. Like I have the accelerator pushed all the way to the floor and my muscles are getting tired from pushing harder but there's nowhere for it to go and I didn't know how long I can do this.

Right.

So you started doing the coffee in the morning which helped you raise your cortisol in the morning, which is great. And interestingly your 24 hour free cortisol was within the range at the low end of the range, but. So your average was okay, but your timing was all wonky. That points to me to a sleep problem or a lighting problem. You are in Canada and let's see what time of year this is in summer. So this is when it's light until 11:30 at night. And a lot of people have a hard time there because it's pretty rough. You have to black out your room. And for me I would just have to wear my glasses, the truedark glasses, because we're very, very similar latitude. I'd have to wear them pretty much like two hours before bed or I just would never get good sleep. And if you do that for four or five months straight, all of a sudden you're going okay, I'm deleted or not deleted, I'm depleted. Deleted is something that happens when you say that people should take bioidentical hormones. But a bunch of now you're in a better situation from cortisol today you're saying you have newer tests?

I don't have newer Dutch tests, just some regular blood tests. I would say subjectively. And what's going on in the body and energy? I recovered a reasonable amount over the subsequent, say six, eight months to that. And then I've had three very, very intense work months and I'm feeling a lot of the same symptoms again currently as we're speaking. So I went back and saw the practitioner and she's reinstituted some of the natural supplements and whatnot. So it's a really good time to be readdressing all of this.

All right.

Yeah.

Do you have a history of autoimmunity?

Not that I'm aware of, no.

Okay.

I had malaria, but I think my immune system is fine. All right, yeah, not that I'm aware of.

So no arthritis kind of stuff? No. Hashimoto's? Nothing like that? No. Okay, good. So that's something that I would look at there and say, all right, is that a part of the picture here? Since it's not. Sometimes people who are lifelong low cortisol, they are much more likely to have autoimmunity. And there's some weird genetic stuff for that. So one thing that is an anti aging hormone. And this will be controversial, but. But I will say, when people are pushing it really hard, whether it's jet lag, and this is only for a few days, or whether you're saying, I'm getting these symptoms returning, there is no rule against bioidentical cortisol replacement at the time of day when it's low. What this does, it allows the adrenals to relax. And what I'm talking about here is working with a functional doctor. It's a prescription medication. The trade name is Cortef, but it's basically cortisol or hydrocortisone, depending on which little brand difference you get. The normal dose for someone who is deficient is 5 milligrams, four times a day. People with autoimmune conditions and lots of health problems that have been there their whole life, they go on that and they get better and they stay better for decades, and then they go off of it and they get worse again in three months. So what I'm seeing here is you're low on DHEA and you're low on cortisol, which is an adrenal function thing. And what I would look at there is working with your doctor on DHEA levels. I think in Canada, DHEA actually might not be over the counter. In the US it is. And then I would consider, at least during times when you're pushing it really hard, you didn't get enough sleep, like 2.5 milligrams of cortisol in the morning and afternoon. This is a very low dose, but enough to just let your adrenals say, I'm going to stop flogging you. And people say, but you might get addicted to it. Well, don't do it every day if you've got a great night's sleep, right? Or you could say, am I addicted to thyroid hormone or the other replacement hormones? You're not addicted. You're using them so that you don't experience the downsides of aging that people think are normal. So that's not addiction. That's just I chose my state any more than you're addicted to food. Because when I eat food, I'm not hungry and then I don't starve to death. So I don't know, sometimes it's just good for you. So I would talk with the doctor about saying, you know what? But on days when I wake up and I'm not myself and I can't get out of bed, I'd like to try this. The step to do before looking at cortisol as an anti aging hormone is try up to a teaspoon of sea salt or Himalayan salt in water when you first wake up. And what's going on here is your body is working to raise sodium when you wake up and it can use that to help raise blood pressure. So there's a circadian rhythm of sodium as well in the body, which almost no one knows about. The Russian space program figured this out. It's super cool. But basically, sodium in the morning can be life changing. So since your adrenals appear to be relatively weak, you could say, okay, I'm going to have some sodium in the morning, maybe with a squeeze of lemon, which I've recommended for years for when people use that lemon as a way to raise acidity in the body. It turns out acidity gives you energy as well and alkalinity gives you endurance. So you want a spike in acid. By the way, coffee has fruit acids that spike it and as they metabolize, they metabolize into an alkaline substance, which is great. So anything like that. Lemon does the same thing. It's got citric acid and then it metabolizes in your alkaline. So lemon and salt in the morning, even before you get out of bed, if necessary. You could try that or you could say, all right, on the days when I wake up and go, bleh, hey, look at what you had for dinner. Did you have wine, et cetera? And if there's no cause for it, and you know that feeling a small dose of cortisol into the tongue is going to be amazing. Surprisingly, it can help with weight loss. But if you had chronic high cortisol, either total or during the day, you had really high spikes. I would say that's causing weight gain and cortisol. Weight gain is usually belly fat, like in the front.

Right, Right.

So. And you see that more in men, but you can see it in women, too. It's the shape of the body. There are still some people who say fat deposition is about the amount of calories, and you can't determine hormones by where fat goes in the body. Except those people are part of the calorie police, and they're mostly angry debunker people who need a therapist. So the way it works actually is what Charles Poliquin, who worked with a couple hundred gold medalists, I dedicated one of my books to him before he passed recently or actually after he passed, I dedicated it. But he was probably the top guy at looking at someone saying, you have too much estrogen because the fat's in one place versus too much cortisol, it's in another. And so gut cortisol. Do you notice a pattern of your fat deposition? Where's it going in your body?

It's pretty much belly, sort of that muffin top belly, a little bit around thighs and butt, but.

Interesting.

Yeah, I know it's a bit of a puzzle. Hence I'm here.

Your cortisol is not too high, but there may be some transient spikes in it, I don't know. So that one's a curious thing. But we do know that if you were to get your DHE or your pregnenolone and or DHE up, your testosterone might go up. So I'd be looking at raising testosterone and raising cortisol at times when you need it, which is going to allow your adrenals to rest and let your body reset.

Right.

And then there's the other big smoking gun. I was looking at your thyroid function here.

Which, like so many of us, I've had multiple tests with regular MDs saying, oh, your thyroid's fine because it's quote unquote in range. But I'm very interested to hear what you're seeing.

I always want to be in range for my age group. Yeah. Because my age group is doing so great on average.

Fair point. I don't want to be like my age group. Thank you very much.

Do you want to be average? You want to be average from 1970. Just watch any movie, any movie from the 1970s. And, like, there's a crowded beach scene. Everyone's about normal body weight. Right. And you do it now and we aren't. And it's because we've got soybean and corn and omega 6 oils and corn syrup and pollutants and glyphosate and all kinds of bad stuff. So you don't want to be average. Average sucks. All right, I'm looking through your other lab here. This is from a different. Probably a local acceleras. Oh, yeah, this is a local Canadian thing. And it also shows low testosterone and.