59: The Power of Personalized Medicine in Achieving Metabolic Health with Dr. Emi

Hello and welcome to the Kenya Breast podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools, and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breasts. I need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being.

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Have you ever felt like you hit your 40s or 50s and all of a sudden there's weight on you that wasn't there before? There's weight on you that you can't figure out why it's there, or there's weight on you that you just cannot get rid of no matter what you do, and you're following all the instructions and you're doing all the right things and you're eating less and moving more, and you really just cannot figure out what's going on with you. Well, my guest today was in that same exact position, but she figured it out. So I am so delighted to have Dr. Emmy here to talk about her own personal struggle and journey with weight loss. And, you know, this isn't about how you look or, you know, society's norms or anything like that, but we know that if you are carrying extra weight and it can even be an extra 10 pounds around your waist, these are risk factors for. For significant chronic diseases like breast cancer. So this is a really important conversation to have. And also, when you lose that weight, you look better and feel better. So it's so important for all of us to get that under control so that we have metabolic health and so we're not suffering. So with that, Dr. Emmy, we welcome. I'm so delighted to have you here.

Thank you so much for having me, Dr. Jen. I'm really happy to be here.

So why don't you just start off by telling us your story, because I'm sure that everyone is on pins and needles waiting to hear it.

Well, so I actually have had kind of a lifelong struggle with weight. Started really in my teens and in My teens, I starved myself so badly that I got super sick. I got rheumatic fever. But back then I was only, you know, maybe sometimes a little bit chubby, and I was trying to get myself down. And so that actually started me on a lifelong issue because they gave me antibiotics for years. Back then they used to give you antibiotics for like 10 years after you had rheumatic fever. This was back in the 1980s.

Oh, goodness.

You know, and a lot of women back then also had the same thing in their teens, except it was for acne. So I don't think I was alone in my huge exposure to probably unnecessary antibiotics.

I do want to add in that any course of antibiotics is going to increase your risk of cancer down the line. So we have totally unappreciated and underappreciated the long term damage that antibiotic courses can do. And for a long time they were given out. You know, if you had sniffles, you were given a course of antibiotics. And we totally unappreciated, appreciated in that teenage population the effect that prolonged antibiotics were going to have to people decades later.

Yep, it really was an issue. But, you know, in my 20s, I was able to mostly hold down my weight by really working out and starving myself. So I got married and then I went on birth control. And that packed on about 40 pounds, which I then took off again because I was in my 20s. But then I had kids. I was working as like the only hospitalist in a little small town hospital. And it was super stressful. And then one of my kids is on the autism spectrum. And at that time he was super affected. I'll kind of talk a little bit more about that because he's the person who got me into looking at things in a more functional and holistic way. So the pounds just packed on and on and on. And I ended up at 235, at about age 34 or so. But back then again, it wasn't that hard to lose weight because it was in my 30s. So a friend of mine was teaching a class on low glycemic eating. He had a supplement that helped with insulin resistance. It had a little chromium and cla in it, took that, took his class and weight came off again until perimenopause hit in my 40s. And then it packed back on and it was very stubborn. It would not come off no matter what I did. So that's when I kind of had to go back to the drawing board because I even saw a colleague, had labs check, they're like, oh, everything's normal. They checked my thyroid. But they never checked thyroid antibodies, for instance.

Well, even when they check your thyroid, they generally only check TSH, thyroid stimulating hormone and a free T4. That's generally what they check.

If you're lucky. Yeah.

I don't know about you, but I don't find that useful because I find so many people with thyroid dysfunction that have in range, let's call IT in range, TSH and in range T4. But then when you look at the ratios of total T3 to reverse T3 and free T3 to free T4, you find a lot of people who are clinically hypothyroid.

Yes. Especially in the perimenopause and menopause years. And the reason for that is that testosterone actually has a lot to do with the conversion of T4 to T3. And also, you know, by we, by the time we get to a certain age, we have issues with our gut health. And those issues with our gut health are affecting our liver. The place where you convert T4, which is the active form of thyroid, that comes from your thyroid, to T3, which is the kind of thyroid, thyroid that your body uses is mostly your liver. So 10% of your T3 or active thyroid is made in the thyroid itself. 90% is converted from what we call a pro hormone, which is T4. It has to have an iodine removed to become T3. And most doctors will only check a TSH, which actually is a hormone that comes from the pituitary. And that hormone basically they use as a marker for what's going on in your thyroid. Because T4 will feed to the pituitary. And, and if your T4 is high, your TSH will be low, which means you know, your, your hyperthyroid. And if you're, if you have no T4, then your TSH is going to go up or less T4. The problem is TSH could be high or low, not because you have an issue with your thyroid, or maybe you do have an issue with your thyroid, but because of your pituitary also having an issue. Like 10% of people have a tumor in their, in their brain. That makes prolactin. 10% of people, if you have a tumor that makes prolactin, your TSH is totally invalid because prolactin is going to affect the pituitary, making tsh. So you could have hella thyroid dysfunction going on, and your TSH is still going to be normal because it's being suppressed by prolactin or for other reasons. There's issues with your pituitary when you give birth. You could have issues that happen with your pituitary. And it gets missed all the time because people don't do complete thyroid labs. So TSH is a beginning point for a hormone that's stable over about six weeks. But you should also have a T4 to see how what your thyroid is actually putting out a T3 to make sure your body's actually converting that into T3. The active form, reverse T3, actually looks at intracellular T3. So what kind of T3 is in your cells? Reverse T3 is a hormone that's made when your body makes the wrong hormone. Instead of taking T4 to T3, it takes off the wrong iodine and it makes reverse T3. But that ratio actually can tell you about what's going on within the cell when it comes to T3. Then you also should look for what else could be going on. Like, is your iodine low? I've never seen people really check iodine, but they should when they're checking someone's thyroid level.

And what is your preferred method of checking people's iodine?

Well, I mean, the best method is a 24 hour urine, but that's not super practical for most people. So a serum iodine isn't perfect, but it's a good start. I think it's better than nothing because if it's low, it's helpful. If it's not low, it's not that helpful. So if it's low, of course you're kind of home free. If it's higher or normal, but you still suspect iodine deficiency, then you kind of have to do a 24 hour urine to prove it. Um, but a lot of times, you know, you'll see these other things like fibrocystic breast disease that you can get with low iodine. So not just thyroid dysfunction. So people don't get their iodine checked when they're getting their thyroid checked, and they don't get checked for autoimmune thyroid disease. So thyroid peroxidase antibody and thyroglobulin antibody are two markers of autoimmune thyroid disease. There's a lot of endocrinologists that maybe don't specialize in thyroid that maybe might ignore that or say, like, if the rest of your thyroid numbers are normal, that's okay. But endocrinologists that are really in the know and focus on thyroid will treat someone who has a positive thyroid peroxidase antibody or thyroglobulin antibody and symptoms of Being low on thyroid, like weight gain, brain fog, hair loss, you know, swelling.

Edema, dry skin, dry everything.

Brittle nails. Yeah. All these things that we associate with thyroid, you would get treated by an endocrinologist that really understands what autoimmune thyroid disease is. Because if you have autoimmune thyroid disease, your thyroid is not going to function properly. Even if your labs look normal, if you have symptoms, you have thyroid dysfunction. Now, from a holistic approach, we don't necessarily treat you with medication. We fix the underlying issues, like your gut health, your liver health, and try to get your body give you testosterone or long testosterone. Try to get your body to convert T4 to T3 the right way. But, you know, it's not always possible. And sometimes I will put people on T3 while I sort of figure out what's going on. Yeah.

And was that one of your issues? Is that what you were dealing with?

That was one of my issues. Of course. Gut health, with the years of antibiotics, that was one of my issues. I had a lot of inflammation in my gut, a lot of issues with my gut barrier. When you have issues with your gut barrier, what can happen is your gut is really where your body meets the world. And everything that you put into your body is actually pretty much absorbed through your gut, your intestinal system. When that system has issues, you are going to have issues because that system is supposed to be a barrier. For instance, your immune system will react to anything that's a big protein. You're only supposed to have small proteins leave your gut once they've been fully digested and cut into what we call amino acids or short chains of amino acids. So long chains of amino acids are very problematic. Your body will treat that as something like a virus or something it needs to react to, because the immune system reacts to big proteins. So if you have an issue with your gut where it's not acting as the barrier that it should or it doesn't have the enzymes that it should to break things down, then you're going to have these big proteins that leave your gut, and then what's going to happen? Your body's going to see you as under attack instead of having a gut that's not doing its job. So gut health is really important. There's actually data that you have. If you have an increase in lps, which is a part of a bacterial wall that should never leak across your gut. I mean, you have bacteria in your gut that help you with digestion. They actually are some of the important things that signal your brain. They make the precursors to neurotransmitters or brain chemicals like serotonin, the one that helps us relax and sleep. Serotonin itself doesn't, if it's made in the gut, doesn't cross into the brain, but the precursors are made in the gut and do cross into the brain. So if you have a compromised gut barrier, you're not going to make those neurotransmitters like serotonin and dopamine that make you feel satisfied where you don't overeat, for instance. So this is super important, not only from an inflammation standpoint, but from a brain standpoint. And, and these microbiota, these little bacteria in your gut, have a lot to do with doing all of these jobs for you. But if they're compromised, for instance, you can have an overgrowth of bacteria that aren't so good, that aren't going to make the right things, that are going to make the wrong things. You could have things grow in your gut, like Candida, that might increase your cravings for sugar. So all of these gut health issues are so, so important when it comes to weight control. And yet they're hardly ever looked at when it comes to the industry. Now they're saying, like, for instance, with some of these drugs that they're using, what it's actually doing is helping to repair the gut barrier. But there's actually ways of doing that without using medications.

So I want to back up a little bit and just talk about how you transitioned from a hospitalist, because I know that hospitalists are not thinking about root cause medicine. And yet you very much, I mean, you consider yourself like the Dr. House of Weight loss, which. I loved that show, like, that show was amazing. And my husband and I used to sit and watch it and he used to like, look at me in amazement when I would name all the things that were happening. So that title really resonates with me. So how did you go from being and a hospitalist, which is essentially like the person that has to take care of someone that they don't know at all when they get admitted to the hospital, Right?

Yeah.

How did you go from that to the Dr. House of Functional Medicine?

Well, so, you know, I was in a small town, so I was the hospitalist, but I also had my own practice. And at that time it was a traditional, like 5,000 person internal medicine practice. And then I also worked at the hospital, but I had my little child. When we moved here, he stopped speaking. He was like two and a half. And at first we thought Gosh, he probably just switched from Spanish to English when we came from Texas, and that's the issue. But it wasn't. And things got worse and worse later. By the time he was six, we were told that he was on the autism spectrum and he was really severe. He could speak only in two or three word sentences. He's a great artist now, but back then he used to tell my husband what to draw because he couldn't draw. He would roll on the floor screaming in frustration a lot. And I just had nothing to do for him. And I took him to several physicians who were like, well, we can give you this drug to calm him down, but we have to do an EKG to make sure that it doesn't cause an arrhythmia. And I was like, he's six, I'm not going to put him on a drug that's going to cause an arrhythmia. It was imipramine at the time. And so I just was very lucky because people knew that I was sort of open to holistic approaches. I come from a long line of physicians that worked in the Persian Court actually for thousands of years, Jewish physicians who survived in this, you know, as a minority in this other empire because of what they knew. And so I believed in holistic medicine. I just didn't know a whole lot about it because I was trained very conventionally, you know, at Parkland Hospital and, you know, very ICU heavy training and all that. And so I went to. I was invited to this dinner that was put on by the. By the Dan Doctors of autism. There's this group called Defeat Autism. Now. They take a holistic approach to autism. There are these parents in our community that had basically connected with these doctors and they hosted a dinner where they brought one of these docs to talk about the holistic approach to autism. He talked about diet, he talked about why you would want to take a child on the autism spectrum off gluten and dairy. Because there's a lot of data that, for instance, biopsy series done in the 90s where they took kids on the autism spectrum and their siblings and biopsied their colons and showed the kids on the spectrum had almost changes that look like Crohn's disease, really wearing of their gut lining and all that. He was talking about putting them on a gluten free, dairy free, no sugar, no artificial color and flavor diet, and using fish oil. I did that for my son. I was like, well, nothing else has helped. I'll give it a try. And when he went on that diet. I did, too, because I thought one person in the family should. And lo and behold, he got a lot better. He stopped screaming. He stopped rolling on the floor. He started speaking. And then a few months later, a friend of mine who was an orthopedic surgeon, gave me a bottle of this antioxidant that he had used for his kids for asthma, because he said, I know that your kid has asthma, but he has asthma. I know that you've tried everything for him. And the medicines just made his tonsils bigger, made him feel worse. A lot of times, people on the autism spectrum, they react more to what's in the medication than the medication helps them. So he gave me this antioxidant. Lo and behold, in three months, my son went from not recognizing letters to reading. I was like, wow, there is something to this holistic medicine. And when I looked up what was in this antioxidant and had pycnogenol, which is pine bark extract. And there are these series of studies in Poland about putting kids on the autism spectrum on this particular antioxidant, because it turns out that kids on the spectrum have low levels of something called glutathione, which is in our cells. It's supposed to protect ourselves from damage and from toxins. A lot of kids on the autism spectrum have low levels of this, the fish oil, which really helps with making dopamine. It turns out a neurotransmitter. And this particular antioxidant really helped my son. And when I went on that diet, I had had lifelong, you know, irritable bowel syndrome, where I would get up in the morning, have to run to the bathroom, could never predict when things were going to happen to me. Had tons of bloating, and with his diet of no gluten, no dairy, no sugar, no artificial color and flavor, a lot of that went away for me. And that was actually the first time I lost weight in my 30s. That diet really helped me. Now. I didn't change my diet in my 40s, but still gained weight, which is why I have so much empathy for other women who are in that particular, you know, place, especially because, you know, we get so much thrown at us as though, like, oh, if you've gained weight, you're, like, just fat and lazy, you know, and you get, like, these male personal trainers and sort of these male nutrition experts and even some females that I think probably don't have a lot of issues with weight who are just really unsympathetic, and they're Just like eat less, exercise more. And a lot of the women that I talk to are already doing that and they are not losing weight because these underlying issues like their gut health, you know, they're eating the wrong diet for their genes, which I really want to talk about. Because personalized medicine is one of the main things that can help you lose weight. Personalizing your diet to you. So there's a lot of data now that if you have certain genetics, certain diets are going to work much better for you than other diets. For instance, if you have a certain variant of a gene called ppara, you're going to be very good at burning fat. But if you have a bad variant of that gene, you're not going to be good at burning fat. So if you eat a high fat diet like keto, you're actually going to do worse. If you have a certain gene, variant of a gene called cetp, it's going to be very easy for you to get into keto. If you have another variant, it's not going to be very easy and keto is not really going to help you. You're never going to get there. You know, if you have a gene called fto, eating super high protein, if you have a variant of the aging, the A variant is going to really help you. If you have the TT variant, eating so much protein is probably going to give you more cravings. You have to eat a more balanced diet. There's a gene called TCF7L2 makes people carb intolerant, you know, so if you have that gene eating a lot of carbs, it's not going to be good for you. So people pretend that they know like the secret to everyone's weight loss, but they really don't because they don't know you, they don't know your gut health, they don't know your genetics, they don't know what's going on with your hormones. And so understanding all of that about yourself is actually going to give you so much of a leg up when it comes to losing weight, because you're going to know what you need to do for you, not someone else's experience, because it's going to be different. I've helped patients who have very different genetics than me. And the diet I put them on was 180 degrees different than the diet I put myself on to lose weight.

And I think that that's such an important point that the notion that there is one right diet for everyone is so false. And I also think that people's dietary needs or their tolerance changes over time. And there are things that you can get away with in your youth that you can no longer get away with in your late 30s, 40s, 50s. Like things change. And I think that, that we have to shift and there's a time and a place for everything. But, but to your point, we are all bio individual and what's going to work for you is not going to work for me and vice versa. So I would like to get into this a little more because I think that this is fascinating. So what tests do you use in order to determine people's genetic predispositions to what they do and don't to and what is best for them?

So I use nutrigenomic testing and I actually use a consumer one because they give you access to 8 million genes. Now I don't look at 8 million of them, I look at maybe 250 of them, but I have the ability to look at that. So if something comes up, I may go back and look at a gene and they have some amalgam reports that are really good where they look at some different genes that contribute to a certain thing and they give you the data for that. But I will say that even that report, which I love, I really modify. Like I don't go by the report totally that they give me because sometimes they're wrong. Like I've read the research on certain of the genes, the way they report them and what they say about them, and it's not what I would agree with. Like for instance, if you have a certain gene, it's called pemt, it's a gene that has to do with fatty liver. And if you get deficient in choline, which is a B vitamin, and you have a bad variant of this gene, you can develop fatty liver. That's why you see thin people sometimes with fatty liver. But those of us who have a tendency to insulin resistance are actually going to do a lot worse with a bad variant of this gene. Now what they tell you to do is take a bunch of choline if you have this gene. The problem is when you look at the studies where they've given animal models lots of choline, nobody's ever studied this in humans at all. What happens is they become insulin resistant. And so you want to really take, just make sure you're not choline deficient, not overshoot the choline mark if you have this gene. But you want to take annatto E which is an antioxidant that protects the liver. That's what the literature says. The Reports in these genetic tests don't say that. I think sometimes they can be misleading. The other problem with genetic reports is that a lot of times they don't look at the interactions between genes, which you really have to be an experienced nutrigenomic expert to sort of understand this. It took me years. I started studying Nutrigenomics in 2008 when my dad had a heart attack and the cardiologist told them he didn't know why. At that time, I was working for a company doing nutrition education for docs and they started doing nutrigenomic testing. It was the first test I'd seen that predated 23andMe. I found out that my dad had MTR, which is a mutation very common in his ethnicity. Middle Eastern Jewish people. MTRR actually causes you to not process B vitamins properly. So you make this thing called homocysteine, which damages your vessels. And, you know, when I was going to residency, they're like, we don't know if homocysteine is like a bystander or if it's really a bad actor. Now they know it's a bad actor, that it can cause damage to vessels and inflammation. And there's even studies linking it to high blood pressure, for instance. And so, you know, you're supposed to get homocysteine down. Usually, though, the mutation most people have that causes homocysteine to go up is mthfr. That's one people have probably heard of. It's called the mother F gene. To some people, for that gene, you have to take a specific kind of folate. But for my dad's gene, you actually have to take a specific kind of B12. Knowing which gene you have is super important. Then the other thing is if you have a separate gene called C comt carboxy O methyltransferase. This is a gene that gets rid of fight or flight hormones. This gene, some people have a slow cognitive.

It's also involved in estrogen detoxification.

It is, yes, exactly.

So it's estrogen or hormone and.

Fight or flight. Yeah, yeah, yeah. So. So it is one of the main genes in estrogen metabolism. Yes. Dr. Jen, thanks for pointing that out. So comt can be one of those genes and people can have a slow copy of this gene. Now, if you have a slow copy of this gene and you take a bunch of methylated B vitamins, which a lot of experts tell everybody, oh, just take a methylated B vitamin, you're actually going to methylate this gene and you're going to slow it down, methylate the making of this gene, and actually slow it down. So people who have comt, who also have MTHFR or mtrr, but don't know they have comt, and they're given a bunch of methylated B vitamins, and they get very anxious. So it is something that you really want to watch. You want to work with somebody that really understands nutrigenomics and the interaction between genes, because that's kind of the most important thing. And there's so much we know now from the literature that isn't reflected in some of the consumer genetic reports that people get. I mean, the ones over the counter, for the most part, the popular ones, are somewhat ridiculous. But even the one I use, which is really detailed, like I said, there's things in it that I would change when I talk to someone about their genes, but it gives me the raw data that I need to start that conversation. When you look at genes, really, you want somebody that's done it a long time and has read a lot of literature about it, because otherwise you can kind of sometimes do a little bit more harm than good when you just follow people that say, just like, oh, just take a methylated B, that sort of thing. Economics is super powerful now. There's people that say, oh, you know, it doesn't really matter what your genes are because our environment is so polluted. It's all about epigenetics. Now. Like, I heard someone I really admire, Dr. Hyman, say, well, you know, your genes are like the keyboard, but you can play different songs on it. You can play ragtime, jazz, whatever. But the fact is, all of our keyboards are really different. You have to know your keyboard to know what to do to turn genes off and on. Even in the polluted environment where we have, which is so bad. I mean, one of the things that women our age face is that the food supply was so different when we were little than it is now. So the same things you ate when you were little ate the same things you're eating now. They're different.

Right. You know, I say all the time, like, we're not. We're not living on our grandmother's earth. We're not even living on our mother's earth.

No, Right.

And so everything is. Is dramatically different. But that doesn't mean that you should go against your basic roadmap.

Exactly. Right.

Like we all have this genetic basic roadmap, and. And we should play to our strengths.

Exactly. Yeah, exactly.

Knowing your genetics is the way to play to your strengths.

It is because your genetics are actually what makes you, for instance, more susceptible to something that someone else can survive easily. There are people who can actually who have robust ways of getting rid of pesticides and herbicides. Believe it or not, they have fabulous detoxification pathways. So they're not as affected by everything that's in our food than some of us are who don't have those great detoxification pathways. So if you know your genetics, for one thing, you know what to concentrate on, B, you know what's coming down the road, like, what you really need to watch out for, and C, you need to know what you need to do today as far as, like, what supplements should you take? What kind of diet should you have? How much sleep do you need? What's actually going to help you sleep? You know, some people are low on glycine. They can't make this amino acid, glycine, and they bang their heads against the wall, take all these different medications. But something simple could have solved it if they knew their genetics. So that personalized medicine and that personalized roadmap is so important in every part of health, but most especially in my field, when it comes to getting to the right body composition. Yeah.

So obviously, your diet and the supplements are a big part of it. Right. And nurturing your nature.

Right.

Giving.

Giving yourself what. What your body ideally needs. That. That is definitely a big part of it. Talk about the movement and exercise part, because that feeds into your genetics, too.

It absolutely does. Yeah. I mean, exercise is one of the biggest, what we call epigenetic switches that you can throw. So the reason we want to know your genetics is we want to know how to encourage the genes that are good, turn off the ones that are bad, and eat to your advantage or take supplements to your advantage. And so basically, you know, it's super important to use exercise as one of those switches, because exercise does a lot in the body that a lot of people know about. For one thing, it really sensitizes you to the hormone insulin. So if you don't exercise, then it's going to take a lot more insulin to get your blood sugar to where it's supposed to be. The more insulin you make, the more your blood sugar is going to be unstable. So, you know, your blood pressure will go way up, you'll have high insulin, drop it way down. That's what can cause a lot of cravings. It can also kind of pack on the pounds. Insulin is an anabolic hormone. So it's a hormone that builds fat. It's kind of like the Way testosterone builds muscle, insulin builds fat, so you don't want a lot of insulin.

So insulin, it's our storage hormone.

It is, yeah, yeah, yeah. So it pushes, you know, sugar into your cells basically and makes you hang on to fat. And so because our ancestors needed that, you know, they had very little food. When they got food, they wanted to store it so they'd have something for later. We're not usually in that situation. So basically, and there are people who have more of our ancestral genes. Like APOE4 is a gene that people demonize a lot because it is linked to Alzheimer's. But when you look at people in the developing world, people with APOE 4 actually do better. They're less likely to die of infection, they're less likely to have low birth weight babies because they hold onto that fat in their blood. Why? Because our ancestors needed that. They didn't have a lot of that around. So 8.4 is an ancient gene that does terrible in our modern society because it increases insulin resistance. It kind of like wraps your insulin receptor in fat sort of because you have so much fat in your blood. So yeah, it can be a huge thing if you know about it, but it is a gene that was protective to our ancestors and totally non protective to the way that we live now.

Yeah, yeah. And we have to remember, like we are modern beings living on a very old gene code and that gene code was very appropriate for survival then and needed for survival then because, you know, unlike now, we were living in times where we didn't have food storage, we didn't have agriculture, and you basically eat what you killed or found.

Right.

And so there were times when food was available and times of deep and prolonged starvation. And it was only the people that could store that could make fat and live off of that that survived. It was a protective medical system. It was, it was absolutely like those were the people that survived. Yes, it was a survival mechanism.

Anomalies of people who don't have any of these thrifty genes now and can eat everything, happen to be married to one. And so the rest of us are like, why? Why? But yeah, like if you have APOE 4, you sort of have to live like a cave person. You need to eat like, you know, game meat and vegetables and very little fat and move all the time. So that's another gene where exercise makes a huge difference as far as your outcomes. If you have APOA4, if you have one gene, your risk of Alzheimer's is double. The general population, if you have two genes, your risk is eight to 10 times. So this isn't just about losing weight or getting to the right body composition. It's about your health, what we're looking at here. But even with those genes, if you have two copies of Apoe 4, if you exercise six days a week, your risk of developing Alzheimer's is cut in half if you make sure you're not insulin resistant, as in keep yourself at the correct body composition. And I'm not just talking about weight, I'm talking about muscle to fat ratio. It's important to have muscle. Muscle dictates metabolism. So all of these, you know, weight loss fads that don't emphasize gaining muscle, they're really going to actually cause huger health problems than we know. And there's people that, let's go there, let's go there. But I've never seen that in a non drug company sponsored study. Not one.

I think that, speaking of Dr. Hyman, who I think has two copies of the APOE 4, hasn't he come out and said that?

I don't know about him. I know Chris Hemsworth famously had that because Dr. Attia did his genetics and talked to him about it.

Almost positive that I remember that. But in any event, wait, where was my brain?

Just, oh, you were talking about APOE.

4 and exercise body composition. Because I know that Dr. Hyman did one of his podcasts where he had two or three experts in the ozempic space come on and talk about semiglutides and that if I remember this statistic correctly, they are losing weight, certainly, but they're also decreasing their muscle mass by 40%. And to me, that's a metabolic disaster. I mean, that's the thing that we have to maintain because that's the center and the foundation of our metabolism. No, Yeah.

I mean, to me what's really important is body composition. So for instance, when I help people lose weight, I send them a box that has skin calipers and ways of measuring their. There's a little thing where you measure all of your body and all that, because what I'm trying to do is make you leaner, not skinnier. When we talk about APOE4, for instance, they call Alzheimer's type 3 diabetes of the brain because insulin resistance, especially local insulin resistance from inflammation in the brain is so important here. And so what we're trying to do is reduce your inflammation by reducing the amount of fat, improving your muscle, and therefore you're less insulin resistant. That's the whole goal here with these medications. What I have seen, and when I followed my diabetics who've been on it with their body composition. They are losing muscle. And my goal when I started diabetic on it is it's better than insulin, but I'm going to try to get them off by changing their lifestyle and doing the other things that I need to do for them.

But so is there a way to do that? I mean, can. Can we help people who are so stuck, Right. And they're in a really bad place? Because the bottom line is if you're 100 pounds overweight, and I know that you can say, speak to this more than Anyone, if you're 100 pounds overweight, you're in a really bad spot. Should we be thinking about a way to marry the world that you're talking about with this conventional medical space and, like, give people a little, little advantage? But can we do it in a way that we're teaching them to eat at the same time and teaching them to move and helping them with, with body composition, or is there a way to do that?

I mean, I think there is. I have never used it except in people who are like, basically diabetics that come to me uncontrolled for the most part. Because, for instance, one of the people in my program is a nurse who weighed 259 pounds and she was already on semiglutide. She was on one of the drugs that kind of acts as a sugar diuretic that wastes sugar through your kidneys. And she was on metformin. So she was on three drugs with a hemoglobin A1C of 15 and, you know, more than 100 pounds overweight because her goal weight is 130 pounds. So she has lost more than 100 pounds now and is off all those medications with an A1C of 5.4 yesterday. Wow. Yeah. So she was. The medications had not really helped her with any, any weight loss at all. So I think the education piece is super important. If you use these drugs and you are not measuring people's body composition, if you use these drugs and you're not getting to the root cause of what actually brought us here, if you're not educating people about how important exercise to build muscle is and maybe even supplementing with certain things that help muscle, like alpha lipoic acid, then I think you're really doing people a disservice, because people do lose some muscle mass when they lose weight in general, but if they're becoming less lean, you're doing them a huge disservice. So, like, for me I went from 45% body fat to 22% body fat. That's huge. That's becoming really lean. And I did not lose that much muscle mass a because it took me two years, more than two years maybe overall, to lose this weight. Most of it I lost in 18 months, but really for six months, I was really changing things and whatnot. And so losing weight slowly is really important so that you lose fat and don't lose muscle. Having a very nutrient dense diet is super important that you're feeding your muscle. And then perhaps supplementation to correct things like not being able to utilize insulin. Well, supplementation to help with deficiencies that you might have and things that might preserve muscle, like alpha lipoic acid.

What does losing weight slowly mean to you?

It really means no more than a pound or two a week because your body can get shocked and your body can actually have issues when you do things too drastically, even with hormones. When I do hormone replacement therapy, I'm really careful to do things kind of slowly and let people's bodies adjust. And if they're coming off something, I usually do it really slowly, too. The body likes set points, and so when you lose weight slowly, you're actually addressing these root causes and getting healthier. And you have a much better chance of hanging onto your muscle because you're exercising over that time than when you drop weight super drastically. Because usually when you drop weight super drastically, you're dropping muscle.

Yeah. And you're also way more likely to rebound.

Right? Exactly. Yeah. Yeah, you are.

You know, I think that when Dr. Fatima Cody came out and said that obesity is a genetic disease, she did a huge disservice out there. Do you believe that obesity is a genetic disease? I mean, we talked so much about how important your genes are, but don't you think that it's more of a lack of knowledge and understanding about how to best manage your genes?

For sure. Because if you look at my genes, I should be morbidly obese, and yet I'm not. Why? Because I learned to use those genes to my advantage. Really? You know, for instance, I know that I have fto, so I know that exercise really helps me. In fact, when I lost the most weight, I was exercising the most. I try to do at least an hour and a half, three to four days a week, because that's what it takes for me to be healthy. And I do other things while I exercise, like listen to podcasts. So it's not a waste of time for me. It's time that I'm actually Engaging in things. And honestly, like, if I want to watch a program, I make sure that I'm exercising when I do it because I will fall asleep otherwise. So if there's a program I really want to watch, it's my reward. I'm exercising. So, yeah, I know that about myself. So I know that I can't get away with less exercise. So I do it, you know, And I think a lot of people who don't have FTO maybe don't need that much exercise. So it's really, it's the importance of knowing your genes. It kind of tells you what your particular roadmap can be. I mean, I had a cardiologist that came to me who tried, he tried Paleo, then he tried Carnivore. As a cardiologist, I was like about to drop to the floor when he told me this because, you know, most cardiologists are vegan, but vegan hadn't helped him either. That's why he kept going all through all these diets. Well, it turned out he really needed a balanced diet. Like when you looked at his genes, he needed to have good carbs. He had to have like about, you know, 30% protein and he needed some fat and he was a cyclist, so he actually needed carbs because he would go on these 100 mile bike rides and really correcting what he was doing. And he also had thyroid problems, which a lot of people don't look for in men. So, you know, knowing, although it's getting.

More and more common.

Much more common, yeah. I think because of, you know, what's going on in our food supply and the fact that it's, you know, that more of us have issues with our intestinal health than we used to. It's becoming more common in men and really overlooked in men actually. But yeah, I mean, he, you know, he was a person that had really tried to lose weight and was very health conscious and really without the right information. He kept trying different things. And that's kind of the thing is that people keep trying different things, trying to find the thing that will hit. But if you know your information first, if you know your hormone balance, if you're low on certain nutrients, if you know your gut health, if you know your genetics, if you know your food sensitivities and food allergies. So the things that could be causing intestinal inflammation, if you know what to do for your gut barrier, all of these things will help you to lay the foundation to make yourself healthier. So that having the right body composition is part of that health. Yeah.

Other than genetics. And we completely appreciate how important it is. But there are other things that serve as barriers to people's health. So what kind of things are you looking for when you're being that Dr. House and trying to figure out the root cause of being people's metabolic disturbance?

Well, I mean, believe it or not, a lot of people that pack on weight do it because of trauma. So I had a patient who was actually a leader in Weight Watchers. She'd lost all the way down. She was very thin when I met her. But when she got down to that, weight abuse that she'd had as a child when she was thin actually came back to her. And she had used this fat as kind of a protection for herself to hide herself from people, sort of. And she freaked out when she got to this very low weight and gained everything back. This was early in my career. I didn't really. I mean, I myself was probably 235 when she was my patient. So I didn't have the tools to really help her. But I've seen this so much mindset has so much to do with it, but also really dealing with trauma through someone who's a competent therapist. If you've had a lot of trauma in your life, you know you're not going to be able to lose your weight away from this trauma. You really need to fix it. Mind body wellness techniques are super important. So I've learned tapping, I've learned box breathing, I've learned all of these techniques. My sister, Dr. Atusa, who's an allergist, is actually really into mind body wellness. And she has a whole library on clubhouse that people have told me they found of her breathing practices that she does for people. So I really like in my practice, I really encourage people to do yin yoga, which is a kind of yoga that really helps with relaxation, that really helps with mindset, because mindset is the most important thing. It's the thing that's going to keep you to the diet that your genetics say you need to have. It's going to keep you exercising, for instance. So that's one huge barrier. I think economics is another barrier for people because it's pretty expensive. People say it's, quote, elite to eat healthy. And in a way it is. But there are foods that are less polluted. For instance, turkey is one example Dr. Hyman gave. Turkey is actually pretty clean, whether or not you get organic. There's a lot of laws about how turkeys are treated in the United States because it's our national bird. So that's one clean source of protein.

That's so interesting because chickens do not enjoy that privilege.

Exactly. No, chickens don't.

The chicken industry is deplorable.

It is, yeah.

But, you know, now we were talking to someone over the weekend whose family is in the chicken raising business and the one thing that that family never eats is chicken.

Yeah.

Because they know the conditions under which chickens are raised.

Yeah. Chicken is, you know, unfortunately in a lot of our ethnic cuisines, there's a lot of chicken and it's not good.

I know you and I share the same ethnic cuisine, so there's a lot of chicken and I really, really struggle with it. Yeah, I, I personally don't and haven't in many, many, many years, but my husband and my sons love chicken.

Yeah, yeah, people love chicken and. Yeah, it's not very good for you. So. Yeah, so I would say turkey is a great meat. Sometimes there's, you know, wild caught salmon on sale for three or four dollars a pound here in Seattle. You know, I think, you know, I love the EWG's Dirty Dozen because. And Clean 15 because it gives you 15 clean foods that you can eat that are non organic and non organic. Non processed food is basically the cheapest food you can get. They charge you for processing and packaging. So that's really what I recommend to people who don't have a lot of money. And then for the testing, I'm actually coming up with a program where it's going to be a lot of DIY functional medicine testing where you're going to learn to interpret your own tests. And the reason I love this is because I think it's going to bring people very close to their testing. Like even in an elite program, a doctor is going to spend two hours with you on each test, but you can spend hours on your own test. And you're not going to lie to yourself about what your habits are. You may not tell me what you're eating, but you're going to know what you're eating and what that means for that test. And so I'm really excited about rolling this out. People will be able to get some coaching if they want to, but really it's going to be learning about their own tests and really how to interpret this for themselves and their lives. Because I think this is something that's sorely needed. It's not done in the regular medical system, in our five minute office visits. Nobody's getting to the root cause of what's going on with you. And so it's super important to actually learn to do that for yourself. And so that's going to be sort of this affordable program that I'm very excited to bring about because I think that this sort of root cause medicine should be accessible to everybody.

Yeah, I agree with you. I think the food is a huge problem because we have so many subsidized crops in this country. And what's being subsidized is garbage. So, you know, people can get very cheap meat and very cheap processed food, and it's garbage. And when you think about the things that are supplemented, I mean, what people are using government money for, they're using it for soda and chips and these things that are very, very bad for them, but they're cheap and inexpensive, and so that's what they end up eating. And I think that we really need to work on our educational system. And why, why are we subsidizing these crops? Why are we subsidizing a wheat crop? Why are we subsidizing a corn crop, a soy crop, a GMO soy crop?

We.

We have no business doing that. And I think if we would put that money and that attention and that interest and that and that support into the vegetable growers, it would have a huge impact down the line. It's just that I'm not sure that that's what their goal is.

Yeah, I mean, there's lobbies, obviously, that keep all of this going, but, you know, there's ways of fighting back. I think there are people with resources who are now looking at changing these laws, who sort of think about hiring their own lobbyists the other way. So if you have friends that have resources, impress this upon them that they really could be somebody that makes a change, that perhaps has a foundation that looks at growing the right food for everybody, changing the laws so that what the government covers for people is healthy. You know, I think it's really partially, you know, a system that's very entrenched, so it's going to be hard to dig out. But. But I think if the will's there, we can do it because, yeah, we all know.

And I also think that we can all vote with our pocketbooks. Right? We can all vote with our money and we can choose to not buy those things. So if we stop the demand for the garbage, it's going to go away.

Right.

So. But we're a long way from that, sadly. But in the meantime, people are concerned about their health. We're sicker than we ever were before. I know in the breast cancer world, I mean, I Am seeing more and more women younger and younger, and it's disturbing and it's sad, and it's completely tied to diet and lifestyle. I mean, 80% of breast cancers are potentially preventable. Some of it is coming from birth control pills, some of it is coming from prolonged antibiotics. But there are things that we can control. And I say if you were in that position where you were on a whole bunch of antibiotics as a child, we can't go back and fix that. It's water under the bridge. But we can start today and build your health.

Yes. And that really started building the intestinal health, which was damaged with the antibiotics and the cellular health. A lot of people don't understand that antibiotics actually in general hit your cells also. So if I have to give someone an antibiotic, I actually give them NAC to protect their cells. There's some data that that does that. And so, yeah, if you've been on antibiotics, there's some road to go back to sort of change what happened to you. You can, you can make a lot of difference. But yeah, it's, it's super important. And I think in breast cancer also, body composition is super important. I mean, estrone, the estrogen, that's so terrible for, you know, sort of stimulating breast cells the wrong way. It's made in fat generally. And so the leaner your body composition, the less chance you have really of those bad estrogens being around.

Yeah. And that is demonstrated all the time in these women who are postmenopausal and not so symptomatic because they have a lot of fat cells. And so the fat cells are making estrone, and so it's hitting their receptors and they're not having hot flashes and they're not having all of these kind of negative side effects that we see with menopause. And so they're like, what's the big deal? Yeah, right. Until they get into trouble with estrogen dominance, which is, you know, when they wind up in my office. So obviously we want to listen. I would be delighted if tomorrow breast cancer was cured and I could go find something else to do because I'm a very purpose driven lady. So I would go find something else to do. Gladly, joyfully. Right. And I'm sure you are the same where if we could solve this obesity crisis, it would be an amazing blessing. Right. We, we are very much the same into, in that we went into this profession to serve, but what we didn't want to see, I mean, I'm 30 years into my career at this time. I Didn't want to see people worse off now than they were when I started. And yet that is the toxic soup that we are all swimming in right now. That people are definitely worse now than they were when I started. I don't know if you feel that way, but you are making an incredible contribution to your community and in the work that you're doing, you're preventing people from coming into my community. So for that, I thank you deeply from the bottom of my heart. I am actually very interested in working with you because I think that my people could really greatly benefit from your knowledge. So let's definitely brainstorm about how to do that. In the meantime, how can people find you?

So I'm on social media. Doctorspelldot d o c t o r dot emi and you can reach me at Dr. Emmy dot com. So d o c T O R E M I this time no.in the middle. So in the in social media, it's Dr. Emmy. Or on Twitter it's Dr.— Emmy because you can't have dots on Twitter. But my website is just dremmi.com so you can find me there. We have some exciting things coming up. We have actually a DIY gut health program, and we have a DIY coaching program coming up. So people who are health coaches or health professionals who really want to learn more about intestinal health and the microbiome and how to help people from that perspective. We have a class coming up this fall, which I'm super excited about. To me, Dr. Has always meant educator. And so moving into this education space with what I do is really something I'm super excited about.

That is amazing. That is amazing. I'm so excited for you. I will support you in any way I can because I really, really believe in what you're doing. We will make sure to put all of that information in the show notes, and there's more to come for us, so stay tuned.

Same here. And I'm excited to get QT imaging. So I want you guys to come to Seattle.

Yeah, yeah, absolutely. And we can definitely talk about that. And if you liked this episode, which I can't imagine that you didn't, so please like it, comment, share it with someone who needs to hear it and who doesn't need more metabolic health in their lives. So please share it and know that I will see you back here this time next week. Until then, it's Dr. Jen.

Bye for now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jennsimmons and remember, my Jen has two N's, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.