Episode 2: How to be a Radiant Woman with Dr. Mark Holthouse, MD

Podcast Drop Date: 10/19/22

Amber Warren, PA-C has an in-depth conversation with internationally recognized hormone & cardiometabolic expert, Dr. Mark Holthouse, MD. In this episode they discuss:

• Connection between inflammation, gut health and hormone imbalances

• Central obesity leading to systemic inflammation leading to insulin resistance and hormone dysregulation

• Stress, cortisol, hormone dysfunction

• Cell signaling protein treatment for supporting improved body fat/lean muscle composition, aging, repair

• Resistance training and HIIT- Not just any movement but the right movement

• Time Restricted eating- more than weight loss

• Toxicants and hormone dysregulation

• Learn more about our Radiant Woman program

• AND MORE

EPISODE 2 | TRANSCRIPT

Host Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Welcome back to our podcast, Amber Warren here again, and I have the privilege to introduce one of my favorite humans. This is Dr. Mark Holthouse. He is our has been our acting medical director at Functional Medicine of Idaho since 2020 and now medical director for Functional Medicine Foundations. He graduated from Loma Linda School of Medicine and did his family practice training at UC Davis. He currently and has spent the last ten years teaching at the Loma Linda University School of Medicine, where he teaches in cardio metabolic preventative medicine. He's also on teaching faculty at the Institute for Functional Medicine, where he also teaches cardiometabolic preventative medicine and teaches their advanced hormone modules. He owned his own functional medicine practice for 28 years before moving to the great state of Idaho, where he loves the outdoors, he enjoys photography, mountain biking and really anything on water or snow. And we are just so honored to have him as a part of our team. So today we're talking about one of the areas of expertise we offer with within functional medicine foundations and essentially how to be a radiant woman. So we're really excited to dig into this today. So, Dr. Holthouse, first of all, welcome. We're so glad to have you.

Dr. Mark Holthouse, MD: Happy to be here.

Host Amber Warren, PA-C: I know you get this question probably more often than I do. Okay, Doc, fix my hormones. Check my hormones, test my hormones, put me on hormones, fix them. I am in a bad place. So how do you approach that?

Dr. Mark Holthouse, MD: Probably the most common question I get right and we try to kind of back people up a little bit because they're usually coming in and they're really not desperate, but kind of they've been on the Internet, they've heard a lot of rumble out in the community about what they should be doing, what what fad they should be chasing, what new podcast might be the thing, right And so we try to get them to kind of back up, take a deep breath and say, Hey, let's hear about your story, let's hear your symptoms. When did they start? And let's look at you as a whole person that you are. You're not a peptide, you're not a molecule, you're not a neurotransmitter, you're not a type of diet. You're not defined by what you've tried and failed. Let's talk about what's making you a less than optimal feeling person right now. And often it comes into this kind of this this taking a breath, a sigh of relief phase where they realize I'm going to be listened to. Right. And they want to know more than just what hormones have I tried and failed. And then suddenly you get this this sacred opportunity to enter into this space with a person where they share with you relationships, where they share with you what's going on with their digestive tract, what's going on with their sleep, what's going on with their energetics, what is missing that they, when they were 20, always thought they would Have.

Dr. Mark Holthouse, MD: Now that they're 30 or 40 or 50 years of age. So, yeah, I get that question a lot. And the first thing we do is kind of take a check, take a deep breath, get their story, and that's where the fun begins.

Host Amber Warren, PA-C: And our patients want to they want to feel heard. They have spent so much time not feeling heard, not no one's ever asked them, How do you sleep? What are your stressors? When did these symptoms start or what happened the 6 to 12 months leading up to these symptoms. I still ask those questions and people are baffled that we even care to go there.

Dr. Mark Holthouse, MD: Exactly.

Dr. Mark Holthouse, MD: So where I've always been impressed with you in what you teach us as a group of practitioners and what you teach on the grand stage is how you make this connection between gut health, which is so commonly talked about nowadays and thankfully so recognized, so gut health, hormonal imbalances and inflammation, and so digging into more root cause of hormone imbalances. I just I love your teaching there, so I really want to go there first.

Dr. Mark Holthouse, MD: Great. I like to go there.

Host Amber Warren, PA-C: I know you do. I know you do.

Dr. Mark Holthouse, MD: But so we always we always talk about gut first when in doubt, any good naturopathic practitioner or any good integrative practitioner that's looking at root cause medicine is always going to start with the gut. And it's funny because we get these these great looks when they walk in. It's like, you know, maybe you're getting me confused with someone else that you have in your schedule today. I'm here for hormones. Yeah. Your your intestinal patient is next after me, possibly because I'm not following you. And it leads into this this kind of playful banter where we can say, I get it. But did you know that most of your hormones are largely metabolized within your intestinal tract? Estrogen in particular, talking about the context of female patient, hugely impacted by constipation, by the health of the lining of the intestinal track. So then we have to talk about everything that affects the gut. You know, Yes, it's the standard American sad diet. Yes, it's stress. We know we know that cortisol, the stress hormone, impacts how the intestine works. Yes. It's your diet. Yes. It's those prescriptions that you're taking, those antacids that are making your heartburn go away magically. But now you can't digest protein, absorb B vitamins or your calcium. And zinc is a problem as well. So you kind of connect the dots. And by the end of the discussion, you know, they're kind of saying things like, well, what do I do for my gut to fix my hormone, my hot flashes, my my libido problems, my whatever they're coming in with. And and so making these connections is so powerful. The intestinal tract is affected by all the other areas that we talk about the nodes, the imbalances, the seven core imbalances in functional medicine. And it really is foundational to understanding not just hormones, but so many other things regarding communication within our bodies, whether they be neurotransmitters or things like peptides. So the gut is always first.

Host Amber Warren, PA-C: I'm always I'm always so surprised how patient's kind of like you touched on this, but they kind of just blow off GI symptoms. Like all know I'm fine and then it's like, are you having 1 to 2 bowel movements a day? Oh I. No, I actually I actually go days without a bowel movement or I don't feel like I completely eliminate. Right. And that's where we we can have those conversations and just bring more awareness to what is appropriate healthy gut health. And maybe we have to start there. Maybe it's not even appropriate to check serum hormone levels, Right. Hormone levels in the blood. That's that's probably not an appropriate starting place.

Dr. Mark Holthouse, MD: Right. Right. It's one of the selling points that we kind of have to educate on. A lot of them come in saying, you know, I'm here for a hormone discussion. Obviously, you're going to check my serum hormones or my salary hormones or what have you. And in the pre-menopausal age group, it's it's always kind of a gut check, no pun intended, where we say, you know, that might not be as helpful because those things are going to be kind of all over the map by definition. Sometimes we do looking at certain phases of the cycle. So we have reference ranges to know what's what's going on, but it's certainly not the first priority. We always start with looking at things like digestion, absorption, assimilation. How is the gallbladder doing? Is the pancreatic enzyme secretion adequate? Is the intestinal heal, the hydrochloric acid that we so desperately need to digest proteins being formed? Are you sending the right messages down with the foods you're eating, not just calories, but what are the messages to your cell saying, hey, alarm, inflammation or anti inflammation or aging or anti-aging? Yeah, And the hormones are just part of that story, right? The metabolism piece is huge because of the direct connection with metabolizing things like estrogen and testosterone there. However, all of these other networking ideas have to kind of fit and they're overlaying like the layers of an onion when you have this conversation. So we try to kind of move them away from just focusing on the hormone levels themselves to these other areas, the gut being foundational.

Host Amber Warren, PA-C: And when you approach a patient. So yes, gut is foundational, but we also call ourselves informed allergists, right? We're casting a wide net to look at all the sources of inflammation. So how do you see inflammation, inflammation impacting hormonal imbalances?

Dr. Mark Holthouse, MD: Great question. Boy, we could talk about this all morning. Yeah, the the effects on allergies choose testosterone and progesterone for today. The effects on progesterone are fairly dramatic with inflammation. We know in the context of the gut where you've got a leaky gut barrier, there are things on the linings of our gram negative bacteria that come in with our food that can get across the gut barrier that directly stimulate inflammation systemically. And it's that systemic inflammation that mediates a kind of a real static turning down of progesterone production in the ovary, ironically, also testosterone production. And that's a big issue on guys, which we'll talk about in the next episode. But so so now you've got this gut connection mediated by inflammation from a from a compromised intestinal barrier that's producing what we call estrogen dominance. Why not? Because you have extra estrogen necessarily, but the dance has been disrupted and the dance being that now there's less progesterone. And as women age, as they move into their mid thirties, early forties, progesterone starts to drop a little bit earlier often than estrogen. And with that becomes this tendency for an estrogen dominant picture, PCOS being an extreme version of that polycystic ovarian syndrome. So inflammation directly with the context of gut health can impact progesterone and testosterone.

Dr. Mark Holthouse, MD: I'm always surprised how women kind of underestimate or maybe there's just this lack of knowledge. We talk so much about estrogens, but you're honing in on progesterone, how important progesterone is for our well being as women, as we age.

Dr. Mark Holthouse, MD: It is it is progesterone is actually more of an androgenic male type hormone that both men and women have. And it is it's the consummate balancer of estrogen. And and there's this change in the ratio that occurs with both men and women as they move from puberty through their mid middle ages. And it's a little different. You guys go through it a little bit more abruptly. Ours tends to be a little bit more of a progressive change after mid twenties.

Host Amber Warren, PA-C: It's just so much harder to be a woman, let's just be honest. But we don't have time for that today.

Dr. Mark Holthouse, MD: Well, you know, we refer to hormone optimization in the in the Radiant Woman program as opposed to the optimal meds as really the Ferrari program versus the Chevy Chevelle. You know. Guys are just they're simple that way. And you guys, when things are running well, it's there's nothing better. It's a fine tuned machine and there's so many other points of of leverage. The guys tend to be a little bit easier overall.

Host Amber Warren, PA-C: Yeah. I find when we can and you know, we don't always have to give progesterone. There's a lot of different really great herbs and a lot of different natural modalities to stimulate progesterone production and just the impact on sleep. Yes. I mean, how many women are struggling to sleep? Their brains are on fire at night. They're they can't stop thinking these these kind of these ongoing thoughts. So do you see a lot when you can get a woman's ratio improved, how much better they sleep and therefore how much better they feel the next day?

Dr. Mark Holthouse, MD: Absolutely. You know, there are botanicals like Chaste Tree Berry and black cohosh that can act as progesterone agonists. They they support progesterone like effects. And so you can kind of combat some of this estrogen dominance that way. Naturally, sleep is hugely affected by both estrogen levels and progesterone with sleep initiation and sleep maintenance both. What's interesting about what you're saying is that when you don't sleep optimally, often your cortisol levels at night, which are supposed to be at a very low level kind of a trough while things like testosterone are are being pulsed and peaking. So you can kind of take out the garbage and detox and regenerate the damage from the day before when that's not happening and cortisol is are high. Instead, that cortisol is directly competing for cholesterol, which is that mother hormone that becomes pregnant alone, that becomes either cortisol or the sex steroids that we're talking about. So I always say, hey, the baby making machinery gets turned off or the normal steroid hormones, estrogen and progesterone when you're stressed out, cortisol.

Host Amber Warren, PA-C: Fight or flight. Right. Exactly. You don't need to reproduce when we're running from the tiger.

Dr. Mark Holthouse, MD: That's right. Yeah. Right. It's kind of one or the other. And so my heart really goes out to countries where women are living in constant stress.

Host Amber Warren, PA-C: Yes.

Dr. Mark Holthouse, MD: Anywhere in the world. You just you look at what's happening to them, what's happening to their unborn children, just being bathed in these high levels of cortisol. Yeah, we know that their sex steroid ratios are being messed with. But yes, premenopausal women who are living in chronic stress, literally your body will support cortisol adaptation to stress every time over making sex steroid hormones that's seen as kind of not frivolous but extra if you've got the bandwidth.

Host Amber Warren, PA-C: So what's your approach to these women that are like, I can't fall asleep, I can't stay asleep, I have that classic 1 to 2 a.m. awakening. I get up to go to the bathroom, I can't fall asleep. My brain starts, starts going. How do you how do you approach? What's your advice? Where do you start?

Dr. Mark Holthouse, MD: I always sleep deprivation and insomnia is the bane of any primary care practitioner, and certainly that's true also for us that are doing integrative route coursework. I always start with trying to figure out the secondary reason. I mean, there are a few people that have true primary insomnia, but most people we see you and I see every day are going to have some secondary reason. Are you not sleeping because of pain? You know, Are you not sleeping because of what we call monkey mind? You know, you're doing the Rolodex and and you can't fall asleep because you're a business owner and you've got financial worries or, you know, you see what's happening to your 401k with the way the stock market's going or what have you, the way the world is going right now.

Host Amber Warren, PA-C: You're a mom of young kids. What is the future of my children's lives look like? What do I do? I don't keep them in school. Do I pull them home? What do I do?

Dr. Mark Holthouse, MD: So many of my my young moms, when you really get down to it, are are worried about the world that their kids and grandchildren are going to grow up in and the maternal hardwiring instincts that that women have are fascinating to me because that becomes paramount to them. The future and where there's a lot of my guys tend to be worried more about money and supporting and being there for their family, which is.Huge as. Well, providing am I an adequate provider or am I an inadequate person. They're defining their own identity through those kinds of things. So I always start with the possible causes. Is it pain? Is it emotional pain? Is it your bladder? So many people, they're waking up because they've got to go pee in the middle of the night and especially with guys, but also with women is their sleep apnea that's been undiagnosed.

Host Amber Warren, PA-C: I'm blown away. How many young, thin trim women have sleep? Have apnea. Yeah, right. It's wild. And how much that's contributing to cortisol imbalances and therefore hormonal dysfunction.

Dr. Mark Holthouse, MD: Exactly. So I always start with trying to find the why.

Host Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: I tell my patients, look, if we can't get you sleeping well. Pretty much everything else that we're doing is going to is going to have a half effect. It's just going to be really hard to move the needle. And and so we always go there first with kind of looking at that. We use sleep counselors, folks that are really good at cognitive behavioral sleep therapy, that are specialists in that we get them involved with that try to get processing out those issues because it's usually emotional. Yeah, it's usually emotional trauma. They have one of these high ACE scores adverse childhood events. Yep. That that is still living with them or their current situation. Yeah. So we'll always start with that. We use homeopathic, we'll use other natural things to kind of help them. Melatonin sometimes will work for sleep and things like Valerian, but yes, you've got to get them sleeping and I'll even use some of the non habituated pharmaceuticals initially if they're really sleep deprived just to buy us time because I know it's going to be hard to move the needle if if they're trying to get through life on 4 hours of sleep chronically. And we know that if you get six or less hours of sleep a night, your brain is like inflamed for the next four days.

Host Amber Warren, PA-C: It's crazy. Data. Yeah, Yeah, it's pretty wild. What are your favorite ways specifically to tackle cortisol imbalances that are driving that early wakening in the morning? What are modalities that you use and our women to get that cortisol down so that they can fall asleep? More importantly, stay asleep?

Dr. Mark Holthouse, MD: Right? Right. There's some adaptogenic types of botanicals and herbs that we can use with things like ashwagandha and phosphatidylserine and rhodiola that we know and even St John's words, things that blunt cortisol response. I don't use a lot of St John's Wart anymore really because of the interactions with metabolism and the liver enzyme systems with meds and other supplements. But we're not. We know that those products can have a blunting effect. The other things that I'll try to do is kind of consider what might be raising cortisol in the middle of the night. We refer to cortisol as kryptonite to sex steroid hormones. Yeah, it's certainly kryptonite to testosterone and guys. And it is also a problem for hormones for for women. So if it's low blood sugar, you know, the body has this obligate need to keep the blood serum sugar levels stable. And the brain senses that at night when it's dropping. And the response that it has is to raise cortisol from the adrenal, which then goes to the liver and wrings out the glucose from glycogen stores to raise it back up so the brain can go back to sleep and chill. So often we'll try to figure out if they're having what's called reactive hypo low glycemic problems.

Speaker2: And sometimes they are. And it's interesting because one of the first things we see with women that are becoming pre-diabetic on their way to diabetes is they become unstable in the way they really metabolize insulin and sugar. And so they'll get low sugar readings and what we call a lack of metabolic flexibility where they can't use various forms of nutrition for energy and adapt and go back and forth between them very easily. So they get hypoglycemic at night and here comes the cortisol surge. So we'll often look at salivary cortisol levels at night. Typically we do a few readings during the day, but I'll have them do a tube of their own saliva around 2 a.m. and we'll look at cortisol and other adrenal hormones, DHEA, kind of the yin and the yang of the cortisol adrenal story and see where it is. And often we find that indeed it's spiking at 2 a.m.. So no one's going to sleep through that. Not even prescription medications often are effective against Mother Nature's onslaught of increase in cortisol. So looking for things like stress, looking for things like chronic infection, inflammation, sleep deprivation, problems with low sugar are the areas we look at to kind of address high PM and nocturnal cortisol.

Speaker1: And then we've got those cortisol spikes that's going to, as women especially well men to allow us to hold on more, more, more adipose tissue specifically in our bellies, which leads to more inflammation, which just further perpetuates the cycle. So it's just a it is a very damaging cycle we can get into. So obviously, talk about blood sugar per day, Betty. Pre-diabetes will lead us into a conversation about intermittent fasting. And that's a really hot topic for menopausal women right now. Right? We want to stay trim. We want to build muscle. We want to lose lose fat. And I know there's a lot of different approaches. Is. And that's where an individualized approach is really important. But what's your take on maybe someone like me, late thirties, looking to keep my metabolism nice and high, not knowing where I stand from a cortisol, adrenal functioning standpoint, throwing myself into intermittent fasting. What's your advice there?

Speaker2: It's a great question and there's been a lot of really questioning the safety and efficacy of time restricted eating or intermittent fasting where you're going 16 hours and then eating in a fasting and then eating all of your same calories that you might eat over a 12 hour period during the day in an eight hour window. So that's the so called 68 protocol raising cortisol, right? Because we know that there is when you fast for a period of time that it's not only lower your insulin, which we think is probably the keys to the kingdom as far as burning peripheral fat stores. But you're raising some of these counter regulatory hormones as well, like glucagon, like cortisol, like growth hormone growth hormone being the one that kind of maintains your lean muscle and promotes fat burning lipolysis we call it the cortisol is is the interesting character in that story. As as in the context we've been discussing, the cortisol can promote abdominal obesity. It tends to decrease lean muscle mass and and yes, it raises sugar. So it's kind of flies in the face of people that are pre-diabetic, that are trying to deal with high fasting sugars. Is this really a good practice? What we look at in intermittent fasting is really what it's doing to metabolism in general. And we see in the thyroid labs the fruits of what happens with intermittent fasting. You have kind of this temporary pulling back of the metabolic rate as the body suspends itself from being overly catabolic a fast metabolic rate when it perceives a threat.

Speaker2: This is what happens