Podcast Drop Date: 12/18/2024
In this episode of the Functional Medicine Foundations Podcast, host Amber Warren sits down with Dr. Mark Holthouse and registered dietitian Hailie Kuttler to introduce our new and improved Weight Loss 2.0 Program, featuring the Nourish to Thrive approach. Together, they dive into what has worked well in past weight loss efforts, the exciting enhancements we’re making to support long-term success, and how cutting-edge research is shaping our program. From personalized nutrition strategies to the science-backed methods we use to address the root causes of weight challenges, this conversation will leave you inspired and equipped to achieve your goals in a sustainable and healthy way.
Transcript:
Amber Warren, PA-C: Welcome to the 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. Hi, everybody. Welcome back. I am so excited for this conversation. But I have to hit the bios first and then we'll get into it. So doctor Mark Woolhouse, MD, is the Chief Medical officer for FMI center for Optimal Health and Functional Medicine of Idaho. He graduated from Loma Linda University School of Medicine and went on to obtain his family practice training at UC Davis Medical Center. While in the Air Force Scholarship program at David Graham Medical Center, Travis AFB, doctor H has over 32 years of family practice experience and brings years of practice in the areas of functional and integrative medicine. As part of the Institute for Functional Medicine Teaching Faculty, he has educated thousands of practitioners in hormone health across the nation over the past ten years as an Assistant Professor of Medicine of Medicine at the Teaching Faculty at Loma Linda University School of Medicine. He is an expert on cardiometabolic diseases prevention, reversing type two diabetes, heart disease, high cholesterol, obesity, and metabolic syndrome. In addition to his clinical and teaching experience, he has over 30 years owning his own private practice as Acting Medical Director, implementing strategic models of clinical practice and business of functional medicine.
Amber Warren, PA-C: Doctor and his wife, Tammy enjoy photography, snowshoeing, skiing, sailing, hiking, kayaking, and of course, good food. Next is Hailie Kuttler. Hailie is a registered dietitian and a board certified integrative and functional nutrition practice practitioner. She provides personalized nutrition counseling utilizing a food first approach in preventing and reversing chronic health conditions. Hailie recognizes that sustainable change rarely happens overnight, and strives to support and empower her clients on their path to better health. For many clients, she has the privilege of partnering with, food is a source of has become a source of confusion, guilt, and stress. She is passionate about supporting people as they learn new ways of nourishing their bodies to achieve their best health. Hayley, a Boise native, holds a bachelor's degree in nutrition and dietetics from the esteemed University of Idaho. Her expertise lies in empowering clients to enhance their our digestive health, achieve a harmonious, harmonious weight balance and optimize our metabolic well-being by employing the principles of functional nutrition with a particular focus on digestive conditions like IBS and Sibo. Hailie exhibits a profound passion for the understanding and nurturing the intricate world of the gut microbiome and overall gut health. To further augment her knowledge and skills in functional medicine, she pursued advanced education through Integrative and Functional Nutrition Academy.
Amber Warren, PA-C: In her free time, you can find Hailie experimenting with new recipes, biking on the greenbelt, backpacking in the Sawtooth, hiking with their two labs, or curled up with a cup of tea. Welcome! I'm so excited to have both of your brains here in this room. So tonight we are discussing all things weight loss. We have been practicing weight loss, what we're calling weight loss 1.0 for the past year and a half. About right. We launched a weight loss program about a year and a half ago that has had tremendous success in this community. I have loved every aspect aspect of it. Selfishly, I never knew I could love metabolic health more, and I've been doing it with the best of both of you. And now we're here to say, what have we learned? What have we done wrong? What have we done right? Because there's a lot we've done right. And we're here to announce weight loss 2.0. What are we doing in functional medicine to really help master metabolic health. Right. Yes. So Doctor H, let's start with you, because I know you've really been the pioneer as kind of our metabolic health specialist here, here at our facility. Um, what have we done? Right. What have we nailed?
Dr. Mark Holthouse: You know, I think that what we've done right has to do with looking at a holism. When you come to this topic, as opposed to just a shot that you put in your stomach once a week, right?
Amber Warren, PA-C: Right.
Dr. Mark Holthouse: We've been able to take a lot of the patients who have failed getting the Ozempic and the GLP one shots as monotherapy. We know there's huge regain, you know, recidivism where they gain their weight back as soon as they quit. So I think I'm really particularly proud of learning that it does take a macronutrient. It takes a gut understanding, it takes hormone understanding, optimizing what's going on with sleep and cortisol, what's going on with obesogens toxicants in our environment that are preventing people from losing weight in addition to low thyroid and things like that. So I think that what we've gotten right is we see sustainable weight success as something that comes from a very holistic approach, as opposed to 1 or 2 magic bullets. I think we've gotten that part of it right.
Amber Warren, PA-C: Yeah, absolutely. Yeah, there's so much more that we've even learned, even in the last year as far as nutrition, metabolic, metabolic health, the kind of anti-aging precision medicine that we're now going to be implementing into what we're doing. Hailie, I know you have, like, dove in deep into what these patients need from mostly a nutrition standpoint. Tell us a little bit about the program that that you've developed that we're going to be definitely offering in our weight loss 2.0.
Amber Warren, PA-C: Yeah.
Hailie Kuttler, RDN: So I feel like we've been doing a heck of a lot, right? Um, Amber, you were talking the other day about some of the patients that you've been seeing through the end, right? I usually have my three appointments and kind of get them rolling, and then I felt like I was kind of missing out on that, like last hurrah, right? And then you were mentioning, oh my gosh, Hailie, like, you're because I'm, you know, thinking always how to make it better. Yeah. When I'm with people. Yeah. Okay. We need to, like, have more support. We need to do all these things. And you're like, hold on. Like, people are having success. It's okay.
Amber Warren, PA-C: Yeah.
Amber Warren, PA-C: Um, sometimes I just have to slap you across the face and say, get back in here, Hayley.
Amber Warren, PA-C: Like you're.
Amber Warren, PA-C: Great. We're doing a great job.
Amber Warren, PA-C: Yes. But I appreciate.
Amber Warren, PA-C: Your do better mantra. I really do.
Hailie Kuttler, RDN: Thank you, thank you. So, one of the main things that I noticed with the way that we have been doing things is that there is a huge opportunity for more structure, more community support. Um, as practitioners, we're a little bit limited by that one on one time. But if we can get people in groups, we can really amplify those resources, right? They start to the vision is and usually what happens in these programs is that people can lean on one another. Absolutely. They can kind of digest that information in their own way, apply it to their lives, and then share what they're doing and inspire the others.
Hailie Kuttler, RDN: So.
Amber Warren, PA-C: Well, part of you've done this beautiful write up in creating this program that we've all been able to review over the past few weeks, and where you where what stood out to me was you talking about how anyone's weight loss journey is a really isolating and frustrating process for them, right? And it's hard as us as practitioners to really be the voice for them and to help them feel heard. And that's where I think that community piece is so valuable, because then they can sit in a group of people and feel heard. And Mark Hyman has done so much work on this topic of just how people heal better. And truly, the data is that they do heal better and more quickly and have more success in a community setting. So I just love how you just laid that out in the program. Like you're just like there's no no ifs, ands or buts about it. People feel frustrated and lost and they need to link arms with people and say, we got this together. What are you doing to have success? What am I doing to have success? You know, it's like the Facebook groups that about autoimmune disease and obesity and they they, you know, get childhood cancer. Those are huge, hugely popular groups because people want. We're built to be in community.
Hailie Kuttler, RDN: Totally. Yeah.
Hailie Kuttler, RDN: Yep. And it is one of those things that it can be a little bit shameful for some people.
Amber Warren, PA-C: Right, right, right.
Hailie Kuttler, RDN: Weight loss. It is something that almost every single person that comes to see me, they're struggling with that, right? Even if they were referred for blood sugar balance or something along those lines, I opened the floor to them to say, you know, what do you want to focus on today? And almost every time someone says, I want to lose weight.
Amber Warren, PA-C: Well, and clinically, doctor H and I were talking about that last week too, right? Like, maybe their primary care provider refers them over or their cardiologist refers them over, or their dentist refers them over for, you know, oral microbiome, gut microbiome health. But it's almost always I also want to lose weight.
Amber Warren, PA-C: Yeah, right. Yeah.
Dr. Mark Holthouse: That's behind most all of the people that are reaching out to us in this clinic. Where what do you guys do? You know, it's, um, often tied to will it help me lose weight? Yeah. So, you know what was interesting? That, um, in our conversations, Hayley and I get to chat a lot behind the scenes. We task each other, these messages. And regarding patients. And it's so fun to work with you, by the way, where she will remind me. Oh, I need to do that. It's great to have that second set of eyes, but she'll say things like this person's relationship with with food is really unhealthy. Mhm. And um, this person has that caloric restriction mentality where the only way to be healthy is to eat less.
Amber Warren, PA-C: Mhm.
Dr. Mark Holthouse: Um this person is struggling with body image. Um not necessarily a full on eating disorder but there's so many degrees of that. And so having that insight with an R&D in the practice, using all this stuff we're doing with peptides and hormones and gut health and toxin evaluations has been phenomenal. So version 2.0, what we're working towards is adding some of these other things.
Amber Warren, PA-C: Absolutely.
Amber Warren, PA-C: And also and not to cut into this because this is this is a good divergence to where we want to go. But I think we've learned that we need more commitment from the client. Right. And not just more commitment but also duration of commitment. Our first month program was a five month program with only you said three visits with you. 3 or 4? Three. Right. There were.
Hailie Kuttler, RDN: Three. Three.
Amber Warren, PA-C: Not enough. Not nearly enough. If we're looking for nutrition to be this this racism of change. Right. So we're this program is going to be more expansive, um, with you, it's going to be some true accountability weekly sessions in a community setting. Right. Um, but yeah, let's start with just the, the as far as nutrition aspect goes, the, the, you know, calorically empty diet, the caloric restriction, the mindset around food. What are we where are we hoping to get these people?
Hailie Kuttler, RDN: Totally. Yeah.
Hailie Kuttler, RDN: Um, I see so many people who are malnourished, probably from the time that they come to us because they've been in this chronic cycle of just yo yo dieting. Their metabolism is just in the tank. I think what I want people to know and we have a module on this is metabolism is a nutrient dependent process, meaning that we need B vitamins, we need choline, we need iron. We need a whole host of nutrients to make that work efficiently. If we are eating fewer calories, then what we need for those essential functions, the body is going to say, hey, I guess we're not getting anything to eat today, and it's going to slow things down. So we're trying to do a little bit, almost like a reverse diet for a lot of our, our patients, um, getting people to be nourished, getting people to eat more food and more of the right foods is really the biggest thing. So, um, you know, really hitting on eating locally, seasonally, organic when possible because those foods are going to be the most nutrient dense. They're going to nourish all those cells in our bodies. Right? It is so fundamental and it is so overlooked in our culture how important the foods that we eat, we eat every day are. Um, our cultural says eat less, weigh less. And people are hearing that message over and over and over again. Um, we were talking a little bit earlier about certain generations really struggling with eating disorders, right.
Amber Warren, PA-C: Yeah.
Hailie Kuttler, RDN: That was kind of like, you know, all the cool kids were doing it. And now we're into our 60s or so and now, you know, bone density is low. Um, you know, their metabolic health is impaired because when we have low muscle mass, we're not going to be sensitive to, um, to soaking up all that good glucose.
Amber Warren, PA-C: Yeah, that's kind of where I wanted to go next. Was the insulin resistance blood sugar piece. Cgm's. They have to be involved now, right? Before it was kind of an.
Amber Warren, PA-C: Optional, like non-negotiable. If your blood sugar is high.
Amber Warren, PA-C: Maybe we'll bring a CGM in. Let's see if we can get your insurance to cover it. And now it's like it's just part of the program. If you don't have good feedback on what your blood sugar does after you think this way, sleep this way, eat this way, you probably can't lose weight and keep it off, right? What other aspects of insulin resistance are we going to be really trying to nail in this program?
Dr. Mark Holthouse: Yeah. You know, the classic type two diabetic, overweight patient that has a lot of belly fat that they're battling with a lot of inflammation from that adipose tissue. Has has dealt with insulin resistance. Yeah. Which is the inability to take glucose from the blood vessels and put it into predominantly your your active exercising skeletal muscle cells. Mhm. And when you lose that energy sink it has to go somewhere. So it usually goes to the liver. And now we've got what. 33% of the US population with fatty liver disease. Because that's where our food's going because they're insulin resistant. Well that's only one mechanism. Come to find out for for high sugar. We've got a lot of what we call skinny folks that are metabolically obese. So they're not overweight but their percent body fat relative to lean mass is is high. And so they'll often have other things besides just a high fat typical type two mechanism where they're fasting. Insulins are elevated, and we see this all the time now in particular, my my female patients will come in, you know, they're doing aerobics and, you know, five days a week and they're, you know, they're this big around and they're Dexa scans say that they're osteoporotic. And yet their hemoglobin A1C is 5.85.9 pre-diabetic. Mhm. And so then we have to go back and look at other things besides that typical overweight mechanism of type two insulin that gets you there and say what else is going on. Well what's your cortisol. You know, I just in the mainstream medicine literature, I saw something come across the other day that says hypercortisolemia a new cause for imbalanced glucose. New, new. I'm thinking.
Amber Warren, PA-C: This is what you.
Dr. Mark Holthouse: Know. And this is this is So, you know, eloquently explains where where we've come from is this kind of siloed thinking. And we have to learn to think broader. Wow. When I don't sleep well, my cortisol circadian rhythm gets screwed up, not just my gut and inflammation. And who grows. They're microbe wise, but also the health of my endocrine system. I'm going to have high cortisol. Cortisol is going to drive my sugar up. My sugar is going to be high. My a1c's my average of sugars over a three month period of time are going to be abnormal. And I might not be overweight. I might have a lot of toxins that are interfering there. Endocrine disrupting toxins, chemical toxicants that are in our air, our food, our water that we're all exposed to and that are easily accessible with urine tox screens, um, in functional kits. And we can see when we detox a lot of those folks, how their blood sugars come back down, how their LDL, which responds to the inflammation, the oxidative stress of the same issues, high cortisol toxicity, stressful lifestyle, poor diet, leaky gut, problems with gut permeability. I mean, it was only about ten years, not even ten, maybe eight years ago when the gastroenterologist laughed at us for saying leaky gut increased gut permeability. And now it's mainstream in the consults I get back from them. Well, it looks like they have an impaired small intestinal, uh, gut going on. And, you know, it's just interesting to see the evolution of thinking, which I'm grateful for, right? But it's taking more of a ten zero zero zero foot view of what seemed like a small, uh, system that was involved. One area, it's become many. Yeah. So we have to we have to look at all of it now when we talk about insulin resistance.
Amber Warren, PA-C: Mhm.
Amber Warren, PA-C: Well, and you mentioned, you know on the topic of toxicant screening, it's kind of like we said about the CGM, that chemical tox test is now in the program like it's part of the program. It's no longer an add on. If we decide later we want to do it because you're still having weight loss resistance or you've gained the weight back. It's we. It's something we learned. We just have to screen our clients for. Because guess what? You're all loaded with toxins, right? We're all loaded with toxins that have to be addressed. If you're struggling in your weight loss journey.
Dr. Mark Holthouse: Something profound that she mentioned, Hailie said that you have to have micro and macro nutrient support to be able to run your metabolism, right, so that you can have optimal body composition. You also have to have micronutrient and macronutrient support to be able to detox through your liver. Yeah. You know, so many of those pathways require B vitamins and the right amino acids and the right antioxidants that you get through a good diet. So restricting really needs to go away as a concept. You know, there's I think in a few remote cases, um, you know, there's maybe a place for that that's very, very short and monitored. Yeah. But as a, as a default, it has gotten way too much attention. Yeah. Over the decades.
Amber Warren, PA-C: Hayley, there's some really. You really have brought this this wonderful genetic test to the table for us. Three by four genetics that I know you're you've really mastered, and I'm learning. And I know doctor Age is probably really good at it as well. But tell us what kind of insights that that genetic test offers for our clients, not only to get healthy, but to lose weight and keep it off.
Hailie Kuttler, RDN: Um.
Hailie Kuttler, RDN: So yeah, that is one of my most favorite tests of all. Not just because I have spent a lot of time looking at it. Um, so in terms of the weight loss picture, as Doctor H alluded to, detox is huge. So it's going to tell us a lot about how well, from a genetic standpoint, if we look upstream. Are you wired to detox?
Hailie Kuttler, RDN: Well.
Hailie Kuttler, RDN: Yes or no? Right. So how do we need to support your body to do that more efficiently? Um, you know, more cruciferous vegetables, more whatever it may be. Um, so that's huge. Um, and maybe for those who are just kind of getting rolling are just starting kind of at this wellness level, right? Seeing a dietician doing this three four test. And then that appears that we need to look more into toxins, maybe consider, you know, more evidence to do that. But um, so yeah, the the toxin aspect is huge. It does tell us a lot about, um, your propensity for potential for insulin resistance. So what is your, you know, glucose, insulin balance. Is that something that you may need to pay a little bit more attention to?
Hailie Kuttler, RDN: Um.
Hailie Kuttler, RDN: Um, I and I know it is so frustrating, right. I have a lot of frustrating genes myself, so to learn that information, it is it's a burden. But it's it's empowering, right?
Amber Warren, PA-C: It's very empowering. Yeah.
Hailie Kuttler, RDN: You know, you know that if you try on a CGM and you get, you know, not not the best results ever, there are things that we can do to improve that. Mhm. Um so yeah glucose and insulin um nutrient deficiencies.
Amber Warren, PA-C: That tells you what you're more likely to be deficient in. So it really ties into the whole detox weight loss picture looking at that test which is amazing.
Dr. Mark Holthouse: Yeah. Methylation. Yep. Methylation. She's always.
Dr. Mark Holthouse: Catching me with overdosing folate.
Dr. Mark Holthouse: Which is great.
Dr. Mark Holthouse: That's what I mean by um, you know, another set of eyes because everyone comes in. Oh, I've got that mthfr thing.
Amber Warren, PA-C: Yeah.
Amber Warren, PA-C: What's it eat? Tons of.
Amber Warren, PA-C: Folate, you know.
Dr. Mark Holthouse: And they're on, you know, two grams of, um, two milligrams, not grams, two milligrams a day of folate. And, um, you know, there's data that it's associated with some malignancies if you're doing long term doses that are really easy to get to and go over both B12 and folate now associated with some cancers with overdosing, and people have been obsessed with getting B12 and folate because they've heard somewhere that it helps with the lowering homocysteine and the whole methylation. So Hailie's been instrumental in using that test genetically looking at hypomethylated under methylation. Histamine, histamine, you know, and that's such an issue with driving inflammation.
Dr. Mark Holthouse: And.
Dr. Mark Holthouse: And symptoms with food that she has to tease out. Is it oxalates. Is it salicylates. Is it histamine. Every day. So that test from a genetic metabolism pathway. What's what's your weak area has been amazing.
Hailie Kuttler, RDN: It's been huge. Yeah that's.
Amber Warren, PA-C: Great. Yeah I love that I love that.
Hailie Kuttler, RDN: Yeah I was listening to I just thought of something. I was listening to a webinar this morning from them, and they brought up a really good point that every single person experiences that sense of hunger and satiety differently. Mhm. Um, so on that report you'll see this nice plate. And for those of us who feel a little, you know, take a little bit longer to feel full, that plate is going to be really loaded down. Right. So you know that's a key insight right there that you're going to take a little bit longer to feel full. So to know that to structure your meals accordingly, prioritize protein. All these things can be. Yeah. So insightful. So I love that test.
Amber Warren, PA-C: Um, the test. One of my favorite aspects of the test is it breaks down the most effective way for that client to exercise their response to exercise, and that we cannot ignore in the weight loss journey. Right. Doctor H, I know you've spent so much time dedicated to this whole, you know, intermittent fasting, especially these premenopausal women, but even postmenopausal women, too long a fasting windows protein deficiency, the wrong kind and the right kind of exercise for these clients. So what have we learned in 1.0 that we're going to do better and be better in 2.0 with regards to exercise?
Dr. Mark Holthouse: One of the things that especially with my my beautiful women clients I am am deeply passionate about is anabolic resistance, which is really the idea that when you go through menopause, the same amount of protein that you ate as a premenopausal female, the same amount of exercise that you may have been or may not have been getting isn't going to maintain the lean muscle like it once did once estrogen is gone. Newsflash this is you know, I'm supposed to be knows some things about hormones, and I didn't realize until the last year or so. Estrogen is the primary driver of maintaining lean muscle mass in women. So when it goes away at age 50, on average, when they go through the change, a lot of things go wrong. They become their body composition Position radically changes. They start losing bone density very rapidly, which is part of that anabolic loss of not just growth hormone, which is slowly decreasing after about age 35, but also estrogen, which just takes a cliff nosedive at 50. They catch up with guys within a few years on the incidence of heart attacks. Their skin changes collagen negative effects when estrogen is withdrawn.
Amber Warren, PA-C: But it sounds like a pharmaceutical commercial, right?
Dr. Mark Holthouse: Right.
Amber Warren, PA-C: Like, if you take this drug, here's what's going to happen. Like, can you stop with the list?
Dr. Mark Holthouse: And that's.
Dr. Mark Holthouse: Without even talking about the fact that estrogen is the primary regulator of glucose and insulin.
Dr. Mark Holthouse: Signaling.
Amber Warren, PA-C: And it's such a potent antioxidant.
Dr. Mark Holthouse: So there's no wonder their their cholesterol goes AWOL the wrong way. They get problems with body comp and diabetes tendencies and frustration with the way they look and feel externally when they go through the change. And not everybody needs to be on hormones, but I'm.
Dr. Mark Holthouse: Sure a lot of people.
Amber Warren, PA-C: Do. It sure.
Dr. Mark Holthouse: Helps a lot of.
Dr. Mark Holthouse: Them. Yeah, yeah. So I think that I think that exercise, the right type of exercise, is going to be something we continue to build on in version 2.0 where it's it's high intensity aerobic efforts, maybe a little less zone two and a little bit more resistance training starting off with trainers that they can help with posture and form so that it minimizes injuries because that's because.
Amber Warren, PA-C: They need to lift heavy. This isn't just bodyweight or taking the Jane Fonda two and a half pounds.
Dr. Mark Holthouse: No, I always laugh. I say, you know, those little kind of turquoise and pink epoxy coated things you got at the sporting goods store that are like 5 pounds?
Amber Warren, PA-C: Give them to your very cute looking.
Dr. Mark Holthouse: Yeah, yeah, those are paperweights. You need to do um, deadlifts and squats and lunges and, you know, there's there are things that, um, traditionally women are very intimidated by, uh, not getting in the gym and not doing those kinds of things because they don't want to be muscular or they don't want to be, you know, around all those guys. And I think that that's really changing. Um, and it's long overdue that women are saying, no, I'm, I want to own how I look and feel. I want to do it from an inside out perspective. Right? I don't want to just spend all my money on things I'm doing externally. I actually want to anti-age from the inside out as well, which is going to not just keep me living longer, potentially, but living better, right? So my healthspan is is longer the number of years that we actually have, we're living that we want to live, that your disease free. And that's what longevity is all about.
Amber Warren, PA-C: And not just disease free. I think it's so empowering. When you talk with your female clients, you know. What do you want to how do you want to feel in three, six, nine months? But it's how about three, six and nine years? Oh, you love to ski with your husband and your girlfriends right now. Do you want to ski with your girlfriends when you're 70 and retired? Like the the bogus girls that go? I mean, there's this vertigo is what they call them, and they're so rad. I see them up there during the week and there's like these retired 70, 75, some 80 year old women that are just killing it on the slopes. Like, that's the mentality we have to have as women that are starting to have some hormonal changes. Right. It's not just, what do I want to do now? Do I want to be able to pick up my grandkid off, off the ground, or. I love Peter Attia. In his book he talks about like, do you want to be able to lift your luggage in the overhead compartment by yourself, or do you want to have to ask somebody help by the time you're 62, right? Like, think about what you want your life to look like.
Dr. Mark Holthouse: Yeah.
Dr. Mark Holthouse: He talks about percentages of VO2 max that you have to be now in your 40s and 50s so that you can do minimal efforts like walking the trails here in the foothills right when you are 7580 and if you're not in the upper quintile on VO2 max when you're 40 and 50, you won't be able to do that stuff.
Amber Warren, PA-C: Have you done VO2 max testing on yourself?
Dr. Mark Holthouse: It's miserable.
Amber Warren, PA-C: Is it?
Dr. Mark Holthouse: I've had it done before.
Amber Warren, PA-C: Yeah, well, miserable to do.
Amber Warren, PA-C: Right. Sorry. I thought you meant your results were miserable. I was like, there's no way. No.
Dr. Mark Holthouse: Results were good. Were they good?
Dr. Mark Holthouse: You know, it's an awful test to do the actual real deal. Yeah, we can calculate it to a pretty close approximation, but to do it on a treadmill or a stationary bike, ergometer, you know, with fully hooked up and you're it's it's 100% effort and it's just you feel like you're going to die. But yeah, it's awful. So we have other ways of helping people exercise their VO2 max, their aerobic capacity above lactate thresholds that are much more civil.
Amber Warren, PA-C: Much more.
Amber Warren, PA-C: Civil, much better.
Hailie Kuttler, RDN: To do. A good way to put it. Yeah.
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Hailie Kuttler, RDN: Oh, that's such a good question.
Amber Warren, PA-C: Um, it.
Hailie Kuttler, RDN: Absolutely depends, as it always does.
Amber Warren, PA-C: Right. Personal medicine?
Hailie Kuttler, RDN: Yeah. So for our women who are active and I know Doctor H talks about this all the time, right? Um, we are especially younger women, right? Of, you know, ages where we're still menstruating. We're trying to produce progesterone in healthy amounts. If we are just going crazy in the gym and we're not replenishing that glycogen and getting those carbohydrates, we're going to run into the ground.
Amber Warren, PA-C: Yep.
Hailie Kuttler, RDN: Um, so, you know, there's cases where it's not going to be appropriate. Um, in cases of, you know, we do see quite a few people who are quite sedentary, right? Um, and we're trying to protect their lean muscle mass with some good protein. And keto gets a little bit dicey, right? When we start to up the protein, then we're going to kick out of ketosis. Um, so it's really just about what is that person's goals? How active are they, how much protein are they requiring. And in a lot of cases, it's quite a bit of protein. Yep. Um, but yeah, I'll let doctor H because I know he's jonesing for this. Well, and.
Amber Warren, PA-C: What other biomarkers too? We're talking about cholesterol. Like we can't just push somebody into keto if we don't know where they stand foundationally with some of these important biomarkers. So that's that's another one that I thought of when you were talking.
Hailie Kuttler, RDN: How are they doing that? What kind of fats are they eating? How much fiber are absolutely.
Amber Warren, PA-C: The quality of food that they're consuming.
Amber Warren, PA-C: To get into ketosis. Yeah.
Hailie Kuttler, RDN: Oh my gosh. Yeah. Absolutely.
Dr. Mark Holthouse: So yeah, the data is pretty clear now that the way that ketogenic diets affect women in particular, it matters whether they're fit and exercising women or they're sedentary. Actually, there's a little bit more benefit if you read what's out there now to sedentary women with initially at least with ketosis in controlling blood sugar and maybe even some weight control, um, what's clear with women that are active is that if you follow them, it actually can lead to increased percent body fat and decrease percent lean muscle mass. The exact opposite reasons why they're doing this.
Amber Warren, PA-C: What's the mechanism.
Amber Warren, PA-C: There?
Dr. Mark Holthouse: I don't know that they have that fully worked out.
Amber Warren, PA-C: I would think it'd be somewhat cortisol. I mean, it's probably not just one mechanism that's playing a role.
Dr. Mark Holthouse: Yeah, I don't know that I have that nailed down, but I know that in reading the studies, it depends if they're active or sedentary and whether they're male or female. Come to find out, intermittent fasting, which was the darling, you know, a few years ago in women has a very different effect than in men. It does not do much for autophagy. Come to find out, it's minimal. It does not do much for blood glucose control. And it doesn't do much at all other than switch the body composition in the wrong direction. More fat, less lean. All the opposite things that their husbands who make this half assed attempt at it have this wonderful success. And for years I've heard that and wondered, well, what's going on there? The data is now showing that women actually aren't small men. They're different than us in a lot of ways, and we're seeing that intermittent fasting and ketosis and ketogenic diets aren't necessarily the answer. I think that the common thread with success with these programs has to do with getting enough of the right kind of clean, clean proteins, fats, and avoiding simple carbs. Those seem to be what run as a common thread. And it's not the fact that they're eating bacon three times a day, you know, and these things that are necessarily healthful. And boy, you get on the topic of saturated fat, which is related to ketosis. And that's a hot, hot topic right now with palmitic acid and some of the tropical oils and and inhibiting AMP kinase and longevity pathways. That's a whole nother discussion. But I think you got to be really aware now, just mass generic generically applying ketosis to all women is is not the necessarily the right move.
Dr. Mark Holthouse: Could be so much more simple. Yeah. Um.
Amber Warren, PA-C: Peptides. So we're not we're not saying no GLP ones. We have seen extremely favorable outcomes with these GLP ones. Uh, we think appetite.
Dr. Mark Holthouse: Yeah.
Amber Warren, PA-C: Thank you, thank you. Yeah. We, um, and not just with weight loss. We've seen improvement to inflammatory inflammation in the body. Inflammatory markers that we're measuring. We've seen improvement to mental health. Um, for me and Haley, I don't know what you've seen, but the, um, the food knows what it's doing to the serotonergic pathway in the brain. That is honestly probably been the most impressive thing that I've seen with my female and my male clients. On how it just calms the food noise so that they feel in control of what they're eating and not eating. It's really impressive. So we're not we're definitely not saying, um, we're we don't find those clinically very, very useful in this setting. For me personally, I want you to hear from you guys as well. I'm saying I'm definitely starting to use and have been using my GLP one agonist in a different way, different dosing, different patterns of them, and using a lot of other peptides to come and be siblings with these GLP one agonists to help people reach their goals. So yeah, I would love to hear more about what you guys are thinking with some of the peptide protocols we've been using and we'll be using.
Dr. Mark Holthouse: She's my partner in crime, because if we use body composition, BIA analysis, or Dexa scans as opposed to the scale weight, we get them on these these shots, these GLP one agonists, which is basically a a pharmacologic production of something that our the cells in our small intestine make when we eat glucose already. And when we inject that once a week as a form it it it's amazing how it does slow gastric emptying. So the appetite is quelled. It affects food craving and the serotonergic neuropeptides. It's got great cardiovascular benefits as well as some other things with glucagon and whatnot. But when it's done as a monotherapy and not coupled with an Rd that that is functionally trained on adequate protein nutrition to prevent the lean muscle mass. I mean, there was this big backlash to these drugs six, 12 months ago about how they caused lean muscle mass loss, when in fact the drugs themselves didn't do it. It was the fact that they were malnourished patients using the drugs.
Amber Warren, PA-C: Losing weight.
Dr. Mark Holthouse: Rapidly, losing.
Dr. Mark Holthouse: Weight rapidly. They were never educated about the proper amount of the macronutrients that they were.
Amber Warren, PA-C: Going to a drive through GLP one clinic.
Dr. Mark Holthouse: Exactly, exactly.
Amber Warren, PA-C: We're buying them from Canada or who knows where.
Dr. Mark Holthouse: I'm not hungry. I just won't.
Dr. Mark Holthouse: Eat. I guess that's part of losing weight.
Dr. Mark Holthouse: Yeah. Amazing.
Dr. Mark Holthouse: So yeah, I think when it's when it's again holism, when it's included in a nutritional program, the right kind of exercise, Especially postmenopausal women, where you've got this anabolic resistance going on. You've got to do those things to thwart massive muscle loss. We've found it very, very successful here as as part of the program. I think the thing that I was most interested in is life after glp1. What other peptides are there which we can talk about as we as we wrap up later? But I would love to know your opinion. Having the onslaught of patients I've been sending your way in these packages on on tirzepatide with my continual protein whip and resistance training. I mean, what do you see?
Hailie Kuttler, RDN: Really? Yeah.
Hailie Kuttler, RDN: Um, you know, I will be so honest. When I first started coming over here, you know, I was working at FMI and COH clinic is like doing peptides. And I was like, what's this all about? I don't know. And then, you know, I'm realizing, you know, I'm hearing all these controversial things, people saying, referring to it almost as liquid anorexia. And so that kind of stuck with me at first. And I was and I was seeing that, honestly, I saw people who had maybe not the most healthy relationship with food coming in. Well, not, you know, just the everyone pretty much has disordered eating in our culture, I would say to an extent. Um, but coming in, you know, just like finally thinking, oh my gosh, I'm not. I don't have to eat. How amazing. Right. So they're, um, they're not wanting to eat. They're not, you know, and then. Oh, yeah. And then they go to Doctor H. And he's like, okay, you need to get this many grams of protein. And they come to me and they're like, I can't do.
Amber Warren, PA-C: That. It's impossible. Is he nuts? Yeah, yeah.
Hailie Kuttler, RDN: They're just like thinking he's totally nuts. So we talk about okay, you know. Yeah. Smoothies. Perfect. Like, you know, all these, you know, lean proteins, um, and just seeing people actually be able to pause on the food noise, because for a lot of us, that rules our thinking, right?
Amber Warren, PA-C: Yeah.
Hailie Kuttler, RDN: For whatever reason, maybe we're genetically prone to binge eating, right? Right. We have kind of low dopamine levels at baseline. Um, we're super stressed out. That's our coping mechanism. We haven't really learned other ways to deal with that in a healthy manner. Right now. That opens the door to these other discussions, these other conversations. How can we kind of take this time to reset, you know, look a little bit more closely at the quality of foods that we're getting, um, versus people, you know, when it's kind of taking over your thoughts. Right? You're not always in the driver's seat. You kind of get into autopilot.
Dr. Mark Holthouse: I think it was you, Hailie, that first, you know, brought the idea up my way. It might have been you, Amber, both of you, about microdosing and going every other week, splitting the dosing where some of the things we've learned and we're going to be, I think, doing differently and that we're doing I think already now is we're we're playing with these doses of these medicines so that we find what I call the sweet spot where the food noise is gone. But you still have an appetite of sorts, right where they don't feel like they're coming in like last six months ago. I feel like I'm having to force feed to get this protein in so I don't lose, lose lean muscle mass. My next thought is you might be on a little bit too much of the medication. Let's bring your appetite back up just a little bit. And, um, and that has worked magic.
Amber Warren, PA-C: Yes, it has.
Dr. Mark Holthouse: And you've referred to it, I think, as microdosing. Amber, uh, where we. So those are things that we've, we've done wrong that we haven't learned from, uh, in, in the practical application of this, um, wouldn't you say?
Amber Warren, PA-C: Yeah, absolutely. Totally.
Amber Warren, PA-C: Yeah. Microdosing is my new best friend because and everybody needs to start at. And we need everyone's. It's personal right. Like I now have the nurses are so great but they no longer give me the handout that says the typical doses. Right. It's all blanks because I fill in my own schedule for each client. You know, now that we've been doing this for a year and a half, almost two years, it's like I now have a pretty good handle on where most people need to start and how quickly they can. They can go up. And I it's to me now it's like a hormone. You start low and you go slow because there's so many more advantages to doing it that way than there are the opposite. Um, it, you know, it's it, it's a peptide. It is very innate to the body, but it is still a pharmaceutical. And if you get the pharmaceutical, you have very standard dosing you have to follow. And so we get this medication compounded from a specialty compounding pharmacy that we trust and have a very good relationship with. And therefore we can customize doses. And I think without that ability. Yeah I think there I think a lot of the reaction out in the medical world is probably legit with this peptide because it's not being paired with the right. The right team and the right approach and and the doses, they're flat out just too high. Yeah. They're just too high. And you, you see all the benefits of this peptide that we just talked through. At the lower doses of it. You don't have to go high to see a lot of these benefits, even the cardiovascular benefits. Um, it's pretty profound.
Dr. Mark Holthouse: Um, I've never seen in my 35 years of medicine anything that works like this, um, for weight loss, um, unfortunately, the 85% failure rate, if that's all you do, speaks to the fact that it has to be done in a holistic perspective.
Amber Warren, PA-C: Absolutely.
Dr. Mark Holthouse: It demands it. There really isn't a magic bullet. You can't just own your physiology for six months, turn off the switch and expect it not to revert back right to where it was.
Amber Warren, PA-C: Absolutely. And and then I think right now a lot of people are really speaking to the some of the side effects we're seeing of this medication. And my response to a lot of those clients or a lot of the colleagues I talked to are okay, but I'm using a 10th of the dose and I'm not seeing those side effects. I'm just not so that we can have that same argument for the side effect profile as well that we're seeing. So yeah, it's really powerful. And then I think we now know have we now have a lot more both scientific data and anecdotal data on other peptides that we're pairing. You know, these growth hormone secretagogues that I know we I love, love, love. I would say I prescribe them almost as much as I do some of these weight loss peptides, because, again, it's so much more about weight loss. It's fat loss and it's anti-aging precision medicine, and it's improving collagen and stabilizing cortisol and improving sleep. We haven't even talked about sleep. And we you know, I personally with my weight loss patients have learned that like I have to start there. That's a non-negotiable. If I get like why even have the discussion about exercise if my clients aren't sleeping right, they really shouldn't be doing much if they're not sleeping because their cortisol, cortisol is going to be, you know, totally wackadoo. Um, sleep is, is is just so instrumental in foundational to getting these people mentally and metabolically healthy for them to even be able to begin a weight loss journey. Right. And we have peptides that, I mean, we have tons of great supplements that help with sleep and different, um, you know, lifestyle modifications that help with sleep. But I've got phenomenal peptides. If we can't get our patients sleeping, that that can really help with sleep. And the growth hormone peptides are are one of those that really help with that deep sleep.
Amber Warren, PA-C: Yeah. Yeah.
Amber Warren, PA-C: That's huge.
Dr. Mark Holthouse: Yeah. We have kind of this weight loss phase and then optimizing body composition phase that's looking more at supporting things like growth hormone without having to give growth hormone that's that's fraught with concerns. Right. Um, but what you said triggered a memory about what you alluded to, Haley. And that is that low energy availability, this LA phenomenon.
Amber Warren, PA-C: Right.
Dr. Mark Holthouse: When there's a lack of fuel going to the body, it's not just a detox issue. It's not just a weight loss issue. When there's not enough energy to support your activity for the day, you have endocrine disruption. You have problems with menstruation, fertility. You have problems with the hypothalamic pituitary adrenal axis. The thyroid gets affected. Um, so not getting enough in has huge repercussions on almost every system I can think.
Amber Warren, PA-C: Of, right?
Dr. Mark Holthouse: Lee in particular is known to cause immune dysfunction. I mean, how many tour de France athletes are isolated? Because if there's a virus in the camp, they're done. Their immune systems are on such a razor's edge. Yeah. Um, there's problems with gut dysbiosis and microbial imbalances with low energy availability. So it goes far beyond just body composition and weight. This whole discussion of adequate fueling, I think, needs to replace the dialog of caloric restriction.
Amber Warren, PA-C: I love that so much. Yeah, it's so good. Hailie, what's the name of your program you've designed?
Hailie Kuttler, RDN: Great segue.
Hailie Kuttler, RDN: It is called.
Hailie Kuttler, RDN: Nourish to thrive.
Amber Warren, PA-C: Nourish to.
Amber Warren, PA-C: Thrive. I love it, I love it.
Hailie Kuttler, RDN: So kind of the idea of you already have that most actualized, you know, the best version of yourself just waiting to be unearthed. So we just need to nourish that and really kind of take care of our bodies and get away from this, you know, state of deprivation. Right. How do we kind of get those nutrients on board to be our best selves?
Amber Warren, PA-C: That's wonderful. And it's a program you'll be offering out of both, really. All three of our clinics here in Eagle Center for Optimal Health, and then Boise, Boise and Meridian FMI clinics. You'll be offering this program, and it's going to be able to I mean, if you want to work individually, of course, but mostly in a group setting for all the reasons that we discussed before, which is so amazing. Who do you think is the most optimal client to come join this nourished thrive program?
Hailie Kuttler, RDN: Who? I would say we address so many things I can. It can fit most anybody. But I would suspect my, you know, my 40 plus females that have been struggling with their relationship with food for a long time.
Amber Warren, PA-C: Mhm.
Hailie Kuttler, RDN: Um, and we have that metabolic dysfunction maybe just behind the scenes that we're really not aware of.
Amber Warren, PA-C: Right.
Hailie Kuttler, RDN: Just kind of on this journey for so long feeling so frustrated. Um we're going to learn in this program about, um, a little bit of that detox stuff. Right. What kind of nutrients do we need? How do we support that? We're going to do that genetic testing and we're going to see your unique blueprint. Um, we're going to use those cgms and we're going to learn about what is your body doing in response to these, these carbohydrate rich foods, right? You know, can you tolerate you know, maybe you've heard oats are horrible. Never eat those, but maybe you actually do just fine. We put some chia seeds in there, we add some extra fats and protein and we're all good. We don't need to worry about that. So, um, yeah, I would say almost anyone, but I would. If you're sick and tired of this journey, then I feel like it would be a great, a great environment, um, for you.
Amber Warren, PA-C: Yeah, yeah. And it's been very intentional that we've chosen we want this eight week program under our umbrella of our new, upgraded, updated weight loss program. So we're thrilled. So thank you for all of your effort and your time and your research that you've put into developing this program, because it's it will be so exciting to launch it. So, um.
Dr. Mark Holthouse: Hailie's input on the continuous glucose monitor has been just amazing. Amazing because we'll say, hey, you know, she'll print out the report and give the average. And I'll say, and I'll say, are there alarms for low blood sugar going off at night because this thing reads 24 over seven and, you know it. We'll find out. Well, yes, I had to turn the thing off. It was driving me nuts. Well, you're getting low blood sugar at night. Guess what happens with your cortisol.
Amber Warren, PA-C: Mhm.
Dr. Mark Holthouse: Your brain senses that drop in sugar and obligates the adrenal to go to the liver and wring out glucose until it can go back to sleep. Now the cortisol shot up and you're awake.
Amber Warren, PA-C: Yeah.
Dr. Mark Holthouse: So it's a cause for not just insomnia, but it's also a cause for a lot of these high blood sugar.
Amber Warren, PA-C: Mhm.
Dr. Mark Holthouse: Thinner people that we were talking about earlier. So having these cgms, even though they're not a perfect science, they're helpful, very helpful and very convenient, especially to find finding these people that have this reactive hypoglycemia at night that's driving their physiology. The other way and sabotaging losing belly fat because cortisol just puts it right back there. Yeah.
Amber Warren, PA-C: Well, and I love you know, I think historically we've said yeah great. Let's get you know, especially if your insurance can cover it, or if not, just pay for one of the CMS for 14 days. But within this program, it's like before and after, right? Like let's yes, let's see the issue. But let's also prove to our patients and empower our patients that they fix the issue, right, that they've stabilized their blood sugar and they're not seeing these highs and lows anymore, and they're not seeing their blood sugar do crazy things in that postprandial window. So I love that we're also going to be doing the follow up to that so that the patient can see that. And then they know how they feel when it's working. Right. They can really put those things together and fix, you know, start, start to put that piece together. This is how I feel when my blood sugar is stable. Um, so that they know it's working long term for them.
Dr. Mark Holthouse: But 2.0, to answer your question, what is it going to look like? It's going to include the CGM. We've got the the Bioimpedance body composition assessments throughout the course because you can't do it without. We have to know what your toxin load is. Um, we need a more structured or No nutritional piece, as opposed to three visits where there's addressing all of those issues. We need the genetic evaluation.
Amber Warren, PA-C: Gut microbiome testing.
Hailie Kuttler, RDN: We need the gut microbiome.
Amber Warren, PA-C: We didn't include in everybody before some more advanced supplement protocols. We've learned, really, the key supplements to helping with insulin resistance, pre-diabetes, and then long term weight loss and.
Dr. Mark Holthouse: Life beyond the initial peptides. Looking at the other peptides.
Amber Warren, PA-C: Ongoing peptide therapies.
Dr. Mark Holthouse: Ongoing improvement in shredding.
Dr. Mark Holthouse: I like seeing that shredding, shredding.
Amber Warren, PA-C: Shredding.
Amber Warren, PA-C: Shredding peptides.
Amber Warren, PA-C: I love that shredding.
Dr. Mark Holthouse: Peptide like that too. Oh, talk about shredding there.
Dr. Mark Holthouse: Like I can get into that.
Hailie Kuttler, RDN: Heck yeah, I want.
Hailie Kuttler, RDN: To be shredded. I know that's not a gender thing.
Hailie Kuttler, RDN: Yeah, I don't necessarily want to be shredded. Yes.
Dr. Mark Holthouse: Big. Yeah.
Dr. Mark Holthouse: And I say that's true. Don't worry.
Dr. Mark Holthouse: About that. We're not doing this to to have huge arms, which you don't want to go sleeveless because you're embarrassed because your arms are bigger than your husband.
Amber Warren, PA-C: We're not going to do that.
Dr. Mark Holthouse: No, although that's kind of cool.
Amber Warren, PA-C: Um, no. I say, I want to, like, walk through the grocery store and have someone be like, what do you do for workouts? Because it's working. You know, you want somebody to recognize the hard work you put in.
Dr. Mark Holthouse: There's definition. You're cut.
Amber Warren, PA-C: Right?
Dr. Mark Holthouse: Yes, yes. But it's.
Hailie Kuttler, RDN: Not. The eye is drawn.
Amber Warren, PA-C: Yes. Yeah yeah yeah yeah.
Dr. Mark Holthouse: But more importantly, you go outside, you do some landscaping and you're hopping around on your terraces. You feel 20 years younger.
Amber Warren, PA-C: Did you call it a terrace?
Amber Warren, PA-C: Yeah.
Dr. Mark Holthouse: You know, you.
Dr. Mark Holthouse: Terrace your backyard.
Amber Warren, PA-C: Yeah. I just haven't heard that in.
Amber Warren, PA-C: A long time. Terrace?
Dr. Mark Holthouse: Yeah.
Amber Warren, PA-C: You said shred, which is cool, but then you follow it up with terrace.
Dr. Mark Holthouse: My backyard is all terrace. Yeah.
Amber Warren, PA-C: So I don't know. I'm on my patio sipping coffee. I'm not sure what a terrace is.
Dr. Mark Holthouse: The veranda? Yeah.
Amber Warren, PA-C: Anyways. So good. Yeah, I think I know there's there's so many details of, of the program and of what we're really looking at that. But it is, it's personalized medicine. So everyone's, um, you know, exact testing and exact outcome. And the protocol and procedure we follow is going to be a little bit unique to them. But for the most part, I think we've put together a really comprehensive, very thorough weight loss program that I'm so excited to start to start running with. So for those of you listening, if you go to our website, FMI optimal.com and search the resources tab, that'll pull down and you can see the Weight Loss 2.0 program. You'll also be able to see Haley's if if you wanted to do her separate thrive to nourish program that will be listed under there as well. And we're just so excited to bring these offerings to you. Um, anything else that we maybe didn't address with with what we're offering? Um, what we're doing differently, I really think we we hit it all.
Dr. Mark Holthouse: I think to piggyback on what you just said is that there's kind of a price point for any consumer.
Amber Warren, PA-C: Yeah. You know, absolutely. As an a la carte option.
Dr. Mark Holthouse: Versus the whole the whole enchilada.
Amber Warren, PA-C: Yeah.
Amber Warren, PA-C: The goal is really this weight loss program. We've learned five months wasn't long enough. So we're hoping for more of like a 12 month, one year to have adequate follow up and not not lose anybody, not have anybody fall through the cracks not having long term success. But yeah, we as always here, at least at center for Optimal Health, we have so many different levels of engagement. Um, and we're always applying what we're, what we're continuing to learn and have learned to, to each and every client, each and every level of engagement.
Dr. Mark Holthouse: Come to a consult, learn about.
Dr. Mark Holthouse: It, and.
Dr. Mark Holthouse: We'll personalize it. And if it makes sense, yeah, I think it'll be a great step in your journey. Yeah.
Amber Warren, PA-C: Thank you. You too, as always, for spending your your time with us to just continue to spread, spread truth in medicine and spread just the realness that we're doing here. So thank you so much.
Dr. Mark Holthouse: Thank you.
Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI center for Optimal Health and the highest Quality of supplements and more. Go to funmedfoundations.com.
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