Taylor (00:00)

Today we have Valerie Goldstein and Angela Garcia from our Thrivelab team of nutrition coaches and registered dietitians talking about healthy aging and nutrition for lifelong wellness and how that all starts with our food choices. So the purpose of today's podcast is to really dive into why nutrition coaching is so important for patients of every age, but especially those that are 40s and beyond, approaching menopause, perimenopause, and then later on into life, those that are on BHRT and TRT, and also those that are on semaglutide. Nutrition is a huge component of our program. Our holistic health program is not just a prescription treatment program. We like to focus on holistic approach and have a care team of clinicians that are prepared to help you in all areas of wellness so that you can thrive and not just be prescribed a medication and be sent on your way because there's so much more to longevity and living a healthy lifestyle than just a prescription.

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Angela Garcia (01:17)

Hi everybody, I'm Angela and I've been with Thrivelab for just over a year now, but so far it's been a fantastic experience. I've been a dietitian for 25 years, originally trained in the UK. I'm also board certified in weight management, so I love to bring those skills to help our Thrivelab patients. It’s one of the most enjoyable, satisfying things that I've been doing.

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Valerie (01:43)

I'm Valerie and I've been with ThriveLab for almost, well, probably six to eight months, almost a year. And I am also board certified, I am a certified diabetes educator and certified in weight management counseling from the American Heart Association. I have also worked for Dr. Atkins, so my experience kind of balances out both conventional and a little bit more of keto so that I have like a blend of experiences to kind of help you and get you through those hormonal challenges.

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Taylor (02:20)

Amazing. Thank you both. Could you start with explaining why nutrition is so essential for patients on BHRT, TRT, semaglutide, or just anyone in general?

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Valerie (02:32)

First of all, one of the best things about working with a nutritionist is that we can help you cheat. Everybody does not want to speak to a nutritionist when they're feeling like they're having difficulty losing weight or they're not able to control what they're eating. And we are like your best friend during this whole process. Once you make a choice that you might not be so happy and you're beating yourself up about, you know, we're there to scoop you up and just help you get back on track. There's more to it than just, oops, I made a mistake. Hormones are driving how you're feeling, what you're eating, the choices that you're making. And so, they're changing not only your choices, but it also changes once you make those choices, how your body is metabolizing and storing the foods that you're eating. So embracing that change within yourself is just something that you need to hear because we need to feel that we are not crazy. Your doctors, your friends, your family, they'll say, what is wrong with you? You've got brain fog, you're gaining weight, you're tired, but it's all real and we can help you.

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Angela Garcia (03:48)

Yeah and what we're doing is we're really addressing those symptoms that you come to us with because they are very much nutrition related as well which might surprise a lot of people but symptoms such as weight gain, muscle loss, digestive issues, poor sleep, dry skin, joint pain, fatigue and even night sweats, these are all things that we can address with nutrition. So what you're getting is the best results from your hormone replacement therapy when you incorporate the nutrition aspect as well.

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Valerie (04:26)

When you embrace the fact that these hormonal changes are actually making you feel differently and this is really happening to you, there are really, in my mind, five important factors that you should really be thinking about. And one of them is identifying what these metabolic changes are. Are you eating almost nothing and starving and still gaining weight? That's an important question. Trying to identify these specific foods that maybe you think are healthy. I'll give you examples of a few patients. They are eating pretty clean. They're eating protein bars, granola, yogurt that happens to be full of sugar. These are foods that a lot of us think are healthy, but they're really not. And they're full of sugar, they're loaded with carbs, they are triggering your hormones. And when your hormones aren't working as they were when you were younger you can eat a bag of chips, but metabolically it's almost like eating five bags of chips. So even though you're not eating the same amount your body's handling it as if you were eating more so we also want to kind of focus on managing your gut issues, your appetite, your cravings. Strategize lifestyle issues, like maybe you're more active, less active. Sometimes the solution is to tone down your activity a little bit, because your body is in metabolic overdrive. And if it's working on so many different aspects of working out and trying to be healthy and doing all these other things, it can't focus on what it needs to do, which is kind of like heal itself and feel better. As nutritionists, we are also going to facilitate your care with the whole care team.

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Angela Garcia (06:24)

What happens when you meet with a dietitian is that, yes, we formulate a personalized plan, but the first thing we have to do is assess you. So past medical history, labs, and then, you know, we are also looking at how well you're sleeping. We want to know, are you taking any particular supplements right now? We're also concerned about what you're eating and drinking day to day. Another thing that I wanted to mention are nutritional imbalances, which we can tell, yes, from lab results, but there are also things that we can identify just through interviewing the person. Like for instance, since COVID, a lot of people have been taking large quantities of vitamin D and zinc. And you have to be really careful with zinc because you can actually develop a zinc copper imbalance. We also have a calcium magnesium balance that we need to check and make sure nothing is being thrown out of whack with that. When people are self-medicating, sometimes they might be taking too much and not being aware of that. So that's something that we're also checking on.

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Taylor (07:36)

One thing that both of you individually touched on briefly was the collaboration piece with the provider, which I think is so unique to our platform comparative to other platforms. Our patients do not have to travel to a nutrition coach and then travel to their hormone clinic and then travel to their PCP. We have nutritionists, you guys, who speak to the hormone clinic right in the same house. So you guys can communicate about that patient, build a plan together that works and no one's in the dark. You guys can communicate and get the best outcomes for the patient because you're working together. And I think that's really unique. Could you elaborate a little bit more on how that works and the success stories that you've seen with that collaboration.

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Valerie (08:26)

There was one situation where a patient who was put on a GLP and a lot of people think that that's like the quick fast solution and it's gonna work. Honestly, it's hard to deny the fact that GLPs work and they work very quickly. This particular patient though was having difficulty. They weren't tolerating the GLP and the patient was referred to me as a last ditch effort. And when I spoke with her, she did not do well the first week on the plan that we had come up with together. So, I thought a little bit about it. And in this situation, I said to myself, this is not about weight loss then. It couldn't be. I spoke with the practitioner she was working with. And I realized that in this case, we really need to hone in on her gut. She was constipated. She wasn't going to the bathroom. And I said to myself, you know what? Let's not think about calories, right? And normally that's the exact opposite as what a nutritionist might think of because naturally, as we get older, our metabolisms are gonna slow down. So what you've been eating for the past, let's say 20, 30 years, isn't what you can eat now to maintain your weight. So I just forgot everything that I knew and everything that I was thinking and just really honed in on what her situation was and I explained to her, I said, you know what, I don't even wanna think about calories right now. I want to help your gut. This is a problem and once we help your gut, you will then start to lose weight. She came back in a week, and I immediately could see a difference in her face, in the tone of her voice. And not only did she lose weight, but she felt much better. You know, her clothes are fitting her better and everything just because she had started going to the bathroom because it was really, really an issue.

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Angela Garcia (10:33)

Yeah, you know, on that point you made about the one week follow up, what I find is that's really crucial to help keep up the momentum, you know, and help keep up the motivation in that individual. Once a month follow up isn't going to really do it. It really helps us both to stay focused on that patient's plan and it really helps with their motivation to see you what's going on we've had some great successes with people on the weight management side in particular.

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Taylor (11:06)

A huge, huge part is the accountability. I do think technology and any online resources not going to hold you accountable and you're always going to have excuses but with that follow-up appointment and these consistent meetings, it helps you be honest with yourself and honest with the nutritionist who is really there to help get the best results. No one should be shameful of making a mistake. You know, you got to give yourself grace, but still having someone there to help you make better decisions. It's almost a mindset thing that comes along with the nutrition coaching that is something people overlook as being valuable, but it is so valuable.

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Angela Garcia (11:28)

That's true. I think sometimes, well, I guess I could be making an assumption here that people think that we're to be judging them. I mean, I've talked to people who are following the carnivore diet and they're maybe a bit nervous or concerned about meeting me. Maybe I'm going to tell them to stop doing that. We're not going to tell you to suddenly start eating sushi, if you don't like sushi, we're gonna start where you are at.

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Valerie (12:23)

Every single person has different needs and has a different treatment that will work for them.

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Taylor (12:33)

I think another thing that people assume when they join Thrivelab or get started on hormones is that BHRT or TRT or semaglutide are just gonna fix all of my problems and all of my symptoms and be this magic prescription. I don't really need to care about my nutrition and I don't really need to care about my sleep or I don't really need to care about moving. Nutrition is a huge part of seeing results on BHRT and TRT. And I'd love to hear your feedback about why those two go so hand in hand.

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Angela Garcia (13:10)

An important message to get across really is the majority of the people we see have insulin resistance and chronic sort of low level inflammation, which, if those things are left to sort of fester, they're going to develop into disease states such as cancer, diabetes, cardiovascular disease, and we don't want that to happen. For anyone who's not sure what insulin resistance is, that's when cells are resistant to the insulin that our body is producing. And so what happens then is our pancreases working even harder to produce more insulin. And then we get weight gain, diabetes, cancer, heart disease, even dementia and premature aging. Those are consequences of unchecked insulin resistance and inflammation. There is no sort of specific pill for those things you really have to address it with diet, behaviour change, physical activity.

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Valerie (14:08)

Yeah, I agree. Most people are walking around and they don't even realize that they have these risk factors. So it's very, very important to get consistent follow ups, understand what the symptoms are, talk with your practitioner. And quite frankly, sometimes you don't really even need a diagnosis. I mean, if you just change your eating habits and you're feeling better, that says enough.

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Angela Garcia (14:31)

Yeah, and if you're wondering if you have any signs of insulin resistance, if you've had that sort of belly weight gain, that can be a sign of it. Foggy brain, mood swings, fatigue and carb cravings are a sign of insulin resistance. There's no, like we were saying, there's no specific medication that's gonna cover all of that. It's a combined effort.

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Taylor (14:58)

Weight is obviously a huge factor that brings people into nutrition coaching, but you did touch on it a moment there, mood swings are something that nutrition really influences your mood stability and your mental health. Could you elaborate a little bit more?

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Valerie (15:13)

In the media, there's been a lot of information that is geared towards this gut brain access and the communication and everything that we're now learning about how the gut and the brain communicates. Your brain and neurotransmitters, your gut with gut bacteria, stress, it all affects each other, which is why this is not such a cut and dry issue. Because there's so many different complexities that are affecting everything. So when your moods have changed that could be because of an environmental factor like you didn't get the promotion that you wanted or you got laid off on your job that actually influences your hormones so that you're eating these comfort foods, more carbs, things like that, you know, maybe you say, I don't even care. I'm just going to eat something. The truth is, is that you probably care. It's just that internally, you're being transitioned to eat those kinds of foods. The same thing with your gut. If your gut isn't healthy, if you've been on antibiotics and not taken a probiotic. If you're drinking tons of coffee and your blood pH is kind of more acidic. There's a lot of different reasons why your gut can be off. I've seen research that shows people who were eating processed foods and those who did not eat processed foods were significantly more likely to experience anxiety and depression. When you eat processed foods, your gut bacteria is creating something called propionic acid. That propionic acid is linked to anxiety and depression. When you eat foods like vegetables, the same gut bacteria is creating something called butyrate. And butyrate has been linked to happiness, improved moods, less stress, less anxiety, less depression. So again, if you're eating processed foods on a daily basis and you're not getting in enough vegetables, you have a higher chance of experiencing these emotional barriers to happiness and productivity.

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Taylor (17:37)

And then sugar, of course, seriously affects your mental well-being. Could you talk a little bit about sugar's effect on the mind-body connection?

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Valerie (17:48)

Well, I'd like to just point out, I think this is a very, very important point when you mentioned sugar because it is extremely important when you're thinking about how you're feeling and the whole hormonal balance on so many different levels. So we can't just talk about sugar, we have to talk about carbohydrates. Because whether it's a piece of fruit, whether it's pasta, whether it's a fruited yogurt, granola, the minute those foods hit your tongue, they are converted 100% to sugar. And this is how your body handles that. When we talk about sugar, I just want people to understand that even though if you're reading a label or you're talking about a food and we say carbs, in the end, when it's inside your body, it is sugar. So there are a lot of foods that are going to affect your hormones. They're going to affect your moods because as a substance, sugar is an addictive substance in your brain. And we know, we've compared it to cocaine. And for some people, and you people know who you are, right? You can't stop eating it or you know you're adding six tablespoons to your coffee in the morning and then you're going all day and you're not eating anything else because you're just drinking your coffee and eating your sugar and it's kind of keeping you afloat but it's not the kind of energy that's going to sustain you and help you focus and really help you thrive the way you need to in today's world.

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Angela Garcia (19:35)

You know, we can show you how to eat those foods, in what combinations, like adding in more protein and things like that. So you can still enjoy those foods in smaller amounts, but with the knowledge that what you're doing is ensuring those foods are getting digested more slowly so you're not getting that sugar spike. But being aware of what effect they're having on your body. We know that people are going on the internet and taking a lot of their dietary advice from there, but we're also understanding that there's a lot of confusion. It's kind of hard as a dietitian actually to have your voice heard when there's so much food chat going on. You know, 49% of those websites, those blogs are actually accurate and reliable. So we know that there's also, you know, 50% isn't. You know, what kind of quality information are you receiving? One of the biggest things is that if you're working with a dietician, you get that personalization, you get somebody who is evaluating you as a whole. We're not just somebody who is saying, well, this works for me, so I'm going to tell everybody about it and they should all follow what I'm doing. A lot of people claim to be like a nutritionist or a nutrition coach and they might've had literally like two weeks education, you could do the class online and then call yourself a nutrition coach. And that's obviously not the kind of person that you want to be taking nutrition advice from. As nutritionists, we keep up with the latest science. We're translating the science into practical, usable information.

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Valerie (21:28)

And I'd like to just take it one step further and say this. I think as a nutritionist, our most valuable contribution is really hyper-focused on your specific needs, which, especially when you're dealing with hormones, you need that individualized care. So, your specific symptoms, your hormone imbalance, your physical weight, all of these things are being taken into account. Your lifestyle, so even along the path of your weight loss, these things are going to change if you're taking supplements, if you're on medications, you know, how tall you are. Unfortunately, I'm short. I don't get to eat as much as a six foot tall man. All of these have to be taken into consideration. And if they're not, because there's no way that somebody on the internet can say, you're taking this medication, you're this tall, and give you the personalized attention. And in our case work with other professionals who are gonna help you achieve your goals. With some of my patients, I've even given them information to share with their physician so that the physicians know that it's science-based. They know they're working with a registered dietitian so that everybody's on board.

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Angela Garcia (22:53)

Yeah, that's true because, you and I have experience with medical weight loss and maybe they have a history of thyroid cancer or they have had a history of pancreatitis who cannot be prescribed the new GLP-1s because it's contraindicated. There are other options out there. They can still get some help with appetite control. With so much chat about GLP-1s, people have forgotten that there are other options out there, which, you know, maybe they qualify for.

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Valerie (23:26)

I will say this about the GLP-1s or any weight loss injection or whatever somebody's doing, which is people think that they're gonna go on this drug, they're gonna lose weight, and then they're gonna get off the medication. This is not what happens. And I want people to understand because I've done a lot of research on these GLP-1s because I'm so fascinated by how well they work. GLP-1s do have side effects. They can cause you to lose lean body mass or muscle mass. if you are not working with a nutritionist to track your behaviors, to make those behavior changes while you are on the GLP-1s, there's a lot of evidence out there that shows that after about 62 weeks on this, your weight loss stops. The party's over, and then what are you gonna do? So the time you seize the opportunity, you seize the moment now working on the GLP-1s to work with the nutritionists to ensure that the same behaviors, the same eating patterns, all of this is carried through as you, let's say, and I suggest this, try to wean yourself off before the 62 week time period. the longer term goal you will meet and you will be happy with instead of just taking that shot and then figuring out like now, what am I gonna do?

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Angela Garcia (24:51)

One of the things that I do is teach people about self-monitoring skills because when you've reached your weight goal, ironically, what a lot of people don't realize is that the weight loss is very kind of reinforcing and exciting and everything, but weight maintenance is really not exciting and it's a chore and you have to have the techniques there to know how to keep your weight around the same kind of five pounds might fluctuate a little bit but if you relax on what you're doing and go back to those old habits the weight will come back on again we know this so that's a big part of what Valerie and I educate on is self monitoring to make sure you don't get that weight regained.

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Taylor (25:36)

And also you go through this whole program, you're on this very expensive medication for months and you invest your time, your money into this and you're so happy with how you look and you're feeling good. And then all of that just to relapse because you didn't make healthy habits for the future and instead just rely on this medication that you're eventually to put it plainly, just going to be a slave to unless you really do put in the work and make those changes that are going to help you with not only your weight but disease prevention and mood and all these other things too.

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Valerie (26:15)

We’re not just nutritionists, you know, we're more like lifestyle coaches. So we aren't going to only talk about nutrition. Making sure you maintain your lean body mass on the GLP-1s, yes, but also as we age, we want to prevent muscle loss, we want to prevent falls. So you should be

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exercising and exercising with weights, heavy weights, so that you will maintain that lean body mass. You're never too old to start. And lifting heavy weights will help your metabolic rate stay up longer than any cardio. Again, just what Taylor was saying about, know, don't waste your money. Use this time to really hone in and focus on the long-term goal, which is sustaining where you're at instead of working so hard and then at the end of the day having to restart everything because you've regained the weight because you're only using the drug and not making those behavior and lifestyle changes.

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Angela Garcia (27:19)

You have to accept that at this stage in your life, progress can take a little bit longer and you have to be patient with yourself and kind of dig your feet in and realize it's going to take a little bit more time. Because I've seen a lot of women, for instance, they're three months into their BHRT and they're feeling great, but the weight is still there. So they're kind of wondering when is that weight going to start disappearing? And that can take a bit longer.

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Valerie (27:46)

And to be all inclusive, we should really make it clear that we are talking about men, women, and not only older people, but even women right after they've had their first child, their hormones can be messed up for the rest of their lives and they don't have to necessarily live with all these symptoms when they're 30 years old or 40 years old. It's very important for people to understand because we always talk about hormones as we age, but I've seen men at 28 who have low testosterone levels that really impact their quality of life and women as well.

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Going through these milestones of life, you have to embrace these changes. Your metabolism slows down by a certain percentage, every year as we age. It's very difficult to talk about nutritional needs at different stages of life but for sure, different factors, as I said before, childbirth or if somebody was on the track team and now they're not because they're in the work world. It will change your metabolic needs. For sure, I would say this, that your protein needs will increase as you get older.

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You need to have more protein. Fats are going to be important for hormones. You need fats for your skin, for your nerves, for your hair, for your nails. Healthy carbohydrates from vegetables are really, really important because that's where you're getting your micronutrients from. So we're not just talking about macronutrients, carbs, fats, proteins, but micronutrients, which are vitamins and minerals, are all working together to help keep your body, fueling your body to do what it needs to do. So we can't forget about those micronutrients that you're getting from your vegetables or your fruits, these are what healthy carbs are. And also your body, isn't going to be able to handle the processed carbs, your chips, your cakes, your muffins, And so we need to reassess what we're eating to understand what your baseline is, and then move from there. Readiness to change is important in all of this. This is a non-judgmental zone. There's always different degrees of feeling better, getting to your weight loss goals, but nothing is going to happen, if you do nothing.

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Angela Garcia (30:28)

Yes, that's true. It's really important for people to consider, you've got these challenges now, but what's happening in the future? How is quality of life when you're older? How important is that to you? It just might not be something that you're thinking about right now. You've got too much going on right now to think about that. But what you eat now, we know has a bearing on aging and how well you age. And I'm sure most of us want to be active. If we have grandkids, we want to be able to keep up with them to a certain extent. We want to be able to live a full life, not be alive, but not be thriving. Investing in your health now is going to make a big difference in the future.

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Taylor (31:15)

And that should be the biggest incentive just to be able to thrive at every age and feel your best for as long as possible. Nutrition coaching is an excellent resource for our patients. Any of our patients can book nutrition coaching through the patient portal and book their intro appointment with either Angela or Valerie. If you aren't a patient with us, please visit thrivelab.com. Take our self-assessment. It asks you some questions about any symptoms that you've been having and to see if you would be a good candidate for hormone balancing or testosterone balancing programs for men and women. And from there, once you become a patient with us, you can book your intro appointment with one of our nutrition coaches. Thank you so much and we'll see you next episode.