Dr. Jay Wrigley: A Journey Through Hormonal Health and Metabolic Optimization - #107

Tell us about our guests today , phil .

Jay and I have kind of known each other for a long time now on the interwebs as it is , and really excited to have a conversation about his approach to this problem that we're all trying to solve together . So with that , dr J , why don't you introduce yourself to our audience ? Give a little bit of your background ? Yeah , okay .

Because of the nature of the work that I do , that is all remote now I can kind of be wherever I want to , so I move around and good debt and do my work through the web and through emails and Zoom podcast and stuff like that . So I'm a functional medicine doctor and I primarily specialize in hormonal health .

Most of the 30 years of me practicing medicine has been probably 70% of what I do on a daily basis is work with women who are either going through the beginnings of hormonal changes into perimenopause or into menopause , or have thyroid dysfunctions or other endocrine problems that are leading to specific types of metabolic health problems .

And there's a different approach that needs to happen here with these women and even men when they reach probably they're 50 or so , because the changing in the hormonal landscape that happens to all of us , as these hormones that play a key role in your metabolism begin to decline .

Each one of these has a metabolic effect and so as they get lower and lower , it becomes a bigger issue . For how do you approach getting someone who is already either obese or metabolically broken and get them fixed .

Because some of the things that are very easy to do for a , let's say , a 35 year old man or woman , by just going on a low carbohydrate diet and getting rid of junk food and their diet and stuff like that , can make such an impact and get them lean again and all this kind of stuff .

It doesn't play out so smoothly for the demographic that I work with because of the fact that as these hormones decline , you become much better at storing energy than you do releasing energy . So the landscape changes and the game plan has changed a little bit so we can get into that a little bit more specifically .

But so anyway , I was just going to introducing that this is what I do with my time in my life is to practice this approach of bringing functional medicine into solving problems around metabolic health , hormonal balancing and these types of things .

Is it the metabolic health that kind of worsens the natural cycles around hormones , or does that , does the hormonal cycling and changes as we age , end up causing the metabolic health problems ?

I would have to say that it's not clearly defined and that more than likely it is a combination of the two because , again , in my experience , what I see is that people who do not know better or , for whatever reason , are not taking care of their metabolic health in their 30s and early 40s are the ones that have much more of a challenge as these hormonal

landscape changes , that they have the bigger problem . So , again for women , which I mainly work with , if they're already metabolically broken , so to speak , they're the symptomology and the problems that they face as they go through the late phases of perimenopause and into menopause are accentuated quite a bit .

They tend to be the ones that have more problems with weight gain , more problems with being able to get that weight off , more problems with the hot flashes , night sweats , insomnia , mood swings , problems with their external protein , like hair , skin , nails .

So there definitely is an accentuated effect of this , again , the symptomology that would show up with these hormonal changes , with someone who is already probably insulin resistant and eating a diet that would be high in refined carbohydrate , seed oils and stuff like this .

Now , on the other flip side of that , there's also some truth to like I was saying , kind of saying in the beginning , it unfortunately for these people it doesn't become as easy as well if you just go on a ketogenic diet or drop your carbohydrates below 25 grams a day or whatnot , and clean up the diet , that all of this gets better .

We do see those cases and we certainly hope for that to be happening , but many times there's got to be some adjunctive therapy brought into this and whether that be something like repleting depleted pathways of nutrient deficiencies , whether that be for a short period of time , this person could really use some true bioidentical hormone replacement therapy to push some of

these pathways that have gotten so low that they're just not working for them . So it's a little bit complicated and we try to keep this to be to minimize bringing outside therapies into this .

But a lot of times again , it's not just that the diet itself will fix all of these problems , and that's okay , because there are so many tools to be used that are not about prescribing medicines or , in your case , having to have somebody on an operating table . They're not that complicated .

But they need to know that there there might be a different approach that they have to take than just what they read on the internet . That would say if you just went low carb , all of this gets better . Not always .

I get to hey well , dr Ovedio would say and she's really struggled with getting results from eating a high fat , low carb diet and I know in her case it is not a lack of doom in the program . So it kind of let's dive a little deeper into the biochemistry or the what's going on .

And I'll confess , at my age I've got a lot of friends who are all dealing with the same kind of thing . I'll unpack that a little bit .

So in your friend's case , here's what I would postulate that may be going on for her .

Is that so , as her estrogen and progesterone levels are dropping and we know that the progesterone levels would have dropped first , they're going to start dropping usually in the mid 40s and estrogen is going to lag behind , but it's eventually going to catch up and drop too , and that's going to stop the period and move the woman into menopause .

As these things happen , what happens is this so just the hormonal change of going through this stage of life increases internal stress . It's just part of nature . It doesn't have to be a huge problem , but it's a stress in in and of itself to have these levels of normal hormones back in your , let's say , 40s or whatever .

And we're talking mainly about three hormones at first , and that is estrogen , progesterone and testosterone , as they begin to decline . This again , this is a stress on the body because the adrenal glands sitting on top of your kidneys are responsible for sending out hormonal signals to keep everything in balance .

So when a woman goes through menopause , even if she's working hard at it , she's pretty stress-free or whatnot she still is under a change of chemistry . That is an internal stress , and what that will do is now the body has got to initiate a cortisol response .

So this hormone , cortisol , that comes from our adrenal glands , that is life-saving to us we would not be around if we did not have it but also as a double-edged sword to it , because prolonged periods of elevated cortisol , or more than you need , are going to slam the brakes on fat loss . You can't lose fat in the presence of circulating cortisol .

So it gets more complicated because cortisol is made primarily from the building block of the hormone progesterone now . So a woman's already got very low levels of progesterone by this age of her life . As she's starting menopause , she already has hardly any progesterone around .

So the little bit of progesterone that she does have , which is used for so many great things progesterone's a wonderful hormone but the little bit that she does have is now getting robbed , basically by the adrenal glands to make cortisol out of it .

So you're pushing progesterone down even further and you've got this little bit of an elevation of cortisol , and those two that ratio there is going to make it really difficult to lose fat .

Then you bring in the estrogen and testosterone component that are lowering also and that are a part of metabolism and building muscle , and you get yourself into this situation where this is why a lot of people who are doing it correctly and diligent about something like a low carb , high fat diet , are not getting rewarded like they should or like they want to ,

and it's because of this mechanism that's got to be straightened out , because we need the body to stop producing more cortisol than it actually needs . We need to support these other hormonal pathways that are going to allow you to be able to burn up fat .

Another piece of this that I got to throw in there is that we all but women , even more than men store our estrogen in our fat cells . Okay , so when a woman goes through menopause and she's not having periods anymore and she's estrogen deficient , one of the things that the body is going to this is kind of an adaptation .

One of the things the body is going to not want to do is to lose a bunch of fat , because that's where the only estrogen that the woman is getting at all at this point because the ovaries are not really producing it anymore is in their fat tissue .

So for the body to sacrifice your fat tissue and deplete even further this estrogen hormone that is needed for so many things , it's like the body's stingy . I don't want to give up fat tissue because that means even a further depletion of estrogen . So it gets . I want to say it's complicated .

I would say it's complicated to somebody who's never heard this for the first time . To me , I don't find it complicated really that much anymore , it's just . But we have to . It's a game changer because now the rules change .

You have to if you're going to get the success that you want with metabolic health , leanness , feeling great , sleeping well and all these types of things . You have to relook at .

Well , okay , maybe low carb , high fat is not working really well for someone who is prone to store energy really well now , and that's what menopause would be , because without these hormones you're going to be great at storing fat or energy , you're going to be very stingy at giving it up .

So we have to modify things a little bit and that's why my information that you would see out there and then Philip would be both of you maybe are familiar with this is that there is a . There's a sweet spot if you can find the how to keep the carbohydrates on the low side but eat a higher protein diet and moderate the fat .

In no way do we mean go on a low-fat diet , because that wrecked us all in the first place . But we're talking about . You don't need to be adding extra fat to your diet . There's no reason to cook a rib eye in a bunch of butter . The rib eye's got plenty of fat already .

So eat the protein with the fat that comes with it and stop adding a bunch of fat to it . And a lot of this . That got pushed out by Bassbury and Bulletproof or what not , and God bless the . He did great work for a lot of people , but we never really needed to be putting sticks of butter in your coffee .

That doesn't really do a whole lot for anybody who is prone to store energy . We're getting to energy toxic is a good word is a lot of the reason that we have this problem with metabolic health is we're energy toxic .

We take in way too much energy than we ever really expend , and there's a better plan for that than always going to the low-carb , high fat part of this .

Yeah , I think that's a great point , though , to emphasize that this is where the individuality needs to come in , because , quite frankly , you know what works for the you know 20 year old woman who's out there on Instagram or wherever and talking about eating all the butter and may not be the right plan for the perimenopausal , postmenopausal woman as well .

Talk a little bit about the concept of adrenal fatigue and how this plays into it , and I think a lot of women will have heard , will have been told that , because of maybe the chronic cortisol state that so many of us exist in these days , that that is sort of a primary driver of all this , and love to hear your thoughts on that .

I think they're kind of , they're somewhat of a wastebasket diagnosis a lot of times for something that actually does exist , of the fact that , again , we talked a minute ago about the adrenal glands are . So I think of them as like your batteries , okay , there , this is where a lot of the primary energy and stability from the body comes from .

So they're constantly under any type of stress , whether it be emotional , physical , chemical , food additive , whatever anything is stressing the body . The adrenals are the first go-to of . We've got to keep homeostasis going on , and so we're gonna fire out whatever hormones going to alleviate the potential breakdown of an organ system .

So , whether we use cortisol , whether we use something like norepinephrine or epinephrine or these various hormones that the adrenals have , probably the main thing I'm trying to get at is they do have a propensity to become exhausted . In the world that we live in today , most people's adrenal glands are pushed to the point where they're exhausted , and they will .

They will have a hard time sometimes to keep up with all of what they're supposed to do and their go-to mechanism would be to elevate cortisol , and not a lot of times this is an elevated cortisol to the point where you can go test it and see that , wow , this is cortisol in this person is off the charts .

A lot of times it's very subtle and it's more symptomatic than it is something that you're gonna pick up on a , especially a blood test , because if you're testing blood , you're testing something that's already traveling from one place to another , bound by a protein .

So you get some reflection of oh , here's a number , but it doesn't give you a whole lot of information about what's your storage level of this and how well is it getting into the cellular chemistry , into the mitochondria and all this kind of stuff . So you get this low-grade , more cortisol than you need and it begins a cascade .

And when trying to tie this back to a specifically asked , here's where it gets complicated is when the adrenals do have a problem whether they're producing a little bit too much cortisol or whatever could be happening there , and that would be the main one is this now begins to affect the thyroid function because all of these endocrine organs the four main ones

pituitary , thyroid , adrenals , and either your ovaries or your testicles . These four endocrine glands play , or need to play , a nice symphony with each other . They're playing off with each other all the time .

Well , if the adrenals are either burnt out or fatigued or producing too much cortisol , that's gonna have an impact on the thyroid's ability to produce T4 and then turn it into T3 and then to get that T3 into the cell of the body , into the heart of the mitochondria , to turn on respiration , which is what burns your fat and keeps your metabolism high , or what

I , so a lot of us . What we see is that a woman is not losing weight menopause Lee and it's because

of she can't get active T3 from her thyroid into where it needs to go . And you , if you just think that it's that and you start throwing thyroid hormone at her which most doctors don't do anyway , but even if you did , you might get some improvement there .

But if the problem really started with a dysfunctional adrenal system , then if you don't correct that , you're not really getting down to the root cause of this problem at all and so in , and then it begins to get this cascading effect .

Right now it also plays into the whole estrogen thing , because when women go through perimenopause women a lot of times let's say , a 47 year old woman still having periods there might be becoming a little bit erratic or whatnot . This is because progesterone levels are falling quickly .

Estrogen levels are not really falling at this point , so this ratio between these two hormones is getting bigger and bigger . Where that becomes a problem is estrogen and thyroid are not best friends at all because estrogen will compete against thyroid T3 for the binding sites on cells .

So if you're in an estrogen dominant state without enough progesterone to antagonize that estrogen , what's gonna happen is you're gonna find a lot of times that estrogen wins out the the receptor site battle so that when T3 comes along to plug in to tell the mitochondria to breathe , burn stuff , be more energetic or whatnot , there's no place for the T3 to land

because estrogen is already bound up the site . That's where this kind of sign of this is gonna be .

Like if you're gonna get doctors realize so much on just looking at a TSH level and going , okay , if that's in the normal range , you got perfect thyroid function , that's a bunch bullshit . She's language way .

So because what happens is if you don't look at other markers , like free T3 levels , and you don't look at things like reverse T3 , which an elevated reverse T3 tells you that the T3 is not getting into the cells of the body , so that's a , that's a marker that can be very helpful for this . But I'll tell you , the biggest one is not even in testing .

It's watching and and paying attention to the two women who are showing seven of ten different hypothyroid symptoms . But get normal labs .

So their hairs getting brittle , their skins getting dry , they're getting constipated , they don't sleep well at night , they're gaining weight , they're having problems with mood swings , they're retaining fluid , all of these symptoms of hypothyroidism that they begin to a lot of times show up with , but the little bit of labs that are done , like a TSH level and maybe

maybe looking at a total T4 level , all comes back normal , that , yeah , this is a . This is probably the easiest way for someone like myself to see that , okay , thyroid's not getting into the cells at all and based on your age and based on your other symptomology , and we can go out and look at something like progesterone or what not .

But if this woman is becoming estrogen dominant and showing all this subclinical hypothyroid symptoms , this is a real challenge for this woman who again , like maybe your friend I'm not saying that this is her issue , but I work with a lot of women who are I'm nailing this , doc , like I'm eating low carb , I'm getting plenty of protein , I am either eating a high

fat diet , or they've already caught on to me telling them why don't we back down on that fellow ? But I'm doing this , I'm getting nowhere ? Well , that's a huge percentage of the cases that I see would be . The reason .

Why is because something is blocking thyroid hormone getting into cells , something is producing more cortisol than they need , something is affecting them to have too much estrogen . Because now we live in a world where , and by too much .

Is it because just progesterone is being is just naturally dropping quicker than estrogen , which happens normally ? Is it because progesterone is dropping even faster than it should be because it's getting robbed to make cortisol due to internal stress or external stress or whatnot ?

And then the third piece is that is it because this woman is way too much under the influence of exogenous estrogen ? I mean , exogenous estrogens live everywhere now . It's in everything that you consume out of a plastic model . It's in every bit of the herbicides , pesticides .

It's just the endocrine disruptors that we have introduced into our environment today through packaging is a real issue , and again , it's a tough one because it's not . You really can't test for it , and I mean , if you can , and I'm aware of a few , but it's ridiculously expensive .

No insurance company's going to pay for it to find out that you have too much exogenous estrogen in your body . But this is a big deal .

A lot of women who are before they would learn anything about I need to clean up my diet and eat better or what not are exposed to all kinds of these endocrine disrupting chemicals that come in the their makeup , that they rub all over their skin every day , and they don't necessarily know this .

But these are some of the issues that lead to these hormonal fluctuations and imbalances and that lead again to poor metabolic health and why they're not getting the success that they need when they follow what we all would say would make a make sense to cause anybody to burn up excess body fat or whatnot , and then they are not getting the results that they want

. You have to look at some of these things .

That sounds like we're describing just an evolutionary adaptation . Hey , this is it's not just normal , it's good , and somehow something has happened that it's not good for us anymore . So I'm thinking about I

think I'm asking you to speculate what is the evolutionary benefit to estrogen dominance ? You talked about estrogen winning the race for the receptor sites in the cells over I don't remember which chemical , which hormone it was . What's the evolutionary benefit to that , and is there anything we can learn as a result of figuring out ?

Oh , that's the evolutionary benefit .

What I think that it would be is about longevity , because one of the complications that we're dealing with today , or that I have to deal with on a daily basis because of what I specialize in , is the fact that the life expectancy rate keeps going up , and this is due to better sanitation , probably better , less contaminated food sources .

We can speculate on all the reasons why it is that human beings are living longer , but there was a day and age where the three of us probably were on our way out . Yeah , I mean like you live to be maybe 50 or so . Now you got people that are especially women who are living in their 80s , 90s , 100s .

So if there were an evolutionary benefit to estrogen dominance , it would be to keep the most estrogen around you can , because it's an anti-aging , it's a longevity promoting hormone and you would want it .

You can see it with women that women who really get estrogen deficient begin to age much , much more rapidly than women who , either because of genetics , don't drop estrogen that quickly or they choose to go on some type of natural bioidentical hormone replacement therapy with a good quality estrogen and it rejuvenates their skin .

So if there were an adaptation that was beneficial for the species , that might be one .

I think that , more importantly , it would you have to look at does that provide a benefit that outweighs the fact that high levels of estrogen , especially if they're coming from an exogenous source , meaning that your body either coming from outside and your body does not recognize this as the estrogen that it ?

thinking about the root cause of these issues and why is this hormone low and why is this hormone high and perhaps out of balance ? It just continues to both amaze and alarm me .

How unusual that seems , I guess I would say , these days , when I see physicians who are thinking about these root cause issues and I contrast that to the general approach of the standard medical system and ignoring or not really searching for those root cause issues . That's what , like I said , both amazes me and alarms me these days .

It depends on the day of the week , I guess .

that's happening with us , metabolically , in our culture , that is driving this ? Or is it just simply because I'm aware now of this Hashimoto's diagnosis that I hear more of it ? And I realize a cardiac surgeon might not be the right person to ask that , but you're the best one I got .

So it is a real phenomena and the question is why and , of course , when we start asking why , we really should be looking at our diet first and what in our diet is causing this increase in autoimmune conditions . What other environmental factors outside of our diets are probably contributing to it as well ?

And I think there are a number of things that we can start pointing to there . But there's a lot of reason to believe that , like I said , it's pretty clear that autoimmune conditions in general are on the increase , are becoming more common , and again , we should be asking why that is and trying to seek out what is really triggering these autoimmune conditions .

Because you look at something like Hashimoto's and , yeah , you can treat it with , oftentimes , thyroid replacement medication . Sometimes you're trying to suppress the thyroid function with that , sometimes you're trying to augment it , depending on what's going on with the thyroid .

But if we don't step back and say , why did this person get Hashimoto's in the first place and can we do something to address that autoimmune response rather than just the end effect of that autoimmune response .

These are the types of approaches that someone like Jay and someone like myself and the doctors that I now count as a part of our community are all trying to do better than we certainly may have in the past .

I was fascinated and I want to know more .

Each one of these hormones that we talked about and then we'll throw in two more but each one of the hormones that are declining fairly rapidly in a late-peri menopausal woman and this to an extent happens in any male also probably around the age of between , could be as early as mid to late 40s , or 50 , 55 or whatnot .

But see , each one of these hormones of testosterone , estrogen and progesterone all play a part in the metabolic machinery that keeps things . That the intricacy of how that . They play a role in everything from controlling insulin levels to partitioning where nutrients get stored and macros get stored or what not . They're part of the whole metabolism , right ?

So these things are declining fairly rapidly . In again , we'll go back and use the menopausal woman , and so it's really as simple as this . They're missing a certain percentage of their overall metabolism by the decline and it's a natural decline that happens .

So again , when we all know a little about like insulin resistance or problems with insulin metabolism , one of the problems with that is that the body has a hard time understanding where it's supposed to partition these nutrients .

So if insulin can't drive glucose into a cell because there's insulin resistance or some kind of problem with that , then it's got to do something with these nutrients right . So a lot of times , if there's complications with not eating pristinely like nobody really does anyway is that it's going to . That would shift things into .

Let's turn these into little droplets of triglycerides , which are basically fat cells floating around your bloodstream which eventually get partitioned or put into fat cells in adipose tissue all over your body .

So the same thing Jack is without , since estrogen and testosterone and progesterone also so play a key role in your 20s , 30s and 40s of where it is and how you partition these nutrients .

For when you've got healthy testosterone levels and estrogen levels , you're going to favor shunting this nutrition towards metabolically active tissue , muscle cells , even liver function and other things .

So as they begin to decline , now the body's taking in more energy than it has the help of being able to just do this without the help of these hormonal metabolic enhancers . Okay , that's what we were also talking about .

And then it gets more complicated , because when those begin to decline , then you're putting a stress on both your adrenal system and your thyroid function , and so this is what is setting people up for that you are more prone at this point to not be able to have the cellular metabolic effect , to be able to eat high energy , dense food like pure fat , even

though it's good for you . We know it's good for you , we know that we don't need to be telling people not to eat it .

It's just that now it's got to be thought through , because if you're taking in that much energy and you don't have the help that you used to have from these hormones being balanced and the proper thyroid function and adrenal health and your cortisol levels are lower and all of this kind of stuff , then you become really good at storing energy , and so you have to

pay attention to that , because if you're really good at storing energy , then you would not , at this time in your life , want to favor a diet . That would be the pro . Let's go super high fat . It's almost like there's a reasoning why some of these , the low carb diets , work for certain particular events and not for others . We know this .

Somebody who has neurological disorder , seizure disorders , things like this , parkinson's probably plays a role in that . I would even say Alzheimer's and other things .

There is a reason why you would want to eat a high fat diet and also moderate protein and probably keep it somewhat low , because you're wanting to produce all the ketones that you possibly can , because they feed the brain in a way that takes away activity , hyper excitability , activity like seizures or whatnot .

It's been a great diet for hundreds of years now , for seizure control is to eat the true ketogenic , high fat , very low carb , moderate protein diet .

So I'm using that as an example to say that things switch if you're not dealing with a neurological condition and you're dealing with a 52 year old woman who stopped having periods a year ago and she is trying everything she can in the keto world and low carb and all this kind of stuff and it's not really working out for her .

One thing you have to pay attention to is that extra fat that was taught to all of us as just being part of a ketogenic diet is not necessarily to your benefit at all , because that you're taking in such nutrient dense , high energy food and you don't have the ability to just shut that . So you're better at storing energy now .

So you're going to find that it's going to be harder and harder to lose , especially like abdominal fat , and usually the problem here is that women are talking about hips , thighs , but things like that . It's harder to get rid of that fat if you're eating a lot of fat in your diet and you're missing that part of your metabolism .

That would have been driven by testosterone , estrogen and progesterone , which would have kept your cortisol levels down . Just by having optimal amounts of progesterone , the body wouldn't shut towards adrenal pathways to produce cortisol . It would relax the adrenals that's what progesterone does and let these other metabolic effects from these hormones take place .

I know this is a lot of chemistry .

A little bit of it is to try to bring back some common sense that if you're in a hormonally declining state and I don't mean that in a negative way , it's not like you're broken or you're diseased as part of the natural aging process but if you're in that declining state , the idea of taking in large amounts of fat into your diet with the prospect or hopes

that you're going to get lean by doing that just

because you kept your carbohydrate low , doesn't work out that way . This is why I see on a daily basis so many women that are very frustrated going I'm doing really good , I'm just eating low carb and I'm eating rib eyes and I'm eating plenty of butter and I'm putting plenty of fat in my diet and all this kind of stuff .

I have to tell them look like the game has changed a little bit . Now You're going into the fourth quarter or the third quarter or whatever , and they move the goalpost a little bit . You can't do it that way . What you can still do is to eat a metabolically balanced diet which would be fairly on the low carbohydrate side .

You would actually want to increase your protein for so many reasons . One is satiety .

The other one is you need to be driving anything that you can for building structure at this area in your life more than ever , because one of the big problems with something like menopause is the rate at which you can get into sarcopenia or muscle wasting or what not , If you're not eating enough protein in your diet and also if you're not doing some type of

strength training , even if it's some yoga or whatever , to build muscle . This is why you need higher protein . When you get to the fat piece , there's no reason for the high fat part of this .

There also is no reason for eating a low fat diet , but you need to moderate that fat a little bit and get away from the idea that it's healthy to eat lots of butter in your diet if you're doing low carb or ketogenic for some people , not for a 52-year-old woman who's struggling to lose weight . That's what I'm saying .

more and more that's becoming low carb that people are finding to deal with these problems and they're kind of given the impression that that will fix it all and it's that simple . Unfortunately , it's not , and for a lot of people that does fix it and it is probably a great first step .

But if it's not getting you there , I think that's when you really need a practitioner like yourself who's going to look at this from a holistic standpoint and really figure out , take into account all of these issues , because we sort of tend to zero in the low carb world on .

Well , it's all about the insulin , but , as you rightly pointed out , there are all these other hormones that are having effects that we need to account for as well . Sure .

Where are they with stress levels and sleep patterns , and where are they with peri or post-menopausal stuff in the woman's case , or andropause in the man's case ?

Then formulating a way of eating that is still based on the principles that we all talk about for metabolic health , which is getting rid of processed food , getting rid of seed oils , getting rid of all of this processed carbohydrate and all this kind of stuff so it's still going to be low carb

or whatnot but then modifying the diet towards what it is that this person needs in order to accomplish their goals .

What I'm finding out there and you see it all the time , both of you is that there's so much extremism I mean , I have so many friends and you would know that from my relationship with people like Sean Baker and Paul Saldinia and whatnot that the carnivore approach to this , and yet we need to be talking about that .

Those are useful tools for a certain situation , like you're struggling with an autoimmune disorder or some kind of high inflammatory process , going for a period of time of eating a carnivore diet proves to be a very useful thing . It's a great elimination diet . It's keeping insulin levels really low , shutting down a lot of inflammation or whatnot .

But the idea that's the way everybody should eat every day , all day long . Yeah , I'm looking for the . Why is that ? As a practitioner , what I'm looking for is I want , at the end of working with my clients , is for them to have the most variety in their diet as they can possibly have .

So even if I need to start them with extremely low carb for some kind of inflammatory process or whatnot , my goal eventually is to bring back in benign foods that actually have lots of good nutrition in them , particularly things like , maybe , cruciferous vegetables that have wonderful benefits for women in helping them metabolize excess estrogen that we talked about

earlier or whatnot . You want to build them a diet that is sustainable , enjoyable and not believing again that just by doing the most extreme version of the metabolic health thing , you know that we're all in the circle of just eliminate all of it and just don't eat anything but meat all the time .

It's not the percentage of people , based on eight billion people in this world , that it you're just not going after the right numbers . The majority of the world needs to hear a lot more information about how to do a diet and how to move it in the right direction than they need to just go to complete carnivore . Does that make any ? Does that make ?

Give our listeners some principles about how to go about getting properly diagnosed and properly treated and , I think , most importantly , how to recognize if you're not being properly diagnosed and treated .

So , with the diagnosis part , we're living in a world today where , if you have a doctor that you can't get what it is that you're asking for , based on something that you have followed on Twitter or anywhere else , that would suggest that I really have . I want to see something like I want to see my free T3 level .

I want to see my maybe even my T3 uptake level and my reverse T3 level . I want to see what my fasting insulin level is and you get met with not . We don't do that . That's useless . You don't know what you're talking about . Leave this up to us . We know whether or not you've got proper thyroid function .

We can tell that just by looking at your TSH level , because if your thyroid's messed up , there's going to be something problematic with your TSH level . So if that's the case , and that's the case that a lot of people are dealing with , you need to get a new doctor . It would be one . Number two I like the free market place . I'm kind of .

I guess , in a sense , I would be more capitalistic and let free market solve problems , and one of the ones that's being solved right now is that they are building out more access to walk-in places in every city where you can walk in and order any test that you want to for , realistically , cents on the dollar .

Because you're not building this through insurance companies . You are paying this out of pocket , but you are because they're not going through the third and fourth party kind of situation the pricing of these things to go walk in and go . I want this testing done myself .

I want to know what my insulin level is , my H8-1C , my C-reactive protein and my whole thyroid battery of stuff and pay a hundred and a hundred to a hundred fifty dollars for all of that out of your own pocket because your doctor is going to go . There's no way I'm running that because there's no way I could get the insurance company to pay for it anyway .

So and you don't know what you're talking about so , anyway , in a lot in it , yeah , I think where I'm trying to tie that up is in the diagnosis , for get what you want . Yeah , you can get the testing that you need . If that's the way you need to know , you need to do this Now . Again , there's another side of this .

On dealing with menopausal women , you can kind of spy it .

I can get a spy without doing a bunch of testing what's moving in what direction and not the right way or whatnot because you don't always get great testing from doing you can't go out and run a blood test on progesterone levels or estrogen levels and rely that's giving you any valuable information whatsoever . We talked about this earlier .

It's already bound to some protein like alveolin or one of the sex hormone-embiting globulins , and so you don't really know what that is telling you . So that would be better off to use something like a Dutch chest .

I don't know if y'all are familiar with the Dutch chest , but it's become kind of the gold standard now , where they send you a kit to your own home . You take a urine sample , you send it back to the laboratory , they dry this , break it apart and break apart the metabolites of what they found in your urine .

They tell you exactly so much clearer than we've ever seen before , of where you stand in any of your hormones your testosterone , progesterone , pregnant alone , cortisol levels , adrenal function , whatever .

So there's a lot of a lot of , a lot more out there now available , so it takes a little bit of work on the patient's part to go okay , I need to access this . So how do I do that ? Well , again , it comes back to kind of what you said the beginning , jack . A lot of people need more than they need a doctor . They need a coach and what that ?

Hopefully the coach should be a doctor . I mean that would make it better , because if you're not , if you're not , then what did you do ? You went and took a weekend course somewhere and now you're a health coach . So , yeah , but they need a coach more than they need a doctor .

A lot of times , and again , we would get it be better off if that coach was a doctor who was going to walk with you and go all right , here's what we need to find out . We need to find out your bio individuality and set you up on a protocol that meets where you are and what you want to get accomplished and what the physician decides .

Also that these are the priorities that we need to get you lean or we need to get you out of insulin resistance , we need to get your A1C levels down , all that kind of stuff , but to do it in an individual thing rather than hey , go read my book where it tells everybody to eat the same diet that that's only useful up to a certain extent , if that makes

sense , right ?

Because , again , we've highlighted that there are probably not an insignificant number of people who they come to something like low-carb carnivore , whatever it is , and but it's not quite getting them the results that they're looking for .

And yes , maybe there are tweaks to be made with in the diet , but there also might be some other things that they may maybe need to be paying attention to that they're not . That can influence all of this as well sure , absolutely some of those would be .

But if you are not managing the stress in your life , if you're not ever getting outside and letting sunshine hit your skin , if you don't do any movement at all where this body was meant purposely to be moved and these joints need to be moved and strengthened or whatnot . So if you're , if you ever start there and go , listen , you've got to .

You want to be well , you want to be lean , you want to be metabolically fit , you want to stay off Phillips operating table , then you need to pay attention to the power of some of these things that we don't sometimes think are powerful , like a good night's sleep , like getting some sunshine any time that you can and letting that get on your skin to promote

vitamin D , and it does so many other things for you , doing some exercise on and on . So then there's so there's the stress management . What do you need for that ? You need some kind of outlet . Do you need to practice yoga ? Do you need to talk to somebody ?

Do you need to start some kind of an activity that lets you manage your emotions or whatnot , through rock climbing or whatever it could be . We need to get those in place , or at least moving in the right direction . Then we can get into all kinds of therapeutics .

Like my specialty is and I get crap for it all the time , but I'm all right with that is that I've done 30 years of research on what can happen through proper use of nutritional supplementation , and it's a shame that so many people take the attitude , at least on Twitter and things like this , of , oh , if you just eat the right diet , you would never need to

take a supplement . Well , maybe , however , you can eat a great diet and you need to know a couple of things about this . One is or I'll give you three of them . One is the top soil has been depleted so badly in the western world that the nutritional value of even the plants or the things that are grown in the top soil are really nutrient deficient .

Number two anytime you increase the stress of an organism , what the organism does is it has to utilize and use up these nutrients that do certain things at a much higher rate . So you're talking about living in a stressed out world . How fast .

You're burning through B vitamins Like crazy , like , no , like probably a hundred times more than we did a hundred years ago or 200 years ago or whatnot . So people are like well , you can get all the B vitamins you want by eating some eggs in a piece of steak . Well , maybe , if you're already topped out , that's probably a great way to manage this .

But you might be running very low on reserves of certain B vitamins that keep your adrenal glands functioning properly , drive metabolism , help with appetite control , immune system function or whatnot . So the use of knowing how to win a certain person again .

We'll go back to my wheelhouse when I see a woman who is having issues that clearly would suggest her nervous system is just wound up tight , and we know that the number one nutrient deficiency in the world today is magnesium .

Now you give a woman a good quality magnesium , like magnesium glycinate , meaning that it's bound to glycine , which is amino acid chelate and allows it to get through the blood brain barrier , so that the nervous system gets the magnesium that it needs , and watch the relaxation in this woman's stress levels , muscles , mood swings and things like that .

These are useful tools , very useful tools .

So I got off on kind of a tangent , but I was saying that , in addition to lifestyle factors , then we would move into some times of can we enhance certain biochemical pathways that are becoming deficient by just using something like nutritional supplementation rather than therapeutic , either pharmaceuticals or even hormone therapy ?

Yeah , you can push , you can strengthen adrenal health by paying attention to things like antithenic acid , vitamin B5 , vitamin C . You can also use botanical medicines like ashwagandha and rhodiola that have been around for 5,000 years , that are adaptogens that keep the adrenals calm and keep them from producing too much cortisol .

So you begin to slowly get into some natural therapeutics that you can do for these people and then it can move on from there .

There are women that absolutely need some , at least for a period of time some bioidentical hormone replacement therapy to move the progesterone needle up so that the adrenals aren't making too much cortisol , to help them relax , to help bring their libido back , and then a little bit of bioidentical ester dial or something like that from a plant source that will turn

off the hot flashes , cool the liver down , because that's what estrogen does . Estrogen is like the radiator fluid in your car when you start running low , and estrogen everything that is a hot burning organ like your liver and it doesn't have the cooling ability of estrogen in it . It's going to burn a lot hotter

and you're going to find out that you wake up at 2 to 3 o'clock in the morning every night , either with your soaking wet with sweat or maybe just waking up and can't get back to sleep . You're going to find out that you've lost any tolerance that you ever had to .

Even going out socially and having a glass of wine wrecks you now because the heat producing of the wine within the liver , without estrogen to keep something cool , just makes it anyways . I'm going to kind of slow down right there .

I've always wondered how do , if I have an insufficient amount of in my case , testosterone , and I'm taking testosterone replacement therapy ? My assumption , my belief , has been you start it , you can't ever stop it , but it sounds like you , it sounds like you may have a different opinion . Can you unpack that ? Yeah ?

But I want to start this part of this conversation with this If we're having a problem with testosterone , why don't we first look at can we identify the root cause of why you're having a problem with testosterone ?

Is it because you're converting too much of your own testosterone to something like DHT , which is the dihydrotestosterone , and therefore it's not useful to you ?

Your own testosterone is not being very useful to you because it's getting side shunted to another metabolite , which could have some problems in it of itself , especially if you're someone who wants your hair to grow back or something like that . Number two is testosterone being converted into estrogen .

This is a big issue that we see today is that men , because of sedentation , sedentary lifestyles , too much beer , drinking too much carbohydrate , too much probably seed oil and all the other stuff that we talk about in the dietary realm are converting their testosterone into estrogen through this aromatase enzyme .

And when that happens and you see these men who are walking around and they've got the man boobs , the whole body shape doesn't look right for a male , because they're shunning all their testosterone to estrogen , which is going to show up as low testosterone because most of it's getting used to drive that pathway of estrogen .

So then another one would be this so if you're mismanaging how your body is supposed to be manufacturing testosterone where it's supposed to be , then you want to find out the root cause of that . So could it be that you are again ? Let's go back to the adrenals .

You're so stressed out that your adrenals are using up all of your preliminary hormones , starting with something called pregnenolone , which gets converted from cholesterol , and then pregnenolone we call this kind of like the master hormone because it gets turned into progesterone , or it can be moved into other pathways , like DHEA , which DHEA is the precursor to testosterone

in both the male and the female . So if you're not making enough DHEA to produce enough testosterone , why would you give this person testosterone ? Why not look at something like DHEA supplementation and allow the body to use whatever part of that DHEA wants to make as much testosterone as it wants to , because that's the way that the body works is .

It's not going to ever make more than it wants , so you don't ever run the risk of having too much testosterone that you might . When you put somebody on testosterone replacement therapy , you could easily get way too much , but if you drive the precursor and let the body make its own testosterone , you never run that risk of making too much testosterone .

All right , so that's a lot to be able to evaluate someone and go wait a minute . In your case , the problem is you're converting too much into DHEA . We need to stop that . This is when we look at okay , what do we know about alpha reductase inhibitors ?

Okay , well , they're found in nature all over the place , and just about every man has heard of taking something called salpalmetto for their prostate issues or whatnot . Well , that's because it's a five alpha reductase inhibitor . It prevents the conversion of testosterone into DHEA , so you have more of your own testosterone available .

If it's the estrogen side of this we talked about , how do we slow down the aroma taste conversion ? Well , we can do that in a number of different ways . There's certain foods that you can eat that can contain these things that keep this in check . Again , some of the best are cruciferous vegetables .

They contain something called indol3 carbonyl which your body converts into something called was DIM , and what DIM does in the body is estrogen and aroma taste in the body , and this is just from eating food and prevents testosterone from getting converted into estrogen . So you would want to promote that in a person who had this issue of .

You probably need a little bit more of eat some Brussels sprouts and broccoli and cabbage and along with your meat and the rest of your low carb diet , and you're going to do a whole lot better for this .

Again , the point is that , as you were saying , jay , testosterone replacement can be beneficial , but it can also be problematic if not done well , and hormone replacement for women , same things . And if it's done right , and if it's , and that starts with a proper evaluation of what the root cause of the problem actually is , then it can be a plus .

But if it's not done right which unfortunately way too often is the case because there is no evaluation of what the primary problem is , it's only looking at the end result of this or that deficiency and trying to address that through oftentimes not letting the body do it , but just giving these supplements , giving these medications .

This whole , the whole realm of health that we're talking about Well , this is where you pimp yourself .

Again , my name is Dr Jay Wrigley and the website is the same DrJayWrigleycom , and you'll find me there , and I do the best that I can to kind of keep people abreast of this type of information to at least get them thinking about that .

There may be more to it and again , the ones that I am most passionate about are that's a bad way to say it , but what I mean is I take it personally when the people who are doing the work Jack , you mentioned this earlier about a friend that you have of you know that in no way could you go .

She's closet eating , or you made it clear that she's really on point , she really takes this seriously . She's been eating low carb or whatnot and not really getting the results that she would have expected , or maybe her neighbor got .

And those are the ones that I feel for and I love to work with , because there's always a work around here and what works for one person doesn't always work for the other person , and sometimes you've got to go . You know what I'm going to stop for a minute . The Dr Googling the .

What I read is the latest thing to take and what I read on Twitter or whatever actually go . I need a coach for a minute . I need a coach that could kind of take my case , build out a protocol based on what needs to be accomplished and that began .

That might be to straighten out their metabolic dysfunction and get their triglycerides down , and they're still up . Maybe that's all that they really need , but also it may go further to unleash them to be a fat burner and all this kind of stuff .

But for those people who aren't getting what they want and a lot of this probably has to do with something that I know a lot about , which would be somewhere in the neighborhood of hormonal

dysregulation and thyroid function or adrenal health or what I try to put content out about so you can find me out there pay attention to it's something that interests you know . Work with someone else or come work with me , because I enjoy what I do . I like building success stories .

I love this hormone stuff . It just it's just fascinating to me and it's really cool to hear him talk about hey , you don't , you don't have to have drugs to get fixed . I appreciate that .

Again , I feel like we've known each other for a year or so now and it's been so great to watch you blow up and understandably so I mean your credibility and just the brilliance of you putting it out there of stay off my operating table when there are so many people where that's their all , their bread and butter and that's what their skill said is I know

how to use the knife , and the fact that you want to not use the knife when you don't have to is a kudos to you , brother Sure .