Ep.113 Hormone Therapy and Weight Loss: Transformative Health Strategies for Midlife with Dr. Nicole Lovat

In this episode, we are excited to welcome back Dr. Nicole Lovat, a specialist in women's health and hormone therapy. Dr. Lovat opens up about her career transition from primary care to hormone therapy and shares the latest advancements in hormone replacement therapy (HRT) and weight loss, offering invaluable insights for anyone facing midlife health challenges.

Discover the profound benefits of hormone replacement therapy for women going through perimenopause and menopause. From understanding the critical roles of progesterone, testosterone, and estrogen to debunking myths about hormone treatments and their risk, this conversation is packed with the latest science. We dive into the protective effects of estrogen on our brains, bones, and hearts and  highlight the cosmetic and libido-boosting advantages of hormone treatments. Dr. Lovat passionately advocates for tailored hormone therapy to enhance the quality of life during these transitional years.

We also delve into optimizing hormone therapy alongside nutrition and self-care. Dr. Lovat emphasizes the importance of addressing thyroid function, incorporating weight-bearing exercises, and ensuring adequate protein intake before considering weight loss medications. The impact of environmental endocrine disruptors on thyroid health and the necessity of proper thyroid testing should not be overlooked as we try to fine-tune our hormones. To wrap up, find out how to connect with Firefly Medical for consultations and support. Don't miss this empowering and informative episode that aims to equip listeners with the knowledge to make informed decisions about their midlife health.

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling rundown. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
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Transcript

Michele Folan: 0:00

My story of midlife and menopause is probably not unlike yours. The midsection fluff came from nowhere. I was tired and achy. Not sure why I waited so long, but I did get coaching, but only after looking at the multitude of programs out there on the market. You don't have to spend a lot of money, do crazy workouts or buy a bunch of special food to get results. Let me show you how. My six-week group program starts every few Mondays and I promise by week two you will feel better and by week four you will start to see body changes. By week eight, other people will want to know what you're doing. This is not a diet. It's a lifestyle with sustainable results. Are you ready to invest in you? I'm happy to get on a call to explain the FasterWay program or just check out the info in the show notes. You can even send me a DM on Instagram. I can't wait to work together Health, wellness, fitness and everything in between.

Michele Folan: 1:10

We're removing the taboo from what really matters in midlife. I'm your host, Michelle Folan, and this is Asking for a Friend. As things are rapidly changing and progressing in the realm of hormone replacement therapy and women's health in general, it's sometimes difficult staying current on all the latest and greatest in order to make the best decisions for our health, but how do we cut through the confusion? My mission is to arm my listeners with information so we can do our own research and feel empowered to have discussions with our healthcare providers. There is a lot of noise out there, ladies, and today we're going to chat with Dr Nicole Lovat about all things, hormones and weight loss. She returns to Asking for a Friend after her top Listen To episode in 2023. And I'm super excited to have her back for round two. Welcome to Asking for a Friend, Dr Nicole.

Nicole Lovat: 2:09

Lovat, thanks, happy to be here. I appreciate being invited back.

Michele Folan: 2:13

You know now that I'm doing the math. You may have been expecting last time you were on the show, because you have a new baby.

Nicole Lovat: 2:20

Yes, we welcomed our son in December of last year. He's turning six months this weekend.

Michele Folan: 2:26

Well, congratulations, that's fantastic. Thank you. I know who you are and if anyone had heard the podcast with you last year, they certainly are familiar with you, but I think it'd be nice to just get everybody caught up on where you're from your schooling and where your practice is.

Nicole Lovat: 2:44

So I was born and raised in Winnipeg, Canada. I took my training at University of Manitoba initially. My undergrad degree was biochemistry and physics a double honors program. Then I went into medical school and I was recruited into the clinician scientist program, where you do your medical degree at the same time as a PhD, and my chosen area was pharmacology and therapeutics, so it was drug science, specifically in women's health, female physiology, pregnancy and metabolism, and so that's sort of my background. I then trained in residency in Canada and eventually moved to the States in 2018 because I married an American. Good reason.

Nicole Lovat: 3:22

Our practice is based out of the Midwest and we have two locations in North Dakota and one in Washington State. Oh wow, how do you manage that? I'm optimized.

Michele Folan: 3:34

You're optimized. That's putting it mildly, or do we call that spread thin?

Nicole Lovat: 3:41

I have a good team and we have really rock solid providers.

Michele Folan: 3:45

Okay, that's great, and so that's new, because since we spoke last year, you've also added a practice.

Nicole Lovat: 3:51

Yes, we purchased a building in Fargo, North Dakota and we opened that this year and we just hired a full-time nurse practitioner, Nicole, who started June 1st at that practice.

Michele Folan: 4:01

Your practice has evolved to really meet the needs of midlife women. I think that's fair to say what drives you to keep offering more services in that realm.

Nicole Lovat: 4:15

I think it's extremely rewarding to introduce therapies to someone's life that actually make them feel better and work. In 95% of your patients. It's sort of like having a magic bullet. You're like I know I can get you to sleep on progesterone, I know I can give you more energy, and so instead of sort of shooting in the dark with synthetic medications, I've used in the past before hormones where maybe 10 to 20% respond. So many more of my patients respond well to this treatment. So it's very rewarding to have those follow-ups and start those consults.

Michele Folan: 4:50

I have to backtrack a little bit, because you did tell me a really cool story that this wasn't the path that you originally had chosen. You had gone to a seminar on hormones and, like right before you were getting ready to open your primary care practice. Can you tell that story a little bit, because this is actually fascinating?

Nicole Lovat: 5:12

So I've always been interested in pharmacology. Clearly, I did the PhD in that area and I was at a filler conference two weeks before we opened to do an advanced anatomy course on a cadaver, and I ran into a colleague there and we started talking about how the dietary guidelines aren't good for people and a lot of the downsides to a lot of the mainstream medications, and I asked him where he had received his hormone training. He said, okay, you need to go to this course and it just so happened there was a course the following weekend and so I signed up for it and went through all the stages of grief, realizing I knew exactly what to do now for myself and a lot of the female patients that were sort of everything's normal, you must be busy, you must just be getting to that age. I knew how to treat them now, and so I talked to my husband and I said we have to change what we're doing and we pivoted to 100% weight loss hormone therapy.

Michele Folan: 6:07

Okay, yeah, I think that's great, and certainly your clientele. That population is growing every day. I do want to talk about HRT. We could probably do a whole show on just that topic. Probably do a whole show on just that topic. What are the current recommendations for women in perimenopause and menopause?

Nicole Lovat: 6:30

It depends who you ask.

Nicole Lovat: 6:32

If you look at ACOG or other OBGYN groups, they will say you should be on the least amount of hormones for the least amount of time and they're using studies based on synthetic hormones.

Nicole Lovat: 6:45

In my opinion, if you're in perimenopause and you have any symptoms of low progesterone, like hot flashes, insomnia, night sweats, anxiety, irritability, you should be on the progesterone dose that cushions that transition as much as possible, so you don't end up with relationship issues or needing any depressants or other interventions. So you don't end up with relationship issues or needing any depressants or other interventions. If you have any symptoms of thyroid, like feeling cold when you're not having a hot flash, constipation, fatigue, weight gain, a thyroid hormone can play a role too in that transition and improving your quality of life. And then we often think of menopause as the time where all of our hormones are gone, but we actually lose testosterone at a much younger age, and so in perimenopause you can replace testosterone to help with libido and preserving sexual function. And then when you transition into menopause, that's when you finally lose the estrogen, when that becomes important to replace to preserve your metabolism and your bone health.

Michele Folan: 7:38

So if I were in perimenopause, you would then maybe use progesterone and testosterone without estrogen.

Nicole Lovat: 7:46

Correct, yeah, so the big distinguishing factor of whether you can use estrogen is whether you're in full menopause or not. If you're not in full menopause, we don't use estrogen, because it can have very unpredictable results, because your own ovaries are still making it and one of the big hormonal changes in perimenopause that gives you the high estrogen to begin with is a loss of the hormone inhibin that controls estrogen production. So you're kind of putting gasoline on a fire, possibly by giving estrogen before that menopausal state.

Michele Folan: 8:16

Ah, okay, I get it now. So when you do prescribe, say progesterone and testosterone, Prescribe, say progesterone and testosterone, Are you doing levels or are you basically assessing based on symptoms?

Nicole Lovat: 8:30

Both Okay. So there's kind of two major groups of women. Women with low progesterone. They aren't making it anymore. They've transitioned close enough to menopause that they just don't make progesterone anymore. And then there's women that may have underlying PCOS, that have progesterone resistance. So they might be still making some, but when the hormone's binding the receptor it doesn't create as much of a signal. So you can think of a stone skipping on a lake. If you have resistance, if the water's really thick, the stone won't make much of a bounce. So when that progesterone receptor gets bound, the signaling cascade is not as intense or pronounced. So they get less of an effect from the same level. So they might need a much higher level for the same benefits.

Michele Folan: 9:12

Okay, got it. Can you talk about the short-term and long-term benefits of being on estrogen? So I'm 60 years old, I am on oral estrogen and I also have osteoporosis. What else, besides bone health are we looking at now in regard to the benefits of estrogen?

Nicole Lovat: 9:33

So, if you're looking at oral estradiol, you generate metabolites in your liver from the blood from your stomach going to your liver. Next, that produces metabolites that will actually eat plaque in your arteries that you formed since menopause or during your 40s. It raises good cholesterol, hdl. It lowers triglycerides, lowers blood sugars, lowers insulin, which results in reduced visceral fat. So you're looking at major disease prevention for Alzheimer's, cardiovascular disease, stroke, diabetes.

Nicole Lovat: 10:10

It also has a central role in the brain in terms of improving sex drive centrally and sexual function, such as your central nervous system, regulation of orgasm versus anything in the pelvis. It keeps the part of your brain that regulates your balance healthy so that you would be less likely to develop balance issues as you age. And then in the brain it also reduces appetite. So a lot of women will get much more cravings for sweets and salty foods after menopause and estrogen will reduce those. And then you're talking about a major improvement in bone density. So instead of losing two or three percent a year, you gain two to three percent of your bone density back. So instead of losing 2% or 3% a year, you gain 2% to 3% of your bone density back. So if we look at women that go into menopause. The quicker you can get them on the estrogen, the better they do, because they're not going to spend years losing bone density that they have to then regain.

Michele Folan: 10:56

Okay, how long can I be on estrogen?

Nicole Lovat: 10:59

Until your funeral.

Michele Folan: 11:00

Okay, I'm so glad you said that because I will tell you right now you're not going to pry it out of my cold, dead hands. I mean, I'm not going off of it, and I think that is such a change that women need to hear. That whole thought process has absolutely shifted. The patch, the estradiol patch, versus oral. Yeah, what do you prefer, and is there a difference?

Nicole Lovat: 11:29

So there's this thought in the medical community that oral estradiol can cause blood clots. No study has ever shown that. Whenever there's been a blood clot finding involving estrogen, there's always been a sidekick synthetic progesterone. That's actually the hormone causing the blood clots. So progestins are prothrombotic because they increase insulin resistance and increase your clotting risk. Oral estradiol does not. In fact they've done studies on women with clotting disorders and they clot at the same rate whether they're on oral estradiol or not. So how could it? And then, when you look at other studies that measure clotting, cascade factors like fibrinogen, those markers in the blood improve on oral estradiol. So again, how could it cause blood clots?

Nicole Lovat: 12:16

But that's the main reason why people are scared of oral estradiol is, like, well, it could give a blood clot to someone and it's just not the case. It's a different hormone than the one that does do that. So that's why a lot of people will choose transdermal, because, like, well, I don't want to get into trouble with a blood clot. Because if somebody gets a blood clot and they're on oral estradiol and they go to the ER, the ER doctor has been taught well, that's what caused the blood clot, even though it's not what the literature says so. That's the main reason why it's not used.

Nicole Lovat: 12:44

I only use oral estradiol unless I have a very compelling reason not to. And the most compelling reason would be somebody with a history of blood clots that is themselves not convinced that it couldn't cause that, and then I'll say okay, then you can get the transdermal. It won't work as well. You're missing out on the first pass metabolism with the transdermal. So I mentioned, you swallow the estrogen and it goes to your liver. It gets chopped into pieces when you have a patch. There's no ingestion, so you don't send that hormone through your liver for that first pass metabolism. So you don't get a lot of the metabolites that'll improve cardiovascular outcomes.

Michele Folan: 13:21

Okay, all right, I'm feeling really good right now about my oral estradiol.

Nicole Lovat: 13:25

Have you noticed a big improvement going on to the oral?

Michele Folan: 13:29

Well, I was on vaginal before. Oh yeah, just on vaginal. So I have to tell everybody this story because this is really pretty good. Last year, after you and I spoke, I took copious notes because I was so intrigued by everything that you were saying. I show up at my GYN appointment talking to my nurse practitioner and I had a list for her. I think she was probably like back it down, sister, you're a little too excited here, but I went from vaginal estradiol to oral, I got put on progesterone and I was already doing topical testosterone because I was post-hysterectomy.

Michele Folan: 14:17

Yeah, so I really feel like talking to you really set me on a much better path. And can I tell the difference? Absolutely, and I haven't had my bone density done yet. I or the second right the follow-up, because I just had the first one done a year ago, but I am very curious to see if there are some improvements there. I did have blood work done, done in September of last year, and all of my metrics, all of my biomarkers, improved. Yeah, so, yeah, so that was really great to hear.

Nicole Lovat: 14:58

Your provider can measure your bone turnover using a blood test as well. Oh really, yeah, used to be N-telopeptide. They don't offer that anymore and I believe it's called CTX.

Michele Folan: 15:10

Okay.

Nicole Lovat: 15:10

CTX. They can measure and if it's a higher range of normal you have high bone turnover and it changes sooner than the bone density will, because you can say, oh look, your bone turnover is low, that's good.

Michele Folan: 15:22

Okay, all right, I just wrote that one down. I did get a question from a listener about progesterone. Do you always recommend that progesterone be added to estrogen therapy?

Nicole Lovat: 15:37

Yes. So again going back to synthetic hormones, the school of thought is if you have a uterus, you need to oppose estrogen with progesterone. But if you've had a hysterectomy, you don't need progesterone. But if you still have your ovaries, ovaries are sensitive to estrogen and if you have breasts, which most women have, those are also sensitive to estrogen. So you want to oppose the estrogen and all the estrogen sensitive tissues to have balanced receptor signaling. And progesterone is so good at promoting deep sleep, rest, reducing anxiety, that it's a very good hormone to be on, just for quality of life. As you know, lots of women in menopause don't sleep very well and that's because they lost their progesterone and you can replace that for them. I don't care if you have a uterus or not. You still have a brain that could use it or breasts that could.

Michele Folan: 16:27

Who should not take oral estrogen or use the patch. Where are we now on the whole realm of cancer?

Nicole Lovat: 16:36

Well, if you look at the oncology literature. Estrogen is, whether it's synthetic or bioidentical, is protective against breast cancer recurrence and lowers the risk of breast cancer, in addition to lowering your risks of heart attack, stroke, diabetes, dementia. There's a big paper that just came out this year talking about the protectiveness of estrogen in breast cancer and recurrence. But if you ask the oncology community, they say it's what causes breast cancer. But that doesn't really make sense because we get it at a life stage when we have abnormal estrogen regulation, not when we're young and fertile. For the most part, most breast cancer is menopausal, so it really just depends. Dr Rousier, it has to be careful with how he teaches this topic. He says you know, if it was my wife or my daughter or me or mine, then obviously this is how you would treat this type of cancer. But you can't really treat patients with it. So it's a sad part of medicine that I think is being mismanaged right now.

Michele Folan: 17:38

I don't know a lot about breast cancer, but there's like estrogen positive-.

Nicole Lovat: 17:44

HER2, progesterone.

Michele Folan: 17:46

HER2, yeah.

Nicole Lovat: 17:47

So if we look at breast cancer cells, they they have various receptors that they're positive for. Every cell has, for the most part, an insulin receptor, and we don't talk about how insulin is the cause of cancer too. It's actually insulin resistance and an estrogen imbalance across the cell that feeds the breast cancer. And if you give high doses of estrogen you restore the insulin resistance and then you get rid of the cancer. And progesterone and testosterone are both apoptotic to breast cancer, ie when they bind. If a breast cancer binds that hormone it commits suicide, basically the cell. So high doses of testosterone and progesterone can also help. But that patient has to really step outside their oncologist recommendations to want a treatment like that. And often they're spouses of hormone doctors or family members of providers that know that this isn't how you would treat it if it was you. But a lot of patients don't get that treatment because it's too risky, because the whole oncology community doesn't support it.

Michele Folan: 18:54

How about using estrogen creams on the face? So, there are some companies out there, My Alloy and Musely. They make these creams that have an estrogen base to them. Can we use our vaginal estrogen? Can we use that on our face?

Nicole Lovat: 19:14

You could. Estriol is not terribly potent. It's sort of one of the lower potency estrogens. You're way further ahead to take oral estradiol and you'll get the cosmetic benefits and combine it with testosterone and get even more cosmetic benefits like cellulite reduction and wrinkle reduction, than using the cream. But if that's the only thing you have, I guess you could.

Michele Folan: 19:39

Okay, I had to ask that because that was a question I got from a listener and I thought it was a really good question, because a lot of us have a tube of that in our bathrooms and when we use it on our faces, all right, I didn't think there'd be any harm in it, but I thought I better ask Dr Lovat. Low libido is a huge topic and we've covered this many times on the podcast. You say you're using testosterone with success. How are you dosing that? Is it topical or pellets? What's the current thought

Nicole Lovat: 20:16

I use topical with daily application for most women. The pellets I think they have a role. If I was elderly and stuck in a nursing home and that's the only way I could get my testosterone, I would get a pellet because my family could break me out once every three to six months for it. But for the average person the cream you're going to get a much more stable level. You're not going to have that up and down where you feel like superwoman for six weeks during the pellet but then you're kind of coming up or going down from that feeling woman for six weeks during the pellet but then you're kind of humming up or going down from that feeling. And then you also have no control once you place the pellet.

Nicole Lovat: 20:52

If it's too much for the patient they can get a lot of hair loss and acne and maybe a libido. That's destructively good. And they're stuck. They have to ride it out because you can't take it out. The transdermal creams we can go from very low concentration to quite a good high concentration, so you can dial it up very slowly. And then there's women like I have a young baby at home that might not want to risk any contamination of the cream spreading to him. So you can also use injections in women, like twice a week or three times a week with a testosterone oil.

Michele Folan: 21:26

Oh, okay, that's interesting. I have not heard that before. The risk of transferring the topical onto somebody else is that a real possibility?

Nicole Lovat: 21:37

It's more so with the male cream and if they're not washing their hands really well, Because I have plenty of men that are on treatment with a high dose male cream and their wives have no testosterone in their systems. When I check their levels I'm like, okay, he's not spreading it at all, Whereas other men. There's been case studies of precocious puberty in the children of men that are putting cream on because they're not washing their hands well or they're sleeping with their children right after putting the cream on. So it's more women that are more a little paranoid that I just don't want even a little bit of a chance. And I get that because it's your baby and you don't want to give them a proclivity no, God, no.

Michele Folan: 22:20

And then where do you typically have patients apply the cream?

Nicole Lovat: 22:24

The best place for the sexual benefits and the tightening of the pelvic floor is the labial area outer labia and they're going to get all the sexual benefits from the testosterone. And then they're going to get some of the estrogen benefits that you would normally expect from a cream, like lubrication and prevention of UTIs, urinary tract infections.

Michele Folan: 22:44

Okay, that's fascinating. Yeah, Okay, that's fascinating. You know, you told me last year to use the testosterone around the labia and I didn't know why. GLP-1s are all the buzz these days? I mean, here are the commercials you know, every time you turn on the radio, the TV. Can you just first get into the mechanism of action of how these GLP-1 drugs?

Nicole Lovat: 23:26

So the main mechanisms? There's a few of them. They increase insulin sensitivity, so they improve the insulin resistance that's underlying a lot of weight gain. They increase satisfaction from food, so you feel full faster, and they also slow down how quickly your stomach can empty, so whatever you do eat sits there longer, so you feel full. It also interrupts some reward pathways between the gut and the brain, where you get a rush from eating a donut. You don't get that rush when you're on the medication for the most part, so you're much less likely to want to eat it because you're not getting the dopamine from it.

Nicole Lovat: 24:03

The problem is, is you they're not being used, in my opinion, in the right order.

Nicole Lovat: 24:13

You have to optimize the patient's naturally occurring hormones first, and also teach them how to eat before you use a tool like that, because you're setting them up for failure. The body is able to compensate for calorie restriction very quickly within months, and so you have patients that don't lose any weight or they lose very little because their body is compensating by slowing their thyroid down a little bit more, slowing their metabolism down, and so you end up with this miracle cure for obesity. That's not working and then your metabolism is that much more deranged by the time we can fix the other hormones and restart that medication. And if you use the weight loss shots as a tool but you don't change your diet and you're eating popcorn and chips and cake on it instead of protein, you get a lot of malnutrition, you lose fat in your face, you look unhealthy, you have a lot of sagging skin and you don't have the protein that you need to keep any of your muscle. Which is the big downside to this drug is loss of muscle.

Michele Folan: 25:12

Okay, May I just say three cheers for Dr Lovat. I am so appreciative of your perspective on this because I'm a health coach now and I have a client who has been on these drugs and she gained all her weight back plus some, and I was explaining to her. I said, when we lose a dramatic amount of weight up to 30% or more that can be muscle. Yeah, and I love what you said about eating protein and what about lifting weights and making sure we're getting a lot of resistance exercise in.

Nicole Lovat: 25:50

So my ideal treatment plan for either men or women, is to get them on, optimize their thyroid if needed, and testosterone if possible, because that will help them preserve more of their lean muscle. And then I do want them to be trying to do weight-bearing exercises to keep their muscle and then trying to get a gram of protein per pound of body weight. So I'm kind of like even if you're not hungry, you need to eat. You need to hit that protein target because if you don't, there's a set point in your brain, in the hypothalamus, that says this person needs to weigh X pounds. And if you don't influence that set point with hormone therapy like testosterone and thyroid, your body will compensate to get you back to that set point.

Michele Folan: 26:34

So you are using these drugs in your practice. Are you doing the name brand or are you doing a compounded formula?

Nicole Lovat: 26:41

If a patient's insurance will cover the commercial, then we'll use that. Otherwise, we have compounded. It's a lot less cost prohibitive for the patient to use the compounded and we have various pharmacies we can get that from and it's high quality and it works well. I would say only about maybe one in four or one in five of my patients ends up on that medication and they don't usually stay on it. We use it as a tool and then they come off. Okay.

Michele Folan: 27:09

Have you heard about microdosing, so using a compounded formula and then microdosing? Can you talk about that a little bit?

Nicole Lovat: 27:16

Yeah. So the idea is, if you're getting toxicity from a drug because of the peak in the valley, so you're throwing up for three days after your shot but you feel fine for four days, then if you take that same dose and you split it up into a daily injection, your peak never gets as high you stay below that threshold that you're going to feel sick, but you still get some of the benefits of the insulin resistance and the impaired reward pathways. So you could say let's say if you're going to take, if you're supposed to take 14 units a week, you take two units a day. Instead you divide it by seven. Other people will do like twice a week injections. Instead they'll take their weekly dose and divide it into two.

Nicole Lovat: 27:53

I do that with some patients that are having that can't tolerate the full dose all at once. How long can we be on these drugs? We don't know. They haven't been around a full human lifespan yet. So there's a lot of bad things in the media about them too, like stomach paralysis, and there's mental health things that are coming out now. But I think a lot of these really bad side effects are because the patient's thyroid levels are crashing to compensate for the drug to get the weight back on and so you're getting like constipation and heartburn and depression because your thyroid levels are going down. And I just don't see really that in my patients because we've done it the other way around, so smart.

Michele Folan: 28:32

I would love to talk about the thyroid, because you had recommended last year that I get my thyroid tested, but you were very specific in the test that I asked for and I don't recall what that was and I'm going to ask you again.

Nicole Lovat: 28:47

So generally at your primary care office we check TSH and we stop there. The TSH is a measure of what your brain is telling your thyroid to do and if that's out of range then we get levels. There's a great deal of evidence out there that anything a TSH outside of the range of one to two naturally occurring like that's your baseline is probably you're probably working too hard. We might want to call that hypothyroidism when the new guidelines come out. That being said, you want to know what you're actually making as well. So I measure free T3, which is active thyroid, and free T4, which is the storage thyroid, and then I may or may not order a reverse T3 level. Reverse T3 is a compensatory mechanism. I usually tell my patients that if you're an Irish peasant running from the English, you activate that pathway so you can get fat on 300 calories a day. That's what it does for you. It blocks your receptor for T3 and it lowers your TSH to help you make less thyroid to get your metabolism to be in survival mode.

Nicole Lovat: 29:45

Inflammation also does that like chronic fasting. That's too aggressive, that kind of stuff. And then you may or may not want to explore antibody testing. So if you have autoimmune disease history, lots of patients in their family have Hashimoto's or Graves. The antibody testing can just give you another layer of well, do I have an underlying autoimmune that I'm losing thyroid tissue from my Hashimoto's, or am I having complications from my Graves disease? Because it's the Graves antibodies that cause the complications that are attributed to a low TSH. It's actually Graves disease patients and they have certain antibodies that attack their bone, their heart, and so it's good if you're having symptoms of that illness to know that you have it. So you can say well, that's why I'm going to get thyroid eye disease or that's why I might get AFib. It's my antibodies, not the thyroid hormone.

Michele Folan: 30:37

Okay, this always blows my mind when I talk to you. I was like I gotta take a minute here. What I appreciate so much about your approach is that it really is a multi-pronged approach. You don't just have an obese patient or someone that wants to lose weight in front of you. You're looking at the entire story there and what you're really saying here is that thyroid is really at the root of a lot of stuff and what we have now in our environment.

Nicole Lovat: 31:11

We've never had so many endocrine disrupting chemicals that affect thyroid. So many endocrine-disrupting chemicals that affect thyroid, like the pesticides and herbicides on our lawns, the flame retardants on our furniture, the microplastics, the BPA, the phthalates. They all affect thyroid hormone, and so we're constantly being immersed in an environment that's disrupting thyroid function. I personally think that it has to be contributing to our obesity epidemic.

Michele Folan: 31:39

Has all of this changed how you live, how you're managing your home?

Nicole Lovat: 31:49

We try to minimize that you can control. We use reverse osmosis water. We try to eat organic. When we can, we get meat from a farm that we know is good quality. But at the end of the day you go on an airplane, you hang out in an airport lounge, you stay at a hotel. There's just only so much you can do to control that.

Michele Folan: 32:10

Yeah, how often should we be getting our thyroid tested?

Nicole Lovat: 32:16

I think it depends on who's testing it. I've had most of my patients that are 35 or older have had their TSH tested probably 10 times by the time they hit my door and they've been told it's normal, so we're not going to do anything. You need to get it tested once by the right person and then the TSH really doesn't matter too much Because, again, there's a cultural thing in medicine that a low TSH is dangerous. But if you look at the medical literature, a low TSH is associated with Graves and Graves is dangerous. It's not. We know that in women without, or men without, Graves disease when we use suppressive doses of thyroid hormone. We don't see osteoporosis, we don't see AFib. We don't see what people are worried about would happen with a low TSH.

Michele Folan: 33:06

Okay, and if you're not having any symptoms, would we still test?

Nicole Lovat: 33:12

No symptoms are fatigue, weight gain, cold extremities, an inappropriately low resting heart rate when you're younger and inappropriately low blood pressure. You can have constipation depression. So I mean there's a lot of thyroid symptoms that could a lot of people fit the bill with that, and so sometimes we'll do a trial of therapy. What that means is your TSH is normal, but your levels look kind of low for your age and you're having a lot of symptoms. We'll give you thyroid hormone. If all of your symptoms get better, that's a success and that's what most patients tell me. Oh my gosh, I feel so much better If they don't. Well, we tried it was a trial of thyroid optimization and there's no permanent damage from taking thyroid temporarily. Your thyroid goes right back to what it was making before.

Michele Folan: 34:02

Okay, I would love to ask you what one of your core pillars of self-care is. Protein, yeah.

Nicole Lovat: 34:11

Yes, Even if it's convenience like I have to buy pre hard-boiled eggs at Costco and packaged proteins like that because I'm too busy I really try to get that in and I never forget my thyroid.

Michele Folan: 34:26

Okay, so thyroid and protein. How much protein are you taking every day?

Nicole Lovat: 34:31

I don't measure it anymore, but when I get off a night shift I'll have a big steak with an avocado, or hamburger patties just with salt and pepper, that kind of stuff. Hard-boiled eggs. Okay.

Michele Folan: 34:43

Yep, I love that. I'm trying to get to 120 to 130 grams per day. With the osteoporosis and being 60 and wanting to be able to do stuff when I'm 80, you know all of that, Dr Nicole Lovat, where can people find you?

Nicole Lovat: 35:02

The best place would be either on our website or social media. So we have a website where you can email in your request for a consultation and then our clinic director will sort people to the right provider, or you can can reach out to us on social media as well.

Michele Folan: 35:19

Okay, and it's Firefly Medical correct.

Nicole Lovat: 35:22

Yeah, fireflymedical. net is the website and it's at Firefly Medical for social media, perfect.

Michele Folan: 35:28

Yeah, Dr Lovat, it was great seeing you again. Thank you, I enjoyed it. Thanks for being here. Follow Asking for a Friend on social media outlets and provide a review and share this show wherever you get your podcasts. Reviews and sharing help us grow.