Terri DeNeui, MSN, APRN,-BC, DNPs, founder and CEO, Clinical Operations, of EVEXIAS Medical Centers in Dallas, Texas, talks about how hormone imbalance can affect weight loss.
Interview conducted by Ivanhoe Broadcast News in July 2016.
What hormone therapy is the best in your opinion?
DeNeui: Our platform is bioidentical hormone therapy. We prefer a natural hormone balance and we utilize subcutaneous pellet therapy, which means the pellets are placed under the skin. The pellets are cardio-activated, your body receives as much hormone, either estrogen or testosterone, as you need at any given time.
What are the most common complaints of patients seeking your service?
DeNeui: When people come in to our offices they’re typically complaining of a plethora of really vague symptoms like depression and anxiety, irritability and mood swings, brain fog, difficulty sleeping, definitely weight gain, loss of muscle mass. Memory loss is also a really big complaint.
Brain fog and memory loss, we’re talking about people in their thirties and forties?
DeNeui: Sure.
Really?
DeNeui: Yep. And it’s nuisance stuff like where did I park my car or why did I walk in this room or where did I put my keys? Just little things that we typically chalk up to stress, overdoing it, and that kind of thing; we have too much on our plate.
But you’re saying that has to do with hormone balance?
DeNeui: Yes, often.
How so?
DeNeui: Well it’s primarily testosterone for men and women both. Obviously, men make testosterone. Most people don’t know that women also make testosterone; it’s a really powerful brain hormone. There are literally thousands of receptors for testosterone in the areas of our brain that’s responsible for mood and thinking and mental clarity. Testosterone levels in women start to decline in their thirties and for men mid-thirties but definitely by their forties. Symptoms are normally very vague when the levels start to decline, like brain fog and memory loss. Kind of the blues, the blahs, and the things they once loved like fishing, golf or shopping (for the ladies) they really don’t have a desire for.
When did you start learning that weight gain or weight loss could be related to hormone levels?
DeNeui: I first discovered the weight gain and hormone decline connection after seeing hundreds of patients over and over with the same complaints. But then, most importantly, after we would get their hormones balanced, added some key nutrients and optimized their thyroid function, they would come back the next time and say, wow, I’ve lost five or ten pounds and I didn’t even try.
There’s a connection between hormones, specifically testosterone and cortisol levels. Insulin is another hormone. They all work in tandem together and have a synergy that when some of them are off, it just kind of messes up the whole metabolism chain. For a lot of people just getting those hormone levels up will make a huge difference. A lot of people would say that their efforts to achieve weight loss actually pay off. One of the biggest complaints we would get is: “I’ve done everything. I’ve gone low calorie and I exercise and I eat healthy and I just can’t budge the weight.” And then, when we get some of these things tweaked, all of a sudden it is working.
Was the feedback from patients supported by research?
DeNeui:. I was getting feedback from patients and then definitely started doing some research. I made it a point to when I would go to continuing education at some of the big conferences, to find conferences and seek out speakers that were really speaking to hormones and weight and those connections. I’m a big reader, so I read lots of books. There is a plethora of information and data out there. I really started connecting the dots and seeing the correlations to low testosterone and high cortisol levels. When your cortisol levels go up, which can happen from stress as well, insulin resistance goes up. Type II diabetes, weight gain, especially in the middle section of your body, that all becomes a real problem.
What is the bottom line to the relationship between our weight and our hormone levels?
DeNeui: It kind of goes both ways. Our hormone levels decline and for a woman, that’s when they lose estrogen, progesterone and testosterone; all three can contribute. There’s a syndrome called subclinical hypothyroidism and that’s where your lab tests are normal but you’re having all the symptoms of low thyroid and sluggish metabolism. That’s a really key aspect to consider because thyroid hormone is the key to metabolism in every single cell.
When we’re talking about looking at hormone balance we’re not just looking at an estrogen or a testosterone, we’re actually looking at all of them and how do they work together. That’s one aspect of it. Also, as we gain weight and we get that weight gain in the middle section, that’s where estrogen is stored. Sometimes men complain that when they get that belly, they also start getting weight in other places that they historically might not have and that’s because they’re actually making more estrogen. As their testosterone levels fall, their estrogen levels go up.
That would be for men?
DeNeui: Yes.
What are the hormones that are affecting the thyroid?
DeNeui: Pretty much just thyroid. There are some minerals and some nutrient deficiencies that can affect thyroid. Obviously there’s iodine. Iodine levels are really low in most of us these days commercially prepared because baked goods are not fortified with iodine like it once was in the seventies. When Vitamin D levels are really low, it can also increase Type II diabetes risk and really mess with your hormones. There’s a lot of autoimmune diseases coming out right now, thyroid being one of them, so we test for that as well. But you really have to pay attention to that because when you’re gluten sensitive, and deficient in selenium and zinc that can cause an autoimmune attack on the thyroid. The number one thing that causes an autoimmune attack on the thyroid is actually gluten. People that are gluten intolerant really have a hard time with their thyroid and weight gain.
Overall, just as a message, if people want to lose weight should they look at their hormone levels, is that what we’re talking about.
DeNeui: Absolutely. Overall, just as a general message, weight loss isn’t just about calories in, and calories out. We’ve always been duped to thinking that it’s just about what we eat. Now that is a huge part of it, obviously, and exercise is key, but hormones and what’s going on inside the body at the cellular level where metabolism actually happens has got to be a part of any kind of weight loss regime. Otherwise you’re just going to be spinning your wheels. The weight might come off but it’s going to go back on if you don’t address the root cause and that’s really what I’m focused on, the root cause.
Are you saying that the root cause is an imbalance in hormones?
DeNeui: I’m not saying it is the root cause for everyone who’s overweight, but in many people, yes. The root cause for a lot of weight gain or difficulty losing weight is hormone imbalance, absolutely.
Is that widely known or widely accepted in your opinion?
DeNeui: Probably not. We’re more interested in quick fixes, low calorie diets, HCG diets and all these things that actually make the thyroid function worse. Some of these low calorie, five hundred calorie diets that people go on really whack the thyroid out and can exacerbate the problem. But unfortunately, it’s not really taught in our curriculum for medical practitioners. We’re not really educated abut hormones. We skim the surface of nutrition but we’re basically taught the general rule of eat less and exercise more. It’s actually so much more than that.
We’re going to meet somebody a little later, what’s her name?
DeNeui: Brandy.
Tell me about Brandy, what was her issue?
DeNeui: Well Brandy had been struggling with difficulty losing weight for a long time. Once she finally decided to really step up and take what we do very seriously she realized some things about herself with her diet. One of the biggest things is that we start with detoxification. It’s an elimination detoxification; she was eliminating certain foods out of her diet. She started feeling better, some of that belly bloat, that ache and some of those symptoms began to go away. Without even trying she started losing weight just on the detoxification. Then, she noticed as she was adding those things back in, that some of the foods caused the belly to start bloating up. All of these symptoms were coming back so it was like putting two and two together. Honestly, a lot of weight gain problems are from food sensitivities, not food allergies but sensitivities. It causes this bloating and this viscous cycle of belly bloat and all of these symptoms, also called leaky gut.
In her case how did hormone therapy help?
DeNeui: Brandy’s testosterone was pretty low, which was causing some sluggishness. When your testosterone is low, your energy is really low. She was tired; she didn’t feel like working out. When she did get to the gym her efforts weren’t really paying off because testosterone also builds muscle. The metabolism piece related to the thyroid, and some of the supplements that she was missing like Iodine and Vitamin D, made the testosterone play a big role in her having more energy and increased muscle mass. Obviously, the more muscle we have the more fat we burn. So, the more muscle we have, the more calories we can take in without gaining weight because our muscles need more calories. The testosterone piece was where she was really deficient. She wasn’t deficient in estrogen or any of the other hormones that we typically associate with females.
Is she a good example then of what we’re talking about here of how hormone replacement therapy can lead to weight loss?
DeNeui: Absolutely. Brandy is an excellent example of what we’re talking about with hormones and how hormone plays a role in weight loss. She was able to not only have the energy and put on the muscle, she was able to see those efforts pay off and she was building muscle. Once you start seeing some of those shifts it kind of it motivates you. You start seeing some changes and you’re like, okay this works.
Then, she started realizing what foods to stay away from and what foods caused this viscous cycle of feeling terrible and bloated. It’s a really strange cycle because when we’ll eat those foods and those sugars we start craving them. It’s really interesting, there’s an addictive quality to junk foods, packaged and processed foods. She’s an excellent story of really just making a decision to not only change her hormones, get her hormones balanced, and pay attention to the nutrients that were missing in her diet, but pay attention to the foods that she was eating. To not eat those foods, and knowing that if she chose to eat gluten or if she chose to eat some of these things, she was going to pay a price and it was a choice.
Would you say she has unusual willpower because a lot of people fail to make a real lifestyle change?
DeNeui: I think she just was sick and tired of being sick and tired. That’s really what it boils down to. Willpower is definitely some of that, but it’s fascinating once you get about a week, maybe two weeks of cleaning up your diet the willpower isn’t needed after that because you just feel so much better. Some of the things you might hear her say is that her thinking was clearer, her brain fog was lifted not just from the hormones but also from cleaning up her diet, and getting all that processed stuff out of her system. Once you feel good like that you just don’t want to go back to the other way. Part of the difference, I believe, that really created the success this time, is not only maintaining her hormone balance but really sticking with just the basics of what she knew her body needed. I think that was really the key. It wasn’t a magic bullet, it wasn’t some special diet of one egg and one piece of chicken and weighing food, it’s just not that difficult. Once you really figure out what your body needs and what it doesn’t like, it’s easier. Some of the healthy foods we think are good for us can actually cause issues, for example the so called “night shade vegetables”. Who knew that tomatoes and potatoes and peppers could cause inflammation and cause you to hold on to weight? But some people are very sensitive to those things, so understanding what foods your body works well with and what doesn’t work is the real key.
Do you share with your patients and potential new patients that hormonal therapy leads to weight loss?
DeNeui: It’s a natural conversation, it comes up very organically. I would say probably seventy five percent of women that come into our clinics have two top complaints: they’re tired all the time and they can’t lose weight. The “tired all the time” is pretty easy to fix with getting hormones tweaked and cleaning up the diet. The weight is one of those you just have to make a decision. I have an honest conversation with the patients. I say, I can help you but there is no quick fix and this is a journey, we establish a partnership but you’ve got to do your part.
Do you have proof that this approach works?
DeNeui: Yes, there’s a much higher success rate when your hormones are balanced when you take this approach. Like I said, there are patients that come in and just simply get their hormones balanced, and that five to ten pound nagging weight that’s been on for a couple of years starts to melt away without even trying. Those are the ones that probably only needed to lose maybe five to ten pounds. But then, you have a whole other group of people that need to lose thirty, forty, fifty, sixty pounds, like Brandy did, and that’s the group of people that we really work very closely with.
We make sure that we’re walking them through the program and that everything is in alignment with what they need. It’s a very tailored approach. We also have DNA testing for diet and exercise. It’s a really amazing technology; Brandy also did this. We draw your blood and test your DNA and it tells you what kind of foods and what kind of diet works best for you. A Mediterranean diet, low carb diet or a high carb low protein diet; some people do better with that. It also tells you if weight bearing exercises work better for your body type, for your DNA. Does cardio work better for your DNA? It tailors that approach. Interestingly the company we use is the same company that they used for “The Biggest Loser” program. They tailor their programs to fit their actual DNA. It doesn’t really get more dialed in than with your DNA. There are lots of approaches to this conversation.
When you look in the future do you think that paying attention to the hormone levels will play a greater role in how people approach weight loss?
DeNeui: I think that in the future hormone levels will definitely start playing a greater role and it’s being paid more attention to now. Testosterone is in the conversation now for women, which it hadn’t been a decade ago. This is really the key. There’s a lot of data coming out around thyroid levels and how maybe those blood tests that we look at aren’t appropriate to look at for everyone. Maybe we should look at the patient; if it walks like a duck and talks like a duck, it’s most likely a duck. I think there’s more openness, and the biggest thing that’s driving that in my opinion are the patients, the people. The internet offers a wealth of information, and people are educating themselves whether it’s for good or bad. It could be a blessing and a curse. You know I call that Dr. Google. But people are educated, and they come in and they want more answers than what conventional medicine has historically given them. That’s where a lot of this comes from.
What else?
DeNeui: Wow, we’ve covered the spectrum. I’ve talked about DNA; I talked about hormones, specifically thyroid and testosterone. Vitamin D deficiency is huge. We’ve talked about elimination diets and detoxing, processed foods. We’re seeing so much obesity now and especially in young children. If I could get in front of the school boards and parents and get those packaged foods out of those kids’ lunches, I would. There’s no nutrition there. That’s where it’s starting, and actually, there’s some data coming out now that is showing that our DNA is changing in our children. They’re born with obesity genes because of the foods. They’re born diabetic and it’s just really a travesty what we’re doing with the foods in this country. My passion is educating, and if I can get in front of the little ones it would be perfect because the food industry markets to those little kids.
Is food one of the causes of these hormone problems?
DeNeui: Absolutely, no question. One of the biggest causes of hormone imbalance is our food.
Tell me why?
DeNeui: Because of all the packaged and processed foods, and the pure lack of nutrients. We’re seeing more and more young men and women; I mean nineteen, twenty coming in. Young men with low testosterone, young men that are obese and have gynecomastia which is fatty tissue around the breast, and it’s because their estrogen levels are high. Now part of that is because there are so many hormones in the food. We’ve got hormones in milk, and hormones in meat. I know a lot of people think this is just some “woo-woo, oh the hormones in the meat”, but actually there’s data now coming out showing that it makes a huge difference in hormone imbalance.
There are lots of estrogens; there are phytoestrogens in plastics that are leaking through in to the foods. We’re going to see this more and more, and more data is coming out about the foods and how packaged processed foods are really affecting our entire body. But hormones are the basis of life. The translation of the Greek word hormone is “arouse to activity”. When our hormones are out of whack, which is starting at such a young age now, kids don’t have energy. You see more and more a toddler or an eight, nine, ten, eleven-year old that’s just like: “oh, I just want to lay here on the couch”? Of course, we’re feeding that with video games and I could go on and get on a rant about it, but I think we’re going to see more data coming down the pike in the upcoming years about the foods and the hormones.
How long is the process of what Brandy went through, is this a long term process?
DeNeui: The process of what Brandy did, and many others do with the hormone therapy, is come in and get a blood test. We check a plethora of things besides hormones and Vitamin D levels. We check iodine levels and of course thyroid, we go really deep into thyroid optimization. After that, we have them come in to discuss all their lab work. We discuss where their imbalances are, where the deficiencies are, what they are looking for: weight loss, sleep deprivation, moods, etc. It’s tailored to them. Get the hormones tweaked from the standpoint of what we see there.
Then, we’ll bring them back in about five to six weeks to retest their blood, to see to which level their hormones got to, how are they feeling, and what’s going on. After that, we have the conversation about the weight that they’re trying to get off and what they’re goals are. Because sometimes, what we see when hormones are really down, and they just feel really down, is that they feel bad. They couldn’t care less about losing weight, right? But when they feel better, all of a sudden they’re open to having the conversation about what they can change in their health and diet. That’s where we just introduce the different modalities.
You said you used pellets right? So in her case, it was mostly testosterone?
DeNeui: For Brandy it was all testosterone. The way we treat hormones is with pellet implants. This is my preferred method, because I’ve done tons of research and I’ve also used several of the other modalities like creams, patches, pills and shots in the past. There are two reasons for this approach: Number one, the pellets have been around the longest. They’ve been around since the thirties. They’re not new; they’ve got the most studies behind them. In the forties is when we discovered women made testosterone, so there’s a lot of data behind them. But they’re also dosed and tailored to the patient. It’s dosed on parameters of age, weight, blood levels and activity levels. Then they go right under the skin in the fatty tissue and they slowly release over time. Rather than a roller coaster you get from shots for instance. Guys get a shot, their levels come up and they stay there for a few days. Then, they come down and they’ve got to get another shot, and you’re on this roller coaster.
With pellet therapy, for men, their levels come up over the course of four weeks. They stay up for about five months and then they start gradually coming down. Men have to come in twice a year. It’s natural, it’s not synthetic so the side effect profile is almost nonexistent. Same thing for women, it’s the same process. It lasts for about four to five months in women. Five to six months in men. That’s where we see the long-term benefits of the hormone balances because you have sustained levels over the course of about three to five months.
Are you also offering hormone replacement as a weight loss tool for men?
DeNeui: For sure. Men are easier. We can get men testosterone levels up to that optimal range which is above nine hundred. That’s where men feel the best. That’s where the disease prevention happens for men, above nine hundred. Annoyingly, for a lot of their wives, the weight just kind of comes off quickly. They don’t have to work as hard. I received a letter from a patient the other day. She was sending a letter on her son’s behalf, he’s twenty-one and she just was thanking me because not only does he feel so much better, he’s lost forty pounds and now he’s enlisting in the Marines. This was his lifelong dream that he couldn’t have done before because he was too overweight; he couldn’t get in the gym, he couldn’t build muscle. He’s really excited about it and that’s just one of many stories for men.
Is hormone therapy also preventative? Do you have to keep coming back or does your body learn this is what it’s supposed to be like?
DeNeui: When hormones start to decline, it does never come back. You have to replace it. The analogy is like when your car is running out of gas, you fill it up with gas and you’ll drive. When you run out of gas again, you’ll fill it up again. It’s the same thing with hormone replacement. We replace what’s missing. You burn through that gas and we replace it again in four to five months.
END OF INTERVIEW
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