Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to the sixth episode of the Conquer Your Weight podcast. I'm really excited to bring a guest on today. This is Dr. Ruth Odoi. She is a functional medicine physician and I'm really excited for her to share a bit about what that means because I think we're hearing a lot about that right now and a lot of people don't even know what that is. So we're going to dive into what is functional medicine, how does that differ from traditional medicine, how that can be helpful in the weight loss journey. So, so excited. It's going to be a great conversation. Dr. Odoi, thank you so much for joining me today. Tell me a little bit about yourself and how you came to be in this space. Dr. Ruth Odoi: Yeah, thank you so much for having me. It's a privilege really and an honor to be here. So my name is Ruth Odoi. I am a board certified internal medicine physician. I've been mostly practicing in the hospital setting for the past eight years now. And over time as I've practiced, what I've come to find is that I find a lot of patients who are one on multiple medications and when you ask them how did you end up on these medications, they can tell you a story of one symptom that led to a diagnosis and then the prescription and then a prescription to help combat the side effect of the other prescriptions. And they ended up on eight medications and I asked them, do you feel well or do you feel better with all these medications? And the answer is always no. So I started thinking, how can we one, reduce medication burden? As conventional physicians, we always work on trying to reduce medication burden, but how do we do it in a safe contest? So that was the first question that came up. The other thing that I noticed in my practice as a hospital medicine doctor was I was getting a lot of patients who would come in with these vague symptoms of pain or mostly pain was the number one thing and we would do all this workup, like the million dollar workup in the hospital and nothing came back, but then the person would still be having this pain and it's like a real thing for them. So that's number two. And then the third thing was for me personally, I started to talk to other women that I know in my circle around my age, and they also had these nonspecific symptoms of fatigue, difficulty with weight loss. That was a big thing. And then some of these symptoms that we are worried about could be perimenopausal. And so I sat there and with all these things I was like, is there a way to one know about these chronic medical conditions before they become a diagnosis? And two, is there a way to treat diseases at the root cause so that we are not just covering with prescription medications but actually treating things at the root cause. So this led me to functional medicine and what it is is that it is a study of root cause medicine. So we look at what is actually leading to the disease before the disease state becomes evident on blood work. For instance, what we do know is that before someone develops type two diabetes, they start to have a mild increase in their insulin levels five to 10 years before they actually develop type two diabetes where their A1C is about 5.8, where we call them and the like. So my goal with functional medicine is let's see these early markers of disease before they actually morph into disease and before you end up on all these prescription medications. So that's a synopsis. Dr. Sarah Stombaugh: I love that. And I imagine of course it plays out very differently depending on the patient in front of you and what their concerns are. Since we are on a weight loss podcast, let's talk a little bit about maybe a patient situation. I think the diabetes insulin resistance is often part of the same disease process or metabolic health, correct. So tell me if you were thinking about a patient that came in is complaining of like I'm doing everything the same and now all of a sudden I'm gaining weight, but nothing's really changed. How would you approach that patient from a functional medicine standpoint? Dr. Ruth Odoi: Yeah, so that's an excellent question. And so first we look at a basic blood panel because there could be many factors that's causing the weight gain or the difficulty with the weight loss. So we do basic vital signs to first check for your basal metabolic rate, something that simple to see what is that number basically how quickly are you processing food? So that's one. And then we look at your blood work and we look for things like your thyroid. So in conventional medicine, most doctors stop at a normal TSH level, but we know that that's one marker of your thyroid health. We look at how much of your thyroid is being converted from the inactive form to the T3 form. We look at how that is related to the reverse T3, which is a conversion to an inactive form of thyroid due to presence of cortisol. So we look at that and we also look at your cortisol levels at different times of the day because in conventional medicine we look at the number and say, well, it's normal, but in functional medicine we look at the levels at different times of the day to make sure that it is physiologic and it's not too low in the morning when it's supposed to be at its highest, for instance. So that's the second thing. We also look at your gut health because we do know that certain gut flora increases your metabolic. We know that some of them also increases the presence of hormones like ghrelin. And so if we look at your gut, we do a stool analysis and we look and see what these flora that you have as a person and try to balance it better. So if you have the flora that is likely to put you in a place of weight gain or insatiable hunger, then we fix the gut issue. And by fixing that if it helps with your weight loss journey. The other thing we do in functional medicine is we work closely with nutritionist and health coaches because a lot of the times you know what the right thing is, but you are just not able to do it. I did some public health and I do know that knowledge alone does not alter behavior. So just because someone knows something doesn't mean that their behaviors will be different. So we have a health coach with our team. Most functional medicine practices will have a health coach to help with individuals with these difficult to lose weight condition, if you will. Dr. Sarah Stombaugh: Yeah, absolutely. And we actually have a health coach in our practice as well because exactly what you said, we know that having knowledge is important, but it's really just the first step in how are we applying it in our lives? And when the rubber meets the road sort of day to day, how do you implement this with a busy work schedule or with children with other obligations in your life? That makes so many of my patients will say, even like I could write a book on nutrition and yet day to day the food choices they make are not in line with what they sort of know or have the knowledge about what would be a healthy choice for them. Dr. Ruth Odoi: Exactly. And absolutely we do know how much stress, we all know stress is not, or toxic stress is not good and it does not help with weight loss, but how many people have stress managing strategy, they're ready to go too. Once you sense that, okay, there is a lot of stress in my body, do you have a plan for it? And what statistics show is that 70% of people who go to their primary care physician office are experiencing some stress and this stress has an impact on their overall health. But when you go in a traditional medical office, there is really no strategy to manage your stress because the visit is what, 15 minutes. And so there's no talk about how your stress is to be managed. So absolutely, we all know these things affect health, but there is really no plan of how to address it or to tackle it head on. Dr. Sarah Stombaugh: Yeah, absolutely. And I love the way you described that because the reality is our physical body and our mental health, I think for so long, and still in some situations people really think of those as two separate entities, but the reality is the impact of our physical health on our mental health and our mental health, on our physical health, it's a two-way street. And so we have to be addressing both of those things together. Dr. Ruth Odoi: Absolutely, absolutely. And just to connecting the mental health and the physical. When you think of the vagus nerve, it's one of the longest nerves in our body and basically it runs our parasympathetic nervous system. And when those two are not in balance, we experience equilibrium in our bodies basically. And so just having the stress management techniques to help with vagal nerve stimulation or vagal nerve activation when needed really goes a long way for overall wellness. Dr. Sarah Stombaugh: Absolutely. So trying to teach people how do they find themselves in that calm state and teach themselves to do that. So tell me, what are some of the techniques that you may use to help teach? I'm sure you could teach a many hour long course on this, but if we could summarize it, what are ways that people can work on reducing their stress on stimulating their vagus nerve to feel more relaxation? Tell me about that. Dr. Ruth Odoi: So I think the first thing is to recognize what stress feels like in your personal body, because for some people it would be tense muscles in your neck. For some people it's like a sick feeling in your stomach. So I think the first step is being able to recognize that, okay, I am feeling stressed. And one thing that has made an impact for me is realizing the difference between the fact that the stressor is moved away does not mean that your body is done dealing with the stress. So the importance of completing the stress cycle and simple techniques and hugging someone that you love and care about for 30 seconds actually increases our happy neurotransmitters and helps with stress. So even if it's a child, I started doing that with my kids and now they know to come to me for a hug and I ask them, is this a long hug or a short one? Because if you were to put a timer on it, most people hug for maybe 10, 15 seconds, but scientifically it needs to be 30 seconds. I don't know how they came up with the number, but 30 seconds or longer is a very good strategy to end the stress cycle. Another thing that we know that helps with vagal nerve stimulation is box breathing. So if you go on Google or YouTube and you type box breathing where you inhale for four seconds, it's like you are creating a box. So you do, you go up inhale for four counts, and then you hold it for four counts and you exhale for four counts and then hold for four counts. So it's like you are creating a box. So that is a very good way to end complete the stress cycle. The third way, which I think it's easy for me because I like to dance, is movement. Any movement, it doesn't have to be in the gym, you can close your door and just dance. Just that movement is known to help to complete the stress cycle because I think it's important to realize that even when the stressor is gone, your cortisol level is still up, epinephrine, no epinephrine, all these neurotransmitters and hormones are still working, and you have to signal to your body that, okay, the stressor is gone, the world is still is back to being a safe place. And this is what I do to end that stress cycle. So I say do it every day, pick one, whether it's a 30 second hug with a loved one, it has to be a loved one, someone you care about, not just anybody. Dr. Sarah Stombaugh: Well, you probably can't just walk up and start hugging strangers though. Dr. Ruth Odoi: Well, I used to do that when I lived in Boston. We stood at the train station and gave people hugs. I don't know, this was back when I was in my twenties where this was pre covid where there was no distance issue. But yes, I say all that to say, yes, it needs to be someone you care about. So another method is the box breathing. Another method is the meditation and movement. Just any movement that makes you happy doesn't have to be in a gym exercising. That is also helpful. But any movement really will help to complete that stress cycle, which is so important to your body to send that signal that, okay, the world is a safe place now. Dr. Sarah Stombaugh: Yeah, absolutely. Okay. I absolutely love that because thinking about when stress is arising and we live in a culture where people are always so heightened, sometimes the anxiety is almost palpable and the speed with which our culture is moving, we live in a very stress provoking society. And so taking time to allow your body to decompress from that so important. But tell me a little bit about what is the role of when you are living in that heightened state, when your body's not having that opportunity to relax, how does that end up playing a role in your health, but that is weight, or even more broadly, how can that impact our health? Dr. Ruth Odoi: Yes. So whenever there is stress, no matter what it is, especially toxic stress, we do know that there is increased production of cortisol. And once there's increased production of cortisol, we do know it leads to release of epinephrine and norepinephrine. And the release of that leads to increase in your vascular tone, which over time could lead to high blood pressure or hypertension. So that's a direct stress related issue. We also know that the release of epinephrine and norepinephrine goes to your liver and it tells your liver, Hey, we need a lot of energy source. So there's increased release of glucose that's running around in your bloodstream. And over time as there is this amount of high glucose in your bloodstream leads to insulin insensitivity because once your cells see the glucose, insulin needs to be released from your pancreas. And over time it's like this continuous alarm in your body because it's like, we need more sugar, we need more energy, we need this, we need this. So your pancreas is just pumping out the insulin, and over time it leads to insulin insensitivity and eventually type two diabetes. So that's two main chronic conditions that there is a direct correlation between stress and that cancers, for instance, is also related because once you have stress in the body and there is increased production of proteins on a very cellular level, we know it leads to the production of, I don't want to go too deep into biochem, but more proteins that tells the cell to divide. And so now your cells are dividing, and we do know cancer is basically cell division gone wrong. And then as simple as your thyroid, because we do know release of cortisol leads production of the inactive form of the thyroid hormone, which is your reverse T3, which doesn't help because it's not really helping with your metabolism. So then you end up with thyroid issues and even connection with sex hormones in your body, which then causes mood issues due to estrogen imbalance. So stress is so pervasive, and it's so important that everyone has a personal stress management plan, just like we have a financial plan or a plan for the day, we need our go-to stress plan to end the cycle of stress. Dr. Sarah Stombaugh: Okay, I love that. And so there's these pieces of, we're looking at all of these different systems and then looking sort of more broadly, what are things that are controlling each of those systems versus something like stress that has such a broad impact, clearly. And so when you think about, let's say, coming back to that patient in front of you, she's been struggling with weight gain, there's an evaluation, working with a nutritionist, working with a health coach. How are you measuring her progress over time? I guess both in terms of what she's seeing, of course we think about the number and the scale, but more broadly than that, how are we measuring and checking in on her goals? Dr. Ruth Odoi: So first thing we look at is energy level, because if you are feeling tired, chances are you will not feel like going to the gym or doing any exercise. Chances are you won't feel like prepping meal prepping ahead of time so you can stay with the diet plan that you have. So we look at those things, what she's telling me about her energy level. We also look at protein content or protein percentage in your body. We do the biometrics, we are looking at the number, but we are looking to make sure that you are losing fat and not protein or just water. So we are looking at those numbers and I mean, I think my main goal is how are you feeling? Are you feeling energetic? Is your energy back? How is your mood? And then the numbers, then we specifically look to make sure you're not losing protein, but fat, which is what we want to go away. Dr. Sarah Stombaugh: Absolutely. When I think thinking about how our bodies are feeling, the reality is a patient, you are the boss of your body, understand you can read and experience your body in a way that no physician or no other can evaluate only how your body is feeling. And I think that metric of how is your body feeling, how is your body functioning for you is so, so valuable because I mean, that's the quality of our life. Who cares about the quantity of our life, who cares about the number and the scale? If you feel miserable, none of that really matters. Yes, Dr. Ruth Odoi: Absolutely. Absolutely. Absolutely. And once you feel good, it just sort of rolls into your relationship, your relationships. It rolls into how you carry yourself and the steps that you are willing to take to continue to feel that way. And so looking at the numbers just really underscores the bigger picture, which is how are you feeling? Dr. Sarah Stombaugh: Yeah. Oh, absolutely. Well, I love that. And I think one of my background's also in primary care and now in doing full-time obesity medicine, I think seeing the impact of our health and our weight, as you said, in so many different areas of our life, it's really unbelievable and it all intersects together. The food choices we make, the stressors that we experience, what our day-to-day movement looks like, our sleep, all of it is intertwined in a way that we can't separate. And so I love this idea of looking at the whole person, looking whole person. Dr. Ruth Odoi: Absolutely. And I'm sure you apply some of these functional medicine principles in your practice, and it's not just how much do you weigh today really? Dr. Sarah Stombaugh: Well, that's exactly it, because thinking this idea of how is your body functioning, how is your body feeling, that is a conversation. And a big part of why I went into private practice is to be able to spend the time with my patients to look at what are some of the underlying causes, not just about, as we talked about at the beginning, nutrition for example. Like I said, many of my patients could write a book on nutrition, gets the day-to-day of how do they implement it, how do they deal with stress, are they sleeping? What's going on with their children or their work or their parents or whatever other circumstances are going on in their lives, and how all of that ends up impacting our health in this much bigger way. And so I love hearing about this functional medicine approach. So tell me if a patient is interested in functional medicine looking to seek that out, what should a patient be advocating for? What should they be looking for when they're trying to find a physician who could help support them? Dr. Ruth Odoi: Yeah, so I'm glad you said physician, because with functional medicine, because it's in the world of integrative medicine, there are a lot of people out there who are functional medicine practitioners. And so I think the first thing if you can, is to find someone with medical training and medical background because we are able to bring in the best of both worlds to properly care for you so that we can avoid. Because I think sometimes the notion is that supplements, it's all natural, there's nothing wrong, but it's still something foreign that you are taking in. And so you need someone with adequate training who can monitor these levels and make sure you are not in toxicity because there is such thing called vitamin D toxicity or vitamin A toxicity or toxicity with different elements that like magnesium or other supplements that you may take thinking, oh, it's all natural. So I think that that base, you want someone who has a balanced approach in terms of looking at numbers, but interpreting those numbers in context of your personal problem so that your symptoms are addressed by looking at numbers. I don't know if that's making sense that Dr. Sarah Stombaugh: I think that's such an important point, and I really appreciate you saying that. And I think one of the things that stands out to me too about working with a physician as opposed to other people, maybe more broadly in this space, is that there are medical conditions that need traditional western medicine. And I'm sure you have patients who do still take anti-hypertension medications to lower their blood pressure, for example. And those medications are absolutely indicated in combination with strategies that are working to reduce or treat those at the root cause. Is that a fair thing to say? Dr. Ruth Odoi: Absolutely. Yes, absolutely. I mean, if someone comes to see me and their blood pressure is elevated, I will place them on an anti-hypertensives while we work to open up the hood and look at what's going down. And the goal is to eventually taper you off the medications, but I will not hesitate to make sure that you don't end up with a stroke, for instance, because that's what high blood pressure will lead to if not treated. So absolutely, I look at the broader picture from that standpoint. And that's one thing conventional medicine is excellent at is to treat acute issues. So we absolutely need to reach out for it if we need it. But not to stop there is where functional medicine becomes the goal. Dr. Sarah Stombaugh: Well, and I think that's such a good way to describe it, is we don't just stop there. It's not just like, let's put a bandage on it. It's like, let's find, if you have a significant laceration, a bandaid is going to help for a couple minutes, but you need to go have it sutured. Right? You have to work on the root cause. Dr. Ruth Odoi: Absolutely. And the way I describe it to people is that when you have an overflowing sink, you have three ways of treating it. You can stop mopping the floor, which a lot of the times we have to do in conventional medicine, but in functional medicine, we turn off the faucet, but depending on what's causing the faucet to overflow, it may take some plumbing work, and it may take time to investigate and find out why you can't turn off the faucet. But in the first thing, you have to mop the floor so you don't fall because there's water everywhere, and then figure out how to turn off the faucet. So that's how I sometimes describe it to people so they can see the big picture with functional medicine. Dr. Sarah Stombaugh: Absolutely. I really love that analogy. Thank you for sharing that. Yeah. Let me ask you, as we wrap up the podcast, is there anything you haven't yet had a chance to share with my audience that you think is just really important that they walk away understanding today? Dr. Ruth Odoi: I think that my main reason of going into it is one, to look at chronic diseases before it happens. So functional medicine, we have advanced testing that will allow you to look at these numbers 10 years, 15 years before you develop it. So if you know that you have genetic propensity to some of these chronic conditions, my encouragement is go and see someone like in the functional medicine space and get some advanced testing to see where you stand as a person. And instead of waiting and trying to do all the right things and not just sitting and waiting till it happens before you fix it. So that would be just once in a while, go see someone, do some testing, make sure that you are picking up things before it happens. Dr. Sarah Stombaugh: Yeah, absolutely. So to speak. And let me ask you, Dr. Odoi, if people are interested in working with you or following you on social media, where can they do that? Dr. Ruth Odoi: Yes. So we have a website, it's oasis functional medicine.com. That's where they could go to book a discovery call, especially if they're in the New York area. And I also have a YouTube channel called Oasis Women's Functional Medicine, where I create content to educate on topics like adrenal fatigue, thyroid health, gut health, and things that are relevant to the functional medicine world. I'm also on Instagram, on Facebook, LinkedIn. I'm everywhere. Dr. Sarah Stombaugh: I love that. We have to have all the good docs out there sharing the information, because I find there's a lot of wild stuff happening in medicine. And so having doctors you can trust, sharing good information is so, so important. Dr. Ruth Odoi: Absolutely. Absolutely. Excellent. Dr. Sarah Stombaugh: Well, thank you Dr. Odoi for joining me today. This was really such a treat. I know my listeners are going to enjoy it. And for my listeners, thank you for joining us this week. We will see you all next week.