September 2, 2025 • 24 mins
Episode Highlights With Emily
- What she’s learned in working with hundreds of women on GLP-1s
- How hormones play a role in midlife weight gain and increased metabolic problems
- For women, weight can be so deeply personal, and why the person you are becoming in a weight loss journey is so important
- The mental health connection that often gets ignored
- How GLPs affect hormones and what to be aware of
- What happens physiologically with rapid weight loss and thyroid changes to be aware of
- Many people who are overweight are actually malnourished and not getting enough protein, minerals, and B vitamins, and how this can be mitigated
- Any time the body’s needs aren’t being met, there is a response
- Emily Sadri - Website
- Follow Emily on Facebook and Aurelia Women's Health on Facebook
- Follow Emily on Instagram and Aurelia Women's Health on Instagram
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello, and welcome to the Waalaswama podcast. I'm Katie from
wamaswama dot com and I am back today with Emily
Sadre to talk about GLP one drugs and what they
reveal about weight, hormones and mental health, which is I
think the part that has not talked about enough. We
talk about the emotional underpinnings of weight loss, why that's
important to address, the muscle and bone factors related to this,
(00:24):
how these can be a valuable tool, but what to
know if they are, and so much more. Emily is
a wealth of knowledge. She's a double Board certified Women's
health nurse practitioner and nurse midwife as well as the
founder of Aurelia Health, which serves women who are navigating
these changes, who are busy and raising kids as she
is as well, and she loves breaking down norms and
(00:45):
rejecting the idea that a woman's worth is derived from
her productivity or her weight. She believes that women can
have it all and that it starts with great health
care and a woman standing beside each other, walking hand
in hand. I learned a lot from her in this episode.
I know that you will as well, So let's jump in. Emily,
welcome back, Thank you for being here again. Thank you
(01:06):
so much for having me. I'm so excited to talk
about this new topic. I think it's super important and
I love your work well, thank you And if you
guys missed it, we recorded a first episode together all
about perimenopause and hormones and supporting ovarian function at all
ages of life and what that actually looks like. It
was super comprehensive and helpful, and in this one, I
(01:26):
would love to shift gears and talk about what seems
to be a very relevant topic in today's world, which
is the topic of glps and their role and their downsides,
which I feel like don't get addressed as much, and
knowing how to navigate decisions around that, and or if
someone's going to try GLP ones, what are the best
and most supportive and safest ways to do this? And
I know that you've worked with hundreds of women in
(01:48):
particular when it comes to golp ones, and I would
love to kind of hear what you've learned in that
process of working with so many women and maybe any
surprising things that you saw that you didn't expect.
Speaker 2 (01:59):
Yeah, such a good question.
Speaker 3 (02:01):
I think that, as you know, weight loss and women's
relationship with their weight is so complex, and I have
a tendency initially to focus on all of the data
and the science and like the labs and all the
things that I'm seeing and my goal of helping people
achieve metabolic flexibility and reduce their risk for chronic disease.
(02:22):
But in reality, for the woman who is either my
patient or the woman who's listening, this is so much
more deeply personal.
Speaker 2 (02:30):
And I think it's interesting.
Speaker 3 (02:32):
We know that, of course, hormones play a really large
role in the reason why women have an increased risk
of or the supersede their male counterparts in risk of
party vascular disease after age fifty, but I also sort
of feel, like, intuitively, and this is not backed by
evidence at all, but just my feeling like some of
our relationship to our increased risk for metabolic problems and
(02:56):
party of vascular problems as we know those two things
go hand in hand, is that for women, our weight
is so deeply personal that sometimes our responses tend to
kind of dissociate from how what's happening in our body
is like translating to problematic pathophysiologic changes internally. So when
I'm working with women on a weight loss approach, obviously
(03:19):
we're doing a very comprehensive approach, right, a real functional,
kind of holistic. Obviously, nutrition is important, and you know
all the things, and we can talk about those things today,
but it's so important that the person that you're becoming
in your weight loss journey is addressed, and that there's
a tension given to that, and that we're acknowledging that
(03:43):
there were aspects of who you were that contributed to
you being in metabolic imbalance, and that we can use
lots of chemical interventions to help you lose weight. But
if we're not also simultaneously working on the who you
become as you lose weight and any aspects of yourself
that you need to let go of, we're really missing
(04:03):
an opportunity to protect your mental health. Which was my
inspiration for chatting with you about this today because there
was a large study that came out last year and
twenty twenty four that showed dramatic data around the incidents
of mental health issues in GLP one users.
Speaker 1 (04:19):
Yeah, I feel like I haven't heard that piece talked about,
and it makes sense to me that if the kind
of underlying factors related to who you are becoming are
not addressed, then you potentially are just going to shift
that same kind of internal friction to somewhere else in
your life, and or that it might show up in
the form of a mental health challenge. I know for me,
I didn't use GLP ones, but I had a massive
(04:41):
weight loss when I started kind of my inner healing journey,
and it was actually for me a big part of
like rewriting those inner scripts and the stories I was
telling myself and the language, and also realizing I had
a story about if I looked a certain way or
if I was a certain size, then I would be happier,
then I could be at peace in my body. And
it actually for me was flipping that script and learning
(05:02):
to be at peace and define happiness. That ironically led
to the weight loss becoming much more effortless when I
wasn't coming from a place of resistance. And I know
that there's so much interemotional and mental work that is
seemingly tied into that, as you explained, with our self
worth being often connected to our weight or how we
feel about ourselves. And in our first episode, we talked
(05:22):
a lot about hormones. I also haven't seen or heard
a lot of data about do we know much about
how these medications might affect hormone levels and the effect
they can have on normal physiological processes, either in a
positive or negative way.
Speaker 3 (05:36):
Yeah, well, I think that there's a lot of answers
to that.
Speaker 2 (05:41):
So when we talk about rapid.
Speaker 3 (05:44):
Weight loss in anyone, and I think there's large populations
of women who are using these drugs, especially in with
traditional dosing and maybe with minimal oversight, as is the
case with sort of many aesthetic clinics or online and
telehealth that prescribe these medications, women can have rapid weight
loss and that can cause major shifts in their entire
(06:08):
endocrine system. Namely, when we lose weight quickly, it triggers
the alert system in our body and it tells our
body to slow down the thyroid. Something must be wrong
if there is rapid weight loss there we must be starving,
we must be in famine. We must slow down the metabolism,
and we slow down the metabolism by slowing down the thyroid.
(06:29):
So can we definitely see thyroid changes, especially with rapid
weight loss, and especially if there is poor nutrition. So
adequate nutrition is incredibly important. And what you probably understand,
and what maybe some of the audience doesn't know to
be true, is that many people who are over weight
or obese are actually malnourished. They're not getting enough be vitamins,
(06:50):
they're not getting enough minerals, they are not getting enough protein.
And so you take someone who's already under nourished and
then you simply reduce their choleric intake, they become nauseous
and food averse, and so they're eating a simpler diet,
and now they're becoming even more malnourished. And of course
these micronutrients and macronutrients really impact our brain chemistry and
(07:14):
or hormonal production. So I have not seen it in
my practice, but I'm sure that there are incidences of
women using these drugs who have cycle shut down, a menorrhea,
who stop menstruating, because we know that that happens with anorexia, right.
I have seen reports of women who have new onset
osteoporosis from using these drugs, and that's.
Speaker 2 (07:36):
A really scary thing.
Speaker 3 (07:38):
So, you know, it's an interesting thing to hold two truths.
On the one hand, the fears are conflated worth with
regard to GLP one medications in that you know, there's
a lot of fear mongering out there, and at the
same time, I think that an important aspect that's missing
and that we're not talking about is really the difference
(07:58):
between using these medications in an individualized, tailored, patient specific
approach or just using them kind of by the traditional
dosing that was originally developed by the commercial pharmaceutical for
the purpose of weight loss and diabetes.
Speaker 1 (08:13):
That makes sense, and I know I've heard some about
the potential for muscle and bone density loss with these medications.
It seemingly can be mitigated if someone understands how to
navigate that, but it seems like it requires a lot
of intentionality and nuance. And I love that you brought
up the point of people can be overweight and still malnourished.
It seems like we actually have an epidemic of this
(08:35):
in the Western world. And that's kind of a theory
I've honed over the last ten years or so. Is
this I kind of call it the protein and micronutrient theory,
which is that nutrition is not just about calories, and
we might be achieving enough calorie consumption, however we're not
getting the bare minimum of minerals and micronutrients and protein,
the body, in its wisdom trying to keep us alive,
(08:56):
is going to continue craving things for survival. And that
is something that we can only out will power for
so long because it's a very strong and important signal
from our body. So I wonder if kind of the
rise and popularity of these medications might actually further exacerbate
that problem. And if there is a way to navigate
GLP ones, like do they have a time in a place?
(09:17):
Is there a way to navigate them while taking into
account the complex emotional factors that come into play, the
nutritional and micro nutrient factors that come into play that
can kind of mitigate some of the downsides, like what
do you see in your work? Is there a time
and a place for them? And if someone is using them,
what are kind of the most important factors to be
aware of to kind of capture the benefit with as
(09:37):
little downside as possible.
Speaker 3 (09:39):
Yeah, now, I think that's spot on, and I think
that anytime the body's needs aren't being met, there will
be a response. And if you're a mother, you know
how this plays out. Right, If your child's needs aren't
met sleep, food, attention. That will come out in some reaction,
but maybe not in a way that tells you exactly
what the unmet need was, right. And so if your
(10:01):
unmet need is micronutrient based or macronutrient based, you know
it will come out in excessive hunger, dysregulated hunger, right,
But it can also come out because there's an unmet
emotional need, right, an unmet need for safety, security, connection, relationship,
all of these things that we know are so important
for the body to function optimally. And so I think
(10:22):
we really have an epidemic of that. I mean, we
have lots of data about how disconnected our population is becoming,
how gen zers are more disconnected than any generation before them,
right with the rising use of technology, and how we
need human connection and we need certain things for a
positive mental health, right, And often though, there's this disconnection
(10:43):
between what we think we need and what we actually need. Right,
So this sort of craving and not feeling full, And
there are some it's like a Buddhist representation of this
where it's like the sort of ghost wo can never
be full, like just continues to eat and never feels full.
And I think that some of that is played out,
and you know, we really need to address so many
foundational things about sort of human health and happiness in
(11:05):
order to think about that.
Speaker 2 (11:07):
That being said, if you're working with.
Speaker 3 (11:10):
Someone who understands those nuances, who treat someone as a
whole person, who also you know, gets to know you, right,
it's just sort of like I think I apply everything
from a midwif free model, because you can't really prepare
to be with someone in birth if you don't know
who they are, what their preferences are, their values, like,
who their people are, what makes them feel safe. Do
(11:31):
they want noise? Do they not want noise? Do they
want touch? Do they not want touch? It's the same
thing on any transformational journey, right, like if we're going
on a weight loss journey, if we're going on a
journey through perimenopause and menopause, this is massive transformation that
we're talking about. And so being in relationship with someone
who you trust and who gives you a feeling of safety.
Speaker 2 (11:51):
And you'll know that that.
Speaker 3 (11:52):
That's true if you sort of end a face to
face visit with them, and I don't encourage that you
do these use these medications. If you're not engaging in
synchronous medical care with someone who you trust, you will
get off the visit and you will feel a feeling
of safety in your body. Right, you will feel more confident, comfortable,
And that's just a we should need to clue into that, right,
that's a gauge. Additionally, and to answer your question, I
(12:17):
think it's really important that the dosing be t traded
to your personal response and that you're working with someone
who can coach you on nutrition from a very additive
versus reductive approach. I find that people who have issues
with their metabolic health and have had trouble losing weight,
that the more that you introduce reductive approaches like restrictive diets,
(12:40):
excessive fasting, a diet that uses a lot of the
words like no, can't, don't, that can be very emotionally
triggering to people. And for example, in our program, we
do spend some time focusing on inflammation at a certain point,
but we wait and we also personalize using any elimination
of say things like gluten and dairy, which could be
very triggering, especially for our autoimmune patients. We really do
(13:03):
not do that in a blanket way. Right, It's it's
we have an assessment that we use within our clinical
team to really determine if someone's emotionally ready to do
those things right, And we're testing and assessing as we go, right,
so we're measuring someone's response and then adapting. And I
think that, you know, what we know to be true
about these medications is that they're incredibly effective at reducing inflammation,
(13:24):
at prevention of chronic disease, at you know, in diabetics,
we have really good studies about how they impact chronic
disease outcomes for these people. We have seen how much
it impacts of autoimmune issues, but also the way that
it impacts craving and sort of that never feeling full,
the way that it kind of impacts that drive that
(13:45):
where there is some psychological route in nature. I think
we have some evidence that it also reduces addictive behavior,
So it reduces the drive to gamble, it reduces the
drive to spend money and even engage in other kinds
of addictive behavior, and we know that from the research,
and I just think that that's so fascinating, especially in
the context of this study from twenty twenty four that
(14:06):
showed a ninety eight percent increased risk of psychiatric disorders
in over one hundred and sixty thousand people that were
observed in the study, So it was observational. It was retrospective,
so not randomized, meaning we were just taking a bunch
of people on GLP one and a bunch of people
not on GLP one who were self selected, right, so
their doctor prescribed it or their provider prescribed it. Then
we were observing in those two populations what were the outcomes.
(14:30):
And in the population on GLP ones there was like
one hundred and ninety five percent chance of major depression disorder,
meaning that like that not that one hundred and ninety
five percent, right, but it was that. So there were
one hundred people in one group that had it, then
there were going to be two hundred people in the
other group, right, that had depression. Just to understand how
percentages work, and I think that there are lots of
(14:52):
things that we can explain about this. One I think
is related to the micronutrient deficiencies, that when you further
deprive people who are already deprived, right, you increase the
chance of psychiatric issues. One I think is probably because
it's stressful on the body, as we mentioned, right, to
lose weight. And if you're not sort of taking an
additive approach in terms of community connection, relationship trust with
(15:17):
a provider, and an additive approach from a nutritional standpoint,
then you are increasing that person's risk of feeling unsafe
right and triggering nervous system dysregulation. We also know that
glps increase sympathetic output. This is why people who take
some of the tide or trusappetite, if they're heart rate monitoring,
they'll notice that their baseline heart rate goes up by
about ten points. And that's one of the ways that
(15:40):
it works. When you increase sympathetic output, just like when
you do exercise, you increase sympathetic output that stimulates the
mechanism by which we lose weight. But if you already
have a dysregulated nervous system, that shift in sympathetic output
can be detrimental, can be positive for people. Some people
report improvement. So I think it's just so interesting and
(16:00):
there's so much more nuance here that needs to be
explored that we're just kind of missing, you know, missing
in our conversation about like I don't know, I mean,
there's just so there's so much out there like, I
know there's one camp that has had a lot of
attention to the current administration about you know, this is
the biggest crime to the metabolic crisis, and we really
need to be focusing on food, like and I agree
(16:22):
with all of that, but I also think that unless
you've really sat with a woman who has failed in
her weight loss attempts for years and years and years,
and you sit with that devastation, and then you see
the impact that even small doses of this drug can
have on changing her life and giving her a leg
up on her own journey. And it doesn't mean that
(16:45):
she's taking herself out of the journey or that she's
not putting forth effort, right, it's just this biochemical hack
that really gives her the support that she needed.
Speaker 1 (16:55):
Yeah, it feels like in if these medications are going
to be used, it's actually very much both ends. Like
it's a call to be even more aware and intentional
of nutritional and metabolic factors because you now have a
unique and different way to support the body, and those
probably become even more important. I love that you addressed
the sympathetic output aspect of this, because I've heard from
(17:16):
people that they saw their readiness scores declined because their
heart rate was elevated and they couldn't figure out why.
And it makes sense to me that would be the mechanism,
and also that in light of that, it might become
more important also to become aware of intentional ways to
bring more parasympathetic tone into your life, to deal with
stress a little bit more, to make sure the body
is getting enough nutrients from all sources so that that's
(17:37):
not a source of stress. To get sunlight, like we
talked about in our first episode, so that the body
is able to kind of function as optimally as possible.
And it seems like to your point, this is an
extremely nuanced conversation that it can and does have a
place and is very helpful, and that it brings the
importance of these other factors actually more into light. It
doesn't discount the need for effort and for quality nutrition
(17:59):
and for addressing sleep and stress and all the things
we would talk about anyway. It just gives another potential
tool that people can use when they understand all of
those things. And I'd love to for the rest of
our time circle back also to the kind of the
emotional piece we started with and address even more deeply,
why so many women are seeing depression, Why women still
seem unhappy even if they reach their weight loss goals.
(18:21):
I know for me it was because I had a
false story and I thought that weight loss would make
me happy, And it turns out the reverse was true,
that finding happiness actually led to releasing a lot of
the stuff that was making weight loss difficult. But you
work directly with women all the time. What are we
overlooking when it comes to how we define weight loss
success and the way we support ourselves or support others
through that journey.
Speaker 2 (18:42):
Yeah, I mean, and I got chills.
Speaker 3 (18:44):
I think so many people come to our program and
we ask them to define what their goal is when
they start, and I would say more than half of
women when they reach their goal go, you know, actually
I'm not happy yet. I want to lose more, like
I want I want to change my goal. And of
course we have conversations about like what's actually physiologically a
proper goal, But I think that's beside the point. The
(19:06):
point is that I think we have an epidemic of
women who have been conditioned to be overgiving, have been
conditioned to be more about everybody else than they are
for themselves because we're praised for that, and I think
that we are so far down that hole many women are,
(19:27):
Especially if you're deeply unhappy, you're so far down that
track that you don't even really know what you want
and desire. Many women find themselves in unhappy marriages, in
friendships that don't actually serve them, because they're so used
to kind of being a yes girl and to going
along with other people's needs that they just really are
(19:49):
deeply unhappy. I think that there are, also, of course,
lots of environmental factors that affect our mental health, but
I think it's a lot more interesting to talk about
the psychosocial factors. Think that especially as we age and
after we're done having children, because there is an aspect
to child rearing and child bearing that is deeply imbalanced
(20:11):
in terms of giving and receiving just by way of
actual nature, Like the ten years that I was breastfeeding
and child rearing and birthing and all of those things.
You know, as much as I wanted to take care
of myself, it's like your brain actually can't hold the
space for you know, who do you truly want to be?
And how do you want to show it? Because you're
just sustaining and nurturing life. So I think when if
(20:33):
you've sort of passed through that threshold, it's a real opportunity.
And I always like to think that healthy when we
work on our body, it allows it's like a catalyst
for us to get to know ourselves. And I think
you've described that process so personally, I've had that experience
that sort of when all is lost and when you
(20:53):
kind of don't know who you are and what you
want or what even makes you happy. One of the
best places to start is with like daily foundational routines
that make you feel better physically, because when you feel
better physically, it starts to open up space for you
to get clarity about like what you actually want and
what's meaningful to you. And so I think it's really
just about all society that hasn't taught women how to
(21:18):
know their bodies and live in accordance with their cycle. Right,
you can go back to our other episode if you
want to know more about that, and to a society
that doesn't train young people to really get curious about
who they are, right, we are trained to be performative
and to know how to be what other people want
us to be in terms of like even how our
education works and how job preparation and you know, finding
(21:41):
our partner. Like, we get really good, especially women, because
we can be kind of chameleon like just sort of
be whoever everybody else needs us to be, especially the
highly sensitive and pathic types. Right, we're really good at that.
But if you start with sort of the foundations, which
you're so beautiful at talking about, right, that just simple
things like a really good regulated sleep schedule, hydration in
(22:03):
the morning, sun exposure movement, and also strip away the
things that inherently kind of make you go, like how
many times do you say yes to something and then
like right before it's about to happen you cancel and
like make up an excuse for doing that thing.
Speaker 2 (22:17):
Like everyone's done that.
Speaker 3 (22:19):
But if you're doing that a lot, like you really
need to ask yourself, are you are you over saying yes?
Like do you need some work on your boundaries?
Speaker 2 (22:27):
Right?
Speaker 3 (22:29):
And that's what I see, like is sort of the
through line of people who are coming to us who
are desperately out of alignment with their body and feeling
on emptiness that they think will be filled once their
body looks a certain way, But in reality it's both.
You have to be on the journey toward feeling better
(22:52):
internally and you have to.
Speaker 2 (22:56):
Get to.
Speaker 3 (22:58):
The change in your physiology and your metabolic health by
way of your personal transformation.
Speaker 1 (23:04):
That was beautiful, and I think both of our post
botes together highlight that, especially for women and all of
the beautiful cycles of our physiology, there is so much
nuance and it's very personalized, and I know that you
work directly with so many women. For people listening who
want to keep learning from you and or work with
you directly, where can they find you and learn more?
Speaker 3 (23:24):
Yeah, please follow me on Instagram Emily Sadri Underscore NP
and you can also go to Emilysadrey dot com backslash
wellness Mama for a direct sort of gift and summary
of the episode that we have for you guys, or
you can follow my clinical practice. It's Aurelia Health dot com,
a U R E.
Speaker 2 (23:40):
L I A Health dot com Amazing.
Speaker 1 (23:43):
I will put all of those links in the show
notes for any of you listening on the go, that's
always at Wellnessmama dot com. Emily. I've learned so much
from you. I love your approach to this and the
understanding and depth and listening that you bring to your
work and how much you've shared today. Thank you so
much for your time and for every thing you shared today.
Speaker 3 (24:01):
Well, thank you, Katie. I'm such a fan, and I
think that you bring such a new and fresh approach always.
You always have a noice will to this thing called life,
the parenting, the mothering, the self development, and I'm just
here for all of it.
Speaker 2 (24:16):
So it's a pleasure.
Speaker 1 (24:18):
Thank you, and thank you as always for listening and
sharing your most valuable resources, your time, your energy, and
your attention with us today. We're both so grateful that
you did, and I hope that you will join me
again on the next episode of the Wellness Mama podcast.
If you're enjoying these interviews, would you please take two
minutes to leave a rating or review on iTunes for me.
(24:40):
Doing this helps more people to find the podcast, which
means even more moms and families can benefit from the information.
I really appreciate your time and thanks as always for listening.
Hello, and welcome to the Waalaswama podcast. I'm Katie from
wamaswama dot com and I am back today with Emily
Sadre to talk about GLP one drugs and what they
reveal about weight, hormones and mental health, which is I
think the part that has not talked about enough. We
talk about the emotional underpinnings of weight loss, why that's
important to address, the muscle and bone factors related to this,
(00:24):
how these can be a valuable tool, but what to
know if they are, and so much more. Emily is
a wealth of knowledge. She's a double Board certified Women's
health nurse practitioner and nurse midwife as well as the
founder of Aurelia Health, which serves women who are navigating
these changes, who are busy and raising kids as she
is as well, and she loves breaking down norms and
(00:45):
rejecting the idea that a woman's worth is derived from
her productivity or her weight. She believes that women can
have it all and that it starts with great health
care and a woman standing beside each other, walking hand
in hand. I learned a lot from her in this episode.
I know that you will as well, So let's jump in. Emily,
welcome back, Thank you for being here again. Thank you
(01:06):
so much for having me. I'm so excited to talk
about this new topic. I think it's super important and
I love your work well, thank you And if you
guys missed it, we recorded a first episode together all
about perimenopause and hormones and supporting ovarian function at all
ages of life and what that actually looks like. It
was super comprehensive and helpful, and in this one, I
(01:26):
would love to shift gears and talk about what seems
to be a very relevant topic in today's world, which
is the topic of glps and their role and their downsides,
which I feel like don't get addressed as much, and
knowing how to navigate decisions around that, and or if
someone's going to try GLP ones, what are the best
and most supportive and safest ways to do this? And
I know that you've worked with hundreds of women in
(01:48):
particular when it comes to golp ones, and I would
love to kind of hear what you've learned in that
process of working with so many women and maybe any
surprising things that you saw that you didn't expect.
Speaker 2 (01:59):
Yeah, such a good question.
Speaker 3 (02:01):
I think that, as you know, weight loss and women's
relationship with their weight is so complex, and I have
a tendency initially to focus on all of the data
and the science and like the labs and all the
things that I'm seeing and my goal of helping people
achieve metabolic flexibility and reduce their risk for chronic disease.
(02:22):
But in reality, for the woman who is either my
patient or the woman who's listening, this is so much
more deeply personal.
Speaker 2 (02:30):
And I think it's interesting.
Speaker 3 (02:32):
We know that, of course, hormones play a really large
role in the reason why women have an increased risk
of or the supersede their male counterparts in risk of
party vascular disease after age fifty, but I also sort
of feel, like, intuitively, and this is not backed by
evidence at all, but just my feeling like some of
our relationship to our increased risk for metabolic problems and
(02:56):
party of vascular problems as we know those two things
go hand in hand, is that for women, our weight
is so deeply personal that sometimes our responses tend to
kind of dissociate from how what's happening in our body
is like translating to problematic pathophysiologic changes internally. So when
I'm working with women on a weight loss approach, obviously
(03:19):
we're doing a very comprehensive approach, right, a real functional,
kind of holistic. Obviously, nutrition is important, and you know
all the things, and we can talk about those things today,
but it's so important that the person that you're becoming
in your weight loss journey is addressed, and that there's
a tension given to that, and that we're acknowledging that
(03:43):
there were aspects of who you were that contributed to
you being in metabolic imbalance, and that we can use
lots of chemical interventions to help you lose weight. But
if we're not also simultaneously working on the who you
become as you lose weight and any aspects of yourself
that you need to let go of, we're really missing
(04:03):
an opportunity to protect your mental health. Which was my
inspiration for chatting with you about this today because there
was a large study that came out last year and
twenty twenty four that showed dramatic data around the incidents
of mental health issues in GLP one users.
Speaker 1 (04:19):
Yeah, I feel like I haven't heard that piece talked about,
and it makes sense to me that if the kind
of underlying factors related to who you are becoming are
not addressed, then you potentially are just going to shift
that same kind of internal friction to somewhere else in
your life, and or that it might show up in
the form of a mental health challenge. I know for me,
I didn't use GLP ones, but I had a massive
(04:41):
weight loss when I started kind of my inner healing journey,
and it was actually for me a big part of
like rewriting those inner scripts and the stories I was
telling myself and the language, and also realizing I had
a story about if I looked a certain way or
if I was a certain size, then I would be happier,
then I could be at peace in my body. And
it actually for me was flipping that script and learning
(05:02):
to be at peace and define happiness. That ironically led
to the weight loss becoming much more effortless when I
wasn't coming from a place of resistance. And I know
that there's so much interemotional and mental work that is
seemingly tied into that, as you explained, with our self
worth being often connected to our weight or how we
feel about ourselves. And in our first episode, we talked
(05:22):
a lot about hormones. I also haven't seen or heard
a lot of data about do we know much about
how these medications might affect hormone levels and the effect
they can have on normal physiological processes, either in a
positive or negative way.
Speaker 3 (05:36):
Yeah, well, I think that there's a lot of answers
to that.
Speaker 2 (05:41):
So when we talk about rapid.
Speaker 3 (05:44):
Weight loss in anyone, and I think there's large populations
of women who are using these drugs, especially in with
traditional dosing and maybe with minimal oversight, as is the
case with sort of many aesthetic clinics or online and
telehealth that prescribe these medications, women can have rapid weight
loss and that can cause major shifts in their entire
(06:08):
endocrine system. Namely, when we lose weight quickly, it triggers
the alert system in our body and it tells our
body to slow down the thyroid. Something must be wrong
if there is rapid weight loss there we must be starving,
we must be in famine. We must slow down the metabolism,
and we slow down the metabolism by slowing down the thyroid.
(06:29):
So can we definitely see thyroid changes, especially with rapid
weight loss, and especially if there is poor nutrition. So
adequate nutrition is incredibly important. And what you probably understand,
and what maybe some of the audience doesn't know to
be true, is that many people who are over weight
or obese are actually malnourished. They're not getting enough be vitamins,
(06:50):
they're not getting enough minerals, they are not getting enough protein.
And so you take someone who's already under nourished and
then you simply reduce their choleric intake, they become nauseous
and food averse, and so they're eating a simpler diet,
and now they're becoming even more malnourished. And of course
these micronutrients and macronutrients really impact our brain chemistry and
(07:14):
or hormonal production. So I have not seen it in
my practice, but I'm sure that there are incidences of
women using these drugs who have cycle shut down, a menorrhea,
who stop menstruating, because we know that that happens with anorexia, right.
I have seen reports of women who have new onset
osteoporosis from using these drugs, and that's.
Speaker 2 (07:36):
A really scary thing.
Speaker 3 (07:38):
So, you know, it's an interesting thing to hold two truths.
On the one hand, the fears are conflated worth with
regard to GLP one medications in that you know, there's
a lot of fear mongering out there, and at the
same time, I think that an important aspect that's missing
and that we're not talking about is really the difference
(07:58):
between using these medications in an individualized, tailored, patient specific
approach or just using them kind of by the traditional
dosing that was originally developed by the commercial pharmaceutical for
the purpose of weight loss and diabetes.
Speaker 1 (08:13):
That makes sense, and I know I've heard some about
the potential for muscle and bone density loss with these medications.
It seemingly can be mitigated if someone understands how to
navigate that, but it seems like it requires a lot
of intentionality and nuance. And I love that you brought
up the point of people can be overweight and still malnourished.
It seems like we actually have an epidemic of this
(08:35):
in the Western world. And that's kind of a theory
I've honed over the last ten years or so. Is
this I kind of call it the protein and micronutrient theory,
which is that nutrition is not just about calories, and
we might be achieving enough calorie consumption, however we're not
getting the bare minimum of minerals and micronutrients and protein,
the body, in its wisdom trying to keep us alive,
(08:56):
is going to continue craving things for survival. And that
is something that we can only out will power for
so long because it's a very strong and important signal
from our body. So I wonder if kind of the
rise and popularity of these medications might actually further exacerbate
that problem. And if there is a way to navigate
GLP ones, like do they have a time in a place?
(09:17):
Is there a way to navigate them while taking into
account the complex emotional factors that come into play, the
nutritional and micro nutrient factors that come into play that
can kind of mitigate some of the downsides, like what
do you see in your work? Is there a time
and a place for them? And if someone is using them,
what are kind of the most important factors to be
aware of to kind of capture the benefit with as
(09:37):
little downside as possible.
Speaker 3 (09:39):
Yeah, now, I think that's spot on, and I think
that anytime the body's needs aren't being met, there will
be a response. And if you're a mother, you know
how this plays out. Right, If your child's needs aren't
met sleep, food, attention. That will come out in some reaction,
but maybe not in a way that tells you exactly
what the unmet need was, right. And so if your
(10:01):
unmet need is micronutrient based or macronutrient based, you know
it will come out in excessive hunger, dysregulated hunger, right,
But it can also come out because there's an unmet
emotional need, right, an unmet need for safety, security, connection, relationship,
all of these things that we know are so important
for the body to function optimally. And so I think
(10:22):
we really have an epidemic of that. I mean, we
have lots of data about how disconnected our population is becoming,
how gen zers are more disconnected than any generation before them,
right with the rising use of technology, and how we
need human connection and we need certain things for a
positive mental health, right, And often though, there's this disconnection
(10:43):
between what we think we need and what we actually need. Right,
So this sort of craving and not feeling full, And
there are some it's like a Buddhist representation of this
where it's like the sort of ghost wo can never
be full, like just continues to eat and never feels full.
And I think that some of that is played out,
and you know, we really need to address so many
foundational things about sort of human health and happiness in
(11:05):
order to think about that.
Speaker 2 (11:07):
That being said, if you're working with.
Speaker 3 (11:10):
Someone who understands those nuances, who treat someone as a
whole person, who also you know, gets to know you, right,
it's just sort of like I think I apply everything
from a midwif free model, because you can't really prepare
to be with someone in birth if you don't know
who they are, what their preferences are, their values, like,
who their people are, what makes them feel safe. Do
(11:31):
they want noise? Do they not want noise? Do they
want touch? Do they not want touch? It's the same
thing on any transformational journey, right, like if we're going
on a weight loss journey, if we're going on a
journey through perimenopause and menopause, this is massive transformation that
we're talking about. And so being in relationship with someone
who you trust and who gives you a feeling of safety.
Speaker 2 (11:51):
And you'll know that that.
Speaker 3 (11:52):
That's true if you sort of end a face to
face visit with them, and I don't encourage that you
do these use these medications. If you're not engaging in
synchronous medical care with someone who you trust, you will
get off the visit and you will feel a feeling
of safety in your body. Right, you will feel more confident, comfortable,
And that's just a we should need to clue into that, right,
that's a gauge. Additionally, and to answer your question, I
(12:17):
think it's really important that the dosing be t traded
to your personal response and that you're working with someone
who can coach you on nutrition from a very additive
versus reductive approach. I find that people who have issues
with their metabolic health and have had trouble losing weight,
that the more that you introduce reductive approaches like restrictive diets,
(12:40):
excessive fasting, a diet that uses a lot of the
words like no, can't, don't, that can be very emotionally
triggering to people. And for example, in our program, we
do spend some time focusing on inflammation at a certain point,
but we wait and we also personalize using any elimination
of say things like gluten and dairy, which could be
very triggering, especially for our autoimmune patients. We really do
(13:03):
not do that in a blanket way. Right, It's it's
we have an assessment that we use within our clinical
team to really determine if someone's emotionally ready to do
those things right, And we're testing and assessing as we go, right,
so we're measuring someone's response and then adapting. And I
think that, you know, what we know to be true
about these medications is that they're incredibly effective at reducing inflammation,
(13:24):
at prevention of chronic disease, at you know, in diabetics,
we have really good studies about how they impact chronic
disease outcomes for these people. We have seen how much
it impacts of autoimmune issues, but also the way that
it impacts craving and sort of that never feeling full,
the way that it kind of impacts that drive that
(13:45):
where there is some psychological route in nature. I think
we have some evidence that it also reduces addictive behavior,
So it reduces the drive to gamble, it reduces the
drive to spend money and even engage in other kinds
of addictive behavior, and we know that from the research,
and I just think that that's so fascinating, especially in
the context of this study from twenty twenty four that
(14:06):
showed a ninety eight percent increased risk of psychiatric disorders
in over one hundred and sixty thousand people that were
observed in the study, So it was observational. It was retrospective,
so not randomized, meaning we were just taking a bunch
of people on GLP one and a bunch of people
not on GLP one who were self selected, right, so
their doctor prescribed it or their provider prescribed it. Then
we were observing in those two populations what were the outcomes.
(14:30):
And in the population on GLP ones there was like
one hundred and ninety five percent chance of major depression disorder,
meaning that like that not that one hundred and ninety
five percent, right, but it was that. So there were
one hundred people in one group that had it, then
there were going to be two hundred people in the
other group, right, that had depression. Just to understand how
percentages work, and I think that there are lots of
(14:52):
things that we can explain about this. One I think
is related to the micronutrient deficiencies, that when you further
deprive people who are already deprived, right, you increase the
chance of psychiatric issues. One I think is probably because
it's stressful on the body, as we mentioned, right, to
lose weight. And if you're not sort of taking an
additive approach in terms of community connection, relationship trust with
(15:17):
a provider, and an additive approach from a nutritional standpoint,
then you are increasing that person's risk of feeling unsafe
right and triggering nervous system dysregulation. We also know that
glps increase sympathetic output. This is why people who take
some of the tide or trusappetite, if they're heart rate monitoring,
they'll notice that their baseline heart rate goes up by
about ten points. And that's one of the ways that
(15:40):
it works. When you increase sympathetic output, just like when
you do exercise, you increase sympathetic output that stimulates the
mechanism by which we lose weight. But if you already
have a dysregulated nervous system, that shift in sympathetic output
can be detrimental, can be positive for people. Some people
report improvement. So I think it's just so interesting and
(16:00):
there's so much more nuance here that needs to be
explored that we're just kind of missing, you know, missing
in our conversation about like I don't know, I mean,
there's just so there's so much out there like, I
know there's one camp that has had a lot of
attention to the current administration about you know, this is
the biggest crime to the metabolic crisis, and we really
need to be focusing on food, like and I agree
(16:22):
with all of that, but I also think that unless
you've really sat with a woman who has failed in
her weight loss attempts for years and years and years,
and you sit with that devastation, and then you see
the impact that even small doses of this drug can
have on changing her life and giving her a leg
up on her own journey. And it doesn't mean that
(16:45):
she's taking herself out of the journey or that she's
not putting forth effort, right, it's just this biochemical hack
that really gives her the support that she needed.
Speaker 1 (16:55):
Yeah, it feels like in if these medications are going
to be used, it's actually very much both ends. Like
it's a call to be even more aware and intentional
of nutritional and metabolic factors because you now have a
unique and different way to support the body, and those
probably become even more important. I love that you addressed
the sympathetic output aspect of this, because I've heard from
(17:16):
people that they saw their readiness scores declined because their
heart rate was elevated and they couldn't figure out why.
And it makes sense to me that would be the mechanism,
and also that in light of that, it might become
more important also to become aware of intentional ways to
bring more parasympathetic tone into your life, to deal with
stress a little bit more, to make sure the body
is getting enough nutrients from all sources so that that's
(17:37):
not a source of stress. To get sunlight, like we
talked about in our first episode, so that the body
is able to kind of function as optimally as possible.
And it seems like to your point, this is an
extremely nuanced conversation that it can and does have a
place and is very helpful, and that it brings the
importance of these other factors actually more into light. It
doesn't discount the need for effort and for quality nutrition
(17:59):
and for addressing sleep and stress and all the things
we would talk about anyway. It just gives another potential
tool that people can use when they understand all of
those things. And I'd love to for the rest of
our time circle back also to the kind of the
emotional piece we started with and address even more deeply,
why so many women are seeing depression, Why women still
seem unhappy even if they reach their weight loss goals.
(18:21):
I know for me it was because I had a
false story and I thought that weight loss would make
me happy, And it turns out the reverse was true,
that finding happiness actually led to releasing a lot of
the stuff that was making weight loss difficult. But you
work directly with women all the time. What are we
overlooking when it comes to how we define weight loss
success and the way we support ourselves or support others
through that journey.
Speaker 2 (18:42):
Yeah, I mean, and I got chills.
Speaker 3 (18:44):
I think so many people come to our program and
we ask them to define what their goal is when
they start, and I would say more than half of
women when they reach their goal go, you know, actually
I'm not happy yet. I want to lose more, like
I want I want to change my goal. And of
course we have conversations about like what's actually physiologically a
proper goal, But I think that's beside the point. The
(19:06):
point is that I think we have an epidemic of
women who have been conditioned to be overgiving, have been
conditioned to be more about everybody else than they are
for themselves because we're praised for that, and I think
that we are so far down that hole many women are,
(19:27):
Especially if you're deeply unhappy, you're so far down that
track that you don't even really know what you want
and desire. Many women find themselves in unhappy marriages, in
friendships that don't actually serve them, because they're so used
to kind of being a yes girl and to going
along with other people's needs that they just really are
(19:49):
deeply unhappy. I think that there are, also, of course,
lots of environmental factors that affect our mental health, but
I think it's a lot more interesting to talk about
the psychosocial factors. Think that especially as we age and
after we're done having children, because there is an aspect
to child rearing and child bearing that is deeply imbalanced
(20:11):
in terms of giving and receiving just by way of
actual nature, Like the ten years that I was breastfeeding
and child rearing and birthing and all of those things.
You know, as much as I wanted to take care
of myself, it's like your brain actually can't hold the
space for you know, who do you truly want to be?
And how do you want to show it? Because you're
just sustaining and nurturing life. So I think when if
(20:33):
you've sort of passed through that threshold, it's a real opportunity.
And I always like to think that healthy when we
work on our body, it allows it's like a catalyst
for us to get to know ourselves. And I think
you've described that process so personally, I've had that experience
that sort of when all is lost and when you
(20:53):
kind of don't know who you are and what you
want or what even makes you happy. One of the
best places to start is with like daily foundational routines
that make you feel better physically, because when you feel
better physically, it starts to open up space for you
to get clarity about like what you actually want and
what's meaningful to you. And so I think it's really
just about all society that hasn't taught women how to
(21:18):
know their bodies and live in accordance with their cycle. Right,
you can go back to our other episode if you
want to know more about that, and to a society
that doesn't train young people to really get curious about
who they are, right, we are trained to be performative
and to know how to be what other people want
us to be in terms of like even how our
education works and how job preparation and you know, finding
(21:41):
our partner. Like, we get really good, especially women, because
we can be kind of chameleon like just sort of
be whoever everybody else needs us to be, especially the
highly sensitive and pathic types. Right, we're really good at that.
But if you start with sort of the foundations, which
you're so beautiful at talking about, right, that just simple
things like a really good regulated sleep schedule, hydration in
(22:03):
the morning, sun exposure movement, and also strip away the
things that inherently kind of make you go, like how
many times do you say yes to something and then
like right before it's about to happen you cancel and
like make up an excuse for doing that thing.
Speaker 2 (22:17):
Like everyone's done that.
Speaker 3 (22:19):
But if you're doing that a lot, like you really
need to ask yourself, are you are you over saying yes?
Like do you need some work on your boundaries?
Speaker 2 (22:27):
Right?
Speaker 3 (22:29):
And that's what I see, like is sort of the
through line of people who are coming to us who
are desperately out of alignment with their body and feeling
on emptiness that they think will be filled once their
body looks a certain way, But in reality it's both.
You have to be on the journey toward feeling better
(22:52):
internally and you have to.
Speaker 2 (22:56):
Get to.
Speaker 3 (22:58):
The change in your physiology and your metabolic health by
way of your personal transformation.
Speaker 1 (23:04):
That was beautiful, and I think both of our post
botes together highlight that, especially for women and all of
the beautiful cycles of our physiology, there is so much
nuance and it's very personalized, and I know that you
work directly with so many women. For people listening who
want to keep learning from you and or work with
you directly, where can they find you and learn more?
Speaker 3 (23:24):
Yeah, please follow me on Instagram Emily Sadri Underscore NP
and you can also go to Emilysadrey dot com backslash
wellness Mama for a direct sort of gift and summary
of the episode that we have for you guys, or
you can follow my clinical practice. It's Aurelia Health dot com,
a U R E.
Speaker 2 (23:40):
L I A Health dot com Amazing.
Speaker 1 (23:43):
I will put all of those links in the show
notes for any of you listening on the go, that's
always at Wellnessmama dot com. Emily. I've learned so much
from you. I love your approach to this and the
understanding and depth and listening that you bring to your
work and how much you've shared today. Thank you so
much for your time and for every thing you shared today.
Speaker 3 (24:01):
Well, thank you, Katie. I'm such a fan, and I
think that you bring such a new and fresh approach always.
You always have a noice will to this thing called life,
the parenting, the mothering, the self development, and I'm just
here for all of it.
Speaker 2 (24:16):
So it's a pleasure.
Speaker 1 (24:18):
Thank you, and thank you as always for listening and
sharing your most valuable resources, your time, your energy, and
your attention with us today. We're both so grateful that
you did, and I hope that you will join me
again on the next episode of the Wellness Mama podcast.
If you're enjoying these interviews, would you please take two
minutes to leave a rating or review on iTunes for me.
(24:40):
Doing this helps more people to find the podcast, which
means even more moms and families can benefit from the information.
I really appreciate your time and thanks as always for listening.
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