Dr. LaKeischa McMillan – OBGYN

00:00
Carmen
Me, can you see me? My reflection. All right, we ready to rock?

00:07
Kevin
Yes, we are.

00:08
Carmen
All right. Welcome to the N of 1 podcast. Today we have our regulars, Dr. Jamie, myself, Carmen, and Kevin. And we have an amazing guest today, somebody who I have been seeking out for a very long time. I think we’ve been talking about this since November, and. And I’m just so excited to have Dr. Lakeisha here with us today. She’s an OB GYN author, speaker, hormone hottie host, and that’s how I found her, because I was just seeking out anything and everything we could here from the south. Dr. Lakeisha, welcome. Thank you so much for being here with us today.

00:39
Dr. Lakesha
Thank you for having me. I’m so excited to be here. You’re talking my talking my language. So y’ all are going to have to give me the whole it’s time to cut, time to get off your soapbox kind of thing.

00:49
Carmen
Listen, we will never say that. In fact, yes, this could be the best southern soapbox we hear today from. Straight from where you. You came down here to Huntsville. Also, I want to just quickly highlight that she’s got a book, the other pms, which I think is something everybody should know about before we get started, the Survival Guide for Perimenopause and Menopause. So we want to just definitely let everybody know about that. But, Dr. Lakeisha, we have a lot of questions here in the South. We’ve got some limited resources here, and Dr. McDowell has come to the realization that people like me could be a problem because we are really digging deep to find the answers about the things that we’ve been feeling for so long and not being validated about.

01:33
Jamie
Right, that’s right. That’s right.

01:36
Carmen
And I think one of the biggest things I wanted to talk to you about today is what resources we have, because now we can make our own decisions. Right? We’re getting information, and we’re getting good information, and we’re giving free information. Right? I mean, you teach me so much, so much all the time. And being part of the hormone hotties, I just feel like, you know, a special person being. Being part of your group, because I get this information, and then we can help share with others. Again, it’s free information that people can then take with and do what they want to kind of go through their own journey because everybody’s so different. So tell us about when you see a patient. I know you do the Dutch test as well. Tell.

02:14
Carmen
Tell us about that, because I know there’s a lot of people that come to us. And they’re like, oh, do you do the Dutch test? Do you do the Dutch test? And I think people need a little bit of information here about kind of where you start cultivating where someone is in their journey and the things that you do, like GI mapping and thyroid testing and things like that.

02:32
Dr. Lakesha
Oh, my gosh, this is such a great conversation. I love having these type of conversations. And what I do is it’s not just about the testing, because when you layer on functional medicine testing on top of being that person that someone can really listen to, someone. Someone can really talk to, rather, where you’re that person that starts sitting there and saying, hey, tell me your story. Tell me what’s going on. And so you validate, first of all, you validate their symptoms.

03:00
Carmen
Yes.

03:01
Dr. Lakesha
Help them to feel as if they’re not making this up in their heads, because they have felt this way before coming to you. And so when you actually sit there and you practice something called narrative medicine, as a term that I heard of a few years ago, where you literally sit. Sit with a patient and you kind of exchange stories so you connect with them, and they’re able to sit there, and they start feeling that they have validation, they have safety, they can open up, they can tell you all the things that somebody else kind of shut them down with and gives them agency.

03:38
Jamie
It gives them agency.

03:39
Dr. Lakesha
Exactly. It gives them that agency. And then they’re able to make these very informed decisions. Right. So you take that part of it. And then I started layering on functional medicine testing. So it’s more than what’s just in the bloodstream, because that’s what our blood tests tell us. They tell us what’s available. Okay, that’s great information. It’s great to start there. But then I want to know, what are the cells doing with this? What’s going on? Are you having good receptor activity where the. Where either hormones or some type of molecule is stuck sitting on the receptors, and then it’s getting drawn into the cell. Then the DNA has the ability to unravel and make these wonderful proteins or metabolize whatever you’ve put in there and then spit out the metabolites on the other side.

04:27
Dr. Lakesha
So that’s why I use this information, because it gives me another data point that I can then start building this story and start seeing this whole person. So that. That’s why I like doing what I do, because I can really practice. What Loma Linda kind of taught me their was to make man whole so I’m able to look at the whole person.

04:50
Kevin
Do you find there’s dysfunction between those tests, particularly like blood test and the Dutch test?

04:57
Dr. Lakesha
What is not necessarily dysfunction? What I find is that I get more information. So what the blood test is telling me is what’s available. The Dutch test or even other types of functional medicine testing is taking me another layer deeper. So then I can help explain the discrepancy or the perceived discrepancy that other people have been getting so far.

05:22
Carmen
Right. And you know, what’s interesting about this is that you can’t just go to anybody for this. And a lot of people here, I feel like we’re seeing a lot of these, you know, I call them Botox clinics or, you know, places that are practicing or trying to practice medicine just by. By grabbing onto these little things, right? And they want, oh, well, we’ll help you with your hormones or we’ll do this. And it’s like I over at Dr. McDowell who’s got, you know, 25 years of medicine under his belt or more, and I’m like, we need a doctor. We need somebody who’s been doing this for a long time to guide these people. It cannot be off the cuff, and it can’t be where you go to get your facials.

06:02
Jamie
You know, one of the things that I have observed in my practice, 80% of my patients who undergo weight loss surgery, and this is. This is across America, female. And so in many ways, I consider myself a female physician. And so I have to address their issues. And so if you look at menopause, I think menopause over the last 20 years has been minimized by mainstream medicine. And so, you know, we just want to chalk it up. Oh, you got some hot flashes. All right, we’ll turn on air conditioning. It’ll be all right. You know, and what I’ve now realized is in my patient population, it’s so much more. When you get out of hormonal homeostasis, it’s depression, it’s weight gain, it is lack of motivation, it’s lack of mental focus. And what does mainstream medicine do about those symptoms?

06:54
Kevin
Right?

06:54
Jamie
They’re gonna put you on an SSRI for your depression.

06:56
Carmen
Yeah.

06:57
Jamie
Psychologist, they’re gonna put you on a semi glutide for your weight gain, they’re gonna give you some speed, they’re gonna give you some Ritalin if you can’t think correctly. And at the end of the day, they’re treating symptoms of menopause. Whereas one molecule, one unifying mole, by God, can solve all of these problems if you can just identify and you can treat appropriately.

07:18
Dr. Lakesha
Oh, you know, you’re. You’re speaking my language here. I love it. Like I said, you don’t have to tell me it’s time to go, right?

07:25
Carmen
No, no.

07:26
Dr. Lakesha
You know, I say all the time, I say, and when I teach practitioners, I actually even teach practitioners the hormone method that I use or the hormone system that I use, because I say that if you have doctors understanding what’s going on and patients understanding what’s going on with their bod, that communication chasm gets smaller. And so I tell doctors, I say, think about it. It is a dysregulation of some main organ or hormone systems. You have dysregulation of not only the sex hormones, but you have dysregulation of the adrenals, you have dysregulation of the gut hormone axis. You have dysregulation of the thyroid axis, you have dysregulation of the HPA axis. So you have to start treating all of these different areas so that everybody can play nicely together in the box.

08:15
Carmen
That’s right. That’s right. Tell us about the gi. GI stuff and how it plays a factor in all of this. Because of course, thyroid is a hormone. Right. We know it’s all endocrine related. But what’s really important too is to listen. Listen to what’s going on in the gut.

08:32
Dr. Lakesha
Oh, that gut. So. So, you know, there are a lot of buzzwords out there, right? We all know, you know, people talk about the microbiome and insulin resistance. Yeah. And it’s like, okay, well, what is it? Well, they are terminology. It is terminology that. And you need to know how to use it and where it actually fits, right. So that you can understand it. There is a gut hormone connection. And what we have found is that gut hormone connectivity is between the gut microbiome. So when you talk about the gut, you’re literally talking about from the mouth to the anus, right? That is the entire gut. And between in all those different areas, bacteria. Certain bacteria live in these certain areas. And when you don’t have the right bacteria in the right area, your hormones do not get metabolized like they should.

09:23
Dr. Lakesha
They do not get detoxified. You all know we love big words in medicine, right? So detoxification is just a big way of saying the way your body metabolizes or uses your hormones. And there are certain areas that certain detoxification processes happen. So, for instance, I love to talk about estrogen detoxification because it’s just very Easy. And I can talk about that very quickly. But estrogen gets detoxified. Detoxify it in three phases. The first two phases are in your liver. The last phase is in your gut. And if your gut is a mess, it’s just like putting water in a bathtub. And the pipes are all gunky. And when you want to take that water out the bathtub, it won’t drain because the pipes are all gunky and yucky.

10:05
Carmen
So you love that.

10:06
Dr. Lakesha
Address the piping system, and that’s the gut.

10:10
Jamie
And where does that estrogen go in your body?

10:13
Dr. Lakesha
If you don’t metabolize it gets reabsorbed. And when it gets reabsorbed, then you have all these symptoms of estrogen dominance.

10:22
Jamie
Polycystic ovarian syndrome.

10:25
Dr. Lakesha
There you go.

10:27
Carmen
And that. That estrogen dominance is also a new buzzword, by the way. People are coming in saying, you know, I’m estrogen dominant. Yeah.

10:34
Dr. Lakesha
And I say, well, you know, in my. In my. In my perimenopausal women, menopausal women, really perimenopausal women, and I do take care of some women that have pcos or have, you know, hormonal imbalances. I actually pro. Go against the grain. I say think of it as progesterone deficiency. If you start thinking about it that way and how we need to balance that progesterone and kind of bring that up most of the time, that’s kind of what we’re working with and working with that detoxification pathway, making sure that your pipes are open. And that’s what the Dutch test can kind of tell me a little bit, because there’s all these little breadcrumbs on the Dutch test that talk to the practitioner that give us insight on what’s really going on biochemically with this patient.

11:21
Carmen
Right.

11:22
Kevin
So many of the patients are struggling with fatty liver, and you’re talking about liver detoxification along with gut biome. So explain the difference and how that would affect it as well.

11:32
Dr. Lakesha
So when you’re talking about fatty liver and you’re talking about how the. Remember the liver is the city dome. Everything gets processed through the liver. So the liver has a big job. Right? But what we can do is we can support the liver’s ability to actually cleanse and take care of all the stuff that’s sent to the city dump. So basically, think about it as it’s going. It’s coming down a conveyor belt, and you’ve got to decide where everything goes. Okay. And so if everything’s coming down this conveyor belt. The liver decides, okay, oh, you’re an enzyme. I’m gonna help you. I’m gonna help you change your shape. I’m gonna put you over there. Oh, this is a hormone. Okay, this is estrogen. I need to change the shape.

12:12
Dr. Lakesha
I need to put a methyl group on here and I need to turn and twist and kind of do these things so that it actually changes the shape so I can send it over to the gut so that it can be repackaged up and sent out in basically your poop. Right. And so liver detoxification, or supporting the liver, is where you give the liver some great nutraceuticals or the environment for it to be able to do its work, to be able to do all this heavy lifting. And when we get fatty liver, because a lot of it comes from insulin resistance or you’re not metabolizing your sugars properly and so your actually starting to stuff this excess sugar as fat in storage areas. You’re sending it to the liver, you’re putting it in adipose tissue.

12:58
Dr. Lakesha
The body’s just like, what do I do with this? Okay, let’s put it over there. Oh, let’s lock it up in a vault. Put it over there. And that’s when it becomes very difficult to lose weight. That’s when you have that fatty liver. That’s when your cholesterol goes up, you start having this whole metabolic syndrome can start happening.

13:14
Kevin
So what percentage of your patients, though? Sorry, Jen.

13:17
Jamie
No problem.

13:18
Kevin
What percentage of your patients that most people consider just a hormone patient actually need detoxification first or simultaneously?

13:26
Dr. Lakesha
That’s a great question.

13:29
Jamie
And as an extension of that question, I think it’s important to identify, you know, what is the connection between estrogen deficiency and metabolic syndrome, fatty liver, insulin resistance. That’s going to be, that’s going to be the big thing, the big question that I want answered, you know, for myself.

13:47
Dr. Lakesha
Well, actually, so it’s interesting. Okay, I’m going to answer both of your questions. Hopefully the way I answer this, when you think about estrogen deficiency, you are deficient in the levels that you used to have.

14:01
Jamie
Yes.

14:01
Dr. Lakesha
So when you start dropping, when your body starts dropping, making as much estrogen, progesterone and even testosterone from the ovary system. Right. So that’s the main system that makes all of that. Then your adrenals should kick in and they should start making some more of these sex hormones so that you don’t feel as depleted. That’s what should happen, ladies? I mean, your body should start making this nice, smooth transition. Think about it now. So you’re now having this estrogen that’s not going as high as it used to. It’s not lasting as long as it used to. So the cycle, women, that’s your cycle starts not. Starts being interrupted. It’s now not the way it used to be. So when you have that estrogen deficiency, you actually do have an increase insulin resistance. You actually do kind of spark some of that metabolic syndrome.

14:56
Dr. Lakesha
You can actually increase your androgen production. You can now increase some chronic. Some chronic inflammation. And now you’re in this vicious cycle again, where you are in that metabolic syndrome. Now, to your point, Kevin, how many of my patients that come in have the fatty liver or have some type of problem? I see a high percent. A high percentage of them do. And when I say a high percentage of them, what I have found is the reason that I started automatically adding on the GI MAP was because I was only looking at the sex hormones doing all this wonderful work and thinking, I’m balancing hormones. They would feel great for two weeks. And then they come back and say, I feel awful. And I was like, what do you mean you feel awful? Your levels look fine, right? The blood work looks normal. Right.

15:47
Dr. Lakesha
If I hear that term one more.

15:49
Jamie
Time, I get so tired of hearing that.

15:51
Kevin
Right? But I think that’s what amateurs end up doing in all these med spa clinics. They end up looking at those blood works and they’re like, okay, I’ve reached my limit of understanding. It’s a you thing.

16:01
Jamie
Well, most of my patients who go see their primary care provider, I don’t have anything against primary care providers, but. But they complain of, you know, symptoms of menopause. So what do they do? They get a serum estrogen level. It’s completely normal for your age. It’s normal for your age. And wait, but we’re not taking. She has menopause symptoms. And so again, they’re not addressing the appropriate thing.

16:27
Carmen
Well, two things. One, in Europe, they don’t do a lot of serum testing, right? They look at just symptoms. That’s number one. Number two, you have somebody like me who’s, you know, 46 years old, had a baby, she’s three. So, like, I mean, this is my fifth child, so I hope that, you know, and my mom went into menopause in her early to mid-50s. So I’m thinking, like, maybe I’ll have a later chance. But I go to my doctor, right? My gyn, and I said, I’ve got all the symptoms. My cycles are changing in their length. I have horrible brain fog. I am so ADD it is. I can’t even finish the dishes and then I start something else and then I’m in the yard before you know it, I’ve got laundry everywhere, dishes everywhere, and I’m out in the grass.

17:09
Carmen
So you know, these are the symptoms. And she says, oh well, you might be starting weather the storm. And I said, why don’t we, do you want to check some labs? And she says, well, that won’t tell us anything any different because it could be different today and different tomorrow.

17:22
Dr. Lakesha
I get that and I see what they’re saying. What we also need to understand is that we need to start really giving our patients agency like you said before, Dr. McDowell, and giving them that power to tell me, because you live in your body every day and you only come see me when you have a problem, maybe seeing you once or twice a year, that something is different, something has significantly changed and it is impacting my life. I cannot function the way that I used to or that I know I can function. And so that is where I think some of the, I believe that may be some of the fundamental things that we need to be talking about and actually unpacking and unraveling. And the other thing we need to realize is how do we even get here?

18:14
Dr. Lakesha
Well, I believe we got here because of the WHI study. And I just feel that I have a special place, I have a special connection to it because I was an intern when that paper came out and got FedExed to my residency program director’s home. We’re sitting in morning report, bright eyed little MDs and gonna save the world. And she rushes in and she says, we have to take all the women off of this, we have to stop it. And we’re like, what just happened? And because of the way that information was given and we took that information which was wrong and ran with it. And we did not stop and backpedal and say, okay, this is what’ really going on in this study. We didn’t say it was synthetic hormones. We didn’t look at the average age of the woman that was studied.

19:06
Dr. Lakesha
We didn’t look at all the different particulars. We didn’t look at the type of tools, statistical tools that were used to analyze the data to be able to come to the conclusions that we came to. And so we have done a two generations a disservice, I believe.

19:24
Carmen
Right.

19:25
Dr. Lakesha
We have done women a huge disservice by making hormones the boogeyman because that study said it was wrong. But we need to go back and understand what that study was, what it was looking at and the fallout from it.

19:41
Jamie
So what, what she’s talking about for our listening audience, she’s talking about the Women’s Health initiative study in 2002. And you know, many of you who are old enough, we used to treat menopause with either Premarin if you’ve had a hysterectomy because you didn’t have any reason to slough off the endometrium, or we used Premarin plus a progesterone analog called progestin. And so in 2002, they did a study and it looked at elderly women 65 or older and it looked at their cardiovascular risk factors and their recurrence of breast cancers. And the conclusions of the study is that those that were taken premarin had no increased risk of any breast cancer or cardiovascular events. But all of the adverse events were in the PremPro arm, that is the Progestin Premarin arm.

20:31
Jamie
And what the conclusion was is that progestin causes problems with cardiovascular events and malignancies in this elderly patient population. Now, does that apply to a 48 year old woman who has had five children who is.

20:47
Carmen
I’m not quite 48, but. But yeah, go ahead.

20:49
Jamie
I’m sorry. So obviously what, by the way, versus Right, and that’s a synthetic progesterone analog. Obviously we have other progesterone that are not synthetic now. And so guess what? They came to the conclusion that estrogen causes breast cancer and heart attacks. And it does not. It does not. And we are doing women a disservice.

21:11
Carmen
But it’s still scary, right? Because you know, my aunt, my grandmother, two aunts, my grandmother and my mother, four people close to me, plus my cousin, all have had breast cancer. So it’s like you take somebody like me who’s so scared because they’ve seen each person so close to them go through it and you take this old information from this old study and you couple that just breeds scary.

21:36
Jamie
Well, I’ll ask Dr. Lakeisha about this. You know, estrogen has a cardio protective effect. We’ve known this for years. Right. It also has a breast cancer protective effect. The longer you have a period, the less chance that you have of having breast cancer. We’ve known this is years, decades old. And so it makes sense that estrogen.

21:59
Dr. Lakesha
Know that estrogen has neuroprotective properties as well.

22:02
Jamie
Absolutely, absolutely.

22:04
Dr. Lakesha
So the brain fog, all the things that women come in, check, check, check. It is due to the lowering levels of your hormones that you’re now experiencing. And we’re just saying hold on for dear life, right?

22:21
Jamie
That’s right.

22:21
Kevin
So I’ll go back to that kind of, that original question I had chicken or the egg, which one would you treat first? When you identify, if you take a look at their gut map and take a look at their hormones, what do you treat first? First treat them concurrently.

22:37
Dr. Lakesha
Do you treat concurrently? Okay, I treat them concurrently because of what I said before. You put hormones in the system, you don’t address the pipes and they feel great for two weeks.

22:52
Kevin
Right.

22:53
Dr. Lakesha
And they come back to you and they feel either just as bad as they did when they came to you or worse.

22:59
Carmen
And that’s why there’s such a yo with this diagnosing and prescribing. Right. But I also noticed, like you in your program, you use herbs to help balance the stress response. And I know that there’s other things that you recommend for, you know, supplements that can improve your sleep and energy and mood. These things like Kevin said, do they come first or do you start straight out of the gate with the hormones?

23:28
Dr. Lakesha
You know, I do a personalized symptom solution blueprint for my patients. So when they come in and they have their testing done and I’ve done their in depth history and then it’s now time to put in to put their program together, it really, they kind of guide me. I will tell them, okay, look, we need to do X, Y and Z. What are you able to really start implementing right now? Because if you give somebody three or four adrenal supplements, you get or GI supplements, then you give them two adrenal supplements, then you’re giving them another supplement to balance their hormones, then you’re giving them prescriptions for their hormones. They can get so overwhelmed they shut down and they do nothing.

24:17
Jamie
And there’s a lot of variables in there that you got to keep control of. You know what I mean? A lot of variables in there.

24:23
Dr. Lakesha
Exactly. So the person really does guide me. I tell them, I said, I’m sitting in the passenger seat, you know where we’re going. And so I’m going to put in the GPS coordinates that I think are right to get us there. Because what is the biggest symptom that is bothering you now? What is the biggest goal that you have? So I give them three because they’ll Come in and give me everything. Yeah. But they also work with me on a basis that we can address these over time. And the funniest thing is that I’ve learned I can tell when my patients are feeling better. They stop. They stop using this, the messaging system. Oh, they are. In the beginning it is like, oh my gosh, Dr. Lakeisha. But you know, I’m. And I’m. Yes, yes.

25:09
Dr. Lakesha
And then all of a sudden they get real quiet.

25:11
Carmen
That’s funny.

25:13
Dr. Lakesha
And then when I come back for their follow up, I’m like, hey, how you. Oh my gosh, I’m doing so great. And they’re.

25:18
Carmen
They forget to message anymore.

25:21
Dr. Lakesha
Their shoulders are relaxed. So to answer your question, Kevin, it really is patient guided. Plus my expertise. And I know asking them, what’s your biggest symptom right now I know which one we’re going to address. And I’ll say, okay, this is what I think we should do. However, if your life is too hectic, you’re too flustered, your brain fog is too much, I do not want to short circuit this experience. Experience. So that’s when you manage their expectations and say, you didn’t get here overnight. I know you feel like you did. Like you woke up one day and you missed a memo because your body literally changed overnight to you. But we’re going to take a little while because X, Y and Z, these are the things. And so I will have, you know, delineate out what we’re doing.

26:12
Dr. Lakesha
Have them do some check ins very frequently in the beginning because depending on how acute they are will be the plan that I put.

26:20
Kevin
I love what we’re hearing because this is what we believe at N1 as well, that hormones aren’t the only answer. They’re part of the answer. They’re part of the tool bag that we all have. And you’re not limiting yourself as a functional medicine physician to just, hey, we’re going to supplement the crap out of this until you get to feeling better. We’re going to do more.

26:39
Jamie
This is the difference between us and your average. I want to say chiropractor on the street corner is just making an extra. Your book treating hormones.

26:47
Carmen
Right. And, you know, that’s why I reached out to you, Dr. Lakeisha, because you have something that we’re trying to really implement here and we have a medical practice. Right. We’re looking at the whole person. We’re trying to get to, you know, the root of the problem. And a lot of it’s all linked, as we know. And these resources are Great. But a lot of people don’t know about these resources. And of course, you know, insurance doesn’t cover them. And so we run into that problem, and we have had to separate ourselves from insurance and really make things up affordable so that people could make their own choices and have those same, you know, resources and the results that they get from them.

27:24
Carmen
But, you know, something I want to back up on really fast is I interviewed on this podcast, actually, a compounding pharmacist who was amazing. Two PhDs, I mean, just. Just so brilliant. And we talked about the bioidentical hormone replacement and the difference. So tell us for our listeners, you know, about that, because I think people, they want to go cheap, right? They want to go the route that’s. That’s the least expensive. They want their insurance to. But we do know that not all drugs are created equal when we’re trying to do this replacement. And I just want your take on that.

27:57
Dr. Lakesha
Exactly. So whenever I’m teaching or even just talking to patients, and I teach patients a lot, I actually will pull up one of my slides that has the organic structure, the chemical structure of bioidentical hormone, biological and synthetic. And I say to them, bioidentical hormones look just like what your body was already making. And the body looks at that and goes, I recognize that. I know what I’m supposed to do with that. Okay, so you go over here, take that piece off, turn this, you know, change the shape. Boom, boom. Liver does what it’s supposed to do. It goes out in the GI tract, all the metabolites. We know what to do with the metabolites as well.

28:41
Dr. Lakesha
When you’re dealing with a synthetic hormone or the ones that, like Dr. McDowell said, were in the WHI study, PremPro, Premarin, they look like what your body used to. They don’t look like it. They are synthetic. They actually. It’s almost like taking and making a key that can fit into the lock if you try it hard enough. So it can sit on the receptor and it can make the receptor do certain things, but the body breaks it down, and the metabolite don’t look anything like what the body’s used to. So then what can happen is now it’s like, I don’t know what this is. Maybe it’s like a bacteria, virus or a fungus. Maybe we need to stimulate the immune response to get rid of this, because I’m not sure what this is.

29:29
Dr. Lakesha
So now you’re stimulating the immune system, and now you have an inflammation type of process that’s Happening that is being kicked off and that’s a chronic that can cause that chronic low grade inflammation. So when you look at bioidentical, they look just like what the body used to make synthetics. They are actually. And all of them are made. They’re all made, but they’re made differently. Now there’s a difference between compounded and compounded prescriptions or bioidenticals and bioidenticals that are made kind of like in mass production. So compounded prescriptions, I love them because you can customize them, right? The pharmacist can really customize the dosing. We can go up very, you know, incrementally. You make sure that there are fillers, certain fillers are not in those products.

30:20
Dr. Lakesha
Because I say think of it as like making a recipe and you have your main ingredients and one. And the main ingredients are going to be the same. But when you have like your generics versus your brand, only the generics are going to be able to put in kind of like different fillers. The way I think about it, right.

30:38
Carmen
And that’s kind of. And tell me if I’m wrong, that’s kind of how I feel about like patches versus compounded. Because I feel like. And tell me if I’m wrong. I feel like the compound is and that’s. We do use compounded prescriptions here. And I feel like that’s like more of a custom versus like a, a blanket.

30:57
Dr. Lakesha
It is, it is more custom. Now what’s interesting is where I have, I’ve had to learn to respect everybody’s individual metabolism. Right. And the way their body actually takes in. I have had patients that I put them on their compounded creams. I’ve done all the things and they only responded to the patch and it’s just probably the way that their body metabolize. So I do prefer the compounded formulations. That’s like my first go to. Absolutely. But like you said, there are other different tools in the toolkit and so I have to be mindful of them and go, hey, maybe your body didn’t read that test textbook. So your body understands me doing the patch.

31:41
Carmen
And do you feel the same way about injections?

31:43
Dr. Lakesha
Injections? Now you put me on the spot. I will do injections for males, for men. But when it comes to women, I’m very, I stick with my creams and patches and probably a not so popular opinion, but even pellets for women. So there are some women that can metabolize their pellets and I dosing. That’s very conservative dosing, when I do that.

32:13
Jamie
So to summarize, what she’s saying for our listening audience is if you think about not all estrogens are the same, right? And there was Premarin, which is derived from cow estrogens. And if you sort of think about the estrogen molecule, a human estrogen molecule, it’s going to hit an estrogen receptor, and your body has a mechanism to get it off of that receptor, because that’s obviously when it hits the receptor, that’s when it does its magic, right? And when the body is done with that, it knocks it off the receptor. And what’s left over is what we call a metabolite, right? Now, one of the things that I always thought when I was studying biochemistry is that metabolite didn’t do anything. It was deactivated. It is not okay. It has effects.

32:59
Jamie
And if it’s a natural human estrogen molecule, your body is used to seeing that metabolite, and it knows how to deal with it. What she’s talking about is if you’re using a synthetic type of estrogen that acts on that receptor, but it’s knocked off, then that metabolite, it may have other effects that she’s talking about. It’s a foreign body. Your body’s gonna treat it like a foreign body. And so even though you still can get estrogen effects from, you know, synthetic analogs of the estrogen molecule, it’s the bioidentical that you’re gonna get the best effect of in the most predictable effect of, at least in our studies.

33:33
Carmen
And. And we know, like you said, that everybody responds differently. So you’re right. Like, some people will swear by the patch. They’ll never, ever want to take it away from them. They love it to death. Other people love trochees, and they want to bypass the GI system. And we use a lot of those because that is just a magical thing sometimes when you can just absolutely, you know, get straight to it. But I have been following, like, you know me, I’m like a social media weirdo. And I kind of, like, I’m in all these groups and I hear people, like, actually ran into somebody that. Who she was treated in Europe. She was doing troches for years. They worked, worked. And then all of a sudden, she said that she got a prescription for testosterone. And she said, I’ve never had.

34:12
Carmen
I’ve never felt better in my life as when she took the injection. And so. And it’s a tiny dose. Right. Of testosterone for women.

34:22
Dr. Lakesha
I just don’t have that. I’m not well versed with the injection.

34:26
Carmen
Yeah, it’s a lower dose. But anyways, long story short, she said for her specifically that she’d never felt better and she’d never gotten the results that she had gotten from other methods. So, you know, like you said, you have to kind of respect where people are and what results they’ve gotten from those things and what works best for them. But I do think we kind of all agree now that, like, there are multiple avenues. We’ve got to educate people, we’ve got to come together and we’ve got to allow people to have that freedom and not just go to your doctor because they don’t agree with something. You can’t have it. Like, to me, that’s just the most frustrating thing in the world.

35:01
Jamie
I think a common clinical scenario is you, if you have a middle aged woman who’s depressed, who is, has, you know, ADHD and all these kind of things, and they’ve gone to every doctor around, guess what? It’s a complex system, but it’s relatively simple to fix it. Yeah, really is. We just have to get the word out there. Because for 20 years, even mainstream medicine, listen, we don’t do this anymore. We do not treat hormones anymore. It is, it is infuriating.

35:29
Carmen
Well, they don’t even educate on it in medical school, right? I mean, so how are you going to treat on it if you don’t know? The other thing I was going to say is I know you have a course, right. And there’s a lot of things that we can do to educate ourselves and come together. Which is why I wanted to have this podcast. Because we can’t just act like, you know, oh, they’re doing this or oh, they’re doing that. Like, we got to come together because if we don’t, I mean, there’s enough patience for all of us, right? There’s enough people who need us that can’t manage. So I feel like coming together and being part of the hormone hotties group is just, it’s just so cool because it unites us from far away.

36:02
Carmen
I mean, you’re so much, you’re not even in this market area. And here we are like, just clinging together to try to hold on, to help women figure this out. I mean, men, obviously, we treat men’s hormones too, but I just feel like it’s such a pleasure to be able to talk to you about this. The other thing I was going to ask you is when you’re talking about. So just get. Not to be too vain, but, like, talking about myself, I am that perimenopausal woman, right. Like, still have a regular cycle. And I’m. I’m here, I’m the brain fog. I’m all the things I’m probably knocking on the door, not quite in. But do you think people should go through some detox first to try to wake up receptors and to kind of go ahead and. And clean everything out and maybe.

36:45
Jamie
Yeah. How do you treat a patient who’s just starting to see these menopausal symptoms, recognizes them, goes to their physician and say, I’m starting to gain weight. You know, I’m having some hot flashes. You know, what are the. How do you start?

36:59
Dr. Lakesha
Oh, yeah, absolutely. I love that question. Because for my perimenopausal like. Like yourself, I will say, you know, let’s start on the gut. Let’s start there. Let’s start. And I am an adrenaline junkie. Oh, my gosh. Not junkie. But I champion the adrenals so much. Like, I preach adrenal gospel everywhere I go. Because I’m saying if the adrenals. If you are running your adrenals so much now, they cannot help you when they’re supposed to.

37:37
Dr. Lakesha
So if you don’t do things to replenish yourself, to turn that parasympathetic nervous system back on every single day, after you’ve been running, running, running, after you’ve been doing all the things, you will not have the environment set up to be able to support you long your longevity and to do all the other things that are necessary at this phase of your life, in this last third of your life. So I will say, hey, let’s work on the adrenals. Let’s work on your liver. Let’s support that and work on your gut. And we can start there. And there are some supplements. I can say you can start with things like that. Yeah, absolutely. And then looking at which hormones really need support, do we need to start adding some bioidenticals as well? But yes, you are absolutely right.

38:27
Dr. Lakesha
Prior to getting there, the more you can do to set up a great environment, the better for you.

38:35
Carmen
Well, and it buys you some time before you have to start taking a prescription, you know, because once you start, it’s kind of hard to stop.

38:41
Kevin
Well, also, I would like to ask you, outside of medication and supplementation, what things do you recommend for a patient that’s having trouble with that parasympathetic situation. Grounding, for instance, all these meditations.

38:57
Carmen
We got. We got kicked off, so we’ll resume.

39:04
Kevin
I gotta charge my computer, too, before I jump on.

39:07
Jamie
Okay.

39:08
Carmen
Do you want.

39:12
Jamie
Yeah, this is good.

39:14
Carmen
This is good.

39:15
Jamie
Good. So the other thing. Got to ask. How does a gastric bypass affect your gut?

39:26
Dr. Lakesha
Yeah, because that’s a.

39:27
Jamie
Well, that’s your problem.

39:28
Dr. Lakesha
Yeah.

39:29
Jamie
And that is a. You know, the gastric bypass. How you change your treatment of the. You know, of the gut.

39:36
Carmen
Well, I. I was going to go into that about weight loss and setting up a good.

39:39
Jamie
Yeah. I think we can sit here and Talk for another 15, 20 minutes if not want. Okay. We can keep going.

39:45
Dr. Lakesha
See where I.

39:58
Jamie
It’s.

40:36
Carmen
I have like maybe 15 minutes, and then I gotta run.

40:39
Jamie
Okay, we are. Wrap it up. We’ll wrap it up.

40:48
Kevin
All right, we’re back.

40:50
Carmen
Sorry.

40:51
Kevin
All right, I’ll re. Re. Ask that question, Laishan, and then give you a chance to answer. So outside of.

40:59
Carmen
Did you push record? Sorry.

41:02
Kevin
Thank you.

41:02
Jamie
Yeah, we got to record. All right. Got to record this.

41:06
Carmen
Recording in progress.

41:07
Jamie
Got it.

41:08
Carmen
And then he will. He’ll ask that question again.

41:11
Kevin
Sorry, Lakisha. So outside of medication supplementation, what things do you recommend to your patients? That is grounding. Doing additional things outside medicine.

41:25
Jamie
There’s parasympathetic nervous system, as opposed to being hammered with catecholamines all day long.

41:33
Dr. Lakesha
Oh, my gosh. You said it, Kevin. I give my patients homework, and one of their homework assignments is to watch the documentary on YouTube called the Earthing movie, the remarkable science of Grounding.

41:47
Kevin
Okay.

41:48
Dr. Lakesha
And I talked to them about going outside, and literally that’s like what we did when were little kids. Go outside barefoot and let your body discharge all that negative ions, all that inflammation, into a bigger vessel, which is the earth, because we can’t keep it all packed up here. And that’s something very simple that you can do because again, remember, these women are coming to you. They’re overwhelmed. If you tell them to go do one more thing, they’re gonna look at you cross eyed, like, really? I cannot add one more thing to my schedule. But if you can stand outside in.

42:24
Jamie
The crowd, but if you can couple it with a physiologic response, I mean, one of the things that I think is really important for all of us to do is we are so inundated with electronic information where, you know, have so much information. It’s good. Not just you can ground, but just turn all that stuff off. Right. Clear your mind. That Activates your parasympathetic nervous system. And that is healthy for you?

42:48
Kevin
Well, it’s a. It’s a spiritual deficiency.

42:50
Dr. Lakesha
And the other thing. And the other thing I say to patients, I said, do you remember when were little, or if you have children, when your children were little, you gave them a bedtime routine, right?

43:02
Jamie
Yes.

43:02
Dr. Lakesha
That was either story time, it was bath time, it was something. And what that does is it actually sends a signal to your brain and says, it’s time to end the day. It’s time to turn this thing off, leave what’s there so that you can start afresh. So I encourage my patients, even start some type of bedtime routine. I say it’s as simple as bedtime social media or I’m done with, you know, wash. I wash my face or do a shower, Something that says to you, and. And you can start simple. And then you can graduate that, and you can layer that and add on to that and do bigger things that will be, you know, that you can incorporate into your. Into your. Into your schedule. Grounding is. Yes. One of the simplest ways. Meditation, breath work.

43:57
Dr. Lakesha
I talk about breath work all the time. I give them something as simple as alternate nostril breathing that you can do in your car, you can do at lunchtime, you can do in between meetings if you need to. You can turn your camera off if you’re in a meet, and you can do that. That literally rewires your brain and brings your parasympathetic nervous system back online.

44:20
Kevin
One of the odd things that helped me. Lakeisha, I’m sorry to interrupt. One of the odd things I found that lowered mine or helped me was getting in the car because I used to drive a lot, and instead of trying to get somewhere fast, get somewhere slow, get behind a slow car intentionally one day and try driving to work. Give yourself plenty of time, and you will find that you will get to work, and you’ll be in a better place. You can function longer, better. Right. Than you ever have.

44:55
Dr. Lakesha
Yes.

44:55
Kevin
But it changed my whole dynamic of how calm I could be. And I think it frankly lowered my blood pressure a lot. Because you just don’t realize that you get in the car and you’re rolling, rolling. You’re always running behind. I’m rolling. Gotta gotta gotta go.

45:08
Carmen
Well, and that’s. That’s just a, you know, a stress decreaser. I mean, you know, all the things you’re talking about, whether it be meditation or yoga or grounding or the things or the things that we do. And not to like, jump topic here, but I just want to, I wanted to wrap this up and I had a major thing to talk to you about because, you know, I’ve struggled with weight loss my whole life and I feel like stress, you know, kind of feeds that. And then, you know, you do all these things. And I wanted to ask you how you felt about a couple of different things because I also know that, you know, Dr. Mary Claire has said in a couple of segments that I’ve watched of hers about weight gain and hormones and things like that.

45:49
Carmen
So you’ve got people who are going through these changes and they’re not really making, not really many changes in their diet or exercise regimen. And then you don’t see the, you know, anything positive. And so they gain weight, they want to stop their hormones. And she’s, you know, kind of on the GLP1 train and saying that these things concurrently will help with weight loss. So I wanted to ask you about that. And then, and then I have another thing I want to unravel about weight loss. But how do you feel about that?

46:17
Dr. Lakesha
Well, you know, like I say, all medicine has its place. Right? Right. So I will never say no definitely to one thing unless it’s really been proven to be harmful. Right. What I will say is that I have learned the body does not lose weight if it does not feel safe.

46:36
Jamie
Safe.

46:37
Dr. Lakesha
So if you are not feeling safe, secure and satisfied, I don’t care what you’re going to do. You can try and trick your body to do some losing weight, but when you’re done with all the tricks that are in your hat, and if you still don’t feel safe, secure and satisfied, your body’s not going to shed anything. And I literally had one patient here recently. She was having a lot of things going on with her family and their daughter and some medical challenges with their daughter and some of the stuff that with her daughter got resolved. And we had started on all this, you know, started her on her hormones, started on doing things, started her grounding. And she came on, she was like, yeah, you know, I lost six pounds. And I was like. And I was like, I’ll take it.

47:28
Dr. Lakesha
And I said, was this around the time everything started getting, you know, kind of situated, which was like, oh, yeah. I said, exactly. So now you don’t have to be in fight or flight and hyper vigilant anymore. You have finally. And if we want to get to that spiritual talk, you have finally released that and taken that off your plate and given it to your higher power, God, source, whatever you call it.

47:53
Jamie
Jesus.

47:53
Dr. Lakesha
And you have finally left that burden there. Right? Well, I think feeling that’s when the body goes, huh?

48:04
Jamie
I think one of the perfect examples of that, Lakeisha, is, you know, you have. Everyone is on a GLP1 on semiglutide, okay? And I think that there is a place for those. But, you know, you’re. You’re starting to see some. Some untoward side effects of these things, like ozempic face and ozempic bones butt. And you see these people, those epic bodies, and you can pick it out. This is a cortisol effect. So they’re not eating, and so their body wants sugar. And so what? How does your body get sugar when it doesn’t have sugar? It releases cortisol from your adrenal glands. It takes it from your lean muscle mass. And you do this over a consistent long amount of time. You’re gonna have chicken legs, you’re gonna have a big belly.

48:45
Jamie
You’re gonna look like you’re 80 years old with a whole bunch of wrinkles. And that is not the effect that these women want, okay? That’s not. That’s not pretty. That’s not healthy. We want healthy weight loss where the cortisol is not activated because it’s not desperate to get sugar.

49:02
Kevin
Right?

49:03
Dr. Lakesha
Exactly, Exactly. Exactly.

49:06
Carmen
Coming from. Coming from the mouth of a true weight loss expert surgeon there. And we know this, right? And we know this. This. We do. We know this. But that’s. I have to bring it up because, you know, it’s. Again, it’s another tool, and it’s a tool that people use to get where they’re going.

49:23
Jamie
That should be used appropriately.

49:24
Carmen
Right? Agreed. Agreed. And you know what? And an appropriate time.

49:30
Dr. Lakesha
And when you think about when you’re stressed, it’s. It. What does it always come back to, right, doc? It comes back to that inflammation being stimulated, that inflammatory response, that chronic inflammation, which is part of that stress, which is part of the cortisol. So if you can start dumping that inflammation, which is dumping the stress which is releasing it, then your body can do its metabolic processes better. The receptors are now very much open. They can now take in what is out there in the bloodstream. You can now do what is necessary in the cell to be able to metabolize everything and do what it’s supposed to and spit out the right metabolites and do that process a little more seamlessly and not stress the system and not overburden the system.

50:21
Carmen
Right. I think that’s what Kevin was asking earlier. The chicken or the egg?

50:24
Jamie
Yeah.

50:25
Carmen
Right.

50:25
Kevin
And I was looking up information about inflammation. And 30 to 50% of patients that are obese because of chronic inflammation. And everybody who’s obese is dealing with chronic inflammation.

50:40
Jamie
That’s correct.

50:41
Kevin
So again, it’s the chicken or the egg conversation once again. But it’s. It’s really interesting when you start taking a look at the human body. Like you are looking at it, and like we look at it changes the dynamic of what, how you’re trying to, you know, help the patient get well.

50:56
Carmen
And right before we started talking to you, were joking in here and I said, jamie, tell me what it looks like when you open up somebody’s abdomen and they have, you know, a big gut. Is, do you see fat? Like fat on the liver? Because, you know, we’re not surgeons. We don’t look inside people’s bodies like he does every day. And he was telling us that, like it’s. It is inflammation.

51:15
Jamie
Well, I mean, like, you know, your average middle aged man has a beer gut. Okay. And we kind of accepted that this is the dad bod. This is what you’re supposed to have when you’re in the 40s and 50s. Well, you know, the assumption that most of the public makes is that gut is fat. It’s not all fat. It’s distended, edematous.

51:36
Dr. Lakesha
Yes, absolutely.

51:38
Carmen
And then, but then if you think about your patients who’ve had like a bypass for example, you know, all the things change, right. Because you’ve got two things.

51:47
Jamie
It’s gonna mess up your gut biome to a certain degree.

51:49
Dr. Lakesha
Yeah.

51:50
Carmen
And. And so it, like you said, it’s not the same story for everybody. It’s not the same receptor for everybody. It’s not the same mode of, you know, transport that we’re gonna need to get hormones or whatever it is in our body. But it goes back to the fact that. And this is what we’re doing here at n of 1, we’re really trying to focus on instead of jumping right to a medication or jumping right to what people want to do for a quick fix is maybe just doing a metabolic reset and just getting to the bottom of it and a cleanse, you know, and something that you can do is, you know, get a baseline lab on everybody and kind of figure it out and then remeasure it.

52:25
Dr. Lakesha
It.

52:25
Jamie
You know, I think that what Lakisha is doing here is. It’s unique. I Think that this needs to be a movement in medicine today where those of us who are in traditional subspecialties of medicine, such as obstetrics and gynecology and surgery, we incorporate functional medicine as if it’s something new and unique. We used to do this. We used to do this all the time. And so there’s this movement among physicians like myself and lakeisha, who, we want to do this. We want to sit down with our patients, get their narrative, understand what their symptoms are and make their lives better. Modern medicine just, we treat numbers, we treat indices, we don’t treat symptoms other than universal symptoms. And we don’t delve into what our specific patients problems are.

53:14
Kevin
Root causes.

53:15
Jamie
Root causes. And that’s what functional medicine is. And I think every physician should take it on and do it well.

53:21
Carmen
It’s, it’s somewhere in the middle. Right. We’re still respecting that. We have a need for those things. We have a need to go to the hospital and have surgery if we need our gallbladder out.

53:30
Jamie
Absolutely. But you have surgeons that can incorporate a functional medicine practice.

53:34
Carmen
Absolutely. Well, I don’t think there’s a lot of them. You’re, you’re a rarity here. So, I mean, that’s why we got to come together with everybody and kind of really get on the same page about how we’re gonna treat this and how we’re gonna educate people and let them make their own decisions. And that’s kind of where we can wrap it up and just say, like, these are the free educational pieces that we can do to help people gather the information that’s out there. Right. It’s so much more readily available than it was years ago. And we, and we can help them make their decisions and give them the ammo they need to go out and do what they want to do for themselves. But again, like you said, everybody’s different. Different.

54:12
Jamie
Lakeisha, this has been wonderful. Thank you so much for your time.

54:15
Carmen
Yeah, we want to give a shout out. We have a couple of sponsors that have really helped support us with the n of one podcast. And MaxGen Labs is somewhere that we turn to a lot. I think you should kind of look them up and look at the information because genetics, we didn’t talk about much in this podcast, but genetics is something that really helps us understand, you know, kind of the decision making process and what we should do for our own individual, you know, situations. And that’s kind of helped me too, as I learned to kind of decipher you know what my body responds to best. So Maxgen Labs, we give a huge shout out to them and thanks for their support and all that we do and hope that you will look that. Look them up as well.

54:59
Kevin
Thank you so much.

55:00
Jamie
Thank you again.

55:01
Carmen
You.