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Dr. Sasha Rose breaks down why eating less and training more stops working after 40, what actually changes in a woman's body through perimenopause, and what protects strength and metabolism instead. Many women describe it the same way: the body seems to change overnight and the only guidance on offer is to cut calories, do more cardio and accept it as normal aging. Why muscle is central to metabolic health, what shifting hormones do to body composition, why under-eating and over-training can make things worse, and which markers are worth watching. Functional medicine for adults in Maine and New Hampshire.
Dr. Sasha Rose breaks down why eating less and training more stops working after 40, what actually changes in a woman's body through perimenopause, and what protects strength and metabolism instead.
Many women describe it the same way: the body seems to change overnight, and the only guidance on offer is to cut calories, do more cardio, and accept it as normal aging. Dr. Rose walks through why muscle is central to metabolic health, what shifting hormones do to body composition, why under-eating and over-training can make things worse, and which markers are worth watching.
In this episode:
Med Matrix is a functional medicine practice serving Maine and New Hampshire. Learn more at medmatrixusa.com
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Hello everyone. Welcome to the MedMatrix Method podcast. If you don't recognize me, I am Leah, the media director. I'm usually on the back end, taking on a lot of front end roles this week, so you're going to be seeing a good amount of me. Sorry about that. Today's episode is called Muscle, Menopause, and Metabolism, How to Protect Your Body After 40. We've been looking forward to talking about this because it's something we see all the time. Women who feel like their body has changed overnight, but are just being told to eat less, exercise more, and accept it as normal aging. I'm excited to be joined today by one of our functional medicine providers, Dr. Sasha Rose, who's going to break down what patients should actually understand about muscle, menopause, metabolism, body composition, hormones, and how functional medicine helps women protect their strength and long-term health after 40. Here's how today's episode is going to work. We're going to start with our discussion, and as we go, if you have any questions, make sure to drop them in the comments. After the discussion, we'll walk through a case study to show what this can look like in a real patient scenario. Then, after the case study, we'll answer your questions during our live Q&A. Just a reminder, before we get started, this episode is for educational purposes only. It is not meant to be personal medical advice and should not replace care from your own medical provider. If you're interested in receiving personalized medical guidance from one of our providers, we would be happy to help. You can go to our website, book a discovery call, and start the process to becoming a patient there. Let's get started. Dr. Rose, why don't you introduce yourself? Yeah, my name is Dr. Sasha Rose. I am a licensed naturopathic doctor as well as an acupuncturist. I am one of the lead providers here at MedMatrix. This topic is really, Leah, as you know, one of my favorites. I could talk about hormones and perimenopause and menopause and metabolic changes including muscle and body composition. I could talk about it all day long. This is really exciting. It's something I talk to my patients about a lot. The more that we can kind of share this information, the better. Thanks, Dr. Rose. Let's jump right in. Sorry for my long-winded entry, right? It was good. I liked it. I liked it. It's kind of new. So, let's get started. What is this? When women say that their body is changing after 40, what is actually happening metabolically? Yeah, so a lot of women notice and comment on body changes that seem to happen around the age of 40 or after the age of 40. There is often, kind of understandably, this level of frustration. I don't know what's happening, but I know something is changing. I think it's nuanced. I think there's a lot of different things that are kind of contributing to that, but I will say it's rare for a woman to go through her late 30s into her 40s and not have anything change. What we're seeing, what we believe is contributing to this very common transition, I guess I'll say, is a shift in hormones, so hormonal levels fluctuating and decreasing. We see muscle mass declining. We see an increase in insulin resistance or a drop in sensitivity to insulin. I know we're going to talk about this a little bit more today, but we did a whole episode on insulin resistance a couple weeks ago, I think, and so just to kind of put a plug in for that, that was a really good topic. We see, this is a big one, sleep, sleep changes. People who maybe slept great their whole lives, now not so easy. We see an increase in sleep disruption. We see a drop in stress tolerance, so maybe the actual stressors in somebody's life haven't changed, but the way that the woman kind of handles it has changed. She just doesn't tolerate stress in the same way that she used to. We definitely see a change in fat distribution. The biggest one, I would say, would be that kind of abdominal or midsection weight gain. What's really frustrating for my patients is that they have the willpower. They feel like they're doing all the same things. It's not for lack of trying or lack of discipline. It's just simply physiology. In a real-life scenario, that can be really upsetting. You kind of went into just perimenopause and menopause affecting body composition. Can you talk specifically about muscle? Yeah. I think it's kind of underrated or not super well understood, the fact that muscle is such a big part of these changes that happen during perimenopause and menopause. We talk in general kind of about metabolism, but muscle is a big part of that. Having adequate muscle mass really supports metabolism. It supports optimal insulin sensitivity. I guess I was going to say obvious, but maybe this isn't obvious, but optimal muscle really supports strength and mobility. Connected to that is bone health. That's something that somebody in her late 30s, early 40s may not be thinking about, but once she's into her late 50s, 60s, and 70s, she's going to be more aware of bone health. What that woman does in those perimenopausal and early menopause years is going to be really important later on for bone health. Even recovery, so recovery from a workout, recovery from an injury, having optimal muscle strength, muscle mass is going to play a role there. I would just say, in general, healthy aging. Everything that I just listed is kind of part of aging, but if there's been really significant muscle loss, everything's going to be harder, right? It's going to be harder to regulate blood sugar. It's going to be harder to maintain an optimal weight. It's going to be harder to kind of have optimal bone mineral density and just have that kind of strength. I think it is an important part of the overall conversation about menopause and metabolic changes. Wow, I didn't even think about protecting yourself from injury. I feel like so often we think about body composition in a visual sense, not in a survival sense. That is just not something that even crossed my mind, but now that you say it, obviously it makes sense. Yeah, that's why we need muscle. Well, I think when we're younger, we really don't think about it too much, and then as you get older, I mean, the older you are, the more debilitating and life-changing a fall or an injury can be because largely muscle is a big part of that conversation, but unfortunately, that's often what can kind of be the beginning of the end for somebody in their 70s, 80s, or 90s. Yeah, well, so protecting your muscle, this is why it matters, right? We're kind of going to venture into that section. Yeah. Why does protecting, I know you kind of just ran around it, why does protecting muscle after 40 matter for long-term health? Yeah, it's really, again, we mentioned kind of metabolism and what metabolism really means is, again, like blood sugar or glucose control. It means insulin sensitivity. It's just how all of that is metabolism and protecting muscles after the age of 40, I think it means even more. It always matters, but especially after 40, you really, because you're having all these other metabolic changes, it's even more important to protect muscle. And we've talked a little bit about kind of both, I would say both recovering from an injury, but also preventing an injury is even better, obviously. And when we have that optimal muscle strength and muscle mass, we're going to see, just to kind of reiterate what I said earlier, it's really going to play a pretty big role in how somebody is aging. And so if you're, say, your baseline going into your 40s or your 50s, your muscle mass is kind of suboptimal, unless there's targeted, intentional effort to change that, to improve that, just to be kind of blunt, it's kind of just going to go downhill from there. So in order to build muscle, you might find that you're losing muscle definition through this process of aging, and you kind of revert to the things that you know, how to get on track with your diet, how to get on track with your workout routine, and these things might not work anymore, right? You might have to change that. So why do so many women feel like their diets and workouts that they've been using all their life stopped working during perimenopause and menopause? Yeah, it's super common for women. I mean, I would say men to some extent, but more so for women to come in and say, I've always been really good at working out. I've always eaten really well. And I used to be able to kind of maintain the body composition, the weight, etc. that felt comfortable for me. And those things aren't working anymore. And I don't really know why. And so a big part of the conversation, I believe has to be about the hormonal changes. And again, we have talked a lot on this podcast about hormonal changes, but what's poorly understood, and I would say even within most of the medical community is that those hormonal changes can start in your mid 30s. And maybe the woman isn't really noticing it until she hits 40. But that's been it's been happening for a lot of women, it can happen, you know, even before the age of 35. And it's, you know, it's really perimenopause is like a 10 to 15 year process. And so things are happening. And she's like, I don't really, I don't know what's happening. I can't I can't lose weight. I'm doing the same things. The other piece that again, is can have a hormonal component, but is that sleep doesn't come and I we said this a little bit earlier, sleep doesn't come as easily as they used to. And really the the the classic kind of perimenopausal menopausal pattern is that they can a woman can fall asleep really well, but she wakes up and she wakes up usually between 1am and 4am. And it doesn't always have an easy time going back to sleep. But you know, you, we all know that like, there's a cumulative effect to that, right? So so night after night, she's not getting adequate sleep. And that's going to of course, impact her stress tolerance, her mood, her energy, etc. So as again, as mentioned earlier, we see that, you know, things like insulin resistance is changing. And part of that hormone conversation also always has to include thyroid. And it's very common for women in their 40s, 50s and 60s. So for that thyroid gland to start working not as well as it always did. And that's going to obviously, excuse me, impact metabolism, impact energy and impact the ability to lose weight. So all of that, and then oftentimes, these women are feeling like I just have to eat less. And so they're actually under eating, they're actually not getting enough calories. And that's not going to help for that for a lot of women, that's not going to help muscle mass, it's not going to help the energy. And it can sometimes play into the into this phenomenon of the body thinking that it's starving, and actually will hold on to weight and hold on to fat. Because it thinks that there's actual calorie, there's actually like, calories are not available. So all of these things can kind of be contributing to that scenario when a woman is eating the same way, working out the same way, and yet her body does not feel the same way. Well, the your body going into survival mode is every time you and Colin bring it up, I am amazed that our bodies just automatically do that. Because we've always been told just eat less, go and eat less. And that's just not how it works. So again, kind of touched on it, but can you talk more about why we need to stop caring kind of about that number on the scale and instead pay more attention to body composition, especially as we age? Absolutely. Yeah, I mean, I think there's been it different, it's a little the focus on the number on the scale, I think, in an interesting way, it's a little bit different depending on the generation. But for a lot of women, that was really ingrained pretty early on to focus on that. And I remember, when I was very young, my grandmother went to Weight Watchers, and she would have meetings at Weight Watchers, I think twice a week. And the first thing that they would have that she would do when she walked into these meetings is she would have to get on the scale. And I remember being in the car driving to these Weight Watchers meetings, and the my grandmother's anxiety was palpable. And it was all about what's the number going to be? Like, how, you know, like, how, what, how, what's it going to look like? And that her whole mood would change depending on what she weighed that day, right. So there's been so much pressure on everybody, especially women, I think, for like, to be a certain weight. And we now know that it's really about body composition, meaning your visceral fat, your bone density, your actual, like distribution of muscle versus fat, even markers like inflammation and metabolic health, like that, that whole picture, looking at the whole picture in terms of body composition, means so much more than a number on a scale, like the number on the scale really isn't telling you much. We have women who come in, and they, we, we have a machine called an in body scale, and it gives us a much better picture of body composition. And we can track over time how that changes for somebody. And so I'll have a woman who maybe her weight over from, you know, point A, three months ago to point B, now, on, you know, just the weight, maybe she's dropped two pounds or something. But she knows physically, like her clothes feel different, she feels different. What we can tell from this, with these metrics is that she's actually gained muscle, she's lost body fat, but she's gained muscle. And so the total number, the weight, the number, again, of weight is a little irrelevant, because she's going in the right direction, she's gaining muscle. And she's losing the body fat. And so if we don't, and those are just two of the metrics. So if you don't have that, you're, again, circling back, you're just so focused on a specific number. And I think that that's not only not healthy, and not the full picture, physically and physiologically, but mentally and emotionally, it's, it's a huge stressor. Yeah, wow. And I guess going into, again, metabolism, other than hormones, and, you know, could there be something else that would suggest a woman's metabolism needs more of a deeper look past hormones? Yeah, I mean, I think, in addition to, in addition to hormones, we're looking at, you know, I think we've kind of talked about it a little bit, but we talk, we hear a lot these days about cortisol levels, and so stress resilience, and so that's going to be a big part of it. And kind of like I referenced, if a woman is not eating enough protein, not eating enough calories, her body is wired to think that there's a famine. It's a little bit similar when cortisol is dysregulated, or she's constantly or most of the time in fight or flight mode. And when a person is in fight or flight mode, it's kind of the same thing is I'm not sure when that next, that kind of primitive brain part of our brain, it's like, I don't know when the next meal is going to be available. And so I'm not going to lose whatever fat that I have, like, those are my that's my storage, those are my reserves. And so that that's part of where that stress and stress resilience come to come in, because if if that sympathetic nervous system is dysregulated, if she's in fight or flight, that's counterproductive to, I guess, losing weight or to optimizing body composition. Yeah. And what are some of those other I guess, root causes like past stress past hormones past, you know, insulin resistance, and we keep talking about insulin resistance, but there could there be another reason why our bodies are resisting insulin that may come with aging that might come with hormone? Absolutely. So we've talked about insulin resistance, we've talked about the hormones, we've touched on thyroid dysfunction, we've talked about sleep, and we've talked about chronic stress, all being some of these root causes that can impact metabolism. Overall, inflammation is going to make it make a difference. We also, you know, can't ignore just basic nutrient deficiencies. And so how we're eating, that that's going to definitely impact metabolism. And that's one of those things where you can sort of get away with not eating great, maybe in your 20s, maybe in your 30s. But by the time you hit 40, it's going to catch up to you. And we also can't have this conversation without talking about gut dysfunction and having like optimal, therefore optimal nutrient absorption and you know, nutrient kind of breakdown and all of that. If that's dysregulated, metabolism, metabolism will be dysregulated. And therefore, it's going to be difficult to kind of have that optimal muscle, muscle mass, body composition, weight, etc. So part of functional medicine is, is a big part of functional medicine is always kind of digging deeper and looking at the root cause and you can kind of keep going layer by layer and gut health is almost always going to be at least one piece of that. I also referenced not enough protein and that's a big one. It's one of the main things that I do talk to all my patients about, but especially my female patients about and you kind of can't go anywhere on social media right now without seeing the importance of protein. So people will often think that they're eating enough, but for their body at this time in their life, they may not be consuming enough protein. And then again, for some of my patients, not all of my patients, just like the calorie deficit issue, they're actually not eating enough. Sometimes they're overtraining and sometimes they're not giving their bodies enough time to recover. Maybe they spent, you know, years leading up to their 40s kind of doing these very restricted diets and that can sometimes backfire, unfortunately. Well, so a lot of the times, I mean, I hear from you, I hear from Colin, I hear from our providers, I hear from patients that they'll come in to MedMatrix where we practice functional medicine, and they'll share an experience of presenting the same problems to a conventional, you know, their conventional care doctors or providers. So where does conventional care fall short when it comes to addressing these issues? Yeah, it's a good question. Because you do know that people are going to their conventional providers. That's often maybe the first stop of and presenting kind of these same concerns of I am gaining weight, I'm tired, my body's changing. I don't know why. And you're, they're going to get a variety of answers. They will sometimes be told that that's just part of aging, kind of suck it up. What I hear a lot of is you just need to eat less and exercise. And that's, and that's kind of the extent of it. There's nothing, there's no, even, even in within that advice, it's not nuanced, it's not personalized. And it can often feel quite dismissive. They might be offered a medication like a weight loss medication. They, and that's, yeah, so it's, it's usually, I guess I would say it's limited, and it often leaves the woman not feeling heard, feeling dismissed, feeling kind of judged, even, like you're just not doing something right. Unfortunately, the convention, and this is not to fault any individual providers, it's just, again, the way that the system is designed. And to some extent, I think the training of the providers, but there really is rarely a look at hormones or an understanding that there is a connection between hormones, insulin resistance, thyroid imbalance, overall inflammation. There's certainly not much recognition that there could be a connection between stress, sleep, or stress tolerance, sleep, basic kind of nutrient status, and, and not really any conversation or understanding around muscle mass, like it's just not part of the conversation. And so, again, it leaves the woman kind of right where she started. Yeah, this is kind of off of our show notes, not kind of, it is off of our show notes. But now, a lot of the times when people are prescribed a weight loss medication, especially when it comes to conventional care, they're given a GLP-1, but not a, you know, personalized GLP-1 dosage, along with all the other factors I know that you work a lot with, but a commercial brand at a very standard dose, right? And then these people, they'll take this GLP-1, and then, you know, GLP-1s are in right now. They'll take this commercial GLP-1, and then it will present them with, I don't know, five new problems, right? Can you kind of speak on that, on, you know, the usage of, of weight loss medications, like to, to support these women and supporting, you know, the rest of their, like, whatever root cause it might be, or whatever other symptoms they might have? Because I know that that's just one solution, right? Yeah. Yeah. So, the GLP-1 medications are really interesting, and we use them a lot, and we use them in a very customized and personalized way. And an important piece that you, that you mentioned is that it's always part of a bigger treatment plan. And it's always after a review and interpretation and a discussion of the lab results. So, again, very specific to this individual, this person's lifestyle, this person's age, hormonal status, nutrient status, metabolism, etc. I think what's often happening in a conventional setting, medical setting, is usually a person has to be at a, like, of a certain weight for it even to be recommended. Oftentimes, some providers might, like, really only think of it if the person is diabetic. That might be changing for the better. But, as you mentioned, they're very standard commercial doses. They cannot be tailored to an individual's needs and can't really be kind of adjusted. The other thing that I'm seeing when somebody is given a GLP-1 by a conventional provider is, again, not because of that individual provider, but because of the system, there's rarely any support. So, there's rarely any support for if the person is having side effects, if it's not the right dose. There's not really a discussion of a long-term plan in terms of, let's talk about this as part of a bigger plan, lifestyle-wise, nutrition-wise, etc. And there's not really a conversation of, do I have to be on the, people come in thinking that they have to be on these medications forever, which is not always the case. And so, people will come in kind of with either negative connotations or just a misunderstanding because nothing has been explained to them. So, I guess my short answer would be, for some people, some of the time, a GLP-1 medication can be a really important tool and even life-changing, but it needs to be done, prescribed, and given kind of in the right context with the right support. That was a very good answer. That answered my question. Okay, thank you. So, that's kind of our segue into how does functional medicine approach, you know, looking at muscle, menopause, metabolism, how does it approach this differently? Yeah. So, we've talked a little bit about how conventional medicine, I guess I'll say, falls short most of the time, not all the time, when a woman presents with what's happening to my body now that I'm 42 years old. Functional medicine looks at muscle, menopause, metabolism, like we do with everything. We really try to look at the full picture. So, as mentioned, we're looking at the hormonal status, we're looking at insulin levels, we're looking at thyroid, and as I've said repeatedly, we're not just looking at your thyroid stimulating hormone, we're looking at a full thyroid panel, giving us a full picture. We're measuring cortisol, we're measuring inflammatory markers, we're asking in-depth questions about sleep quality and quantity, we're diving pretty deep into gut health, and, you know, nutrition is like, you know, a huge part of what we're doing with all of our patients. We're looking at what kind of physical activity is somebody doing, is there any strength training, you know, what's their baseline body composition, not what the number is on the scale, but the whole body composition, and just overall, like, lifestyle, like what they have been doing up until now, what they are doing now. And, again, everybody is so different, everybody's life and lifestyle is different, everybody's history is different, everybody's just genetics are different, biochemistry is different, and so we, it's just not a one-size-fits-all in any shape or form. And what we're, you know, I did mention some testing, some labs, but some things that I will use, and that I think most of the providers here at MedMatrix will use, and hopefully most functional medicine providers would use, when we're kind of looking at somebody's, again, baseline metabolism, is we're looking at fasting blood sugar, we're looking at your fasting insulin level, we're looking at your hemoglobin A1, we're looking at your blood sugar. We're looking at your B1c, which is honestly a better marker than your fasting glucose, it's a three-month average of your blood sugar. We're looking at a full lipid or cholesterol panel. I mentioned the thyroid being a kind of a more comprehensive panel, not just that one TSH. We're looking at hormone levels and inflammatory markers, nutrients that are done frequently, but not limited to, would be vitamin D, B12, iron, ferritin. We're looking at liver enzymes or liver markers, kidney function, and again, I mentioned that in-body scan, we're tracking somebody's kind of body composition. So, we're getting a baseline, and at least every three months, we're kind of tracking that. So, all of that together, combined with somebody's health history, what they're presenting with, what they're telling us symptomatically, is going to give the provider a really good sense of their metabolic status. Sorry, what does a plan look like that prioritizes preserving muscle? That's a good question. So, again, it's very personalized, but we're always looking at kind of protein targets. Some people like to track their macros. They like to kind of be really scientific about it. For other people, that's not going to work, and so it's really about, say, that's kind of new to them to even think about protein. You can start with something, I'm going to say a little bit more simple, but maybe more doable, which is you simply need to have protein on your plate at every meal. They're used to having a plate or a bowl of pasta and a sandwich that doesn't have a lot of protein in it, and so kind of switching that focus where a good part of that is some healthy protein. Baseline, is somebody new to strength training? Do they even know what that means? Setting them up with the appropriate trainer, really education, I guess, around not just movement and exercise, but specifically strength training. Again, coming back to blood sugar stabilization, and so that's going to be both what they're eating and kind of sometimes even combined with exercise, being able to kind of maintain more level, less volatility in terms of blood sugar. We're looking at sleep support, we're looking at different tools to help with stress resilience or stress regulation, and I've kind of overstated the importance of hormone evaluation, but that's going to be a big part of it. We're looking at thyroid support, hormone support, really helping with any nutrient depletion that we're seeing on the blood work, and the gut support, again, we have advanced tests to look at the gut microbiome and gut inflammatory markers, leaky gut. All of that is going to play a role into looking into somebody's metabolism and therefore protecting their muscles. I also mentioned kind of tracking on the in-body scale, and all of that's going to be a little bit different depending on the individual, but usually, collectively, that personalized plan is going to help kind of put somebody in the right direction. We talked a lot about the different things that come with perimenopause and menopause, and obviously, this is perimenopause, menopause is hormonal, so where would you specifically put hormone therapy, where would this fit into this conversation, and then we talked a lot about how it's not the whole answer, so can we kind of go over that again? Yeah. I mean, hormone therapy is not the whole answer. I think it rarely is in medicine or in functional medicine. It's for better or for worse. It's not like, oh, here's this magic pill, but when we are looking at maintaining, improving, preserving muscle mass and strength, I feel like the hormone piece has to be a big part of the conversation because that's a big part of why things are changing and why somebody is doing the same things they've always done and it's like, quote, not working anymore. So it does need to be considered in the context of somebody's symptoms and their goals and their history and everything and their risk. It's not for everybody, but it's not a magic pill. It doesn't take the place of the really important lifestyle modifications, which again is like your nutrition, your sleep, your strength training, all of that, and just kind of general root cause care, but when we use hormone therapy as a piece of the treatment plan, it really can be kind of sometimes the or a missing piece. Well, okay. Let's specifically talk about MedMatrix. Where would that process begin if a woman is coming in and they are struggling with weight, muscle loss, and metabolism? They're post 40 years old. Where does that process start? Yeah, so it really kind of would start with that. I think we've alluded to it in other episodes and I think I mentioned it a little bit, is that when a woman is coming in and at the top of her list of concerns is difficulty losing weight, it's muscle loss, her metabolism is changing, and she hasn't been able to find answers, the process is going to start with that very comprehensive panel of labs of blood work. That initial visit is going to include really extensive symptom review, health history, very thorough interpretation and review of the labs, looking at kind of her current nutrient status, where she is nutrition-wise, looking at where she is sleep-wise, stress resilience-wise. If she's, again, moving her body at all, is she exercising at all? If so, what is she doing? How much is she doing? How often is she doing it? Reviewing all supplements, all medications, reviewing the in-body scan. So that's done with one of the lab technicians initially, that in-body scan, but then we do a second interpretation during the visit with the provider. So that's kind of mostly what I focus on is what's going on in that full one-hour visit with the provider, but a lot of that work has kind of been done even prior to that visit. But I hope that that partially gives a sense or a picture of how comprehensive it is, right, that we're not just focusing on one thing. We're not just focusing on a scale, and we're not telling somebody to just eat less and figure out a way to exercise. So you kind of answered all my other questions there. What would be your biggest takeaway for a woman who is listening to this feeling like their body has changed after 40? Yeah. So if there was one thing, if there's a woman listening to this or watching this, and there's one thing that I would want her to take away, and she's in this camp, she feels like, again, she's over 40, things are changing. I guess one of the biggest things that I would hope that she hears is that she's not broken. It's not just about willpower or discipline, and that all of these things are really connected. So we have menopause, we have muscle, we have metabolism, and that they're just very interrelated. And so with the process in functional medicine, ideally, is to kind of figure out what has changed and what's at the root, kind of at least contributing to these changes, doing what we can to protect muscle mass, improve strength, optimize hormones, blood sugar, all of that. And figure out for this particular person, what's working, what isn't working, and what maybe needs to be added to kind of get her to the place where she really wants to be and should be for health reasons. Thank you, Dr. Rose. Yeah. I learned a lot, per usual. I always learn a lot from you. I don't have any more questions. It looks like we have no questions in the Q&A. I have no game for you, Dr. Rose. I have a case study. I have a case study. I would love to hear a case study. But while Dr. Rose is saying this case study, if you do have a question, please leave it in the comments, and we can get to it after her case study. So, I was thinking about this woman prior to the episode, but then when I was talking about, I think you asked me the question about how big of a role do hormones and hormonal changes play a role, she came to mind again. So, this is somebody that I actually saw today, and she's a 63-year-old woman, and I think I first saw her the very beginning of the year. I think it was January, so right now we're in July. And she was kind of the classic doing everything right and not getting the results she wanted. So, she eats very cleanly, eats really well, had done various diets of minimizing the number of calories per day. She worked out three to five times a week, and really is retired, on the outside really doesn't have a lot of stressors, hadn't really had to work that hard to kind of maintain her optimal body composition. And she hits around 60, so a little bit later than what we've been talking about, hits 60, and suddenly she's gaining weight, especially in the midsection, and has this like, at least on the outside, very healthy lifestyle, really kind of knows how to take care of herself. So, we did all the things that I kind of mentioned in terms of the testing, and the tracking the body composition, and looking at cortisol levels, insulin, all of that. For this individual, everything was pretty optimal, actually. So, her nutrient levels were pretty good. I think we had to boost up her vitamin D a little bit, but otherwise, nothing was really glaring. Her sleep was actually pretty good. Like, a lot of things that we've talked about, we kind of could cross them off as being contributing factors. Now, she had gone through menopause 15 years earlier, is of that generation when hormone therapy was not offered, not advised, and that's where I started with her, was kind of an introduction to hormone, to bioidentical hormone replacement. The first few months, she was still really frustrated. She reported back to me that she didn't think anything was working, nothing changed, and we kind of kept tweaking her regimen. She shifted what her workouts looked like a little bit, and it's now been in the last two to three months that she's actually seeing the change. She's seeing the weight loss. She's maintaining muscle. Her in-body scan is just what we want, just the trajectory that we're looking for, increasing muscle mass, decreasing body fat, lowered visceral fat, which can be kind of an indicator of one's risk of cardiovascular disease, fatty liver, type 2 diabetes. That's all improved. My point with this is that for this individual, that hormonal tweaking, that hormone optimization, that was kind of the biggest missing piece, I think. It's not the case for everybody, but it was for her. My other point is that it doesn't happen overnight. It really took almost six months for her to start to see the results because we had to kind of figure out exactly what the right customized plan is for her. It's not a magic pill. It doesn't fix things overnight, but in this case, when we got it right, that seemed to be the thing that really did kind of jumpstart her metabolism. Thank you for sharing that, Dr. Rose. Nobody's leaving any questions, so I guess you've answered every question that anybody could have. I think we're just going to wrap it up here. Thank you so much for joining this episode of the MedMatrix Method Podcast. Dr. Rose, thank you so much for your time. As always, it is always incredible after seeing patients all day, every day, after a very long day, to get on here and to speak. My pleasure. Always a pleasure. Always an honor. Thanks, Leah. Again, if you are interested in becoming a patient and getting personalized care, visit our website, book a call, and we can see if you would be right for our practice. I hope you all have a great night. Thank you again, Dr. Rose. Thank you.