Podcast #404 – Weight Loss Resistance, Hormone Balance and Thyroid Health with Dr. Jessie Hehmeyer

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Dr. Jessie Hehmeyer focuses on hormonal issues, gut issues, and weight loss resistance in perimenopausal women. She highlights that weight loss resistance is often caused by elevated inflammation, compromised insulin sensitivity, and detox pathway dysfunction.

– Elevated inflammation is a common barrier to weight loss in perimenopausal women.
– Compromised insulin sensitivity can hinder weight loss efforts.
– Detox pathway dysfunction can affect metabolism and weight loss.

💉 Compromised insulin sensitivity can impede weight loss progress.
🧪 Detox pathway dysfunction can slow down metabolism.
🍭 Sugar consumption is a significant cause of inflammation.
🍞 Simple carbohydrates contribute to inflammation as well.
💊 Curcumin supplements can help reduce inflammation.
🐟 Omega-3 fatty acids and pro-resolving mediators can also be beneficial.



Dr. Justin Marchegiani: Hey guys, it's Dr. Justin Marchegiani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justinhealth. com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.

J, and our colleagues and staff to help dive into any pressing health issues you really want to get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. Hey guys, Dr. Justin Marchegiani here, really excited to be back with y'all on today's podcast.

We have Dr. Jessica Haymire on the show. So Dr. Jess, how are we

Dr. Jessie Hehmeyer: doing today? Doing great. Thanks, Dr. J. How are you?

Dr. Justin Marchegiani: Great. Very nice to meet you. Very nice to meet you. Well, excited to chat today. Your website is WellEmpowered. com, we'll put links and coordinates if anyone wants to reach out to you. I know you see functional medicine patients all over the world, just like myself.

So excited for that. People want to reach out. Coordinates will be down below. So let's chat today. I know one of the biggest things that, you know, you focus on, you focus on a lot of hormonal issues, gut issues, a lot of weight loss, resistance. When you see patients coming in, maybe especially, you know, you see a lot of female patients in that perimenopausal, menopausal range.

What do you find is like the big Top three causes of why they're having a hard time losing weight. What are those big weight loss resistance

Dr. Jessie Hehmeyer: barriers? Yeah, great question. And one thing I, I'm going to break your listeners hearts right now and just kind of put it out there and say, it's not your thyroid.

And I should say, shouldn't say, shouldn't say it's not your thyroid. Even if it is your thyroid, it's not your. It's not only your thyroid. So certainly we want to make sure your thyroid is humming along and functioning like a dream, but even when that's handled in my experience, there are actually three other metabolic barriers that are recurring in perimenopausal women in particular, that really get in the way of their weight.

loss endeavors, right? And so the top three include number one, elevated inflammation, right? So elevated inflammation. And I'm sure you see this Dr. J too, right? Sometimes people come in and they say, Oh my gosh, I'm so inflamed. And they tell you about their symptoms. My joints hurt or bloated or my skin's red, whatever the case may be, but more often than not.

Inflammation is elevated without any symptoms, but we can do labs. We can actually measure inflammation. So we want to measure inflammation and see if that's one of the barriers to their weight loss, right? So we get the numbers whether someone has symptoms or not. Their symptom may only be that they're struggling to lose weight, right?

So inflammation is number one. Number two is compromised insulin sensitivity, which is a far cry from lab normal, right? Lab normal insulin, fasting insulin is 19 or less. I like to see it. It's crazy. It's bananas, right? So, you know, kind of like seven is where I'd like to see it or less, right?

Dr. Justin Marchegiani: I think seven or seven is good.

Seven or below.

Dr. Jessie Hehmeyer: Yeah. Seven or below is good. Right. So many, many people, I'm sure you see this all day long, right? They're far out of outside of that range, right? But they're walking around thinking it's normal because it's in the quote unquote lab normal range. And then, you know, the last. thing that I see, and this involves a lot of different things, but I would say, I like to say detox pathways gunked up.

So detox pathways gunked up because, you know, when our detox pathways aren't rolling well and, you know, those, those are physiological processes, right? Like the word detox is so chic these days and people get latched onto it real quickly. But the truth is, is these are physiological processes happening in our body and when they're not working well.

We reabsorb our toxins and we don't just reabsorb the toxins we encounter in our environment. Our hormones go through those detox pathways too. So we reabsorb those hormones. And, and so, you know, all of that together can really set the stage for someone's metabolism moving along at the pace of a snail.

Dr. Justin Marchegiani: Yep, I totally agree. When you talk about, so if we kind of summarize that, we talked about detoxification, we talked about insulin resistance and inflammation, and it's important when the thyroid, when you have thyroid issues, for instance, your thyroid very rarely just spontaneously combust. There's other factors upstream.

with the different systems, right? You talked about insulin resistance, inflammation. Also, inflammation can drive insulin resistance because now you're as part of the stress response, right? You're surging cortisol, which is mobilizing more glucose, which is then potentially creating more insulin problems.

And so it's most of the time when you have an organ dysfunction downstream, there's so many things upstream that can easily get ignored while you're focusing on the downstream kind of organ, if you will.

Dr. Jessie Hehmeyer: Absolutely. Absolutely. Oh, yeah. Totally. And even, you know, just as you were so eloquently tying together the impact of inflammation on insulin.

It's like, yeah, these are, this is all a dance. It's rarely just one thing. There's usually an interplay, you know, when, when people aren't detoxifying things while they're, you know, toxins are building up in their, in their body, that's going to drive inflammation too. There's probably some kind of disruption in their microbiome, which definitely, you know, impacts everything, metabolism to mood.

immune function, all of it.

Dr. Justin Marchegiani: Now, how are you assessing inflammation? Like in my practice, we may run certain gut tests that look at Calprotectin or EPX or, you know, you just typical blood markers like C reactive protein or homocysteine. What are some of your kind of ways that you can assess someone has inflammation outside of like, they're just inflamed, they have joint pain issues, they have a lot of pain issues in the body.

What are some of your other clinical ways you die deeper into

Dr. Jessie Hehmeyer: that? Yeah. Well, you know, exactly. We just, as you were saying, we get numbers on them, right? So for the person, right, certainly we're going to do some blood labs, right? So we're going to get that HSCRP that you mentioned, we're going to get that homocysteine that you mentioned.

And then if it seems germane and often it does, especially when it's weight loss resistance, getting some of those gut markers, whether it's calprotectin or lactoferrin or you know, all those different things. So. It's a good one. So, yeah, so, so we will get those numbers and use, use it to understand is this playing a role and, you know, how significant is it, you know, just a mild, mild inflammation that's really the side effect of something else, or is this inflammatory process driving the dysfunction?

And, and, you know, we need to really go after it hot and heavy before we're going to make any progress.

Dr. Justin Marchegiani: Yeah, that makes sense. And so what a couple of strategies, what are the big kind of vectors that you see out of the gates with, with patients as a means to knock down inflammation? Are you making diet changes?

And if so, like what are some of the typical foods that people are consuming that are throwing them off inflammation wise and making them work? And then what are some of the big supplements you may use to kind of help put out the fire too?

Dr. Jessie Hehmeyer: Yeah. So supplements and nutrition, huge, huge aspects that we dive into, you know, when we're working with someone with, when, when their inflammatory load is, is, you know, high.

So from a nutritional perspective, the ones that are, you know, foods and beverages that are going to be driving inflammation, number one enemy is sugar, right? And yeah, and, and people can have normal gluten, you know, normal insulin, normal. You know, optimal glucose, optimal fasting insulin, even optimal hemoglobin A1c.

All those things are optimal and yet sugar is still driving inflammation, right? So the other systems just haven't taken a hit yet, right? Give them 10 years. You'll see it if you don't do anything, right? Dr. Justin Marchegiani That's

Dr. Justin Marchegiani: where fasting insulin I find is helpful. I find fasting insulin will go awry or some kind of a functional glucose tolerance where you're measuring your glucose like an hour or two after your meal.

Usually you can see, you know, a response issue in those kind of lab markers.

Dr. Jessie Hehmeyer: Yeah, absolutely. I totally agree. So, so, you know, sugar definitely public enemy number one. And then, you know, although not sweet, right? The simple carbs, which functionally speaking are sugar, right? Of course. Yeah. And then also it's a deficit, right?

It's like, what don't you have, right? If, if you're, if you're caloric what composition is favoring all these things that are creating inflammation, you're also, So, not consuming things that are anti inflammatory. So it's a little bit of what are you doing and what aren't you doing. And when I work with people, we actually look at their truth.

We don't just guess. So I have people I work off of a shared platform where I'm tracking their nutrition on a daily. They're tracking their nutrition and I'm seeing it, you know, on a regular basis. Dr.

Dr. Justin Marchegiani: Justin Marchegiani How do you track it? Are you using Cronometer or MyFitnessPal? How are you doing?

Dr. Amy Grover

Dr. Jessie Hehmeyer: Actually, I do it old school. I do it old school. I make people use Google Sheets. So I have a Google Sheets. that I've created. And you know, one of the things I love about that, Dr. Jay is people really think right. It makes them think at a different level and they also track a lot of different things on that, right.

They're able to start to gather their insights. Oh, I realized when I don't. Get more than six hours sleep. I'm starving by three o'clock and can't have no control over my choices or, you know, like they can gather insights that help lead them to changes that really are sustainable, right? So so I do work off of an old school Google.

Google Sheets. And and, and so, you know, like, okay, what's causing, of course, alcohol can be in there, right? And in high amounts, alcohol is definitely going to be driving inflammation. And then in the way of, okay, what are we going to do about it from a supplemental standpoint? Well, you know, of course, we're going to do things about it, nutritionally, pulling things out and putting things in.

supplements, you know, the mariva form of curcumin. So curcumin, as I'm sure your listeners have heard from you, is the active ingredient in turmeric. And not all curcumin is created equally. I'm sure you've played around with it clinically as well. But you know, for me, it's just mariva hands down, like that's the form we're using.

And we're using it in high doses, which might be, you know, 1000 milligrams, three, four times a day. Dr. Justin

Dr. Justin Marchegiani: Marchegiani kind of Curcumin absorption system, right? Because I think what 90, 95 percent of curcumin, if it's not in some kind of a liposomal carrier or like a black pepper carrier, you're going to only absorb a very small percent.

Is that

Dr. Jessie Hehmeyer: correct? Yes. Yeah. And you're not going to see the movements that you will when you use the appropriate form. Yeah. Absolutely. So yeah, that and you know, sometimes depending on what those inflammatory markers look like or if we retest and they haven't moved as much as we want, I'll use SPMs like pro resolving mediators, right?

When someone's body is just really locked into the inflammatory, you know, vicious cycle and we can't get that number to move like we would expect, then I'll go in there with some the pro resolving mediators also use omega 3 fatty acids both in their diet. Okay. Yes. well as supplement, you know, in the way of supplement.

And we, we check those numbers so that we make sure we dose it according to their

Dr. Justin Marchegiani: needs. Dr. Justin Marchegiani How are SPM is different than fish oil. Is it like concentrated fish oil? What's

Dr. Jessie Hehmeyer: the difference? Dr. Sarah Silver It's, it's basically further down the chain of biochemistry. And so, and I have, you know, I've looked at this a few times and, and I don't have a top of mind to give you a great explanation other than to say.

say, the EPA and the DHA, DHA rather, EPA and DHA, right? The active forms of omega 3s as they go through enzymatic processes, eventually they arrive at these pro resolving mediators. And so I will use them both together on certain people. Cause just fundamentally speaking, that's, that's what you need.

And if you, if they can be really, really effective in helping when someone just, you just can't get that number to move. Dr. Justin

Dr. Justin Marchegiani: Marchegiani Do you use the SPM active one by Medigenics? I

Dr. Jessie Hehmeyer: do. I like that one. I do like that one. It's concentrated. It works well. Yeah, I like

Dr. Justin Marchegiani: that. Dr. Justin Marchegiani Okay, cool.

So we have fish oil. We have a liposomal curcumin. I think that's really important. Any other big supplements that you use kind of in your back pocket to kind of really reduce inflammation? Dr. Sarah Silver I

Dr. Jessie Hehmeyer: mean, ultimately, I use what people need, right? So I'm looking at their labs and I'm making choices.

specifically based on that. Right. As you know, right. If their B12 is measuring 300, we want to, you know, eight, 900, we know their detox pathways are all gunked up. Right. And so we're going to use B12 at a level that their body needs. And that's going to be a different work around to help their body resolve inflammation.

So acknowledging the different ways that we can come in and affect you know, what's at the source of inflammation.

Dr. Justin Marchegiani: Dr. Justin Marchegiani So, of course, you're going to individualize some of that with some lab testing to figure out kind of what nutrients or what other issues. Any other specific herbals that you find that kind of are helpful for reducing inflammation like you have an experience with like.

Boswellia or CBT or any systemic

Dr. Jessie Hehmeyer: enzymes? Boswellia and ECGC, right? The active ingredient, green tea. Yeah. Those will be some things I'll throw in there if needed. But honestly, I gotta tell you the, it's like, it just cannot be. Dr. Justin Marchegiani, J. D. Oh,

Dr. Justin Marchegiani: yeah. If you look at a lot of the drug companies right now, if you look at kind of their pipeline, they're taking a lot of these herbs and these compounds and they're trying to take little isomers of these herbs so they can kind of patent it and then get some of the benefits.

But, you know, when you take an herb Just like they did with

Dr. Jessie Hehmeyer: omegas. Yeah.

Dr. Justin Marchegiani: With the omegas. Yeah. Exactly. And they charge hundreds of dollars, you know, per prescription when it could be a fraction of that, you know, over the counter. But yeah, so they're trying to take these little isomers, but when you take an herb out of context, right, you may have side effects plus there's other.

It's hard to really patent nature, but that's how they're, they're doing it to be able to bring it to market because they need to have a massive, you know, profit incentive to spend the millions on the clinical trial. So yeah, I get it.

Dr. Jessie Hehmeyer: Absolutely. Mm hmm.

Dr. Justin Marchegiani: And so where does food come in here? I mean, you talked about sugar and glucose, obviously that impacts insulin, insulin resistance that, you know, cortisol surges, glycation, all that.

But what about your typical food allergens? What are the big things that you see? you know, outside of like your typical, we have gluten is pretty trendy. Now we know gluten is a big thing. What's your take on food allergens as a whole?

Dr. Jessie Hehmeyer: So I think about them in a few different ways, but to first kind of speak to the most common, you know, we have got food sensitivities and we have food allergies, right?

So sensitivities, delayed reactions can take up to 72 hours to show up. These are the ones that people are going to Not know that they're reacting until they've gone a long time without them and bring them back in right? Yeah, there are food sensitivity tests, but that that's a different conversation and then food allergies, right?

These are typically more immediate responses typically people will know within you know a minute 30 minutes usually with a true food allergy, what the, what food they're reacting to, right? So with food sensitivities, yes, of course, gluten is a big one. But you know, and I, I, I'm sure your, your listeners are probably pretty well educated.

You know, gluten, dairy, yeast, yeast is a big one.

Dr. Justin Marchegiani: Dr. Justin Marchegiani Does that include like nutritional yeast? Like, like nutritional yeast, B vitamins kind of things or no? Typically,

Dr. Jessie Hehmeyer: not as much, but sometimes I would say I will base that based on a microbiome assessment, right? If I see someone's yeast off the charts, I'm going to pull all yeast out of there.

If I'm not doing something like that, and I don't have, you know, huge reason to suspect it's that level of a reaction, then I'm going to be a little bit more flexible with things like nutritional yeast. Dr. Justin Marchegiani

Dr. Justin Marchegiani: What are the big yeast foods? Is it just more like fermented foods or? What would be the food?


Dr. Jessie Hehmeyer: mean, gluten free bread, right? Name it. Name the gluten free fill in the blank. Yeah.

Dr. Justin Marchegiani: Got it. Got it. Any of your processed flours, processed grains that are so called gluten free,

Dr. Jessie Hehmeyer: right? Yeah. Exactly. Exactly. So, you know, pulling those foods out goes a long way and, you know, making sure people are not just well educated, but are actually taking the actions.

Okay. And that's one of the great things of the shared tracker is, you know, I always think it's, I'm, you may have had this experience too, right? I joke that I have like this amazing knack for picking out the right day to meet with people when the day before their nutritional habits were just totally out of whack.

You know, in what I mean by that, it's like, you know, in a, in a first appointment, one of the things I'll say is, you know, can you walk me through what you had to eat yesterday from start to finish? And I would say, Dr. J, you know, maybe 80 percent of people say, Oh, yesterday wasn't a normal day. It's like, it doesn't matter which day of the week it's like, okay, maybe we'd expect that on Monday.

Cause. It doesn't matter what day of the week it is, 80 percent of the people say, you know, yesterday wasn't a normal day. Right. So I say that because people come to this with really good intentions and mastering nutrition isn't just about information. It's about, yes, it is about, you need the information, you need effective information.

For your body for sure. But there's also, you know, the saying knowledge is effective action. So it's, how do we help you create changes? that produce the outcomes you care the most about, but also that you can sustain, right? Because if it's not a sustainable action, it's not a sustainable outcome. And I'm not interested in that.


Dr. Justin Marchegiani: Justin Marchegiani Yeah, that makes sense. All right, that's cool. So out of the gate here, we talked about food. We talked about some of the lab markers. That's good. Any other big kind of hidden inflammation vectors that may fly under the radar for some people or even some clinicians?

Dr. Jessie Hehmeyer: Yeah, I mean, honestly, I think insufficient sleep.

Is a huge one, huge one. I, I do not think I, I, people are starting to get, you know, catch on, but I think there is just such a huge, you know, it's an underrated point of leverage, right? When people are routinely not getting enough sleep or get, you know, sleeping restlessly, whatever the case may be. It's, it's definitely going to drive inflammation, you know, it's, I think about the people who I've worked with over the years and, you know, one woman who comes to mind she, on her journey to lose weight, she realized along the way that she, when she was diagnosed with sleeve apnea, got a CPAP machine, she actually wore it, which is great.

And one of the things she noticed that was totally unanticipated. Was that it completely changed her mood. She had had a history of anxiety and depression and sleeping well. I mean, no surprise to you and me, but like how cool for her to have that experience. So obviously not everybody in the sun fortunately has sleep apnea and CPAP machine.

It's just to illuminate, you know, the myriad benefits. of quality sleep. You know, whether it's mood or, or helping your body resolve inflammation because so much of our body's work and taking out the trash happens at night, happens

Dr. Justin Marchegiani: while we're sleeping. Dr. Justin Marchegiani And I find sleep apnea too, like that's still a result of typically inflammation, like it's that blockage of the airway.

I mean, so a CPAP is kind of a band aid, but if it gets you better sleep in the meantime, while you fix those things, then it's kind of helped bridge the gap. And it's okay as, as long as it's kind of pushing you towards that better state of healing,

Dr. Jessie Hehmeyer: for sure. Absolutely. Totally. Yeah. It moves you along the trajectory of your healing.

Dr. Justin Marchegiani: Exactly. Yeah. People talk about inflammation, too. I like to just clearly define it because inflammation is good to a certain degree. There's a hormetic inflammatory response of lifting weights and that muscle builds back a little bit stronger and you eat certain foods or, you know, certain nutrients. You get this hormetic response where.

you have a little bit of inflammation, but then your anabolic response to it's a little bit greater. So in the end, you're getting stronger. I think inflammation is more of that inflammatory response without that anabolic response. So you're breaking down a little bit more than you're building, building up, which puts you on a trajectory for pain, joint pain, hormonal issues, fatigue issues, sleep issues.

Would you agree? Oh

Dr. Jessie Hehmeyer: yeah, completely. You know, it's, it's the, you described it perfectly, right? And it's, it's the fertilizer for all the things in the world nobody wants, right? In the way of disease processes. So, you know, it, it can be the first you know, maybe every other metric looks great and this is the one thing that's out of whack.

It's like, great. Let's play Waka Mole on that thing right now and turn this

Dr. Justin Marchegiani: around. Yes, exactly. Well, you're talking about weight loss. I'm just curious. Where does your take on the calorie model kind of fall? I'm just curious to get your take on that and how that connects to weight loss.

Dr. Jessie Hehmeyer: Yeah. So I, so calories are a part of the equation and they're not the whole story, right?

In other words, the law of thermodynamics is real. Right. So we acknowledge that even, well, I'll just say, yes, calories play a role, but there's more to the story, right? So how foods impact our hormones has a huge, huge effect on. our metabolism. It also has a huge effect on whether we experience satiety or hunger, which then affects our caloric intake, right?

So we've got the caloric impact, we've got the hormonal impact, and we have the inflammatory impact. I would add in that inflammatory impact, the impact food has on our microbiome. Right. Because our microbiome's impact on our metabolism is tremendous also. So, you know, from a high level, we've got calories, we've got hormones, and we've got inflammation.

And then as a subset of inflammation, we want to really acknowledge microbiome as playing a big

Dr. Justin Marchegiani: role. That makes sense. Yeah. Because when you look at calories, right? A calorie is nothing more than taking. Essentially, an amount of food, right, a calorie, and the amount of energy it takes to heat one gram of water, one degree Celsius.

That's it. The problem with that model is there's no impact in satiation. There's no impact in these neuropeptides that get produced that allow you to feel satiated. Hormones. Hormones are the air traffic controller that tells calories where to go. Go to the mitochondria, get burned, go to the fat, go to the liver, get stored, go into the muscle, get converted to glycogen, right?

There isn't that signal. So when you, when you look at it, calorie as a whole, you got to look at the hormonal aspects. Also, I think you have to look at the nutrient density aspect because you can have a calorie of processed sugar that has virtually zero nutrition where you can have the same calorie from an egg yolk that has vitamin A and all these nutrients in there that are going to be so important for satiation.

And so I think the nutrient, the nutrient density aspect is important because the more nutrients you get per calorie. the more chance that you're gonna feel satiated, but you also have the, the nutrients to run these metabolic pathways. And you get other things like peptide YY, adiponectin, cholecystokinin that tell you to feel full.

And then if you're, you know, keeping your carbs in check, that's gonna be putting more of your fats into the mitochondria to get burned versus to get stored in the liver. Or in the muscles. Thoughts on

Dr. Jessie Hehmeyer: that? Absolutely. You mentioned one of my favorites there, cholecystokinine. I remember, you know, learning about this, you know, this hormone and being totally amazed by it.

Right. And thinking back to the 90s when the fat free craze was the rage. Olestra.

Dr. Justin Marchegiani: Oh

Dr. Jessie Hehmeyer: my God. Well, yeah. Right. All that stuff. stuff, right? Grown nastiness supreme. But, you know, avoiding fat, you know, how we produce cholecystokinin is through eating fat and cholecystokinin cues satiety. And so we weren't eating fat, so we weren't queuing satiety.

So we're eating more fat free crap to be quite honest. Right. And it just was, you know, it was just a hot mess. Oh

Dr. Justin Marchegiani: yeah. And I find the calorie. like, calories are definitely like an end result. The question is, why are you eating too many calories? Because if the nutrients are there, you know, the data is very clear.

People that eat more fat, eat more protein, and a lot of studies actually tend to go a little bit lower on the calories. And it's not because they're actively trying, it's because they have better satiation mechanisms to say, stop. I do think people that eat too fast, a couple of bites per chew, because you're going to get it.

So many more nutrients and calories in your system before that feedback system says, Hey, chill out, you got enough. So I do think eating a little bit slower, taking a little bit longer to chew your food up, maybe giving yourself another five minutes before you go back for seconds. I think the food timing aspect is important.

Your thoughts?

Dr. Jessie Hehmeyer: Yeah, totally agree. And I also say, you know, along with that chewing is like mostly if we're eating nutrient dense foods, and I would say in particular in that, because, you know, obviously proteins are essential, healthy, you know, nutrient dense fats essential. But if we're thinking about, you know, our colorful vegetables and things like that, right.

It's really hard to eat them quickly. Like I dare you to swallow a salad whole like you can't do it right. And so it's kind of like, you know, you want to hack that one, eat a salad and put some, put your protein on it and put your avocado and put your olive oil, blah, blah, blah. Right. All that stuff. And you will eat it solely because there is no way to eat it

Dr. Justin Marchegiani: quickly.

Yeah. And then the cholecystokinin that you get from your gallbladder into the small intestine, if you do too much, you will get nauseous. I mean, that's why it's hard to eat more than a dozen eggs at a time, but you know, everyone has experience of eating too much pizza or too much, you know, processed food of your choice, right?


Dr. Jessie Hehmeyer: Yeah, for sure.

Dr. Justin Marchegiani: Yeah. That makes sense. And also I look at calories too, is are you eating enough? Because if you're low calorie, you're probably low nutrition. And if you're low nutrition, well, which organ system is going to be the one that gets shorted, so to speak.

Dr. Jessie Hehmeyer: Yeah. Yeah. I know that's well said.

That's well said. I will say there, there certainly are times when people are under eating, but I will say mostly my experience is exactly what you were pointing to Dr. J and that they're eating more calories than ideal, mostly given by, they're not queuing their satiety, right? But they're, they, and so it's.

You know, they, they actually are hungry. It's not like they're necessarily, you know, quote unquote stuffing themselves or anything like that. They're just not, they're hungry and they're eating. And so they're eating more and they're low nutrient foods. And so at the end of the day. Dr. Justin Marchegiani more often than not, it's more calories than, than ideal for that

Dr. Justin Marchegiani: person.

Dr. Justin Marchegiani Yeah. I tell patients always start your proteins and fats with your meal because that's gonna, when it's gonna hold up a lot of the food in your stomach, so it sits there a little bit longer. So you get a little bit more of the stretch reflex, fill it up, you know, and then you do your proteins and fats, you do some good fiber in there because fiber does add bulk to your tummy.

It does make you feel more full. Plus you're, you know, it's takes, like you said, it takes some time, but chew that food up, gives you a little more time to, for your brain to catch up signal wise. And then if you throw any carbs on top of that, usually you're going to have your appetite more in control because you already have that satiation going.

So you can, you can say, okay, I'm going to have maybe only a handful or two of some CFA chips and I'm okay. Right. You can kind of push it back a little bit.

Dr. Jessie Hehmeyer: Totally. Yeah. And you know, as you were speaking there, what just came to mind was I'm like, oh my gosh, yeah. Dr. J is like describing to a T. Natural ozempic natural, natural, you know, it's like natural Manjaro.

Okay. There you go. Listen to what Dr. J just said. And you hit all of the physiological touch points that these drugs are

Dr. Justin Marchegiani: hitting. Yeah. And then let's hit that too. Do these newer peptide medications like the ozempic or the Manjaro, do they have a role at all for certain people? I actually do.

Dr. Jessie Hehmeyer: I do think they have a role for certain people.

And, and, and okay. Who would those people be? Right. So first of all, they would be, it would be someone who is quite literally not willing to make any changes, you know, that then if, if they are morbidly obese and they're not willing to make changes, or maybe they feel so overwhelmed by what's ahead.

Okay. Maybe, maybe that is, that's probably a better choice than nothing, right? Probably. And I say the probably part because we want to acknowledge that we don't, there are unknowable unknowns, right? There are unknowable unknowns of the long term use of these things. And if you want to keep the outcomes long term, you got to keep using them long term.

So, I

Dr. Justin Marchegiani: saw, I saw it's helping with addictions too, but it's like, well, that's another, you know, if it's helping with that, well, what other things maybe that are unwanted side effects are happening too. So, it almost seems like there's. Some parts of the brain in certain people that control satiation that are just fried.

And these are the people that even if you give them a steak, they may eat two 20 ounce steaks, right? There's just, they, they, they miss that satiation signal. And even healthier foods, it's better, right? But they're still missing that, hey, you're good. You, you had enough, like, put it back. And I think that's where it could maybe play a little bit of a role.

Anything else on

Dr. Jessie Hehmeyer: that? Yeah. No, I think you're right. I think you're totally right. And I, I think about that, you know, and I'm sure you've encountered people like this, right? We are all born into the, whatever family and situation we're born into. And for all of us, I think we would say there are things we got really lucky on and there are things that were like, Oh darn, when that have been nice, you know, kind of a situation.

Right. And that's fine. That's life. Right. But. But, you know, there are people who for a million different reasons, maybe they had a single mom or maybe both their parents were working overtime or whatever the situation was. But, you know, maybe their dinner and lunches when they were six and seven years old, we're kind of like, whatever you want.

And I mean, I don't know about you when I was six or seven years old, I probably would have eaten Twinkies and ho hos all day. Right. So it's like, they've got this. This physiological memory that's like decades and decades old. And so, you know, what you're talking about with that satiety, it's like, it wasn't, it's not their fault.

You know, it's like this, this really, this could be useful in helping their body. And my real wish is that it leads to a future where they're able to pull away the training wheels. Yeah. I hope. And my concern is that if, if it's working and they're losing weight, are they learning anything new about how to fuel themselves in a way that's a good fit for the outcomes they're committed

Dr. Justin Marchegiani: to?

But I guess that appetite kind of issue would fall more under the leptin resistance kind of umbrella, right? I know insulin resistance and leptin resistance are intimately connected. So the more sensitive your insulin gets. The more sensitive your leptin should get, which is that satiation signals other things going on there too.

So, but like you're talking about, you know, memory stuff. I mean, I can think of, I haven't eaten at McDonald's in 20 plus years, but I can drive by McDonald's and smell the fries from the road and you just get these flashback memories. You're like, Oh my God. That was so good.

Dr. Jessie Hehmeyer: That's how Annie Anne's is for me.

I haven't, I haven't, I can't tell you the last time I had Annie Anne's. It's probably 25 years ago also, but when I'm walking through an airport, I'm like, Oh man, that's, that

Dr. Justin Marchegiani: smells good. That smells good. Exactly. So let's plug in some, like, let's. plug in like some perimenopausal patients or menopausal patients, right?

How do, how do these principles plug into them? There's also a big a book that's kind of getting traction out there called Fast Like a Girl. And it talks a lot about, you know, fasting principles for cycling women, menopausal women, perimenopausal women. So, first off, do you make any different changes? in regards to diet or lifestyle and how do you plug in fasting modalities if you do anyway?

Dr. Jessie Hehmeyer: Yeah. So I, when it comes to the cadence of eating, in other words you know, like the timing of eating, right. I, I really do collaborate with the people in front of me on that because. For a lot of women, they have many decades of stuff of their relationship around food. And, and a lot of people have had some kind of disordered eating, right?

I don't mean eating disorder, maybe somehow, but disordered eating of sorts. Right. So when it comes to fasting, I'm always interested in finding out from the person in front of me, does this feel like punishment, right? Does this feel like it is? You being mean to you, and if it does, then it's not a solution I'm interested in.

So, typically, I'll start with people in looking at the composition of their nutrition, in whatever the case may be and making those shifts, and then start fine tuning it based on what we're seeing and the way of outcomes. So, I, I'm just not dogmatic when it comes to fast, not fast. Snack, not snack. I really do work with the person and we start to make changes and we see how their body responds.

And if we need to go make more changes, if I do need to suggest, okay, let's do bring in fasting to, to, you know, whatever extent makes sense for them. Then we will. But yeah. Do you have a background

Dr. Justin Marchegiani: being an RD?

Dr. Jessie Hehmeyer: so I, I have an LDN. So LDN is like the graduate equivalent of an RD. Oh, got

Dr. Justin Marchegiani: it. Got it. Okay, cool.

And so do you use any good like calorie counters that, that look at nutrients as well? So you can get a sense of the nutrient density along with what they're eating too? I

Dr. Jessie Hehmeyer: actually don't. I don't. Sometimes I'll have, what I will say, sometimes I'll have people turn to MyFitnessPal, which is, you know, high level, kind of generic, but it's okay, right?

So sometimes I will use MyFitnessPal with people, but mostly I find With people, we, what can happen is, you know, I'm sure you've seen the, the the video of the rocks and the sand, right. And trying to get them all in, right. When we focus on the rocks, like everything to, you know, unless someone has really mastered all those rocks.

Yeah. Then we're not going to focus on the granular sand. And mostly when they have, it's like, it just all handles itself. Yeah.

Dr. Justin Marchegiani: Right. And essentially it's the jar, right? Where you put the rocks in. Okay. It's stuffed. Then you throw the sand in. Oh, you get way more than you could with just the rocks alone.

And then you put the water in after that. Right. And you can keep on finding more space to fill everything up.

Dr. Jessie Hehmeyer: Exactly. Exactly. So, so what I mean by that is, you know, in the nutrient aspect, I think about that more like the sand. More granular, smaller. Yeah, exactly. Exactly. So, we're focusing on that. Yeah.

Exactly. Exactly. So, it's, it's just infrequent that we need to go there. But, you know, if we need to, we will. But,

Dr. Justin Marchegiani: mostly we don't. Plus, you know, you kind of know if like, okay, you're eating processed flours and sugar and now we're getting you to eat some grass fed meat and a big salad. Okay. We know the nutrient density is going up.

We can see that, right? Yeah.

Dr. Jessie Hehmeyer: Yep.

Dr. Justin Marchegiani: Yep. Yep. And so how do you adjust macronutrients? I mean, you know, you're obviously a leaner person. I find sometimes you get people that are leaner. They do well on carbohydrates. And so they're like, they kind of have their own personal fat like, oh, I feel great with couple servings of starch a day and some more fruit and I do okay.

How do you kind of look at what you need, but then also try to personalize it for what your patients need?

Dr. Jessie Hehmeyer: Well, I consider people's activity level, right? I also consider how they feel, you know, how they feel when they consume different carbohydrates. And

Dr. Justin Marchegiani: I look, is there a false starting point that you, that you find that most people, you know, may, maybe you start a little bit lower carb, a middle of the middle of the road carb, and then you kind of adjust?

Is there a, a general starting point that Yeah, yeah, yeah. If someone comes in that's overweight, you kind of put 'em in.

Dr. Jessie Hehmeyer: Yeah. So I do not go to specific grams of carbs, but what I, what I do is I focus on the quality of carbs, right? Mm-Hmm. . So, like we said earlier. We want to keep those simple carbs to a minimum by a minimum, you know, it, it really depends on where people are starting from.

Right. So some people, the first step might be okay, simple carbohydrates once a day, but where I want them to be is. Maximum of one serving of simple carbohydrates twice a week, right? That might be the future we're working towards. But I think about it like crossing the monkey bars. We want you to grab the next rung as opposed to go all the way, you know, reach too far, fall off and feel defeated and not get back on.

Right. So but where I, in the way of the quality of their carbohydrates, like I, you know, vegetables or carbohydrates, I'm going to give a whole different value assignment, a different value assignment to, you know, roasted broccoli with sweet potatoes that I am to, you know, the bread, so to speak. So I am going to encourage people to load up on those nutrient dense carbs at least twice a day.

Getting heavy handed with those nutrient dense carbs, half a plate twice a day, the, the higher fiber legumes kind of situation if people tolerate them well, at least once a day. And, and I, you know, pulling out the sugars and the simple carbohydrates. It's that that aren't a good match for their outcomes.

Dr. Justin Marchegiani: That makes sense. And so what does a typical day look like for you? Like is there a certain level where, you know, you do this many servings of starch or like what, what allows you to feel the best in a certain breakfast, lunch and dinner?

Dr. Jessie Hehmeyer: Yeah. Okay. So my breakfast, I love a good smoothie. So I, Monday through Friday, I typically do a smoothie Saturday and Sunday I do avocado toast with two eggs, gluten free toast, one piece of gluten free toast.

Two eggs. And

Dr. Justin Marchegiani: lunch. Is it like, is it gluten free? Like like corn or right or oat rice or oat base? Or is it more

Dr. Jessie Hehmeyer: like a yucca? So as I shared with you before we hopped on we live in Switzerland right now. So in Switzerland, what I can get is different than the state. So when I'm in the States, I love cauliflower sandwich rounds.

They're like, they might be the number one thing I missed. They're so good. Right. You can find them at Trader Joe's. They have an in house brand and then the, the brand it's self can be the cauliflower wrap kind of thing or what is it's actually it's like it's, you know, a nice size. It's like the size of a corn tortilla, maybe a little bit smaller and it's got a nice spongy thickness to it.

It's got for people who do, who can't do dairy, it has a little bit of Parmesan in it, but most people who are lactose intolerant are fine with it. But it's, you know, it's made with some eggs. So it has some protein in there also. And so in the States, I'll take one of those and do some avocado mash on top of it with a, you know, fried egg and then have another fried egg on the side.

That's, that's my fave. But here I'll do, you know, like a millet and chia gluten free toast. One, you know, one piece of that. And and then, you know, for lunch, I am a salad girl. You know, I love my salads. And I mean, I mean, huge salads, like really, really big salads. So lots of mixed greens, I will use leftover vegetables from the night before, always some kind of protein, whether it's chicken or salmon or, you know, whatever, whatever protein we have on hand, I'll do that.

Usually some lentils in there, you know, kind of, to me, I think one of the things I think about, you know, with these nutrient dense foods, people's reference point. They're like, Oh, you're going to make me eat a chef salad. I'm like, Oh God, I would not eat a chef. I'd throw a chef salad at me. If he, yeah, you, if he told me I had to eat a chef salad every day, you know, it's like, there's so many ways to make super delicious, interesting, nutrient dense foods.

So so, you know, always some avocado on my salad, you know, like that, that's my, my thing. And then for dinner. You know, we'll rotate through our proteins. We always have a half a plate of vegetables at dinner we typically go out to dinner twice a week friday and saturdays. We usually go out the other nights.

I usually cook And some nights i'll make some black rice Maybe one night I'll make a bean pasta and serve it with some kind of protein and lots of veggies. Yeah, that's kind of, and then for snacks in the States, I love being my, I'm like a savory gal. So I like chips with hummus. That's like one of my fave snacks.

And here I'll do corn chips with hummus.

Dr. Justin Marchegiani: Nice. And then, so you're in Switzerland. So how about the cheese or the dairy out there? How was that? You tried it all often?

Dr. Jessie Hehmeyer: It's delicious. I've never been, you know, I sometimes I'll put some cottage cheese on my salad. I, dairy has never been a problem for me from a digestive standpoint.

I do well with it. It's. It's fine with my skin. You know, all those things. My hormones are fine. I don't like, Oh my gosh, have to have dairy, but I like dairy. So have a little, you know, maybe when we're out, I'll get some kind of salad and maybe it will have some dairy on it. But it is, it is the cheese here is amazing.

It definitely is amazing. It's not my kryptonite, but it is amazing.

Dr. Justin Marchegiani: That's good. Awesome. Well, cool. Excellent. So we hit a lot of different topics here today in the in the podcast. Anything else you wanted to emphasize or leave delicious with

Dr. Jessie Hehmeyer: Oh, I would say, you know, for those of you who are listening out there and are kind of, you know, your wheels are spinning about where to start, what I would invite you to start with is asking yourself a question the next time.

You're about to, whether it's eat or think about moving, you know, exercising, things like that. And the question is what is the best game I can play right now? What is the best game I can play right now in, in what that question, if you think about it and answer it, honestly, we'll give you access to is.

It's really just choosing the best game for the moment at hand, right? Rather than being dogmatic and playing your best game over and over again and being in that journey. It will take you so far. So far.

Dr. Justin Marchegiani: Excellent. Well, Dr. Jesse, appreciate you being on the podcast here today. Wellness empowered. com, correct?

Wellness empowered. com. Well empowered. Well empowered. Dr. Justin Marchegiani I think I have the right link down below here in the video. Yep. I got the right one. So if you're driving or you're out and about, click down below, you'll have the link right to your site here. And now you see patients on the functional medicine side.

Anything else you want to say to the listeners, coordinate wise?

Dr. Jessie Hehmeyer: Thank you so much, Dr. J. It's been a pleasure to be here with you and your tribe.

Dr. Justin Marchegiani: Dr. Justin Marchegiani Thanks, Dr. Jessica. I really appreciate it. You take care. Have a good one. Dr.

Dr. Jessie Hehmeyer: Jessica Silva You too. Take care. Dr. Justin Marchegiani Bye. Dr.

Jessica Silva Bye bye.

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