Hi there, friends. Welcome back to The Tamsen Show. I'm so glad you're here. So, I learned something recently about myself. I am a health optimizer.
And if you're listening to this, there's a good chance you are, too. Here's what it is. An optimizer is somebody who tracks their sleep, their steps, their protein. We follow the experts, we get our labs done, we buy the supplements, and we live and die by our sleep scores. We believe that if we can just gather enough information, we can stay one step ahead of what might happen.
Does that sound like you? Well, here's what nobody tells the optimizer. All that data means nothing if you don't know what you're actually looking at. I've gotten blood work back, and I had no idea what the numbers meant, but I thought I did. I've stared at my sleep score without knowing how to really make it better.
And I've wondered if I needed more testing, or if I was just overthinking all of it. I know I'm not alone. Today, we're building the health dashboard every woman actually needs in midlife. We're going to talk about what labs matter, which ones don't, what we should really be tracking, how we know when something's actually wrong, and once we have all the information, how do we use it to make decisions that actually improve our health? Dr.
Lucy McBride is joining me today. She is a primary care physician who spent more than 25 years helping patients make sense of their health. And today, she's going to give us a guide that, I don't know, I've been looking for for sure, and you might be, too. Before we dive in, I love hearing from so many of you every week about what you're learning or you love on The Tamsen Show podcast. But if you could do me a favor, please and subscribe to this channel here on YouTube, I'd be so grateful.
I promise you, we will continue to have conversations you do not want to miss as we make this time in life an incredible one. We have so many guests who spend their time sharing their expertise and their stories with us, and our team is working around the clock to always ensure we bring you information you can use right away. It would mean so much to all of us. All right, let's go ahead and get into it with Dr. Lucy McBride.
Dr. Lucy McBride, welcome to The Tamsen Show. Tamsen, thanks for having me. It's great to see you. You as well.
So, we started talking before we started rolling and I'm like, "Oh gosh, I have so many more questions for you than I thought I was going to have now." And I have so much more to talk about than we probably have time for. Okay, here's what I want to dive into though because you've become the person that women come and talk to when they're not getting an answer from their doctor and that's a really specific role to fill. So, can you explain who you are when people come into the office because I think you speak very differently to your patients because you're talking beyond what they're initially coming in for. So, I think I am someone who refuses to accept false binaries. What's a false binary?
So, meaning GLP-1's are all good or all bad. Hormone replacement therapy is a yes or no. Got it. The answer to so many health questions is it depends Okay. on your goals, your tolerance for risk, your particular health issues. You know, population-based studies don't talk to an individual.
Mhm. So, my job is to help people understand how their genetics, their lifestyle, their everyday habits, and their personal goals play into the decisions we make. So, you're asking people to become a partner with the doctor, but not all doctors necessarily are going to become a partner with the patient. To ensure that's right. I mean, the system is not set up to It's not possible. have these conversations.
The system in the US treats patients like a set of transactions, like a bag of organs. Yeah. What that does is it deprives people of a sense of agency over their health. I can empower patients one at a time by helping them understand that health is about more than just their lab test results. They have so much more control over their health outcomes than they think, but it takes time and a conversation with the doctor to partner with to hand that power from me back to them.
Well, so that's why I wanted you here today because not all women who are listening are going to be able to come find Lucy, right? They're not going to be able to come and find you, but we do want them to feel empowered. So, if somebody's listening and they don't have a Lucy in their lives, what do you want them to go into their doctor and say or ask? I want them to ask things like this. I want to talk about things that may not show up in my blood work, like my habits, my stress, my sleep, and I'd love to hear from you how you think those habits may be impacting my health and longevity.
Do you think a doctor's receptive to that? I do because I think doctors want to be able to help people with invisible metrics, but they don't have time. And it's much easier to look at a set of labs and say normal, abnormal, normal, abnormal, than it is to have a conversation. But if the patient comes in with an appetite for partnership and dialogue, that's what we love. All right, so we're going to make all these patients lovable who are listening today.
But, you know, you wrote the book Beyond the Prescription. Is it because before you were a doctor, you were a patient yourself and experienced a lot of this? Yes, I was a patient as well. No one asked me "What's going on in your life?" As a stressed-out college student, I had symptoms of anxiety, insomnia, irritable bowel syndrome, without going into details about my bowel habits. We've done that here, so it's okay.
Okay. Um headaches, migraines, and I was seen by a number of different specialists. I had MRIs, I was tested for giardia, I was told everything was normal, but I didn't feel well. And it was only when I started asking myself some important questions and took myself to a therapist that I realized I wasn't sick, I was human, and I was suffering from unrealistic expectations of myself and the physical manifestations of perfectionism and stress. So, we can't measure all those things in lab work.
No. Your wearable device isn't tracking burnout or you know, lack of self-compassion. You know, we need to track labs. We need to track metrics, but we also need to be aware of how we think, feel, and behave in our everyday lives and how that affects our health outcomes. Yeah, I think that's a good point and I and obviously it can't I don't think you can attract it yet, but I feel like at some point those wearables are going to be tracking our The self-compassion monitor. to yourself?
Do you love yourself? I mean, really. Some of them feel very human to me. I want to talk about some of those wearables because I feel like there's a lot of them out there. There's you know, obviously the the wearables to figure out your sleep.
There's a wearables to figure out your glucose, your heart. There's the Dexa scans. So, can we go through each one of those and get your take on them and I know a lot of the take is it depends on who the person is. So, it's not a one-size-fits-all, but I would I'm curious to hear what you say about each of these. Sure.
So, let's talk let's start with health trackers. I wear my Aura ring all the time. What number should I pay attention to when I wake up in the morning? So, you want to make sure you're getting ideally 7 or 8 hours of restful sleep every night. Now, you if you're listening may throw your head back laughing thinking that's ridiculous, but that is the goal.
Sleep is the glue for your whole health. It's good for preventing dementia, depression, diabetes. It's good for everything. So, when someone's not getting sleep, there's no amount of Prozac or Lipitor or medicine that can help people solve the problems that insomnia generate. They need just rest.
You need to focus on that first. If there's anything else over and over what I've heard with any doctor that's come into here or anything I've read or any study is sleep is number one in so many ways. Sleep is number one. Sleep is the glue. So, I want you to get 7 or 8 hours of sleep.
I want you to protect it like you protect other parts of your health. It's not a luxury. Let's go on to steps and what women in midlife should be doing. Do we need to hit a certain amount of steps? It went from 8,000 to 10,000.
I try to go somewhere in between. Not on a day like this in New York City where it's 120° out, but on most average days, what's that amount of steps you should be taking? So, when I'm talking to a real person in real life, I don't give them a specific number on their step tracker. I tell them, "Look, the best exercise for you is the one you'll do." [snorts] So, instead of being perfectionistic about it, Mhm. let's just try to get some sort of movement most days of the week and try to get the golden triangle of exercise, cardio, strength, and stretching. If you skip a day, it's okay.
Start over the next day. I love hearing that cuz I think that we don't do that enough. We see everyone like, "I do it all 7 days and I don't skip anything and if you do, you suck." And that's that's how kind of how you feel if you're on social media sometimes. And in reality, that's probably not the And you're setting yourself up, you know, how many patients do I have who don't exercise at all and live with some sort of chronic sense of shame about it. The last thing I should do with that patient is tell them, "Exercise 7 days a week and count your steps." That's setting themselves up for failure. 100%.
All right, glucose monitors are I see them everywhere right now. I wore one for a little while. I'm not sure if I really liked it or not, but I wore it. I don't even remember what it said at this point. How do you feel about those?
I think they're great. Obviously, for my type 2 diabetics, my type 1 diabetics, but for anybody who's curious about how eating affects their glucose and their energy, their sleep, and what the relationship between sugar and the invisible metrics of health, um it can be really, really empowering. Okay, that's good to hear because I understand for if you're a type 1 or type 2 diabetic, but I see a lot of people just doing it to try to figure out how sugar affects them. So, Yeah, I mean, some people find that they are sensitive to green beans when lima beans don't affect them. Like that insight it can be very powerful for some people.
For me personally, it would feel like an albatross. It would [laughter] cuz I would get obsessed about it and then I would feel like I was dealing with a bad boyfriend, like someone who's judging me and shaming me and I and I don't want that. I don't need any more I don't need any more of those. I've had enough of those for a lifetime. Hormone panels, how often should we be getting those done?
If you Well, let's go through the different stages. You're perimenopausal, you're postmenopausal. How often should we getting them done? What should we be looking for? There's sort of two uses for hormone panels.
One is to make a diagnosis of perimenopause or menopause. Mhm. Number two is to monitor your hormone therapy dosing. Now, that is controversial. There are many gynecologists and doctors out there who will say, rightly, that you don't need a hormone panel.
Post menopause? As you have noticed, Hampton, online there's a lot of debate about who's right and who's wrong and when to do hormone panels and when not to, which only confuses the general public and furthers the kind of trust in experts, right? The truth [snorts] is it depends. You don't always need a hormone panel to prove you're in menopause. You don't always need a hormone panel to prove you're in perimenopause.
We use symptoms as our guide, not labs. But, there is a role for checking hormone panels when you're trying to gauge whether someone's estrogen level, when they're taking hormone replacement therapy, is appropriate, whether they're taking hormone replacement therapy during perimenopause or after menopause. And testosterone, when we add testosterone to that, is it important to have those hormone panels done? I do check a testosterone level pre and during testosterone therapy. You know, testosterone therapy for women is not FDA approved in the US.
Patients are a little more skittish about it and we also don't want to give them too much so as that they're becoming, you know, hirsute or developing the symptoms of, you know, hyper testosterone levels. Yeah, let's let's stay on that for 1 second because testosterone is a little confusing. It is a little scary when somebody hears it's not FDA approved in the United States, they think there's either something wrong with it or it's not allowed. What does that mean that it's not FDA approved in the US? Just so we have clarity on that.
That just means that testosterone hasn't cleared the regulatory hurdles with the FDA. It doesn't mean that women don't need testosterone. Testosterone levels in women start falling in our late 20s, not around menopause actually. So, when someone comes into my office and she says, "I have low libido, I'm have a having trouble, you know, maintaining muscle mass despite protein intake and strength work, and they have low testosterone levels or even normal testosterone levels, we'll sometimes add testosterone to their hormone replacement therapy profile. Yeah, I think I feel like the conversation is is opening up a little bit.
It's getting a little bit more mainstream on testosterone, but we still got to move the hormone therapy conversation along. We're at what? 5% of the of women? We still have a lot of work to do to get women access to fact-based information about basic hormone replacement therapy, estrogen and progesterone. As you well know, women have been sold a bag of misinformation about hormone therapy. This is not to say that hormone replacement therapy is right for every woman.
It's to say that every woman deserves access to a conversation about whether it's right for them. And by the way, hormone replacement therapy is the standard of care, should be the standard of care for every woman unless there's a reason not to be on it. Yeah, I can't wait till we get to that place, right? Yes. Right?
So, I get blood work done every year. I kind of think I know what I'm looking at. 55 years old now. What should I really be paying attention to? What is important when it comes to blood work for a woman in midlife? I want you to look at your cholesterol profile, your apo lipoprotein B, and your lipoprotein(a).
What is that going to tell me? It's going to tell you about your metabolic health. It's going to tell you in part what your risk for the development of cholesterol plaque is. It's going to tell you about your vascular health. So, cholesterol alone is not responsible for cholesterol plaque accumulation, believe it or not, in the arteries.
The other risk factors are high blood pressure, diabetes, cigarette smoking, family history. However, getting specificity on what your cholesterol levels look like can help you understand where you need lifestyle adjustments and where you might need medication with or without lifestyle modifications. When somebody comes in and now you've done that blood work and those levels are high or abnormal or out of range, when you're talking about beyond the prescription, what do you tell them to do? The question becomes to what extent is your cholesterol level when it's high informed by things you can't control like genetics, menopause, Mhm. and to what extent are your cholesterol levels high because of things you can control like working on muscle mass to improve your metabolic health, like limiting red meat, butter, cheese, processed foods. So, there's no one-size-fits-all prescription for cholesterol.
It depends on who you are and what kind of levers you have in your life to control it. When we talk about what's going on in someone's life, are there two things that you would love every patient or you like every patient to come in and tell you whether it's I'm super stressed out. I just got a divorce. I, you know, I'm in a new job and I don't know what to do. Are there two things that are really important to you?
What keeps you up at night? And what are you embarrassed to say out loud? Wow. Okay, those are specific. So, do you ask every patient that?
I mean, I've known most of my patients for decades. Yeah. So, they know to come in to say, you know, I'm going through a divorce. I can't sleep. I'm drinking more alcohol than I'd like to and I know it, and that's why my blood sugar's up.
And so, what do you suggest? And sometimes they don't need a continuous glucose monitor, they need a divorce. [laughter] Those are very extreme differences, right? I don't know. In my when 10 years ago I'd rather have the divorce than the glucose monitor.
Right, like like the treatment plan for a patient depends on what the mechanism is. If you're binge eating because you're stressed out, because your marriage is falling apart, again, you may need a divorce attorney. But if your glucose is high because you're genetically predisposed to diabetes and you're exercising and eating healthy, then maybe you need a CGM and you need a GLP-1. It's funny we have a divorce attorney coming in here this week, so we're I should bring her on staff. It's going to be right in line.
I have a question. This is like I don't know. This is just my curiosity. What are most women telling you that's keeping them up at night? Oh my gosh, it's such a good question.
The state of the world, their children, even their adult children, Mhm. [clears throat] marriage, Mhm. sex life. When I ask people what they are worried about and the private moments of their life, it's aging, it's dying, Mhm. it's the vulnerability of being mortal. Mhm. Wow.
All of these things are relevant to people's health because if you think about it, right? You and I are human beings. The things that I worry about, which are, you know, fall into those categories, that cause me to skip my workout that day because I'm tired and sleep well, or that cause me to not sleep so well. And if you don't sleep well and you're drinking more alcohol than you want to, and you're eating things that aren't so good for you, like that shows up in your blood work. But the treatment for those things isn't necessarily a lecture from a doctor, a sermon about Mhm.
You really got to eat less, you really got to exercise more. It's empathy and compassion for what's happening and helping patients connect the dots between how they they and their behaviors. Well, you do a just a great job of connecting the dots. You really do cuz you take it down level level level right there. it down to the studs. You You really do bring it down to the studs and that's the only way that we learn because otherwise we're going to go reach for that glass of wine again.
There's something that has come up now for the last few years, at least for me, is this conversation of GLP-1s. Yes. When I started this podcast, I think the second episode was about GLP-1s and I was I had no idea and I thought it was just kind of outlier and now it's in almost every conversation I'm having. So, can we talk about your feelings toward them and both sides of the GLP-1 conversation cuz I know there are a couple of different sides to it. So, where do you sit in that?
So, GLP-1s are the most sophisticated technology that has come along in my lifetime in medicine. They are very elegant mind-body drugs. They are not a panacea. They are not for everybody. But, particularly for my patients with obesity and type 2 diabetes and sleep apnea who have struggled with their weight for decades and can't lose weight despite diet and exercise and they've been lectured by doctors for decades, eat less, exercise more.
They are transformative. I have patients who've lost 100, 150 lbs. We were able to peel back their medicines for high blood pressure, for high cholesterol. We're able to take their sleep apnea machines off because they no longer have apnea. They're extremely empowering.
But, they are not a substitute for habit changes. They are also extremely powerful for patients who don't meet criteria for insurance coverage. Like they aren't obese, they aren't diabetic, but they are having difficulty losing weight and being metabolically healthy despite their best efforts. So, I'm not opposed to prescribing them off-label for patients who already are doing the right things. They're getting their protein, they're getting their strength work, and they just can't lower that cholesterol, they can't drop that blood pressure, and they add a GLP-1 as a tool, not a panacea.
Mhm. And it can be very empowering. You know, I've been reading a lot about disordered eating in women that are in midlife. Right. And I've been really honest about the fact I was in my 20s, I was in television.
I I dealt with that for a very long time. It probably started in college because I used to have to be weighed to be able to be on the dance team. So, every week if I didn't hit my weight, I didn't get to perform. Um and that carried on into television where, you know, skinny was the the better thing to be for whatever reason it was at the time, and they didn't say it, but you kind of knew it. That's certainly changed, which is amazing.
However, uh food noise and disordered eating live with you forever. Is it helpful to people that are in midlife that have had that maybe their whole lives, and maybe quote have it under control, but still struggle with it? So, this is the potential problem with the GLP-1s is that they can enable disordered eating. At the same time, they can also, as you said, quiet the food noise that drives disordered eating. Is that something that's being studied right now?
Is that something that there's data? is. Um and I think that, you know, my colleagues who work in the eating disorder space um are are pretty categorically opposed to GLP-1s. Mhm. But in my experience, when you take a patient who perhaps like you, Tamsen, who has done the work, who understands her relationship with food, who is motivated to stay healthy, not by restricting calories, but by feeding herself, they can be empowering because they help people quiet that food noise, and then it can liberalize brain space, real estate up here that's occupied by thinking about food. Mhm.
But it can also cut the other way. It can cut the other way where you can accidentally wake up a latent eating disorder. I have patients who they didn't know they had restrictive eating tendencies. And then when they got on a GLP-1, not through me, and lost the 10 lbs they didn't need to lose, it wakes up that disordered eating. So they want to keep going.
And they want to keep going, and then they're frail, and they're weak, and they're passing out on the tennis court, and that is not healthy. And that is not That is not my goal as a physician to enable that. Well, I think um I think about if people don't understand what food noise is, and maybe not everybody does, can you explain what that is? So, food noise is ruminations about food. It's like this little circular loop of thinking about food.
It's a thought pattern. Mhm. And then the result of food noise is, you know, anxiety, Mhm. and then sometimes overeating or restricting to kind of numb out that that circuit. Are you seeing that more in women in midlife, or are we just uh we're just talking about it more? What's interesting is that patients who I'm putting on a GLP-1 for their obesity or diabetes are coming back to me and saying, "I didn't realize how much food noise I had.
I didn't even think I had it." Wow. until it was gone. Mhm. Ask any woman in America, particularly high-achieving women who are motivated to be healthy, about how much brain space is occupied thinking about food and body image. And some people are aware of how much brain space that occupies, and some people just aren't. And maybe you're one of the lucky people who only eats when she's hungry and doesn't eat when she's not hungry.
But that is not true for most women, or most humans. No. I mean, I I told you before we sat down that I, you know, I I it was very severe, and until I got very sick, and then my father stepped in, and he made sure that I was at the right doctor, and there and we didn't even know what it was. We didn't call it eating disorder that. We didn't call it disordered eating.
We didn't call it anything. We just knew that like Tamsin was upset obsessive about something and trying to control something. Um but I'm I'm curious what you think a woman should do if they're listening and said like, "Yeah, I I think about it all the time. I'm having breakfast, I think about lunch. I have lunch, I feel guilty I had bread.
So then I'm going to not eat something for dinner and I have belly fat that I'm dealing with. I'm sure you hear this all the time." That goes way beyond any prescription there is. All the time and that speaks to the bucket of questions you want to ask yourself before you show up in your doctor's office. What's your relationship with food like? Is it tortured or is it straightforward?
Because that informs, you know, we have to eat three times a day ideally or ideally five times a day, snacks. So you want to understand what your relationship with food is like. The ease with which we police women's bodies in the United States is is shocking and terrible. The ease with which we as women shame ourselves for body imperfections is shocking and sad. So I think the first thing I tell that woman is give yourself a break, give yourself some compassion for who you are.
Like you're not alone. And secondly, let's figure out what that rumination food noise is about. Sometimes it's that you're hungry. Mhm. Sometimes you don't need a GLP-1, you just need to start eating lunch.
Mhm. Right? Sometimes you don't need medication or more exercise or strict diet, you just need permission to feed yourself and feel full with food, not with the help of a medication. So I feel like people listening are going to say, "Oh my gosh, where do I find Lucy or somebody like her?" What is your suggestion for people that don't have time to take off five days of work to go find the perfect doctor. What do you suggest?
So How do you ask the right questions? So you want to ask a new doctor what their approach is to health. Do they think about health beyond just people's lab tests? Are they interested in a partnership and a conversation? And if they say no, find a new doctor.
If they say yes, I'm interested in thinking about lifestyle and habits and how you can in in your life impact your health in a meaningful way, that's that's a keeper. What do you want the woman who's tracking everything, paying attention to all her levels, still kind of feels like crap to know that she needs to do starting today? She needs to start mapping her complete health ecosystem. That's in my book. But what I mean by that is tracking the things you can't measure in blood work.
Where did your stress go? What happens when you don't sleep well? What behaviors result of that from that? What are your relationships like with your own body, with your partner, with your work? What is your relationship with alcohol like?
What's your relationship with food like? Your doctor will ask you how much do you drink? Mhm. That's a good question. My question is more, what's your relationship with alcohol like?
What do you use it for? What is it serving? What purpose is it serving for you? And can we redirect it somewhere else? If you have one final word for women, what would you like them to know about taking charge of your health as a doctor?
You have more control over your health outcomes than you think. We have often outsourced our intuition about health to someone else's definition of health. Mhm. To the guru online, to the lab results at your doctor's office. You have so much knowledge inside you.
You just need to look in the mirror and ask yourself some hard questions, put it on paper, and bring a more honest rendering of yourself to your doctor and hope they're interested. Lucy, where can people find you if they can't come see you? lucymcbride.com Thank you. Thanks, Jansen. You're wonderful.
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