Some conversations stay with you long after the microphones are turned off. This one with Dr. Jen Ashton did exactly that.
Jen has lived multiple lifetimes in one. She’s a board-certified OB-GYN, a national medical correspondent for nearly two decades, a leader in women’s health, and a physician deeply trained in nutrition and obesity medicine. But what gives her voice its gravity isn’t just her résumé. It’s what she’s lived through, and how she’s chosen to respond.
Eighteen days after her divorce was finalized, Jen’s former husband died by suicide. He was a world-class cardiothoracic surgeon. A man with no obvious warning signs. A man who looked, from the outside, like he had everything together.
Listening to Jen talk about that moment — the police at her door, the shock, the paralysis — was a reminder of something we too often forget in medicine and in life: you cannot see mental suffering from the outside. And success does not protect you from despair.
What struck me most wasn’t just her honesty about grief. It was her clarity about what carried her forward.
Her children. Her body. And the discipline of strength, practiced daily, long before the crisis ever arrived.
Mental Health Is Not Separate From Physical Health
Mental health and physical health are not two separate buckets. They’re one system. And Jen said it as plainly as it can be said: you can’t have a healthy body without a healthy mind.
That matters, because we still treat mental health like it’s “optional.” Like it’s softer. Like it’s less real because you can’t always point to a lab value and say, “See? That’s the problem.”
But depression, anxiety, emotional volatility, and despair aren’t moral failures. They’re not character flaws. They’re not something you can simply “think your way out of.”
They’re real states of physiology. Real changes in brain chemistry, immune signaling, stress hormones, sleep architecture, appetite regulation, and decision-making.
And here’s the uncomfortable part: we’re living through a massive, uncontrolled experiment that our brains never signed up for. For most of human history, your attention was pulled in a few directions: your tribe, your work, your immediate environment, and the real problems in front of you. Now it’s pulled in a thousand directions, every hour.
The modern internet environment encourages rapid attention shifting, shallow processing, and constant multitasking. Research on “digital natives” suggests this style of living is linked to greater distractibility and weaker executive control, and it may even be associated with measurable changes in the brain over time.
Now, I wouldn’t say that the internet is “ruining everyone’s brain,” but it is shaping how we think, focus, and regulate ourselves. And pretending it’s neutral is probably naive.
This is particularly problematic for our children, who are exceptionally more sensitive to these signals due to their ongoing physical and mental development.
A large U.S. sample of over 40,000 kids found that after about one hour per day, more screen time was associated with lower psychological well-being, including lower self-control, more distractibility, less emotional stability, and more difficulty with friendships and finishing tasks. And in teens, very high use (7+ hours per day) was linked with roughly double the risk of ever being diagnosed with depression or anxiety compared to low use.
Now, does that prove screens cause depression? Not necessarily. But it’s hard to argue it’s harmless when the same pattern shows up across so many markers of well-being.
And that’s where Jen’s story turns this from abstract to painfully real. Because mental suffering doesn’t always look dramatic. Sometimes it looks like numbness. Sometimes it looks like quiet withdrawal. Sometimes it looks like someone who’s “fine”… until they aren’t.
One of the most striking moments in our conversation was when Jen shared what her son said shortly after his father died by suicide: if he died of cancer, we wouldn’t hide it. This shouldn’t be different.
That line carries so much wisdom. It treats mental illness like what it is: a health crisis, not a shameful secret. And it points toward the only real path forward.
Less silence.
More honesty.
More “checkups from the neck up.”
Because healing can’t start in the dark.
Why Physical Strength Becomes a Lifeline
What Jen described in those early weeks after her ex-husband’s suicide stopped me cold. She wasn’t “sad.” She was in clinical shock. She couldn’t eat. She lost weight rapidly. She felt numb and disconnected from her body, like she was moving through the world behind glass.
And the only thing that brought her back into herself wasn’t distraction. It wasn’t staying busy. It wasn’t cardio to burn off stress.
It was lifting weights.
Feeling her muscles contract. Feeling gravity push back. Feeling effort, strain, and control. In a moment when her world had become completely unmoored, strength training gave her something tangible. Something real. Something that reminded her she was still in her body.
That distinction matters. Because movement isn’t all the same. And the mental effects of resistance training are not interchangeable with stretching, mobility work, or even aerobic exercise.
We actually have data showing this. In controlled experiments, a single resistance training session using moderately heavy, multi-joint lifts significantly reduces anxiety and depressive symptoms within minutes. Stretching and mobility sessions don’t produce the same effect. Meta-analyses of randomized trials show that resistance training produces large reductions in both anxiety and depression, with effect sizes that rival, and in some cases exceed, those seen with other non-pharmacologic interventions.
Even more interesting, resistance training appears to drive structural and functional changes in the brain itself. Studies link it to improvements in executive function, preservation of white matter, and reduced brain atrophy, particularly in regions involved in decision-making, emotional regulation, and self-control. This isn’t just about “feeling better.” It’s about reinforcing the neural systems that help you cope.
But here’s the deeper lesson Jen highlighted without even meaning to. She didn’t turn to strength training because she was in crisis. She turned to it because it was already part of who she was. That’s the part most people miss.
You don’t build resilience in the middle of the storm. You draw on it. Resilience is built beforehand, through habits that reinforce self-trust, agency, and competence over time.
And this is where Jen said something I wish every woman could internalize: if you can’t give yourself time to care for your body, something is already wrong.
Strength training isn’t vanity. It’s not punishment for what you ate. It’s not optional once life gets hard. It’s a practice that teaches your nervous system, over and over again, that you can apply effort, tolerate discomfort, and come out stronger on the other side.
In moments of crisis, that embodied confidence can become a lifeline, not because it fixes everything, but because it gives you an anchor when everything else feels like it’s drifting.
We Are Getting Medicine Wrong When We Lose Nuance
One of the most valuable threads running through my conversation with Jen was her long view of medicine, not just as a clinician, but as someone who has spent nearly two decades translating medical science for the public in real time.
She’s seen what happens when nuance gets flattened. When complexity gets reduced to headlines. When uncertainty gets mistaken for danger.
She lived through the Women’s Health Initiative as a trainee, then as a practicing physician. She watched flawed data get rushed to the public without context. She watched media narratives explode overnight. And she watched millions of women pulled off hormone therapy almost instantly, not because of careful clinical reasoning, but because fear spread faster than understanding.
The result wasn’t just confusion. It was harm.
Two decades of women suffering unnecessarily. Hot flashes dismissed. Sleep disrupted. Bone loss accelerated. Cardiometabolic risk ignored. Quality of life was sacrificed because medicine forgot how to speak in probabilities instead of absolutes.
And what struck me is that Jen sees the same pattern emerging again… with menopause, with hormone therapy, and with GLP-1 medications.
Different decade. Different tools. Same mistake.
The problem isn’t that these therapies exist. It’s that we keep swinging between extremes. Either everyone should be on them immediately, or no one should touch them at all. Either they’re miracle cures, or they’re dangerous shortcuts. Either you’re “behind” if you don’t use them, or irresponsible if you do.
That’s not medicine. That’s ideology.
Real medicine lives in the gray. It requires tolerating uncertainty. It requires holding multiple truths at once. It requires understanding that risk is never zero, but neither is the risk of doing nothing.
Jen’s approach (and one I fully agree with) is grounded in choice. A good clinician doesn’t dictate. They lay out the landscape.
- Here’s what we know.
- Here’s what we don’t.
- Here are the risks.
- Here are the benefits.
- Here are the alternatives.
And importantly, opting out is also a valid option. No treatment is still a decision. And it should be made consciously, not by default, fear, or social pressure.
What worries me most right now is how quickly medicine is becoming moralized. If you’re not doing X, you’re negligent. If you are doing Y, you’re reckless. That kind of thinking shuts down dialogue. It discourages questions. And it ultimately erodes trust.
Personalized medicine doesn’t mean one-size-fits-all protocols with better marketing. It means recognizing that biology, history, values, and goals all matter. It means meeting people where they are, not forcing them into camps.
If a provider only offers one path forward, that’s not individualized care. That’s a belief system masquerading as science.
And history has already shown us how badly that can go.
Hormones, GLP-1s, and the Danger of One-Size-Fits-All Thinking
Jen was very clear about this, and I appreciated her honesty.
Hormone therapy can be absolutely life-changing for some women. It was for her. She described feeling like herself again within 48 hours, and I hear versions of that story all the time. Better sleep. Better mood. Better cognition. Relief that’s hard to put into words if you haven’t lived it.
But she was equally clear about something else that often gets lost online: hormones are not a magic wand, and they are not mandatory.
The same framing applies to GLP-1 medications.
These drugs aren’t new. Variations of GLP-1 receptor agonists have been used for decades in diabetes care. What’s new is their scale and visibility, and with that comes a lot of misunderstanding. Risk isn’t just about what could go wrong if you use a therapy, but also about what happens if you don’t.
GLP-1s can dramatically improve metabolic health. They reduce appetite, improve glycemic control, and lead to weight loss in the range of 15–20% of body weight, rivaling bariatric surgery in many cases. Large outcome trials also suggest reductions in cardiovascular events, kidney disease progression, and possibly even neurodegenerative risk in certain populations. For people with obesity, insulin resistance, or longstanding metabolic disease, these drugs can be genuinely transformative.
But transformation comes with responsibility.
One of the most important concerns, and one Jen and I both take seriously, is lean mass loss. Across major clinical trials like STEP-1, SUSTAIN-8, and SURMOUNT-1, roughly 25–40% of the weight lost on GLP-1s comes from lean tissue. That number isn’t wildly different from traditional dieting, where 20–30% of weight loss is often lean mass, but context matters. Losing muscle when you have excess fat and poor metabolic health is very different from losing muscle when reserves are already low.
And a big driver of this lean mass loss isn’t the drug itself. It’s what people aren’t doing alongside it.
GLP-1s suppress appetite powerfully. Many people unintentionally under-eat protein as a result. Most clinical trials also involve sedentary participants who aren’t strength training. That combination—low protein, no resistance training, and rapid weight loss—is almost guaranteed to cost muscle, regardless of how the weight loss is achieved.
We actually have very good evidence that this is preventable. Even under extreme calorie restriction, muscle can be largely preserved if protein intake is high enough. The Protein-Sparing Modified Fast is a perfect example. In nearly 1,400 obese adults eating just 600–800 calories per day but consuming about 1.5 g/kg of protein, only 16% of the weight lost came from lean mass. That’s dramatically better than what we typically see with GLP-1s alone.
It gets even more interesting when resistance training enters the picture. In one study, overweight and obese adults eating in a 40% calorie deficit actually gained lean body mass when they combined resistance training with very high protein intake (around 2.4 g/kg), compared to those eating closer to 1.2 g/kg. Not just muscle preservation, but actual muscle gain while dieting.
This is why nuance matters so much.
A person with obesity and insulin resistance is not the same as a lean individual chasing “optimization.” Someone losing dysfunctional muscle alongside excess fat is not in the same physiological position as someone already at the edge of sarcopenia. The risks, benefits, and priorities are completely different.
The answer isn’t fear, and it isn’t blanket enthusiasm either. The answer is intelligent pairing: adequate protein, structured resistance training, thoughtful dosing, and a clear reason for using the therapy in the first place.
Jen’s perspective really reinforced this for me. Hormones and GLP-1s are tools, not identities. They can be incredibly helpful in the right context, and completely inappropriate in the wrong one. Good medicine doesn’t ask, “Should everyone do this?” It asks, “Who is this for, why now, and what needs to be in place to use it well?”
That’s the difference between individualized care and one-size-fits-all thinking. And right now, that difference matters more than ever.
What I Took Away Most
More than any specific therapy, medication, or protocol, this conversation kept circling back to something far more fundamental.
Resilience is not a personality trait. It’s not something you either have or don’t have. It’s a practice, built slowly through repetition, self-honesty, and self-respect.
Jen’s story makes that impossible to ignore. She didn’t become resilient because she was spared hardship. She became resilient because she met hardship head-on, without pretending it was something else. She allowed grief to be real. She allowed vulnerability to exist alongside leadership. And she continued to show up, not because it was easy, but because showing up is a choice you make again and again.
That’s something we often get wrong in health conversations. We talk about strength as if it’s a destination, or a look, or a number on a chart. But real strength is quieter than that. It’s the willingness to care for your body even when motivation is gone. It’s choosing structure when life feels chaotic. It’s doing the unglamorous work of sleep, movement, nourishment, and boundaries, especially when no one is watching.
You can be broken and still lead. You can be grieving and still build something meaningful. You can feel lost and still take responsibility for your health. None of those things are contradictions.
What struck me most is that Jen never framed healing as a transaction. There was no sense of “I did this, so I earned that.” Helping others wasn’t a brand move. Community wasn’t performative. Strength wasn’t loud. It was embodied, practiced daily, and rooted in something deeper than optimization.
That’s the kind of resilience worth building. Not the kind that hardens you, but the kind that steadies you. The kind that allows you to carry pain without letting it define you. And the kind that reminds you, even in the hardest seasons, that you are still allowed to take ownership of your health, your body, and your life without waiting for permission.
Action Checklist: Building Real Resilience
You don’t need to overhaul your life. Start here.
Lift weights regularly. Build strength as insurance for life, not just aesthetics.
Protect your mental health like your physical health. Therapy, support, and honest conversations all count.
Be skeptical of extremes. In hormones, nutrition, and medicine, nuance is wisdom.
Prioritize protein. Especially during stress, perimenopause, menopause, or weight loss.
Question headlines, not credentials. Expertise matters. Humility matters more.
Build community intentionally. Not for status. For support.
Practice gratitude daily. Not because life is easy, but because perspective is powerful.
Strength isn’t something you’re born with. It’s something you build one decision, one habit, and one honest conversation at a time.
