Dr. Mary Claire Haver: The Science-Backed Guide to Menopause

# Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality
# https://www.youtube.com/watch/6P8hrzjnetU

00:00:00.320 welcome to the huberman Lab podcast
00:00:02.159 where we discuss science and
00:00:03.800 science-based tools for everyday
00:00:05.650 [Music]
00:00:08.119 life I’m Andrew huberman and I’m a
00:00:10.559 professor of neurobiology and
00:00:12.280 Opthalmology at Stanford School of
00:00:14.280 Medicine my guest today is Dr Mary Clair
00:00:17.080 Haver Dr Mary Clair Haver is a
00:00:19.560 board-certified OBGYN and an expert in
00:00:22.920 perim menopause menopause and all
00:00:25.519 aspects of female specific health during
00:00:28.000 today’s episode Dr Haver explains
00:00:30.000 exactly what per menopause and menopause
00:00:32.119 represent in terms of their underlying
00:00:34.360 psychology and biology and the specific
00:00:37.320 actions that all women can and should
00:00:39.440 take in order to navigate these stages
00:00:41.640 in Optimal Health she also describes the
00:00:44.039 things that all women should know and do
00:00:46.640 long before per menopause arrives in
00:00:48.920 order to best navigate perimenopause and
00:00:51.000 menopause once they arrive we discuss
00:00:53.640 specific nutritional practices
00:00:55.760 supplementation practices as well as
00:00:58.079 conversations that you should have with
00:00:59.719 your mother and with your physician in
00:01:02.160 particular your OBGYN not just as per
00:01:05.119 menopause and menopause approach but at
00:01:07.240 every developmental stage a fair amount
00:01:09.439 of our discussion centers around hormone
00:01:11.159 replacement therapy not just for
00:01:12.759 estrogen but for testosterone in women
00:01:14.960 as well and the many misconceptions and
00:01:17.680 controversies that exist around hormone
00:01:19.520 replacement therapy for menopause Dr
00:01:22.079 Haver explains how the specific timing
00:01:23.960 in which hormone therapy is initiated
00:01:26.079 plays a key role in whether or not the
00:01:27.920 hormone therapy is beneficial for women
00:01:30.280 or not and of course today’s discussion
00:01:32.360 gets into ways to offset some of the
00:01:34.640 more common difficulties associated with
00:01:36.320 menopause including sleep issues hot
00:01:38.680 flashes inflammation and more by the end
00:01:41.560 of today’s episode you will have a clear
00:01:43.759 picture from Dr Marie Clare Haver about
00:01:46.360 what per menopause and menopause
00:01:48.079 actually represent the best way to
00:01:50.280 approach perimenopause and menopause and
00:01:53.240 the various considerations around
00:01:54.799 hormone therapy and lifestyle choices
00:01:57.000 that can allow any woman to approach the
00:01:59.320 years of Perry menopause and menopause
00:02:01.320 and Beyond with the utmost vitality and
00:02:04.000 wellness before we begin I’d like to
00:02:06.079 emphasize that this podcast is separate
00:02:08.119 from my teaching and research roles at
00:02:09.440 Stanford it is however part of my desire
00:02:11.800 and effort to bring zero cost to
00:02:13.520 Consumer information about science and
00:02:15.239 science related tools to the general
00:02:17.120 public in keeping with that theme I’d
00:02:19.080 like to thank the sponsors of today’s
00:02:20.879 podcast our first sponsor is arero press
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00:06:21.800 huberman and now for my discussion with
00:06:24.240 Dr maryclair Haver Dr maryclair Haver
00:06:27.520 welcome thanks for having me delighted
00:06:30.160 to have you here and to learn about
00:06:32.759 menopause and other aspects of women’s
00:06:35.639 health there’s a lot happening in this
00:06:37.840 area right now yeah and you are at the
00:06:40.240 center of what I understand is a new
00:06:44.919 direction for the understanding and
00:06:46.440 treatment of menopause that’s what we
00:06:47.919 hope and related themes like per
00:06:50.000 menopause yeah and the many important
00:06:52.599 aspects of female Health that stem from
00:06:54.680 it like cardiovascular disease
00:06:56.199 osteoporosis right and so on so we will
00:06:58.479 get into all of that today
00:07:00.160 but just to kick things off how do we
00:07:02.440 Define menopause so the medical
00:07:05.479 definition of menopause which I have a
00:07:07.960 huge problem with is one year after the
00:07:11.400 final menstrual
00:07:13.080 period And the reason why I have a
00:07:16.039 problem with it is not everyone has a
00:07:17.680 menstrual period what if you’ve had a
00:07:20.120 hysterctomy what if you have an IUD what
00:07:22.520 if you’ve had an ablation or something
00:07:24.000 that’s suppressing your periods PCOS so
00:07:26.840 for a lot of women and even clinicians
00:07:30.199 they are struggling to like find that
00:07:32.360 diagnosis because it doesn’t fit
00:07:34.240 everything what it represents is
00:07:35.800 something much
00:07:37.080 bigger menopause is also one day of your
00:07:40.360 life it is that one day exactly one year
00:07:43.120 after your last period but it represents
00:07:45.039 the end of your ovarian function some of
00:07:47.400 us call it ovarian failure ovarian sence
00:07:50.599 but basically what separates males and
00:07:53.240 females
00:07:54.879 is many things separate us but in my
00:07:57.520 world um we are born with all of our
00:08:01.360 eggs we have 1 to two million at Birth
00:08:04.919 by the time we’re 30 most of us are down
00:08:06.599 to about 10% maybe
00:08:09.120 120,000 by the time we’re 40 we’re down
00:08:11.159 to 3% of our egg supply and the quality
00:08:14.599 is declining as well so menopause is
00:08:18.319 when you have no more eggs left and
00:08:20.960 therefore no more sex hormone or very
00:08:22.840 little sex hormone production from the
00:08:24.639 ovaries so estradiol levels will decline
00:08:27.120 less than 1% of your reproductive years
00:08:29.840 your progesterone levels will decline as
00:08:31.599 well testosterone declines for sure but
00:08:34.159 we have other ways to produce it so it’s
00:08:36.479 somewhere 50% or less than your
00:08:38.159 healthiest years so is it fair to say
00:08:40.799 that we need a redefinition of what
00:08:43.760 menopause is I think so I think defining
00:08:47.240 it as the presence or absence of a
00:08:48.800 period is a mistake is there any
00:08:51.600 consensus about the quote unquote
00:08:53.959 typical age of onset for men and paws
00:08:56.880 and is it changing you know I hear a lot
00:08:58.640 about how the onset set of puberty is
00:09:01.120 Shifting earlier in females and given
00:09:05.360 that puberty at least by some
00:09:07.000 definitions relates to the onset of
00:09:08.959 menes uh one could imagine that
00:09:11.920 menopause would be shifting earlier as
00:09:13.880 well so the things that determine when
00:09:17.959 we have puberty or not are different
00:09:20.600 than the things that determine when we
00:09:22.720 run out of eggs um right now in the US
00:09:27.480 it’s the average age of that one year
00:09:29.720 after your cycle so menopause that one
00:09:31.920 day is about 51 to 52 years old however
00:09:35.480 normal is still 45 to 55 and there’s a
00:09:38.560 big variation you know that curves
00:09:41.160 pretty wide
00:09:43.000 um Perry
00:09:45.079 menopause begins 7 to 10 years before
00:09:48.440 that last minstral period wow okay I say
00:09:51.640 wow because um it’s the first time I’ve
00:09:53.640 ever heard a specific number tacked to
00:09:55.880 this word per menopause maybe we could
00:09:58.680 talk a little bit about per menopause
00:10:00.839 since it sounds like it represents a
00:10:04.160 transition phase into official menopause
00:10:08.519 right um however one chooses to Define
00:10:10.800 that what are some of the I don’t know
00:10:13.760 if I should call them symptoms sure
00:10:15.160 where I should uh just well let me let
00:10:17.000 me do let me walk you through the
00:10:18.240 endocrinology and then we can go through
00:10:20.320 symptoms so you understand so in a
00:10:22.920 normal healthy menstrual cycle before
00:10:24.959 menopause ever becomes an issue the
00:10:27.600 female hormone cycle is a very EKG like
00:10:30.560 reproducible monthly rise and fall of
00:10:33.440 estrogen progesterone and then the brain
00:10:36.000 hormones LH FSH and then g& RH so the
00:10:39.519 way it works is our brain in the
00:10:42.040 hypothalamus um is sensing for has a
00:10:45.360 little sensor in the blood looking for
00:10:46.959 estradiol levels and when they get low
00:10:48.920 it sends G&R down to the pituitary
00:10:51.160 saying hey tell the ovaries to start
00:10:53.800 trying to ovulate so we can get more
00:10:55.399 estrogen on board the process of
00:10:57.440 ovulation is what drives up our estrogen
00:10:59.360 levels okay so pituitary sends out the
00:11:03.000 pulses of LH and FSH which then lead to
00:11:06.000 ovulation when we reach in perimenopause
00:11:09.279 the beginning of perimenopause that
00:11:10.680 critical level of egg
00:11:12.639 supply those signals don’t work as well
00:11:15.600 we start becoming resistant to the LH
00:11:18.360 and FSH pulle surges
00:11:21.480 so the brains like hey I told you we
00:11:24.920 need more estradiol and the pituitary is
00:11:26.959 like I sent the signal and the brains
00:11:29.560 like send more so we get much higher
00:11:32.120 pulses of FSH and then finally the ovary
00:11:35.399 kind of is able to get that egg out but
00:11:38.399 sometimes it’s delayed so we have the
00:11:40.760 timing of that monthly predictable cycle
00:11:43.839 goes arise sometimes the periods are
00:11:45.920 closer together sometimes they’re
00:11:47.320 further apart but also the estrogen and
00:11:50.480 progesterone levels start changing
00:11:52.200 dramatically we see much higher surges
00:11:54.240 of estradiol than we ever had in our pre
00:11:57.600 productive years and then much lower
00:11:59.440 levels underneath so we end up with this
00:12:01.720 very volatile curve and not predictable
00:12:04.200 at all we call it in our world the zone
00:12:05.920 of chaos so it is literal hormonal chaos
00:12:08.720 what used to look like this you know
00:12:10.160 every month is
00:12:12.279 now just just insane and very very very
00:12:15.240 unpredictable that is why we don’t have
00:12:17.320 a good blood test in per menopause to
00:12:20.160 make the diagnosis those of us in the
00:12:22.800 mense use symptoms usually to make the
00:12:25.680 diagnosis and we rule out other
00:12:27.279 conditions that might overlap so per
00:12:30.120 menopause basically critical threshold
00:12:32.399 it’s a downward Trend overall of
00:12:34.360 estradiol but is a very chaotic you know
00:12:37.160 race till you Flatline and bottom out I
00:12:39.680 see so for those listening um your
00:12:42.000 description of the um kind of the
00:12:44.920 amplitude of the estrogen surge it gets
00:12:48.000 much greater in this per menopause phase
00:12:50.120 you also mentioned that follicle
00:12:51.240 stimulating hormone which comes from the
00:12:52.800 pituitary has to be or somehow is
00:12:55.720 upregulated in this phase because I
00:12:58.120 don’t know is it that the recept for FSH
00:13:00.160 are somehow not responsive at the level
00:13:02.800 of the ovary do we know what’s happening
00:13:05.240 to the ovary is it obviously the signals
00:13:07.079 getting there it’s not effective so then
00:13:09.600 the brain is kicking out more FSH is it
00:13:12.440 that the quality is poor and then around
00:13:15.639 each germ cell is the tholian cells
00:13:18.880 which is actually where the estradi the
00:13:20.560 whole pathway going from you know
00:13:22.279 actually testosterone’s converted to
00:13:23.600 estrad so that whole pathway you know it
00:13:27.399 still will respond but the cells are
00:13:30.000 just old you know is the way that it’s
00:13:31.959 been explained to me and from what I’ve
00:13:33.399 read I think we need a lot more research
00:13:34.920 in this area because that is how we’re
00:13:37.920 going to help women I think longer term
00:13:39.760 is understanding that process better but
00:13:41.920 you know all I learned in school 25
00:13:44.279 years ago was it’s the transition to
00:13:46.519 menopause the end you know the whole
00:13:49.199 endocrinological process I didn’t learn
00:13:51.360 till about two years ago and my guess is
00:13:53.759 just based on my understanding of the
00:13:56.000 only recent Trend
00:13:58.040 toward emphasizing studies of both
00:14:00.560 female and male even just mice in mouse
00:14:02.959 models which is where generally this
00:14:04.839 stuff originates and then it shifts into
00:14:06.399 humans once certain targets are
00:14:07.839 identified um only recently has the NIH
00:14:11.000 insisted that there be uh female uh mice
00:14:15.160 in the studies of mice I mean it’s it’s
00:14:17.279 been a few years now but that’s a you
00:14:19.000 know sex as a biological variable is is
00:14:21.160 actually a requirement in most Grant
00:14:23.600 applications unless of course there’s a
00:14:25.519 specific reason to study only one or the
00:14:27.800 other um sex of mice so you can imagine
00:14:30.279 that um the dir of research in this area
00:14:33.759 is due to a a long um desert of um
00:14:38.600 absence of studies into what is per
00:14:40.560 menopause right so for women who are in
00:14:43.040 the age range of per menopause or who
00:14:45.199 are thinking about this are there things
00:14:47.560 that they can do in order to either
00:14:50.199 upregulate the sensitivity of the ovary
00:14:52.399 to FSH or to somehow prolong this period
00:14:56.519 of per menopause um and I should also
00:14:59.560 say what are some reasons why they would
00:15:01.079 want to do that um you know obviously
00:15:03.759 this is part of the um of the Arc of
00:15:07.000 maturation of the female reproductive
00:15:09.079 axis but of course that alone is not a
00:15:11.600 reason to not try and um I guess we say
00:15:13.959 optimize it for one’s well-being so we
00:15:17.560 don’t know when you the best way I can
00:15:20.320 highlight why we don’t know or or where
00:15:22.360 the dollars are going for research you
00:15:24.240 know we go to PubMed and you type in the
00:15:26.839 word pregnancy 1.1 million articles come
00:15:29.399 up type in the word menopause it’s down
00:15:31.199 to
00:15:31.880 97,000 really you type in the word per
00:15:34.600 menopause and I checked this like 2
00:15:36.079 weeks ago and it was like 6,400 and
00:15:38.639 something wow yeah that is surprising so
00:15:42.519 or maybe it shouldn’t be surprising
00:15:43.759 given what we were just talking about in
00:15:45.360 terms of so as far as like why those
00:15:48.399 cells are becoming resistant and what’s
00:15:51.000 happening at the level of the receptor I
00:15:52.519 think we need a lot more research in
00:15:53.800 this area I think it’s starting to
00:15:56.000 happen because women are realizing
00:15:58.120 there’s a demand now because the older
00:16:00.560 you are when you go through menopause
00:16:02.600 the healthier you are for cardi
00:16:04.480 metabolic disease it’s the loss of
00:16:07.160 estrogen that accelerates our path to
00:16:09.399 those
00:16:10.279 diseases so are there clinical signs of
00:16:14.279 perimenopause that either directly or
00:16:17.360 indirectly relate to these bigger surges
00:16:19.720 in FSH and these larger amplitude um
00:16:23.600 estrogen uh surges the the two best
00:16:26.519 documented and studied are mental health
00:16:28.519 changes
00:16:29.839 um the brain does not like the chaos of
00:16:33.240 and and the neurotransmitters are very
00:16:34.959 very sensitive to estrogen and
00:16:37.000 progesterone and even testosterone and
00:16:39.839 so we see aberration in serotonin and
00:16:43.759 orpine phrine and and dopamine as the
00:16:46.519 levels start becoming chaotic so we have
00:16:49.360 at least a 40% increase of mental health
00:16:52.480 disorders in and SSRI use doubles across
00:16:55.880 the menopause transition across per
00:16:58.440 menopause
00:16:59.800 and now the data is showing that women
00:17:02.360 who are given hormone therapy in their
00:17:04.439 per menopause have a lower incidence of
00:17:06.640 neonet depression and now the
00:17:08.799 neuroscientists are saying hey for these
00:17:11.559 women who are developing depression in
00:17:13.359 per menopause giving them estrogen is
00:17:16.919 better than an SSRI they’re going to
00:17:18.640 have a better outcome I think most
00:17:21.000 people don’t realize how rich the brain
00:17:24.480 and rest of the nervous system are with
00:17:27.359 hormone receptors in particular I
00:17:29.799 estrogen receptors and as you mentioned
00:17:32.559 testosterone receptors as well Androgen
00:17:35.080 receptors um and the often direct
00:17:38.280 relationship between estrogen and the
00:17:40.600 neuromodulators such as serotonin
00:17:42.960 dopamine epinephrine aceto Gaba for for
00:17:46.160 um
00:17:46.919 progesterone yeah it’s it’s interesting
00:17:49.039 during neural development which is where
00:17:51.080 I started off which was um neural
00:17:53.640 embryonic development the hormones exert
00:17:57.320 you know these widespread roles in
00:17:58.919 defining even which neurons will Express
00:18:01.600 certain neurotransmitters and then
00:18:03.360 somehow the field of Neuroscience is
00:18:06.000 only recently gotten on board the idea
00:18:09.000 that um this intimate relationship
00:18:11.080 between hormones and neurotransmitters
00:18:13.000 is something to consider in essentially
00:18:15.200 every aspect of of brain health right
00:18:18.080 not just cognition but maintenance of
00:18:19.880 neurons and um offsetting neurod
00:18:21.760 degeneration and so on um I mentioned
00:18:24.000 that only um so that people I think
00:18:27.440 typically think of hormones as something
00:18:29.600 sure there’s a signal from the brain and
00:18:31.720 but that hormones are mostly of the body
00:18:33.840 when in fact hormones play an absolutely
00:18:35.799 crucial role within the brain yeah so
00:18:39.200 you mentioned that during per menopause
00:18:41.000 there there are symptoms that are I
00:18:43.960 guess it’s per are mainly reflected as
00:18:47.240 shifts in mental health so is this women
00:18:49.799 suddenly feeling um kind of um less uh
00:18:54.679 optimistic is it like what what’s the
00:18:56.280 sort of um constellation of of of
00:18:58.799 psychological shifts that can occur so
00:19:00.520 we
00:19:01.320 see uh increasing anxiety we see
00:19:04.240 definitely loss of executive functioning
00:19:06.760 so new onset of add type symptoms um we
00:19:10.880 see of course the cognitive you know
00:19:13.760 what we call brain fog and and lay
00:19:15.320 terminology which is cognitive you know
00:19:17.600 so they lose their words they’re not
00:19:19.679 able to do the calculations at work like
00:19:21.520 their executive functioning ability in
00:19:23.480 their jobs is huge like one in five
00:19:25.840 women will quit their jobs because of
00:19:27.679 menopause symptoms
00:19:29.679 um that’s that’s an outrageous number
00:19:32.480 yeah and the the economic impact is huge
00:19:34.480 and so now companies are starting to get
00:19:35.960 on board and this is a Time Of Our Lives
00:19:37.559 when the kids are grown for a lot of us
00:19:39.480 you know and we’re trying we’re ready to
00:19:40.960 lean into our positions and really get
00:19:42.640 into leadership we have all this
00:19:43.880 experience and now we can’t REM you know
00:19:46.200 and now all of a sudden these and their
00:19:47.960 confidence is just wrecked so and then
00:19:50.880 the depression and they’re not sleeping
00:19:52.360 and like it’s this horrible feedback
00:19:53.880 cycle that they end up in that we end up
00:19:56.039 in yeah I wasn’t aware that one in five
00:19:58.320 is is striking that came out of the UK
00:20:01.159 but they’re starting to like crunch the
00:20:02.440 numbers here in the US and it’s looking
00:20:03.880 very similar I know we’re going to get
00:20:06.000 into actionable tools later as it
00:20:08.320 relates to menopause but as long as
00:20:09.640 we’re discussing this phase of per
00:20:11.039 menopause uh what are some of the basic
00:20:13.880 things sure that women could a pay
00:20:16.240 attention to we don’t want to make
00:20:17.919 people hypervigilant to the point of
00:20:19.440 anxiety but but um certainly given the
00:20:23.000 frequency and given the
00:20:24.480 implications um it’s important for them
00:20:27.159 to pay attention to this phase and then
00:20:29.120 some of the things that they can do to
00:20:31.080 you know either behaviorally or perhaps
00:20:33.240 through other tools offset um some of
00:20:35.400 these changes uh dysfunctional uterine
00:20:37.919 bleeding um which is abnormal periods so
00:20:41.120 and again nothing’s off the table it
00:20:42.880 could be heavy periods menaga too
00:20:46.600 frequent too few skipping it’s really
00:20:49.840 really chaotic and but a lot of women
00:20:52.640 are suffering horribly from really
00:20:55.120 debilitating periods either through the
00:20:56.840 volume of blood loss or they’re having
00:20:59.400 you know cramps and you know really and
00:21:02.120 so 90% of us will have that as a symptom
00:21:07.240 um fatigue is a huge one a lot of them
00:21:10.880 the symptoms are kind of vague you know
00:21:13.000 and can be attributed to a lot of other
00:21:14.600 things in our in my what we call the
00:21:18.159 menopausia chat group you know we have a
00:21:20.080 lot of theories about a lot of
00:21:21.799 conditions like
00:21:23.039 fibromyalgia and the irritable bladder
00:21:25.679 syndromes and that probably just per
00:21:28.080 menopausa menopause and doctors didn’t
00:21:30.320 know how to put you know make that
00:21:32.000 diagnosis and so you know muscular
00:21:34.159 skeletal system takes a huge hit through
00:21:36.799 the transition so all of a sudden you
00:21:38.159 have no injury and you’re having hip
00:21:40.240 pain joint pain back pain with you know
00:21:42.159 you go to the doctor and you get an
00:21:43.480 x-ray you do whatever work up and they
00:21:45.480 can’t find anything wrong palpitations
00:21:47.600 are huge it is a vasomotor symptom so
00:21:50.919 along with hot flashes palpitation so a
00:21:52.880 woman will walk into the emergency room
00:21:55.080 sweating profusely horrible palpitation
00:21:57.440 she’s anxiety and they’ll tell her she’s
00:21:59.039 having a panic attack you know um
00:22:01.159 they’ll work her up you know
00:22:02.360 everything’s negative and just say well
00:22:03.640 it’s panic attack go home and no one
00:22:05.200 knew to connect the dots and figure out
00:22:07.720 that this woman was in her menopause
00:22:09.320 transition and this is how her body was
00:22:10.960 expressing it it’s complicated because
00:22:13.120 we have sex hormone receptors as you do
00:22:15.080 in every organ system of our body and
00:22:17.080 when these levels start going chaotic it
00:22:20.120 can present in so many different ways
00:22:22.200 and so when the patients come to me I’m
00:22:24.240 doing blood work not a lot of hormone
00:22:26.200 levels because they’re not super helpful
00:22:28.200 but I am doing thyroid workups and
00:22:30.640 autoimmune workups and looking for
00:22:33.159 nutritional deficiencies and anemia and
00:22:35.320 different things because I don’t want to
00:22:37.159 miss those things and just pen
00:22:39.080 everything on per
00:22:41.000 menopause are there lifestyle factors
00:22:43.600 that can offset some of this it’s not a
00:22:46.279 perfect correlation but the healthier
00:22:48.400 you are so anti-inflammatory diet you
00:22:51.000 know Mediterranean s galison dietes you
00:22:53.240 know nutrition pattern um regular
00:22:55.880 exercise good sleep habits you know all
00:22:58.559 the pillars of Health the healthier you
00:23:00.480 are when you hit per menopause the
00:23:02.320 better the course is going to be for you
00:23:04.960 they’re looking at extending the life of
00:23:06.840 the ovary with pharmacology we know what
00:23:10.400 can shut it down faster so we have kind
00:23:13.039 of a genetic predetermined age of when
00:23:15.200 you’re going to lose all your eggs but
00:23:16.919 we can speed that up so if you smoke
00:23:18.840 you’re going to go through menopause
00:23:20.000 sooner than your twin would have if she
00:23:21.760 didn’t smoke okay if you don’t have
00:23:24.559 children and you ovulate regularly then
00:23:27.679 the more you OV the faster you run
00:23:29.799 through your egg supply okay interesting
00:23:31.840 I I wasn’t aware of those data that’s I
00:23:34.720 I don’t know that most people are aware
00:23:36.000 of those dat if you have a hysterctomy
00:23:37.559 and you leave your ovaries behind I
00:23:39.600 didn’t know I didn’t never counsel my
00:23:40.799 patients about this you lose four years
00:23:43.039 off the life of your ovaries if you have
00:23:44.880 a tubal liation you use lose a year and
00:23:46.840 a half huge genetic disparities so
00:23:49.320 African-Americans tend to go through a
00:23:50.679 year and a half sooner and then there’s
00:23:52.799 caucasians in the middle and then Asian
00:23:54.840 family tend to go through later and
00:23:56.440 they’re not sure why you know a year or
00:23:58.120 two years years so there are if you have
00:24:00.799 chemotherapy if you have surgery if you
00:24:02.200 have any inflammatory process in the
00:24:03.720 abdomen irritable bowel or
00:24:06.559 endometriosis you’re going to lose some
00:24:08.600 of the life of the ovary you mentioned
00:24:10.520 smoking are there any data on vaping not
00:24:13.559 yet I haven’t seen any there might be
00:24:15.360 out there I just haven’t seen it yet no
00:24:16.720 I’m I’m guessing uh if they’re out there
00:24:18.840 they’re not um prominent or you would
00:24:20.400 have seen them I’m curious about vaping
00:24:22.080 because a lot of people are vaping
00:24:23.520 instead of smoking and hopefully people
00:24:25.840 are neither vaping nor smoking because
00:24:28.039 it seems that we had an expert on vaping
00:24:30.240 on the podcast recently from Stanford
00:24:31.760 and it seems that um there’s nothing
00:24:34.279 great about it right and there may be
00:24:36.080 some things really bad about it but was
00:24:37.840 just curious given that a number of
00:24:39.799 young women and men for that matter are
00:24:42.880 vaping nowadays who smoking rates have
00:24:45.840 gone way way down another 10 years
00:24:48.520 before we’d be able to you know see when
00:24:52.159 those women are going through menopause
00:24:53.520 you know because vaping I think of
00:24:54.880 vaping as younger the younger generation
00:24:57.200 um like my kids they’re they people in
00:24:59.520 their 20s and 30s 10 V so we’re you know
00:25:01.399 we’re 20 years out from seeing how it’s
00:25:03.279 going to affect them is there any
00:25:05.520 evidence that alcohol can impact
00:25:07.679 menopause I haven’t seen any but I can’t
00:25:09.399 imagine that you know heavy use of
00:25:11.480 alcohol would prolong the life of the
00:25:13.320 ovary in any way right so um and we know
00:25:15.760 that any use of alcohol has some
00:25:18.279 potential role in disrupting sleep and
00:25:19.960 presumably like everything else uh if
00:25:22.120 you disrupt sleep you disrupt things for
00:25:24.200 the for the worse and got it so you
00:25:26.960 mentioned um rough ages for onset of uh
00:25:31.480 menopause um 51 but anywhere from 45 to
00:25:34.720 55 and the per menopause uh is defined
00:25:38.399 as a period about seven years prior to
00:25:40.320 that 7 to 10 okay um what’s the earliest
00:25:43.559 you’ve ever had a patient come in who
00:25:45.840 entered menopause what’s the latest you
00:25:48.200 personal patient 27 and she came in just
00:25:51.399 a couple months ago so she had a special
00:25:54.200 condition we call premature ovarian
00:25:56.399 failure and she had found me on social
00:25:58.919 media and wanted to come just to make
00:26:01.799 sure she was doing everything right and
00:26:04.640 so early menopause is defined as between
00:26:07.679 the ages of 40 and 45 and then premature
00:26:10.919 menopause or pre premature ovarian
00:26:13.640 insufficiency it’s not a complete
00:26:14.960 failure for most women but it is very
00:26:16.960 very low is any time before the age of
00:26:19.080 40 so this patient kind of got kicked
00:26:22.840 around for 2 years went to her doctor no
00:26:25.000 periods horrible hot flashes again she
00:26:27.559 was 25 and it was not on his radar and
00:26:31.279 he never tested her for menopause and it
00:26:34.799 took her you know 18 months to get the
00:26:36.880 diagnosis and so the longer your body is
00:26:39.840 away from estrogen the higher the risk
00:26:42.399 factor and it’s been all over the news
00:26:44.000 this week where we know that untreated
00:26:46.880 premature ovarian insufficiency has a
00:26:49.279 earlier death so they have higher
00:26:51.279 cardiovascular disease diabetes stroke
00:26:53.520 all because estrogen is so protective
00:26:55.320 and they have to go so long without it
00:26:57.159 we can back negate most of those risks
00:27:00.440 by giving her aggressive hormone therapy
00:27:02.520 early so she came in to make sure she
00:27:06.240 was on the right dose because in
00:27:08.080 premature ovarian failure we don’t want
00:27:09.679 to give them menopause hormone therapy
00:27:11.080 doses they’re too low we want to get her
00:27:12.960 more like she would have which is three
00:27:14.960 to four times the amount of estrogen as
00:27:17.640 a reproductive aged woman and so and she
00:27:21.120 wanted to have a period so she would
00:27:22.799 seem like her friends you know it was an
00:27:25.200 emotional thing for her which I totally
00:27:27.320 respect and so um so we were doing
00:27:29.679 cyclical progesterone for her so that
00:27:31.720 she would have a withdrawal bleed and
00:27:33.000 feel like she was normal basic question
00:27:35.960 but I I’m curious all I’ll ask um given
00:27:38.600 that levels of estrogen change so much
00:27:42.080 naturally during the course of the um
00:27:44.600 ovulation cycle menstrual cycle um with
00:27:48.279 estrogen therapy is it a constant dose
00:27:50.039 or it’s modulated by week to week day to
00:27:53.200 day question so there are some formulas
00:27:55.640 so and when we look at hormonal
00:27:57.120 contraception so the the biggest
00:27:58.559 difference
00:27:59.760 between contraceptive Doses and
00:28:02.039 menopause hormone therapy doses they’re
00:28:04.120 both based in estrogen and progesterone
00:28:07.360 mostly okay
00:28:10.240 the hormone therapy was developed to
00:28:13.080 stop a hot flash for decades menopause
00:28:17.360 was defined by the presence or absence
00:28:18.760 of you know severe menopause was defined
00:28:20.159 by hot flashes or not they didn’t didn’t
00:28:22.399 nothing else and so they developed the
00:28:24.919 formulations with enough estrogen to
00:28:26.880 stop hot flashes birth control was
00:28:29.080 developed to stop ovulation you don’t
00:28:30.720 ovulate you don’t get pregnant and it’s
00:28:32.760 but the difference between lowd dose
00:28:35.559 birth control pill and higher dose
00:28:37.320 menopause hormone therapy is not that
00:28:38.919 far away and
00:28:41.679 so um that a lot of people don’t
00:28:44.080 understand now the types of estrogen we
00:28:45.799 use in birth control are a little bit
00:28:47.519 different most birth control is ethanol
00:28:49.440 estradiol which is one of the synthetics
00:28:51.320 we have literally millions and millions
00:28:53.440 of women’s year data on it we know it’s
00:28:55.880 safety profile I think we’re not
00:28:57.279 counseling patients adequately about
00:28:58.919 birth control as far as what it does to
00:29:00.440 their testosterone and what it can do to
00:29:02.519 you know oh it’s fine it’s safe I took
00:29:03.799 it for years but I think we need to do a
00:29:05.640 better job as a specialty on counseling
00:29:07.679 women but I do think it’s a good
00:29:09.000 medication and then on menopause hormone
00:29:11.519 therapy you know it’s much lower dose it
00:29:14.120 does not suppress ovulation so in per
00:29:16.600 menopause it’s a little bit of the Wild
00:29:18.519 West which one we’re going to use how
00:29:20.600 high do we want to go do we need to
00:29:21.880 suppress her ovulation because she’s got
00:29:23.480 acne or horrible periods or cramps or
00:29:25.240 something where I want to suppress that
00:29:27.080 ovulation to help her
00:29:28.559 or can I give her menopause hormone
00:29:30.000 therapy doses which in effect think of
00:29:32.399 the hypothalamus I’m giving her just
00:29:34.080 enough estrogen to calm the brain down
00:29:36.080 and tell them everything’s okay we’re
00:29:38.120 not going to get those big Peaks and
00:29:39.600 drops and if she still ovulates that’s
00:29:41.480 okay too as many of you know I’ve been
00:29:43.760 taking ag1 for more than 10 years now so
00:29:46.519 I’m delighted that they’re sponsoring
00:29:47.799 this podcast to be clear I don’t take
00:29:50.039 ag1 because they’re a sponsor rather
00:29:52.279 they are a sponsor because I take ag1 in
00:29:54.919 fact I take ag1 once and often twice
00:29:57.240 every single day and I’ve done that
00:29:59.120 since starting way back in
00:30:00.880 2012 there is so much conflicting
00:30:03.080 information out there nowadays about
00:30:04.799 what proper nutrition is but here’s what
00:30:07.120 there seems to be a general consensus on
00:30:09.600 whether you’re an omnivore a carnivore a
00:30:12.080 vegetarian or a vegan I think it’s
00:30:14.039 generally agreed that you should get
00:30:15.480 most of your food from unprocessed or
00:30:17.559 minimally processed sources which allows
00:30:19.799 you to eat enough but not overeat get
00:30:22.120 plenty of vitamins and minerals
00:30:23.559 probiotics and micronutrients that we
00:30:25.760 all need for physical and mental health
00:30:28.000 now I personally am an omnivore and I
00:30:29.880 strive to get most of my food from
00:30:31.399 unprocessed or minimally processed
00:30:33.039 sources but the reason I still take ag1
00:30:35.600 once and often twice every day is that
00:30:37.960 it ensures I get all of those vitamins
00:30:40.159 minerals probiotics Etc but it also has
00:30:42.960 adaptogens to help me cope with stress
00:30:45.200 it’s basically a nutritional insurance
00:30:47.039 policy meant to augment not replace
00:30:49.200 quality food so by drinking a serving of
00:30:51.279 ag1 in the morning and again in the
00:30:53.000 afternoon or evening I cover all of my
00:30:55.320 foundational nutritional needs and I
00:30:57.440 like so many other people that take ag1
00:30:59.720 report feeling much better in a number
00:31:01.760 of important ways such as energy levels
00:31:03.960 digestion sleep and more so while many
00:31:06.519 supplements out there are really
00:31:07.720 directed towards obtaining one specific
00:31:09.600 outcome ag1 is foundational nutrition
00:31:12.240 designed to support all aspects of
00:31:13.960 well-being related to mental health and
00:31:15.720 physical health if you’d like to try ag1
00:31:18.360 you can go to drink a1.com huberman to
00:31:21.880 claim a special offer they’ll give you
00:31:23.720 five free travel packs with your order
00:31:25.320 plus a year supply of vitamin D3 K2
00:31:28.039 again that’s drink a1.com
00:31:31.320 huberman as long as we’re on the topic
00:31:33.480 of birth control earlier you mentioned
00:31:35.679 that the IUD and presumably this is some
00:31:38.159 form of the IUD not necessarily copper
00:31:40.440 IUD can um disrupt or stop a period a
00:31:45.360 period um maybe we could talk a little
00:31:47.919 bit about the different forms of birth
00:31:49.200 control um IUD um as the pill quote
00:31:53.320 unquote um old term but um uh I think
00:31:57.240 most people know what we’re referring to
00:31:58.760 when we say that the ring um and and on
00:32:01.919 and on um what is your stance on on
00:32:04.480 these different forms of birth control
00:32:05.880 as it relates to their safety um you
00:32:07.919 know a guess about a year and a half ago
00:32:10.440 I hosted a um a female physician guest
00:32:13.880 on on this podcast and both sides of the
00:32:16.799 uh birth control issue were touched on
00:32:19.240 one the relationship to um potential um
00:32:22.840 inhibition of certain forms of cancers
00:32:24.919 but then also the potential for certain
00:32:26.799 side effects maybe even Cancers and so
00:32:28.840 it you know it seems like it can play
00:32:30.200 out both ways and this is a very heated
00:32:32.000 topic yeah um in fact so much so that I
00:32:34.480 learned that if one is going to post a
00:32:37.200 clip of any of this on social media it
00:32:39.799 almost makes sense to have them in the
00:32:41.279 same post because we actually did both
00:32:42.919 of them we we we did a post where it was
00:32:44.960 more about the the pros of birth control
00:32:46.760 and then the cons of birth control as as
00:32:49.200 stated through um the words of this very
00:32:52.200 same clinician um so we will be sure to
00:32:55.760 so for anyone listening would you ever
00:32:58.399 answer comes first stay tuned for the
00:33:00.320 next answer because um my understanding
00:33:03.159 is that it’s not a black and white issue
00:33:05.559 I think the best form of birth control
00:33:07.200 is a vasectomy and so much of
00:33:10.080 contraception is dumped in a female’s
00:33:11.960 lap you know in a committed relationship
00:33:14.799 and I can’t tell you the comments I’ve
00:33:16.200 heard when a patient comes to me and she
00:33:18.279 wants to get X Y and Z simply for
00:33:20.159 contraception she’s absolutely perfectly
00:33:21.960 healthy there’s nothing wrong with her
00:33:23.279 she just doesn’t want to be pregnant and
00:33:25.840 I’m like okay you’re done how you know
00:33:27.320 she’s completed her family she’s out you
00:33:29.919 know and I’m like tell your partner to
00:33:33.399 get a vecto oh he won’t do that you know
00:33:36.320 so now all of the risk and the onus goes
00:33:39.039 on her and so we we go through the
00:33:41.480 options of surgical like you know tub
00:33:43.880 legation um which is basically blocking
00:33:47.279 the tube so when I you know talk to my
00:33:49.039 teenagers I’m like here’s how you not
00:33:50.440 get pregnant a you don’t have sex well
00:33:52.000 if that’s not an option then we have to
00:33:53.840 either block the sperm stop the egg from
00:33:56.279 coming out or stop the place where they
00:33:58.039 communicate which is the fallopian tube
00:34:00.039 and so when we look at the different
00:34:01.720 forms of hormonal contraception which
00:34:03.519 are meant to stop ovulation suppress
00:34:05.799 ovulation because they’re telling the
00:34:07.440 brain we have enough estrogen
00:34:09.599 progesterone on board quiet down so it
00:34:12.199 doesn’t send those signals to the ovary
00:34:14.000 right and so that can come in a pill
00:34:16.599 form a patch form a ring form and they
00:34:18.560 each have their own Pros cons risk
00:34:20.560 benefits you know transdermal has less
00:34:22.440 risk of blood clots versus oral has a
00:34:25.159 higher risk of blood clot in any form of
00:34:26.719 estrogen so so we talk about that we
00:34:28.520 look at their family history or if they
00:34:29.918 have MTHFR any of the clotting genes you
00:34:32.320 know then we Council directly versus the
00:34:35.399 IUD the iuds create an an inflammatory
00:34:39.239 environment in the uterus that blocks
00:34:41.879 and it creates a plug in the servic so
00:34:44.159 that the sperm can’t get
00:34:45.679 through and then if any do get through
00:34:48.399 it’s a toxic environment in the uterine
00:34:50.440 cavity for the sperm so that’s really
00:34:53.918 how the those iuds work some iuds are
00:34:56.280 coated with progesterone progestin not
00:34:58.480 progesterone progestogen and those end
00:35:01.359 up decidualizing the endometrium so
00:35:03.400 thinning that lining from that constant
00:35:05.280 progesterone to the point where you stop
00:35:07.280 bleeding so a lot of my patients really
00:35:09.320 loved that option of being aaric no
00:35:11.640 periods just for the convenience of it
00:35:13.920 but they were still ovulating in the
00:35:15.160 background so we’re not suppressing
00:35:16.520 their natural cycles just their periods
00:35:19.280 I see and is there any evidence that the
00:35:21.440 use of any form of birth control can
00:35:23.800 disrupt the um timing or the uh
00:35:28.119 availability of I realize availability
00:35:30.560 of eggs is a very um uh clinically naive
00:35:33.560 biologically naive statement but
00:35:35.000 basically what I’m saying can it can any
00:35:37.160 of them accelerate the onset of per
00:35:39.480 menopause can they delay the onset of
00:35:41.760 onset a little bit you know it’s it’s
00:35:44.440 maybe a year if you use it for a long
00:35:46.920 time from what the data shows so women
00:35:49.119 who suppress ovulation we lose about
00:35:51.160 11,000 eggs each month with the
00:35:53.800 ovulation process to get one out 11,000
00:35:56.720 race to the Finish Line and only one
00:35:58.760 makes it but we lose about 11,000 in the
00:36:00.800 process so women who are constantly you
00:36:02.960 know for a long time suppressing
00:36:04.800 ovulation will have um a slightly older
00:36:08.920 age of menopause had they not done that
00:36:11.400 when you say slightly older what’s the
00:36:13.079 longest extension of of the best I could
00:36:15.640 see in the data was maybe nine months
00:36:18.720 okay from nine months use ofth control
00:36:21.640 so so maybe like 5 to 10 year use I have
00:36:24.079 to look at the data again to be you know
00:36:26.240 I’d have to look that one up but it was
00:36:27.839 years got it um to to gain an extra
00:36:31.839 maybe N9 months maybe a year of ovarian
00:36:35.000 life I see and um nowadays uh at least
00:36:38.839 if people have the means there’s some um
00:36:42.400 Trend if you will toward um freezing
00:36:45.720 one’s eggs um this might be a good
00:36:47.599 opportunity to just State something that
00:36:49.160 came up before when we had Dr Natalie
00:36:51.280 Crawford on the podcast to talk about
00:36:53.119 female fertility um I think surprising
00:36:56.680 to many people
00:36:58.640 was her statement that not because it’s
00:37:01.839 controversial but because we just don’t
00:37:03.359 hear this often enough that harvesting
00:37:06.839 eggs for freezing or for IVF does not
00:37:10.960 diminish the pool of eggs that one would
00:37:14.319 have meaning you’re losing them each
00:37:16.400 month right anyway yeah and so they’re
00:37:19.319 only pulling out I don’t know 10 12
00:37:21.720 maybe in a cycle and when you’re losing
00:37:24.640 11,000 with an ovulation so it really
00:37:26.760 isn’t going to to effect when you go
00:37:29.480 through menopause such a crucial thing
00:37:31.760 for people to hear um I think uh there
00:37:34.119 were a number of comments when we posted
00:37:35.640 that clip on social media of people uh
00:37:38.200 women saying wow I didn’t realize that
00:37:41.960 harvesting eggs would not um somehow uh
00:37:46.000 shift the onset of menopause earlier and
00:37:48.800 so for the record we are not saying that
00:37:50.520 we’re saying that um it does not and um
00:37:53.240 and very interesting that the use of of
00:37:55.079 birth control but I’m guessing only
00:37:57.520 forms of birth control that suppress
00:37:59.119 ovulation can delay the onset of per
00:38:01.960 menopause menopause by about 9 months
00:38:04.359 maximum maximum um so things like the
00:38:06.240 copper IUD that right which um prevent
00:38:09.760 pregnancy by creating a unfavorable
00:38:11.920 environment for the sperm rather than
00:38:13.480 disrupting ovulation in any way will not
00:38:15.720 presumably extend par menopause
00:38:17.560 menopause okay just want to make sure
00:38:18.960 we’re crystal clear for people you’re
00:38:20.680 being very clear but I I want to make
00:38:22.119 sure that I’m clear on it and then
00:38:23.200 reiterate because this can be um uh kind
00:38:26.400 of tricky territory I think there are a
00:38:28.400 lot of assumptions about this stuff and
00:38:30.000 there’s a lot of lore out there what why
00:38:31.800 do you think that is is that because of
00:38:33.079 the lack of solid research and
00:38:34.520 communication in this area I think so or
00:38:36.800 or is it something else you know I I I
00:38:39.119 think these are um tricky topics for for
00:38:43.119 uh discussion often because we hear all
00:38:45.880 this stuff like birth control pills
00:38:47.960 disrupt one’s ability to get pregnant
00:38:49.319 when they come off or where it we just
00:38:51.319 learn that it can delay the onset of per
00:38:53.560 menopause which by extension means
00:38:55.440 there’s a greater window for pregnancy
00:38:57.040 if one
00:38:58.079 um thinks about it that way but uh why
00:39:00.359 do you think it’s it’s so um such a
00:39:03.640 tangled discussion out there I think
00:39:06.280 just the way that Society views
00:39:10.560 pregnancy and female health and you know
00:39:15.480 at least you know I live on the internet
00:39:17.160 now you know this new life has brought
00:39:19.000 me life on the internet and this what
00:39:21.119 the algorithms are showing me yeah it’s
00:39:23.359 a very friendly everyone is super
00:39:25.720 everyone loves you it’s a listen it’s
00:39:28.359 what you’re doing um is so important and
00:39:32.400 uh I understand the the statement behind
00:39:34.599 that statement I I think um but it’s so
00:39:37.839 important because it people are getting
00:39:39.760 the opportunity to learn about really
00:39:41.400 critical public health and female health
00:39:43.720 issues um in a way that just was
00:39:46.040 inaccessible before yeah it is and I I
00:39:49.800 it’s good and bad you know there’s a lot
00:39:51.640 of lore and misinformation that’s
00:39:53.760 getting propagated and I feel like as a
00:39:55.839 specialty you know as a women’s health
00:39:57.359 specialist we did this to ourselves you
00:39:59.160 know we have
00:40:00.800 not properly educated ourselves we have
00:40:03.920 not spent the money the research really
00:40:06.280 you know championed women after
00:40:07.760 reproduction when you look at the
00:40:09.359 dollars and and the research and where
00:40:12.160 it goes in women’s health I mean Women’s
00:40:13.760 Health just gets a little sliver of all
00:40:15.359 the NIH funding when you look at all NIH
00:40:17.680 funding and what goes to menopause it’s
00:40:20.520 0.003% unb less than half a percent this
00:40:23.079 is onethird of a woman’s life and when
00:40:25.839 you look at McKenzie and Company just
00:40:28.800 just published um a report where they
00:40:32.440 pulled 680 studies on like chronic
00:40:34.720 diseases diabetes hypertension
00:40:36.160 cardiovascular disease and they looked
00:40:38.240 at how they had they were women included
00:40:40.960 in the studies but how many presented
00:40:42.880 the data for the different Sexes like
00:40:45.560 what happened to men versus what
00:40:46.560 happened to women it was only 50% of the
00:40:49.200 Articles actually did Sex specific
00:40:51.160 differences and how this medication
00:40:52.680 affected this process or whatever and
00:40:54.720 then the ones that did 30% of women had
00:40:57.359 poorer outcomes and and the other and on
00:40:59.920 the flip side 10% of men had poorer
00:41:01.880 outcomes and these things aren’t just
00:41:03.640 being brought to light so the the lack
00:41:06.200 of recognition of sex specific
00:41:08.800 differences in chronic disease and how
00:41:10.440 menopause kind of plays into all that I
00:41:13.160 think is where the future needs to go so
00:41:16.000 we deserve as much good health as
00:41:17.760 everyone else because yes we’re living
00:41:19.640 longer than men but 20 to 25% of that
00:41:22.359 life is in poor
00:41:23.640 health wow that’s a a really significant
00:41:26.560 statement I mean I think think that the
00:41:28.280 National Institutes of Health has been
00:41:29.920 terrific in establishing new institutes
00:41:32.920 within it um they even have a
00:41:34.839 complimentary Health Institute now
00:41:37.000 there’s the the national eye institute
00:41:39.160 there’s you know cancer here um is there
00:41:42.839 a plan or one would hope for a dedicated
00:41:46.319 Institute for Women’s Health there push
00:41:49.119 um so there was one piece of legislation
00:41:52.000 that got pushed through the Biden signed
00:41:54.000 it and it was a $100 million for Women’s
00:41:56.760 Health and that that got chopped up very
00:41:58.520 quickly and menopause did get a little
00:41:59.960 piece of it because we’re also really
00:42:02.119 struggling with endometriosis and you
00:42:04.800 know a lot of the female specific
00:42:06.319 uterine diseases and and PCOS and things
00:42:08.960 and so we need more funding there as
00:42:10.880 well um and then there’s another bill
00:42:14.200 that just got that’s the one hi Berry
00:42:15.839 was like um on TV talking about another
00:42:18.800 bill for $250 million that bill includes
00:42:21.760 language for education of providers so
00:42:25.040 we have a whole generation of providers
00:42:27.200 ERS like I graduated my residency
00:42:30.079 training the year of the Whi came out so
00:42:33.720 all we had very little like real
00:42:35.800 clinically significant menopause
00:42:37.520 education and then we knew about HRT and
00:42:39.960 we were giving it in clinic um if she
00:42:42.359 was coming in with severe hot flashes
00:42:44.599 but that got taken off the table after
00:42:46.599 the Whi and then we have a whole gener
00:42:48.599 like all menopause education basically
00:42:50.119 stopped after so Whi Women’s Health
00:42:52.720 Initiative HRT no that’s that’s okay
00:42:55.040 just so that people are on board hormone
00:42:56.680 replacement therapy
00:42:58.960 um yeah it’s um it’s a Well we can
00:43:03.839 encourage the uh expansion of of uh
00:43:06.440 research in these areas and with this
00:43:08.480 discussion and um certainly uh I was on
00:43:11.240 NH panels for years um as a regular
00:43:13.800 member in the I institute and what I’ve
00:43:15.800 noticed with um NIH is that they are
00:43:18.760 very responsive uh to the public call
00:43:22.160 for growth of research in particular
00:43:24.319 areas you know it can take time it’s
00:43:26.559 government after all and they need
00:43:28.079 funding there’s a finite amount of
00:43:29.400 funding but but I think that um R rarely
00:43:32.240 do I ever get into legislature based
00:43:34.200 things but if you are somebody who cares
00:43:35.880 about um more funding in a given area of
00:43:38.040 research it’s actually very
00:43:39.280 straightforward what to do you call your
00:43:41.240 Congressman or Senator and you tell them
00:43:44.520 literally you leave a message I find
00:43:46.000 this kind of interesting it’s so it’s
00:43:47.680 kind of like what we learned in um
00:43:49.240 social studies and uh in elementary
00:43:52.960 school but you call your you call your
00:43:55.720 um Senator or your governor and you
00:43:57.520 leave a message and you say Hey you know
00:44:00.240 there’s this issue that impacts a ton of
00:44:02.119 people and it’s really important and um
00:44:04.400 the next time it comes up uh when
00:44:06.880 budgeting uh comes up in Washington it’s
00:44:10.280 really important and if you hear about a
00:44:11.920 bill you can call and support a bill and
00:44:13.880 believe it or not some of that stuff
00:44:15.280 actually translates to more funding in a
00:44:17.599 given area in fact that the brain
00:44:19.359 initiative which unfortunately had its
00:44:21.520 budget cut significantly recently maybe
00:44:24.280 put that funding back um but you know
00:44:27.280 arose from the um I believe it was the
00:44:29.520 child of two Neuroscience professors up
00:44:32.559 at University of Wisconsin I’m probably
00:44:34.160 going to get some details wrong but um
00:44:36.119 so the khil are the are the professors
00:44:38.760 as I recall and their son over Hood all
00:44:40.720 these conversations growing up about the
00:44:42.119 importance of brain science and then
00:44:43.720 eventually pushed through government
00:44:45.960 channels for more money for brain
00:44:47.720 research and then we had a a long phase
00:44:49.680 of of um pretty pretty substantial
00:44:51.760 research and then it was cut so these
00:44:53.079 things um but it persists and so these
00:44:55.319 things really matter can impact so and
00:44:57.839 maybe we should send them a clip of of
00:44:59.359 your statements on this podcast getting
00:45:01.440 back to um kind of things that people
00:45:04.040 can control so for people who are
00:45:05.839 heading into per menopause or who are in
00:45:08.480 the perimenopause phase um aside from
00:45:11.240 the the typical things that we hear
00:45:12.880 about fortunately a lot these days like
00:45:15.040 getting adequate sleep um getting
00:45:17.280 exercise um nutrition maybe we could
00:45:19.599 touch a little bit on nutrition in a
00:45:20.839 moment you mentioned Mediterranean diet
00:45:22.640 Galviston diet um things that are going
00:45:25.119 to promote overall health right um are
00:45:28.000 there any things that people can do
00:45:30.720 maybe even take that would improve uh
00:45:33.760 their outcomes in this phase like I I’ve
00:45:35.599 heard of people and I have no bias here
00:45:37.440 or even knowledge of the research on
00:45:38.800 this if there is any of people taking
00:45:40.359 for instance grape seed extract or
00:45:42.480 people trying to do a number of things
00:45:44.280 to reduce inflammation kind of General
00:45:46.200 themes around um self-care and wellness
00:45:48.960 these days but what are sort of the five
00:45:51.319 or six that come to mind um perhaps as
00:45:53.720 like the things that can move the levers
00:45:55.680 in the right direction what would tell
00:45:57.640 my 35-year-old self you know who just
00:45:59.839 kind of went into this obliviously and
00:46:02.160 what I know now
00:46:04.040 is your diet is probably one of the most
00:46:07.760 important things that determines your
00:46:09.319 level of inflammation and then estrogen
00:46:11.480 is a really powerful anti-inflammatory
00:46:13.559 hormone and we lose that protection when
00:46:15.880 we go through we start losing it through
00:46:17.119 the transition so whatever you can do in
00:46:19.520 the other areas especially with
00:46:21.160 nutrition sleep stress reduction we need
00:46:23.920 to do it so fiber we are not getting
00:46:26.440 enough fiber in our diet in the western
00:46:28.040 diet I think it’s most women are getting
00:46:29.599 10 to 12 grams per day and we need at
00:46:31.599 least 25 and the health benefits tend to
00:46:33.599 max out around 30 32 grams per day so
00:46:37.040 focusing on foods that are rich in fiber
00:46:39.000 Fiers is feeding the gut microbiome
00:46:40.520 slowing down glucose absorption you know
00:46:42.319 glucose levels of sugar absorption into
00:46:44.480 the bloodstream it is slowing down the
00:46:46.760 rate you know certain parts of Transit
00:46:49.160 and pulling more water into the gut like
00:46:50.880 there’s nothing bad about it
00:46:52.480 right the foods that are rich in fiber
00:46:54.960 have a lot of other stuff that’s good
00:46:56.119 for you too co-actors vitamins minerals
00:46:58.319 nutrient you know just they’re just so
00:47:00.200 healthful um and then ansans you know
00:47:03.480 just find things that crunch that are
00:47:05.040 and get as many colors as you can you
00:47:06.760 know green red purple yellow every color
00:47:08.640 represents a phytochemical that is going
00:47:10.920 to be good for you in different areas of
00:47:12.839 your body and try to keep it as varied
00:47:14.520 as possible um we’re not getting enough
00:47:17.079 protein and I have to thank Dr Gabrielle
00:47:19.079 lion you know really helping me focus
00:47:21.000 and on that you know when I first wrote
00:47:23.440 galison diet to be honest and
00:47:25.480 transparent it was for weight loss and
00:47:27.960 you know I was frustrated with my weight
00:47:29.520 gain and I that was the pain point my
00:47:31.359 patients had and that was my pain point
00:47:33.160 but I didn’t realize it represented
00:47:34.559 something much more Sinister than than
00:47:36.640 just the way I looked you know the
00:47:38.119 visceral fat gain and so uh learning
00:47:40.920 about visceral fat and what it really
00:47:42.280 means and that is for your listeners the
00:47:44.119 fat that wraps around our internal
00:47:45.640 organs it’s a very different fat than
00:47:47.319 the subcutaneous fat and you know a
00:47:49.839 premenopausal woman so we age matched
00:47:51.800 and looked at visceral fat levels
00:47:53.319 measuring it with the uh um dexus
00:47:56.520 scanner
00:47:57.839 you have about 8% of your fat as
00:47:59.920 visceral as a premenopausal person and
00:48:02.079 then when you go through the transition
00:48:03.359 it’s 23% wow with no changes in diet and
00:48:06.680 exercise the visceral fat is not
00:48:08.960 something that gets enough attention I
00:48:10.480 think everyone thinks about subcutaneous
00:48:12.000 fat because it’s relation cosmetically
00:48:13.839 distressing but really yeah um and one
00:48:17.280 doesn’t want too much of it for health
00:48:18.760 reasons e either but the it’s the um
00:48:21.079 intval fat that at least by my
00:48:23.880 understanding is is really uh the most
00:48:25.839 problematic for for for our health it’s
00:48:27.880 a harbinger of of chronic disease so I
00:48:31.559 read that weight gain is one of the
00:48:35.000 primary symptoms of menopause itself
00:48:37.520 yeah so it’s you have to be careful how
00:48:39.200 you think about that when we when we
00:48:41.119 plot weight gain versus age it’s a very
00:48:43.680 straightforward linear curve and
00:48:45.640 menopause does not seem to affect that
00:48:47.599 what is happening is a body composition
00:48:49.680 change we are losing muscle and we are
00:48:53.280 gaining visceral fat and so and you
00:48:56.240 might be gaining some subcutaneous fat
00:48:58.200 but those are kind of the key things
00:49:00.520 that are happening and so that’s really
00:49:02.920 when I’m counseling patients what I’m
00:49:04.319 focusing on because I have a body
00:49:05.680 scanner in my office where I can tell
00:49:07.160 them what their level of visceral fat is
00:49:08.480 in their muscle mass and so we bone and
00:49:11.359 muscle that muscular skeletal unit works
00:49:13.599 together and so we see this acceleration
00:49:16.400 of muscle loss which controls our basal
00:49:18.400 metabolic rate which determines our
00:49:20.160 resistance to insulin which you know so
00:49:22.960 it’s just that’s the the organ of
00:49:25.200 longevity that’s what I I’ve learned
00:49:27.079 from Dr lion you know and everything we
00:49:29.680 can do to hang on to it and build is so
00:49:32.839 important so protein going back to the
00:49:34.520 original Point protein intake is key and
00:49:37.559 women by and large are getting 50 to 60
00:49:40.200 grams of protein per day and we really
00:49:42.960 probably need 80 100 120 depending on
00:49:45.240 our body composition yeah thanks for
00:49:47.240 mentioning Dr Gabrielle L she’s doing
00:49:49.720 what I view world yeah terrific work
00:49:52.480 really promoting Women’s Health and
00:49:54.880 health generally I know she’s now I
00:49:57.240 believe is exploring um Advanced
00:49:59.280 Training in uh in urology for males as
00:50:02.839 well and um so you know it’s um it’s
00:50:06.760 it’s only fair to to credit her with
00:50:08.599 with really expanding into these
00:50:10.400 different areas but especially this idea
00:50:14.200 that we need and women perhaps in
00:50:17.160 particular from what I understand um
00:50:19.359 she’ll be on the podcast soon so we’ll
00:50:20.680 get more of a of an understanding at
00:50:23.119 least one gram of quality protein per
00:50:25.319 pound of lean body mass maybe even per
00:50:27.640 pound of body weight per day in order to
00:50:29.480 optimize their their health yeah she’s
00:50:31.880 she’s definitely on the higher end you
00:50:33.880 know the Whi the Women’s Health
00:50:35.440 Initiative some of the my favorite data
00:50:37.520 you know it’s not all bad it’s data and
00:50:40.319 was looking at Frailty scores and
00:50:42.480 protein intake in women and what they
00:50:44.440 found was women who were having 1.5 to
00:50:47.799 1.7 so basically it was the higher their
00:50:50.240 protein intake the less likely they were
00:50:52.240 to be frail the end and it was you know
00:50:55.960 they were reaching that was kind of
00:50:57.200 peeking out somewhere around 1.5 to 1.7
00:51:00.119 gram per kilogram of lean body mass and
00:51:03.599 most women are getting around you know
00:51:04.920 the FDA recommends
00:51:06.480 08 wow and source of protein also
00:51:10.000 important high quality right right you
00:51:11.760 need all the amino acids yeah very
00:51:13.520 interesting um now that’s in menopause
00:51:17.640 but presumably also so starting those
00:51:20.280 habits in Perry just getting that laid
00:51:23.200 down and getting those habits laid down
00:51:25.119 are going to set you up for a much
00:51:26.799 better post-menopause a much healthier
00:51:28.760 postmenopause and we have to stop
00:51:31.160 defining menopause by your hot flashes
00:51:33.319 you know it may or may not make your hot
00:51:35.040 flashes better and we have great
00:51:36.520 medications for that if it’s disruptive
00:51:38.839 but I’m talking about your your
00:51:40.559 cardiometabolic disease risk I meant to
00:51:43.480 ask this earlier so forgive me for for
00:51:45.640 leaping back briefly but is there any
00:51:48.040 value in knowing the age at which your
00:51:50.359 mother went into menopause as a metric
00:51:53.799 or a sensor rather uh for or a as a
00:51:57.079 window into whether or not you will go
00:51:59.319 into menopause at more or less the same
00:52:01.200 age yes there is a of course it’s not
00:52:04.000 one to one we get half of our DNA from
00:52:05.640 our fathers so but I always ask and
00:52:09.119 there’s a you know the latest data that
00:52:11.920 looked at it genetics is the biggest
00:52:13.839 factor that determines when you’re going
00:52:15.760 to go through menopause so knowing when
00:52:18.280 your mothers your aunts you know went
00:52:20.319 through and if there were any medical
00:52:22.119 conditions associated with that is huge
00:52:25.480 okay so now we’re talking not so much
00:52:27.400 about perimenopause but also menopause
00:52:30.160 itself what is the typical constellation
00:52:32.680 of symptoms as one enters menopause like
00:52:36.760 right at the beginning and then does
00:52:38.480 that constellation of symptoms change as
00:52:40.520 one is you know a year two years three
00:52:42.599 years into menopause so it’s almost 100%
00:52:44.720 with body composition changes like very
00:52:46.839 very close you know that visceral fat is
00:52:49.880 tough to beat it’s beatable but it takes
00:52:52.160 a lot of work you know do people know if
00:52:54.240 they have visceral fat I mean there’s
00:52:55.599 their scanning approach
00:52:57.640 gold you know of course the gold
00:52:58.880 standard is a DEA or even an MRI but no
00:53:01.960 one can afford that so we have in like
00:53:04.400 what I have um in my office is the
00:53:06.400 inbody scanner so it’s electrical
00:53:07.920 impedance scanner and it’s it’s pretty
00:53:09.520 good so you stand on the scale hold the
00:53:11.280 hand I have a medical I have the highest
00:53:12.880 grade one for my patients um and most
00:53:15.040 people doing what I do you know
00:53:17.040 utilizing a body scanner use that one um
00:53:19.839 but you can use the waist tip ratio and
00:53:22.720 so the waist tip ratio is a better
00:53:24.839 measure of your risk of metabolic Health
00:53:27.520 than your weight or your BMI so it’s so
00:53:30.160 simple you take a tape measure and a
00:53:31.559 calculator you can do it in your head
00:53:32.920 but you measure the smallest part of
00:53:34.640 your waist and if you don’t have a small
00:53:36.200 waist if it goes out then just use your
00:53:37.640 belly button just use something you can
00:53:39.280 measure again are people sucking in or
00:53:41.200 are they relaxed you should be relaxed
00:53:42.839 and I tell my patients you know do it
00:53:44.799 first thing in the morning when your
00:53:45.680 bladder’s empty and you’re not bloated
00:53:47.079 and you know um and then the widest part
00:53:49.680 of your hips it’s not perfect but it’s
00:53:51.720 better than your weight or your BMI so
00:53:54.000 widest part of the hips with people feet
00:53:55.799 feet
00:53:59.040 people are going this and so um I only
00:54:02.000 know the data for women so forgive me
00:54:03.559 but um for a female if it’s less than
00:54:08.319 0.7 then your chance of having
00:54:10.799 clinically significant aberration in
00:54:13.240 visceral fat are low and then if it’s
00:54:16.079 greater than one you likely have higher
00:54:19.680 levels of visceral fat and so in clinic
00:54:22.760 or when I was coaching online for
00:54:24.359 galison diet we were using the waste
00:54:26.599 ratio as one of the you know measures
00:54:28.839 for their success when measuring the
00:54:31.119 waist um which point along the waist is
00:54:33.839 it right at Naval is it it’s just
00:54:36.119 wherever your smallest so that’s kind of
00:54:38.160 different for different women so I would
00:54:40.079 just say look in the mirror wherever
00:54:41.280 your hourglass goes in is where you want
00:54:43.040 to kind of stick to but if you don’t
00:54:45.400 have that kind of a waist and you have a
00:54:46.880 wider waist just pick the belly button
00:54:48.559 because you always know you can go back
00:54:49.839 to that level you know that’s because
00:54:51.920 we’re tracking them over time great
00:54:54.520 those are um very useful um
00:54:57.400 recommendations and how often should
00:54:59.200 people do that I you know you should
00:55:01.720 never weigh yourself every day you
00:55:02.680 shouldn’t do this every day we were
00:55:03.720 having patients do it or you know our
00:55:05.160 followers do it once a month so changes
00:55:08.200 in body composition as measured by dexa
00:55:11.240 or impedance or you don’t have access
00:55:13.599 that waste of hip ratio uh what are some
00:55:16.240 of the other symptoms of menopause
00:55:18.119 fatigue multiple causes for the fatigue
00:55:20.240 um a lot of sleep disruption um sleep
00:55:22.440 disruption is another huge thing so all
00:55:25.400 of a sudden you’re struggling to go to
00:55:26.920 sleep or you’re having middle of the
00:55:28.559 night Awakenings and not able to go back
00:55:30.480 to bed that are new and different from
00:55:33.160 prev new and different than before right
00:55:35.119 I see there was a recent study that came
00:55:37.559 out and most of my patients in hindsight
00:55:40.400 say I knew something wasn’t right or
00:55:43.440 something was different something had
00:55:44.680 changed but I couldn’t put my finger on
00:55:46.240 it and they just had a study come out
00:55:48.000 saying something’s then when they looked
00:55:50.520 at what that means what does I’m not
00:55:52.200 feeling like myself mean and it was
00:55:55.000 psychological changes so you lose
00:55:57.200 resilience you’re suddenly more
00:55:58.400 irritable you’re suddenly not able to
00:56:00.039 like go with the punches or or do you
00:56:02.839 know you’re you’re not adjusting as well
00:56:04.480 to change that you used to you’re
00:56:06.079 snapping at your kids more your partner
00:56:08.200 you’re you know you’re you’re getting
00:56:10.119 frustrated at work you know it’s just
00:56:12.000 very kind of subtle and it takes going
00:56:14.720 through it and then looking back to say
00:56:16.480 yeah I really say may maybe about 47
00:56:18.559 that something was changing and I just
00:56:20.640 thought I was just stressed out or
00:56:22.000 whatever and then now I can see that was
00:56:23.640 the beginning of the pattern so
00:56:26.480 menstrual changes as we talked about um
00:56:29.640 you know the big highlights
00:56:31.680 vertigo tenus ringing in the ears um
00:56:36.079 skin changes so dry skin itchy skin
00:56:38.400 feeling like you’re having crawling
00:56:39.880 Under the Skin big gut changes so Nuance
00:56:42.760 set bloating you’re kind of eating all
00:56:44.160 the same things and your guts just not
00:56:45.760 handling things like it used to so the
00:56:47.799 Zoe nutrition study took 1100 women and
00:56:50.920 and did stool samples through menopause
00:56:53.160 through the per menopause menopause
00:56:54.599 transition and saw the changes in the
00:56:57.119 gut microbiome from the loss of the sex
00:56:59.480 hormones and basically we went from what
00:57:01.920 a typical female microbiome to that of a
00:57:04.760 male through the
00:57:06.880 transition is there any direct evidence
00:57:10.280 that um supplementing the gut microbiome
00:57:13.480 and here I don’t necessarily mean pills
00:57:15.119 and powders I mean um my understanding
00:57:17.480 is that getting enough fiber and low
00:57:20.599 sugar fermented foods can also support
00:57:22.760 the gut microbiome things like um
00:57:24.960 sauerkraut kimchi miso miso um plain
00:57:29.039 yogurt just straight up nothing added
00:57:31.640 yeah so is there evidence that
00:57:32.920 supporting the gut microbiome can um
00:57:35.119 make this uh stage of menopause more I
00:57:38.880 guess um reduce some of the symptoms of
00:57:41.079 of menopause so the best I could find
00:57:43.440 was most of them are are done with
00:57:45.440 supplements because those are easier to
00:57:46.720 measure than handing someone a cup of
00:57:48.160 yogurt right and you know which bacteria
00:57:49.760 you’re providing so um they did
00:57:52.920 lactobacillus and looked and bifido
00:57:55.520 bacterium I think and saw that women who
00:57:57.799 were obese and hypertensive in
00:57:59.280 menopausal and they had visceral fat
00:58:01.799 decrease and blood pressure improvements
00:58:03.640 versus placebo um also it’s hard to do
00:58:06.240 Placebo studies with food you know so
00:58:08.480 right um but they do and then in the
00:58:10.599 retrospective studies they can look at
00:58:11.920 dietary patterns and women who ate rich
00:58:15.200 foods fermented and lots of yogurt you
00:58:17.480 know Mediterranean type diets um have
00:58:20.359 better symptoms overall what’s the
00:58:22.760 difference between the Mediterranean
00:58:24.520 diet and the Galviston diet so so um
00:58:27.359 when I so I got my culinary medicine
00:58:30.319 certification I was culinary medicine
00:58:33.160 yeah so I was frustrated in when I was
00:58:36.319 working because I didn’t know anything
00:58:37.880 about nutrition and suddenly like
00:58:39.599 everything I was trying to tell my
00:58:40.920 patients was based on like the one
00:58:42.400 lecture I got in medical school and you
00:58:44.799 know good nutrition was like porn you
00:58:46.520 know it when you see it you know the
00:58:47.720 Supreme Court definition of pornography
00:58:49.280 and so you know the best I’d ever gotten
00:58:51.920 was the gational diabetic diet and it
00:58:54.000 was this Xerox things with you know was
00:58:56.280 in the Deep I was in Texas so it had
00:58:57.720 like tortillas and stuff on it and and
00:59:00.000 it had been copied so many times you
00:59:01.319 could barely read it anymore and that
00:59:02.799 was the diet we would that was the only
00:59:04.280 nutrition I’d ever like handed to a
00:59:05.920 patient and so I’m like eat healthy and
00:59:08.559 so I’m like I got to do better than this
00:59:09.839 I don’t know enough and so we had a
00:59:12.160 guest speaker for a Alpha Omega Alpha
00:59:13.920 which is the Honor Society for medical
00:59:15.200 school and I was one of the advisers so
00:59:17.039 and it was this guy Tim Harland who had
00:59:20.119 started this culinary medicine movement
00:59:22.680 and it was basically nutrition for
00:59:24.240 doctors and he velop this like online
00:59:27.160 program and I had to go to New Orleans
00:59:28.640 for a lab and San Antonio for a lab and
00:59:30.319 work in kitchens where you were learning
00:59:31.960 how to counsel patients how to cook and
00:59:33.839 also basically like getting a little
00:59:35.920 minor in nutrition um so it was the best
00:59:39.680 thing I’ve ever done say very cool I
00:59:41.440 mean I learned about allergies and like
00:59:43.119 all this stuff you know food allergies
00:59:44.520 and things that I just didn’t know and
00:59:45.640 just basic nutritional principles like
00:59:47.760 what it takes to build a healthy body
00:59:49.200 and and what you know I knew about
00:59:50.440 quashi oror and like severe deficiencies
00:59:52.359 but not good basic nutrition and so you
00:59:55.480 know they talked heavily about
00:59:56.599 Mediterranean they talked a lot about
00:59:58.000 the fat diets and stuff but you know the
01:00:00.359 principles of the Mediterranean I was
01:00:01.599 like I want to teach this to my patients
01:00:03.640 but they’re not going to eat a lot of um
01:00:06.480 Greek yogurt or they’re probably not
01:00:07.920 going to eat a lot of feta you know like
01:00:09.640 how can I kind of take these blocks and
01:00:11.359 make it more Americanized that was kind
01:00:13.039 of like the brain child for me around
01:00:14.480 galison diet was let me like create
01:00:17.079 something and I really was into fasting
01:00:18.760 at the time too so I was like let me put
01:00:20.240 this fasting thing together with you
01:00:22.760 know good nutritional anti-inflammatory
01:00:24.760 principles and talk about the things we
01:00:26.160 know were probably you should you know
01:00:27.720 not having a whole lot of you know
01:00:29.359 processed foods and high sugars and
01:00:30.920 stuff and and explaining in a way and
01:00:32.640 how it’s affecting their menopause and
01:00:33.960 like how can she approach her nutrition
01:00:35.359 and that’s how Gallison diet was born it
01:00:37.000 was for my patients and then I gave it
01:00:38.960 to my girlfriends and then they started
01:00:40.920 sharing it and I talked about it one day
01:00:42.280 on Facebook and the world exploded in
01:00:44.160 the best way in the best way yeah it l
01:00:46.440 me here right so right um and we all
01:00:49.240 benefit what is the evidence that
01:00:52.880 fasting can be beneficial or detrimental
01:00:55.319 to um per menopause menopause so the
01:00:58.839 jury’s kind of still out on that one I
01:01:00.480 was re really liked the data that you
01:01:03.160 know uh I think it was Mark Matson had
01:01:05.960 done on neurodegenerative disease and
01:01:08.160 and using fasting as a tool there and
01:01:10.240 lowering inflammation levels so I was
01:01:11.680 like this is amazing this is great
01:01:13.079 because so much about menopause is
01:01:16.039 pro-inflammatory you know is this
01:01:17.760 intermittent fasting so timri he was
01:01:20.400 basically doing 168 you know and uh you
01:01:23.359 know very scheduled intermittent fasting
01:01:25.400 and so that was something I was coaching
01:01:27.760 my followers about you know consider
01:01:29.520 this try this this would might be
01:01:31.000 something to help lower inflammation I
01:01:33.079 pulled back on that because it’s really
01:01:35.160 hard to get enough protein in for a lot
01:01:37.280 of of women especially if they came in
01:01:39.559 at 60 and now I’m telling them to double
01:01:41.359 their protein you know and then giving
01:01:43.240 them an eight hour window to do it
01:01:44.559 they’re like I’m walking around n on a
01:01:45.920 chicken breast all day you know this is
01:01:48.000 hard right and metabolizing protein is
01:01:50.280 its own work right and so you have to
01:01:52.440 spread it out throughout the day you
01:01:54.160 know and a lot of that work was done at
01:01:55.880 UTMB where I did my underground I mean
01:01:58.319 my residency and where I taught for
01:01:59.720 years and so I was friendly with the
01:02:01.279 Nutrition department there I was getting
01:02:02.520 all excited about everything and they’re
01:02:04.440 like you know I went to several of their
01:02:06.480 conferences and like talking about
01:02:08.200 breaking up protein intake into nuggets
01:02:10.839 throughout the day because most women
01:02:12.200 have very little protein with breakfast
01:02:13.920 maybe weak gluten in their toast and
01:02:16.839 then have a little bit at lunch and then
01:02:18.520 kind of Stack their protein at night and
01:02:19.880 they’re still not getting enough but
01:02:21.359 they’re overdoing it in their evening
01:02:22.839 meal that’s their big protein meal and
01:02:25.000 so like teaching them to kind of you
01:02:27.400 know what I was teaching in galison diet
01:02:28.880 was you need to have a healthy fat a
01:02:31.240 good healthy carb and a protein with
01:02:33.279 every meal in snack that you eat you
01:02:35.000 know why do you think that protein has
01:02:38.400 not been
01:02:39.559 emphasized um enough until recently I
01:02:42.680 think because we didn’t understand it
01:02:45.559 you know we didn’t understand how
01:02:46.760 important muscle was and I mean we knew
01:02:49.480 that protein intake was important for
01:02:51.200 muscle but muscle was for bodybuilders
01:02:53.039 and not for women I lived my whole whole
01:02:56.079 life up until about 5 years ago eating
01:02:58.640 to be thin and moving to be thin that
01:03:01.480 thin was the only measurement of Health
01:03:03.039 that I needed to worry about and what I
01:03:04.960 did was chip away at my bone and muscle
01:03:06.520 strength and thank God I don’t have
01:03:07.960 osteopenia yet you know i’ I’ve
01:03:10.200 hopefully have reversed whatever Trend I
01:03:11.920 was on and I’m naturally low muscle so
01:03:14.680 now it’s just a battle to try to hang on
01:03:17.079 to what little I have and build some
01:03:19.799 resistance train yeah yeah yeah yeah now
01:03:23.160 three days a three days a week three to
01:03:24.680 four days a week yeah resistance
01:03:26.160 training much less cardio I was running
01:03:28.000 marathons I and it was a great social
01:03:29.880 thing with my girlfriends but you know
01:03:31.640 everything I did was cardio I taught
01:03:34.119 step aerobics you know the only weights
01:03:35.960 I did were maybe in Zumba maybe one or
01:03:37.680 two pounds you know so and that was
01:03:40.200 great better than being on the couch I
01:03:41.359 mean I loved the community and doing
01:03:43.640 that but you know for me to like stay
01:03:45.839 out of the nursing home which was my
01:03:47.359 ultimate goal for as long as possible I
01:03:49.359 need to pick up some weights and heavy
01:03:50.640 weights so that’s where my focus has
01:03:52.559 changed isn’t it interesting that it
01:03:54.880 wasn’t until Rec Rec L that um it was
01:03:57.640 only bodybuilders and football players
01:03:59.760 and people preparing for military or
01:04:01.319 specific sport would resistance train
01:04:03.960 and now we are told that everybody male
01:04:06.760 female young old should resistance train
01:04:10.640 absolutely probably three times a week
01:04:12.599 yeah and the my generation is struggling
01:04:14.880 because we don’t know how to do it and
01:04:17.440 so I’m you know and I’m not a personal
01:04:19.279 trainer I don’t pretend you know I hire
01:04:21.119 one to help me develop a program so that
01:04:23.240 I don’t hurt myself and then I can get
01:04:25.279 stronger you know Progressive load so
01:04:28.000 you know and again Dr lion such a huge
01:04:30.240 proponent of that and so what I try to
01:04:32.760 do publicly is show my workouts so that
01:04:34.839 people I normalize it and people see me
01:04:36.920 doing it and they’re like well she can
01:04:38.079 do it then I can do it it’s great super
01:04:39.960 inspiring and it really helps uh cross
01:04:42.960 that threshold where people as you said
01:04:44.440 they don’t know how it’s scary right for
01:04:46.760 people who resistance trained for a long
01:04:48.240 time they go into a gym they they know
01:04:49.400 how all that stuff works but uh for
01:04:51.359 those that don’t it’s you’re wandering
01:04:52.680 around like what does this one do you
01:04:54.039 know intimidating for a whole bunch of
01:04:55.760 reasons well thank you for putting that
01:04:57.079 content out um both the uh prescription
01:05:00.760 if you will but also the example that
01:05:02.839 that one can go about it so I’m guessing
01:05:04.440 if you could go back 20 years you would
01:05:06.640 have started resistance training earlier
01:05:08.119 and eating more stronger skinning
01:05:09.760 nutrition over calories and and stop
01:05:12.760 looking trying to look a certain way you
01:05:14.520 know you’re you’re undermining your
01:05:16.760 future health by doing that I’d like to
01:05:19.400 take a quick break and acknowledge our
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01:05:37.000 impact your immediate and long-term
01:05:38.480 Health can only be analyzed from a
01:05:40.640 quality blood test now a major problem
01:05:43.000 with a lot of blood tests out there is
01:05:45.039 that you get information back about
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01:05:48.799 lipids and so forth but you don’t know
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01:06:31.240 some other symptoms of menopause you you
01:06:33.920 mentioned body composition changes the
01:06:36.240 one that we hear about the most for some
01:06:39.160 reason I don’t know is hot flashes yeah
01:06:40.960 so think hot flashes um so in medicine
01:06:44.279 we call it a Vaso motor symptom so we
01:06:46.599 have a a disregulation of the thermo
01:06:49.480 regulatory Center in the hypothalamus
01:06:51.839 and that that the the thermostat gets
01:06:54.599 reset basically and so what happens is
01:06:57.160 we have this vasal dilation of it starts
01:06:59.559 in the core typically for most women
01:07:01.279 somewhere in the chest neck area and you
01:07:03.720 feel this heat yeah I can probably
01:07:06.400 trigger one just by talking about it um
01:07:08.799 and it it goes up into the neck and out
01:07:10.960 into the extremities and then you just
01:07:12.440 start profusely sweating from all the
01:07:14.440 blood vessels dilating and then it can
01:07:16.480 last minutes to a second but for some
01:07:18.559 women it’s preceded by sometimes
01:07:21.319 palpitation sometimes by this intense
01:07:23.400 feeling of of dis Foria you know this
01:07:26.640 intense sadness feeling and then it and
01:07:28.839 then it just kind of passes but you know
01:07:30.720 say you’re you know wherever you are in
01:07:32.440 your life whatever you’re doing all of a
01:07:33.760 sudden you’re just like sweating
01:07:35.279 profusely in the middle of some
01:07:36.799 important area of your life work you
01:07:38.480 know whatever your jobs are in your life
01:07:40.680 and it’s disruptive if it happens at
01:07:42.920 night you don’t sleep and for some women
01:07:45.480 it’s severe where they’re having
01:07:46.839 multiple ones a day and when any time
01:07:49.599 you disrupt sleep Then daytime is far
01:07:51.559 worse regulation you yeah you stress
01:07:54.960 differently you you know everything
01:07:56.599 changes and so when my patients come in
01:07:59.119 the first questions we ask are sleep and
01:08:02.079 that’s the first thing we work on is is
01:08:03.880 you know what can we do to get your
01:08:05.559 sleep better what can be done for hot
01:08:07.880 flashes aside from the things that
01:08:09.440 you’ve already described to offset
01:08:11.200 menopause absolute goal standard is
01:08:13.680 hormone therapy is like giving your body
01:08:15.680 back the estrogen which will readjust
01:08:18.040 get your serotonin levels back to where
01:08:19.600 they were and leave that thermal
01:08:21.439 regulatory Center alone so it’s back to
01:08:23.198 where it used to be let’s talk about hor
01:08:25.759 therapy it’s a bit of a controversial
01:08:27.880 topic for no reason yeah I I was going
01:08:29.759 to say I don’t know why yeah it’s
01:08:31.640 demonized it it got such a bad rap and
01:08:34.120 we need to to it’s just some of the was
01:08:37.479 the worst misinformation campaign in the
01:08:39.319 history of medicine well that’s a bold
01:08:41.198 statement but I believe you the um the
01:08:45.198 way I understand it is that there was
01:08:47.198 this large scale hormone therapy trial
01:08:50.600 um and the interpretation of that
01:08:53.520 trial was something different than we
01:08:56.759 now believe um as a medical ini so it
01:09:01.080 was really groundbreaking at the time
01:09:03.080 aging women were finally being studied
01:09:04.759 we knew from observational data that
01:09:07.158 women on hormone therapy probably 40% of
01:09:09.198 the population of females eligible were
01:09:11.158 on HRT okay so very large amount so the
01:09:14.279 women who were given hormone therapy had
01:09:17.000 lower incidence of cardiovascular
01:09:18.839 disease older ages of cardiovascular
01:09:20.640 disease lower death from cardiovascular
01:09:22.640 disease some people argued that that was
01:09:24.719 an artifact of healthier wealthier women
01:09:27.359 get HRT because they go to the doctor
01:09:29.479 okay so this is just because they’re
01:09:31.040 healthier that they have less
01:09:32.198 cardiovascular disease so let’s prove it
01:09:34.880 what do you do that with a randomized
01:09:36.319 control trial so flaws in the study so
01:09:39.198 they take I think there were 11,000 is
01:09:41.839 women in the estrogen only arm because
01:09:43.920 they’d had hysterectomy so for your
01:09:45.920 listeners if you have a uterus and
01:09:48.080 you’re getting estrogen you must have a
01:09:50.359 progestogen with it to protect the
01:09:52.238 lining of the uterus from minimetro
01:09:53.679 cancer as long as you give an adequate
01:09:55.080 proest
01:09:55.840 you’re fine okay but if you don’t have a
01:09:58.719 uterus progesterone is not mandatory so
01:10:01.800 the women who had had hysterectomy got
01:10:03.400 estrogen only or Placebo and the
01:10:05.800 estrogen at the time was primin which
01:10:08.239 was the number one prescription for HRT
01:10:10.080 at the time so nothing weird about that
01:10:12.159 so it’s just um synthetic estrad
01:10:14.480 actually no uh primin is is primin
01:10:17.040 stands for pregnant mayor urine it is
01:10:19.000 actually very natural they take pregnant
01:10:21.840 horses and extract the estrogens from
01:10:24.000 their urine because they’re pregnant and
01:10:25.840 they were screeing a lot of it and it
01:10:27.120 was cheap and easy and I have a lot of
01:10:29.120 ethical issues about how they do that
01:10:30.760 but and I don’t prescribe it but that’s
01:10:32.520 what was done at the time so I I’ve seen
01:10:35.560 horses urinate they urinate a
01:10:39.320 lot there’s dozens of estrogens in that
01:10:43.040 comp but the main one is estrad so um
01:10:46.239 then there the other group who had
01:10:48.520 uteruses were given Prim Pro which is
01:10:50.679 primin plus
01:10:52.120 proa and or Placebo so off we go they
01:10:55.920 recruit 11,000 and then I think 15,000
01:10:58.280 in the other arm huge study it was like
01:11:00.239 a billion dollar study like we’re so
01:11:01.920 excited this is happening this started
01:11:03.360 when I was in med school and then they
01:11:05.760 start recruiting patients and then um
01:11:08.480 you know everyone’s taking their meds
01:11:10.159 they excluded women with hot
01:11:12.120 flashes what because if your hot flashes
01:11:16.360 go away you know that you didn’t get the
01:11:18.520 placebo ah so they excluded one with hot
01:11:21.320 flashes problem number one yeah that’s a
01:11:23.480 big problem this the end outcome the
01:11:26.159 what they were trying to measure was
01:11:27.199 cardiovascular disease so they started
01:11:28.880 with an older population the average age
01:11:31.120 was
01:11:32.080 63 whereas the typical onset of
01:11:34.560 menopause is 51 wow so these women had
01:11:38.199 been menopausal you know on average for
01:11:40.400 10 12 13 years so time away from
01:11:44.040 estrogen is when disease starts
01:11:45.679 accelerates right okay so put them on
01:11:49.320 their meds start measuring in the
01:11:51.400 estrogen plus progestin arm they saw
01:11:56.880 a non-statistically significant
01:11:58.639 increased risk of breast cancer and it
01:12:00.320 was this the relative risk relative now
01:12:02.800 you know what this is but your Mone your
01:12:04.360 listeners may not was 25% and and I hope
01:12:08.080 I get the numbers right it was four out
01:12:09.719 of a thousand women per year to five out
01:12:12.320 of a thousand women per
01:12:14.239 year okay so Placebo arm was four so we
01:12:17.400 have breasts we are females we get
01:12:18.880 breast cancer about four out of a th
01:12:20.880 women per year and that increased to
01:12:23.000 five and the estrogen only arm there was
01:12:26.040 a 30% decrease risk of of breast cancer
01:12:28.960 regardless of the of the average age and
01:12:31.800 they kept that arm going right because
01:12:33.280 it’s randomized so presumably the
01:12:34.880 average age for the other group is
01:12:36.960 roughly 61 as they were match so in
01:12:38.960 their 60s as well so they call a press
01:12:41.880 conference at the Watergate Hotel the
01:12:44.560 Watergate Hotel announce the
01:12:47.840 findings they hadn’t even published the
01:12:50.000 data yet no one had had a chance to read
01:12:52.199 it and these the head researchers called
01:12:55.239 this press conference and say estrogen
01:12:56.920 causes breast
01:12:58.280 cancer exogenous estrogen from these
01:13:01.239 yeah yes and they said it’s a 25%
01:13:03.679 increased risk but the absolute risk was
01:13:06.040 like 8% per
01:13:07.760 year but that didn’t get that that’s not
01:13:10.239 a headline thing so on every like ABC
01:13:12.280 NBC CBS all the morning shows Nightly
01:13:14.239 News every major magazine it was the
01:13:17.440 number one medical news story of 2002
01:13:19.560 that that estrogen was bad and it caused
01:13:21.880 cancer and da d da the estrogen only arm
01:13:24.400 kept going
01:13:26.560 and they found after a couple more years
01:13:28.360 a slightly increased risk of stroke so
01:13:30.120 they stopped the study the effects on
01:13:31.960 cardiovascular disease were neutral but
01:13:34.679 there was lower um colon cancer in both
01:13:37.239 groups but no one talked about that so
01:13:40.639 the American Heart Association in 2020
01:13:43.199 went and looked at they looked at ages
01:13:46.400 so there were younger women who were
01:13:47.719 given HRT and what they found was if you
01:13:49.560 started hormone therapy between the ages
01:13:51.719 of 50 to
01:13:53.000 59 you had a 50% decreased risk of
01:13:55.920 cardiovascular disease and death from
01:13:57.280 cardiovascular disease and all cause
01:13:58.880 mortality wow so age at which you start
01:14:01.920 matters estrogen so that’s where there’s
01:14:04.600 something called the healthy cell
01:14:05.920 hypothesis or and so basically estrogen
01:14:08.800 is better at prevention than cure and
01:14:11.320 it’s very protective especially in the
01:14:13.040 Tima of the coronary arteries so taking
01:14:16.639 that estrogen away we lose that
01:14:18.080 protection once the disease builds up
01:14:21.560 there’s some worry that adding estrogen
01:14:23.560 once you’ve developed a sclerosis or a
01:14:25.960 plaque might loosen the plaque
01:14:28.000 especially in that first year so which
01:14:30.560 led for some people maybe to have a
01:14:32.120 slightly increased risk of stroke so
01:14:33.840 when my patients come in we are talking
01:14:35.840 about these differences it doesn’t mean
01:14:39.000 that after 60 you might not have
01:14:40.480 cardiovascular benefit we start losing
01:14:42.520 the benefit so it’s the timing
01:14:44.520 hypothesis is key and it’s the years
01:14:46.760 away from estrogen that’s the problem
01:14:49.719 there’s a great study in the British
01:14:50.920 medical journal they looked
01:14:53.679 at years years of reproductive life plus
01:14:58.000 HRT and looked at cognition scores and
01:15:01.480 saw that the longer your body is exposed
01:15:03.639 to estrogen in any form like whether
01:15:07.000 natural cycles or exogenous estrogen of
01:15:09.239 any form and it was estradi in that
01:15:11.159 study actually then you
01:15:13.880 had higher cognition
01:15:16.199 scores healthier brains which had a just
01:15:19.040 very you know top Contour level makes
01:15:20.880 total sense given that estrogen is
01:15:22.880 neuroprotective I realize my not be
01:15:25.199 neuroprotective in every instance in
01:15:26.600 every neuron in the brain but it’s
01:15:28.239 generally neur neur protective and
01:15:30.679 decline in estrogen is correlated with
01:15:32.800 neur degeneration which does not mean
01:15:34.600 it’s causal I have to ask when they
01:15:37.600 announced this study at the Watergate
01:15:39.400 Hotel of all places um and the
01:15:42.920 conclusion that they put forth was that
01:15:44.920 estrogen therapies can um increase rates
01:15:47.760 of cancer
01:15:49.480 um I have to wonder if that had
01:15:52.960 something to do with what I understand
01:15:55.280 is a sort of party line around Cancers
01:15:57.960 and breast cancers in particular which
01:15:59.320 is that you want to quote unquote block
01:16:00.960 the estrogen receptor you want to get in
01:16:02.560 there and put give tamoxifen or nowadays
01:16:04.880 I’m sure there are other drugs that are
01:16:06.080 more effective to block the estrogen
01:16:07.960 receptor it all seems to um pile up on
01:16:10.600 the side of a story that says you know
01:16:12.480 estrogen and estrogen binding to the
01:16:14.199 estrogen receptor is proc cancerous
01:16:16.600 which obviously I think you’re telling
01:16:18.719 us um in a in a indirect and direct way
01:16:21.560 now and we’ll go further into is simply
01:16:23.400 not the case if you take a healthy
01:16:25.280 breast cell and dump it at a petri dish
01:16:26.880 and then marinate it with some estrogen
01:16:29.080 it’s not teratogen I it’s not
01:16:30.679 carcinogenic estrogen is not
01:16:32.199 carcinogenic we live with it our whole
01:16:33.760 lives if it was in pregnancy for those
01:16:36.440 of us who are ever pregnant when our
01:16:37.800 estrogen levels Skyrocket we would see
01:16:39.960 this into uptic in breast cancer and we
01:16:43.159 don’t in fact I think there’s some
01:16:44.840 evidence uh for the opposite that
01:16:47.000 getting pregnant prior to age 40 is is
01:16:50.320 it true that that’s protective against C
01:16:52.320 be somewhat protect for certain forms of
01:16:54.040 breast cancer yeah so we have this whole
01:16:56.520 generation of Physicians who really
01:16:58.040 weren’t taught much about menopause
01:16:59.520 don’t understand the protective benefits
01:17:01.280 of estrogen and and and menopausa effect
01:17:03.960 on metabolic disease and they have this
01:17:07.000 me this mentality of estrogen is bad and
01:17:10.440 so a woman walks into her today 2023
01:17:13.000 they looked at the data she goes into
01:17:14.679 her doctor complaining of menopausal
01:17:16.280 symptoms which right now are still only
01:17:17.880 recognized as genit urinary syndrome
01:17:19.719 menopause hot flashes night sweats you
01:17:21.800 know the very cliche symptoms
01:17:25.360 documents in the chart she’s having
01:17:26.840 whatever only 10% are offered any
01:17:30.199 therapy and they’re most likely four to1
01:17:33.000 to be offered an
01:17:34.679 anti-depressant that is where it stands
01:17:36.560 today that is what we are fighting
01:17:38.280 against is not every woman will choose
01:17:41.480 HRT but every woman deserves an informed
01:17:44.360 conversation about it and let her make
01:17:46.080 her choice you know if you believe the
01:17:48.520 Whi data which there are some problems
01:17:50.760 there the risk is small okay but did you
01:17:54.280 talk to her about about cardiovascular
01:17:55.719 disease and diabetes and insulin
01:17:57.920 resistance and her cholesterol because
01:18:00.480 those things go up through the menopause
01:18:02.000 transition with no changes in diet and
01:18:03.639 exercise and those are all you know
01:18:05.679 you’re more even with the diagnosis of
01:18:07.320 breast cancer the most likely thing a
01:18:08.960 woman is going to die
01:18:10.520 from is cardiovascular disease a heart
01:18:14.000 attack or a stroke so framing it like
01:18:16.920 that I think is where we need to head
01:18:18.880 and the other thing is you know I was a
01:18:21.120 great Oben in so many areas of what I
01:18:23.719 did why should this all be dumped in the
01:18:26.600 lap of the poor busy OB Jen who’s
01:18:28.120 running around the hospital doing pops
01:18:29.719 smar trying to deliver babies surgery
01:18:31.440 and all the things like this should be
01:18:33.800 required education for all everyone in
01:18:36.159 medical school we are females and we’re
01:18:37.960 not little men with breast and uteruses
01:18:40.040 we react differently to medications
01:18:42.080 disease disease burden you know and
01:18:45.000 that’s not been studied adequately and
01:18:46.840 that’s where the the push needs to go
01:18:49.080 it’s bigger than just half flashes do
01:18:51.239 you think that one solution is to deepen
01:18:54.800 in the medical school curriculum
01:18:58.560 absolutely and more and and I hate
01:19:00.520 saying women’s health because everyone
01:19:02.440 thinks breast and uterus right and
01:19:04.320 reproduction it’s the health of
01:19:07.199 women and we’re not addressing it
01:19:09.360 differently than the health of a man and
01:19:11.560 we’re different we you know and so that
01:19:13.920 I think is where we need to head given
01:19:16.320 that it’s half of the population yeah um
01:19:19.280 one would imagine that the best thing to
01:19:20.840 do is to make the Core Curriculum of
01:19:22.960 medical students expand to include this
01:19:25.800 as opposed to making it a specialty I
01:19:28.000 think so does that mean a fifth year of
01:19:29.800 medical school I’m not kidding I mean I
01:19:32.360 I guess maybe I mean people said well
01:19:34.280 you’d have to extend the the OBG in
01:19:36.239 residency I’m like no any any specialist
01:19:38.840 who touches a female should understand
01:19:42.040 how that female I mean the starkest
01:19:44.159 example is cardiovascular disease you
01:19:46.159 know how much longer we have to wait in
01:19:48.120 the Ed how much more likely we are to
01:19:49.880 die in the hospital setting from a heart
01:19:51.760 attack because we don’t present the same
01:19:54.000 symptoms as men do and it’s just the
01:19:56.440 default has always been how it happens
01:19:58.600 to the basic you know really Caucasian
01:20:00.560 male and so at least in the US and so
01:20:03.719 because we respond differently because
01:20:05.560 we wait longer because our symptoms are
01:20:08.800 considered to be psychologically induced
01:20:11.159 less than biologically induced and so
01:20:14.719 women are dying at higher rates when you
01:20:17.199 look at the data on
01:20:19.480 Statin you get high cholesterol so 80%
01:20:22.520 of women will have abnormal cholesterol
01:20:24.679 levels through the minum PO transition
01:20:25.880 if they were normal before okay so
01:20:27.600 elevated LDL LDL and lowering HDL so now
01:20:30.960 they are at higher risk for
01:20:32.120 cardiovascular disease automatically a
01:20:34.120 PCP will offer her a Statin okay that is
01:20:36.480 standard of care do you know that the
01:20:39.360 American Heart Association published in
01:20:40.679 2020 that statins have never been shown
01:20:43.120 to decrease their primary heart attack
01:20:44.880 in a woman secondary yes but no primary
01:20:47.320 prevention and it does not decrease risk
01:20:49.199 of death from cardiovascular disease
01:20:51.440 they’re know that yeah yet we’re routine
01:20:54.000 you know what does
01:20:55.840 HRT if given in the right window of
01:20:59.199 opportunity how is HRT um in this case
01:21:02.840 estrogen HRT given is it a patch is it
01:21:05.920 injections is it great question all the
01:21:07.960 above so we have I like to break it down
01:21:10.280 into oral and non-oral forms so
01:21:13.080 everything oral we ingest goes into the
01:21:15.239 gut the liver the hepatic system will
01:21:17.520 pick up the portal vein and take
01:21:19.400 everything to the liver for processing
01:21:21.840 when that bump of estrogen hits the
01:21:23.800 liver we can see a slight increase in
01:21:26.159 some of our clotting factors so for that
01:21:29.480 reason I tend to go with the non-oral
01:21:32.080 formulations to avoid that risk
01:21:33.840 especially if she has any family history
01:21:35.520 of clotting or personal history of
01:21:36.880 clotting you know we’re going to go with
01:21:38.520 a non-oral form so these are things like
01:21:40.520 elevations and Factor 5 lighten MFR if
01:21:43.480 she’s had a history of a blood clot we
01:21:45.080 are not going with an oral estrogen
01:21:46.600 formulation and for people that haven’t
01:21:48.320 had a history of a blood clop my
01:21:50.440 understanding which admittedly is is
01:21:52.320 very um sparse is that you can do a
01:21:55.040 genetic test just by blood draw to see
01:21:57.040 whether or not you have U two normal
01:21:59.239 copies of the of the gene for Factor 5
01:22:01.199 lighten um some people are heterozygotes
01:22:03.800 so they’re more at risk of presumably
01:22:06.239 bleeding in that case right um but in
01:22:09.320 other
01:22:10.239 words can people go into this knowing
01:22:13.800 whether or not um they’re more or less
01:22:16.560 at risk from taking estrogen so I don’t
01:22:20.159 think that there’s a high enough for
01:22:23.000 that reason because we’re not routin L
01:22:24.760 screening for these things unless they
01:22:26.320 have a family history I’m going with
01:22:28.320 non-oral estrogen as a primary product
01:22:31.239 for my patients because I can just skip
01:22:32.800 that worry so a patch typically so
01:22:34.920 typically transdermal so a patch there’s
01:22:37.000 even miss spray there’s FDA approved
01:22:38.480 options of a patch there’s gels there’s
01:22:40.760 a ring there’s a um spray and um there
01:22:44.440 is a vaginal ring which I love love love
01:22:47.080 because it’s so you put it in for three
01:22:48.360 months and it treats you know you get a
01:22:50.719 two for one you get a local treatment in
01:22:52.600 the vagina as well as a systemic treat
01:22:54.480 treatment as well um it’s just really
01:22:56.520 expensive and typically not covered by
01:22:57.920 insurance on the first tier so very few
01:22:59.440 of my patients can afford it um there
01:23:02.600 are um some injectables which no no one
01:23:05.239 in the menop posi uses um there the
01:23:07.600 menop yeah great there are also the mene
01:23:11.600 and the menop posi are those terms that
01:23:13.320 you coined I love it um I think I did
01:23:15.679 yeah great all right you heard it here
01:23:17.840 so the menasi is a a group of healthcare
01:23:20.600 professionals who are from multiple
01:23:22.920 Specialties we have card ologist
01:23:25.080 orthopedic surgeon um Internal Medicine
01:23:28.440 you Dr lion is a member and we have a
01:23:31.440 big group chat and we all support each
01:23:33.320 other we support each other’s books and
01:23:34.880 research and and we send articles back
01:23:36.880 and forth and we support each other on
01:23:38.639 social but we also band it together to
01:23:41.440 kind of negate one of the bigger
01:23:43.120 Publications on menopause that when the
01:23:44.440 lanet published it’s a whole another
01:23:46.360 discussion um but you know we are
01:23:48.159 fighting for equity in menopause care
01:23:50.800 and and Fe and Women’s Health great
01:23:53.040 nothing succeeds like a group it’s like
01:23:54.880 the old menopause versus the new
01:23:56.280 menopause I love it love it um so
01:24:01.440 hormone therapy to increase estrogen how
01:24:04.440 does it make women feel um
01:24:07.239 psychologically physically what are some
01:24:08.880 of the positive changes that can OCC
01:24:10.520 aside from just offsetting some of the
01:24:12.120 negative and I want to make sure that I
01:24:14.400 remember to ask what if a woman has been
01:24:16.719 in menopause for you know uh has passed
01:24:20.159 that point because as you said it’s a
01:24:21.320 day so they passed that point um a year
01:24:24.400 earlier 2 years earlier 3 years earlier
01:24:26.800 um given the results of this first study
01:24:29.360 um which as you explained it are uh
01:24:31.840 problematic and their interpretation the
01:24:34.080 way it was interpreted as opposed to
01:24:36.000 initially yeah yeah um what’s too long
01:24:39.760 should um women should wom starten
01:24:43.080 therapy in their 40s just in just to you
01:24:46.040 know smooth the transition maybe we need
01:24:48.159 more studies in this area like should we
01:24:50.480 just the minute we figure out like I
01:24:52.280 would love like I would glucose monitor
01:24:55.480 I have um insulin resistance so for
01:24:57.719 those listening there’s just it looks
01:24:58.840 like a little button sized um sticker on
01:25:01.080 the back of the arm I would love to
01:25:02.880 develop one to track estrogen levels
01:25:06.199 starting your 30s just see where you’re
01:25:07.960 at you know start seeing are you having
01:25:10.520 aberations in your cycle and we can
01:25:12.199 start the per menopause journey and
01:25:13.760 talking about should we begin supporting
01:25:15.880 I think there’s a tremendous amount
01:25:18.080 opportunity for research in this area um
01:25:21.159 but typically we are not starting
01:25:23.239 patients until they’re very symptomatic
01:25:24.840 if they’re per menopausal or they’re
01:25:27.320 postmenopausal so in general so if a
01:25:30.760 woman is um in her let’s say late
01:25:34.360 30s um
01:25:37.280 she is anticipating perimenopause maybe
01:25:40.119 is in per menopause and wants to start
01:25:43.520 lowd dose um hormone replacement therapy
01:25:47.159 I think it’s something um worth
01:25:48.280 mentioned that not all you know
01:25:49.800 presumably the dosages are tailored and
01:25:51.800 then blood so a given dose is tried
01:25:54.000 blood is drawn you measure estradi so
01:25:56.040 we’re not um we don’t have established
01:25:58.440 levels of like therapeutic ranges of
01:26:00.280 estradi what we found is that when we do
01:26:02.880 that so far I think we have some
01:26:04.560 opportunity here if my level’s 50 and
01:26:07.040 your level’s 50 I could feel like I’m on
01:26:08.920 top of the world my symptoms are gone
01:26:10.400 you still need more so we are titrating
01:26:12.840 from symptoms I see yeah interesting
01:26:15.920 that’s similar to what is done
01:26:18.360 similarish with um testosterone
01:26:20.040 replacement therapy which these days um
01:26:22.840 you know I sort of have joke that the
01:26:25.040 you can uh change out the r in
01:26:28.280 testosterone replacement because a lot
01:26:29.679 of people are a lot of men are taking
01:26:31.880 testosterone not as a replacement
01:26:33.480 meaning their levels are not lower than
01:26:35.119 300 n per deciliter which is kind of
01:26:37.159 lower range um they’re sort of low
01:26:39.000 middle and they’re trying to get high
01:26:41.000 you know higher range but hormone
01:26:43.320 replacement therapy as I understand it
01:26:45.560 has never been um strictly in men or
01:26:49.000 women strictly for people who are out of
01:26:50.960 range that it in in theory it can be to
01:26:54.280 optimize reduce symptoms and to optimize
01:26:57.679 well-being right um and I don’t know if
01:26:59.520 the medical establishment wants it used
01:27:01.679 that way but certainly in the case of
01:27:03.719 testosterone replacement therapy in men
01:27:06.000 it’s being used that way quite often in
01:27:08.360 fact
01:27:09.520 so the we don’t have established
01:27:12.080 therapeutic ranges for estrad if she’s
01:27:14.400 POI premature Varian insufficiency we
01:27:17.400 know we want to get her to 100 or around
01:27:19.239 100 or higher in picograms per deciliter
01:27:23.080 um and but in the menopausal patient
01:27:26.679 we’re rarely checking levels but I do
01:27:28.520 think we have an opportunity to learn a
01:27:30.280 lot more now that we’re able to track
01:27:32.159 how is it how does it affecting your
01:27:33.480 cholesterol we need to look at those
01:27:35.280 numbers like what’s the optimal dose for
01:27:36.960 cholesterol what’s the optimal dose for
01:27:38.360 cardiovascular disease all we all these
01:27:40.159 Studies have looked at was was she on it
01:27:41.920 or not so that’s where I think the
01:27:44.760 opportunities can come so if a woman
01:27:47.199 goes on hormone replacement therapy how
01:27:49.880 often is she coming in for blood draws
01:27:51.360 or are you just you know well depend
01:27:53.280 testosterone we tend check more often
01:27:55.360 there’s we don’t have an FDA approved
01:27:57.199 option for women for testosterone and so
01:28:00.239 no so we either try to get her t- stem
01:28:03.239 mhm um or she’s finding someone to
01:28:07.119 insert a pellet or something and there’s
01:28:08.880 there’s other issues with that um what I
01:28:10.960 do in Te Texas it’s really hard the
01:28:12.800 pharmacists do not like to do the t-
01:28:14.840 stem for patients and I’ve even T t-
01:28:17.440 stem is the gel you know um and I end up
01:28:21.920 compounding it in a cream and do a
01:28:23.520 transdermal PR for the patients but
01:28:24.960 there’s such variable absorption we do
01:28:26.920 tend to check more levels of that just
01:28:28.719 to may try to get her therapeutic so
01:28:32.119 what for women at Peak dose is somewhere
01:28:35.760 in a healthy female you know 35 to 70
01:28:39.440 and it’s so so I had a woman coming in
01:28:41.040 with signs of hyperandrogenism you know
01:28:42.880 she’s you know deep voice hair growth
01:28:45.080 whatever acne and I’m going to check a
01:28:46.800 level if it’s above 90 for females I
01:28:49.880 need to look for a tumor like that’s too
01:28:51.719 high okay or PCOS it can get that high
01:28:53.719 certainly 200 that’s that’s outrageous
01:28:56.400 so I’m trying to get my patients you
01:28:58.800 know 60 50 70 but if she’s like 50 and
01:29:02.280 her she’s got her libido back and she
01:29:04.199 feels great and everything’s wonderful
01:29:06.159 then I’m hold you know because the
01:29:08.560 higher we go the more likely you are to
01:29:10.239 have side effects so you’re losing hair
01:29:12.400 you know temporal hair loss voice
01:29:13.960 steepening acne new chin hair you know
01:29:16.880 losing hair where you want it gaining
01:29:18.119 here where you don’t want it is how I
01:29:19.760 explain it to patients and so when you
01:29:21.920 say 50 that’s 50 nanograms per de
01:29:24.800 I think um many people including myself
01:29:27.000 were surprised to learn um that women
01:29:30.280 actually have higher levels of
01:29:31.360 testosterone than they do estrogen um
01:29:34.040 outside absolute ranges right in
01:29:35.679 absolute ranges and I can tell you right
01:29:37.880 now your natural level of estradiol is
01:29:39.719 higher than mine now I’m I supplement
01:29:42.080 but you know like when I go through
01:29:43.800 menopause your residual estradi is now
01:29:46.199 higher than a postmenopause a woman so
01:29:48.480 this is the uh estrad that I have
01:29:51.360 because testosterone was aromatized into
01:29:53.600 into EST yeah interesting interesting uh
01:29:56.840 so much uh is breaking down around the
01:29:59.480 uh the old
01:30:01.440 stereotypes female hor like testosterone
01:30:03.560 is a human hormone right estrogen’s a
01:30:05.320 human hormone and they exist in in both
01:30:07.560 uh biological Sexes yeah it’s um it it’s
01:30:11.440 sometimes unfortunate that compounds in
01:30:13.600 the body get names like steroid hormones
01:30:15.880 because then people hear steroids and
01:30:17.360 then it has a gravitational pull toward
01:30:19.679 um anabolic steroid use um or uh even
01:30:24.239 the word fat you know it’s like you know
01:30:26.800 dietary fat versus subcutaneous fat
01:30:30.000 versus fat we need better nomenclature
01:30:33.480 um to avoid a lot of the confusion that
01:30:35.440 exists out there what are some of the
01:30:37.040 other hormones that um can be reduced
01:30:40.000 and can possibly be replaced by hormone
01:30:42.400 therapy like progestins um you know are
01:30:45.960 there is there a role for um you know
01:30:48.159 adjusting things like prolactin or is
01:30:49.840 there a is there a role for other
01:30:52.000 hormones in that what sure is to be a
01:30:55.840 multifactorial thing I mean I think
01:30:57.520 menopause is a process not an event
01:30:59.440 hypogonadism for females right and so we
01:31:03.560 know that you know because the pituitary
01:31:06.000 and hypothalmus are involved and that
01:31:08.119 G&R you know there’s some cross
01:31:09.840 reactivity so for example hypothyroidism
01:31:12.239 when I have a patient who’s on her and
01:31:14.000 doing well on hormone therapy for her
01:31:15.920 thyroid so she’s on T3 T4 whatever she’s
01:31:18.560 on I’m like listen you know we need to
01:31:22.119 recheck your thyroid levels in six weeks
01:31:25.040 because giving you back estrogen is
01:31:26.960 going to mess with a little bit of that
01:31:28.920 feedback cycle so we need to make sure
01:31:30.400 you’re still therapeutic so I think
01:31:32.679 we’ve got more work to do with some of
01:31:34.480 the other hormones um but when we talk
01:31:36.960 about replacement and menopause we are
01:31:39.119 mostly looking at your estrogens your
01:31:41.440 androgens and your progesterone so the
01:31:45.119 formulations can differ um when we you
01:31:48.840 know there’s a lot of misunderstanding
01:31:50.600 around what is bioidentical versus
01:31:52.320 synthetic and I think a lot of cottage
01:31:54.040 Industries in this little bubble that we
01:31:56.199 had for 23 years where doctors were
01:31:57.880 afraid to prescribe hormone therapy and
01:32:00.880 then women were desperate for care we
01:32:03.199 had some little cottage industries of
01:32:04.960 people I think were well meaning and
01:32:06.560 trying to help but kind of developed
01:32:09.400 terminology that really isn’t medically
01:32:11.400 specific like estrogen dominance you
01:32:13.320 know and what that really is and so that
01:32:15.520 is not a term that is in any medical
01:32:17.000 journal it’s kind of something coined I
01:32:18.840 think from a well-meaning provider
01:32:20.679 trying to explain what’s happening in
01:32:21.960 per menopause that you’re having more
01:32:24.119 produced than progesterone than you used
01:32:25.840 to have so PCO patients do the same
01:32:28.600 thing you know there’s multiple reasons
01:32:29.880 for that to happen um so when we talk
01:32:33.199 about you know in the miniverse of what
01:32:35.960 we’re trying to replace we all agree
01:32:38.520 that we stick pretty much with estradiol
01:32:41.040 we’re just trying to give you back the
01:32:42.159 water you were drinking so I want to be
01:32:44.000 get as close to what your body used to
01:32:45.400 make because that’s what the receptor
01:32:46.719 like I’m trying to give you progesterone
01:32:49.080 you know rather than a synthetic not
01:32:50.719 that they’re all demonized progesterone
01:32:52.239 doesn’t work for everyone I’m glad I
01:32:53.440 have option
01:32:54.639 and then for your androgens we pretty
01:32:56.800 much just do testosterone and we do a
01:32:58.760 transdermal again because the oral can
01:33:01.000 be hepatotoxic unless it’s un8 which
01:33:03.199 isn’t um available in the US so but in
01:33:06.840 there’s no FDA approved option for women
01:33:08.400 so it’s not covered by
01:33:09.800 insurance we know it works for
01:33:12.040 hypoactive sexual desire disorder what
01:33:13.880 your followers would would call libido
01:33:16.280 um we think we know testosterone women
01:33:19.080 at the highest quartile of testosterone
01:33:21.040 have better bone density and stronger
01:33:22.360 muscles so I’m using off label for my
01:33:24.719 patients who come in with osteoporosis
01:33:26.400 osteopenia or sarcopenia I’m using it
01:33:28.600 off label telling them this is a
01:33:31.000 probably a hel it’s not a h Mar we think
01:33:32.719 it works but we don’t have the you know
01:33:34.360 it’s not approved for that yet yet um we
01:33:37.320 know it has receptors in the brain my
01:33:39.000 patients are saying that they’re more
01:33:40.960 clarity of thought they’re sleeping
01:33:42.119 better they really really like the
01:33:44.119 testosterone um so there’s you know DHEA
01:33:47.840 there’s a great vaginal preparation for
01:33:49.400 DHEA called inosa and then the receptors
01:33:52.360 there will start converting it into to
01:33:53.920 both testosterone and estradi you know
01:33:55.679 through the process and so um the sexual
01:33:59.280 medicine docs really like in Roa
01:34:01.159 especially for breast cancer patients
01:34:02.560 because they get that little boost of
01:34:03.760 testosterone in the vulva intr Roa intr
01:34:06.679 Roa is the brand name I think it’s
01:34:09.360 prostone and this is a prescription drug
01:34:11.679 yeah these are prescriptions so intr
01:34:13.280 roa’s prescription DHEA was specifically
01:34:16.520 formulated for the vagina got it which
01:34:18.199 sits further Upstream to the production
01:34:20.679 of testosterone and estrogen right and
01:34:22.639 so fortunately
01:34:24.360 the what’s left in the vagina is able to
01:34:26.760 you know plug that guy in and get it to
01:34:29.280 produce both testosterone and estrad
01:34:31.360 which testosterone is the immediate
01:34:32.520 precursor we have to aromatize it right
01:34:34.400 to make estrad in females as well these
01:34:36.880 local effects on tissues um are
01:34:40.040 interesting um I they make perfect sense
01:34:42.840 if the highest concentration is at the
01:34:44.440 site of release from the from the patch
01:34:46.480 or the gel or the whatever the um the
01:34:49.679 the you said intravaginal what is it
01:34:51.639 it’s like a capsule uh I think the
01:34:53.719 Prestone is a um insert like a little
01:34:56.679 gel looking not a gel but a um I forget
01:34:59.440 what The Binding material is but it’s
01:35:01.080 like a little insert you put in okay so
01:35:02.840 the local effects because I guess you
01:35:05.000 know it stands to reason that the
01:35:06.560 highest concentrations can be at the
01:35:08.360 sight of the thing that’s releasing the
01:35:09.679 hormone but then it also goes systemic
01:35:11.560 by getting into the blood actually so
01:35:13.600 the the local formulations e the
01:35:15.840 prostone and the um the inosa and as
01:35:19.400 well as the estradi formulated for the
01:35:21.520 vagina do not absorb Sy ically they’re
01:35:24.440 so low dose there’s not been clinically
01:35:26.600 significant tissue absorption I have a
01:35:28.639 formulation for my face as well so it’s
01:35:30.639 a cream a cream that I put on my face
01:35:32.440 it’s estriol and so there’s some decent
01:35:34.679 studies with estriol but we lose 30% of
01:35:36.760 our collagen it’s a very big pain Point
01:35:38.880 for women when they go through menopause
01:35:40.360 that we lose so much collagen so quickly
01:35:42.080 in the first five years of menopause and
01:35:44.040 so we can slow that process down we
01:35:45.679 can’t stop it completely we can slow it
01:35:47.520 down by using a topical estrogen and the
01:35:49.800 topical really seems to help with the
01:35:51.159 elastin concentrations as well
01:35:53.239 interesting so you you will often
01:35:55.440 prescribe a lot of local treatments for
01:35:57.920 hormone it’s so safe so we can take
01:36:00.159 breast cancer off the table all the
01:36:01.600 discussion around blood clots and
01:36:02.960 everything everyone can use vaginal
01:36:05.119 estrogen and they should and I’ll tell
01:36:06.920 you why starting at what age relative
01:36:08.840 toop the old menopause thoughts is do
01:36:11.480 not give adinal estrogen until she’s
01:36:13.080 symptomatic now all of us will become
01:36:15.480 symptomatic from GSM so that’s genital
01:36:17.280 urinary syndrome of menopause so from
01:36:19.159 the pubic bone all the way to the sacrum
01:36:21.040 all of that tissue is heavily you know
01:36:23.800 tied to estrogen testosterone and when
01:36:26.520 those levels decline we see thinning of
01:36:28.280 the tissue loss of elasticity loss of mu
01:36:30.400 mucous production as well as the health
01:36:32.000 of the urethra and so UTI like the best
01:36:35.360 treatment for recurrent u in a
01:36:36.800 menopausal patient is vaginal estrogen
01:36:38.880 interesting not recurrent antibiotics
01:36:40.760 and what about um so it’s preventative
01:36:43.679 we can probably keep 50% of women out of
01:36:46.280 the ER and out of urosepsis if we gave
01:36:49.360 them all prophylactic vaginal estrogen
01:36:51.360 all these ladies in nursing homes should
01:36:53.040 be on vaginal estrogen so just to
01:36:56.080 protect them from getting Euros sepsis
01:36:59.080 interesting what about um like urinary
01:37:02.760 incontinence and some of these other
01:37:04.360 symptoms that are associated with more
01:37:05.840 elasticity presumably more elasticity of
01:37:08.320 of tissue in that region if you’re early
01:37:10.560 in a so we have stress incontinance and
01:37:12.560 then we have um overactive bladder urge
01:37:14.800 incontinence and so it definitely helps
01:37:17.560 with urgent condet it rela you know it
01:37:19.199 helps to relax and decrease the
01:37:20.360 inflammation in the wall of the bladder
01:37:22.280 so thumbs up there so people are getting
01:37:24.560 up at night and having that urge to go
01:37:26.719 um but stress incontinence is an
01:37:28.280 anatomical problem we’ve lost you know
01:37:30.600 the the sling that holds up the urethra
01:37:32.239 and the female fails right from
01:37:34.119 herniation and and poor tissue Health we
01:37:36.520 can build up that health and we you know
01:37:39.520 there’s Physical Therapy there’s lots of
01:37:40.880 options and you you know no Euro
01:37:42.960 gynecologist wants to take a woman to
01:37:44.639 the o to do a
01:37:46.960 lift if she’s not estrogenized they’re
01:37:49.320 all going to get vaginal estrogen pre
01:37:52.199 you know through healing and forever to
01:37:54.480 keep the tissue
01:37:56.360 healthy everything that we’ve been
01:37:58.159 talking about for about the last 15 or
01:37:59.719 20 minutes seems to go directly opposite
01:38:04.000 this large scale study that was
01:38:05.840 discussed at the Watergate Hotel um is
01:38:09.239 your read that the medical establishment
01:38:11.840 in particular the OBGYNs in the US and
01:38:14.280 in other countries understand now that
01:38:18.040 that study was um flawed to some extent
01:38:22.080 in its design no or
01:38:23.960 is what we’re talking about here like
01:38:25.159 really cutting edge I mean if we were to
01:38:26.880 gather a room full of a thousand OBGYN
01:38:29.320 trained in various decades and put there
01:38:31.320 10% would have any idea here’s why and
01:38:33.760 I’m going to call out the American Board
01:38:35.040 of Oben directly on this we take our
01:38:37.440 board certification exams every year in
01:38:39.080 our specialty as every specialty does
01:38:40.760 and they give us a set of Articles of
01:38:42.599 The Cutting Edge newest research and
01:38:45.000 it’s divided into categories obstetrics
01:38:47.199 office practice Gynecology GYN surgery
01:38:49.760 Pediatrics onc you know there is no
01:38:52.679 menopause
01:38:55.719 category
01:38:57.280 nothing so I went back over like 10
01:39:00.320 years of all my green journals and
01:39:02.880 looked at how many articles were
01:39:05.000 anything to do with menopause and it was
01:39:06.719 less than 1% so they were not
01:39:11.960 systematically trying to put the latest
01:39:14.199 menopause information in front of us
01:39:15.760 they don’t even recognize the menopause
01:39:17.320 society as a like entity well now they
01:39:21.760 have to contend with the menop posi they
01:39:23.599 do and because and they might you might
01:39:26.159 see me banned from the a but you know
01:39:27.960 what no no no but I’m so proud of what I
01:39:30.119 learned I learned amazing things I am a
01:39:32.880 boss at delivering a baby of taking care
01:39:34.679 of a pregnant patient I am great at
01:39:36.159 pediatric Gynecology I was so good with
01:39:38.119 adolescence where I failed and where
01:39:40.920 this I let the system let me fail was in
01:39:43.840 the care of a woman after reproduction
01:39:45.760 outside of surgery outside of her
01:39:47.239 surgical needs well I have to imagine
01:39:49.520 that given the medical profession is
01:39:51.239 interested in the well-being of people
01:39:53.480 and in uh for sake of the discussion
01:39:55.400 today women that um they will be
01:39:58.000 grateful that uh now you you have a
01:40:00.679 microphone um many microphones uh in
01:40:03.520 various contexts so uh that is
01:40:06.119 surprising to me however I would think
01:40:08.159 that given the exciting findings around
01:40:12.119 hormone replacement therapy and the I’m
01:40:14.639 kind of obvious at least when you
01:40:16.599 describe them to me obvious flaws in
01:40:18.840 these earlier studies of you know
01:40:20.800 starting hormone replacement therapy
01:40:22.360 when women are already 61 when they’ve
01:40:24.960 already accumulated um in many cases um
01:40:28.360 some health health issues that uh it
01:40:30.599 would be kind of you miss miss the
01:40:32.520 ability to to measure the protective
01:40:35.000 benefits so but fortunately we’ve got
01:40:38.119 great studies coming out of like the
01:40:39.880 Danish data the Scandinavian data that
01:40:42.360 are really looking at this again and
01:40:45.360 showing the protective benefits so is it
01:40:49.400 generally the case that the studies out
01:40:51.000 of Europe and Scandinavia are more
01:40:52.880 forward W thinking it depends you know
01:40:55.119 some of the most Forward Thinking
01:40:56.840 shockingly is um come out of Asia a lot
01:41:00.000 out of China and I asked my husband he’s
01:41:02.199 worked there before and he said there’s
01:41:04.560 as many researchers in China that are
01:41:06.719 female as male it’s not like they have a
01:41:09.080 big stay-at-home culture you know
01:41:10.920 they’re they’re not um women are
01:41:12.880 expected to work and they’re getting
01:41:14.440 phds and they’re they’re doing the
01:41:16.080 research and so and he thinks at Le in
01:41:18.560 his in of one you know his humble
01:41:19.880 opinion and he’s an engineer you know
01:41:21.960 that that’s I was like why do you think
01:41:23.480 you’ve worked over there he goes I think
01:41:24.880 because there’s just as many women who
01:41:26.719 are writing the papers as men
01:41:28.639 interesting take I like it um it makes
01:41:31.880 good
01:41:32.800 sense what are the various things that
01:41:35.679 people can do in terms of a non hormone
01:41:38.520 replacement therapies that can support
01:41:41.040 them through really into and through
01:41:44.199 perimenopause and menopause we talked
01:41:46.199 about nutrition earlier maybe we could
01:41:47.719 touch on that a little bit more we
01:41:49.080 talked about behaviors resistance
01:41:50.599 training maintaining maybe even
01:41:51.880 increasing muscle mass um there’s no
01:41:55.199 pressure to uh include them but what
01:41:57.880 about the very supplements that we hear
01:41:59.480 about that can touch on or we we are
01:42:01.360 told can touch on these hormone Pathways
01:42:03.280 things like dim things like grape seed
01:42:05.639 extracts things like um evening primrose
01:42:09.520 I I don’t think they’re harmful but
01:42:11.440 there’s just not robust data to really
01:42:13.840 support so um menopause Society went and
01:42:16.080 looked at all of them even soy and
01:42:18.040 everything and they just outside of
01:42:19.920 cognitive behavioral therapy which can
01:42:21.440 be helpful but is not a menopause cure
01:42:23.880 um they didn’t find much in the
01:42:27.520 supplement world that would stop
01:42:30.840 remember we’re defining menopause as hot
01:42:32.440 flashes and general urinary syndrome of
01:42:33.960 menopause so you know when I’m
01:42:36.040 recommending supplements to patients I
01:42:38.560 do think there’s some okay data on
01:42:40.159 turmeric for maybe hot flashes but I’m
01:42:42.599 not saying to take that instead of
01:42:44.239 replacing the estrogen your body is is
01:42:46.280 missing greatly um I like the
01:42:48.239 anti-inflammatory benefits of of you
01:42:50.280 know of that supplement I’m recommending
01:42:53.199 F 80% of my patients are deficient in
01:42:55.560 vitamin D and struggling to get it
01:42:57.280 absorbed you know um I’m recommending
01:43:01.040 creatine for muscle I’m recommending um
01:43:04.719 there’s a specific bioactive collagen
01:43:06.639 that was studied in menopausa one with
01:43:08.159 osteoporosis where they saw Improvement
01:43:09.800 in bone density so I’m recommending a
01:43:12.280 weighted vest great studies elderly
01:43:15.000 women but saw improvements in bone
01:43:16.639 density and I’m like why do we wait
01:43:18.360 until we’re osteoporotic to make the
01:43:19.840 diagnosis yeah this is interesting so
01:43:21.560 weighted vest a weighted vest they
01:43:23.280 looked at creatine weighted vest
01:43:24.719 vibratory training in nursing home
01:43:27.159 dwelling so they were kind of a
01:43:28.679 population where they couldn’t go
01:43:29.599 anywhere vibratory training is the shake
01:43:31.239 plate uh the shake plate and so you know
01:43:33.800 anything that stimulates that muscular
01:43:35.360 skeletal unit will will send the signal
01:43:37.719 to get stronger you know what most women
01:43:40.040 don’t realize I mean they know about
01:43:41.480 osteoporosis right and they don’t want
01:43:43.199 to have it but they don’t understand
01:43:45.040 that like your habits in your 30s and
01:43:46.800 40s are going to put you on that path
01:43:49.560 and that your body is going to fight to
01:43:51.040 lose muscle and bone naturally through
01:43:53.280 the aging process and accelerated with
01:43:55.080 menopause it doesn’t have to be that way
01:43:57.280 but you have to do the work you know and
01:43:59.440 and there’s some hacks and so I love the
01:44:01.080 way to vest for a hack I’m like do the
01:44:02.679 dishes with it on go walk the dog you
01:44:04.920 know like like how heavy so you want in
01:44:07.199 the nursing home they started at 10% of
01:44:08.840 their body weight so I’m like 10 PB 12
01:44:11.199 PBS start with that so now my husband’s
01:44:13.159 obsessed and we have six of them and
01:44:14.880 they go from 8 to 35 lbs you know so I
01:44:17.760 have different weights that I wear like
01:44:19.159 if I’m doing leg day I’ll put the
01:44:20.639 heavier one on so I don’t have to hold
01:44:22.040 as heavy so you’ll use a a weight vest
01:44:24.639 when you’re doing leg day mhm wow so I
01:44:27.080 can’t cuz I don’t have great grip
01:44:28.199 strength and you know and so it’ll help
01:44:30.560 me be able to squat heavier you know but
01:44:32.880 now I’m getting better I’m got the bar
01:44:34.480 going so I’m I’m getting there you know
01:44:36.119 I’m want to tell my sister and my mom
01:44:37.400 this yeah and you know I’ve got my
01:44:39.400 sister yeah doing some resistance
01:44:41.320 training it’s been and it’s just a cheat
01:44:42.960 I’m so it’s so cute on social because
01:44:44.800 they’ll post and tag me and they’re
01:44:46.239 walking their dog and they’re doing
01:44:47.880 whatever with their way to vest on and
01:44:49.440 now in galvaston where I live you can’t
01:44:51.440 go you see it all over the sea wall
01:44:52.639 everyone’s walking with their weighted
01:44:54.239 best on I love it and it’s hot down
01:44:56.360 there a lot of the year so no excuses
01:44:58.320 people outside of Texas or in Texas for
01:45:00.760 that matter but my experience is that
01:45:02.040 people in Texas don’t tend to make
01:45:03.520 excuses anyway that’s said like a real
01:45:06.199 Californian here um we were talking
01:45:08.280 about this a little bit earlier in uh
01:45:10.920 female specific weight vests I would
01:45:13.280 love to develop one because the ones
01:45:15.040 were made for men and they’re okay but
01:45:16.840 if you have larger breasts it’s hard
01:45:18.880 where the Snaps are to get it on right
01:45:21.080 and I know there’s a big Trend with
01:45:22.520 Wrecking
01:45:23.599 but that puts all the weight on your
01:45:25.119 back and I really like the weighted vest
01:45:27.159 because I feel and this is my opinion
01:45:29.119 really but that you know the reason why
01:45:31.159 it’s helping with your bone density is
01:45:32.760 it’s putting the weight on the entire
01:45:34.280 axial skeleton rather than just the
01:45:36.360 muscles on your back so we’re putting
01:45:38.400 the force more evenly supported yeah um
01:45:41.719 and so but some of my uh followers have
01:45:44.360 written in and said they’re struggling
01:45:45.679 because they have larger breasts and how
01:45:47.080 to get this around I’m like I got to
01:45:48.480 make one that’s going to accommodate you
01:45:50.639 know have longer you know dist strap
01:45:52.639 down here underneath the breast so
01:45:54.440 that’s yeah someone should develop that
01:45:55.520 you should develop that um not that you
01:45:57.320 don’t already have enough on your plate
01:45:58.599 already uh along the top I like rucking
01:46:01.119 it is sort of backloaded you know by
01:46:03.159 definition um some of the weight vests
01:46:05.159 that are out there are little um are
01:46:07.119 evenly distributed in a way that makes
01:46:09.040 them pretty comfortable they’re not all
01:46:10.040 loaded up up front like like a a special
01:46:12.320 operator or something would wear so I
01:46:15.239 positive effects of of the weight vest
01:46:17.159 would be increased bone density you
01:46:20.920 you’re doing more burning a little more
01:46:22.360 calories
01:46:23.599 getting stronger but I’m I’m I coach to
01:46:26.400 it you know with my followers for this
01:46:28.840 is part of my osteoporosis prevention
01:46:31.000 pack love it are you willing to share a
01:46:33.360 few other things that are in the
01:46:34.360 prevention pack uh you know eating
01:46:35.920 adequate protein doing resistance
01:46:37.440 training wearing your weighted vest
01:46:39.119 creatine five grams a day where most of
01:46:41.159 the studies were done in in the women
01:46:42.880 creatine monohydrate monohydrate yeah
01:46:45.000 and then um the that cagen consider that
01:46:48.199 uh collagen full disclosure I do sell
01:46:50.119 that one but um really good investment I
01:46:52.679 think
01:46:53.840 maybe we could talk about collagen for a
01:46:55.400 moment um it it’s a complete protein no
01:47:00.040 no no it’s missing one I think one or
01:47:02.360 two amino acids so it’s not a complete
01:47:04.599 protein um it’s better than none so I do
01:47:07.679 like include my collagen in my protein
01:47:10.480 intake for the day because I eat all
01:47:11.920 animal-based protein pretty much um so I
01:47:15.119 figure I’m I’m covered my bases to have
01:47:17.159 you know 10% of it coming with just
01:47:18.840 missing two amino acids or I think it’s
01:47:20.440 one valine I have to look it up so and
01:47:23.239 what are the specific effects of a
01:47:24.760 quality collagen so you know there’s a
01:47:27.080 lot of controversy there I’ve seen the
01:47:28.639 videos it is broken down into its
01:47:30.679 component amino acids you know through
01:47:32.480 the digestion process but the first ones
01:47:35.520 I looked at were totally for vanity I
01:47:38.639 was changing bathing I was trying on
01:47:40.639 bathing suits with my daughter who was a
01:47:42.480 little girl at the time and I was
01:47:44.440 complaining about the appearance of my
01:47:46.000 cellulite even then people have
01:47:47.560 cellulite and oh mommy it doesn’t look
01:47:49.880 that bad and I you know scientist in me
01:47:52.880 was like goes on PubMed and starts
01:47:55.119 looking up articles on on cellulite and
01:47:57.880 how to decrease the appearance of it and
01:48:00.040 so I found these articles on something
01:48:01.920 called verisol and it was a college in
01:48:03.719 made in Germany and they’d studied
01:48:05.280 actually done like really high quality
01:48:06.800 studies like laser measuring wrinkles
01:48:09.280 and cellular ger are precise and uh they
01:48:12.320 and it looked they had positive outcomes
01:48:14.040 I’m like well it won’t hurt me so I
01:48:15.320 ordered some I Googled where do I find
01:48:16.840 this verisol collagen I find this
01:48:18.080 company I order it and then one day I
01:48:20.119 talked about it on the
01:48:21.560 internet and the company called me and
01:48:23.520 said would you please let us know when
01:48:24.840 you do that cuz they sold out of their
01:48:27.119 supply for like 3 months so the same
01:48:30.840 like manufacturer of that particular
01:48:33.920 verosol made this
01:48:36.639 forone did the studies five years doing
01:48:39.679 bone density scans on these women it was
01:48:41.880 a small study but they saw improvements
01:48:44.000 we know what happens to bone density if
01:48:45.360 you do nothing it goes down these went
01:48:48.119 up and I thought okay I want to do and I
01:48:50.520 want to offer this to people like if not
01:48:52.560 then me this is a high quality product I
01:48:54.840 can rep you know and that so that’s part
01:48:56.480 of my um what I offer to people or what
01:49:00.400 I recommend you can get it anywhere
01:49:01.840 other people sell it not just me great
01:49:04.119 um
01:49:05.520 so I’m perplexed this isn’t a challenge
01:49:08.360 but I’m perplexed how would a protein
01:49:10.800 that’s not a complete protein um be
01:49:13.599 beneficial for a body organ like skin
01:49:16.360 whereas the complete proteins don’t seem
01:49:18.119 to do it on their own nobody knows okay
01:49:21.320 I don’t know interesting are they
01:49:22.719 studying the right thing or they’re not
01:49:24.000 really looking at it so I don’t know
01:49:27.199 there great when I hear I don’t know the
01:49:29.320 know the scientist in me says great area
01:49:30.920 for for exploration because we don’t
01:49:33.920 really believe in fact we don’t believe
01:49:37.440 um that amino acids um that are derived
01:49:42.119 are derived from a particular body part
01:49:43.800 Target that tissue we’ve heard this
01:49:45.639 argument before um Dr Lane Norton and I
01:49:48.840 have both gone on record publicly saying
01:49:50.639 there is basically zero not basic delete
01:49:53.119 the basically there is zero evidence
01:49:54.719 that when you ingest heart uh let’s say
01:49:56.920 you you like eating liver or heart or
01:49:59.400 skeletal muscle that somehow the amino
01:50:01.560 acids are selectively trafficed to the
01:50:03.119 organ uh of the heart or the liver or
01:50:05.360 the skeletal muscle there’s no evidence
01:50:07.119 of that whatsoever certainly not in
01:50:08.920 humans if there is evidence um I’m sure
01:50:10.760 they’ll let us know in the comment
01:50:11.800 section on YouTube and let let us know
01:50:14.320 but yeah it’s it’s it’s perplexing why
01:50:17.040 collagen would have a selectively
01:50:19.400 beneficial effect on skin they didn’t
01:50:21.040 study it versus a steak you know they
01:50:23.400 just they just looked at bone density if
01:50:25.920 they took this product every day for 5
01:50:27.639 years and what happened and they weren’t
01:50:30.320 you know they weren’t having tremendous
01:50:32.040 cardi metabolic disease they weren’t on
01:50:34.119 bone building medications they weren’t
01:50:35.800 on HRT so you know they they did a
01:50:38.560 pretty clean so there’s you know not a
01:50:40.000 huge study but it was interesting and I
01:50:41.840 thought okay you know I don’t want to
01:50:44.000 break because if I break my hip well 50%
01:50:46.239 of women will have an osteoporotic
01:50:48.000 fracture before they die 50% 50 what
01:50:51.360 about men do we know just by way of
01:50:52.840 comparison I think it’s 25 wow but don’t
01:50:55.560 quote me on that I need to look that one
01:50:57.199 up so it’s it’s about half okay and then
01:51:00.000 hip fracture if you if you break that
01:51:02.199 hip if over the age of 65 you have a
01:51:06.280 your one-year mortality with surgical
01:51:08.760 repair is 30% if you if you’re not
01:51:11.239 healthy enough to have the repair you
01:51:12.480 can’t afford to have it it’s 79 goodness
01:51:15.599 so that’s what we’re trying to avoid is
01:51:19.440 that you know and the tremendous if
01:51:23.239 you’ve seen the women who have
01:51:24.679 tremendous osteoporosis in their spine
01:51:27.119 and just how their lives are so hard and
01:51:31.599 how much pain they live in every single
01:51:33.119 day you know this a lot of this is
01:51:34.760 avoidable with aggressive you know being
01:51:37.239 aggressive and and intentional about
01:51:39.199 this and HRT can be a huge part of that
01:51:41.320 as well what I’m about to ask is a
01:51:43.440 little bit outside the box but I feel um
01:51:45.480 Fair asking given that um you know I’m
01:51:48.760 not a clinician but I have some
01:51:50.560 background and certainly understanding
01:51:52.199 of neurod degenerative uh conditions of
01:51:54.520 the eye and vision have you ever
01:51:57.000 observed in your patients that when they
01:51:59.199 get on hormone replacement therapy for
01:52:01.000 menopause that things that are typically
01:52:03.599 associated with aging like diminished
01:52:05.560 visual function um hearing you mentioned
01:52:08.719 tenus also called tentis I understand
01:52:10.599 but tenus I think we’ll do both tenus
01:52:13.400 cored and said tenus we’ll do both um
01:52:17.440 here that that they um they report
01:52:21.040 seeing better hearing better and any
01:52:22.880 kind of sensory Improvement or offset of
01:52:25.079 sensory loss so we know the data is
01:52:27.520 clear on dry eye and how that can affect
01:52:30.920 um but how it affects like the optic
01:52:33.679 nerve you know we know that estrogen is
01:52:36.360 anti-inflammatory so any kind of like
01:52:38.760 inflammatory condition in and around the
01:52:41.000 eye does tend to get better but we need
01:52:44.079 you know probably more data in this area
01:52:46.520 for hearing most of the research is
01:52:49.040 around tenus and vertigo so the the the
01:52:52.520 rate of which the crystals break off in
01:52:54.040 the ear accelerates in menopause and
01:52:56.119 people on HRT have less vertigo new
01:52:58.679 vertigo than they would have had before
01:53:01.280 and I forget what the pathophysiology I
01:53:03.400 wrote it in the book but I can’t think
01:53:04.760 of it right now um what the physiology
01:53:07.079 was behind why tenus increases in um
01:53:10.960 menopause but it’s due to the estrogen
01:53:12.719 levels declining you mentioned dry eye a
01:53:15.079 lot of people might hear dryeee and
01:53:16.320 think oh no big deal but actually dry
01:53:17.840 eye is one one of the most frustrating
01:53:20.639 things um to have and it’s a uh I
01:53:25.239 believe a many billions of dollars of a
01:53:27.599 year industry to find treatments for for
01:53:29.520 dry eye um so does estrogen replacement
01:53:31.960 therapy improve dry eye it does seem to
01:53:34.119 they have less incidents most of the
01:53:35.880 studies are just retroactive and they’re
01:53:37.520 looking at the incident of those things
01:53:39.040 on women HR on HRT for other reasons are
01:53:41.520 not and they just see especially like
01:53:43.280 frozen shoulders the best data there I
01:53:45.000 think and um what they see is a
01:53:47.520 decreased risk of occurrence and then if
01:53:49.760 they do have it they have a shorter
01:53:51.079 duration and easier cour you know easier
01:53:53.480 to treat if they’re on HRT fantastic so
01:53:57.320 um what are some of the cases where uh a
01:54:00.679 woman can’t or shouldn’t do hormone
01:54:04.199 replacement therapy and here we’re using
01:54:05.880 hormone replacement therapy is kind of a
01:54:07.560 proxy for for estrogen therapy yeah so
01:54:10.320 any hormone sensitive cancer a one of
01:54:13.480 the things a lot of women don’t
01:54:14.520 understand if you have dysfunctional
01:54:15.920 uterine bleeding that has not been
01:54:17.400 evaluated you should not start hormone
01:54:19.199 therapy because we don’t know if it’s
01:54:20.599 cancer so if you’re having really heav
01:54:23.320 especially if they’re heavy bleeding
01:54:24.960 clots out of nowhere you know something
01:54:27.119 unusual about the volume or the the
01:54:29.400 frequency of your bleeding you need to
01:54:31.199 go see a gynecologist and get that
01:54:32.599 evaluated before you start hormone
01:54:34.320 therapy okay it may not be anything
01:54:36.599 cancerous or tumorous it might just be
01:54:37.920 the hormone changes but that needs to be
01:54:40.040 evaluated um if known breast cancer no
01:54:42.679 if you’re actively having a blood clot
01:54:44.440 that you’re being treated for they’re
01:54:46.679 saying let’s hold off until that therapy
01:54:48.679 is
01:54:49.440 over um even if you’ve had a hormone
01:54:52.400 sensitive cancer including breast cancer
01:54:54.960 depending on the stage the type and and
01:54:56.760 it’s a very nuanced conversation does
01:54:58.719 not mean that you automatically
01:55:00.159 disqualified for hormone therapy after
01:55:02.320 your
01:55:03.079 treatment so that is one of the biggest
01:55:05.520 misconceptions out there if you have
01:55:07.560 really severe liver disease I’m not
01:55:09.159 talking about mild fatty liver disease
01:55:10.800 lots of menopausal women have that and
01:55:12.840 it does tend to get better with HRT if
01:55:15.280 you have severe liver disease that is
01:55:17.280 where estrogen begins to be metabolized
01:55:19.679 and so you could have abnormal
01:55:21.719 metabolism you don’t want that so that
01:55:23.800 you’re that’s going to keep you from
01:55:25.280 being a
01:55:26.280 candidate why do you think we’re seeing
01:55:29.400 or at least hearing about in my case uh
01:55:32.400 PCOS polycystic ovarian syndrome so much
01:55:35.320 more is it because people are aware is
01:55:37.480 it because I think two reasons one the
01:55:39.920 Obesity epidemic had led to more PCOS
01:55:42.520 that is definitely a risk factor for for
01:55:45.079 you know insulin resistance is usually
01:55:47.840 the the main pathophysiologic cause
01:55:50.040 behind PCOS and I a PCOS then PCOS
01:55:53.760 sufferer so I had it my whole
01:55:56.159 reproductive life um both but you’re not
01:55:58.560 obese at all no no they missed it
01:56:00.520 forever I was just stressed out medical
01:56:02.480 student which can potentially cause PCOS
01:56:05.320 with acne yeah I mean you you can have
01:56:07.840 PCOS is a symptom of something
01:56:10.599 biologically a barent turns out I’m
01:56:12.560 insulin resistant which is why you know
01:56:14.599 even though I’m thin and so we’ve had
01:56:17.679 higher increasing levels of obesity
01:56:19.320 which is a risk factor for that also
01:56:21.239 people are talking about about it and
01:56:22.800 that writing books about it Karen Tang
01:56:24.440 just published um it’s not Hyster wait
01:56:27.840 hysteria it’s uh it’s not hysteria and
01:56:31.040 she’s a gynecologic surgeon does a lot
01:56:32.840 of work around enetri so she has like
01:56:34.840 huge chapters on PCOS and how to
01:56:37.159 advocate for yourself and you know all
01:56:38.760 about the disease process so people
01:56:40.520 understand interesting what what are
01:56:42.440 some of the primary treatments for PCOS
01:56:44.199 is it going to be blocking androgens so
01:56:47.079 yes and so for me you know in all my
01:56:49.920 training it was always put them on birth
01:56:51.360 control because it w it it will suppress
01:56:55.480 ovulation and suppress the over
01:56:57.360 production of androgens in their system
01:56:59.400 so I was a very happy birth control
01:57:01.280 patient because I was thin for the obese
01:57:03.880 patients if we can help them lose weight
01:57:06.239 it does tend to they start ovulating
01:57:08.400 again and so now with the new go 1s a
01:57:13.119 lot of PCOS will probably resolve itself
01:57:17.560 and they’ll start ovulating again and go
01:57:19.000 back to normal Cycles that’s the
01:57:20.520 pregnancies that are happening from G
01:57:22.239 ones I see so glp1 associated1 babies
01:57:25.760 yeah gp1 we saw a surge of that when all
01:57:28.880 the patients the obese patients were
01:57:30.159 getting the gastric bypasses then they
01:57:31.679 get pregnant and so we were advising
01:57:34.199 them to not be pregnant until their
01:57:36.520 weight was stable for a year after
01:57:38.159 surgery because of the medical
01:57:39.719 implications of nutrition and pregnancy
01:57:41.960 but they were going to you know they
01:57:43.440 were so excited and CED and now their
01:57:45.639 libido’s up and and they’re you know
01:57:48.040 getting pregnant and um never really
01:57:50.560 needed contraception before and just
01:57:51.880 assum they’d still have trouble and so
01:57:54.239 now they’re ovulating and getting
01:57:55.679 pregnant and we’re seeing the same thing
01:57:56.800 with gop1 so I’m anyone listening out
01:57:59.000 there who’s prescribing a gop1 please
01:58:00.719 talk to your female patients about
01:58:02.440 contraception if they don’t want to be
01:58:03.719 pregnant very interesting and um
01:58:06.119 admittedly uh unforeseen uh implications
01:58:09.239 of glp1 as long as we’re there um what
01:58:11.760 are your thoughts onic monjaro um I
01:58:15.280 think that they can be a really
01:58:16.719 important tool for a lot of patients I
01:58:18.840 don’t think they’re for everyone I don’t
01:58:20.480 think people are being counseled
01:58:21.679 adequately a lot of them I mean in my
01:58:24.400 area outside of Galveston where I live
01:58:26.719 there are Med Spas giving out GOP ons
01:58:29.040 and as far as I can tell they’re just
01:58:30.639 giving them the meds and sending them
01:58:31.880 out the door I’ve had patients coming in
01:58:33.360 on it who were never counseled about the
01:58:35.560 potential for muscle loss so when I look
01:58:38.079 at a patient’s health I look at a
01:58:39.320 30-year plan right and so they come in
01:58:43.079 with a lifelong history usually of of
01:58:45.280 having a weight problem and a fat
01:58:46.920 problem and and here’s this medication
01:58:48.599 that’s going to take the food noise away
01:58:49.920 and help them focus on the habits that
01:58:52.239 are going to keep them healthy longer so
01:58:53.480 I do have patients that I’ve prescribed
01:58:54.760 it to we have a very long discussion
01:58:57.079 about adequate protein intake resistance
01:58:59.840 training you know I have a a way to
01:59:02.760 measure their muscle mass we are
01:59:04.159 tracking that every month for them every
01:59:06.040 month to six weeks while they’re you
01:59:07.920 know on the medication so women who are
01:59:10.800 on HRT with the glp1 have a 30%
01:59:13.480 increased weight
01:59:14.719 loss wow yeah yeah I appreciate that you
01:59:17.920 mentioned that the use of OIC monjaro is
01:59:22.320 not mutually exclusive with resistance
01:59:24.520 training and improved nutrition the way
01:59:26.520 it shows up on social media sort of like
01:59:28.119 people assume well you know you gotta
01:59:30.079 take great care of yourself and exercise
01:59:31.599 well great but there are also a number
01:59:33.360 of people that are carrying excess
01:59:34.639 weight to the point where um they are at
01:59:37.599 risk of injury when they exercise um I
01:59:39.880 mean everyone’s at risk of injury when
01:59:41.159 they exercise but what I’m hearing is
01:59:42.920 that you basically take the view
01:59:44.520 whatever can get people in a kind of
01:59:46.320 forward Center of mass around management
01:59:48.560 of blood insulin levels Etc cuz wasn’t
01:59:50.599 that the original FDA approval
01:59:53.920 diabetes diabetes um and there’s also
01:59:56.199 some dat I recall that OIC monjaro can
02:00:00.159 reduce alcohol cravings that so yeah the
02:00:02.960 reward center in the brain are the the
02:00:04.840 noise so they’re looking now I guess
02:00:07.800 that my friends who are like obesity
02:00:09.400 Medicine Specialists and are all like
02:00:10.840 reading every study that comes out any
02:00:12.880 kind of impulsive behavior or
02:00:14.440 reward-seeking behavior gaming gambling
02:00:18.840 alcohol you know people are tending to
02:00:21.520 do less of those behaviors because
02:00:24.079 whatever the whatever is being blocked
02:00:25.880 in the brain and you know more about
02:00:27.040 this than I do seems to help with that
02:00:30.400 those drives that’s interesting that the
02:00:32.520 hypothalamus is uh choca block full of
02:00:35.040 neurons associated with all sorts of
02:00:36.360 drives and temperature regulation you
02:00:37.719 mentioned earlier you know the preoptic
02:00:39.440 area of the of the hypothalamus involved
02:00:41.719 in temperature regulation and we’ve
02:00:43.880 always viewed those as somewhat separate
02:00:46.079 but they’re actually um quite
02:00:48.079 interconnected and and so I’m not
02:00:49.880 entirely surprised that uh a drug that
02:00:52.920 would reduce cravings for food might
02:00:54.360 also reduce cravings for other things
02:00:55.840 it’s going to be really interesting to
02:00:57.040 see um what the science and the animal
02:00:59.320 models and human shows us over time it’s
02:01:01.599 definitely happening I mean this is has
02:01:03.840 it hit a trillion dollar industry yet
02:01:05.520 it’s probably hundreds of billions of
02:01:06.760 dollar know the majority of big F
02:01:09.920 research and funding is is being
02:01:11.639 funneled into this um maybe not all for
02:01:15.239 the right reasons but the the Obesity
02:01:16.880 Medicine Specialists who are kind of who
02:01:18.480 I turned to for how do how do I do this
02:01:20.920 how do I do it right
02:01:22.520 um how do I not hurt someone just to get
02:01:24.199 them to lose weight you know and are
02:01:28.119 very excited because these new levels
02:01:30.639 they say it’s like the iPhone 12 the
02:01:32.000 iPhone 13 like they’re just going to get
02:01:33.440 better and better with Lower Side
02:01:34.800 Effects better profiles you know as time
02:01:37.000 goes on that we’re going to look back at
02:01:39.440 the mjo and these earlier meds and be
02:01:42.480 like oh my God what were we doing you
02:01:44.480 know because of the side effects well if
02:01:46.520 nothing else there very interesting to
02:01:48.199 pay attention to because it’s uh clearly
02:01:51.480 uh in the cultural Zeitgeist right now
02:01:55.040 so every once in a while when a guest
02:01:58.119 for whom the topic is of immense
02:02:00.320 interest coming on the podcast I’ll put
02:02:02.400 out a call on social media for questions
02:02:04.920 and so uh if you’re willing I’d like to
02:02:07.639 just ask you a few of the audience
02:02:09.719 questions um and U we can treat these as
02:02:13.159 rapid fire or um as much depth as you
02:02:16.760 like um first off that many of the
02:02:19.320 questions you’ve already answered things
02:02:21.199 like um what the role for testosterone
02:02:23.360 replacement therapy in women um as
02:02:25.960 opposed to just estrogen replacement
02:02:27.679 therapy but one of the more common
02:02:29.679 questions in here that uh We’ve touched
02:02:31.760 on but I think could um uh deserve a bit
02:02:35.360 more attention is you know if a woman is
02:02:37.880 in her 60s and has already gone through
02:02:40.119 menopause is it appropriate for her to
02:02:42.239 consider or at least just talk to her
02:02:43.800 doctor about hormone replacement therapy
02:02:45.599 or she putting herself at risk there’s
02:02:47.760 definitely worth the conversation so if
02:02:49.840 I have a patient who comes in and she
02:02:51.840 she’s she’s more than 10 years passed
02:02:53.719 her menopause or over the age of 60 and
02:02:55.639 has not been on
02:02:57.199 HRT then we start looking at risk
02:03:00.159 factors for cardiovascular disease or
02:03:01.960 stroke and so we’re looking at her blood
02:03:05.280 pressure her lipids her you know
02:03:08.159 cholesterol and triglycerides and
02:03:09.800 looking for things that are going to put
02:03:11.679 her at higher risk she’s lost probably
02:03:15.280 the maximum cardiovascular benefit but
02:03:18.119 we don’t want to put estrogen on top of
02:03:20.199 severe atherosclerotic disease so if she
02:03:23.119 has abnormal cholesterol I’m going to
02:03:25.480 send her for a calcium cardiac score I
02:03:27.760 want to see if there’s calcified plaques
02:03:29.760 around her heart I may even if if stroke
02:03:32.079 is a risk we may even Cent her for an
02:03:33.760 ultrasound you know looking at the
02:03:35.119 intimal thickness um of the kateed so if
02:03:38.360 those are normal or lowrisk then we will
02:03:41.920 talk about the benefits of what what
02:03:45.119 would the benefits be for her after the
02:03:46.679 age of 60 will we probably lost the best
02:03:48.880 of the cardiovascular protection but it
02:03:51.119 will always protect her bones it will
02:03:53.679 always protect her genital urinary
02:03:55.320 system it will always protect her skin I
02:03:57.239 mean there’s things that estrogen will
02:03:58.800 do for us forever and so and then let
02:04:01.440 her make the decision certainly if she’s
02:04:03.320 still symptomatic meaning hot flashes or
02:04:05.320 things we can easily identify that we
02:04:07.320 know estrogen will help with but you
02:04:09.639 know that first tenear window is kind of
02:04:11.679 critical for the preventative benefits
02:04:14.520 but it doesn’t mean she’s not going to
02:04:15.760 benefit forever now when do we stop used
02:04:18.719 to be doctors make up numbers three 10
02:04:21.400 years whatever if she’s been on it since
02:04:24.760 early in her menopause and has not
02:04:26.920 developed any of these diseases and she
02:04:29.079 wants to keep going we’re going to keep
02:04:30.719 her on I will probably die with my
02:04:33.040 estradiol patch on if I don’t develop a
02:04:36.079 reason to take it off because I know
02:04:37.920 it’s protecting me in so many levels and
02:04:40.079 I want to keep that
02:04:41.639 going in so many ways it sounds very
02:04:43.920 similar to testosterone replacement
02:04:45.679 therapy and Men the ideas that people go
02:04:47.559 on why you stop at 70 why would you do
02:04:49.559 that right you know if you didn’t
02:04:51.360 develop a contraindication to it very
02:04:53.920 clear and um potentially very actionable
02:04:57.000 answer thank you um a number of the
02:04:59.920 questions related to um the relationship
02:05:03.679 between menopause hormone therapy and
02:05:06.520 mental health mental well-being um but
02:05:09.800 let’s just keep it simple for now and
02:05:12.520 ask what are the things that women can
02:05:14.719 do in order to um optimize or their
02:05:18.079 mental health in per menopause and
02:05:20.280 menopause and that they can do to offset
02:05:24.040 any mental health issues that might
02:05:25.599 arise during per menopause and menopause
02:05:27.679 and there’s a reason why I asked about
02:05:28.920 those two things separately one is just
02:05:30.360 to very different than menopause for
02:05:33.239 mental health so a great question so I
02:05:35.880 just went to a menop posium menopause
02:05:38.719 conference in
02:05:40.960 Chicago and uh there was a whole section
02:05:43.760 on mental health and it was uh
02:05:45.679 neuroscientist psychiatrists and and
02:05:47.840 menopause Specialists all up there
02:05:49.880 discussing the latest data it was so f
02:05:51.639 fascinating and so there really is a big
02:05:53.920 difference as far as mental health for
02:05:55.679 what’s happening in per menopause and
02:05:57.480 what’s happening postmenopause and as we
02:05:59.360 talked about earlier in per menopause we
02:06:01.360 have that hormonal zone of chaos and we
02:06:04.360 see this you know in the Australian data
02:06:06.440 it’s a four times risk of mental health
02:06:08.480 disorders especially
02:06:10.199 depression and then in
02:06:13.360 postmenopause a lot of these things tend
02:06:15.599 to stabilize or get better probably
02:06:17.719 because just the estrogen is bottomed
02:06:19.119 out and the brain is not having to deal
02:06:20.719 with these fluctuations
02:06:22.840 so we think that the data is looking
02:06:26.599 like the best treatment for the mental
02:06:29.840 health issues in per menopause is going
02:06:32.040 to be
02:06:33.920 estrogen for stabilization and not the
02:06:37.199 traditional ssris snris you know the
02:06:39.800 anti-depressants and the anxiety meds
02:06:42.440 not incidentally uh one of the more
02:06:44.400 common questions was um in this case
02:06:46.880 very specifically worded I’ve been on
02:06:48.840 HRT for 5 years and I’m 61 I feel great
02:06:51.119 but how long as it quote unquote okay to
02:06:52.840 be on them seems like I hear conflicting
02:06:54.679 opinions well we just heard a very
02:06:55.880 straightforward opinion from you so
02:06:57.520 thank you for that as long as you want
02:06:58.639 to be as long as you’re still
02:07:00.719 healthy how can I stop waking up in the
02:07:02.920 middle of the night this is a problem
02:07:05.400 since entering menopause MH so we see
02:07:09.960 sleep disruptions definitely from not
02:07:12.960 only from the vasomotor symptoms which
02:07:15.199 will wake you up okay if we can get
02:07:17.639 those under control you know your sleep
02:07:19.800 function should not be affected by that
02:07:22.520 what we’re seeing though is people even
02:07:24.960 with HRT even with estrogen are still
02:07:27.400 having middle of the night Awakenings or
02:07:29.159 racing thoughts or having they get up to
02:07:31.040 pee or something in the middle of the
02:07:32.520 night and they can’t go back to bed
02:07:33.639 usually because their brain is is going
02:07:35.239 on what we found is that progestin
02:07:37.599 probably through the effects of Gaba is
02:07:40.440 very effective at settling your brain
02:07:43.400 down and allowing for sleep so I’m
02:07:45.679 having my patients take their
02:07:47.360 progesterone Orly at night before they
02:07:49.920 go to bed and we’re seeing better sleep
02:07:52.520 with that and that was also something
02:07:54.239 covered in detail I was so excited by
02:07:56.520 the neuroscientist that’s part of her
02:07:58.000 area of research that they are showing
02:07:59.840 clearly and she can point to the neuro
02:08:01.559 receptors of where that’s happening that
02:08:04.199 progesterone seems to be really
02:08:06.000 protective for our sleep now take
02:08:08.159 hormones off the table sleep hygiene is
02:08:10.760 still hugely important and I need to see
02:08:14.040 the studies to prove it but I’m telling
02:08:15.719 you we do not tolerate alcohol like we
02:08:18.040 did Prem menopausal women are in at
02:08:21.679 least 90% every time I post about it
02:08:23.440 online I see thousands of comments of I
02:08:26.119 quit I had to give it up I cannot sleep
02:08:28.119 and even in my own life if I choose
02:08:29.800 socially to have more than a glass of
02:08:31.360 wine I am giving up sleep like it is a
02:08:34.079 choice I’m choosing not to sleep that
02:08:35.760 night I will wake up 2:23 3:35 whatever
02:08:38.960 time in the morning sweating and I’m
02:08:41.199 like you know too much champagne at New
02:08:44.400 Year’s or whatever so you know that is a
02:08:46.800 choice and it’s something I counsel my
02:08:48.040 patients about like you probably can’t
02:08:49.880 tolerate alcohol like you used to aging
02:08:51.840 is a factor here our body composition
02:08:53.400 changes and there’s probably something
02:08:54.639 hormonally that’s going on we don’t
02:08:56.320 understand yet but like you choose this
02:08:59.040 you’re going to choose not to sleep more
02:09:00.480 than likely interesting I wonder whether
02:09:02.239 or not um estrogen modulates the alcohol
02:09:04.559 dehydrogenase enzyme but uh time hav’t
02:09:07.520 seen the data yet but I’m sure it’s
02:09:08.639 coming here’s an interesting One how can
02:09:11.719 men help their female loved ones
02:09:13.880 navigate these stages yeah you get that
02:09:16.239 question a lot my and it’s it’s great
02:09:18.800 and it always comes on the when I’m
02:09:20.199 being interviewed by a male you know
02:09:21.679 when I’m interviewed by a female they’re
02:09:23.840 wonderful but they they have their own
02:09:25.679 experience and they have to talk about
02:09:27.320 it and that’s fine that’s my job you
02:09:28.960 know is women have to unpack their
02:09:30.320 menopause trauma to me but the men are
02:09:32.320 just so curious and just have so many
02:09:33.880 questions and then how can I support a
02:09:35.599 partner and or my mom or whomever in my
02:09:38.199 life who’s who’s dealing with this one
02:09:40.239 is is acknowledge that this is happening
02:09:42.360 and and try to educate yourself there’s
02:09:44.159 my book other books there’s lots of
02:09:45.679 information now on the internet about
02:09:47.280 the subject but she is going through a
02:09:49.840 transition that is in her world more
02:09:52.320 than likely and is affecting her brain
02:09:54.239 her bones her heart her kidneys her skin
02:09:56.559 her ability to relate her ability to
02:09:58.360 tolerate it’s probably going to affect
02:09:59.800 your relationship in some way go there
02:10:02.679 with her go to the appointments with her
02:10:04.520 be there to advocate for her you know be
02:10:06.920 a partner through this with her because
02:10:08.559 you will get her back but it’s going to
02:10:10.880 take you know changing the way that you
02:10:12.480 address things a couple of questions
02:10:14.840 about quote how to rekindle libido oh
02:10:18.199 yeah this person in particular says it’s
02:10:20.719 packed bags and moved out since I
02:10:22.679 started menopause they’re reporting
02:10:24.239 their individual experience but um you
02:10:26.440 touched on testosterone therapy earlier
02:10:28.639 any woman
02:10:30.840 in her menopause Journey at any time
02:10:33.840 there’s a 50% sexual dysfunction rate
02:10:37.559 meaning she’s not happy with whatever is
02:10:39.639 going on now when we look at the buckets
02:10:41.520 where sexual function fall into we have
02:10:43.559 orgasmic disorder now in menopause when
02:10:46.199 we lose blood flow to the area people
02:10:48.199 can have delayed orgasms or less um the
02:10:52.199 peak of the orgasm is lower you know
02:10:54.360 less vibrant orgasms for lack of a
02:10:56.440 better word um they have decreased blood
02:10:59.559 flow to the area they lose elasticity so
02:11:01.719 pain is another bucket you know it hurts
02:11:04.440 the skin gets torn it’s very fragile
02:11:06.639 it’s very Frable so vaginal estrogen
02:11:09.320 therapy can help there there is arousal
02:11:11.520 disorders where you want to do it but
02:11:13.920 the blood’s not getting where it needs
02:11:15.360 to go so you’re not having all the
02:11:17.480 arousal type symptoms so sometimes
02:11:19.960 Viagra selenophile topical selenophile
02:11:22.239 can be helpful there there and but the
02:11:24.280 most common thing that women have is hsd
02:11:27.199 or of course relationship disorder you
02:11:29.000 don’t love your partner you don’t feel
02:11:30.159 supported it’s going to be hard to you
02:11:31.960 know relationship disorder official the
02:11:34.119 official term so but then hsdd is
02:11:36.280 hypoactive sexual desire disorder that’s
02:11:38.159 in the brain and so first thing I ask is
02:11:40.760 did you use to have a good libido or a
02:11:42.920 drive yes you know and you have a good
02:11:45.119 relationship with your partner it
02:11:46.159 doesn’t hurt you we have to rule out the
02:11:47.639 other things that’s where testosterone
02:11:50.119 comes into play that that is those
02:11:51.960 patients it does tend to help there are
02:11:53.800 two FDA approved medications for libido
02:11:55.800 one is VII it’s an injection you give
02:11:58.079 yourself and actually works for men as
02:11:59.520 well about 30 minutes before it’s in the
02:12:01.440 alpha melany stimulating hormone path
02:12:03.400 mordon and then there is um Addie addyi
02:12:07.480 works at the level I think of dopamine
02:12:09.440 in the brain so it’s more in the family
02:12:11.440 of ssris that you know so it affects
02:12:14.199 neurotransmitter and so you take that
02:12:16.280 every day um and it works it was only
02:12:19.880 studied in premenopausal women but it
02:12:21.960 does you know it’s modest but it does
02:12:23.400 seem to have an effect so but most of my
02:12:26.239 patients
02:12:27.599 because testosterone has so many other
02:12:29.880 benefits you and then the the cost the
02:12:32.239 to get it compounded in Texas is maybe
02:12:34.159 30 bucks a month so it’s really
02:12:35.760 reasonable um and the V and the atti can
02:12:38.400 be very expensive and usually not
02:12:39.639 covered by insurance so because of cost
02:12:42.119 and and potential other effects most of
02:12:43.920 my patients choose testosterone if it’s
02:12:45.639 hsdd I see this is a question about the
02:12:49.079 um side effects associated with estrad
02:12:52.440 hormone replacement therapy in this
02:12:54.639 particular instance um the person says
02:12:57.559 um what are the best alternatives to
02:12:59.760 estrad I’ve tried tiny amounts and the
02:13:01.960 side effects in this case um skin rashes
02:13:04.239 and hives are what they are describing
02:13:06.040 so I wonder if it’s the patch so um
02:13:08.559 there’s a certain percentage of patients
02:13:10.040 who it’s not the estradiol it’s actually
02:13:11.840 the adhesive in the patch they will have
02:13:14.000 a reaction to it so one is try an
02:13:16.520 alternative form another thing that one
02:13:19.000 of the members on my team saw in her her
02:13:21.239 chat group is they get the flon so
02:13:23.599 corticon nasal spray over the counter
02:13:25.639 and they spray it on and let it dry then
02:13:27.520 they put the patch on and it decreases
02:13:29.280 the risk of the reaction to the glue um
02:13:32.079 I don’t know how if that lasts forever
02:13:33.880 but I thought that was a cool thing to
02:13:35.159 know about and um but what I typically
02:13:37.719 do for my patients is change them to an
02:13:39.760 alternative form interesting um thank
02:13:42.480 you for that they went on to ask about
02:13:44.920 um trying a new supplement called equil
02:13:48.199 EQ u e l e about that one again I don’t
02:13:52.159 know what’s an equil um but again not
02:13:55.040 really robust studies but most of these
02:13:57.239 things are not harmful but you may just
02:13:59.639 it may be a little snake oil you know
02:14:01.719 throwing your money away really the
02:14:03.199 thing that’s going to fix the problem
02:14:04.880 for most women is restoring your estr
02:14:07.840 yeah because there were other questions
02:14:09.040 about you know wild yam and and things
02:14:12.040 more in the supplement um space um as
02:14:14.760 well as things like acupuncture and
02:14:16.199 herbal medicine so um acupuncture can
02:14:19.719 really be helpful
02:14:22.000 um but again it’s it’s hard to access
02:14:24.199 and can be expensive for a lot of
02:14:25.559 patients and it’s not treating the root
02:14:26.800 CA but it definitely can help you deal
02:14:28.800 with some of the symptoms and make you
02:14:29.960 more comfortable and then um last
02:14:32.400 question um how best to attack and here
02:14:35.599 I’m quoting attack the fat distribution
02:14:37.679 problem at this time yeah uh you need a
02:14:39.760 multifactoral approach to visceral fat
02:14:42.639 so nutrition exercise women on HRT have
02:14:46.440 less visceral fat you know um those are
02:14:49.480 kind of the key things and and the way
02:14:51.440 you approach your nutrition with the
02:14:53.079 exercise with the stress reduction
02:14:54.800 getting those cortisol leveled down are
02:14:56.079 going to make you healthier in every
02:14:57.360 other way as well great well Dr Mary CLA
02:15:02.960 um thank you so much for giving us just
02:15:06.400 a wealth of knowledge about per
02:15:08.360 menopause menopause really explaining
02:15:10.360 what those are clearly um for the first
02:15:13.599 time on this podcast and really
02:15:16.520 illustrating the things that people can
02:15:18.040 do to think about these stages of life
02:15:20.559 and to to I don’t know if I should say
02:15:22.480 tackle or to dance with the stage of
02:15:24.960 Life whatever um term one prefers in
02:15:27.960 order to offset the negative effects and
02:15:31.159 it sounds like in fact it’s very clear
02:15:33.199 based on what you’ve told us that there
02:15:34.360 are real levers of control yeah
02:15:37.400 including hormone replacement therapy
02:15:38.880 but other things as well
02:15:40.760 nutrition exercise um sounds like when
02:15:44.199 we put all these together there’s almost
02:15:45.360 like a mindset around per menopause and
02:15:47.599 menopause that you are um promoting um
02:15:51.000 which is one of of real agency that this
02:15:53.440 is not something that is um going to
02:15:56.040 bury us mentally and physically that’s
02:15:57.920 something that really can be worked with
02:15:59.320 and I just want to say on behalf of
02:16:00.960 myself because I’ve learned so much from
02:16:02.320 you here and uh the listeners and and
02:16:04.559 viewers of the podcast thank you for the
02:16:07.159 information today thank you for your
02:16:09.520 clinical work um thank you for your
02:16:11.480 ongoing Research into this area for
02:16:13.119 attending these conferences and learning
02:16:14.599 so much about it so you can bring us the
02:16:16.480 latest and thanks for your public
02:16:18.800 education efforts because they are
02:16:20.719 really really making a tremendous
02:16:22.079 difference thank you thank you for
02:16:24.480 joining me for today’s discussion with
02:16:26.079 Dr Mary CLA Haver to learn more about
02:16:28.440 her work please see the link to her
02:16:29.960 website in the show note caption as well
02:16:32.160 as the link to her terrific book the new
02:16:34.200 menopause navigating your path through
02:16:36.240 hormonal change with purpose power and
02:16:38.679 the facts if you’re learning from Andor
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02:18:02.920 you once again for joining me for
02:18:04.240 today’s discussion about per menopause
02:18:06.359 and menopause with Dr Mary Clare Haver
02:18:09.398 and last but certainly not least thank
02:18:11.718 you for your interest in science
02:18:16.080 [Music]