Mastering Menopause: The Truth About Hormones and Weight Gain

# Women Learn This Too Late! Truth About Weight Gain, Fatigue, Hormones & Menopause | Dr. Cindy Geyer
# https://www.youtube.com/watch/jKJFbieEHks

00:00:00.040 there are a whole lot of hormones in our
00:00:01.760 bodies it’s not just estrogen and
00:00:03.800 progesterone which start to oscillate in
00:00:06.080 the menopause transition but all of
00:00:07.839 those hormones are talking to each other
00:00:09.840 we’re kind of going to get deep into it
00:00:11.240 today we’re going to talk about some
00:00:12.440 cases uh you know at the ultra Wellness
00:00:14.120 Center we’ve been doing this work for a
00:00:15.400 long time before that at Kenya Ranch we
00:00:17.199 work together we’ve been doing that for
00:00:19.199 a long time and you know I think we cut
00:00:21.080 our teeth on this topic because the
00:00:23.800 people who came to Kenya Ranch were
00:00:25.359 generally women between their 40s and
00:00:27.240 60s and so basically our entire PA
00:00:30.119 ulation was Perry and pre and
00:00:32.800 postmenopausal women which forced us to
00:00:35.320 learn a lot about this whether we liked
00:00:37.360 it or not and uh and also it was
00:00:40.239 interesting because I remember early on
00:00:43.800 we were we were getting hints from early
00:00:46.640 data that premine and proa the hormones
00:00:49.800 that were being at the time were were
00:00:51.879 concerning and that that I remember a
00:00:54.280 woman coming up to me at one of the
00:00:55.399 lectures at kyya ranch when we were
00:00:57.320 there and uh and she said
00:01:00.559 because I was giving a talk about
00:01:01.559 menopause and I was saying well how
00:01:02.800 hormones might be risky and you know we
00:01:04.959 still don’t really have enough data and
00:01:07.280 they’re
00:01:08.720 concerning and she said to me Dr Heyman
00:01:11.560 my doctor said if you don’t prescribe
00:01:13.920 prent prar to me it’s
00:01:15.840 malpractice wow and I was like okay and
00:01:19.080 you know a lot of this sort of push
00:01:20.759 towards the the hormones for everybody
00:01:23.640 came from a large study called the
00:01:25.520 nurse’s health study which was a
00:01:27.960 populationbased observational study
00:01:30.400 essentially where they track people over
00:01:32.759 time this case nurses out of Harvard and
00:01:36.079 they tracked them for years and years
00:01:37.439 and they gave them questionnaires what
00:01:38.680 did you eat how much you exercise did
00:01:40.240 you take hormones what did you do and
00:01:42.880 and it looks for patterns in the data is
00:01:45.399 there a correlation between smoking and
00:01:47.840 heart disease there a correlation
00:01:49.040 between eating lowfat diets and heart
00:01:51.360 attacks or between taking hormones and
00:01:54.200 your risk factors and your risk of
00:01:56.719 different diseases and so they saw
00:01:58.520 certain patterns in this data that were
00:02:01.159 in the early 70s that showed that women
00:02:02.880 who took hormones seem to do better in
00:02:05.079 every way they had less dementia less
00:02:07.240 heart disease less breast cancer they
00:02:08.800 were great and so that’s when everybody
00:02:11.680 piled on and was like okay everybody
00:02:13.680 needs to take hormones and that’s where
00:02:15.599 This Woman’s doctor was coming from was
00:02:17.840 based on this data but correlation does
00:02:20.160 not mean
00:02:21.519 causation and and and I’m starting at a
00:02:23.920 high level here because we’re going to
00:02:24.879 get into the cases and the story and
00:02:26.519 what to do and all that but I I want to
00:02:28.239 kind of start set the stage here because
00:02:30.239 at a very high level this was a
00:02:33.200 show because what happened was nobody
00:02:36.879 actually studied it and actually looked
00:02:38.560 at a randomized controlled human trial
00:02:40.840 on whether hormones did what we thought
00:02:43.080 they did or not and you know every day
00:02:45.200 the sun comes up and I wake up it
00:02:47.120 doesn’t mean they had anything to do
00:02:48.400 with each other right it’s 100%
00:02:50.200 correlation but zero causation right and
00:02:53.560 and so what turned out to be was this
00:02:55.920 healthy user effect in this Nur Health
00:02:57.519 State the women who actually took the
00:02:59.840 the hormones were the ones who went to
00:03:01.159 the doctor and took care of themselves
00:03:02.800 and had their check offs and exercise
00:03:04.560 and ate better so it wasn’t the hormones
00:03:06.360 it was everything else that protected
00:03:07.519 them and when they finally did the
00:03:08.680 women’s health study which was a billion
00:03:10.280 dollar study of like 160,000 women I
00:03:12.640 think the and we’re going to get into
00:03:14.360 the the issues with it in in a little
00:03:16.000 bit uh that that study was commissioned
00:03:18.840 by bernon Healey who was the first woman
00:03:20.920 to head the NIH said you know what men
00:03:22.599 and women are different we haven’t study
00:03:24.000 women how about we do that and they did
00:03:26.360 it except it was a very flawed study and
00:03:28.680 it kind of led to a lot of backlash and
00:03:30.599 all of a sudden everybody went from the
00:03:32.519 entire menopausal cohort of women in
00:03:35.040 America taking hormones to the next day
00:03:37.000 they’re going to kill you stopped them
00:03:38.280 and all of a sudden it was Mayhem and
00:03:40.439 women were suffering and all these
00:03:41.799 withdrawal symptoms and it was it was a
00:03:44.040 disaster so we we’re kind of in a new
00:03:46.239 era where we have a more nuanced
00:03:47.760 sophisticated View and that’s really
00:03:49.519 what we do at the ultra Wellness Center
00:03:51.319 in lenx we we really take a very
00:03:52.840 sophisticated deep view uh an analysis
00:03:55.599 of people’s overall health their
00:03:57.079 hormonal Health their metabolic Health
00:03:58.519 their genomics your gut microbiome and
00:04:00.879 then you call it the estrobolome which
00:04:02.319 is something you probably never heard
00:04:03.519 about which is we’ll get into which is
00:04:04.840 how your microbiome affects your
00:04:06.120 hormones right and we do a really deep
00:04:08.079 personalized approach and we figure out
00:04:10.040 who needs them who doesn’t which ones
00:04:11.360 you should get and which ones you
00:04:12.319 shouldn’t get and and how actually not
00:04:14.480 just how to use hormones but how to use
00:04:16.519 all the other tools we have in
00:04:17.639 functional medicine to optimize a
00:04:20.199 women’s health trajectory through the
00:04:21.440 course of their life so with that
00:04:23.880 intro Cindy I I I want to kind of have
00:04:27.040 you sort of it break down you know
00:04:30.320 um the the issue of of menopause in our
00:04:32.720 society because you know when we were a
00:04:34.520 cany ranch remember learning that you
00:04:36.080 know women in Japan had no word for hot
00:04:38.400 flashes right so I was like I don’t know
00:04:40.560 if that’s true or not but it it was kind
00:04:42.360 of a myth or something and I was like
00:04:44.960 well all right well that means not
00:04:47.000 everybody’s suffering from the same
00:04:48.280 symptoms right um so uh talk about this
00:04:52.360 transition that happens to women when
00:04:53.960 does it start um you know how does it
00:04:56.840 progress because it’s not like okay one
00:04:58.160 day you’re fine and the next day you
00:04:59.199 have menop
00:05:00.199 it’s just a lot of changes happen in
00:05:01.919 every cycle of a woman’s life from
00:05:04.560 puberty to adolescence to 20s the 30s
00:05:08.240 the 40s to 50s and so it’s really about
00:05:10.680 understanding all that trajectory so
00:05:11.919 take us through you know what happens in
00:05:14.000 an optimal way and what could happen and
00:05:16.240 then what typically happens for women
00:05:17.800 and why so that’s a great setup Mark and
00:05:21.080 I think the really important thing to
00:05:22.600 recognize is women are not a monolith
00:05:24.479 we’re not all the same we come into this
00:05:26.680 with to this whole transition phase
00:05:28.240 which we’re going to explain a little
00:05:29.199 bit in a minute it with different sets
00:05:31.160 of expectations different things going
00:05:32.800 on in our lives different genetics
00:05:34.880 different relational concerns different
00:05:36.960 dietary habits Etc so life exposures yes
00:05:40.400 and how a given woman is going to
00:05:41.960 experience that transition is all over
00:05:43.560 the map yeah and what we’re talking
00:05:45.400 about menopause itself is a very narrow
00:05:47.880 window in time it’s defined as one year
00:05:50.120 past your last menstrual period right
00:05:52.800 but the transition phase that’s when
00:05:54.479 your hormones start to oscillate all
00:05:56.680 over the map can start as early as a
00:05:59.080 decade before for that last period so
00:06:00.840 that means for some women late 30s early
00:06:02.840 40s their bodies are giving them little
00:06:04.919 clues that things are shifting and it
00:06:07.280 can be anywhere from okay your periods
00:06:09.440 start to get a little more irregular
00:06:11.360 they get longer or they get shorter um
00:06:13.880 some women will start to experience
00:06:16.039 significant hot flashes and night sweats
00:06:18.000 what we call the vasomotor symptoms of
00:06:19.639 menopause yeah they might have more mood
00:06:21.680 shifts around their periods if they’re
00:06:23.360 prone to having per menstral migraines
00:06:25.680 those can get worse more intense more
00:06:27.319 frequent so there’s a lot going on sleep
00:06:30.000 disruption starts to happen um more
00:06:32.680 irritability so there’s a lot of SYM
00:06:35.000 cyes heavier Cycles or long Cycles yeah
00:06:38.240 all the everything everything goes klui
00:06:39.960 right that’s some women there are other
00:06:41.639 women we do see them Mark regular
00:06:44.120 periods like clockwork they wake up one
00:06:45.880 day they don’t have another one and
00:06:47.000 that’s it that’s right but that’s not
00:06:49.000 the majority right and historically
00:06:51.759 because women were still getting periods
00:06:53.400 they weren’t technically at menopause so
00:06:55.240 the hormone conversation wasn’t really
00:06:57.199 on the radar at the time or just give
00:06:59.240 the pill
00:07:00.199 or just take the premine and you’ll be
00:07:01.840 fine honey no no conversation about what
00:07:03.919 else is going on right so Cindy how how
00:07:06.400 how is it that women experience these
00:07:08.960 transitions differently are there
00:07:10.479 factors that are causing women to have
00:07:12.120 worse menopausal symptoms and Par
00:07:14.240 menopausal symptoms and other people
00:07:15.759 just to sail through like the Japanese
00:07:17.639 women who don’t have a word for hot
00:07:18.879 flashes like what’s the deal so there
00:07:21.400 are there are can be genetic pieces to
00:07:23.319 it so for some women we don’t understand
00:07:25.400 exactly why but genetics can play a role
00:07:27.440 if your mother had a rocky or course um
00:07:29.639 with a lot of symptoms you might be more
00:07:31.199 predisposed to that we know that women
00:07:32.919 who have a history of hormonally related
00:07:35.720 symptoms for example PMS pmdd uh
00:07:39.759 postpartum depression may also be more
00:07:42.479 likely to have the mood swings as the
00:07:44.879 per menopause transition occurs as well
00:07:47.000 so some Clues from your past history
00:07:49.280 nutrition plays a huge role yeah um for
00:07:52.599 example coffee is a pretty notorious hot
00:07:55.360 flash trigger alcohol is a pretty
00:07:57.120 notorious hot flash trigger OS ations in
00:08:00.039 blood sugar stress can all be hot flash
00:08:02.759 triggers so depending on a woman taking
00:08:04.800 away all the fun coffee sugar and
00:08:06.000 alcohol I know it’s a bummer isn’t
00:08:08.240 it but it means that some of the foods
00:08:10.720 and substances you ingested in your 20s
00:08:12.960 and 30s really can contribute to
00:08:15.240 symptoms in your 40s and 50s yeah or
00:08:17.319 even this food you’re eating then like
00:08:18.560 if you’re drinking a lot and drinking a
00:08:19.879 lot of coffee and having a lot of
00:08:21.400 alcohol and eating a lot of sugar and
00:08:23.120 refined carbs it’s going to make this
00:08:24.840 whole process a lot worse for you right
00:08:27.039 right and we also know that when we we
00:08:28.919 think about hormones there are a whole
00:08:30.759 lot of hormones in our bodies it’s not
00:08:32.679 just estrogen and progesterone which
00:08:34.958 start to oscillate in the menopause
00:08:36.640 transition but all of those hormones are
00:08:38.839 talking to each other think people talk
00:08:40.599 about the hormone soup or the yeah the
00:08:42.479 hormone dance because we have insulin
00:08:44.640 for example and we know as estrogen
00:08:46.839 levels start to go down we become less
00:08:49.839 sensitive to the impact of insulin so
00:08:51.880 our ability to regulate blood sugar
00:08:54.279 deteriorates or can go down so that can
00:08:56.120 make us more prone to those blood sugar
00:08:57.760 swings as I mentioned that can trigger
00:08:59.120 hot FL flashes and a lot of women
00:09:00.399 complain about that extra weight around
00:09:01.560 the middle that they get around
00:09:03.240 menopause too which is related to what
00:09:04.959 you’re talking about absolutely
00:09:06.360 absolutely and of course thinking down
00:09:08.160 the road that’s also setting the stage
00:09:09.920 for higher risk of cardiometabolic
00:09:11.760 disease diabetes heart disease and ctive
00:09:14.440 issues down the road so it’s not just
00:09:16.040 about symptoms yeah that’s why women
00:09:17.560 sort of delayed a little bit in getting
00:09:18.959 heart attacks but it’s because of the
00:09:20.360 protection they had early on right yeah
00:09:22.600 we know there’s an interplay with
00:09:23.720 cortisol uh stress hormones um that the
00:09:26.959 as estrogen goes down our body May
00:09:28.920 respond more more significantly to the
00:09:32.440 effects of stress might feel it more or
00:09:34.480 may have more symptoms and we can talk
00:09:35.880 some more about genetics that play a
00:09:37.720 role with that it was actually an
00:09:39.320 interesting um study I came across
00:09:41.519 recently that found that women who had
00:09:43.519 experienced adverse childhood
00:09:45.440 experiences at least two or more even if
00:09:48.640 they didn’t significantly have issues
00:09:51.320 that they knew of in their 20s and 30s
00:09:54.040 it significantly increased the risk of a
00:09:55.839 first onset of major depression in the
00:09:57.760 menopause transition so even the things
00:09:59.959 that we experience early on can have an
00:10:02.040 impact on on important say we’re going
00:10:03.920 to put this in the show notes but
00:10:05.120 there’s a questionnaire and a link to it
00:10:07.040 you can take online called the ace
00:10:08.760 questioner which means adverse childhood
00:10:10.640 events meaning did your parents neglect
00:10:12.360 you did they beat you was there
00:10:13.320 alcoholism in their family was there
00:10:14.640 someone in prison like what happened
00:10:16.519 when you were a child that impacted your
00:10:18.760 psychological State and and how that
00:10:21.600 impacted your biological State and so
00:10:23.480 even though we think it’s psychological
00:10:25.360 it’s translated into our biology as k
00:10:29.440 say our biography becomes our biology
00:10:32.519 right and the unmasking of that as
00:10:35.200 estrogen levels go down might not show
00:10:37.240 up till a woman is in her 40s or 50s so
00:10:39.639 it’s important to recognize that and
00:10:41.560 there’s other factors that affect this
00:10:42.800 like smoking right exercise exercise
00:10:46.680 absolutely or lack of it or lack of and
00:10:49.600 we’ll talk about the importance of that
00:10:51.399 so as women go through the menopause
00:10:53.320 transition it’s actually a really rich
00:10:56.040 time to start paying attention to
00:10:58.040 Lifestyle factors that you can put into
00:11:00.480 place not only to help your symptoms but
00:11:02.800 to set you up for the second half and
00:11:04.920 aging well and some things move up in
00:11:07.279 priority for example when you mentioned
00:11:08.839 exercise resistance training yeah so I
00:11:12.040 mean we can come back to that but but so
00:11:14.000 weightlifting is more important as you
00:11:15.240 get older because you lose muscle you
00:11:16.760 become fat and then you you know needing
00:11:19.120 more more of that to help your
00:11:20.399 metabolism and and up you know when say
00:11:22.920 I might metabim slowed down well yeah it
00:11:24.279 did because you’re losing muscle so yeah
00:11:26.920 and another important contributor is is
00:11:29.320 coincident with those changes in
00:11:30.560 hormones there’s a lot of Life stuff
00:11:32.519 that’s often happening sandwich
00:11:34.160 generation the sandwich generation so
00:11:35.920 your parents are getting older if you’re
00:11:37.600 fortunate enough to still have them and
00:11:39.160 they might be experiencing health issues
00:11:41.440 and requiring more attention and Care
00:11:43.120 from you if you have children I mean
00:11:45.680 mine I hit the menopause transition my
00:11:48.320 two boys were 14 so that was a very
00:11:50.240 interesting hormonal mix in my house
00:11:52.360 which brought up some challenges of its
00:11:53.720 own or you might be having children
00:11:55.480 leaving home so you’re reating your
00:11:58.440 relationships and your career is
00:12:00.079 probably at its peak right so you’ve got
00:12:01.839 like these triple whammy almost yeah you
00:12:03.720 might even be looking at your partner
00:12:04.959 and saying is this the same person that
00:12:06.760 I married and where are we going with
00:12:08.440 our relationship so there’s a lot of
00:12:10.480 things that are happening coincidence
00:12:12.000 with those hormonal shifts that play a
00:12:13.480 role with our experience so so there’s
00:12:15.680 other things that also contribute like
00:12:16.880 environmental toxins oh my gosh that are
00:12:18.560 a huge Factor right they’re huge and
00:12:20.839 that that also plays a role when we’re
00:12:22.680 working with women to kind of have a
00:12:24.560 more informed personalized discussion
00:12:26.440 about pros and cons of hormone therapy
00:12:29.360 interactions with endocrine disrupting
00:12:31.360 chemicals are also going to impact how
00:12:34.120 that woman is going to respond to those
00:12:36.320 hormones and they might be more risky if
00:12:38.279 she’s taking hormone replacement therapy
00:12:40.480 and she’s exposed to pesticides and
00:12:42.800 solvents and heavy metals and phalates
00:12:45.839 and Plastics Etc so it’s it’s it’s much
00:12:48.519 richer conversation than just do I take
00:12:50.320 hormones yeah I mean these even are
00:12:51.839 called xenoestrogens they’re called
00:12:53.760 foreign estrogens and they’re effective
00:12:56.560 at very small doses to create a big
00:12:59.360 effect and they’re synergistic so 1 plus
00:13:01.160 one doesn’t equal two it equals 100 or a
00:13:03.360 thousand and so we’re just living in a
00:13:05.360 soup of these chemicals it has a huge
00:13:07.480 role so it’s complicated um and yet it’s
00:13:10.839 knowable we we actually are able to
00:13:13.240 assess all these things even looking at
00:13:15.040 your gut microbiome and how that plays a
00:13:16.800 role in your hormone metabolism so we
00:13:18.639 look at toxins and we look at hormones
00:13:20.880 we look at insulin at cortisol thyroid
00:13:23.240 we look at your lifestyle we look at all
00:13:25.199 these variable factors that are
00:13:26.920 affecting how you feel and go through to
00:13:29.839 the different cycles of a woman’s life
00:13:32.519 that that can be sometimes very
00:13:34.120 symptomatic and I you know I I got very
00:13:36.600 angry when I started learning about this
00:13:37.760 Cindy I don’t know about you but I was
00:13:38.920 like wait a minute like all these women
00:13:41.279 are suffering for no reason this is not
00:13:43.279 a normal design flaw if you believe in
00:13:45.680 God or don’t believe in God like whether
00:13:46.959 it’s nature or God whatever it designed
00:13:50.000 it wasn’t a design flaw like this
00:13:52.399 something’s wrong that 75% of women have
00:13:54.519 PMS right something’s wrong that most
00:13:57.160 women suffer with all the symptoms
00:13:58.800 through menopause because it means that
00:14:01.240 something’s out of whack and so when
00:14:03.360 when we look at conventional medicine
00:14:05.600 and its approach how is it how is it
00:14:08.639 limited what are the challenges that and
00:14:10.720 what is sort of the current view on this
00:14:12.240 because it’s very different than what we
00:14:13.639 do in functional medicine we do at the
00:14:14.920 ultra Center I just want people have a
00:14:16.240 sense of like if they go to their doctor
00:14:18.000 and they have these issues what are they
00:14:19.079 going to get well it’s interesting
00:14:21.279 because I think um we kind of touched on
00:14:23.720 this briefly the conversation about the
00:14:25.480 menopause transition really has has
00:14:27.560 boiled down to do I take hor or not and
00:14:30.240 we’ve talked about the pendulum shifts
00:14:31.959 first it’s everybody takes hormones then
00:14:33.839 it’s nobody takes hormones and now the
00:14:36.199 pendulum is Shifting back I think there
00:14:38.079 was an article last year in the New York
00:14:39.639 Times that says why have women been
00:14:41.600 deprived of this very effective
00:14:43.240 treatment yeah for symptoms yeah so the
00:14:45.519 pendulum is Shifting back and saying
00:14:48.160 maybe women should all be on hormones
00:14:50.160 again and again it’s it’s it’s missing
00:14:52.040 the Nuance of all the other factors that
00:14:54.360 are happening um because not all women
00:14:57.759 are going to necessarily Ben so how do
00:14:59.759 we navigate that risk benefit equation
00:15:01.959 by looking at all of the factors we just
00:15:03.639 talked about so it’s sort of binary you
00:15:05.680 either take hor or you don’t take them
00:15:07.279 where you don’t if you have risk factors
00:15:08.600 or breast cancer well sorry just suffer
00:15:10.399 we’ll see you later right right you know
00:15:14.000 hopefully it’ll go away in a years or
00:15:15.519 not as as opposed to saying well how do
00:15:18.320 you feel what’s going on in your life
00:15:20.279 what’s working for you what’s your
00:15:21.920 nutrition like what’s your sleep like
00:15:24.360 yeah um what’s your exposome like um
00:15:27.680 what else could be going on looking at
00:15:29.800 somebody’s genetics that could influence
00:15:32.040 how she’s going to process those
00:15:33.639 hormones that she takes or makes looking
00:15:35.959 at the health of her gut looking at her
00:15:38.199 key nutrients that really we know really
00:15:40.120 support estrogen detoxification and
00:15:42.319 Metabolism yeah so that’s that’s really
00:15:44.639 key so when we when we see someone who
00:15:47.040 comes in with hormonal disregulation you
00:15:49.079 know what are the kinds of things we
00:15:50.240 look at you just mentioned you know EST
00:15:52.519 estrogen and genetics well I remember
00:15:55.399 basically thinking it was estrogen
00:15:56.720 progesterone testosterone and I didn’t
00:15:58.600 realize there were like a million
00:15:59.839 estrogen metabolites there’s no such
00:16:01.399 thing as estrogen it’s estradi estriol
00:16:03.959 estrone and then all the metabolites of
00:16:05.920 estrogen it’s like it’s it’s complicated
00:16:08.680 and the average the average person who
00:16:10.399 goes to medical school never learned it
00:16:12.399 and if if you’re even a hormone expert
00:16:15.240 it’s still kind of not really on the
00:16:16.440 radar it’s shocking to me we’ve been
00:16:18.160 doing this for decades Cindy and we knew
00:16:20.920 this stuff decades ago and are checking
00:16:23.440 this stuff including the microbiome
00:16:26.079 including estrogen metabolites in the
00:16:28.319 urine being able to customize
00:16:30.319 nutritional supplementation or diet or
00:16:32.639 other factors and it’s it’s stuff that
00:16:34.360 we know it’s in the science it just
00:16:36.000 hasn’t gotten in the clinic yet right
00:16:38.160 all right so Cindy pretend I’m like a
00:16:39.600 47y old per menopausal woman which
00:16:42.040 clearly I’m not but I’m just going to
00:16:43.560 pretend for a minute I come in and I’m
00:16:45.079 I’m complaining you know my Cycles are
00:16:47.079 really heavy I get premenstrual
00:16:48.959 migraines uh I’ve got like bloating
00:16:51.120 after I eat and digestive issues or bow
00:16:54.800 you know I love I love um eating my
00:16:57.720 Sushi all the time I have tune every day
00:17:00.000 and and I uh I you know I maybe I drink
00:17:02.360 a little too much have a couple glasses
00:17:03.720 of wine every night and um I’m also I
00:17:06.720 love Dairy I just love cheese uh I love
00:17:09.240 my yogurt um what what are you going to
00:17:11.880 do with me because I’m like miserable
00:17:14.240 and I I can’t sleep I’m Moody my husband
00:17:16.799 wants to leave me and uh you know I’m
00:17:19.480 starting to get like no sex drive and
00:17:22.319 you know I just I don’t feel right and
00:17:24.199 I’m gaining weight so I
00:17:26.480 help what’s the workup how do you
00:17:28.439 approach that is such a common scenario
00:17:31.520 you would not believe how many women I
00:17:33.280 see like that so really I I just didn’t
00:17:35.400 just make that up out of nowhere think
00:17:37.120 of like a dozen Nations like that so the
00:17:39.280 first thing I want to say is I think the
00:17:41.720 importance of setting space to
00:17:44.080 acknowledge somebody’s experience and
00:17:46.559 just reflect back wow that’s a lot um
00:17:49.760 we’re going to work together to figure
00:17:51.080 out a way to help you feel better and
00:17:52.880 tease out what’s going on yeah I think
00:17:54.720 that’s really important so giving them
00:17:55.760 hope them validating their experience
00:17:58.200 you’re not crazy this isn’t in your head
00:18:00.200 right there’s stuff going on and we can
00:18:02.440 dissect it understand it and help put
00:18:04.880 Humpty Dumpty back together
00:18:06.640 again yes and thinking of this is
00:18:09.760 actually a a a wonderful window of
00:18:11.679 opportunity to really take stock of
00:18:14.000 where you are in the moment what’s going
00:18:15.760 on with your hormones so hearing that
00:18:17.640 history when she’s got digestive issues
00:18:19.600 she’s got mood changes she’s clearly
00:18:21.360 having symptoms related to her periods
00:18:24.120 she’s having relationship concerns as a
00:18:26.080 result you know how do we tease all this
00:18:27.640 out we go back and start with the basics
00:18:29.720 yeah um so we we want to understand her
00:18:32.679 nutrition and and you know at the ultra
00:18:34.400 Wellness Center everybody who comes to
00:18:36.159 see us also works with a nutritionist
00:18:38.400 because that’s such a Cornerstone of
00:18:40.320 Health well food is medicine how can I
00:18:42.080 practice medicine without work the
00:18:43.640 nutritionist right ex exactly so that’s
00:18:45.039 going to be a big part of it and and of
00:18:46.640 course what comes up for her is all
00:18:48.080 right well she loves her Dairy and she’s
00:18:49.480 got a lot of digestive issues does she
00:18:51.039 have lactose intolerance does she have a
00:18:52.520 dairy sensitivity so we’re going to be
00:18:54.440 wanting to uh know a little bit more how
00:18:56.480 does dairy affect hormones because
00:18:57.760 there’s so many hormones and it can
00:18:59.400 really affect women’s hormones insulin
00:19:00.919 like growth factor um in most Dairy
00:19:03.880 which can raise estrogen levels and play
00:19:06.240 a role with tissue production of
00:19:07.520 estrogen yeah so that definitely plays a
00:19:09.559 role um we want to do a deep dive into
00:19:13.480 what’s going on for her so not only
00:19:15.320 what’s happening in the moment but what
00:19:17.080 are the things we want to start paying
00:19:18.360 attention to as she moves into the
00:19:19.919 second half if you want to think of it
00:19:21.320 like that so what I’m going to want to
00:19:23.520 understand for her is sometimes we can
00:19:25.679 get a lot just from a family history you
00:19:27.880 know what runs under family did
00:19:29.840 everybody in her family get
00:19:30.919 cardiovascular disease and Dementia or
00:19:32.760 does everybody have uterine cancer
00:19:34.440 ovarian cancer because that’s going to
00:19:36.559 potentially set the stage towards which
00:19:38.520 way we might be leaning from a hormonal
00:19:40.559 standpoint um the adverse childhood
00:19:42.799 experience what her childhood was like
00:19:44.520 what stresses her inner life yeah we
00:19:46.320 have like a 32-page questioner at the
00:19:48.000 ultana center and then we and then we
00:19:50.200 ask another 400 questions so we do a
00:19:52.679 very deep history way more than you’d
00:19:54.480 get when you go to a traditional doctor
00:19:56.039 because we take the time and that
00:19:57.919 teaches us a lot about your whole
00:19:59.919 timeline the risk factors where to look
00:20:02.559 what the issues are um and so once we’ve
00:20:05.000 done that whole deep history and we’ve
00:20:07.200 kind of picked up the clues what do we
00:20:08.640 do diagnostically because there’s a lot
00:20:10.039 of testing that we do there is that’s
00:20:11.919 different and that helps us understand
00:20:14.600 what may be really going on underneath
00:20:15.960 the surface yeah so from a conventional
00:20:18.200 standpoint we still want to look at
00:20:19.640 those um looking at her levels of
00:20:22.840 hormones we want to know her
00:20:24.120 progesterone her estrogen her DHEA her
00:20:26.799 cortisol an inp thyroid her insulin so
00:20:30.280 we want to know the whole hormonal M
00:20:32.320 even vitamin D which is a hormone so we
00:20:34.559 want to look at that piece really want
00:20:36.799 to understand which often don’t get
00:20:38.240 looked at properly even when you go to
00:20:39.559 the regular doctor nobody measures an
00:20:41.440 insulin we’ll look at a glucose or they
00:20:43.600 won’t measure your full thyroid panel
00:20:45.039 they’ll just look at TSH or they don’t
00:20:46.520 measure cortisol or cortisol saliva
00:20:48.960 testing or right so they don’t look at
00:20:51.159 all your hormones they don’t so they
00:20:52.880 just kind of and they don’t look at the
00:20:54.159 timing necessarily of them so it all
00:20:56.159 matters and I actually do nutrien
00:20:58.600 genetic testing in most people because I
00:21:00.520 think it actually sets the stage for a
00:21:02.480 more personalized approach to diet and
00:21:04.559 lifestyle what did you come into the
00:21:06.000 world with that’s going to be modulated
00:21:08.440 or influenced by what you’re eating and
00:21:10.520 what you’re exposed to and it can really
00:21:12.720 help us personalize the conversation in
00:21:14.400 a much better way than I can just from
00:21:16.760 asking about family history yeah and we
00:21:19.039 we can come back to that but that’s
00:21:20.080 really helpful that’s important yeah
00:21:21.559 looking at the advanced cardi metabolic
00:21:24.279 markers not just knowing the insulin and
00:21:26.240 glucose and A1C but cholesterol partic
00:21:28.799 size and number the inflammation related
00:21:30.919 markers I think that’s also important
00:21:32.919 because as we know cardiovascular events
00:21:35.320 start to creep up for women in their 50s
00:21:37.159 and Beyond so we kind of want a baseline
00:21:39.679 right we want to know some of those key
00:21:41.559 nutrient markers their B vitamin status
00:21:43.640 magnesium status I think you mentioned
00:21:45.720 she likes a lot of fish yeah want to
00:21:47.840 know her mercury levels yeah right so
00:21:50.039 the things that aren’t typically looked
00:21:51.559 at omega-3 fatty acid levels so we can
00:21:54.200 do some specific nutritionally related
00:21:56.919 markers yeah we can look at those
00:21:58.799 estrogen metabolites is she processing
00:22:01.120 estrogen whatever she’s making right now
00:22:03.080 is she processing it along these
00:22:04.480 Pathways that we know have more of a
00:22:06.600 potential risk from a tissue effect more
00:22:09.120 breast um stimulation for example so we
00:22:12.080 can do urine and blood levels of those
00:22:14.960 estrogen metabolites which are really
00:22:16.520 helpful yeah it’s important and I think
00:22:18.200 something was sort of shocking to me
00:22:19.520 when I when I started learning about
00:22:20.600 this like wait wait it’s not just
00:22:21.919 estrogen it’s there’s all this other
00:22:23.480 stuff going on and and what regulates
00:22:25.400 these things so you can actually see the
00:22:27.840 different pattern patterns of the
00:22:29.360 breakdown products of estrogen and some
00:22:32.039 of them are hardly carcinogenic and
00:22:34.200 toxic and some of them are highly
00:22:35.840 protective right so there’s ones that
00:22:37.440 are called like two hydroxy they’re
00:22:38.720 protective and 16 hydroxy estrogens that
00:22:40.840 are toxic and then we can look at
00:22:42.640 patterns of methylation like the four
00:22:44.679 methoxy estrogen so we can see all these
00:22:46.360 different kinds of estrogen metabolites
00:22:48.480 and then we can look at genetics we can
00:22:50.000 tie it together we can understand then
00:22:51.720 how to give them the right supplements
00:22:53.039 or the right diet or the right lifestyle
00:22:54.840 interventions to actually regulate these
00:22:56.840 things and I think that part is really
00:22:58.840 important it’s not just about looking at
00:23:01.080 the metabolites themselves they have an
00:23:03.200 action step there are things we can do
00:23:04.799 to shift those metabolites to support
00:23:07.720 detoxification and really help a woman
00:23:10.559 with her symptoms and to reduce risk if
00:23:12.440 she does choose to take hormones yeah
00:23:14.520 the other thing you know that sort of
00:23:15.480 seems weird is um that we we look at the
00:23:18.559 gut right yes and uh you talked about uh
00:23:21.480 something called the estrobolome
00:23:23.720 estrobolome and and the the microbiome
00:23:27.360 and how that relates to estrogen can you
00:23:29.400 talk about that a little I think it’s
00:23:30.440 sort of Novel and we we actually look at
00:23:32.200 that in our at practice at the ultraa
00:23:34.000 center yeah so so one of the things that
00:23:36.080 we know is that when we package up and
00:23:38.200 detoxify estrogen one of the primary
00:23:40.320 routes of excretion is in the gut so
00:23:43.559 what’s going on in your gut can
00:23:44.919 influence how efficiently you can clear
00:23:47.000 estrogen metabolize out of your system
00:23:50.200 we also know that your gut microbes can
00:23:52.039 make hormones themselves so depending on
00:23:54.279 the balance of your gut microbes you
00:23:56.279 might have more or less circulating
00:23:58.679 hormones who knew right that’s really
00:24:01.000 been seen in women who have polycystic
00:24:02.679 ovarian syndrome for example that the
00:24:04.679 gut microbiome influences the level of
00:24:06.799 the androgens the more male hormon like
00:24:10.480 metabolites yeah um yeah there’s a whole
00:24:12.760 thing called the enterohepatic
00:24:14.679 circulation which is from the gut to the
00:24:16.799 liver and back and and usually when you
00:24:19.520 finish with your hormones you poop them
00:24:21.120 you go through your liver they go
00:24:22.679 through your bile they go into your gut
00:24:23.960 and you poop them out right but
00:24:25.559 sometimes they don’t all get out and
00:24:27.120 they get reabsorbed can you talk about
00:24:28.679 that and why that’s a problem yeah so so
00:24:31.000 one example of something we would see on
00:24:32.480 a stool test that we would do is an
00:24:34.200 enzyme called beta glucuronidase yeah
00:24:36.480 and beta glucuronidase is produced when
00:24:38.760 we have an imbalanced gut microbiome so
00:24:40.760 certain microbes will produce this
00:24:42.320 enzyme why is that important well we’ve
00:24:45.120 talked about methylation of estrogen but
00:24:47.640 glucoronidation is another pathway by
00:24:50.320 which we kind of package up those
00:24:51.799 estrogen metabolites and stress hormones
00:24:54.480 and some toxins yeah to allow them to
00:24:56.480 get excreted in the stool well if you
00:24:58.640 have a microbiome that’s secreting high
00:25:00.720 amounts of this enzyme beta
00:25:02.440 glucuronidase guess what kind of
00:25:04.840 unpackaged everything yeah and allows
00:25:07.799 recirculation yeah of estrogens stress
00:25:10.159 hormones and toxins so it adds more
00:25:12.240 burden to the detoxification systems and
00:25:15.640 what’s so amazing when you start to pay
00:25:16.880 attention and you watch this and we’ve
00:25:18.480 done this again we’ve done this for
00:25:19.720 decades you see someone with a high bet
00:25:22.360 GLC itties you see someone who’s got a
00:25:24.240 higher circulation of recirculation and
00:25:26.279 absorption of of estrogens you see that
00:25:28.919 they’re symptomatic from it meaning they
00:25:31.039 have estrogen dominant symptoms of
00:25:32.840 breast tenderness fluid retention
00:25:34.600 migraines you know heavy bleeding clots
00:25:37.440 all that stuff and when you treat the
00:25:40.720 gut and you clear out the bad bugs that
00:25:42.919 are causing this met enzyme to be
00:25:45.360 produced because that’s what bacteria do
00:25:47.039 they produce molecules and metabolites
00:25:49.200 and enzymes and there’s millions of them
00:25:51.320 in there billions trillions uh probably
00:25:54.279 like 40 trillion bacteria and they’re
00:25:56.679 all doing that and so some of these are
00:25:58.399 bad some of them are good and when it
00:26:00.799 does that it it kind of causes more
00:26:03.080 problems and we can actually treat the
00:26:04.480 gut as a way of treating hormonal
00:26:07.360 disregulation that’s so important who
00:26:09.919 would have thought right yeah and that
00:26:12.559 that’s the kind of stuff you’re not
00:26:13.399 getting when you go to your chologist
00:26:15.200 right it’s really the the things that
00:26:17.360 that we’re doing are not like eat your
00:26:19.760 wheat grass and get a coffee enema and
00:26:22.000 everything’s going be fine this is deep
00:26:23.960 science we’re talking about it’s not
00:26:25.520 stuff that’s not in the National Library
00:26:27.480 medicine Pub Med it’s not evidence-based
00:26:29.919 we talk about evidence-based medicine we
00:26:31.399 don’t we don’t have evidence-based
00:26:32.840 medicine we have reimbursement based
00:26:34.159 medicine and and what we’re doing is
00:26:36.679 taking a look at literature and trying
00:26:37.880 to close that gap of 20 or 30 or
00:26:39.720 something 50 years from when we know
00:26:41.120 something to when we do it and so we
00:26:43.240 we’ve been seeing the clinical resoled
00:26:44.520 of this for decades in these cohorts of
00:26:46.640 women and it’s it’s revolutionized our
00:26:49.279 our care and their lives and their
00:26:51.240 health and I think it’s so important so
00:26:54.559 um you’re talking about Cindy is really
00:26:56.640 a very methodical way of packing a
00:26:59.399 personalized map of each person’s life
00:27:02.799 history their psychology their biology
00:27:05.559 their genetics their microbiome their
00:27:07.480 toxin levels their nutritional status
00:27:10.120 all of it and that gives us then
00:27:12.520 Direction about what to do and where to
00:27:14.760 go with these people and and how to
00:27:17.240 understand how to take the right steps
00:27:19.559 to create the balance that leads to the
00:27:22.600 resolution of symptoms so we’re not
00:27:24.600 necessarily treating disease per se
00:27:27.399 we’re treating function or balance like
00:27:29.080 having a high bet glucon is not a
00:27:31.080 disease right but it’s it’s it’s a
00:27:33.360 deviation from optimal function and so
00:27:35.799 we can kind of get people back towards
00:27:37.279 that and then you know hormones start to
00:27:38.760 regulate and I think it’s it’s amazing
00:27:40.320 when you start to fix all these other
00:27:41.519 things hormones kind of kind of go back
00:27:43.600 in the line like they often go back in
00:27:45.519 the line without needing to take
00:27:47.039 hormones or take drugs and it’s not that
00:27:49.360 they’re bad or we don’t use them and
00:27:50.399 we’re going to talk about how we use
00:27:51.279 them but often you kind of start with
00:27:52.760 all that stuff first and then you see
00:27:54.080 where you are right I think another
00:27:56.360 hormone that’s really really important
00:27:58.200 if you had I probably shouldn’t say this
00:28:00.480 if you had to pick one to really focus
00:28:02.720 on insulin I would agree I read about
00:28:06.320 five 10 books on that one yeah I mean I
00:28:08.399 think insulin and and and estrogen will
00:28:11.320 regulate to some degree if we really
00:28:13.240 focus on insulin so how do we do
00:28:16.120 that all the things you just talked
00:28:18.120 about so so there again there are
00:28:20.200 genetics some of us are going to be more
00:28:21.880 predisposed to have insulin resistance
00:28:23.760 than others but lifestyle really moves
00:28:25.360 up in priority there so we’re of course
00:28:27.760 going to limit or avoid the foods that
00:28:30.399 give you a quick bump in blood sugar and
00:28:32.159 then a decrease in blood sugar so
00:28:33.760 process carbohydrates sugars Ultra
00:28:36.279 processed foods yeah really drive that
00:28:38.919 whole thing which is about 65% of our
00:28:40.960 diet it is unfortunately unfortunately
00:28:43.240 we got to yeah diet’s a huge Factor but
00:28:45.960 you know stress also impacts insulin um
00:28:49.159 sleep impacts insulin with sleep you and
00:28:51.559 I have talked about this before but it’s
00:28:53.399 quality quantity and timing of sleep
00:28:55.559 also influence our insulin regulation
00:28:58.519 and we haven’t really touched on this
00:29:00.039 yet but sleep disruption can often be
00:29:02.559 huge in the menopause transition um so
00:29:05.360 as a cause or as a consequence it’s both
00:29:07.960 yeah it’s actually both so so as you we
00:29:10.519 talked about the vasomotor symptoms of
00:29:12.320 menopause so as the hormonal shift hot
00:29:14.279 flashes hot flashes and night sweat so
00:29:16.600 for some women it’s waking up at night
00:29:18.200 and throwing the covers off and sweating
00:29:19.799 and then putting them back on and then
00:29:21.159 throwing them off and then put it back
00:29:22.559 on that you can wake up pretty grumpy
00:29:24.960 and tired if that’s happen sounds you’re
00:29:26.279 pretty familiar with that Cindy oh yeah
00:29:29.480 you know you talk about what you know
00:29:31.279 right so somebody who’s been through
00:29:32.960 that absolutely yeah but you know
00:29:34.840 there’s another thing that starts to
00:29:36.360 emerge we know that um you know estrogen
00:29:39.159 affects other tissues and it affects the
00:29:41.640 connect connective tissue and elasticity
00:29:44.760 so this sounds like the depressing part
00:29:46.559 but what women often notice on the
00:29:48.120 outside with wrinkles is happening on
00:29:50.919 the inside with our Airway so the airway
00:29:53.640 can become more collapsible and sleep
00:29:56.039 disordered breathing upper Airway
00:29:57.640 resistance snoring sleep apnea goes up
00:29:59.960 fourfold in the menopause transition we
00:30:02.080 don’t want to miss sleep disordered
00:30:03.640 breathing or sleep apnea as a
00:30:05.360 contributor to insulin resistance mood
00:30:08.080 swings weight gain irritability loss of
00:30:11.120 sex drive because it’s both cause and
00:30:13.360 effect with the metapa transition and we
00:30:15.600 don’t want to just blame it on the hot
00:30:17.000 flashes and the night sweats there might
00:30:18.360 be more going on yeah so yeah it sounds
00:30:20.360 like you know we call ourselves holistic
00:30:22.120 doctors because we take care of people
00:30:23.519 with a whole lose of problems and so
00:30:25.399 this is really what we specialize in uh
00:30:27.760 I I’d love you to talk about this case
00:30:30.399 that you shared a little bit earlier
00:30:31.360 with me about this 52y old woman who had
00:30:32.960 allergies migraines weight gain over
00:30:34.799 eight years yeah lost your parents and
00:30:36.720 it was it’s a really great case talks
00:30:39.000 about how we think about people going
00:30:40.640 through this phase of life differently
00:30:42.720 yeah so I and by the way before you do I
00:30:44.159 just want to say it doesn’t matter what
00:30:45.600 phase of life you’re in as a woman
00:30:47.480 whether you’re a teenager going through
00:30:49.240 hormonal changes in your 20s 30s 40s 50s
00:30:52.240 60s and Beyond we take care of all of it
00:30:54.200 we’re just sort of focusing a little bit
00:30:55.360 on menopause now but this applies across
00:30:57.320 the board and we you know have different
00:30:59.440 issues at different ages but looking at
00:31:01.480 the life cycles of women is really a
00:31:03.080 core part of what we do I agree and I
00:31:05.240 and I think as I mentioned before it’s a
00:31:07.519 window of opportunity it’s often the
00:31:09.000 symptoms that bring you into the to talk
00:31:11.080 to the functional medicine practitioner
00:31:12.919 but it opens the door for a conversation
00:31:14.720 about everything yeah which is really
00:31:16.880 important um I’m going to look back on
00:31:19.000 this so this this is somebody who didn’t
00:31:20.600 come to me initially for menopause but
00:31:22.840 she happened to be in the menopause
00:31:24.200 transition she was 52 I think her last
00:31:26.320 menstrual period was about 6 months
00:31:27.679 before before she came to see me and she
00:31:29.720 had this history of allergies and
00:31:31.320 migraines so just so you know I’m going
00:31:33.440 to talk as I go through this one of the
00:31:35.120 things that comes up for me with
00:31:36.200 allergies and migraines is thinking
00:31:37.799 about the role of histamine in some of
00:31:40.000 her
00:31:40.919 symptomatology um the last eight years
00:31:43.320 so as she’s entered the menopause
00:31:44.960 transition her weight’s been going up
00:31:47.320 and she had what’s a very common
00:31:49.200 occurrence she lost both of her parents
00:31:51.240 unfortunately her partner had a serious
00:31:53.519 health issue so there’s been a lot of
00:31:55.240 added stress and face it more ity was
00:31:58.600 right in front of her so that can bring
00:32:00.720 up a lot of things about oh my gosh what
00:32:02.880 does it mean to be getting older and
00:32:04.880 what’s going to happen for me um she’
00:32:07.960 also noticed in the last three years she
00:32:10.039 was starting to have some hot flashes
00:32:11.399 and sleep disruption brain fog which she
00:32:13.760 imp particular linked to uh more sugar
00:32:16.120 and carbohydrate intake and at the same
00:32:17.880 time she was craving more of those Foods
00:32:19.639 as she was more stressed a little bit of
00:32:21.480 a vicious cycle and we started her
00:32:25.039 really on a nutrition plan while we were
00:32:26.720 gathering some of the data yeah and our
00:32:28.639 original nutrition plan was kind of what
00:32:30.399 we talked about uh whole food
00:32:32.519 plant-based diet minimizing those
00:32:34.320 processed carbohydrates even trying a
00:32:36.200 lwh histamine diet to see if we could
00:32:38.440 sort of clear the decks and what would
00:32:40.000 happen with her allergies and her
00:32:41.919 migraines um recommended doing a sleep
00:32:44.919 study uh some breath-based practices
00:32:47.519 which we know have shown some evidence
00:32:49.240 for reducing the hot flashes and just
00:32:50.919 helping support her yeah with all the
00:32:52.799 stuff that she’s been dealing
00:32:54.639 with um and then when we got her Labs
00:32:57.000 back her estrogen was not measurable so
00:32:59.480 she’s not making any at all some women
00:33:01.880 will make a little bit she had some
00:33:04.000 yeast overgrowth like had some Mark in
00:33:06.120 her gut we had some some elevated
00:33:07.919 markers and it also showed up in her
00:33:09.279 stool test and she had uh intestinal
00:33:12.519 methane overgrowth as well which was
00:33:14.320 probably playing a big role with some of
00:33:15.919 her digestive issues and this estroone
00:33:18.600 that we talked about um and she was
00:33:21.480 showing some evidence of increased
00:33:23.240 intestinal permeability her LDL
00:33:25.279 particles were higher than we wanted to
00:33:26.720 see it so she Hadad had bugs grow in her
00:33:28.720 gut too much yeast too many bugs in the
00:33:30.559 wrong spot she got bloating and you know
00:33:33.480 she had leaky gut and all these things
00:33:35.240 were causing allergies
00:33:37.120 inflammation and making everything worse
00:33:39.559 yes so it wasn’t just the hormones yeah
00:33:42.200 yeah and I think that’s a really
00:33:43.360 important piece to pay atten I don’t ask
00:33:44.840 you if this your experience too is any
00:33:46.279 like what I found is that that if I
00:33:48.480 start with all these other things the
00:33:50.039 hormones often get in the line that that
00:33:52.880 actually the hormones are often screwed
00:33:55.159 up as a downstream consequence of other
00:33:57.360 up causes yes it’s not usually the
00:33:59.720 hormones themselves are the issue right
00:34:01.480 I think about it like we all have
00:34:03.279 hormones they all should be working why
00:34:04.760 aren’t they working like it’s not if you
00:34:06.519 have a toxin like
00:34:07.960 Mercury that’s a bad thing if you have a
00:34:10.560 parasite that’s something that’s
00:34:12.399 Upstream cause right but if you have
00:34:15.639 screwed up hormones It’s usually the
00:34:17.199 consequence of something else that’s
00:34:18.760 screwing them up it’s not a primary
00:34:21.000 thing it can be it can be it can be but
00:34:23.440 you can have an insula and producing
00:34:24.918 insulin as a as a tumor or you could
00:34:26.879 have you know
00:34:28.679 uh I don’t know what else you could have
00:34:30.239 a lot of things you have a cortisol
00:34:31.399 producing tumor and have Cushing so
00:34:32.879 there’s a lot of things that you know
00:34:33.960 obviously aren’t what you’re doing right
00:34:35.520 but for the most part uh a lot of it are
00:34:38.760 we I see as Downstream you is that your
00:34:40.280 experience it is and I will say with the
00:34:42.480 exception of menopause because while a
00:34:44.879 lot of women get better there’s still a
00:34:46.918 subset that the estrogen itself being so
00:34:49.359 low can be playing a role with some of
00:34:51.159 the symptoms okay so because there is a
00:34:53.359 there’s a a documented change in those
00:34:55.639 hormone level like 85y women are not
00:34:57.240 having hot flashes true and they have
00:34:58.599 low estrogen true right so what’s going
00:35:00.680 on oh that’s true that’s true actually
00:35:02.480 about 15% of them will continue to have
00:35:04.720 that so we don’t know what’s going on
00:35:05.960 with those women but um and oh and one
00:35:08.640 other thing that showed up for her she
00:35:09.920 had some common nutrient deficiencies
00:35:11.480 her B12 was low her vitamin D was low
00:35:13.800 and we mentioned about vitamin D playing
00:35:15.320 a role as actually a hormone as well
00:35:18.280 yeah so we targeted all those things and
00:35:20.680 she was feeling better um especially the
00:35:23.520 brain fog and fatigue so that responded
00:35:25.520 really well to the nutrition approaches
00:35:27.079 and addressing gut so you basically
00:35:28.640 fixed your gut got an Elimination Diet
00:35:30.280 and healed the the microbiome which is a
00:35:32.200 core part of what we do in functional
00:35:33.920 medicine and whatever you’ve got it’s G
00:35:36.640 usually plays a role whether it’s heart
00:35:37.960 disease or diabetes or cancer or
00:35:40.119 allergies or autoimmune disease or
00:35:42.040 Autism or add or hormonal issues we we
00:35:45.640 really have to look at the gut as a
00:35:47.040 central feature and so you’re saying
00:35:48.440 just by getting rid of the bad bugs
00:35:50.160 getting rid of the bad foods put her on
00:35:52.359 foods that healed her gut and things
00:35:54.680 that healed her Le he gut she improved
00:35:57.240 and support or nutritionally absolutely
00:35:58.920 her migraines got better her allg
00:36:00.280 migrain got better migraines got better
00:36:02.640 allergies got better um yeah so Cindy we
00:36:05.800 did all these things you did all these
00:36:07.079 incredible things um you diagnosed her
00:36:09.200 with all these imbalances we corrected
00:36:11.160 them you know and we do this kind of
00:36:13.319 work the on the center we do deep Dives
00:36:15.240 we find all these things that need to
00:36:16.839 get corrected we correct them and
00:36:18.240 People’s Health just dramatically
00:36:19.640 improves but sometimes you know with the
00:36:21.800 hormone issue you need to use hormones
00:36:23.760 and it’s not that they’re bad or good
00:36:25.760 and I think we get in this binary
00:36:27.119 thinking medicine it’s good it’s bad
00:36:29.160 it’s good it’s bad and the truth is it’s
00:36:31.119 got to be personalized right and it’s
00:36:33.240 different for everybody and there are
00:36:35.280 some rules and principles that I think
00:36:37.119 we follow in functional medicine around
00:36:38.839 prescribing hormones which I want to get
00:36:40.640 into but tell us the rest of the story
00:36:42.839 with this women you got her mostly
00:36:44.720 better but then she was still having
00:36:45.880 very low estrogen and what did you do
00:36:49.079 she came back in about three months
00:36:50.400 later and and articulated that she was
00:36:52.480 feeling bad the brain fog the fatigue
00:36:54.520 her migraines her allergies they were
00:36:55.880 all better but it’s interesting The Hot
00:36:57.960 Flashes were continuing and her sleep
00:37:00.040 was being more affected so she now came
00:37:02.160 back saying you know what I think I do
00:37:03.680 want to try hormones we had this
00:37:05.160 conversation back and forth and of
00:37:07.200 course you’re going to do your due
00:37:08.280 diligence before prescribing hormones
00:37:10.040 you want to make sure that she’s up to
00:37:11.200 date with her mammogram and there’s no
00:37:12.720 concern there um that she hasn’t had any
00:37:15.040 dysfunctional bleeding that that it it
00:37:17.359 raises a red flag and you want to make
00:37:18.880 sure that there’s no hyperplasia or
00:37:20.240 anything going on there heavy bleeding
00:37:21.920 in the per menopausal area where you get
00:37:23.640 like pre-cancer stuff in the uterus and
00:37:25.640 you can check that with a vaginal
00:37:26.760 ultrasound right right right and she
00:37:29.520 didn’t have any of that so um we decided
00:37:33.240 and now and now we have something really
00:37:34.520 cool we do is a liquid biopsy which we
00:37:36.319 didn’t have years ago which is
00:37:37.599 essentially ability to track cancers
00:37:39.880 through a blood test that looks at
00:37:41.359 fragments of cell-free DNA where we can
00:37:43.760 actually see OG well maybe we should
00:37:45.119 screen and see not just with a mamogram
00:37:47.079 which misses a lot uh but but actually a
00:37:49.560 a gallery test which looks at liquid
00:37:51.520 biopsy and then you gee I’m pretty
00:37:53.160 comfortable this person is not having
00:37:54.680 some latent cancer and I’m going to
00:37:55.839 throw some estr on it and give her a
00:37:58.160 right so we decided to try hormones and
00:38:01.319 my general thinking about hormones you
00:38:03.640 know that term bioidentical like created
00:38:06.000 a lot of confusion back in the day but
00:38:08.480 my favorite way to do it is to use a
00:38:10.520 patch which has a lot of customizable
00:38:12.880 Doses and it’s an estradi that is
00:38:15.400 pharmacologically exactly the same as
00:38:17.599 what your own ovaries would have
00:38:18.760 produced before menopause I like it
00:38:20.520 because it’s convenient you put it on
00:38:22.040 twice a week it gives you a steady
00:38:24.400 amount of estrogen and like I said
00:38:25.880 there’s a range of doses because she’s
00:38:28.160 symptomatic I’m going to start with a a
00:38:30.400 midlevel dose we started with a
00:38:31.920 mid-level dose for her um because she
00:38:34.760 has her uterus she does need
00:38:36.520 progesterone um because progesterone is
00:38:38.520 going to protect over stimulation or
00:38:40.280 over thickening of that lining of the
00:38:42.000 uterus and we can also take advantage of
00:38:44.319 progesterone because it has some calming
00:38:46.800 sedating effects and give it at night so
00:38:48.599 it might also help her sleep like the
00:38:50.240 body’s natural volume yeah yeah yeah
00:38:53.040 absolutely so that’s what we did we
00:38:54.359 started on a patch and was that an oral
00:38:56.240 progesterone or prester is oral for her
00:38:58.800 it was and it’s and it’s not just the
00:39:00.560 progesterone that we used to prescribe
00:39:02.040 proa right and my joke with that one
00:39:04.440 it’s a it’s called meth progesterone it
00:39:06.560 makes wom fat hairy and depressed oh
00:39:09.960 gosh and it does it’s horrible fact it
00:39:13.079 makes it makes uh people eat more they
00:39:15.240 use it during cancer treatment to get
00:39:17.280 people to eat more right it’s so when
00:39:19.800 cancer patients are starving because
00:39:21.480 they’re losing weight they give them
00:39:23.119 this to increase their appetite right
00:39:25.119 yep yeah and we can we can talk about
00:39:27.079 that because I think the Women’s Health
00:39:29.200 Initiative which prompted everybody to
00:39:31.200 throw their hormones in the garbage one
00:39:33.640 of the downsides of it or one of the
00:39:35.359 potential flaws of it two of them
00:39:36.800 actually most of the women were in their
00:39:38.160 60s so they’re a decade past the average
00:39:40.960 age of menopause and physiologically
00:39:42.880 women are in a different place then they
00:39:44.599 may not get the same tissue
00:39:46.240 responsiveness to estrogen and they used
00:39:48.760 Premarin which is conjugated equine
00:39:50.720 estrogens horse estrogen horse estrogen
00:39:54.040 but it means pregnant Mar’s urine
00:39:57.680 Premarin that’s actually how they got
00:39:59.520 the name it’s get it from pregnant mares
00:40:01.839 and then they concentrate it and it’s
00:40:03.440 horest which is very different than ours
00:40:05.079 and it’s very inflammatory and quite
00:40:07.160 toxic and when it’s given by mouth it
00:40:09.200 goes through the liver and creates
00:40:11.240 higher SE C reactive protein
00:40:12.920 inflammation markers higher clotting
00:40:15.119 factors worse insulin resistance instead
00:40:17.640 of better insulin resistes higher
00:40:19.560 triglycerides so all of the things that
00:40:21.359 were blamed on estrogen and hormones may
00:40:24.240 have been more a function of the older
00:40:26.200 age group of the women when they start
00:40:27.319 started and the formulation in the route
00:40:28.960 of administration so they use they use
00:40:31.440 basically the wrong kind of estrogen and
00:40:33.079 the wrong kind of progesterone and the
00:40:35.079 wrong route of administration and the
00:40:36.440 wrong route of administration so yeah so
00:40:38.520 of the philosophy we use basically is
00:40:40.599 use as little as possible for as short
00:40:42.839 time as
00:40:43.960 possible for with a forone the hormone
00:40:47.240 that’s the same as your body makes and
00:40:49.160 give it by bypassing the liver Through
00:40:51.640 Your Skin hopefully or under the tongue
00:40:54.359 or there’s a million ways to do it but
00:40:56.720 but basically it’s it’s doing it mostly
00:41:00.319 trying to mimic nature right right and
00:41:02.760 not overdoing it and not underdoing it
00:41:04.960 right so that brings up another point
00:41:06.720 right it is not common practice once you
00:41:08.720 put somebody on hormones to follow up
00:41:11.640 blood levels
00:41:13.839 amazing you know and and for me I it’s
00:41:16.240 like it’s like giving a person a blood
00:41:17.640 pressure pill and not checking their
00:41:18.800 blood pressure or giving someone a
00:41:20.160 cholesterol pill and not checking their
00:41:21.640 cholesterol so so we want to see does it
00:41:23.880 help the symptoms but we also want to
00:41:26.000 see well well what is your blood level
00:41:27.960 because that can help you gauge for
00:41:29.319 example if I started a given dose of a
00:41:31.240 patch and she comes back and she’s still
00:41:33.400 having hot flashes how well is she
00:41:35.480 absorbing that patch is it enough to get
00:41:37.800 a measurable rise in her estrogen or not
00:41:39.839 because then that can guide the dosing I
00:41:42.119 also just from trying to thread the
00:41:43.680 needle of risk and benefit I don’t
00:41:46.160 believe in supplementing somebody’s
00:41:47.599 estrogen to the level it was when she
00:41:49.359 was in her 20s we’re trying to get the
00:41:51.520 benefits but not really drive too much
00:41:54.640 estrogen so we mitigate risk yeah and
00:41:57.240 and you know I don’t have you this any
00:41:58.880 but I often will check estrogen
00:42:00.680 metabolites on women who are taking
00:42:03.079 hormones yes so I can assess whether or
00:42:05.520 not they’re producing toxic estrogens I
00:42:07.960 will often look at their genetics you me
00:42:09.359 some genetic testing and there’s
00:42:10.880 genetics around estrogen metabolism we
00:42:12.599 can look at like CT and other hormones
00:42:15.040 methylation hormones methylation
00:42:17.240 Pathways like MTHFR and basically in in
00:42:19.960 English that means we can check various
00:42:21.760 enzymes that are involved in detoxifying
00:42:24.480 estrogen and whether they’re working
00:42:25.839 well or not and then we can use science
00:42:28.440 to find the right co-actor for that
00:42:30.680 enzyme which is a nutrient right and so
00:42:33.160 we can start to build a very scientific
00:42:35.400 way of of personalizing care and this is
00:42:37.920 where all the medicine is going we’re
00:42:39.880 we’re all going to be doing this and
00:42:41.319 right now sadly very few people get this
00:42:43.559 and it’s really why we we do the work we
00:42:45.599 do at the ultra Wellness Center to give
00:42:47.160 people the chance to get access to the
00:42:49.559 future of medicine now and and and the
00:42:52.040 good news is people get better like it’s
00:42:53.920 just amazing to see these stories that
00:42:56.200 you you’re telling yourself so
00:42:57.359 satisfying because you know people have
00:43:00.480 have all these symptoms not just
00:43:02.240 menopause like allergies migraines gut
00:43:04.280 issues like this woman had and and you
00:43:07.040 able to get all that sorted and then get
00:43:08.599 her back on track and you know people
00:43:10.680 can come back and basically have a
00:43:12.640 resolution a lot of these really
00:43:14.440 difficult problems that we don’t have
00:43:15.880 good solutions for In traditional
00:43:17.040 medicine right so so um there you know
00:43:21.599 the the issue around the the hormones I
00:43:23.400 want to dive into a little bit more
00:43:24.559 because you sort of brought it up with
00:43:25.720 this woman the Woman’s Health initia you
00:43:28.480 mentioned was problematic for a lot of
00:43:29.880 reasons they used the wrong forms of
00:43:31.520 hormones the wrong dose of hormones the
00:43:33.400 age group they gave in was problematic
00:43:35.720 um but the data was kind of um a little
00:43:38.800 bit mixed in a way and there’s been more
00:43:40.720 data that actually shows that that so
00:43:43.640 the right use of hormones using
00:43:45.760 bioidentical hormones may not have the
00:43:47.119 same risks can you talk about that
00:43:48.400 because there is a risk like of breast
00:43:49.640 cancer yes and and other other risk
00:43:51.960 factors yes so what emerged after the
00:43:54.640 women’s health initiative and I remember
00:43:56.119 us having conversations about this is
00:43:57.839 this timing hypothesis yeah like could
00:44:00.440 you potentially is there a window of
00:44:02.520 opportunity when the body still has
00:44:05.359 upregulated estrogen receptors that if
00:44:07.520 we introduce the bioidentical forms
00:44:10.079 through the skin so you’re not going to
00:44:11.520 have those other effects that there
00:44:13.119 might be a delay in the onset of some of
00:44:15.200 the organ system effects that start to
00:44:17.280 happen after menopause we touched on it
00:44:19.440 briefly but we know that insulin
00:44:21.559 resistance goes up um weights shifts to
00:44:24.680 be more around the middle and women
00:44:27.160 start to accelerate loss of muscle mass
00:44:29.000 and bone mass there’s endothelial
00:44:31.480 dysfunction the arteries become less
00:44:33.400 elastic and more reactive and plaque can
00:44:36.079 start to form and what’s really a big
00:44:38.720 concern and I think this is where some
00:44:40.119 of the the research has been interesting
00:44:42.040 is is risk for cognitive decline we know
00:44:44.920 unfortunately that Alzheimer’s disease
00:44:47.160 disproportionately affects women and
00:44:49.319 women who’ve gone through menopause
00:44:50.760 early are at a much higher risk so
00:44:53.319 there’s also been this real interest in
00:44:55.319 well do hormones play a role in in
00:44:57.200 delaying the onset of cognitive changes
00:44:59.520 yeah because estrogen does a lot of
00:45:01.319 things in the brain that should be
00:45:03.200 protective it’s um reduces
00:45:05.520 neuroinflammation it helps artery
00:45:07.359 elasticity it reduces amalo plaque
00:45:09.880 accumulation and more recently there has
00:45:12.200 been research so a couple of studies
00:45:13.800 came out after the Women’s Health
00:45:15.160 Initiative looking at that timing
00:45:16.599 hypothesis and they found that
00:45:18.599 introducing hormones within the fiveyear
00:45:21.760 window of the last menstrual period 5 to
00:45:23.520 10 year window of the last menstrual
00:45:24.839 period in most women again we’re back to
00:45:27.079 monolith but most women the benefits
00:45:29.720 actually seem to outweigh the risks so
00:45:31.760 that’s great it was support for what we
00:45:33.640 suspected yeah but then we got some data
00:45:36.000 to show that so the the keeps trial and
00:45:38.640 the elite trial were two of the ones
00:45:40.240 that that that showed that um and more
00:45:42.319 recently like within the last couple of
00:45:44.319 years there’s actually been a
00:45:45.800 segregation with looking at cognitive
00:45:48.160 protection for hormones and the evidence
00:45:50.599 is suggesting that particularly for
00:45:52.520 women who carry an APO E4 alil which is
00:45:55.839 one of the genetic predictors of higher
00:45:58.280 risk of Alzheimer’s disease which we
00:46:00.119 check yeah which we check that estrogen
00:46:02.599 therapy is associated with more
00:46:05.440 preserved cognition higher volume in the
00:46:08.280 parts of the brain that are involved in
00:46:10.200 memory like the hippocampus so it’s S as
00:46:13.319 long as it’s introduced within that
00:46:15.440 critical window that per metop pule
00:46:17.240 window it’s just so essential what
00:46:18.440 you’re saying Cindy because it it just
00:46:19.800 speaks to the way we think in functional
00:46:21.520 medicine which is fundamentally
00:46:22.880 different and it’s about personalization
00:46:25.680 it’s not one size fits all all and it’s
00:46:28.000 understanding each person’s unique risks
00:46:30.000 their genetics their other risk factors
00:46:32.400 and like you said someone’s got a high
00:46:34.160 risk factor for Alzheimer’s with this
00:46:36.000 apoe Gene this apoe4 alal they’re
00:46:40.280 benefiting from hormone therapy right
00:46:42.880 potentially yes so that’s really
00:46:44.720 interesting of course it helps bones it
00:46:46.359 helps skin I want to talk about sex for
00:46:48.319 a
00:46:49.000 minute because I think you know a lot of
00:46:53.119 women complain of vaginal dryness lowo
00:46:55.839 and all these things that Happ happen
00:46:57.240 and they they’re they’re not just
00:46:58.440 inevitable parts of getting older I I
00:46:59.960 had one woman who was like 85 came to
00:47:01.720 see me she’s like I got a new boyfriend
00:47:03.400 I wanted you to help me out I’m like
00:47:04.640 okay you know like so how how how do you
00:47:07.839 think about getting a woman through the
00:47:10.520 menopause transition and using hormones
00:47:12.960 to help her deal with some of the
00:47:14.280 challenges that happen uh with with
00:47:16.119 menopause and sexuality I think that’s a
00:47:18.440 great question and I’m going to unpack
00:47:20.359 it a little bit as well because I think
00:47:22.240 I think for women libido and sex drive
00:47:25.160 is incredibly complicated um hormones
00:47:27.839 play a role and we’re going to talk
00:47:29.000 about vaginal Health in a minute but
00:47:31.280 it’s also important to recognize that
00:47:33.559 for women if they’re not comfortable
00:47:35.680 with what’s happening in their bodies
00:47:37.319 and they don’t like the way they look
00:47:38.960 and they’re exhausted and they’re um
00:47:42.280 taking care of their parents and taking
00:47:44.040 care of their kids you know frankly it’s
00:47:46.319 a triage Theory it’s the last on the
00:47:48.720 list so so I I want to really
00:47:50.680 acknowledge that that it’s not just
00:47:52.359 hormonal but we also know that the
00:47:54.319 vaginal tissues and the urethra that
00:47:56.119 little tube Le leing from the bladder to
00:47:57.640 the outside has estrogen receptors so
00:48:00.359 what happens as estrogen levels go down
00:48:02.599 is those tissues get thinner they get
00:48:04.480 dri the urethra shortens um the pH of
00:48:08.319 the vagina changes the microbiome of the
00:48:10.680 vagina changes so what does that lead to
00:48:13.800 burning irritation pain with intercourse
00:48:16.880 dryness urinary tract infections yeast
00:48:19.480 infections so really things that can
00:48:21.640 affect quality of life and here’s where
00:48:24.200 even if a woman comes in and decides
00:48:26.880 doesn’t want to do systemic hormone
00:48:28.839 therapy there’s still a real role for
00:48:31.480 vaginal hormones yeah because they don’t
00:48:33.640 get systemically absorbed or very little
00:48:35.599 get systemically absorbed they can
00:48:37.599 really allow those tissues to
00:48:39.800 reepithelialize get stronger and
00:48:41.559 healthier and more resilient yeah
00:48:43.520 improve the pH yeah help with sex drive
00:48:47.119 indirectly because it’s not painful
00:48:48.680 anymore or you’re not getting a bladder
00:48:50.040 infection every time you have
00:48:50.960 intercourse yeah so I think I think
00:48:53.079 there’s a real good role there and both
00:48:55.720 estradiol even compounded estriol and
00:48:59.319 DHEA that precursor of estrogen and
00:49:02.359 testosterone have all been shown to help
00:49:04.760 improve the tissue Integrity reduce
00:49:06.680 urinary tract infections and help with
00:49:08.400 lbo yeah I’ve seen the data on that you
00:49:10.040 know intravaginal DHEA which is
00:49:12.200 something that I hadn’t really heard
00:49:13.520 about years ago is sort of a new
00:49:15.160 approach to helping with some of the
00:49:16.680 sort of vaginal dryness issues so I
00:49:18.359 think you know you know I want topical
00:49:21.520 vaginal is important because it helps
00:49:23.400 you know kind of revitalize the tissues
00:49:25.240 and it also helps prevent the the
00:49:27.319 thinning between the bladder and the
00:49:29.200 vagina which leads to all these frequent
00:49:31.720 urination problems and right you know
00:49:34.319 coughing and sneezing and peeing and
00:49:37.920 also problems with urin tract infections
00:49:40.480 after sex and so forth so it’s it’s not
00:49:42.480 just a you know for sexuality it’s
00:49:44.359 really for overall health uh what about
00:49:46.880 testosterone because that’s a male
00:49:48.359 hormone right do we look at it do we
00:49:50.400 treat it what you do with it it’s
00:49:52.599 interesting because I’ve I have actually
00:49:54.640 gone back and forth with testosterone I
00:49:56.240 used to use more of it than I do um now
00:50:00.000 if I use testosterone I tend to use it
00:50:02.760 mostly for women who have either low
00:50:04.880 levels or no sex drive no libido and
00:50:07.839 it’s not related to the quality of the
00:50:10.040 relationship it really feels like
00:50:11.680 there’s a physiologic component so I’ve
00:50:13.640 used topical very lowd dose topical
00:50:16.079 drops on the skin on the clitoris yeah
00:50:17.960 on the clitoris yeah I I found that to
00:50:20.040 be one of the greatest hacks of all time
00:50:22.799 I learned about it years ago and and we
00:50:25.160 we have it compounded and
00:50:27.160 and a compounding pharmacy and two drops
00:50:29.640 every night on the clitoris seems to
00:50:31.440 have a profound impact and I I know
00:50:34.079 because women keep calling back for
00:50:35.799 refill so I think I think it works and
00:50:39.599 and I’ve heard many anecdotal stories so
00:50:41.119 I think it’s there’s ways to sort of get
00:50:43.000 around some of these issues as women age
00:50:45.319 and it’s really got to be personalized
00:50:46.880 we’ve got to do a deep dive into each
00:50:48.799 woman’s biology and their health we take
00:50:51.079 a very different approach at the ultraa
00:50:53.119 center than traditional gynecologists or
00:50:55.359 hormone or endocrinologists specialist
00:50:57.359 and we look at everything like like you
00:50:58.920 said we look at everything from
00:51:00.280 Nutritional Lifestyle to toxic load to
00:51:03.240 the gut microbiome to uh metabolomics to
00:51:07.319 genetics of of estrogen metabolism to
00:51:10.000 uring metabolites of estrogen I mean the
00:51:11.720 list goes on and on so we really do a
00:51:13.359 very detailed View and that allows us to
00:51:15.680 really help so many people where they’re
00:51:17.599 stuck so you we both worked at Kenya
00:51:20.200 Ranch which is a health resort and I
00:51:21.559 always jokingly say we were resort
00:51:23.119 doctors the doctors of Last Resort if
00:51:25.400 you love that last video you’re going to
00:51:27.359 love the next one check it out here
00:51:29.599 nutrients work as a team and if you
00:51:32.440 don’t have all of them your about
00:51:34.440 chemistry kind of gets gummed up and it
00:51:35.880 can actually cause worse
00:51:41.240 problem