Hidden Impacts of Menopause: Gut Health, Methylation, and More

Today on the Root Cause Medicine podcast,

you have to look at women in their 40s because we're seeing women are going through menopause or menopausal transitions earlier and earlier. And the longer the fecundity, the longer the duration of time that a woman is fertile, there's a decrease in all morbidity and all mortality. And in women that go through menopause earlier than age 40, it literally doubles their risk for strokes. Like we could go through so many chronic diseases and help diminish that if we could protect women in these vulnerable years.

Hello, I'm your co host for Today, Dr. Carrie Jones, and I am so excited to Bring on the Dr. Bridget Briggs. She is a board certified family medicine doctor in California who specializes in geriatrics and women's health. She is also a phenomenal speaker and educator. I've heard her multiple times talk about methylation and menopause, the effect of hormones on the GI tract. So I had to have her on to talk through both of these things. As women go through perimenopause and menopause and their estrogen changes, it creates body wide symptoms. And as I said, I've heard Dr. Briggs mention the complete change it has on the skin, the complete change it has on the brain, the complete change it has on the GI tract. And we talk through the effect of methylation. Now you may know of methylation through the idea of mthfr. So it's important that you listen up to understand what's going on. Before we get started though, I want to talk to you about something that comes up pretty often on this podcast and that of course, our supplements. There is a lot of confusion around supplements and you only want to take the best quality that uses top tier certified manufacturers and most importantly do third party independent testing to make sure what's on the label is in the capsule. That's why I've teamed up with New Ethics Formulations as their Chief Medical officer. The team already had a strong history in the supplement world, but started the company to really focus on bettering your health and helping to enhance your physique or performance goals. I'm excited to help them continue to focus on the endocrine system and hormones as it relates to glucose, thyroid, estrogen and even your gut microbiome. Right now you can get 20% off one order using code drjones20@newethics.com that's Dr. Jones 20@newethics.com today. Now let's get on with the show. Dr. Bridget Briggs, welcome to the Root Cause Medicine podcast. I cannot wait to get into all the ins and outs on menopause with you.

Thank you, Dr. Jones. Very excited to be here.

Well, you're definitely quite the expert. I have now heard you lecture a few times on all things menopause. And today I really want to start out with on menopause and the GI tract, the microbiome, because I think that's probably what I've heard you lecture on the most. And I think the thing that surprises most women, they're familiar with the hot flashes or the night sweats or the crazy periods or they can't sleep or the weight gain. But when I point out, you know, it affects your GI tract, they go, what? And how does that affect the whole body?

True. The estravelone, which is just a term that I've just fairly recently bumped into along the literature search, really connecting the gut, which I think has been connected to so many disease states, imbalances. But I mean, who would have really thought that there was this huge connection to the loss of the microbiome diversity by the loss of estrogen. I think it's also very interesting that there's a new kind of a body of evidence looking at xenoestrogens and their impairment and their impact on the health of the GI tract as well. So I think we can look at it whether we're looking at menopause or higher concentration of imbalance that's created by the xenoestrogens with a loss of our own estrogen.

Let's start there. What is a xenoestrogen? Explain that to people who don't know.

Sure. So we go way back into the times of the invention of pesticides and BPA and what have you. We were taught that they were not true estrogens. If you can remember, DES was one of the very first kind of synthetic estrogens that came into being. And we were once again told that these estrogens, these xeno kind of pretend estrogens, really didn't have the impact at the DNA level that an estrogen has. But what we're really beginning to understand is xeno, which is false estrogen actually can impact the estrogen receptors at modulation, whether it's an antagonism and an agonism. Right. And these fake estrogens create imbalances. Key disease right now that we're really looking at that has an impact with xenoestrogens is pcos. Right. So as a clinician, it's incredible. I've been doing this for 23 years. Started off as OBGYN and moved into family medicine. And I can tell you, 23 years ago, when I came out of residency, PCOS was a rare disease. Do you know what I mean? It wasn't something that you saw every single day in clinic. They were definitely women that sought out health care. And if you remember the birth control pills that were tutor to be there was like the Yaz and the B Yaz and those that had the spironolactone kind of mimic inside of them. So if I go back in those days, it felt like PCOS was kind of novel. And yet I want to say in clinic, I probably treat three to four PCOS young women a day. And so when we look at their bloodstream, we see that women that have polycystic ovarian syndrome have three times or Eightfold higher levels of BPA found in their bloodstream. And so this is a xenoestrogen. And we have. We may be looking at women that have a genetic imbalance that they cannot handle the detoxification pathways of these xenoestrogens like bpa. And there's so many more, Carrie, like the Thalys, the dioxins, there's so many more out there. But I think what we're really becoming aware of right now is, yes, there may be those of us that are genetically more susceptible to these, you know, estrogens, like girls that have pcos, but at really fragile times of our lives, like in low estrogen states, which can be breastfeeding moms, right? So they have very low estrogen, so they have less protection of their own estrogen at that receptor site. And so those receptor sites are often found in the GI tract, like the ER alpha site and ER beta site. These are estrogen receptor sites that apparently xenoestrogens can actually bind to and create imbalance. Women that are on birth control pills, especially low dose birth control pills, these girls are susceptible to microbiotic changes that occur because of these xenoestrogens and the loss of the protection of our own estrogens. And of course, that gets us back to menopause, because this is where a woman is really at risk. The loss of the diversity of the microbiome occurs. We develop more of an androgen like microbiome instead of a female microbiome. And so this is where we begin to see the GI connection to the state of menopause. And then, Carrie, I don't know if you remember in that talk that I gave, this was totally novel to me, that the GLP receptor sits right next to the estrogen receptor alpha. Right. And so women recognize at the time of hormone changes, whether it's like before your period and you have a heightened appetite with this drop of estrogen, that's when you start to see that the inability to be satiated as equally as previously. This is where women start to connect with like appetite changes, more bloating, more gas, indigestion. These are common complaints that perimenopausal and menopausal women start complaining about. So even though it's never been tuted to us, besides the hot flashes and things like that, that there's a huge shift in the microbiome. But finally it's kind of emerging that women have a drastic loss of diversity of the microbiome at the time of menopause. And it really begins in perimenopause.

And I've even read that the decline in estradiol affects our tight junctions, like the gates that keep our intestines intact and doesn't allow big food particles, chemicals, bacteria, viruses, things we come in contact with through to the other side of the bloodstream, which just further increases inflammation for these women. So not only are they losing that diversity and they're experiencing more hunger. And as you said, they're, they have a more androgenic microbiome, which of course can lead to an androgenic body type. So they get the visceral fat, the belly, as opposed to the legs, the hips, the booty. Then they get all the GI stuff too, the gas, the bloating, constipation or diarrhea, heartburn, et cetera.

And so, Carrie, it kind of makes you wonder, like, why are so many women coming to the clinic asking for these GLP analogs? And in the data pool that we looked at for our talk on menopause as an inflammatory state, what was fascinating is that if we antagonize the ER alpha receptor, it dramatically reduces the amount of GLP that we naturally produce, which is critically important in the tight junctions of a gut. Right? So solid tight junctions and non leaky gut is all GLP mediated. And so it's easy to understand postprandally, like we have this crazy chronic inflammatory state that occurs with the diminishing concentration of GLP production. And it was so interesting, I think, when we read that if you give an estrogen analog, like even if it's a phytoestrogen, it supports GLP secretion, right? Which, I mean, think about like the berberines and the cinnamons and the things that we're nutritionally told help to improve the glp. Many of them fall in the line of the phytoestrogens.

And for those who are listening, if the GLP sounds familiar but not quite sure, I'm sure you've heard about it with the medications that are out now that are called GLP1 agonists, so many of you may be familiar with semaglutide or maybe with Ozempic or Manjaro, they have the ability to bind to and activate GLP. What Dr. Briggs is saying is because the estrogen receptor is right there next to it, a lot of women going through perimenopause, myself included, I have definitely noticed my appetite has gone up, right? A really robust, balanced, healthy lunch, for example, and not blood sugar related. Not calories in, calories out, not stress. I can tell. I can tell the difference. I can still be hungry. It's harder for me right now, in my mid to late 40s, stay satiated. And I hear this from a lot of women. It's surprising.

And what's really interesting, Carrie, is since we've come out with the continuous blood glucose monitors and we are able to prescribe them to our patients, giving women the insight into wearing a blood glucose monitor and seeing their sugar spikes, right? So they say that 65% of women between the ages of 45 and 55 meet obesity. And after age 65, 75% of women reach obesity. And a lot of this kind of takes us back to the GLPs and if we can facilitate women and teach women how to enhance their GLP secretions, which one is hormone therapy? Whether it's plant based hormone therapy or bioidentical hormones, we see that they potentiate your own GLP secretion. And this is in part largely why there's such a. Not only just the leaky gut, the inflammation, the bloating, which is horrible for women, feeling bloated all the time every time you eat, that's from a great decrease in the GLP secretion that you know is naturally there in an estrogen robust woman.

And then all the other thing I want to talk about too, or have you really explained, is we become more insulin resistant as we go through perimenopause into menopause. We struggle with our glucose more. And that's a almost a hidden symptom I have found where women recognize the overt symptoms, hot flashes, night sweats, insomnia, et cetera, but they don't know their blood sugar is creeping up there. They don't know they're becoming insulin resistant. So can you just explain what that means and then what's actually happening due to the decline in hormones? Yeah.

So in one of the studies that we talked about in the menopause conference that we gave is we actually see that when, er, alpha receptor is activated by estrogen, it not only increases the appropriate insulin secretion and the appropriate GLP secretion, but the loss of, er, alpha receptor activity creates an imbalance in the insulin secretion. So in part is you have hyperinsulin secretion and insulin resistance that occurs. So it's kind of like the chicken before the egg. We don't always know, you know, who's the culprit here, but we recognize it's the loss of estrogen receptor activity that creates a shift in the GLP and the shift in the appropriate insulin secretion. And again, one of the most interesting things, Carrie, because I'm 54, and so, you know, I started wearing the continuous blood glucose monitor just to really understand this is a silent disease. Like, women are not aware of these big sugar spikes. And it's interesting because if you have good insulin secretion, like, you make too much insulin, remember, they don't get big sugar spikes. They get big insulin spikes. And so a lot of times, this is where that A1C takes 10 years to change. So as you and I are practitioners are watching their hemoglobin, A1C, a lot of these women have very low A1Cs, and they have a very, you know, striking spike of their blood glucose and a striking drop in their glucose as a reflection of their insulin. And then that's what eventually creates that insulin resistance. So I think it's so important to equip women with these monitors so they can see it early on before they develop the insulin resistance than the diabetes. Honestly, Carrie, like, wearing one, I literally walked around telling everybody in my master's class, I'm a diabetic. I'm dying.

Like.

But really, I think that we need this type of awareness to see we're not really giving women hormones in that perimenopausal phase. Right? So you let women take progesterone. We're trying to balance them, you know, take care of these high estrogen spikes. But the tragedy is these moments, two, three periods that are skipped. And these women have these, like, seesaw estrogens, and they can gain £20 in a year. And a lot of it is just making innocent dietary choices, which we're not aware of because we become increasingly more insulin resistant and hyperinsulinemic, meaning too much insulin.

When you Send somebody for a blood draw. A fasting insulin, fasting glucose.

What do you like to see?

Now, obviously those listening to the podcast, the numbers she's going to give are the US Metrics. But what's your goal for women?

So you'll start to see women creep close to 5.7, right? So we call diabetes 6.5 in the United States on an A1C. Yeah, on an A1C. But remember, we're looking at prediabetes for anybody hitting a 5.7. What's really interesting is the continuous blood glucose monitors. They'll give you what's called a GMI, and that'll give you what your A1C would have been in that week. So I always do not only an A1C, but I do a C peptide and an insulin level and an insulin resistance with my lipid panel to give women that kind of like, this is what's going on with your annual well woman appointment. So they can see what's creeping. And to me, I want my girls below 5.5 if possible. Carrie gets really hard. It gets really hard around the girls missing their cycles. They can start creeping, but it gives them more attention to watch what they're eating.

So with a 5.5 again, is that with an A1C or with an insulin level?

No, an A1C. So insulin levels, when you start seeing girls creep at like 13, 15, that's high. Insulin levels at 3 and 5. That's really ideal. But honestly, a lot of times, even though their insulin levels are normal, don't be fooled, right? So they can still get those really high sugar spikes. I like to watch C peptide. We'll see women that have very low GLP secretions. They actually have low insulin levels. Right? There tend to be your thinner women and they're like that premenopausal, low insulin level, low GLP because the estrogen. So, Carrie, there's really two kinds of girls out there that are going to transition. There's the girls that are getting, like, the high insulin may have higher insulin or C peptide on blood test. And then those are women that are more fluffy. They're more insulin resistance fluffy. And then you'll see your, like, sarcopenic, thinner women that are going through menopause. And a lot of them have low insulin, they have low C peptide, they have very low glp.

And when you have sarcopenia, that's the loss of lean muscle mass. And I'm sure people have seen this or maybe can relate.

They have these really thin legs and

these really Thin arms, and then a more apple shaped around the center. And then maybe they've been like that their whole life, or maybe they've sort of transitioned into that shape as they've gotten into menopause. I love talking about these numbers because I was just talking to somebody last week who is in her 50s. Doctor. Great conversation. And she said. It seemed like overnight. She said, carrie, like overnight, I feel like my glucose went up, my insulin went up, my cholesterol markers went up, my triglycerides went up, and nothing changed. And I don't think women know this enough because there's no symptom to tie to it other than, hey, it's your annual physical. You need to check these every year. We need to keep an eye on

it, especially the cholesterol. And tragically, I feel like in traditional medicine, the first thing you do is they check the cholesterol, they put them on a statin drug rather than recognizing that just with hormonal therapy, the cholesterol completely normalizes. So I feel like so many women are mistreated. And we've seen the data that statin therapy can actually increase the development of diabetes. So, like, I'm excited about the North American Menopausal Society 2022 update, the 2023 update. I've been waiting literally 20 years, Gary, practicing bioidentical hormones and recognizing these patterns. But finally the information says hormone therapy decreases all morbidity and all mortality. We needed that data, and yet we still go to lectures, and we have people that are just quoting old data. So I think we're practicing in the perfect time for women's health.

Well, one of the things you mentioned early was around genetics and detoxification. And I know that a lot of women have said to me, oh, I can't do hormone replacement because I have the dreaded mthfr. There's something wrong with this snp. There's something wrong with that snp. Can we talk about genetics and menopause? Like the active methylation in menopause? Is that changing for us?

Definitely. One of the most important things to recognize is even if you don't carry a genetic SNP in the MTHFR enzyme we see across the board, Americans especially, are strained in methylation. So the xenobiotics, the xenoestrogens, greatly diminish the body concentration of methylation. And methylation is happening billions of times a second. If you carry the MTHR polymorphism, depending on if you have a double C or you're a compound heterozygote, Like a cat, you're going to have a little bit more difficult time keeping up with your methylation balance. But across the board, all Americans are. What's really important to recognize is that women in the perimenopausal phase, if you keep them methylated, you increase their fecundity. Sorry for that word, because it's a really odd word, but fecundity is the duration of fertility, so that you could actually ovulate and get pregnant during that zone. And yes, progesterone increases fecundity, but we see that if you look at some of the hypothalamic areas of the brain, demethylation happens first, and then we start to see missing of our cycles. So during perimenopause, I think it's so important to support methylation. And remember, there are genotypes out there like your comt. They're always going to be slow at methylation through this COMT enzyme, but you can support them with other methyl groups like choline. Choline is so underutilized. Sami is so underutilized. Choline is almost never offensive. It's almost always welcomed with gallbladder function and fat reduction. I don't want to focus excessively on methylfolate and methyl B12, because sometimes I feel like people think that's the only fix. But I do think that in perimenopause, it is so important in women in their 40s to make sure that their multivitamin is supporting methylation. I love the phytomalti. It's one of many multis out there that supports antioxidants but is methylated. And then one of the things that we can do, Carrie, is we can test people's global methylation, right? So say somebody says, I can't take hormones because I can't methylate. Well, this is where the Dutch has become one of the most fantastic tools to make sure that if I am supporting somebody hormonally, am I meeting their methylation needs at the same time? And, Carrie, your talk in Vegas was one of my favorites. And it was the first time that I actually saw. With your little red doors and your green doors, I see this all the time. I see women that have impaired methylation. But what I didn't totally understand until you gave that talk is when people have impaired methylation, they jump over methylation and tap into sulfation. And so I think we see that all the time. We see women that have an excessive amount of DHEAs or they have an excessive amount of estrogen. Sulfate by blood. And so this is that PCOS girl, right? These kind of androgenic dominant, insulin resistant, high testosterone women. This is just one more example of somebody that probably has impaired methylation. And so they're over utilizing another detox store. But we also see on our detox genetic studies, like girls that have sult two A1 polymorphisms where they're a hypersulfate, or we see PST EST1 polymorphics. So I know we always talk about methylation, but what we're really seeing is whether one door in the liver's clogged and so they're over accessing sulfation or simply we need to help them dump excessive sulfur in their body. And this is where molybdenum is a God's end. And I think molybdenum is very underutilized. In my early days, I felt like I had to self teach myself this stuff. I would run 24 hour urines and I would measure sulfation excretion. And so I would look at like estrone sulfate and then I would use like 600 micrograms of molybdenum. And then I would recheck the estrone sulfate by blood or 24 hour urine sulfate excretion. And it was absolutely impressive, the number of clinical symptomatology that would come in the door, like tendinitis, bursitis, plantar fasciitis, like tendinous issues that would completely resolve along with bloating, gas and indigestion. A lot of the GI symptoms that women complain about when they start losing the diversity of their microbiome. So a lot of times you're right, Carrie. It's methylation is stressed. And so they're tapping into excessive sulfation, which causes a lot of the GI imbalance, like the bloating, the gas, the heartburn, the sibo. How many people are on all these specialty diets, fodmap this, that, and really they're just excessive sulfur. And so if you help purge the excessive sulfur either through the kidneys or through the gut with molybdenum, dramatic improvement in a lot of the GI yuckies that people complain about.

And with molybdenum, do you have them cycle it? Do you have them do it for a while and see how they feel and can they go off is how do you work somebody up when you're working with molybdenum?

So what's so funny, Carrie, is I've done hundreds of blood tests to see if I could ever make somebody toxic on molybdenum? Never. I've looked if there are any toxic levels of molybdenum in the literature. There isn't. Manganese is a different story, right? So often link manganese and molybdenum together. But what's interesting is you can give too much molybdenum to the wrong person. And here's the person, if you clear out too much sulfur, you get laxity of your joints. Sulfur is what creates proteins. Our ability, like cysteine, disulfide bonds to kind of like link your tendons together. So if you already have somebody that is low in sulfur and you give them molybdenum, and I am that girl, I'll just confess. I was working out with my trainer and he's like, your kneecaps are rolling off your knees every time you do a lunge. And I thought that's really weird. And like, if I lifted, I would pop at a joint. And so I think that there may be no toxic level. But literally, I do think that it's a really good idea to cycle molly in. People that are really lax, like, feel they have that dealer's danlos physique. Be careful with these people. You can really improve. Tight people that really tight, kind of like curly, thick nail individual, they tend to have a lot of sulfur. Those of us that are like floppy gumbies, yeah, don't give us too much.

Don't confuse molybdenum with manganese. Everybody who is listening, and I should have asked you this the very beginning part of this conversation, just because if somebody doesn't quite understand what is the verb methylation? Can you give us a few sentence summary of what you mean when you say methylation?

First of all, methylation is a carbon and three hydrogens. But the human body, first of all, the liver uses it continuously for phase two detoxification. Methylation is occurring billions of times a second. And really the purpose of methylation at the DNA level is methylation sits on the promoter region of the gene at the primary structure of the DNA, acting almost like a on off switch, right? Like you can replicate this or turn it off. So when you see methylation stop signs, it means do not replicate this part of the DNA. So you can imagine that methylation is very important in cancer prevention, controlled cell division, like prevention of autoimmunity. So at the secondary and tertiary levels, your DNA is also wrapped around a double helix and around histones. And so at every one of those stages, when our bodies put methylation stickers, it Kind of compacts the DNA and keep it closed once again, preventing replication of DNA that once you've grown breast tissue, you don't want to keep growing fresh breast tissue. So obviously, areas of the DNA that are methylated are supposedly turned off equally in the brain. What's so interesting is methylation through, through the COMT enzyme, which stands for catechol methyltransferase, is deeply involved in your immune and your adrenal and your energy function. So the ability of the body to break down catecholamines like dopamine, adrenaline and noradrenaline, that's your methylation and that's who the molecule sami, which is considered to be the global methylator in the entire body. So to break down catecholamines, you need methyl groups. To break down estrogens. In phase two, you need methyl groups. So your liver uses methyl groups, your brain in neurodevelopment. What's really interesting is methylation drives speech development. Trimethylglycine and choline are utilized right now in children with delayed speech. So it's kind of interesting to see that at certain stages of hit, in methylation balance, we can see developmentally where children may have auditory processing problems or speech problems. And obviously an embryogenesis carry methylation is so super critical in steering the appropriate stages of neurodevelopment, embryogenesis, so on and so forth.

So I've watched you on YouTube talk about methylation too, so people have more questions. Search her Dr. Briggs Methylation on YouTube

and you will see her talks.

I want to go back to choline for a second, speaking of methylation, because when women go through menopause and our estradiol goes down, we struggle to make choline. The methyltransferase enzyme called PET helps us make phosphatidylcholine. And I remember reading, and I, I said this in the lecture too, that we were at in Vegas, that there's a little bit of a debate out there whether creatine powders or choline. So the act of creating creatine or the act of creating choline, there's a debate on which one sucks up the most Sam for methyltransferase. And I thought that's so interesting because we have over 200 methyltransferases for methylation, but a huge percentages are going to that. And then we further lose out on that choline. It puts further strain on our body because our estradiol goes down. And then we don't get to make that phosphatidylcholine like we used to. And so I love that you brought up choline. Cuz I think we just lose out as we get older because of the change in estrogen. Of course we can eat choline, they can egg yolks as an example. But not everybody does that or gets enough choline in with choline supplementation. Do you check or worry about in the GI tract that tmao, do you test for that?

I traditionally don't. I read a really good article that said dietary choline from plants does not convert into TMAO whatsoever whereas creatine can. We do supplementational creatine. So I prefer to use choline through the diet whenever possible. And I think Carrie, you hit the nail on the head because it is not preached outside of pregnancy the importance of choline and that we dietarily absolutely as women cannot synthesize sufficient choline. We just can't. And this may be more revealing why the Asianic diet, they do so much better than women in more western based societies because a lot of the soy lecithin and a lot of their dietary choline that found in such a high plant based diet may help them with their fat metabolism, their insulin resistance and kind of back to what you said, the PMT enzyme has an estrogen binding site. So if you don't have estrogen you cannot synthesize enough. And it's funny because in pregnancy what do we give in our prenatals? We give them extra choline, but we don't really focus on that as something that's needed in like a postmenopausal multivitamin for women. And I think it's really something that you hit the nail on the head. I think it's critical that we highlight that.

I was just looking at the component of lipids in a cell wall. Our whole body is cells and our cells have a wall around them and phosphatidylcholine is in there. Imagine losing the percentage of that. It's no wonder our poor little cells aren't doing so well as we get older. It's important for reducing the risk of fatty liver. And something like 25 +% of Americans have fatty liver. It's choline itself is important to make acetylcholine, which is the neurotransmitter of choice or the communicator of choice for our vagus nerve which runs from the brain down to the gut, but mostly communicates from the gut up to the brain and plays a role with memory and mood and all this stuff. And I Agree with you. Why is it not in some sort of postmenopausal multivitamin?

And choline also becomes very important, making deoxycholic acid your bile acids. And we recognize how many women already have lost their gallbladder, which is something that is very much a problem in our 40s. Right. So I remember in surgery they'd say, who's in the ER? Fat, female, 40, fertile. That's the whole, like excessive estrogen in the gallbladder dysfunction. And then one of the things that's really important even in pediatric health, because again, look at children, they're not estrogenized yet. So look at female or a male child. Choline is really important in neurodevelopment. If you look at what cells of the body have some of the highest concentrations of choline, choline tends to be more in the inner membrane of a lot of the neurons. And so there's great data out there that says when the body's balance of methylation is deficient, the body will convert, literally steal intracellular lipid membrane, choline, flip it to the extracellular, and rob your brain of choline to control maybe the DNA protection or what have you. So one of the things that's important is one in five women in menopause in the age of 70s has Alzheimer's. And so I love Carrie, what you said, acetylcholine and the vagus and the memory neurotransmitter. Like, I just wonder how many women could we protect? Yes, hormone therapy, Right. Because I think Dr. Bredesen says the five leading causes of Alzheimer's menopause, untreated was one. And we said that 65% of women in menopause develop cardiometabolic disease. So that's diabetes, hyperlipidemia, menopause untreated, and you got the apoe fours and then the head trauma. So, like, we women don't stand a great chance if our doctors aren't promoting either bioidentical hormones, high plant based diet, extra choline support. Great job.

Well, that's the next transition I wanted to get into. Is that area right there that you just ticked off? Because obvious question will be, Dr. Briggs,

what do I do?

The people who are listening are going, where do I start? How you do, how do you approach somebody who's in the perimenopausal transition or maybe fully transitioned through and is postmenopausal? And of course, I do want to get into the whole hormone therapy discussion.

Again, I think you have to look at women in their 40s because we're seeing women are going through menopause or menopausal transitions earlier and earlier and the longer the fecundity, once again, the longer the duration of time that a woman is fertile, there's a decrease in all morbidity and all mortality. And in women that go through menopause earlier than age 40, it literally doubles their risk for strokes. Like we could go through so many chronic diseases and help diminish that if we could protect women in these vulnerable years. So one is pay attention to women in their 40s. Never underestimate the power of plant based estrogens. Whether we're looking at Vitex or Maca or but you know what I'm saying. We look at data of women that eat a high plant based diet and look at their transition through the perimenopausal phase, whether we're looking at insulin resistance, weight balance, prevention of sarcopenia. The plant based diet is really where we start. For women that are still having normal periods or transitioning early but haven't gone into this, you know, one year without a period. In that one year that women are like on off, they haven't gone the one year without a period. I really try to stay with like estrovera, Siberian rhubarb or any of those, something that modulates that ER beta receptor because that's how we diminish the inflammasome activation. So one of the things that we recognize is the presence of estrogen is anti inflammatory and very immune protective. The loss of estrogen means inflammation just goes cray cray. So inhibiting interleukin cytokine activation, all of that in this transition zone, it's really your plant and your progesterone, they're going to protect these women. Once women hit the menopausal phase, this is the inflammation is just a fire that we have to get a hold of. And so pull out all your tools in your tool belt. And yes, estrogen modulators are going to be important, progesterone will be important. I know we're going to talk about hormone therapy in a minute, but all your high antioxidant ingredients out there that we know, from the turmerics to the gut support and the probiotics, all of that. But these are the women that to watch them like a hawk if you can prevent the transition which is considered to be a major activation of the inflammasome and trying to get that blazing fire has gotten huge is so much more difficult than when the fire is Just like a little flame. So watch the women when they have little baby flames, take them seriously, don't let them get out of control. And then at the actual one year mark, when they've gone a year without a period, thank God, we can start implementing bioidentical hormones. And not every girl can be treated the same. Whether we're using troches, whether we're using intravaginal applicators or patches or whatever. I don't use anything oral. I keep women off all oral estrogens. That's just my thing. That's how I was raised in the world of early functional medicine. I've been doing this 23 years and I can count on one hand the number of women that have ever been diagnosed with breast cancer in my 23 years of practicing medicine. So bioidentical hormones clinically have been so therapeutic, they have been so successful. Whether we're looking at cognitive health, depression, anxiety, insomnia, hot flashes, I can't find anything that could even touch the bioidentical hormone therapy for women's health. And I know that there are women out there that have gone over 10 years, they have never instigated using hormone therapy. And this is tricky because if we follow the NAMS update from 2022 and 2023, it says if women have gone more than 10 years into menopause and they haven't started hormone therapy, we really can't promise you that. There's this evidence based research out there that we're going to do amazing, therapeutic, wonderful preventative things for you. And that's a tough place for these women to be in because they were listening to the 2002 nurses study. And so my heart goes out to these women because they're going to face are we going to do it in cognitive support only? Because if they've got early coronary artery disease, they've got it. I'm a big believer in calcium scores. The moment my girls hit 50, I'm going to get your first calcium score and I'm going to do that every five years. That's the recommendation. They're never covered by insurance. But I want to encourage you that 50% of people that have normal lipid panels have coronary artery disease. So we can't just look at the at risk lipid panel, but we do see that our women have a dramatic change in their lipid profile in menopause. And so we need to be mindful of that activation of the inflammasome and looking at blood markers of inflammation and adding hormone Therapy and seeing if it is taking the fire back down to the baby flame, which is the goal.

And for the calcium artery score for people, it's like a little ultrasound and it's generally pretty affordable. It's generally under $100.

It's a single radiation CT score, and it's about 150 to $300, depending on where you go.

I just got a flyer in the mail that they were doing. It was like 99. And obviously they were just lining them up and they were aiming, of course, at women, which is why I got one. Depending on your area, you might find these kind of situations where they're hosting screening days and then it's a bulk rate, so it's a lot cheaper.

And just to remind women, women are more apt to throw soft plaque, which would not show up on a calcium score. So we proceed with caution when you're interpreting your calcium scores. The harder plaque is more commonly found in men, but that doesn't mean it has no value. It has a huge value. And I especially watch those women carry that. Carry the LP because they really prematurely do it all right. And can still develop a calcium score.

And an LP is a blood test that you really only need to do once because it's more genetically based and harder to move the needle as opposed to like a thyroid or hormones that you might be doing every year. So definitely for people who are taking notes and on what test to get LP is part of that, at least have it once. If you haven't had it at all, do you want to go back to the hormones? You had mentioned that once they've gone 12 months with a period that you then prescribe hormones, do you ever start earlier? Do you ever start, like, let's say a woman is in her early 50s and says, My gosh, Dr. Briggs, it's been six months. I'm dying over here. Do I have to wait six more months or can I go now? I haven't had a period. I'm in a halfway point. What do I do?

Absolutely. I make most girls go a year. But if I get your really tough cases and you know these girls, they've gone like two months, and then they go nine months and they go two months and they're really symptomatic, then what I'll do is I'll cycle them like a period. And if you outside them, you're like massively cleaning up irregular periods all the time. It always worries me to start it early because if you start a bleeding cycle, they can get really hard to control.

And how often do you use testosterone or DHEA as part of your therapy?

I would say 80% of the time. I'm a big testosterone believer. I am a big intervaginal applicator person. So, again, in one of our talks in Vegas was the dramatic shift of the microbiome in the gut is not left behind by the vaginal changes that occur with the loss of vaginal microbiome. And once again, what's so therapeutic is if you keep the application of the estrogen in the vagina, you protected the vaginal microbiome, the pH, you protected the tension of the tissue, especially with testosterone and things like that. So we're just trying to make sure our girls don't have, like, cough and spill urine, you know, incontinence, things like that. So I'm always like the intravaginal pusher. That's what I prefer to do. But I have plenty of women that would rather wear a patch. They don't want to think about it every single night. So we do both.

And it's so wonderful that there are these options out there for women. And I think it's important that women listening know that there are options. Obviously, certain doctors have certain preferences, but if that preference doesn't work for you, for example, let's say you go see somebody who only does injections. I absolutely know practitioners only do injections. And you're terrified of needles. Know that there are other options out there. You can ask for another option, or there are doctors like Dr. Briggs who can do a patch or do a troche or can do the intravaginal. So there are all these options, which I absolutely love. I do want to touch on as we sort of wrap up, is the 2002 the Women's Health Initiative. I even got asked the other day. I just forget how much that information is out there. I was on an Instagram live, and in the chat, a few people were like, oh, no, no, I don't do hormones because the risk for cancer is so scary. And I thought, oh, we've come so far. And also that hasn't been completely disseminated. And in fact, I take progesterone, and in my progesterone packet from the pharmacy is all about the 2002 Women's Health Initiative and how hormones cause cancer. And I thought, what? So can you explain that study a little bit? And then why that set it off for everybody and where we are now.

So things to remember that the average age of the woman who enrolled in the Women's Health Initiative study, she was 62 years of age. And that's probably that a little bit of that residual that we're talking about right now. Like, if you've gone more than 10 years into menopause, we don't know how much protection we can give you. So we've got some remnants from the Women's Health Initiative study. And that's really part of it was. We don't know what was brewing in these women long before they became a member of the study. There were two arms of the study. There was the estrogen alone arm, which was Premarin, and then there was the Prempro arm, which was the synthetic progestin, remember? And there's fantastic books out there by Dr. Jonathan Lee about how bioidentical progesterone is not the same thing as a synthetic progestin. But I think at the end of the five years of going back into the data and really hashing it out, the end study showed that the women taking the Premarin were not the ones developing the breast cancer on a whole. It was the women taking the synthetic progestin as a part of the Prem Pro arm. But once that information disseminated that hormones cause cancer, retracting it was incredibly difficult. Difficult. There were so many attempts out there to warn women about the differences between progestin and progesterone, but honestly, so many doctors don't know the difference, so many pharmacists don't know the difference. So make sure, even if you're being treated by another physician and you're taking progesterone, that it is bioidentical progesterone or prometrium. Carrie, I don't know if you have this problem right now, but in our valley, there's a nationwide shortage on patches, There's a nationwide shortage on prometrium. That scares me because bioidentical progesterone is bioidentical. That is not a progestin. We know by the data that women that have taken a birth control pill for over 15 years have a 39% chance of developing breast cancer because of synthetic progestin. And the irony is the OB's never stopped prescribing birth control pills. Through all of this data, they kept giving these young women synthetic progestin. And so I want everybody to take a step back and remember that that is still being prescribed. And so, sadly, we need to make sure that our young women are aware of what's in their birth control pills and then try to make recommendations to get them off that.

Yes. I love that you said that with all the attempted education around progesterone, Progesterone, it just didn't hit home. It didn't make the COVID of Time News. It didn't make the nightly news. It's still not in the pharmacies, unfortunately. And so definitely, please listen, understand, read your label. Does it say progesterone? That's what you want, or is it a progestin such as Provera? Probably not what you want. So great clarification there, Dr. Briggs. I could talk to you for hours and hours and hours. But as we wrap up, I have one final question. Since you are in your 50s, what is the biggest takeaway you can leave women with? Is. Women are either entering into the perimenopausal transition, they're in the transition themselves, and they're just trying to do the best they can for their body so they can thrive. As somebody who is both a doctor in this field and in her 50s, what's your biggest takeaway?

Don't wait when you're in hormone disaster to practice prevention the entire time. Whether you're in your 30s, your 40s, your 50s, or your 60s, it is so important that you grasp hormones are at the base of all balance. So maintaining hormone balance, whether that's in your 30s and your 40s, you're doing like a non hormonal IUD. But try to keep your body clean and pure. So many women wanting children, practicing in vitro fertilization and things like that, like, women, we need to protect this temple. We only get one movement should never stop. It's not like you're too busy because you're having children. I just got back from Hawaii yesterday, and I'm looking around at, you know, everybody in the bikini, and I gone to Taiwan earlier this year. And it's so interesting that Americans do not value health and fitness. And I think stepping on that scale once a week and making sure that you know what creates balance and what creates imbalance, and that's not to give people food disorders. It's just if your hormones are shifting and you can tell that something is different where you can't fit into your pants in the next week, why are people waiting till they're £80 up the scale? Because inflammation, your fat cells are sources of toxins. So I will see women do these, like, drastic weight loss programs. Drop 30 pounds, drop all this toxins that are in their fat cells, and then they have breast cancer. Take care of your body's, your temples, maintain hormone balance. See your doctor once a year. Don't be afraid of bioidentical hormones. Don't be afraid to seek natural remedies that maintain hormone balance as well, like Siberian rhubarb, like Maca, like Chase and Vitex and things like that. Seek out your functional medicine doctors, nurse practitioners that practice more naturopathic doctors like Carrie. Like, I feel like without us Carrie, these poor women are getting so much misinformation. So be on top of your body while you're young so you never develop the old body.

I love it. And your clinic is seeing patients, correct?

Oh, yeah. We have two clinics. I'm in Southern California. I have a clinic in Temecula, California. And we have a clinic in Murietta. And we are a primary care doctor, I'm a family medicine primary care doctor that we see 20 something patients a day, all of us, all the practitioners, and we all practice bioidentical hormones and hormone balance.

So where can people find you? Where can they learn more, learn from you, or if they're in California, look up your clinic.

I just prettied up my website, drbriggs.com so please come look us up. I actually have AI running it now, which is nice. So, like the moment somebody has a question, it goes right to my cell phone. And then I have an amazing group, staff members that have been with me literally since they were babies. But my staff works really hard to reach out to you guys right away and make sure, even if you're not near me, can I get you to one of my girlfriends? And we do telehealth as well. So if anybody needs help, please reach out.

Bridget, this has been amazing having you on the Root Cause Medicine podcast. Thank you so much. As usual, this has been a wealth of information, such fascinating discussions we have. I think talking about menopause, the whole transition is just so important to get that information, that education out there and really clear up that miscommunication. So thank you again for being a guest today.

Thank you, Dr. Jones.

Oh my goodness. Thank you so much for listening to today's episode.

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