Reproductive Aging, MenoAge & Women's Health

Hello, lovely listeners. I'm your host Claudia von Boeselager, and welcome to the Longevity and Lifestyle Podcast, where I invite pioneers and thought leaders in all things longevity and lifestyle to give us the strategies, tools, and practices to live better and help us reach our highest potential. This episode is a part 2 with the wonderful Nikolina Laug. Nikolina is the co-founder and CEO of GlycanAge and a successful serial entrepreneur. Nina's on a mission to unlock the human glycome for preventative health and longevity. Nikolina has built and scaled startups in the field of SaaS, travel, and consumer health to multi-million revenue businesses with a valuation of over $25 million. An offshoot of the Human Glycome Project, GlycanAge is a simple, groundbreaking test that analyzes your glycobiology to determine your biological age. With over 70% of diseases being preventable, the team at GlycanAge believe that our health is in our hands. In this episode, we dig into menopause being the world's second largest market after aging, yet doesn't have an accurate diagnostic test. How you can reverse your biological age and what to avoid that is aging you. Why women over 30 should proactively be paying attention to maintaining their healthspan and what to do. MenoAge as the revolutionary diagnostic tool for women to understand where they are in their reproductive aging and menopause timeline. Hormone replacement therapy, or HRT, and the difference between synthetic, bioidentical, and body-identical HRT, advice for young entrepreneurs, and much more. Before we begin, please hit subscribe to the podcast to get your weekly dose of longevity and lifestyle inspiration. I would also love to hear from you, so please leave a comment to let me know what you think, or reach out on Instagram @longevityandlifestyle. Please enjoy.

Welcome back, Nina, to the Longevity and Lifestyle podcast. It's such a pleasure to have you on today as part 2.

Thank you for having me again.

Such a pleasure. So in our last podcast episode, we covered a lot of ground, including everything from glycans to biological age and biological age testing and what influences our biological age. And I'm so excited to continue our conversation today about something so important in women's health and their health journey, specifically around female reproductive aging. Testing and how to optimize it. So, Nina, I'd like to start with a question on an incredible statistic that menopause is the world's second largest market after aging, yet it doesn't have any diagnostic tool. How is that possible?

Well, actually, I think even in 3 years' time, you're going to have 10% of the global population in menopause. There'll be 1.2 billion women. And obviously aging affects everybody, but like menopause is a key aging inflection point in women. Basically, right now menopause is diagnosed 12 months plus 1 day that you haven't had a cycle, but it's already known that you can be in perimenopause, or this transition phase into menopause, up to a decade before then. So somebody was telling you, oh, you can be diagnosed with, for example, arthritis for a year and 1 day that you've had it, and also another 10 years before that you've had the start of symptoms, that would be completely ridiculous. But for menopause, that's how it's currently done. And one fault is the lack of tools. So if you're just looking at hormones, they fluctuate a lot. And that's similar to the problem you had with diabetes and glucose, where if you measure it daily, you get a very different result, even if it's fasted. Similar to estrogen, you can try and measure it in certain days of the cycle, but it does fluctuate a lot. Particularly fluctuates a lot in perimenopause. So you may be having a completely normal result one day and then you have a very abnormal one a few days later, and then you don't really know what's going on, or it's hard to tell you the trend of what's been going on. And that's one problem. That's why when women come in with symptoms, there's no test you can run. So they're mainly treated for the symptoms. So they will come with anxiety and depression and automatically they're put on antidepressants, or they come with joint pains and they get referred to a different specialist. Heart publications, they go to cardiologists. He can't find a problem because he's a cardiologist. He's not a menopause specialist. And you're often just put on the wrong drug. And that goes on for a long period of time until you actually enter menopause.

Which is quite scary, right? I mean, being put on a wrong drug, which has its own side effects. I mean, why is there such a gap in knowledge for general practitioners or physicians? Is it just not been trained in medical school enough? Or why are people being sent to a cardiologist if they have menopause symptoms?

It's not really talked a lot in medical school, or there's only a couple hours on it. And there's many reasons. So it's not just one. Another one, it's aging. So in a way, menopause is also not a disease, although it's medicated. So it's not treated as a condition. It's not given the same weight and value as it would to something else. So I think that's one of the reasons it's not prioritized. Another one is women's health is actually very poorly managed in general. So if you're even looking at PCOS, endometriosis, the time to diagnosis is horrible, 9, 7 years. So generally women's health is a very neglected space. And then also it's a taboo. Like my mother didn't tell me when it was going on. I just saw her change shape within a year and I didn't want to say anything. We don't really talk about it enough. It's been hidden behind. Nobody really shares their experiences.

Yeah, such a good point. And I recently did a podcast episode just to talk about women's superpowers and actually that there are 4 different people in the space of a month as well. And I think that the more it becomes okay to talk about symptoms, to talk about this and share experiences, that women are not left so feeling isolated and that they realize it's okay. And actually all women go through the same thing and it's better to be open about it and discuss it. And this leads me to my next question. Can you explain for listeners why every woman over the age of 30, and every partner of a female over the age of 30, should be listening as well? Why it's so important to be on top of your hormonal health and where you are in the perimenopausal journey?

It actually starts far earlier than you think. So even when we looked at our data, and we followed over 150,000 people in some longitudinal cohorts, we have historical data. We see that some of the changes start at 45 as an average, and while 51 is the average age of menopause. So even in your mid-40s, you're probably in the average for when hormones will start to decline. 1 in 100 women, it happens below 40, and 1 in 1,000 below 30. It happens a lot earlier than we think. And right now, in a way, you don't expect it until you're 51. So you tell yourself, oh, I'm not in menopause or I'm not close. And actually, maybe it's been going on already for a few years.

Exactly. And I think— and we'll get into it around inflammaging— but I didn't realize that even under the age of 30 that it can affect women as well. And I think this, you know, point is not to actually just scare people, but it's almost scare people into action because the beauty of it is that you can actually do something about it. Can you talk a little bit about the famous wording inflammaging, what it is exactly? And then I'd love to discuss perimenopause, what type of effect it has on the body and the mind as well.

So inflammaging is this accumulation of damage as you age. So your immune system creates inflammation.. And a lot of our also age-related diseases are connected to inflammation, from autoimmune to cardiovascular, metabolic, neurological, pretty much the majority of them. And then as we are aging, we overactivate the immune system or the immune system gets dysregulated. So often there's a misconception that says as we're getting older, we have an underactive immune system. And that's wrong. We have an overactive immune system in the wrong direction. We create inflammation. And we don't shut it down fast enough. So we overreact to the wrong thing and underreact to the right one. And this low-grade chronic inflammation, we see it go naturally up with age. But there is a gender difference. So whenever we look at the data, we always see that men are very simple. They have a straight line going up. So they just accumulate these pro-inflammatory structures and lose the anti-inflammatory ones. And women have a curve where in a way they have an early advantage. So in reproductive age, they have a better functioning immune system and they have less inflammation. This is probably why we have the man flu. They're not wrong. It's a different type of disease. They have a different immune system. And then that rapidly changes around menopause. And in our data, we see in terms of biological age or inflammaging. So we measure biological age by looking at the immune system and your antibodies and these glycans around them. And we see that in women perimenopause to menopause, the rate of biological aging is more than double. In the transition, the average increase in biological age is about 9 years, but it can go from 5 to 30 plus. Wow. It can be a very rapid shift.

Just repeat that, that women can age up to— I mean, this is more an exception, but up to 30 years biologically in that short space of time between perimenopause onset menopause.

Okay, wow. Yeah, and that's by looking at the immune system, and it is actually a good proportion of women. So we see that some are phenomenally young, so they have very young biological age, right until a couple years before menopause where they have a very rapid shift. While in other women we would see more gradual aging, more similar to what we see in men. So genders— obviously also differences within gender are more than the differences between the two. And that, when we connect it to perimenopause, it's probably connected to when estrogen drops. So in some women, it may be more of a rapid drop over a couple of years. In others, they lose it gradually, maybe over a decade. So potentially also when they receive therapy, what type should be different.

Yes, exactly. And I'd love to move on to this exciting product that you're working on, MenoAge. How does it solve for this testing and what can be done?

Can you talk a bit about it? Well, the first challenge is to identify it correctly. So to identify menopause, not when it's already over. So you haven't had your cycle for a year, but hopefully years before. And because the glycans we look at, they have a long half-life. So one way we try to interpret it is, for example, with diabetes, if you look at glucose, it's really hard to make a conclusion on the trend. Well, if you look at HbA1c, which is glucose over the last few months, then you can make a reliable decision. Or if this is or it isn't diabetes, similar to menopause, because this long half-life and this direct connection with inflammation in the immune system, we see a type of HbA1c for estrogen or something we're trying to call long estrogen. So you're seeing what's going on with your hormones over the last couple of months and weeks rather than what happened this day or what happened in the last couple of days. So it can be more stable. Hopefully one day it can be something that your GP can run. So when he's trying to make a decision, or if you have depression, anxiety, or some other problem, he can just run a simple test and know if this is related to your hormones rather than you having to come in all the time and test your hormones.

And one day you're normal, the other day you're abnormal, and nobody's really giving you a straight answer, or you get sent to a cardiologist instead of being treated for menopause. And so once you have the results, what can be done? Is it just a matter of getting on to hormone replacement therapy, or what does that process look like? And maybe you can actually talk about how the test is also done.

Glycans that we have in the biological aging test, but we don't interpret them in terms of menopause. As soon as we can make the clinical claims, we will. But you can already, looking at your biological age, if you're looking at the shift in biological age, you can even use GlycanAge for it now. But you would have to have a baseline before and after it happens. So if you're already there, we can't yet make these claims. So a couple of years ago, we had this first study with hormones and we had no idea it would have such a big impact. So we always knew that there was some type of gender difference in aging, and we thought that it was menopause, but we only really got menopause data last year so we can make a conclusion. And there was a study done in the States where they manipulated hormones in women. So they gave them the therapy you usually have with IVF to block hormonal hormones for a couple of months. It was about 5 months, and one received placebo, the other received an estrogen patch. And in the placebo, they age 9 years within 5 months. And with the estrogen patch, they don't age or they stay in the healthy range. So you can potentially prevent this increase in inflammation with estrogen, similar to, let's say, hysterectomy. So you rapidly cut off hormones. So it's easy to make a decision on what could prevent it with natural menopause because different hormones decline at different pace. It's a bit more complicated. So we were interested in what happens in the menopause clinic when you're treating patients as you usually would. So we followed a group of women in a menopause clinic, and this is not published yet, so this is something we're hoping to publish next year. But we saw that even in natural menopause and now with body-identical hormones, we see a reduction of 7 years on average after 3 months and 10 years on average after 6 months. And not all women respond. Some don't change. We haven't had anybody change in a negative direction yet, but we probably haven't looked at enough. Women, but the response rate is much better than any other intervention we looked at before.

That's so exciting. And also maybe for people just to better understand what is the benefit of reversing your biological age.

So with GlycanAge, we have really good data. So our data previously always focused on cardiovascular, metabolic, and we knew that these certain levels of glycans were predictive. Of cardiovascular events, diabetes, and sometimes up to a decade in advance. We never actually correlated the acceleration of glycan age with general health risk. And that was done last year by an independent study. So it wasn't even us. We analyzed the glycans a few years ago. It was a biobank called the ArcaDES, which had 1,000 people followed over a decade going from age 18 to over 100. So it was a very vast age range. Oh, wow. And they did a study where they compared all different biomarkers. So they looked at DNA methylation, proteomics, metabolomics. They modeled the aging clock on top of the clinical biomarkers, everything you do at your doctor's at the moment. And the glycans were most predictive of future hospitalization of a broad range of conditions. So methylation and glycans track this early molecular aging process. They're not disease-specific. They're general aging or the early phase. Proteomics, metabolomics, clinical biomarkers were risk-specific. With clinical biomarkers, they're very specific because already a certain organ has failed and you can identify this organ, which is really the late stage of disease. So you want to be finding things much earlier on. And then the glycans and metabolomics were the most predictive of your future health or hospitalizations, which is a very concrete metric. So we know that when your glycemic age is reducing, you're effectively reducing future risk of hospitalizations of a broad cause, increasing your extra years of healthy life.

So basically you're increasing your healthspan by reducing your biological age, and ideally then will have no reason to end up in hospital for a very long time. Hopefully, if you manage it correctly and don't have any accidents. Before we dig into some more details, I just want to switch over to some rapid-fire questions, Nina. So what are some daily or weekly routines and practices that help you perform at such a high level?

Oh, I am a horrible example at the moment. I don't think lockdown was helpful, but I meditate and that helps the most. So I think that if I would not meditate, I wouldn't be so resilient to stress. I wouldn't be able to handle as much as I can. And then I make sure I sleep. I can compromise on a lot of things sometimes, particularly if you're working 15, sometimes 18 hours a day, you make some sacrifices. But I try not to compromise on sleep. If I do compromise, then I feel the effect. If I don't, I can be quite resilient.

And tell us a bit about your meditation practice. Do you follow a certain type, or do you mix different ones? What do you find most effective?

About maybe 8 years ago, I did this meditation retreat called Vipassana. It's like a 1,000-year-old type of meditation, and it's a 10-day silent retreat, so you're forced to learn how to meditate. And I think it took me about 6 days to learn how to meditate. And the impact is very much long-term. So the type of my response to stress, any type of positive, negative stimulants in a way, has changed. I don't respond to things automatically. I feel it at the moment, then it's gone. So I don't recreate things. And that was pretty permanent. I did it a couple times after and I practice it not even as regularly, but I do. And the effect is permanent. And before I went there, I was nearing burnout or probably full burnout. And when I came back to the equally stressful environment, nothing changed in it, but I wasn't stressed. So my environment didn't change, but I changed. So I think that that's a really powerful way to— I'm sure other ways also work. I think I needed something radical, but it's a very interesting one.

And do you do it every day for a certain amount of time or twice a day, or how do you incorporate it into your schedule?

You're supposed to do it twice a day. I do it maybe 20 minutes every few days, and that works for me.

But it still works for you. Exactly. I can confirm you're always very calm and collected, so clearly it works very well. Nina, in the last 5 years, what have you become better at saying no to, be it distractions or invitations, and what new realizations or approaches helped? Do you have any other tips for people struggling with too busy schedules and too many things going on?

I value my time more. I think before I would say yes to everything, or I wouldn't always have the kind of value for money and the time investment. Now I really focus on things that make a big impact. Also, if you are running a business, you're liable for all the people in it, so you have to invest your time in a way that you can support the whole team. So make sure to always choose to focus on things that will make that return, and I think No to the things that wouldn't. Excellent.

If you feel overwhelmed and unfocused, which I think with your meditation practice doesn't happen very often, but if you lose your focus even temporarily, what do you do?

I'm pretty good at focus and I sometimes hyperfocus, so it's more complicated for me to get out of it than get into it. But if I feel overwhelmed, I would just take a moment to do something like go for a walk. Go for a walk and listen to something, take a break in a way. So stop the work and just think or try and do something which takes me out of the overwhelming scenario, at least for 5 minutes or 10, but whatever I can afford.

Amazing. So let's change gears and dig a bit more into the science. And we talked a bit about glycans and measuring that. And I'd love to talk also a little bit more about the hormones. And HRT, which is obviously can be controversial for some people. First of all, maybe just taking a step back in terms of hormones, there are different types. You have the synthetic hormones for hormone replacement therapy, you have the body identical ones, and then the bioidentical ones. Can you explain the difference and what your view is on the different ones?

One thing we maybe should start with is what is menopause? If you look at what is menopause, so menopause technical definitions when periods stop, but actually it's your ovaries stopping to work in a way. So if you look at the ovaries as an essential organ that's important for your health as it is, then menopause is a hormone deficiency. It's the same if you have an underactive thyroid, you have a hormone deficiency and your health is at risk unless you address it. Similar to menopause, it is a hormone deficiency and it's a health risk. And if you look at it as a hormone deficiency, then the way to balance it out is to give back the hormone. And that's where HRT comes. But I think similar to aging and longevity, you have this conflict that it's a natural event. So everybody ages, all women go through menopause. And because it's a natural event, we have this mentality, oh, we shouldn't meddle with nature, we shouldn't treat it. Although, you know, that organ has died, it's not there anymore. So I think that's wrong. And that's why menopause was probably underlooked and mistreated because they looked at it as this natural event. But if it's a hormone deficiency, then you need to address it. And there's different ways to address it. Addressing it with lifestyle is very hard. So we're trying to do a lot of research to see what lifestyle interventions you can do. And we haven't found any evidence that was positive, but replacement works really well. And there's different types of HRT. The old forms of HRT, so the ones that were in the first study, there was a huge Women's Health Initiative trial, which created the whole scandal. It was actually the first ever longevity trial because you were treating aging or natural events in healthy women, and it failed dramatically. And a lot of it was political or politically driven or exaggerated in a way as well. But that type of hormones was made from pregnant horses' urine. It was the first form of drug. It wasn't the nicest one. It's still in some developing countries, I think it's still the primary type. I think it was called primarine, and it's not really used in practice anymore. It shouldn't be used. And then you have these more modern types of HRT like body identical, which are synthesized from wild yams. So they're the same molecule as your body produces in the most natural form, and they haven't been identified with some of the increased risk. And what was found is that really the synthetic progesterone was the one that had a little bit of an increased risk, and that's the same progesterone we have in the contraceptive pill. So with the body-identical synthesized from wild yams, they call it micronized progesterone, that seems to be the best form. And then you have bioidentical compounded hormones which is a separate, in a way, industry because it's not a regulated drug or it's not as well regulated, which is compounded by a pharmacy. And because it's compounded, you don't have one type and dose, and there's very few trials that were run with it. So you don't really know the efficacy and the safety. And there's some concerns that they wouldn't be really absorbed as well in terms of progesterone. And if they're not absorbed as well, and you still have a womb, so you haven't had a hysterectomy, then you need the progesterone balances out estrogen so you don't build up this lining of the womb. And if you build up this lining of the womb, then some women are in danger of endometrial cancer. The best form is this natural regulated body natural drug, which is available, for example, on the NHS. You can hopefully get with your doctor if you can battle him enough to get there, which, you know, the efficacy and the safety profile. Well, with the compounded, they also help. There was a lot of women that have benefits from it and they help them, but they're a little bit less regulated, or I would say safe, but maybe somebody would argue.

Yeah. But of course, if it's regulated, then it's a bit easier as well. And I think out of the US, you hear more about the bioidentical versus in the UK, they have the body identical. Or would you say that the body identical is also available in the US?

So the body identical, you can call it bioidentical as well. So in the US you also have basically their bioidentical is the body identical unless it's compounded by a pharmacist. So the compound that is the pharmacist puts it together.

Mm-hmm. For people wondering, how do you know when to start on hormone replacement therapy? I've just turned 40 and I have a bunch of friends also that are older. Experiencing symptoms, and because of learning more about this myself, I encourage them to speak to their doctor about it and actually be proactive versus kind of waiting and be reactive. But I think the concern is, you know, well, it's not really well known when you're supposed to start on the hormone replacement therapy. So is there a typical biomarker? When is it decided to actually start on estrogen and progesterone and maybe even testosterone as well for women, which which I think a lot of women don't realize, but it's also a key hormone that we need to get through the day.

Currently, there's no test, so hopefully we'll have that test, but at the moment it's all symptoms related. So if you have symptoms which relate to it, and in some countries you're just treated because of the symptoms, not because of menopause, and you have lots of ways to track these symptoms now, so we'll definitely look at them longitudinally and see how severe they are and then it's your choice. You can do it to prevent it, or you can do it where you feel things are getting a little bit worse. How HRT is prescribed is post-menopause at the moment, or it's the labeling on it, but it's probably way too late. And because we don't have at least a year when you've started to lose your cycle should be the better time than waiting a year. But hopefully there'll be a blood test you can run and then you can make a simple decision and personalize it as well because we all respond differently and it's different doses of hormones for different women.

So, so helpful, especially getting ahead of the curve. As you know, I want to live to at least 150 in a 20-year-old body. So I think as a female, this is such an important area to really tackle because of the aging that does take place by ignoring hormones and waiting too long. So for all listening, I really encourage you to be proactive in this field so we can all stay as youthful and enjoy life as long as possible. What are some other developments in the longevity space, Nina, that you find most exciting?

There's a few exciting biotech startups looking at ovarian aging, addressing different hormones to see if they can extend the lifespan of ovaries or the quality of eggs affecting fertility, which would be amazing because we have first this inequality that comes from having a biological clock. Which runs out quick. The ovaries are the fastest aging organ in the body, which is not quite lucky for women. So we need to make some decisions a bit earlier. We need to manage it in different ways, which are— none of them are ideal. And then we also have menopause. So I think when we handle ovarian aging or fertility and menopause, then we can have a level playing field. But until then, it is working against us.

I agree, which is Such an interesting space to see how this develops. Nina, what are some bad recommendations you hear in your area of expertise?

So one area we did a lot of research on is exercise, and we've also talked about exercise in menopause. I think this is interesting, but we did both studies of people going to the gym for the first time and competitive sports, and we see that generally people do one mistake, which is combining caloric restriction plus intensive exercise. And we were first really confused because that's what everybody does. That's the recipe to lose weight, reduce calories and increase exercise load. On the biology front, it's completely wrong. It doesn't work. It just creates damage. And probably a reason why the fitness industry works as it does. But when you are building muscle and you're restricting your calories, building muscle, if it's acute, it's a stress to the body. So if you do it in, for example, intervals and we had a few studies with, let's say, interval sprints and we saw this group of guys get younger in 3 months. So yes, interval sprints makes you younger. But this gym studies we did in competitive bodybuilding and we did women's competitive bodybuilding, they all become older. And significantly older, or their inflammation levels go up. So if you're building this muscle and you're restricting your calories, then you're not fueling the repair process. So you are in something we call energy insufficiency, and you're potentially just accumulating scar tissue. So it's not healthy muscle. You haven't fed it properly. And this is probably why now from January you have this big influx in the gyms, or for the last 30 years they make 40% of their annual revenue in the first 3 months, January, February, March. And then all of a sudden, all members drop off and you have 1,000 people paying membership, but maybe 100 come to the gym. And, you know, you can argue that they're lazy or they don't want to, or they failed their New Year's resolutions. But actually, I think the body just tells them, this is too much. You know, this is stress for you. It's not healthy for you. Please stop going to the gym. But then you get all this guilt tripping. You should. And I think this combination of dieting and exercise is really the dangerous part. Exercising alone is positive. We should do it in a smart way, but we shouldn't be doing both of those at the same time. They don't even work for weight loss because if they worked for weight loss, we wouldn't have such a big obesity pandemic as well.

That's a very interesting but totally makes sense way to think about it. I mean, how many people sign up for gym memberships and like, this is going to be the year and I'm going to do it. But actually what you're just saying there, what you can see from the test results, is that typically it's, you know, going on a very severe diet in January, plus then probably trying to go to the gym like 5 days a week, and the body's just saying it's not possible. So I guess it's finding the more moderate form of A, going to the gym, but also B, just shifting the foods to quite healthy food, a little bit less focus on calorie restriction and more on just eating healthy whole foods.

Interesting point. Smart exercise, not just hard. And then in women who really understand what's going on now, so we had this very tightly controlled study where we looked at gene expression on the immune system and for the immune system. And also they suppress nonhormones. So that's different to men. Men boost testosterone, women suppress their hormones when they're exercising and they lose bone density. So overexercising women mimics menopause and mimics osteopenia and all the damage to the immune system and your glycogen age goes up. So it's at least 4 levels of aging damage you can do with overexercise. And now you have, because the population is aging, you have more and more of this fitness programs or PTs for women in menopause. And a lot of that is just completely wrong concept because a lot of times in menopause you gain weight because your body's losing estrogen. It was a fuel that your body was used to and needed. So now it's accumulating fat. To create more estrogen. And then if you are exercising and you're suppressing these hormones, when your body's already trying to do this to survive, you're just basically accumulating more and more of this inflammation. And that's something we see in our clients who are trying to tackle menopause with exercise and over-dieting. It just works against you. And even if you're trying to eat a diet for menopause, you can't eat that many yams and you would need to eat them every single day. Because, you know, they're in and out the next day. So you're not going to find this. And also Westerners, we don't have the microbiome for the plant estrogens. You know, maybe Asian countries have it. Maybe they even have different menopause symptoms. There's a few theories there, but we can't really outeat a hormone deficiency. So all these diets and exercise programs for menopause are just money-making schemes and are probably not benefiting your health. One thing that has potential. So we did this diet study for perimenopause, and usually nobody researches women in perimenopause or menopause because they fluctuate so much. So the researchers just kick them out because it's noise in the data. But we did one for dieting and all of them kept going up. So the diet really didn't tackle it for them. But there was one woman who started meditating and she reversed 6 years after treatment. And that was in the next cycle. So we did 3 months and then we did another 3 months and this lady started meditating in the last 3 months. So maybe, and this is one woman, so it's not conclusive evidence. It's N of 1, but it could be potentially some stress management meditation that could manage it a bit better, which we're very keen to research because HRT works very well, but there are some women who don't respond to it and they need some solutions as well. And it shouldn't be the menopause diet and exercise programs. Maybe some yoga can work, but you shouldn't go on an intense boot camp for menopause.

I love that. And how interesting with the meditation as well. I mean, we know across the board what you were saying before, just from peace and calmness, etc. And potentially, do you think that stress is— obviously meditation is sort of the balance to stress, right? So I guess stress ages the body a lot. So do you think that that maybe is the reason behind the meditation reducing biological age?

Potentially. So that's something we really need to look into further because it's hard to study stress. We did some mice stress or rat stress studies, and that's very different. But we know that, for example, people with PTSD are on average 15 years older, like, like in age. And some depression has a connection to inflammation as well. So that's the area of research for the future. And PTSD is like You're stuck in chronic mental stress, and stress is created in the mind. We're the only animal species that gets stressed for missing a meeting or having a deadline. Our dog doesn't have the same stress.

I can't see the— exactly being stressed because they missed the meetup or having FOMO. What are some of the learnings and insights that your clients you work with have found the most valuable, Nina?

A lot of it does come to this over exercise because we as a company mainly had biobank data or different clinical trials. So it was the average population and it was a very good baseline. So 150,000 people in total from both genders, a little bit more female actually, and 30 different countries around the world. But that was the average population. So our customers, when they buy it commercially, they already have this, we call it healthy user bias. So they're already in a way making good decisions for their health, or they're proactive. And not all of them, of course, we have clients who are not in great shape and are using this as a motivator to get into a healthier state. But a lot of them are healthy people who are making mistakes. And that's when we find the overexercise, we find the over-dieting, also now very trendy for longevity is fasting. Fasting is great, it has lots of benefits. Maybe you shouldn't do it every single day for 20 hours, 18 hours. I don't know. Maybe for some people it works, but a lot of people, clients that we have, it sometimes creates more damage. And one way it creates damage is the thyroid, underactive thyroid. So it looks like a Hashimoto, although it's self-created in a way. So long, long time ago, they had the mice trials where they restricted calories in mice. And then they live 20% longer. So you had this group of people called the Cronies who lived like that. So they only ate about 20% of the calories they should be eating. And I'm sure they didn't calculate very well. And all of them had a thyroid problem. I don't know if they got extra longevity, but I know that all of them had a thyroid problem.

So the quality of life wasn't so great because—

and the quality of life was, you know, you're hungry every single day. There's benefits to all of these interventions, but more of something is not always more. So we find a lot of these misconceptions where you're actively investing your time, sometimes money, into something that's causing you more harm than benefit. Apart from that, you always have sometimes a bit more of a mystery, and then it takes a bit more digging. But we had a recent lady who was 10 years older. And she's been looking at it for some time now. And she had the perfect BMI, very healthy lifestyle, tried to change her diet, do everything as much as she could to affect it, and nothing changed. And then she looked at all if she potentially had any celiac or fiber problem, anything autoimmune related, and nothing came up. Every— all of her blood tests were normal. Everything was coming back normal. But she was 10 years older. And she was trying to get pregnant. She had recurrent miscarriages. And when she got pregnant, she developed gestational diabetes. So lots of these symptoms were related to it, but she didn't know the cause. And then she tested a protein called zonulin, which basically controls this distance of the cells in the gut. So if you have too much of it, you can have leaky gut and it's triggered by gluten, gluten stress, but gluten is a big part of it. So although she wasn't celiac and didn't seem to be intolerant to gluten, she had this high levels of this protein in her gut. And now she went gluten-free and finally we had her reduce too. So sometimes it's a little bit of guesswork until you find a problem because there are anomalies or there's something invisible because it can be such a broad range of causes that are driving your accelerated aging or inflamed aging. Sometimes it's very obvious, so you don't need to do any digging at all, and we make a lot of easy conclusions. But sometimes it's a bit more digging, and when you find it, then it's really amazing that you caught this early, or as early as you could, and then you responded to it in a positive way.

Yeah, I mean, I don't have the statistic offhand, but the amount of people that are gluten sensitive— so not celiac disease, that they are allergic, but gluten sensitive, which causes the inflammation in the body— and I think also my learning was that I had this chronic sinusitis. And it was only until I managed to really, with clean eating, healthy eating, reduce inflammation in my body to actually get rid of chronic sinusitis. So I, you know, I had doctors saying, oh, you're allergic to dust. But, you know, lo and behold, when the inflammation isn't there, then my body can deal with dust wonderfully. So really reducing that and knowing that gluten sensitivity could be it. So I think for many people, it's even just doing a test, you know, stay off gluten for a few weeks and see how you feel. Nina, do you have any particular books, documentaries, or movies that you recommend people must watch? Again, it can be across the spectrum of anything.

I think some older books I loved when I was first reading them. So I think one entrepreneur I always looked up to was Richard Branson, probably because he was dyslexic, so I could associate with him. I think it was Screw Business As Usual. This is a very, very long time ago. And I haven't read it in a very long time, but I love that book in my teens. And then I think there was another entrepreneur, I think it was called The Maverick, which was an entrepreneur in Brazil who basically, his company did everything opposite of what you were supposed to do with a company and it worked amazingly. So no, very flat structure, no managers, all kinds of like complete contradictory to what it would, no secretaries. And it worked amazing. So I like the rebel entrepreneurs. I think that's a theme in all the books I enjoy a lot. And then for movies, I guess I also like entrepreneurs, but there is a nice movie called Joy. I think I watched it a bunch of times. Joy? Okay. Joy, Joy. And then there was the Hidden Figures, which I also liked, which is the woman in the space industry.

Oh, I love it. Excellent. Thank you for the tips. Nina, if you could get one message out to the world, say, skywrite it, metaphorically speaking, what would it say and why?

The way we detect health problems now is way too late. And even now you have technology that can detect it a decade before it happens. So being afraid of future health or living in this Waiting until something happens, until traditional healthcare discovers that a certain organ's not working, and then we respond to it is wrong and very disempowering. So I think that this movement of preventive health, because it's not coming from the health industry at the moment, it's driven by consumer demand. And we really have all of these tools to take control of our health. So we don't need to worry about what will happen in the future. We can be empowered and control it and at least with biological age, you know, when you're getting extra years of life and when you're taking them away, and you can do it in a very measured way. So you know that how you're living, the time, money, energy investing in something is actually paying off for your longevity. And longevity still needs this. So I love your podcast and everything that's happening in space. But if we are tackling aging on a biological level before it turns into diseases, then that's the ultimate way of health prevention. It's nothing to do with superficial. It's protecting your health and the health of your loved ones for as long as possible.

Yeah, I think just, you know, knowing cases of the alternative. I mean, I have an uncle who's had several heart surgeries and my aunt's having constant state of stress, you know, with strokes, etc. So there's so many things you can proactively do to increase these healthy, fun years. And, you know, why not? I think I don't know a person that wouldn't like to be healthier for longer and not sort of suffer all these preventable diseases. And thanks to tests like GlycanAge and MenoAge, when it comes out, you know, you can stay ahead of the curve and actually do something about it. So it's really so exciting. Nina, what advice would you give to a smart, driven, say, college student about to enter the real world?

And what advice should they ignore? That's complicated because I'm clearly biased on this. I would say go into entrepreneurship early. You can gain some experiences. Maybe you have to self-learn as an entrepreneur, but it definitely pushes you in every way, from mental to any limitations you think you had. So I think that's the best way of learning, and we should have more entrepreneurs, particularly more young entrepreneurs who are bold in starting things. So I would say go for it and also pick yourself. So don't wait for them to pick you. You don't need this whole selection process to get there. Just find ways how to start small and build up from where you are. And yeah, don't depend on anybody's approval.

Nina, for listeners interested in understanding the perimenopause and menopause for longevity better, which resources, be it online or books books would you recommend they start with?

I haven't seen any good books, but the Buck Institute and Jennifer Garrison has some amazing talks, and I think they hold regular webinars and a few podcasts as well. So we'd look at her and listen to some of her talks. And then for menopause in the UK, there's Dr. Louise Newson, who's an amazing advocate. And what she's done is she's really changed the perception of menopause in the UK and put it in the public eye. And she also happens to run the largest clinic in the world now. And she did it all on her own with a lot of resistance and criticism at the beginning. So I think her story is amazing as well.

Yeah. And she's been on the podcast. She's really excellent. Nina, where can people learn more about what you're up to and GlycanAge and MenoAge? Where can they follow you, be it website or social media?

We're pretty active on Instagram. Just Glycanhage and a little bit on LinkedIn. And I am mainly on LinkedIn or Twitter.

So Glycanhage, G-L-Y-C-A-N-H-A-G-E, for people unfamiliar with the spelling. And then, Nina, do you have a final ask or recommendation or any parting thoughts or message for my audience?

So if you'd like to learn about a new and exciting part of biology, I didn't spend too much time today because it's a bit technical, but learn about glycans. Follow us on social. We'll be launching a podcast soon about glycans only, and it'll be the first in the world. So it's the biology of sugars. You probably didn't know, but you're made of sugars, and it's really important for your future health.

Amazing. So you'll have to share that with us when it comes out. Thank you so much, Nina, for coming on again today. This was a fabulous part 2.

So thank you so much.

Thank you. Hey everyone, it's Claudia von Boeselager here. Before you take off, I hope you enjoyed the episode and learned as much as I did. If so, please hit subscribe so you don't miss out on our next episodes. I would also love to hear what you thought, be it your favorite part, quote, or other feedback from the episode. So please leave a written review on Apple Podcasts or on social media. And if you think this episode will help someone in your own life, share it with them. Together we can change our own lives and the lives around us for the better. Until next week, goodbye, farewell, and choose to live well.