Perimenopause Isn’t Just About Hormones: What Every Perimenopausal Woman Should Know Before Starting HRT with Dr. Deanna Minich | Ep 368

Within functional medicine, we always look to the root cause. And the root cause of menopause is not just looking at the decline of the ovaries, it's looking at the decline of the endocrine system. And so, just like you said for yourself, when things were kind of going down with your thyroid, with your gut, all of that is precipitating and leading to these changes in hormone imbalances. And for a premenopausal woman, this could actually start to look like perimenopause, and then she could wrongly be given hormones to try to rebalance. But it's not really about the end product of those hormones. It's about her overall physiology working together in this beautiful systems web.

Welcome to the Functional Nutrition podcast, spelled with a K, because we do things a little differently around here. I'm your host, Erin Holt, and I've got 15 years of clinical experience as a functional nutritionist and mindset coach, creating a new model that I call intuitive functional medicine, where we combine root cause medicine with the innate intelligence of your body. This is where science meets self trust. Your body already knows how to heal, and this show is going to show you how. If you're looking for new ways of thinking about your health, be sure to follow and share with a friend, because you never know whose life you might change. Hello, my friends. Today's show is pretty next level, if I do say so myself. We are continuing on with the perimenopause, menopause, and HRT conversation that I started a couple months back and I've been speaking into a little bit more in my Instagram stories. I actually brought Deanna Minick back onto the show to have this conversation with me. That's because she just speaks the same language that I do, meaning she can have a hardcore clinical conversation and also have more of an esoteric conversation, but skillfully weave them both together. So I felt she was the exact right person to hold space for the nuance of this conversation. Not only is she a practitioner herself, she also holds a PhD, she's a nutrition scientist, and she's been in the functional medicine space for decades and has been mentored and collabed with some of the pioneers in the industry, and she is, in fact a pioneer in and of herself. So I just love her work, I adore her work and wanted to bring her on to the show. So we start off with some of my thoughts, some of my observations, and then Deanna really leans into the science of it all, the conversation about perimenopause. It does not begin and end at hrt. And I think that that's sort of the premise of this show, although that might be the message that you are seeing, whether it is on Instagram or on podcasts or other social media platforms. I think we're all being really hit with this message that it's like HRT or bust. So we're bringing forth more of a root cause conversation that I think is really crit right now. We are absolutely not taking HRT off of the table. And at the end of the show, Deanna even talks about how she's weaved in HRT into her post menopausal journey. But we're just recognizing that there's a lot more to the story that needs to be addressed and we are addressing some of those things. So it's really a great conversation. Stay till the end Practitioners. This is one where you're probably going to want to listen to a couple of times and take notes. Deanna is big on building out frameworks so you can learn a lot from her. She actually has lectured for us in fna, the Functional Nutrition Academy. And then we also talk about MACA toward the end of this show. Maca is one of my faves. I have loved it and used it for 15 years now. But she'll talk about it in the clinical research behind it as a tool for both women and men's hormones. So just a brief BIO Intro to Dr. Deanna Minick in case you're not familiar with her, she is, like I said, a nutrition scientist. She's an international lecturer, educator and author with with over 20 years of experience in academia and the food and dietary supplement industries. She's currently the Chief Science Officer at Symphony Natural Health. Side note, I was very surprised by that because I was about to tell her. You'll hear this later on in the show. I was about to tell her about this product that I absolutely love and adore, but I didn't know the parent company's name was Symphony Natural Health. So you can hear my surprise and my delight when I learned this about her. She's been very active as a functional medicine clinician in clinical trials and her own practice. She's the author of seven consumer books on wellness topics, four book chapters in over 50 scientific publications. No big deal. Through her talks, workshops, groups and in person retreats, she helps people to transform their lives practically and artfully through nutrition and lifestyle. I love her. I'm a big fan. You will too. So without much further ado, here is our conversation. Thank you for coming back to the show. I'm very excited to have you here.

Great to be back and I'm excited for this conversation. It feels very timely.

Very timely. I was saying to you off air that I really want to create a space where we can have this conversation and talk to another, not just practitioner, but somebody who's very steeped in the research and the medical literature and is also responsible for creating some of that medical literature. So I'm excited to have this with you and I'm actually going to queue things up and start things off by reading a post that you created and shared that stopped me in my tracks and said this is the conversation that needs to be broadcast a lot wider than it currently is. So I'm going to read it to our audience. You wrote if you are choosing hrt. And by the way, I just love the beginning of that because you are positioning it as a choice, not as a necessary step in order to maintain health. If you are choosing hrt, don't forget to optimize your hpt. A G L O A which stands for hypothalamus, pituitary, thyroid, adrenal, gut, liver, ovarian adipose Access said menopause is big right now, or maybe it's just finally out in the open. There are so many ways a woman can approach her menopausal journey. One of the dominant discussions is HRT hormone replacement therapy. And yes, there are absolutely valid reasons to consider it. But what I'm observing far too often is a quick jump into hrt. So this is really what caught my attention because me too. Me too. Without first tending to the body's inner intelligence, that feels like a lot. The hypothalamus, pituitary, thyroid, adrenal gut, liver, ovarian, adipose. And it is your inner endocrine code to connecting to the whole of you. Yeah, it's the beautifully interlocking system that integrates sleep, stress, metabolism, detoxification, inflammation, hormone balance, and so much more. So if you're considering hrt, you may want to support the rest of your inner access. So you're not just treating a symptom, but honoring the whole system embedded with your being, carefully orchestrating your psychobiology. So what a doozy of a post. And that is exactly what I want to touch upon in this episode with you today.

Exciting. Great. I love the fact that we're going to look at the medicalization of menopause and women's bodies because I feel like we need to step back, we need to look more functionally, we need to look more from an integrative intelligence standpoint as it relates to a woman. Woman's body and how to best help her navigate her personalized decisions, like you just said. Right.

Can you explain, in case somebody's not familiar with that term, what you mean by medicalization of menopause?

Yeah, just quickly going to a pharmaceutical treatment or therapy in order to quell symptoms related to our bodies. Right. So taking a medical approach which may be indicated for some women, I don't want to negate that, but I also think we need to look more holistically. We need to look more fundamentally and probably most importantly, physiologically. I do think that this is an opportunity for women to reacquaint themselves with anatomy and physiology. Just what is happening as she moves through her lifespan, as she is in her twenties, her thirties, her forties, her fifties, her sixties, and on up? How are things changing? What are the labs we need? What is the endocrine system? Because what we're hearing out there now about peri and postmenopause is that it's very simply an estrogen and a progesterone deficiency done. Ovaries are kaput. Done. It's kind of like a very simplistic play on what is happening in our very complex, dynamic bodies when we know that there's actually more underneath that waterline. And as an example, I mean, if we just think about thyroid health, you know, one in three women having some kind of autoimmune thyroid condition, and that's happening in the 20s, the 30s, the 40s. We also see a lot of adrenal issues. Right. And so taxing the adrenal glands and the connection with the brain. We also see a lot of gut issues. The gut gets overlooked when we talk about the endocrine system, but it's surely a huge part of how we make hormones, how we metabolize them, how we excrete them. So we can't overlook the entire circuitry. It's almost like we have to look back and say, how do we create endocrine fitness? So we think about physical fitness, we think about nutrition, but we don't often talk about endocrine fitness. And how do we help to address the root causes that are related to. To premature ovarian and endocrine decline. So that's where I was coming from with that post. So when I talk about hpta, you know, all of those letters, what I'm actually doing is just bringing forward that we are a systems web. We're not just ovaries talking to the brain. We are the hypothalamus, as it connects to the pineal gland, pituitary, the thyroid. So we have this whole inner circuit, which in ancient traditions we would see that as the chakra system. Right. It kind of has its esoteric origins as well. But in modern day medicine, we see this as the psychoneuro, endocrine, immune system. And so I just feel like, because that sounds more complicated, for the most part, what we see in social media is a very reduced message of now you need to get on hrt. It's almost like the pendulum has swung in the opposite direction. And we just went through this whole landscape of a lot of different terrain that would really speak to a woman's personalization, her sense of choice, and what would truly be best for her outcomes. Because not every woman that goes on HRT solves every problem either. And I think that's not getting talked about. It's kind of like I went on HRT and my life is now a miracle. It's not really like that for all women. We need to actually have the foundational aspects of our hormones, which I look at as synthesis, transport, activation, metabolism, and excretion. If those respective aspects of hormones are not addressed and we just hammer on putting more exogenous hormones in the body, then it's a very incomplete picture.

So I really want to drill into that quite a lot. But when you're talking about this pendulum swinging, neither of us are saying HRT is bad, wrong, and not an option or shouldn't be an option. But my concern is that when we are positioning HRT at the epicenter of this conversation about women's health and hormones and perimenopause and menopause, we might be missing the mark. And so that's exactly what I'm hearing you say. Now bear with me, because I'm going to share a little bit. I haven't shared this publicly on the podcast. What I have shared, actually, is exactly what you just said. I was receiving a lot of messages that you're 40, so you're in perimenopause hard stop. You need to get on some hrt. And when I actually, actually looked at my labs and did our deeper dive, I saw that my thyroid physiology was a little off. Like, my thyroid numbers weren't great, my gut needed a little support, My beta glucuronidase levels were off the chart high, and my stress levels were not great either. And so I'm like, look, is this perimenopause or do I just have to support other parts of the system. So I have talked about that. But what I've been talking about a little bit more on social media and getting some kind of mixed feedback is I personally do not feel I am ready to go on hrt. I don't think that that is going to be the be all and all that saves me right now. You said in that post that I just referenced, you said healthcare practitioner or people should seek out a healthcare practitioner who understands the context and the complexity of hormones. My friend and a colleague of mine who's a functional np, she just commented on the fact that a lot of med spas are now dishing out hrt and it really is that mindset of rapid replacement like you mentioned or this quick fix. You kind of go in, you get your Botox, you get your fillers, you get HRT, you get your GLP1 squeaky clean jelly bean like we can get out of here. And I'm joking. But Again, as a 41 year old woman, this is the predominant message that I am seeing in a lot of places in spaces and I fully recognize the appeal. And I feel like once again in my life here I am swimming upstream away from the collective programming in Zeitgeist. But I find myself in an interesting position where I'm feeling this way and there's not a lot of places where for me to talk about it. Which is part of why I want to bring this conversation to the podcast. When everyone goes right, I don't go left just to be different, right? But when a massive chunk of the population starts saying the same exact thing at the same exact time, it does make me question like, where is this coming from? I'm not a cynic, I'm not a conspiracy theorist, but it does make me pause, it does make me question. And what I saw recently and this was so brilliant, it like stopped me, it gave me chills. It was this woman talking on Instagram, obviously I spent a lot of time on Instagram and she was talking about the same population of women that were targeted marketed. The diet products of the 90s are now at the age where they are being marketed in targeted hrt. And I thought that that was really interesting. We were a cash cow then and we're a cash cow now. And it felt very true to me. I went to the comments and people were not having it. They were like, I completely disagree, this is not the right take. And it was a of women sharing that a whole generation of women lost access to hrt, which is absolutely true. A lot of people were saying we're done suffering in silence. Again, very true. But it felt like the same party line over and over and over, which was very interesting to me. And it doesn't make it not true. It's very true. But multiple things can be true at once, where HRT can be a lifesaver and a game changer and it can be overly promoted as the savior, as the cure all, as the quick fix. But I just feel like that conversation is being shut down in a lot of places and this might be a little bit of a reach and a little bit of a stretch. Clearly, I've had a lot of time to think about it, but it sort of reminds me of the birth control. Like, birth control was a tool for female liberation. So if you spoke out against birth control or even questioned it, you are considered an anti feminist. You were like, there's no space for that conversation. So again, maybe a little bit of a reach here, but it's. It's like flavors of the same thing. If you're questioning the use of hrt, you're complicit in women suffering in silence. And it just makes me question because I think that female hormones, and I know you would agree with this, female hormones, female health, menopause, perimenopause, finally getting its time in the sun. That's such a good thing. That's so necessary. It deserves that time in the sun. And ignoring it and allowing women to suffer in silence is problematic. And also not being allowed to question the Zeitgeist is equally problematic. So I'm not coming to this conversation saying I have all the answers, but I'm coming to this conversation saying there needs to be more nuance in this dialogue.

Aaron, you said that really beautifully, and I would concur. In fact, even that post that you alluded to that I made on Instagram, it didn't really take off in the way that I thought women would be more receptive of. And I was thinking, don't women want this information? Like, it's just not a shiny object of like, we've been wronged now let's just get to our HRT and get on with our lives. It just kind of feels like it's not just quelling the physiology, it's actually in some cases making a statement. And there feels like a psychological underpinning to it. And again, just kind of negating that. There's a lot of nuance and interpretation for the individual. And I think some women, quite honestly, they're scrambling. They're scrambling to figure out what their choices are. And it's not really clear. And the loudest message is hrt. So if you are playing on Instagram like yourself, and you're just scrolling and it's like, that's what you're going to see. And it's like, oh, it's the obvious choice. I don't see a lot of other things. Right. And so I think it's great that you're having this conversation with me and others, because within functional medicine, we always look to the root cause. And the root cause of menopause is not just looking at the decline of the ovaries, it's looking at the decline of the endocrine system. And so just like you said for yourself when things were kind of going down with your thyroid, with your gut, all of that is precipitating and leading to these changes in hormone imbalances. And for a pre menopausal woman, this could actually start to look like perimenopause and then she could wrongly be given hormones to try to rebalance. But it's not really about the end product of those hormones. It's about her overall physiology working together in this beautiful systems web. So getting the thyroid back on track, getting the gut back on track. And within functional medicine, that's one of the first places we start, is the gut, quite honestly, because through the gut you can achieve a lot. So you mentioned GLP1 agonists. You know, women are concerned about their body weight, they're looking at their appetite and all of these changes that are happening to their bodies, but again, looking for the quick fix. And it's kind of like the old adage, if you have a hammer, everything looks like a nail. So for pre menopause, you know, looking, everything has been these synthetic hormones or even now, you know, we nuance it, now we talk about bioidentical hormones, but still, that is just kind of the tippy top of all of the other choices that could lead up to including mht, hrt, oral contraceptives. You know, that's part of the journey. But to me, it's like an artist's palette. You have many different options available to you. So you might need a fraction of HRT if you were just to do X, Y and Z and help your endocrine system. And again, just because you're putting in a bunch of hormones doesn't mean you're going to fix the problem. You could actually perturb the problem because of what you and I were just talking about, which was the detoxification of hormones. For some women in Pre menopause and into perimenopause. Some of the reasons for dysmenorrhea, amenorrhea, you know, just a variety of different imbalances as it relates to the menstrual cycle may be connected to different metabolites of hormones. So if we're not addressing that, but we're just pouring into the body more hormones and expecting that problem to correct, we might actually get a backfired type of response. So we need to look at that.

And I had quite a few women reach out to me on social media and just say like, I started hrt, like this is not the predominant conversation to your point. This is not what we're hearing. These are not the posts that are taking off. But they were like, I started HRT and it wasn't the magic bullet actually. Like I didn't feel better or I got worse and what I had to do instead was xyz. So these things are happening. I just don't think we're seeing them as much now. You keep talking about the endocrine system and you also referenced earlier the foundation of hormones. You said synthesis, transport, and there was a list of other things. So can we get into that a little bit more?

Yeah, I'd love that. That's just something I made up in terms of looking at all of the different steps. So synthesis, actually looking at the neurotransmitters, the hormones together, looking at the building blocks of those respective molecules in the body. So synthesis is key. Then we look at transport, how the hormones are transported through the body, Are they bound up with a protein and not accessible to the tissue? What about phyt estrogens and activation? That would be the third step. So activating at the level of the estrogen receptor. Then we look at metabolism, which would incur things like liver enzymes. We think of cytochrome one, a two or we look at a variety of different types of phase two enzymes to get those hormones out of the body and then excretion. You alluded to beta glucuronidase, but just having healthy bowel movements and moving these different biotransformed metabolites out of the body. So hormones need to come in or be synthesized in the body. They need to work at the level of the tissue and then they need to be metabolized and then excreted. So again, it's like a whole process. It's not just the synthesis piece of having things on the outside and come in and just dumping them in, but then not tending to that whole process. So Yeah, I, I just think of it like that. Synthesis, transport, activation, metabolism and excretion.

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You know, there are different ways to do that. Just like again, every person is a little bit different and it depends on the practitioner and how they have been trained and how they actually work up a patient in that way. Just like I mentioned a little while ago, we could start with the gut. Just make sure that the excretion part is moving and flowing right. You don't want to have somebody who's constipated start taking hormones or, you know, you would really create a bottleneck there. So I think that's one of the first places to be thinking about because again, you can start to rectify a lot of the different systems in the body just by working on the gut. So within functional medicine we have the 5R approach. So looking at remove, replace, reinoculate, repair and rebalance, there's a whole way to do that. So just getting the gut in order. And I would say, you know, most people have gut issues, there's some kind of, whether it's reflux, constipation, bloating, just a whole array of different things that could be worked on there. And there are many different sophisticated tests now where people could actually give a stool sample and just look at things like the diversity of the microbiome, looking at inflammatory compounds. So we actually learn a lot about our diet, our immune system, our hormones, just by looking at a stool sample. So I think even starting there is a really good place to start. And from there, you know, going further into different testing parameters, you know, doing something like, you know, depending on the woman's life stage. And I know that practitioners operate a little bit differently in this regard, but some practitioners focus more on symptoms and other practitioners like to focus more on laboratory tests. And then you have kind of this Venn diagram of some practitioners, like a little bit of both and like to match the Symptoms with the laboratory tests. So it just kind of depends from there. But I think working on the gut is key. The second system that I would think of and that addresses, by the way, the pancreas. So many times when we think of the endocrine circuit, we don't often think of the gut as part of that. But the literature on the gut gynecological access is actually increasing. You start to see that there is this interplay between the ovaries, the uterus being very snug in there with the intestines. Right. And so if you've got leaky gut, but chances are you probably have leaky ovaries or you have leaky membranes that can lead to inflammation. Right. So you may actually see some connection from a root cause physiologic perspective with things like the gut. If there's inflammation there, you might actually see that in the reproductive tract. So why not just rule that out? We know that in functional medicine that the bedrock of many different diseases and conditions is truly inflammation, a heightened inflammatory immune response. So I think that that's, I would say, a really good place to start.

And even in, like, things like endometriosis, we can see elevated LPS in the pelvis, which may originate from bacterial contamination in the gut. So it's like there is this interplay, there is this crossover. So it's happening before perimenopause. So it makes sense that through perimenopause and menopause, the same will be true. And you were talking. Some practitioners go more symptoms, some people go based off of more labs. And with the conversation that I'm hearing about perimenopause in particular, like, there's no one test to really show, yep, you've got it all right. You're there. And so I think a lot of practitioners are going based off of symptoms. But where that is a little bit of a struggle point for me is that we know so many different things can contribute to similar situations, like brain fog, for example. It could be like eight different things causing the brain fog. So are we supporting women by just writing it off as perimenopause and be like, you just need some estrogen progesterone, or are we potentially doing women a disservice by not doing that deeper dive to really uncover the different root drivers?

That is an excellent point. So let's just go with that on brain fog. Right? So I teach a lot on environmental health, and one of the issues that can be connected to impaired cognition or mood states could actually be increased toxic Load. So things like heavy metals, things like, I mean, just every day I think I'm reading articles on microplastics. We're looking at just the parabens, the phthalates in our personal care products. So when we have an accumulation of these toxicants from the environment, we can start to see overall system imbalance. So if we were to add hormones on top of our existing total toxic load, it could exacerbate things because again, hormones are treated in the body, they go through the same pathways as a toxicant does. So now we are overloading the system. So I love what you just said because it makes good sense to ensure that we are getting, you know, if the symptom is brain fog. Just to go back to what you said, I would be thinking at how that person's toxic load is playing into their symptoms. Right, so this is where we start. Let's start to build the gut liver access. And in fact, I didn't mention liver per se in that whole acronym I gave, but liver is really key when it comes to hormones. And what we see is that the gut liver is so essential for ensuring healthy hormones. And whether it's traditional Chinese medicine or functional medicine, we see that liver health is essential to consider with hormones. There's also the liver brain access. So just to wax on that for a second, I could have actually, I mean, I did put hypothalamus, pituitary and pineal in there. But essentially when we are sleeping, we are undergoing this whole process of releasing toxic metabolites from the brain. We're undergoing this brain detoxification. So if a woman has distorted circadian rhythm regulation, so this is back to whether she's bathing her eyes in artificial blue light at night, she's doing shift work, she is just eating at the wrong times of the day, she's eating way too late at night. High alcohol, high caffeine, you can start to see issues with sleep and then you can start to see issues with brain fog. Right, so how do we know that our hormone imbalance is not related to circadian rhythm dysregulation? I mean, I would think you'd want to get at a lot of these low hanging fruits rather than just again, try to patch the gap with what seems like a band aid with hrt.

You know, and it's like the conversation is like, is it the practitioners offering this or have we colluded in this by going to our practitioners and our providers in looking for like the slam dunk answer, like the one thing I need, the one reason That I feel this way and then I need the one solution. And that's what we're actively seeking out, which I get. You know, I really get it. I think that we just have the perspective of like really understanding the human body and knowing how complex it can be. And so looking for that, like one problem solve is probably not going to get us very far.

You know, it's hard. I have a lot of compassion for people and for practitioners because you only know what you know. And if you have in your clinical toolkit certain things, that'll just be the framework in which you see every person's symptoms. Right. I'm kind of smiling a bit because it brings to mind this cartoon that I recall of like there are two windows and people are lining up up. One is for the pharmaceutical and the line is really long and then the other one is lifestyle and nutrition. The line is really short and, you know, it's a lot of work. And when we are talking about the health of the endocrine system here, it's not an easy fix. This is like a lifelong relationship that we have with our bodies. Right. So when I'm talking about some of the antecedents, triggers and mediators with that, I'm talking about things like genetics. We didn't even talk about that. But, you know, genetics plays into perhaps, you know, your life cycle and how things will transpire to some degree. Right. We know that genes aren't the destiny of a person. Also, any kind of personal history of diseases that they might already have, Are they already taking medications for other things? And now you're going to start to overlay other medications. What about just the gross obvious of, of nutrient insufficiencies and deficiencies. So when I think of hormones and bringing hormones into the body, I also start to think about things like methylation. So methylation is part of the metabolic detoxification process and it's a nutrient requiring process. So if we're deficient in magnesium, in B vitamins, and so many people are deficient or insufficient in these things, then already we're perturbing the endocrine system. Right. Stress is a big one, Disruptive sleep. We have to look at our jobs, our work. Are we subject to secondhand smoke, recreational drugs? You know, one of the biggest things, Erin, I think, and you know, I see this in a number of different studies and it's truly endocrine disruptors. I already touched on that. But I do think that looking at the role of endocrine disruptors, because many studies look at, okay, let's just revert to men for a second. Why is men's testosterone levels, why are they plummeting like 1 to 2% every year from the time that he's in his 30s? They're declining. And if you compare a man's Testosterone in the 1980s, like when he's in his mid-60s, that's about what you have now for a 30 something year old man, you know, that's pretty profound. So why is that even happening? Why do we have this endocrine disruption? It's not just seen in women, it's seen in men. And I would say in the studies, like they can't explain it away. They control for all of the variables like diet. They look at sedentary, just no activity. If the person is sedentary. The only thing, they just keep looking at all these variables but nothing seems to explain it away. So the other thing to consider is endocrine disruption and how that can be changing the overall health of our, our endocrine system. So we do need to deal with that because even I'm going to kind of put a little boomerang and a ripple in this whole conversation depending on the HRT that we take. Right. We're also introducing some degree of endocrine disruptors. You look at a patch, you know, if you look at a patch of estradiol, what makes it stick to the skin, those adhesives, I don't know if you've ever read the package on one of those products. Products, you know, different people have done different calculations like over a lifetime of whether it's a patch, a cream, an oral pill, like even progesterone, you know, some kind of, you know, it's still encased in some kind of material. Like if you kind of add it up over time, are you just introducing more endocrine disruptors by way of these different pharmaceutical preparations? Now of course you have to weigh everything, right? You have your risk to benefit ratio. And for some women, they just clearly need to be looking at hrt. But you want to compress and potentially reduce, I would say, the long term exposure to those hormones. I mean, think of oral contraceptives like if you have a woman in her 20s and 30s, and I must say I was part of that whole. Yeah. Generation of women where I took oral contraceptives for seven years in my 20s. So then you go from oral contraceptives and then you come off of them for a little bit, you start having symptoms and then it's like, oh, wait a minute, I'm probably going through perimenopause. Now. Now you just jump over to some kind of hormones, hormone replacement therapy in some way. Right. So it just feels like there's just a lot of input. And again, I don't want to just cast the message as polarized of yes, no, black, white, yes, guess, you know, it's a good thing or not. I think, again, it's a nuanced message and every woman needs to look at that balance.

Somebody said to me in my DMs, she's like, it's just so difficult to like, I, I follow all these accounts and I listen to all the podcasts and I take in all the information and it's really hard to like, discern the truth.

Yeah.

And I was like, if you're trying to discern the truth about health, it's a kind of a futile goal because this is one area, our human bodies, our health, hormones in particular, where paradox exists. And we have to be able to hold multiple truths at once. So there isn't one finite truth. There isn't. HRT is good and everybody should be on it is horrible and nobody should be on it. It's always shades of gray when it comes to our health and healing. It's just hard for our minds to wrap ourselves around that because our minds do really good with categorization and like hard truths and this or that black or white thinking. So it's just really difficult to have these conversations. And one thing that speaking of the mind is that the power of the placebo and also the nocebo effect is very real. And so I think of all of these women that are hearing this message that like, these are the symptoms you will experience. This is exactly when it kicks on and this is exactly what will happen. I start to question for myself how much of, like, what I, I'm experiencing is real or how much is it because of the fact that I've been told this will be your experience. And just hearing that like a metronome over and over and over again, I mean, that's a little bit of a far out conversation. But I think it's. If we're going to have it, like, we got to talk about all of it.

We do. And actually you do see that placebo effect even in trials where women are given phytoestrogens for their hot flashes. And in some cases, I can recall from those studies, you could see that the placebo does better than the phytoestrogen preparation. Right. And in some cases it doesn't. You know, so there is the Mind playing into it. And hormones are powerful vectors. Anything where we're changing our hormones in. Well, if I think of functional medicine, hormones are part of the communication node, and so communication within body systems. And this can change our behavior. But the thing is, like, long term, will it still have the same impact? Or people will say like, oh, do I need to change the dose of my HRT but. Or is it maybe how they were thinking about it is now change, and that is also maybe changing the response. So I think maybe what we can leave the listeners with too is not to again, create this conundrum and this kind of confusion and just kind of get people's heads spinning here, but to kind of, I guess I think about it in terms of a sequence and maybe we kind of talk through that a little bit. And again, I'm just presenting my own personal and professional take on it. This is not to be construed with medical advice. You definitely have to work with a practitioner who can meet you where you're at. Right. But we can kind of go through what I would see as a sequence of how would I approach this? And I can even tell you what I did and kind of move through that. And again, I'm not advocating that because again, everybody is so different, but maybe we kind of walk through some of the diet, the nutritional aspects, the lifestyle aspects, and kind of move through those things so that people feel like they have some degree of that information which is very foundational to kind of work with their practitioner.

You know, I would love that. I would love to bring it back to food. I would love to hear about how you've navigated this. I think starting with food and nutrition, do nutritional needs change for women as that? We go through these big endocrine transitions, these big endocrine shifts. So do our nutritional needs change if we want to stick with perimenopause? Are nutritional needs changing through that time?

Yeah, they do. In fact, there was an article that I posted on LinkedIn not too long ago and it created quite the conversation. But it was an article that talked about how we have to navigate nutritional needs for women throughout her decades of life that we do need to flex and flow with every decade. And you know, I think that some people were saying, like, that just makes it even more difficult and it just leads to challenges. But I don't think so. If we think about every decade of life, just to make it more simplistic, there could be certain labs, there could be certain ways of eating. It just kind of depends on your personal health history. And what your goals are. So do you want to become pregnant or not? And that has to be nuanced into the conversation. But let's just start with the adrenals. Right. And I know that I mentioned the gut before and we'll kind of move through, but I'm just thinking of, of when it comes to macronutrients. Right. And so when I think hormonally about like a hormone sandwich, in terms of a layered approach, I would say that the first layer in this whole hormone cascade is not the sex steroids, it's not estradiol, it's not progesterone, it's not testosterone. What I think of first is cortisol, insulin and glucose. Cortisol, insulin, glucose, that triad and how important that is for framing the rest of all of the other hormones in so many ways. So if we were just to think very simply about, well, what do we need in order to help to balance cortisol, glucose and insulin, we'd be looking at things like protein. So a little bit higher in the way of protein. I think that too, Erin. What we're seeing is that there's a lot of discussion about high protein, lots of strength training. You know, it's just kind of like these very, again, they can be very rigid messages if we don't understand how to nuance them. I do think that looking at protein intake in order to stabilize blood sugar would be important, but it's not the only thing. We also have to look at carbohydrate. I do think that carbohydrate has been maligned as a macronutrient. So it's just kind of like, don't eat carbs. Carbs. But actually we need carbs. We need prebiotic starches and fibers in order to create things like short chain fatty acids in the gut, which can help with the gut brain access, which can help with the immune access, which can help with neurotransmitter signaling in the gut. So I do think that just some of the basics of recalibrating to healthy amounts of protein, of course, healthy, balanced omega 3 to omega 6 ratio. And I have to say that I've been in nutrition long enough where again, I see another pendulum swing. Whether we're talking about protein seed oils, you know, don't eat plants, they're toxic, or just we could probably have one podcast per each of these. But anyway, I think we stay the middle path. You know, we stay in that realm of healthy quality protein balanced anti inflammatory fats and not oxidized fats. Fats being attentive to how we use fat in cooking and preparation. But I think fiber is really key. And it's not just fiber. Here's the nuanced message. I think that rotation of different kinds of dietary fiber is really important because that helps to foster a more diverse gut microbiome which will in the long run help you with things like again, brain health, mood, immune health and just the overall resilience of the gut. So I think that's kind of like how I see if I'm thinking of just glucose, cortisol and insulin. So, you know, just stabilizing the body with that. And one of the things that I also think needs to be overturned is that of salt. Have you noticed that there's been a lot posting on social media about salt hydration? You know, I think that this is one of those undervalued under just underutilized aspects that could be brought to the forefront because just even back to what you said about brain fog, you know, just even minor amounts of hypohydration, which again we don't have very good metrics for, can lead to things like cognitive changes. And hydration will also influence how we circulate hormones through the body and detoxify them and eliminate them. So I think just some of the basics I would say to start there because when we we come out of our 20s, 30s, and we've had a lifetime of a lot of chronic low level stress, we need to think not just about glucocorticoids and cortisol, but also the mineralocorticoids and salt.

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Yeah, well, one practice that I don't think a lot of people know about this, but have you heard of Soleil therapy? S O L E. Yes, but never.

Talked about it here before.

Okay, so Soleil therapy, what I really like about it. So some people when it comes to their water, maybe they're drinking purified water. So everything's been stripped out of it, including the minerals, but also the toxins. And that was the goal, but then we took the minerals out as well. So then you just have water with nothing in it. So in order to add back essential trace elements, what you can do is you can take a supersaturated solution. And this is Soleil where you take Himalayan crystal salt, you take the stones, you put it in purified water and you create a solution where it's supersaturated. Right so then you just take a teaspoon of that into 8 to 12 ounces of water and then drink that first thing in the morning when cortisol and testosterone are at their highest. Right. So supporting the adrenals at the start of the day. And when we have proper minerals, we have proper cofactors for so many different reactions in the body. So I do think that starting there is important because it forms the basis of so many, I would say, even metabolic reactions. And because our soils and our foods are becoming increasingly depleted of minerals, I do think we need to bring in something like that to replenish.

That's such a great tip. And it's like, I love it because it's not like another supplement you have to buy too well.

And a lot of these electrolyte supplements, and I have looked into them just even for me personally and also for what I recommend to people, and a lot of them have sugar, even some of the ones that are touted on social media that a lot of people like. It's like, have you looked at the label? So do you want a lot of sugar with that salt? I mean, it just doesn't make sense to me. Now if you're an athlete and you need to replenish fuel sources and you have other goals in that way, then yes, maybe. But for the average person who just needs a good mineral foundation to start their day, I would say something like the Soleil therapy would be wonderful in that regard. Drinking water throughout the day, bringing in also diversified beverages like herbal tea can also help with phytochemical diversity and complexity and increasing your overall nutrient density. So even something as simple as a cup of tea can be helping in something like our brain health. So not to underestimate things that are small because these could have great impacts.

When I talk about diversity, I. I give. I'm like, shoot for like 40 species a week, which is like, whoa, how am I going to get that in? But I'm like, spices count, herbs count, and teas count. So if you have a tea blend and I, I'm a big tea drinker, I'm a coffee drinker, but I'm also a nighttime tea drinker, or I'll do nettle infusions. Like, I love lemon balm, I love nettle, and I'll turn that into like, I'll do a strong brew and turn that into an iced tea to sip on. So there's so many different ways to get this in that is like really, like low budget, really low energy output on your end. But we can get these phytonutrients and these phytochemicals into our body just to help our whole body thrive from tip to tail.

Exactly. And especially if you're a menstruating woman, you are losing these minerals throughout your cycle. Right. And so the phytochemical support from exactly what you're saying, like a cup of tea, getting the minerals in through salt, I think, can help to stabilize the entire, I would say, physiology and psychology that you have throughout your menstrual cycle. And there have been papers on that, by the way, just kind of looking at how. And it's kind of obvious, right? The follicular and the luteal cycle, the phases, they could be very different in terms of nutritionally, how they're playing out. So if we think about the sex steroids, so to layer on from cortisol, insulin and glucose, and then we start to think about estradiol, we think about progesterone, we think about just the ovaries. Right. The health of the ovaries and ensuring that they're fit. A couple of food things. You might have seen me talk about this on social media before, but there is a connection between carotenoids, which are plant compounds that are very colorful in reproductive health. So, you know the corpus luteum, the yellow body, Right. This is connected to beta carotene and retinol. So what we see is that the ovaries concentrate the carotenoids between 13 to 14 different ones. So they can be things like alpha carotene, beta carotene, beta cryptoxanthin, which is an interesting one. And some of these come from orange fruits like mandarins, oranges or tangerines. So that's important to be thinking about is carotenoids, which hide out typically in the fatty compartments of the body body, so the skin, the breast, the brain, but also the ovaries are collectors of the carotenoids. So they have been implicated in reproductive health. If you look at some of the studies, the other one I like to talk about too, is maca.

Nobody can see my face, but you saw how excited I got. I love maca. And I was going to ask you about this, so I'm so glad you're.

You're going there. Well, and it's not just any maca. I want to qualify this because people will say, oh, I'm taking maca. That's great, great. Check mark. I actually, together with the team, wrote a review paper called not all maca is Created Equal. And we published that in the Nutrients journal in 2024. And basically the outcome of that was that, you know, and this totally makes sense because maca is a plant, it's a root, right? It's a tuber that grows in Peru natively. But you can get all different kinds of maca, and they can have very different effects. So the different colors of maca where they're grown, they can have different phenotypes, different physiologic effects. You could have some that are more geared for men in a more androgenic profile, and some that are more geared for women and helping with the ovarian brain communication a bit more. Right. So that's where in. In full disclosure, I am chief science officer at Symphony Natural Health, where they have feminescence, which has three.

Are you kidding me? I did it. I have been for 12 years now or longer. Like a huge fan of. I was just gonna bring that up to you. I was like, well, did you know about this company? It turns out you do. I love their product. So I just wanna. This is not an ad. This is not a pitch. No, this is something that I use personally. We use it clinically in practice. So I would love to hear more about what you have to say about the this.

It's a phenomenal product. So I've been working with the company for a little bit over three years, and essentially, so they have three products. One is for premenopausal women, so for fertility, menstrual health, Then there's one for perimenopausal woman, and then there's one for postmenopausal women. So it's very distinct per the life stage, which really speaks to her different endocrine needs during those times of life. They all have different maca phenotype formulation based on preclinical and other types of studies that determine their physiologic effects. So if we just think about. There are four published clinical trials, there are a number of case studies, and it's something that I personally use. So I think that this is really important because the mechanism of action. You probably know this already, Erin, because you've been using it. But the mechanism of action is quite different than something like a phytoestrogen. So a phytoestrogen like red clover or soy isoflavones, what they do is they kind of act as like a weak binder to the estrogen receptor so that you kind of get a weak signal transmitted to the cell. But what feminescence does, is it actually nourishes back to the whole acronym, the hypothalamus, pituitary, thyroid, adrenal, ovarian, axon us so it can help to support hormones through the different life stages. So for a premenopausal woman that is menstruating, it can help to foster more balance in her body. And it's because it's connecting to the ultimate control center in the brain that is establishing the communication to the ovaries, but then also the adrenals. And also in some cases, you can see this ripple through effect even through the thyroid gland. So I love the product. So I am now postmenopausal. So I have transitioned from the perimenopausal product, which is called Maca Life feminescence MACA Life into the feminescence maca pause. And the research is also because the product supports hormones, there are no exogenous hormones in the product. It is supporting the body's own production of hormones. What can happen is you start to see a ripple effect into things like brain health, bone health, heart health. You know, just the same categories of where you would see a lot of the benefits of something like bringing in exogenous hormones. Because we know that hormones keying into those body systems. And then the natural question is, well, could somebody take HRT with this feminescence product? And the answer is yes. I mean, feminescence has been in the market for, for decades. And so it has a history of safe use and many practitioners. So we have a whole medical team. So we field a lot of queries and questions that practitioners have. So if anybody wants a little bit more specificity there, you can definitely email the medical team. But what I would say is what we've heard from clinicians over time is that in many cases. So if you think about kind of a two prong approach, let's just say a woman is going through perimenopause instead of introducing exogenous hormones, Looking at something like feminescence, the Maca Life product, which is designed for perimenopausal symptoms just to recalibrate, right? To kind of streamline and fine tune the symphony. I love this metaphor, the symphony of her hormones and how everything is orchestrated in her body. And then eventually, if she were to decide that, okay, my hormones are, they feel like they're recalibrating, my symptoms are going down, maybe I just want to tweak it slightly with exogenous hormones somewhere down the line, then it would be perfect to kind of overlay that. And that can be done with the help of a practitioner, of course.

So I will say that I've used this on and off for, I said 12 years, but actually 15 years. I learned about this company. I worked at a health food store and it was was a product that we knew and loved. So I had taken the one for menstruating ones. They changed the name a few years ago. That's why I can never remember the name. And then I just recently transitioned into perimenopause because Instagram told me I was in perimenopause and I actually didn't feel as good. So I'm back to like the original, like the one for menstruating females. So it's just that my body has noticed it. What I would love to ask you is I've clinically, we've used this in clients that tend toward a lower estrogen picture, but not so much with higher estrogen folks, do you find that people do well who tend to have a higher estrogen load, still do well with this product?

Yes. So in general it's recalibrating. So if a woman has high hormones, then it could bring them back into balance. If she has low hormones, it can bring them back into balance. It's stimulating the hypothalamus, thymus and the pituitary. Right. So whatever is required by her body to re establish that communication is what, where it's helping. So we do know that it's creating that recalibration. So it wouldn't be an issue for a woman with estrogen dominance or high estrogen levels in some way. Because what you start to see over time is that her hormones start to change, they start to balance. And you know, for some women, that can take a little bit longer. Like what we've seen through case reports and just different people's accounts and clinical experience is something on the order of just like two to three months, sometimes up to four months. And then by that time she may be able to go off of the product. But it just kind of depends on the woman. Did she change her diet? You know, what are all the things that are changing? The communication that needed to be improved and modulated with feminist. So just to clarify too for everybody listening, the one that you're speaking about, the one for pre menopausal women, so before perimenopause is called feminescence maca harmony. So again the hormone harmony, right. And then you have feminescence maca life, that's the perimenopausal one. And then Feminescence, maca.

Pause.

So they have different colors. So the harmony one is yellow. This is how I like to remember them. Color. Of course, the Perry is pink and then the post one is purple. So if you just remember the color, that would be an easy way to designate them. You know, again, they've been on the market for a while, they have been clinically tested and they're very specific to women's hormones. Right. So. And we also have a product for men's health. There are two products. One has been on the market for a while. We're coming out with a new one. But they have other types of maca phenotype ratios and combinations that you won't see with the women's products. So there's so much about maca actually that we could do a deep dive into. But just to high level it. Again, not all maca is created equal. You see changes whether it's in color, where it's grown, if it's raw or gelatinized, the concentration of glucosinolates. So when you were just asking me about high levels of estrogen, one of the benefits of maca, and specifically with the feminescence maca, because it's, it's enriched, it has high levels of glucosinolates. What we know about them is back to my favorite detoxification. Right. So we know that glucosinolates, which typically we associate with the brassica family, so cruciferous vegetables, that is a shared compound family by maca. It's just that the maca plants have some different glucosinolates compared to broccoli and other cruciferous vegetables. So theoretically you would think that the product would also help with detoxification. And that's actually something that we've started to study. So that's exciting. So if it can hit on not just helping the body's own production of hormones, but also helping in the metabolism of hormones, that's even better. Right. It takes us back to the. That synthesis, transport, activation, metabolism and excretion.

Right. That's exactly what I was just going to say. That's really very cool. I know we've touched upon liver and detoxification here. One thing that I will say that I think is noteworthy is that what we're finding right now is that our clients are doing. My lead practitioner, Rachel, just like, we just kind of called a meeting on this because she's like people are doing, primarily women are doing really, really well on, on bile support, whether that's bitters or something. Else. And she's like, even when their labs don't indicate that they need it, just people are doing a lot better when we get them started on it. And I think that that's just interesting and probably feeds into the environmental, toxic and endocrine disrupting conversation that you were having earlier. But if somebody's looking to support their overall hormones, we do want to support those excretion pathways as well.

Well, I Love that. My PhD dissertation was all about bile solubilization and essential fatty acids. So whenever somebody says bile, it's like, I perk up. Because, you know, anytime we're dealing with fat substances, right, that's what bile is doing. It's helping to emulsify and help with the uptake as well as helping with the detoxification or the output of some metabolite like hormones. And so especially when women start to change up their diets and they start to go a little bit higher in fat, a little bit lower in carbs.

Carbs.

This has implications for obviously the gut health. But then also looking at the amount of bile. So in many cases bitter is better. Right. We want to ensure that we've got all the different tastes. It's not just hammering on bitter, but, you know, it's kind of like the omega 6 to omega 3 ratio and how that's been thrown off, like 20 to 1. It's the same. We tend to see high sweet, very low bitter. Whereas in other cultures you start to see a little bit more of an equilibration. So there's medicine. If we look at bitter foods, I mean, they are stimulating those bitter taste receptors. And bitter taste receptors go beyond the gut, actually. They're in the ovary as well. They're in the brain, they're in the respiratory tract. So I think that we're learning more about how these bitter taste receptors are changing up our functionality, even at the level again of the ovary. So, and I learned that just even in working with Dr. Jeffrey Bland, he did some research on bitters and looking at ovarian health. And so there's kind of like that whole, you know, it hasn't really emerged in kind of a, I would say a more vocal, like, stage and talking about it. But I do think it's important.

So obviously, bitter foods, incorporating more of those into your diet in your day to day. Do you have any other favorites for supporting biohealth health?

I mean, I guess I think of yellow, I think of yellow foods. I think of bitters, dandelion, just kogogs, coloretics. In general, a lot of different herbs and teas can be helpful there sometimes just even thinking about the basic building blocks of bile. So thinking of taurine, again, just thinking of the amino acids and making sure that we have enough of those different amino acids and in complete amounts in order to fuel bile acid synthesis. So yes, I do think, you know, we need to look at bile. We also need to look at back to what you said about beta glucuronidase. We need to be looking at kind of the overall balance because especially as you move through perimenopause and you move into that menopausal transition, the 12 months, you know, the gut microbiome is just by default changing. And in fact we know of this, that the microbiome starts to look more like a man's as a woman is going through menopause. Right, right. So we do need to be tending to that throughout the way with bile, as you mentioned, whether it's just having ox bile or we're giving the precursors to making the bile, we have to establish healthy liver health too. You know, it's not just focusing in only on the bile. But you know, I was reading an article this morning about how we don't really know long term what will happen with women taking HRT and liver health. Health because the liver is implicated in hormones and metabolism of hormones. So looking at this whole kind of the fatty liver epidemic that we see in our society. Right. I don't know if there's any connection or are we worsening or lessening that by changing up our hormones, but you would think that the liver plays some role in our overall hormone balance. So we need to really, really tend to liver health during this time of life, I think throughout the entire time of life, quite honestly.

Right. And we're seeing now in practice it means like I learned about this in school and I hear about it in research and now I'm like, oh, it's like actually arrived at our doorstep where we're seeing like healthy women my age ish come to us with fatty liver. And I'm like, oh, this is real, this is happening. We are here and we are dealing with it. And that's like one of the big things is like the long term repercussions of, of hrt, but starting HRT earlier and earlier and earlier and like, how does this all play out? So I just really hope that we are considering that our liver health in all of that, because that's a, a reasonable concern.

Yeah. And not considering detoxification. So yes, considering hrt, potentially. But then if we're not looking at the other side of the equation, then the liver could have some changes. So we'd want to monitor that with liver function tests. Would be important to be looking at that. That's why I often say, even though I'm not really strict about labs, I do think it's important to get time points in a woman's life to kind of see how things are moving. And it doesn't mean just her hormones, but just like you did with your thyroid, you know, just monitoring those things so that when you start to feel off or that symptoms start to arise, you can always go back and look at your baseline and how does it match. Right.

Basic lab work. Basic blood work too.

Just basic cbc, cmp. Ye, actually, yeah. And just those basic liver enzymes can tell you a lot. I think that can key you into certain things.

Yeah, it's one of the things that we really, really love to look at. We love the razzle dazzle of all the functional labs, but, like, you gotta look at the basic lab work, blood work too. Okay. Before I let you go, you had said that you would share how you've navigated this journey yourself. I mean, is it all the stuff that we've talked about?

It is all this stuff, stuff. So I've been in nutrition science for a really long time for like decades. Right. So my eating was pretty much on track. And I. I didn't really think that I would have any issue with perimenopause, quite honestly, but I did. So I had done a lot of yoga and I was very bendy, but that also led for me specifically my Achilles heel is actually my musculoskeletal system. So I have a paternal history of osteoporosis, grandmother, you know, just lots of issues with bone and brain and breast. Kind of like the whole circuit, but mostly the bone. So that has been kind of my lens into it. So getting a dexa, looking at different bone tests and bone markers to assess that and doing the best I can with pivoting over to more strength training. That has not always been a love for me, but it's a necessity at this point. Point. So changing that up. And obviously I was on the feminescence. The Peri product. Right. The MACA life. And then I transitioned over to postmenopausal product, which has helped me greatly and helped to reduce a lot of my just overall menopausal effects. I did get hot flashes, which really surprised me. And I really. I had night sweats, perhaps that was like the worst part of it. Like, I didn't like the night sweats because it really disrupted my sleep sleep. So the feminescence helped with a bulk of that, I must say. I did bring in small amounts of plant melatonin in order to just kind of smooth out, because we know that melatonin does a nosedive as we get older as well and also just helps with overall markers of aging. So I did do that. I also did decide to do very low doses of bioidentical hormones in order to just have a precautionary measure for my bones, which I am assessing. So if I find, like, my bone markers continue to improve, you know, then eventually not really being as concerned about that. So I kind of do it all. So that's why I'm not against hormones. Low doses, you know, once you've done everything else is. That's been. My approach is like, let me just get all of my potholes filled, my foundation in place, and then tweak with my bones in mind. Because I just think about functionality, I think about frailty, and I think about falls. And so that's kind of in the back of my mind what I'm thinking about as I cobble all of this together for myself.

Well, thank you for sharing and thank you for coming on the show again and sharing all of your wisdom. I just appreciate your perspective on things and I appreciate that you're somebody who can hold. You have the ability and the willingness to hold all of the nuance, no matter what the conversation is, as it pertains to our health. So thank you so much. I will link you up everywhere in the show notes, but can you just tell listeners where to find more of your work and what you're getting up to?

Sure. My website is deannaminick.com and if anybody is curious about the feminescence, it's symphonynaturalhealth.com, you can read about it there. But on my website, I would say that there's a lot in the way of blogs and also my Instagram. That's where I like to have fun and make artistic posts about hormones. You know, often a little bit disruptive. I would say you and I share a similar mindset where if we don't feel like we are saying the party line, we're going to come out with kind of our own creative talking points, whether or not they're popular. So, yes, that would be where to find me as well.

Thank you again. I just appreciate your time and I appreciate your work and you so much.

Oh, thank you, Erin. It's been a delight. Thanks for having me.

Thanks for joining me for this episode of the Functional Nutrition Podcast. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. If you got something from today's show, don't forget, subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.