Why weight gain is part of menopause and how to counteract it

Hi, and welcome to how humans heal. I'm Dr. Donny Wilson, and in this episode, I'm excited to introduce you to my friend, Dr. Betty Murray. She is a women's health expert and researcher, and she's also the founder of a clinic in Dallas, Texas, as well as a telemedicine clinic called Minerva, where she helps women to master menopause. She has a podcast, she has a TV show coming out, and she has a program where she helps women with menopause. And her research is related to the microbiome and metabolism of women in menopause. I think all of this is so apropos and important for women to know. So I'm so glad you're joining us today. Betty, thank you for being here.

Gosh, thank you for having me. I love talking about this subject, so thank you.

I know it's one of those things when you. You just, like when you're researching it and you're just in it, and then you're getting passionate and inspired to help women with it, and we're in it ourselves, right? So it's like you're just swimming in this experience of menopause and saying, hey, women deserve so much more. They deserve better. They deserve more support with menopause. And I love that. You're just, like, taking that and running with it and helping all of us to understand more what we can do to thrive through menopause. Tell us more like, is there something that got you inspired in this area that said to you, like, okay, this is where I want to put my focus?

Yeah. You know, it's. So I. I came to functional medicine and functional nutrition because of my own health problems over 20 years ago. So I opened Open LivingWell Dallas 20 years ago, and it really was my own autoimmune condition. It was colitis. I was diagnosed, and when I asked the doctor, you know, could I change my diet and change the trajectory of my disease, he laughed in my face and said it had nothing. Nothing to do with diet. And I was like, oh, wait a minute. See, that's really interesting, because when I don't eat something, I start to get better, but I can't starve myself, you know? And so, you know, that's what led me on my journey, led me back into school for nutrition and sort of led me down that pathway. Well, kind of flash forward into my late 30s, and, you know, I'd actually had a tubal. Right. I didn't want to. I didn't want to take birth control anymore. I had a tubal and you know, everybody told me, like, nothing's going to happen when that happens. You're just. You know, it's just going to be easy. You don't have to take the pill because I didn't want to be on the pillow. But, you know, within about six months, I started getting acne. My hair started falling out, like, all this stuff. And probably the most insidious is I started gaining weight right, and around the midsection. And I had. I had been in the bodybuilding world, so it wasn't like I didn't know how to manipulate body composition. And I'm a nutritionist by training, so you can imagine how that feels. You're like, oh, my God, I feel like a fraud. I can't figure out what's going on. So over the course of about a year and a half, I gained 35 pounds. I get told it's everything under the sun. It's your thyroid, it's your hormones, it's this, it's that you need progesterone, you need this put on medications. And I. And I'm in the functional medicine community. I have providers that work with me. I have access to some of the best minds. But to tell you Honestly, I'm 55. What, yesterday? Two days ago. And I.

But I feel better today at 55 than I did at 40. And my. My 40s were just a dumpster fire, you know, with people, somebody pouring kerosene in it. And. And so for me, that's what led me back to get my PhD and then really kind of put me on this path. Because women pay such a price for being women. You know, we suffer autoimmune conditions 10 to 1 to men, IBS, depending on which study you look at somewhere, you know, between two and three out of four have IB, women will have IBs. And it's just all these things. And it's because we are so biologically different, and we just don't get studied, we don't get resources, and we get gaslighted. And so this has become the hill I'm dying on, probably, you know, in multiple ways that I never thought I would actually get involved. You know, I was always going to be out there, passionate for women's health. But now it's like it's at a sort of a ramped up level that I never thought I would see. But that's. Yeah, that's. That's where my passion totally is.

Mm, that makes sense. And it always surprises me, especially with Crohn's disease, when a practitioner says it has Nothing to do with diet. It's like we're talking about the digestion. Of course what we eat is going to, it's, we know it's going to impact our whole health, but of course it's going to impact our digestion. I think that's pretty straightforward. But even then a gastroenterologist doesn't learn about diet. And so as a nutritionist, I also originally trained as a nutritionist before becoming a naturopathic doctor and midwife. So I relate to you like, you know, we go from nutrition to let's help women with nutrition. And I'm really intrigued by your research, research about the microbiome because of course the microbiome is also in the gut. So let's make that connection. Like, how is it. Here we are talking about menopause, which is like estrogen, progesterone, the ovaries, and that's changing. But now we're also talking about the microbiome which is in the gut. So how is that, that those are even in the same sentence together?

Yeah. So I think it's really important to understand that we have a microbiome in every tissue of the body. Right. There's microbes all over the body. So yes, we think of the microbiome that's the gut, you know, the three to four pounds of bacteria that we have in there as, as, and it is primary for sure, but we have, we have a symbiotic relationship with these probiotic, mostly probiotic organisms and they help us do a lot of things. And I think what, what people don't understand is the food that you eat in most instances are acted on by the microbes before you get a chance to absorb any of the nutrients. So you get what the microbiome leaves for you.

They do it, they get to the food first.

Right, exactly. And so, you know, and so I've always been fascinated, obviously with digestive problems. It's always like, what's going on? You know, what can I change? And, and so I've always been fascinated by the microbiome. But, you know, several years ago, back in, I think it was 2011, Patel and Blazer.

Came out with a study where they were doing, is when DNA, DNA research started to hit the ground, particularly with the microbiome. Because the thing people need to understand is old school stool testing or the kind that your gastroenterologist does is a culture. Right. So they get a sample of your stool, they put it in a petri dish and then they look for what grows. Well, 80% of the microbes that are in your gut will not survive an exposure to oxygen. They're going to die.

You can't even see them on the culture.

No. Yeah, your doctor's like, let me close for that. Like, woohoo. You're gonna get like nothing, right? So, you know, and so we had to wait for DNA technology to get good enough to start identifying these bacteria. And actually we're still learning a lot. Like that identification process is, we've gotten better, but we're not by no means where we, where we need to go, but we all of a sudden we identified all these different bacteria. Well, they identified several bacteria strains that actually produce an enzyme called beta glucuronidase. And that enzyme actually exists in the human body. Our lymphatic system makes it, our bones make it. It's, it's, it's part of an enzyme pathway that we have in our gut and, or I mean in our body. But these microbes make this beta glucuronidase. And what it does is it liberates estrogen and other estrogen like compounds. Also things like toxins that are slated to go out in the stool, right? So they go, they get trapped in the bile, they get wrapped into the stool with fiber and all that other stuff and they're supposed to go out with the trash. Well, these bacteria liberate that and allow it to get recirculated into hepatic recirculation. So that's going back through the liver and going into the bloodstream. And I was like, okay, that's fascinating because you think, okay, number one, nature is usually, always symbiotic, right? Even, even. I was reading an article today about sharks and how the, the overfishing of sharks is starting to ruin the ecology of different oceans.

So something to think of as a bad animal is actually necessary.

Totally necessary, right? And so we always have this sort of black and white thinking. So everything in nature exists to create homeostasis or balance, right? In most cases there's an, there's always this equilibri by whatever natural system, you've got to sort of fix it. So, you know, I look at it and I'm like, okay, so why does that exist? Well, when you look at age groups, right, so small children, infants don't make much beta glucuronidase. They don't, they don't grow naturally. Let me rephrase that. A natural, healthy child that's been breastfed and vaginal delivery, they don't have a lot of microbes that make beta glucuronidase. But as we shift and get older and hit where we're starting to menstruate and we get, we get to the point where we're having cycles and reproduce producing, we see more of them. But then even more interestingly, the bacteria, the estrobolone, the bacteria that produce beta glucuronidase, grow significantly in menopause, significantly, like a whole different set of microbes. And you know, that is what got me fascinated because I'm like, what is it they're doing and why is it beneficial for them and why is it beneficial for us?

And so the idea was that beta glucuronidase, this particular enzyme, which happened to be one of the world's expert on it because I studied it, not many others have, has always been perceived as bad, right? So it's in, in research, it's been associated with colon cancer, it's been associated with drug induced toxicity, it's associated with chemotherapeutic drugs being toxic, it's associated with breast cancer and prostate cancer. Not as closely, but we have associations. And so you look at that and you go, why? Okay, so it allows things that should be going out to the trash to get recirculated. That would make sense. Okay, those are things that we don't want in the body, but they're getting to recirculate. But that doesn't explain why we see it increase in production by the bacteria as we get into our 50s and 60s and beyond. And what the research sort of points out is that that shift in the microbiome, the increase in beta glucuronidase, is possibly and probably a shift to try and allow for more estrogen to get recirculated while the ovaries are petering out and losing the capacity to make estrogen interesting.

You know, that there, that there is this relationship between the microbiome and a woman's body where they both benefit from the circulating level of estrogen and that those microbes grow to help what little might be going through there. Now, if our environment was fully organic and we didn't have toxins everywhere on the planet that look like, you know, basically bug pest control and bug birth control, we wouldn't have this problem. But now we have so many other toxins going through that look like these hormones that were kind of overloading the body. But the truth is, is there, there's a relationship with our hormones and our microbes and our microbes and our hormones. You can't divorce them from Each other.

Mm. Wow. That's like, that's huge right there. To just, to just realize that our hormones are in communication with the microbiome and vice versa. And we can't just be thinking of estrogen by itself or even estrogen and progesterone without automatically thinking about what's happening with the microbiome. How are they talking to each other?

Right, right. Well, and the thing is too, so obviously that particular enzyme made by the bacteria, the estrobolo, affects whether estrogen gets recirculated or not. But estrogen is not the only thing that gets conjugated or what. What basically, I like to think of it this way, is when you go to get rid of estrogen or any toxin, your body doesn't break it apart. So when I first learned about biotransformation, to me it was kind of like a broken chair. Right? The chair is broken. I can't get it in the trash can because it's too big. So I'm going to break the other legs off of it so I can shove it in there. Right. That's what I thought of. Right. But our body does an opposite effect. What it does is it's adding things to the toxin that it needs to get rid of. So I think of it as I have this molecule toxin. So anybody that's listening, you won't be able to see me. But imagine I have a pen that is leaking and I want to get rid of it. The body, in order to detoxify at each stage of that process, which in the liver is a multi stage process, it's taking a wrapper and wrapping it around it. Glucuronidation, methylation, you know, all of those things, glutathione conjugation, all those things, it's a different colored wrapper. So in order for us to detox it, we have to put multiple colors of wrappers on the toxin and they must go in order, right? Well, in the, the other things, our other hormones go through that same pathway. So testosterone goes through glucuronidation, progesterone does your neurotransmitters, dopamine, serotonin, epinephrine, norepinephrine, they do too. And so my hypothesis was that when a woman had higher levels of this, either estrogen or some of these other hormones or neurotransmitters were being liberated in the gut in a way that was abnormal because they can affect the smooth muscle contraction or the relaxation of the gut. The neurotransmitters do like, dopamine and serotonin, but same with estrogen, testosterone and progesterone. And that was my hypothesis is that there's this interaction that may be happening that makes IBS worse for women and worse in the second half of our cycle.

Wow. And it's so interesting and just to kind of see if I can fill in some of the questions. You know, when we talk about estrogen as well as the other hormones and metabolites in our body, the idea is that they eventually the blood is going to go through the liver to detoxify, and the estrogen in particular needs to be detoxified and sent out of the body. Because a lot of times you're like, well, why would we even want to get rid of our estrogen? We want estrogen. That's part of the issue with menopause is that the estrogen's dropping, but it's really understanding that it's a recycling. It's like we need the estrogen to be present and to go through the liver and be detoxified and then we need new estrogen to come in in order to stay in a stable state. So to know, to think of it as like a. Right. Like it's a constantly processing machine. It's not just put estrogen in and it. The same estrogen sticks around forever. No, it's aand when our ovaries are active, they are making estrogen. And if we're not taking a birth control pill, our estrogen is coming from our ovaries. But if you're taking a birth control pill or you're on hormone replacement, that's the source of estrogen. Right. And still it goes through the liver and then it has these interactions that you're talking about in terms of being able to detoxify it. And what we're aiming for is for healthy detoxification of estrogen and moving it out of the body. But you're saying, hey, there's all these other interactions that are happening and possibilities that can occur. And if to the degree that we can understand that and we can then make choices that could influence that. Right. Like what. What did you find around that? Like, how could someone then say he. What's then my. What's my best strategy to maintain the healthiest glucuronidase for my age, for example, and my healthiest microbiome for my age?

Oh, yeah, definitely. So I've got a really crass but good example of how to think about how most of the body works. Most of the body works in what we would call a negative feedback loop, right? Which is what you were describing. Body makes it, body uses it, preps it for trash, and then it goes out through the trash. So my, my analogy, or what you can imagine is you have a toilet, right? The back of the toilet fills with water, and that's your body filling up with the estrogen. Your body uses it, I. E. Fills the. Now the bowl with water, it gets dirty, and now it needs to get flushed out. In order for the tank to refill, that whole step must occur, right? And so that's how your body does almost everything. It has to, like, use it, wrap it, get it, rid of it, and then that tells it to make it again. And so our hormones are like that. And so. Which is super, super vital now. So the. So the question you had was around hormones and, and how they operate and what they do in the body and why.

So to think about the woman's hormones, as we go through, obviously, menopause, they flatline, our ovaries run out of eggs, so therefore we run out of estrogen. Now, our fat cells make estrogen, right? So most women, 90% of women, will gain up to 15% of their body fat going through menopause, right? So their body weight. So if you weigh 150 pounds, the average woman will gain 15 of their body weight. That's a protective mechanism. So the body can get more estrogen, right, and have more circulation, gaining fat.

So that it'll have more estrogen in the fat, Right?

Exactly, exactly. So, so if we're gaining more estrogen, right, through that mechanism, it's by no means close to what we were making while we were cycling, right? And so therefore, then the microbiome sort of shifts and grows. So how can I improve those microbes that are most healthy, right? Because the thing is that we don't completely understand. And a lot of this comes from researcher bias. So only about 15% of any studies get published. So that's the first thing people need to know, is lots of studies get done, and a lot of times if they're not super favorable to whatever medication, they just get buried. Because there's no requirement for the company to ever publish, right? There's no requirement. Now, I can tell you as a PhD student, the only way you get your degree is you must publish. Publish or die. But. But a lot of studies may not go anywhere. So, you know, there's a lot of things that have been looked at that just have been left behind or just are obscure and no one sees it. So the bias is, is that everybody thought beta glucuronidase is negative. So a lot of times you have to look at it from that lens and understand maybe it is, maybe it isn't and maybe it depends on time and what we're looking at. But if we were to look at what helps the healthiest microbiome survive and do the positive things it needs to do, you know, eating foods. So the fastest way to change your microbiome is change your diet. You can take truckloads of probiotics. Probiotics have not shown to actually colonize. We don't see significant changes to the microbiome by taking things like Lactobacillus, bifido, spore forming bacteria, maybe, but not that much. They're, they influence, they absolutely influence. So that research is clear. But if you take a bunch of Lactobacillus, let's say ramnosis, because yours were low, doesn't mean it's going to get any better on a test.

Yeah, just like flooding the system. Right. You're just like, you're just flooding it. But that doesn't mean they're actually gonna. Because that's the key is we need them to move in. We need to thrive and survive and, and work for us. We don't want them just floating through.

Yep. Yeah. Because they're kind of like snowbirds. They come hang out in Florida from New York, but as soon as New York warms up they go home like. And so, and so, but, but what does show significant changes? Right. Because that's what you want. I want the healthiest microbiome I can have because much across the board that's going to have a positive impact even all the way to dementia. Right. We have pretty good research that came out in the last couple months showing that there's significant impact with Alzheimer's and dementia with the gut enough that there wasn't already. But even, even more powerful. So the foods that are most powerful at shifting the microbiome to a positive, positive grouping are your fermented foods. Right? Fermented foods. Foods like resistant starch and fibers and complex carbohydrates because they are the food source for the healthy microbes. High polyphenolic foods, you know, high phenolic olive oil.

Things like pomegranate, kiwi kiwi extract. Who knew that they were super kiwi fans, but they love that stuff.

Really?

Because that's. Yes, yes, it's so and more and more we're probably going to find individual polyphenols that are microbiome growing.

We hear A lot about like pomegranates, right?

Yeah, yeah, pomegranate. You know, even your, your deep dark red purple blue fruits, you know, so a diet that has a very high content of a high variety of brightly rainbow colored foods feeds your microbiome. And part of it, what we're starting to understand is it's not even so much about the microbes themselves. It's what they make, right? It's what they make. Why is a fecal transplant so profound? It is not even so much about the microbes. It's itself. It's all of their growth factors and stem cells and enzymes that actually influence. And so our, our goal is to use food in that way because that helps shift our microbiome. And so, yes, it may make my menopausal symptoms and my gut symptoms better and maybe my perimenopause and all that other stuff, but it's probably going to have a positive effect on my risk for all cause mortality.

It's really something. And I always like to emphasize that it's because, believe me, I went into, when this started all coming out and I was doing all of these different DNA analysis stool panels with patients and we were, and I was searching like, okay, which food, if this one's low, which food feeds that bacteria and which food feeds that bacteria? And then we would have the patient eat more of that particular food and retest it a couple months later. And we tried it. You know, it's tempting, right, to get down to that level. And yet when we did that and retested it, it's really not that simple. It's way more complex than that. It's not as simple as saying, oh, just eat a pomegranate a day or. And the thing that always really interested me the most is that is to remember that we're talking about a microbiome. These are microscopic organisms. So I always say it's like feeding a goldfish, right? It's very tempting when you have a fish to just the kid, you know, your kids just keep putting more food in for the goldfish fish. And then a goldfish only really needs like a teeny little sprinkle of food each day. You know, it's like a tiny sprinkle. So we realize, like, okay, as much as we're saying we need to feed our microbiome, we also need to remember that it's like feeding a goldfish, right? Because we can. It's also such a thing that we could overfeed them easily, right?

Yeah. Overfeed them or, or Shift the balance. Because some of our microbes come out at night and when we're supposed, our gut's supposed to be relatively empty because we've gone three or four before bed to go, you know, between eating. And there's other microbes that go in there and sort of scavenge stuff off the gut wall and help clear stuff up. There's, it's, it's, it's way more complex than that. And you know, it is like a jungle in there. And that ecosystem is very, very.

Resilient, but also complex. And I think, you know, for all the, all the advances we've made, you know, I love functional medicine because we are early adopters and we're like, okay, research is going this direction, let's go. Because the real reality is traditional medicine is at least 18 years behind in capturing anything. And the only way we move the needle forward is that we are earlier adopters of the breaking edge kind of research. So we can keep moving it forward. So we're always getting better at it. But it's, you know, it's just, even just looking at just the DNA to identify the microbes, I'm like, actually that's not nearly as important as identifying what they're making. Like, you know, that are they making histamine, cadaverine, putresine, Are they making, you know, ammonia? That's a different story. And, and it's just, we have to just wait for, for commercial technology to come together where we can actually get that kind of data. But, but I think people need to understand that we have an extraordinary amount of power in how we eat to influence our health, either for the better or for the worse. And extreme dieting, I'm sorry, carnivores, that if you want to, if you want a bacteria group that will produce a ton of beta glucuronidase and inflammatory byproducts, eat a carnivore diet for a long time. You will kill off your good bacteria. Right.

And on the other side, if you have a hundred percent plant based diet, it has a whole other set of concerns.

Right, right. It goes both ways. It's like either way, we weren't designed to eat in these extremes. We were designed to eat seasonally, opportunistically. So that means that we were eating a lot of variety and that we ate a lot of plant food and we ate, we ate meat, but we were never exclusive meat eater. We would never have made it this far. We would have been a much smaller population.

Yeah, that's such a good point. Because I think as humans, it is so tempting. Again, that black and white thinking you were mentioning, we think, oh, we're looking for that quick fix, you know, so it's that we're going to do, you know, extreme fasting or we're going to do. It is all or nothing.

Right.

We're going to do all animal protein or nothing, and we're going to do zero carbs or we're going to do, you know, and every time we pull to any of these extremes, it's tempting at first and you might see initially some shifts, but in the long run, you're likely to see shifts in your microbiome that end up causing other symptoms later, would you say?

Right? Oh, yeah. I mean, it's. I think it's the difference between understanding there's a therapeutic diet. Right? Right. The vast majority of the diets that people see, whether it's a fodmap, low histamine, low fermentation, gap diet, all of those, they are therapeutic diets, meaning that they are designed to do something very dramatic in a relatively short period of time. Right. Same thing with Carnivore. Have I used Carnivore with somebody that had pretty severe sibo? Yeah. You know, if we're trying to starve off somebody that doesn't belong in the gut in high levels, that's an easy way to do it. But they are not a maintenance diet. And a maintenance diet is for full body health and microbial health and everything else. And the goal is to always shift to the most varied diet possible, because the one way to guarantee that you have an intolerance or a sensitivity or other things is to remove more and more foods from your diet. You will eventually end up sensitive to.

Those because you're eating the same thing every day. And I think that a lot of times when people are in a busy, stressful life, they end up doing that too. We end up just going, I'm going to go to the same place for breakfast or same place for lunch, and I'm going to just put it on repeat. And we end up just eating the same thing all the time. And it's, it's. That's what ends up. Of course, then you're feeding those things. So keep in mind, like, whatever you're eating is going to feed the particular bacteria that like to eat those foods, but who like to eat other foods are starving. So it creates an imbalance. And so what. I love what you're saying, Betty, which is, I completely agree. It's about how do we create variety how do we challenge ourselves really, to say, hey, how can I. Yes, we're going to have some things that are consistent in our dietary structure, but how do we create variety so that we're getting different types of fibers and different types of foods in this beautiful blend over time, so that we're. So that we get a nice diversity of bacteria in our gut. Right. Because they all have. Some of them make this nutrient, some of them make this neurotransmitter, some of them help our immune system in this way. So we want them all to have a chance to help us. We don't want to just be lopsided.

Yeah. I mean, you know, even when I was a kid, I mean, obviously that was a long time ago, we couldn't have strawberries all the time, we couldn't have blueberries all the time, you couldn't have kale every day. But the reality is, because we can do that because of a global food supply, people eat a really narrow diet and then we overeat things like oxalates or phyto. All of that stuff. Phytic acid, because we just eat the same stuff every day. Like, I remember when I was in the bodybuilding world, you know, I would food prep and I, as we still. My husband and I still food prep, but I had gotten into this rut, you know, you're doing contest prep. So, like, you're allowed so little. It's like, oh, I can have oatmeal and brown rice and broccoli and green beans and chicken and protein powder and eggs and so I would make like a week's worth of that stuff. I'd eat the same stuff every day. And I'm like, that was really interesting, like, what did that do to my colitis and everything else? Right. So we couldn't have eaten that way until global food supply.

And sometimes foods that are considered healthy could actually become unhealthy, like you're saying, because we're eating it too often and we end up throwing things out of balance. And so it's just. But at the same time, I don't want people to get, like, it's not about just throwing whatever your latest pattern is out the window. It's, I think about how do we start to have, with all of this awareness, work toward a more balanced way of a relationship with our food and a relationship with our microbiome and a relationship with ourselves that allows us to be in this. Right. This more flexible, mobile, healthy place versus the extremes, right?

Oh, no, definitely, definitely. And I like to think of the idea of adding rather than subtracting things because almost always we focus on, on subtracting more and then subtracting more. It's like, okay, no, maybe my first thing is I'm going to eat the way I have been eating, but I'm going to add a new fruit or a new vegetable, you know, every couple days something different. So I have a wider variety.

I've done a lot of detoxes over the years and many of them made me feel a lot worse. Not only that, but I've had a lot of patients come in and tell me how after doing a detox they have a stomach and headache and they can't sleep and they're feeling anxious and.

I'm like, I can't just recommend that.

My patients do a program that's going to make them feel worse. So I finally decided to design my own detox program. It's a 14 day detox program that's not like other detox programs out there in several ways. One is that I'm focusing on focused on helping you to get the toxins out in a safe and effective way using nutrients, antioxidants and supporting our natural detoxification pathways in the body. Also, I'm helping you to decrease your exposure to toxins by learning the ways that you've been exposed to toxins and how to change your day to day lifestyle to decrease your toxins over time. And I'm helping you to look not just at chemical, environmental, toxins but also emotional and energetic toxicity. And yes, it's possible to accomplish all of this in 14 days. I have so many patients who have done the 14 day detox and report back to me how much better they feel. And I think it's also because I help people you to know what to eat, you are getting adequate food that tastes good plus protein shakes that I developed that are good for your body, that your body knows how to use these nutrients and take them in and use them to help you safely detoxify without feeling worse. Also I help you to balance your blood sugar levels, get better sleep, sleep and introduce things like meditation, biofeedback and other types of stress recovery into your.

Day to day routine.

So I just am so excited about it.

I want to make sure you know.

About this 14 day detox. I'm going to put the link, you can find it at drdani.com forward/detox-program but I'll also put the link below so so you can find the 14 day detox program@doctrordani.com I look forward to guiding you through this detox so that you can actually feel better on your way to better health.

I love it.

And especially because, as you mentioned in your story about the. About noticing the weight gain, and I want to cover that. Is it because it's such a common thing that women experience in menopause, is this, like, you mentioned this 15% of the weight gain in your life, like, almost overnight, it feels like it appears, and you're like, what do I do now? And so women end up restricting, right? It's like, okay, I'm gonna do what worked before. I'm just gonna restrict my eating. And yet it doesn't work so well anymore with menopause. So what can women do at that point? How do we navigate that difference in menopause?

Yeah. So I think first off is to help define menopause for women, because menopause technically is one day in your life, one year from the last time you had your period. The problem is, is we're in perimenopause, which is the time before when the symptoms start showing up, which is an average of almost eight years. It's an average, which means some women get 15 to 16 years, some women get two to three. Right. And so for me, all of my symptoms were early perimenopause and menopause. So I was going into that transition in my late 30s, right. And everybody was like, oh, no, not yet. Not yet. That's not it. It's just. It's your thyroid. It's just this. And. And. And so I think women need to understand that it's varied. One, you know, you could get 12 women together, and we're all going to have a completely different menopause experience. Right. There's some truisms, like, I've never had a hot flash. That was not my symptom. I had a hundred other ones, but I did not have that one. Right. So everybody's different. One of the most insidious things that happens is we get. Get two very large changes in our body. So first is women. When we go through menopause, we have to understand that estrogen in particular is kind of like Goldilocks. We need the right amount, not too much, not too little. And so when you're cycling and we're in our, let's say, 20s and early 30s generally, most of us have pretty decent hormone balance. They fluctuate throughout the month like they're supposed to, but they're balanced to each other. And so we may not experience wild weight gain or if we do. We're like, okay, hey, I can cut it back a little bit or I exercise a little more and I can get it off. Well, the first thing that happens is we see progesterone decline early, so that one declines as we go into our 40s. So it's down. So estrogen's high relative to it. And we have what I like to call the ketchup bottle effect. So when we're, when we're young, our ketchup bottle, it's organic and all that stuff is completely full. Right. So you go to squeeze it out and you get this perfect S on your all organic, all beef hot dog. Right? Right. And it's the same every month. You know, it works just fine. Now you get to perimenopause and it's starting to go empty. So you shake it and you go to squeeze it. Nothing happens. You squeeze it and it goes flat. Right. So it's a roller coaster. Your. Your hormones start to go all over the place, particularly estrogen. But in that early part of it, it tends to be high relative to progesterone. So we start to get more insulin resistance at this time. Progesterone also affects stress and sleep. So we often see insomnia or early waking, like waking at 3am and not being able to fall back asleep. So that makes us more insulin resistant, more stressed out, unable to burn fat. So we start to gain weight. When you get into menopause, what happens is estrogen nose dives, and one of. And one day we take a cliff dive and it's just gone, right. The ovaries, the eggs are out of the ovaries. There's none left. And when that happens, we see a radical increase in the years leading up to that, usually the last, like two to three years where estrogen has really bottomed out. And we see a significant increase in visceral fat. So that's the fat that's underneath the muscle in your abdomen. Right. So it's not the jiggly bits. We hate the jiggly bits on our butt, you know, and hips and thighs, the, you know, kind of junk in the trunk. We don't like that, but that doesn't kill us. Visceral fat can't. And when we gain that weight in the middle, the research shows exercise and reduced calories or cutting back foods does not move it. So your trainer that told you you need to eat less and work out more, your doctor that said that hasn't read any research, because it is being driven by the hormones. So that's why your waistline gets bigger. Right. And like a women will say, you know, I swear my butt just creaked around to the front, you know, I. Gaining weight around the middle, middle. So it makes it harder to lose around the middle. And then we get more inflammation because that fat produces inflammation and then it produces more insulin resistance and then we get this kind of vicious cycle. Right. So that is one of the major things that happens, the mechanism that causes this. And this was interesting because I had to find this looking at dementia studies and brain studies. You know, I got off on a tangent while looking at other stuff and would get kind of end up down another rabbit hole while I was researching. So we, so in our cells we have these little things called mitochondria. It's kind of your powerhouse. That's the little thing that actually creates energy. It's your, it's your engine and its primary fuel is glucose. And then when you're not eating and you don't have a significant amount of glucose circulating around, it's meant to burn fat. Well, there is. So there's a transporter. Once glucose, once blood sugar gets inside the cell, that transports it to the powerhouse. It's not insulin. Insulin gets it in the door. But insulin doesn't drive it to the powerhouse. It's a transporter called glute 4. And glute 4 is what they call a passive transport. So I, I have all these visuals. So you remember the game Candyland and the Chutes and Ladders kind of thing? Well, it's kind of like the ladder that doesn't have much of a pitch. So it's like just the slow kind of ooze. It's not a very fast transportation. Well, it happens to be estrogen sensitive.

So when you lose estrogen, your transport to get your glucose from inside the cell is impaired significantly. Right. So what happens when the cell has glucose inside the cell but isn't burning it efficiently? It becomes glucotoxic and so the, the cell becomes overwhelmed and we get less able to burn fat at the same time. Right. So your powerhouse isn't getting its fuel. Now the powerhouse is going to run slower at the same time. Because of that, it's not going to be very efficient at burning fat either. So you think, oh, well, cool, I'll just cut my carbs and I don't have to worry about it. I'll wait for body fat. Well, it can't do that if it's, if it's got glucose as a fuel source waiting. Right. So basically you have Two fuel sources that are sitting and one of the other major things that happens is, well, there's two others. So one is inside our powerhouse. We have a mechanism that is designed for.

Transformation of, of cellular beings, right? So caterpillars do it, animals that hibernate do it. Every single single cell. Organisms do this. And so the mechanism that allows a animal to hibernate, meaning the thing that sort of switches the powerhouse down so they start gaining weight. So bears. Bears, right? Bears gain a bunch of weight so they can sleep all winter. The mechanism inside the cell is driven by uric acid production. So inside the powerhouse, uric acid comes up, it shuts the power down. So it says, okay, run at 30%. So we become less efficient. So instead of being this really high end Tesla, you now got a 1984 Yugo in every single one of your cells, right? And it's a protective mechanism. It's meant to do that. So animals that hibernate, that's how we found it. We're like, oh my God. This is the mechanism that allows them to gain weight. Weight. It also makes them more slow and they, they actually crave the foods that will cause weight gain, like fructose containing foods. So the powerhouse slows and slows down. That is also estrogen dependent, right? So you go look at the research, you're like, oh, amazing. We can check for uric acid in the bloodstream, which could be an indication that this is happening. And it is. That's Rick Johnson's work. Well, you go look and go. Menopausal women increase in serum levels of uric acid. Well, lo and behold, we have this automatic steady rise of uric acid as we go through menopause because our metabolism is being slowed at the engine itself, right? So I can't get the sugar in there. My engine's now being told to run slow. And then the last thing is the subcutaneous fat. So the jiggly bits, the junk in the trunk, like I said, that we don't like, has adrenal receptors. So think of it as, we have nerves that go down into those fat cells. They're adrenal receptors that produce epinephrine and adiponectin. Adeponectin gets it out of the fat cell, epinephrine picks it up and drives it to the cells to drop it off the nerves. The receptors on those nerves go to sleep when they don't have estrogen. So the first on last offs the jiggly bits on your butt that makes it hard for you to Zip your pants, have a hard time getting out. Because we have all this hormonal mechanisms that is basically telling us to save it. So then I look at it and I go, why? Why? Why would all these mechanisms. Because women, we're humans, are one of the only animals that have been able to survive postmenopausally. Right. And no, like two other mammals do it, right? There's the grandma theory that it's to help raise our kids because they are not, you know, functional, usually until much older. Right. Compared to other mammals.

But that still doesn't answer the question. And I think the answer to it is, is all those mechanisms increase fat storage, which increases the capacity to make estrogen at the fat cell out of testosterone by the aromatase enzyme. Right. And that we stay alive because the body does that, you know, not to the same degree as if we were cycling, right? So then you look at it, you go, what would change all of those metabolic mechanisms? And what would change all of that? Restore hormones to a biological state so the body doesn't have that hormone deficiency anymore. It's the only time you. It's. This makes me so crazy. If a man loses testosterone, heaven forbid we make sure they get testosterone. If somebody's thyroid quits working, we replace thyroid growth hormone, insulin, We. We do it. But a woman goes through menopause, we're like, no, you can't have that. Just deal with it.

It's such a good point. It's such a good point, Benny. And you go. And all. And if we. And they're safe, we. Now we know they're safe. I mean, we've known this really for decades. Because I also learned bioidentical hormone replacement when I was in naturopathic medical school. But it's starting. The research is starting to catch up now where it's even showing. Hey, this is actually a smart thing for women to do, is to replace estrogen and progesterone postmenopausally, right?

Absolutely. Even in the Women's Health Initiative, Even in that horrible crappy. I would have failed the entire committee if I was on the committee. I'll be like, such a crappy job on research. Even in their own study, the arm of women that were on estrogen alone, right? So the women that took estrogen alone had a 23% reduced risk of breast cancer. There is no association with breast cancer, but yet people still parrot that. And it's just I'm. It's like, obviously, I'm super passionate about it. Like, I just want to scream every day, you Know, because we basically robbed. The boomers should be pissed. We robbed 20 years of health from women. They have osteoporosis. Their risk for dementia is radically high. 34% higher. You have a. You have a decreased risk if you take hormones by 34%. Like, we have all these women that are pushing the envelope on illness, cardiovascular disease and everything else because they were told it would kill us. A hundred percent of women go through menopause. 87 are symptomatic for up to eight years. Less than 4% of United States women are actually freaking being treated with hormones. It is a travesty at an epic level. And we should march on Washington in demand.

You're giving me goosebumps, Patty. You're really giving me.

People know that. I'm like, I'm just. Yeah, I'm rabid about this because it's just not fair. No, this would never happen to a man. Sorry.

And it. No. And it's. I'm really glad you are saying this because I think that what I hear from women is that there is such a fear, that fear has been so pushed and so pushed as a truth that I'm sure women listening right now are still in shock saying, wait a minute, I was. That wasn't true, that I was lied to about estrogen all these years, all these states. And so, you know, for you to be able to say, wait a minute, it's actually the lack of estrogen that's leading to the health issues, not the delivery and the replacement of estrogen that could be helping us.

Yeah. I mean, here's the thing. So let's think logically. Like, I'm a scientist and I'm also a daughter of an engineer.

I love that. Those are good qualities.

I was not allowed to come in with beliefs. I needed some facts to show up. Right. I couldn't defend myself with my beliefs. Beliefs. And so. So the things that protect you against breast cancer. Right. So the average age of diagnosis of breast cancer is 63. So the majority of women who are diagnosed are postmenopausal. No hormones. Right. So if you have more children.

Children earlier and have a longer, longer menstrual history, you have a reduced risk for breast cancer. Then how is it that it is totally safe to give really high dose breast birth control pills, which are enormously high dose, but something magical happens at the date of 50 and now every hormone is going to kill you. Like that defies logic. Like, I'm okay, I'm logical. This is like, there's just no way that that Math, the math doesn't matter. It doesn't add up.

That's true.

And the reality is, is I think the other thing is, is women are also being told they're, they're going to get really high doses. And I'm like, actually the standard of care in a bioidentical menopause method trained clinician that is functionally medicine minded is probably replacing about 10 to 12 to 15% of what you made on any given time. Yeah, that's all we need to be biological. Right. Our, our estrogen levels at ovulation can reach over 500. Our estrogen levels in the second half of our cycle every freaking month. 250 to 400. When you're pregnant, it's 4300. We're looking at a blood level of like 50 to 160 to 80 is kind of the sweet spot. Like we're talking like minuscule amounts. But that protects your heart, your brain, your bones, protects your vaginal tissue, gives you back your brain, helps you sleep. Like all of that. And it's just, it's a travesty that women still have to fight to hear it.

It, it's so true. And, and I, I'm seeing that, and I'm sure you're seeing this now too, that there, there are more and more even sort of like.

I guess I was a conventional or standard medicine gynecologist and endocrinologists who are, who are realizing and seeing this research and starting to prescribe more hormone therapy for women. And yet oftentimes what I see is that they are, it's like a cookie cutter approach, you know, like, okay, now everybody is going to have the same. And here again like we talked about with the microbiome, we're so also unique. And how do you know? Like, so I always like to emphasize like the hormone replacement needs to be individualized as well. It's not, it's not, it's also not about what being one size fits all with these hormone replacements either.

No, actually there's a study that, released last week by Louise Newson's group out of England looking at, because the standard of care in England is again, we don't give it to women because they just need to deal with it. But the standard of care is very low doses. Right. And in her, in this study they looked at therapeutic levels and found that for many women the therapeutic level was going to be higher than the absolute low dose. That's generally recommended because the FDA has approved hormone replacement for the treatment of hot flashes. Right. So it's symptom suppression. So the, so even the menopause society, who, I think, you know, they're doing a good job, but the reality is, is they need to get into this decade in research and start moving forward and stay ahead. Right. The reality is, is it's not just about suppressing symptoms. It is actually about reducing your risk of dying early or actually having a really crappy health span. Like, I go see my mother every day in assisted living center. There are not a lot of men in there there. It's all women. It's all women. They spend, you know, way more years in assisted living than men because we have, we live longer, but we live crappier.

Isn't that something? It's very eye opening, right. When you go in and you see how what's happening to women, like you're saying, these are the women who were told not to do hormone replacement and now what does that look like for them in their 70s, 80s, 90s. What is that looking like?

Like, yeah, yeah, they've got osteoporosis, they've fallen, they can't walk, or they've got dementia, or they've got advanced cardiovascular disease, chf, like all these things. And so the reality is the guidelines need to be rewritten to get to true therapeutic levels where you're testing, like we test every patient before, during, while we also test for how you metabolize it. Again, that was my research. Like, how do you package this to get it out? Right. Can I get rid of it? Well, you know, because that's going to impact a bunch of other things and it should be individualized to the person, to the symptoms and also the biology. Because just because you don't get hot flashes doesn't mean you actually benefited. So I'll give a really good example. I met with a woman. She's seeing people in my office. I don't Prescribe. I'm a PhD. I'm the thinking side of medicine, not the prescribing side. But I have people obviously who do. And so we see this woman and she'd had a DEXA about nine years ago, had not had another one because doctors are not doing adequate, proper care of women and preventatively checking it early enough. And so, and it was good before, and she had been put on bioidentical hormones by a well meaning physician years earlier. And so I said, okay, great, you know, let's make sure you get a dexa, because we have a DEXA in our office and, and we got labs. So we sit down with her and we start going through it and her DEXA had gotten significantly worse, right? So she went from being within normal limits to osteoporosis. Well, the leading cause of loss of bone is the loss of estrogen. It's menopause. All women are losing bone. It's just to what degree and how fast. So she was eating right, lifting weights, using weight vest, you know, getting plenty of protein, doing all the lifestyle things that you could think of to do that. Lo and behold, we check her estrogen levels on labs and it was 32 to. And her doctor had always told her as long as she didn't have hot flashes, she was fine. And the reality was she was under therapeutic dosing period, full stop, not getting any benefit, right? And I look at that and I go, okay, how many doctors are out there? Well, meaning, thank you, thank you, but please, for the love of God, we have the ability to do math, do some science, run some labs and confirm, right? You don't give somebody a statin drug, we won't even get into the argument for or against those, and then never check cholesterol again. But yet we look at women and we're like, you know, you're not bitching anymore, so, you know, go away. Right?

It's really shocking to me. I completely agree. How can we be putting in a hormone, give it, swallowing a hormone or putting it on our skin and then never assessing the dose or the metabolism of it. And it's. And yet the testing that we can use to evaluate that isn't even part of the standard of care. So we, if you're going to a gynecologist and even if they give you a patch or a prescription and they, but it's under your insurance, your problem, they're not, they're not going to cover this. So you just have to, you, I think right now women have to realize, I mean now maybe, maybe in 50 years this is going to be covered. But right now is when it's your life and when you, when it's important to your life. And so right now is when it's important to an invest in saying, hey, I deserve to have. Even if my insurance doesn't cover it, even if my standard doctor doesn't order it, I deserve to have this information. I'm going to go get access to it. And this is why I agree, this is why I lead a, this is why I run a clinic where it's where, where I give women access to this hormone replacement, to the testing, because I know it's not Available. And I believe women deserve access to in.

Oh, absolutely. So the important thing for people to understand is, so CMS is the governing body over Medicare. CMS sets the standards in which commercial payers like Blue Cross, United, Aetna, all those companies then decide what they're going to cover. So in CMS guidelines, they say that they do not pay for or cover at all anything that is the prevention of disease or the improvement of health span, period, full stop. Hormones are considered that. Much of the things that we really need are considered that. That's why it's not covered. And so your Aetna and everybody else and Blue Cross, all of them, they aren't going to cover it either because they say it's only to suppress symptoms of hot flashes. It's not to actually reduce your risk of dying later. Right. And the reality is, here's even more insidious reality is statistically, all of those costs medically are going to get hit by medic because we don't usually die until after 65. Blue Cross, United and all these other people aren't going to pay because they know they're not actually going to incur the cost of your disease later on because that's the government and the US taxpayers that pay for it. So it's like your car, you own your car, you pay for your car, you pay car insurance for when you wreck it, but it doesn't change your tires, it doesn't change your oil, it doesn't replace your windshield wipers. That's your job. And your body is your car. And it's your job to assess and just think about, hey, I've got to put some resources to my vehicle. And some of that is hormone replacement. I do it too. I pay for shitty insurance that doesn't cover anything either.

I do too, Betty, because. And from time I didn't, but then I realized, like, I'd rather have it for. In case, right?

Yeah, you have it for emergencies. You have to have something because it's, it's the leading cause of bankruptcy in the United States is medical bills. But so you have to have something. But the stuff that we had when we were, you know, 20. I remember when I was 20, and that's where managed care came out and it was like, oh, it cost me nothing. And I, you know, and, but that's not the reality anymore. It's really expensive and it covers nothing. And we just saw with the killing of the United CEO, there's a major problem there. And they're, they're racking up World class.

Never seen before, billions of dollars of profitability because they're doing it on the backs of you being sick but not dying. Fine. And so the reality is, you just have to say, okay, I'm going to make some resource assessment and put some things towards myself, and it might mean less Starbucks, less Target. I mean, I don't know, after the last election and everything else, I'm like, you know what I'm going to do? I'm going to not be a consumer for a while. So my husband and I made a commitment to not play the game. And it was like, okay, so I'm going to quit buying crap that I don't need. So just think about where that money goes, because we have a lot that probably. Probably. I know, for me, I was like, wow, I have a lot that just sort of just goes, you know, and you don't think about it.

Well, this is a really important topic, too. I'd love to ask you, Betty, because I know you are so such a brilliant businesswoman as well, is that I think as women, we were not trained to think about our budget, especially our budget, related to our healthcare. You know, it was like, kind of like, that's for somebody else to figure out. And so. So I've been now realizing that, helping to educate women in particular about how to not only prioritize ourselves and prioritize our health, but prioritize our finances for our own self and our health. And I don't know if you have any wisdom around that for women, how to start shifting those thought processes.

Yeah, I mean, we got to remember that it wasn't that long ago. I mean, my grandmother was born in 1894, and she got married because it was a agreement between families. Love had nothing to do with it. That was a business arrangement. So, you know, like, in the late 20s, that was a business arrangement. So the idea of being married for love is a new concept. Right. Well, so you got to remember, we've got millions of years of women being sort of gendered into this role of we're here to take care of everybody else. You know, I'm the therapist mother, you know, baby maker, just everything else. And then if there's anything left over, mom gets it in the end. Like, I even remember my grandmother. She wouldn't sit down at the table until everybody else had sat down and started eating. And I would just sit there because I'm like, y'. All. Y' all need to put your forks down because she made the food. You know, because I'd been feminist from the start, right? I was just like, make me mad, right? Because we were trained that way. So we got to remember that even if we. It were environments that taught us we have this sort of gender background that we've been sort of pushing into. And I think the biggest thing is women have to understand in order for you to be there for your people, you must be healthy, right? If mama's not healthy, nobody in the family will be because everything does fall back on you, right? We have all those unseen hours and time that we spend being the. The extra on top of what. What else we're doing during the day, which many of us are also earning money if not becoming breadwinners, right? And so we have to put ourselves on the schedule, and we have to schedule things, and we have to put resources to it, which means you have to sit down and go, some of that budget's going to me, right? And if you have somebody gatekeeping it, it might be some really, you know, confrontational, potentially conversations about where money is or isn't being spent. Because the reality is you can't take it with you. If you don't spend it now, you will spend it later, but you will spend it on keeping a body alive. Life that is failing, and you do not want to spend your resources that way, right? So it's pay now, pay later. And so I just look at it and I go, hey, I'm going to do the things now to avoid the nursing home of the future. Because I don't want really, honestly, if I'm dying from something, I'd much rather check out early and fast rather than do a Hail Mary and spend all. Everything I ever had as a resource to try and keep my body alive. That's just me. So I'm like, okay, prevent it by putting resources to it now. Now, often it really isn't that expensive because there is all these other things, like, how much is a Starbucks? 375 to 550. How many times do you go, right, right there. That's a significant amount of money. Like, there's ways to do it where you don't have to break the bank. The other thing I think about too is our children learn not from what you say, but from what you do. Every action you have and do is what they're going to model. And so if you show your daughters that you don't mean anything. If you show your daughters that you run yourself in the ground for everybody else and you take crap off everybody else and you don't do, they're not going to listen to you. They're going to repeat the pattern, right? So you can't tell them. You have to show them, which means you have to enable yourself to do it first. And I think that's where the rubber hits the road. That's how we start to change future generations, by teaching the right thing. And it's hard, you know, it's hard to say, you know, I matter. I'm a business owner, and yeah, I get up and I'm like, oh, yeah, I'm supposed to meditate. Hey, I don't need to answer email yet. You know, I have to. I have to force myself to do the things that I know are really important to my own health.

Yeah. Yeah, thank you for that. And it's such. Such brilliance. And it is. It is an area that I think the more we can talk about, about that and come together as women and say, share that like, that it is a. It is a struggle. It's a learning process. It's something new. It's different. And yet it's so clear that it's essential. And it's the time for it, us to. To create these changes and to create these shifts and support each other through it and. And to realize that, hey, there's other options out there that you can choose and that it's something that isn't just going to come for free. It's going to be something that you. That comes because you're making that decision to prioritize and to invest in yourself and your health. And I wanted to come back to, you know, like, where you're, you know, here, you and I both are saying, hey, we. We're wanting to. We're seeing this need. We see it for ourselves. And we know we're not the only ones that other women out there are needing this and are. And we want to help people. We want to help other women to also benefit from this. And so that's the reason why you have your clinic in Dallas. And then you're also your. Your telemedicine clinic to be able to say, hey, you know, you can come and you can get support with this. And it's why I have also my clinic, so that I, I can, you know, to say, hey, this is an area that we have the training experience to help you. So if you're listening and you're like, okay, I get it. I want help with this. Now you have resources to get help. Betty, tell us more about, like, how for people to contact you. And of course, I'll put this in the Podcast notes as well. But how best for people to reach out to you to learn more and to find your clinic so they can see what that looks like. To go to a clinic where you can get this kind of help.

Sure, sure. So first, if you like to hear me rant and rave, you can listen to me on Menopause Mastery Podcast. Put out something weekly. It's usually very science driven, but you know, every once in a while I get on a soapbox. I'll admit it.

Yeah. And so my telemedicine company, you can find us at get hormones now.com and then my clinic actually in Texas is livingwelldallas.com and then you can find me@betty marie.com got a lot of email, a lot of websites.

Perfect. Well, we'll list them for everyone. And to just know that if you're on this path of realizing, hey, maybe there's something more. Maybe I don't have to just resign myself to menopausal symptoms and weight gain and the nursing home at some point. Maybe there's things I can do now to change this. Then here's some resources for you and and I also am happy to be a resource for you and have I'll put also links down below where you can learn more from me on this topic as well. Thank you so much for joining me today. Betty is so awesome to get to talk this through with you.

Yes, thank you for having me. It's been fun.

Yay. Okay, well, thank you and I'll talk to you soon. And thanks everyone for joining us. If you're not already subscribing to How Humans Heal, I welcome you to join us for the next episode and I'll check in with all of you again soon.

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