63: Thrive Through Menopause with Life-Changing Tips Every Woman Needs with Dr. Mariza Snyder

Hello and welcome to the Kenya breasts podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breasts and need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being.

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I'm going to be super honest and vulnerable with all of you today because I, as most of you know, if you know me, I come from a breast cancer family. Almost eight every woman in my family had breast cancer. I finished my training in 2003 with the release of the Women's Health Initiative, and I really thought for the majority of my life that I was not a candidate for hormone replacement. And then I did not go quietly into my goodnight. And when I was in perimenopause, and even as a physician, even as a provider, even as someone who has been thoughtfully in this space, I still did not know or recognize what was happening with me. So I started to have brain fog where I would walk into a room and have no idea why I went. And then I would walk out, remember, walk in again, and still forget why I walked in that room. I suddenly had a tire around my waist that I had not had my entire life. I would have dizzy spells at work, I would have palpitations. And every time I had one of these symptoms, I underwent an enormous workup. And then there were never answers given to me. Oh, you know, you're just getting older. The same thing that we tell women over and over and over again when we don't have the answers. And fortunately for me, I was able to figure out why I was having all of these symptoms and educate myself. But not everyone has access to that information. And I want this to be crystal clear to everyone. Exceedingly clear. And so I brought you the world expert on perimenopause and menopause. She has an amazing summit coming up that I'm sure you all want to attend, but in the meantime, we're going to welcome Dr. Marisa Snyder to the show. Thank you so much for being here today and for covering this so important topic that we really need to understand. We need to understand what happens to our bodies in perimenopause, what happens to our bodies in menopause, and how we can change, change that trajectory for ourselves when we address it correctly.

I wholeheartedly agree.

So you're definitely want to going to sit down, get, take notes, stay tuned for this because this is going to be an awesome, awesome, awesome show. First, please tell us how you even got into this space. What made you interested in perimenopausal or menopausal medicine?

Yeah, absolutely. I, I've been in women's health for a very long time, but perimenopause specifically when I my mom's 18 years older than me, so she had me very young. And so when I was 30 and in practice, my mom was going through kind of late perimenopause. And we suspect that my mom had pretty severe PMS symptoms, potentially PMDD when she was younger. And so when she got into perimenopause, it was really the mood changes, it was the brain changes that rocked her world. And I remember her being around 48 years old. And that typically punctuates, you know, for the average woman. Late Perry. And really what that defines is that we're skipping periods, you know, for more than 60 days. That's when you know, you're in that late period and you've got about four years until you hit that defining moment of the one day where your period hasn't happened for a year and ta da, you're in menopause, and then the next day you're in post menopause. So if you're wondering how that all works. So she is in it, she's having heavy bleeding. I mean, she's going through, we're talking about boxes of tampons. You know, she's anemic. But most importantly, this is a phase of my mom's life where there's four days out of the month when she's having her period. The months that she is that she doesn't even leave her house because she's afraid she may run somebody over with a car or hurt somebody because her perimenopausal rage was so extreme. And she tells me she went to a, an ob GYN at that time and she asked her point blank, is it normal for someone to want to kill everybody, like really want to kill people for about, you know, four to five days. And. And the. And luckily, thank goodness, in that moment, her doctor was like, yes, yeah, unfortunately, yes. But that was it. That was the end of the conversation. So my mom just left. Validated, but no solutions.

Yeah, well, unfortunately, our gynecologists are really not trained in menopausal medicine. They're not.

Not at all.

It's not part of their curriculum. And we think of gynecologists as hormone experts, but it's actually not true. Gynecologists are trained to be surgeons.

Yeah, they're surgeons.

Exactly right.

Yeah. Hysterectomies, babies, you know, fibroids, maybe endometriosis. No, they're surgeons. Um, and so I always tell people, you know, it's like. It's like, I feel bad even going to your gynecologist, your OB gyn. It's kind of like getting milk, trying to get milk at the hardware store. When it comes to menopausal care or very minimal. It's just, you know, they're in their specialty and they're going. When they're getting their continuing education, you know, anyone who's in a really niche specialty like that is going to be doing continuing education specifically in that area of focus. And so. And it's menopausal.

It gets like. Right. Like, you can only train someone on something that, you know, so the training programs just keep. It's like rinse and repeat.

Yes, exactly.

Yeah.

Yes. And so, you know, again, validity there, which I think eased her heart a tiny bit, but no solutions. So she kept. It got worse and worse and worse, and. And ultimately she ended up getting through it. And I remember her, you know, again, SSRIs were recommended, and those didn't work. I mean, it just. She just suffered. And. Yeah, she just. Yeah, she basically just, you know, struggled her way through it. And I remember it just felt like. It looked like, to me, a nightmare unfolding. I was like, I. No, no, thank you. And I ended up, you know, I ended up as an integrative practitioner. I ended up taking over her care and working with her. Luckily, she was kind of at the tail end by the time. I didn't. You know, I just didn't know a lot of this was happening behind the scenes for so many women, including my mom. There was so much shame, embarrassment. And when you feel so deregulated and you don't even know who you are anymore, you know, you don't want to tell people. And so I think a lot of women find themselves, you know, not Seeking support in these moments. And so I am Now, I'll be 45 in a couple of weeks and I'm in perimenopause. And I remember watching that and taking care of my mom and really getting her through. And we'll be talking about the lifestyle strategies and all the things that I ended up implementing. And one thing that she ended up not using as a tool, which I think would have been game changing for her, profound for my mother was hormones. It just, you know, she was very much, this was, what was this? 15 years ago, 14 years ago. And it was very much a no go. And so I, even though I was like, you know, I think, I think, you know, oral, micronized progesterone would be helpful, she was like, no. There was just this deep seated belief that hormone replacement therapy was very dangerous at that time. And so I worked with a lot of the tools I had, but I didn't get to use that tool.

So that deep seated belief was very intentional. As you and I know, that one of the goals of the Women's Health Initiative was to end the runaway train of hormone replacement. And it was done that way. So that, you know, why give women one solution when you can give them eight, nine or ten?

Oh, yeah, all the solutions. Yeah, all the solutions. Right.

Even though those substitute drugs, the drugs for the anxiety, the drugs for the lack of sleep, the drugs for the palpitations, the drugs for the bone loss, the drugs for the weight gain, the.

Drugs, yeah, the Zola, the Paxil, the Ambien, the statins, the Metformin, even more and more, the Fosomax, like the list is endless. We're just siloing women into different departments, right? When we know that it's this decline in hormones that are leading to a lot of these systemic changes that are happening in the body. And so, you know, being a big part of my mother's team in helping her get better, I just, I want to paint a picture of what's going on with her today. So she's, she's 63 and she has ran, I want to say 75 half marathons and I want to say a dozen marathons. You know, she turned that corner. She is a competitive tennis player and she is just, I mean, kicking butt, taking names. You know, she looks incredible and she's got energy for days. Like, I know she was up at 4am this morning running. And I'm just like, that's, that's offensive. Like, who wants to do that? But you know what? Get it, get if that's what, that's what she wants to do, then let her do it. And I just, I love that. So it, she had again, this, this, you know, moment of reckoning, which I think so many of us go through in midlife, especially in perimenopause, where all of a sudden all the things that used to work are not working anymore. Because whether you like it or not, or whether you understand it or not, your body is systemically shift, changing because of these life, life giving hormones. They're, they're depleting and they're shifting everything. And so my mom had an opportunity to say, okay, I know that I'm at a tipping point. I can go one way or the other. You know, I'm, we're, we're Latina. I'm, that's my Mexican side of my family. My, my uncles and my grandfather have had bypasses in their early 50s. I mean, my mom had seen a lot of, you know, lots of diabetes, lots of prediabetes. And, and we know that when we start to move through this perimenopausal transition into postmenopause, there is an abrupt change in our, in our metabolic function. We see a major abrupt reduction in metabolic rate, a loss of skeletal muscle and strength, an abrupt change in glucose metabolism in the brain and in the body, redistribution of fat to the abdominal area, unfavorable shift in lipids. That just seem to happen out of nowhere. And so my mom, luckily she knew a lot. She could feel it, she knew something wasn't right and she could see the changes. And man, she grabbed the bull by the horns and just yanked it back. And it's amazing to me how resilient because I know a lot of grandmas who are my mother's age who do not have the capacity that she has at 63. And I thought, man, gosh, it could have gone a different direction for her. And, and she's been such an inspiration for me, especially now that I'm in perimenopause and I'm experiencing some of those mental changes. I'm experiencing some of those mood changes. Yesterday, I thought, I thought heads were going to roll yesterday. And you know, on the first day of my period, I was like, oh, ooh, the spicy version of me showed up today. And, and so it's really interesting to be not only in it, but to have watched women go through it for over 15 years and realize it's profound and it's an area in our lives that deserve our attention.

So let's go through what's happening physiologically. What's happening in terms of the estrogen deprivation, the progesterone deprivation, which ends up happening before the estrogen for most women.

Yes, it does.

Why they get these heavy periods and, and situations that feel like estrogen dominance and it may be excess estrogen because our bodies don't do so well in that perimenopausal period of regulating. But it can also just be an absence of progesterone that that's happening there as well.

Oh yeah.

So can you go through that and talk about the symptoms? Because like, you know, I was having palpitations. I didn't need a cardiac workup. I had a huge cardiac workup, but I didn't need a huge.

You didn't need a cardiac workup.

I had dizziness and I had a huge neurologic workup. And I need a huge neurologic workup.

I needed hormones.

Yeah, yeah.

But I mean, I think it's a yes.

And no one was putting those things together.

No, no. And we're still not. And I think that's what's, you know, we think about who should be. And this is a, this is a big leap. But I feel like if we're going to shift the way that we take care of women in this time in midlife, 40s, moving on, it is, it's just not the OB GYNs that need to be menopause experts. Neurologists need to be menopause experts. Cardiologists need to be menopause experts. Urologists need to be menopause experts. I mean, if we're talking about massive systemic changes, particularly the brain taking on the bulk of that, you know, vasomotor symptoms. I know you feel it on your chest and you know, on your body, but that is a brain driven symptom. You know, we think about the brain.

Fog that you're talking about hot flashes and.

Yeah, hot flashes and night sweats. That's brain, that's brain related. And, and so those, you know, we think when we think about the, the encompassing of menopausal care, there's a, the knowledge gap in the health care system is widespread spread. Like we need to educate up a lot of different areas of our healthcare system.

Agreed. Although it would help if we made OB GYN a 5 year residency instead of the 4 year residency and 1 year and the 5th year be menopausal medicine.

Yep. 1.2 billion women will be in menopause by 2030. And so yeah, I mean we are going to be the majority and I, and I think we're about ready to demand. We're like, we. Every menopause affects every single one of us. 1.

We're all going through it.

Yeah. By the way, we're all going to go through it one way or the other. Whether it's premature early or it's natural. However it happens, every woman's going to go through it. But every man's mama, every, every son's, you know what I'm saying? Like, there's nobody that isn't affected by this profound transition. So I'd love to break it down, as you mentioned. So menopause is, is ultimately that defining moment, as I talked about earlier, that one, that one day after 12 months of not having a period in perimenopause is the 4 to 10 year transition leading to it. Now, natural menopause can happen anywhere between 45 and 55 years old, but the average age is like 51.6. And so if we do the math and women can go into natural menopause as early as 45, well, then even some women in their 30s can be in perimenopause. And ultimately what this is, is our ovaries are going offline, they are retiring out. But it's more profound than that. We think about our menstrual cycle as a fifth vital sign. You know, predominantly because these hormones, estradiol and progesterone, are fluctuating very consistently, very rhythmically every single month. And our body's receptor sites in every organ system and pretty much every organ system in the body is really reliant on those hormones to do what they do. So whether you go into menopause at 40 or 45 or 52 or 57, I don't care. The loss of those hormones is profound. And that first one that's going to shift for you is going to be progesterone. She starts to shift. I would say again, every woman's a little bit different, but she can shift up to four or five years prior to we see that kind of roller coaster of estradiol and it's a precipitous decline along with progesterone dropping. We peak Testosterone in our mid-20s and then testosterone is peak is precipitously dropping as well. Not as fast and as extensive as progesterone and not as profound for all women. But it's also happening behind the scenes too. So just note that if you're noticing your lack of confidence, muscle loss, that sex drive, even brain function, testosterone has been connected to our brain healthy. It's worth looking at that as well. And what we'll notice with progesterone, what women explain to me one, a lack of stress, resilience. All of a sudden things that they could just do effortlessly starts to feel a little bit harder. They're feeling more irritated, more frustrated. And that's, that is how I have felt the last couple of days.

I called mine walking around in a silent rage.

Oh yeah, it's or a not so silent. It depends on where you know what, what you're doing.

Yeah, I tried to keep mine silent.

I know, exactly. Me too. I mean I have a young boy, a young beautiful boy. I just, I tuck it deep. I have a lot of friends. Poor sleep due to loss of gaba, stimulation in the brain from a loss of progesterone. Mood swings. Again, that irritability due to that loss of gab in the brain as well. Brain fog. So loss of concentration, focus, alertness, word recall can also happen with the decline in progesterone. Again, those inconsistent mood changes and then also heightened PMS symptoms. Like you want to know if you're losing progesterone, it's pms. It could be the, it's the bloating and then also again estrogen in relation to progesterone. If we don't have the checks and balances there, we'll start to see an increase in estrogen dominant symptoms. And so that is the fibrocystic breast, the painful, tender breasts. Maybe it's the heavier periods. Potentially migraines can be related to this time as well. And so all of a sudden you've noticed that things are just, especially in that luteal phase. So after ovulation, the second phase of our cycle is our luteal phase. And our first week of our luteal phase is early and most women are doing okay, but you hit day 22, you know, in your 28 day, 27 day, whatever it looks like, cycle and oh goodness, like that late luteal week can feel like the wheels have fallen off and there's this deeper sense of dread. So those are the signs. And often in the literature will say the first signs of perimenopause is inconsistent in irregular periods. And I have not found that to be true at all. Women tell me they have lost their brain either due to their moods or their brain fog. Like that's the shift, especially for a.

Colleague, even when their cycle is still absolutely positively regular.

Mine is absolutely positively regular and I knew when my brain shifted, you know, out of the 50 plus symptoms of perimenopause, the most profound, besides the weight. Nobody, nobody, nobody loves the weight change. Even when the scale doesn't change. No one loves the redistribution of fat from their booty to their stomach. But the most profound changes and the most common symptom of perimenopause, it's irritability. Women are irritable. I woke up irritable today. I'm not gonna pretend. And so I get it. It's the brain changes. And anytime I talk to my colleagues, whether it's Dr. Carrie Jones or it's Dr. Stephanie Estima or it's Dr. Mindy Pels or whoever it may be, that they're like, it was my brain, I felt that shift. And I'm like, that's progesterone and it's estradiol too. But it's the first, first shift, so it's not usually your cycle change. It is this, it's this shift that, gosh, I don't, I feel, I don't feel like myself anymore. I feel like a shell of myself, you know, even five days out of the week, or like my mom said, I feel like I want to kill somebody, you know, for a couple of days before my period. And so, so that's, that's early perimenopause. We start to notice those types of changes. And, you know, again, cycle still normal. You may still see lesser days, maybe a 26 day cycle or a 20 day, 25 day cycle instead of a 28 day cycle. So tracking your cycle is so critical. Two things I always tell women, one, track your symptoms because, again, you'll start to notice. We get this beautiful estradiol peak a couple days before ovulation. It is every. I call it day 12. The day 12 version of all of us. Everybody wants the day 12 version of you, of your cycle. It's testosterone's doing her thing. Estradiol's peaking. You're about to ovulate. You're feeling vibrant and good. The caretaking energy, high sex drive. I mean, you're on point. And you'll start to notice kind of between the early and even late perimenopause, where that peak isn't peaking. She's not doing what she's supposed to do. Yeah.

And so I miss her so much.

Oh, my gosh. I'm starting to notice her disappear here occasionally. And I'm like, well, where is, where is. I feel, I feel like day 25 version of me on day 12. Like, where did she go? And so it's important to be Tracking like, I'll get a migraine when I'm supposed to have this nice peak. My sir dial will tank as that luteinizing hormone comes up for ovulation. And I'll get a. I'll get a migraine. And so I'm like, oh. So tracking your symptoms around your menstrual cycle. Track them both at the same time so that when you go to see your doctor and you're advocating for care, you're advocating for bioidentical progesterone or whatever you're needing at the time, that you really have some good evidence about what is happening with your body. So those are two things. Then we move into late. Late is technically punctuated by you are skipping periods for more than 60 days. And the symptoms. Now we're talking about the really irregular estradiol. So it's up and down. Some months, again, you're skipping your period. Other months, it's heavy. And this is where we start to really see a redistribution of. We. We start to see again, sleep issues, hot flashes, night sweats, maybe vaginal dryness, vaginal atrophy, low libido. This is where I'll also start to see unfavorable lipid levels. Fasting, insulin resistance, insulin going into insulin resistance, blood glucose levels shifting and changing. A hemoglobin A1C getting closer to pre diabetes. We start to see major shifts. Women are complaining of joint pain, neuromusculoskeletal pain, palpitations, you know, things like tinnitus or even, like a fuzzy tongue. Their hair's falling out again. That could be a thyroid thing too, but just. Just bigger shifts and changes, like undeniable. Something is going on. And that is going to be, as we start to see that progesterone, by the way, 70%. She's gone almost. She's hanging on by a thread at this point, you know, for most of us. But then estradiol is also. She's declining, too. And so we're really beginning to notice. And as a result, we see deregulated cortisol. We start to see funky insulin, maybe. Maybe thyroid is being impacted. And so this is a time where we really want to do a full. We want to start really looking at that full lab panel and seeing are there inflammatory markers that are going up? What's your highly sensitive CRP looking like? What's homocysteine and fibrinogen and sed rate? I just want to get a better. I know that the big cardiovascular workup probably is inappropriate for those palpitations. Due to a lack of estradiol. But also I know that women's cardiovascular panels and cardiovascular risk factors begin to shift in an unfavorable direction towards the end of perimenopause. And so I at least want to be looking at labs to kind of indicate, you know, when you were 40, what did labs look like? 43, 45, 49. Are we seeing an un, you know, a shift? Did all of a sudden cholesterol jump into the 200s? Did your APOB go from 70 to 99? You know, did your triglycerides go from 50 to, you know, 102? You know, I want to look at those types of things to see, like, are we seeing, with the decline of estradiol, a shift in some of these cardiovascular numbers that I would love to keep an eye on. Yeah. So.

As you kind of go through this process, the symptoms that you're feeling are a result of organ degeneration. So how can you stop this? I mean, there are so many people out there saying, like, well, this is natural and this is what is supposed to happen. No, and no. I understand their argument in that, you know, most women historically died of natural, died of an infection or, you know, something that that was what we see as totally preventable now. So we can't compare, like, what happened on an evolutionary basis.

There's nothing okay with ovarian failure. There's nothing. There's nothing natural. You know, there are a lot of people right now working very hard to, you know, how can we. How can we revive our ovaries, really? And nothing short of that is going to. Is going to stop, you know, that decline.

That's not really our goal in that we're not trying to prolong fertility.

No, no, we're talking health span, longevity. Yeah, that's what we're talking about.

It doesn't require premenopausal levels of hormone.

And you. It's funny, people would argue, yes, no, no, they do not need, you know, and, you know, you think about no. And. And some would, you know, there's. That's interesting, a lot of the controversy of hormone replacement therapy. Right now. You've got a lot of different camps saying a lot of different things. And you're going to have people who are going to say, yes, you need physiological hormone levels to maintain health span and prevention. You're going to have others. And I think this has been the camp ever since the Women's Health Initiative. Is that the smallest amount of dose for the least amount of time to treat hot flashes, osteoporosis and vaginal dryness. So general urinary symptoms. So you've got a wide range of camps here where you got who people are doing, rhythmic cycling of hormones and others. It's static cycling or not cycling at all. It's just static hormones. And so, you know, I'm in the camp of we need to manage your symptoms, and we also need to prevent disease. So it's a yes. And, like, how do we get to that? And so we know that there's a certain. Certain level we. Estradiol can't go below 60 in terms of preventing osteoporosis and dementia. So does it need to be in the hundreds? No. You know, but it needs to at least be at a level where we're not just mitigating hot flashes. We're actually. We're actually preventing disease. So there's a. And there's a sweet spot there of. Of managing those symptoms. And I'm a big proponent of, you know, hormone replacement therapy is really about prevention. And so us waiting until women are in menopause, to me, it doesn't feel right. We shouldn't be waiting till women are 12 months out, when estradiol levels dropped many, many months before, especially if women are symptomatic. So I'm as. I'm in still an early menopause. I'm early. I'm still in early perimenopause. I hope to stay there for a little bit longer. But symptoms were dictating that I was. Not only was I progesterone, she. I met postmenopausal levels of progesterone. So I already supplement that. I cycle it because I'm still cycling, and I take 400 milligrams to manage the big mood changes and the migraines that I deal with in my luteal phase. And also I'm on an estradiol patch for some of the major brain changes that happened to me. It's not a crazy amount right now because I'm still making it. But my symptoms, although labs were, you know, I was someday. Sometimes I was a little bit lower. Sometimes I was okay. With estradiol, it can really be a moving target when you're trying to test it. And so as a. As a functional doctor and integrative, I was like, okay, I'm looking at all the labs, I'm looking at everything. But I'm also in my body, the symptoms are just not okay. And so I am on estradiol and progesterone at what would be considered an earlier Age for. For some women.

So I hear you that the testing is unreliable in the perimenopausal phase, but that the important thing is to address the symptoms.

Yes, most important.

So you need to work with a hormone literate provider who understands those symptoms and knows how to address them.

Yes. In. And labs too. I mean, I guess I mentioned some of these other labs that I think are really important. If I start to see lipids, you know, things moving, unfavorable, direct, unfavorable directions. And I've been treating that patient for years and I'm like, oh, things are shifting and this is due to a decline in hormones. That to me is reason enough as well, especially if they've got the symptoms to back it up, to start using hormone replacement therapy. And so I find it's a yes and, you know, specific, like nailing hormones with a Dutch test or nailing hormones with serum blood levels. Again, that can be really challenging. And symptoms first. But also I like to look. I still like to look at labs, you know, 10 weeks out just to make sure that we're nailing it. But most importantly, if your symptoms aren't being managed with the right dosage or the right application, because goodness knows, when it comes to hormone replacement therapy, it's like a snack shop of options. And so we gotta. I'm still titrating and figuring out my dosage. It takes a minute to kind of figure that out. And over time.

The perimenopausal phase.

Yeah.

Isn't that like a constantly. Yeah. So it's constantly moving and changing, right?

It's constantly moving and changing. So what, what you may be on with that, that 200 milligrams or 100 milligrams of progesterone in, you know, at 42, may not cut it at 47 anymore. And so you get to. Again, as our bodies shift and change. I think that's why it's so important to have a hormone literate doctor, but a doctor who's on your team, who's going to listen to you when things start to shift and you're like, you know what these hot flashes are? Night sweats are coming on. Can we play with my dosage? Like, what was working for me then isn't working for me anymore. So expect to be changing these dosages over time.

Yeah. So I want to back up a little bit and talk about what are some things that people can do in this perimenopausal phase as they start to get symptoms, what should they be paying attention to? And what lifestyle changes or maybe supplement changes can they make to improve their situation before they start hormone replacement? Because I know you wrote a couple of books on this.

Yeah, I did. So the first two things I recommended already just again, having agency over your body and knowing your body. The best things you can do, track your symptoms, track your cycle, if you're still cycling in perimenopause and run those labs. Those are going to give you a lot of information, a lot of agency and kind of explain what's going on. The next thing I recommend, because I am very concerned about women's cardiometabolic health, it's going to be optimizing your blood glucose and your insulin sensitivity. And there's a lot of things that we can do every single day to help support that one. Know your numbers. And so one of the things I recommend, recommend to women, especially in perimenopause, if they've, they've never really had a sense of what's going on with their blood glucose, is to wear a continuous glucose monitor. So I have one on right now. I've been wearing one on and off for three years. And I always learn something new about myself when I wear one.

And I would love for you to talk about, first of all, which one you're wearing.

Yeah.

And second of all, what are the things that you are learning from your cgm? What kind of things are you tracking?

When are you.

You checking? Oh, yeah, I would love.

Absolutely.

Hear that.

So the two, two companies I love who have continuous glucose monitors, because right now, unless you have type 1 diabetes or really severe type 2 diabetes, you're not going to get one from your doctor. And I'm just, that's just where. Unless you're working with an integrative and functional doctor like myself, and then, then we can, then you can get one. But you go to your typical primary doctor or your OB gyn, most of them are going to tell you it's type one, actually. Yeah. Not even type two or PDF, but.

Also because they don't understand the disease.

No. Yeah.

Or how to reverse it, which it can't be reversed.

So once you put one on, so levels, nutrients, whoever you prefer, there's a lot of beautiful companies that are coming out that are offering these. And it's always the Libre Abbott Libre that you put on your arm. It's really easy. It's, it's, it's painless. It just pops right on there. My son's been trying to pop it off. I'm trying to. I'm like Kingston he's like mama, what is that? And so anyway, so the first thing I do first thing in the morning when I, when I wake up is I scan it. So I, you have your phone, it's got, it's got the app and it scans the Libra app. It scans your sensor and my sweet spot. So I'm looking for as a practitioner. And again these are optimal levels. I basically set people from 70 milligrams per deciliter up to 140 milligrams per deciliter. Now ideally I don't ever want it to get up to 140 milligrams per deciliter. My optimal range is I want you to stay within 70 to 120. That's optimal, but that's not always the case.

120 would be like a post eating.

Post eating, post crandial. So two, one and a half to two hours after a meal. So when I scan mine scans anywhere between 75 milligrams per deciliter to 83 milligrams per deciliter in the morning. And that is your fasting blood glucose. And that's the interstitial fluid that this sensor is in. And that is a beautiful, that's a great place to land. Then after breakfast I scan it. So about an hour and then two hours out I scan it after workouts and then I scan it after meals. About two hours after meals and then I always scan it before bed. I want to see where is my blood glucose. One of my big recommendations for women, particularly around their metabolic health and improving sleep quality is eating three plus hours before bed. So you have that dinner and then you shut it down. And so in my family we eat by 6:30 because one my son goes to bed earlier than we do and I want at least a three hour cushion between my last meal and dinner and sleep. And what I've learned, probably one of my biggest aha moments is I could eat the same meal at 6pm and 8pm and that 6pm meal, let's say it's salmon and salad. That's often what we eat for dinner. It again, I don't raise, I don't even go up above 105mg per deciliter two hours later at 8:00'. Clock. But if I eat that same meal, same exact thing, I just wait two extra hours. Now I'm clocking 120 milligrams per deciliter because we become more insulin.

Yeah, our, our insulin sensitivity wanes throughout the day and as we get to night. Your, your metabolism is shutting down. It's preparing for sleep.

Yeah, we're not thermogenic anymore. Yeah, yeah. And so, yeah, so we, so we are, we are. Usually dinner's on the table by 5:30. We're done by 6, 6:30 at the latest. And that for as, again, as a perimenopausal woman who's Latina, we've got, you know, got a major precursor for prediabetes in my family. My blood sugar stays within range really well and, you know, it does. Occasionally we have friends over for dinner and we eat a little bit later. Yeah. And I see the change and occasionally that's okay. But yeah, so the other things I look at is stress throughout my day, see if that has any impact. Does coffee before I eat in the morning have an impact? And so I'm just looking at this. Is sleep impacting my blood glucose? Is stress impacting my blood glucose? What I'm eating, how I'm eating it, the timing of my meals, does that impact my blood glucose and the amount of movement every day? So I, I am outside walking about four times a day. I resistance chain four times a week. And so the, the consistent movement throughout my day really keeps my blood sugar stable. And that has been consistent over the last three years. So those are some of the things I'm looking at and markers I'm measuring.

I'm curious as to what you think about the Latina predisposition to diabetes. Do you think that that is a genetic thing or do you think that that is a cultural thing in that in general, the diet has a lot of starchy foods and complex carbohydrates?

I think it's a yes, and I think it's epigenetics. You know, I think it's cultural and it's, it's, it is, you know, that, that epigenetics that is passed down. And I think also it's, you know, there's, there's something to be said about, you know, generational trauma and, and that, that plays out as well. Like there's a higher level of stress. I mean, my mom used to tell me when I was younger, two things she told me when I was really young. One, that I was going to have horrible periods. That, that was just how it was going to be. Like, get ready, girl. It's going to be. It's going to be. And you know, that was her experience with my grandmother's experience as a. And, but that was just how it was. So that was the first thing I was told. And the other thing I was told when I was in my, like, in my late teens, early 20s, she's like, by the way, the women in our family, we don't, we don't have progesterone. And I was like, what is. And I didn't know what these things meant yet. I hadn't gone through med school, medical school. Like, I didn't. I just took it for like, par. For the course. Like, obviously my mama knows what she's talking about. She didn't know what she was talking about. She was right in the sense that we did have lower levels of progesterone. But I was like, but why? And it was because our, our systems were deregulated. High levels of cortisol that just kind of just wore us out over time. And so I think it's probably socioeconomic, it's probably epigenetic, and it's probably cultural as well.

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Yeah, yeah.

Okay. So you're telling people that they should have an awareness around their blood glucose.

Yes.

What is the reason that blood glucose starts to rise? What is the reason for the dysregulation in the perimenopausal period?

Well, there's a couple things playing out. One, it is lifestyle. There's definitely a play there. I believe it is the 93% of women in perimenopause will have insulin resistance. And that is alarming. And that more women than men by the time they're 45 years old will be overweight or obese. And it isn't for, you know, again, it's not for, you know, some of it's not for lack of trying. It is most definitely the lack of estradiol that is playing a major role here. And progesterone, progesterone is very metabolically protective as well. But that lack of estradiol, again, as I mentioned earlier when I was talking about it, when we lose estradiol, we're talking about again, more fat in the belly area, an unfavorable shift in our lipids, an increased risk of fatty liver disease, a reduction of physical activity, energy expenditure, and again, that increased level of insulin resistance. And so as estradiol, we start to lose estradiol, that sensitivity for estrogen to bind or sorry, for insulin to bind to our cells. We begin to lose that, that resilience. And so as we start to see an increase in insulin resistance in the blood, we start that glucose is not being taken in by our cells as effectively or efficiently anymore, especially the brain, especially our muscles. And we know that insulin resistance is the number one risk factor for cardiovascular disease. So yeah, if there was a scale that got tipped, it's that lack of estradiol. And I think sometimes we don't realize how much our life, the daily pain points of life, this modern day life that we live, is also lending to this, this level of insulin resistance and blood glucose variability.

Yeah, because, you know, we lead these crazy, stressful lives. I mean, we're really only meant to be in that sympathetic state, that fight or flight state like 5% of the time. And yet we most, we're in it, we're in it all the time. Most of the time.

I would say most women trigger up that stress response system. You know, I Recent research article 20 plus times a day where they are spiking cortisol and adrenaline and they are, you know, they're, they're shooting off that stress response system. You know, whether you're running late to a meeting or you get a crazy text message or your, your son is having a moment or you, whatever it may be, you're. There's constantly this level of stre that's being triggered. And we know that cortisol co elevates insulin and it causes leaky gut issues. I mean it causes cravings, it causes our body to go into fat storage survival mode. So there's that. And then with our lives being so busy, we're not able, a lot of us aren't able to move as much as we need to move. So we're often more sedentary that we need to be. And then I think a lot of us don't realize the impact of certain foods on our blood sugar, on our metabolic health. And so those were some of the most profound things that I learned. Like I. Looking at a naked carb, you know, a processed carb, I can just look at it and my blood sugar is like we're just going to creep up a little bit. And so one of the things I learned is I. Naked carbs are a no go for me. Meaning, you know, I'm, I'm not going.

To tell people what that means. I don't know that everyone knows what a naked carb is. They think that we're, we're talking about something very racy here.

Oh, I know it's, it's straight up grapes, okay. Eating grapes by themselves in that, you know, and you're thinking oh well that's fruit but. Or an apple or an apple without almond butter. Right. So there's acellular carbs. Those are our crackers, our chips, our gluten free cookies, you know, our bread, our toast with butter. Those are acellular carbs, highly processed carbs against some of those things as well. But any carbs really, fruit, grains, rice, you know, anything that can break down into glucose very easily and readily. Your smoothies in the morning, if they're not just a protein smoothie, you know, anything, any of those things, your yogurt, you know, look at your Greek yogurt, make sure that it's you. And so all these things can really add up and it can raise your blood glucose again into pre diabetic or diabetic ranges. And when you have enough of those spikes throughout the day, unknowingly, unwittingly, that adds up over time. Compound that with stress. You're not getting good sleep, you're not able to move your body enough, and you're losing estradiol. That is a recipe for insulin resistance and greater risk of cardiometabolic disease.

It still amazes me that there are. There's so much belief in the fact that estrogen is a harmful substance and we, like, glom onto estrogen being bad and a complete lack of realization and understanding that most of the chronic diseases that happen in our society, including breast cancer, are happening after estradiol is basically immeasurable.

Yeah. I mean, if we, if breast, if, if breast cancer was. Was caused because of an increase in estradiol, wouldn't all pregnant women have breast cancer?

That's correct.

Or, or every teenager or every teenage girl, right? Yeah, yeah, exactly. Yeah. No, it's inflammation. Let's just call it. It's, it's, it's inflammation. It's. It's poor metabolic dysfunction. It's metabolic disease. It's a maladaptation of those poor mitochondria that are just doing the best they can to survive in that toxic muck. And that's really what it comes down to. And so I always say the first thing is we gotta get control of your cellular energy. Yes, get the hormones online, because we need those too. But get control of your cellular energy. Every thought, every emotion, every. Every. Every movement that we do, every single day is reliant on our cellular energy, our mitochondrial energy. And when those mitochondria get past capacity of 50%, that's when we see the biomarkers go up. That's when I see fasting glucose go up. That's when I see triglycerides go up. That's when I see blood pressure begin to rise. When, when we have, you know, that hip to waist ratio gets out of control. That's when. It's when mitochond capacity that we see the metabolic biomarkers begin to go in unfavorable ranges. So how do we control mitochondrial function? How do we control energy metabolism? It has everything to do with managing our blood glucose. It's a simple thing. Like, if we could track that and understand that we can begin to walk back some of these changes. Yes, the microbiome is important. Yes. We've got to manage that stress response system as well. But I would say that if we can get our metabolic health in line, that we really get to win the game of having that resilience. And that's why I'm a big proponent of the cgms, because you can learn so much about yourself and your body by wearing one and seeing, you know, how your blood glucose responds to everyday life.

So we're, we're tracking our cycle, we're tracking our symptoms, we are putting our cgm. Cgm, yeah. And then, yeah, lifestyle and. Yeah, so, yeah, yeah, go ahead.

So it's blood sugar hacks to be thinking about really quickly. As I mentioned, don't eat carbs naked. So always pair them with protein and fiber. Really prioritize protein in general. You know, I always recommend 1 gram to 1.2 grams of protein per pound of lean body mass. So kind of where you want to be, that's going to be massive.

So.

So you're talking about where you are with your ideal weight. Your ideal weight, that's what you, that's what you match up the protein with.

Yeah. So for instance, my ideal weight is 110, 110 pounds. So I consume 110 grams of protein every single day. So that would be my, my lean body mass goal. So for some women it would be 120 or 130 or 140. So around that ballpark, especially in midlife, eating enough protein alone not only is going to help curb that blood sugar rollercoaster, but it's also going to ensure muscle protein synthesis. Even if you're not lifting the heavy weights in the gym, it's going to make a difference. Now, do you still need to protect and maintain as much of that muscle as possible? I mean, your muscle is your metabolic sink. Probably the most profound way that you can maintain that metabolic health and that again, that metabolic sync is by building or at least maintaining that muscle. And so picking up the weights is going to be imperative here. Picking up heavy weights is going to be very imperative. And so I'm a big fan of walking as much as possible. I think it's the number one longevity hack anyone can implement in their life every single day for stress, blood glucose management, for, you know, for, for protecting muscle and for protecting your mitochondria and also your. I think your brain loves it too. My brain loves it, but also. And lifting weight. So I'm a yes and yes, I walk all the time and I'm lifting heavy weights. That next is the protein, but also supporting your gut microbiome. So making sure you're getting enough fiber and enough fermented foods to really support your microbiome. I'm also a big fan of digestive enzymes and probiotics for supporting that. So we eat very metabolically healthy in my household. We focus on protein, lots of fruits and veggies. We even add fiber to our smoothies. Fiber and frozen cauliflower. My son doesn't even know what's going in those smoothies. But that's the deal. And then the other thing I think is really important, which I know you probably talk a lot about on the show, but I tell women that they have to treat their sleep routine and their sleep like it's a million dollar medium. Like, and earlier than you think. Yeah. So I get my son to bed. He's in bed by 8 o'. Clock. I have an hour. I am in bed at 9. I am asleep by 9:30, 10 at the latest, because I know he's gonna wake up between six and seven. I have no idea. It's, I'm rolling the dice every morning. Who knows when he's gonna wake up. And I gotta make sure that I'm getting my sleep and that I'm, I'm on the wind down. I remember being in my 20s, being in college or in, in, in. And you know, you would just, you would just fall, you would just like race to bed and you just fell asleep. I got it now. It's like I got a wine and dine. No, by no means wine. By the. No wine. I am a no wine, no alcohol person. But I gotta like ease my body and my brain. Coaxed her into sleep. You need to seduce her, seduce her into sleep. Every night I seduce my brain into sleep. And so, so it's with supplements like magnesium, L theanine and some progesterone. I'm not going to lie in that luteal phase of my cycle. And then it is, maybe I'll put some lavender on, I'll diffuse a little essential oils and then I'll have a good book or a sleep meditation. And I make sure that I'm in bed about 45 minutes prior to going to sleep because my. And the lights are dim. No more electronic. Definitely no alcohol. I gave up alcohol years ago because every morning, even with a glass of wine, my body would be like, why? Why did you do that to me last night?

My trainer and I talk about this all the time. That like when we were in our 30s, it was no problem. We hit our 40s and alcohol was like, yeah, no, you just wake up the next day and you're like, why? I can't go through this day needing a Head transplant.

Exactly.

Do this to myself. And then.

And it's not a deep privation.

And just.

Yeah. Gave it up. Yeah.

Right.

Because it was, it was a life giving habit. Get. Like I was giving by giving up alcohol. It was a life giving move for me because if every, if every morning I had a glass of really amazing red wine, you know, a super Tuscan or something like that, like, I love Italian wines and I love a good Barbera. But like, and I can talk all about, you know, I was, I was a bartender when I was in grad, you know, when I was getting my, my medical degree, all those things. And so I have an appreciation for alcohol, but man, my body stopped having an appreciation. And it wasn't deprivation for me at all. It was like, what, how do I want to show up tomorrow for my family, for my patients, for, for my interviews? How do I want my brain to feel? Like anytime I'm putting something into my body, maybe except for coffee, I don't know. Every time I put something in my body, I have to ask myself like, like, you know, is this gonna, is this gonna feed my future brain, My future brain cells, my future cardiovascular cells?

I think there's a lot of data that coffee feeds your future brain.

It does, it does. I was, you know, it totally does. There's a lot of research that shows coffee is great for the brain.

But I also think you need to be careful with coffee because you, you.

Need to, you may not metabolize it mold free. Yeah.

And there are some people with comp genes that they just do not, they can't metabolize with coffee.

I have tested it multiple times and my body is a super metabolizer of coffee. So I am good to go. But I'm also a big matcha drinker too. I love Matcha. And so again, blood sugar regulation again. And sleep is a big part of that. I can tell if someone. You had dinner at 6 o', clock, but your sleep was crap. And your blood glucose level, your fasting blood glucose is 88 the day next, next day. Like, and normally it's 82 or 79. Like, I track a lot of my patients, they send me text messages. I want to see their fasting glucose in the morning. And I'm like, okay, well how was that sleep? Is that. Is sleep messing with your blood glucose or is is snacking and dinner messing with your sleep because you had deregulated blood sugar going into sleep? And so all these things we get to tease out other things that I look at when it comes to perimenopause is going to be supplementation and there are some non negotiables on my list for supplementation. For one, magnesium. I'm a big fan of magnesium. Glycinate 2 is going to be vitamin D. I run vitamin D levels all of the time and almost all the time they're under 30 or under 40 and optimal range is between 50 and 70, 15 and 80. I'm good with that. So vitamin D usually I recommend 5000ius with K1 and K2 omega fatty acids for brain support and reducing inflammation. This was a profound. Omegas were profound for me when I had a brain injury last year. I also recommend. I love again I talked about probiotics, digestive enzymes. I think so much of this is your gut microbiome. I'm a big fan of minositol and berberine especially if blood glucose levels are heading into the pre diabetes range or I see a fasting insulin higher than 6 or hemoglobin A1C higher than A 5.5.

I love to recommend bioinosol and berberine.

No, I usually it's one or the other. Unless I'm dealing with someone with, I mean they're pre diabetic then I'm bringing on, you know, more than one thing.

Yeah.

I'm a big fan of activated B vitamins, methylated B vitamins. And so again we. I'm working with women who've maybe never ran their SNPs or know if they have a comp gene mutation or MTM mthfr. So I just, you know what, might as well have them taking methylated B vitamins.

But for anyone who is watching this, if you have a fast comps, those methylated B vitamins are going to make you feel a little crazy.

Yes. Yeah.

If you don't know your genetics but you feel, you feel anxious or crazy when you take methylated B vitamins, know that, that the methylated forms are not for you.

Yeah, yeah. Be. Yeah. Listen to your. I mean at the end of the day it's important to listen to your body. Yeah. And then I love adaptogens. I think adaptogens can be so profound for women especially when they're trying to regulate their mood. Again, I love progesterone for this too but adaptogen. So I'm a big fan of holy basil. Especially at night before bed to kind of calm things down. I love ashwagandha overall. I love rhodiola as an energizer bunny. It's great for not only brain resilience but mental energy. You know, when women talk to me about fatigue, it's often mental fatigue that they're really, really struggling with. So I love Rhodiola schisandra as well. Very similar to Rhodiola. And so I think adaptogens really do have their place here. Again, I do love matcha with the L theanine and all the antioxidant rich properties of that. So if in the afternoon I'm hitting a wall, I'll make a little iced matcha and I'll take a walk. So those will be the things that I'll do to get through that two o', clock, three o' clock lull. If I have it, I'll do, I'll do my, I'll make my little ice matcha because you know I'm doing something good for me and then I'll take it on the, I'll take it on a walk for like 10 minutes. So those are, those are usually the non negotiable. I mean depends on the woman. Sometimes they may need a little glutathione boost. You know, sometimes they may need, you know, more CoQ10, like some mitochondrial support. Sometimes they need some adrenal cortex. You know it just really depends on what I'm, who I'm working with. But those would be my tried and true non negotiables. And I think all of us really, I mean those are my everydays for sure.

Yeah, yeah. And I know you've written a lot about, oh, I wanted to ask you about medicinal mushrooms. Are you into medicinal mushrooms as adaptogens?

Am I into plant medicine for healing trauma or. Oh you mean like reishi and lion's mane? Oh yeah, yeah, yeah, absolutely.

Turkey tail.

Yeah, turkey tail. Absolutely, absolutely. Yes. I'm a big fan. I mean they're pretty much in everything. Like we have mud water, you know, we, we have, we have brain, I have all, I have every brain supplement you could possibly imagine. And you know, some of them are just a full out mushroom blend. But yeah, I say try, try them out and see how you do. Usually early in the morning is when I recommend those B vitamins as well. Try not, do not take your B vitamins.

Yeah, I wouldn't take B vitamins after. And I do want to, I do want to ask you about, you know, we talked a lot about protein. As, as we get older we all make less stomach acid. I know that you encourage people to do digestive enzymes. What about acid? Do you talk about acid supplementation?

I talk about, I do talk about ox bile. And I do talk about apple cider vinegar as one. I love apple cider vinegar as a way to blunt a blood sugar response. Not like anybody's trying to take a tablespoon of apple cider vinegar before they have their gelato. I always tell people, if you're going to eat gelato, walk the second you get it from the ice cream parlor, start to walk.

Just walk with it.

Just start walking with it. That's what the Italians do. But I do love apple cider vinegar for supporting stomach acid but also ox bile for bile salts. Again, if we're going to be moving, you know, hormone metabolism, estrogen metabolism through phase one and phase two, we need bile. So I, there's a company that makes super enzymes that actually have bile salts and HCL built into it. And so I definitely rotate my digestive enzymes. And I also, because of inflammation, I have Hajimoto's thyroiditis. I actually take systemic enzymes at night before bed. Bed. So I take designs for health has one called inflammatone that I love that's got also polyphenols. So again, really. So turmeric, it's got boswellia, it's got green tea extract and it's got all these proteolytics.

I love that one.

So I'm a big fan. I take those. So that's a part of my nighttime right before bed routine is I'll take systemic anti inflammatory enzymes because I just know that. But for whatever reason in my system, again, stress is I have trauma, there's child abuse. I have an ACEs score of a 7. So it's, you know, I've already a propensity for autoimmunity and I have it. And so how do I keep those antibodies low? There's a lot of lifestyle strategies that I implement. But also I also use supplementation to keep that in check too.

Yeah. So you've written several books about essential oils.

I have.

So I would love to hear your go tos for essential oils and how we can use them and incorporate them to improve our health.

I think again, this is the reason why I love hormone replacement therapy. I love a win. I love a win. I love if you have a low thyroid issue and you start taking armor thyroid or whatever and the lights go on. Oh my goodness. I was explaining to. Yeah, I remember when my estradiol kick kicked for my brain function. I was like, hallelujah. I mean it was like a hallelujah moment. Yeah. I was like, are you kidding me? My brain could have been this again. Like, you know, and so that's what I love about hrt. Like, oh my gosh, the lights come on and it's, it's miraculous. But I also love, you know, I wish vitamin D did that. You know what I'm saying? Like supplements. It's the long game. Eating protein. It's the long game. Walking your butt outside every day. Long game. Okay, these are, those are long game. But it's all worth it. It. I like also.

Short game wins part is necessary too.

Oh.

You have like, you have to lay the foundation. You have to set the stage. And as much as I fully believe in hormone replacement for the breast cancer patient, for the non breast cancer patient, like, I think everyone needs access to it because it is the key to longevity and health, but quality of life. You can't just take hormone replacement and not do the other things and eat.

Potato chips, tips, you know, and like you said, it's a yes and oh, no. Hormones are optimizers and it's. And I. Where I really find that they work is you. Someone like me, who's got, I mean, my, my metabolic labs, my inflammatory labs, chef's kiss. I mean, they are so sexy, you know, and, and they're like a poster child. So I knew. I was like, okay, my labs, every time we run them, they are dialed. And yet I'm struggling. You know, it's not my fasting insulin. That's three. That's a three. You know, I was like, it's not my blood glucose. That's. That's clocking in at 80 on my labs, you know, and MIC. GM. So I knew it wasn't these, These things. My triglycerides, 40, you know, so I was like, okay, what is it? Go. It's my hormones. I'm losing those. And so especially if things are dialed, you're. You're getting your sleep. You're. You're clocking your 10,000 steps. You're eating, you're eating your protein numbers, you're eating your 30 grams of fiber. You're. You're, you're consuming those, those, those fermented. You're doing all the things and yet you're still, still struggling, man. You bring hormones onto the, into the mix and it is, it is like, it is the ultimate game changer. But if you've got crappy sleep, your blood sugar's in the, in the tank, you're pre diabetic, you're not moving, you're not even clocking 4,000 steps per day, and you're expecting hormone replacement therapy to Be the miracle drug. It's. I mean, they, they'll work for a hot second, but, man, they're just not going to make up for that lack of, of, of lifestyle. They're just not. They can't. Yeah. Yeah. Essential oils. So I, I fell in love with them because I was, I was struggling with some energy issues and I was needing to pick me up. I was, you know, had massive, big, big patient load and I just, I was having a hard time getting through the day. There wasn't enough coffee to save me. And. And so I remember a friend of mine gave me some peppermint and I remember having a headache that day. And I put him on. She told me to put him on the back of my neck and on my temples and, and it was, I mean, the headache was still there, but, man, it dulled it down. And all of a sudden I got this energy boost and I was firing and I put, I put peppermint on before any interview because I'm like, let me get a little something, something like a little boost. It just opens up airways. It helps to oxygenate, oxygenate the brain. And so I started playing with them and we use them. We put lavender oil on my son every night before bed to calm him down. He's a boy. He's three. He's trying to do cartwheels on the bed before, before nighttime. Oh, I know.

I raised two of them.

It's like, how many gymnastics flips can you do before we turn these lights off? And so we, we put oils on. I use, I use eucalyptus and, and spearmint when he's not. He doesn't feel good on his, on his chest. And. But for women, I use peppermint sprays for hot flashes and night sweats. I love. I always say you can choose your mood with an essential oil. So, so like florals like lavender, clary sage, jasmine and rose, if you're feeling super deregulated. Research shows that oils like clary, sage and lavender can actually reduce the levels of anxiousness and reduce the levels of stress you're dealing with in a matter of seconds. And so I use these oils a lot. I recommend them for sleep, for mood support, for energy support, maybe for neck tension, but also for hot flashes and for cravings. Just breathing in peppermint oil can reduce cravings. So if I'm dealing with a really big craving, which again, I think often it's blood sugar deregulation, right? We get that blood sugar crash and burn. That's where we get those cravings. Or it's stress which also causes that crash and burn as well. So managing the blood glucose is good. But if you are finding yourself running to that cabinet, you know, have some peppermint oil in your kitchen, breathe that in, grab your sneakers, go out for a walk. And so you can pair them with your rituals to accentuate and to help kind of leverage those lifestyle habits. Like if you're struggling to get outside, have peppermint by the doorside. If you're struggling to calm your mind before bedtime, have lavender and Clary sage at your bed so that you can, you can pair these things together to actually get the result, the lifestyle habit result that you are looking for.

For people who want to learn more about that, tell us the name of your book.

So the last book I wrote in 21 is called the Essential Oils and Menopause Solution. And although that book is really based on root causes, again, lack of hormones, gut issues, stress deregulation, liver, you know, and inflammation driven issues, because I know a lot of what exacerbates in our body is inflammation in menopause and perimenopause. So you're going to find a lot of root cause medicine type of stuff in there. And what, how can we get these quick wins? And that's where the essential oils come into place. You're going to get a lot of yes. And in that book.

So I want to talk to you about the patient or the woman that isn't having symptoms, right? Like she is one of the exceptions. She's sailing through menopause, she's looking around like, like I don't know what all you people are talking about. I'm fine, my brain is fine, my weight is fine. I'm not having palpitations, I'm not even having the vaginal dryness. My mood is fine, my sleep is fine. Like, what about that woman that looks at all of us like we have 10 heads and like, what are you complaining about?

So even that woman, I tell you, no matter whether you have symptoms or not in perimenopause, your body is profoundly changing. Whether you know it. Those hormones are declining and they are not binding to the receptor sites on all of those organ systems. On your heart, on your brain, general urinary tract, your gut microbiome, it is all shifting. You may not see it or feel it, but your gut microbiome is changing. Your, your cardiovascular, your health is shifting, your brain health is shifting. We know that to be true. And so that's why I always tell women whether you have symptoms or not, track those labs and really Listen to your body. And again, I think one of the things that happens a lot is I think we misunderstand what perimenopause is and remember for so long, I think it's still the narrative that menopause and late perimenopause is hot flashes, low libido, night sweat, and maybe poor sleep. And we have to look at the milieu of all the different types of symptoms that can happen. The women will tell me like, oh, I didn't, I didn't go through perimenopause. That's what they'll say. And sometimes they. It's because they were on hormonal birth control and they didn't know that their cycle changed, but they had, that they had the increase in weight, they had the weight resistance, they had the less stress resilience. Like all of these are indicators of perimenopause as well. And so, so again, just note that symptoms are not systemically. Everything is changing. Your brain is changing. Your brain is literally reorganizing for the third time in your life in such a profound way that if we're not mindful, we know that 70% of Alzheimer patients are women, 67% of all dementia and cognitive decline patients are also women. So this needs to be on our radar. Are. Yeah.

Because even if you're not symptomatic, you are still at risk for heart disease, for osteoporosis. And we know as many women die as a complication of a fracture every year as do of breast cancer.

Right.

So this is a problem. If you think breast cancer is a problem, you have to pay attention to bone health. And women die exponentially more of heart disease than they do a breast cancer.

Yeah. And. And more than men. Oh, yeah. No, it's. Now, I think by 2050, 66% of us will have. Will have cardiovascular risk factors or we at risk for cardiovascular disease. It's 8% for breast cancer across our lifetime. And so more women are having stroke and ischemic attack starting at the age of 30 every single decade, more than women. It's just not. It's not. It's not sexy to talk about. I guess, you know, it's not as scary to talk about as breast cancer is. And the number one risk factor for that is the reason why I really.

Belabor as breast cancer is it's not as lucrative. That honestly is the problem is that it's not as lucrative. Like if you scare women about breast cancer, they'll start screening earlier. And it's just a better business model. It's really, really sad, but that's what it's all about. And the third thing is that, you know, we. You start to talk about it, the dementia and the Alzheimer's and these risks factors, they are very real, and they are there. Whether you are having hot flashes or not, in our 40s, walking around in a silent rage, whether or not you are having libido issues or not, these things are happening. And our whole goal is to keep women out of nursing homes, out of adult diapers. You know, these are our goals, and we're not going to meet those goals unless we address the hormone deficiency.

Yeah, I mean, it's. It's clear. I remember reading it was the journal of, I think, neuroinflammation. And they basically said perimenopause, that menopause transition is associated with severe physiological changes, including increase in risk of metabolic, neurological, and cardiovascular diseases, and that most women are going to see a uptick in neuroinflammation due to that lack of estradiol and perimenopause. Yeah. It's a default inflammatory state. But most important, where we see that inflammation is in the brain.

Yeah. So whether or not you're symptomatic, you need to be paying attention to this. This is really a conversation that every single woman needs to hear, and they need to attend your summit.

Oh, my gosh, yes. Oh, I am so excited you're on it. Dr. Gabrielle Lyon is on it. Dr. Casey Means is on it. JJ Virgin's on it. Dr. Suzanne Gilbert Lentz is on it. I just. So many incredible speakers talking about brain health and metabolic health and longevity. And ultimately, I understand that we want to mitigate those symptoms. No woman deserves to suffer needlessly. But we also have to understand what the root cause of those symptoms are and how do we address that root cause. Is it. How do we address it with addressing and fixing hormone deficiency? So we've got a lot of topics on hrt. HRT with breast cancer. You know, how do we have good quality of life with hormone replacement therapy? How do we dose out testosterone and really make it great for women? Are pellets the right thing? It's a full body nutrition. No. No, they're not. And so we get into all of the nuance of hormone replacement therapy, because I know a lot of women are like, what do I do? Is the cell hypothesis really legit after 60 years old, can you not get on HRT anymore? We debunk that. I have a doctor who just comes on and talks about what it looks like to be on HRT if you've never been on it over the age of 60. And so we get into that. But then longevity medicine, muscle centric medicine. How do we age powerfully? Like, like JJ loves to talk about. And how do we.

I love it when she talks about that.

I know. And so it's really about how do we build power, resilience and freedom in the second half of our life and how do we do that? By integrating these powerful lifestyle strategies along with tools like hrt.

So we will.

And it's free.

We will link to, to your summit, but tell people how to find you, how to get more from you, because I'm sure that they're going to want to.

Well, the summit's going to be for free. And we, we are going to have a minimum of 75,000 women there. I mean, it's going to be big. It's going to be incredible. I'm so excited. And it's in pick and choose. Like cherry pick, whatever you want. Like, if you're just like, I need to know about hrt. Listen to the HRT topics. I need to know how to build muscle. Listen to the. I mean, the muscle experts in the country are on this, on this summit. So listen to that. I need to manage my prediabetes. Girl, I got you. Okay? Whatever you need. So you can find me @doctorMarisa on Instagram. D R M A R I Z A. I have a podcast called Energize in your episode blew up because they have so many women in post menopause. Either they are in a breast cancer journey or they are post breast cancer. So that that episode was fire. So you energize it as 12 million downloads and counting. And my books are all on Amazon. You can find them there. But the summit is where it's at. Like you're gonna get so much value from that. Because I know, I know what you want. I know what you need. I'm in it myself. And I want to live with. With epic freedom. I want to throw my luggage at 5 foot 2 into the overhead compartment and tell that man who is graciously trying to help me, yes, tell him I'm good. I got this. O. I can. I can shot put that thing into the overhead compartment. I love it.

Well, if you want to shot put your luggage, make sure that you attend Dr. Marissa summit. And this has been an awesome conversation. Thank you so much for sharing your experience, your wisdom, all your knowledge with my audience. I know that they are just going to want more and more and more because this is something that truly affects everyone. And if you're not there yet, you by the grace of God, get there. Or you're, you're married to someone who's gonna get there or you know, your mother is someone who's, who's been there. So this is such an important topic, one that we're not talking about enough. We really need to have so much clarity around these symptoms of perimenopause and menopause so that women can understand what they're going through, but also so that they can be advocates for their self and go out and get what they need. And for most women, that is going to be hormone replacement, but layered on, it's a yes and right. Layered on top of all the other things that we Talked about today. Dr. Marisa, thank you so much for being here today. I so appreciate you and I appreciate all of you listeners. So if you liked this episode, please share it with someone who also needs to hear it and know that I will be back next time next week, same time, same place. It's Dr. Jen. Bye for now.

Thank you for joining me on this episode of the Keeping abreast podcast with Dr. Jen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jensimmons and remember, my Jen has two N's. So until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.