Top 3 Stress Busting Strategies with Dr Shilpa Sayana | Free Webinar

Foreign. Let's just give everybody a minute to enter. Excellent. So for those of you who are here today, some of you know me for years and some of you are new. If you could share what you hope to get from today's talk, that'll just help me. Help me tailor it to a more informed talk that's at least answering your questions. So just put in the chat why you're here or what you hope to get from today's talk. And if you're a woman in perimenopause, menopause, and post menopause, that would help. And then, so what do you want to get from this talk? Where you are in your menopausal journey, hormonal journey. And how would you rate your stress out of 10? 10 mean you're super stressed. 0 means you have no stress. You're as cool as a cucumber. So those three questions, if you could just put them in the chat so I could understand them. So the first question is what you hope to get from this talk. The second question is where you are in your hormonal journey. Pre menopause, per menopause, Menopause, post menopause. And then the third question is, so what do you want to hope to get? Oh, your post menopause, and where do you consider your stress out of ten? So somebody said she has stress is seven, and she's postmenopausal. Anybody else care to share? Before I jump into what I have to share, I have so much to share. I just want to make it sure it's relevant to what you're going through. So if anybody else wants to share, are you. What do you hope to get from the talk? And where are you in your hormonal journey and how you rate stress out of ten? I'll give you guys a minute. Right. Thank you for sharing, ladies. Excellent. Great. So a majority of you, I'm post menopause and a few of you in Perry, but everybody's stress is pretty much over a 6. And some people's stress are a 9 or 10. Do I need to give up wine? Good questions. Okay, so Alyssa, who's moderating this? Just make sure I get to these questions if I don't during the presentation. Okay. And a lot of questions about hormone replacement therapy. And what if that's safe is what I've gotten, if it makes you feel good and actually if it helps you with stress management. Okay. For those of you who knew or just joined, we were just asking everybody what they hope to get from this talk. And where they are in their hormonal journey, pre menopause, per menopause, menopausal or postmenopausal. And where they. Where you rate your stress perception 10 being you're very stressed and zero being your no stress. Where do you think you are? Great. Okay, thank you ladies for sharing. Okay, so you know, as a, for those of you who don't know me, I'm Dr. Sayana. I am a conventionally trained internist and also a Functional Medicine Medicine, M.D. got the Functional medicine through my own health journey. And for me, stress was a big part of how I got here. Just we don't think about stress as a bad thing. Actually, the US kind of celebrates stress. We look at the woman who is working all day, working long hours, and then coming home to figure out food for her family and then part of the PTA and just constantly giving of herself as a very successful woman. And you know, you can't imagine the stress of holding all those balls in the air. It's a ton of. But we just feel like, you know, as a woman especially you should be able to do it and do more. But unfortunately it does have unintended consequences on your body as well as your longevity. Let me make sure I got everything. Okay, good. So stress is very sinister. And I will go through a study that, a recent study that showed that stress potentially is an independent risk factor for cancer. So all as ladies, and I would probably say my stress is a six, maybe today, maybe a five, but it's constantly juggling way too many balls and we need to stop. And I'm going to explain why and give you some strategies as things you can do to stop reduce stress perception. Stress is a good thing. Stress keeps our body active and responsive to things. But this constant stress in our life is dangerous. And remember, your body is not meant to be stressed all the time. It could spurts of stress when you like responding to the, you know, the tiger that's or the lion that's outside your caveman time, but not stress that's continuous because stress by itself is a high cortisol state. And we'll go through this hormone, but this hormone puts you in a high. When you are stressed, your cortisol is high. And the problem is if you're stressed all the time, then you're in this high cortisol state, which is in essence a pro inflammatory state all the time. So your body's always ready to respond to things, but it doesn't have time to rest and repair. And that is dangerous. We're not meant to be in this high stress period all the time. And remember, if you're getting your body genetically doesn't know the difference between you being chased by a tiger where you can, you know, run and save yourself in a cave or just get eaten. This way your cortisol or your stress hormone has time to come down versus you taking your kids to school, having an intense job, working long hours, being stressed about the political situation, being stressed in general, having just too many things to do in your life or exciting things to do. Some of my patients say I love my job, I travel so much. That itself is stress on your body. That constant stress without a turn off button is a pro inflammatory state because your body thinks you're running from that tiger all the time. So yes, if you are stressed, it should be an anxious state, it should be an inflammatory state. So I my goal with this talk is to really explain to you the dangers of stress. What are some natural things you can do to improve that stress perception and how it's really important to know what's going on in your body with regard to your hormones and the hormone. We check, check for stress is your cortisol and your dhea. Okay. And I will definitely address some of these questions that I've got on here. So I like this quote. And so menopause, for those of you are postmenopausal or menopausal can appreciate isn't the end of your is not the end of your cycle, but it's the beginning of your wisdom. And I must say in my practice, and my sisters are older than me, once women hit like 52, for those blessed women, they learn to say no. They're very good about saying, you know, this is my time, this is what I can and can I do before they would go to a dinner party to make their partner happy. But they're like, after 52, I find that women in general are more empowered to say no. I just wish women would learn this earlier and after 52, be a little more consistent because saying no is something our gender doesn't know how to do well. And it's so important to create boundaries for your own self care and for your own rituals at their own time. Because if you don't do that, your cortisol will constantly be high and you'll be eating up other hormones that protect your longevity. So I wanted to talk about this very important thing before going into the talk. And this is, you guys are all sisters here and in the United States. For those of you who don't know. The female suicide rate that is the peak is actually in perimenopause menopause. It's between age 45 to 54 years. And this is a time where we think among ourselves that, you know, women are probably independent and don't really need community and we don't reach out to our sisters enough. So I really want to encourage all of you, if you know women between 45 and 54 years old or you are a woman in that age group, please reach for community. Because I think what's happening in this age group is your kids are leaving to college, your parents are aging, maybe you're caring for them, you have transitions, you may have reached your peak in your career and you may be like, is this it? This is where I'm going and I'm working so hard. And you're very isolated because either your kids have gone to, to college and you're not friends with their parents anymore or your time in your career where you may have come up the corporate ladder and it's lonely. So it's super important with this age group is make sure you have community because it is a high suicide rate, probably because there are a lot of hormonal changes, there's a lot of, we're very much at risk to inflammation and our stress is super high. So just want to make sure you're aware of the statistic and that you. We are protecting our sisters in this decade because it's a very vulnerable decade. So this is a lot of biochemistry I know, but I wanted to kind of just go through this chemistry in terms of how stress impacts our hormones. So and before going there, I wanted to kind of set the stage for hormones. So as a conventional doctor, when we think of hormones, we may think of testosterone, estrogen, progesterone, but in functional medicine it's three layers. It's your adrenals, which are the two little coin shaped glands and sit on top of your kidneys, make the stress hormone cortisol. That's your survival hormones. And then it's your thyroid and your liver. Thyroid is producing your thyroid hormones and then your ovaries are producing your fertility hormones. And how I like to see this is kind of like a family of hormones. Think about the adrenal glands, which is the survival hormones, as your grandmother and your wise grandmother and your thyroid as your supporting mom and the ovaries as a sensitive child. So the ovaries are a sensitive child because they're very responsive to the two generations above it. If wise grandmothers the adrenal glands have gone through years of chronic stress. It's going to have downstream effects on the thyroid and the ovaries. And as a over a decade practice as a functional medicine doctor, if we treat the adrenal glands, what I generally see is your thyroid gets better and so do your fertility hormones, like your ovarian hormones. And for us, it's not so much about fertility, but it's your entry into perimenopause. And menopause is much smoother if you can make sure you protect your adrenal glands. What impacts the adrenal glands the most is stress. Stress, stress, stress, and then inflammation, which is generally gut inflammation, high level of toxins, chronic pain. All of those things impact your cortisol. And I don't think we realize for the decades of stress that we've had, we keep eating up other hormones like the thyroid and the fertility hormone. So if you've had a ton of stress, your entry into perimenopause and menopause can be very abrupt with a lot of symptoms. And so it's important to kind of get into that, those stages of life gently by protecting your cortisol. And even if you're postmenopausal, your, the rest of your post. When you're in postmenopause, your hormones, your sex hormones are not coming from your ovaries. They all are coming from your adrenal glands. So the adrenal glands are producing cortisol and dhea, and your DHEA is making testosterone. So it's super important to protect the cortisol by reducing your stress. So this is just a pictogram about showing where the hormones are in perimenopause, menopause and post menopause. For those of you perimenopause, which could be anywhere after age 35. I know that sounds like a young number, but I've seen many women who are in perimenopause between 36 and 38, and that could be because of years of chronic stress. And that cortisol has eaten up progesterone. And I'll show you in the next slide as to why how that happens. But when you're in perimenopause again after age 35, all the way till 50 for some women, your progesterone at the hormone that just kind of steadily goes down, but your estrogen kind of stays good until menopause, and then it suddenly goes very erratic. So you're very estrogen dominant in this perimenopause state. And that's why the most amount of abnormal mammograms with fibrocystic breast disease and ovarian cysts are found in this perimenopause stage because you're estrogen dominant. And what I mean when you're estrogen dominant is no progesterone to balance that estrogen. So you, when there's so much estrogen in your system, things tend to grow. You get breast cysts, ovarian cysts, uterine fibroids are super common. And that's because you don't have enough progesterone to balance the estrogen. So yes, we could give you progesterone or look upstream as wise grandmother the adrenals and protect that cortisol. So the cortisol is not eating up that progesterone. What I mean is this. So this is biochemistry. And what it is is something called cortisol steel. And what it means is that when you all are hormones, for those of you who aren't aware, come from fat from cholester. So when you eat cholesterol, it becomes your hormones, so it becomes pregnant alone, which is the main hormone. And that can go to DHEA or can go to cortisol. Those are the two pathways. But if your body has a lot of stress, anxiety or inflammation or chronic pain, it's going to this cortisol will burn out its reserve and will look for the next hormone. And that poor hormone is progesterone. So that's why so many women who come to see us have fibroids, uterine fibroids, which are big growths in the uterus of the muscle. They have ovarian cysts, they have endometriosis, they have chronic anxiety and the anxiety tends to peak pre period. And they're like, you know, I'm just such a raging monster the week before my period and my husband knows not to come to me, my kids are scared of me and they're like, we know this is happening, but we can't even control it. And that's because that hormone, progesterone is getting eaten by cortisol. So if you checked her hormones the week before her period, you would see that her progesterone is quite low from what it should be. And unfortunately in conventional medicine, A, we don't even check her hormones or B, we give her Prozac and we like take Prozac the week before your period and see if that helps. It could give some benefit, but it's not treating the root cause. And remember the difference between conventional medicine and Functional medicine is why, why is this happening? And I want to empower you all to really understand that. So if you can. So why is it important to reduce your stress? Because your cortisol won't eat up the rest of your hormones. And I mean it's so tragic. I saw a young patient the other day, she was like 19. And when she has so many health issues and so many health symptoms and when you looked at the hormones, her dhea, which is the hormone that makes testosterone and estrogen was so low it was almost that she was only 18, it was almost that of a 70 year old. And that tells me that she's had years of chronically high cortisol that's eaten up for progesterone and now is coming after dhea. And the common symptoms you feel is fatigue, inability to gain muscle, word finding issues and depression. So it's important again look upstream. And the main reason to protect your cortisol is so it doesn't eat up these hormones. And the one thing we can do that's tangible is reduce our stress level. So everybody who said their stress level is above a 5, it's too high. You really have to somehow figure out how do you bring a stress level to a two out of three. And you may say that's just not possible and I have to quit my job, I'd have to really downsize, I'd have to move countries. But it is possible. And I'm going to give you some techniques where you can do that. And it's all about perception change. How can you not consume so much TV and news, especially now? How can you make sure you're walking and moving? How can you do things that are joyful and fun and community driven where you can really feed your soul and improve your keep your cortisol balance so it's not eating up these other hormones. I wanted to just take a break here and stop for a couple seconds and ask anybody if they have questions so far. So I know I went through a lot of biochemistry and these scary statistics. Do you guys have any questions so far? Just drop it into the chat because it's a lot of information. So I'll give you 30 seconds. If you have questions, please ask. And this may be like super familiar for a lot of you, but for those who are not, ask because I just want to give you this background of this chem biochemistry so you can understand what's going on in your hormones. And when we do any kind of lab testing looking at hormones, we check your dhea, we Check your cortisol, we check your progesterone, we check your testosterone, we check your DHT and we check your adrenals because we want a snapshot of where all your hormones are. Yes, good question. So one of one of the participants asked about your liver. Liver and glucagon. So what happens? Think of this as the supportive mom level. If your liver is congested with a bunch of toxins that you may not have know you have. And again, the most common toxins I see in our patients is high levels of mercury because everybody eats a ton of sushi or they have silver fillings or you have mold toxicity because you've had some water damage in your office or your home, your liver can be very inflamed. And if your liver is inflamed, it is going to drain your cortisol and you're not going to be able to make your sex hormones. So the liver is a very, very important part of this cascade. But we usually just focus on your thyroid and. Yeah, so if your liver is overwhelmed with toxins, you won't be able to make insulin and glucagon. When you're constantly being chased by the tiger because you have bills to pay and things to do, your cortisol is going to go up. And when your cortisol is going to go up, your body's thinking you're running from the tiger. It's going to need immediate blood sugar. And since there's no end to your stress, your blood sugar that's always going to be high is going to tell your body to start making insulin. And insulin is the hormone that tries to bring your blood sugar down, but that's not ending because your stress is not ending. So the chronically high insulin congests your liver. And for some people, that can really, you know, push them toward pre diabetes or high cholesterol. But if you can bring down your cortisol, your insulin will come down and your body will respond. Okay? Yes. So a question from another participant is increase is increasing cholesterol because of estrogen, progesterone changes or high cortisol? Absolutely. As an internist, I would never say that before functional medicine because we just got high cholesterol. Genetics. Here's your prescription for a statin. But the question into why it is absolutely related to hormonal changes. So, so many women come to us and they're like, last year I went to see my primary and my, my cholesterol was perfect. It's always been perfect once a year at my annual. And so is my blood sugar. But this year I went and my periods are kind of erratic over the year. My cholesterol is high and my blood sugar is high, and I haven't changed my diet. If anything, I'm going to pilates three times a week. I'm eating better, I'm seeing a trainer. And this is because what's happening during this perimenopause menopause journey is when you're estrogen dominant, your liver has a harder time processing all your blood sugar and your cholesterol. And if you have a lot of toxins, they, they can impact your liver and also increase your cholesterol. But the biggest thing that has to do with a lot of this is your cortisol. So a lot of our patients, when their cholesterol goes high, we look at the root cause in terms of their toxins and their gut health. We improve those before even touching their sex hormones. And the big hormone we do work a lot on is your cortisol. Because if we can improve your cortis, then we can improve your insulin. If you can improve your insulin, we can improve your blood sugar and you can improve your gut health. And so the gut has a big part to do with this is your gut is inflamed and you have sibo, small intestinal bacterial overgrowth, or sifo, small intestinal fungal overgrowth, or just the wrong bacteria in your gut, what you will see is a high amount of cholesterol. And so a lot of times, you know, you would think if you can improve the gut and it reduce the gut inflammation, you will see your cholesterol get better without touching a medication. High cholesterol, it's not something to worry about. As an internist, you know, I'll give you medication, but as a function medicine doctor, you have to see why. Because I would say 50% of the time, if you improve the gut, your cholesterol will get better. If you have genetic reasons where your cholesterol is super high in your family, you can consider medication. But again, you really want to see what can you do to improve your liver and your gut. If you've done that already, then focus on medication. And in terms of medication, I would microdose a low level of statin. So our general conventional medicine, we use 40 milligrams of Crestor or Lipitor, but I would do 5 milligrams of Crestor twice a week. And again, it's not conventional medicine, but we don't know genetically what epigenetics or what genetic tolerance you have. So 5 milligrams twice a week is a good dose. And again, the big thing is, you know, a lot of these studies are done in the 70kg white man. It's not done in women, hardly many studies until like 20, 20, 30 years ago. So we don't have data to say that this is the correct dose for a woman or a woman of different ethnicity. So I would do tiny doses and just see how your body tolerates it. Okay, so this is a study I just wanted to share briefly. And it is a recent study that showed that they took two women, two groups of women who had breast cancer and they looked at how severe that breast cancer women that breast cancer was. And what they found was it wasn't like sudden stress, like having a death of a loved one or loss of a job that was related to how severe and aggressive the cancer was, but it was daily perceived stress. So it's a choice you have to make daily that will impact your hormones and your cortisol and your inflammation that's going to put you at risk for cancer. So I think the study, it's nice to see it was well done and well researched showing that stress is probably all intuitively know this, but stress is probably most likely an independent risk factor for cancer. So ladies, we really have to get our stress under better control so that we can reduce that risk factor. And especially cancers and inflammation rapidly increase in your 40, end of 40s, 50s, 60s. So this is something we can choose to do. And again, some, some people might be just genetically susceptible to high stress. They may have a comt gene or an mth of our gene. And for those people it's even more important to have a stress reduction ritual. Like we have so many medications we take for blood pressure, diabetes, high cholesterol for stress. It's practices. You may take some supplements which I'll go through, but it's really about what kind of practices can you do daily because it's daily stress that causes disease. What kind of practices can you can do daily to choose to not be stressed? How can you step back and have better perception as to what's going on? So why stress feels harder now? It's when we went through this is really because of your hormones. So you before you would have some progesterone. Progesterone is the happy hormone, the calming hormone. But when you've had high levels of cortisol due to chronic stress, it eats up the progesterone. And now you're in perimenopause menopause where your Progesterone is already quite low and that's why stress, your stress perception is actually much harder in this time. So what are some symptoms associated with hormonal changes? You're going to have brain fog, Anxiety, irritability, insomnia, mood swings, fatigue, sugar cravings. Sugar cravings are a big one around this, this demographic or this age. And it's truly due to insulin, the insulin cortisol cascade I just talked about. Women can't tolerate wine as well. And all these toxins become more impactful after age 40, mainly because your blood brain barrier gets thinner and you may not be able to tolerate alcohol as well. And also your bone densities diminishing. So you're putting out more of these toxins into your bloodstream. And so insulin naturally increases. And also another big thing is stress. Chronic stress increases cortisol. You need the sugar now to run from the tiger. And hot flashes, especially during stressful moments. There's so many women who come to us say I need estrogen because I'm having hot flashes. And we check the cascade of hormones. The biggest hormone that's off is actually high cortisol and that's causing the hot flash, not low estrogen. And we'll talk about some supplements you can take outside now. Supplements you can take to drop that cortisol so it's not chewing up your progesterone. One is Cortisol Manager. It's probably a supplement we've used for many years that has Ashwagandha, cordyceps and magnolia bark is one pill at night can really help you stay sleeping because when you have high cortisol, you're up between 3am and 5am, you usually don't have trouble falling asleep, but it's trouble staying asleep. So that's Cortisol Manager. Another common supplement we use a lot and I've seen good benefit from is Relora. Relora is magnolia bark. It's in Cortisol Manager, but it's much higher dose. Can really help with stress perception. Things like Chal Gaba as well as things like Ashwagandha by itself. All of those naturally drop your cortisol. And people can be very like emotional again. They don't have that progesterone to balance. It's just all estrogen dominance and they just don't feel like themselves. So here are some strategies that I wanted to go through. The first one is breath work. So this can, you know, you can reset your whole cortisol rhythm within 60 seconds. And breath work calms your body's fight or flight, which is a cortisol response by stimulating the vagal nerve. And the vagal nerve is a nerve that runs all through your body that helps control parasympathetic movements such as having a bowel movement controls sleep and also controls breathing. So breath work can really drop your cortisol from high to low, but you just have to do it regularly. And this box breathing, where you inhale for four seconds, you take a deep breath in, count for four, you hold for four and you exhale for four and you repeat four times. My favorite is Pranayama where you block your one nostril, breathe in through the other like this, hold close the nostril and breathe out through the other. And then you breathe into the one that's open, hold, breathe out and you'll see me doing this in LA traffic. And you can just do it and count for eight seconds each time. It's again another mechanism that really helps drop your cortisol. The thing with the breath work and meditation studies have shown is you need to do daily and it has to be for 20 minutes. And all majority of my patients are like, I don't have 20 minutes, but think about it as if I can do this 20 minutes at least once a day, it could prevent cancer. So it's so important to drop your cortisol. With practices I have, so many patients are so sick of swallowing supplements that like, what can I actually physically do? But breath work, meditation can really pause the mental noise. And journaling is great. Get it out of your head. Writing it and just putting it all on paper really seems to help your stress response. So you don't feel like you're just burdened with all that things to do. But two minutes is what I said here. But really, data has shown this 20 minutes, 20 minutes of daily meditation sometime during the day has been shown to reduce cortisol, improve hormones and improve longevity. But 20 minutes, ladies, I mean, you're doing a lot of my business, like I have to take the kids, I'm doing this for others. You need to take care of yourself so that you can be alive and strong for others. And that's a complete like paradigm shift because so many of the time women are just taking care of everybody else. So you need to do this and make this a priority for yourself. And it's not a pill. It's easy to do. I listen to Joe Dispenza a lot. I like his, his meditations, it's free, it's on YouTube. But any quiet thing you can do where you can sit and pause the noise. I have mthfr, one of the methylation genes, where my mind is constantly going. So listening to somebody really helps. But if you can be quiet, just time yourself for 20 minutes and be consistent. Some mind body practices. So this is the science really behind it is that, you know, if you do mind body practices, it can activate the parasympathetic, lower your heart rate, lower blood pressure. It can also improve digestion. So a lot of times when patients, we've been treating their gut issues but they have a stress event or they just, they've got, they're like so excited, they're like, I got a promotion. And I'm always like, oh no. Because that means more daily stress and more high cortisol and then all their gut symptoms come back. So if you can do work, I'm not saying quit your job, I'm not saying change your environment that much, but change what you can. But have this daily practice of perspective. So meditation, some sort of breath work is super helpful and has been shown by itself to reduce hot flashes triggered by stress and your brain changes. You know when you can reduce your cortisol levels and you're not in this constant fight or flight. It has been shown to improve the amygdala, which is your desire response or stress response, as well as improve memory. A lot of times patients are like, I'm really losing memory. But they have all this long, long history of high stress. Is it memory from high cortisol or is it memory due to other hormones? So that's why checking is really helpful. So the second strategy is nutrition. What kind of foods can you do that help with stress perception? The first thing is magnesium. So magnesium is a nutrient. It's very depleted from our soil. But foods that have high magnesium are leafy greens, pumpkin seeds, dark chocolate. All of that help reduce our increase our magnesium levels. Magnesium is a muscle relaxant, so it can just help us just be relaxed and calmer. Can be used for anxiety and sleep. If you're going to do it as a supplement, you should do magnesium glycinate and start with 100 to 200 milligrams. Magnesium side effect is diarrhea because it relaxes everything. So it's a good thing to think about taking. There's seven different kinds of magnesium, but magnes, glycinate or threonate are the two. You can try for stress perception and take it at nighttime because it can cause sleepiness and making sure you're eating a protein with each meal. Remember I told you, per menopause. Menopause, post menopause is a time of dysregulated insulin and blood sugar. So you really want to make sure you're eating enough protein and fiber with every meal so that it's keeping your blood sugar low and your in terms of protein for women, I would Ideally recommend around 60 to 80 grams a day and about 30 to 40 grams of fiber. Fiber. I know that seems like a lot, but you just have to try and make that effort to get that. This way you don't have to take so many supplements. Make sure you're taking healthy fats, like any kind of omegas or these foods such as sunflower seeds, almonds, walnuts. And the other big thing is hydration. The one thing we commonly see in our practice is lack of people dehydrated and don't have enough electrolytes. So especially if you're going to be acting or sweating, make sure they electrolytes in your water. So all these nutrients can really help with stress perception. And I would say a lot of my patients either skipping meals or eating processed foods. So that's like a simple fix if you can try and do is hydrate. I keep a bottle of water with you. Always make sure you're eating good, unprocessed foods and try and make sure you're eating balanced meals, things with high magnesium, high protein and high fiber, less processed foods. And then this kind of talks about the gut brain, the gut brain hormone connection. So why it's so important to look at gut inflammation is because the gut is your primary organ system that processes all your hormones. And a lot of times people don't realize that. Majority of my patients are like, I don't have many gut gut symptoms. But when you do a sibo breath test or any kind of stool testing, you realize they have a lot of gut inflammation. And why that's so important is gut inflammation causes anxiety, depression and a lower threshold for stress tolerance. And so the gut brain connection is real. And if you improve gut inflammation, the stress tolerance can really improve. So it's important to kind of look at what's going on with your gut, either with a stool testing, a breath test, and use that data to improve your overall gut health so you can tolerate stress better. And then we talked about skipping meals, eating heavy, sugary snacks. All that can cause your blood sugar to crash. And if your blood sugar is constantly crashing, especially in this time of hormonal changes, you can be more at risk for irritability, anxiety and belly fat. And Your the nutrients, you know, super important to get some sort of good methylated B vitamin, magnesium, protein, high fats to make sure that the fats are enough to make your hormones and help again with your fats will be important to make your DHEA which is going to make your testosterone and improve your stress recovery. So very, very important to focus on nutrients. So the one thing before going to understanding your body is magnesium glycinate. Yeah, that helps with sleep. Magnesium glycine is only other questions. Magnesium glycinate or magnesium threonate all help with sleep. Is there any other questions so far before I talk about understanding the body I also look at your questions and making sure I've answered them. So ways you can roll over cortisol is with Laura Cortisol manager. Really breath work, community fun like figure out what you you love in your life, what gives you a lot of fun and joy and do more of it. That'll definitely drop your cortisol. Being in nature. So just being in nature and sitting in nature for at least 30 minutes has been shown to lower your cortisol and oh, so which is the magnesium? Okay, so let's let me come up to that so I'll go through from the top and see these questions. So if you're dealing with with hormone replacement I would say for any kind of hormone replacement when you're thinking of using B identical hormones, check your gut. Make sure your gut is in a good place and your liver is in a good place to tolerate tomorrow's hormonal prescription. So you really want to make sure you're working with someone to your gut before hormones and lower your cortisol. Because sometimes I have patients who come to me saying that they gynecologist put them on hormones, they felt great for three months and now feel horrible. It's because they haven't dealt with that hormonal access. Now they're just getting all this progesterone externally but it's more fuel for the cortisol to make them feel more anxious and more irritable. So it's important again to look at all your hormones before starting hormone replacement therapy and gut health health. And if you're having a lot of anxiety and sleep issues around perimenopause, it's likely due to low progesterone. So either consider progesterone or I take cycle support. I'm in perimenopause myself. Cycle support has Chase Berry B6 and magnesium in it and helps keep my progesterone a little bit high. Stress management super important with postmenopausal we at high risk for depression and suicide and anxiety. So so important to bring your stress level to less than four. And we talked about breath work, some supplements you can try and actually just really like seeing a therapist to really see. Sometimes it's so hard to see the frame when you're in the picture. So having some sort of external person who's cognitive behavioral therapist who's trained in therapy to really help you see what your goals are, what your priorities are and what you can cut out of your life, what can you say no to Hormone Worried about hormonal side effects? It's important to be the hormonal side effects when you are on hormones. We only layer in hormones. We only give you progesterone if they need it. We give them testosterone if they need it. And we save estrogen for the last because most of my patients don't detoxify well and can have high levels of estrogen. It is important to check your estrogen metabolites like through a Dutch test or Genova test to see if your metabolites for hormones like you, you have a lot of inflammatory estrogens because those are the ones that can cause things like breast cancer and inflammation. So if you're on hormones and are concerned about it, do a metabolite test to see what's happening. Starting HRT after menopause we think men starting hormones is okay before 60, 10 years after menopause we a little concerned about it but I still do it. As long as you're going to check your gut health, you've looked at your adrenals and you're starting low and going small then I think it's safe to try and see how you feel. Lowering cortisol. So supplements we talked about magnesium 38 of lysonate relora cortisol Manager can all lower cortisol but with lowering cortisol that's just stress related. What else is causing a high cortisol? Gut inflammation, high levels of toxin. So look at those things too. Do you need to give up wine unnecessarily? I would say if you're a big wine drinker ideally you should not have drink a glass of wine more than five times a week because that anything more is associated with breast cancer and you want if you are drinking wine think about taking some NAC or NAC to help your liver process this toxins toxins and just try and see if you can do a month of no alcohol. You see how you feel and then if you feel the same, then you can drink, but just in lower levels. I stopped HRT because some people made hormone replacement therapy. It has to be personalized. Like, who are you? I always think of, like, who is the person sitting in front of me? What is their trauma burden? What is their gut health? Like, what is their hormonal? What are their hormones? Like, what is their toxic burden? And really tailor it. Most of my patients feel incredible on hormones. I would say very few of them actually feel worse. Vaginal dryness. What's safe for vaginal dryness beside estrogen cream? Good Clean Earth has a cream called. It's a vaginal estrogen collagen. It's what's in it is hyaluronic acid. And it's pretty safe. And a lot of my patients feel like it does help. And no other menopause syndrome is 63. That's great. You know the other biggest thing if you don't have any menopause symptoms, the other thing in terms of considering hormones or checking your body is do you have any osteopenia, osteoporosis? How is your bone health? And if your bone health is not the best, maybe consider some natural hormones to increase testosterone like epic tea, which is fenugreek. So things that could naturally increase it. But it's great. You have no, no symptoms. The one thing not having symptoms in menopause is this is the time in your 40s and 50s and 60s to become strong. Like you really need to increase your muscle mass. It's great you're not having symptoms of menopause, but this is the time to become. To really increase muscle. Because as you age, not having enough muscle leads to frailty and is associated with baking your bones and having a more complicated, less longevity and more complicated deaths. Okay, so here, Magnesium glycinate, Which magnesium helps with sleep? Yeah, magnesium glycine and magnesium threonate. Which magnesium is the least likely to loosen stools? Magnesium glycinate works for most, but magnesium chloride, which you can probably get on Amazon, is the least likely to loosen stools. Magnesium chloride is also magnesium carbonate. Probably magnesium carbonate is easier to find. How do you know your vitamin B is methylated before? So the. The chemical Name for vitamin B12 is cynocobalamin and the chemical name for B9 is cobalamin. It should say methyl cyanocobalamin or methylcobalamin. That's how you know your B vitamins are methylated on the bottle. Is this still an issue for with liver? If you use estrogen the cream? Yeah. No, all these hormones. Your liver is like the organ that processes all your medications and toxins. It is true, though, not taking oral estrogen impacts your liver more, but also topical estrogen does impact your liver, so it's important to stay on top of that for your liver. How do you check your gut health? So we do a couple things here. We do a SIBO breath test, which is collecting your breath. You breathe into a tube every 20 minutes for three hours. I know, sounds like a long journey, but it's important to check because there's a lot of people who have sibo, small intestinal bacterial overgrowth, and don't know it. And you get SIBO from having food poisoning or having a lot of toxic burden or having chronic stress. And when you have sibo, you can't process your estrogen very well. So it's super important to check sibo, sibo. And then another thing we do is a stool test to see what's your whole microbiome like. Do you have any parasites? Do you have enough digestive enzyme, do you have an overgrowth of some different bacteria? And do you have a ton of gut inflammation? And then the third way we check your gut is to look at do you have leaky gut? And a leaky gut is. Your tight junction. Should be nice and tight. This is the lining of your small intestine. And when it's damaged and porous, that's a leaky gut. And why that's important is when you're eating foods, it's coming from your small intestine intestine into your bloodstream at a much higher level. And so blood's like, oh, we see a piece of gluten or some dairy. More than 20%. What's usual is 20 is allowed to leak into the. Into the bloodstream. But when it's more than that, because of the barrier lining, the body sees it as. It creates an autoimmune response to it. So you have a piece of a glass of milk, and then eight hours later you have bloating or you have a headache or you have an anxiety attack. Is it because of your food sensitivities? So we do food sensitivities, a stool test and a breath test to do a comprehensive GU check. Great. So I will be a couple of minutes. So understanding your body, it's really important to. We have so many tracking devices. You have your aura ring, you have your phone. Ways which we can measure your sleep quality and how restful it is. You can look at your mood and Energy fluctuations and bleeding patterns. Are your periods irregular? Are they getting shorter? Are they just when if they're not happening? Happening how? Sometimes even though people are post menopausal, they can feel like when their period should be and how you're feeling at that time. I know what stressful triggers they are. And the one thing I would say all of us women need to do is we need to say no more. We need to kind of step away from toxic environments. If we can't step away from that person or that object or that thing or that experience that's happening, then we need to really go deep into meditation to really develop perspective or see a therapist to come up with tools to kind of manage that and then really understand what's your bloating like? Is it more pre period if you're perimenopausal? When are you having hot flashes, when are you having cravings? Because all of that is super important. We have, most of our patients do a lingo which is basically like a continuous glucose monitor. And it's always surprising what people found. One of my patients said whenever she went to her mother in law's house, her blood sugar spiked and she just, there was so much stress and trauma there that you know, she kind of had to change that. Either the stress perception or cut her mother in law that frequency of visiting her. More reasoning down because it could be triggers, it could be every time you have a piece of avocado that's good for you, but you're sensitive to it. So getting more data is important and we have the capacity for data and it's not expensive. So I would highly encourage you guys to understand your body. Would also encourage you guys to check your blood work to really try and see, see where you are in terms of your hormones, where you are in terms of your gut. And this one quote, you don't need to control everything. Just notice what's true for you and that's really where your power starts and get the data, know your hormones. I can't tell you how many patients come to us who are on 50 different supplements. And I'm like, do you feel good? And they're like, no. But I'm like, why don't you stop these supplements? They're like, I'm so worried to stop them because how about if I feel worried worse? So work with someone who's not going to put you on so many pills and try and use food as, as supplementation and joy and fun. One more question here. She had sibo and it didn't show sibo, but I've shown that I previously feel better. So the one thing with sibo in a hospital it's surprising generally that they would have checked sibo in a hospital because it is a three hour breath test, but it's amazing that they did. Usually with sibo it should show up in three days. The one thing that can infect the studies, if you've had recent antibiotics, the sibo won't show up or if you've had a lot of if you haven't done the sibo prep work. So the sibo prep work is a day or two before you have to have no plant based foods because if you do have a bunch of plant based foods, your sibo breath test can be falsely negative. So it's super important to to do a sibo breath test. And the biggest things in terms of treating with biggest thing in terms of treating for sibo is look at the underlying root cause. I've had sibo, I've tested sibo positive twice. One was after a food poisoning event and one was post Covid. But my root cause was I had a high level of toxins. And so that's important. Look at deeper what's causing the sibo because you want it to be really in remission. So you want to do a detox. Make sure you're detoxifying. You can do supplements, sauna, things to help help detoxify, but that would really help. General recommendations to deal with bloating the most important thing about bloating is to see why you bloated because of sibo co small intestinal fungal overgrowth. It's a commonly missed thing that happens post sibo. So you have sibo, we treat that and then you have cfo. So treat both of them together. Another reason for bloating can be high levels of inflammatory estrogen. So you're on hormone replacement therapy with estrogen, but that's making inflammatory estrogen because you just genetically don't detoxify from it. So look at a to things you could take are indigo greens, which is a green supplement that helps you kind of open your detox pathways and help you get rid of inflammatory estrogen. And then the third thing for bloating is is it a gut lining issue? So sbi protect as a supplement we have or l glutamine to heal the gut lining. But the question is why now with bloating? You know, I want to make sure all women here understand bloating may not be just your gut. So the most one cancer that presents with bloating that can be missed is ovarian cancer. So if you are have chronic bloating and don't have much of an explanation, please get an ultrasound off your pelvis to make sure your ovaries look okay and do some cancer screenings for your ovaries just to make sure they look okay. Because all of us are focused on the gut, but there are other organ systems in there that could be a root cause. Therapist recommendations. Yeah, there's a whole bunch of therapists we had have that we do recommend. I would say the one person that you can. Who I really like is Dr. Nancy golden and G O L, D N. She's older, but she's excellent. And she's quite affordable. I think she's like 110 bucks, which honestly for LA, that's quite affordable. And she does take some insurances. She's right here in Sherman Oaks. Dr. Nancy Golden. And she's in person and online. I really recommend that. She's older, she's cognitively behavioral. Cognitive behavioral therapy trained. And she is just a sweet lady who, who I think a lot of people resonate with. Great. 150. Thank you. So yeah, she's great. She's a good one to see. Other good therapists. We have a lot of therapists who are more like somatic therapists who deal with brain and trauma and therapists who work along with like specific issues around. Around eating disorders and around sleep issues. So just depending. There's so many offsets them. Yeah, she's great. And new patients. So yes, we are seeing new patients. So for those of you who don't know, we've done functional medicine through insurance for about a decade and then got into four audits from insurances. They thought we were seeing patients for too long doing unnecessary testing and wanted just being a regular primary care doctor. And then I changed our practice about a year ago now and I'm so grateful. I do have a much smaller level of patients. We had 3,000 patients and now we have 150. Our goal is 350, but we are in no rush to increase those patients. Mainly because patients can message us at any time. They see us doing unlimited visits. That's just really great. It's a partnership with them to improve their health. And I understand it's not for everyone because it's an investment, but those people who can't do our programs and memberships, we do offer labs, consults. So this is just a panel where you can do your hormones and your longevity labs. For us, the longevity labs Are like autoimmune, inflammatory labs, iron, ferritin, vitamin D12, those things that you traditionally maybe a primary care won't check. You can check all those labs before seeing us and come and see us for two hours where we can give you like a deep dive as to what's going on with your body and give you a snapshot of what your hormones are. If you are in perimenopause, you want to check those hormones. Hormones a week before your period. If your hormones are everywhere, I mean, your period is everywhere. Or in post menopause, you can check those hormones anytime. So you can do a lab consult or you can do a program or a membership with us. It's this kind of medicine has been so rewarding for me personally, just knowing that I know my patients and they can get a hold of me at any time. It's kind of how I think medicine should be practiced. Unfortunately, it's not how traditional conventional medicine is, but yet we are seeing new patients. Can do a lab consult program or medical membership. But the most important thing, I think for you or for anyone is to make sure that you are checking your hormones and really trying to understand what your body's trying to tell you. If your stress is that high, please, please, please be more conscious of it. See a therapist. I'd rather you not come and check your hormones, but work on therapy. Because remember, chronic stress can lead to things such as chronic anxiety, depression and even suicide. And this is the age group. The women I see are the age group who take their lives the most in the States. United United States. So if you know someone, if you yourself feel like that, please see a therapist just to work on those. If you want to get to deeper dives, please see us. And you know, lab consult program membership for those people on here. I see a lot of my current member patients. You know, it's great to see you all here. And just know that that age group is a very scary age group, 45 to 54 in terms of suicide risk. So reach out to your sisters, your friends, and make sure that they are safe. Safe and help them if you can get go deeper as to the why. Perfect. Any other questions, ladies, from me? Oh, there's a guy on there. Apologizes all of our women, but hopefully you got something out of it. Any questions for me around things you can take before we do our raffle? So for all of you, for patiently waiting here or being part of this webinar, we pull one name and Alyssa is going to ping me the name right now. For raffle and today. Hey, a lot of you guys have taken for the members. You guys have already have access to so many of these supplements. But I would say the one supplement you should try if you haven't for stress is Cortisol Manager or Relora. So whichever one you haven't tried, if you're a member patient here, you can try. So who is the lucky person? Alyssa. Let me see. Sandra. Sandra, you are the lucky person today. You. We will ping you tomorrow and ask you how you want the Cortisol Manager or Relora and we'll explain what they are. They're basically supplements that naturally drop your cortisol. They're great to take. They'll help. But more importantly for everybody, it's so important to look at the root cause and why you you're feeling stressed. Awesome. Thank you ladies. Thanks for joining me tonight. Have a great evening. And any questions, you know where to reach me. If you guys are missing members, please ping me on the messaging app. And I look forward to hearing you. Take care. Bye. Bye.