Biohacking Perimenopause with Alisa Vitti

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Hey it's JJ and welcome to Ask the Health Expert. But this isn't just any old Ask the Health Expert Expert session. This is your bonus session. Yes, it's the weekend and because it's the weekend, we are going to take some time with an amazing expert. So be on the lookout for these.

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Hey it's JJ and help me welcome back to the show my friend Alisa Vitti. I am so excited to have her back. We are going to be talking perimenopause and you know, how you know when you're in it, how best to prepare for it, what to do if you're in the middle of it, you haven't prepared and then how you know when you finish that and moved into menopause. We'll be talking about so many important things here. Everything from the right diet, should you do intermittent fasting, what's the best type of exercise? What what about supplements? And she is the perfect person to do this. She is the best selling author of Women Code and In the Flow, which is the first book ever to describe the Infradian rhythm and its importance for women's health. She's also the creator of the Cycle Syncing Method, which is a diet, fitness and lifestyle program that's based on women's biological rhythms for optimal health, fitness and productivity. And she's the femtech founder of floliving.com and has built the world's first menstrual healthcare platform that helps women around the world put their period issues into remission naturally using her highly effective Flow protocol and Flow Balance supplements. And finally, she's also the creator of the My Flow Period app and this is the first and only functional medicine period tracker designed to help users eliminate symptoms and optimize their diet, fitness and time management according to their cycle. It's consistently ranked in the top 10 of paid apps in the health and fitness category on itunes Alisa is a graduate of John Hopkins University and the Institute for Integrative Nutrition and has been featured in the New York Times, Dr. Oz, Vogue, Forbes, and keynoted at south by Southwest, TEDx, and Google. And again, we cover a lot in a short amount of time. And fasten your seatbelts and get your notepad out. And one more thing, you're going to want to go to jjvirgin.comvsign that's V as in virgin sign. You'll find out why during the interview. We'll be right back. Stay with me.

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Welcome back Alisa. It's so good to have you here.

Good to be back jj. How are you?

I am great. Well, it's always good to talk to you about this because I get badgered with questions about perimenopause. And you are such a voice of reason of such great easy explanations and strategies. So I'm super excited to dive in. And, you know, I thought this might be an interesting place to start. It's kind of 101 basic. But I mean, how would a woman actually know that she's in perimenopause? Like, what constitutes this? What makes someone in this?

I love this question. Yeah, I love this question. Because there is so much confusion, right? People say perimenopause, they say menopause, they don't know where they are. And we really do need some specific structure to understand. Where are you on the timeline? So here's how it works. Starting at 35 for every woman, the brain begins the process of perimenopause, which is this transitional phase like puberty, but in reverse, which takes a decade or longer, just like puberty does. Right. Puberty starts in the brain at 9, but you don't start to see physical symptoms until 12, 14, et cetera, et cetera. And they increase in their presentations. Right? And it completes around 22 in the brain.

Okay?

Perimenopause starts at 35. You may not notice a thing for seven to 10 years in terms of your cycle, right. You can still have regular ovulation, regular menstruation. That is wonderful. In fact, you should strive for that. The longer you ovulate regularly, the more you bank cardio, neuro and osteoprotection for when you are no longer cycling. Right. So it's a good thing to slow down this process then. So that's of what I call stage one perimenopause, approximately 35 to 45. What's happening in the brain is that slowly, slowly your body is making more and more follicular stimulating hormones. When it crosses a certain threshold, right. Over a certain number, like 14 to 16, right. Then we're at a place where you are going to start having irregular ovulation. And eventually, when that number gets high enough, you will not ovulate anymore. And then we sort of begin in that process. That's where the sort of perimenopause completes. But stage one, you're still. Your FSH levels are still fine. You're still ovulating, still menstruating. Stage two, 45 to 52, approximately. That FSH level is going to creep up. You're going to have skipping of ovulation, you may have skipping of cycles, and then you may go on this fun. I'm putting that in air quotes. Estrogen roller coaster that creates a bunch of symptoms. So that's the journey. And then it culminates with menopause, which is the last bleed. And then 12 months after that, you are then considered postmenopausal if you do not have another period and you can count 12 consecutive months.

So you said you had the kind of fun in air quotes. I would say, yeah, just wait. And what happens is estrogen starts to, like, shift and drop. Like, what are some of those symptoms that people might start to notice?

And it's not just that it drops. Actually. The issue is that it goes, like, erratically up and down in response to this changing situation inside your brain and ovaries around not ovulating. So it's the roller coaster that can create the issues around or that could exacerbate the issues around hot flashes and night sweatshirts and mood swings and vaginal dryness and some weight gain and these types of things. But I think we're going about taking care of our perimenopause journey. Not the right way. I think we could do better. I think we could dial it in better. And here's why. Because we wait until stage two to take care of it at that point. If we haven't been taking care of our cycle leading up to that, and you have had, let's say, unaddressed PMS for, who knows, three decades, you should plan on having perimenopause symptoms that feel like you're in a constant state of pms. Right. Because that's the whole problem there. You're having spiking and dropping estrogen levels at rapid rates, and you're having a cessation in the production of progesterone. Right. So now you don't have enough to oppose that estrogen. So you could feel like you're in chronic PMS all the time. But if we can start to take care of our cycles earlier and start to use supplements. So strategically at 35, there's a lot that we can do to not only prolong stage one, but mitigate dramatically what happens in stage two. And that's also where we have to change diet and lifestyle again. So there's sort of a diet and lifestyle supplement kind of thing that you want to do in 35 to 45, and then you want to switch things up after 45.

Okay, wow. This is great information. So the. The tracking your cycle, the 35 to 45, what should you be looking for in your cycle? What would tell you that things are a little bit off? And how should you be tracking this?

I Think it depends on how deep down the rabbit hole you go. But using any tracker, we have a tracker called My Flow that you can use to get yourself oriented to the cycle and the different phases of the cycle. But you can also use that in accompaniment with a basal body temperature tracker to see what's happening if you are ovulating. If you want to go even deeper, you can use one that you can. There's a urinalysis that you can do on a testing strip that connects wirelessly to a device that will let you know if you're having that LH surge. All of this is really for you to start to really track ovulation, right? You want to see if you're still ovulating. And this is an important thing to do. You can also then do some at home hormone fertility testing, again, not for fertility purposes, but to see what is happening with fsh. You can do that, I would say, every six to nine months during this stage, just so you can really keep an eye on what's happening with fsh, because it's going to really tell you where you are. In this timeline that we've talked about, tracking symptoms is important as well. So again, if you have PMS, every single luteal phase, 35 to 40, so don't brush that off and say, oh, well, it's just normal. I'm just moody and cranky and hungry and tired and acneic. You want to really do what you can to boost progesterone production and support estrogen metabolism. So that, again, you're really keeping yourself. Because what we're talking about here, in order for you to do that, is to stay micronutrient rich, right? The more sort of full of healthy, balanced micronutrients, you are going into stage two, the better your experience is going to be if you go into it, which so many women do, totally depleted from. If you've had kids, depleted from childbirth, if you have a career, depleted from stress, if you drink alcohol and caffeine, depleted from that. If you have a history of taking synthetic birth control, micronutrients get depleted. I mean, there's so many ways in which you are just leaking out in essential micronutrients that then put you in sort of a deficit position as you go through this very major transition after 45, that makes it worse. And it doesn't need to be that way if you get strategic about it.

So we're definitely going to talk about 45 plus and what to do if you hadn't done anything yet. So breathe, don't worry. But let's say you're listening and you're 35 to 45. What are some of the key things in terms of diet and supplements that you should be doing at this age? Age to set you up for this, to prepare.

So this is the whole thing of my second book, in the Flow. You want to be using this process that I created called the cycle syncing method. Because what that does is it aligns your diet, not just calorie intake, but also the types of foods you're eating with each of the four phases of your cycle, as well as your fitness intensity. Right. The workout intensity you're doing to match what's happening hormonally in each stage of the cycle. When you get that wrong, you disrupt your hormones every single month. You make PMS worse, you can cause premature hormonal aging, and you will definitely make stage two of perimenopause more symptomatic. So the first thing is to sort of really understand that you have to change. You don't want to be the same every day. Right. If you think eating the same calories every day, doing the same workouts every day is going to get you optimal health in your cycling years, it does not. Once you're postmenopausal, yes, you want to strive for the same every day because that's what your body is back on as far as a chrono clock. So there's that food wise, fitness wise, match it to your cycle. It's all chapter four and chapter five of in the Flow have the charts all in there. So does the app, the My Flow app.

And I love this because I think every single woman intuitively knows this to be true. They may ignore it.

Well, and for good reason. I mean, you're constantly being bombarded in the wellness media with people you know, especially, you know, not calling, calling anyone out in particular, but just the fact that we have so many men talking to us about this is the optimal thing to do for your health. The fact is women are being left out of medical, fitness and nutrition research. So if they're saying, oh, they always.

Have been left out, they always have.

Been research, so it's a problem. So anything you're hearing about hiit workouts are the gold standard. You should do it every day. You should wake up at the same time every day. You should eat the same amount of calories every day. That works and has been studied and gives the benefits that are talked about in those studies to the men that were studied in those studies, but not for You. And that was sort of the big reveal of in the flow is that we have a different, a secondary biological clock. And this is through the science of chronobiology called the infradian rhythm. We also have a circuitian rhythm. And these things cause our metabolism, our cortisol patterns and more to shift in each of these four phases of the cycle. So there is no other way except to synchronize your self care with your cycle. And the more you do that, the sooner you do that, the healthier you'll be, short term and long term.

So someone's listening to this, they're 45 and they go, oh, oops, yeah, see, I didn't know this.

Right. It's brand new information, so don't beat yourself up.

I blame you because you should have been talking about this 20 years ago. I don't know what you were doing.

Starting my research 20 years ago.

Come on. So, so now someone's hearing this, they're going, okay, so I'm behind, but I don't want anyone to go, okay, well, shoot, it's too late for me because it's not. It's never too late. So if you are in that perimenopausal state now with zero preparation, what can you do? What can you do to catch up and to have the best outcomes? Yeah.

So if you're still cycling, and you may very well be, a lot of women still get their period regularly 45 to 50, which you may skip a month or two here or there. Right. While you're cycling, take care of yourself in a cyclical fashion. The months where you are missing a period. Right. Instead of doing the cyclical self care here, you would sort of dial up intermittent fasting, actually, and more strength training. So the whole purpose of what we do, from a food and fitness point of view in perimenopause is to really reduce as much exposure to unnecessary amounts of carbohydrates, AKA sugars, as possible, because that can exacerbate hot flashes and night sweats dramatically because our metabolism is recalibrating. Right. So you're going from this infraredian cyclical pattern where your metabolism speeds up and slows down and speeds up and slows down like clockwork every month. But now you're moving into this new space where your metabolism slows down a little bit. So you've got to biohack that with intermittent fasting and with much more strength training. Right. And really looking at making sure that you are, whenever you do eat carbohydrates, they're Complex. They're coupled with lots of good quality fats and you're limiting your exposure to them. So you can explore more of a ketogenic diet. And I think Dr. Anna Kabeka has done some great work on this sort of plant based forward ketogenic way for women post 45 keto greens 16. Exactly. So doing that I think is really smart because it matches what's happening in your biology and that's the whole purpose of this. So you're still synchronizing with your hormones, but you're doing it in a way that matches what's happening now. So the months that you're cycling, if you're seeing signs of ovulation, you feel like you're about to get your period, try to synchronize your activities with your cycle. And the months where you know you're skipping start to move toward this postmenopausal experience where you'll be doing much more intermittent fasting, much more strength training in terms of your self care. That's more consistent 24 hours a day, right? Like every 24 hours as opposed to every 28 days.

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I think for women 35 to 45, you can do the gold standard that is safe for women in their cycling years, which is a 12 hour fast between dinner and breakfast. For women who are transitioning in the second stage of perimenopause. 45. Until you have your last bleed and you counted 12 months, you can't go full force like the guys do with the intermittent fasting. You can once you're post menopausal. You can do it until you're content, until what feels good. But in this sort of transitionary period, I would say play with what feels right to you. It could be postponing breakfast a little bit, it could be doing it on alternating days. There isn't unfortunately enough research being done where there's a formula that I could give you that would be something that's evidence backed. But in the meantime, as per usual, we have to kind of figure it out ourselves. And you know, which is, I know.

Frustrating but I think it's the best way, honestly. Because here's the thing. Even if there was the perfect window, if it wasn't the perfect window for your lifestyle, then it wouldn't be the perfect window for you. It still has got to work, right? So, you know, that's one of my things. I look at all the diet books out there and I always think, you know, the person who wrote the diet book probably wrote the diet book because it worked really well for them, even if all the research is there. So if their lifestyle fits well for a, you know, a 12, 7. Right. Or eating specific things. So, you know, but maybe for someone else it's 10, 5 or whatever. So I think it still looks at that sounds like that really, once you get past all of this stuff, it becomes super easy because you know what to expect. But as you're going through it and now your estrogen's all over the place, progesterone's dropping. What do you do about hormone replacement therapy when you've got a moving target like this?

I think the key really is to focus on estrogen metabolism and because.

Breaking.

That down efficiently is going to mitigate symptoms, right? So really looking at how you can supercharge your liver and its ability to break down estrogen to make sure your gut is functioning properly, making sure the estrobolome in the gut is really helping your body break that. Because if not, then that's when you're going to start to feel like you're breaking out and you're gaining weight and all of these things, Right. And then on the hormone replacement therapy side, you know, this is very old information, but, you know, bioidentical progesterone is fairly safe for everyone, even if there's, you know, you have to check with your physician, obviously, but, you know, and if you have a history of cancers in the family and all of that, but, you know, using bioidentical progesterone can be a really great assist during this time because it's the missing progesterone that really makes us feel not great. More so than the estrogen fluctuations, which you're more accustomed to anyway from your cycling years. And your body is supposed to downregulate that estrogen over time. That's the whole purpose of this, is to make a little bit less of it. And the question mark is, well, shouldn't we supplement with it if we're making less? It's a controversial conversation because for some women, it's dangerous to do that because of cancer history.

The family.

And I Think there are other solutions that you can use that you can try first. Right. I think if you're in a position where you're now having sort of like a crisis moment where everything is falling apart and you can't function, then, you know, you may feel like you need to go a little bit more aggressive with your treatment plan. But if you start to prepare in advance and take care of yourself and use supplementation. We haven't even talked about melatonin. You know, these things, all of these things really can help your body go through this natural process. Right. Much more gracefully. And that's the thing, is that this is something that's supposed to happen. It's not a problem to solve, it's a process to support.

We just turned it into a medical problem rather than a natural case. And it just sounds like hormone replacement therapy here would be something you'd look at when you have done everything else.

Exactly.

And yeah, that makes a ton of sense. So let's talk. You've mentioned supplements a couple of times and especially detoxifying estrogen. What are some of your favorite supplements? And we talked. I mean, Obviously we've got 35 to 45. 45 plus. Let's focus. 45 plus. And what's going on?

Melatonin is critical. I think starting at 35, you want to start taking melatonin, but as soon as you hear this podcast, start taking it. Whatever stage you're in, whatever age you are. After 35, you know, we make so much less melatonin as we get older. And that really is a problem because this is sort of the key hormone that really is involved with the circadian rhythm. And this is the dominant biological clock that is going to come into play after you're done with this transition. So you want to keep supporting the circadian clock as much as you can while your infraredian clock winds down. Right. So you're supporting the infraredian clock with the cycle syncing work, but you're going to be supporting that circadian clock with some melatonin, with some good sleep hygiene, with your blue light blocking glasses. These basic things that we know are so essential. You're going to reevaluate your caffeine and alcohol intake, AKA potentially eliminate them from your lifestyle. And I know that can be hard for people, but when you think about the fact that 50% of the population doesn't make they have a mutation in A gene, the CYP1A2 gene, that means that you're not making enzymes that metabolize caffeine, half of the population struggles with this. Caffeine may not be your friend.

And you can find that in, I think, 23andMe. I know I did it in another. I'm happily a fast caffeine metabolizer.

I know that about. I know that about. It's so obvious. I feel like it's so obvious when I look at people, which one they are.

I know.

And I am totally opposite.

I know. I'm so Sad for you.

24 years without caffeine.

Yeah, it's so funny. It's like I. Doesn't faze me. And I've switched over to decaf.

I'm.

Yeah, you know, I can roll right through it.

But a lot of women with hormonal issues tend to also be the ones that, you know, do not do well with caffeine as well. So, you know, if you're someone who's had a history of pcos or fibroids or endometriosis and you're going into perimenopause. Right. Caffeine is something you really want to think about, you know, eliminating. And you could. And you're saying to yourself, elisa, oh, my God, my energy is so bad. How am I going to function without caffeine? Well, the caffeine is disrupting your insulin and your cortisol levels, which is actually making the energy problem worse. So it isn't about constantly boosting yourself artificially to get more energy. It's about actually creating energy reserves in the body by giving the body the food and the lifestyle and the supplements to help it get there. So other supplements outside of melatonin. I do want to say the other really amazing thing and why melatonin is so I think the unsung hero of women's hormonal health is because in the 90s, Italian researchers who were focusing on infertility figured out that a combination of melatonin, selenium and zinc could restart postmenopausal ovarian function.

Wow. Wow.

Okay. Wow.

Wow.

So we all want to get on that melatonin early because, again, it's so important to slow down our hormonal aging process and to ease it.

And what dosing are you recommending there?

Small 3 milligrams of melatonin, a tiny dose. You do not need to go big with melatonin. Less is definitely more. It's about staying consistent. And I always say you want to take it about two hours before you want to get on your sleep train. So if your 10 o' clock is your sleep train, like, take it around 8 but don't change it every day because it is a hormone. So you want to take it thoughtfully, just like you would take birth control at the same time every day. You kind of want to take melatonin at the same time every evening. So melatonin is a great one. B vitamins are essential. They're water soluble. You lose them every day. Getting yourself on a good B complex is really important because vitamin B5 supports your adrenal glands response to stress, which you need that as you go through life. And vitamin B6 helps your body produce more progesterone naturally without taking synthetic progesterone.

Right.

So if we're trying to biohack our way through a better perimenopause journey, making sure you dial in the right supplementation is critical. Then I think, you know, there's just some basics. You gotta have a probiotic that, you know, actually gets into your gut and, you know, enterically coated, you've got to have magnesium. I like the glycinate form the best. And then, you know, some other things for the liver. The liver needs a lot of help. And I think as we go through perimenopause, when we do have those spikes, as I talked about, they can feel really rough. I like things like DIM for that. Really? Really. There's lots of studies that show DIM is not only beneficial to breaking down estrogen, but is also very protective for women's bodies, especially around things like the big, scary things around cancer. So I think it's just important to start thinking about adding in some key supplements that can really help your body go through this process. Better not to feel overwhelmed. There are certainly adaptogens and things that you can add into, like Ashwagandha for stress management and MACA for overall hormonal smoothing out, which I think is really great, especially if you're struggling with any sort of libido issues. MACA can be a really nice addition too.

Here's something awesome for everybody is that you actually put these together as packages, because I was listening to this going, oh, people are probably going, oh, no, I'm driving. I didn't write this down. So we will have all of this when you will have all of this information, obviously with show notes. But here's the important thing. If you go to jjvirgin.comvsign V AS in virgin sign. But it's not that you are gonna be able to take Alisa's assessment. She's gonna tell you a little bit about that, and then we'll have the information there as too. She's got two great books. You're gonna wanna get these. Clearly, this is just like we scratched the surface a little bit. As you can tell, she is the go to here on everything, on cycles, cycle syncing her special method. So you want to grab all of this because honestly, wherever you are at this point, as you learn these things, you can improve. So if you feel like, ah, it's too late, it's never ever, ever too late, this stuff will make a difference wherever you are. And if you are a mom with a daughter who is heading into this, get this all for her too, because gosh, what a gift, you know, to have this early and to be able to be on your app and have women code and in the flow. So tell us about the quiz, the assessment.

Yeah, so, you know, listen, in 2015, the American College of Obstetrics and Gynecologists decreed that our cycle and its symptoms are to be considered now a fifth vital sign. And just to put that into context, the other four vital signs they take in the emergency room when you drop by for a visit, right? Unexpectedly. And in our. Our post Covid reality, right, we all know because we've been educated properly, like, we want to take an elevated temperature seriously, we would know what to do, hydrate, take, you know, rest, take, drink chicken soup, whatever. In a. If you had elevated blood pressure, you would not ignore that and joke about it with your friends, like, ugh, you know, my blood pressure is high. Ha ha, right? If you have PMS now, right? Or if the color of your bleed is the wrong color, right? These are not things that you should ignore or sort of like joke about in that commiserating way you do with your girlfriends, like, oh my God, my period's so heavy, or my PMS is so bad, I'm a different person. That kind of thing that has to go. Because now, from a medical point of view, any symptom that you're having is critical biofeedback as important, equal to the biofeedback of blood pressure and temperature and the other. So this evaluation tool is going to help you understand what is going on with the biofeedback of your cycle, giving you an analysis of what it is telling you right now in real time based on what's happening to your cycle as you answer the evaluation. So it's a really great thing to be able to look and see, okay, what does the color of my bleed mean? What does the symptomology, you know, the symptom burden that I'm having, what is that telling me, does it mean that I'm estrogen dominant? Does it mean that I'm progesterone deficient? Does it mean I don't have have enough estrogen? What is going on? Because it's pretty straightforward, actually. There are not too many patterns that exist with what could go wrong with our hormones. And so it's good to be able to see what's going on for you right now.

I'm just so happy that this information is now getting out. Right?

Yes. More and more, more and more.

Thank you. Thank you for getting it out there. So again, you'll be able to take this assessment. You're gonna go to jjvirgin.com sign and it will guide you right there. And make sure you pick up the books too and grab the app. And the app is called myflow myflowtracker.com.

And it has the circle icon. Not any other icon.

The circle icon. All right, thank you so much for joining me. I appreciate it.

Thanks for having me.

All righty now. You know, I was so excited to have Alisa back on the show. She is such a wealth of information on this topic and it's so key critical. So again, wherever you are, it's not too late to get started. I highly recommend grabbing her books in the Flow and women code getting downloading that app My Flow and be sure you take the quiz and you can do that@jjvirgin.com Visyin see you next time.

Foreign. Hello listeners, this is Anne Bogle, author, blogger and creator of the podcast what Should I Read next? Since 2016, I've been helping readers bring more joy and delight into their reading lives. Every week, I take all things books and reading with a guest and guide them in discovering their next read. They share three books they love, one book they don't, and what they've been reading lately. And I recommend three titles they may enjoy reading next. Next Guests have said our conversations are like therapy, troubleshooting issues that have plagued their reading lives for years and possibly the rest of their lives as well. And of course, recommending books that meet the moment, whether they are looking for deep introspection to spur or encourage a life change or a frothy page turner to help them escape the stresses of work, school, everything. You'll learn something about yourself as a reader and you'll definitely walk away confident to choose your next read, with a whole list of new books and authors to try. So join us each Tuesday for what Should I Read Next? Subscribe now wherever you're listening to this podcast and visit our website whatshould I readnext podcast.com to find out more.