Lifestyle is Important…and Sometimes It’s Not Enough During Menopause with Laurie Marbas, MD

You are listening to Hit Play, Not Pause, a feisty menopause podcast for active performance-minded women. I am your host, Celine Jaeger. Each week I bring you advice from athletes, scientists, researchers, and other experts to help you feel and perform your best no matter what your hormones are doing. This show is a production of Live Feisty Media. Hey there, strong, feisty women. I hope you all are well. So as I think I've shared with you a few times, before menopause hit me, I kind of arrogantly didn't really think menopause would affect me. I mean, I was a semi-professional mountain bike racer, right? I was super fit. I was doing all the right things. I ate well. And we're taught to believe that if we quote unquote, do everything right, we will be protected from life's challenges and ills. And this is kind of especially becoming true for menopause. I often see women in our group who are frustrated and feel like failures because they're quote unquote doing all the right things and they're still suffering. And I also see the occasional comment from someone who says they are not suffering because they are eating plant-based or because they exercise and They're doing everything right. And the matter of the fact is that all the good exercise, diet, and lifestyle habits in the world will not necessarily protect you from hot flashes, joint pain, sleepless nights, soaring lipid levels, mood swings, all of it. Which is something that this week's guest, lifestyle medicine telehealth physician, Dr. Laurie Marbas, really, really— really wants women to know because she is one of those women. And I loved this conversation with her. It's all about how we have to stop feeling like we have failed because we have menopause symptoms and that you don't need to think of it like you are resorting to hormone therapy or throwing in the towel because you're using hormones. Conventional medicine is another great tool in our toolbox along with lifestyle, and we should feel 100% fine With using any and all tools we need. So this is just a great conversation with Laurie about her journey through menopause and how she was received by some of the doctors in her community, in her lifestyle medicine community, when she started using hormones, and how she has come to think about how women should wrap their minds around this transition and what tools that they should feel free to use and And just all the things. It was a really great conversation, and I think you will love it as much as I did. Laurie is super well qualified. She is a double board-certified family physician and lifestyle medicine physician who holds medical licenses in all 50 states as well as Washington, D.C. She is also a menopause-certified practitioner, and she operates a concierge practice where you can check her out at drmarbas.com. I'll put a link to that in the show notes. She also provides lots of resources on her website, including Master Menopause and Feel Fabulous webinar, where she provides, you know, a 5-step blueprint to managing the transition. She has her own podcast and YouTube channel called the Dr. Laurie Marbas Podcast. And I was just on that last week, and I highly recommend checking that episode out, of course, but her whole show. She is a real gem, and I will put that in the show notes as well. All right. Quickly before we get to it, head on down to those show notes and sign up for my free weekly Feisty 40+ newsletter. Give us a follow on Instagram and Facebook at Feisty Menopause. And while you are in those show notes, do not forget to check out the incredible gravel riding camp that we are doing in Girona in April. Spots are filling fast, so come join us. It's going to be amazing. Amazing. Thank you as always for those great reviews and 5-star ratings. I have a lot of amazing guests planned in the new year. I'm very excited about this going into year number 5. And speaking of the new year, it is time for our annual holiday podcast break. So we'll be replaying a couple of the greatest hits over our break and then back in the new year with all sorts of great feisty fare. So with that, enough of me. Let's have a few words about our awesome sponsors and get on with the show.

Random people don't.

Oh no, it's fine. Anyway. All right, Laurie, it is so nice to have you on the show. You know, my producer Carrie introduces me to so many great people, and I was really stoked when she made our virtual introduction and then we got to know each other a little bit. I think you're doing some really great work and going into the menopause space, so I want to hear about that. My understanding is that you have sort of entered the menopause transition yourself and found it perhaps a bit of a cliff. So let's talk about your background, your medical and athletic background, and just get into what you've been discovering as you enter this menopause space.

Oh heavens, there's a lot there.

Yeah, there is.

Oh, well, thank you first of all for having me. I'm delighted to be here. Uh, basically I'm a family medicine physician. I've been a doctor for a couple of decades now, and in that transition of practicing medicine, I was active duty military. I practiced in rural America. I trained in Texas, and I've kind of ventured upon lifestyle medicine through a plant-based diet about 13 years ago. And that's really been my primary focus, I would say, is really understanding The lifestyle interventions as far as the the health attainment and disease reversal and all that good stuff that comes with it. So that is primarily where that's been. But I have a really interesting and unique background. I also started a company called Plant Based Telehealth, and then we sold it. And so the entrepreneurial side is there as well, just trying to provide better opportunities for physicians and patients to connect. So there's that piece. And then so athletically inclined, I mean. As far as, you know, going back through, I think I've been— enjoyed running since, gosh, late high school as I was getting ready to, uh, try to go to the Air Force and the ROTC program. And so that's probably where the running started, and off and on through those years and doing lots of things like, you know, the, the 5Ks, the 10Ks, the half marathons. I've done one marathon. I've just done the full marathon with family. Raising a family back then and training and practice, as that was for me too much, um, because the kids are all scattered and doing their thing. And honestly, um, it was exhausting. So I really found that the running, kind of that half marathon, 10K, is the fun space. We did all sorts of, um, you name it, we've done it. As far as like, uh, any type of obstacle courses, we've done. all sorts of stuff. And so try to encourage the family. So we're always active and doing those things. And, uh, that transitioned to, you know, as I've gotten older, because I'm 54 now, um, last year I had— with running the company through COVID, I didn't run as much as I wanted. So I spent the year of like, let's say, '22 to '23 really getting ready, wanting to run a half marathon with my daughter who lives in Boston. She's she was finishing up her family medicine residency, which she has now since done. And I ran a PR for myself in the Boston Half Marathon in November of last year. But it was really interesting. I felt great. It was— I've always eaten well. I have good health. I mean, I have had hypothyroidism since my middle child was born 28 years ago, but that's never been an issue other than just make sure my medications are properly monitored. It actually decreased my dosage when I went plant-based 13 years ago. And so that was That was an interesting story. But the, the piece that was curious is, you know, I'm doing everything I tell patients to do to stay healthy, and I'm healthy. But then the menopause hit, and you read all the research, and it's always focused on hot flashes. And like, suddenly, like, hot flashes are the only— people think the only symptom of menopause. I'm like, no, there's so much more. And that's kind of what happened to me. I ran the half marathon. I did well. I was doing great. And within 2 weeks, I suddenly had this crazy stuff. I mean, I'd had lengthening of my periods, but they hadn't gone over maybe 60 days, and then they'd have another and then go 30 days, and then, you know, it was doing its thing. But, uh, this is when periods just stopped. I am now considered postmenopausal. Like, nothing came back in this last 12 months. And what was interesting, uh, I had severe joint pain. Mm-hmm. And difficult— more difficulty sleeping. I had slept pretty well, but then this was like insane. And the hot flashes, They weren't like some of the women I've worked with where they're just consistent and constant all day, but they were enough and bothersome that I was like, I cannot live like this. I wouldn't have so much the mood stuff, but my lipid panel— so I've had phenomenal lipids my entire life that I've ever checked. Suddenly my LDL, which is your bad cholesterol, bumped above 100 for the first time in my life, and I was like, what the heck is going on? I'm doing everything I know what to do, and So I went down the menopause rabbit hole, and it was really interesting to just see the research really hone in on HRT or MHT, what you want to call it now, that, that transition. People don't always know what that is, but understanding the safety profile for, you know, these hormone replacements there is actually pretty good, and the majority of women could benefit if they choose to incorporate that. And there shouldn't be this fear of even having the discussion with patients, including myself now as a patient. And a few months later, I decided to go ahead and embrace the MHT, and I felt so much better. My lipids went back to normal. My joint pain pretty much has resolved. That took a little bit more time, I think probably 3 to 6 months. But what menopause allowed me to do was it, it Literally said, Lori, stop. You need to pay attention to what's going on here. I need you to quit running like you're running for your life at full speed, 180 miles per hour down the road, running off, and I'm going to throw you off this cliff, but you'll be able to climb back. That's basically what menopause said to me, and I listened. And now that's kind of the message that I bring to patients is that one, the lifestyle factors, if I hadn't been as healthy as I would, I can't even fathom what that would have been like. I don't even know. Like, I don't even know. So that's the beautiful piece about it is I was already doing what I was doing. So there's a piece there for women who are like, I am so confused. I'm doing everything I'm supposed to and I'm still not well. Well, I was one of those people. And I've had opportunities to speak to male counterparts in this space who are like, you shouldn't— they're older white gentlemen, no disrespect, but they're like, oh, well, you could take a little estrogen. I guess that would be okay. I was like, who are you to decide how much or what? And they're like, I was always saying it's symptom resolution. That's per guidelines. That's recommendation that would make sense. And they're like, you shouldn't do it to symptom resolution. You should just do a little bit. I'm like, then what's the point? And I was like, dude, you're really annoying me. So this was on stage in front of an audience.

Wow. I can't even believe what I'm hearing.

Oh, yeah. Oh, trust me. Trust me. So it's really interesting. And then the research, they're like, oh, just eat more soy. I'm like, I'm already eating soy. I'm eating all those phytoestrogens, and they're wonderful. And many women who walk this line and do plant-based, they have no symptoms and they do great, which is such a true blessing. But I'd never think that the universe doesn't send us an opportunity to learn. And that's what I've learned, is that there's others, and you have to look outside your, your little dogma or your, your little belief system and understand. And that, you know, that's been an ongoing growth, is just being open to Diving deeper into understanding this is a place where medication for me was absolutely essential because I was already doing the lifestyle components. You know, the the diet, making sure you get a protein. I was doing resistance training. I'm doing the the um the cardiovascular fitness, all of that, and maintaining a very healthy weight. So I was and am healthy. But there was a piece here is like okay, we need to broaden this perspective and open the door to this discussion around. You know, other alternatives other than just lifestyle, which is weird for me to say because that's all I've been doing, right, is encouraging patients to do. I mean, we use medication, of course, still, but—

Yeah. Yeah. No, I extend enormous amounts of gratitude for you to come on and share your experience here because all too often we have a complementary Facebook group that goes with this podcast. It's got about 33,000 women in it at this point, a lot of women. And very often, and I know it's well-intended and coming from a good place, but somebody will come in and say, oh, I don't experience anything because I'm plant-based and follow this and I don't drink. And I think that, that definitely helps. It's not a guarantee because every woman has a different journey through this and it's And it's not a failing. It's not a shortcoming. It's not— it doesn't mean something's wrong with you. It just means your body is responding differently to this transition and has different needs. And I wish we could take the— and we do it with all health, right? Like, we like to blame people for their cancer in the same way or say, oh, I'm not going to get that because I eat so much broccoli. You know, we have this tendency to do that.

Yeah.

And I just want to take that off of health in general and especially off of menopause. You are not necessarily doing anything incorrectly or wrong because you have XYZ symptoms, or you have not failed menopause because you are seeking hormone therapy. You know, none of that is—

Right. 100%. And I, I will tell you, I— it's almost like you get shamed into failing because you're not— you're obviously not doing it right. You're not doing this. You're not— and That's the piece that really bothered me. And so I think the important thing here, just to kind of— I wanted to highlight something. I think what was interesting is there's 2 things that I think affected my journey. Was one, how rapidly I probably stopped producing estrogen, right? So it was that— it was the actual, like, I was still producing and suddenly I stopped. And I think that was part of it. And then I think number 2 are the genetics. My mother and my grandmother suffered for well over a decade. With symptoms of menopause. And so the unfortunate thing was that, that I don't— I can't find a— I mean, there is some evidence pointing to the severity of your menopause symptoms genetically, but I think for me, I've seen— I watched that journey in those women in my life, and I was probably already new. But I think it was just how quickly my— because I was still having some periods with some pretty good predictability, and then it just stopped. And I think that rapid decline— but when you're getting back to the whole belief that, you know, we do this and therefore every— I'm— it's like, just because you're on a plant-based diet, you're not going to die of something, you know? Yes, you decrease your risk, you're probably increasing your health span, I mean, probably increasing your lifespan, but at the end of the day, we're still going to die of something. Yeah. And things, right, you know, what are the environmental toxins? What were the first, you know, 30, 40 years of your life before you transitioned to the plant-based diet? And I still truly hold the plant-based diet as the foundation, one of the foundations, along with exercise and sleep, that we all need to be doing as far as at least being more plant-forward, eating more vegetables, eating more of these things. And certainly meeting patients where they're at. If they don't want to go fully plant-based, then that's fine too. But, I mean, I've seen patients do dramatic, dramatic health turnarounds by going all in plant-based. But certainly, you'll see benefit by eating more fiber. There's no doubt there. But at the end of the day, we absolutely need to stop this judgment and stigma around blaming the person who's suffering for their suffering. Now, are there better decisions as far as, yes, maybe they're They were overweight most of their life, and they're but but let's talk to them about what's truly going on. Let's talk about the habits. Let's pull them out of the shaming, and you know, let's talk to them about what can we do to move forward to a healthier lifestyle that will definitely help. You know all of those symptoms, but you shouldn't feel like you failed if let's say your cholesterol stays high on a plant-based diet, right? Or I mean, those are the— I do videos on my YouTube channel, and those are the videos that get the most. They're the ones like, why are you still struggling to lose weight on a plant-based diet? Why is your cholesterol still high on a plant-based diet? Why are your blood sugars in a burst on a plant-based diet? These are the people that come to see me because I'm licensed in all 50 states. I get the ones who are not the ideal beautiful case, you know, that's in front of the magazine cover. They're the ones that are still struggling, and there's a lot of them. There is a lot of them, and I— it just blows my mind, um, the how people can make themselves feel guilty because they're not living up to this some perceived expectation in their head of what, you know, some diet or some exercise or something should make them do. It's— it really is— our brains are— there's some interesting things go on here. Well, I just know the voice in my own head. I can't even fathom everyone else's. But

yeah, there's a lot. There's a lot of voices in all of our heads. I am— I want to explore a lot of the advice that you do give, you know, that is complementary to all of these, whether or not somebody is on hormone therapy. Going back to that doctor who was like, oh, just take a little, like, What, what do you think the genesis of that was? And why wouldn't you take what you need to resolve what you're feeling?

I think it's because these individuals who speak that, they live in— one, they're male. There's that. Uh, because I have never— because what I'll just highlight, after that conversation, there were 4 of us on the stage. And 2 females, 2 males. The other female was a naturopathic physician, and she get— she talked a little bit, but her more specialty was GI related. Um, but the 2 males, one, they're older, and they've lived through decades of just promoting plant-based diet, plant-based diet, plant-based diet, cure for all things. I almost feel like they've, they've so much gone down their own little construct of what the plant-based diet can do. Um, or what certain lifestyle elements or interventions should be able to do, should be able to cure everything. Like, they truly believe that that is the antidote to every single thing, back to the level of health that you are when you were born or something. I don't know. I think they're just so deceiving themselves that they can't even fathom that there's a place that pharmaceuticals can be very, very helpful. And understanding the research, right? So they, they'll poo-poo anything Before they actually will look at the evidence and speak to the patient about the symptoms, because the moment that you start blaming someone, the same individual I certainly know will like then you're lying to me basically is basically what they're saying. You're not doing the diet correctly, right? So that's that's the the the the why I speak they're saying to themselves, and that's the unfortunate piece here is I think he almost said oh you can take a little estrogen just to. Be respectful in the sense of like, well, I disagree. You shouldn't take any just because I was sitting there. I truly believe he said it that because of that, and I I had to be very politically correct. I was just trying to be calm in that situation and not just create a situation, and it went out okay because after that that conference, after that that you know we're up on stage, we had. So many women come up to us, but one lady in particular, she came up with her little walker. This is what was brilliant. She's like 70, 80 years old, right? And she's like, you listen to that young lady. Let me tell you, I wish someone would have given me hormones 30 years ago, but someone wouldn't do it, or 20 years ago, whenever it was. But you need to listen. Don't suffer, ladies. Don't suffer. And like, I was like, oh my God, I love her. And so that was just speaking. you know, the audience I was speaking to, even though they were there for eating a plant-based diet and doing those things, there was true understanding. Like, I, I hit a really raw nerve that was not being addressed in this lifestyle medication or lifestyle interventions. You know, it's not just diet, it's, it's got to be the continuum. It's just like me saying a regular doctor who doesn't understand lifestyle interventions or lifestyle medicine If they're just offering the conventional treatment of pharmaceuticals and not speaking to you about what you're eating, what you're moving, what you're sleeping, that is malpractice in my opinion. It's the same to do just lifestyle intervention and not say, you know, there's this place here you need medication. I write scripts for statins. Yeah. I write scripts for medications for diabetes. I've even utilized drugs for weight loss with patients because you know what, that's what that patient needs and that's where they're struggling and that we're creating a personalized plan for them. And to say that all women across the board are gonna have the same menopausal journey is a complete lie and fallacy. It's just not true. It's just not true. And that if you are suffering, that you've done something wrong, that is not true either. Oh, gets me, gets my goat. But anyway, yeah, that's where I am.

Were, were you able, and I do, I don't wanna just gloss over because I think that was important too that you said, because you said a lot in that. in that story, that I too found that menopause, that point in that transition, and I think most people hit that inflection point where they're like, okay, what is happening? I need to figure this out. It is a really good opportunity to reflect and to go, what am I doing? You know, what do I want to continue to do? You know what, why am I— Yeah. It's just such a great reset, you know, if you, if you let it be one. And I'm wondering what you personally, besides like looking into hormone therapy and saying, oh yeah, this, this is a tool that I can put in my toolbox, did it, did it change anything else? That— do you still run half marathons? Like, did it change anything else that you were doing and have gone forward to do?

Yeah. So when I was doing my running, And this happened so quickly. I couldn't run as much because it hurt. Like, I just was hurting. I couldn't sleep because of the joint pain. I wasn't sleeping as well. And so I had to stop my running. And when I stopped my running, I said, well, I'm still moving. So I started walking. I would walk— I mean, I walk 5, 8, 10 miles a day. Depends on the day, but I'm walking, walking, walking. And Wonderful point, uh, there was I started really diving into my spiritual journey as well. Mm-hmm. And so wherever anybody believes in their beliefs, I'm not here to judge that. I'm just sharing my own story, is really understanding, you know, my faith and understanding a true broader sense of spirituality and why we're actually here. And it just really opened me up to a really cool place in my life I've never been, and I've really enjoyed that journey. So I'm thankful for menopause for that because it gave me a new perspective on life and with people, and I'm hoping it makes me even a better person, kinder, more a person who understands that every moment is a treasure, right? And so like understanding that us and our conversation is is a true gift, and not to just ignore that that literally every moment. And that's really where I want to go into life, and that's kind of what's interesting is that. perspective really made me start thinking about what I want to do with this latter part of my life, and including my athletic endeavors. And thinking back, why was I doing what I was doing? Was because I want to prove, one, to myself that I can still do it? Okay, that's fine. But, or is it because also I want to be the younger person in my kids' lives, you know, that can do it? Or was it because I just want to You know, show that, you know, my YouTube channel, whatever, you know, why I really started evaluating why was I even doing what I was doing. Do I find— do it for the enjoyment? Fantastic. If I'm doing it for any other reason, I would— I struggle. And so what I've decided to do was my running probably won't be as long a distance. It's more of the walking and hiking, which we've always done, but more of the hiking and enjoying and traveling. And in my month of my running, It's more for the cardiovascular benefits at this point, um, because I, I really want to spend more time with my family and that hiking and just that, that slowing down. Because when I'm running, I'm thinking, okay, here's my pace, this is what I gotta do, I gotta do this and do that, versus the walking and hiking. I can still get some of that cardiovascular benefit by carrying a load or whatever, but that allows my time for my brain to slow down and go, okay, Laurie, I'm in nature. Let's really ex— soak it in and be able to look. Because when you're running, also, I'm looking at the ground. If I'm on trails, I don't want to trip.

Yeah.

I'm missing this amazing vistas in front of me, right? And you look up, you're like, whoa. And that really came— there was a— I ran a— I can't remember which half marathon it was in, uh, Colorado when I used to live there. And I remember there was a picture of me that they had taken, and it was this huge, beautiful canyon. And he's like, I don't even remember that. And I was like, oh my God. And so I just really changed my priorities. Right? And so that's really the beautiful story legacy of my menopause journey was just allowing me to sit back and go, dang, there's a great part of my life that I'm gonna really enjoy right now.

I love that.

Yeah. So that, that was, that's really where menopause struck me. And so now I'm, I'm doing, um, resistance training. I'm, I'm, we're traveling full-time in an RV. We sold our house and everything the last 4 months.

That's right. You told me that.

We're literally all over the country and we're enjoying life. And so I've had to adapt weights to bands and I've created some pretty decent way of doing that. So I'm feeling good about that, where that's going. But the mobility training for me was really, really key. And creating that flexibility with the mobility piece. And then, you know, really focusing in, like, maybe, you know, I'm still doing the walking, but now I'm bringing in, you know, HIIT training, a little bit more of that, because I certainly know that will help VO2 max and all that. Because I know what the science says. I'm just like, how can I do it and enjoy it? So I do jump roping, right, versus sprinting. Oh, nice. So it's a weighted jump rope. That's been really nice. So again, I'm just trying to figure out what is portable. And doable in a small space. Not that I jump rope inside, but, you know, around. But that is— that's kind of where I'm at right now, is to maintain the flexibility, the functionality as I get older. And that's what I encourage my patients. But one thing that I've really noticed with— because most of my women, most of my patients, I'd say 80% are women, and most of them are 45 and older. And as they're approaching this, they're so stressed about the symptoms, they're not taking time to slow down. And that's kind of been my message. To them, I was like, menopause is for a reason. We're one of a few species on this planet that live old enough past post-reduction age. There's a reason, and we you know I try to say like there's there's wisdom in your experience. There's wisdom in your journey, and this is a time that you have to slow down and take care of yourself because you cannot keep functioning in this capacity. You'll go crazy. I mean, I felt like I was going crazy, and I didn't even have near the suffering that some of my patients do. I don't know how they suffer so much. Like, literally, I don't understand. I'm a wimp. I'm like, I don't know. I just—

They shouldn't, though. They should not suffer so much. Nobody is. If there's any message on the show, it's like, do not suffer. You do not need to suffer. But I do love that you are— you know, I, I worry sometimes that That people get so hung up on what, what is held up as the ideal that they don't just do the good enough, you know, for them.

Yes.

And that, yes, I am a big proponent of lifting heavy. I 100% am. I think there's a lot of benefits to that. And I think it's amazing that you are living this amazing life in your RV and just richly absorbing what this earth has to offer. So if you don't have a barbell, so be it. You've got bands and, you know, you're stressing your muscles in another way, right? And you're

doing

HIIT training and you're getting some jumping in and you're getting all the high notes. You're getting the medicine, if you will, that you need to be your best.

Right. And I think the— I'm building off a good foundation already, which allows me to kind of really use my curiosity and explore different things in, you know, this isn't working, so maybe this will. So that's a piece here. But I really want— I love what you said that, you know, what's— we're missing the good enough. And sometimes people— it's kind of like watching the Olympics, right? You see someone who wins a gold medal, you're like, man, that would be amazing to win the gold medal. But, you know, there's so many athletes that don't win the gold medal, but they're amazing athletes, right? And so— You don't have to be the best at every little thing that you're doing, but those small little movements will get you to an amazing high point.

Yeah.

And being okay with what your body can do and your journey and knowing your journey is unique and special and nobody else is gonna live this journey. So you might as well embrace what you have because every time we're comparing to someone else's journey is where, you know what they say, comparison is the thief of joy or something.

The thief of joy. Mm-hmm.

Yeah. This is so, so true, right? Even in our health journey. So then they give up. I'm like, why are you giving up? These small little steps add up. I have a perfect patient explanation, lots of patient opportunities to share stories to share with you, but one in particular struck me, happened years ago. And she was a woman who was diabetic, overweight, older woman, probably in her mid-60s at this point, my early 60s. She's still working. And we're trying to get her— I was trying to get her to start eating better, right? Incorporating more plant foods. That was Okay, was struggling. But then I started talking about exercise and movement, and she's like, "Dr. Marbas, I don't have time for that. I'm too tired." I was like, "Listen, we're gonna have a little conversation. When are you outside?" She goes, "I'm outside two times a day. I go to my car to work, and then I come home, and I go right back in." I'm like, "Okay." I like, "Do you have a driveway?" She goes, "Yes." And she's like, "Where is this going?" I was like, "Listen, I need you when you pull up." At night, you open your door, you leave the door open, and you walk down to your driveway, and you walk it back, and you slam it shut. And you said, good, I'm done. That's all I want you to be. I just want you to walk down to the end of your driveway, back, and that is your exercise. She goes, are you serious? I was like, yes. I was like, do you promise to do that? And she goes, oh my God, yes. I was like, do you pinky promise? So this is when I was still seeing patients. So we literally pinky promised in clinic. And she was like, I even wrote in her note, pinky promise, so I'd remember to ask her about that the next visit. And I will show you what happened over the course of time. She went from— she did it because we pinky promised, and she walked down to the end of the driveway and back. And then at the end of the driveway, she goes, this is ridiculous, I'm going to walk around the block. And over time, what you see is a 2 to 3 mile walk and a 60-pound weight loss and reversing her diabetes and hypertension. Wow. And so This is the type of thing you— she just had to get over that first hump. Yeah. And then once you get over the first hump, that's a downhill slide. It gets so much easier, but you just have to make that first small habit stick. And what you do is you anchor it to something she was already doing. She was already driving home. We just added literally 30 seconds, and that 30 seconds literally transformed her life. And I, I like to tell people it's like a compass, right? So we know we're, we're like, we're heading north, let's say, and we're, we know we're heading north. But what we're gonna do is we're gonna just deviate 1 degree. And over time, as you see, you get further and further away from where you would've been. And that 1 little degree makes a big difference over time. It's like the penny that compounds every single day for 30 days. You end up with like $10 million or something, right? So that's the piece here is this, this, this small little habit done over and over and over again over the course of 30, 60, 90, a year, date. Yeah. All these days. Mm-hmm. That makes a huge, huge difference. And once people get that, they're like, whoa! One more patient story. You like this?

Yeah, yeah.

I had a patient. This must have been was about two years ago, and she was in her early sixties as well. And I was like, okay. I was about the resistance trays. Like I needed you to start moving your body. She goes, oh my! Are you kidding me, Dr. Marbus? I can't do that. I was like, yes, you can. Let's talk about it. I was like, where in the world? Let's say if you were traveling or anywhere in your day, you there was one thing you always had to do. I don't care where you. are? She goes, I have to have coffee. I'm like, okay, brilliant. I was like, what do you do when the coffee's brewing? She goes, I stand there and wait for it. I'm like, okay, so during that time there's usually a counter. She goes, yes. Or a wall. She goes, well, yeah. And I was like, what I need you to do is do 2 push-ups against the counter or the wall every single time your coffee's brewed. And when you're done with those 2, you're done. She goes, okay. I couldn't pinky promise because literally She was video, you know, like, okay. But what ended up happening was, of course, we're talking about her other issues. A couple months later, I kind of just, you know, the push-ups kind of fell off the radar for myself. And what was funny, she goes, Dr. Marbas, you haven't asked me about my push-ups. I was like, oh, I'm sorry. Well, tell me about your push-ups. She goes, well, let me tell you, I can do 60. 6-0. Now against the counter. I was like, you can do what? She goes, yeah. She goes, look at these guns. And she's pulling up her arms and showing me her biceps. And she's— I'm like, that's fantastic. What's the next level? And so we started talking about how to make it a little bit harder, but she was so excited and so confident that she just kept pushing herself. So it's like, it's just have to get over— you have to believe it. You can do something so small. That it's ridiculous. And then it gets so easy that you start adding even more ridiculous easiness. And before you know it, you're doing something amazing like 60 push-ups against the counter. That's a lot.

That is a lot. That is a lot. That's a lot.

That is a lot.

That is— those, those are both really awesome stories. And I really, really, really like that, that idea. And people who are, who are listening and can't see this, Is that when you were talking, you know, you had your hands pointed up as you were going north, and then you just moved one of your hands off a little bit to show moving a degree, and then you traveled them over time. And it really does show how it's just like if you walk 1 degree off of where you're going, you're gonna go somewhere else, right? Over time.

Right, right, exactly.

Yeah, it's such an interesting way to— It's a vector. Yeah. It

really is a vector, right? So if those of you who are scientifically inclined in physics, it's vectors, right? So you start at one point and it just goes straight. So if you were to write on a piece of paper one line have it go to the top and now start back at that same point where that line started and just veer it just a hair and then draw it straight. You're going to see that imagery of those two, those two endpoints get further and further apart over time. And that really is the key to success.

Yeah. And it trans— it, it sort of transitions us well into— I want to talk about some of the specifics. I've had other people on who are lifestyle Doctors Amy Commander comes to mind. Michelle Tufelson comes to mind. Yeah, they've written books. They're really cool. Yeah, really, really great people. For menopause specifically, and for some of the things that you talk about, I went to your site. You have a lot of really nice, you know, carousels and all of that on your Instagram that I think are really useful. But I wanna hit some of the high notes that you think are important for women in this time of life. I know fiber comes up, and phytoestrogens, and anti-inflammatory nutrition. This isn't a vegan podcast, but we have plenty of plant-based audience members. Protein, how you get your protein, I definitely want to ask you. But just talk about like the benefits of including these elements specifically, which definitely come from eating plant-forward, if not plant-based. What do you think the high notes are?

Right. Wow. There's a lot here too. So I think there's 3 elements that I find that are going to be the big

The big rocks.

Yeah. Well, that I almost think of as like the big ones that can start a small snowball that grow into a bigger snowball.

Okay.

Because it— so what I'll do is I'll work with patients or women I work with and say, okay, what are one of these 3 elements? Is it adding more fiber to your diet? Is it moving a little bit more? Is it working on your sleep? What is the easy lever here that we can do? Because once you start moving one lever, the other 2 levers get easier to move. And that's step one. And the reason I bring it down to these 3, because stress, Mm-hmm. Community, you know, those other pillars of lifestyle medicine will naturally have what I call— it's, it's, it's— I cause it— I call it positive collateral damage, right? So you start getting collateral things start moving better and all those things, right? So if I can focus on these things, one, because it's you taking care of yourself, which makes you show up in the world as a better human, right? And you're mentally— you start thinking about things, you start building habits. So those things start working. I'm a big fan about— I've done a lot of research in how can I connect with patients and talk to them about behavior change and understanding, you know, how can they change that voice in their head, you know, to be a more positive influence, what that means, really understanding utilizing mindfulness is a huge, huge one. But anyway, but as far as—

What does that mean? Mindfulness? Because, well, are you saying like utilizing mindfulness is a huge one? And then you sort of left it. But I think that to get to these other things, that is often the first piece.

Right, right. So when I work with them, so I have a mindfulness group that I work with, we meet twice a month for like 90 minutes and, um, or a, a menopausal group. But the, the, in the menopause group, the first habit that we first, we learn what a habit is, right? So it's a cue, a trigger, the behavior, and a reward. We start talking about the important pieces to that, but the first habit we build is mindfulness. And what is mindfulness? It's just being present in the moment without your brain living in the future, without your brain living in the past. So when we're living in the future, we're sitting in anxiety and worry and thinking about all the things that could possibly go wrong. When we're sitting in the past, where we're living in regret, shame, guilt, whatever women are very good at doing— we all know these feelings— In the present is when we said, you know, I'm done with those voices. Now I'm gonna be here. And the way, way to do that is connecting with the breath, connecting your, some through your senses to this moment. And I think that's what the joy is with walking in nature for me is. And then start filling your mind with more positive inputs. You know, it'd be a podcast or, you know, uh, music, whatever that is. Meditation. I find it harder to sit and be still with meditation. I do better with like what I call a walking meditation where I'm just— Breathing in. When I notice that a thought comes in, understanding that I'm not my thought, I'm not those voices, I'm the observer of those. And when I realized that, that I'm not— for example, if my voice in my head says I'm a pink elephant, last I checked, I'm not a pink elephant, right? Or, God, Laurie, you're a failure, you suck. And I know women say that to themselves. You have no value, or you have this, or you're overweight. You're never going to be it. I have had patients tell me, you're not worth it to start working on a better diet. I have had patients tell me I have no value, that they don't have a purpose in life. And so, as a physician sitting in front of someone, I'm in a really unique place because they tell me intimate details of things that they wouldn't tell even their spouse. And as a woman hearing this from another woman, it breaks my heart because they're so valuable because you're freaking human. You're amazing. And so that's the other piece of that. So that mindfulness piece allows us to detach from these voices that are just decimating any feeling good and positive in the world, right? It's just, it's so loud in their head that they can't hear anything else. But once they understand they don't have to To argue with the voice. They don't have to try to ignore the voice. All they have to do is step back and observe the voice and know that it's there. But that power of just stepping back and going, wow, I'm not actually the voice. I don't have to listen to the crazy roommate that lives in my head. Right? And so what happens is you can just allow— I said it's like you're in this tumultuous river, right? And it's flowing. What you're gonna decide one day is to step out of the river and just watch the river go. Mm-hmm. And the river's carrying away the thoughts and the feelings and the emotions and all of that. You get to step out. Now, if you wanna step into the river, you can, but just know there's consequences to stepping into the river. But you can make a mindful choice, right? So you're present to make that choice. And I said, when you start practicing this, let's say you're chopping vegetables and all you're doing is you're taking a deep breath and you're just observing. You're not saying, oh, I'm chopping vegetables. You're not commenting it in your head. You're just observing it. And what's happening here is you're building that mindful muscle. And the more you do it in these mundane activities, What's really incredible is you find that you're being more mindful in the more stressful situations, like when menopause symptoms start occurring, or when your spouse is arguing with you, or your kid's doing something you don't want it, and it gives you a space of calm. You're getting your thinking brain engaged, and you can make mindful choices, right? Anyway, so that's kind of the mindfulness piece that I really, really want people to understand. It's such a— it's a superpower. And once you understand the mindfulness piece and you become aware of what you're doing, because you might be starting to be pulled into the river, and then you step Oh, look, I'm in blockage. I'm gonna step back out of the river. And suddenly peace and calm. That's the piece that's so important is really understanding that calm and peace that occurs with it. That I feel like that has been the biggest. I'd already been practicing mindfulness and working on that, but with menopause, it made it such a stronger presence in my life. Yeah. And so that is what I teach my patients. And when we understand the mindfulness muscle and we build that, We can approach other things and other things like how to get better sleep, how to eat better, because a lot of times around wrapped around the diet is emotional eating and these relationships with comfort foods and stuff. And so we explore that because that's a different that's a different discussion with every patient. I mean, I've had patients as far back as going well when I was a kid, I couldn't control anything else in my life. I was abused, so I would hide food and sit in my closet and eat it.

Yeah.

Um, and going to the point that as they got older, they would dress up in disguises and go to the, you know, convenience store and buy food and hide it, you know, to, um, one of my patients lost 350 pounds embracing a whole food plant-based diet. She was in her, you know, early to mid-30s, and she's kept it off now. That was, uh, she started her journey in January 2017, so now we're, we're almost 8 years in. And so these are the type of stories, incredible things that people witness when they realize, one, they're worth it, and we don't have to listen to the crazy roommate in our head. We just don't, because it's not you. It's, it's just an energy that will pass. Yeah. And the more we feed it and engage with it, the more it's gonna say, well, I like it. I'm gonna stay here. You don't have to allow it to live right— be in your head. You don't. Because most of the time those voices are— were placed there by someone in our past or some experience.

Yeah.

Or our interpretation of an experience to try to help us figure out. Once we realize the world is going to always be changing and accept change is the one constant in our lives, and that we can step back and, and just appreciate that that's fine. We don't have to fight reality. The reality is what it is. And the moment you accept it, you can step back and go, okay, now With wisdom, I'm in a calm place. I can make a decision on what to do now. It doesn't make it— doesn't make it that it's going to be always joyful and delightful, but you're in a place that you're in a wiser place, right? Your place coming from a place of calm to make a decision. But yeah, that's the mindful muscle that I like to incorporate with patients. That's my number one.

I love that. I love that. So then when we talk about what we, what we, what we present them as helpful dietary pieces, what, what do you add in there?

So I do a few things. One is, you know, understanding depending on their age, but most women, um, I really want to encourage them absolutely to get enough protein minimally. And that's another interesting conversation that I have, you know, like The, the, the story is you can get plenty of protein on a plant-based diet, which is true.

Mm-hmm.

But there are some caveats to this. So let's say that I, I have a little older lady, and she will have heard some gurus say, eat a pound of vegetables for breakfast. So they go and eat a pound of vegetables, which is one, calorically not very sufficient. 2, it's full of fiber, so she's gonna be full.

Yeah.

Very full. And we're not getting the protein that we need, right? And so over time, I will absolutely see evidence. One, they're fatigued, they're losing too much weight, or if they do, you know, they're, they're just not feeling well. So there's some, some tweaking to the diet. And number one is understanding you need to eat a wide variety of plant foods. Build on legumes, build on soy products if you don't have any allergies, build on whole grains, add in those non-starchy and starchy vegetables, add in those fruits. But really make sure you're eating a calorically sufficient diet to maintain a healthy weight. And I do say, let's follow what your diet is. Let's put it into Cronometer. Let's make sure you're hitting all those micronutrients and macronutrients. But we start with 1 gram per kilogram and go up. You know, if we can hit 1.4 kilograms or 1.4 grams per kilogram and with some resistance training in there, that's a great one. And if they're struggling to lose weight, we might do a very small caloric deficit. And again, that's— but this is a planned plant-based diet.

Right.

It, it just blows their mind that they're like, but that's not what I've been told. That's not what all you gurus are saying. They're always saying you can just eat a plant-based diet, lose the weight, and be fine. I was like, well, that's not necessarily true. There's hormonal things going on here. Maybe you're on medications. Like, let's say if you're an insulin-dependent diabetic, that is going to drive weight gain. I don't care who you are. And so there's so many things. if you're insulin resistant, let's talk about— there may be more lower glycemic, higher protein foods I want you to engage with. I don't want you eating a banana right now. Doesn't mean you can't eat a banana, but you will. But we need to make you more insulin, you know, sensitive before we do that. That's where I utilize CGMs with patients. And this gets back to each patient is an individual with individual genetics, individual experiences, individual medications. And we just can't say yes, Just do this and you'll all be fine. No, that's because I get patients every single day that are like, I've started eating this plant-based diet and I'm seeing some initial results, or maybe now it's getting worse. I can't lose the weight because they're doing something out, you know, that just needs a little tweaking. Once we do the tweaking and they understand with education, boy, then they thrive, right? You just need a little help. Then I may see them once a year just to get some labs and make sure they're doing okay. So that's where I show them with the protein, but I really love that, you know, the soy products, one, because of the phytoestrogens, number 2, because of the bone building capacities with the higher protein and the phytoestrogen. They help with the— there's certain estrogen receptors that those hit in your bone. They also help with cholesterol. So soy, if I can say, and decreases risk for breast cancer, all these wonderful tool things that come with soy products. Um, and then as far as, you know, fiber, I like the fiber will take care of itself. I just need you eating plants from every category, including nuts and seeds, right? A handful of nuts and seeds a day. And making sure you try to get as many colors, right? So if you can get a few different colors in there every day of the rainbow, that is fantastic. Reminds you of the wall in the background that you have there. Um, you know, make sure your plate is beautiful and colorful. And, um, that's how we kind of approach it. Now, let's say someone wants a tortilla. Do we do a white tortilla? No. Maybe we try to do Um, you know, whole grain, let's start moving in that direction. Um, if they want pasta, let's look, let's play around with some bean pastas, right? So just kind of changing certain foods and those certain elements, that's step 1 with the diet. So like I said, if you're eating primarily plant-based or plant-based diet, the fiber will take care of itself.

If you're not, it will not though. I mean, I can—

If you're not, if you're not, but I would say, I would say certainly minimally 35 grams, try to push it above that if possible. But we have to be careful because people who haven't been— their baby have been fiber deficient, there's going to be some GI ramifications. So it's like before you go start, you know, pounding down a pound of black beans every day, let's start with lentils, a quarter cup, see how you do. You know, a good rule of thumb is the longer you have to soak it, if it's a dried bean, probably that needs to be towards a later introduction date. But lentils, you're not soaking, right? You just cook them up. They're easier to digest. Yeah. And just slowly start building that in. Sometimes when people go all in, they're always like, oh my God, there's bloating and there's gas. And I'm like, yes, because your microbiome's going, whoa. So there's some things there that we can do to make that transition better. But yeah, that's— that would be that. And calcium is another one too. I want to make sure they're getting enough of that in their diet. I'm not a huge fan of calcium supplements unless someone is really struggling, just because there's some ramifications with taking calcium supplements. increased risk of atherosclerosis and some other things. It makes the blood more likely to clot. So if you do need to take a calcium supplement, I'd break it down to probably 200 to 300 milligrams in multiple doses throughout the day. Plus, you're not going to absorb as much in those larger doses. But, you know, a lot of times their primary care doctor will just say, oh, take a 1,200 milligram calcium supplement, and not even think that, you know, where are they maybe they're getting sufficient calcium in their diet, which is better absorbed anyway.

Yeah.

You know, making sure your vitamin D is good. As a plant-based person, absolutely need to take a B12 because it's only made by bacteria. It's not made by animals. It's not made by plants. And I typically would see most people, when you're checking your B12 levels, you want to be above 500 but below 1,100. And most individuals, at least that I work with, are going to need 500 to 1,000 micrograms per day, which is actually a very small amount. But we're— if you're in a plant-based diet, you're coming from a place of deficiency in B12 already. You know, the RDA is like, what, 2.6 micrograms or something like that? It's not enough. And what I see when I say 500 is that I've certainly seen patients with one lab, um, uh, results showing that they aren't getting enough B12. For example, a homocysteine is elevated, or methylmalonic acid, which are require B12 to be further metabolized, or the size of the red blood cell is larger than it should be, and that's called an MCV. And once we start adding enough of that B12, that will all get better. Sometimes they'll have symptoms of fatigue. Um, the fatigue is a big one. Um, but the B12 is, is probably my— the only supplement that I say has to happen on a plant-based diet. Yeah. The other 2 that I do recommend and I would test, don't guess type thing, is vitamin D. And also your omega is an algae form of omega-3s. And those 3, I would say, are a nice edgy, you know, research evidence-based. You're going to see some benefit there. So those, those would be the 3 minimal. But calcium, iron, depending on if you're, if you're a menstruating woman, Sometimes that might be a place that we really need to pay attention to because the non-heme iron is not absorbed as well, which is the plant-based iron versus the animal-based. That's a ferritin. I would check ferritin and make sure it's over 50. Okay. Because sometimes even your iron in your— in the blood, because that's what's available for to be used, but the ferritin is— think about it, that's the storage in the back that we go to when we're iron deficient. We go back there, and if your storage are low, you're going to notice fatigue, hair loss, sometimes restless leg syndrome. Those would be the big ones as far as, you know, thinking about certain things on a plant-based diet that are the big levers that will make people feel better and do well. But the exercise piece, yeah, is one, start a movement that you'll enjoy. Like I said, I just say, what can you do and what will you do? It's not what I think you should do. It's like, what will you do? Tell me what you will do. Yeah. I never— I try to be very careful unless they're just like, cannot think of anything about giving options. I'm like, you tell me what you'll do. And the sleep, the sleep is a big one because people think it's a commodity that they can just sacrifice when honestly they don't understand the ramifications of, you know, continual sleep deprivation is horrendous. I will say that I thought I was sleeping well. Before menopause, but I'd wake up in the middle of the night just thinking I'm a light sleeper, quote unquote. Yeah. After starting the HRT, I just realized that 5 to 6 years of perimenopause was totally playing with me. They're just like, we're just gonna play around and make you lose some sleep. Now I sleep so much like a log. It's like, what is this amazing thing called sleep? And so it's even more, more Important to speak to patients about, for sure.

Yeah, no, all of that is, all of that is outstanding. And for, for women in this transitionary period, particularly, you know, we talked about fiber, and I'm seeing more and more like that those minimum doses don't seem to be quite enough for this, for this group. Can you just speak a little bit about the benefits of fiber? I mean, I know there's even an estrogen connection, you know, with our—

Yep.

Estrobolone. So I, I'd love to talk a bit about that.

I'd have to dive deeper into the mechanism there. But as far as fiber in, in and of by itself, one, I— you would not believe— people don't talk about poop. So I talk— we're gonna talk a little bit about poop. People will go days without pooping. I mean, I've had patients tell me they go a week without pooping. I was like, how do you even live? This is not normal. And So one, you're gonna have bowel movements, right? So you're reg— you know, the regulation there, the, the potential for cancer decreases, right? And you have your colorectal type cancers. Did you know the age group that are at the highest risk of colorectal cancer? Take a guess of what age group you think that is, or maybe you already know.

I have heard it's younger than you think. So—

18 to 35.

What?

Yeah, so these are my kids' age, right? My kids are in their late 20s, early 30s, and their, their cohort, that population is at higher risk than ourselves, their grandparents, or great-grandparents because one, we're introducing such unhealthy habits at such an early age that they're gonna— they're getting the consequences of chronic disease such as cancer, type 2 diabetes, high cholesterol, heart attack and stroke. Earlier than their, you know, their predecessors, their parents, grandparents, and such. So that's one thing. You're decreasing risk for that. You're going to have better insulin sensitivity because that fiber slows down the gastric emptying, right? So you eat food, it slows down the sugar being released, yada yada. That's why, example, when I have patients who, let's say, are very insulin resistant, I'm like, listen, there's certain, like the non-starchy vegetables, let's try to make it, you know, the salad before the meal come back. That was a great thing. I know when I grew up, when you go to restaurants, they served your salad first. That is a great way to think of this is your engine, and the engine dictates the rate of that absorption. So that's one piece. So you have that beautiful fiber. Then you have different types of fiber that grab hold of cholesterol as it's being recycled, and that excretes it out. So that lowers your cholesterol. You're changing that microbiome. You know the the plethora and the diversity. of your microbiome is so, so important. And when you look at people who live in our society now, the diversity of our microbiome is so much less than it was someone, let's say, who lives in, you know, the South American jungles or the Amazon. So there's going to be wonderful things. You'll see a decrease in autoimmune disease, right? Because we're taking care of the cells in the intestinal lining. There used to— there should be a nice tight junction. And there's this very thin link between, or this layering, I guess, is the best way to describe it. Trying to describe it as I'm seeing it. But there's a layer here. And anyway, when you have inflammation, that, that special goopy layer that goes away and there's some inflammation and those cells become quote unquote leaky in the sense that now if you, if you could see my fingers, they're interlaced. First they were tight and now they're kind of loosened up. And now you can see the immune system can look through that, it's like, huh, what is that? And so you might see the immune system react to passing proteins, you know, that go through, and they— and then the immune system gets confused, and it looks like, let's say, your joint, and they started attacking your joints, or they attacked your pancreas, right? So all these really interesting things happen when we start feeding our gut well, because it's— that decreases that inflammation, and we'll see autoimmune disease, uh, calm down. And many times at least go into remission. And so really fascinating stuff happening. It's such an interesting— um, I mean, if I was a GI doctor, I can't even imagine what that, that, that rabbit hole would be so deep because it really is the new frontier. Yeah. Um, but the, the fiber, you cannot get enough fiber. If you actually look at paleo poop, From back, you know, they say paleo diet is the way to go. But if you actually look at paleo poop, first of all, their lifespan is like 26 years. Number 2, the paleo poop had 100 grams of protein in it, right? Showing that they were eating 100 grams of— not protein, 100 grams of fiber per day. 100. I eat maybe 65, 75.

Wow.

In my daily diet, which is full of plants. So if I hit 100, it's a, it's a day that I'm going, dang, I can't eat another bite, right? So, uh, there, I'm like, if you really want to follow the paleo diet, you need to start eating a lot more plants. And they're not going to be the plants that we're seeing in the grocery store. These are going to be plants that are like, what is that?

They were very fibrous. I've actually written about that. Like, it was real hard to chew. Your teeth get strong, those big jaws that they talk about. Yes. There's a lot going on. Yes.

Yes. It's fascinating, right? Did— have you ever read the book Breath?

Yes.

And the whole, you know, the— how the mandible and the changing. Yeah. It's fascinating. It makes complete sense. Absolute sense. We don't— we slurp our food, right? We slurp our calories. We eat soft food. We're, we're not chewing. Yeah. And so our, our— over time, our facial structure actually has changed. For sure.

Fascinating. We could talk all day about so many things, but I, I think that this has covered a lot of ground and a lot of honestly important ground, and I'm very, very grateful for you sharing your time with us. Is there anything, Laurie, that we have not covered that you did want to make sure that we talked about in this?

Yeah, if you don't mind, I just— a selfless plug, um, you can check anything I have at drmarmas.com and would love to— I'm licensed in all 50 states and DC. So I can see patients from across the country. I don't accept insurance, but I can provide a super bill. So that's pretty cool. And I have a couple of programs. One is Healing Kitchen, and we meet live every week, single week, with Brittany Girutti, who actually lost 70 pounds herself on a plant-based diet. She's only 4'11, so that's, that's huge for someone of that stature. Wow. And we've— and then during that, I also provide monthly workshops in depth, like cholesterol, osteoporosis, menopause, um, upcoming or hypertension. Um, we have someone on diabetes, uh, habit building, all these things. And they get an ebook that comes with that. And then I have my menopause, um, which will probably be morphing into more of a weight loss, uh, way to help women understand in this type of thing. But it's Master Menopause and Feel Fabulous. And we meet twice a month. They get a course, um, and we dive deep. We order CGMs if they want one. I can prescribe those. We can order labs. And that's also, I can get it covered by your FSA or HSA funds. So those are things that we can do which are really cool.

Well, thank you for that. And thanks for your service and for working with women. It's exciting. It's an exciting time, I feel like, in this midlife journey because there's so many really great people like yourself, so many women with platforms and in powerful positions making a difference. And I love to see it.

Oh, thank you. Well, I'm excited to be here and thank you for hosting this and sharing the message. It's such an important thing.

Well, that's our show. Come on back in the new year because January is packed with amazing guests like menopause exercise and diet experts like Dr. Alyssa Olenek, Dr. Bill Campbell, Dr. Nicola Guess, and many, many more. It's gonna be a great 2025. So have a wonderful holiday season, a very happy New Year, and I'll see you in January. And until then, as always, stay feisty. You've been listening to Hit Play, Not Pause, a feisty menopause podcast for active, Performance-minded women. I'm your host, Celine Yeager. The show is edited and produced by the strong, talented, and amazing women at Live Feisty Media. Follow us on social media @FeistyMenopause, and please help us spread the word. Screenshot and share this episode on your social media channels with the tag @FeistyMenopause. Share the show with your friends, and please subscribe, like, review, and rate this show wherever you get your podcasts. Thank you. Word of mouth and good reviews make it easier for other listeners to find. Thanks for listening, and as always, stay feisty. Stay feisty.