Kelly & Lori Live 💬 | Functional Medicine, Wellness & Real-Life Health Conversations

word for saying perimenopause. And, you know, the crazy thing about it is you don't know you're in it until you're in it, right? No one gives you a "you are here" notification. GPS of instructions: turn it around, go back, go back. You know, I say if you're, if you're going through hell, just keep going. Don't look back. Yeah, so yeah, it could feel that way sometimes, right? Um, so yeah, let's define middle essence.

Yeah. So how, when a person asks you, you know, what is middle essence? How do you describe it to them? Do you describe it based on feelings or do you, or sensations or symptoms, or do you correlate it to a timeframe, like an age? Like, what do you say?

Yeah. So I think about middle essence is essentially perimenopause. And to my point earlier, you really don't know when you're in it. It's hindsight thinking, looking back. Unfortunately, we have a very poor definition of menopause. You know, it's 1 year after your last menstrual cycle. Okay, and that's a very poor definition. I want someone to kind of reinvent what menopause is and how we define it, but that's what it is. So that 10 years, maybe for some people even 15 years leading up to menopause can be very tumultuous. In regards to hormones. You know, sometimes our hormones feel balanced and then sometimes they don't. And it can be a very confusing time for a woman's life. So oftentimes we don't know where they are until someone says, maybe you should get your hormones checked. Maybe it's a good idea to get your hormones checked when you're chomping at the bit or, you know, you're a little less tolerant to things or, you know, what do we say?

Um, you know, we have— what are the, what are the symptoms? We say, you know, edgy, a little bit bitchy, moody, you know, itchy, bitchy, sweaty. Yes. Grumpy, intolerant, you know, things that used to not bother you are bothering you a lot. Um, everything seems exaggerated and quite frankly, not sleeping usually, you know.

Yeah. So you're— if your friend asks you, um, do you feel like you've been a little more edgy recently? Maybe that's a sign. Maybe that's a sign. Yeah.

Plus, you know, menstrual cycles are so irregular, you know, when it's, you know, the— we say a year after your last cycle, but there could be a period of years in which you are having very random, very rare, you know, once every couple of months or, you know, 6 months. So it's just, it is really a bad definition.

Yeah.

And it is really important to just understand that, that time period between 40 and 50, and for some a little bit younger, a little bit younger.

I am seeing my 35-year-olds coming in with low progesterone and all the symptoms of perimenopause and, you know, needing to address that a little bit earlier. So it's very individualized. So don't, don't think if you're not bumping up against 50 that it couldn't be you, right? And I know we've done a very poor way of having women realize what symptoms of perimenopause are, right? So we think about hot flashes, night sweats. I think we all go there in our head, and some women think, well, if I haven't had hot flashes and night sweats, everything must be fine, right?

Exactly. Yeah.

So it is also difficult for women to understand what is normal aging versus what is a symptom that needs attention. So what would you say about that, Lori Esarey MS?

Yeah, well, I mean, what is normal aging, right? We, we often say that, you know, we get caught in that conversation of chronological age.

Yes.

Versus biological age. And I think we have to start by kind of defining that first before we can define anything else. You know, I think so many times we all go to the doctor and we get the, you know, we get the, oh, you are whatever age, you're 45 or you're 50, what do you expect? Well, I think what we all expect is to live optimally, to live, to live to the best of our ability, to have the energy to do the things we love to do and want to do every day. Um, so I think that whole, um, you chronological age thing. It's not about your age. It's being attentive to your body. It's being connected to your body, you know, understanding when things are different, when things aren't the same as they have been. And I think you've just— what you said about, you know, menopause in and of itself, I think for, for many, it's just been kind of put in this little basket of symptoms of it's just, it's just hot sweats or night sweats or hot floods, whatever you want to call it.

Because a lot of times they're not sweats, they're floods.

Let's be honest. Um, or just— or not sleeping very well, or, um, you know, like, um, um, changes in our skin, our texture in our skin. You know, I think we, we put them in this little bucket of symptoms, but the reality is it's a major change in so many things in our body, and we have to be— we have to be aware of it. Like, what are our bowel movements? I mean, if we want to talk about poop here tonight, we could. Yeah, just even our GI system, how it changes. to things change, our sleep changes. All of those things can be key cues and clues to a change in the season of our lives, moving more towards that.

And let's face it, some women in that age group of perimenopause are still taking oral contraception, which totally suppresses their output of ovarian output, and they may miss some of the symptoms. They may not even be aware that the symptoms of GI changes, not sleeping well, being more irritable, Having low libido, all of that, you know, could be part of that change in hormone.

Yeah, for sure. For sure. So another one is, if I'm in middle essence and I want to feel strong, sharp, and energized going into my 60s and 70s, what are the top 2 to 3 things that I should prioritize now? Okay, so I'll start.

Okay. But I want to say I'm proud of this question because most people are not future focused. They're thinking about, just get me out of the weeds today, help me feel better today, right? So this person is really thinking about, hey, I want— there are things I want to do as I age. I want to travel. I want to be with my grandkids. I want to wake up feeling good. I don't want to be stiff and achy. So I don't know what inspired that question. Like, if you've seen your mother or your grandmother not so have such a good time, or if you're just one of those people that like to forward think. But I love the question. It is a good question. So Lori, what would you say?

That's right. I think the first thing is sleep. You know, sleep is your superpower.

What did you say?

I know.

What did you say? I know. Who am I talking to right now?

Someone who has woken up.

There we go.

No pun intended. Woken up to the data. You know, the data is very, very clear on how important sleep is and honoring sleep. And, you know, it's also the cycle of sleep. You know, what time we go to bed, what time we get up. And I do think, you know, I don't know about you, but the, um, wearable devices for me have been a game changer because I would have said I was fine. You know, I would have said I was fine because, you know, going to sleep, getting good quality sleep, feeling like I got good quality sleep. And I realized that not only was I not getting quality sleep, I wasn't getting deep sleep. So that's when we say quality sleep, it's deep sleep. But getting to bed at a time where I was really capitalizing on the time period of sleep, that's so important. So on Honoring sleep is a, is a big deal. And there are so many really cool devices. They don't have to be wearables. I mean, even some of the Sleep Number beds, you know, that people are sleeping on gives some, you know, fair data back on how people are sleeping. So for me, I would say one of the things you have to prioritize is sleep. What's yours?

Yeah, I always say that. I would say sleep is really, really big. That deep sleep that we get early in the night helps reset our hormones. And then that REM sleep where we're dreaming helps us process emotions. It's just such an important time. You're not wasting your time when you're sleeping. So make sure you are prioritizing your sleep. And I'm so glad to hear you say that.

Yes.

So I would say if we only had to pick two things, I would say sleep and mindset. I think we need to go into this phase of life strong and not strong in a hard way, but strong in a flexible way, strong in a way that we can pivot when we need to pivot. We know how to take care of ourselves. You know, I want someone entering into this stage of life with a solid footing so they know the things that are going to make the biggest impact. And I think mindset is a big part of that. Yeah, we need to train today for the things we want to do tomorrow.

That is such a good one because that was going to be my second one is movement.

Yeah.

You know, cardiovascular recovery, strength, flexibility, agility. Those things are core foundational necessities to age well. So I love what you said about training now for what you want to do tomorrow, you know, make that next 10 your best 10. What's that going to look like?

That's right. And it can be the best 10 because think about all the wisdom you've gained over your lifetime. And then with the skills, you know, that you need to kind of pull off a lifestyle that you'll enjoy, it can be the best 10. Yeah.

Yeah. So true. So true. It's hard to pick the top 2 to 3 things because we know how important food is. Well, we—

I would say the other thing is making sure you understand your body because to Lori's point, there's some big levers. Sleep is a big lever. Mindset's a big lever. Your ability to detoxify is a big lever. Nutrition's a big lever. And so if we understand where we are through proper testing and evaluation, wearing a wearable perhaps, then the things that we choose to focus on may shift. They're all important, but they may shift in priority. Depending on what we're trying to accomplish.

Right. In addition to that, I think that we go through seasons where some of those levers are easier to manipulate.

Oh yeah.

Oh yeah. Right? Like food might be my easy right now, but movement may not, you know, mindset may be more difficult or it might be an easy. So as we transition through these seasons, it's really being attentive and connected is what is the area that needs most of my focus right now?

That's right.

And we tend to not focus on the things that are hard. We tend to focus on the things that are easy.

Our defaults, right? We go to our defaults. Yeah. And that's where I think being in a group, group of like-minded people can really help because you see other people doing things and you see, oh, it can be done. Because sometimes with our mindset, we convince ourselves, I don't have time for that. And then you see someone else doing it and they're doing it well. It just inspires you to kind of, okay, I can figure this out too.

Yeah, for sure. For sure. Yeah. So is it cortisol? Is it insulin? Is it hormones? How do I know?

It's all of it. I'm just going to tell you right now, it's all of it, right? Where there's a cortisol problem, there's an insulin problem, right?

So true. It is all—

we can't, you know, and I think that's something that we are guilty of in the world of hormone therapies is siloing a hormone. And honestly, it's not a hormone, it's a symphony of hormone. And not only is it a symphony of hormones, It's the environment we put those hormones into.

Yeah.

So if we have an inflammatory environment and we throw hormones into the mix, oftentimes we can make that even worse. So the way we know is to test. Yeah. Right.

We want to— test don't guess.

Yeah. Test don't guess. We want to make sure that we're doing the right test at the right time. And this is another question that I oftentimes get. When should I test my hormones?

Right.

It depends on what we're trying to see. Is the long answer, right? And the short answer would be, depending on where you are, we would decide when is the best time. What are we trying to see? What are we trying to accomplish when we're assessing these hormones? But doing the right test, figuring out that symphony, and helping you understand how to navigate through the maze of perimenopause is golden.

Yeah, for sure. And I think one of the things you said is, you know, I, I think even looking back in history in traditional medicine, we have unfortunately done I think detriment to treatment in putting things in silos and recognizing that hormones do not act independently of another. Hormones, there's crosstalk. They, they, they work together. And we can put the blinders on and just treat a person for thyroid disease, right? But the reality of that is that you're— everything you do from an adrenal standpoint, that's your stress, that's your ability to manage and adapt. Anything you do in that area will affect your thyroid, anything you do in the area of your metabolism, which is thyroid, is going to affect your pancreas, which is your blood sugar. Anything you do in the area of adrenals is going to affect— so they all— it's like that triangle, right, is that they're not independent of another. We can't silo them, and we have to recognize that when we are working on lowering inflammation, which is the— I think the biggest concept that most people have to understand is that inflammation is, although a very important thing, we need it in the short term, of course.

Yeah, it has a purpose. It serves a purpose.

That's right. But if we get stuck in an inflammatory loop, all of our hormones become dysregulated. And that's why those levers of great food, sleep, you know, moving our body, drinking our water, doing all of those things foundationally are essential. They're, they're definitely essential. So, um, any other, you know, any other thoughts there about, um, about how do I know, you know, what hormone it is before we move on to our next question.

Yeah, I think the other thing I would say to that is oftentimes I get people coming in, and I'm sure you do too, where they've been to their primary care, they've been to their GYN, and they, they're just being told, oh, it's just stress.

Yes.

Right. And, and, and the truth is it probably is a lot of stress, but we can dig in and figure out what are the drivers of stressors, because we know the body responds the same regardless of where the stressor is coming from, whether it's a physical stressor like blood sugar dysregulation or an environmental stressor like chemical overburden, toxicity, or an emotional stressor, our body is going to produce the same cascade of hormones that can be destructive over time. And so not just saying, oh, it's just stress, let's talk about the stress. Let's figure out how we can mitigate some of that stress, because that is the biggest, I think, factor in perimenopause. We have a backup system to our sex hormones. So our sex hormones come from our ovaries. We have the adrenal glands that fill in the gaps. And if we go through perimenopause and then menopause at a time when we are highly stressed and not well supported foundationally, nutritionally, sleep, we're gonna have a harder time. Yeah, we just are. So figuring that piece out is golden in navigating that stage of life.

And it's not easy. No, I think everybody says it's easier.

It can be easier. It does easier. What's hard is walking through the fog.

Dog.

Yeah. And not knowing how to fix it.

That is correct. Yes, absolutely. Yeah, I agree. And, and I love what you just said about, you know, that whole easy, easier. I had that conversation with a client today, is it's never going to be easy, right? But it does get easier.

It gets easier.

It gets a lot easier. It gets easier to recognize your own patterns. Um, particularly when you're forcing yourself.

We have a question from someone that's listening live tonight. Yeah, Ariel. Is asking about wearing wearables like the Apple Watch, um, any of EMF exposure. You know, I have concerns about that too. I had an Apple Watch for a while. Not only did I find it distracting on my wrist all the time, but I just felt like I didn't want to wear it at night. And so with your Oura, you can turn your Bluetooth off at night on your phone so that it's not constantly searching signal and then just uploaded in the morning. So you can mitigate some of that with Oura. I feel like the other devices you could too. I don't know about Apple Watch just because I haven't worn one in a while. What would you say to that, Lori?

Yeah, I think the bigger question here is the whole EMFs is, is you always want to look in your environment and lower your risk. And so, you know, if you don't have to have an Apple Watch on, don't have it on. You know, I'm with you. I think it does beep and buzz. It does more to disrupt sleep than the games of the watch. There are just too many other devices that, that I would be more likely to recommend. I think you also have to look at your environment as a whole. I mean, I think a lot of people have been and, you know, we've all been in this situation before, but with Wi-Fi, even in routers in our bedrooms and TVs in the bedrooms and, you know, other EMFs. So I think taking an assessment of every everything that you have in your environment and going, what do I need here? What can I get out of here to lower those risks?

Okay.

I love also that you can turn off— there are a lot of devices, even CGMs, right? So the continuous glucose monitors, which we love them as giving us data through the night, but we can turn off those as well and log out of those programs so as not to have that exchange where it's searching, as you just mentioned. So I don't know the exact answer other than to say looking at your environment and getting rid of the that you don't necessarily need to have and only utilize the things that give you— I mean, I think there's a bigger story to wearables as well, but the things that give you the data that you need to move the needle in the direction that you want to move it, right? Because, you know, wearing a bunch of devices can be very, very overwhelming, not just from an EMF standpoint, but just from a data standpoint too. You know, how much information can you possibly go through that's not going to create, you know, a degree of hysteria or additional stress, unnecessary stress.

So we have another question, and I like this one. I feel like I'm doing the right things. I'm eating well, prioritizing sleep, moving my body, but my body composition and other markers aren't reflecting my efforts. What might be happening? And we hear this one a lot, right? We think we're doing all the right things and it feels like a lot of work and it's not paying us back. Yeah, and what I would say to that, I don't know what the other markers are that you're evaluating, so I'm just going to talk broadly, but I think that, um, we have to assess whether we're using the same strategies we used in our 30s, in our 40s, and they're not working, or in our 50s, right? Are we using old strategies that used to work for us that are no longer working? So maybe you're doing a lot of good things but not at the right time or not in the right way. So understanding your body a little bit better and what it needs, I think is important. But bottom line, dysregulation in hormones is what's creating that, whether that's an insulin signaling issue or whether that's just an inflammatory burden that your body's carrying. You know, a lot of times when we do our evaluations, uh, you know, I do a stool test as part of my evaluation for hormones. And I know that sounds crazy. I had this conversation this week with a patient, no GI symptoms, but I'm like, I feel obligated to do a stool because oftentimes I find a body burden of stress. We go back to those stressors that keep hormones dysregulated, that if we didn't evaluate and treat that, we can get ourselves in the weeds thinking we're doing all the right things and nothing's working because we have something brewing in that gut microbiome. And so I just think of a full evaluation test to make sure we know which way we're going. And then markers over time. Are we measuring markers over time that are gonna show us, are we moving in the right direction? Yeah.

I love that you actually do a stool evaluation. I do as well, as you know. And I think part of the reason for that stool evaluation, even if a person is completely asymptomatic, is one of the primary ways in which we discard and get rid of hormones is through the GI system. That's right. It's the elimination. It's getting rid of it. In addition to that, this is a little fun fact, but women gain anywhere from 10 to 12 pounds per year. Per year when their gut microbiome is imbalanced. So you could be doing a lot of things right and have a hidden low-grade infection in the gut, have no idea that you have it, and be super frustrated that you're not making headway. So those stool evaluations, a comprehensive stool evaluation, not just any stool evaluation, not just looking for blood or not look—

it's a very comprehensive look at what is going on in the gut microbiome, really really powerful information. Yeah, yeah, for sure. Yeah, for sure.

Um, do I really need hormone replacement or can I support this naturally? And I want to start out with the difference between hormone rebalancing and hormone replacement. I think it's a really important concept for everyone listening, um, to understand the difference is we always want to start with hormone rebalancing and really understand again root cause. We've been talking about that tonight already. Um, not everybody body that's hormonally imbalanced needs hormone replacement. True story. So I think we have to start there in, you know, understanding and doing a really good evaluation of what are the symptoms, what is your history, what are, what are those foundational pillars, you know, how are you eating, how are you moving, you know, how are you sleeping, what's, what's going on in your life. Let's do some evaluation of some biomarkers, some testing to gain an understanding of your inflammatory markers. Those are just so important because, you know, we say sex hormones are downstream. They're downstream to very critical upstream hormones, which are your adrenals, you know, which are glucose and insulin, which are getting a little bit more hype now than I think they ever have. But the reality is, for a very long time, they weren't getting any attention. And the truth is, if we don't get that regulated, we will never get sex hormones regulated.

That's right. So what Lori Esarey MS is saying is the major hormones that we talk about— insulin, cortisol, um, we want to balance those first, right? Because if we can balance those, a lot of times adding other hormones is not necessary. Everything kind of settles out. And then if we need to add other hormones, they stay balanced much easier. So all the efforts that you're doing with your diet, your sleep, your movement, your stress management pay you back big when it comes to hormone balance. They matter a lot. And if we ignore those things and we just add hormones hormones, we may feel better temporarily. We may feel better temporarily, but we're just adding fuel to a forest fire, to be honest. And we'll burn ourselves down.

It's risky business, right?

It is risky business in a lot of ways. Yeah.

Yeah. In fact, I mean, you know, if we don't do the foundational work and we add hormones into that and we skip to hormone replacement before doing the evaluation, we as clinicians can be putting you in harm's way. That's the truth. Truth, because elevated levels of inflammation and those biomarkers that are elevated increase risk of disease. So we don't want you to just feel better in the short term. The goal is for you to be better in the long term, you know. So, and lowest effective dose— you're not going to need as much for rebalancing if you have those foundational things right. So they do matter— what you eat, what you drink, how you sleep, how you move, and how you think. Those are the 5 key things that we do need to be paying attention to.

How awesome. Yeah, so we, I think we have time for one more question. I know this has been a lot of fun. Time went by really fast.

Yes.

So you want me to pick it or do you want to pick?

Um, you pick it.

Okay, so I want to, we get this one a lot, so I want to make sure we answer it. Um, why does my brain feel foggy or slow? Well, that's a horrible feeling, right? You're just trying to do life. It's awful. Yeah. And you just can't find the word. You can't complete a sentence. You can't remember somebody's name and you just feel like everything is so heavy.

Yeah. Well, I think one of the primary reasons, and it's probably multifactorial, right? But one of the primary reasons is most people that are hormonally imbalanced are not sleeping well. And sleep deprivation is very detrimental to your ability to think, to your ability to process, store information. So if you're having symptoms, that's one of the major reasons why you're not sleeping very well, right? Hot flashes, just not getting to that restful deep sleep at night. We do know that progesterone plays a huge role in calming the brain and calming the body. So I think that that's one of the major reasons. There's many reasons. What are some additional reasons that—

Yeah, I'll oftentimes see that when someone's coming in before they walk through diet changes, and then once we get them on an anti-inflammatory diet, they feel better, their brain feels better, and they're amazed. I think my brain feels better. And I just think it's a testament to what we're putting in. Sometimes we are medicating that brain fog symptom with caffeine and sugar. We're just trying to feel better in the moment, not realizing that it's actually making it worse. So I think it can be blood sugar dysregulation. I think it could be toxic burden. Um, definitely low hormones, estrogen, progesterone, and testosterone all affect the brain. And so that can be an issue too. So I think it's multifactorial, as you said. I would definitely start with sleep cuz that's gonna do so much. Powerful. To help, you know, just being able to tease apart what's causing what and what is the solution for getting your brain back. Yeah.

Yeah. So definitely for those that may be going to bed a bit late is one of the first strategies would inch it back a little bit. So if you find yourself scrolling on Facebook, which can happen, you know, first of all, stop the scrolling. None of those devices at night. Get that ambient temperature of that room at 67. I know it's a bit low, but getting that temperature of the bedroom down and getting to bed a bit early. And you don't have to go from 11 or 12 o'clock at night all the way to, you know, 9:30 or 10 o'clock. I always tell people to inch it back by 15 minutes. Yeah, you're currently going to bed at 11 o'clock, try 10:45 for a while, you know, then 10:45 to 10:30. But it's all about making very small changes. I love James Clear, just as he talks in Atomic Habits, we do not rise to the level of our goals, we fall to the level of the systems that we have in place. And so it's little tiny atomic habits that are absolutely critical. So this was fun.

Yeah, this was a lot of fun. We'll have to do this again. Sure.

Yeah. So we invite everybody to check out our app, Reset to Resilience, R2R app our— on, I guess, on any of the app. If you have an Android, we have people— I have some people behind us, they love Android, by the way.

Yeah.

He's behind me. He's out in the kitchen. You know, some people love Android, other people love Apple. It does not matter. You can be an Android user, an Apple user, but check out our app. Seriously, in all seriousness, check it out. There's some really good information on there, so get signed up for that. There's both free content as well as content that you can lean into that it's a bit more.

And we have a community that we're developing on Facebook that we want to invite you guys to be a part We heal in community, and as you can tell, Lori and I have a really good time being together, even online with you guys tonight. We want you to be a part of that. We're going to be sharing tips, tools, wisdom, um, to support you through this time of life. And you can find a lot of joy during this time of life. And so show up, um, be there with us, let us know what you're interested in hearing about, and we'll make it happen.

Absolutely. We look forward to seeing you next time and send over your questions.