400: Blood Sugar and Cortisol Deregulation in Perimenopause with Dr. Mariza Snyder

I'm a yes. And I mean, if you're, if your levels are in the pre diabetic range and you need a kickstart to get yourself back into range and it's not just a crutch or a band aid, you're, let's say you're clocking in at a fasting blood glucose around 110. I mean, I don't think of prediabetes as prediabetes. I think of prediabetes as diabetes. Hi.

I want to welcome you to Midlife Conversations. I'm Natalie Jill, your host and I help midlife women redefine and rebrand aging. On this podcast, I do what I do best, taking complicated information and conversations around aging that are relevant to us now and breaking it all down simply with actionable steps that you can implement.

To level up your life, because your best years are yet to come.

I also regularly interview some of the most inspiring people living in their best midlife years. On this show, I cover topics about our health, hormones, navigating weight, blood sugars, our mood, focus changes, even our relationships, career changes, beauty, and more.

Today we're going to be discussing blood sugar and what changes, changes with that as we age. Because it does change as we age. There's a lot of things that we're navigating in menopause, perimenopause and midlife. But blood sugar is one of those key things that we've got to grasp, get under control. It causes a whole host of problems when we don't. So today on Midlife Conversations, I've got my good friend Dr. Marisa Snyder, and she's an expert with a lot of things that we're going to get into today. But one of the things that really got my attention, the reason I wanted to bring her on an interviewer I've had her on before, is this whole conversation around blood sugar, why it changes in midlife, like what, what's going on there, how this correlates to hormones and what we can actually do to control this. Because the answer is not always just you need metformin or you need to, you're going to be a type 2 diabetic. Deal with it. So thank you so much for being here.

Dr. Marisa. Hey, honey, how are you? It's so good to see you. And thank you for having me.

Yeah, I can't wait to dive in. And by the way, those of you listening in right now, if you're listening on the podcast, make sure that you're subscribed to the podcast so you don't miss a future episode. And if you're watching this on YouTube, that's great. We've recently started adding all of these to YouTube and really up leveling those so you can see a lot of the things that we're talking about. If you're there, make sure you hit subscribe if you're on YouTube so you don't miss an episode. Okay, Dr. Maritza, let's. Let's sort of dive in. How did blood sugar become this interesting topic to you?

It became a very interesting topic to me because I, I like yourself, get to serve women in their 40s and 50s and beyond. And a lot of women were coming to me with weight resistance and this struggle around, really symptoms of insulin resistance and crazy blood glucose variability, things like poor sleep, getting sick often. Again, that tummy, belly fat, hot flashes and night sweats. A lot of women don't realize that there is a deep connection between vasomotor symptoms and blood sugar issues and insulin resistance and then also even acne, fatigue, fibroids, reproductive issues, like polycystic ovarian syndrome. And so I started connecting the dots and I was like, okay, what is really the root cause? And so often we're all told it's hormones. And yes, insulin is a hormone, so it very much is a part of that conversation. But I realized that many of the women I was working with were being told their labs look normal, everything looked normal, even when they were pre diabetic. And. And yet they had these, what I call subtle symptoms or kind of these other chronic conditions that were going on that weren't being associated to metabolic health. And I started putting the pieces together. I'm like, oh, my gosh. This is very much a metabolic situation that we gotta wrap our, our mind around.

Okay, so I want to dive into this because metabolic syndrome is truly the root of so many diseases.

So let's.

I want to back up a little bit. And I know this might sound basic to some, but I think it's important we revisit this. Let's talk first about metabolic syndrome. What is that and what does that link to?

Yes. So how we, how we diagnose metabolic syndrome is there are four metabolic biomarkers, indicators. Number one, it's going to be your fasting blood glucose. I have a continuous glucose monitor on right now. And when you go to your doctor, they're going to run this panel every single time. So fasting blood glucose, they're going to say they want it under 100 milligrams per deciliter. I don't want it above 90. I mean, when I start to see it creeping in the 90s, I'm like, like, let's get that under control. So that's one.

And when fasting, meaning when you first wake up in the morning to eat. So not like in between meals, just when you wake up in the morning.

Exactly. So when you go and run your, your physical, hopefully, hopefully you're doing an annual physical or at least getting the labs ran. I always tell women, like, get a timeline of your lab so we have a sense of what's going on with your body. Especially as you start to go into perimenopause and declining reproductive hormones start to have an impact on these labs. Like all of a sudden women wake up and their cholesterol is just out of control, like out of unfavorable range. And they're like, what? Those are reproductive hormones shifting, but so fasting blood glucose, triglycerides. So again, they want a normal triglyceride. Is anything lower than 150 milligrams per deciliter. I don't want it above 80. Okay, so just a heads up. But again, doctor is going to be like, oh, it's fine, it's good, you.

Know, because you're talking optimal versus just standard testing.

Yes, standard testing. So. And note that once it's at 150 milligrams per deciliter, I mean that's a massive indicator of insulin resistance as well. Yeah. Then we're looking at HDLs and HDL. Is that good cholesterol? We want to have it high. And really for women it's over the number of 40 milligrams per deciliter. Optimally I would love it above 50. So you want to be looking at that. And then it is going to be blood pressure. So those were the first three. Blood pressure is next. Normal blood pressure is 120 over 70. But what they consider unfavorable or a diagnosis of metabolic syndrome is 13080 and the last is going to be the inches around your waist. So women, if your waistline is greater than 35 inches and men greater than 40 inches, that if you have three of these markers out of range, you are, you would be diagnosed with metabolic syndrome.

Okay, so do. So three of these markers out of range means metabolic. So if you just have high cholesterol or you just have one of them, that's not necessarily metabolic syndrome. If you have metabolic syndrome, what does that actually mean? What does that create?

That means that what I think it means in mitochondrial scientists, because ultimately all of this is cellular energy, right? Your. Your cells are gunked up, there's inflammation in the body. But I believe that once your mitochondrial capacity drops below 50%, so basically these little powerhouses in the cell that make all the energy for you and I to have this conversation, for anybody to be watching us have this conversation, Any feeling, any thought, any physical movement requires. Any ATP requires cellular energy that's manufactured from our mitochondria. When our mitochondria get below that 50% capacity, that's when we start to see these biomarkers go out of range. And so to me, what it tells me is that our cellular energy is significantly compromised.

And if our cellular. And if our cellular energy is significantly compromised, what does that create?

So that could create dementia, that could create cardiovascular disease, that could create polycystic ovarian syndrome. That could create I. Through every single system of the body. Natalie. And name a disease state due to higher, you know, higher levels of blood glucose or metabolic syndrome. 1. That one being the biggest facet of it, and basically a. An issue with cellular metabolism inside of the cells of our body.

Okay, so I have so many questions now from here, because I'm gonna, I'm gonna want to ask what do we do about it? But I want to rewind a little bit. And how do we look at these things individually? And should we be looking at them individually? Like, do we need to be looking at cholesterol separate. Then we look at blood sugar. Are you looking at all of this as a whole? Help us understand this?

Absolutely. I mean, a great doctor, an integrative doctor, is really looking at all of this as a whole. But if we were to take a look at one, if I had a name, a biomarker, I was like, if I had to look at the biomarker besides like an inflammatory biomarker, like highly sensitive C reactive protein. I'd like to know, is it the body inflamed? The biomarker that I would love that is unfortunately.

Not readily available. You know, you can't ask for it, and they're probably not going to do it, but it's extremely cheap and there's no reason why they should not run it. It's going to be your fasting insulin. So well before your A1C, your hemoglobin A1C goes up, or well before your fasting blood glucose is closer to 100, which is pre diabetes. We know that for a decade your insulin levels are less sensitive, meaning that they've become more resistant.

Wow.

And the test that can tell you that like 10 years in advance before we. And note that insulin resistance is kind of the reason for higher levels of triglycerides. If our cells cannot intake more. More of that sugar, it converts to fat, it converts to triglycerides. So anytime I see a high triglyceride number, I know for a fact that we're dealing with insulin resistance. So if I see high blood pressure, I know for a fact that we are dealing with insulin resistance. And so all of those biomarkers are indicating this more insidious issue, which is insulin resistance. So.

And this is important because I think a lot of doctors are overlooking this and they're just saying, no, your A1C is normal. Your A1C is your combination of your blood sugar over three months.

Yeah. Or.

Or that you're. And they're. Or they're saying your fasting is 100 or, you know, right at that mark there. So it's not at that 90. And they're saying. So they're not even looking at this part with insulin and seeing that trend.

No. And, and this is very dis. Alarming as far as I'm concerned, because insulin could be in resistant, like it could be pouring out of your panc, trying to shove that glucose into the cells, kind of like a train pusher in Japan. Have you ever seen those? They're just trying to shove people onto the train. All the while, your blood glucose can look pretty normal. And behind the scenes, there is a war raging of basically a dysfunctional situation of cellular energy. Basically, we're not converting energy efficiently and it takes years before it actually shows up on a blood test like a hemoglobin A1c or, or on a fasting blood glucose.

So what's extra concerning about this to me is that, okay, so you mentioned triglycerides, not necessarily cholesterol, even though they somewhat go together. So, yeah, someone could have a high triglyceride or a higher cholesterol or one or the other. And then what the doctor might say is, okay, let's give you a statin, let's put you on cholesterol medicine, which is now just giving kind of a band aid of what was creating that in my, in my view. So we're. We start knocking down these numbers without actually addressing the root cause. Am I accurate in my thinking?

There's absolutely. Well, and research is very clear when it comes to statins, is that they do not increase mortality rate. They do not significantly. They do not, especially in women. They do not reduce you mean they don't decrease? Yeah, yeah, sorry, sorry. They don't decrease. It doesn't.

It ends up like 2%, something like that. Right.

It's even less than that. It's, it's. And then the side effects of taking things like that, like statins can lend towards more insulin resistance, which is the number one root risk factor and root cause for ischemic attack or stroke.

Okay, I have some random questions. I don't know if they're connected or not, but I want to make sure I'm covering these.

So.

Okay, if your triglycerides are actually normal, but your cholesterol is high, your LDL is high, is that still a marker?

Yes, that is still a marker for, for cardiometabolic disease, yes.

Okay. Okay, so let's talk about blood sugar then. Because you think that this is a lot of the root cause for things or do you think something's creating the blood sugar issue? What is that?

Yeah, no, there's definitely things that are causing. What is the. Why is the cell malfunctioning? Right. And there's, there's, I would say there's a number of them, but the number one is over consumption of ultra processed foods. I think the average person is consuming like 60% of their calories are coming from ultra processed foods. It's almost impossible to escape them. Today, your almond milk or your oat milk, guess what? It's got preservatives and garden and gums and seed oils. I mean, you take a look at the label and you're like, ah, organic or not, it could have, you know, it still has organic sunflower oil.

So you're, you're preaching to the choir with me as far as unprocessing your diet. And I tell women, unprocess your diet. You've got, that has to be that absolute first must in midlife. What about the person listening that is eating an unprocessed diet and they're still creeping up on their blood sugar?

Yeah, let's take a look at that as well. So also it's acellular carbs. So I always say that. And you know, again, we can go into why we become a little bit less insulin sensitive in general. Yeah, but that's, you know, the breads, the, the, the gluten free crackers, you know, all those types of things that just are lacking fiber are ultimately going to spike your blood sugar. I mean, I'm still, I wear a CGM and continuously, I'm like, oh, like something. I thought maybe not. And I'm like, oh no, no. Even sweet potatoes for some women can be a big.

For me, they're crazy. Yeah, sweet potatoes will drive mine up huge.

And so, you know, we start to learn these things about our body and the way that our bodies work. And so if I eat a naked carb, even if it's an amazing naked carb, like even without almond butter, it's most likely gonna have kind of more of a spike in my blood glucose. And so it's important to note, like eating carbs naked by themselves, whether they're acellular, maybe even some fruit like grapes. Grapes are high blood sugar spikers that, you know, you're having these snacks maybe at 2:00 in the afternoon, that, that may be setting off that cascade or maybe you're not thinking that that little bit of sugar, that little bit of honey in your coffee first thing in the morning is also setting the tone for what's going on with your blood sugar. I always tell people what for breakfast is going to set the tone for your blood sugar, your. And your basic. And insulin as well. Right? What, what comes into the system has to be modulated by insulin so that it goes into your cells. And so with that rise in blood glucose, you're going to see that rise in insulin as well. It's going to be, it's going to be the same, you know, same experience. And so if you're eating an unsavory breakfast, it's more of a, you know, carb driven breakfast, then you're, if you eat a very sugary breakfast or you know, again, just toast and jam and, and a little bit of sugar in your coffee.

Oatmeal and banana even.

Oatmeal and banana? Yeah, A little bit of, little bit of maple syrup. Like, like maple syrup is not sugar. I don't know where this comes from. Pancakes. You know, I make protein pancakes for my 3 year old, but I'm not eating those protein pancakes. It's just, it's not gonna have the same effect at 45 years old, you, it'll take over 36 hours to recover from that blood glucose spike.

Let me ask you about these blood glucose spikes because people listening, they might be interested in CGMs or they're using a fingerprint, a CGM as a continual glucose monitor like she has on her arm. Finger pricks are actually a little bit more accurate because there can be a calibration period on CGMs. But what are, can we talk about normal ranges? Like what you, what you, as in the functional practice, what you believe is for optimal. What numbers are alarming and where do you try to stay?

Absolutely. So when I'm putting on a cgm, I get to set my, basically my blood glucose range in milligrams per deciliter. It's how we measure it. And I set it. The low bar is 70 and my highest bar is 120. So. And normally on a normal CGM it's 70 to 140 or maybe even 150. We know that a spike past 140 is basically in the diabetic range. Wow. And so let's start first thing in the morning. That's the first thing I do every morning when I have a CGM on is I scan my sensor. That's going to be my fasting blood glucose. Now most CGMs, they just, they're on your kind of the underside of your arm. They come, they snap in really quickly, almost pretty much painlessly. It takes, like you said, about 24 hours to calibrate it and then it's good to go for 14 days. And the first thing I do is I scan that. And what I'm looking for is I want a fasting blood glucose between 70 and no higher. It's an 85mg per deciliter. Most of the time mine scans under 80mg per deciliter. So I'm like 77, 75, 76. And then I'll watch it after that first meal of the day. What is that? Because any time you eat, you're going to have a blood glucose response that is totally normal. Don't expect that it's going to stay static the whole day. And I usually test about. I'll check it again. One hour and two hours. I'm curious what's going to happen. And it's extremely rare. Optimal, I would say, is you're staying in the range of 90-120mg per deciliter. I personally, because I've been doing this for a long time and I really dial in my metabolic health, I rarely go past 110. So post meal to what I call two hours post prandial blood glucose is around 1 10. Okay, yeah.

So then alarming. And I don't want to. When I say alarming, I want people to hear this a lot. We're going to share alarming numbers. But just because you have alarming numbers doesn't mean you can't control it. So I'm, I am that example, by the way, if I were to eat a sweet potato for breakfast and nothing else, my blood sugar would go probably over 200, which is alarming. That's, that is pre diabetic mode. But because I do not eat that way, I keep my blood sugar low. Like you are sharing. Dr. Marisa. So this is, I want everyone to feel empowered by this. It doesn't mean you, you're testing this and something shoots up that all of a sudden you're diabetic and you have to go on medication for it. It just means you get to work on combining your food and changing how you're eating is, correct me if I'm.

Wrong, that you can do lifestyle wise to get this under control. And so an example of this is I was at an engagement party the other night and I have an autoimmune condition. So I'm gluten free and dairy free. And they had picked up this insane decadent, dairy free, gluten free cacao cake.

Which was all sugar.

It's all sugar. Yeah. No, it was not sugar free, let me tell you. And I knew I was, I was, I usually finished dinner by six o' clock at the latest because I love, the sooner I eat dinner, the more I bounce back. You know, we're more insulin resistant at night just because that's our circadian clock. That's how our bodies work. And so I have, I've learned that if I have salmon and salad at 6 o', clock, I'm probably again, maybe, maybe 109, 110 milligrams per deciliter a couple hours after that meal. But if I were to eat that same exact meal again, salmon and salad. There's no carbs here. Vegetables are carbs, but nothing that's gonna quote, unquote rise my blood sugar. Just the two hour difference. Later in the night I will jump up to 120 milligrams, same exact meal. So it's seven and I'm about, I'm, I have made a decision. I'm going to have this cake. And mind you, it's an engagement party. So I'm not. And you're also human.

You're trying to live your life.

And it's, I mean it's this gorgeous boutique. I mean it's, it's 40 minutes away to even get this cake. Like I'm not driving there in downtown San Diego and I eat it and I'm in a really cute dress. So I'm not doing air squats, I'm not doing jump lunges or jack squats after this. Like I'm talking to people I'm hanging out, hanging out. And so I checked my blood sugar. It goes. It goes up to 135. The next morning, my fasting blood glucose was 88. And this was Saturday night. So today I'm finally recovering from that cake.

Wow.

Here's the thing. I knew. I knew that. And did I implement all of my other blood sugar strategies and eat really beautifully and eat metabolically healthy these last couple of days? Absolutely. But my, you know, at 45, it takes a little minute to rebound. So I always want people to know, if you decide to have that pancake for breakfast or the sweet potato, or you have the sexy, yummy muffin with a vanilla latte, it's going to take about 36 hours for your body to rebound, even if you eat super clean for the rest of the next 36 hours.

So here's the conversation. I want to open up, too, because I know somebody's listening, going, gosh, why does it have to. Then I don't like my food or I don't enjoy anything. But here is the thing. This is not just about weight loss or. And this is about our health and our.

It's about your heart.

Yes. And every single disease is linked to this.

Yeah. So when we are eating, not combining foods, when we're not eating protein, fats, higher fiber, low glycemic foods, then we're creating this, this whole problem here.

Cascade.

Yes.

We're creating silently. It's happening multiple times a day, potentially.

I want to talk about a few things besides preventative, because obviously that's important, how we're eating and we're doing that. There's a lot of things that people are doing that are somewhat trendy to manipulate the sugar and insulin response. And I want to just kind of run down the list, and I just want to get your take on them. And I'll start kind of simple. I'll start with berberine.

Yeah, I love it. I think berberine is great. I mean, a lot of research shows that it is as effective, if not more effective than metformin. And so I'm a big fan of. I'm really 1,000 milligrams a day, 500 before breakfast, another 500 before dinner.

So you take it before dinner. 500 of that. Milligrams. Okay, great. So not with food, not after food.

Before. It can. No, it can. Ideally it's before, but I'd say up to 20 minutes after. Great.

Okay. Love burn.

Just like apple cider vinegar. Same thing. Ideally, 20 minutes before, but up to 20 minutes after.

Okay, let's talk about metformin. Now. What are your thoughts on metformin for diabetics and non diabetics? Because that's another trendy thing in the biohacking space where people are taking metformin.

Yeah. And they're micro, they're micro dosing metformin when it comes to biohacking, microdosing GLP1 agonists, you know.

Yeah, I was gonna ask that next, so don't go there yet.

So let's talk.

Start with the, start with the metformin.

I'm a yes. And I mean if you're, if your levels are in the pre diabetic range and you need a kickstart to get yourself back into range and it's not just a crutch or a band aid and, and you know, you're, you're, let's say you're clocking in at a fasting blood glucose around 110. I mean I don't think of prediabetes as prediabetes. I think of pre diabe as diabetes.

Yeah.

I don't know why there's a pre associated like Once you're at 100 milligrams per deciliter, we have a metabolic issue that we need to address. And so if metformin can kick you back along with blood consistent blood sugar hacks every single day, like you are really changing the way that you live your life. Then I say yes.

So she's not saying y', all, she's not saying metformin and go eat pasta, popcorn, oatmeal, cookies and cake. She's saying do it. Optimize how you're eating the balance. Low glycemic eating. Okay, so then my next question is GLP ones and I, I want to like so Most people associate GLPs with tirzepatide. All the, all the fat loss drugs though we, we think semaglutide. We've heard of all. What's the other? I don't know. Yeah, wegovy all those. So that is one use for, for weight loss. But then there's a whole nother camp of thought with this around doing small doses to instead of metformin instead of berberine or maybe it's with it to help this. What are your thoughts around that?

I'm a yes. And again if, let's if for especially you know we're talking about smaller dosage like even micro dosing and like I'm.

Talking like 0.25 0.50 not the standard starting dose for Weight loss.

Exactly. My. So let's say you're, let's say you're in midlife, you have been an athlete or you've worked out your, all your life. You've, you've, you've eaten at a deficit, you've hitting your protein numbers like you've done a lot of the things and all of a sudden you put on that extra five to ten pounds and there is no amount, there's no amount of willpower, power or efforting that is getting you out of there. And your metabolic labs look good. You really are still crushing it in that department. I think, I think, you know, bringing on and cycling, you know, lower peptides. Yeah, peptides. Tirzepatide or some, some agotide or wegovy playing with it like cycle it maybe for one month off, one month on and see if it can kind of, you know, get rid of that fluff. I call fluff. Like yeah.

Labs are going to shift because of the decline of estradiol, testosterone and progesterone. I mean it's going to happen for the majority of us. And yes. Am I a big fan of hormones as optimizers? Absolutely. And you may need a little bit of extra support there too. I mean I think it can be a very short term support like a booster to kind of get those long term cardio metabolic benefits.

I'm starting to see just so many pluses with GLP and I think they got really dismissed quickly because, because they got looked at as high dose only weight loss. But in small doses. I just, I, the research is just supporting so many benefits.

Cognitive function. Yes, cognitive function, reducing cognitive neuroinflammation, even inflammation of the joints. Yeah. And so yeah, I've seen a lot of great. But particularly again if women, if the, if we die more of heart disease than men and this can be a tool in the toolbox to reduce that risk, even shove it back, back another decade then I mean, I'm a huge fan.

Yeah, I, I think I'm just, I'm learning a lot more about this. I recently interviewed Dr. Tina Moore about this too and she really enlightened me about just so many benefits with that.

Yeah, I mean she and I are both in agreement that you know, those peptides, GLP1 peptides and some hormones and then implementing those metabolic lifestyle strategies. I mean, why not have the trifecta.

Yes.

To really support our bodies, especially if we see again a major fall off the cliff moment once we, once we hit like 51, 52 years old.

Totally. Almost 53 over here. So I see. And I'm seeing my markers change. And then. So, you know, a lot of people, me included, you know, you look at the genetic markers and you say, okay, I've got a whole family history of all this. However, when you start adding these things on board, that history doesn't have to be our own reality.

No.

Especially with you.

Yeah, she had a stroke last year. She's younger than me. She's 40, 42. And.

From the Mexican side of my family. All the men in my family have had bypasses by the time they were 53 years old. And so seeing my sister have a stroke before the age of 43, I was like, oh, my gosh. It just really put things in perspective of how, you know, how critical it is to be looking at these numbers even in our late mid to late 30s, so that we're coming into our 40s, more resilient. You know, we all think it's in our 50s, we start to notice that lack of resilience. But no, we are. We are seeing shifts and changes. We're losing that resilience in our 40s.

Now, I've known you for quite some time, and I've never known you to be overweight, but when I saw you, gosh, I just saw you recently at an event, and you are, like, tiny and leaner than I've ever seen you. Is this. Some of this because of these changes?

Yes, a big part. Well, in hormones. So I brought hormones in as well, and we can get into that. Yeah, but, yeah, I mean, I've really. I mean, my. My metabolic labs are dialed. I'm really focused on hitting my protein numbers, making sure that I'm lifting heavy. I think the body composition changes with weights have been a game changer. And I move all the time. Yeah, I am constantly moving. I'm like our dear friend J.J. virgin. I mean, that woman's moving exercise snacks throughout the day. I'm doing little mini hiit movements. But I would say that the more consistent that I move throughout the day, the more my. My biomarkers just continue to optimize.

Okay, let's talk about the main. The sex hormones now for a minute, because there is a role in that. And you. And I'm a huge fan of adding those in in midlife. And we're talking specifically estrogen, progesterone, and testosterone. Can you talk about the link with that and metabolic?

Absolutely. So even. Even, you know, there's not as much research to be had regarding progesterone and good metabolic health, but it's there, I mean, there's some women who are supplementing progesterone kind of as a blood sugar hack as well to lower insulin resistance in meals. So I'm really interested in that research. But again, we have more research with estradiol than we do with progesterone currently today. So perimenopause, as you know, is that I would say 5 to 10 year transition leading into that defining moment when you hit menopause and then you move over to postmenopause and it's in that, that time period, that transition kind of the decention. And as one of my dear friends, Dr. Carrie Jones says, she's like, she calls it unconscious uncoupling. I call it. Your body is changing without permission.

Yeah, true.

I mean, no one asked, you know what I'm saying? So progesterone drops first. And what you'll notice there, especially in that second phase of your cycle, that luteal phase where she's normally abundant, you'll notice less stress resilience, less exercise resilience. You'll notice more mood changes, things like depression, anxiety, sleep disturbances, inability to get to sleep, or also waking up in the middle of the night. And then you'll also notice, I mean, even vasomotor symptoms like hot flashes and night sweats have been associated with lowered levels of progesterone. And then comes in estradiol and she starts to roller coaster out about, I would say like early and late perimenopause. I also think there's like a mid perimenopause where you're kind of in between. But late perimenopause is defined as you are now skipping 60 days or more of your periods.

Okay.

And estradiol is very much on the decline. And we know that as we start to lose that estradiol resilience that we begin to lose basically insulin sensitivity. So the decline of estradiol, the impact is pretty great. One, our resting, our resting metabolic rate begins to drop, not significantly, but a little bit. And it adds up, up. We see a redistribution in belt in fat from our butt and our thighs to our belly. And that could be the, you know, testosterone still may be high. So we see that that kind of apple shaped distribution relative to estradiol. But either way, all of a sudden fat is moving in the direction you do not want it to go. No, we see a loss in muscle strength and a loss in muscle mass and an inability to build more muscle because we just don't have estradiol to drive that muscle Protein synthesis. We see an increased rate again in insulin resistance, and we see a shift and change in cardiovascular flexibility and basically an increase in inflammation. So all of this is happening due to estradiol. The biggest thing I'm concerned with is again, that body composition, that loss of muscle mass, and that creeping. Of insulin resistance.

Yes. Oh, my gosh. Okay. So many things. So when women. It's so crazy to me because there's so much research now supporting hormones, and we've completely debunked all of those risk associated with it back from years ago with Women's Health Initiative.

Like, it's all been debunked 2002. Yeah.

So to me, when a midlife woman is saying, I. They're using it like a hero's cape, like, I'm not gonna do estrogen replenishment or I'm not gonna do hormone. I think you're just missing such a huge piece of the puzzle.

Yeah. And unfortunately, the dark, looming cloud that the Women's Health Initiative brought to women globally has had. It's still. It's still very much, very pervasive today. I was actually. I literally just got my hair cut for you. My hair. I just got it done. I was getting home to do this interview, and I was sitting next to a woman who was asking. Her skin was very dry. She was 50 years old. She looked. Looked like she was 50 years old. Okay. I'm so. I'm. You know, I just. I could. I. I thought maybe she was older.

And you can tell who's not on estrogen. I can tell.

Oh, my gosh. Immediate. So she. Dry skin, and she's asking what to do for this dry skin. And my hairstylist is like, oh, my gosh. You just. You just happen to be sitting next to.

Yeah.

Like, literally a perimenopause and menopause expert. And I was like, okay, well, tell me. Tell me what? Break it down. And basically she was like, well, my doctor put me on birth control control.

That's not hormone replacement, y'. All.

It's endocrine disruptors, especially. And she's like. And she's just gonna keep me on it until I'm 52 years old. And I was like, that's a big part of what's going on right now. Yeah. You have. There's no amount of estradiol or progesterone being made. You're not even getting the last of. The last of it that your body would be making. I'm like, it's lazy medicine. I was like, super lazy. Oh, My gosh. I was just so. I was like. And that's. What you're seeing is you're seeing. I'm like, and that's. That's not even. That's not even the concern. I mean, obviously we all care about having beautiful skin, but I'm like, but what about the cardiovascular situation? The. The increased risk of dementia and inflammasomes in the brain or even the risk, the diseases of frailty, like osteoporosis. And so she was like, whoa. She's like, well, let me go back to her and see what's up. And I'm like, there's a good chance that she's going to tell you to stay on those until you're 52 years old. And I'm telling you, yeah, if they.

Prescribed it, they're not the right doctor for this. Yeah, I just, I don't. I just think I agree with you. It's lazy medicine. And if your doctor is telling you this, I think it's time to find another doctor.

So I gave her some other resources and some other locations. And I could tell it was, again, there's some deep belief. You know, her mom grew up without hormone replacement therapy because she was at the generation that she didn't get to get to have it. And so I was truly. I mean, a lot of it was trying to dispel that belief. I said, I'm. I am about to be 45. I'm on both estradiol and progesterone as we speak because I'm not willing to wait until my levels start to drop.

I'm on all of them, too, and I can't imagine not being on them. And just. And to me, it's replenishment. It's not replacement. It's. We're just bringing it back up to some levels.

I'm pretty sure our menstrual cycle and our ovarian function is our fifth vital sign. And there is no age where it is appropriate it to lose that vital sign and have hormone deficiency. You know, if you were in pre menopause or early menopause. So let's say you had, you know, a complete hysterectomy or an ophorectomy at 40 years old, standard of care is we would slap an estradiol patch on you. Unfortunately, a lot of people still wouldn't give you progesterone, but that really should be standard of care as well, especially.

If you're taking an estradiol patch.

Yeah, well, no, they're. They would. The uterus is gone. So there's a lot of, yeah, there's a lot of, of talk where oh, if you don't have a uterus, you don't need it. And I was like, I'm pretty sure that progesterone is not siloed to just the uterus. I'm pretty sure estrogen is, has progesterone has receptor sites on every single system of the body. So why if we lose the uterus because of a surgery that it then there's no need to take progesterone. Like that is just ridiculous to me. But so if you were 40 or 41, that is standard of care. It's even now comes guidelines is if you have early menopause or premature menopause, you have to be on hormones because if you're not, the increase of you dying early or having a chronic disease earlier than you should is so great. But, but then we fast forward five, ten years later and all of a sudden it's okay for us to lose all these hormones. And I'm like, what happened between the 10 years? If anything, we've aged more 10 years later, you know, and we need that support. And so, so it's just, I, to me it's just so backwards. But we'll give you high levels of endocrine disruptors known as birth control instead.

That's right. It's. It is not.

It doesn't make any sense to me.

Yeah, that's so interesting. Let's talk about thyroid for a minute. How is thyroid plan to all of this? Because I understand that thyroid misfunction can also mimic some of this.

Oh, absolutely. So I, I have thyroid dysfunction. I was diagnosed with Hajimeto's thyroiditis, which is a very common cause for hypothyroidism. So if you have, you know, again, you know, TSH, that is to me it's under 2 or 2.5. It's worthy to run the full panel.

TSH is thyroid stimulating hormone hormone.

Sorry. Yeah. And so. And that's a pituitary gland hormone by the way. It is not a thyroid hormone. And so I would run the full panel. But 80.

When you say full panel, you're meaning T3, T4, reverse T3, all of the.

All of that TPO and thyroglobulin. Yeah. I would like look at the antibodies and so if we're, we're, I'm working with a woman who's got low thyroid function, basically low T4, low T3, and TSH is elevated below my optimal range. Thyroid stimuli hormone. Then I would run, I would always run the antibodies. And most likely there's an autoimmune component. Yes. Now T3 and T4. T3 is the, what I call the gasoline. T4 is the crude oil. So T4 is converted over to T3. But T3 has receptor sites on every, every single cell in the body. So there's only like three hormones that have receptor sites on every single cell in the body. And it's going to be cortisol, thyroid and insulin, pretty much not even estradiol. But she comes close. And so when we start to see decline in low, in low thyroid function, we'll notice a lot of the same symptoms as insulin resistance or even perimenopause again because of that low level of estradiol is driving that insulin resistance. And so I always, I mean, I think all of it, all of it needs to be ran. We need to look at a woman from every perspective, not only her symptoms, but also the labs to corroborate and validate what she's going through. But I think, you know, I have a dear friend of mine who's my thyroid doctor or my thyroid practitioner is McCall McPherson. And I've talked to her many times about this and she tells me, she's like, it's not a matter of if, it's a matter of when. And so often when we start to see a decline in these very critical reproductive hormones, we see an uptick in inflammation and that is where we'll see a greater rise in autoimmune conditions, particularly Hajimoto's thyroiditis in midlife due to these changes. So, yes, always be looking at the thyroid, especially if you're dealing with constipation, hair loss, brittle nails, slow gut motility, weight gain, fatigue, brain fog, these are all very classic symptoms of low thyroid function.

So it's so interesting because literally we could have this same conversation but be talking about gut health, or have the same conversation and be talking about just hormone replacement, or have the same conversation and talk about just replacing T3, T4. So you could take like these same lump sum things and plug it into maybe it's blood sugar, maybe so. And so I can see why it gets so confusing for women. So I want to kind of unpack that a little bit because I think number one, the first thing that's happening wrong is that some doctors, some people are just going, oh, it's just your age, so suck it up. Because that answer does not work. Because, no, it's not just your age. Suck it up. But we have to Be a detective and figure out which of those things do you find there's kind of an order of priority. How do you like talk to us about that?

I do believe there's an order of priority. I do believe that your cellular energy is everything. Your mitochondrial energy is everything. It really sets the tone for all of it. And what impacts your mitochondria are going to be the same things that impact your gut. And what impacts your gut is going to be the very similar things that impact thyroid. So I find that the assaults, the, the root causes which we, I think we talked about, we got into and then we pivoted a little bit. They're, they're very much the same across the board. They. The same things that are, that are gunking up and causing stranger danger moments with your mitochondria are often the same things that are causing major alarm bells in your gut microbes.

So let's talk, let's kind of go if we could go through this. I just want to kind of put this in a nice bow here because I think it can get very confusing for women. I get why it's confusing using.

Absolutely. So the guy I consider the biggest root causes and gosh knows I've had them. And sometimes they're coming back into circulation. Number one is going to be again, ultra processed foods, acellular carbs, added sugar. And they again, they can be sneaky, they can be insidious. That's why I always tell people like really just scrutinize over all of those labels and at the. And I know this is time consuming and gosh knows it's because we do it ourselves. Make as much of the food you eat in your kitchen.

Yeah. And I love that you just said that because, you know, I'm thinking about my thrive community. And every now and then you'll have a woman come in and say, like, it's just hard. I don't want to eat this way. I don't like. Well, my question is, do you want results or do you want comfort? Because that's. Unfortunately, we have to make a decision at some point. It's like, do you want to be. Do you want to convince me that you should be able to eat this stuff or do you want results? Because to get healthy, we cannot rely on those foods.

Yeah, I was, I was meeting with a VIP patient of mine today who was trying to convince me that I was like, girl, you don't have wiggle room. Yeah. Like you are operating, you're eating metabolically healthy meals, you are loving your gut you're getting the fiber, you're hitting your protein numbers, we're getting your prediabetes under control. And I was like, you cannot have.

Pizza a few nights a week.

Yeah, that's what she was trying to do. She's like, well, I could. What about gluten free pizza a couple nights? I'm like, there is nothing. Nothing.

There's no wiggle.

No, there's no wiggle here. You know, it's, it's, there's, there's. I have never met a gluten free pizza that, that my blood sugar loved.

So I, I was just camping recently and I eat just like you do, Marisa, but just like your gluten free, dairy free cake story, I, you know, I'm camping. I'm like, I want s'. Mores. Like that's what I wanted. I just, you know. And you go to, we went to Target and to get marshmallows and there's no pack of one marshmallow or two. So you buy a pack of like a hundred. But so, and I had, I had my samora. I was very happy to have it, knowing what it. But I literally still feel it days later. Like it's like that sugar spike. I feel that in my system and you start craving more carbs. And it's like it's a never ending cycle when you just can stay off of it. You don't have those cravings, you don't have that fluctuation.

Exactly. So that's a big, it's a big one. And it's more insidious than you think. You know, even what our son eats, my little three year old eats. And I mean, it's crazy. I mean, I remember sitting my husband down and saying, we have, we're cooking everything. We're cooking everything. And he was like, yep, that's what it is. Frustrating.

But we almost, you have to do.

It like you don't know. We're cooking snacks, we're cooking. I make his protein balls, you know, from the ingredients that I know. So it's, I mean, yeah, it's time consuming and gosh knows I'm busy, but I have to ask myself, like, what is my family's metabolic health worth? You know, when a third of our children between the age of 12 and 19 have prediabetes. 80s. A third. It's a lot. Okay, so the next thing.

So number one was, the first one was sugar, processed foods, starchy carbs, basically it's all lump sum here, even if it's gluten free. Even if it's fat free, it's processed junk. So no to that.

Okay, number two, next thing is stress.

Okay, let's talk about that. Because that's, that's definitely not a good one for me, I'll tell you that. Like, I have not mastered that.

The. Honestly, the highest, the highest number I ever saw. My blood glucose was because I was racing to an appointment. I hadn't eaten at all like for hours. And it spiked over 150 milligrams per deciding like 175. And I was like, oh my gosh. So stress. To me, it's like, especially when we're racing around and we're constantly in a state of chronic stress. You might as well just eat that cupcake because that's exactly what you're doing. And you know, a lot of our stress is really related to our beliefs around how productive we need to be be how many things, how many things we're conquering. And so, I mean, this is a whole nother. But let me just share this. This was on my favorite kind of snippets from the Journal of hormones in 2009. It says chronic stress can lead to overeating, co elevation of cortisol and insulin and the suppression. Suppression of certain anabolic hormones and white blood cells. So the suppression of your immune system. This state of metabolic stress in turn promotes abdominal visceral fat. Both the direct stress response and the accumulation of visceral fat can promote Amelia a systemic inflammat inflammation and oxidative stress, ultimately ending in disease.

Wow. Okay, that's so, so there's any advice on that? What do we do?

So I, I'm a big fan of first knowing your triggers, like really listening to your body, you know, and, and a, a big trigger for that is going to be like, are you getting clammy? Do you find your. You're getting. Everything's getting tight, that your mind is racing, that all of a sudden you're in like massive conquering mode or you're snapping at your family members like, like. And then like implement breath. One of my favorite breath technique techniques is the 4, 7, 8. So you inhale for four seconds, you hold for seven, and you exhale for eight. Another thing that I love is somatic work. So shaking out the. That cortisol energy, or maybe it's old trauma. So dance. It could be even like, you know, like really kind of of heavy going dancing where you're really moving the energy. Walking outside in nature.

That's it. That's one I've really noticed lately. Ladies listening up to this one. Like if you like today happened. As I'm interviewing you today, I happen to have a very unusual day of sitting. So I've had meetings happening since first thing this morning. Still on now. More sitting than I ever do. And I can literally feel it in my body like this. I've got to move like that. You feel the cortisol like you feel it. It.

If there's anything you take away from this interview, not the numbers, not, not that that ultra processed food is killing you because you know that it is that the number one longevity hack that you should double down on from morning to evening is walking outside in nature. There is nothing that walking outside in nature does not fix, including metabolic issues. Now, yes, you need to be lifting those weights, but yes.

And it does make it easier because I was, I was in San Diego for 20 years like you are, Marisa. It makes it easier. Easier right now in Scottsdale when it's 120, I don't really want to walk outside.

Yeah. Or have a. I have a walking desk right here next to me. So I have a walking desk. I have a peloton. I was reviewing copy today on a peloton and you know, right after breakfast. But also you want to really double down on that longevity hack and make it a massive blood sugar hack is great. Walk or do something. Walk your stairs, do 20 air squats, bust out some push ups, some jump squats. So I love jack squad squats. After every meal I move my body somewhere between 5 and 10 minutes. Ideally I love it to be a walk, but not every day it works out like that. Kind of like you big meetings. So instead I will just bust out two minutes of hit. Like a little exercise snack.

Yeah. So okay, so you said number one was the sugar processed foods. Two is the stress. Three, is this a separate one? Moving your body.

Three. Yes, movement. So movement. Well, movement. A lack of movement.

Yep.

Sedentary lifestyle, which is 66% of us aren't even getting. I think the average person is clocking 3,000 steps a day.

That's crazy. Yeah, we need to at least.

At least. Yeah. I mean at the very least. Eight. You know. Okay, next is going to be. The next thing is going to be toxins. There are endocrine disruptors. Even birth control. Medic. You know, birth control is an endocrine disruptor. But chemicals in your water, chemicals in the exhaust, you know, in your car, chemicals inside of your personal care products. I mean all of that plastic, you know you'll never see plastic containers in my house. It's all glass. Chemicals in your water, in your, in your house. So whatever you can do to mitigate the amount of chemical load, your mitochondria work so much better when they are not inundated with chemicals. But also one of the big reasons why ultra processed food is so dangerous is the freaking chemicals. That's the big reason. So that's going to be. And then the next one, I think. And you know, it's hard to avoid some of these, but it's going to be, you know, transmutable diseases. So, so mold, parasite.

Viruses, bacteria. I had no idea that I, we would be so we would be as sick as we were with a, with a preschooler in the house. Like, I just, I thought I had a really. I know we do have a great robust immune system, but no, I guess I was just avoiding little people coughing in my face all the time.

When you have toddler, it's a whole different world.

It's all different. So. Yeah. So bacteria and virals. If you think about COVID and the impact that Covid's had on our reproductive health. And I've known women who went into menopause because of long Covid and so, so there's those, those aren't doing us any favors either. And so clearing those and often, you know, you're looking at those kind of once you hit all of the other pillars and then you're like, okay, something I'm still not. Well, like we went through a massive mold remediation. But don't, don't think we didn't click all the other boxes first.

Yeah.

Before we were like, okay, is this, is it mold?

So if you're doing all the things right, I want to offer like a little bit of opinion from me and then I would definitely want to get your perspective on this because there's, there's definitely people listening that go, okay, I'm doing all these things. Like I'm, I'm not eating processed foods. I'm working on this. Like I'm doing all these things. I'm avoiding this stuff and I'm still have these crazy markers that are not working for me. My first question I'm going to throw back at people is, are you really doing all them? Because if I dig through somebody and I can usually find that they're not. They say they are, but they're not. They're. It's like what you said, it's the still the pizza three times a week. It's still the it's the, oh, but I'm still having Diet Coke. It's, oh, but I'm still doing this. So, so it's. My first question is like, are you really doing that? What would you add to that? If. Because, Because I don't want to get. I'm not getting people in trouble. This is not a grade. This is not a test. If you really believe you're doing all the things and your numbers are not changing, what do you suggest for them?

Absolutely, no, no, it's an audit. It's time to do an audit. Like, let's do a food journal. Let's put on a continuous glucose monitor. Let's. I mean, wearables are a lot cheaper than like that. Deeper testing, you know, how is your, how is your heart rate variability? What's your body score? What's your sleep score? So, I mean, we live in a time where we can really bio individualize what is going on and we can biohack our bodies with wearables. And I mean, it's a small investment. I tell people, put a continuous glucose monitor on even for one month. It's one of the best investments you can make. Buy a whoop strap or buy an aura ring and track that for three months and see what's going on. So that would be the first thing is like we, you know, test, don't get guess.

Yeah, yeah, you just mentioned hrv. Can we just touch on that for a minute? Because HRV is so individual for people.

It is individual for people. And I think with a really big part for HRV heart rate variability, which is really, it's again, measuring the variability between each heart rate and the, the longer that that gap is that variability between those heart rates. We know that we have more resilience, less likelihood of, you know, dealing with a cardiovascular event or having inflammation. And so, but, you know, when we're running on high levels of stress, we're running on, on stress in the system, we're going to see that variability drop. Or if you're a mom, like the woman I was talking to at the, at the, at the hair salon today, she's like, okay, well, once my kids, once I get my kids into college. And I was like, it's today. Today is the new later, you know, and so she was like, I need to take care. And just like, how many women are that way where they're just like, let me handle my family first. And I wanted to ask her. And, you know, she wasn't in an intake with me. We were just at the nails or at the hair salon. But I wanted to be like, how long have you been saying that? Decades. I don't know. You know, great point.

Well, this is. This has been so fabulous today. You're so knowledgeable.

This is.

This is incredible. Where can people find you?

Absolutely. So I have a podcast called energized with Dr. Marisa, and it's literally focusing on women's hormone health and metabolic health. Because of. That's. If that's the ticket, like, how do we dial that in for. For. For everyone listening? And then on Instagram @ Dr. Mariso. So Dr. M A R I Z.

A. And then you have a summit coming out.

Too. I do. Yay. Yes. So, you know, again, so many questions around hrt. Is it right for me? Should I get on it? Is it too late for me? And what does it look like to actually build, you know, resilience and great metabolic health? How do you have the freedom to do what you want in your 70s and your 80s? And so I've taken all of the biggest thought leaders and do in the area of perimenopause and menopause, and I've culminated them all into one place. And so the event is free October 14th through 19th. And you're going to get all kinds of goodies as well. But what I recommend is you go and listen, register, get the free guides, get all the free stuff that you can start taking action on now, including a blood sugar, like all my favorite blood sugar hacks. But then listen to the. Listen to the speakers that you're like, this is the thing I need to solve. You know, whether it's sleep issues or thyroid issues or it's an autoimmune condition from Dr. Sarah Gottfried. Whatever. I'm going to cover the gamut of what you need to know. Can I be on HRT after breast cancer? We are going to be covering that.

Topic. That's amazing. And we'll link up all these things in the show notes. Thank you so much, Marisa. Stay on after Marisa. For those of you listening on YouTube or podcast, we have an after party where I invite my 365 members in to ask questions. If you're interested in that, you can go to midlifeconversations.com forward/live. And we're going to wrap the podcast now and take it over to the after party. Thanks.

Maritza.

I hope you enjoyed the episode. Thanks for taking time out of your day to listen in as my guest. If you found this episode valuable, please share it with friends and on social media. Be sure to tag me and our guests so that we can find you and share the love. I'm Natalie Joe Fisk on all social media platforms and the biggest thank you that you can give me is leaving a review and hopefully a nice one at that. This will help others find these episodes so we can help and reach more people. If you do leave me a review, please Message us@supportataliejillfitness.com with a screenshot of your review and we would love to send you a free digital download of my DSR journal as a thank you.