Navigating Menopause and Hormonal Health with Dr. Shilpa Sayana

We see a lot of mainly a female population, patients who are dealing with unknown symptoms such as insomnia, fatigue, weight gain. And it's really important for the root causes. What's causing that? It's so important to see who is the vessel, who is the body we put in this implant. What are their genetics? Can they detoxify? Well, how are they going to deal with this implant? Are they super inflamed? Is their gut inflamed? Are they detox pathways and genetics skewed toward wanting to be inflamed? What can you do proactively to make sure that they accept them this implant? Well, so it's super important to actually know what your body is like. Is it inflamed? Is it not inflamed? Can it detoxify? Well, before putting a suction side.

I have a special guest on the show, Dr. Shilpa Sayana. Dr. Sayana is a triple board certified MD in internal obesity and functional medicine. She has been in private practice for over a decade serving the greater Los Angeles community. She is an expert in training women dealing with perimenopause and menopause, optimizing their hormones, energy and weight, especially if they've been told that their labs are normal. She helps them reclaim their balance and feel like themselves again by using the Sayana medical Roadmap. She has been recognized by her peers by being nominated for the most humanistic intern slash resident award in all three years of medical residency and by her patients by receiving the best doctors Women's Choice Award in 2023. We look forward to everything she can share with us today on the show. Welcome Dr. Sian. Today you all have probably heard of her and her work with perimenopausal and menopausal women. We were just talking offline about a number of topics, but one of the things in our health entrepreneur groups that we're in or in our spaces where we're dealing with integrative providers and functional medicine providers is on intake forms making sure that they understand if a patient has like a dental implant, a breast implant implant, hip, cardiac, whatever it is, having an implant has a lot of of it heightens my awareness obviously because of what I do. But I also used to help take care of other patients with other implants and other problems that may have been related to them. And so I'm glad that you said on your intake you're asking this. So let's kind of get your take on, you know, what is, you know, my patient population, which are folks with implants are dealing with chronic inflammation and maybe tips and tricks to help with their perimenopausal symptoms.

Absolutely. So, you know, we. Thanks for having me here, by the way. And we see a lot of, mainly a female population, patients who are dealing with unknown symptoms such as, like symptoms such as insomnia, fatigue, weight gain. And it's really important to look at the root causes, what's causing that. But I would say specifically around implants of any sort, it's so important to see who is the vessel, like, who is the body we putting this implant in, what is their, what are their genetics? Can they detoxify? Well, how are they going to deal with this implant? Will, Are they super inflamed? Is they got inflamed? Are they detox pathways and genetics skewed toward wanting to be inflamed? What can you do proactively to make sure that they accept this implant well and thrive in it? Because a lot of people who do okay with breast implants or implants in general, but there's a, in a subset that doesn't. So if you, even when I live in la, a lot of people have implants here and if they're considering doing that and they ask me, we already have testing where we've checked their genetics and we know how they're going to do with it. We have looked at their gut inflammation specifically, either with a stool test or blood testing, seeing what is their gut microbiome like, because if they're inflamed and you're putting a foreign object into this inflamed vessel, you're not going to have a good outcome. So it's super important to, to, to actually know what your body is like. Is it inflamed? Is it not inflamed? Can it detoxify? Well, before putting a substance like this.

In, yeah, I think, you know, that is in alignment with our program and, and certainly the, the way we discussed and wrote my book Sharp, is we're trying to make sure that from a preparation standpoint, you understand genetics and how someone detoxifies. Because I always kind of joke around like, you can't pick your parents and you can' bad diet. Because those things are inherently going to affect us as well. As, you know, I, I always prioritize sleep kind of above everything else in my recovery program because if you can't get enough sleep, then all the things that, you know, we talk about from a hormonal standpoint don't ever happen. And to introduce an implant of any variety into a Patient who's not doing well or has an established autoimmune disorder or gut inflammation or what have you. I never felt comfortable with that. I always had a lot of options that I did for reconstruction that didn't involve implants. So I was a micro surgeon for almost 20 years before I stopped because my neck had had enough of the operating room microscope and its positioning. But that was a really useful skill set to have, especially in those cases where you're like, ah, it's really not a good idea. Patients already got, you know, Sjogren's or they already had some other issue. And I just use that as example. But. Or Hashimoto's or something. Whatever you can.

Yeah. And, you know, so many people are living with, like, unknown amounts of inflammation. Like, we don't. As a traditional internist, I'm not. You know, in my previous life, before functional integrative medicine, we weren't checking these kind of labs. You came in for your physical. We did like a tiny subset of labs, and those were normal, hence you. Or normal. But there's so many of our patients we see now where we just check a battery of tests and say, okay, you can't sleep and you're losing hair. Let's just check everything. And we find a lot of people have hidden autoimmune markers that are elevated, like Hashimoto's or positive ana. And we've had really good success in terms of reversing those antibodies or at least limiting them. So they're not having disease without it's disease without progression. And then once you've optimized all of that, that's the perfect time to consider having a foreign. A foreign object inside of yourself. And then a lot of times with what you're doing, we have patients who come in here in the perimenopause, menopause time, and we've really optimized everything we can. And then suddenly they're not getting any better. Like, they've gotten somewhat better, but not fully better. And then when we think about the fact that they had an implant, could they have this? And could it have been breast implant illness all along, but we just never recognized it?

Yeah, it was interesting. I was on a panel a couple years ago, and it was. A report came out, it said 45. I'm sorry, 48% were reported to have bacterial contamination or if you want to think of like a biofilm. And I thought that was extremely high. And in my experience, I thought it was more of, you know, a roughly 35% ish. And then last year we published a paper that actually when you looked at our sample that we submitted for examination, it was about 600 in size. So 600 explant specimens were examined and 29% had bacterial contamination with, in our experience, staph epi and cutobacterium acnes cd bacterium acnes was above staf epi in our study and then in others it's been staph epi. Both readily produce biofilm. So it's not surprising because if you look in orthopedic literature, people have shoulder replacement surgery. One of the biggest problems is kidobacterium acnes in terms of infections, because used to be called propion bacteria is found in very high concentrations on the shoulder, chest, neck and facial skin. And so, like, none of this is that complicated. I think the issue that we run into from a provider standpoint is, and I'll say this like I always do on every appearance or show I do, is I don't envy a provider trying to figure out what's wrong with the patient in this situation. Because if they haven't asked about an implant, hip, knee, breast, dental, cardiac, neural, whatever it may be, right. They may just be really behind in understanding, you know, what the patient's experience. And if they don't know, then the things that you traditionally use that from a protocol or supplementation or therapeutic modality that would work normally, they don't work in this instance. And to your point, chronic inflammation like this where the implant's involved and it's really ramped up. There's studies to show now that oxidation of oleic acid in the breast tissue tissue leads to oxylipin tin home which downstream the immune system causes a polarization of macrophages. A lot of fancy words for it creates more symptoms in our immune system.

So, yeah, yeah, it's complicated in terms of trying to unpackage and unravel a patient like this. But I think that's where you really need a system. We use this four pillar approach. So we do test hormones in everyone from adrenals to thyroid to insulin to sex hormones. The second thing is really looking at the gut, right? And sometimes patients like, I don't have any gut symptoms, like, I don't need to do the test. I'm like, no, we do it on everyone. But it's like, what's the gut microbiome and what's the gut lining? Is that lining intact and is in. And then the third pillar we look at is toxic burden. Do you have a bunch of toxins in terms of heavy metals, plastics, mold exposure. And then the fourth thing we look at is lifestyle. But when you have a systems approach and asking those questions, do you have any implants of any sort? Do you have any metal in your body? What do you have that's so important to actually get a comprehensive understanding of what's their journey till you. So you can actually intervene and have some hypothesis as to why.

Yeah, our Sharp method is similar to that. And it's, you know, trying to unravel much of what you're describing. And I really love how everybody's put so much effort into treating these patients. I found that it's very difficult. Like you understand if, if you don't know they have implants or if after explant, you don't quite know what to do with those patients, because they can be a little challenging. In terms of your perimenopause, perimenopause, perimenopause practice, what do you try to do to maybe from a holistic standpoint, help with hormones and balance and things like that to get people on the right track in terms of, do use bioidenticals ever? Do you use creams or do you prefer a pellet therapy or rejection?

Yeah, generally, you know, patients who come to us perimenopausal or menopausal, but the perimenopausal stage, they can come to us even in their late 30s. And at some point in that phase, it's really looking at what's going on with the other hormones. So they think about it more as a. Think about it as an access. So your adrenals are like the grandparent. And then the thyroid is the mom or the dad or the parent, and then the. The ovaries and the testes of the grandchild. As in regular traditional medicine, as you know, we look at the sex hormones, we look at the thyroid, but we hardly look upstream as the adrenals. But if you focus on the grandparents and the adrenal glands and work on what's addressing that in terms of stress, anxiety, inflammation, we generally see the thyroid get much better and the sex hormones improve. So we'll try all kinds of natural approaches. First, what can we do in terms of improving that access? What can we do in terms of inflammation? What can we do in terms of gut health? What can we do in terms of improving toxic burden? And just by doing that, I would say 30% of patients feel markedly better. And then we give natural hormones. But we do want to know is they. Do they genetically get rid of dirty estrogens. And we do check genetics for that. And so we ginger about giving people estrogen right off the bat. We start with things like progesterone to help with sleep or natural supplements that increase progesterone like vitamin C, Chase Berry, Vitex. And then we move on to testosterone. And both men and women lose testosterone. And giving a tiny amount of topical testosterone can help them with energy, memory, libido and muscle making capacity. And then we move on to estrogen. But a big protein that is often overlooked is something called a sex hormone binding globulin. And that protein, if it's high, it's going to bind all your free available testosterone or hormone. So it's not available to you. So we have a lot of patients who come in already on hormone replacement and we only use bioidenticals and they're like it's not working. But when you check that sex hormone binding globulin, you realize that they're not feeling that hormone. It's not bioavailable to them. And common reasons we see, see why that sex 1 binding globulin is high is inflammation and toxicity. And we live in la, everybody eats a ton of sushi. So a lot of times we see is mercury toxicity or because we have it in our question mark, do they have implants, especially amalgam fillings that's causing that toxicity?

So you see elevated mercury levels quite tons, A lot. You see parasitic problems with the, the raw fish at all or is that not a thing?

You know, not so much. But we definitely said because we have a lot of people who travel to Mexico because we're so close in terms of traveling. So we do see a lot of parasites that way. But the mercury pretty much almost every other person in LA has high levels of mercury that they're just not being tested for. And that mercury is like, it mimics estrogen in terms of how it works. So people can have headaches, be anxious, have insomnia, have a bloated belly, all due to high mercury levels. And just they know that genetically they don't detoxify well and they not they, they keep eating and being exposed to the toxin. And so for those kind of people really want to clean up all that stuff before considering an implant. And if they have an implant and already are inflamed, that kind of toxin can exacerbate it.

I guess, you know, because we're, we're central, we're more going to be on the grass fed, you know, grass finished beef side of things getting, you know, we have very good sushi here, but obviously we're not coastal and it's not going to be as obviously frequently as you're seeing it. You know, it's probably considered fast food there at some point. And then we do have a similar problem because Texas is so close to Mexico and many, many people travel. And my, my common thing is to ask them, like, where do you go, you know, for holiday or spring break or, you know, are you going to Cabo? And, you know, it's a very, very common problem. And I really underappreciated, you know, probably in the community at large, the medical community. I mean, I, I think about it all the time now. It's just like parasitic problems from travel and mold toxicity from living in an old.

Yep.

Like where you went to school, first lived when, you know, none of us had any money. And we're living, you know, in these small, multiple roommates. And, you know, those just environments are bad.

They really are. And I don't think people appreciate LA having a lot of moles, but it does because we've had a bunch of rain over the past couple of years. Well, not this year, but we have. And there are quality of roofing. Isn't that great, of old homes. And there has been a lot of mold exposure. And the one thing with mold, especially thinking about hormones, is we do find people who have high levels of zeleron with a Z, and the zeleron mimics estrogen. And when we're thinking about hormone replacement, really want to make sure there's no estrogen mimickers that could be exactly exacerbating any kind of symptoms. And we're giving somebody estrogen who already has a high estrogenic potential. So we do do a lot of mold testing, but people, again, just don't appreciate or don't realize that, wait, I lived in this place 10 years ago, and it's still impacting my health. But if they think back, they're like, oh, that was the time where my health did shift, but it wasn't so bad because I was in my 30s.

It is very interesting how when you point that out to people, it's like it's a little bit of cognitive dissonance in that you moved away from some place and so now everything's magically better. Yes, of course, you and I know it's not the case.

No, it's not.

And you're incapable of detoxifying. You know, we all talk about the bucket analogy, but you reach, you know, your point. Your Capacity and then, you know, maxed and to become more and more symptomatic. Your inflammation is, is more than you could cope with. And so just because you moved from LA to Austin, which is. Yeah, you know.

Yeah. I mean, even just, you know, growing. I grew up in Southern Africa where my genetics don't detoxify well, but there was no industry there, so I didn't have any major medical issues when my kids are growing up in LA where there's tons of toxins and LA is considered one of the most polluted cities now. And they do have health issues and, you know, affects their lungs or affects their hormones, but toxins are just everywhere. But our regular, unfortunately our conventional medicine hasn't got there yet in terms of saying, oh, this is a toxic issue and this is what needs to be done. And that's why you have to spend the time with the patient to figure out where have they lived, what do they have? It's what do they do? And they may not even be aware of a toxic exposure.

So you brought up, I'm glad you brought that up. In terms of air quality, I think that's like one of the most underappreciated problems that I see. We live in Central Texas and Austin specifically in the Hill country. And it has very high mold, very high cedar, very high oak, because it normally, like today, you know, once again, I said it froze, but normally year round, the trees are producing pollen. It's a very difficult environment for folks who have reactive airway disease or have allergies. And every time someone moves from LA or the, the Bay Area and they're like, oh my gosh, I got all these allergies. I'm like, no, you didn't just magically develop a bunch of allergies. It's, you know, the, the climate here is such that people want to leave their windows and doors open all the time. And now you have this rush in of all of the, you know, allergens, if you want to think of it like that, the pollutants that are in the air and your H. VAC system, your home system, can't cope with it. And so we're always talking about using, you know, additional air filtration. We use Jasper and IQ Air and these things are very aggressive in terms of controlling your air quality so that your, what you're taking in is high quality as can be.

Exactly. I mean, we just had these horrific fires in L. A over the past 10 days and I've had patients whose genetics don't detoxify at all and they finally are better. Finally things are stable but fragile and suddenly now they have like another upper respiratory infection. I was like, you need to leave, leave. Or have these really high air quality with multiple filters going on. Where are they able to really limit your exposure or not go out at all? But I think it's important to actually have that knowledge. They don't detoxify well, so you could pick a place to stay that actually has better air quality. However, you know, where we are right now, air quality is such a premium and clean water, clean air, those basic things are becoming inaccessible.

It is interesting there's been such a effort made to understand filtered water. I mean, like it's been beaten into your head. There's so much that, gosh, I can't remember the little animated movie that talked about bottled air. But you know, the air. Yeah, really like you just wait. I guess when you go to altitude they give you. Or you can buy bottles of water.

Think about it.

Kind of feel like, yeah, roll it around with those.

It's probably a good idea, especially now. I mean, they're like, oh no, the air quality is not bad. But we're not measuring. You know, we had all these fires and we had a bunch of flame retardant, you know, everywhere. And the flame retardant has high levels of cadmium, lead, antimony, all these heavy metals. Nobody's really testing in regular medicine or measuring is the air quality. And these are what kids have gone back to school and are breathing in. And the impact of this, you know, Cadmium's life is 16 years. It's going to be in your system for so long. And that same little girl might grow up and get an implant and have these toxins in her body where, you know, she didn't have the benefit of knowing to have a clean body and a clean vessel and what you've been exposed to before doing such a procedure.

Great point. That is going to have so many downstream effects for so long. It's terrible situation. You know, the, the. What are your tips or tricks then given obviously where you are in Los Angeles. And I think everybody listening should just understand your environment's not getting to be any safer. It doesn't matter where you're living.

Right.

Let's, you know, let's listen to Dr. Shilpa and what she recommends is some things that are takeaways that will be that you, that you can utilize on a day to day basis to just help yourself, protect yourself, if you will, from the environment. It.

Yeah, I would say the most important Things are making sure that, you know, your gut's working and you're not inflamed. I'd say most of America, a lot of our patients are constipated. Like, you really have to be eliminating. And how do you detoxify? By peeing, pooping and sweating. And a lot of patients aren't sweating. Like, this whole concept of like, going to the sauna or exercising till you sweat is just lost. And if you don't detoxify well, or just to be safe, it's a good idea to, at the local gym or the YMCA to try and go into a sauna and go slowly so you can acclimate to sweating, but open up the sweat channels. But my patients who don't detoxify well don't sweat well. And it's important to, like, wake up those. Those channels so you can start sweating, make sure your gut's in good working order. So sweating, pooping, and make sure you're hydrating. Like, a lot of us are just very dehydrated. We don't take the time to drink water. And I have a lot of executives are like, I have to go to the bathroom all the time. I'm not going to drink. But you have to drink. You have a human body.

Right. I have the. The converse of this. I have people drinking too much free water. That creates. So for everybody listening to my. My patients know this. So when you have surgery, you get a big burst of cortisol release and that turns on your thirst center and you want to drink more because your body's trying to part of the inflammation cascade. Is that so? What I try to do, Dr. Shipwreck, is I quickly, I fake out the body and I tell them, okay, you can drink your Stanley, if and only if you do these things, you're gonna have to add protein to it or amino acids to it. So the. You're not drinking straight free water because we know this setting we don't want. It's just gonna leak out into the tissues because the pressure. So we're trying to, yeah, fully do this in a way that promotes rest and recovery. Gets people in the parasitic parasympathetic state in a. At a. You know, we want anabolism or catabolism, so.

Exactly. I think for us, our biggest challenge in our patient population here in LA is I have a lot of, like, vegan vegetarian patients who just don't get enough protein. And so I can't imagine that must be a challenge for you just in terms of recovery.

You need protein for us, the way we've tried to navigate that is the amino acids are vegan basically. And the, the protein source that we prefer to use is in my line is based on pea protein. So I've tried to, and for everybody listening, I, you know, I, I do this just like Dr. Shilpa does. It's just trying to be very careful about what she's recommending and trying to keep the, I try to keep the ingredient list very low.

Yeah, that's key.

More things in there, the more worried I get.

Exactly.

Fillers and things like that. So a gram of protein per pound of body weight is kind of the minimum for us in, in the post period. And that's very hard. Like you said, for vegan and vegetarian clients, that's way more than they're used to taking in in a given time frame. But you will swell more and you will stay swollen longer. Your body, your, your liver, your GI tract, your kidneys will not be able to manage the post operative period. Well, if you're, if you're not increasing your dietary protein, which just to keep it simple, we'll say affects your.

Yeah, right. Yeah. I mean, that's a challenge for I think a lot of my patients. But in terms of other things for detox, apart from sauna and apart from the gut health, it's really also about increasing antioxidants like through your food, like getting enough color. I think the recommendation from the functional medicine organization is 12 colors a day. That's difficult, but I would say at least five, like five different colors of fruits and vegetables if you can of some sort. A real food, not something processed, would be ideal. And then the last thing is looking at some supplementation. So if you don't detoxify, well, either an antioxidant supplement or things that have nac, which becomes glutathione, which can help you liver with detox. I mean, so many of my patients, when we just check blood work, have slightly elevated liver enzymes and they're like, oh yeah, my primary doctor told me I have a fatty liver and there's nothing to worry about. But it's like, why do you have a fatty liver? Are you not able to detoxify? What can we give you to help your liver enzymes calm down? Because your liver is so important to get rid of toxins.

It's astonishing. Even in people who eat well, we see not Frank, you know, Nash or fatty liver, but you know, the amount of processed things that have been in the food system for so long in this country. I mean, hopefully that will change. I'm not going to hold my breath on that. I think in general, you know, don't eat anything that. Or be mindful of things that have labels because that's not really food. Food doesn't exactly.

No, it doesn't. I think going back to what you were saying earlier, like, keep the ingredient list very short. Like ideally three or less. If it has stuff on there, it probably has stuff that's processed. But we've become such a culture of like, what's quick and what's easy, but that's not really good for our bodies.

Right. You know, it's funny, in Austin, we go to all these little. My wife and I now have like date night, but it's at the farmer's market. We go, oh, nice. Buy our food. And we can almost get everything we need. Produce is the hardest thing to get in Texas. You're in connection. Yeah. Obviously you have options than. Than we would have, but we can get fish from Alaska and we can get, you know, obviously quite a bit of meat because we're in Texas. So for those things, it's a little bit easier. As you get to the vegetables, it becomes more complicated. And then produce is infinitely complicated here. So that becomes sense. High mean wise too. It's, you know.

Yeah, yeah. And I think we probably. And then the idea. Another big nutrient category is fiber. Like how many times we tell patients to like, make sure you're getting enough fiber. And people are like, oh, I eat a ton of salads, but in like a bowl of arugula has like 02 grams of fiber. It has other benefits, but fiber comes from beans and from avocados. And I always tell people, you can have a bowl of raspberries that have 8 grams of fiber or a bowl of blueberries that have much less. It's like picking the foods that have high fiber, ideally trying to get to 30 grams. Why fiber? Because it helps you detoxify, it helps your bowels moving. It's such an important ingredient. But I think it's hard for people to get or be aware of where. Where it is. Like, I'm eating a ton of salad. I have a lot of fiber.

Yeah, the. That's why the, the produce part. Fruits and yeah, it's very. That's the challenging part. Especially, you know, we have a lot of folks increasing their protein higher than they've ever increased it in their diet. So then having sources of fib and you know, keeping it so they can eliminate is challenging with obviously medications after surgery, things of that nature that's right. Yeah, we have a good system in place to help and we try to use only, you know, those holistic options until exhausted. Obviously, if folks want to find you and work with you. Do you, do you do virtual as well as in person?

Yes, we are. We do a lot of virtual, but we are licensed own. I'm only licensed in California, so they would have to come. The initial appointment has to be in person. We are looking to expand that in many states. But we have so much, we have demand here. Just trying to keep up with patients here and make sure that we are comprehensive. And they see somebody once in person and examine them. And most patients come to us for hormones, but they come to us a lot for like longevity medicine and, and anti kind of healthy aging. So we end up taking the care of the whole person. So a lot of times we do see people in. And then once you see us once they can, we can manage their care for the whole year without seeing them. So yeah, telemedicine has been amazing.

Well, I have a lot of listeners across the country, including California, so let them know where they can find you.

Yeah, you could easily find us@cyanamedical.com so s a y a n a medical.com and then when on the front page there's like work with us and you can click on that and you would get scheduled to see a discovery call person and then very soon with me, me.

All right. Thank you. Thank you so much for coming on. I'm glad we were able to get together and chat today. Really?

Yes. Thank you so much for having me and take care and hopefully this year will be a good one for all of us. And these fires will finally stop in in la.