REVERSE and PREVENT Metabolic Dysfunction with Dr. Mariza Snyder

So making sure you know what you're eating in the morning, it's going to set the tone for everything. If you have that almond milk latte and you have some oatmeal, you know, with a little bit of, you know, crumble or whatever, that blood sugar spike, because I'm telling you right now, you're going to have it. It's going to happen to you for sure.

Today on Midlife Conversations, I've got my friend, Dr. Marisa. Thank you so much for being here. We're going to be talking about metabolic dysfunction. Sounds a little scary, but we're going to talk about how to prevent it, how to identify it, how to even reverse it, repair it, which is what we all want to know. So thank you so much for being here today.

Thanks for having me. I'm so, so excited for our conversation.

So how this conversation came about. True story. Marisa and I were on a party boat. It was a true party boat. We were the only ones not partying.

We were not drinking.

We were not drinking. We were not partaking in any of it. But we were sitting in the corner cold and talking the whole time. And I was telling her about my blood sugar debacle, which is now resolved. So grateful for that. But I was telling her about it, and she was asking me a lot of questions that no one else had asked. You know, I had gone down the path of gut questions, I'd gone down the path of wearing a CGM of diabetes markers, all these things. But she was asking me a lot of questions. Started to really get me thinking about metabolic health in general. One of the things she brought up was thyroid. She was talking about heart markers, a lot of things. And I said, I've got to have you on the show. And because I want to talk about this whole topic about metabolic dysfunction, because typically, especially us as women, we go into the doctor, we're looking for, like, one general marker. Like, we look for cholesterol, like what's our cholesterol or what's our A1C, but we're not looking at all these things in between. So she today is going to save us a lot of time, probably prevent a lot of health problems. So let's dive in.

Yay. Well, I wanted to really speak into out the gate. I know we're talking about metabolic health and everywhere it seems. And it is, it is a really complex process, right? It's. It's our ability for our cells to curate energy from the food, AKA substrates that we're consuming, whether they're carbs or they're protein or they're, they're fats. And you know, for women in particular, because I know I'm talking to women today who are my favorite people to talk to. I always say I serve everybody by serving women. That there's a little bit more complication to our metabolic health and has a lot to do with, no surprise, our hormone system, our menstrual cycle. And obviously I know that a lot of women who are listening to you and on this show are probably out of that phase. But it's important for us to kind of understand what was going on there. That kind of moves us into perimenopause and then into menopause and beyond. And why it's important for us to make pivots and shifts and changes, especially between the ages of 35 and 55, that really gear us up for the level of endurance, longevity, energy, and really living our best life for the many, many years to come into menopause and beyond.

So we, we've had people on talking about hormone replacement therapy or bioidentical. Let's start sort of with that. Like, what do you consider is where we should be hormone wise? And then where do you get into? Like, should we be balancing them? Should we replacing. What do we just navigate and accept? Like, where do you fall on that spectrum there?

That's such a great question. And we're talking about hormone replacement, we're talking mostly about sex hormones. But I just want you to know that there are other hormones involved as well. Insulin, growth hormone, thyroid hormone, and, and some of these we can't. I mean, obviously we can replace insulin. Hopefully we don't get to a place where we need to be replacing insulin. Unless you're a type 1 diabetic growth hormone. Yes, there's growth hormone out there, but ideally we can build it on our own naturally. And then testosterone. You know, we don't do a great job in, in, in the medical world of having a great alternative to testosterone for women. And you can go and get it compounded. You have to work with someone very specialized with it. But we just don't have testosterone available for women. So there are ways to naturally build that up as well. But when it comes to hormone replacement therapy and thinking, we're always thinking progesterone and estrogen, right?

Yeah. And when it, and testosterone that into.

It, as long as you're working with someone who really can dial that in and it's particular for estrogen and testosterone, there's a lot of nuances when it comes to those particular hormones, your health history needs to be taken into consideration. You know, you know, we need to be a unique approach to you. But the one hormone that I think that we can kind of play with a little bit more fluid and we can kind of just kind of test it out, see what happens is progesterone. And, and one of the areas that I think we're not talking about enough when it comes to progesterone is that we lose her way earlier than we think we do. Like she starts to tank in our 30s. And depending on the lifestyle that you're living, how you're operating in this world, I will tell you that this modern day life that we live, that women operate in and that we try to thrive in is not conducive for happy hormones. It's just not especially progesterone. And so she begins to. I've been looking at hormone tests of women, Whether it's blood tests or salivary tests, mostly I love looking at Dutch tests. And I will tell you that in mid-30s, early-30s, I start to see levels of progesterone much lower than I would expect or I would love to see. And where I think women should even consider using a bioidentical like progesterone is as early as if you start like looking at your hormones, you know, even in your 20s. If you can get a baseline for what your hormones look like in your 20s, start to track it throughout your 30s. Usually it's your mid-30s or so when we start to see that shift. And if you're struggling with mood issues, you've got literal no resilience before your period. You are struggling with sleep and you just feel like you are easily triggered, easily lit up. You know, your family is kind of responding to you in a way that like, they're scared. They're scared, yeah. One of my favorite remedies, I mean, again, lifestyle is such a major piece here, but one of my favorite ways to kind of soothe things out and to, to kind of get you back to a place of having resilience is boosting progesterone levels, especially during perimenopause. I don't think that we deserve sure to have a depleted progesterone reserve for the second half of our cycle. We're not supposed to. So that's the first bioidentical hormone I ask women to look into as early as their mid to late 30s.

I have a question about progesterone and I'm going to definitely. Then I want to dive into like the Other three, the untalked about ones like the thyroid, insulin and cortisol because they're so crit cold. But when it comes to progesterone, there's a lot of confusion around two things with that. Number one, and I'm going to say them both and you can tell me how number one, bioidentical versus HRT or the ones that are like in synthetic hormones, like a birth control pill. That's number one. Like in. Yeah, yeah. Because there's some danger around that that you hear about very much so. The other question I have is do you have to cycle your progesterone? Like for me personally, I am not cycling it right now and the reason I'm not is because my cycle is not on point. So I'm curious your thoughts on both of those topics there.

Such a great. Such two phenomenal questions. Okay, so the difference between bioidentical progesterone, which is bio literally identical. It's not your progesterone. Don't get it twisted. We're still having to make it in the lab, but it is identical to the progesterone that you make inside of your body. I, I would. I bet on that horse. That's the horse I'm going to bet on. That's the one I want you using. The other one is the progestin. Again, it's in birth control. You can obviously get it as a hormone replacement therapy. And yeah, there are a lot of side effects and negative impact side effects that you can get from just taking progestins. Things like. Well, actually some of the things you're trying to avoid like mood swings and feeling irritable, it could mess with nutrient deficiencies. It can mess with your other hormones at play as well. So my recommendation is if you're going to add in a progesterone, do, do the bioidentical progesterone. Do. If you want an oral prometrium, obviously there's topicals on the market. I carry a serum called Progesteror, which is freaking amazing. And you know, I like topical because you really can play with it month to month and figure out what works best for you. Some of the women that are using mine double, double the amount they need. Others use half of the amount. That's the beautiful thing is you get to play with it with.

I didn't even know there was a topical progesterone. I've only done the oral with that. I've done the topical estrogen and testosterone. I didn't know about the progesterone being.

Topical, it's so nice and it works so beautifully. And it's nice because you can, you can kind of play with it, right? You just apply it to, you know, inner arm or belly or still at.

Night the same way you would still at night.

Okay. Same exact way. I use my topical to get pregnant at 41 years old after having a miscarriage. Um, I had, I, you know, I remember growing up, my mom telling me when I was like 14 or 15 years old, she's like, the women in our family just don't have progesterone. And I was like, okay. I had no idea what she meant, but I was like, all right. And she just means that, what that means is that you're going to have horrible periods. It's going to be awful. You're going to have crazy moodiness and you're going to want to like slice everyone's neck off.

Oh, boy.

And I was like, okay, okay. She's like, just gear up. Experience for the rest of your life. But, and here's the thing is she's, she's right. The most of my family members, most of the women my family have low progesterone. But I would, I'd wager to say that so many women in the US have lowered levels of progesterone.

Yeah.

And intention. And that has to do with a lot of stress that we're dealing with and has to do with a lot of, you know, environmental toxins that we're dealing with. And so again, like living this life and playing full out in this life isn't always conducive to our hormones. The one that we take for granted until she's gone and man, you notice her, is going to be progesterone. Yes. Topical. Again, if you do go to your doctor, they're mostly going to recommend a progestin first. Stop them right there and say, hey, I really want prometrium. I want to try it the natural way, given my health history. Whatever you got to kind of say to, to move them in that direction or try a topical, you know, over the counter and give it a go. See how you do over, over 30 days. Now, if you are cycling, if you have a regular 26, 27, 28, 29, 30 day cycle wherever you land. Please, please, please, if you're still cycling, track your cycle so that you know what's going on. Right. It's a fifth vital sign. I know I'm talking to, you know, women here who may not even be cycling anymore or maybe towards the end of it. But, man, that information just really can really serve us. So if you are someone like myself who still. I'm 40, 43, and I still have a cycle, 20, 29 days, give or take. I. When I'm. Unfortunately, I'm still. Well, fortunately and unfortunately, I'm still breastfeeding. And progesterone will tank your milk supply. So the second I am done with this journey, which I'm hoping is this month after Mother's Day, going back on. I'm going back. I'm going back on it because I know I've seen my levels. They are, they're not looking so hot. And, and so I'm going to get on. But I will get on. I will track my cycle as I do. I track it with, with basal temperature every single day in the morning. And once I know that I'm ovulating, I will then start using my, the topical progesterone. So if you're cycling, please only use it during the luteal phase of your cycle. That is the only time in your cycle that you are making progesterone. Now, remember, progesterone is, the only way that you get it is if you ovulate. So ovulation precedes the release of what happens if you take it.

Okay, so for instance, so you, you take it from, from ovulation on what? Because there's a whole different train of thought here where doctors say, take it every day, take it every day. So that's what I'm doing right now. And I'm, I, I don't even know if that's the right or the wrong thing. I just know I sleep better, everything feels better when I'm on it. So I just, I take it around the clock.

Yeah, there are definitely instances where you would just take it around the clock. One of those instances is during trying to get pregnant, like heading into pregnancy, you're cycling it in and then once you're pregnant, you just take that until somewhere in your second trimester. Right. Because you want all that progesterone to maintain that pregnancy. That's one occasion. Number two is you are at, you are at the, the waiting door, like phase three of perimenopause and your cycle, she's been gone for months. Who knows if she's going to come back or not? I don't know. You know, who knows that six months mention, she comes right back. Yeah. And then you start all over again. So that is when I would be recommending that the time where you could be on progesterone more consistently.

Any dangers in taking it around the clock if you are not skipping periods.

It's really case by case. Here's the thing about this is what I love about progesterone. Based on the research that we have right now. No.

Okay.

No. It's one of the safest hormones. I think honestly my opinion is all women should be on it after.

Yeah.

Age because why the freak not like to. To have to soothe out some of that.

Yeah, it absolutely. I enjoy. I like it. It also does balance estrogen dominance if you another way to balance that. So which I think that's why I actually am on that.

Well, it's guaranteed 95% of women will have estrogen dominance only because of the way that our it the natural ebb and flow of the precipitous decline of hormones. So those hormones are testosterone, growth hormone and progesterone. Progesterone and testosterone will precipitously drop earlier than you think. For testosterone, we're talking about early 30s. We start to see a drop in decline for progesterone mid to late 30s. And there's no reason to have to suffer per se now with when it comes to progesterone, it's a lot harder to build it back up. I would love to tell you that you could naturally boost progesterone, but it's not that easy. It's like, it takes like 90 days. Gets you there. Vitex, there's, there's really wonderful herbs that you can use. But if you're definitely in the perimenopausal window, you're experiencing severe estrogen dominant symptoms. Do yourself a favor. Yes, you could help your liver clear that excess estrogen by really ensuring that phase one and phase two detoxification pathways are open. But just don't suffer. Yeah, don't, don't suffer. That's my recommendation there.

So let's talk about the other not talked about hormones enough unless they're in dysfunction. And that's where I want to talk about them because there's some signs ahead of that. Like we, we typically hear about thyroid insulin or cortisol when there's dysfunction. Like we already. When it's too late. So like most women will hear about an insulin problem when they already have an A1C that's too high. Right. Like that's the first they're hearing of it. Or they start testing that and then same with thyroid. When they have there's a thyroid issue. How do we, what do we need to be knowing about these things and what do we need to be looking for and how do we start taking care of them better?

That's a great question. So I would say, as I mentioned earlier, with the sex hormones, that if you can afford it and it's doable for you, I think every woman deserves to have baseline labs in their 20s when, you know, and ideally I say 20s because hopefully everything's working like a fine tuned machine in those years. That's not the case for all of us, right? We have women who are struggling with polycystic ovarian syndrome in their 20s, thyroid issues in their 20s, even estrogen dominance in their 20s. But let's say, let's just say for the most part, most of us are running a pretty normal cycle. Things are working. Environmental factors, lifestyle factors haven't put us at that risk of some of these hormones not working properly. So that would be the first thing is really getting baseline numbers to kind of know where you, where you start personally. And then it would really be about, you know, again, the, the best monthly report that you could be looking at every single month that could really identify a thyroid issue, identify insulin resistance, identify estrogen dominance. Is your menstrual cycle, Are you even ovulating? What is, what is your, what's the luteal phase of your cycle future feel like? What does it look like? You know, what does it look like when you're menstruating? This is probably one of the best biohacks. I would say that we were the first biohackers because there was, there were no tools and apps until like 10 years ago. We really had to understand what was happening with our body. And when you think about the menstrual cycle, it is one of the, if not the most energetically demanding system of both men and women with the most mitochondria inside of the ovaries. And so it's if for whatever reason your menstrual cycle isn't working, like, isn't based on what we would consider normal, like, you're seeing, you're just, things are not right, you know, things, it's inconsistent. You're spotting, you're having severe, you know, estrogen dominant symptoms like heavy, heavy periods, fibrocystic breasts, migraines, before your, your period, if these types of things are happening, it's really a sign that we got to look deeper into what is going on. And if you're not ovulating, that could easily be a thyroid issue. It could, or it could easily be an insulin resistance issue. So it's when you start to See these kind of changes happening in your menstrual cycle. That's kind of the window of saying, oh, it's time for me to start looking deeper into why is it that the thing that's supposed to run like 28 day clockwork isn't running like 28 day clockwork for me until I'm getting into perimenopause, where obviously these things are. I'm. Things are starting to shift.

So we hear a lot about in perimenopause that you start having a cycle that's not, you know, every 28 days that you might skip some. That symptoms kind of change. All of that what I never hear about and it's what I personally experience and it's what a lot of my friends experience. So I'm wondering if it's a common thing or it's just. I don't know why I have not heard this before. Periods getting heavier.

It's. Oh, that's 100%.

Can you speak into that? Yeah, a little bit. Because that's. I hear this common from so many people, but no one I've had on yet has spoken into that.

Oh, I love this topic. Great. So there's, there's a couple of reasons why we experience estrogen dominance. As I mentioned earlier, that about 95% of us are going to experience it. And it has everything to do with as we head into perimenopause, especially even as early as 35 years old, due to either we don't have the right nutrients to fuel like great ovulation because it doesn't have to be an ovulatory, meaning no ovulation. It could just be that ovulation isn't as great as it could be. Right, right. And that has a profound impact on that corpus luteum, which is the kind of a temporary hormone creator for releasing progesterone into that second phase, into the luteal phase of your cycle. So if anything's compromised in, in that ovulatory part, which I call the main freaking event. Like, I know there's so much on the period, but it's not about the period.

It's about no ovulations when you feel amazing. Like, I love my that week. It's like I'm on point, I'm focused, I'm energetic. I want to every love everybody.

Yeah. And she's what's driving all of it. She's what matters. You know, it's. It's the periods on the back end. Oh, you didn't get pregnant. Let's reset it. So that's what, but that's, you know, we always, when it comes to women, we just focus on the, the, the, the, the not fun stuff, like the issue and, and the, you know, you grew up like I grew up in a Catholic family and it was like the sin. And it was, it was all this, all this stuff, right, that made women, you know, not as, not as equal what, you know, all the junk around it. And so, but we don't realize is that it's ovulation that's driving all of this. And so even if ovulation just isn't optimal, it's going to have an impact on, on progesterone. And there's a lot of reasons for that. Too much stress, not enough nutrients, being on the pill for too long, toxins, you know, all the liver not working properly, insulin resistance. Any of these things can be playing a role. But so then what ends up unfortunately taking a hit because of that is the rise in progesterone levels. And again, in that second phase of our cycle, not only does progesterone, it should be 100 to 1 progesterone to estrogen. And if it's not, you know, if estrogen, even if estrogen is normal and progesterone, she's just, she tanked. So now maybe you're at a, like a 50 to 1 or a 25 to 1 estrogen. Now we have a situation of estrogen dominance because in relation to progesterone, estrogen is dominating in that part of the cycle. And what ends up happening because estrogen isn't count or progesterone is not counterbalancing estrogen. We see the heavy periods, we see the painful, heavy breasts. We see weight distribution in the thighs, butt and even abdominal area. Bloating, mood swings. We experience brain fog, we experience migraines. All of these are symptoms of estrogen dominance. So you don't even have to have a crazy amount of estrogen coming through on that part of the cycle. It just is in relation to progesterone. Yeah.

Okay, that answers probably my next question. That, and again, I'm not alone on this one where we are getting into hot flashes which are typically from not having estrogen, but then we're also estrogen dominant. So that was my other question. Like, how can that be both. Yeah. So like, so like for me personally, I'm just, I'll volunteer to share. But, but my, I was having severe hot flashes, like five an hour. But taking a small dose of estrogen cream, the bioidentical stopped my hot flashes. But I'm estrogen dominant, so it's like a mind bop. I'm like, how I don't understand.

It is multifaceted. So one of the one, and I'm about to do an episode on my show on this, which is the blood sugar hot flash connection. So it may not just be a decrease in estrogen that's driving hot flashes. Often it is, it's insulin resistance and it's blood sugar regulation that is driving. So glucose intolerance to some degree. Yes. It can also be a decline in estrogen, but often we see it, especially during the perimenopausal phase, as a blood sugar concern more than anything else. I know.

Wow. That's. Okay, that makes sense.

We also have to look at the liver, right? The liver is playing a big role in this, particularly around the insulin resistance piece. But also, you know, are these pathways open properly so that we are, we are moving through these, these estrogen metabolites that shouldn't be hanging around that we're moving like in terms of estrogen dominance, but making sure that the liver is optimized so that it's able to do its job in terms of glucose metabolism as well.

And I'm going to probably say this wrong, but I also have learned recently about the gut health connection where, like, if you have. Am I going to say it right? Glucose glucan. Is that what it's called?

Glucuronidase. Yeah, glucuronidase.

That affects your oxygen. So if you are, Is it if you're low there, if you're high there, I can't remember which one, but it's high.

It's gonna.

Yeah, so mine was high. So, so that was. So if it's high there, you're not gonna detox your estrogen correctly, which can also create that.

Right. So we're talking about three phases in the detoxification phase. Right? Phase one, which, you know, you think about a bathtub, if, if, if the drains on and you didn't turn off the faucet of the bathtub, right, it's going to keep overflowing. That's phase one. So then let's say, okay, I'm going to fix phase one. I'm going to, I'm going to give my dylmethane antioxidants and broccoli seed extract. You know, all that's going to help clear phase one. But then you take off the, the, the little, the little thing that's blocking the drain and what you realize and you turn off the faucet that it's still overflowing. So now, you know, it's a pipe issue. So it's inside of the pipe. So then that's phase two. So what we got to look at is, well, am I getting enough B vitamins? Am I getting enough, you know, basically, can I methylate this and package up estrogen in a way that it is safe to move over to the gut to the estrobolo. And so that's where you have to add in choline, B vitamins, essential amino acids, you know, making sure that you have, you know, all the nutrients that are necessary to run phase two and then you get it over to the gut. Because here's the thing is if every, if, if we have, you know, an imbalance in your gut microbiome, if we're not able to break down estrogen and sending it through the colon or you're chronically constipated, we will unpackage that perfectly packaged water soluble estrogen and send it back into recirculation. And it's an oxidative estrogen.

Everything you just said is exactly why in three, whatever, in a paragraph, whatever the paragraph is just everything you just said is why I unfortunately am not a fan of just so much traditional western medicine anymore. Because we're not looking at all these different areas of things. So the way you just did that, like I feel like so many times like if you go to the ob GYN and they say you're estrogen dominant, it's like one thing they give you or one solution, like go on birth control pills or whatever, whatever it is when, like what you just explained or somebody might say maybe a doctor's a little better, like oh, just do dim. But they're not checking all the layers and if you're not checking on the layers, you're not going to get to the root, you're not going to really fully connect. Correct this because like you said, if you've got a methylation problem, you can have all dim in the world, but it's not going to fix it. Or if you have a gut health problem, you're going to have all, you can have all the correct methylation, all that, but you're still not going to fix the problem.

So really women have more than one, you know, majority of us do have more than one of these issues. So yeah, it's a multifaceted approach. What will get you there faster is the right supplementation. It'll move the needle, but you need supplementation for Every single, every single part of these of 1, 2 and 3.

Let me ask you about that because I'm as the older I get, the more I'm less convinced about a one size fits all supplement approach. I used to say, like, oh, there's signature staple things that everyone should take. Now that I've been through so much with my own journey and I watch other people, I feel like there's just so much customization like there. So what is your thought on that? Like, are there things that everyone should be taking or is it really, truly, should it be customized around everyone?

There are things that I think every woman should be taking, yes and yes. And there are definitely things that need to be customized to you. But the question is, is, can everyone afford customization? And so my always, my recommendation is like, I, I have a full, I do a full masterclass on specifically estrogen dominance and women will show up to the class and be like, like other things. And I'm like, I am literally walking you through the top 20 symptoms of estrogen dominance. If you have three or more of these symptoms, you are in the right place. And what I'm talking about today is only a solution for that.

Yeah.

You know, that's what I am solving for you today. And, and again, the majority of us at some point are going to have estrogen dominance simply because progesterone is going to precipitously drop way faster. So by the time we're 45 years old, we've lost over 50% of our progesterone, only 25% of our estrogen. So just the imbalance and then just add on to lifestyle. You've got to do lists that you're never accomplishing. So that is something you're having snacksidents, you know, maybe late night or late afternoon to get you, just to get you through part one and part two of your day. Right. You're, you're dealing, you're not sleeping well enough, you're not moving enough. Like, you know, you're sedentary, you get that one workout in and then, but you're not able to move throughout the rest of the day consistently because you're at a desk job. You're, and you're, you're doing the best you can in your career and for your family. And so when we take a look at all these things, those compound over time and lend to again a greater drop in progesterone levels. It's what's going to be one of those hormones that takes a, takes a hit. And so you'll see that discrepancy happen sooner or happen bigger. It'll be a much more bigger, like a Mack truck kind of moment. Even still, like, that's just solving one specific kind of issue. We still got to look at the whole rest of the body because if you've got estrogen dominance, it's, you know, you could even still have a low thyroid. You could even still have insulin resistance. All those I had, I'm. I use me as an example. I did have all of those right when I was diagnosed with estrogen dominance is the same exact time that I was diagnosed with my. With my autoimmune condition, Hashimoto's thyroiditis. And little did I know that I had been insulin resistant for probably like slightly for 10 years, because I basically just gobbled sugar all through my 20s just to survive, you know. And so all of those things were playing a role, kind of feeding on each other, but. And I still also had to like, deal with them kind of one at a time. So what.

How do we help women from not just throwing in the towel? Because there's a lot of stuff, there's a lot of information, and we can go down rabbit holes in every which direction. Like, where do people start? Because this is like, like I. Not with my own blood sugar thing. Like, I wouldn't have known that had I not seen markers on my blood test. And then I thought it was the blood sugar. And it's like you keep going down the rabbit hole. And it. Mine ended up being gut health. And we got to the root of that. But how somebody listening right now there, it's like, I get it. Where they just give up because I guess a lot.

Where do you start? Such a great question in, in looking at all of this for many over, oh my gosh, 15 years now, and taking care of women, estrogen dominance or low progesterone or thyroid issues, or just in perimenopause, for goodness sakes. And looking at what most women want, which I know, you know, we want to feel strong, we want to feel toned, we want to feel lean, we want to have energy so that we can take care of the people that matter to us and do the things that we love. And so one of the first areas that I feel are very overlooked that have a profound impact on the rest of the system is really our blood sugar. And, you know, I think that until we're flagged as pre diabetic or worse, it's just not something anyone talks about. But you have to realize that unsteady Blood sugar. So, you know, blood sugar that's up and down all over the place, it's going to have a profound impact on our energy levels, on our mood, and it's going to really have a major impact on our liver function, which could have an impact on estrogen dominance. It's going to have an impact on our brain function. And then we also know that it's leading to cardio metabolic disease down the road, heart disease, diabetes, those types of Alzheimer's. And we win, by the way, when it comes to mortality rates for all of those diseases, including autoimmune conditions, we win. We have the most men don't go anywhere, come near. When you think about these as mental diseases, Alzheimer's, stroke, heart disease, we lead the pack on all of this. And so there's a couple of areas I always tell women to focus on. One, know your blood sugar. So I want us to get into the habit of checking. As often as you check your bank account, I want you to be checking your blood sugar. Like if that's once a day. Once a day. Your fasting blood sugar being that most important number, which by the way, that.

Needs to be under 100, like, for sure. I think it's.

I would love it under 90.

Yeah. I was going to say I aim personally to get it like 70 to 80 these days. I mean, I get.

Yes. So optimal range would be 70 to 80. I'm. I'm good. Regarding, like optimal 70 to 85 milligrams per deciliter. And then if we're creeping over 90, and the reason why this is one of the things I talked to when we were on the boat not drinking or doing any of the other things that were going down, was that the research right now, when it comes to. Well, when, when does the fasting blood sugar become extremely dangerous for cardio metabolic disease? And right now the General consensus is 126mg per deciliter. But what they don't realize are that damage there. Yeah. So, but for women in particular, where we start to where our threshold is, is 110mg per deciliter. So once we go past 110mg per deciliter in terms of a fasting blood sugar, our rate for stroke and heart disease just skyrockets.

Yeah. And you're already pre diabetic, by the way, as soon as you're over 100.

And. But then most people have no idea. I think it's like 84% of people, people, including women that are pre Diabetic have no idea that they are.

Also, if you go to the endocrinologist and they, you tell them that I eat, I eat and after I eat my blood sugar goes over 200, they will tell you, they will tell you it's fine as long as it goes back down within two hours. That is not true. That is not optimal blood sugar. So that might be fine for you staying alive right now, it might be fine for delaying your diabetes problems, but it's not optimal health. It's not, you're going to have issues there. And I, it took me a long time to really get this. Like you, you're after eating. What I Learned from you, Dr. Marisa, was that it actually should really never be over 130 after you eat. Even after eating sugar and heavy starches.

Yeah, ideally, like, and ideally, what I would love in an, in an optimal way world, if we were really focusing on our metabolic health and one of the biggest indicators of that is blood sugar, is that your numbers stay within 70 milligrams per deciliter to 110 milligrams per deciliter. And then if you have a little, kind of couple little hiccups here and there around 120, that's fine. But daily consistent, steady blood sugar is literally the name of the game.

So what I found too, if this helps anyone listening, is if you're like, well, how do I control that? Or maybe you're doing a CGM or you're doing a finger stick test and you're like, but I eat, you know, I piece of bread and it goes way up. Well, there's a couple things. Number one, if as long as you, if you balance your foods with proteins and fats, then you really, and fiber, you really shouldn't have that issue. If you still have that issue, then there's something bigger going on. And that's what I learned with myself. Whether that's something with diabetes going on or you have a gut health problem, there could be a number of issues. But that is not like, don't, don't try to be a hero like I was. I was trying to control it so hard being on a keto diet and it was not working for me. So if that's happening to you, go, go deeper and find out why. Because if you are balancing with fiber, fats and proteins and you're still spiking, there's something bigger going on.

Yeah, you investigate. And so what I want to, just want to share the five tenets of like, what's going to keep Us metabolically healthy. And then I would love to share a couple of blood sugar hacks that I think are absolutely amazing. So that first thing is, yeah, maintaining good blood sugar and that's by eating metabolically healthy meals. And that is meals with enough, sufficient protein to get the job done. Enough micro and macro, micro and antioxidant rich nutrients. So things that are going to feed your gut. So plant foods. So the aim is like 30 different types of plant foods per week. But Start, start at 10, start at 15 and work your way up making sure that you're getting appropriate amount of omega. So through, you know, salmon, you know, mackerel, sardines, or taking an omega supplement, that's going to be really helpful. And then the other thing is making sure that you're getting adequate amounts of fiber. Most people recommend 35 to 50 grams. I would say 50 grams is really, really well, you want to play and, and it does, it takes effort. Things like chia seeds, flaxseeds, you know, basil seeds, you know, just doing your best to integrate fiber into every single meal is going to be.

Do you recommend taking fiber pills or capsules if you have to?

If you, yeah, if you got to do it. If you need to put fiber in your green smoothie or your, your protein smoothie to get that, that protein and to get that fiber, do it. But there was some of the biggest metabolic scientists out there will say to you that fiber is half of the obesity epidemic solution. That's how important it is because it's your gut health. It's literally your gut health. And then adding fermented foods to your daily diet as well. So that's a metabolically healthy kind of meal set is, you know, as many antioxidant and micronutrient rich foods that are going to feed that microbiome. It's honestly, it's really a microbiome kind of protocol. It's giving your, your gut what it needs to survive and that you've got those good gut bugs working for you. Next is making sure that you're getting good, deep quality sleep. I believe me, I know I have a toddler. We co sleep, I get it. And I can see the competing priorities there. But just like do what you gotta do to get the sleep that you need. Next is move, move, you know, clock 7500 steps or more per day. It's, I'm talking walking and add resistance training. Especially in our 30s, 40s and 50s and beyond, we are just losing muscle mass at a great percentage every decade. We go and so however you can maintain that muscle mass as early as your 30s, that's kind of really the good, the kind of the time to do it. But resistance training with its heavy of weights as you can do, that's going to be the name of the game there. And then the other piece is going to be outside of a sedentary lifestyle, is making sure that you are mastering your stress, you know, getting where you fit. And whether it's breath work or meditation or walking in nature or it's hugging your puppies or your toddler or your, your teenage daughter, you know, whoever it is, those are the things that are going to move the needle. It's about that consistency that's going to make the biggest play. When we look at metabolic health for women, those are going to be the things that we have just got to be consistent on, especially as we kind of enter into early perimenopause that will allow us to saunter through perimenopause a little bit better and to be able to manage it, manage menopause on the other side with strength and just, you know, just feeling like you are well resourced, moving into that, into that part of your lifestyle. And then I will share blood sugar hacks whenever you're, when you.

Yeah, no, I'm ready for those. I want to hear them. I would love the blood sugar hacks.

So first things first is your morning when you break your fast, whether it's 11am or 9am or 7am, I don't care when you do it. If you love intermittent fasting, yay, as long as it's working for you. I'm a big fan of circadian based fasting. So 12 hours on, 12 hours off. I find even with, even women who've got stress stuff can still get away with a 12 hour on, 12 hour off circadian rhythm, intermittent fasting schedule. But whatever that is, that first fast, do not break it with dessert. Do not break it with a Frappuccino or a vanilla latte at Starbucks or Pete's Coffee or even a oatmeal latte. Because oatmeal has like oat milk, has like 10 grams of sugar in just the milk. So be really mindful. I will tell you right now, Pete's Coffee, Starbucks coffee. Like Starbucks, it's only almond milk if you're wondering. All the rest of the milks have got a ton of sugar. They will spike coconut milk too. Yep. They will spike your blood sugar. And just ask, be the person who's like, hey, can I just see, Can I see your. Can I see the box. Almond milk box. Because then you'll know. Like, you'll know. My husband and I, we go to all kinds of really fun specialty coffee shops and we'll ask, like, if we see it's barista blend almond milk, 12 grams of sugar guaranteed, and it'll spike.

And people are thinking just because it's coconut or almond, that it's healthy.

Yeah. And they're not adding extra sugar. I didn't order an vanilla latte. I only ordered an almond milk latte. Yes, but almond milk latte is at least 4 ounces, you know, of. Of milk. And I guarantee that's at least 8 grams of sugar. And it's. It's liquid sugar. It's going straight. You might as well just pump it into your bloodstream right now, like, so making sure you know what you're eating in the morning. It's going to set the tone for everything. If you have that almond milk latte and you have some oatmeal, you know, with a little bit of, you know, crumble or whatever, that blood sugar spike, because I'm telling you right now, you're going to have it. It's going to happen to you.

Sure.

Um, it will take up to 48 hours to recover, and that means you only ate just salmon and salad for the next two days. It takes forever to recover from that. And so if you start your day with waffles or a, or toast and orange juice or oatmeal or whatever it is, like if it's high simple carbs or it's sugar, I don't care if it's paleo waffles. You know what I'm saying? Like, it doesn't matter.

It's going to set you on the first thing, Risa.

So I have, I have leftovers. So this morning I had salmon cakes. So we have autoimmune friendly salmon cakes that we make with, with almond flour that my husband made last night. Wild caught salmon. And I had a big green salad with avocado, bell peppers, some celery, and some cucumbers.

So what time was that, that you had that?

I had that at 10:00am okay, so everyone hear that?

You can have lunch and dinner for breakfast. We. It's Americans that made this rule that we have to have waffles or eggs or whatever.

It is so crazy to me.

And if you want breakfast, I know what I. What I pretty much have every morning now, it's, I'll have turkey bacon.

Yeah.

And I put it in the air, fryer and then I will do some avocado, and I'll do a bunch of berries.

Perfect. That's perfect.

No, that's my protein. Because I don't. I. I tried to avoid an overdose of eggs, so.

But not everyone can tolerate eggs. I mean, it just really depends. I can't. So it just depends. Or I'll have a big, big protein smoothie with frozen cauliflower chia seeds, a bone broth, protein powder, even some greens. On top of that, a half an avocado. So I really make sure I've got all my fiber, I've got my healthy fats, I've got my protein. And then I'll put usually, like a half a cup of blueberries in there. Because blueberries have so many great benefits. Does. Believe me. I've been tracking my blood sugar forever.

Yeah.

Not spike my blood sugar. And I'm kind of getting all the things that I want. So a fast breakfast for me to make for the whole family would be like a big blueberry green smoothie with a ton of protein powder in it. Or I just eat leftovers from the night before if I'm.

I love it.

So that just sets the tone. Next, ideally, if you could not snack. If we just go meal to meal to meal to meal, your mitochondria and your digestive system so appreciate it. They don't have to work so hard all day long breaking everything down. So, like breakfast, lunch, and dinner. Great recommendations.

If somebody is a snacker, though, and they want to snack, like, what would you suggest they do?

Protein and fats. Or. Or like veggie and. And fats. Like, let's say almond butter and celery.

Yeah.

Or, you know, something like that. Or avocado, like a little guacamole and some cucumbers.

So I personally like to sip on bone broth pretty much all day long.

Bone broth is perfect.

That. Especially if you're like a. I'm a snacker. Like, I want food in my mouth. Like, I'm not sleep. I would definitely be obese if I listen. Didn't listen to my body.

Yes.

I want to eat all day long. So what I find, if you're. If that's you. If you want to eat all day long, I take bone broth and use a lot of salt in it and put vegetables in it. And I sip on that all day long.

Oh, I love that. I love bone broth.

It feels like you're eating. It's like. It just feels like it. But you're getting really protein. Just really good protein and collagen.

And I'll tell you, I've always had my Achilles heels two to three o'clock in the afternoon. And usually what I'll do is I'll make a sparkling water. So Pellegrino. And we usually have decaf iced tea in the fridge and some lemon. And I will because I feel like I need to do something. Yeah, you're like, it's not going to cut it. No, I'll do something. Or I'll do a little handful of cashews and a couple of blueberries. Again, I'm tracking this with my blood sugar because I'm curious to see, you know, again, you don't ever want to have dessert naked, meaning it's first thing for breakfast or it's a snack, like you eat a kind bar or something like that, it's going to spike your blood sugar. There is no protein bar that I found that didn't spike mine on its own.

Oh, mine too. And even some of those sugar free candies spike mine. The ones that the smart sweets.

Yeah.

I love those. But they totally spike my blood sugar, which I don't understand, but they do.

They just, you know, it's so crazy.

Yeah. So just because something says no sugar doesn't.

Yeah.

It's not going to do it to you. So it's really important to watch that. And if you're wondering, if you're, if you're thinking, okay, I hear all this, but I don't really feel bad. If you are wondering why you are tired an hour after breakfast or after your first meal. That's why. Because when you do eat a high starchy, high sugar meal without anything else, that's what happens. Your blood sugar will crash. And that's the tired that you feel.

Yeah. I tell people if you're not tracking your blood sugar the three ways that you know on a blood. You're on a blood sugar roller coaster. Yes. You crash and burn. You're about to eat your own fist, you know, at 11:00am, like two to three hours after you had breakfast or two to three hours after lunch. You are just declining in terms of energy reserves as the day goes by. So you're just feeling more and more run down and more and more tired and you find yourself super moody. Super moody, super angry. Yeah. You're just kind of snapping at people out of nowhere. You're like, where did that come from? Those are often the fact that you're on a blood sugar roller coaster because what comes up has got to come down. It's got to come down and it comes down hard. I've seen it, I've tested it and it's, it goes from 135 or 140 down to like 54.

Oh, totally. Yeah.

Your body overcompensates and you feel it. Oh my gosh. So next for dinner, move. If you can move your dinner window as early as you can. So we eat before 6pm that way we have a three hour window between dinner and when we go to bed. Obviously you don't eat after that. No late night snacks and then you're making dinner. Remember we're more insulin resistant. So that same meal, let's say it's salmon and salad. I'll say salmon cakes and salad because I'm talking about, let's say I have salmon cakes and salad. Again, no clear carb. Obviously carbs are veggies too. But I'm not having rice, I'm not having quinoa or something like that or a big piece of bread. Let's say I have salmon and salad at 6pm Blood sugar looks great. I'm very happy. I have that same meal at 8 o' clock and I'm going to have a much bigger rise because I've just become more insulin resistant as the night progresses. Our genes were always meant for us to eat before the sun goes down, you know, because back in the day we didn't have electricity. Those weren't, we had to eat before the sun went down. And so the later we get, the more our body goes into storage mode. We're not in a thermogenic state anymore. So I recommend try to eat, if you eat, eat by seven is great. But if you can move it to six, 30 or six, even better. And then one of the best hacks is walking after every, any and every meal, especially dinner. So where the juice is worth the squeeze is right after that dinner. Up to 90 minutes after that dinner, go for a 15 to 30 minute walk. It will stabilize and it will, it will, it will significantly reduce that blood sugar bump up by about 30, 35%, up to 40% depending on the situation. And then the other things that I recommend is again, pairing your carbs with protein and fats, having a fiber or veggie starter out the gate. So if you were to go and order, not fun, not sexy, but it would be veggies first, then protein, then fat, then the carbs. So if you're like, I got to have the roasted potatoes, I just have to. Then you would eat those last.

Yeah, yeah, that's why I see our. It wasn't wrong being raised when they said eat your dinner before dessert.

That's why. And if you're ever going to eat dessert, if you decide and then you. Absolutely, we get to have dessert, just make sure dessert is right after dinner. Yeah, don't, don't do it two hours later. Like you're not going to be able to take advantage of all of the, the fiber, the protein, the fats that are slowing down the blood sugar release from the digestive system over to the bloodstream. So if you're going to, if you're going to stack on that sorbet or you're going to stack on the brownies, whatever it may be, gluten free paleo brownies, make sure it's right after, right after your meal. And honestly the best time to do that is after lunch because again, you're in a more thermogenic state during the day than you are in the evening. So. Or eat that super healthy dinner, have the paleo gluten free brownie afterwards and then go take your walk. You know, that 20 to 30 minute walk. And I promise you won't see any jump in your, any significant jump in your blood sugar unless there's something going on behind the scenes.

Well, this was so good and so helpful today. You gave, I agree with me and I'm sure you gave listeners a lot to think about here. If people want to learn more, they want to follow you, they want to find more. Where do you want them to go?

Yes. So the, my, my podcast, the essentially you podcast is literally on women's hormone health, metabolic health, I mean, name it, all of it, but I specifically dive a lot into perimenopause and menopause and what's happening there. So the essentially you podcast, my books are on Amazon and Instagram is at. Dr. Demarisa. D r M A R I Z A.

Thank you so much, Dr. Marisa. Thank you.

Sam.