The Lab Markers Your Doctor May be Reading Wrong for Optimal Aging with Dr. Sabrina Solt

Today on Midlife Conversations, I've got one of my favorite people. I've got Dr. Sabrina salt on. And she is so good when it comes to helping us reach our most optimal state. Now, first and foremost, she specializes in regenerative and anti aging medicine. She told me she has a gift for needles, which we'll get into in a little bit. But I wanted to have her on today specifically to talk about the labs, the lab markers that our GPS are not testing for that we should be for optimal aging. But also how to read some of these because there's a difference between optimal and standard levels. And this has come up so many times with many of you that follow me on social. You'll see me post. You ask about numbers and it gets confusing. And the reason I wanted to do this specific conversation is Sabrina and I had a conversation offline recently where I had a low ferritin marker, a really low ferritin marker on my labs. And for those of you that know what ferritin is or don't know, ferritin is basically how your body absorbs iron or that's what we've been told, it's how it absorbs iron. And there was a huge amount of thought process that most gps will say that, oh, you must be anemic, you must have severely low iron. This is terrible. You need to fix this. And I happen to see a post from Sabrina speaking into how that's amazing to have low ferritin, how it's actually a really great way to age, optimize. So I messaged her and we ended up talking offline about like what this meant. And I thought, this is so interesting, more people need to understand this because we could have that same conversation around cholesterol or other markers too. So thank you so much for being here today, Sabrina. I can't wait to dive into this.

Thank you so much. I think this is going to be fun and super helpful for a lot of people.

Yes, I do too. So I'm not even sure where to start, but because I just brought up the ferritin, let's start with that because if you could help explain really what's going on with iron and ferritin and why are so many people talking about low ferritin being dangerous? And where did this train of thought and what you've studied come into play?

Where?

Why it's it actually is beneficial to have lo Ferritin.

Yeah, it's such a great conversation because it can really lead us in a bunch of other directions too. As far as Even things like insulin resistance and implication on hormones and cardiovascular disease. So as you were saying, so there's iron, which is we generally describe as like our circulating iron, and that's important for our oxygen carrying capacity in our red blood cells. If a woman has ever been anemic in the past, usually the first signs of that are pretty, pretty easy. Fatigue, shortness of breath, easy bruising. Sometimes the fingernails start getting the ridges and cracking EAs easily. And usually this is a problem, the anemia side for women who are still menstruating, because of course, we're losing blood every month. And not a lot of women are eating a diet that's very, very rich in iron, like a ton of red meat and whatnot. There is a, an issue with the iron that is fortified in other products. And we'll get there in a second.

Okay.

But when we start getting into the postmenopausal and midlife conversations and we're no longer losing that iron every month, and. And maybe we're still consuming it, and maybe we're still consuming it in the fortified foods. Well, now it starts to store up and it starts to store as this molecule called ferritin. And ferritin is a bunch of iron molecules. I forget the exact number that's in there, but it's a bunch of them stored. And it stores in tissues, usually even places like the liver. Liver is a really great store, a house for this stuff. And the way that I like to think about it is iron itself is technically something that can be inflammatory or oxidative. Right. So if you've ever seen like somebody's old rusty truck sitting in their backyard, right? That's iron that was exposed to water and oxygen, and it starts to rust. When we have this excess therein start building up in our systems, we get kind of like this internal rusting, and we call it oxidative damage or oxidation. And this can produce a whole bunch of other issues in the body. And it can lead to things like insulin resistance, it can cause cardiovascular damage, it can even predispose to certain types of cancers. And so you start seeing these levels start to increase as people reach middle age, because these levels, they just. The body starts to store it if it's not using it. And there is kind of a sweet spot, especially for both women and men, where once you reach this threshold, it becomes more problematic than not. So I'll stop there.

So, no, that, that's making sense, but I want to, like, why? What confuses me is that why do so many doctors go automatically to like, this is the problem zone. When you're saying, like, this is where this is actually a. A healthy Z is not. Where does that come into play?

This is a really great. This is. This is so interesting. You can actually have functional anemia with high ferritin stores. So there's a lot of things to look at when we're talking about what's happening with iron in the body. Because you have your circulating iron, you have your storage iron, which is the ferritin, and then you have what are called your iron binding capacities. And if somebody's not taking in enough iron, but they have all the stored ferritin, you're probably wondering, well, why are they maybe showing up as anemic? Why are these doctors so concerned that their iron is low and wanting to give them more? And it has to do with which type of iron came into the body in the first place. So a lot of people don't know this, but all of the grains in the United States legally have to be fortified with iron because, of course, they think anemia is this big rampant problem. And what they use is actually, like, metallic, unabsorbed, non bioavailable iron. I've seen this video on YouTube before, and you can probably go find it where they've taken this, like, bag, I think it was like, of a Kellogg cereal, some random cereal. They crush it into a fine powder and run a magnet over top of it to pull out the iron flex, and you can see the iron coming out, and it's metallic iron. The body can't use that. So what does it do? It stores it as ferritin. So you can get this functional anemia where you're eating iron, but it's not being absorbed, and then it's being stored and the body can't do anything with it. There's a couple other things that can play into this as well, too, which is other mineral deficiencies. So interesting. We'll talk about spinach for a second. Or, you know, leafy greens in general. You know, Popeye, everyone says leafy greens are really, really great. And spinach is supposed to be a good source of iron. I've done the math on this. In general, when you're eating spinach, a max of like a quarter of that might be absorbed for that iron and possibly converted in the body. But what you're missing is that sometimes the oxalates that are present in the spinach will actually block further mineral absorption and deplete other minerals in the body. And actually a deficiency in copper will make the body Further sequester and store ferritin so you can end up with not only just the iron being off and the excess ferritin being stored, but then you have this copper deficiency that could be at the root of it. And one of the things, I think we talked about this on last time is maybe it was with you. Copper deficiency in women can start to actually look like sagging skin and an increase in wrinkles because copper is actually one of the minerals that we need for collagen production.

So wait a minute, I'm going to make sure I understand this. So a decrease in copper will, can help, have you look older, can change your skin. But what did you say it does to ferritin? It increases it or it decreases, actually.

Increases how your body stores the iron.

Increases how you store it. Okay, so this is important because there is definitely women that have brought this to my attention where they, because I had the same thing, low ferritin, their GP is raising red flag. Like this is a problem. You got to, you got to increase. Even some natural doctors are saying this is the problem, you have to increase it, even though they have zero symptoms of what they're thinking. And this was my case, by the way. I had low ferritin, zero symptoms of what they said low ferritin should present. And what should people be saying or asking their doctor around this? Because as you pointed out to me, low ferritin could be a great thing. And I believe being celiac, for example, because I don't eat fortified grains, that's probably has to do a lot with why I don't have this excess.

Yep. And what matters is, is your circulating iron too, and then your iron binding capacity and you can get those values ordered within that same iron panel. A lot of labs will have this checkbox as an iron panel, so you can see all of it. And if you're circulating iron is normal and your bind, your binding capacities are also normal. Having a low ferritin isn't necessarily pathological. And again, you're probably not storing up a lot because I know you don't really go for the red meat. You're not eating these fortified grains. And so it's not necessarily a bad thing as long as you're still getting enough for your daily requirements and that your body is, you know, recycling it appropriately. So I don't see it as an issue. And you know, for men especially, especially because they've never really lost any blood, most of them, throughout their entire lives, a lot of the heart disease that we see in men is Usually rooted in some excess ferritin. Same with goat gout. Can have really two main, main roots to it. It can be like the excess fructose and high triglycerides that we see. But it can also be related to high ferritin.

Wow. Okay. Now you also said on that post that I saw one more thing on ferritin question that you felt low ferritin is actually an aging benefit. Can you explain that a little bit? I want to make sure we understand this.

Yeah. Because you, you're just reducing the oxidated, your inherent oxidation and the inherent damage that might be happening on a daily basis because you're storing less of this molecule. That's really great at using up your antioxidants.

Wow. Okay, that's, that's a different train of thought. And when I asked Sabrina why she had reshared that post, she mentioned she had been at a recent conference and no one was talking about this. And she thought, this is so interesting. Like, no one's talking about this. I have to bring this up. Why is there such a lack of information on ferritin? Let's talk about some of the other ones that are commonly misrepresented. And I want to ask, I'm going to ask about the big one, cholesterol. Let's talk about that.

Okay. So people have a love hate relationship with cholesterol. And there's, there was so much propaganda that was trying to tell people, okay, cholesterol by itself is bad. But there's so much nuance to this conversation. And a high cholesterol panel is almost par for the course by the time you reach middle age because of what cholesterol truly is. And it's a building block. It's an essential nutrient. So cholesterol is what is the starting molecule for all of your sex hormones. Your testosterone, your estrogen, your progesterone, even your cortisol, all synthesized from cholesterol. So when you hit middle age and your hormones naturally start to decline, well, it makes sense that your body's going to turn up production of cholesterol. Your body actually makes, your liver makes 70 to 80% of your cholesterol levels. You're getting maybe 20%, 30% from your diet at the most. So besides the hormones, cholesterol is also the building blocks for every single cell in your body. It's also the building blocks of all the lining of all of nerves. So when we see cholesterol going up, it shouldn't be a question of, well, how do we lower it? The question should Be well, why is it going up in the first place? And how can we support the body in a way that doesn't. Doesn't make it necessary to do this? Right. And part of the cholesterol panel that we usually look at, well, we have the total cholesterol, we have the hdl, we have the ldl. Then we usually look at the triglycerides. Out of all of those things, the one thing that I'm looking at first and most importantly is the triglycerides, because they're both probably the most menacing thing on that panel. And high triglycerides are, in my opinion, are a far better indicator of future health concerns than even a high LDL. And it's because once your triglycerides reach over 80, and this isn't actually coming from me, I learned this from another doctor, Dr. Thomas, I think Day Spring, I believe, is his name. And he's the one who says if your triglycerides hit over 80, you've reached a level of insulin resistance. And we know insulin resistance is a big deal as you start aging.

So I love this conversation because you always make me feel normal. That's why I love talking to you, Sabrina, because you always make me feel normal, because I am that person that's had genetically higher cholesterol, but my triglycerides are completely low. And so you also assured me about that, too. When you look at HDL and ldl, what do you think is okay? And where. Why are the alarms sounding to so many doctors around this? I have my own theory, but you're the doctor, so I want to ask your opinion about all of this.

The reason that why so many doctors get upset about this and want to lower cholesterol is because when they see somebody have a cardiovascular event and there's a plaque formation or buildup in the arteries, it's cholesterol that's there. But, you know, it's the same thing as saying that, oh, just because there's a fire truck at a fire, that it was the fire truck that caused the fire. And that's not the case. The cholesterol is there. As Good analogy molecule.

Yes, good analogy.

It's here to do the repair. Whereas the damage was likely being done by alcohol, carb intake, excess stress, certain medications, eating processed foods, certain environmental exposures. There's so many things that can actually cause that arterial damage, including even something basic like a folate deficiency.

Right?

There's so many little things, and yet they want to blame cholesterol, and it gets completely vilified so beyond just saying, okay, the cholesterol is high, like you were saying, it's important to look at the other numbers. So your hdl, which is your. We'll call it the good cholesterol. And if your HDL and your triglycerides are about a one to one in ratio, you're super solid. Like, that is a really fantastic.

Explain what you mean by that, one to one in ratio, because somebody might have a higher. So. So you're saying they should be even, or did I hearing that right?

Yep, as close to even as possible. So if somebody has really great triglycerides at say like 70, 75, even up to 80, you would want your HDL to be similar. Anywhere from 60 to 80 in that range. So they're about.

According to you, I'm living forever. Because every time I talk to you, I feel better about my lab. So my lab's always assigned, you know, make alarms to people. When do you worry about LDL with people?

Good question. It depends. So you always have to coordinate with what the symptoms are that the patient's experiencing. So say I have somebody and they come in and their LDL is sky high, but they're not.

What's sky high? Tell us what you mean by sky.

High versus like, over. Over 150, over 200. You know, anything below that. And again, it depends if the HDL and triglycerides are looking good and it's just a sky high ldl. I'm wondering what process is the body trying to compensate for what's going on underneath? Are their hormones low? Are there. Are they trying to recover from a chronic infection? I see this a lot in people with Lyme and mold, where the body is just increasing this LDL to try to repair some of this damage that's being done. But even then, we can actually check to see if that LDL is misbehaving badly. We can run other markers that are a little more advanced. We can run something, an oxidative LDL to see if the LDL is actually in that oxidative or inflamed state. And we can also run something called an hscrp, which checks for systemic inflammation, but it can also be cardiac specific. So is there something happening in the cardiovascular system that is generating this? And we'll find that.

I love. See, this is when you hear, doctors should get to the root, root like you are the definition of someone who gets to the root, root, root. Because this. Can you explain what could go wrong if we start treating cholesterol without Looking at all of that, the, I guess.

Biggest thing would be that you stop all the repair process your body's trying to do anyway, and you never allow that to heal. So this is why, like women, they, you know, they hit menopause, they start feeling terrible, they go to their doctor to figure out what's wrong. The doctor runs the basic labs, you know, blood counts, cholesterol panel. They want maybe run like a tsh, which is no indicator. And they don't even look at the hormones, but they see the cholesterol elevated, they give them a cholesterol lowering medication.

And.

And now all of a sudden, their menopausal symptoms are so much worse, their brain fog starts going nuts. All their joints are feeling even more achy because you just took away this essential repair molecule from them.

Is this why people have that soreness when they take cholesterol statins?

Yes, absolutely. You need lipids in your joints to run the synovial fluid, run the cushioning.

Okay, so I would assume that, I mean, I, obviously it's case by case, but you probably rarely are prescribing cholesterol or lipids, cholesterol lowering medicines.

I don't know if I've ever prescribed a cholesterol lowering medication. In fact, I work to get a lot of patients off of them.

Wow. Okay. And then so I, again, not the doctor here, but I'll. In my train of thinking, if you've got high cholesterol and you're worried about it, you look at your triglycerides. That's number one, like make sure. Then you look at the one to one ratio. Is that even with my hdl? You look at the root. Root. And if you're really worried, you go and get a coronary artery scan. I would imagine that's what I've done, you know, and you make sure you're a zero. And then you really know, like, okay, I don't have this. I, I know, I want to bring this up because you, I know your husband a little bit more than you, but you are a part time or a majority time carnivore. He's a big carnivore. Right. And talked about cholesterol with him. And his, his was a pretty hefty number. And he's super healthy. Right. Was that accurate?

Yes, his went very high. And this is an interesting scenario and why I was kind of explaining the chronic infection thing, we came to find out that he was dealing with pretty significant mold. And there is nuance to certain types of diets. And I think that Certain things can be therape in some cases. And in a carnivore diet where you're not consuming a lot of fiber, you don't get as much bile removal as you would with fiber.

Okay.

You get a lot of bile recycling. And those mycotoxins like to live in that bile. So you're kind of telling the body, hey, there's this consistent thing for us to keep fighting. Ergo, the cholesterol goes up. Whereas if somebody would have been eating, if you would have been eating more fiber, it could have bound that up. And you know, since, since we've learned a lot of the stuff, he actually has added some more fibrous. It' it's actually a sort of a cholesterol lowering medication, but it's fiber based to help bind that stuff up.

So now there were three specific enzymes that he was like saying I had to take that everyone should take. Prevent heart. What were those and why?

So those are the systemic enzymes, I believe we were talking about the lumbrokinase, the serrapeptase and the nattokinase.

Yeah.

And these are actually. So say we do the cholesterol. Look, say we do find somebody who has something like a calcification on the coronary artery calcium scan. We can actually use a lot of these enzymes in conjunction with some other therapies, depending on the whole kind of root cause picture to help dissolve a lot of those calcifications. And we've seen it work.

Can anyone take those just as preventative.

I. In general, they're relatively safe. But of course, if you have, you know, I would still recommend checking with your doctor if you're on other certain medications or have like a bleeding disorder or something like that.

Okay. But if so it's basically, it's a natural way to thin, I'm assuming to thin your blood. Is that by when you said that about the bleeding disorder?

It can, it's just, just, you always just want to be cautious when taking anything that's going to like remove stuff.

Okay, maybe this is a dumb question, but I'm going to ask it anyway because I know what people think when you call it an enzyme or I call it an enzyme, how is that different than a digestive enzyme? Like why are they, why is that also called an enzyme?

So digestive enzymes, basically what an enzyme does is it like binds to something to carry out an action your digestive enzymes are going to work in. There's, there's different ones that you can use. Like you have your betaine, you have your Pepsin, you have the hydrochloric acid. You even have enzymes, like, specific for gluten. I think it's called dtp.

For and for lactose and for different.

Exactly. And they just bind in a way to help your body break down certain various food types. These systemic enzymes. You, of course, want to take them away from food, because if you take them with food, they'll just break down your food, but they're going to be basically attracted to protein structures to help kind of break those things down and dissolve them away. Got it.

Okay. So when we say enzyme, like when I'm talking about using digestive enzymes, a specific. Because it's breaking down food, but when you talk about something else being an enzyme, it's breaking down something. And in this case, that's what it's breaking down. That makes sense.

The calcifications. Yeah.

I want to ask another question on the cholesterol, because I know this comes up, too. People still believe that, oh, I'm eating eggs or I'm eating shrimp, and those are high in cholesterol, and that creates cholesterol. And I've continually said dietary cholesterol that you are eating, like, because it has cholesterol and it doesn't create cholesterol in your body. Could you help explain that?

Yeah. And it has to do with the fact that it's a very tightly controlled mechanism, because just because you're consuming it doesn't mean that's what your body's going to do with it. It has to go through the whole digestive process, and by the time it reaches the part of the intestine where it's going to be fully broken down and then reabsorbed, and your body's going to kind of shuttle at different places. There's not a lot that just, like, makes its way into circulation. And the liver is actually the thing that's in charge mostly of creating the cholesterol, depending on what it needs to build and repair. So it'll produce like, 70 to 80% of your actual levels. You don't increase usually more than 20 to 30% by diet. And a lot of the time, if you are eating things in your diet, the things that will negatively impact your cholesterol are going to be things like your processed foods, your fried foods, the trans fats, the excess sugars, the excess carbs. You're not going to increase your bad cholesterol by eating healthy and good fats.

Makes sense. Makes sense. Okay, let's talk about some of the other lab markers that are commonly mistake that we should be looking at that are commonly misread. I'm going to, I'm going to ask about a 1C and then I'm going to open up to this. Because to me, my understanding with A1C is it's your average over the last three months of your blood sugars and what most GPs say is regular or not pre diabetic. Yet I think most more natural doctors will say that's actually not optimal. There's a danger zone you need to.

Be aware of earlier.

So can you help us understand, like, what are, what are you trained in medical school to look at? And then what, where do you take them?

Yes, in medical school, we're really taught overt diagnoses you, you know, whether you're naturopathic or not. A lot of the training and the nuance comes afterwards and just seeing the patient in front of you and learning that, hey, if they've already hit this state, on paper, they were messed up far before that. And I would rather catch them at the first sign and prevent this than just be reactive at this last point. So when we start, when we talk about A1C, generally, you know, anything over six is of course we'll say pre diabetic or possibly diabetic. But my personal preference is I like to keep things under like 5.5, 5.6, even into the fours, if we possibly can. Because what's happening is the A1C is basically measuring glycation levels of red blood cells and it's the sugaring of it, the caramelization of them. And that glycation is a really, really strong indicator of how rapidly a person is aging. So you can get extreme aging just from having poor blood sugar management. But beyond that, you also want to, of course, see what a patient's fasting blood sugar level is. And I would argue that a fasting blood sugar should be at least below 85. I think that, you know, the labs will tell you below 100. I like it a little tighter than that. I like it at least 85 or below. And then you want to even look at fasting insulin levels. So a lot of doctors won't look at these, but you can have a relatively normal A1C, a relatively normal blood sugar. But if your insulin levels are reaching over 10 or over 12, you're. You're on your way to some degree of insulin resistance. Now, of course, if all these levels are off, you have reached insulin resistance, you have reached possible pre diabetes or diabetes. The good news, though, is that it is reversible like you can of course take these markers, change your lifestyle, get on certain targeted supplements, maybe even possible medications, peptides, and you can reverse this process and get yourself to a better place.

Now, when you say possible medications or are you a fan of doing things like how people. There's now this, the trend to microdose dose, like some of the semi glutide, things like that. Or are you more like let's take berberine or do you go traditional metformin for things like this?

It depends on the individual. I don't love metformin in people that I suspect an MTHFR defect on because they already have a difficult time regulating their B vitamins. And B12 is very rapidly depleted by metformin. It also can cause a mitochondrial dysfunction in a lot of people because it attacks mitochondria, which isn't very fun. I am a fan of microdosing the GLP1s. I've been doing that since I think the first time I did that was sometime in 2021 or 2022 with people because I was like, you know, these things are strong, but we don't need that full effect. And they've been really useful for a lot of people because they do increase that insulin sensitization. And you do get the people who are able to give up their food addiction and really, you know, stop the overeating, which may have got them there. So that's been pretty powerful. Sometimes I'll use bear brain. It really depends on the patient, what their goals are, how hard they're willing to work, and all the kind of the constellation of everything we're trying to put together.

Got it. Okay. Okay. What else should we be looking at? I have so many I want to ask about, but what are the main ones that we need to be looking at?

Obviously hormones. I know you talk a lot about hormones.

Yeah. But let's talk about that because that's in my question with the hormones. Let me ask is this gets confusing and every guest they have on to something different. So I'm so curious what you say. I've had guests on that say you must do blood with Dutch, which is the urine test and saliva. I have some that say that saliva is baloney, some that say only blood. What is your recommendation and help us understand why. And then what should we really be looking at?

So I've been prescribing hormones since, gosh, I would say about 2013, 2014. I have never had a case that I couldn't figure out without just blood, honestly.

Wow.

I'VE because if you can piece together the patient's symptoms and you can look at what the serum markers are saying, you can get good results just from that. And I feel like it's the easiest for most patients. It's usually the most affordable for most patients. And like I said, I haven't needed.

The Dutch test is not cheap. Yeah, you have to.

Dutch isn't cheap. You know, and I. And I've seen. I've done a Dutch. I've tested their stuff out, and I compared data on myself and my husband. So I was like, I just want to see what this is going to do. You know, how I. How it might make me change my approach. And it was wildly incorrect for my husband and for me. It didn't offer me any additional data that I. That I was surprised by.

So to. And I find that too, with. With the Dutch. To me, like, my. I always feel how my labs say, so, like, I can see, like, if it says I'm low on something, but then the Dutch gets it confusing because it's showing how it's metabolizing. And then I get. I go down the rabbit hole trying to figure out, like, why does it say this different? And that's not. But. But literally, like, my symptoms will typically match my blood serum. So it's so interesting that, like, this has been so introduced to do all these other ways.

Yeah. I remember when Dutch was pretty newish. I went to one of their lunch. It was like a lunch and learn at a conference I was at, I think in 2015 it might have been. And I wasn't enthused by it because I couldn't see what the difference in the data would be. And I think a lot of their. Their process is just making things a little more complicated than I think the average patient needs it to be. Because most people come in, they're like, I want to feel better. I'm like, well, then let's do that. Like, yeah, let's just make you feel better. Like, we just. We do that now. On the saliva point, I will say, early in my career, I did use saliva testing for cortisol patterns, because cortisol is one of those things that is supposed to be released at four different times throughout the day. And you're supposed to kind of hit certain thresholds. So sometimes it can be useful to collect the saliva at those points and really actually see what the cortisol is doing. I don't do that anymore for two reasons. One, because it was annoying for patients. It was an added cost.

It's super annoying. It's like the worst ever. I can't stand it.

Yes, and you can. With a good history, you can kind of pick up on what a person's cortisol levels are doing. But there's kind of a back way to do it on labs. So you can test cortisol on the labs and you can see of course at that point in time what the cortisol is doing. Obviously, if it's up or down or either which way, you know for sure it's an issue. But another marker that I test is something called prolactin. So prolactin is actually the hormone that moms make when they are lactating. It promotes lactation. But prolactin has very much like sister signaling with cortisol release. So when you have your cortisol misbehaving and perhaps it's misbehaving at a different time of day in the blood draw and it's not showing up, if it's something's off, your prolactin will also be going up too because of that signaling. So say your cortisol is misbehaving at night. You're getting those like really pain in the butt wake ups from 2 to 4am can't go back to sleep for a good 30 minutes to an hour. Like I know clinically like from that presentation it's cortisol. But when we see the prolactin spiked on that as well, we definitely know that cortisol is wonky at that point in time.

Wow. Okay, good to know. And then what do you. This gets very confusing. I know this is going to be super individual, but for. Since most people listening are perimenopause or post menopausal. Postmenopausal to me feels like it would be a little bit easier to correct hormones because you are not. But when you're in the perimenopause and you are shifting up and down all over the place, how do you even do that with. With blood? Like, how does someone know what they should be replacing? What are your beliefs around that? And are you a fan of one type of hormone replacement over another? Like, meaning like for estrogen, for example. My question is like do you prefer the cream or the patch or like, or the lozenge? Like, how do. There's so many, so much confusion around a lot of this. Yeah.

When I'm. Well, I'll insert her first. So I'm talking to a patient about what their options are for actually doing the replacement. I kind of lay out what the options are for them. And I will say I don't ever recommend creams if somebody has a partner or a pet that it could transfer to. So if they got a husband in the house or something like that, I don't recommend not going to want that estrogen at all.

Okay.

If they don't have anyone else in the house and it's just them by themselves, creams can be fine. They have some pretty good absorption. You usually want to rotate sites on those, though, so that you're giving the sites a break and you can get better absorption overall. A lot of people like trochees just because they're easy. You can kind of dissolve them in the cheeks and you can combine quite a few things in those. So you can combine the testosterone, you can combine progesterone, you can combine estrogen. You could even combine other things like dhea. Whatever you kind of want to compound. You can make it very specialized and specific to that person, which is nice. I have some patients that prefer to do pellets. They kind of just like to set it and forget it. And we insert those in the top part of the hip. Last about three to four months. Your levels stay pretty even. People like those. Progesterone, I almost always give as an oral capsule at bedtime, simply because people feel the best when they're on that, on it that way, as far as deeper sleep, more relaxation, less anxiety, it's just gorgeous. And I have some women who like these testosterone injections.

And then what about the patch with the estrogen?

Estrogen patches. I start a lot of women on those because we can start at a very, very low dose and we can remove it if things go weird. To your point in the perimenopause, there's these weird phases some women go through where they're like, I had a cycle and then it was a few months and I did, and then I had a little bit of breakthrough bleeding. And it's like the ovaries are kind of like puttering out, so to speak. If you give somebody too much estrogen during that point, you can make them feel completely miserable. They'll get the breast tenderness, the nipple tenderness, the water retention, the swelling, the moodiness, because you just don't really know how much their ovaries are outputting at that point. So it's. It's better to start low and slow, in my opinion, in the perimenopause state, because then once you hit menopause, of course, if you know that there's nothing coming out, we can it's usually once we hit those, like, safe levels, we're good to go.

So good. Okay, so do you have a. I'm going to ask about estrogen specifically. I know there's a lot of different hormones we can get into, but I feel that there's been, you know, and I know we talked about this on previous episodes, but I want. It's important to bring up again. There's been a lot of misinformation around estrogen replacement based on a flawed study years and years ago. Can you speak into that and your thoughts and the benefits of replacing with estrogen?

Yeah. So it's the Women's Health Initiative study, and it was somewhat retracted, or at least they redid a lot of the data to actually discuss the true. We'll call it, risks. And a lot of the things that they were studying with that population of women who were on hormone replacement therapy was not the bioidentical stuff that a lot of us use in clinical practice today. It's not to say the other stuff doesn't exist. It does. It's still available out there. Things like Prempro and whatnot. But those ones, they're synthetic. They're not bioidentical. We don't see the same risks with the bioidentical hormones that they identified in that study. And they were making, you know, the estrogen from. From horse urine. The progesterones were completely synthetic as well. So they're not gonna. They're not gonna bind the same way in the body, and they're not gonna produce the same positive and protective benefits that you would get from the bioidenticals. And one of the examples that I like to share with people when they're on the fence about this, like, oh, I'm so scared that estrogen is. Is going to cause cancer or estrogen is going to, you know, cause cardiovascular disease. I'm like, you know what? Let's just think about it this way. A normal woman, depending on where she's at in her menstrual cycle, may have levels of estrogen around 100 or so during pregnancy. Estrogen levels can reach into, like, the ten thousands, okay? If estrogen caused cancer, pregnant women would just be riddled with it. It's not that it causes it. It's. It's protective against it in the most part for a lot of people. For breast cancer, ovarian cancer. It's protective for your bones. It's protective against Alzheimer's and dementia. It just. It helps your skin. It helps keep your. Your wrinkles away. It helps keep your vaginal tissue moist and young and not, you know, thin. It's just so great. It has like over 500 functions in the body. Those, those needs don't go away just because you hit menopause. So I'm. I'm really a big proponent of making sure that women at least can get optimal levels of that in the bioidentical form so they don't get the risks that come with the synthetics.

And what I've learned just interviewing countless people around this topic and just talking to so many midlife women is most den, most dentists, most not dent doctors are just. They're not super educated around hormones here. And so you have to be your own health advocate and really take a stand and educate yourself and tell them what you need. Because being on what a lot of women will say is they're in menopause or having these symptoms and the. The standard of care tends to be, here's anti, an antidepressant, and here is the birth control pill, which is not the same as what we're talking about here, replacing estrogen. And it's. There's so many benefits to using bioidentical or HRT to help help bring your.

Levels back up 100. I honestly feel like proper hormone replacement therapy is like a woman's rights issue. Like, this is what women should be like fighting for.

They should be 100 to have it.

You know, Otherwise, what else are you going to do? You're going to let your bones disintegrate? You're going to let your brain go? Like, I'm sorry. We deserve better than that. We deserve hormones.

Let's talk about cortisone. Cortisol. Cortisol. And I want to talk about that. And what happens with that as we age. And is this affecting us in a negative way?

Oh, my gosh. It's such a good question. So there's something called the steroidogenic pathway. And I'm not going to bore you. You can Google it and you can find this picture of how these. These hormones are created. And again, they're all starting with cholesterol. But when you're in an overly stressed state, there's something that can happen that we've called in the industry. It's called the pregnenolone steel. It's basically the cortisol. The cholesterol can go down this one pathway via pregnant alone, another precursor hormone to make more cortisol instead of making your sex hormones, which is the opposite direction. And so sometimes women can get themselves into such stressful situations that they end up messing up their cycles because of how the body is pushing the cortisol pathway. And a lot of the time it's things that we can control. But some of the times it happens because the other hormone processes just are no longer happening in places like the ovary because you're entering perimenopause or pre menopause cause. I usually don't see cortisol itself as like a root cause, but definitely something that I would call an obstacle to cure. Meaning if you don't work on cortisol, if you don't work on stress management, if you don't pay attention to what it's doing to you, physio, physiologically, you're not going to be able to heal past that.

Got it. It's so important. Okay, and then my last question is about thyroid, because that's another one that is commonly misread, misinterpreted. Doctors are giving telling people that they're normal when they're actually low or high. Can you talk about that one?

It's so frustrating. In a traditional model, a lot of doctors will only order TSH as a thyroid marker. And TSH stands for thyroid stimulating hormone. This is the signal that comes from within your brain and goes to tell your thyroid, hey, it's time to release thyroid hormone. When thyroid hormone gets released, it first exists as the version of T4, the free T4. And then your body requires various nutrients. Zinc, selenium, iodine, B12 in order to do the conversion of the T4 to the T3, which is your active form. Unless you're running all three of those, you're not going to get a full picture of what's actually happening at the thyroid because you could have a deficit, of course, at the tsh, where the signaling is not going well to the thyroid. And Normally I like TSH personally to, to be below about 1.5 or so. As you start getting like 2 and above 2, the risk of certain things, like even thyroid cancers does go up, up pretty significantly. And then when you're looking at the T4, well, you have to see, well, is T4 high? I like T4 personally to be above 1, free T4 to be above like 1.3 or 1.4. And if that level is high, but you're still not getting a lot of T3, well, you may want to look at those micronutrients that I just mentioned and see, well, is there a deficiency in maybe something like zinc or B12 that isn't allowing this Conversion to happen to get adequate T3. Now, if the T3 itself is low, usually this is an indication of kind of a subclinical hypothyroidism. And this is where we usually want to use a prescription natural desiccated thyroid to actually boost those levels back up. And of course, we want to correlate with symptoms. Right? So low thyroid symptoms look like your extremities are cold, constipation, brain fog, mild depression, hair falling out, dry skin, brittle nails, just a general feeling of malaise.

And then, you know, one of previous guests that I've had on many times, Dr. Amy Horneman, who specializes in thyroid, she said, always treat the symptoms, not just the numbers. So sometimes we're getting this alarm sounding because of one specific number. But if you're not feeling those things, it doesn't necessarily mean you have a problem. I don't know if you agree with that or not, but that. That really resonated with me because I feel sometimes we go in and we're told a certain lab number, but you're like, I don't have those symptoms. I don't have that. That issue.

Some people do naturally run better with lower thyroid function. So you're absolutely right. You have to parse out these symptoms. And of course, some of those symptoms can be due to other things, right? Like constipation isn't always low. Thyro could be, you know, a leaky gut issue. You can have multiple rhymes and reasons. So it's important to really, again, look at the labs, look at the symptoms, and see what else could be causing this. And that's why obviously, we do this root cause approach with people.

This was so good. And in just a minute, we're going to turn over to the afterparty. And for those of you listening to the podcast, I just started doing an after party where we do midlife Conversations live, where I do many of my interviews live with my members of my 365 community and more. Done the interview, we pause and we bring them on to ask my guest all the questions that they have and they're able to interact with the guests and they get to hear the podcast before that where it airs, if that's of interest to you. If you go to Midlife Conversations.com/live. Again, it's Midlife Conversations.com/Live. You'll have the information on how you can participate in the live podcast, recordings and the afterparty. But, Sabrina, for everyone listening, where can they best find you? What do you want them to know? What are some final parting words that you have for them?

Them? Yeah. Thank you. I'm most active on Instagram. I'm just at Dr. Solt on there. D R S O L T. My clinic's website is Stem Cell Therapy pro dot com. And I would just say, you know, find the information that allows you to be the best advocate for yourself and for your health. There's, you know, piles of information like this out there. And if you have to take the time to educate your doctor, it's going to be worth it for you and anyone else who comes behind you.

Thank you so much, Sabrina. Thank you.