Simple Nutrition Insights
Welcome to Simple Nutrition Insights, your practical guide to understanding nutrition in less than 30 minutes. Join us as we break down the science of healthy eating into digestible insights and actionable tips. Whether you're a busy parent or just short on time, our goal is to provide you with straightforward advice to enhance your well-being. Tune in for expert interviews, evidence-based advice, and quick, easy-to-implement strategies for nourishing your body and living your best life.
Simple Nutrition Insights
Navigate Menopause with Confidence: Insights from Dr. Sayana
Menopause is a natural phase of life that can bring various physical and emotional changes, often starting as early as a woman's mid-30s. This episode explores the symptoms of menopause, the importance of hormonal balance, and practical lifestyle adjustments to manage its impact, including nutrition, stress management, and sleep improvement.
• Introduction to the concept of menopause and perimenopause
• Common symptoms associated with hormonal changes
• Importance of checking hormone levels and advocating for healthcare
• Role of stress, inflammation, and diet in hormonal health
• Discussing the significance of testosterone in women's health
• Addressing sleep issues and mental health during menopause
• Offering actionable lifestyle tips for readers and listeners
• Understanding the impact of autoimmunity in hormonal health management
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Hey, hey everybody. Thank you so much for joining me today. My name is Leonila Campos, registered dietitian. I am so excited to have this amazing guest, dr Sayana. We're going to talk about an amazing topic, which is menopause, and she's an expert in this area. I have lots of clients and patients that are going through it, so stay tuned and welcome. Thank you so much, dr Sayana, for joining me today.
Speaker 2:Thank you so much for having me. I'm so excited. This is one of my favorite topics Amazing.
Speaker 1:So for the listeners right, tell us a little bit about yourself and your expertise and where they can find you.
Speaker 2:Sounds good. I'm an internal medicine doctor, so I'm a regular MD and also functional medicine certified doctor. I live in Los Angeles. Here in Sherman Oaks in the Valley I've been practicing for more than a decade and truly our whole practice are experts in dealing with women going through perimenopause and menopause, mainly if they've been told their labs are normal or, god forbid, not even had any labs and are concerned that they're having issues with sleep, energy, weight gain and hormonal imbalances yeah, oh amazing, it's so, so, um, amazing to have you, because this is such a topic that I mean now you've seen him, that is talked about more now, but it wasn't right and I think absolutely we we should talk about that right, like it's something that we need to to learn and understand, because we all are going that.
Speaker 1:You know, women, we're going that way, so we need to be able to understand it.
Speaker 2:Yeah, you can't escape perimenopause menopause, but you can go through it gracefully, where it doesn't have to like wreck your life or cause all these unknown symptoms. You can go in there empowered and really meet it head on and actually just nicely and easily go through perimenopause menopause. And it's so important for your listeners to understand like, when is this happening? People think this is happening in my fifties or my sixties. No, we see women entering perimenopause as early as 35 and can go all that, can that, that deck, that period can last for five to 15 years and then they can go on into full menopause. But all these changes are happening in our bodies and it's determined by certain things where you can go through menopause a little bit later or earlier, depending on your stress, anxiety and inflammation, and under inflammation it's really your wheelhouse in terms of nutrition and your body's stress response. All of that has an impact of when exactly you'll go into the menopause journey.
Speaker 1:Yeah, thank you for explaining that, and so for our listeners. Right, let's talk a little bit about what that exactly is, right? What is perimenopause, what is menopause, what is postmenopause? Because there's so many of them.
Speaker 2:Absolutely, and you know the thing with menopause. First of all, you know it's a really not talked about much in terms of we haven't talked about it. Maybe these past two years with the M-Factor, the documentary talking about menopause, there's been a little bit more attention to it, but really not much, especially in terms of hormones. Because there was one big study that showed that hormones could be inflammatory or could cause cancer and from that one study that people just stopped prescribing hormones or were so scared of hormones. But now, looking back at that study, we realize it was not done, it wasn't interpreted correctly. Look, hormones don't the kind of hormones that were tested don't cause cancer, or the ones that were tested were very inflammatory and the bioidentical ones are a little bit safer and it's so important to see what's happening with the body before giving hormones to someone. So back to your original question perimenopause, and what kind of symptoms people can feel during that time.
Speaker 2:Sometimes women can have issues with their period, where it becomes more irregular or closer together and then suddenly you start missing periods. But the definition of menopause medically is one whole year, that's 12 months of no period. But symptoms patients commonly come to us with is I just can't sleep through the night, or I'm super hot and I'm sweating, or I am just suddenly I look in my closet and none of my clothes fit me. Everything is like so tight around my belly, or I have word finding issues, the word is at the tip of my tongue but it doesn't come out and I have brain fog, or I am suddenly having some palpitations. So all these symptoms, they seem so nonspecific but they all could imply you entering perimenopause and eventually menopause. And then there's some women that go through this journey without having any symptoms and there's so many factors that you can modify that can impact how nicely or easily you go through menopause and the perimenopause journey.
Speaker 1:Right, yeah, thank you for sharing all those descriptions and really emphasizing right like we don't talk about these things. And you do hear, and I'm sure you see that in your practice too right, women come in and they are complaining of these problems Like I don't, you know, I have brain fog and I can't sleep at night, or my clothes is not fitting and nothing has changed right, and that can be so frustrating so I can't imagine going to try to figure out why that is happening and not getting any answers, absolutely.
Speaker 2:And I think a lot of our patients have gone to the conventional primary care doctors or the gynecologists and they may be like 36, 37, 38. And the first things maybe people notice is pre-period like the week or two before the period they become these hormonal monsters. Their kids don't want to have anything to do with them, their husbands are scared of them. Everybody's like walking around eggshells because they're like scared of them and they recognize it too, like they feel bad but they can't control it. They have irrational anger, can't sleep, maybe have the munchies, and usually they go to their primary care doctor and the doctor is like you know, maybe you need Zoloft or an antidepressant, but they're not thinking about the why. And what's important, is super important, is check your hormones. As a conventional internist, we were never taught to check people's hormones. We're just like oh, it could be depression, or we don't. Because these hormones fluctuate so much we were not taught as to what they should be in certain parts of your cycle, so you do need to see somebody who's a little more educated in that. But pre-period those crazy symptoms are generally because of a drop in progesterone, and progesterone is the happy, the calm hormone and when that hormone goes down, people get irritable, get anxious. Think about a woman in pregnancy. She has the pregnancy glow, she's full of progesterone, and then she has the baby. Progesterone goes away. She can be anxious and there's risk of postpartum depression. So that progesterone hormone is so important.
Speaker 2:And you may ask, like why is it that women some women don't have the issue until much later? It's because of things such as stress, anxiety and inflammation. It all impacts your stress hormone, cortisol. So whenever you're stressed and stress could be like I'm juggling all your million things in your life right now it may not be like a death or something so scary in your life, but just could be a current life for women. We're just busy being a mom, being a partner, being a mother, having a full-time job, running a podcast, like you're busy, and so all of those cortisol spikes, which is your stress hormone.
Speaker 2:As you keep spiking your cortisol, just looking at the steroid pathway for hormones, it eats up progesterone. So a lot of times women come in and they're like oh, my period's all messed up. And we talk to them. We realize that they've had a bunch of stress three or six months later and they're having these hormonal imbalances because of that. And you don't have to give someone progesterone, but if you can just treat that high stress period and help them manage that better, their cycle can go back to normal. But it's so important to check like what are your hormones and are they in the optimal ranges?
Speaker 1:Yeah, oh, this is so good, right, that just understanding that you can do something about it, right, you can check your hormones, you can check your labs, right, and see, okay, where am I. And I think a lot of our listeners right, or just clients and customers in general, they don't know what to ask, right, or they of our listeners right, or just clients and customers in general, they don't know what to ask, right, or they don't know, okay, what should I look for? Right. And so I think it's so important, again, like you said, right, try to find the answers right.
Speaker 2:If it's like doing more, you know, checking and working with the right doctor who's not going to dismiss you. Historically, medicine has been so dismissive of women. You know, checking and working with the right doctor who's not going to dismiss you. The historical, historically medicine has been so dismissive of women. You know we consider it hysterical in terms of having these symptoms. We are not really listened to and, unfortunately, conventional medicine is quick medicine, Like I can see you in eight minutes and I can write the prescription for Prozac and then you're gone. But the sad thing is so many women come to our practice and they're like wow, nobody's ever listened to us. Like an initial appointment with us is two hours.
Speaker 2:We want to get a whole in-depth story of who you are, because there are clues in there as to what might impact your hormones.
Speaker 2:So it's so important to partner with the right kind of practice that's going to measure your hormones and also, if they do find that you are hormone deficient, not just give you hormones. Also, if they do find that you are hormone deficient, not just give you hormones, because we want to make sure is your body in a clean state where you can accept those hormones, whether it's supplements or whether it's bioidentical hormones, and actually not just prescribe the same dose for every woman, Like, where are you in your stage of life and do you have which hormone is off and really have used precision medicine to say, okay, your progesterone is off, and really have used precision medicine to say, okay, your progesterone's off? You can try a natural vitamin C and chase berry to increase it or the hormone, and not just give you estrogen and progesterone all at once. So it's so important to know where are your hormones at this time and what's going on in your life life-wise, emotionally, physically and inflammatory wise so you can decide if hormones is the right thing, right.
Speaker 1:Yeah, absolutely, it's really going deep into the root causes of like okay, let's figure out why this is happening. Oftentimes, there is going to be a root cause and I love that. You can imagine your clients and your patients feeling so relieved and, like she's listening to me, she's literally spending time to figure out my problems, right, and I do agree, right, seeing the patient as a whole person, versus, like, all these organs and, like you know, different compartments, because you know, with my clients to, I spend about an hour to 90 minutes trying to figure out, okay, let's really look into the causes as to why we are here, right, and that's going to give us that background information to provide the interventions that they need, right, individually and so customized. So it's so amazing that you are absolutely able to do that and help your patients and one big organ system.
Speaker 2:you know when we're talking to patients the functional medicine, which is root cause medicine a lot of people are like well, what is functional medicine and what's internal medicine?
Speaker 2:So internal medicine is the conventional medicine as you know it. That's how I was board certified. I'm board certified. But functional medicine is, like you said, the root cause, like what's fueling these symptoms? Why now do you have this symptom and what can we do? That's a root cause approach, which is like your diet and lifestyle how can we improve your gut health that'll improve your symptoms without having to automatically jump to medication, and that's so important to look at. And a lot of people are like I don't have gut symptoms, but when we do stool testing and we do a super breath test, which is the wrong bacteria in their gut shows a lot of abnormal gut testing, and I think we just are out of touch or we're avoiding those foods that cause bad symptoms and so we don't realize oh, your body's like she's going to eat the way she's going to eat. I'm just not going to have symptoms. So it's important to do that kind of testing. So no patients in our practice actually get bioidentical hormones without testing them.
Speaker 1:Yeah, and it's just so interesting and I know it seems like we're moving away from the topic, but it's all interconnected. So, really, constipation, right, it's a huge one and I know you did some videos about it, right, and that comes in this. Another question I asked too how are your bowel movements right? It can tell you so much, like just knowing that and like what are the interventions?
Speaker 2:Yeah, most of America is constipated and we're not even taught from a young age that we should have a regular bowel movement, at least one bowel movement a day. That looks nice like cobra shaped. A lot of patients are like, oh, I thought I was going once a week and that was normal. But we're not talking about these things. And it's so important to have good, regular bowel movements daily because that's how you detoxify. And it becomes super important if you're thinking about taking hormones and perimenopause and menopause, because you want your liver to be able to process your hormone so that it's ready for tomorrow's prescription dose. So if it can process your hormone through the gut and eliminate any excessive hormone through the stool. Eliminate any excessive hormone through the stool is so important. But if you're constipated, you're going to have side effects from hormone replacement therapy. So it's so important to really treat the canvas and say how are you going to process these hormones or supplements to improve hormones, before just jumping to giving you a prescription.
Speaker 1:Right. Yeah, I love how so in-depth. That is right and really again understanding where are we right, what are the interventions that we have to make and how is this person going to react to that too. Right, and so I want to linger here a bit. In terms of the constipation right. If someone is having any hormonal issues or hormonal imbalances right. Are there any correlation to the estrogen levels or progesterone in terms of, like, bowel movement function?
Speaker 2:Yeah, so it's often the women come to us first of all. It's probably the first time they're checking their hormones and we check their hormones and we find a lot of women have super high levels of estrogen. This is like a week before her period. We check it in the mid luteal phase, which is around day 19 to 23 of your cycle, where sometimes women have super high levels of estrogen that are actually just high in conventional lab testing and the symptoms could be I'm really bloated, I'm anxious, I'm on two antidepressants. I just keep gaining weight and you can see that they're in the perimenopause menopause state because of one specific lab called FSH, the follicle stimulating hormone. When that is very high, you're already in menopause and like above a hundred. But that is a moving target depending on your gut inflammation and your other hormones.
Speaker 2:So when things like when your estrogen is super high, what we focus on is your gut elimination, like what's going on with your liver Are you able to process all your nutrients and actually eliminate? And when we ask a lot of patients with elimination, the number one we see is nobody's drinking enough water and nobody's eating fiber and a lot of times with fiber they're like what is fiber? Is there fiber in my steak? No. Is there fiber in my salad? No, you know. Is there fiber in my salad? Yes, but very little, and I think what you're referring to is I did a video on a bowl of arugula that has like 0.2 grams of fiber, versus having black beans or beans in general and avocado, and we really try to encourage women to get 30 to 40 grams of fiber. That takes effort and we're in such a fast-paced environment that nobody either knows or is aware enough to do that, and I'm sure you see that as you're working with your clients, and that must be so empowering because you actually teach them how to.
Speaker 1:Right, yeah, you're absolutely correct. Usually we talk about all those things constipation, bowel movements and fiber. Fiber is. You know, I spend a good amount of time and I talk about it every time we have a follow-up, because oftentimes we think, oh yeah, I'm just going to eat a salad and that's my fiber. Okay, that might not have enough. Right, as you mentioned, at least 30 grams of fiber and focus, you know, let's just add them with these high fiber sources like beans. Amazing, you know, you can get a really good amount of fiber in your beans. If you like salads, let's add more fiber to that salad, right, like the blackberries, or maybe some chia seeds or something like that. That is going to increase the fiber and just being more regular, right?
Speaker 2:increase the fiber and just being more regular. Right, it doesn't have to be difficult. You know, I'm sure you see the same kind of patients we do who are like between 35 and 60, that in the peak of their careers and they're working really hard or having kids and just don't have time. But you can pre-plan all these things where it doesn't have to feel so overwhelming, right?
Speaker 1:Yeah, absolutely, we can definitely work on that on smaller steps. And you mentioned a few occasions, right, about the weight gain as they get into menopause. Let's talk a little bit about that. Why do you think that happens if nothing changes? What are the changes happening internally that is causing that?
Speaker 2:So you know, I talked about it. I think maybe the best way to do this is divide the women by age group. So the ones who are like 35 to 45, they're probably really right there in their perimenopausal state where that progesterone is going away because of stress, anxiety, inflammation, and just they are aging. So when the progesterone goes away, you become more estrogen dominant. It's not that you're making more estrogen, it's just that the hormone is left and the progesterone is kind of quickly eaten away. It's just that the hormone is left and the progesterone is kind of quickly eaten away. It's just that progesterone is in a very fragile place in the hormonal pathway. So if you're stressed, anxious or inflamed it's something called progesterone steel You're just left with estrogen, and estrogen by itself is a hormone that is very pro-inflammatory and can cause weight gain.
Speaker 2:The second reason, the second hormone we look at a lot, is insulin, and so I liken this to the body doesn't know genetically the difference between you being chased by a tiger or you having your life stresses, where you're juggling all these balls and your body's going to produce this hormone, cortisol, which is your stress hormone. And if you're being chased by the tiger, you get eaten or you get saved and that's the end of it. But unfortunately in our modern world, especially for women, when they have so many things going on, you have these micro cortisol peaks and the constant time you increase your cortisol you need the blood sugar because you need to run from that tiger, and every time this happens it increases insulin because it's trying to manage and push your sugar. And so another big thing we see in perimenopause and this 35 to 45 age group is an increase in insulin. And when your insulin is higher you see a lot more weight around the belly. So estrogen dominance, insulin resistance. And then the third biggest one is inflammation. And a lot of times patients are like well, what is inflammation? Inflammation is actually a good thing because when you cut yourself, inflammation heals it. But it's dysregulated inflammation where the cortisol is constantly coming up and you feel like you're constantly running and there's no end point to that. It's that kind of inflammation that can cause weight gain. So those are like three big reasons.
Speaker 2:And at the same time this poor woman is losing her testosterone and as the testosterone levels keep going down, you can't make muscle as well. And I have women who come in there who are like I'm a Pilates instructor, I'm so active, but I just feel like jello. And when we measure their testosterone levels they're super, super low. And so, as you're considering hormones, you can take high dose fenugreek, which is just an herb that increases your testosterone, or you could do a little bit of testosterone replacement therapy and it's a game changer. Women just really feel like they can make muscle, they're more confident, they have better energy, less word finding issues. So, if you can get to giving progesterone and then maybe some testosterone, eventually women in their 40s, 45 to 55 is where really women do see benefits with those hormones. But that's really what's contributing to weight gain, and it's not just about giving people a Zempik or Wegovia Manjaro. It's about why is this happening and how can you actually target those pathways so you can get long lasting weight loss, not just a quick fix.
Speaker 1:Right, and I really love that. The long lasting changes right, because if we are definitely looking to, okay, we're having this increase in insulin, right, and these high cortisol levels and low testosterone, which is also affecting our muscle mass, and as we age, we are losing muscle mass. It's almost like a catastrophe in a way. Right, because we're having some of those issues and we know that increasing our muscle mass is going to help us right with increasing our metabolic rate, and so it is so important. Now, one of the things that comes to mind when we talk about testosterone right, it's like why do I need testosterone? I don't want to be bulky and I don't want to look manly. Yeah, tell us a little bit about that. How is that?
Speaker 2:different, and so testosterone is such an important hormone. Both men and women have estrogen and testosterone, so men have a lot more testosterone than we do. But women have quite a bit of testosterone and as you're aging it goes down. But also, if you're chronically stressed or chronically inflamed, you eat up a hormone called DHEA, which is the mother hormone to cortisol, and as that hormone goes down, your testosterone just naturally goes down. So but when you actually replace testosterone, you're measuring levels and the things you want to ask your doctor to be checking is total testosterone and free testosterone. And that's really important because a lot of times patients come to us and their total testosterone is excellent and they're like I don't feel good because their free testosterone is so low. And that's commonly because of a common protein called the sex hormone binding globulin and it's just bound all your testosterone, so you can't feel it. So those kind of patients if we give them testosterone, it won't really help. And what impacts that protein, the sex hormone binding globulin, is inflammation, your nutrient absorption and your gut health, and if you work on those things, the sex hormone binding content becomes lower and then they can feel their testosterone.
Speaker 2:Back to your question as to we're not trying to make women men and the doses we give them are super different. So for a man, we have quite a few male patients. We give them around 200 milligrams of testosterone. They take that every day, versus a woman is getting one milligram or maybe up to 10 milligrams of testosterone every. They take that every day, versus a woman is getting one milligram or maybe up to 10 milligrams of testosterone daily.
Speaker 2:So the difference is very, very, very low and it's important to also measure your level. So if you are giving someone testosterone, it's important to make sure your liver is able to tolerate it. You're seeing the level that's optimal. Most importantly is we're not treating a lab. Your patient or client has to say I actually feel better, and I feel better and I'm actually exercising, which I have been doing but I can see muscle, I feel like my strength is better and I do feel like my libido is better, because a lot of women have issues with libido and it's so important to actually optimize the testosterone levels so they can actually feel intimate yeah, and I think it's so.
Speaker 1:You know, I hope that, as the listeners are listening to these, right, and it's hitting all these points, that they do something like it's not, like this is what it is and I'm a woman and like I'm aging, and like that's that right, because that's not the case, right? We, there are things that we can do to change that right and optimize the levels and if you don't want hormones.
Speaker 2:a lot of times some patients come to us like I'm really scared of hormones or my mother had breast cancer so I'm not going to try any hormones, and you can give natural supplements.
Speaker 2:But sometimes when you improve your downstream hormones or your upstream hormones, people just feel better in the perimenopause menopause stage, because we found that in the perimenopause state people are more inflamed because they don't have these protective benefits of these hormones. And if you can think about the hormonal cascade as an axis, think about the grandmother as the adrenal glands, and these are the two coin-shaped glands sit on top of your kidney, make cortisol, and then think about the thyroid as your mom and then the granddaughter as your ovaries. And a lot of times in regular medicine we'll just give you hormones, hormone replacement therapy. We might check your thyroid, but we never check your adrenals and this is your stress hormones. And if we looked at grandma and really focused on grandma and fixed her, the other hormones would fall into place. So a lot of times when people work with us, or functional medicine doctors in general, and just work on cleaning their foundation, they do feel at least 30 to 40% better and may not even need hormones.
Speaker 1:I love that analogy and just giving the patients the choice right, like if you don't want hormones, that's not the end of the world, right. We can do other things and, I'm sure, optimizing other areas that we have to work on, like nutrition, gut health, having better bowel movements, increasing our water right those are things that we can start doing right away and see some changes.
Speaker 2:Completely. And I think another big thing I see in our population is, you know, really high stress perception. People are so stressed and so anxious and so worried and that's kind of a modern life. Unfortunately, if you're living in that high stress state, your cortisol is going to be high and it's going to eat up your progesterone and push you quicker to menopause, push you quicker to perimenopause. But actually just walking five to 10,000 steps a day, being in nature, being able to do some breath work, all those things can really drop your cortisol. And some of my patients are like it sounds like you want me to quit my job. No, I want you to be able to thrive in your job, where you don't feel like you're surviving and can't wait till 5.30 to be done with the day. But it's so important to at least help your body pretend that things are okay.
Speaker 1:Yeah, I love that you also talk about stress. Stress is another thing that I talk to my patients too, because it affects nutrition, right, it affects our ability to make, you know, healthier choices. Or because we do have this high cortisol levels, right, we're craving all kinds of things because now we have the you know the insulin, and so as we think about, okay, how, how, the first thing that I ask them you know what's your stress, tell me about your stress. You know, I want to say, 99% of the time I hear this like I don't know. That might be the first time during the day where they take a nice deep breath and like that tells me, okay, it's probably high. And then you know, they tell me about it or they say, oh, I think it's okay, right. And as we talk more about how about you know blood pressure wise, if you're having the blood pressure issues, or how about you're eating, so I think the stress management plays a huge role in so many aspects it does.
Speaker 2:And another big thing we do in our practice is we look at genetics. So you know, I explain to patients as an internist we're very siloed, right? You get a UTI, we give you antibiotics, you get better. We think You're constipated, you know, take psyllium or it doesn't really matter drink water and it's supposed to get better.
Speaker 2:But functional medicine is more triangular.
Speaker 2:You have genetics on one side, you have exposures or mediators on one side and then triggers things that are highly stressful to you and genetics.
Speaker 2:What's amazing about genetics is just because you have a gene, it doesn't mean you have to have an epigenetic disease. Genes are like on and off switches and you can switch them off by managing your exposures of mediators and managing your stress perception. So we do almost all our patients, we check genetics, and by the genetics we can tell if they are very sensitive, like some people just came to the world sensitive. It doesn't take too much stress to get them worried, and it's that same kind of group of people that are also very sensitive to toxins. And so it's important to measure your genetics, especially if you're thinking about hormone replacement therapy, because a lot of our patients are just on progesterone and testosterone and not on estrogen, because genetically they don't detoxify well and keep the estrogen levels very high, so giving them estrogen could actually cause some side effects. So understand your genetics and really work on what you can control, which is your stress, your diet, your environment, and together you can switch off these genes that may not produce the best.
Speaker 1:Yeah it's so different things that we have to consider right as well. Let's talk a little bit about sleep. I know you mentioned sometimes some women have issues with sleep as they get into menopause. Yes, let's talk a little bit about sleep. I know you mentioned sometimes some women have issues with sleep as they get into menopause. Yes, let's talk a little bit about that.
Speaker 2:Absolutely. Sleep is so important because we want to get at least five to six hours of consolidated sleep where you're not waking up in the middle to help with memory consolidation. So a lot of times people are like I'm sleeping, god, I sleep eight hours, but when you actually dive deeper, they're waking up every two hours and looking at their phone or looking at their alarm all the time. And so it's very important to have good sleep hygiene where you're like don't on a screen before you sleep, sleeping in a regular bedtime, using the bed mainly for sleep and making sure that you're not having these like caffeinated beverages throughout the day. That's keeping you awake.
Speaker 2:But apart from that, when women go into that perimenopause like above 35, and their progesterone starts going away, that's when they might really feel issues with insomnia.
Speaker 2:And the biggest thing with not having a progesterone is you might notice that you have frequent times where you wake up in the middle of the night. And then the second hormone that's not a sex hormone, but it's cortisol, which is your stress hormone, and so a lot of times patients feel like they look at the time and it's between three and five in the morning, like they fell asleep. Okay, but they couldn't stay sleeping. And the question in my mind is it an issue of high cortisol or is it an issue of low progesterone? And that's where it's important to check your numbers, because I can't tell you how many people have come to us and like 40 supplements bottles they bring in and I'm like, oh, are you feeling okay? And they're like no, but I'm too scared to stop anything in case it's working, and so it's important to check levels and say, okay, is your cortisol the issue or is your progesterone the issue? So you could be a little bit more precise where you don't have to swallow so many things yeah, absolutely, I, absolutely.
Speaker 1:I think that is so important to measure right and then provide their recommendations instead. And I can imagine, you know, taking so many supplements and like still not feeling well, you're like I don't know, I'm just doing it because something might work Exactly, but the safe thing to try is magnesium.
Speaker 2:So magnesium is a muscle relaxant. There's magnesium glycinate, magnesium threonate. Glycinate and threonate work pretty well for sleep. Threonate goes into your blood-brain barrier. You could start with like 100 milligrams and 200 milligrams and you might notice you fall asleep easier because magnesium relaxes your muscles. So it helps with anxiety, helps with sleep and helps with constipation. So the same measure if you're taking magnesium and have diarrhea or loose bowel movements, you may be taking too much. So that's where the magnesium is a super easy one.
Speaker 2:Another super easy thing to think about taking is things like a magnolia bark, which is Rilora or Ashwagandha. But all of these things, at the end of the day, can have side effects. So it's important to work with someone where you're checking levels. I had a patient recently come to us with palpitations and what we found out is because she was taking high doses of ashwagandha that was making her thyroid work a little too well. And once we dialed down those ashwagandha doses, the palpitations went away and by this time she had had a cardiac stress test. She was doing a Holter monitor, but nobody thought to ask her if she was on supplements. So it's important to kind of go deep dive and figure out. If the supplements are natural, they can have side effects. So who are you giving these supplements to? What's their genetics? What's their body going through? What's the emotional state? What is their gut?
Speaker 1:Yeah, absolutely. Thank you for providing those quick recommendations and things that our listeners can do right away to see a little bit of change. As you mentioned, sleep is so important, right, For many reasons, but as well just for overall health and also nutrition wise. Right, it plays a huge role in our nutrition choices throughout the day. How about mental health-wise? You talked a little bit about depression, and you do see those changes in women that are going into menopause or perimenopause. Why do you think that happens?
Speaker 2:Yeah, so the biggest reason with, let's say, anxiety and depression. So anxiety is more really the it can be the lack of progesterone, the high cortisol, the same thing that's impacting sleep, Like, and when you can't go to bed and your mind just keeps going in that anxious state. That could be viewed as those two hormones. And then depression can be kind of you burn through all your cortisol and there's nothing left to give. Or you have high estrogen. And think of the woman like pre-period naturally that's a high estrogen state. She's like anxious. The woman like pre-period naturally that's a high estrogen state. She's like anxious, she's irritable, she's hangry, and that's that emotional impact that hormones can have.
Speaker 2:And then sometimes, when we look at people's genetics, we see that they're genetically predisposed to not use dopamine or norepinephrine or serotonin very well. And knowing that data, you can give them natural precursors to these hormones, like 5-HTP SAMe that can help them make these neurotransmitters better. It doesn't have to be prescription meds. That being said, if you do find that you are very depressed or anxious and need prescription medications, there is a test I want your listeners to be aware of, and there are multiple of these tests, but they're called Gene Insight and it's a swab on your cheek that'll tell you, based on your genetics, which antidepressants or which anti-anxiety medications would be best.
Speaker 2:Because in regular medicine we just give you all these medicines and say, oh, you're having side effects, let's try the next one. So if you need them again, there's good medicine and technology out there that can tell you if you do need one which could be the best one, and also doing the lowest, lowest dose, because lots of these studies were done on the 70 kg white man and we're not that. So you really want to make sure you start low work with someone who's willing to try. Natural first the biggest thing is therapy, community purpose, belonging all of those things are important. And then hormones, inflammation, and with anxiety and depression there's a big gut brain connection. So if your gut's inflamed you probably will be anxious or depressed. So try and clean up the gut, clean up inflammation, before thinking about medication.
Speaker 1:Right, absolutely. And so with that note, right, if someone is like yeah, maybe I'm having these problems, how can they start? Or what are maybe some of the tips that they can start doing to help with that inflammation.
Speaker 2:Yeah. So the first things you're doing is where is this inflammation coming from? And a lot of times sources of inflammation can be food. Processed food is a big source, like there's lots of good studies If you have a big Mac and check your inflammatory levels right away, super sky high. And we have a lot of patients who are wearing those continuous glucose monitors. Now One of my patients that she ate like the In-N-Out French fry, which only has a few ingredients compared to the McDonald's French fry, and her blood sugar was super high. So processed food is a big one. So, as much as you can, try and make sure your food is real and is clean, ideally organic. And if you are eating packaged food, make sure they're not like a list of resilient ingredients. Just try and keep it simple, as I'm sure that's your expertise on. So really try and process foods.
Speaker 2:A second source of inflammation is if you've had any kind of recent infection so COVID is a big source of inflammation. Or if you were traveling to like India or Mexico and had food poisoning, that's going to be a source of inflammation. And then another big source of inflammation is toxin exposure. So if you were exposed to toxins such as, you know recurrent LA fires or you had silver fillings in your mouth and have a ton of mercury. In LA we see a lot of mercury toxicity, mainly because of sushi, like my patients love sushi and they think it's really healthy, which it should be. But our oceans are not healthy and if you don't detoxify you can have high levels of mercury causing inflammation. And another source of toxins which is again fairly common in LA is mold. Like you've had, we had a lot of rains two years ago and they cause a lot of water damage and mold can be a source of inflammation.
Speaker 2:So, again, it's important to know how you process these toxins and these could be obvious sources of inflammation that are causing that you need to look at. So in terms of practical things you can do is watch your food take enough fiber so you're binding these toxins and eliminating them naturally, and make sure you're not constipated. If you have access, go to a sauna, like someplace where you can sweat, like a sauna at the YMCA or at your gym. See if you could put some sort of sweating practice. It doesn't have to be for long, like 10, 15 minutes, to just open up these detox pathways. But the last thing about inflammation, which is the biggest source of inflammation is chronic stress, because your cortisol is high and your body thinks you need to keep running and it's in this pro-inflammatory state. So it's so important to manage stress perception, because most of the things we're worried about are not going to happen.
Speaker 1:Right, yeah, yeah, amazing. So I hope everybody took note of that. Things that you can do right away and start helping your body to feel better as we look into, look ahead how can women prepare for menopause in their early ages right, 30s, 40s?
Speaker 2:yeah, honestly, you should start. So I would say the biggest hormonal thing, which is probably a whole nother discussion, is hormonal issues that impact you in your teenage years. We see a lot of women with something called polycystic ovarian syndrome, where they have a lot of testosterone, irregular periods, they may have acne. So if you're already having things like that, you really want to make sure you jump on your hormones early, like in your teenagers and your 20s, where you're either looking at your gut, looking at toxic burden, looking at anxiety, stress, perception, but if you haven't had PCOS and have been marching along to your 30s, so things you can do. A big trigger for just hormonal imbalance is pregnancy, pre-pregnancy, post-pregnancy. Post-pregnancy can be a very lonely time for women where they're solely responsible for this beautiful creature. But you're it and that's where your cortisol can go really high and can start causing the progesterone steal, the weight gain. So, really trying to manage every stage of your life consciously Say I'm going to really protect my adrenals. Make sure I'm saying no to too many projects. A lot of my women well, women, which is why I say yes. So say no more. Make sure that you are moving and exercising. Make sure that you have some space for self-care, because the more self-care you can have where you're protecting that cortisol, the less likely you are to slip into perimenopause early and then know your body. We have some means in the technology now where we can know our body's genetics, know our hormones. I mean we check cortisol for patients every three months because life happens. You know you had a stressor, you had a horrible boss, you had to move homes, you got a parking ticket, something happened where it's totally like stressed you out and that's going to impact your cortisol. So, and there are lots of good herbs you can take to help keep your cortisol healthy. Things like ashwagandha that I mentioned, relora, cordyceps, breath work. So just meditating, breathing, stretching can all help.
Speaker 2:So, as you're going through your 20s and phase, really focusing on stress perception with the knowledge of what's happening inside your bodies and finding a good functional doctor, a good doctor around you to really be like OK, let me get a sense of what's my body trying to tell me and then you know those baseline numbers and then you can work from there and empower yourself to know what your optimal number should be. Because so many patients say I went to my doctor, they actually checked my hormones and they said everything was normal. And then when I'm like, when did they check your hormones? They're like, oh wait, they did it on day three. Day three is fertility hormones and progesterone will be zero anyway. If you want to really check your hormones, it's really right before your cycle.
Speaker 2:And so a lot of times and and in defense of my regular medicine colleagues we're not taught in that approach. We talk about medications. So work with someone and be aware and know that you have the power, and you have power in choice. The more things you say no to, the more times you put yourself first, the more times you choose a healthy meal for you. And a lot of my patients really try and get clear with what is your, why, like, why do you want to be healthy? Sometimes I'm doing it for my kids, I'm doing this for my when I'm aging, I'm so scared of dementia, like, why are you doing? Why do you want to be healthy? And as long as you have that vision clear, it's easy to make healthy choices.
Speaker 1:Oh, I love all those steps that you gave and I almost feel like we're like in sync, like in tune, right, because it is really some of the pretty much all the things that you know we talked about in, like, my sessions to you right, you have to take care of yourself, right, like you're taking care of everybody else and who takes care of you? You need to be taken care of as well, and you gotta do that. I love that. You say you know knowing your body, because nobody knows your body more than yourself. Right, you know how things feel, you know how what hurts and like, how you know your cycle goes, and so I think is that's really important in being an advocate.
Speaker 2:like you say, you have the power, right, um, and so and that's what's so important is that you do realize you do have that power. Another big epidemic that a lot of us just are unaware of is the amount of undiagnosed autoimmune markers in women, and especially around the perimenopause. Menopause time when inflammation is high and life stress is high. And just knowing that, even if you have these autoimmune markers, they can be reversible. So it doesn't mean you have to keep progressing, because once you have one autoimmune marker, the likelihood of having the next one is three times higher. So what can you do to clean up inflammation, clean up the gut, clean up anxiety, get more joy in your life, get better nutrition, get better bowel movements All those things will help reverse the autoimmune epidemic happening.
Speaker 1:Thank you so much for really focusing on the prevention right and things that you can do and these practical tips. So, if there's, how can patients reach out to you right? Or if someone is interested and maybe they don't live in LA, can they still see you how?
Speaker 2:how does that work? Yeah, so basically I'm a licensed internist in California, so I can see anybody in California, even online. So if they're living in California, which I'm assuming most of your audience is you can come see us. If you live outside of California, you have to physically come and see us one more time, one time before we initiate care. But if you're in California, we could do all of this online and that's the magic of really telemedicine. But it's important when you could. There's multiple ways where you could utilize us. Once you could just follow us on our social media stuff and learn from that.
Speaker 2:The second most common thing people do is they do lab consults where they just want to know, like I feel good, but is she really talking to me? Maybe I do have some of these symptoms that I don't need all these medications for, maybe I'm just not crazy. It's my hormones, and so you can come and do a longevity panel with us that includes hormones and you do the lab work first, and then you would come and see a functional medicine certified providers it's myself, my nurse practitioner, annie or Serena, my functional certified physician's assistant. They would spend two hours with you, kind of taking that history, learning about who you are and then making sense of your blood work and saying, hey, by the way, you do have an autoimmune process going on. You do have a really low progesterone. Here's some natural things you can take. And then sometimes patients are like, oh, I really want to work on this with you. And then they kind of join a program and our programs are between two months to six months where they work with us, really addressing some key issues. The goal of a program is to really empower our patients. That this is what you can do. It's not to give you 40 supplements, it's what can you do to take control of your life. How can you empower your life? And then, after a program, a lot of our patients just choose to stay with us in a membership. They see us twice a year and they do check these labs. What's most important with any of these choices is you have an app where you can contact us at any time and we can contact you, and that's really important in terms of accountability both ways.
Speaker 2:Another big thing that happens is you know if somebody's sick and they have a bad sinusitis or cold and they go to the urgent care and they get these really strong antibiotics. We would like to be in charge of giving you more natural things or maybe a gentler antibiotic before you reverse all the gut health work that we've done, so you can choose multiple options to work with us. I know functional medicine or this kind of medicine insurance doesn't really cover it doesn't see it as medically necessary, but we do try to utilize your insurance if we can with lab work or, for sure, any kind of testing. But if you wanted to do like, for example, a lab consult with a longevity hormonal panel, it's usually $1,900. And now that sounds like a huge investment. But we do have like a hormonal special for anybody who's listening to your podcast now, where they can do it for less than a thousand and you do all the blood work, which is about 40 to 50 markers. So if you're scared of blood, it might not be the best thing and you could break it up, but you could do it locally. We'll send you the order and the lab. The cost of the whole thing is inclusive of the blood work, inclusive of the messaging app and then for us to review everything, and the goal of this kind of approach is that you shouldn't need to need other kinds of medicine.
Speaker 2:Right. It shouldn't be functional medicine, internal medicine. It should just be good medicine where you don't have to go to the ER, you don't have to be on chronic medication and it's really telling you what's going on with your labs and your hormones. And some patients just choose to do like a lab consult with us once or twice a year and be like I just want to know what my body's telling me, and sometimes they become big advocates and they're teaching other people of what their labs show. So anyway, it doesn't have to be us. Just find someone close to you, someone you trust and someone who's not going to discount you. I can't tell you how many women, and especially women of color, who get discounted. So it's really important to advocate for yourself and if they're not listening to you, find someone else to partner with.
Speaker 1:Right, yeah, so do not be dismissive. Right, and it's awesome that you are providing different options for the listeners and for your patients to work with you, and I'll make sure to add your information, your social media info, your website, all that I'll add it in the show notes For your listeners. You can go there and check it out.
Speaker 2:And make sure they mention your name, like your name, in your podcast, so that my onboarding coordinator knows what was offered on this podcast, so we can make sure we honor them.
Speaker 1:Absolutely, thank you. Thank you for saying that. Any final thoughts, anything else that you would like to share with the listeners, or anything else?
Speaker 2:For those women in California. Right now we're going through all these fires in LA and the air quality has been not great even though it looks good on our phones, and the lead levels have been a hundred times more what they should be two days ago and I'm sure eventually even your part of California was going to get some of these toxins. So just be super, not now, but in the next three to six months. Check your toxic load. Check your lead, cadmium and mercury, because that's what we're seeing in the air. All of those toxins impact the thyroid, the ovaries and the gut. So I would say, check. You live in the same state, I do so check and know what your levels are, and just know that it's easy to check these things. Just look online. Research reach out to us, but it's just so important to be aware and most most importantly is don't give up hope, because know, because there's something out there. If you're feeling it and somebody's told you the labs are normal, they haven't checked the right lab.
Speaker 1:Right. Don't give up hope Absolutely and advocate for yourself. Thank you so much, Dr.
Speaker 2:Shabazzu, you're so welcome. Take care, be safe.
Speaker 1:Take care Absolutely. Thank you everybody, Take care I.