January 29, 2025 • 47 mins
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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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hey, hey everybody.
Thank you so much for joiningme today.
My name is Leonila Campos,registered dietitian.
I am so excited to have thisamazing guest, dr Sayana.
We're going to talk about anamazing topic, which is
menopause, and she's an expertin this area.
I have lots of clients andpatients that are going through
it, so stay tuned and welcome.
(00:23):
Thank you so much, dr Sayana,for joining me today.
Speaker 2 (00:26):
Thank you so much for having me.
I'm so excited.
This is one of my favoritetopics Amazing.
Speaker 1 (00:31):
So for the listeners right, tell us a little bit
about yourself and yourexpertise and where they can
find you.
Speaker 2 (00:37):
Sounds good.
I'm an internal medicine doctor, so I'm a regular MD and also
functional medicine certifieddoctor.
I live in Los Angeles.
Here in Sherman Oaks in theValley I've been practicing for
more than a decade and truly ourwhole practice are experts in
dealing with women going throughperimenopause and menopause,
mainly if they've been toldtheir labs are normal or, god
(01:00):
forbid, not even had any labsand 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 atopic that I mean now you've
seen him, that is talked aboutmore now, but it wasn't right
(01:20):
and I think absolutely we weshould talk about that right,
like it's something that we needto to learn and understand,
because we all are going that.
Speaker 1 (01:29):
You know, women, we're going that way, so we need
to be able to understand it.
Speaker 2 (01:33):
Yeah, you can't escape perimenopause menopause,
but you can go through itgracefully, where it doesn't
have to like wreck your life orcause all these unknown symptoms
.
You can go in there empoweredand really meet it head on and
actually just nicely and easilygo through perimenopause
menopause.
And it's so important for yourlisteners to understand like,
when is this happening?
(01:53):
People think this is happeningin my fifties or my sixties.
No, we see women enteringperimenopause as early as 35 and
can go all that, can that, thatdeck, that period can last for
five to 15 years and then theycan go on into full menopause.
But all these changes arehappening in our bodies and it's
determined by certain thingswhere you can go through
(02:14):
menopause a little bit later orearlier, depending on your
stress, anxiety and inflammation, and under inflammation it's
really your wheelhouse in termsof nutrition and your body's
stress response.
All of that has an impact ofwhen exactly you'll go into the
menopause journey.
Speaker 1 (02:31):
Yeah, thank you for explaining that, and so for our
listeners.
Right, let's talk a little bitabout what that exactly is,
right?
What is perimenopause, what ismenopause, what is postmenopause
?
Because there's so many of them.
Speaker 2 (02:46):
Absolutely, and you know the thing with menopause.
First of all, you know it's areally not talked about much in
terms of we haven't talked aboutit.
Maybe these past two years withthe M-Factor, the documentary
talking about menopause, there'sbeen a little bit more
attention to it, but really notmuch, especially in terms of
hormones.
Because there was one big studythat showed that hormones could
(03:06):
be inflammatory or could causecancer and from that one study
that people just stoppedprescribing hormones or were so
scared of hormones.
But now, looking back at thatstudy, we realize it was not
done, it wasn't interpretedcorrectly.
Look, hormones don't the kindof hormones that were tested
don't cause cancer, or the onesthat were tested were very
(03:26):
inflammatory and thebioidentical ones are a little
bit safer and it's so importantto see what's happening with the
body before giving hormones tosomeone.
So back to your originalquestion perimenopause, and what
kind of symptoms people canfeel during that time.
Sometimes women can have issueswith their period, where it
becomes more irregular or closertogether and then suddenly you
(03:50):
start missing periods.
But the definition of menopausemedically is one whole year,
that's 12 months of no period.
But symptoms patients commonlycome to us with is I just can't
sleep through the night, or I'msuper hot and I'm sweating, or I
am just suddenly I look in mycloset and none of my clothes
fit me.
Everything is like so tightaround my belly, or I have word
(04:13):
finding issues, the word is atthe tip of my tongue but it
doesn't come out and I havebrain fog, or I am suddenly
having some palpitations.
So all these symptoms, theyseem so nonspecific but they all
could imply you enteringperimenopause and eventually
menopause.
And then there's some womenthat go through this journey
without having any symptoms andthere's so many factors that you
(04:35):
can modify that can impact hownicely or easily you go through
menopause and the perimenopausejourney.
Speaker 1 (04:42):
Right, yeah, thank you for sharing all those
descriptions and reallyemphasizing right like we don't
talk about these things.
And you do hear, and I'm sureyou see that in your practice
too right, women come in andthey 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 isnot fitting and nothing has
(05:02):
changed right, and that can beso frustrating so I can't
imagine going to try to figureout why that is happening and
not getting any answers,absolutely.
Speaker 2 (05:12):
And I think a lot of our patients have gone to the
conventional primary caredoctors or the gynecologists and
they may be like 36, 37, 38.
And the first things maybepeople notice is pre-period like
the week or two before theperiod they become these
hormonal monsters.
Their kids don't want to haveanything to do with them, their
husbands are scared of them.
Everybody's like walking aroundeggshells because they're like
(05:34):
scared of them and theyrecognize 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 totheir primary care doctor and
the doctor is like you know,maybe you need Zoloft or an
antidepressant, but they're notthinking about the why.
And what's important, is superimportant, is check your
(05:55):
hormones.
As a conventional internist, wewere never taught to check
people's hormones.
We're just like oh, it could bedepression, or we don't.
Because these hormonesfluctuate so much we were not
taught as to what they should bein certain parts of your cycle,
so you do need to see somebodywho's a little more educated in
that.
But pre-period those crazysymptoms are generally because
(06:16):
of a drop in progesterone, andprogesterone is the happy, the
calm hormone and when thathormone goes down, people get
irritable, get anxious.
Think about a woman inpregnancy.
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'srisk of postpartum depression.
(06:37):
So that progesterone hormone isso important.
And you may ask, like why is itthat women some women don't have
the issue until much later?
It's because of things such asstress, anxiety and inflammation
.
It all impacts your stresshormone, cortisol.
So whenever you're stressed andstress could be like I'm
juggling all your million thingsin your life right now it may
(06:58):
not be like a death or somethingso scary in your life, but just
could be a current life forwomen.
We're just busy being a mom,being a partner, being a mother,
having a full-time job, runninga podcast, like you're busy,
and so all of those cortisolspikes, which is your stress
hormone.
As you keep spiking yourcortisol, just looking at the
steroid pathway for hormones, iteats up progesterone.
(07:20):
So a lot of times women come inand they're like oh, my
period's all messed up.
And we talk to them.
We realize that they've had abunch of stress three or six
months later and they're havingthese hormonal imbalances
because of that.
And you don't have to givesomeone progesterone, but if you
can just treat that high stressperiod and help them manage
that better, their cycle can goback to normal.
(07:42):
But it's so important to checklike what are your hormones and
are they in the optimal ranges?
Speaker 1 (07:49):
Yeah, oh, this is so good, right, that just
understanding that you can dosomething about it, right, you
can check your hormones, you cancheck your labs, right, and see
, okay, where am I.
And I think a lot of ourlisteners right, or just clients
and customers in general, theydon't know what to ask, right,
or they of our listeners right,or just clients and customers in
general, they don't know whatto ask, right, or they don't
know, okay, what should I lookfor?
(08:10):
Right.
And so I think it's soimportant, again, like you said,
right, try to find the answersright.
Speaker 2 (08:17):
If it's like doing more, you know, checking and
working with the right doctorwho's not going to dismiss you.
Historically, medicine has beenso dismissive of women.
You know, checking and workingwith the right doctor who's not
going to dismiss you.
The historical, historicallymedicine has been so dismissive
of women.
You know we consider ithysterical in terms of having
these symptoms.
We are not really listened toand, unfortunately, conventional
medicine is quick medicine,Like I can see you in eight
minutes and I can write theprescription for Prozac and then
(08:39):
you're gone.
But the sad thing is so manywomen come to our practice and
they're like wow, nobody's everlistened to us.
Like an initial appointmentwith us is two hours.
We want to get a whole in-depthstory of who you are, because
there are clues in there as towhat might impact your hormones.
So it's so important to partnerwith the right kind of practice
that's going to measure yourhormones and also, if they do
(09:00):
find that you are hormonedeficient, not just give you
hormones.
Also, if they do find that youare hormone deficient, not just
give you hormones, because wewant to make sure is your body
in a clean state where you canaccept those hormones, whether
it's supplements or whether it'sbioidentical hormones, and
actually not just prescribe thesame dose for every woman, Like,
where are you in your stage oflife and do you have which
hormone is off and really haveused precision medicine to say,
(09:24):
okay, your progesterone is off,and really have used precision
medicine to say, okay, yourprogesterone's off?
You can try a natural vitamin Cand chase berry to increase it
or the hormone, and not justgive you estrogen and
progesterone all at once.
So it's so important to knowwhere are your hormones at this
time and what's going on in yourlife life-wise, emotionally,
physically and inflammatory wiseso you can decide if hormones
(09:45):
is the right thing, right.
Speaker 1 (09:47):
Yeah, absolutely, it's really going deep into the
root causes of like okay, let'sfigure out why this is happening
.
Oftentimes, there is going tobe a root cause and I love that.
You can imagine your clientsand your patients feeling so
relieved and, like she'slistening to me, she's literally
spending time to figure out myproblems, right, and I do agree,
(10:08):
right, seeing the patient as awhole person, versus, like, all
these organs and, like you know,different compartments, because
you know, with my clients to, Ispend 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 informationto provide the interventions
(10:31):
that they need, right,individually and so customized.
So it's so amazing that you areabsolutely able to do that and
help your patients and one bigorgan system.
Speaker 2 (10:40):
you know when we're talking to patients the
functional medicine, which isroot cause medicine a lot of
people are like well, what isfunctional medicine and what's
internal medicine?
So internal medicine is theconventional medicine as you
know it.
That's how I was boardcertified.
I'm board certified.
But functional medicine is,like you said, the root cause,
like what's fueling thesesymptoms?
Why now do you have thissymptom and what can we do?
(11:01):
That's a root cause approach,which is like your diet and
lifestyle how can we improveyour gut health that'll improve
your symptoms without having toautomatically jump to medication
, and that's so important tolook at.
And a lot of people are like Idon't have gut symptoms, but
when we do stool testing and wedo a super breath test, which is
(11:22):
the wrong bacteria in their gutshows a lot of abnormal gut
testing, and I think we just areout of touch or we're avoiding
those foods that cause badsymptoms and so we don't realize
oh, your body's like she'sgoing to eat the way she's going
to eat.
I'm just not going to havesymptoms.
So it's important to do thatkind of testing.
So no patients in our practiceactually get bioidentical
hormones without testing them.
Speaker 1 (11:45):
Yeah, and it's just so interesting and I know it
seems like we're moving awayfrom 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 toohow are your bowel movements
right?
It can tell you so much, likejust knowing that and like what
are the interventions?
Speaker 2 (12:06):
Yeah, most of America is constipated and we're not
even taught from a young agethat we should have a regular
bowel movement, at least onebowel movement a day.
That looks nice like cobrashaped.
A lot of patients are like, oh,I thought I was going once a
week and that was normal.
But we're not talking aboutthese things.
And it's so important to havegood, regular bowel movements
daily because that's how youdetoxify.
And it becomes super importantif you're thinking about taking
(12:29):
hormones and perimenopause andmenopause, because you want your
liver to be able to processyour hormone so that it's ready
for tomorrow's prescription dose.
So if it can process yourhormone through the gut and
eliminate any excessive hormonethrough the stool.
Eliminate any excessive hormonethrough the stool is so
important.
But if you're constipated,you're going to have side
effects from hormone replacementtherapy.
(12:50):
So it's so important to reallytreat the canvas and say how are
you going to process thesehormones or supplements to
improve hormones, before justjumping to giving you a
prescription.
Speaker 1 (13:01):
Right.
Yeah, I love how so in-depth.
That is right and really againunderstanding where are we right
, what are the interventionsthat we have to make and how is
this person going to react tothat too.
Right, and so I want to lingerhere a bit.
In terms of the constipationright.
If someone is having anyhormonal issues or hormonal
imbalances right.
(13:22):
Are there any correlation tothe estrogen levels or
progesterone in terms of, like,bowel movement function?
Speaker 2 (13:29):
Yeah, so it's often the women come to us first of
all.
It's probably the first timethey're checking their hormones
and we check their hormones andwe find a lot of women have
super high levels of estrogen.
This is like a week before herperiod.
We check it in the mid lutealphase, which is around day 19 to
23 of your cycle, wheresometimes women have super high
levels of estrogen that areactually just high in
conventional lab testing and thesymptoms could be I'm really
(13:52):
bloated, I'm anxious, I'm on twoantidepressants.
I just keep gaining weight andyou can see that they're in the
perimenopause menopause statebecause of one specific lab
called FSH, the folliclestimulating hormone.
When that is very high, you'realready in menopause and like
above a hundred.
(14:12):
But that is a moving targetdepending on your gut
inflammation and your otherhormones.
So when things like when yourestrogen is super high, what we
focus on is your gut elimination, like what's going on with your
liver Are you able to processall your nutrients and actually
eliminate?
And when we ask a lot ofpatients with elimination, the
(14:32):
number one we see is nobody'sdrinking enough water and
nobody's eating fiber and a lotof 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 Ithink what you're referring to
is I did a video on a bowl ofarugula that has like 0.2 grams
of fiber, versus having blackbeans or beans in general and
(14:56):
avocado, and we really try toencourage women to get 30 to 40
grams of fiber.
That takes effort and we're insuch a fast-paced environment
that nobody either knows or isaware enough to do that, and I'm
sure you see that as you'reworking with your clients, and
that must be so empoweringbecause you actually teach them
how to.
Speaker 1 (15:16):
Right, yeah, you're absolutely correct.
Usually we talk about all thosethings constipation, bowel
movements and fiber.
Fiber is.
You know, I spend a good amountof 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 asalad and that's my fiber.
Okay, that might not haveenough.
Right, as you mentioned, atleast 30 grams of fiber and
(15:38):
focus, you know, let's just addthem with these high fiber
sources like beans.
Amazing, you know, you can geta really good amount of fiber in
your beans.
If you like salads, let's addmore fiber to that salad, right,
like the blackberries, or maybesome chia seeds or something
like that.
That is going to increase thefiber and just being more
regular, right?
Speaker 2 (15:58):
increase the fiber and just being more regular.
Right, it doesn't have to bedifficult.
You know, I'm sure you see thesame kind of patients we do who
are like between 35 and 60, thatin the peak of their careers
and they're working really hardor having kids and just don't
have time.
But you can pre-plan all thesethings where it doesn't have to
feel so overwhelming, right?
Speaker 1 (16:15):
Yeah, absolutely, we can definitely work on that on
smaller steps.
And you mentioned a fewoccasions, right, about the
weight gain as they get intomenopause.
Let's talk a little bit aboutthat.
Why do you think that happensif nothing changes?
What are the changes happeninginternally that is causing that?
Speaker 2 (16:33):
So you know, I talked about it.
I think maybe the best way todo this is divide the women by
age group.
So the ones who are like 35 to45, they're probably really
right there in theirperimenopausal state where that
progesterone is going awaybecause of stress, anxiety,
inflammation, and just they areaging.
So when the progesterone goesaway, you become more estrogen
dominant.
(16:53):
It's not that you're makingmore estrogen, it's just that
the hormone is left and theprogesterone is kind of quickly
eaten away.
It's just that the hormone isleft and the progesterone is
kind of quickly eaten away.
It's just that progesterone isin a very fragile place in the
hormonal pathway.
So if you're stressed, anxiousor inflamed it's something
called progesterone steel You'rejust left with estrogen, and
estrogen by itself is a hormonethat is very pro-inflammatory
(17:15):
and can cause weight gain.
The second reason, the secondhormone we look at a lot, is
insulin, and so I liken this tothe body doesn't know
genetically the differencebetween you being chased by a
tiger or you having your lifestresses, where you're juggling
all these balls and your body'sgoing to produce this hormone,
cortisol, which is your stresshormone.
And if you're being chased bythe tiger, you get eaten or you
(17:36):
get saved and that's the end ofit.
But unfortunately in our modernworld, especially for women,
when they have so many thingsgoing on, you have these micro
cortisol peaks and the constanttime you increase your cortisol
you need the blood sugar becauseyou need to run from that tiger
, and every time this happens itincreases insulin because it's
trying to manage and push yoursugar.
And so another big thing we seein perimenopause and this 35 to
(17:58):
45 age group is an increase ininsulin.
And when your insulin is higheryou see a lot more weight
around the belly.
So estrogen dominance, insulinresistance.
And then the third biggest oneis inflammation.
And a lot of times patients arelike well, what is inflammation
?
Inflammation is actually a goodthing because when you cut
yourself, inflammation heals it.
But it's dysregulatedinflammation where the cortisol
(18:21):
is constantly coming up and youfeel like you're constantly
running and there's no end pointto that.
It's that kind of inflammationthat can cause weight gain.
So those are like three bigreasons.
And at the same time this poorwoman is losing her testosterone
and as the testosterone levelskeep going down, you can't make
muscle as well.
And I have women who come inthere who are like I'm a Pilates
(18:43):
instructor, I'm so active, butI just feel like jello.
And when we measure theirtestosterone levels they're
super, super low.
And so, as you're consideringhormones, you can take high dose
fenugreek, which is just anherb that increases your
testosterone, or you could do alittle bit of testosterone
replacement therapy and it's agame changer.
Women just really feel likethey can make muscle, they're
(19:05):
more confident, they have betterenergy, less word finding
issues.
So, if you can get to givingprogesterone and then maybe some
testosterone, eventually womenin their 40s, 45 to 55 is where
really women do see benefitswith those hormones.
But that's really what'scontributing to weight gain, and
it's not just about givingpeople a Zempik or Wegovia
(19:27):
Manjaro.
It's about why is thishappening and how can you
actually target those pathwaysso you can get long lasting
weight loss, not just a quickfix.
Speaker 1 (19:36):
Right, and I really love that.
The long lasting changes right,because if we are definitely
looking to, okay, we're havingthis increase in insulin, right,
and these high cortisol levelsand low testosterone, which is
also affecting our muscle mass,and as we age, we are losing
muscle mass.
It's almost like a catastrophein a way.
(19:56):
Right, because we're havingsome of those issues and we know
that increasing our muscle massis going to help us right with
increasing our metabolic rate,and so it is so important.
Now, one of the things thatcomes to mind when we talk about
testosterone right, it's likewhy do I need testosterone?
I don't want to be bulky and Idon't want to look manly.
Yeah, tell us a little bitabout that.
How is that?
Speaker 2 (20:17):
different, and so testosterone is such an
important hormone.
Both men and women haveestrogen and testosterone, so
men have a lot more testosteronethan we do.
But women have quite a bit oftestosterone and as you're aging
it goes down.
But also, if you're chronicallystressed or chronically
inflamed, you eat up a hormonecalled DHEA, which is the mother
hormone to cortisol, and asthat hormone goes down, your
(20:39):
testosterone just naturally goesdown.
So but when you actuallyreplace testosterone, you're
measuring levels and the thingsyou want to ask your doctor to
be checking is totaltestosterone and free
testosterone.
And that's really importantbecause a lot of times patients
come to us and their totaltestosterone is excellent and
they're like I don't feel goodbecause their free testosterone
is so low.
(20:59):
And that's commonly because ofa common protein called the sex
hormone binding globulin andit's just bound all your
testosterone, so you can't feelit.
So those kind of patients if wegive them testosterone, it
won't really help.
And what impacts that protein,the sex hormone binding globulin
, is inflammation, your nutrientabsorption and your gut health,
(21:19):
and if you work on those things, the sex hormone binding
content becomes lower and thenthey can feel their testosterone
.
Back to your question as towe're not trying to make women
men and the doses we give themare super different.
So for a man, we have quite afew male patients.
We give them around 200milligrams of testosterone.
They take that every day,versus a woman is getting one
(21:40):
milligram or maybe up to 10milligrams of testosterone every
.
They take that every day,versus a woman is getting one
milligram or maybe up to 10milligrams of testosterone daily
.
So the difference is very, very,very low and it's important to
also measure your level.
So if you are giving someonetestosterone, it's important to
make sure your liver is able totolerate it.
You're seeing the level that'soptimal.
Most importantly is we're nottreating a lab.
Your patient or client has tosay I actually feel better, and
(22:04):
I feel better and I'm actuallyexercising, which I have been
doing but I can see muscle, Ifeel like my strength is better
and I do feel like my libido isbetter, because a lot of women
have issues with libido and it'sso important to actually
optimize the testosterone levelsso they can actually feel
intimate yeah, and I think it'sso.
Speaker 1 (22:23):
You know, I hope that , as the listeners are listening
to these, right, and it'shitting 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, andlike that's that right, because
that's not the case, right?
We, there are things that wecan do to change that right and
optimize the levels and if youdon't want hormones.
Speaker 2 (22:44):
a lot of times some patients come to us like I'm
really scared of hormones or mymother had breast cancer so I'm
not going to try any hormones,and you can give natural
supplements.
But sometimes when you improveyour downstream hormones or your
upstream hormones, people justfeel better in the perimenopause
menopause stage, because wefound that in the perimenopause
state people are more inflamedbecause they don't have these
(23:05):
protective benefits of thesehormones.
And if you can think about thehormonal cascade as an axis,
think about the grandmother asthe adrenal glands, and these
are the two coin-shaped glandssit on top of your kidney, make
cortisol, and then think aboutthe thyroid as your mom and then
(23:27):
the granddaughter as yourovaries.
And a lot of times in regularmedicine we'll just give you
hormones, hormone replacementtherapy.
We might check your thyroid,but we never check your adrenals
and this is your stresshormones.
And if we looked at grandma andreally focused on grandma and
fixed her, the other hormoneswould fall into place.
So a lot of times when peoplework with us, or functional
medicine doctors in general, andjust work on cleaning their
foundation, they do feel atleast 30 to 40% better and may
(23:51):
not even need hormones.
Speaker 1 (23:53):
I love that analogy and just giving the patients the
choice right, like if you don'twant hormones, that's not the
end of the world, right.
We can do other things and, I'msure, optimizing other areas
that we have to work on, likenutrition, gut health, having
better bowel movements,increasing our water right those
are things that we can startdoing right away and see some
changes.
Speaker 2 (24:13):
Completely.
And I think another big thing Isee in our population is, you
know, really high stressperception.
People are so stressed and soanxious and so worried and
that's kind of a modern life.
Unfortunately, if you're livingin that high stress state, your
cortisol is going to be highand it's going to eat up your
progesterone and push youquicker to menopause, push you
quicker to perimenopause.
But actually just walking fiveto 10,000 steps a day, being in
(24:37):
nature, being able to do somebreath work, all those things
can really drop your cortisol.
And some of my patients arelike it sounds like you want me
to quit my job.
No, I want you to be able tothrive in your job, where you
don't feel like you're survivingand can't wait till 5.30 to be
done with the day.
But it's so important to atleast help your body pretend
(24:57):
that things are okay.
Speaker 1 (24:59):
Yeah, I love that you also talk about stress.
Stress is another thing that Italk to my patients too, because
it affects nutrition, right, itaffects our ability to make,
you know, healthier choices.
Or because we do have this highcortisol levels, right, we're
craving all kinds of thingsbecause now we have the you know
the insulin, and so as we thinkabout, okay, how, how, the
(25:21):
first thing that I ask them youknow what's your stress, tell me
about your stress.
You know, I want to say, 99% ofthe time I hear this like I
don't know.
That might be the first timeduring the day where they take a
nice deep breath and like thattells me, okay, it's probably
high.
And then you know, they tell meabout it or they say, oh, I
think it's okay, right.
And as we talk more about howabout you know blood pressure
(25:44):
wise, if you're having the bloodpressure issues, or how about
you're eating, so I think thestress management plays a huge
role in so many aspects it does.
Speaker 2 (25:53):
And another big thing we do in our practice is we
look at genetics.
So you know, I explain topatients as an internist we're
very siloed, right?
You get a UTI, we give youantibiotics, you get better.
We think You're constipated,you know, take psyllium or it
doesn't really matter drinkwater and it's supposed to get
better.
But functional medicine is moretriangular.
You have genetics on one side,you have exposures or mediators
(26:17):
on one side and then triggersthings that are highly stressful
to you and genetics.
What's amazing about genetics isjust because you have a gene,
it doesn't mean you have to havean epigenetic disease.
Genes are like on and offswitches and you can switch them
off by managing your exposuresof mediators and managing your
stress perception.
So we do almost all ourpatients, we check genetics, and
(26:40):
by the genetics we can tell ifthey are very sensitive, like
some people just came to theworld sensitive.
It doesn't take too much stressto get them worried, and it's
that same kind of group ofpeople that are also very
sensitive to toxins.
And so it's important tomeasure your genetics,
especially if you're thinkingabout hormone replacement
therapy, because a lot of ourpatients are just on
progesterone and testosteroneand not on estrogen, because
(27:03):
genetically they don't detoxifywell and keep the estrogen
levels very high, so giving themestrogen could actually cause
some side effects.
So understand your genetics andreally work on what you can
control, which is your stress,your diet, your environment, and
together you can switch offthese genes that may not produce
the best.
Speaker 1 (27:24):
Yeah it's so different things that we have to
consider right as well.
Let's talk a little bit aboutsleep.
I know you mentioned sometimessome women have issues with
sleep as they get into menopause.
Yes, let's talk a little bitabout sleep.
I know you mentioned sometimessome women have issues with
sleep as they get into menopause.
Yes, let's talk a little bitabout that.
Speaker 2 (27:39):
Absolutely.
Sleep is so important becausewe want to get at least five to
six hours of consolidated sleepwhere you're not waking up in
the middle to help with memoryconsolidation.
So a lot of times people arelike I'm sleeping, god, I sleep
eight hours, but when youactually dive deeper, they're
waking up every two hours andlooking at their phone or
looking at their alarm all thetime.
And so it's very important tohave good sleep hygiene where
(28:00):
you're like don't on a screenbefore you sleep, sleeping in a
regular bedtime, using the bedmainly for sleep and making sure
that you're not having theselike caffeinated beverages
throughout the day.
That's keeping you awake.
But apart from that, when womengo into that perimenopause like
above 35, and their progesteronestarts going away, that's when
they might really feel issueswith insomnia.
(28:21):
And the biggest thing with nothaving a progesterone is you
might notice that you havefrequent times where you wake up
in the middle of the night.
And then the second hormonethat's not a sex hormone, but
it's cortisol, which is yourstress hormone, and so a lot of
times patients feel like theylook at the time and it's
between three and five in themorning, like they fell asleep.
(28:41):
Okay, but they couldn't staysleeping.
And the question in my mind isit an issue of high cortisol or
is it an issue of lowprogesterone?
And that's where it's importantto check your numbers, because
I can't tell you how many peoplehave come to us and like 40
supplements bottles they bringin and I'm like, oh, are you
feeling okay?
And they're like no, but I'mtoo scared to stop anything in
case it's working, and so it'simportant to check levels and
(29:04):
say, okay, is your cortisol theissue or is your progesterone
the issue?
So you could be a little bitmore precise where you don't
have to swallow so many thingsyeah, absolutely, I, absolutely.
Speaker 1 (29:13):
I think that is so important to measure right and
then provide theirrecommendations 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 somethingmight work Exactly, but the safe
thing to try is magnesium.
Speaker 2 (29:30):
So magnesium is a muscle relaxant.
There's magnesium glycinate,magnesium threonate.
Glycinate and threonate workpretty well for sleep.
Threonate goes into yourblood-brain barrier.
You could start with like 100milligrams and 200 milligrams
and you might notice you fallasleep easier because magnesium
relaxes your muscles.
So it helps with anxiety, helpswith sleep and helps with
(29:50):
constipation.
So the same measure if you'retaking magnesium and have
diarrhea or loose bowelmovements, you may be taking too
much.
So that's where the magnesiumis a super easy one.
Another super easy thing tothink about taking is things
like a magnolia bark, which isRilora or Ashwagandha.
But all of these things, at theend of the day, can have side
effects.
So it's important to work withsomeone where you're checking
(30:12):
levels.
I had a patient recently cometo us with palpitations and what
we found out is because she wastaking high doses of
ashwagandha that was making herthyroid work a little too well.
And once we dialed down thoseashwagandha doses, the
palpitations went away and bythis time she had had a cardiac
stress test.
She was doing a Holter monitor,but nobody thought to ask her
(30:35):
if she was on supplements.
So it's important to kind of godeep dive and figure out.
If the supplements are natural,they can have side effects.
So who are you giving thesesupplements to?
What's their genetics?
What's their body going through?
What's the emotional state?
What is their gut?
Speaker 1 (30:54):
Yeah, absolutely.
Thank you for providing thosequick recommendations and things
that our listeners can do rightaway to see a little bit of
change.
As you mentioned, sleep is soimportant, right, For many
reasons, but as well just foroverall health and also
nutrition wise.
Right, it plays a huge role inour nutrition choices throughout
the day.
How about mental health-wise?
(31:15):
You talked a little bit aboutdepression, and you do see those
changes in women that are goinginto menopause or perimenopause
.
Why do you think that happens?
Speaker 2 (31:24):
Yeah, so the biggest reason with, let's say, anxiety
and depression.
So anxiety is more really theit can be the lack of
progesterone, the high cortisol,the same thing that's impacting
sleep, Like, and when you can'tgo to bed and your mind just
keeps going in that anxiousstate.
That could be viewed as thosetwo hormones.
And then depression can be kindof you burn through all your
(31:45):
cortisol and there's nothingleft to give.
Or you have high estrogen.
And think of the woman likepre-period naturally that's a
high estrogen state.
She's like anxious.
The woman like pre-periodnaturally that's a high estrogen
state.
She's like anxious, she'sirritable, she's hangry, and
that's that emotional impactthat hormones can have.
And then sometimes, when we lookat people's genetics, we see
that they're geneticallypredisposed to not use dopamine
(32:07):
or norepinephrine or serotoninvery well.
And knowing that data, you cangive them natural precursors to
these hormones, like 5-HTP SAMethat can help them make these
neurotransmitters better.
It doesn't have to beprescription meds.
That being said, if you do findthat you are very depressed or
anxious and need prescriptionmedications, there is a test I
(32:29):
want your listeners to be awareof, and there are multiple of
these tests, but they're calledGene Insight and it's a swab on
your cheek that'll tell you,based on your genetics, which
antidepressants or whichanti-anxiety medications would
be best.
Because in regular medicine wejust give you all these
medicines and say, oh, you'rehaving side effects, let's try
the next one.
So if you need them again,there's good medicine and
(32:52):
technology out there that cantell you if you do need one
which could be the best one, andalso doing the lowest, lowest
dose, because lots of thesestudies were done on the 70 kg
white man and we're not that.
So you really want to make sureyou start low work with someone
who's willing to try.
Natural first the biggest thingis therapy, community purpose,
(33:13):
belonging all of those thingsare important.
And then hormones, inflammation, and with anxiety and
depression there's a big gutbrain connection.
So if your gut's inflamed youprobably will be anxious or
depressed.
So try and clean up the gut,clean up inflammation, before
thinking about medication.
Speaker 1 (33:32):
Right, absolutely.
And so with that note, right,if someone is like yeah, maybe
I'm having these problems, howcan they start?
Or what are maybe some of thetips that they can start doing
to help with that inflammation.
Speaker 2 (33:44):
Yeah.
So the first things you'redoing is where is this
inflammation coming from?
And a lot of times sources ofinflammation can be food.
Processed food is a big source,like there's lots of good
studies If you have a big Macand check your inflammatory
levels right away, super skyhigh.
And we have a lot of patientswho are wearing those continuous
glucose monitors.
Now One of my patients that sheate like the In-N-Out French
(34:05):
fry, which only has a fewingredients compared to the
McDonald's French fry, and herblood sugar was super high.
So processed food is a big one.
So, as much as you can, try andmake sure your food is real and
is clean, ideally organic.
And if you are eating packagedfood, make sure they're not like
a list of resilient ingredients.
Just try and keep it simple, asI'm sure that's your expertise
on.
So really try and process foods.
(34:26):
A second source of inflammationis if you've had any kind of
recent infection so COVID is abig source of inflammation.
Or if you were traveling tolike India or Mexico and had
food poisoning, that's going tobe a source of inflammation.
And then another big source ofinflammation is toxin exposure.
So if you were exposed totoxins such as, you know
(34:48):
recurrent LA fires or you hadsilver fillings in your mouth
and have a ton of mercury.
In LA we see a lot of mercurytoxicity, mainly because of
sushi, like my patients lovesushi and they think it's really
healthy, which it should be.
But our oceans are not healthyand if you don't detoxify you
can have high levels of mercurycausing inflammation.
And another source of toxinswhich is again fairly common in
(35:11):
LA is mold.
Like you've had, we had a lotof rains two years ago and they
cause a lot of water damage andmold can be a source of
inflammation.
So, again, it's important toknow how you process these
toxins and these could beobvious sources of inflammation
that are causing that you needto look at.
So in terms of practical thingsyou can do is watch your food
(35:33):
take enough fiber so you'rebinding these toxins and
eliminating them naturally, andmake sure you're not constipated
.
If you have access, go to asauna, like someplace where you
can sweat, like a sauna at theYMCA or at your gym.
See if you could put some sortof 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 aboutinflammation, which is the
(35:55):
biggest source of inflammationis chronic stress, because your
cortisol is high and your bodythinks you need to keep running
and it's in thispro-inflammatory state.
So it's so important to managestress perception, because most
of the things we're worriedabout are not going to happen.
Speaker 1 (36:12):
Right, yeah, yeah, amazing.
So I hope everybody took noteof that.
Things that you can do rightaway and start helping your body
to feel better as we look into,look ahead how can women
prepare for menopause in theirearly ages right, 30s, 40s?
Speaker 2 (36:31):
yeah, honestly, you should start.
So I would say the biggesthormonal thing, which is
probably a whole notherdiscussion, is hormonal issues
that impact you in your teenageyears.
We see a lot of women withsomething called polycystic
ovarian syndrome, where theyhave a lot of testosterone,
irregular periods, they may haveacne.
So if you're already havingthings like that, you really
want to make sure you jump onyour hormones early, like in
(36:52):
your teenagers and your 20s,where you're either looking at
your gut, looking at toxicburden, looking at anxiety,
stress, perception, but if youhaven't had PCOS and have been
marching along to your 30s, sothings you can do.
A big trigger for just hormonalimbalance is pregnancy,
pre-pregnancy, post-pregnancy.
Post-pregnancy can be a verylonely time for women where
(37:13):
they're solely responsible forthis beautiful creature.
But you're it and that's whereyour cortisol can go really high
and can start causing theprogesterone steal, the weight
gain.
So, really trying to manageevery stage of your life
consciously Say I'm going toreally protect my adrenals.
Make sure I'm saying no to toomany projects.
A lot of my women well, women,which is why I say yes.
(37:35):
So say no more.
Make sure that you are movingand exercising.
Make sure that you have somespace for self-care, because the
more self-care you can havewhere you're protecting that
cortisol, the less likely youare to slip into perimenopause
early and then know your body.
We have some means in thetechnology now where we can know
(37:56):
our body's genetics, know ourhormones.
I mean we check cortisol forpatients every three months
because life happens.
You know you had a stressor,you had a horrible boss, you had
to move homes, you got aparking ticket, something
happened where it's totally likestressed you out and that's
going to impact your cortisol.
So, and there are lots of goodherbs you can take to help keep
(38:18):
your cortisol healthy.
Things like ashwagandha that Imentioned, relora, cordyceps,
breath work.
So just meditating, breathing,stretching can all help.
So, as you're going through your20s and phase, really focusing
on stress perception with theknowledge of what's happening
inside your bodies and finding agood functional doctor, a good
(38:38):
doctor around you to really belike OK, let me get a sense of
what's my body trying to tell meand then you know those
baseline numbers and then youcan work from there and empower
yourself to know what youroptimal number should be.
Because so many patients say Iwent to my doctor, they actually
checked my hormones and theysaid everything was normal.
And then when I'm like, whendid they check your hormones?
They're like, oh wait, they didit on day three.
(38:59):
Day three is fertility hormonesand progesterone will be zero
anyway.
If you want to really checkyour hormones, it's really right
before your cycle.
And so a lot of times and and indefense of my regular medicine
colleagues we're not taught inthat approach.
We talk about medications.
So work with someone and beaware and know that you have the
power, and you have power inchoice.
(39:21):
The more things you say no to,the more times you put yourself
first, the more times you choosea healthy meal for you.
And a lot of my patients reallytry and get clear with what is
your, why, like, why do you wantto be healthy?
Sometimes I'm doing it for mykids, I'm doing this for my when
I'm aging, I'm so scared ofdementia, like, why are you
(39:42):
doing?
Why do you want to be healthy?
And as long as you have thatvision clear, it's easy to make
healthy choices.
Speaker 1 (39:47):
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 prettymuch 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 takescare of you?
You need to be taken care of aswell, and you gotta do that.
(40:08):
I love that.
You say you know knowing yourbody, 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 cyclegoes, and so I think is that's
really important in being anadvocate.
Speaker 2 (40:21):
like you say, you have the power, right, um, and
so and that's what's soimportant is that you do realize
you do have that power.
Another big epidemic that a lotof us just are unaware of is
the amount of undiagnosedautoimmune markers in women, and
especially around theperimenopause.
Menopause time wheninflammation is high and life
stress is high.
And just knowing that, even ifyou have these autoimmune
(40:43):
markers, they can be reversible.
So it doesn't mean you have tokeep 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 upinflammation, clean up the gut,
clean up anxiety, get more joyin your life, get better
nutrition, get better bowelmovements All those things will
(41:05):
help reverse the autoimmuneepidemic happening.
Speaker 1 (41:06):
Thank you so much for really focusing on the
prevention right and things thatyou can do and these practical
tips.
So, if there's, how canpatients reach out to you right?
Or if someone is interested andmaybe they don't live in LA,
can they still see you how?
Speaker 2 (41:26):
how does that work?
Yeah, so basically I'm alicensed internist in California
, so I can see anybody inCalifornia, even online.
So if they're living inCalifornia, which I'm assuming
most of your audience is you cancome see us.
If you live outside ofCalifornia, you have to
physically come and see us onemore time, one time before we
initiate care.
But if you're in California, wecould do all of this online and
that's the magic of reallytelemedicine.
But it's important when youcould.
There's multiple ways where youcould utilize us.
(41:47):
Once you could just follow uson our social media stuff and
learn from that.
The second most common thingpeople do is they do lab
consults where they just want toknow, like I feel good, but is
she really talking to me?
Maybe I do have some of thesesymptoms that I don't need all
these medications for, maybe I'mjust not crazy.
It's my hormones, and so youcan come and do a longevity
panel with us that includeshormones and you do the lab work
(42:10):
first, and then you would comeand see a functional medicine
certified providers it's myself,my nurse practitioner, annie or
Serena, my functional certifiedphysician's assistant.
They would spend two hours withyou, kind of taking that
history, learning about who youare 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 lowprogesterone.
(42:32):
Here's some natural things youcan take.
And then sometimes patients arelike, oh, I really want to work
on this with you.
And then they kind of join aprogram and our programs are
between two months to six monthswhere they work with us, really
addressing some key issues.
The goal of a program is toreally empower our patients.
That this is what you can do.
It's not to give you 40supplements, it's what can you
do to take control of your life.
(42:53):
How can you empower your life?
And then, after a program, alot of our patients just choose
to stay with us in a membership.
They see us twice a year andthey do check these labs.
What's most important with anyof these choices is you have an
app where you can contact us atany time and we can contact you,
and that's really important interms of accountability both
ways.
Another big thing that happensis you know if somebody's sick
(43:15):
and they have a bad sinusitis orcold and they go to the urgent
care and they get these reallystrong antibiotics.
We would like to be in chargeof giving you more natural
things or maybe a gentlerantibiotic before you reverse
all the gut health work thatwe've done, so you can choose
multiple options to work with us.
I know functional medicine orthis kind of medicine insurance
(43:40):
doesn't really cover it doesn'tsee it as medically necessary,
but we do try to utilize yourinsurance if we can with lab
work or, for sure, any kind oftesting.
But if you wanted to do like,for example, a lab consult with
a longevity hormonal panel, it'susually $1,900.
And now that sounds like a hugeinvestment.
But we do have like a hormonalspecial for anybody who's
listening to your podcast now,where they can do it for less
(44:00):
than a thousand and you do allthe 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, butyou could do it locally.
We'll send you the order andthe lab.
The cost of the whole thing isinclusive of the blood work,
inclusive of the messaging appand then for us to review
everything, and the goal of thiskind of approach is that you
(44:22):
shouldn't need to need otherkinds of medicine.
Right.
It shouldn't be functionalmedicine, internal medicine.
It should just be good medicinewhere you don't have to go to
the ER, you don't have to be onchronic medication and it's
really telling you what's goingon with your labs and your
hormones.
And some patients just chooseto do like a lab consult with us
once or twice a year and belike I just want to know what my
body's telling me, andsometimes they become big
(44:44):
advocates and they're teachingother people of what their labs
show.
So anyway, it doesn't have tobe 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 toadvocate for yourself and if
(45:05):
they're not listening to you,find someone else to partner
with.
Speaker 1 (45:08):
Right, yeah, so do not be dismissive.
Right, and it's awesome thatyou are providing different
options for the listeners andfor your patients to work with
you, and I'll make sure to addyour information, your social
media info, your website, allthat I'll add it in the show
notes For your listeners.
You can go there and check itout.
Speaker 2 (45:28):
And make sure they mention your name, like your
name, in your podcast, so thatmy onboarding coordinator knows
what was offered on this podcast, so we can make sure we honor
them.
Speaker 1 (45:37):
Absolutely, thank you .
Thank you for saying that.
Any final thoughts, anythingelse that you would like to
share with the listeners, oranything else?
Speaker 2 (45:44):
For those women in California.
Right now we're going throughall these fires in LA and the
air quality has been not greateven though it looks good on our
phones, and the lead levelshave been a hundred times more
what they should be two days agoand I'm sure eventually even
your part of California wasgoing to get some of these
toxins.
So just be super, not now, butin the next three to six months.
(46:05):
Check your toxic load.
Check your lead, cadmium andmercury, because that's what
we're seeing in the air.
All of those toxins impact thethyroid, the ovaries and the gut
.
So I would say, check.
You live in the same state, Ido so check and know what your
levels are, and just know thatit's easy to check these things.
Just look online.
Research reach out to us, butit's just so important to be
(46:28):
aware and most most importantlyis don't give up hope, because
know, because there's somethingout there.
If you're feeling it andsomebody's told you the labs are
normal, they haven't checkedthe right lab.
Speaker 1 (46:40):
Right.
Don't give up hope Absolutelyand advocate for yourself.
Thank you so much, Dr.
Speaker 2 (46:45):
Shabazzu, you're so welcome.
Take care, be safe.
Speaker 1 (46:48):
Take care Absolutely.
Thank you everybody, Take careI.
Hey, hey everybody.
Thank you so much for joiningme today.
My name is Leonila Campos,registered dietitian.
I am so excited to have thisamazing guest, dr Sayana.
We're going to talk about anamazing topic, which is
menopause, and she's an expertin this area.
I have lots of clients andpatients that are going through
it, so stay tuned and welcome.
(00:23):
Thank you so much, dr Sayana,for joining me today.
Speaker 2 (00:26):
Thank you so much for having me.
I'm so excited.
This is one of my favoritetopics Amazing.
Speaker 1 (00:31):
So for the listeners right, tell us a little bit
about yourself and yourexpertise and where they can
find you.
Speaker 2 (00:37):
Sounds good.
I'm an internal medicine doctor, so I'm a regular MD and also
functional medicine certifieddoctor.
I live in Los Angeles.
Here in Sherman Oaks in theValley I've been practicing for
more than a decade and truly ourwhole practice are experts in
dealing with women going throughperimenopause and menopause,
mainly if they've been toldtheir labs are normal or, god
(01:00):
forbid, not even had any labsand 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 atopic that I mean now you've
seen him, that is talked aboutmore now, but it wasn't right
(01:20):
and I think absolutely we weshould talk about that right,
like it's something that we needto to learn and understand,
because we all are going that.
Speaker 1 (01:29):
You know, women, we're going that way, so we need
to be able to understand it.
Speaker 2 (01:33):
Yeah, you can't escape perimenopause menopause,
but you can go through itgracefully, where it doesn't
have to like wreck your life orcause all these unknown symptoms
.
You can go in there empoweredand really meet it head on and
actually just nicely and easilygo through perimenopause
menopause.
And it's so important for yourlisteners to understand like,
when is this happening?
(01:53):
People think this is happeningin my fifties or my sixties.
No, we see women enteringperimenopause as early as 35 and
can go all that, can that, thatdeck, that period can last for
five to 15 years and then theycan go on into full menopause.
But all these changes arehappening in our bodies and it's
determined by certain thingswhere you can go through
(02:14):
menopause a little bit later orearlier, depending on your
stress, anxiety and inflammation, and under inflammation it's
really your wheelhouse in termsof nutrition and your body's
stress response.
All of that has an impact ofwhen exactly you'll go into the
menopause journey.
Speaker 1 (02:31):
Yeah, thank you for explaining that, and so for our
listeners.
Right, let's talk a little bitabout what that exactly is,
right?
What is perimenopause, what ismenopause, what is postmenopause
?
Because there's so many of them.
Speaker 2 (02:46):
Absolutely, and you know the thing with menopause.
First of all, you know it's areally not talked about much in
terms of we haven't talked aboutit.
Maybe these past two years withthe M-Factor, the documentary
talking about menopause, there'sbeen a little bit more
attention to it, but really notmuch, especially in terms of
hormones.
Because there was one big studythat showed that hormones could
(03:06):
be inflammatory or could causecancer and from that one study
that people just stoppedprescribing hormones or were so
scared of hormones.
But now, looking back at thatstudy, we realize it was not
done, it wasn't interpretedcorrectly.
Look, hormones don't the kindof hormones that were tested
don't cause cancer, or the onesthat were tested were very
(03:26):
inflammatory and thebioidentical ones are a little
bit safer and it's so importantto see what's happening with the
body before giving hormones tosomeone.
So back to your originalquestion perimenopause, and what
kind of symptoms people canfeel during that time.
Sometimes women can have issueswith their period, where it
becomes more irregular or closertogether and then suddenly you
(03:50):
start missing periods.
But the definition of menopausemedically is one whole year,
that's 12 months of no period.
But symptoms patients commonlycome to us with is I just can't
sleep through the night, or I'msuper hot and I'm sweating, or I
am just suddenly I look in mycloset and none of my clothes
fit me.
Everything is like so tightaround my belly, or I have word
(04:13):
finding issues, the word is atthe tip of my tongue but it
doesn't come out and I havebrain fog, or I am suddenly
having some palpitations.
So all these symptoms, theyseem so nonspecific but they all
could imply you enteringperimenopause and eventually
menopause.
And then there's some womenthat go through this journey
without having any symptoms andthere's so many factors that you
(04:35):
can modify that can impact hownicely or easily you go through
menopause and the perimenopausejourney.
Speaker 1 (04:42):
Right, yeah, thank you for sharing all those
descriptions and reallyemphasizing right like we don't
talk about these things.
And you do hear, and I'm sureyou see that in your practice
too right, women come in andthey 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 isnot fitting and nothing has
(05:02):
changed right, and that can beso frustrating so I can't
imagine going to try to figureout why that is happening and
not getting any answers,absolutely.
Speaker 2 (05:12):
And I think a lot of our patients have gone to the
conventional primary caredoctors or the gynecologists and
they may be like 36, 37, 38.
And the first things maybepeople notice is pre-period like
the week or two before theperiod they become these
hormonal monsters.
Their kids don't want to haveanything to do with them, their
husbands are scared of them.
Everybody's like walking aroundeggshells because they're like
(05:34):
scared of them and theyrecognize 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 totheir primary care doctor and
the doctor is like you know,maybe you need Zoloft or an
antidepressant, but they're notthinking about the why.
And what's important, is superimportant, is check your
(05:55):
hormones.
As a conventional internist, wewere never taught to check
people's hormones.
We're just like oh, it could bedepression, or we don't.
Because these hormonesfluctuate so much we were not
taught as to what they should bein certain parts of your cycle,
so you do need to see somebodywho's a little more educated in
that.
But pre-period those crazysymptoms are generally because
(06:16):
of a drop in progesterone, andprogesterone is the happy, the
calm hormone and when thathormone goes down, people get
irritable, get anxious.
Think about a woman inpregnancy.
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'srisk of postpartum depression.
(06:37):
So that progesterone hormone isso important.
And you may ask, like why is itthat women some women don't have
the issue until much later?
It's because of things such asstress, anxiety and inflammation
.
It all impacts your stresshormone, cortisol.
So whenever you're stressed andstress could be like I'm
juggling all your million thingsin your life right now it may
(06:58):
not be like a death or somethingso scary in your life, but just
could be a current life forwomen.
We're just busy being a mom,being a partner, being a mother,
having a full-time job, runninga podcast, like you're busy,
and so all of those cortisolspikes, which is your stress
hormone.
As you keep spiking yourcortisol, just looking at the
steroid pathway for hormones, iteats up progesterone.
(07:20):
So a lot of times women come inand they're like oh, my
period's all messed up.
And we talk to them.
We realize that they've had abunch of stress three or six
months later and they're havingthese hormonal imbalances
because of that.
And you don't have to givesomeone progesterone, but if you
can just treat that high stressperiod and help them manage
that better, their cycle can goback to normal.
(07:42):
But it's so important to checklike what are your hormones and
are they in the optimal ranges?
Speaker 1 (07:49):
Yeah, oh, this is so good, right, that just
understanding that you can dosomething about it, right, you
can check your hormones, you cancheck your labs, right, and see
, okay, where am I.
And I think a lot of ourlisteners right, or just clients
and customers in general, theydon't know what to ask, right,
or they of our listeners right,or just clients and customers in
general, they don't know whatto ask, right, or they don't
know, okay, what should I lookfor?
(08:10):
Right.
And so I think it's soimportant, again, like you said,
right, try to find the answersright.
Speaker 2 (08:17):
If it's like doing more, you know, checking and
working with the right doctorwho's not going to dismiss you.
Historically, medicine has beenso dismissive of women.
You know, checking and workingwith the right doctor who's not
going to dismiss you.
The historical, historicallymedicine has been so dismissive
of women.
You know we consider ithysterical in terms of having
these symptoms.
We are not really listened toand, unfortunately, conventional
medicine is quick medicine,Like I can see you in eight
minutes and I can write theprescription for Prozac and then
(08:39):
you're gone.
But the sad thing is so manywomen come to our practice and
they're like wow, nobody's everlistened to us.
Like an initial appointmentwith us is two hours.
We want to get a whole in-depthstory of who you are, because
there are clues in there as towhat might impact your hormones.
So it's so important to partnerwith the right kind of practice
that's going to measure yourhormones and also, if they do
(09:00):
find that you are hormonedeficient, not just give you
hormones.
Also, if they do find that youare hormone deficient, not just
give you hormones, because wewant to make sure is your body
in a clean state where you canaccept those hormones, whether
it's supplements or whether it'sbioidentical hormones, and
actually not just prescribe thesame dose for every woman, Like,
where are you in your stage oflife and do you have which
hormone is off and really haveused precision medicine to say,
(09:24):
okay, your progesterone is off,and really have used precision
medicine to say, okay, yourprogesterone's off?
You can try a natural vitamin Cand chase berry to increase it
or the hormone, and not justgive you estrogen and
progesterone all at once.
So it's so important to knowwhere are your hormones at this
time and what's going on in yourlife life-wise, emotionally,
physically and inflammatory wiseso you can decide if hormones
(09:45):
is the right thing, right.
Speaker 1 (09:47):
Yeah, absolutely, it's really going deep into the
root causes of like okay, let'sfigure out why this is happening
.
Oftentimes, there is going tobe a root cause and I love that.
You can imagine your clientsand your patients feeling so
relieved and, like she'slistening to me, she's literally
spending time to figure out myproblems, right, and I do agree,
(10:08):
right, seeing the patient as awhole person, versus, like, all
these organs and, like you know,different compartments, because
you know, with my clients to, Ispend 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 informationto provide the interventions
(10:31):
that they need, right,individually and so customized.
So it's so amazing that you areabsolutely able to do that and
help your patients and one bigorgan system.
Speaker 2 (10:40):
you know when we're talking to patients the
functional medicine, which isroot cause medicine a lot of
people are like well, what isfunctional medicine and what's
internal medicine?
So internal medicine is theconventional medicine as you
know it.
That's how I was boardcertified.
I'm board certified.
But functional medicine is,like you said, the root cause,
like what's fueling thesesymptoms?
Why now do you have thissymptom and what can we do?
(11:01):
That's a root cause approach,which is like your diet and
lifestyle how can we improveyour gut health that'll improve
your symptoms without having toautomatically jump to medication
, and that's so important tolook at.
And a lot of people are like Idon't have gut symptoms, but
when we do stool testing and wedo a super breath test, which is
(11:22):
the wrong bacteria in their gutshows a lot of abnormal gut
testing, and I think we just areout of touch or we're avoiding
those foods that cause badsymptoms and so we don't realize
oh, your body's like she'sgoing to eat the way she's going
to eat.
I'm just not going to havesymptoms.
So it's important to do thatkind of testing.
So no patients in our practiceactually get bioidentical
hormones without testing them.
Speaker 1 (11:45):
Yeah, and it's just so interesting and I know it
seems like we're moving awayfrom 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 toohow are your bowel movements
right?
It can tell you so much, likejust knowing that and like what
are the interventions?
Speaker 2 (12:06):
Yeah, most of America is constipated and we're not
even taught from a young agethat we should have a regular
bowel movement, at least onebowel movement a day.
That looks nice like cobrashaped.
A lot of patients are like, oh,I thought I was going once a
week and that was normal.
But we're not talking aboutthese things.
And it's so important to havegood, regular bowel movements
daily because that's how youdetoxify.
And it becomes super importantif you're thinking about taking
(12:29):
hormones and perimenopause andmenopause, because you want your
liver to be able to processyour hormone so that it's ready
for tomorrow's prescription dose.
So if it can process yourhormone through the gut and
eliminate any excessive hormonethrough the stool.
Eliminate any excessive hormonethrough the stool is so
important.
But if you're constipated,you're going to have side
effects from hormone replacementtherapy.
(12:50):
So it's so important to reallytreat the canvas and say how are
you going to process thesehormones or supplements to
improve hormones, before justjumping to giving you a
prescription.
Speaker 1 (13:01):
Right.
Yeah, I love how so in-depth.
That is right and really againunderstanding where are we right
, what are the interventionsthat we have to make and how is
this person going to react tothat too.
Right, and so I want to lingerhere a bit.
In terms of the constipationright.
If someone is having anyhormonal issues or hormonal
imbalances right.
(13:22):
Are there any correlation tothe estrogen levels or
progesterone in terms of, like,bowel movement function?
Speaker 2 (13:29):
Yeah, so it's often the women come to us first of
all.
It's probably the first timethey're checking their hormones
and we check their hormones andwe find a lot of women have
super high levels of estrogen.
This is like a week before herperiod.
We check it in the mid lutealphase, which is around day 19 to
23 of your cycle, wheresometimes women have super high
levels of estrogen that areactually just high in
conventional lab testing and thesymptoms could be I'm really
(13:52):
bloated, I'm anxious, I'm on twoantidepressants.
I just keep gaining weight andyou can see that they're in the
perimenopause menopause statebecause of one specific lab
called FSH, the folliclestimulating hormone.
When that is very high, you'realready in menopause and like
above a hundred.
(14:12):
But that is a moving targetdepending on your gut
inflammation and your otherhormones.
So when things like when yourestrogen is super high, what we
focus on is your gut elimination, like what's going on with your
liver Are you able to processall your nutrients and actually
eliminate?
And when we ask a lot ofpatients with elimination, the
(14:32):
number one we see is nobody'sdrinking enough water and
nobody's eating fiber and a lotof 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 Ithink what you're referring to
is I did a video on a bowl ofarugula that has like 0.2 grams
of fiber, versus having blackbeans or beans in general and
(14:56):
avocado, and we really try toencourage women to get 30 to 40
grams of fiber.
That takes effort and we're insuch a fast-paced environment
that nobody either knows or isaware enough to do that, and I'm
sure you see that as you'reworking with your clients, and
that must be so empoweringbecause you actually teach them
how to.
Speaker 1 (15:16):
Right, yeah, you're absolutely correct.
Usually we talk about all thosethings constipation, bowel
movements and fiber.
Fiber is.
You know, I spend a good amountof 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 asalad and that's my fiber.
Okay, that might not haveenough.
Right, as you mentioned, atleast 30 grams of fiber and
(15:38):
focus, you know, let's just addthem with these high fiber
sources like beans.
Amazing, you know, you can geta really good amount of fiber in
your beans.
If you like salads, let's addmore fiber to that salad, right,
like the blackberries, or maybesome chia seeds or something
like that.
That is going to increase thefiber and just being more
regular, right?
Speaker 2 (15:58):
increase the fiber and just being more regular.
Right, it doesn't have to bedifficult.
You know, I'm sure you see thesame kind of patients we do who
are like between 35 and 60, thatin the peak of their careers
and they're working really hardor having kids and just don't
have time.
But you can pre-plan all thesethings where it doesn't have to
feel so overwhelming, right?
Speaker 1 (16:15):
Yeah, absolutely, we can definitely work on that on
smaller steps.
And you mentioned a fewoccasions, right, about the
weight gain as they get intomenopause.
Let's talk a little bit aboutthat.
Why do you think that happensif nothing changes?
What are the changes happeninginternally that is causing that?
Speaker 2 (16:33):
So you know, I talked about it.
I think maybe the best way todo this is divide the women by
age group.
So the ones who are like 35 to45, they're probably really
right there in theirperimenopausal state where that
progesterone is going awaybecause of stress, anxiety,
inflammation, and just they areaging.
So when the progesterone goesaway, you become more estrogen
dominant.
(16:53):
It's not that you're makingmore estrogen, it's just that
the hormone is left and theprogesterone is kind of quickly
eaten away.
It's just that the hormone isleft and the progesterone is
kind of quickly eaten away.
It's just that progesterone isin a very fragile place in the
hormonal pathway.
So if you're stressed, anxiousor inflamed it's something
called progesterone steel You'rejust left with estrogen, and
estrogen by itself is a hormonethat is very pro-inflammatory
(17:15):
and can cause weight gain.
The second reason, the secondhormone we look at a lot, is
insulin, and so I liken this tothe body doesn't know
genetically the differencebetween you being chased by a
tiger or you having your lifestresses, where you're juggling
all these balls and your body'sgoing to produce this hormone,
cortisol, which is your stresshormone.
And if you're being chased bythe tiger, you get eaten or you
(17:36):
get saved and that's the end ofit.
But unfortunately in our modernworld, especially for women,
when they have so many thingsgoing on, you have these micro
cortisol peaks and the constanttime you increase your cortisol
you need the blood sugar becauseyou need to run from that tiger
, and every time this happens itincreases insulin because it's
trying to manage and push yoursugar.
And so another big thing we seein perimenopause and this 35 to
(17:58):
45 age group is an increase ininsulin.
And when your insulin is higheryou see a lot more weight
around the belly.
So estrogen dominance, insulinresistance.
And then the third biggest oneis inflammation.
And a lot of times patients arelike well, what is inflammation
?
Inflammation is actually a goodthing because when you cut
yourself, inflammation heals it.
But it's dysregulatedinflammation where the cortisol
(18:21):
is constantly coming up and youfeel like you're constantly
running and there's no end pointto that.
It's that kind of inflammationthat can cause weight gain.
So those are like three bigreasons.
And at the same time this poorwoman is losing her testosterone
and as the testosterone levelskeep going down, you can't make
muscle as well.
And I have women who come inthere who are like I'm a Pilates
(18:43):
instructor, I'm so active, butI just feel like jello.
And when we measure theirtestosterone levels they're
super, super low.
And so, as you're consideringhormones, you can take high dose
fenugreek, which is just anherb that increases your
testosterone, or you could do alittle bit of testosterone
replacement therapy and it's agame changer.
Women just really feel likethey can make muscle, they're
(19:05):
more confident, they have betterenergy, less word finding
issues.
So, if you can get to givingprogesterone and then maybe some
testosterone, eventually womenin their 40s, 45 to 55 is where
really women do see benefitswith those hormones.
But that's really what'scontributing to weight gain, and
it's not just about givingpeople a Zempik or Wegovia
(19:27):
Manjaro.
It's about why is thishappening and how can you
actually target those pathwaysso you can get long lasting
weight loss, not just a quickfix.
Speaker 1 (19:36):
Right, and I really love that.
The long lasting changes right,because if we are definitely
looking to, okay, we're havingthis increase in insulin, right,
and these high cortisol levelsand low testosterone, which is
also affecting our muscle mass,and as we age, we are losing
muscle mass.
It's almost like a catastrophein a way.
(19:56):
Right, because we're havingsome of those issues and we know
that increasing our muscle massis going to help us right with
increasing our metabolic rate,and so it is so important.
Now, one of the things thatcomes to mind when we talk about
testosterone right, it's likewhy do I need testosterone?
I don't want to be bulky and Idon't want to look manly.
Yeah, tell us a little bitabout that.
How is that?
Speaker 2 (20:17):
different, and so testosterone is such an
important hormone.
Both men and women haveestrogen and testosterone, so
men have a lot more testosteronethan we do.
But women have quite a bit oftestosterone and as you're aging
it goes down.
But also, if you're chronicallystressed or chronically
inflamed, you eat up a hormonecalled DHEA, which is the mother
hormone to cortisol, and asthat hormone goes down, your
(20:39):
testosterone just naturally goesdown.
So but when you actuallyreplace testosterone, you're
measuring levels and the thingsyou want to ask your doctor to
be checking is totaltestosterone and free
testosterone.
And that's really importantbecause a lot of times patients
come to us and their totaltestosterone is excellent and
they're like I don't feel goodbecause their free testosterone
is so low.
(20:59):
And that's commonly because ofa common protein called the sex
hormone binding globulin andit's just bound all your
testosterone, so you can't feelit.
So those kind of patients if wegive them testosterone, it
won't really help.
And what impacts that protein,the sex hormone binding globulin
, is inflammation, your nutrientabsorption and your gut health,
(21:19):
and if you work on those things, the sex hormone binding
content becomes lower and thenthey can feel their testosterone
.
Back to your question as towe're not trying to make women
men and the doses we give themare super different.
So for a man, we have quite afew male patients.
We give them around 200milligrams of testosterone.
They take that every day,versus a woman is getting one
(21:40):
milligram or maybe up to 10milligrams of testosterone every
.
They take that every day,versus a woman is getting one
milligram or maybe up to 10milligrams of testosterone daily
.
So the difference is very, very,very low and it's important to
also measure your level.
So if you are giving someonetestosterone, it's important to
make sure your liver is able totolerate it.
You're seeing the level that'soptimal.
Most importantly is we're nottreating a lab.
Your patient or client has tosay I actually feel better, and
(22:04):
I feel better and I'm actuallyexercising, which I have been
doing but I can see muscle, Ifeel like my strength is better
and I do feel like my libido isbetter, because a lot of women
have issues with libido and it'sso important to actually
optimize the testosterone levelsso they can actually feel
intimate yeah, and I think it'sso.
Speaker 1 (22:23):
You know, I hope that , as the listeners are listening
to these, right, and it'shitting 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, andlike that's that right, because
that's not the case, right?
We, there are things that wecan do to change that right and
optimize the levels and if youdon't want hormones.
Speaker 2 (22:44):
a lot of times some patients come to us like I'm
really scared of hormones or mymother had breast cancer so I'm
not going to try any hormones,and you can give natural
supplements.
But sometimes when you improveyour downstream hormones or your
upstream hormones, people justfeel better in the perimenopause
menopause stage, because wefound that in the perimenopause
state people are more inflamedbecause they don't have these
(23:05):
protective benefits of thesehormones.
And if you can think about thehormonal cascade as an axis,
think about the grandmother asthe adrenal glands, and these
are the two coin-shaped glandssit on top of your kidney, make
cortisol, and then think aboutthe thyroid as your mom and then
(23:27):
the granddaughter as yourovaries.
And a lot of times in regularmedicine we'll just give you
hormones, hormone replacementtherapy.
We might check your thyroid,but we never check your adrenals
and this is your stresshormones.
And if we looked at grandma andreally focused on grandma and
fixed her, the other hormoneswould fall into place.
So a lot of times when peoplework with us, or functional
medicine doctors in general, andjust work on cleaning their
foundation, they do feel atleast 30 to 40% better and may
(23:51):
not even need hormones.
Speaker 1 (23:53):
I love that analogy and just giving the patients the
choice right, like if you don'twant hormones, that's not the
end of the world, right.
We can do other things and, I'msure, optimizing other areas
that we have to work on, likenutrition, gut health, having
better bowel movements,increasing our water right those
are things that we can startdoing right away and see some
changes.
Speaker 2 (24:13):
Completely.
And I think another big thing Isee in our population is, you
know, really high stressperception.
People are so stressed and soanxious and so worried and
that's kind of a modern life.
Unfortunately, if you're livingin that high stress state, your
cortisol is going to be highand it's going to eat up your
progesterone and push youquicker to menopause, push you
quicker to perimenopause.
But actually just walking fiveto 10,000 steps a day, being in
(24:37):
nature, being able to do somebreath work, all those things
can really drop your cortisol.
And some of my patients arelike it sounds like you want me
to quit my job.
No, I want you to be able tothrive in your job, where you
don't feel like you're survivingand can't wait till 5.30 to be
done with the day.
But it's so important to atleast help your body pretend
(24:57):
that things are okay.
Speaker 1 (24:59):
Yeah, I love that you also talk about stress.
Stress is another thing that Italk to my patients too, because
it affects nutrition, right, itaffects our ability to make,
you know, healthier choices.
Or because we do have this highcortisol levels, right, we're
craving all kinds of thingsbecause now we have the you know
the insulin, and so as we thinkabout, okay, how, how, the
(25:21):
first thing that I ask them youknow what's your stress, tell me
about your stress.
You know, I want to say, 99% ofthe time I hear this like I
don't know.
That might be the first timeduring the day where they take a
nice deep breath and like thattells me, okay, it's probably
high.
And then you know, they tell meabout it or they say, oh, I
think it's okay, right.
And as we talk more about howabout you know blood pressure
(25:44):
wise, if you're having the bloodpressure issues, or how about
you're eating, so I think thestress management plays a huge
role in so many aspects it does.
Speaker 2 (25:53):
And another big thing we do in our practice is we
look at genetics.
So you know, I explain topatients as an internist we're
very siloed, right?
You get a UTI, we give youantibiotics, you get better.
We think You're constipated,you know, take psyllium or it
doesn't really matter drinkwater and it's supposed to get
better.
But functional medicine is moretriangular.
You have genetics on one side,you have exposures or mediators
(26:17):
on one side and then triggersthings that are highly stressful
to you and genetics.
What's amazing about genetics isjust because you have a gene,
it doesn't mean you have to havean epigenetic disease.
Genes are like on and offswitches and you can switch them
off by managing your exposuresof mediators and managing your
stress perception.
So we do almost all ourpatients, we check genetics, and
(26:40):
by the genetics we can tell ifthey are very sensitive, like
some people just came to theworld sensitive.
It doesn't take too much stressto get them worried, and it's
that same kind of group ofpeople that are also very
sensitive to toxins.
And so it's important tomeasure your genetics,
especially if you're thinkingabout hormone replacement
therapy, because a lot of ourpatients are just on
progesterone and testosteroneand not on estrogen, because
(27:03):
genetically they don't detoxifywell and keep the estrogen
levels very high, so giving themestrogen could actually cause
some side effects.
So understand your genetics andreally work on what you can
control, which is your stress,your diet, your environment, and
together you can switch offthese genes that may not produce
the best.
Speaker 1 (27:24):
Yeah it's so different things that we have to
consider right as well.
Let's talk a little bit aboutsleep.
I know you mentioned sometimessome women have issues with
sleep as they get into menopause.
Yes, let's talk a little bitabout sleep.
I know you mentioned sometimessome women have issues with
sleep as they get into menopause.
Yes, let's talk a little bitabout that.
Speaker 2 (27:39):
Absolutely.
Sleep is so important becausewe want to get at least five to
six hours of consolidated sleepwhere you're not waking up in
the middle to help with memoryconsolidation.
So a lot of times people arelike I'm sleeping, god, I sleep
eight hours, but when youactually dive deeper, they're
waking up every two hours andlooking at their phone or
looking at their alarm all thetime.
And so it's very important tohave good sleep hygiene where
(28:00):
you're like don't on a screenbefore you sleep, sleeping in a
regular bedtime, using the bedmainly for sleep and making sure
that you're not having theselike caffeinated beverages
throughout the day.
That's keeping you awake.
But apart from that, when womengo into that perimenopause like
above 35, and their progesteronestarts going away, that's when
they might really feel issueswith insomnia.
(28:21):
And the biggest thing with nothaving a progesterone is you
might notice that you havefrequent times where you wake up
in the middle of the night.
And then the second hormonethat's not a sex hormone, but
it's cortisol, which is yourstress hormone, and so a lot of
times patients feel like theylook at the time and it's
between three and five in themorning, like they fell asleep.
(28:41):
Okay, but they couldn't staysleeping.
And the question in my mind isit an issue of high cortisol or
is it an issue of lowprogesterone?
And that's where it's importantto check your numbers, because
I can't tell you how many peoplehave come to us and like 40
supplements bottles they bringin and I'm like, oh, are you
feeling okay?
And they're like no, but I'mtoo scared to stop anything in
case it's working, and so it'simportant to check levels and
(29:04):
say, okay, is your cortisol theissue or is your progesterone
the issue?
So you could be a little bitmore precise where you don't
have to swallow so many thingsyeah, absolutely, I, absolutely.
Speaker 1 (29:13):
I think that is so important to measure right and
then provide theirrecommendations 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 somethingmight work Exactly, but the safe
thing to try is magnesium.
Speaker 2 (29:30):
So magnesium is a muscle relaxant.
There's magnesium glycinate,magnesium threonate.
Glycinate and threonate workpretty well for sleep.
Threonate goes into yourblood-brain barrier.
You could start with like 100milligrams and 200 milligrams
and you might notice you fallasleep easier because magnesium
relaxes your muscles.
So it helps with anxiety, helpswith sleep and helps with
(29:50):
constipation.
So the same measure if you'retaking magnesium and have
diarrhea or loose bowelmovements, you may be taking too
much.
So that's where the magnesiumis a super easy one.
Another super easy thing tothink about taking is things
like a magnolia bark, which isRilora or Ashwagandha.
But all of these things, at theend of the day, can have side
effects.
So it's important to work withsomeone where you're checking
(30:12):
levels.
I had a patient recently cometo us with palpitations and what
we found out is because she wastaking high doses of
ashwagandha that was making herthyroid work a little too well.
And once we dialed down thoseashwagandha doses, the
palpitations went away and bythis time she had had a cardiac
stress test.
She was doing a Holter monitor,but nobody thought to ask her
(30:35):
if she was on supplements.
So it's important to kind of godeep dive and figure out.
If the supplements are natural,they can have side effects.
So who are you giving thesesupplements to?
What's their genetics?
What's their body going through?
What's the emotional state?
What is their gut?
Speaker 1 (30:54):
Yeah, absolutely.
Thank you for providing thosequick recommendations and things
that our listeners can do rightaway to see a little bit of
change.
As you mentioned, sleep is soimportant, right, For many
reasons, but as well just foroverall health and also
nutrition wise.
Right, it plays a huge role inour nutrition choices throughout
the day.
How about mental health-wise?
(31:15):
You talked a little bit aboutdepression, and you do see those
changes in women that are goinginto menopause or perimenopause
.
Why do you think that happens?
Speaker 2 (31:24):
Yeah, so the biggest reason with, let's say, anxiety
and depression.
So anxiety is more really theit can be the lack of
progesterone, the high cortisol,the same thing that's impacting
sleep, Like, and when you can'tgo to bed and your mind just
keeps going in that anxiousstate.
That could be viewed as thosetwo hormones.
And then depression can be kindof you burn through all your
(31:45):
cortisol and there's nothingleft to give.
Or you have high estrogen.
And think of the woman likepre-period naturally that's a
high estrogen state.
She's like anxious.
The woman like pre-periodnaturally that's a high estrogen
state.
She's like anxious, she'sirritable, she's hangry, and
that's that emotional impactthat hormones can have.
And then sometimes, when we lookat people's genetics, we see
that they're geneticallypredisposed to not use dopamine
(32:07):
or norepinephrine or serotoninvery well.
And knowing that data, you cangive them natural precursors to
these hormones, like 5-HTP SAMethat can help them make these
neurotransmitters better.
It doesn't have to beprescription meds.
That being said, if you do findthat you are very depressed or
anxious and need prescriptionmedications, there is a test I
(32:29):
want your listeners to be awareof, and there are multiple of
these tests, but they're calledGene Insight and it's a swab on
your cheek that'll tell you,based on your genetics, which
antidepressants or whichanti-anxiety medications would
be best.
Because in regular medicine wejust give you all these
medicines and say, oh, you'rehaving side effects, let's try
the next one.
So if you need them again,there's good medicine and
(32:52):
technology out there that cantell you if you do need one
which could be the best one, andalso doing the lowest, lowest
dose, because lots of thesestudies were done on the 70 kg
white man and we're not that.
So you really want to make sureyou start low work with someone
who's willing to try.
Natural first the biggest thingis therapy, community purpose,
(33:13):
belonging all of those thingsare important.
And then hormones, inflammation, and with anxiety and
depression there's a big gutbrain connection.
So if your gut's inflamed youprobably will be anxious or
depressed.
So try and clean up the gut,clean up inflammation, before
thinking about medication.
Speaker 1 (33:32):
Right, absolutely.
And so with that note, right,if someone is like yeah, maybe
I'm having these problems, howcan they start?
Or what are maybe some of thetips that they can start doing
to help with that inflammation.
Speaker 2 (33:44):
Yeah.
So the first things you'redoing is where is this
inflammation coming from?
And a lot of times sources ofinflammation can be food.
Processed food is a big source,like there's lots of good
studies If you have a big Macand check your inflammatory
levels right away, super skyhigh.
And we have a lot of patientswho are wearing those continuous
glucose monitors.
Now One of my patients that sheate like the In-N-Out French
(34:05):
fry, which only has a fewingredients compared to the
McDonald's French fry, and herblood sugar was super high.
So processed food is a big one.
So, as much as you can, try andmake sure your food is real and
is clean, ideally organic.
And if you are eating packagedfood, make sure they're not like
a list of resilient ingredients.
Just try and keep it simple, asI'm sure that's your expertise
on.
So really try and process foods.
(34:26):
A second source of inflammationis if you've had any kind of
recent infection so COVID is abig source of inflammation.
Or if you were traveling tolike India or Mexico and had
food poisoning, that's going tobe a source of inflammation.
And then another big source ofinflammation is toxin exposure.
So if you were exposed totoxins such as, you know
(34:48):
recurrent LA fires or you hadsilver fillings in your mouth
and have a ton of mercury.
In LA we see a lot of mercurytoxicity, mainly because of
sushi, like my patients lovesushi and they think it's really
healthy, which it should be.
But our oceans are not healthyand if you don't detoxify you
can have high levels of mercurycausing inflammation.
And another source of toxinswhich is again fairly common in
(35:11):
LA is mold.
Like you've had, we had a lotof rains two years ago and they
cause a lot of water damage andmold can be a source of
inflammation.
So, again, it's important toknow how you process these
toxins and these could beobvious sources of inflammation
that are causing that you needto look at.
So in terms of practical thingsyou can do is watch your food
(35:33):
take enough fiber so you'rebinding these toxins and
eliminating them naturally, andmake sure you're not constipated
.
If you have access, go to asauna, like someplace where you
can sweat, like a sauna at theYMCA or at your gym.
See if you could put some sortof 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 aboutinflammation, which is the
(35:55):
biggest source of inflammationis chronic stress, because your
cortisol is high and your bodythinks you need to keep running
and it's in thispro-inflammatory state.
So it's so important to managestress perception, because most
of the things we're worriedabout are not going to happen.
Speaker 1 (36:12):
Right, yeah, yeah, amazing.
So I hope everybody took noteof that.
Things that you can do rightaway and start helping your body
to feel better as we look into,look ahead how can women
prepare for menopause in theirearly ages right, 30s, 40s?
Speaker 2 (36:31):
yeah, honestly, you should start.
So I would say the biggesthormonal thing, which is
probably a whole notherdiscussion, is hormonal issues
that impact you in your teenageyears.
We see a lot of women withsomething called polycystic
ovarian syndrome, where theyhave a lot of testosterone,
irregular periods, they may haveacne.
So if you're already havingthings like that, you really
want to make sure you jump onyour hormones early, like in
(36:52):
your teenagers and your 20s,where you're either looking at
your gut, looking at toxicburden, looking at anxiety,
stress, perception, but if youhaven't had PCOS and have been
marching along to your 30s, sothings you can do.
A big trigger for just hormonalimbalance is pregnancy,
pre-pregnancy, post-pregnancy.
Post-pregnancy can be a verylonely time for women where
(37:13):
they're solely responsible forthis beautiful creature.
But you're it and that's whereyour cortisol can go really high
and can start causing theprogesterone steal, the weight
gain.
So, really trying to manageevery stage of your life
consciously Say I'm going toreally protect my adrenals.
Make sure I'm saying no to toomany projects.
A lot of my women well, women,which is why I say yes.
(37:35):
So say no more.
Make sure that you are movingand exercising.
Make sure that you have somespace for self-care, because the
more self-care you can havewhere you're protecting that
cortisol, the less likely youare to slip into perimenopause
early and then know your body.
We have some means in thetechnology now where we can know
(37:56):
our body's genetics, know ourhormones.
I mean we check cortisol forpatients every three months
because life happens.
You know you had a stressor,you had a horrible boss, you had
to move homes, you got aparking ticket, something
happened where it's totally likestressed you out and that's
going to impact your cortisol.
So, and there are lots of goodherbs you can take to help keep
(38:18):
your cortisol healthy.
Things like ashwagandha that Imentioned, relora, cordyceps,
breath work.
So just meditating, breathing,stretching can all help.
So, as you're going through your20s and phase, really focusing
on stress perception with theknowledge of what's happening
inside your bodies and finding agood functional doctor, a good
(38:38):
doctor around you to really belike OK, let me get a sense of
what's my body trying to tell meand then you know those
baseline numbers and then youcan work from there and empower
yourself to know what youroptimal number should be.
Because so many patients say Iwent to my doctor, they actually
checked my hormones and theysaid everything was normal.
And then when I'm like, whendid they check your hormones?
They're like, oh wait, they didit on day three.
(38:59):
Day three is fertility hormonesand progesterone will be zero
anyway.
If you want to really checkyour hormones, it's really right
before your cycle.
And so a lot of times and and indefense of my regular medicine
colleagues we're not taught inthat approach.
We talk about medications.
So work with someone and beaware and know that you have the
power, and you have power inchoice.
(39:21):
The more things you say no to,the more times you put yourself
first, the more times you choosea healthy meal for you.
And a lot of my patients reallytry and get clear with what is
your, why, like, why do you wantto be healthy?
Sometimes I'm doing it for mykids, I'm doing this for my when
I'm aging, I'm so scared ofdementia, like, why are you
(39:42):
doing?
Why do you want to be healthy?
And as long as you have thatvision clear, it's easy to make
healthy choices.
Speaker 1 (39:47):
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 prettymuch 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 takescare of you?
You need to be taken care of aswell, and you gotta do that.
(40:08):
I love that.
You say you know knowing yourbody, 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 cyclegoes, and so I think is that's
really important in being anadvocate.
Speaker 2 (40:21):
like you say, you have the power, right, um, and
so and that's what's soimportant is that you do realize
you do have that power.
Another big epidemic that a lotof us just are unaware of is
the amount of undiagnosedautoimmune markers in women, and
especially around theperimenopause.
Menopause time wheninflammation is high and life
stress is high.
And just knowing that, even ifyou have these autoimmune
(40:43):
markers, they can be reversible.
So it doesn't mean you have tokeep 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 upinflammation, clean up the gut,
clean up anxiety, get more joyin your life, get better
nutrition, get better bowelmovements All those things will
(41:05):
help reverse the autoimmuneepidemic happening.
Speaker 1 (41:06):
Thank you so much for really focusing on the
prevention right and things thatyou can do and these practical
tips.
So, if there's, how canpatients reach out to you right?
Or if someone is interested andmaybe they don't live in LA,
can they still see you how?
Speaker 2 (41:26):
how does that work?
Yeah, so basically I'm alicensed internist in California
, so I can see anybody inCalifornia, even online.
So if they're living inCalifornia, which I'm assuming
most of your audience is you cancome see us.
If you live outside ofCalifornia, you have to
physically come and see us onemore time, one time before we
initiate care.
But if you're in California, wecould do all of this online and
that's the magic of reallytelemedicine.
But it's important when youcould.
There's multiple ways where youcould utilize us.
(41:47):
Once you could just follow uson our social media stuff and
learn from that.
The second most common thingpeople do is they do lab
consults where they just want toknow, like I feel good, but is
she really talking to me?
Maybe I do have some of thesesymptoms that I don't need all
these medications for, maybe I'mjust not crazy.
It's my hormones, and so youcan come and do a longevity
panel with us that includeshormones and you do the lab work
(42:10):
first, and then you would comeand see a functional medicine
certified providers it's myself,my nurse practitioner, annie or
Serena, my functional certifiedphysician's assistant.
They would spend two hours withyou, kind of taking that
history, learning about who youare 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 lowprogesterone.
(42:32):
Here's some natural things youcan take.
And then sometimes patients arelike, oh, I really want to work
on this with you.
And then they kind of join aprogram and our programs are
between two months to six monthswhere they work with us, really
addressing some key issues.
The goal of a program is toreally empower our patients.
That this is what you can do.
It's not to give you 40supplements, it's what can you
do to take control of your life.
(42:53):
How can you empower your life?
And then, after a program, alot of our patients just choose
to stay with us in a membership.
They see us twice a year andthey do check these labs.
What's most important with anyof these choices is you have an
app where you can contact us atany time and we can contact you,
and that's really important interms of accountability both
ways.
Another big thing that happensis you know if somebody's sick
(43:15):
and they have a bad sinusitis orcold and they go to the urgent
care and they get these reallystrong antibiotics.
We would like to be in chargeof giving you more natural
things or maybe a gentlerantibiotic before you reverse
all the gut health work thatwe've done, so you can choose
multiple options to work with us.
I know functional medicine orthis kind of medicine insurance
(43:40):
doesn't really cover it doesn'tsee it as medically necessary,
but we do try to utilize yourinsurance if we can with lab
work or, for sure, any kind oftesting.
But if you wanted to do like,for example, a lab consult with
a longevity hormonal panel, it'susually $1,900.
And now that sounds like a hugeinvestment.
But we do have like a hormonalspecial for anybody who's
listening to your podcast now,where they can do it for less
(44:00):
than a thousand and you do allthe 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, butyou could do it locally.
We'll send you the order andthe lab.
The cost of the whole thing isinclusive of the blood work,
inclusive of the messaging appand then for us to review
everything, and the goal of thiskind of approach is that you
(44:22):
shouldn't need to need otherkinds of medicine.
Right.
It shouldn't be functionalmedicine, internal medicine.
It should just be good medicinewhere you don't have to go to
the ER, you don't have to be onchronic medication and it's
really telling you what's goingon with your labs and your
hormones.
And some patients just chooseto do like a lab consult with us
once or twice a year and belike I just want to know what my
body's telling me, andsometimes they become big
(44:44):
advocates and they're teachingother people of what their labs
show.
So anyway, it doesn't have tobe 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 toadvocate for yourself and if
(45:05):
they're not listening to you,find someone else to partner
with.
Speaker 1 (45:08):
Right, yeah, so do not be dismissive.
Right, and it's awesome thatyou are providing different
options for the listeners andfor your patients to work with
you, and I'll make sure to addyour information, your social
media info, your website, allthat I'll add it in the show
notes For your listeners.
You can go there and check itout.
Speaker 2 (45:28):
And make sure they mention your name, like your
name, in your podcast, so thatmy onboarding coordinator knows
what was offered on this podcast, so we can make sure we honor
them.
Speaker 1 (45:37):
Absolutely, thank you .
Thank you for saying that.
Any final thoughts, anythingelse that you would like to
share with the listeners, oranything else?
Speaker 2 (45:44):
For those women in California.
Right now we're going throughall these fires in LA and the
air quality has been not greateven though it looks good on our
phones, and the lead levelshave been a hundred times more
what they should be two days agoand I'm sure eventually even
your part of California wasgoing to get some of these
toxins.
So just be super, not now, butin the next three to six months.
(46:05):
Check your toxic load.
Check your lead, cadmium andmercury, because that's what
we're seeing in the air.
All of those toxins impact thethyroid, the ovaries and the gut
.
So I would say, check.
You live in the same state, Ido so check and know what your
levels are, and just know thatit's easy to check these things.
Just look online.
Research reach out to us, butit's just so important to be
(46:28):
aware and most most importantlyis don't give up hope, because
know, because there's somethingout there.
If you're feeling it andsomebody's told you the labs are
normal, they haven't checkedthe right lab.
Speaker 1 (46:40):
Right.
Don't give up hope Absolutelyand advocate for yourself.
Thank you so much, Dr.
Speaker 2 (46:45):
Shabazzu, you're so welcome.
Take care, be safe.
Speaker 1 (46:48):
Take care Absolutely.
Thank you everybody, Take careI.
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