Latest / She’s Smart / Dr. Katie Takayasu – Is It Stress… or Is It Perimenopause?

Transcript

Dr. Katie Takayasu – Is It Stress… or Is It Perimenopause? · She’s Smart

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Hey, everybody. Welcome to She's Smart. I'm your host, Maria Robotham.
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Each week, we sit down with incredible women to talk about life,
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work, and everything in between.
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Today's episode is one I've been especially excited to share.
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If you're anyone in your late 30s, 40s, or early 50s, this conversation is for you.
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If you've woken up at 3 a.m. wondering what is happening to your body, this is for you.
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If you felt anxious out of nowhere, foggy, irritable, overheated,
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or just not quite like yourself, you are not alone.
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Today, I'm joined by Dr. Katie Takayasu. We call her Dr.
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Katie, an integrative medicine physician and founder of Wellness Insights in Darien, Connecticut.
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Dr. Katie is board certified in family medicine, fellowship trained in integrative
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medicine, and licensed in medical acupuncture.
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She completed her residency at Columbia University, New York Presbyterian,
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where she served as chief resident and has spent more than a decade helping
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women navigate the hormonal changes of perimenopause and menopause with clarity,
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science, and compassion.
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What I love most about Dr. Katie is that she walks the walk.
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Her journey through stress, burnout, fertility changes, and discovering acupuncture
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shaped the way she practices medicine today.
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She blends traditional Western medicine with evidence-based complementary therapies,
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thinking about the whole woman, mind, body, and spirit.
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In this conversation, we talk about what perimenopause actually is, why your anxiety,
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sleep changes, and mood shifts might be hormonal, what integrative medicine
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really means, the truth about menopausal hormone therapy, which was previously known as HRT.
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How nutrition, strength training, and stress management can dramatically change
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the season of life and how to advocate for yourself if you're feeling dismissed.
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This episode felt like sitting at a table with a brilliant, grounded,
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compassionate doctor who genuinely wants women to feel better,
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not just to get through it.
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So whether you're in it now, approaching it, or supporting someone who is,
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I hope this conversation fills your cup the way it filled mine.
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A very important note, this conversation is for educational purposes only and
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is not meant to replace personalized medical care.
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Every woman's body and health history is different.
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Please speak with your own health care provider before making decisions about
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medications, hormone therapy, supplements, or lifestyle changes discussed in this episode.
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Now, let's get cozy as we connect, learn, and laugh together on She's Smart with Dr. Katie.
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Today. I'm really grateful that you're here to chat with us.
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This all has tied in with the universe a little bit.
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Christine Dunst and I are doing a screening of this new docuseries Balance, a menopause journey.
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We're going to do a screening of it at Le Chat in two weeks,
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and we're going to just all watch it together.
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People can ask questions and just kind of women being in the same space,
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going through the same things.
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So talking to you, it's really poignant because this is what we're going to
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be talking about today, menopause, premenopause. You would You're a doctor.
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You also do integrative medicine. And I'm wondering if you could share a little
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bit about your personal and professional journey that led you to focus particularly
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on women's health and integrative medicine.
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I approach this part of my life so authentically, meaning I walk the walk,
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talk the talk, do all the things.
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I think it started when I was younger.
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I grew up in a very small town in Northwest Ohio, truly amidst farmlands. My town is 7,000 people.
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It's very tiny. My dad is the local doctor. And I grew up with this very holistic
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view of what family medicine was.
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And it was the person you drive your pickup on a Friday afternoon when there's
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a farming accident and you can't
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get to the local ER and like dad rushes over and helps you stitch up.
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I kind of knew that I wanted to do family medicine when I went to medical school,
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but it really was my journey in residency when I wanted to become pregnant and
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wasn't having a regular period.
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Stress was super high. I was eating too much hospital food, not moving my body
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enough in the right ways.
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I was getting off steps walking around the hospital, but not in a joy-filled
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exercise kind of way and really not paying attention to my sleep or my spiritual
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self, just feeling like a shell of a person.
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It was my primary doctor who listened to me, my family doctor,
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and said something like, you should go see my wife's acupuncturist.
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It was then that I really discovered on the table what it feels like to experience joy again.
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I thought to myself, I've got to figure out how to do this for other people.
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They have an integrative medicine fellowship.
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While I was pregnant with twins, I applied to a fellowship in integrative medicine,
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moved up to Stanford, Connecticut.
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And that's how I ended up in this area of the country. I've been practicing
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integrative medicine for just about 13 years. It's been fantastic, a great journey.
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Yeah. How are patients typically responding to this combined model.
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I personally am a huge believer in both sides.
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I really don't believe that in the United States we do enough preventative medicine.
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So many doctors just prescribe a fix.
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How are your patients typically responding to this model, the integrative part of it?
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Truly, I think they love it. And one of the reasons is that we care so much
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about the littler details.
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And also, I care immensely about my patient at this particular stage of their
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life, whether they're a 30-year-old or a 50-year-old or a 70-year-old.
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But I care even more about what it looks like when they're 85.
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Having watched grandparents in my own life age, I know what aging well looks like.
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We have to be trained at this stage of our life to prepare for what is to come.
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So when I'm doing squats in my workout class or at the gym, I'm not really thinking
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about how great my butt's going to look in my swimsuit.
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I'm thinking about my grandmother getting out of her car and squatting on her
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own toilet and climbing the stairs to her basement.
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That's what I'm training for. And that's what I want people to train for too.
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It's so funny when I see a perimenopausal patient who says something like,
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well, I've never had cholesterol problems before.
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And all at once, they're in the red. But when we look back at the trajectory
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and actually rewind several years, you can see it happening.
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It's creeping up, right? It's the hormonal sort of influence and the age influence
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and the genetic influence creeping up over time.
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But we don't pay attention to that in Western medicine because it didn't meet the cutoff.
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And these cutoffs are established for a good reason, right?
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When your hemoglobin A1c goes above 5.7%, your likelihood of complication goes
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higher. So we call that prediabetes.
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But what does it mean when you're 5.6 or 5.5? It's not normal,
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but it's not a diseased state either.
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So what can we do when we see these 5.5s, 5.4s?
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What can we do to reverse some of that aging that's happening and that insulin
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resistance or that cardiovascular disease?
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What can we do about it now to prevent a problem in the future or reverse what's actually happening?
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And I think if we were just a little more proactive and looking at things over the course of time.
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That we would do a better job overall. Yeah, absolutely.
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Let's go back just a second before we dive into menopause and perimenopause.
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Can you give like a brief overview of what integrative medicine is?
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Because I know what it is and I have friends who practice it.
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But for those listening who aren't really sure about what it actually entails.
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I always talk about integrative medicine as the beautiful marriage of regular
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Western medicine, along with evidence-based complementary modalities.
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Meaning that I'm trained in residency and medical school.
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I'm board licensed just like every other doctor, but I'm using other tools outside
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of just prescriptions to influence health.
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I'm thinking about supplements. I'm thinking about the impact of diet,
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of exercise, of sleep, of how we attend to our spiritual self.
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I'm thinking about adaptogens and helping people adapt to stress in their lives,
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I'm using different modalities that drive shift in the body and reduce inflammation.
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If we drill down to the root cause of problems in the body, it's unresolved inflammation.
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We all have short-term inflammation that comes and goes and it's normal.
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This morning I was lifting in the gym and I lifted a little too heavy. Now I have a little ache.
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That's an inflammatory process. I need that to happen in order for two days
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from now when I lift again to be in a repaired state, right?
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So I'll baby it a little this afternoon, do some foam rolling, put some ice on it.
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I'll maybe take some ibuprofen to dial down a little inflammation,
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but I don't want to squash that inflammation because I need it to improve my
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body again, get it back to normal.
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The problem is if we injure ourselves and instead of it resolving,
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it just hangs around and sort of smolders and the pot kind of bubbles over time.
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That unresolved inflammation is when we have trouble with our health.
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If we really want to fix our health or to improve it, we need to understand
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what are those root causes of inflammation.
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And I think that's what integrative medicine does. It uses all these different
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tools in a huge toolbox to really get to the bottom of that.
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Yeah, I wish every doctor did it. I really don't. I don't understand why more people don't do it.
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Just logically, it makes sense. Okay, so let's dive into the paramenopause and menopause.
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This, thankfully, has become really front and center in medicine over the last 10 years.
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Thank God for that because we really needed people to be studying women more.
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We are so different than biological men when we grow and build and become who we are.
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So what are the most common symptoms that women experience as they enter perimenopause?
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The big ones. What are some things that women might start noticing as they're going through this?
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You know, I think even to rewind it back one little step and say like,
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what is perimenopause? What is menopause?
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Just in case people are unclear on the definitions. And menopause is the one
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day in time that you have been 12 months without a period.
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Everything after that is postmenopause and everything before that is premenopause.
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And then we call that sort of blessed 7 to 10 years around that time perimenopause.
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And the hallmark of perimenopause is lots of change.
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A lot of women feel great when they are postmenopausal, when they've gone 12
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months or longer without a period, because even if things are different,
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at least they're not changing moment to moment, day to day.
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And that's what makes perimenopause so challenging for still women is that hormones
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can be really all over the place.
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I once had a patient who had a very indulgent doctor who was testing her FSH,
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follicular stimulating hormone, the brain hormone that is basically talking
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to the ovaries and directing estrogen traffic.
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It was measuring estradiol levels and FSH over the course of a year or two.
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And she was doing it every couple of months. and I am not kidding.
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Some days it looked like she was a 90-year-old woman. Her FSH was like 90.
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Her estradiol was undetectable. A few months later...
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It looks like she could get pregnant. Her FSH would be like 10 or 7,
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and her estrogen would be in the hundreds.
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It was wild. And I'd never really seen the data before.
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Just know that when you're having these ups and downs in perimenopause, they are real.
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And if we were all monitoring these hormones all the time, you'd see all that
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shift, all that shift to know what's going on in your body.
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Literally from head to toe, things start to shift. The first thing that tends
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to happen is someone in their late 30s or early 40s.
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And the average age of menopause is 51, but the symptoms can start a good 10
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or even more years earlier.
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So in your late 30s or your early 40s, you may start to notice changes that
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are affected by a drop in progesterone.
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Your periods may become a little heavier.
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You may notice them a little closer together. They may be more profound with PMS-type symptoms.
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You could also notice that you're not sleeping quite as well.
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Really having that like sort of prototypical wakening at 2 to 4 a.m.
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And having difficulty going back to sleep, you could notice that you're a little
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more anxious or more irritable.
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And those are often the soft signs that are happening early that people are
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just like, oh, I'm just anxious or, you know, I'm just having a sleeping problem,
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but probably are the very first signs of perimenopause.
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And then as testosterone starts to wane, and testosterone is waning sort of the entire time.
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That's when you'll start to notice things like libido change you
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could notice poor mood because testosterone generally helps
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us have very positive mood so you could see changes there
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you could sort of just see changes in your energy and feel tired when estrogen
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starts to decline and that tends to happen in the mid 40s to late 40s and into
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the 50s that's when you start having more prototypical symptoms of perimenopause
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so things like hot flashes night sweats changes to your vision and brain fog,
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and just inability to like word recall as quickly as you once did, right?
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I know. That one is terrible. It's the worst.
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Changes to your eyesight, changes to your hearing, changes at the dentist to
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your gums, dry mouth, or this awful thing called burning mouth of menopause,
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which is when you get this sort of.
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Fiery feeling in your mouth that kind of never goes away.
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You can get changes to your joints, changes to your muscles,
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changes to your digestion because, of course, anytime you're manipulating hormones,
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you can change the microbiome and that can change things up.
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You get cardiovascular changes. So just like our tissue and our vaginas gets
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less elastic, as we have less estrogen on board, our arteries also get less
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elastic. So we tend to get higher blood pressure, more cardiovascular disease and plaque formation.
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Our rates of stroke go up. We also have more dementia.
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And then, of course, the impact to bone, meaning we're at risk for osteopenia or osteoporosis.
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That's not even all the things. But literally, head to toe, there's something
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happening in every part of our body because there are estrogen receptors everywhere,
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not just in some of our tissues, but all the tissues.
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So there's the perimenopausal quick and dirty.
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That is a lot. So many of those things I have felt so far.
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I've been there. I know friends have been there.
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And there are times when I will wake up and call. My sister's two and a half
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years older than I am. I'm 47.
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I'll call my sister and she's slowly going through all these symptoms, too.
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I'm like, seriously, Christina, what is up with my legs burning with sweat in the middle of the night?
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What is happening to me by night? She's like, I know.
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Yesterday, all of a sudden, I had to throw open a window because I was dripping sweat.
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Like, she's a little bit further along. But at least we know now that when we
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talk to our friends or our sisters or our moms, you know, people in our lives,
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women in our lives, there's a team around you. everyone's in this club and everyone's welcome.
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No one really wants to be there, but we're all in it together.
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Knowing that these symptoms are happening to other people is very comforting.
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My mom, when she was going through it, barely felt anything.
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You know, that's genetics for you. When I talked to her about it,
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she's like, I didn't feel much.
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It's just comforting to know that we all are going through this and we're not
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one person having to deal with this whole thing.
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It's all these women are doing this at the same time together.
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That's exactly right. There's a camaraderie and going through this kind of phase of life together.
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And thank goodness we're talking so much more about it. It's hard to discern
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for our mothers and our grandmothers in further back generations,
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were they just not as aware?
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Did they get gaslit when they went to the doctor and they were having trouble
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sleeping or feeling hot or not, you know, not feeling like themselves?
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Were they just told, like, just suck it up and move on? It's hard to know.
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And it's also hard to know how much our environment is influencing these symptoms.
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The hierarchy of hormones, truly like your stress hormones, your cortisol,
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and all the things that play into our stress response are probably the most important.
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Types of hormones to really consider treating first, and then kind of like whittling
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your way down to thyroid and sex hormones last.
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And so if you are a stressed out person who's under sleeping,
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not working out, eating a lot of food out, or just not being mindful of what
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you're putting down the hatch, then those symptoms potentially could be worse.
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We do see women who are more clued in, potentially eating more whole organic
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soy, maybe doing more meditation, taking more better care of themselves,
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having less stress, actually do a better job, you know, through this perimenopausal timeframe.
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It's possible that you're had less stress in you and your sister.
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The symptoms are real. And I think it's important to look at all the pieces
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that contribute to them, including caffeine, alcohol, spicy foods.
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Sugar is a huge driver of vasomotor symptoms. And I cannot be the only person
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who has ice cream before bed and then wakes up in a drench in the middle of the night.
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Or if I have a glass of wine, as I sip the wine, I am saying goodbye to sleep that night. Yeah.
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The choices that we make, but then sometimes I'm like, this ice cream is so
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good, or I just really want this beautiful glass of Sancerre. And we make choices.
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And so, you know, we have to be okay with our choices as well.
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Oh, absolutely. Are there stages of perimenopause and menopause?
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You said menopause is just one day in time.
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Are there stages you go through to get to that one day? Does it fluctuate for different people?
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How much time it takes for women?
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Absolutely. It's a very individualized journey, and some people have kind of
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all of this happen in their later
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40s, and they kind of just go fast and furious through all the shifts.
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Other people have the shifts starting in their late 30s. It's so variable from person to person.
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The big key piece here is paying attention. If you're not feeling like yourself,
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consider the possibility that perimenopause is at play.
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If you are having regular breast tenderness, noticing that your periods are
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coming closer together and they're really heavy, or you're having lots of clots,
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or you're spotting all the time, or you just notice that you're irritable 24-7 with your family,
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these are signs that you should be thinking about the possibility of perimenopause playing into it.
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And I think all the time we either are gaslit and we're just like,
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oh, I just need to calm down or, you know, it's not me, it's them.
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The medical system does it to us as well.
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So I think we have to advocate for ourselves and really think concretely about
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what we can do to improve these symptoms because there are so many things to
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do. And hormones are one.
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And progesterone and estrogen and testosterone are wonderful.
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But there's also things like acupuncture and dietary change and all organic
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soy and omega-3 rich fish and magnesium and all sorts of things that can be so helpful.
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And we don't really exhaust all our resources there either.
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Yeah, that was one of my questions. The lifestyle changes that are most effective
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and like reducing the symptoms, especially early on.
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And you just answered it because those are all the things you can do.
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So how does the integrative medicine support the emotional and mental well-being
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during this transition? I'm an anxious person by nature.
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And now my anxiety has gone back up. And when I get on a plane,
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all of a sudden, I'm nervous again.
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So I recognize this and I'm like, okay, we do deep breathing. We listen.
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We, you know, all the tapping. I have all these different tools in my toolbox
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that I can use. But what can other people do to kind of help them emotionally
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during this change? Because it's a lot.
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There's a lot going on. Jobs, volunteering, animals, spouses.
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And then on top of this, there's so much internally going on.
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What are some things that women can do to help themselves get through this a little bit?
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There's a lot of data to support the use of cognitive behavioral therapy for
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insomnia and perimenopausal shifts.
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The reason that CBT is helpful is because there is some mental emotional work
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that can be done to challenge the thoughts that we have, to change our behaviors,
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to be a little bit more in line with what we want.
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To use those kinds of skills successfully, we first have to be aware of what
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we're doing and then make a pattern shift.
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And those two things are actually really hard.
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As far as taking care of your spiritual self, I'm a big believer in movement-based meditation.
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So one tool that I've used for years is yoga.
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And I make space in my life to do yoga on Zoom twice a week for an hour because
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when I walk away, I feel like a better version of myself.
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Yes, my muscles are stretched. Yes, I did some push-up chaturangas,
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but really it's because it changes my emotional state.
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And we can use other somatic therapies. You mentioned tapping.
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We could do things like tai chi.
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We could do acupuncture. We could do other somatic therapies that actually change
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the mental emotional state.
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That's a really nice way to get
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into that meditative state because it's not as difficult while
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you're moving and doing things state sometimes
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if you just want to sit down to complete physical and
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mental stillness your brain's like what are you doing and it's kind of still
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firing very fast right if you're moving through your life fast like i am and
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so it probably takes me the first 20 minutes of a 60-minute yoga class to get
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out of my head and actually even stop projecting to the teacher,
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like, why are we doing this move?
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This is so slow, or whatever crazy thoughts enter one's mind during that time.
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I think movement-based meditation would be very helpful.
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But I do think making space in your day for physical stillness is key.
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Physical stillness is hard for many of us who are on the go through the day,
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running kids around, maybe working a job, volunteering, maybe helping our elderly parents.
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It's just go, go, go all day long. And if you don't take any time for physical
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stillness, how is your brain supposed to take a break?
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The whole point of meditation, which I think is fascinating,
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is just to relax. Like it literally is a vacation for your brain.
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There's no other purpose other than allowing your brain to get out of that fight
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or flight response and back into the rest and digest parasympathetic place.
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But if we don't give ourselves space for that, it won't happen.
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And so the way that this might manifest for someone might be.
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God forbid, take a rest in the middle of the afternoon.
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Like if you just feel like you've had enough of the day and you have a few minutes,
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lie on the couch, sit in your office chair and close your eyes for five minutes.
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Or if you can't do that, go out and take a walk with no distraction,
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just for five minutes to air yourself out.
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And I know it's cold outside, but hey, they make really great winter coats and
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heated gloves, put them on.
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But these are tools that I use to still my mental space because if I didn't,
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I would run around like a chicken with my head cut off all the time.
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And I honestly wouldn't really feel that good.
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And I really wouldn't get that much done because I'd be too crazed.
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So we have to make space for these kinds of things. Deep breathing is another beautiful thing to do.
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And it's not hard. You just have to do it. The problem is we just blow right
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past it because we've got 10 things on our to-do list. It's inconvenient.
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And we need to make some inconvenience in our life to pause.
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I totally agree with you on that.
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So let's dive into hormone replacement therapy. because it's a big word.
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I have not talked about it yet. With my doctors, I don't know much about it.
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I just know it's out there.
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And I'm curious to learn more about it.
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So what is hormone replacement therapy in the realm of menopause and perimenopause?
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So they've actually returned it from HRT, hormone replacement therapy,
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to MHT, menopausal hormone therapy.
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And the reason that they've done that is because we're not really replacing the hormones.
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More likely, we're just supporting them. You don't have to be completely devoid
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of estrogen and progesterone to start menopausal hormone therapy.
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You could still be having a regular period or a slightly irregular period and start the hormones.
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You don't have to wait until things are truly all dried up before you start
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them. I think that's an important piece.
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The three components mainly are estradiol, progesterone and testosterone.
25:06
We used to use things from coarse urine or synthetically to drive hormones.
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Now everything's being prescribed,
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mostly, is bioidentical. What's
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great about that is it's all available through your regular pharmacy.
25:20
You can get bioidentical, meaning identical to your own hormones, available at CBS.
25:25
They have them everywhere. And so the first thing people generally tend to use is an estradiol patch.
25:30
There are three types of estrogens in our body, but estradiol is the most prevalent.
25:34
So that's the one we use in patch form.
25:36
And that one you generally change twice a week. The reason for the transdermal
25:40
or through the skin application of the hormones is because it bypasses part
25:44
of the processing in the body and thus lowers our risk of heart attack, stroke, and blood clot,
25:50
but makes it a little more safe, which is amazing. And that's the standard of care.
25:54
Generally, you start low and then you increase every month or two as the symptoms
25:58
tell us. You don't necessarily need to check any labs.
26:01
You don't need to know what your estradiol level is. If you're having symptoms
26:04
and your doctor deems that estradiol is appropriate for you,
26:07
then you can start it and titrate to symptoms, meaning if you're still having
26:10
night sweats and hot flashes, even though you're on the patch,
26:13
we'll just give you a bigger patch.
26:14
Then we wait until those symptoms are gone or all gone.
26:17
I tend to like perfection here, so I like to see all the symptoms gone.
26:20
To balance that out, if you have a uterus, you have to give yourself progesterone.
26:24
If you didn't, the estrogen would lead to proliferation of your lining.
26:28
That would lead to lots of bleeding and aerobatic bleeding, which would not be very fun.
26:33
The progesterone helps to balance that. In addition, progesterone is really
26:37
great for helping with sleep and irritability.
26:40
It kind of calms everything down. And that's an oral pill that's usually compounded
26:44
in like peanut oil. So it's 100 or 200 milligrams.
26:48
If you happen to be allergic to peanuts, you can find it from a compounding
26:51
pharmacy like in a different form.
26:53
But usually 100 or 200 milligrams, you could take up to 300 if you needed to.
26:57
And that's once a night, every night.
26:59
And then the third thing is testosterone. And there's a couple of different
27:02
ways you can do testosterone.
27:04
I like to check levels of testosterone before I prescribe it because I kind
27:08
of want to see where we are and I don't want to overshoot the target.
27:11
If you overshoot the target, it could lead to things like extra hair on your face or chin.
27:16
In very rare circumstances, things like deepening up the voice and like that.
27:19
So you would just prevent that from happening.
27:21
We give them modest dose and then we check it again in a month.
27:24
You can get testosterone either from a regular pharmacy, which unfortunately
27:28
is dosed for a man, so it has to be then shifted over for a lady dose.
27:32
It's not FDA approved for women yet.
27:35
And if you don't go that route, you can do it from a compounding pharmacy.
27:39
And one of the benefits of doing that is it's in a very small amount of cream,
27:43
and that cream absorbs extremely well into the skin.
27:46
So it's just a lot cleaner, a lot less messy, a lot easier to use,
27:50
and the dose can be titrated up as needed. The number one thing that people
27:54
notice from taking testosterone is that their mood feels better.
27:57
In a couple months, they feel more positive.
28:00
Sometimes people notice that their bone density improves, their ability to put
28:03
on muscle at the gym improves.
28:05
Once you're on estrogen and progesterone, it's worthwhile thinking about testosterone,
28:09
or even before that, if you're having more libido or mood changes.
28:14
Are these necessary to take testosterone?
28:16
For the duration perimenopause until that menopause hits?
28:21
Or do you continue taking it after menopause? At what point do they get weaned
28:26
off of it and stop if they do at all?
28:29
The guidelines years ago when we were trying to minimize hormone exposure was
28:34
to stay on it for the least amount of time and then titrate off.
28:37
But now the data looks like we can stay on it long term.
28:41
Many women feel so good when they take hormones that they joke that you're going
28:46
to have to rip this out of my cold, dead hands.
28:48
Many people now are taking it for the duration of their life.
28:52
I'm 45, almost 46, and being on hormones, I feel so much better,
28:57
so much more even keel than I did before. I'm going to stay on it for the duration.
29:02
I'm interested to see the impact over time on my bones, brain, and heart.
29:07
Those parts of my body are really important to me, as well as my vaginal health,
29:10
as well as my mental outlook.
29:12
Like all these pieces are so
29:13
important to me. Why would I stop something that's helping me age better?
29:18
I still have to do my part on all the other fronts, but this is one aid.
29:21
For many women, it's successful to take for a longer period of time.
29:25
Yeah, that's very interesting. A lot of women, myself included,
29:30
get kind of dismissed by their doctors when they bring up symptoms.
29:34
Like, for example, I had this happen to me. I'm no longer with that doctor.
29:39
I was talking about, you know, this anxiety I was having, the suggestion was
29:43
to just go to a therapist.
29:45
And I was like, well, I already do that. I know the triggers in my life that cause anxiety.
29:51
This is different. This is a very different feeling.
29:54
It's completely unwarranted. It comes out of nowhere.
29:56
So I left that doctor because I was like, this is not, we're not aligned in this.
30:01
Do you have any strategies for women to advocate for themselves during this process.
30:07
When they're trying to get information, they're trying to get better,
30:10
they know something's up, they're not sure what it is, but their gut is telling
30:13
them something's going on.
30:15
The biggest piece is that if you have the question in your mind,
30:18
if this could be perimenopausal symptoms, then you need to search far and wide
30:23
for the doctor who's going to have the conversation around what to do about the hormonal shifts.
30:27
And if you're being pushed aside or told like, oh, this is just what you have
30:31
to accept for this part of your life, or you're too young for hormones,
30:35
then you just need to search for a different doctor.
30:38
Because if someone can't even entertain the conversation, like they can't engage
30:43
with you on that, they're clearly not going to be able to help you.
30:46
Are hormones going to solve all your problems?
30:49
Absolutely not. They are just another aid. Like you said, I'm already going
30:53
to therapy, but I'm having anxiety. If it was really the only thing you needed...
30:57
You wouldn't have symptoms, right? And I think that's the key part of this. It is multifactorial.
31:03
It's not just one thing for us to pretend like it's all hormonal or it's all
31:08
life stuff or it's all my own anxieties about things.
31:11
That's very short-sighted. Integrative medicine is so helpful because we naturally
31:15
take a multifactorial approach.
31:17
It's always about what are the many tools that we can use to help solve this problem?
31:22
It's not just one tool that will help. I think that's another reason people
31:26
don't love traditional medicine because it is just prescription writing heaven, right?
31:31
It's just a prescription. Oh, you're having this, here's a prescription.
31:34
Not really drilling down into where is this coming from?
31:37
What are the situations leading to this? for you having
31:40
an unexplained feeling of anxiety or
31:43
anxiety that crops up when you're doing something stressful like
31:46
flying it's worthwhile thinking what can i do
31:49
both from a mind body and a spirit way to make that feel better hormones could
31:54
be great and they could be one piece of the puzzle the other piece of that is
31:58
you need a fertile ground in which to plant these interventions if you're not
32:01
eating well if you're not getting enough sleep if you're not exercising if you're
32:05
not having a moment of stillness in your day.
32:08
Like it doesn't matter if you take hormones or do acupuncture or all these other
32:12
things because there's no fertile ground in which these flowers to grow.
32:16
So you've got to do your part in the lifestyle front.
32:19
And that takes, let's be honest, that takes a lot of work, a lot of effort.
32:23
Yeah. You live a plant-based diet, right?
32:26
I am plant forward. So I'm not only plants, I eat animals too.
32:30
I just want to make sure that people are clear that I do love and eat animals.
32:34
Okay. So plant forward diet.
32:35
Good. I'm glad you corrected me on that one. Let's talk a little bit about nutrition
32:38
through all of this. I've worked with Christine Dunst of Embody.
32:42
She changed my life with her help. And,
32:46
she's been such a great guide for so many women. When you're going through this
32:51
with a patient, what are some steps that people can take that you like to suggest
32:56
that can help start them on a path of feeding themselves well?
33:00
If you're not putting the right things into your body, your body's not going
33:03
to give you what you want back.
33:04
Like, you've got to put the right things into it. So we're going through this
33:09
new change and our body needs different things.
33:12
So what are some things you'd like to talk about adding into that diet and that
33:16
nutrition to really feed and fuel the body?
33:19
So I think the most important thing is to really think about the quality of
33:24
the food that you are eating.
33:26
When I say quality, I'm talking about organic and farm-raised and all the qualifiers.
33:31
It does matter if you are eating organic grass-fed meat versus the cheapest
33:36
form at another grocery store. Those little kinds of things matter.
33:40
Organic does matter. Not only does it tastes better, but actually having less
33:44
pesticide residue on your food makes you healthier too, right?
33:48
We don't want to ingest all that stuff.
33:50
But if you don't have access to those kinds of foods, and many grocery stores,
33:55
especially in the middle of our country, you have to think about the quality
33:58
of the components of what you're eating.
34:00
You can eat a holistic diet with lots of fresh vegetables and whole grains,
34:06
but if you're not getting enough protein or fiber, it doesn't matter that it's
34:10
an organic grass-fed diet because you're not getting the right components.
34:14
So there's this intersection to me of holistic nutrition, the quality of the
34:19
food that we're eating, alongside fitness nutrition.
34:23
Are you getting enough protein? Are you getting enough fiber?
34:26
What's your carbohydrate intake like? And how does that correspond to how you
34:30
move your body every day?
34:31
What's this intersection of fitness nutrition and holistic nutrition?
34:35
From a fitness perspective, we all need more protein as we get older.
34:39
It is a virtual certainty. When we are little, I read the stat once and it just stuck with me.
34:44
You can get a little kid's muscles to grow with as little as seven grams of protein.
34:49
So if you send your kid to school in the morning and give them a piece of sourdough
34:54
toast smeared with peanut butter and one egg, like they've got enough protein
34:59
that they can make muscle.
35:00
But you give that same thing to a 40-year-old woman, it's not quite enough protein
35:05
to stimulate her muscles to grow.
35:07
So getting at least 100 grams of protein down the hatch every day is incredibly important.
35:13
And that's hard because most of us are not trained to eat that much meat or
35:17
chicken or eggs or egg whites or protein powders or Greek yogurt.
35:22
But those kinds of things can be really helpful. And certainly it's helpful
35:25
to do it with plants as well.
35:27
So adding in things like full organic soy or lentils or legumes are great sources
35:32
of protein and complex carbohydrates.
35:34
And then I think where we really lose out is that a lot of women eat really
35:37
low carb, especially when they're trying to be super healthy.
35:41
And if you eat too low carb, you just don't have as much energy as you need to get your stuff done.
35:46
And you certainly don't have enough energy to run around all day or,
35:49
you know, do burpees at the gym or whatever it is that you're doing.
35:53
So this idea of getting enough carbohydrate in our bodies that we're getting
35:56
somewhere between 25 and 40 grams of fiber a day, as well as a good amount of
36:01
carbs that give us energy is important.
36:04
How do you know Oh, if you're getting all these things, you may actually have
36:07
to do some calculations and take an average three days in your life and track
36:11
it and then do some calculations and say, oh, I am only eating about 80 grams of protein or shoot,
36:17
I'm only eating 15 grams of fiber.
36:20
If that seems overwhelming, that's where health coaches and people like Christine
36:24
and people that I work with come in because we can help guide you.
36:28
If all that seems very overwhelming, then just come back to plate real estate.
36:31
And when I say that, I mean, look at your plate and say, I'm going to fill half this guy.
36:36
With good vegetables. I'm going to fill about a quarter of it full of protein,
36:41
both from plants and animals.
36:42
And then I'm going to give the remainder to a little fat and some complex carbs.
36:46
And on the days where I might be doing a little more physical activity,
36:49
I hit my 10,000 steps, I went to the gym, well, then I'm going to eat more carbs.
36:53
And if I have a day where I got to do a bunch of desk work and drive my kids
36:56
around, well, you eat a little less.
36:58
And you just kind of flex it that way and see how you feel. I always joke with
37:02
patients, aside from cocaine, if you take something or do something and you're
37:06
like, this makes me feel better, you're probably doing something really great for your body, right?
37:11
Pay attention. If you eat a certain way and you're like, damn,
37:14
this feels good, you should continue doing that.
37:16
If you eat a certain way and you're like, this does not feel good,
37:19
even if it's quote, quote, right for everybody else, then it's not right for you, right?
37:23
I love this. I love the plate real estate. That is something that I think everyone can get behind.
37:29
I've never heard that before. And I think that is such an easy way to get what you need in,
37:35
in not a way where you're counting and tracking, you know, because there are
37:42
some people who can't, won't track.
37:46
They've had history of whatever. Eating disorders, it's a trigger.
37:49
But knowing that plate real estate, it's just perfect.
37:53
Makes so much sense. Oh, it's so great. I had a patient once who was like,
37:57
you should make a plate, like you should is like a baby plate,
38:00
you know, like with the sections. And she's like, you should design a plate.
38:03
I'm like, next life. Next, next life. When I have more time. When I have more time.
38:08
Yeah, yeah, yeah. That made me think of a question. But again,
38:11
with this mind now, I forget them sometimes. This is what happens. It just escapes us.
38:16
So you had mentioned if you had a uterus. So women who have hysterectomies,
38:21
are they immediately into a menopause state?
38:26
Or will they have fluctuations in hormones as well?
38:29
So I'm wondering, what does that look like, this transition for women who have to go through that?
38:36
People get hysterectomies for all sorts of reasons. Probably the most common
38:40
reason is fibroids that are leading to heavy bleeding.
38:43
Those are super common because they're estrogen-driven. In that earlier part
38:47
of our 40s, we tend to have that imbalance of estrogen and progesterone.
38:51
Fibroids can grow more and cause even more bleeding.
38:54
If you decide to get a hysterectomy, you can decide at that juncture to take
38:58
the ovaries or leave them.
38:59
In a hysterectomy, generally, unless you have, say, a BRCA2 gene or a family
39:05
history of some kind of ovarian situation that you want to prevent,
39:10
most times, unless there's something wrong with your ovaries,
39:13
they will leave them, and they'll take maybe the fallopian tubes and they'll take the uterus.
39:18
So you won't have any more periods because you have nothing to bleed,
39:22
but you'll still have the fluctuations of perimenopause because you still have your ovaries.
39:27
Even though you don't have bleeding to understand where you are in perimenopause,
39:30
you can use your other symptoms to help you figure out, am I still cycling and
39:34
what I might do around that.
39:36
Now, if you have your uterus removed, the body does shift its hormones on its
39:40
own, which is kind of strange.
39:42
You'd think like everything would be just the same the next day if I just didn't
39:46
have a uterus because I still have my ovaries.
39:48
But sometimes you can have an onslaught of perimenopausal symptoms that are
39:52
more significant after the uterus is removed.
39:55
If you have your ovaries removed because of, you know, something that,
39:59
you know, that needs removed or you have ovarian cancer or you have a torsion
40:03
or something happens where you need the ovaries removed and you go into surgical menopause.
40:07
Then you need hormones the very next day, unless they're contraindicated for some reason.
40:12
Because then you'll go rip-roaringly fast into menopause.
40:16
And that can feel really, really bad. And so, you know, whether the rest of
40:20
perimenopause is very, you know, it's erratic, but it's kind of over the course of many years.
40:25
That happens, you know, in the course of hours. And so it makes sense to then
40:30
try to think, am I a candidate for menopausal hormone therapy and can I start that right away?
40:34
Many people will start an estrogen patch right away after they have the hysterectomy
40:39
or take out the ovaries to help with the estrogen withdrawal.
40:42
You don't necessarily need progesterone if you don't have a uterus.
40:47
So if you had a hysterectomy, you could just use estradiol.
40:51
Some women like to use progesterone even though they don't need it for the endometrial lining piece.
40:55
They like it because it makes them feel calm and because it helps them sleep
40:58
better, even if they don't need it for that bleeding risk. You can do different
41:03
combinations of things, but if you have a hysterectomy, it's important to think about hormones.
41:08
Or if you have your ovaries out, it's a definite, you want to have this conversation.
41:12
And of course, there are contraindications, but many women are able to successfully
41:16
use menopausal hormone therapy after having their ovaries out.
41:20
This has been such a wonderful conversation. I have learned so much.
41:24
I think everyone listening to this is going to learn so much and hopefully take
41:28
the knowledge when they talk to their doctors to get better help,
41:33
which I think is the key in all of this as we're getting educated, right?
41:37
Absolutely. Thank you so much for being here with me. I really appreciate your time.
41:42
I'm sure there are more questions that I have that will pop up,
41:44
but as I'm thinking about this, some of them get lost.
41:47
It happens. That's all right. That's the name of the game for this stage of
41:51
life. But I've enjoyed this too. You're so easy to talk to.
41:56
Sincerely, you bring such a sense of genuineness to the work that you do.
42:00
And the other podcasts that I was listening to prior to this episode being recorded,
42:05
just so I had a flavor of how you operate.
42:07
You have such a sweet, very genuine way with your guests. So thank you for that.
42:12
Thank you. Thank you so much. Thank you for that. You're so welcome.
42:16
We can both fill each other's cups today. Thank you. Yes.
42:19
I'm going to go lift my weights now. Yeah, for sure. Go and try to get out there
42:23
and negative 10 or whatever. It's cool. Get your long underwear off.
42:27
Thank you so much for being here. I really appreciate your time. Of course. My pleasure.
42:31
And we will talk soon. Thank you. Thank you so much for joining me today on
42:36
She's Smart. New episodes drop every other Thursday.
42:39
Don't forget to subscribe, like, and share. Stay cozy.