Tag Archives for " menopause "

May 7, 2024

Managing menopause with Dr. Mary Claire Haver

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On episode 641 of the 40+ Fitness Podcast, we meet Dr. Mary Claire Haver and discuss her book, The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts.

Episode Notes



Music by Dave Gerhart


The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch– Ken McQuade– Leigh Tanner
– Eliza Lamb– John Dachauer– Tim Alexander

Thank you!

Another episode you may enjoy

August 8, 2023

Personalize your approach to menopause with Dr. Heather Hirsch

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On episode 602 of the 40+ Fitness Podcast, Dr. Heather Hirsch and I discuss her book, Unlock Your Menopause Type: Personalized Treatments, the Last Word on Hormones, and Remedies That Work.


Let's Say Hello

[00:02:51.430] – Allan

Hey, Ras. How are you?

[00:02:53.400] – Rachel

Good, Allan. How are you today?

[00:02:55.320] – Allan

I'm good. I'm back in Bocas where I like to be. It was great to visit family. Don't get me wrong, that was a great catch up and I'm glad I did it, but I'm just happy to be home.

[00:03:08.170] – Rachel

Yeah, I hear you. It's hard to be away from your own home, your own habits, your own kitchen, your own bed for so long.

[00:03:14.940] – Allan

And my dogs. Those little things.

[00:03:20.750] – Rachel

That's right.

[00:03:22.110] – Allan

How are thing up there?

[00:03:23.570] – Rachel

Good about the same. I'm doing the same thing you are. I'm squeezing every moment I can with family. When I get it, we're trying to get some vacations planned and just being as busy as we can. Summertime just feels like it goes by so fast because we aim to spend a lot of time together. Because I'll tell you right now, in the winter time, I shut down. I do not want to drive in the snow. I don't want to be outside except to run where I can at least generate some steam, some literal steam. Yeah, but, no, I'd like to spend as much time with my family as can.

[00:03:59.600] – Allan

So, yeah, Tammy and I are planning our September holidays because we're going to close Lula's down for the month and just go explore. So we're going to take some time off and just travel around this country. And Mexico. We're going to go up to Mexico for a little while, but that's kind of the plan for September. So we're putting that all together right now. But this trip will be the two of us together. To be better.

[00:04:25.330] – Rachel

Yes. Oh, that's wonderful. I'm glad you get the time to do that. That's great.

[00:04:30.330] – Allan

All right. And I mean, guys, guys, because I don't normally say this kind of thing, but look, the topic we're going to talk about today is menopause. And if you've listened this far, you need to keep listening. The health of the women around us is important to the quality of our lives, too. And so just recognizing that, no, she's not crazy, she is going through something, maybe seeing these buckets and that we're going to talk about in this interview and just saying, hey, that's her, that's her. And maybe this book will give her some options that will help her, I think that'd be a very valuable thing for both of you. So don't tune out just because this is a menopause issue. There's a lot of education in here that can help you, help the people around you and your relationships. So please do listen on.


[00:06:06.310] – Allan

Dr. Hirsch, welcome to 40+ Fitness.

[00:06:09.590] – Dr. Hirsch

Well, thank you so much for having me. This is so exciting.

[00:06:13.510] – Allan

So your book is called Unlock Your Menopause Type: Personalized Treatments, the Last Word on Hormones, and Remedies That Work. Now, my wife has just recently gone through menopause and so I've experienced this side of that relationship thing. I haven't experienced it, obviously. I've had a lot of conversations with experts in the field and in talking to them, particularly women that have experienced it, there's this concept that every woman experiences perimenopause and menopause differently. But your book took them and kind of said, look, we can group these into buckets, if you will, and within that, basically now you can be a lot more specific about how you address your health and wellness and mental everything by knowing kind of what your type is. I really like that idea because I think so many times people think, well, what's the answer? The answer? And it's a lot more complex than that.

[00:07:16.170] – Dr. Hirsch

Right, exactly. Wouldn't that be so easy? I'm glad you liked the types because certainly it was meant in many ways to really help women really help better target their symptoms by thinking through what are the predominant symptoms or what is the predominant health history I have leading up to menopause. So did I have surgery or cancer or did I never have a hot flash at all? Because if you never had a hot flash or an outward symptom, it may not even be on your radar. And therefore, actually your health could be really deterred by not knowing what that means. And so I also love The Buckets because I think truly there's not one size fits all. But I couldn't write a book that was like the million types of menopause that could add into limited at some point.

[00:08:14.770] – Allan

Yeah, your editor probably would have had a problem with a million types

[00:08:19.020] – Dr. Hirsch

she would have. Yeah. Actually, my agent actually, before I got to my editor, I said, I really want to write a book on why nobody cares about menopause. And she said, Well, I think that might make a better blog post. And actually we spent a lot of time thinking about the menopause books that were already on the market and what would make mine different, because there are good books, but I really also felt that there weren't inclusive enough. So I talk a lot about depression and anxiety. Younger women, women with cancer, seemingly kind of get left out of the equation because they just don't fall into the cookie cutter, 51 year old with hot flashes.

[00:09:01.150] – Allan

Yeah. Now, while we're on it, let's just briefly go over the six types and what kind of makes each of them unique.

[00:09:11.020] – Dr. Hirsch

Yes. So the first type is the premature type. And actually this is one that is a medical diagnosis. There is something called premature menopause, and that is when you have menopause before age 40 and early menopause is menopause between ages 40 and 45. Meaning really simply whether it's surgery and your ovaries were taken out or your period stopped and you had lab levels that showed menopause about one to 5% of the population has early menopause. And I had a patient last Friday she was sitting with me in my New York City office, and she said, how rare is this? And I said, Well, I think I did the math. And I said like 1%. I'm going to get this wrong, but 1% of 5 million is 50 million is 1% of 50 million. I don't know what the number it was either. How much is it?

[00:10:12.360] – Allan

I think it's 50,000.

[00:10:13.640] – Dr. Hirsch

50,000, right? Yeah, 50,000 women a year, and that's just 1%. But we could go up to 5%, right? So I said 50,000 women each year is not nothing either. And I also think that that number is dependent on getting lost in the weeds here. But I'm really passionate about this. I think that number is also getting lost in the weeds because she said also I haven't seen a doctor in a really long time, and I don't even know if my doctor really even considers the fact that I haven't had periods anymore. So that number 1 – 5% is probably an underestimate. Okay.

[00:10:45.070] – Dr. Hirsch

The second type is the sudden menopause type, often due to either something suddenly happening. I think of chemotherapy for cancer treatments. I think of surgery for maybe endometriosis or cysts or cancer, again, thinking of lupron or certain medications, even high dose steroids. I had a lady who went into menopause after a traumatic car accident. She had a traumatic car accident. Boom. Never got her periods again. And so for most women, the sudden menopause type is potentially where hormone therapy is not indicated because there are patients here who are suddenly waking up and taking chemotherapy for cancer.

[00:11:29.040] – Dr. Hirsch

And so this type really talks a lot about, in my book, non hormonal therapies, but also different ways of exercising, different ways of treating your body with a sudden type of menopause.

[00:11:40.930] – Dr. Hirsch

A full throttle menopause is exactly what it sounds like. Symptoms from head to toe, hair loss and night sweats and waking and fatigue and lack of motivation. And every single symptom you could think of is really your full throttle menopause.

[00:11:57.750] – Dr. Hirsch

The mind altering menopause, which is type four, is really near and dear to me as well because I think there are many women for whom their symptoms are really more mental health hearing, whatever that means. So there still could be a big shift in hormones, and they may get either misdiagnosed with depression, anxiety, bipolar, and there certainly could be multiple factors, but the shift in hormone there is huge. And this is actually one where I say movement really is medicine. There's the lingering menopause type, which is symptoms that just sort of never seem to go away, never as terrible as full throttle or as obvious as sudden menopause. But too many women let menopause symptoms go on for many, many years without feeling as though they are worth treatment or they're worthy of treatment, or they're just taking care of too many other people.

[00:12:55.530] – Dr. Hirsch

And then silent menopause type is really what I touched upon is that even if you never had a symptom, your body still changes. So what are the exercises you need to do? What are the health tests you still need to do? Because women with silent menopause type may seem lucky on the outside, but if that doesn't remind them that their body is still changing, they may be left at a disadvantage.

[00:13:18.030] – Allan

And I think it's important for them to kind of go through that process of deciding, okay, what's the best approach for me? Because there is no one size fits all. So here's an opportunity for you to do a lot of different things. And one of the things that's going to come up unfortunately or unfortunately, I guess it's unfortunate, is there's kind of this confusion about hormone therapy, because there was the nurse's study, and so we have information from a nurse's study. And that's what most, I think probably most general practitioners and maybe even a lot of gynecologists were taught was okay, this was the science. But we've learned a lot since that study. So pros and cons, should a woman consider hormone therapy or not?

[00:14:04.510] – Dr. Hirsch

So absolutely a woman should consider hormone replacement therapy. And I always like to preface all of my either talks or podcasts with again, I still don't think one size fits all. So it's not h or T or bust. But there are so many indications and there is so much now we know about the safety and efficacy. So I kind of think about it like this. If a person was diagnosed with hypothyroidism and they were feeling sluggish and slow and their hair was falling out, we wouldn't say to them, oh, well, just set your alarm earlier and meditate like you'll be okay. We would give them thyroid hormone. We would replace their medication because they're missing a hormone that is crucial to their entire body. And truly, estrogen is very similar. Now, biologically, women were meant to go through menopause. I don't know how long women lived postmenopausally, probably not as long as we do now. Maybe five years, ten years, I don't really know. And I actually think there is an evolutionary basis to being in menopause. You could help your children and then they could help their grandchildren. So I actually think there is an interesting evolutionary basis for menopause.

[00:15:26.880] – Dr. Hirsch

But now we live very, very long and our symptoms can be really quite severe. And now midlife is the peak of a woman's functionality in terms of intellectual capability, financial capability. And so not that all women need hormones or hormone replacement therapy, but for so many women it's just like that hypothyroidism, they lose their estrogen, progesterone, testosterone, and yes, things like meditation and gratitude and journaling, they can certainly help. But just like that example I gave you, oftentimes when I give them estrogen back, boo, it's like night and day, they're back to functioning and feeling so well. And we should not demonize an endocrine dysfunction or disorder. Now people get all up in arms. You ask the simple question about is it safe? But truly it is. And the thing about the safety of HRT back to your original question, is, it is so peppered with cultural and societal norms about menopause and whether we should take hormones or not. But anyways, it's not necessarily that menopause is a disease, and yes, it is a natural part of life. But when you are a doctor, when you see what I've seen, that the majority of women really feel so much better almost instantaneously, not all of them.

[00:16:46.850] – Dr. Hirsch

It really does. You really just see at the basics of this, you lose a hormone, I replace it, you function well again. So we know from the Women's Health Study, as well as some of those longer studies, right, the Nurses Health Study, lots of studies about HRT, that there is an immense amount of safety data, particularly for women who start within ten years of menopause. That's the one thing that the Whi scared people about. And the idea that hormone therapy increases the risk of breast cancer has also been demystified. And that if we use certain formulations, estradiol and prometrium, which are FDA approved, which you should absolutely get FDA approved, we don't see statistical increases in breast cancer. And we do know that women who do take FDA approved hormone replacement therapy live longer, die less from all causes, have less diabetes, gain less weight, have improvements in quality of life, better bone health. Oh, stops your symptoms, I forgot to say work longer, retire later. So many benefits from hormone replacement therapy. So before I get off my soapbox, my last thing is you're not doomed if you don't take hormone therapy. It's just that the last statistics showed that probably about seven to 10% of the US population is taking hormone replacement therapy. And if we can even get that numbers to 20%, at the peak before the WHI, it was 45% to 55% of women. I just want women to be able to have better conversations with their clinicians, with themselves, and to think about HRT as a valid option.

[00:18:27.730] – Allan

Yeah. And I think that's what's really important here is that you educate yourself. You're your own coach. I mean, you're your own CEO, and you have to make the best health and life decisions for yourself. And if you just go at it like a knee jerk, oh, no, that's bad, without really looking at your particular situation and what it would mean, and talking, of course, to your medical advisor, your practitioner, your gynecologist, and having those conversations, then at that point you can make an educated judgment of what's best for you.

[00:19:03.630] – Dr. Hirsch


[00:19:05.950] – Allan

Now, this is not all about getting a shot or pellets or whatever else, creams and everything else. There are things you can do every day to help symptoms help yourself feel better, to get through this easier and come out stronger. And we call those diet, exercise and self care. Can you talk a little bit about how those play into this?

[00:19:30.150] – Dr. Hirsch

Yeah, I think they're really crucial. And even to come off the backbone of talking about medication, sort of right off the bat, I do think that diet, lifestyle, mental health and sleep really lay the foundation for adding a medication on top of this. Because whether you take that medication off or on or you change the dose, these are the things that set up good habits for the rest of our lives. And once we're postmenopausal, we're always post menopausal. So to keep it brief, I will say one more plug for my book is which is incredible that I was even able to do this, but for each of those different types, I talk about the best types of diet, lifestyle, mindsets and foods for each one, which is really crucial. So let me give you a little window. The sudden menopause type, we talk a lot about anti inflammatory foods because I'm thinking if something suddenly brought you into menopause, perhaps you have cancer or you're taking chemotherapy. And when we talk about exercise, I'm talking more about like graded exercise, stretching, mobility, flexibility. When we talk about the mind altering menopause type, I feel as though because of that loss of dopamine, there are certain foods that can include those feel good that could increase not include increase those feel good hormones in the mind type of menopause.

[00:21:02.730] – Dr. Hirsch

I think that exercise is really medicine here. And getting your body moving, getting your cardiovascular system moving is so, so crucial to also help you release dopamine, serotonin and those happy neurotransmitters. And for the silent menopause type, I talk a lot about weight bearing exercise. And actually, of course, I should say across the board, weight bearing exercise for women as we get into our 40s is absolutely crucial.

[00:21:33.070] – Allan

Thank you for thank you for saying that.

[00:21:37.330] – Dr. Hirsch

Yes, it does not have to be going to CrossFit, does not have to be. But really, if you're new to it, starting with weight bearing exercises, squats and then picking up your milk and doing deadlifts with that, and upper body, your shoulders, your back. In my book, I talk about a lady who had silent menopause. She had a BMI of 20, played tennis two, three times a week, and as she was getting the turkey out of her Thanksgiving, out of the oven for Thanksgiving, she stood up, fractured her spine, and she hadn't been weight bearing, hadn't been told about osteoporosis at all. And so the weight bearing is so crucial, not just for the silent, but for all women post menopausally.

[00:22:21.780] – Dr. Hirsch

It really has to be incorporated in some way, shape or form. When we think know, I am not a bona fide nutritionist. I actually had Elizabeth Ward as a dietitian who wrote a wonderful book, a great companion book called The Menopause Diet Plan. And there are really certain foods that are so important that we should be getting for vitamins like zinc and iron and magnesium. Now, iron is not as important postmenopausally because you're not bleeding anymore. But perimenopause in your 40s, it's really crucial because it can lead to a lot of fatigue. And me, I always recommend a diet with at least 80 to 100 grams of protein a day. I have tracked macros once in my life. I personally hated it just because it just made me feel so crazy about it. But increasing protein in midlife is so important. So weight bearing, exercise, increasing your protein intake. And then we can talk a little bit more about some of the other lifestyle tips like sleep. But these are really such foundational backbones to thriving and feeling well because how you treat your body between ages 40 to 60 really sets up how you're going to spend the rest of your time on this planet.

[00:23:46.630] – Allan

Now, one of the topics that's come up, it's like why is a guy interviewing and reading all these books on menopause? Because I try to do at least one per year.

[00:23:57.290] – Dr. Hirsch

We love this. We love this.

[00:24:00.760] – Allan

Well, to me it's important to understand what's going on in my wife's life. And I know there's a lot of women out there that need this information. Me being a guy, that's not a valid reason for me to say I don't need to know this. But I've read some statistics. I couldn't quote them right now. But there's a lot of divorces that happen during perimenopause and during menopause and a lot of it can probably be traced back to just changes in behavior, changes in what's going on in your life. And as a result, there's a disconnect in your relationship. And there's a lot of other things that probably play into that like kids moving out of the house and other things. But I think it's just really important and I wanted to bring this up is that you have a conversation with your significant other, with your kids. I'm not screaming at you because I hate you. Maybe I'm just going through something here and helping them understand it. Could you talk a little bit about how someone can start that conversation? Particularly once they know they're tight?

[00:25:03.570] – Dr. Hirsch

Oh my gosh, 1000%. And really I got so excited and clapped. Is because it's so fundamental that men really understand this. And I think that it's easy to look at this now. We're in 2023, right? In terms of your partner being pregnant, certainly there are some nowadays I'm going to make some assumptions and a heteronormative relationship. So an assumption there, and that's not always the case. But in this assumption, or this scenario, men now are expected to go to some doctor's business, not all because that would be bizarre and touch the belly and help build the crib and take maternity pictures and help if their wife is and learn about and learn about breastfeeding and all of those things, right? There is no difference here. There is no difference here. There's not a big belly and there's no crib that needs to get built. But the process is so uniquely similar. We're going through a complete hormonal shift that we do so that we can reproduce for the species, right? And for men to be inquisitive, to want to learn, for their partners, to want to educate too, and educate other men or women, who knows?

[00:26:25.210] – Dr. Hirsch

And I actually think that men find this very interesting because as much as women have been shut out, they certainly feel shut out and also feel like same thing in the hospital when the baby's being born. Like, what can I do? What can I do?

[00:26:41.730] – Dr. Hirsch

I think you asked me what are tips for women to start the conversation. But gosh, I think that if men also were there for the conversation or almost even said actually men should say nothing. Women should take the lead maybe, right?

[00:26:59.370] – Allan

Well, that's what I'm thinking. You know, one of the things is at this point of this show, my guess is that our listenership is all women. Most of the guys tuned out the first minute when I said we're going to talk about menopause unless their wife was going through it or they thought they were going through it, most men are going to tune out. If you didn't message me, let me know. I'd be very interested to hear otherwise. But I think it's incumbent on the woman to recognize that as she changes, as hard as it is having conversations, because I've heard of women unable to complete their jobs. They have to quit their jobs because of the symptoms they're experiencing. And that's so unfortunate because it's a medical condition. And so they need to have a conversation with their employer and say, okay, I'm going through a medical situation. I'm treating it. I'm working with a doctor, and then you have certain protections that you wouldn't have otherwise. But I think it's just that point of saying, okay, I need to start these conversations because this is not just a thing I'm going to just breeze through and accept this could change me.

[00:28:03.340] – Allan

It is going to change me at some level, but it could change me drastically. And I need my partner to know that. I need my children to know that. I need my work to know that so that I can live a whole full life and not let these symptoms take me down.

[00:28:17.870] – Dr. Hirsch

I couldn't agree more. And I think that there may even be shows like this, for example, that they could sit down with their significant other to say, I think I could be entering perimenopause. There's probably some cute, humorous things that can light heartedly bring up the conversation. I have a small section on this, on my book, too, and telling not even just your partner, but also if there's children still at home, which sounds kind of silly, but it can help your children better understand that there's just…

[00:28:53.610] – Allan

Mommy's not crazy.

[00:28:54.190] – Dr. Hirsch

That there's a transition here that's not them. But women can have shorter fuses, feel more irritable because they're having trouble sleeping, because they don't feel good, and they're so used to more often taking care of the whole family. So there's also guilt and there's worry and anxiety there. But even just sitting down at the dinner table one day and talking a little bit about it and the physiology books are always great, unlock Your Menopause type is a great one. Podcasts like this show can be great for partners to listen to because it's so nice sometimes to hear a guy's voice. I did another interview on a Boston radio show with two male hosts, and it was just great because I love having men as hosts. These can serve as bridges, and it's so crucial.

[00:29:46.090] – Allan

Thank you. So, Dr. Hirsch, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:29:56.030] – Dr. Hirsch

Oh, what a good question. Okay, I'm just going to go with what I've been doing. So, you know, not that I'm perfect, but I am certainly just a mere mortal myself. I try to be pretty introspective when I can. So I actually just started going back to therapy. I've been in therapy on and off for many years, and certainly I have no problem saying that out loud. And it really helps me to take off the mental load of I listen to a lot of patients talk about their lives and their histories. And for me to be the best doctor, for me to be the best mom or parent, I need a place where I can digest all of that information so that I could be a better continue to be a better doctor, continue to be a better wife and mother and friend. So for me, that's kind of what I call my mental health. That's my mental health, right? So for me, that's cognitive behavioral therapy, and I'm lucky that I have resources. But another way of doing that is other things that you can do, like journaling or journaling especially. It's basically free cognitive behavioral therapy.

[00:31:06.140] – Dr. Hirsch

For me, it's 20 minutes of exercise most days that keeps me also really feeling my best. I used to be a long distance runner. I used to run marathons. And in this time in my life, actually, I think that would be more stressful on my body if I didn't absolutely love it and have all the resources to refuel my body. And so I like to do 20 minutes of exercise a day, if I can, in the mornings, and it really sets me up for just a wonderful day. And oftentimes I'm either doing my Peloton or some cardio sorry, or some weights because the weight bearing activity is so important. The third thing that I do to be my best self. I would say gosh, I could say so many things, probably I could say sleep. But let's not lie. I love scrolling it. But I like being present, so I like to be in the present moment. So whether my kids are snuggling with me on the couch or I'm reading a book to them, my husband's telling me about his day. I'm looking out, beautiful scenery outside. I'm taking my first breath of air.

[00:32:07.180] – Dr. Hirsch

I'm just trying to live in the present moment that actually keeps me very sane and happy.

[00:32:12.970] – Allan

Awesome. If someone wanted to learn more about you and learn more about your book, Unlock Your Menopause Type, where would you like for me to send them?

[00:32:21.090] – Dr. Hirsch

I would love for you to send them to my website, heatherhirschmd.com. It's got all the resources you could ever need or my social media. I'm @heatherhirschmd across all the platforms.

[00:32:33.930] – Allan

Great. Well, thank you so much. And thank you for being a part of 40+ Fitness.

[00:32:38.450] – Dr. Hirsch

Thank you. It was a complete joy and pleasure to chat with you today. Thank you so much for talking about this topic.

[00:32:46.160] – Allan

Thank you.

Post Show/Recap

[00:32:47.160] – Allan

Welcome back, Ras.

[00:32:48.650] – Rachel

Hey, Allan. Menopause is the topic of the day for me right now. As I mentioned to you and our viewers, way back in the spring, I hit menopause. So I'm postmenopausal now and I'm trying to deal with all these weird symptoms. But I also appreciate what you just mentioned in our intro that for the guys to listen in. And I happen to be married to my husband Mike, and I've been cluing him in on my strange behavior and my questions that I have and all the things that I've got going on. We do have an open discussion and for any of the ladies out there whomever your partner or spouse is, be open and start talking about it because it can be very helpful to get that conversation started.

[00:33:32.320] – Allan

Yeah. Me doing what I do, I talk to a lot of people in the field that are doctors. I try to have at least one menopause issue per year because I think it is an important age related topic for us to get into. But guys, we're going to live with this for potentially a decade or more. They're living with it and we're not experiencing what they're experiencing, but sometimes they're not going to articulate why they are all emotional and going off on you because you didn't mow the yard right or didn't pick out the trash right. Or like, okay, it went out and it's not in here. Sorry, I forgot to put the bag in there, that kind of thing. It's not worth trying to choke me to death, you know, just realize that that could be a symptom. And so it's worth having that discussion. And one of the things that I liked about Dr. Hirsch's book was the concept of the buckets.

[00:34:27.870] – Rachel


[00:34:28.620] – Allan

Because it shows you just how different the different symptoms for different women can be. And here's something we didn't really get into in the conversation, but the woman can be a combination of a couple of these. Actually, when you start reading through the descriptions and getting into a little bit more detail, you can be, well, I'm sort of a little bit that one, and sort of a little bit that one. And you may not be having all of the symptoms. You might only really have one or two, or you might have every single one of them that anyone's ever listed in any kind of thing. It's like, do you have yes, I got every one of them. Check them all off. But again, the book gives you some practical guidance and talks about different solutions and things that you can consider and if it's adversely affecting your life, again, you have to have the conversations and you have to find the relief that you can so that you can live as normal a life. Now, it's not a new normal. And I think that's one of the big takeaways from most of the interviews that I've done is that a lot of doctors in the past have just told women this is just how it is.

[00:35:41.710] – Rachel


[00:35:43.710] – Allan

Okay. And it's not. You do have some treatment options and you should really pay attention to those.

[00:35:50.590] – Rachel

Yeah. I think that's one of the biggest mysteries of menopause is that we all think this is natural. We went through puberty, now we did our childbearing years, now we're going through menopause. It's all very natural. But when things do interrupt your life, when things aren't quite right, there is a solution. And the second part to that, the second tricky part is that we're used to when you get a cold, you take antibiotics. When you break a bone, you get a cast. When you get menopause, there's a big blank after that and that's the hardest thing. So when you're young and in your thirty s and forty s, it's really important to start paying attention to what your body is doing, what's normal for your body. And then as you're shifting into perimenopause, which is when your hormones are all crazy and fluctuating, then you really got to dial it down. Because I think that's where I went wrong is that I'm a very athletic person. So when I'm getting achy and emotional and tired, it's probably because I ran too many miles and didn't eat enough. But that's not necessarily the case. So trying to piecemeal these different symptoms, it can be really difficult.

[00:37:01.830] – Rachel

And before you know it, like in my case, I'm in menopause and now I am really dealing with the carnage of my hormones being all out of whack. So I think that it is important to find a doctor who knows you to pay attention to your symptoms, start tracking some things and then doing some blood work when necessary to see if there's anything that can alleviate the symptoms, but that's part of it is chasing the symptoms. And that can be hard sometimes.

[00:37:28.620] – Allan

Yeah, well, I mean, when most of us went through puberty, a lot of folks really suffer with acne as an example. So what do you do? You look for treatment for acne because, again, it's somewhat debilitating as a 15 year old, 16 year old who's just completely breaking out with acne and feeling self conscious, and that's affecting everything in your life. This is actually maybe even a little bit more severe than that. And so just knowing, okay, I'm going through this. I do not want this to affect my career. I do not want this to affect my relationship. I do not want this to affect my kids. And so, depending on where you are in life, you're juggling a lot of different things, and now, boom, here's

[00:38:13.470] – Rachel

another thing to deal with. Yes.

[00:38:16.080] – Rachel

That highlights everything. It overshadows everything. And like you had mentioned, too, because emotions are often tied with menopause. Like, we are emotional people. I'm an emotional person just to begin with. But anxiety and depression is another side effect of these changing hormones. And if your husband or your partner notices those things and can talk to you about that, that could be another signal to go to your doctor. And we have talked about, or you guys talked about hormone therapy. A lot of people call it hormone replacement therapy, but that is another way to treat some of these symptoms, especially if you're getting super emotional with anxiety, depression, and even anger. Like you had mentioned, sometimes we are quick to get angry. And I noticed that in my own personality, I'm usually a very happy, very patient, very calm person. But since I've hit menopause, my emotions are pretty quick to change, and I've noticed that. So if your spouse or partner notices that, that could be a helpful symptom to chase with a doctor.

[00:39:26.540] – Allan

Yeah, because you're half aware of what you're doing most of the time.

[00:39:32.230] – Rachel

Yes. Half aware,

[00:39:34.480] – Allan

or you feel it afterwards, it's like, why did I go off on him? Why did I run into the bedroom and start crying? Those kind of things. And granted, I can't say I've experienced that we go through andropause so there is a lowering of our hormones, and we recognize that as we get older, we get a little softer, usually. But it's not that you have to or must do, but it's that you can. And so it's the thinking through, how do I properly treat myself so that I can live the best life possible? Because I say wellness is healthiest, fittest and happiest. And if this is adversely affecting your happiness and your lifestyle, it's a health problem. It's something that you should spend some time addressing. Now, it's not always hormone therapy or hormone replacement therapy, right? HRT, however you want to define it, but that's an option that's out there, and it's worth you having a conversation with your doctor. Now, if you're well out of menopause, you've been in menopause for several years, you're probably not a candidate for hormone replacement therapy, particularly estrogen and progesterone, if you still have a uterus.

[00:40:54.060] – Allan

But just recognize that it's available to most women that are perimenopause or just going through menopause. So while you're going through the heat or hot or everything else of the symptoms, the worst of the symptoms, that's the point where you have an opportunity to lessen the blow and live probably maybe even a better normal life, maybe even a better life than you had before. Because you know yourself and your body so much better when you give yourself the energy and stuff that you had when you were in your 30s. By this hormone replacement therapy, you're capable of moving more, you're capable of thinking clearer, you're capable of better, making better decisions and all that put together, it's kind of like a trifecta of health because you're moving more, you're eating better, and you're feeling better and you're happier. So just look at these solutions and decide what works best for you and your lifestyle. But don't just think you're a victim of your body. You do have a team and some people you can talk to that can help you work through this.

[00:41:59.050] – Rachel

So true. I think this book would be a really great place to start. I really like how she did put the six types, or the buckets of symptoms of menopause. I think that would be a fantastic place to start. And then also, I'm personally working with the women's health department of my hospital network, so I actually have a menopause specialist helping me get through all this. So start with your symptom management. Start taking notes, start journaling with how you're feeling. Get a book like this to maybe kind of put some of those thoughts into a framework and then maybe speak with your doctor and see how it's going. But please don't wait. If you're even thinking something's off, you're in perimenopause. Your periods are kind of wacky. Start now and go see a doctor and figure this out before it's too late. Or not that it's too late in a bad way. But the better you can get started now, the better you'll be later.

[00:42:55.110] – Allan

Yeah, well, the cool thing about the buckets is that then she gives you some ideas of protocols, like how you should be moving, how you should be eating. Hint, it's whole food. Yeah, for just about every bucket. Well, for every bucket. But it's just that concept of you're going to have some tools, some things you can try that she's worked with thousands of patients and helped them through menopause. So she's in a really good position to teach you how you can treat your body to make the symptoms less where you feel better, more like yourself. And yeah, after reading what she has to say about it, if you believe hormone therapy or hormone replacement therapy or HRT, however you want to say it is the right thing for you, then you can have that conversation with your doctor from a point of self education that now you can understand the answers to the question. Your doctor is just poo pooing it and saying no. You'll know, that that's not entirely the case. And you can just ask them if they've read anything since medical school, but just talk to them and you have a team and just make it work for you.

[00:44:04.350] – Rachel

On that note, Alan, I have a general practitioner. Like everybody, you have your main doctor and they know a lot. But when you have something important going on, you find an expert, whether that's a menopause specialist, a cardiologist, anybody out there you see a PT for muscular or other imbalances know, start with your general practitioner. But then when you need to see an, just go right to the expert.

[00:44:30.390] – Allan

Excellent. All right, well, I will talk to you next week.

[00:44:33.910] – Rachel

Great. Take care, Allan.

[00:44:35.440] – Allan


[00:44:36.030] – Rachel

bye. Bye.

Music by Dave Gerhart


The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch– Ken McQuade– Leigh Tanner
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Thank you!

Another episode you may enjoy


How to use food to manage your menopause symptoms with Dr. Anna Cabeca

Apple Google Spotify Overcast Youtube

As we age, our hormones make some drastic changes that can lead to some difficult symptoms. We all experience this, although women suffer the most with weight gain, sleep issues, and hot flashes. In her book, MenuPause, Dr. Anna Cabeca provides 5 unique eating plans to help you address these symptoms. 


Let's Say Hello

[00:03:27.790] – Allan

Hello, Ras.

[00:03:29.230] – Rachel

Hey, Allan, how are you today?

[00:03:31.110] – Allan

I'm doing all right. How are things with you?

[00:03:33.360] – Rachel

Good. As we recorded this, we're leading up to my race day, which is this weekend. This is my final week of taper, so I'm just going to enjoy myself this week.

[00:03:43.580] – Allan

Good, good. And unlike a lot of people that would be in your position, you're not carving up. You're not really changing anything about your nutrition. And that's a different take than what you'll read elsewhere of what you do for a long race like this. But you know, your nutrition, you're set, you've done the training, so you're set. And you have a plan. You have an actual plan for approaching this race, which I think is outstanding.

[00:04:15.850] – Rachel

Yeah. My trainer only suggested that I not changed my eating habits this week, that I eat, get in enough calories. I may not be as hungry as I would be as I'm running tons of miles and doing tons of drills, but just to maintain my standard way of eating. And in the past, I would do something very similar, and I just prefer to play it safe this week. So no restaurant eating, no crazy spicy dinners, nothing that I think could even possibly upset my digestive system. I just want to keep it status quo as I lead into race day.

[00:04:56.590] – Allan

Yeah, it's funny. There was this article they were talking about how they opened up a Popeye's restaurant in UK, and nobody was complaining that the mild was too spicy.

[00:05:09.430] – Rachel

Oh, boy.

[00:05:10.500] – Allan

Good. Don't get me wrong. I love the spicy stuff. I love it, love it, love it. In fact, I had been to Lou this weekend, and I have the sauce in there so I can put it on my eggs. So I love spicy foods. But it was just they were complaining that Popeye's chicken was too spicy in the UK.

[00:05:31.270] – Rachel

Oh, gosh.

[00:05:32.250] – Allan

Well, they might not make it over there, which is probably just the better because it's not the best food for you to be eating so good. You've got control. Yeah, well, things here are going pretty good. We're winding down to our big season for Bocas, so Lula's will start to probably wind down. We've been fully occupied pretty much for the whole time since we opened in November, which has been good. But it's just that point we're like, okay, go. Hopefully we're going to get a little bit more of an opportunity here to settle down. Tammy is planning a trip to Ireland, and then we're going to have our anniversary break, which will just be a kind of a staycation for us. So we're planning those things. Nothing huge. And then just being I am looking at launching my six week program again. I'm kind of going back and forth of whether I do it as a group thing, like where we literally have everybody come through together or whether I do it at their own pace over a six week period of time. So that's kind of where I am planning it. But I am planning on going live again.

[00:06:45.970] – Allan

I only take clients during certain periods of time, and that's really just to fit my lifestyle the way I want to. So if you are wanting to work with me, this is a good time to send me an email, allan@40PlusFitness, I'm sorry, coach@40PlusFitness. It's coach@40PlusFitness. And let's get you on the list. Let's make sure you're aware of what I'm going to be doing as I figured it out. But it is a six week program. The intention is to teach you what you need to know to lose weight, to get fit, to figure out where you need to be. And so it's an educational thing in addition to the direct coaching. So it's a very direct, intensive coaching for you about what you need, where you are with what you have to do, what you want and be who you need to be. So if you're interested in that, coach@40Plusfitness.com and we can start that conversation.

[00:07:41.830] – Rachel

Sounds great.

[00:07:42.980] – Allan

All right. So are we ready to have another conversation with Dr. Cabeca?

[00:07:47.680] – Rachel



[00:08:23.660] – Allan

Dr. Anna, welcome back to 40+ Fitness.

[00:08:26.950] – Dr. Cabeca

It is great to be here with you, Allan. Thanks for having me.

[00:08:30.910] – Allan

Initially, you brought up the concept for me anyway. I mean, I talked to some other people, but in general, how there's pulls and pushes and there's a keto community and there's a plant-based community. And never, ever should we go between the two. You got to pick your tribe and you got to get on one side or the other. And then you come out with Keto-Green, which is basically saying, yes, you can have your meat and your vegetables, too, and you can do it in a way that promotes health. Your new book, MenuPause: Five Unique Eating Plans to Break Through Your Weight Loss Plateau and Improve Your Mood, Sleep and Hot Flashes. Love the title.

[00:09:12.710] – Dr. Cabeca

Thank you.

[00:09:13.820] – Allan

But it takes a lot of the concepts from your previous two books, and it kind of lays it out in a way to say, okay, food is medicine, so let's use it that way.

[00:09:25.310] – Dr. Cabeca

Absolutely. And bringing in these different pauses in our life. And I say there's magic in the pause. Right, Allan? We really have to look at it that way, and especially when it comes to a hormonal shift, whether we're talking about menopause or andropause or whatever. But there is magic in the pause. There's a rewiring or reshifting. And where I was, I certainly had fun with the title Menu Pause. So I thought that was great. My editor came up with that title as we were looking for a new title, and I just love it. So I laugh every time I say it. And the five different eating plans to each pause, something different. And that came out of women in my online communities doing keto green and me now keto green since 2014, 2015, and how that's changed my life, especially with hormone balance and seeing the changes. But sometimes we had a roadblock. Why isn't it working for this person or why did it stop working? And so that had me really looking at, okay, well, what are some of the pauses that we have to make that we've had to make or adjust to break through some of the plateaus that we can hit?

[00:10:37.560] – Dr. Cabeca

Because when what we're doing stops working or we stop seeing those improved benefits, we start seeing continued improvements or some of the problem, we need to look a little bit deeper, change things up, bring some variety as a spice of life, right?

[00:10:54.840] – Allan


[00:10:56.150] – Allan

And there's a lot of good reasons for this book. But I want to say before the men tune out and I always say this in the preamble and I'll say it again to them is that this is first and foremost a weight loss book and a hormone shifting book, but not just for females. If a man uses these five eating plans as a way to structure their eating, they will lose weight too. So if you're in a relationship, not in a relationship, it doesn't matter. These eating plans will help you. And what you were saying about the pause is I think that's right. In Dr. Fung's book, The Obesity Code, one of the things he says is all diets work and all diets fail, and it's because our body will adjust to the way we're eating. So you start eating a certain way, a keto diet, and then something happens and your body just stops responding to it. You go vegan and your body's doing great, you're losing weight, and all of a sudden your body stops responding to it. So this ability to have these different eating plans, that structure pauses for various different things for various different reasons gives you a structure to say, okay, I'm going to go in, check this out, see if it serves me.

[00:12:05.420] – Allan

If it does, then I'll stick with it till it stops serving me. And if it doesn't serve me, I move on.

[00:12:11.690] – Dr. Cabeca

Absolutely. And we give it enough time to figure out every plan is designed to be safe. And we give enough time, the six days to just be the shortest, essentially amount of time to really get a benefit. And then also to see to be able to check in with yourself. How are you feeling now with this lifestyle, with this diet plan, it's always more than what we eat too. And I really established with my whole Keto Green approach, it's the keto green way, it's the lifestyle, it's the hormone oxytocin becoming more oxytocin rich in our lives. And that joy connection, that important physiologic effect of joy connection. Right. Pleasure and becoming more insulin sensitive. So when it comes to guys too, we'll see an improvement in their adrenal hormones, their testosterone, a decrease in blood pressure and sugar management and blood sugar as well in the short amount of times. And I expect it pretty much with every plan because again, there's a shift, there's a change up, except for maybe the carbohydrate up plan that I put in as plan number five.

[00:13:26.630] – Allan

Yeah. Now, I think a lot of women and maybe even men when they're going through some of these changes, obviously a woman's change is drastically different. So I'm going to try to compare what we guys go through, through what women go through. Not even close. So don't think it does, guys. I guess it feels bad, but not even close.

[00:13:46.820] – Dr. Cabeca

He's a wise man, right, ladies? He's a wise man.

[00:13:50.200] – Allan

But as they go through this, I think the knee jerk reaction today is what supplement do I need to take? What pill can I take? What surgery do I have to fix this problem? Why is food the better answer?

[00:14:10.910] – Dr. Cabeca

Definitely. Because how we nourish, our body is a whole framework for how we nourish other aspects of our lives. Right. And we have to give our body the fuel. We are designed to work with our environment, to interact and to respond to the energies of the food we eat. So beyond the micronutrient and macronutrient breakdown of what we're eating, there's a lot more to it than that. And I think when we set up, as we set up our eating plans, the key aspect is diversity. And I always tell clients, I interview a lot of people and selling when someone says, yeah, I eat a chicken salad every day for lunch, I just want that hand emoji to the top of your head. Like, I want that hand emoji because it is like, okay, we're eating the same thing every day, and that's just not good for you. I don't care how good of a health food you're eating. If you're eating the same thing every day, you can create a food sensitivity to it. So the importance of how we nourish our bodies, how we're going to do everything, and that sets the tone for hormonal balance.

[00:15:25.730] – Dr. Cabeca

Our behavior is affected by our physiology. So a balanced nourishing eating plan is key for willpower, brain power, love power, whatever it may be that we're working towards. So for physical and mental, wellbeing, how we nourish our body is key. And so having that as food, as medicine, it's absolutely true.

[00:15:53.510] – Allan

Yeah. Now the other aspect of this that I thought was really interesting and you brought science to bear. So this wasn't just you saying this is how you solve this problem or this is why this problem might be worse for you than someone else. I think we know is if you have a knee problem, you go to your doctor. Your doctor is going to say if you need to, you might want to lose some weight because the excess weight is causing knee pain. That's why part of the reason why you have the pain. So he encourages or she encourages you to go lose some weight. Why is weight loss part of a solution to the menopause symptoms that many women suffer with?

[00:16:30.390] – Dr. Cabeca

Yeah, because our fat is inflammatory and two of the things that cause worsening symptoms in menopause is inflammation and hormone imbalance, those two things. And fat is a contributor to both of those things. We naturally become more insulin resistant as we age, and that's why we can develop diabetes or prediabetes in menopause. And we've been doing really well up until then. And post menopause, that's because we're becoming more insulin resistant. And so type two diabetes becomes very prevalent in our age group, and that's got to stop. And that's why that's, again, why keto green eating is so critical for this. But fat holds inflammation and it creates basically cytokines storms within our body and inflammation creates increased hormonal imbalance. So what we see as people clear this up decrease inflammation through how we're nourishing the body, providing appropriate nutrients and not feeding it junk and sugar and inflammatory foods. We also see an improvement in hot flashes tremendous. Within two weeks, we can see 80% reduction in hot flashes through these lifestyle and nutritional changes. The other big thing I want to mention is, like, women will say, oh, I can't fast 13 hours. I'm hungry when I go to bed.

[00:17:58.480] – Dr. Cabeca

I'm hungry when I wake up. That's just how you've trained your body. Your body is not designed to be like that. And so let's retrain it into a healthier way that's actually going to serve you. And we know this really important factor. So built into the plan, I do at least 13 hours of intermittent fasting between dinner and breakfast, but you start where you're at. But the reason I do that is because research has shown in women with breast cancer that if you have at least twelve and a half hours between dinner and breakfast, you have a significantly reduced risk of recurrent breast cancer. So that should be number one health guideline, all the initials that you want, but really should be promoting that intermittent fasting is a key component of our lifestyle. And that improves insulin sensitivity and then improves really all of our symptoms and age related diseases that can occur. So the hot flashes, the mood swings, the night sweats, difficulty sleeping will improve with these shifts and how we're nourishing our body.

[00:19:02.530] – Allan

Yeah. And the same is true for men. If a man is obese, it's affecting their insulin sensitivity and therefore, it's affecting their hormones. And so it's creating a similar effect to us, we call it Andropause but it's basically a very similar approach, similar thing happening in our body. If we can reduce our fat stores, we're going to improve all of that and improve our health. And weight loss is often a side effect of better health. But basically what we're showing is the main symptom we see is when we step on that scale.

[00:19:38.540] – Dr. Cabeca

Yeah. And we want the weight loss, but we want in a way that we don't gain Yoyo dieted from my teens through my 20s and into my 30s. And I think that especially others, I went to high school and College in the 80s. So that's when the low carbohydrate craze was in place and we would do all these crazy things like Apple juice fasting and just nut stuff, like you're fasting on sugar. What the heck? If you're going to fast anyway, now we fast on bone broth a little bit better or just fast on water. But the key thing is and what we know is that calorie restriction decreases your metabolism more than fasting does. And that's a really important concept for people to understand. So you're not going to Yoyo diet back. And being of the, I would say of the warrior body type because there's an epigenetic component. We know this just from observing friends, family, colleagues, et cetera. Some of us are designed to be empowered to be very conservative with our nutrient use. I would say I could survive in the Sahara for six months without food or water, and I'd still be fine.

[00:20:47.780] – Dr. Cabeca

I'm thriving. And I see that among many of my clients, I say they have Pocahontas or Warrior, Viking heritage or Amazonian. Right. Because you're designed to be metabolically conservative, so you're at higher risk. However, you're designed to live through a famine, right? Live through deprivation cycle. But in America, we don't have that right. And so then we think, oh, I just have fat genes. I have obesity and diabetes on both sides of my family. And I want that mind shift to switch to say, no, you've got Warrior genes, you've got Survivor genes. You're amazing. You've got leadership genes. Let's use them. Part of what I really want to empower people to understand this epigenetic component. So it's kind of built in into my plans and into my program. And that's where that whole individual bio individuality comes in, like, what's right for you right now based on what you've been doing up till now and the state of life you're in, how your hormones are, are you burned out? Is your DHA estrogen, testosterone progesterone? Are you tanked in your hormone levels? Are you pretty resilient? And I think with this, with changing up and my goal with this, with cross training in the gym, cross training in your diet is to improve your resilience.

[00:22:11.080] – Dr. Cabeca

So you improve the diversity of your gut microbiome, and with that, you improve your immune system and you improve your overall longevity and quality of life.

[00:22:22.590] – Allan

Yeah. Now you have in the book five plans, and each of them starts out with kind of a six day approach. And I like the six day approach because it gives you that opportunity to check in with yourself to see how it's going. And I think anyone can agree you can do anything for six days if you put your mind to it. So it kind of gives them that finish line, even though it's not intended to truly be a finish line. But it's just give it six days, see if it works. And I like all of that. Obviously, if we've gotten ourselves obese, it's not going to fix itself in six days. So don't think that these are magic pills that are going to make everything great in six days. But each of them gives you a kind of a phase. A pause is the way you like to put it, gives you a pause on something so you can start to see the results and move forward. I want to go through each one of them because I think each of the one of them is really important, but I think it's important for them to know why would they use this plan and what is the plan entail?

[00:23:21.590] – Allan

So the first one and it has extreme in the title because it is kind of an extreme one, is the Keto Green Extreme. Can you talk about that one? Why we would want to use it?

[00:23:33.320] – Dr. Cabeca

Yeah, definitely. First want to say why six days? And six days if we consider that the gut gastrointestinal mucosal lininging of the intestines of our intestinal tract, GI tract regenerates in 72 hours. So that's three days. So incorporating two, three day cycle should be very healing and restorative to our GI tract, certainly in the cleanse. But even as we remove some of these inflammatory triggers or these pauses, as we take these pauses, it gives our body those two full 72 hours cycles to regenerate, respond, react. I think that's where some of this checking in, checking in with yourself can really be powerful. So with Ketogenic Extreme, because I definitely have clients who have had autoimmune diseases and have reactions to night shades. I mean, I was sitting at dinner with Dave Ashbury the other day and he sent his plate back twice because one time it had peppers and one time they had mushrooms in it. So anyway, some people are super sensitive to nitrates. Right. And so I removed that. It's really an autoimmune, kind of following some of the autoimmune protocol dietary changes with restriction of nightshades and peppers and some of those other inflammatory foods, if we're sensitive to that.

[00:25:02.410] – Dr. Cabeca

So checking in on that one is the number one reason to do that, especially if you have an autoimmune issue.

[00:25:08.970] – Allan

Okay. The next one is and you're using a word, well, there are two words that you use in two different ones, and I'm talking about each of those, but it's not exactly what it would mean to somebody else. Is the keto green plant based detox. Now, a lot of us will look at detoxes and thinking, oh, this is one of those where I'm going to take this supplement thing, and I'm going to be going to the bathroom for three days really bad and then not feel good. But this is a detox, but it's not a normal detox. Can you talk about this one and why we would want to use it?

[00:25:40.410] – Dr. Cabeca

Yeah. This is a grain free plant based plan. So it's more of a keto green plant based plan. So again, low in carbohydrates also. And I wanted to address my plant based eaters because my keto green 16th book, I did a 16 day omnipresent, a 16 day plant based plan. So I got a lot of feedback. Right. And then people who are omnivores did the 16 day plant based. And they loved it, too. So being able to again, do that periodically, and this is why I put it in for all of us to just detox from meat. And that's where that comes in. Detox from meat. And plus, one of the biggest problems that keto eaters and diet and diabetics and et cetera have is constipation. And the number one thing I want to clear from your system without, ideally, additional drug support vitamins, et cetera, is having regular bowel movements. So I put it after ketogenic stream. You can do them in any order. Certainly. But I did have a method to my madness, as usual. So putting it there because right now we've just reduced a lot of inflammation. But it's been pretty ketogenic. And I want to make sure your bowels are resuscitated to 72 hours of a low inflammatory diet.

[00:27:04.020] – Dr. Cabeca

But let's work on this to add in fiber support the gut microbiome. To add gut microbial diversity. We know the more plant diverse foods you have, the higher diversity in the gut, the better your immune system, the lower your risk of all inflammatory diseases, including diabetes, cardiovascular disease. And that goes again for men and women and all the menopausal symptoms. So that's why I incorporated a six day plant based diet, because we all need to do it periodically.

[00:27:31.290] – Allan

Okay. And now we're going to go to the other extreme because you have this carbohydrate pause. Can you talk about that? Because this is going to get some attention. It's like, wait, are we plant based or are we meat eaters? So where are we here? Can you talk about that?

[00:27:45.620] – Dr. Cabeca

Like I said, variety is the spice of life. And this is one of the things that I definitely had tried carnivore being keto green for a while and wanting to switch thing up, tried carnivore. And again, same thing felt good for a little bit, but then started gaining weight. I was like, wait, what's going on? Actually connected with another perimenopausal woman in the carnivore community. And she had run across this issue, too, again with women. Again, we talked about this before we started recording. It's really awesome to have diversity. There are certain plants that work for a short time and not for the long time. And that's why disruption. We want to disrupt what we're doing. And it's so good for us. But the carnivore knows to tail. And I wanted to show people how a healthy way to eat carnivore number one. Also, again, after I've just increased the microbial diversity of the gut that was powering you up. You're taking a break from all plant foods pretty much in the carnivore plan in just a healthy way, very carbohydrate restrictive. And again, we're pausing plants in this cycle.

[00:28:59.670] – Allan

And I can say this, if you go through the carbohydrate pause, when you finish it, you're going to be in the deep cut ketosis, which is going to help with your sensitivity. Whichever direction you go after this is going to make that next plan that much better for you.

[00:29:18.870] – Dr. Cabeca

Yeah, exactly. Right.

[00:29:22.720] – Allan

Okay, now the fourth one. And again, this is using one of the words that I typically don't like to see in any kind of eating plan is the cleanse, because it usually involves buying some very expensive juices and spending a lot of money and not getting many calories and rebounding after. But yours isn't going to do that. It's called the keto green cleanse. Can you talk about that?

[00:29:45.580] – Dr. Cabeca

Yeah, absolutely. And actually ran my pre release permission from my publisher to run my selected group, my girlfriend doctor club, through the six day cleanse. And the reason for the cleanse, too, right, we're in high ketosis number one from our carnivore for going in this order. And then so we're not hungry. We are not hungry. We're chewing. We've had good protein. The other part of carbohydrate pause the carnivorous plan is to give us more protein. Women, we don't get enough protein. And protein is so important for our muscle. And muscle is magic and menopause. So then going into cleanse number one, you're not hungry. And now we really want to detox the liver and detox your gallbladder and really work to support your body so the cleanse, we did this six days. I start you with an oil, lemon juice, olive oil, lemon juice, shot in the morning. And believe me, I had objections. They're very intelligent group of women, but they're like, okay, you're recommending it. So by day three, they're like, I can't wait. Can I stay on this forever? Can I do this? I'm like, no, just six days. We have to change things up.

[00:30:56.630] – Dr. Cabeca

So this liver, gallbladder flesh and very much it is a cleanse. So it is smooth, smoothies. It is teas, it is alkaline broth or bone broth. And making sure ideally you're getting enough protein and healthy fats during this. But it is a cleanse. So you are continuing to give your GI tract rest. You will see glowing skin, glowing complexion. You will feel higher energy. You'll start checking things off on your to do list that have been on your to do list. And so it's cleansing off the things that are weighing you down, as well as really working on an internal system. So, yeah, I'm excited for that. And honestly, you're not hungry. You're doing great. You're very supportive advice from my girlfriend doctor club because some of them were used to extended intermittent fasting. They're like, just follow the plan, as Dr. Anna says it, and you're not going to get hungry. And that's really key.

[00:31:57.210] – Allan

And then the final one is and I think this is really kind of a critical piece of all of this is at some point you're going to fit a level of health and maybe a level of weight loss where you're like, okay, this is a weight I feel comfortable. And maybe it was a weight that you were when you were 29. Maybe it was a weight you were when you graduated high school. And now you could wear the same size jeans, you were wearing then. But you get to a point. And now it's like, okay, I don't want to Yoyo, I don't want to go back to where I was because it worked so hard to get to where I am. So the last plan you have is the carbohydrate modification plan. Can you talk about that and how that works?

[00:32:36.810] – Dr. Cabeca

Yeah, and I love it. And I just opened my book to one of the recipes in the Carb modif. My Texas Rodeo Skillet. Skillets are big in Texas and everything's bigger in Texas. That's where I'm living now in Dallas. And so this is a modification for some of the beautiful skillet breakfast. So this has sunny side up eggs, Sriracha sauce, avocados and sweet potatoes and bacon mixed in. I mean, it's just so yummy. I'm getting hungry thinking about this plan. But the reason is because being in the keto green community for so long, sometimes we've been so restricted that we need the additional carbs. And when some of my clients have added in a sweet potato in the evening, they're sleeping better. Right. And I think it's really important to understand that. And some of them will lose weight once they do that because they have been really conservative and adding in a carb, at least it's a beautiful thing to do. And I think once you get through the plans, it's the principles of the plant and how balancing the fats, but also for flavor, the salts and the citrus that just makes things so much better, addressing your full taste palate so that you're really looking forward to your meals and even better.

[00:33:58.990] – Dr. Cabeca

So these concepts that have been built into the recipes that are all outlined in the book have really been designed to balance and nourish and set. You enjoy them, too. So I think that a lot of times we'll do a carb up, we'll do a carb up day periodically. That's absolutely okay. And it can be very good for you unless it triggers eating disorder. Unless it triggers an eating disorder.

[00:34:30.650] – Allan

Yeah. And just as you mentioned, you mentioned the recipe. So I'll kind of jump into that. You believe in variety. You talked about that several times today. And so this cookbook is really built on a massive variety of different foods. And each plan has some foods that fit. And some of the foods some of the recipes you have actually fit multiple plans. And you put that in there. In fact, last night for dinner, my wife and I had your egg roll soup because I love egg rolls. And I walked by the Chinese we have one Chinese restaurant here on the island, and I walk by there all the time. And I'm like, I just love to go in there and order their egg rolls. And I was just like, no, I won't do it. That's not what I'm doing right now. But I was able to make your soup and it was delicious. And I actually had a second serving of it because it was that good. So these are really good recipes. They fit each plan. So it's not just that. Here's a plan and go figure it out. It's like, here's how this works.

[00:35:30.100] – Allan

Here's a plan. Here's some tips. Here are some recipes. And so you build out recipes to pretty much fill the six days. And you give guidelines if you want to do it yourself. So it's really kind of a cool way that you're not going to get bored because it's not like a lot of plans. You're eating the same foods every day. In this case, I think the most I saw you like, you Cook something one day, and then maybe the third day you have it again as a leftover for lunch or something like that. But it's not eat the same food every day all the way through. You work through these plans, and maybe other than the cleanse, you're doing fairly similar things through the cleanse. But for the others, there's great recipes that are going to keep you interested. And you even give them a shopping list, which I think is also pretty cool.

[00:36:18.670] – Dr. Cabeca

Thank you. You know, my mom raising kids, was making things early. Sometimes having leftovers is just a one less meal I have to Cook. Right. So that's always definitely an option in the plan, too. And maybe if there's adding something a little bit more interesting, too, but to create as much simplicity and shopping as possible. But it's six days. So I want this diversity. I want this experience. I want it to be an experience.

[00:36:48.970] – Allan

Yeah. It is. That's what I'm saying.

[00:36:51.980] – Allan

Mine, it's something I would order at a Chinese restaurant. I'm like, I want egg rolls. So it's like cabbage. And I did it with pork and went through the whole process of making it. And I think it took me less than an hour to make the soup. And that included prep. And I'm a slow prepper. So I didn't even get to watch a whole TV series. I was watching a TV show. I didn't get to watch the whole thing because I had the meal ready before I finished. So really good recipes. You should check that out.

[00:37:22.400] – Allan

Dr. Anna, I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

[00:37:31.510] – Dr. Cabeca

Thank you. Well, definitely get keto green. So incorporate the lifestyle, the nutrition into your lifestyle. That concept, that is by design, a number one way, certainly for me and for women going through menopause, and I think for so many, my kids are doing it. The second thing is make oxytocin the most powerful hormone in your body and so not stress. Really think, where do I see love today? Where am I loving, giving, grateful? What am I grateful for? Really focusing on that. How am I showing love to those I love? How am I receiving love? Sometimes that's even harder. So make oxytocin the most powerful hormone. And the third is just smile. Really smile, really genuinely feel good about yourself. And for women, oftentimes we have this, like I would say the negative, that nasty bitch on your shoulder talking down to you. So like, knock that nasty bitch off your shoulder and enjoy yourself. And that concept of truly, genuinely being happy in your own skin with whatever is in your life at this moment, it's a really powerful concept.

[00:38:43.750] – Allan

Well, thank you, Dr. Anna. If someone wanted to get in touch with you, learn more about MenuPause or your Girlfriend's Doctor club, where would you like for me to send them?

[00:38:54.220] – Dr. Cabeca

Definitely, just come to my website dranna.com. We have a MenuPause book page and some great bonuses to go along with the MenuPause book. So some trackers, some additional handouts and recipes and good things to support you in the videos, cooking videos, all this good stuff is there for you. So, dranna.com, and then join me on social media at the Girlfriend Doctor.

[00:39:19.120] – Allan

Awesome. You can go to fortyplusfitnesspodcast.com/533 and I'll be sure to have the link there. Dr. Anna, thank you so much for being a part of 40 Plus Fitness.

[00:39:29.970] – Dr. Cabeca

Thank you for having me, Allan. I love what you're doing. Thank you.

Post Show/Recap

[00:39:40.850] – Allan

Welcome back, Ras.

[00:39:42.380] – Rachel

Hey, Allan. That was a fun interview with Doctor Anna Cabeca. Anytime I hear anything having to do with menopause, my ears peek up. So her book, MenuPause sounds like a really good book.

[00:39:55.130] – Allan

It is good. Obviously, I will not experience menopause, can't and won't. And so for me, it's really just about understanding what my wife, with my clients, with my friends, with my family, what they may experience as they're going. And I think there are periods of time when we really have to ratchet in our nutrition. For the most part, most of us can go through life and not really think about what we're eating. But there are particular periods in a woman's life where I think it becomes really important. Obviously, when you're trying to get pregnant and you are having a baby, there are times when your nutrition is tantamount to having a healthy baby, dealing with any kind of major illness or recovery. So cancer surgery, something like that. Nutrition is going to be really important to make sure that you're addressing your body's nutritional needs so that it can heal properly so that you have a good, strong immune system, really important. And then, of course, during menopause, when you're going through significant, significant hormone changes, and those changes, the perimenopause process, if you will, can take minutes where they're actually pulling out your ovaries and uterus, or it can take decades as you're going through those.

[00:41:24.750] – Allan

This is month to month, day to day, week to week. All of it changes in your hormones. And if you are just eating about doing your thing, you don't have information. What you have is a symptom. And you don't know if it was directly affected by what you're eating, what you're feeling, the movement or, yeah, you're just going through a huge hormone shift that you really couldn't deal with otherwise. Those are important. And within approach, you literally can sit down and look at a swath of time, the six day plans and say, okay, I'm going to do this thing over six days and see if my symptoms abate. And if they do now you have data, now you have information to say, hey, if I cut out this food, yes, my body screaming at me, eat more chocolate, but I don't eat more chocolate. Instead, I eat more vegetables, I eat more meat. I make sure that I'm eating whole food, and you feel better. You didn't need the chocolate. And I know that's hard to hear. Sometimes you need the chocolate. I understand. But sometimes your body is telling you something, and the answer is actually the exact opposite.

[00:42:54.060] – Rachel

That's so true. And what's interesting, how Anna put it, is that instead of turning to supplements or surgery or something, that a lot of doctors will suggest a pill for this or for that, it's turning to food. And food can actually really be true medicine for you. And I appreciate how she created these five different eating patterns or these five different types of eating for a six day window of time. Six days isn't that long. You can get through some sort of change, and you never know how you might feel afterwards. If it works for you, then it's a tool in your toolbox for all these different times in our lives when our hormones will fluctuate. Like I mentioned earlier, all of us have different symptoms as we approach menopause. Perimenopause is kind of tricky. That way our hormones can fluctuate day to day, week to week, month to month symptoms could be different from another. But by trying food as medicine, at least you have another tool in the toolbox that you can pick out later on.

[00:43:55.880] – Allan

Yeah. The only caution I put out there is if you're making a fairly drastic change. So let's just say you're eating the standard American diet today or something close to it, and you immediately say, okay, well, I'm going to go to the hardcore, intense low carb thing. Six days might not be enough time for you to fully adapt to that change. And so just recognizing that if you find that this food is affecting you and maybe even in a negative way, you may need to lean in instead of pulling back and saying it's not working. The six days is a great trial. And for a lot of people that don't have, say, insulin resistance or some other health issues going on, they're going to start seeing some potential positive change, weight loss and some other things will be happening during that period of time. But you might not feel really good. And there's a couple of reasons for it. One, yes, could be that you're going through the change into keto, and they call it keto flu. I prefer to call it carb withdrawals because your body used carbohydrates for fuel and now it doesn't have as many it's got to shift fuel systems.

[00:45:12.710] – Allan

That can be a little disruptive for most of us it is. But there's also other things. Our body stores toxins in our fat. So if you're starting to lose body fat, your body now has to deal with those toxins that it shuttled away earlier and didn't deal with. And if you're under a toxic load at home or at work or whatever, now you're adding more toxins to the mix. You might feel worse before you feel better. So just recognize six days is a good rule of thumb because as you said, you can do just about anything for six days.

[00:45:46.600] – Rachel


[00:45:47.630] – Allan

People can go without eating for six days and be fine. But that said, if you're feeling bad, you're making a change. If it's hard, just consider whether this is something you need to lean into or whether it is okay. You did your six days and it just didn't work. And let's say you tried that and it didn't work. That doesn't mean that tool is useless. If you needed to screw in a screw and the first thing you grabbed was a hammer, the hammer didn't work, but you get a screwdriver and it works. Later on, you got a nail. The hammer is going to be just fine. So just recognize that time and space and where you are now is different than where you will be later. So a tool today that's not useful can be a useful tool later. But there's really good eating plans in there. Really sound advice from Dr. Cabeca. And if hormones are an issue for you as you go through these changes, food will affect your hormone levels. What you think will affect your hormone levels, what you physically do will affect your hormone levels. All of that input, all of that information and it will affect how your body expresses hormones.

[00:47:06.550] – Allan

So while you can't fix this change because it is what it is, it's coming, you can reduce the impact of it with the right foods.

[00:47:16.740] – Rachel

Yeah, well, you both were discussing bio individuality and what is right for you right now is going to be different from what is right for you later. And that's just the way our hormones fluctuate. I think every woman understands and agrees with me that like I said, week to week, month to month, our hormones, our symptoms, the way we feel just changes so greatly. So what works for you today may not work tomorrow, but the point is that you get to try something new and it sounds like Dr. Cabeca offers several different meals that you get ways to try to eat in order to satisfy those changes. It's a great idea.

[00:47:56.510] – Allan

And if you're listening to this and the guys have tuned out, they can eat this way too.

[00:48:02.710] – Rachel

Oh, for sure.

[00:48:04.670] – Allan

These are healthy, good ways to eat. This is not like, oh, well, here's an estrogen pill. I'm going to give it to my husband too. No, it's not like that. This is food. This is really good. These are really good meal plans. They're very easy. She gives you the shopping list, the whole set. So it's really simple for you to kind of go in and say, okay, this is my meal plan for the week. It's the meal plan for my family for the week.

[00:48:25.090] – Rachel

I love that.

[00:48:26.110] – Allan

And so they're getting what they need to be healthy. You're getting what you need to heal and be healthy. Just recognize this is not a woman's eating plan this is an eating plan that anyone can do and be more healthy for doing it.

[00:48:42.500] – Rachel

That sounds great. Sounds like a great book.

[00:48:45.040] – Allan

Yeah, it is. All right, well, Rachel, we'll talk next week.

[00:48:48.120] – Rachel

Sounds great.


The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch– Eric More– Leigh Tanner
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Thank you!

Another episode you may enjoy


June 14, 2021

Hormone intelligence with Dr. Aviva Romm

Apple Google Spotify Overcast Youtube

On this episode, Dr. Aviva Romm and I discuss her new book, Hormone Intelligence.


Let's Say Hello

[00:01:04.370] – Allan
Hey, Raz. How are you doing?

[00:01:06.080] – Rachel
Good, Allan, how are you today?

[00:01:08.300] – Allan
Good. I get a chuckle out of that voice when we go on Zoom here to do these recordings. Now, when you record on Zoom before you just hit record in your recording. But now there's this female voice that wants to tell everybody on the call that they're being recorded and and then when we get off the recording it does the same things. Call is no longer being recorded. It's just funny because it's in the headphones. It's really, really loud.

[00:01:33.470] – Allan
So it's like we're having a nice conversation, good conversational tone, and all of a sudden this woman's yelling at me. Recording this call.

[00:01:41.300] – Rachel
Yeah. I've been warned.

[00:01:43.130] – Allan
And I have been recording this call because this is our welcome for this podcast. And how are you doing, Rachel?

[00:01:50.480] – Rachel
Good, good. Things are great up here. We've had some beautiful summer days. It's nice to get out, spend some time outside. Our vegetable gardens are growing really well. So, yeah, it's a perfect time of year up here.

[00:02:03.410] – Allan
Yeah. You have your little animal kingdom with your pond.

[00:02:06.350] – Rachel
We do.

[00:02:07.610] – Allan
Posting the other day with a snake and a frog. Or snake versus frog. Is that what it was?

[00:02:11.990] – Rachel
Yeah. And he was back. My husband Mike just saw him the snake again today and he had a bulge in his belly. So I know he ate another one of my frogs. Need to make..

[00:02:23.090] – Allan
maybe he's also eating rats.

[00:02:25.580] – Rachel
I would like to think that.

[00:02:28.250] – Allan
It was a rat. We're gonna call it a rat. Lacking any other evidence to the contrary. It was a rat.

[00:02:34.610] – Rachel
Makes me feel better. That would make me feel a lot better. How are you doing?

[00:02:39.890] – Allan
I'm good. Yeah, we actually have a new houseguest. It's a crab. It crawled into the kitchen late last night, so I was there shutting everything down and I'd like you know, we leave things open because we don't do the air conditioning for most the house. It's just our bedroom. It's air conditioned. When I was walking in and right there by the refrigerator here's this crab and it's not a huge crab.

[00:03:01.970] – Allan
You know, it's probably about the size of my fist. And I'm like looking at the crab. I'm like, I'm not going to get you to walk out of here right now. And he just looked at me with his pinchers up and I was like, OK, so I went, got a pan thinking OK, I'll just try to go scoop him in a pan and then toss them out the back. And then he ran back behind the refrigerator.

[00:03:17.630] – Allan
And I'm like, I'm not moving the refrigerator.

[00:03:20.000] – Rachel
Oh my gosh.

[00:03:21.470] – Allan
Clean up after yourself and we're cool. And so I went back to bed. Apparently he's still out and about. And so my wife saw this morning, so, yeah, we have a pet crab now. I haven't named it.

[00:03:32.630] – Rachel
I'd say. It's so funny.

[00:03:36.200] – Rachel
Well, I hope he doesn't stay too long.

[00:03:38.600] – Allan
Yeah, well, Buster is pretty excited to have a houseguest. And so if I think of Buster, Buster has an opportune meeting with him. Yeah. Not going to go well for the crab or I don't know, maybe the crab, the upper claw and Buster will not want to deal with crab.

[00:03:56.870] – Rachel
Well, oh boy.

[00:03:59.360] – Allan
So I have wild kingdom in our house too. Just like a different set. I think the mammal's going to win this one.

[00:04:05.520] – Rachel
Oh my gosh. Well, good luck.

[00:04:07.670] – Allan
Yeah. All right. So let's talk to Dr. Aviva.

[00:04:11.240] – Rachel


[00:04:48.500] – Allan
Dr. Aviva, welcome to 40+ Fitness.

[00:04:51.840] – Dr. Aviva
Thank you for having me here. It's a delight.

[00:04:54.540] – Allan
Now your book, Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring the Body's Natural Blueprint for Well-Being. I've read a few books on this topic, and obviously I don't have to deal with women's health issues myself, but I am a husband and I'm a father. So it is something that I try to stay at least somewhere of. And being the host of this podcast, I've had several authors on to talk about menopause, hormones, and women's health.

[00:05:22.710] – Allan
This book is maybe the most comprehensive complete guide I've ever read. You didn't leave anything out and you really kind of I don't know that there's a question I've ever would have had with my wife and all the things that we've dealt with over the years and my daughters that wasn't answered in this book somewhere.

[00:05:43.350] – Dr. Aviva
That makes me so happy to hear I was truly driving my publisher crazy because they would like, Aviva, this is too long. We have to shorten it. Like, yeah, but if a woman comes in, she's going to ask this question and they said, well, that's the problem. And the beauty is that because you're a physician and you're actually working with women, not just, you know, how a celebrity writing a book, you already anticipate the next question.

[00:06:05.770] – Dr. Aviva
So I'm glad that came through in a positive way.

[00:06:09.110] – Allan
It did. It did. It's you know, so it's an in it all. It all fit together in a way where, you know, as you're reading through it, it's both informative and then it's this reference guide. You just you put it on yourself and you know, when you start feeling something's going on, a hot flash or, you know, your periods are too painful and you're trying to understand what's going on, pull out this book. And there's a section in the book specifically with protocols for how to deal with that particular issue.

[00:06:37.230] – Allan
So it's like I said, really the most complete book I've seen on this topic. So thank you.

[00:06:43.650] – Dr. Aviva
Thank you. I'm hoping it'll be part self-help, how to and part one of those books that you do have on your shelf year after year and you kind of, you know, this may come up or that may come up and you go to it or you're just going through normal transitions in your life and you just want to hear, OK, well, what can I expect? What can I do? And I kind of have this dream that it's that book that mom's always wanted to actually have something to pass onto their daughters that's meaningful as well. Say, OK, you know, this really helped me.

[00:07:11.370] – Dr. Aviva
And now here it is to really help you.

[00:07:14.140] – Allan
Yeah. I mean, like I said, with my daughter's taking her to the gynecologist, going with my wife, to her appointments and these things, there were things that came up that I want to talk about during the podcast that I was just like, I really wish I knew this going in because I would have asked smarter questions. And that kind of leads me to the first thing is you start the book and you're talking about these tips for dealing with Medicare.

[00:07:37.590] – Allan
And it's so interesting because we don't want to be advocates for ourselves sometimes. And from reading your book and kind of just general knowledge, women especially are kind of put into this. Oh, well, that's just normal girl stuff. You know, go deal with it. But when we go to our doctor, we have to do a few things. Can you talk about those six tips for better medical care?

[00:08:00.140] – Dr. Aviva
Yeah, absolutely. I don't have the six in my book, kind of in my mind in order, but I can give you the tips and why it's so important, you know, on an individual basis. I've really honestly, in all my decades of working in women's health and being a physician and studying with, you know, numerous mentors and through my medical training, I've never met a physician that wasn't well-meaning and well-intentioned and didn't care about their patients.

[00:08:25.190] – Dr. Aviva
But the system of medicine is based on a lot of inherent biases that most physicians never learn about or think about. And a lot of those biases, unfortunately, play out in women's health. One of the biases and it's misinformation is that, you know, as women, it's just normal to have miserable periods to blow through boxes of tampons, you know, because you're having heavy bleeding or to be bent over with period pain or to have to take ibuprofen for a day, a month or three days a month or, for PMS to just make you miserable.

[00:09:01.070] – Dr. Aviva
And then things like chronic pelvic pain, weight gain, depression over things that can have to do with polycystic ovary syndrome, or there are a lot of these biases that end up causing women to go to the doctor and being told by their doctor, oh, that's just normal. And what we're taught in medical school is, OK, it's normal, but let's just give the pill or let's just tell her to take more ibuprofen or let's give her an antidepressant.

[00:09:30.470] – Dr. Aviva
And while those things may be helpful at times, one, they have side effects that are just, you know, unfortunate kind of byproducts of taking pharmaceuticals on a regular basis or even on a short term basis, but they also don't get to the root of the problems, things like chronic inflammation, stress, things that we can change in our diet that we never learned about in medical school. So there's that one set of biases that this is just normal. Just take a pharmaceutical.

[00:09:59.100] – Dr. Aviva
So when you go to your doctor and you ask for something different, hey, I heard about this herbal hey, can I try this diet or I read about that a lot of women get dismissed or an eye roll. And I've had many patients who have been told something like, well, where did you get your medical degree, doctor google? There's this very dismissive attitude. Also, physicians have kind of learned as part of the institutionalization of medicine that we only have seven to 15 minutes to spend with any given patient.

[00:10:31.430] – Dr. Aviva
And so we tend to get right to the symptoms, not really hear what's going on in a woman's life, not really ask the questions. And when a patient starts asking questions, it can really cut into the time that we think we have to get all this information from them. And so patients who start to push back or ask questions or look for alternatives are sometimes labeled as difficult patients. So when you go to the doctor's office and you've got concerns and a lot of women don't even go to the doctor's office for these concerns because they've been treated with dismissal before, or they just think these symptoms are normal.

[00:11:07.430] – Dr. Aviva
But when we do go in, we really need to be prepared and preemptive in order to get the answers that we need. So one of the things that can happen to any of us when we go to the physician's office, but especially to women, is that there can be a huge power differential. Right? You're going in. You're vulnerable because something's going on in your body that you're concerned about. You're worried about. You're already thinking it's the worst thing it could possibly be.

[00:11:34.730] – Dr. Aviva
And now you go in and you go into the waiting room. You know, you're in the waiting room waiting for however long. Then you finally get to your doctor's office and the nurse comes in and says, here, put this on. And it's a little Johnny with the back flapping open and nobody feels empowered. They're wearing one of those, but on top of it, then your doctor comes in and is dressed up in their in their office professional clothes with their white coat and their stethoscope.

[00:11:58.790] – Dr. Aviva
And all of a sudden this power differential becomes really intimidating. So one of the things that I tell people go into the doctor is keep your clothes on until the part where you get the exam, because the first part is usually the talking to. Right, the conversation. Keep your clothes on, have the conversation first, and then when it's time for the exam, you can have your physician step out and get into your Johnny and then get that part done.

[00:12:25.460] – Dr. Aviva
So that really helps you be heard. That's really important. Another thing is before you even go to your medical appointment, write down all of your concerns. Really great like a script card for you up yourself. It can be just bullet points. But when you get into that moment and you're in that power differential, even if you've kept your clothes on and your doctor is clearly in a rush, and we know that on average, medical doctors interrupt their patients after 60 seconds of their patient talking.

[00:12:55.580] – Dr. Aviva
So you've got 60 seconds and then your concerns aren't hurt anymore. So when you're in that pressured environment is very hard to remember to say, oh, well, I wanted to talk to you about this pain I'm having every month, let alone I want to talk to you about this vaginal itching that's really driving me crazy. Right. That's even harder to say. So have your script card there and say to your doctor, I really want I know this is weird, but I really want to use these notes I brought to make sure that I cover all the things that are really important to me.

[00:13:25.590] – Dr. Aviva
Also trying to get all of that squeezed in when you're going in for your annual exam can be really tough because, again, a doctor only has a certain amount of time. They have things they're supposed to check off their list to ask you for their own, you know, medical licensure and all of that to stay safe that they want to ask you, are you depressed? Is this going on? Is that going on? Maybe hard to get to your actual concerns.

[00:13:49.530] – Dr. Aviva
So if you're having a concern that is intimidating, you may forget to ask it. Having that little cue card there with you really helps to make sure you're getting through that. But having an appointment set up separately just for those concerns can really make a difference. Another really important point is to bring an advocate with you. And it sounds like, Allan, you've gone to the doctor with your wife and you're with your daughter to the gynecologist.

[00:14:15.600] – Dr. Aviva
And that's so important for someone to know there's someone out in the waiting room for you. But obviously, it's going to be a little more awkward for a dad to go into their daughter's gynecology appointment with them. But it's really important for women to have someone there, especially if they get intimidated in that setting who can kind of elbow them and nudge them and say, remember, you wanted to ask your doctor about that. It just gives you a lot of confidence and support and it makes sure that you're getting your concerns heard and your doctor's more likely to be on their best human behavior if there's someone else in the room as well paying attention.

[00:14:52.740] – Allan
There was one thing, though, that you put in there that I think was really important for the men to consider here is that there is this power structure you were talking about, and we need to be an interference to that and making sure that our wife or girlfriend is being heard versus being in there and saying, but the doctor said, suck it up. And, you know, that's not the approach we want to have. But sometimes you end up on the wrong side of the fence defending the wrong issue.

[00:15:22.120] – Allan
So go in there with your eyes open, know what your wife or significant other know what they're dealing with so that when they're asking the questions, all you really want to know, the doctor is hearing her. And then is giving a response, and she's thinking the response is reasonable based on her experiences, because you're not experiencing that. So that's really, really important to not..

[00:15:45.920] – Dr. Aviva
Yes, in the book. I talk about being careful about bringing in a male partner, especially if it's a male doctor, because it's so easy for the bro thing to happen.

[00:15:54.650] – Dr. Aviva
And the male doctor is like, you know, giving you the look like, yeah, right. She's got this PMS thing going on. I bet it's driving you crazy too like all the like the inside joke stuff. And I've seen it happen. So your point is so important and I talk about that in the book, which is like don't let the bro thing happen. Your job is to be there for her or your partner and to validate her and make sure she is heard and not to, like, partner up and take sides with the doc.

[00:16:21.040] – Allan
Now, there are a few things that you said in the book, and I was like, you know, just they just hum to resonation, as you were saying. And the first thing you said that I thought was just really important for people to hear is that hormones are messengers. If they're not there just in a certain amount at a certain time for just no reason at all, they're there to do something very specific and sometimes not having enough of them or having too much of them is a signal to our body that something else is wrong, not that we need more of something added just to balance it out or there's something going on in our system that's causing that imbalance.

[00:17:02.530] – Allan
And that's what we want to get to the root of.

[00:17:04.840] – Dr. Aviva
Exactly. So hormones literally, as we define them in medicine, are chemical messengers. And I jokingly I think they say someone, don't shoot the messenger. But as women and as men, we're always like, oh, she's hormonal. I'm hormonal. Like, we blame it on the hormones and the hormone imbalances. Or in the worst case scenario, as women, we blame ourselves like there must be something wrong with me or I must be doing something wrong because I feel like crap for my period every month or I feel, you know, doubled over in pain because of my endometriosis.

[00:17:37.900] – Dr. Aviva
And so instead of blaming our hormones and shooting the messenger, what is it that these imbalances, these symptoms are trying to say to us as a reflection of that there is an imbalance going on, like what is the message happening with PMS? What is the message happening? Why are you having these painful periods? And that kind of starts to get under the hood of what some of the answers are to then starting to solve some of those problems?

[00:18:09.190] – Allan
Yeah, I don't think we can get to the answer unless we're actually looking at the problem. And the problem is not the symptom. The problem is, is the underlying issue. And then the other thing you had in there that I think is just really important to take home is that, you know, more and more, yes, doctors will just say, you know, take this pill, get on antidepressants, do this thing, or let's get this hysterectomy, because it's so common that the issues that we're talking about are so common with women.

[00:18:35.410] – Allan
But common doesn't equal normal.

[00:18:38.520] – Dr. Aviva
Exactly, you know, when there's a saying that if all you have is a hammer, you see everything as a nail. And I can tell you from having spent seven years in medical training that we are basically never taught to do anything but give pharmaceuticals and do surgeries when it comes to pretty much everything in women's health, whether it's fertility, something going on in pregnancy or birth, whether it's a mental health problem, another gynecologic problem or menopause.

[00:19:11.790] – Dr. Aviva
And I'm not, you know, as I say, so open mind that my brains are falling out. I think there's an absolute time and place for a pharmaceutical and a medicine and a surgery. And, you know, I think it's also important to meet women where they are. If a patient comes to me and she's like, I really just want to take the pill from my PCOS acne, I'm not going to judge her or withhold that. I'm going to say, look, I just want to make sure you understand the ramifications of taking this.

[00:19:38.730] – Dr. Aviva
And would you be open to possibly trying these things first or instead? To me, it's you know, it's like if you had to kill a mosquito, you wouldn't get out a cannon, you would use your hands or get a swatter or something like that. Hopefully I'm not offending any Buddhists or someone who doesn't kill mosquitoes. But point being, we tend to go after symptoms in medicine with the biggest guns rather than looking at what can we do to maybe reduce stress or shift the diet or add in a particular supplement.

[00:20:16.080] – Dr. Aviva
And there's so much judgment in medicine, all those things don't work. But that's not actually true. Not everything that's touted out there in the natural medicine world works. But there are actually some substantial interventions that are natural, that have been shown to be phenomenally effective. And so most it's like, well, try that first and then if we need to progress to this, that or the other, we always can do that.

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[00:22:49.550] – Allan
My wife was really having some heavy periods and in a lot of pain and, you know, a lot of women will think, OK, that's just normal stuff because it's just so common. But hers was not normal.

[00:23:02.480] – Allan
And we you know, we went into the doctor and, you know, the doctors kind of like, well, you can be on the pill. That would help. And then we finally opted for the ablation. And so she went in for the ablation surgery. And I got called into the room because the doctor was surprised by a fibroid that she ran into while she was in there. And it startled her a little bit and being startled, she startled my wife then my wife is under, you know, a little bit of sedation.

[00:23:28.100] – Allan
So she's not completely there. So they brought me into the room to discuss this. You know, that there's a fibroid, that there's nothing wrong that's normal. It's there. We knew about it, you know, just. It was there. Again, had I known about fibroids and what they're indicative of, I would have started asking a lot more questions. But I didn't. I didn't have this book back then. And so I want to kind of talk about fibroids a little bit because we just went through now having to have that fibroid removed with a hysterectomy because it had gotten so big.

[00:24:04.610] – Allan
It was scary big. When I actually saw the picture was, wow. We even named it Elmer because it was so big. Can you talk a little bit about fibroids and what as an outward symbol of fibroid would indicate is going on with us or with the woman? I'm sorry.

[00:24:26.210] – Allan
Yeah. So, you know, there's sort of like these meta levels of things, right? So fibroids are a result medically of high levels of estrogen. Women post menopause. Once our estrogen levels go really down, fibroids tend to shrink on their own. And we don't have fibroids before puberty because there's no estrogen feeding them. So fibroids are a result of high levels of estrogen and then usually a result also of something called insulin growth factor and other growth factors, which can happen as a result of a little bit of insulin resistance.

[00:24:59.810] – Dr. Aviva
It can happen as a result of just other hormonal imbalances. And so that's the meta level of there's too much estrogen, usually too much insulin like growth factor and maybe some insulin resistance. And then cortisol may play a role in triggering stress hormones that actually feed the fibroids as well. So catecholamines may feed the fibroids and that those are breakdown products of adrenaline and stress. And so that's sort of like the immediate medical. We know that from an upstream perspective physiologically or pathophysiological.

[00:25:34.370] – Dr. Aviva
We know that. And then there's sort of like the next level question is, what's causing those things? Why did your wife have high levels of estrogen? Why might she have had elevated levels of insulin like growth factor? And then we started to get to even a level above that, you know, as upstream as we can go, if you will, which is we know that environmental chemicals, herbicides and pesticides, for example, or plastics that leach out of our Tupperware's that we all ate out of growing up or may still out eat out of.

[00:26:01.100] – Dr. Aviva
Now, the plastic water bottles that were so popular in the 80s and 90s that we were all drinking out of. Our cosmetics and these things where you may just be getting nanoparticles like the most tiny little particles of these different environmental chemicals, but they act as estrogen disruptors. So they actually are contributing or adding to our estrogen load. And when you think of tiny little nanoparticles, well, you only have nanoparticles of estrogen anyway. It doesn't actually we don't have that much.

[00:26:31.810] – Dr. Aviva
It's is very potent. And when it finds to our receptors so environmental triggers can cause these high levels of estrogen, chronic stress can cause those high levels of stress hormones. And it's not that your wife is necessarily some stressed out person either. It's just the chronic normal stressors that we're all facing 24/7. And then there are a lot of dietary factors. One, the packaging that our food does come in which leaches plastics into it. But also most of us aren't getting the amount of fiber we need.

[00:27:04.340] – Dr. Aviva
You know, paleo diet was really popular and it still is. And it's not something I subscribe to necessarily. But we do know that our paleo ancestors got about 100 grams of fiber every single day. We know from the American Cancer Society that we should be getting thirty grams of fiber a day just to prevent colon cancer, like just basic good health for colon cancer prevention. The average American is getting fifteen grams of fiber a day, but fiber is critical for maintaining estrogen balance.

[00:27:33.020] – Dr. Aviva
So there are a lot of factors that go into why so many women are experiencing fibroids. Then from a medical level, there have been some really significant studies looking at how women with fibroids and other gynecologic concerns, heavy periods, et cetera, even women in their late 20s and 30s, let alone in our 40s and 50s, go in for treatment. And particularly fibroids is one big area. This happens and end up with a hysterectomy without their doctor ever providing them with the list of alternatives that they can and should be able to do long before surgery.

[00:28:14.570] – Dr. Aviva
And when I'm talking about alternatives, I'm not talking about herbal medicine or detox or something like that. I'm talking about pharmaceuticals. So one study, for example, done in the state of Michigan, and it was a multicenter study, meaning they looked at patients, they gathered data from patients at five different major medical centers. And aggregated that data and found that only a small percentage of women who were going in for a fibroid or another reason for a hysterectomy that was non cancer, cancer would be an appropriate reason, but only a small percentage were ever told that there were other medical things that they could do, including medical things they could do to shrink the fibroid, so that if they did ultimately still need to go into surgery, they can have the fibroid removed and not their whole uterus removed.

[00:29:03.070] – Dr. Aviva
So there's a lot of lack of knowledge among physicians that there are alternatives. And not to be callous, but I am a doctor, so I'm speaking for my own profession. There's a huge amount of financial incentive to choose to do a surgery over recommending a pharmaceutical. It just it's night and day when it comes to what ends up in your pocket at the end of the day. And it's not just your pocket, but it may be the hospital you work at gets much more money from you having more patients get surgery so that there's a lot of incentivization that's built into the system that we don't really

[00:29:42.980] – Dr. Aviva
Think about or know about as individual patients, and it sounds almost conspiratorial when I talk about it, but it's actually very real. So, you know, it comes back to what we were talking about before, which is how do you manage your own medical care? How do you be the CEO of your own health? And I think it's really tough. You know, I think as women, as human beings, we shouldn't have to be. We should be able to go in.

[00:30:08.120] – Dr. Aviva
You know, when you go to your car mechanic, you don't have to know everything about your car to make sure your car gets cared for properly. You don't have to research about your carburetor. You hope that your mechanic knows what they're supposed to do and does it. But when it comes to heavy bleeding and whether you should get that hysterectomy or not, first of all, it's terrifying because sometimes the word cancer is tossed in there even when there's no cancer.

[00:30:33.200] – Dr. Aviva
But like, well, if you do it now, then you have to worry about cancer later. Well, OK, I'll take that. I'll take door number three, you know, and if you're not told that you can use Generation inhibitors or other pharmaceuticals to shrink a fibroid, how are you supposed to read that? You know or learn about that one? Half the words aren't even that pronounceable. And there's so much noise on the Internet.

[00:30:57.410] – Dr. Aviva
Where do you even go and trust? So I think it gets really the burden ends up falling on the person who's got the problem to sort it out. And then you go to your doctor and you're like, well, can I try this medication first? And they're saying, well, where do you get your degree, doctor google? You end up just shutting up and going in for the surgery. And I'm not saying that the surgery is wrong.

[00:31:16.220] – Dr. Aviva
I've sent patients with fibroids and for hysterectomy too at times, you know, they're just they're anemic. They're exhausted, they're bleeding. They're peeing all the time because the fibroid is so big, it's sitting on their bladder or sitting on their bowels and they're constipated. Sex hurts. They have pelvic pressure all the time. So there's a time and a place for sure. It's just that we're jumping to that as step number one when it should be step number five.

[00:31:39.710] – Allan
Yeah, and that's one of the cool things about this book, is it does give us some tools to understand the problem. Better to ask the right questions and know that there are alternatives because you discuss them very clearly in the book. The other one I wanted to get into because, you know, women were in their 40s and their 50s. They go through this period of time. It can be three years. It can be eight, almost 10 percent, I guess.

[00:32:01.910] – Allan
But it's this perimenopause period of time, and it's when things are changing. And you said you said something that was just actually kind of kind of funny and little brilliant when you said we should celebrate that the same way we celebrate puberty. It's another phase of life. It's an interesting phase for a lot of women. And as you kind of put it, it's that point where, you know, I don't want to use language, but just we don't have you can kind of let go a little bit.

[00:32:32.300] – Allan
You're wiser, stronger, more powerful person. And you can own this. You can own this process. Can you talk a little bit about perimenopause, some of the basics of how someone should approach this and what they should be looking for as far as if things are going well or not going well?

[00:32:52.160] – Dr. Aviva
Yeah, so you know, as young girls, right, were 11, were 12, I mean, it may be a little intimidating to go through puberty.

[00:33:01.400] – Dr. Aviva
And it can feel like a roller coaster, of course, but we're excited because we're becoming women. It's something we look forward to. It gives us new privileges in our life, new things that we're allowed to do. And then so that's one big life transition. Then when we become mothers, that's hopefully celebrated. You know, you're welcomed into the Mom Club when you hit perimenopause. You know, the way it's described in our culture. You know, just because our estrogen is declining doesn't mean we're going downhill.

[00:33:33.290] – Dr. Aviva
But it is like it's been described as over the hill. Well, the only thing over the hill is downhill. Right? Our grandmother's house, I guess. But it's downhill. And we're historically considered not sexy anymore. Not fertile anymore. Kind of washed up. Now, I think that so many women are changing that paradigm. You know, when you think about it, like Halle Berry, Jennifer Lopez, Julia Roberts, I'm just thinking of a few women like women who would sort of.

[00:34:04.580] – Dr. Aviva
Penelope Cruz and Salma Hayek, I'm just saying, you think of the women who we would undoubtably you'd have to be blind to not think they were hot, sexy women who are still considered hot, sexy women who are now in their 50s. And I think about thinking about it that way. The paradigm is changing and half of women in the US are now 50 or over. But internally, psychologically, and have just gone into menopause myself a year ago.

[00:34:31.040] – Dr. Aviva
So I'm solidly on the other side of it. I'm turning 55 this year. You know, if I could curse, I would say it was a mind, something that starts with an F to go through menopause. In our culture, we don't necessarily have that. Oh, now I'm a woman or we don't necessarily have that. Now I'm a mom to look forward to. It's like now I'm what fifty five are now I'm older and I'm middle aged or, you know, all that stuff.

[00:34:57.560] – Dr. Aviva
And now nobody's looking at me. They're looking at my daughter when we walk up the street together. So you really have to be willing to embrace a new way of thinking about your body, a new way of thinking about yourself. And it's also a time in women's lives where their life definition may be changing. Right. It's a time when often our children are finally going off to college or depending on how old you are getting married or having their own children.

[00:35:25.320] – Dr. Aviva
So now you're not just you, you're grandma. And that can really start to affect your self concept if we think about a certain age in a very old fashioned way. But if we think about going through this transition, as Helen Mirren has a quote, which I said in my book, which is basically, you know, if there's and she's in her 70s, you know, if there's anything I would tell my younger self is to not give enough a lot more often.

[00:35:52.130] – Dr. Aviva
And I think there is something liberating about walking into this phase of our life, feeling really empowered and looking at what we've accomplished and looking at all the met, you know, the sort of like massive skills we've accumulated at this point. And often, you know, that maybe you were a stay at home mom and now your kids are grown and you have major, you know, social management skills and time management skills and you've raised adult human beings.

[00:36:18.260] – Dr. Aviva
Or it may be that you're at a certain point in your career, which may be quite accomplished at this point. And I think that we're also at a stage where because we're not sexualized in the same way, it does give us room to redefine what sexy means to ourselves. And what does that mean to be sexy for myself? What does that mean in a bigger context of life? It's not just about reproduction, it's about actually full ownership of ourselves.

[00:36:44.150] – Dr. Aviva
So I think if we can embrace this new experience, it can feel really empowering. And so then if you are going through some physical symptoms, they're easier to appreciate. But interestingly, some studies from the sociology and anthropology world have shown that when we enter menopause with more embracing attitudes about it, we actually have fewer physical symptoms. And we also know medically, when you have more stress, which can happen from being really stressed out about your stage in life, we have more hot flashes.

[00:37:17.060] – Dr. Aviva
So it's a win win to to reframe this time of life. How do you know things are going well? Well, when we enter perimenopause, we can start to have really irregular cycles. And as you shared from the book, you know, perimenopause can happen for up to eight years before we're going into menopause. So from a medical perspective, you shouldn't enter menopause before age forty two. If you do, that's considered premature or early menopause and that can have some medical consequences.

[00:37:45.590] – Dr. Aviva
You might need hormone therapy to support your bones in your heart, etc. But any time in your 40s that you start experiencing some changes in your menstrual cycle, which can be you skip some periods once in a while, your periods get further apart, your periods get lighter, they may be heavier on occasion. That's actually all normal. You may experience some more mood changes that may hearken back to when you were a little bit, you know, in puberty, your hormones are going up and down.

[00:38:18.170] – Dr. Aviva
You may just experience some different shifts. You may have PMS when you never had it before. As estrogen drops, you may even experience migraines if you've never had them before. Any symptoms that you're having then are mild, not really interrupting your life. And you're kind of going, huh, that's a little different is usually a normal symptom of menopause, which shouldn't be happening is miserable hot flashes day in and day out or hot flashes waking you up all night or several times a night.

[00:38:47.360] – Dr. Aviva
Anything that's making you not sleep all the time and exhausted, you should not be having, heavy like, you know, just gusher menstrual cycles. You shouldn't be having really, really heavy periods. You shouldn't be skipping periods for more than a few months in a row. Until you actually get into the year where you're going to stop, so menopause is actually defined as one year of not having a period. So let's say you don't have a period for eight months and then you have a little vaginal bleeding.

[00:39:16.490] – Dr. Aviva
You're not in menopause. It starts over again another year. But once you've not had a period for a year after that, you shouldn't have vaginal bleeding. So if you have vaginal bleeding after that, it's important to go to your gynecologist or your family doctor and nurse practitioner and get a workup to make sure everything's OK. You know, if you're experiencing extreme depression or depression, that's just getting in your way of your life really significant sleep problems. It's normal to gain five pounds in perimenopause, menopause, our estrogen, the kind of estrogen we're producing most of our lives, shifts to one that has less metabolic activity.

[00:39:55.490] – Dr. Aviva
So we might put on a few pounds, but the symptoms, they may be they may get your attention, but they shouldn't make you miserable. If they're making you miserable, then there are things that you can do about that, whether those are natural therapies or whether they're pharmaceuticals to help you get through that time. And I think, you know, another thing is some women experience a little bit more vaginal dryness and so that can interfere with sexual pleasure or wanting to have sex.

[00:40:23.620] – Dr. Aviva
So if a person is in a partnership, it's really important to be having those conversations and it's really important for partners to be incredibly understanding. You know, I really had to talk with my husband. We've been together for thirty seven years now and I really had to explain to him, look, my self perception is and I didn't have like really significant physical symptoms, but my self perception is really changing. And I need you to understand that this is hard.

[00:40:53.540] – Dr. Aviva
There's some part of me that is mourning and grieving, being young, the way culture defines being young and my kids are grown. I've got grandkids, you know, it's just different. And I need that deeper level of support and understanding. You know, in our culture. I mean, you can age as a man, you can be bald as a man. You can be short and squat as a man. And you can still be you know, I always remember what was Dudley Moore with Bo Derek.

[00:41:25.040] – Dr. Aviva
I'm old enough to remember Dudley Moore was Bo Derek, and he's this five foot tall, you know, average looking guy who's with this, you know, ten, right? That's what she was ten. I think it was Dudley Moore. You know, we see that. But in our culture, women were just treated differently. The standards are different. So as we go through physical changes our skin, changes our hair changes, our facial structure changes, our bodies change, it can be really tough.

[00:41:50.640] – Dr. Aviva
And so having a lot of self compassion and having your partner be really supportive is so critically important for this time. And yes, have celebrations, you know, I mean, do it on Zoom. Do it with your girlfriends, you know, buy yourself that thing that you wanted as you enter menopause, you know, the way you would celebrate your daughter getting her first period or your daughter having her first baby do some special things for yourself.

[00:42:14.680] – Dr. Aviva
It's I think it's really a beautiful thing to do.

[00:42:17.760] – Allan
Dr. Aviva , could you take just a moment and walk us through your six week hormone intelligence plan? Because I really like some of the lifestyle things that you have in there as far as a way to support women's health as you go through and actually many of those things are things that men should be doing, too, but..

[00:42:34.620] – Dr. Aviva
Peopla ask all the time can men do your books. And I'm like, absolutely, you have gonads. We have ovaries.

[00:42:40.350] – Dr. Aviva
And a lot of the environmental factors, the dietary factors, the stress factors, they're affecting all of us and people who have a uterus, who don't identify as who, you know, who are men. So we're in a time with gender fluidity so anyone can really use the book. And I've had men who, with my last book, Adrenal Thyroid Revolution, did the book with their partner, which is great because it's supportive for the woman doing it.

[00:43:04.620] – Dr. Aviva
But men get phenomenal benefits. So, yes, you can. And so the six weeks are based on six, if you will, root causes or things that we can do and look at supportive areas. So the first thing is it starts with what we eat because what we eat is such low hanging fruit and our diet can be one of the most phenomenal things that we do to support our hormones and our overall health. So the diet is really very simple.

[00:43:31.890] – Dr. Aviva
It's based on a Mediterranean style diet, which all evidence shows is the best thing we can do for ourselves in terms of eating. And it's not restrictive. It's based on eating plenty of plant based foods, but also fish very low on red meat. I'm not opposed to eating red meat, but we know that red meat can contribute to inflammation that can contribute to period pain and Demitrius as chronic pelvic pain, et cetera. So it's good quality protein, mostly plant based, but also fish and poultry, lots and lots of vegetables, nuts and seeds, good quality fats, very simple.

[00:44:08.400] – Dr. Aviva
And like five weeks of meal plans that come with the books of the recipes are done for you. And they're really, really wonderful. I mean, I created all of them except for two that I asked permission to use, but they're all from my own kitchen. I love to cook and they're just formulated to be really great for our hormone health. The second part, the second and the third week, are based on our stress response and sleep and circadian rhythm, which are interrelated.

[00:44:35.580] – Dr. Aviva
So we know that stress has a huge impact on our hormone health. It also makes our lives not as fun and wonderful. So there are some really actionable, straightforward tips. And, you know, I know we're all busy human beings. We don't have time for a crazy, complicated plans. So it's really simple things that you can add into your everyday, like spending a little less time on Instagram before you go to bed or checking your email before you go to bed or just adding in five minutes of breathing exercises.

[00:45:03.870] – Dr. Aviva
When you wake up in the morning, it's getting out in nature once in a while. It sounds very simplistic, but it's really simple shifts that I know women can incorporate because I work with women all the time that do actually make a difference. And then with sleep, it's about how we get better sleep and why we need better sleep. There's a chapter on gut health. The relationship between our hormones and our microbiome is phenomenal and fascinating. And it's how you can use your diet, your stress release, your sleep, but also very specific things that we can do for our gut to get our gut working for our hormones.

[00:45:40.470] – Dr. Aviva
And also, 90 percent of women have some gut symptoms, whether it's IBS, constipation, gas and bloating, premenstrual bloating. So it's specific tips to get all those things in line as well. Then there's a chapter on detoxification, not like a juice cleanse or detox, but actual how do we use our diet and supportive supplements and botanicals to make sure that our liver detoxification pathways are working optimally? Because that's where our hormones, after we've used them and the ones that we pick up from the environment that I talked about earlier get broken down and packaged for elimination.

[00:46:19.440] – Dr. Aviva
So we're literally enhancing our bodies are supporting our body's ability to do that. And in each of these chapters, I talk about, well, why are these things not working optimally? What is it about our world that's affecting each of these? And then the last of the six weeks is really novel specifically to my book, which is how to support our ovarian health and our ovarian function. So we're supporting how the ovaries literally work through mitochondrial health and how that can help us have an easier, healthier menopause, easier, better fertility, but also more normal and regular cycles throughout our reproductive years because ovulation happens there.

[00:47:00.720] – Dr. Aviva
And then the book then has a whole separate section, which is advanced specific protocols. So you do the core plan, but then let's say you do have endometriosis or uterine fibroids or you do get urinary tract infections all the time or you do have PMS. There are also very targeted plans that you can add in to the core plan to help you with those specific conditions and symptoms.

[00:47:25.810] – Allan
So, Dr. Aviva, if I define wellness as being the healthiest, fittest and happiest you can be, what are three strategies or tactics to get and stay well?

[00:47:37.540] – Dr. Aviva
Well, I think, one, as women, I think we can start to think that we're not healthy people. If we have fibroids, if we have PMS, there's something wrong with us. So the first thing I think to get healthy and fit is to actually recognize that you are not defined by your symptoms, that you are healthy, your body is doing the best it can. And so really reminding ourselves every day that my health is not defined by this, that I can be a healthy person with my attitudes, with choosing things that make me happy.

[00:48:09.550] – Dr. Aviva
And then I think the next thing is something that a psychologist that came in and taught us when I was in medical school said to me, I've been a psychologist for like 50 years, and it was such simple wisdom. He said, figure out what you love and do more of that, figure out what you don't love and do less of that. And I mean, obviously, we all have to pay our taxes and, you know, we go in for our pap smears every five years.

[00:48:32.500] – Dr. Aviva
None of us loves that. Those are the things that we have to do. But what are the things in our life that are just making us miserable that we can actually take off of our To-Do list? And what are those things that you know, that make you happy that you're always putting on the back burner that you can just do more of? And it can be picking one thing from each category. You know, I really, really don't love X, Y, Z.

[00:48:54.910] – Dr. Aviva
I don't love getting together with those people every week. So I'm just not going to force myself to do that anymore. But what I really love is dancing to loud music, and I hardly ever do that. So I'm going to put it in my calendar that every day for ten minutes I dance to loud music. So, you know, whatever those things are for you. And then the third thing I would say, and it's kind of almost like a take your pick, either add in a little bit more exercise, a little bit more time in nature, making sure that you're getting better sleep.

[00:49:23.950] – Dr. Aviva
You know, there's sort of this smorgasbord of things that are really important for daily basic wellness and just start with one, but then aim to do a few. So if you're not getting seven hours of sleep at night, aim to get those seven hours, if you're not exercising or moving your body, figure out how you love doing that and do it. And it can be a walk. I just bought myself a hula hoop. I bought myself a two pound weighted hula hoop.

[00:49:49.750] – Dr. Aviva
I can I tell you, I'm laughing my way through my exercise. And apparently thirty minutes of hula hooping, which goes by in a minute, if you put on great music, is equivalent to like thirty minutes of salsa dancing or other aerobic, gentle aerobic types of exercise but solid gentle aerobic types of exercise. So I think those are three things. Yeah. Love yourself, do more of what you love, less of what you don't love, and add in some healthy habit that you really make a commitment to good sleep, good exercise, good eating, any of those.

[00:50:24.670] – Allan
And all that. Get this book.

[00:50:29.110] – Dr. Aviva
Yes, that would make me happy and healthy.

[00:50:30.880] – Allan
It will definitely make them happier and healthier because there's a lot in here. Dr. Aviva, if someone wanted to learn more about you, learn more about the book, Hormone Intelligence, where would you like for me to send them?

[00:50:42.220] – Dr. Aviva
So to learn more about me, go to avivaromm.com. Tons of free resources for you. I mean, you can spend hours in there learning things, enjoying things, finding great recipes of delicious foods to make and learn about me. If you want to learn more about the book, go to avivaromm.com forward slash book. That's the easiest way to find out about it. And that's right on my website. So you can still link over to all the good stuff and then also my Instagram, just avivarommmd. I'm on there a lot and put up, you know, I try to always like add a lot of value to my Instagram.

[00:51:14.710] – Dr. Aviva
So it's fun stuff, informative stuff, moving stuff, empowering stuff. Those are the main places to come hang out with me.

[00:51:21.750] – Allan
You can go to 40plusfitnesspodcast.com/490 and I'll be sure to have links there. Dr. Aviva, thank you so much for being a part of 40+ Fitness.

[00:51:31.210] – Dr. Aviva
Thank you so much for having me, Allan. This is a pleasure.

Post Show/Recap

[00:51:40.260] – Allan
Welcome back, Raz.

[00:51:41.640] – Rachel
Hey, Allan, wow, I don't even know where I want to start with your interview with Dr. Aviva, but I do want to highlight and amplify her six tips for dealing with medical care, because as she read off every one of those six items, I was just nodding my head, shaking my head. I think I've experienced every single one of those situations, which is an unfortunate situation.

[00:52:06.450] – Allan
It is. I mean, you know, we grew up kind of in that I would say we're in that gap, the nexgen gap, you and I are. And so for us, we're a trust but verify kind of people. And so we're not as maybe as likely to believe the white coat means the world than maybe the generation before us was. And why not? So, yeah, when a doctor walks in and says, you have to do this, you know, I think particularly when I was younger, I know the answer was absolutely doctor.

[00:52:38.250] – Allan
But then as I got going, I started realizing, OK, he's the guy who I went to medical school and yeah, he's preg ty smart. But I actually have to answer some of these questions myself. You know, I remember going in and I mean, I had no money whatsoever as a kid, young guy going into the doctor. And I had these moles and I went in and I said, OK, you know, these moles on my back.

[00:53:03.060] – Allan
And I said, they keep coming off when I'm playing football and I'm bleeding all over the place. He's like, yeah, I guess I could burn them off, but they might come back when it was five dollars each to burn them off. And I mean, I had hundreds of these. So there's been a whole lot of money. And then he's like. So I said, you really can't tell me what's causing it or what I could do to make it go away.

[00:53:21.660] – Allan
And he said, no, I'm like, OK. And then I walk out and give the nurse fifty seven dollars and I'm like, you know, and I'm fifty seven dollars now doesn't sound like a whole lot. But then that was, that was a week's worth of pay. I mean that was a lot of money when you're making 3.25 an hour giving someone 57 dollars to just tell you I can't help you.

[00:53:42.480] – Rachel

[00:53:44.250] – Rachel
It's disappointing.

[00:53:45.810] – Allan
It is. So but that was actually probably a really valuable lesson to say, OK, you know, I'm going to have to make decisions for myself. I can't rely on the doctor to know everything. And I can't rely on the doctor to tell me what to do. I can ask the doctor questions and then I have to make the right decision for myself. And the right decision was to just let football keep taking them off, which it did.

[00:54:15.390] – Allan
so it's a pain as each one got ripped off my back as I was playing football. But it, they came off and they didn't come back. So that was the good thing. And I didn't have to pay five dollars apiece. I got to play football to do it. But you know, but it was fine. He just he said, you're not in danger. You're not you know, it's sometimes it seemed like it with a white jersey, like I was going to bleed out.

[00:54:38.280] – Allan
But in a general sense, it was just, you know, a little bit here, a little bit there. And it was not that much pain, but it was pain and it was what it was. But it was over, you know, and so they were gone. And so I think, you know, even though that's not relative directly to women's health, it's just one of those things to say the doctor can give you information.

[00:55:00.380] – Allan
and then you have to process that information, and if what the doctors told you doesn't answer all your questions, you have to ask those questions. That's going to be a normal thing for all of us.

[00:55:12.110] – Rachel
That is true. I also like Dr. Aviva's analogy where she mentions when you take your car to the mechanic, you're not a mechanic. You're trusting your mechanic to tell you all the things that might be wrong with your car. And then you make the decisions and what you need to do. And similarly, you know, I didn't go to medical school. My doctor went to medical school and she's got years of experience with patients. And the interesting thing about women's health is that we literally have generational levels of data regarding menopause and perimenopause.

[00:55:45.980] – Rachel
This has happened to every single woman for a really long time. So you would think that there would be a whole ton of data in that you would think that it would be a lot easier to figure out what's going on when it's going on. But it still seems to be a mystery.

[00:56:02.090] – Allan
Well, for one very, very important reason. And this is the key. This is the magic bit. We're talking about hormones.

[00:56:12.020] – Rachel

[00:56:13.280] – Allan
OK, and your hormone profile is different from every other woman that's ever gone through perimenopause. It just is. OK, you're a long distance runner, you eat a certain way, you sleep a certain way, you have stress, you're in a certain part of the country, a certain part of the world. You're exposed to different toxins than other people might be less than some more than others. So your hormonal profile is slightly different than everybody else.

[00:56:46.470] – Allan
And as a result, your experience of all of this will be different than other people. Now, within a range of opportunity. So perimenopause, as it goes, tends to have some similarities. And that's where you kind of start looking at it. And that's why some of the things we got into, you know, like fibroids and those types of things is like, what are the things that if this were happening that a woman should

Consider or be concerned about and so it's not so much comparing yourself against another woman. I don't understand, she went through perimenopause like it didn't even happen. She popped into menopause. Bouncing around. And, you know, she's my running partner and she didn't have any of these problems that I'm having. So what's going on? Well, you're different. Have a conversation if she's available, have the conversation with your mother, because genetically, she's probably the closest individual that you have.

[00:57:45.720] – Allan
If you have older sisters, they're a good source of information for you to have conversations about what their experiences were because, again, they're genetically similar to you. So there's likely to be some overlap in how you are affected. But beyond that, where you really want to spend your time and this is what was in Dr. Aviva's book is comparing yourself to you.

[00:58:09.720] – Rachel

[00:58:10.800] – Allan
You know, if things are changing. So if your flow is a little heavier now or you're experiencing a lot more PMAs or things like that, well, those changes are indications that something inside is changing. Something in your hormone structure is changing. And there are some some remedies and things that you can do that are natural and there are some that you definitely need to be speaking to a doctor about and those that's going to be the information that you process.

[00:58:43.760] – Allan
So you go into a doctor's visit with the right questions.

[00:58:48.860] – Rachel
I think it's been about two years I've been dealing with changes. I'll be turning 50 in July. So that's right around the corner. So for the last couple of years, I've noticed a whole lot of changes. I was on birth control that wasn't working, changed it. It's not working. I've been seeing my doctor different hormonal changes and fluctuations. I also had the ablation procedure pretty recently. So, yeah, it's been helpful to keep a journal of what happens to me every month.

[00:59:24.830] – Rachel
And I write everything down. I write down the days that I'm moody or craving chocolate, all the classic symptoms. I have bad cramping days where I just can't seem to get anything done and which is all strange. And this is why I want to mention this, is that this has been a notable change in my life, which means something's different. And so when I go to a doctor and I say this is not right for me, something is going on right now, then they can help me pinpoint, you know, what blood tests do I need to do?

[01:00:01.400] – Rachel
What hormone tests can we get done? And the more information I can give my doctor, the better she can prescribe a remedy. And that's how it's been going for the last two years. And perimenopause is one of those things. It's not an overnight situation. It's not like you got the kind of colds. You take some antibiotics and you'll be done in a week. This is a very long process, a very long hormonal change.

[01:00:25.370] – Allan
Yeah. I mean, because it can go on eight, ten years. Someone can go through a little quicker, but it can be up to eight to ten years is where I think most of that kind of falls, that your body's just changing its hormone profile. You're getting past your reproductive years and you're moving into the next phase of womanhood. And much like, you know, I've had several women on. But it's somewhat you know, it's just a moment for you to celebrate that you are who you are and, you know, you've had children.

[01:00:57.410] – Allan
And so it's like now, you know, you're you're moving on to a phase where, you know, they've got some college to do. But then I'm assuming that there's probably some grandbabies like the third, mike the third coming out.

[01:01:10.610] – Rachel
Fingers crossed.

[01:01:13.190] – Allan
You know. And so that's just kind of this is a transition in life. But that said, you deserve adequate medical care. And the way you get that is by educating yourself and then not so much depending on Doctor Google, but with the information that you're able to kind of understand.

[01:01:32.830] – Allan
Having an empowered conversation with your doctor.

[01:01:35.740] – Rachel
Yes, yes, that's perfect. I think do your Google research, ask your mom, ask your aunts, go online, see if any of it makes sense to you, and then ask the professional, ask the doctor for added insight. And if you're not happy with your doctor, it's time to change. If you're not getting good answers, it's time to change. There's got to be somebody out there that can help you.

[01:02:02.650] – Allan
Yeah, and I've had doctors that I'd meet with and we'd have some conversations and then I'd be like, oh no, he doesn't get it right, you know, or I don't get him. And therefore, if I don't feel like he understands my situation well enough or is taking it to the right level of seriousness, then I'm like, OK, I have to move on. Yeah. Because I, you know, for most of you know, the last I'd say 10 years or so, 15 years maybe I've been more concerned about well care than sick care.

[01:02:34.420] – Rachel
Well, yeah.

[01:02:35.050] – Allan
When you try to make an appointment with a doctor and they're like, OK, what's the problem. And I'm like, I don't have one. I just want to I want to get these labs. I want to get labs done. I want to sit down, talk to you about them. And they're like, well, OK. But I don't you know, it's like they know they don't have time to sit down and talk to you about your labs.

[01:02:56.860] – Allan
so what they're really going to do is they're going to sit there and say, OK, what's high, what's low? OK, you need to be on a statin. And your blood pressure was a little high this morning. And, you know, so maybe we need to watch that. OK, and how much are you going to bill me for that? and it's more than fifty seven dollars

[01:03:18.280] – Rachel
in this day and age. It is, that's for sure. But the other thing I want to mention too, is, like you just mentioned, cholesterol and and statins is that there is a bell curve like most people have certain levels of iron in their blood or certain cholesterol levels. I mean, we all know what cholesterol means. But just because your numbers are high or low or in or out of that bell curve doesn't mean that they're not normal. I mean, my iron is always low, which means I'm usually fatigued.

[01:03:50.620] – Rachel
It's in the healthy range of iron, but it's always on the low side of the healthy range. So I still will take an iron supplement to fix that because that's what I need. And going back to where all individual, that's just another one of those examples.

[01:04:06.640] – Allan
Yeah. And that's one say you just you know you and then that's kind of your job. Number one, as you're looking out for your own health, is to say, OK, what do I know about myself? What are my tendencies? What are the things that I've seen in the past? And then as those things change, that awareness, I love the fact that you're doing a journal that's that's brilliant because that's going to give you that data to flip back and say, well, you know, I was really stressed out this time last year, you know, because of stuff going on in the world.

[01:04:39.910] – Allan
How does that relate to how I'm doing now? and you start seeing some similarities. You're like, oh, OK. You know, I might my son just went got his first intern job and we moved him there. And it was a tough weekend. And then I'm feeling this way. My energy is low. What was going on a year ago when I felt the same way and it's kind of I call stress and I realized my Iron's low well have I've been taking my iron lately or getting enough for red meat.

[01:05:09.250] – Allan
It's like, no, I haven't. So there we go. OK, maybe that'll help. And so it kind of gives you that that information of who you are and how your body works, because most of the time it's going to follow particular patterns. Menopause is one of those weird things where your body is now changing over. So there is an opportunity for it to be quite different.

[01:05:33.130] – Rachel

[01:05:34.240] – Allan
And this is also important. You know, we talked about this and probably aren't very many men still listening to this show at this point. But this is just as important for you to understand as it is for her, because in the end, if she's going through something, you're going to be in a better position to recognize the change and you're going to be in a better position to remember objectively what she did last time.

[01:05:59.940] – Rachel
Yup, it's helpful to have another set of eyes.

[01:06:02.460] – Allan
If there's not a journal involved, it is really hard particularly when we're dealing with hormonal issues to be objective.

[01:06:12.030] – Rachel
That is so true.

[01:06:13.380] – Allan
I'm not gonna say it's impossible, but I'm just saying, if you're struggling with some things, with PMS, with heavy bleeding, with some other things that are going on as a woman, women can never wrap our minds around that. And I'm not ever going to try. But all I can say is I know that's not a time for my wife to be rational. All I can say is, hey, how about you try this iron supplement and I'm taking us out to Último Refugio tonight to have steak, how's that?

[01:06:43.010] – Rachel
That a good idea.

[01:06:48.360] – Allan
You know, and just knowing, OK, what did I just do. I got to start upping her iron. And you know, at least at that point, I'm not being, kind of stepping in and say, well, you know, the last time I mean, that's not I'm not Dr. Allan and I'm not trying to be that person. I'm just trying to be supportive and say, OK, I see a pattern and I know what helped last time.

[01:07:13.380] – Allan
And so I'm going to try to make sure that is at least in play here to see if that does some good.

[01:07:19.890] – Rachel
it's helpful for sure. You know, these are frustrating times. I mean, even for myself, this has been a frustrating couple of years because I know I don't feel good on these certain days. I know that some days I could run for days and some days I just can't barely get out the door. But and it's frustrating. And so that's frustrating for me then it becomes difficult to manage the rest of what I do on a day to day basis and help my family.

[01:07:46.260] – Rachel
So, you know, we could always use a little bit of empathy when we're having those types of bad days.

[01:07:52.680] – Allan
Yeah, that's a good word, empathy.

[01:07:54.990] – Rachel
Empathy. Yeah, that sounds like a great book. I might have to read it myself.

[01:08:02.370] – Allan
You know, that's one of the things I try to make. I make a point of about once a year trying to have a book on women's health in this area. I'm in a particularly menopause, perimenopause. And so this was one of the better ones that I've read on the topic. And she's, you know, she's really walking you through it from the medical perspective. Of course, you know, I've had other authors on that have talked about it from an emotional perspective.

[01:08:27.180] – Allan
This is this is a really good one to get into because she really is an advocate for health care for women and that you're not getting necessarily the health care you deserve all the time. And you and your spouse, partner or anyone, you're going to go to the doctor and talk to the guy who's got to go in with the united front. Yeah. Get you the best health care you can get.

[01:08:49.500] – Rachel
That was a great, great tip for sure.

[01:08:52.060] – Allan
Yeah, right. Well, Rachel, I'll talk to you next week.

[01:08:54.750] – Rachel
Great. Thanks. Take care.

[01:08:56.670] – Allan
You too.


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Another episode you may enjoy


October 19, 2020

How to thrive during menopause with Amanda Thebe

Apple Google Spotify Overcast Youtube

Perimenopause is a time when a woman's hormones are going amuck and it can literally ruin her life. Amanda Thebe's book, Menopocalypse, takes you through her journey and the journeys of 1000s of other women so you can know what to expect and thrive during menopause.

Also, Amanda wants to send you a signed copy of the book. Go to 40plusfitnesspodcast.com/menopocalypse for more details.


[00:03:29.210] – Allan
Amanda, welcome to Forty Plus Fitness.

[00:03:31.230] – Amanda
Thank you for having me on the show. I'm happy to be here.

[00:03:34.860] – Allan
You know, the interesting thing is, you know, when you see a book about menopause and your book is called Menopocalypse.

[00:03:46.950] – Amanda
Think of the zombie apocalypse, this is similar to that only with menopause. Menopocalypse.

[00:03:51.610] – Allan
Yes. And the subtitle on that was How I Learned to Thrive during Menopause and How You Can Too. And so, you know, the book is basically addressed to women. But I'm going to be very honest with you as a man, with a woman, with a wife or anybody around you that's aged anywhere from sometimes as early as thirty-five, all the way up to mid 50s.

[00:04:14.250] – Allan
This is good stuff to know. You know, this is a playbook to understand what could be going on in their lives and your relationship and everything else. I'm really excited to have this conversation with you because even though it doesn't apply to my health, it does apply to my life because I have a wife that is going through some of these changes right now.

[00:04:33.900] – Amanda
I think it's that was one of the ways I approached writing this book is obviously I'm knee deep in the fitness industry. I've been in it for decades. And this is new information for me. I couldn't find this information on our usual fitness sources. I was really quite frustrated how fitness information went from like pre postnatal pardon, you call it pre postpartum fitness and health to the over fifty health. And it was like this big chunk in the middle that was missing.

[00:05:04.590] – Amanda
And it wasn't until I had my own personal experience of struggling through this time that I realized that if I could get information out there, it would be really helpful not just to women, but male trainers and husbands and partners and fathers of daughters. And my husband obviously has read the book. And as just as well, we had conversations during my time through perimenopause and menopause.

[00:05:32.760] – Amanda
And he just said, I think all men should read this because it just makes us feel like we understand what's happening and we can support, you know, and help. And the male trainer has been able to support your female client is really important if you have that empathy and understanding, it goes a long way.

[00:05:52.230] – Allan
It does. And because I've got I've got clients all across that spectrum and I think many of them think I'm not going to get this till I'm in my 50s. This is something that happens in the fifties, but it can start happening a lot earlier and in fact, run longer than I thought. You know, like I said, I learned a lot from the book, and I really appreciate the opportunity to have this conversation with you.

[00:06:12.190] – Allan
Now when we're talking about menopause, I think I just kind of thinks it's just this this day or as a guy I would relate it to say, OK, I went through puberty and it was an awkward two years, you know, where my voice was cracking and I was growing and hair started showing up where it was supposed to show up.

[00:06:32.610] – Amanda
We could stop there. I know.

[00:06:36.100] – Allan
Yeah. You know, and so it's just a couple of awkward years for most of us that we go through. But menopause is very, very different because you have the different stages, the perimenopause before and then the post menopause after. Can you kind of just walk us through that cycle of what's going on when it happens, why it happens and, you know, just kind of so we can lay the groundwork.

[00:06:58.920] – Amanda
Absolutely. And I really like the analogy to puberty. So, you know, I sometimes hear people saying, well, isn't menopause essentially like reverse puberty? Isn't it that type of thing? I mean, it's a life transition. Every every woman, if she's lucky enough, is going to go through it and go into old age. And essentially that is what it is. But it just comes with a lot of nuances and it comes and it doesn't just feel like a life transition because it can go on for a long time.

[00:07:27.790] – Amanda
It can start late thirties and I'll go through the three different stages. But essentially, once you've reached menopause, you're in menopause until you die. So it's half your life potentially that you're in this different state where you need to have an awareness about what's happening. So the three common stages that you will hear talked about through menopause is perimenopause, menopause and post menopause. Perimenopause typically lasts between eight and 10 years on average, depending on which data source you look at. Can start any time from late 30s into into your 50s.

[00:08:08.290] – Amanda
It's a time when your sexual hormones will start to decline, which are estrogen and progesterone. And what happens is they don't just stop. You know, they don't you don't just stop producing them. The end result is that you don't produce any you can't produce anymore babies. Right. Like you, you cease to reproduce. But the hormones don't just want to say, OK, that's it, you're done. Time to tie up your tubes and then move on into old age. You have an eight to ten year period where these hormones decline, but not always in a linear fashion. Progesterone tends to fall in a more finite, linear fashion but estrogen just goes crazy. It jumps all over the place.

[00:08:52.600] – Amanda
And these wildly fluctuating hormones can cause a horrendous amount of symptoms for women that are often unassociated with hormones, hormones often not recognized by the medical community, and often can impede a woman's quality of life. And I don't just mean so she feels crap. I mean, so that it ruins it can ruin her life. And we'll talk about that later. And it can be managed. But not many people talk about it or are aware of how it can be managed.

[00:09:26.230] – Amanda
Then we move on to menopause, which is supposedly like a line in the sand, like a timestamp of when a woman hasn't had a menstrual cycle for twelve months and she is considered to be in menopause, and then she would that day forward, she is then postmenopausal or menopausal.

[00:09:45.550] – Amanda
I mean, they're words and interchangeable, but essentially you have a period of time before your periods stops and then the time after your periods stop. And that's what happens. When a woman goes into post menopause, we typically see a lot of those crazy erratic symptoms die down, but a woman can still have symptoms that impede her quality of life and will stay with all of her life after that. And then she is then also at considerable risk because of the lack of the protective hormone estrogen for major diseases that will kill her, that can kill us. And so we need to be aware of the symptomatic side of perimenopause and then the health protective side of post menopause.

[00:10:33.010] – Allan
Yeah, and I think that's the thing. You know, this is this is the rest of your life. And once it's kind of starts down the perimenopause, there's a period here you've got to manage. And then after that, there's going to be a period afterwards that you then have more of a steady state. So, you know, I think one of the things that was surprising as I went through the book was how many types of symptoms there are that are associated with this, because I just thought, you know, from my wife's perspective, having the conversation is like, I'll be glad when I don't have periods anymore, you know, because she's not going to have any more children.

[00:11:06.340] – Allan
So she's. It's no use for the periods in her mind, but losing your period or sporadic or erratic periods is not really the end all be all this is this is massive, the conditions that you can suffer through. Can you talk about the most common symptoms?

[00:11:24.620] – Amanda
Yeah, and actually, I'm referring to my book as I talk to you, because there is so many I often can't remember to quote them all. And it's interesting because I also had the same, I might add, the same sort of viewpoint. I can't wait till this is all over. I don't need my periods. And I also assume that menopause really was just a case of you stop having your periods and you might have a few hot flashes.

[00:11:47.150] – Amanda
And we know it's so much more than that. And interesting enough is that the symptoms are very individual to every woman. It's a common journey that we all share, but no one woman is going to have the same experience as another. And so these symptoms are broad scope. You may have them, you may not have them, but these are some of the more common things that women talk about during especially perimenopause.

[00:12:16.330] – Amanda
So the regular periods may or may not happen. And some women lose their periods for months and months. Some have them continually. And so there's no rhyme or reason to when a woman's period can well, come on. And some continue to have regular periods right up until they reach menopause.

[00:12:35.450] – Amanda
But some other things they can happen to them are things like depression, anxiety, chronic fatigue. And it's a fatigue that you just can't sleep off. It never goes away. Migrans, hot flashes, weight gain, which is like a bit of a you know, I touch on this in the book and it's not really a symptom, but it's something that seems to happen to women and when they put weight on, it definitely doesn't help with their feelings of low self-esteem and depression.

[00:13:06.230] – Amanda
And sleep problems are huge. Insomnia, which is often exacerbated by night sweats, which are essentially hot flashes during the night. And women can have multiple like twenty, thirty of those a night. And losing sleep, as we know, is just terrible for our overall health and cognitive issues like short term memory loss. Even just remembering words. I mean, I've literally changed the sentence I was going to say because I can't remember a word that I was going to use.

[00:13:38.120] – Amanda
And I know that that's part of aging as well. But these things are really exacerbated when our estrogen levels start to fluctuate because we have estrogen receptors all over the body. And so they're in our blood brain barrier. They're in our joints. So many women have aching, sore joints that feels like a rheumatoid arthritis. And that's essentially from the estrogen fluctuations. Sex drive is another thing. It can, it usually falls off the edge of the planet. But sometimes you can crawl the wall, but not very often.

[00:14:14.270] – Amanda
But I mean, that's something that can impact relationships. And women put a lot of, you know, stress and fault on themselves. And GI issues are also another thing that women complain about. They can not get food, food, sensitivities and bloating, some irritable bowel, those type of things. And and then some of the things that, like lesser known things that women experience and I think are really relevant to the fitness crowd, are things that impact their self belief, their self-esteem and their confidence.

[00:14:46.220] – Amanda
We see a real decline in that in women and that sort of lack of belief in their athletic ability. And I think that's really sad because we know women are very strong and very capable, but we see it presented to us in the gym that I can't do that. I don't think I can do that anymore. And so and that's really not a symptom, but it's definitely something that happens through menopause as well. And it's something you can work on with your clients.

[00:15:15.310] – Allan
Yeah, you know, I think as we went through the book and I went through a lot of those, one that really hit me is that there's this relationship between estrogen and oxytocin. And those that don't know oxytocin is basically the love hormone. It's the feeling close and and connected. And so if you're if you're if you're dealing with some of the physical changes because, you know, when your estrogen goes down, you're more apt to store fat in your belly.

[00:15:45.010] – Allan
So you're going to notice some changes in your body shape. As you mentioned in the book, I think people tend to put on about 10 pounds during that period of time. Men do it, too. So just so you know, it's not it's not just a woman thing, but 10 pounds. And even if you don't gain or lose weight during that period of time, you're storing it differently. And so it's going to be it's going to pick up from the places where you liked it and it's going to set down on some places that you might not like it so much. But all these changes to your body, all these changes in your emotions, you know, sometimes, you know, I'm not going to use the word, but women can get a little abrupt, a little stressed and a little crazy.

[00:16:28.240] – Amanda
The abruptness is actually one of the positive aspects of menopause because we just don't want to stand for your crap anymore. So, you know, as far as weapons thats a good thing.

[00:16:35.680] – Allan
And that's perfect. Yeah, that's a good thing. But during that transition, it's you're feeling like you're a different person. You're looking like a different person in many senses. But then now you also have this hormone change where you're just not feeling as close to people and that can really impact relationships.

[00:16:56.020] – Amanda
You know, it's one of those really interesting things that I never even thought about. But I have a community on Facebook and we often talk about just how we are feeling and how we're doing. And women just kept saying all the time, I just don't feel like as close to my husband as I used to. I just I just don't I just want to be on my own more.

[00:17:15.850] – Amanda
I really I really feel like I need to start looking after myself more. And it often happens at a time, you know, just statistically that our teenage children also may be sort of like being more independent and they don't need us as much. And it all sort of links together.

[00:17:33.700] – Amanda
And so I dug deep into the research and I found the genuine connection between the lowering of our estrogen levels and the lowering of our oxytocin too and as you said, it's like our love hormone. And it's the thing that bonds us. And it's at our highest when we have children, when we're breastfeeding. It's the thing that sort of connects us to our partners and helps with orgasms. I don't know if that's OK. It's still on the show, but it does and and also helps, you know, with anxieties and our ability to thrive and sort of take chances.

[00:18:07.270] – Amanda
And we see all of that sort of ultimately shift. But what happens is at the same time like menopause is happening. There's so many things that are changing Allan. Like you say, we are the ultimate shape shifter. We we can shape our fat deposits where they land change. We feel different about ourself. The change is happening and we're not really in control of it. And then we start to pull away from our partners and maybe our children and we start to feel as though, well, what about me?

[00:18:38.410] – Amanda
And they often call it the like the we to me transition for women. And while that might seem like a little bit selfish, hearing me say this, I actually think it's a good thing. Because as mothers and as wives and as just women who are nurturers, we give, give, give all the time and we put ourselves on the back burner often. And one of the things that menopause made me realize is that.

[00:19:04.800] – Amanda
Well, actually, I have to start taking care of myself now because I'm really important to their whole puzzle of my family, and if I'm not functioning properly, then the rest of it just goes to pot. Nothing works. And that's often the keystone of a like a relationship or a family. And so even though all of these changes are happening and relationships may feel different or strained or unusual, I think it's just a really good time for reflection and for us to sit down and say whats important to me right now? What makes me thrive? How can I make this situation work for me and my family and my partner?

[00:19:46.770] – Amanda
And so, like for me, I went through something very, very similar to the analogy you've said, and I am with my husband at one point, like I didn't realize, but his mind was wander and he had no idea what I was going through. I was riddled with depression. And migraines that sent me to bed for days on end with no help from the medical community and I know we're going to touch on that. I eventually went to my annual gynecological checkup I suppose, like, you know, the tune up that you take in your car and follow.

[00:20:19.530] – Amanda
Well, I went in for mine and the doctor recognized that something wasn't right. And he said, I think you're going to perimenopause. These are very typical symptoms and you don't need to suffer needlessly. I can help you. And I just felt this massive relief and I felt, oh, there's an answer to why this is happening. And I went to see my husband afterwards for dinner, for lunch, sorry. And I said to him, yes, I've got perimenopause and I've got depression and, you know, migraines and. Oh, my God. So you're not going to leave me then?

[00:20:54.440] – Amanda
Because the poor guy the whole time had been thinking that I hated his guts, that I couldn't stand to be around him and all those things were true. But I don't feel like it was what I was feeling. I feel like if they were being masked by these horrendous symptoms that were just consuming me. So we are also good by the way.

[00:21:15.180] – Allan
That's good to hear. You know, again, going through some of your story, going through some of the things that you've talked about in the book, I was like, OK, my main problem getting older is that hair is growing out of places I don't want it to grow out of. So I think I've got it pretty easy. I can figure out how to get along with my wife. But that said, there are ways that you can improve your chances, improve and thrive through this period of time.

[00:21:40.370] – Allan
But you have to take a proactive approach. You can't just sit back because this is not going to just go away in a couple of days or a couple of weeks. And, you know, it's not like just getting through one migraine or saying, oh, I'm a little depressed, I'll take an antidepressant and we'll just we'll just move on.

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[00:23:25.590] – Allan
Now, in the book, you talked about hormone replacement therapy, hormone therapy and bioidentical hormones, but there are also some natural remedies like black cohosh and natural Ashwagandha. Yeah, and so but there's some, you know, I think when we start talking about some of these things, because there was a study, of course, there was a study that tied breast cancer to estrogen. And while the study might not have been the best in the world at the way it was done, there's still lingering effect.

[00:23:57.150] – Allan
People think that they can't do these hormone therapies or do these things because of the potential problems. Can you talk about what's available and how how someone can kind of evaluate what's right for them?

[00:24:09.750] – Amanda
Yeah, it's a bit of a minefield out there. And I have to admit, I was one of those people, too. When my mom went through menopause, I was like, you are not going on any hormone therapy. I knew about this study. And I was like, that's not for you. And it was about that time for my own mom. When I went to the gynecologist and he sort of said, yeah, this is perimenopause. I can get you on hormone replacement therapy, it will help you.

[00:24:30.960] – Amanda
And I was like, no way. No, I mean, this is nine years ago almost nine. And I said, I don't trust it, I don't feel good about it. So I actually opted to go on an antidepressant and the antidepressant helped with both my migraines and my depression. But when other symptoms started to come up, because they do they come and go, they you know, they fluctuate like your hormones. It wasn't enough. And by this time I'd spoken to lots of experts and I dug deep into the research and I felt very confident with my choice.

[00:25:04.520] – Amanda
And I just thought it was so difficult to get this information and I didn't understand why. And so that's sort of why I wrote a whole chapter on this, because women and well, humans sorry. We hold on to the fear. It's just what we do. And so in 2002, the WHI, which is the Women's Health Institute, published a report and the report said that there was an increased risk of the following diseases. Cardiovascular disease, stroke and breast cancer by using estrogen therapy.

[00:25:38.840] – Amanda
And so what their advice was right then in 2002, they said the risks are too grave to issue estrogen as a treatment and it should be stopped immediately. And so that's what happened. Doctors all over the world just stop prescribing estrogen. What happened, though, since that date is the WHI. Some of the researchers in that study came up and stood up and said we didn't even research their findings properly. We didn't actually have the chance to. It was as soon as there was an inkling there was a risk, it was published and we didn't actually analyze the data properly.

[00:26:19.010] – Amanda
And so some of them have come out post hoc and analyzed it again and come up with completely different, a completely different viewpoint. And it's the viewpoint now that's shared by all of the medical bodies, including the North American Menopause Society and the British Menopause Society. And they have categorically stated that there is no increased risk for any of those diseases.

[00:26:42.320] – Amanda
Specifically, breast cancer is the one that women talk about by taking estrogen therapy. No more so than lifestyle choices. And, you know, like if we drink or heavy drinkers, smoker, if we do carry extra weight, if we're on the up on the obesity, I don't really like talking about obesity like it is, but it's considered a risk factor that there is no significant statistically significantly different risk. And and in science, the statistical significance is something that they talk about. And it's it was minuit and it was so small it wasn't worth considering.

[00:27:22.820] – Amanda
And so they now, all of the medical bodies, like I say, have agreed that estrogen therapy is safe and estrogen is not a carcinogenic substance. We know that. Right. So then but what happened in the meantime is during that period of 2002 and recently, I think probably in the last 10 years, I don't actually know when when people started using HRT more confidently.

[00:27:50.270] – Amanda
But there was a period of time when doctors refused to prescribe estrogen therapy. And the compounding pharmacies then were like, this is our chance to like to help women out. And they did. So they were prescribing uncompounded hormones that weren't regulated. And that's just the difference, right? They were issuing women hormones that the FDA had not approved. And so there was a there was a concern about the efficacy, the safety, and also the fact that when you take an estrogen, you have to take a progesterone with it.

[00:28:27.920] – Amanda
The progesterone protects your uterus. There's the compounding pharmacies were issuing a progesterone cream to women that wasn't providing enough protection to the uterus and was put women at high risk of uterine cancer. So it was an opportune moment for them. They made millions and billions and trillions probably.

[00:28:47.900] – Amanda
I actually don't have never looked at the numbers, but but now we're in a situation where if a woman wants to go on a hormone therapy and she is a candidate and there's parameters that women have got to fall within, a doctor can safely prescribe FDA approved hormones for a woman to take.

[00:29:08.210] – Amanda
Now, I just want to touch on bioidentical hormones because what happened, the compounding pharmacies use the word bioidentical because they said that the only hormones you could get from your doctor was synthetic and they weren't natural and they could give you natural hormones. And it's a false equivalency because it's it's just not true. The FDA have bioidentical hormones. And all that means is that the hormones are produced to match the molecular structure of the hormones in your body. And they're derived from plant sources.

[00:29:45.680] – Amanda
And you can get them and have been tested for efficacy and safety and they usually covered on insurance for a couple of dollars a month, whereas the unregulated ones can cost women hundreds and hundreds every month, and it doesn't make sense to me when you're talking about cost safety against safety and lower costs. So that's where we are with bioidentical. So my advice to women and I'm not a doctor and so I'm not telling you what to do, but I've talked to experts and I've done my research is that if you want to go on hormones, you go and speak to your doctor.

[00:30:18.460] – Amanda
If your doctor is not informed because many aren't asked to speak to a referral to a menopause specialist and get regulated hormones. Now, when it comes to doing things outside of medical intervention, and I have no problem with medical intervention and I just don't see why it should be a problem for people. I hear the idea that menopause is medicalized. And I'm like, yes, so what? It's a micro dose of hormones that literally gives the woman back her quality of life.

[00:30:49.570] – Amanda
It can help with the symptoms. And we know it's protective against some of these major diseases that kill us in post menopause. But things, other things that a woman could do to support her journey. Like you said, the black cohosh and Ashwagandha, there have been some studies on this. But the problem is, is none of those medications are regulated. So you just don't know the quality or the efficacy of the supplements like all supplements.

[00:31:17.860] – Amanda
You know that, right? So and for women with really bad symptoms, sometimes it's not enough for some women with some mild symptoms, it can be enough. But neither of those natural things will replace the estrogen that your body's lost. Neither will food. You can eat as much phytoestrogen based food as you want, which is like soy, tofu. And it will help you and it will support your body, but it will not replace the estrogen that you are losing.

[00:31:45.430] – Amanda
So you can do things to add the journey and smooth the journey. And I definitely recommend that women speak to a specialist, talk about different options and see what works for them. And then also know that you may need to change it, because as your hormones change, you may not need to do everything you've been doing all along. It's like literally I don't even know how to describe it.

[00:32:10.500] – Allan

[00:32:13.630] – Amanda
Something like, yeah whackable. But the upshot of it is that women do not need to needlessly suffer. There is help available for them. They should grab it and they should advocate for it and actually give women ideas on how to advocate in the medical profession, because it can be hard. We've got to we've got to be tough in there. But honestly, we deserve to be helped.

[00:32:38.120] – Allan
Absolutely. Now, one of the things you got into in the book, which I thought was was really important, was one, you kind of went through some things with the healthy diet, you know, to avoid processed foods, limit your alcohol intake, those types of things that people should be just doing anyway. But you got into something I thought is critically important when it comes to food because it's not talked about enough is not just what you eat, but how to eat.

[00:33:05.650] – Allan
Would you would you take us through that? Because I think this is important. We forget this. We forget this a lot. And as a result, we end up not getting the results we want or getting the health outcome we want. And I just think it's really important for people to recognize that it's not just when, it's not just how much, or what kinds of foods, but actually how we eat.

[00:33:27.710] – Amanda
Psychological process around. Right. It's really important. And so like the nutrition part of my book. So the essentially the second part of the book is broke down into four areas. We have a strength training component. We have nutrition component. We have a stress management component. And we have a mind set component as well.

[00:33:47.290] – Amanda
And then the nutrition component, there is no menopause specific diet. So this nutrition component is actually valid for most people. Like there's nothing in there that's rocket science, right? Like I tell you what the micronutrients do, how they respond in the body. There are some nuances when it comes to menopause for sure. And I talk about those, but essentially the whole how we, the what we eat shouldn't really change much from what we know from nutrition science.

[00:34:16.630] – Amanda
But the how we eat is so important because, you know, I always think that, like menopausal women are targets. Like, you know, we are lion's share of the like the fitness world, whether with a desperate women, we have probably a bit more disposable income.

[00:34:31.900] – Amanda
And so they see our vulnerability and go try this keto green diet, try this, try that supplement. And it's just, stop. Please stop doing that because it is unethical also. It's not necessary. And I think that what I've tried to do in the nutrition component is simplify everything so that a woman can just go into this with valid choices. And so I talk about like the how to eat, right?

[00:35:00.120] – Amanda
So we're a nation of people that eat too quickly. We don't consider what hunger feels like. We don't know when to stop. And we eat mindlessly. We don't eat mindfully. And so don't sound like a bloody hippie, but like it really matters how you approach eating. And so I try and break that down. And so, you know, I try and explain to people that, you know, hunger won't kill you. It's OK to feel hungry. And that where we can become like robots. We can say, oh, it's noon, I better eat my lunch instead of like like sitting there and saying, I'm hungry. Am I am I ready to eat? Is it appropriate?

[00:35:43.790] – Amanda
Like because sometimes we eat because it's what's expected and not what our body needs. And so the cues that I talk about help you try and understand your body signals. And these are things that can stay with you for life. And it's amazing. So some of the key things are, recognizing true hunger. Is it true hunger or is it boredom? And so I always, even just take a simple pause, even just by your tummy starts to rumble a little bit.

[00:36:13.220] – Amanda
I want I ask people to sit and just think about it and say, OK, am I actually bored? Like, am I eating because I'm bored. I'm eating because I'm like, thirsty. Should I take a drink or is this true hunger and then sit for 30 minutes and just see if that hunger dies away. If it dies away, then you probably weren't hungry. If it doesn't, then eat. Right. You actually recognize what true hunger feels like.

[00:36:39.320] – Amanda
And I give like a scale in the book to sort of like try and pinpoint because we boredom eaters and we will have chips on the desk and we'll eat them without even thinking and wonder why we've consumed an extra eight hundred calories a day. And so my family, no electronics at the table ever.

[00:36:59.390] – Amanda
We put our electronics off, we all sit down and we converse and we actually make family meal times again where we sit down and we appreciate the food I've made because I make sure they do, that when they appreciate the food that they're eating and they enjoy food and that they appreciate like all of the cultural stuff that goes around it. Instead of just wolfing it down, watching the telly and, you know, not actually focusing on what you're doing.

[00:37:26.840] – Amanda
And then specifically in menopause, the estrogen has an impact on our ghrelin and leptin hormones, which are our hunger and satiation hormones. And so if you if your body's a bit screwed up and it doesn't know if you are really hungry or if you're really full by slowing down and sort of recognizing what true hunger feels like, slowing down the eating process and stopping before you are full, you know, like stopping when you're satisfied instead of like opening the button of your jeans type full.

[00:38:03.730] – Amanda
Like those are really good ways to suck you back in and recognize what real hunger and what real satisfied feeling feels like when you're eating. And I talk about that a lot in the book because it personally has worked for me and others, you know. But I truly believe in building up those type of habits.

[00:38:23.530] – Allan
Now, and one of the strategies they had in the book that I thought was pretty cool was you said one of, leaving just a little bit of food on your on your plate. You know, we were taught as kids, clean your plate, clean your plate. You know, kids in India are starving, so you have to clean your plate.

[00:38:38.820] – Amanda
Why did we say that?

[00:38:40.680] – Allan
I don't know.

[00:38:41.620] – Amanda
It's so true. It's always India.

[00:38:41.650] – Allan
I don't know, but we did. And so it's just you just clean your plate. And yeah, we want to multitask so we're on the social media or we're watching the television and we're not paying attention to eating. And, you know, before you know it, you've cleaned your plate. And so kind of having those strategies in place, you know, serving yourself a good a good portion a plate, you know, knowing your portions, getting it all on your plate and sitting down at the table and and really focusing on that food.

[00:39:16.580] – Allan
Putting your fork down between bites, having a conversation, you know, actual face to face conversation with your family. You know, those are those are the moments where you're taking care of your food, you're taking care of your body and you're building social connections and relationships that you know, we need.

[00:39:35.610] – Amanda
And you know, they're valid ways and they're proven ways to show how to stop overeating. I mean, clearly, it matters what you put in your mouth, but I think the two things go hand in hand. You can eat the best food in the world and have all of these plans in place on what to eat. But if it feels like restriction and it feels like it's a job or it feels like this is limiting you in some way, then you're just going to fall straight back to where you were.

[00:40:02.240] – Amanda
But if you approach this with a mindset that this is doing you good and that you're actually supporting your body and understanding what the body needs, then when you eat the food that you've chosen because of your knowledge that, you know will support your body, it just makes it such a smoother ride. And the chances of you stick and adhering to this long term are increased.

[00:40:25.520] – Allan
Amanda, I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

[00:40:34.540] – Amanda
You know, I think the hardest question, you know, I know I had this coming and, I was like, oh, God, you make it sound so easy. And I was like, how can I give you three when I have like, a hundred?

[00:40:44.500] – Amanda
And so but I think if we're talking about menopause, the first thing I would do, the first thing I would say is that you should control the things that you can control. Because it's the time of a lot of change and things are out of your control and so the certain parameters within your life that you actually can take a handle on. And I encourage women to do that. So whether that's like actively moving every day or choosing the food that they eat or the company that surrounds them, I would suggest that that's the first thing. So take control of those things that you can control.

[00:41:20.360] – Amanda
The second thing is for a menopausal woman is build a community and that community can be just your sister or your aunt or a group of friends. It's a bit more difficult in a pandemic. But like I have an online community where women exchange stories, where talk about their problems and lessen the burden.

[00:41:42.190] – Amanda
When you know that you have something that's eating away at you and literally you can't get out of this hole that you're in when you share that story with someone and get somebody else's opinion, even if they just say, hey, I hear you and I'm listening, that can just make you feel so much happier.

[00:42:00.220] – Amanda
And then the last thing is do exercise that brings you joy. I'm a big believer in moving every day. And sometimes in perimenopause and menopause, you're exhausted and you don't feel like you can move. But even if it's just a patrol around the kitchen, consider that to be active movement. And so while I'm a big pusher of strength training for women and as we age, it's so important if you want to do them three times a week because it just makes you laugh and brings you joy, then do it. Like do some type of movement that makes you smile and makes you feel better about yourself when you're finished.

[00:42:39.680] – Allan
Well, if someone wanted to learn more about you, learn more about the book Menopocalypse, where would you like…

[00:42:48.860] – Amanda
It will fall off the tongue soon, don't worry.

[00:42:50.810] – Allan
Soon enough, where would you like for me to send them?

[00:42:54.710] – Amanda
Yeah, you know, everything is off if you go to my website everything there are links to my social media page, links to purchase in the book. The book came out yesterday, October 18th, which was, well, menopause day. But everything is on www.fitnchips.com. You can find everything there.

[00:43:20.400] – Allan
OK, you can go to 40plusfitnesspodcast.com/456 and I'll be sure to have the links there. Amanda, thank you for being a part of 40+ Fitness.

[00:43:31.160] – Amanda
I'm so happy to have been on the show and thanks for having me.

[00:43:39.300] – Allan
Where Ras. Pretty good episode, you know, women's health is the highlight of October, you know, breast breast cancer awareness and things like that. And, you know, I like getting on some guests where we can talk about a single issue. But again, I hope men, you're still listening because if your significant other is going through this, you're going to have some experiences, too.

[00:44:02.960] – Ras
Thanks for doing this episode on menopause. I know. I appreciate it. And it's pretty timely for a lot of women. And in October, this is perfect, perfect timing for this topic.

[00:44:15.330] – Allan
You know, I think a lot of people are concerned. You know, when you start talking about hormone replacement and some of the science that was out there before talking about how it could cause cancer. And, you know, obviously that's been refuted. So if you're not on an estrogen because you're afraid of cancer, go back and do your research again, because I think you're going to find what's written out there is very different than even maybe what your doctor knows.

[00:44:39.950] – Ras
That's a really good point. And menopause itself is really a scary topic for a lot of women. It kind of seems like a homeless or hopeless part of our lives that we just have to suffer through. And then when you add hormone replacement therapy to that, that's another huge red flag for us, because we've always heard that estrogen replacement is a danger. And personally, I actually have a higher propensity for breast cancer, it runs in my family. So that's always been a huge red flag for me as well. So it was really refreshing to hear from Amanda that that may not be what I had always thought it was.

[00:45:16.850] – Allan
Yeah. And if you if you resonated with this episode, I just want to let you know, I try to do a menopause episode about once a year. So I've actually had a few other episodes about menopause. And if you'll go to the show notes for this episode, I believe this is episode 456. So if you go to 40plusfitnesspodcast.com/456, I'll be sure to have links to all of the other episodes where we've discussed menopause, because there's a lot of, a lot of new information out there and a lot of authors, you know, they don't write about this very often.

[00:45:52.070] – Allan
So, you know, get a book about once a year. I do try to get them on because I think it's a really important topic. But even men, you know, I again, we are going to start talking about men's health over the course of the next couple episodes. But, you know, for you to recognize that you're struggling with andropause, you know, you're watching your testosterone and growth hormone and all those, those men feel good things going on. Your wife's going through complete chaos.

[00:46:21.470] – Allan
And, you know, the link between estrogen and oxytocin is just scary because, you know, that's the empathy that's that's that's her giving a crap about what you're going through. And she might be struggling with that. So just recognizing that that hormones not only impact what our body physically does but impact what's going on in our brain. And that can actually change our mood and behavior and make someone seem like an entirely different person. So I think that's just worth paying attention to. If you value your relationship, just recognize that as a symptom. That is an issue and something that can be addressed if you take the time to do it.

[00:47:06.260] – Ras
That's a really good point. That was actually a kind of a light bulb moment for me in your interview with her. The connection between estrogen and the ocytocin. Is Yeah. And and how that changes our emotions and how we cope or react to certain situations, I'm 49, so I'm right in the middle of this whole perimenopause program. And as she was checking off all these symptoms, I'm like, yeah, I felt that. Yeah, I've noticed that as well. But that that estrogen oxytocin, that's a huge light bulb moment for me. And I think this is a perfect storm situation. Allan, you mentioned that men's hormones are fluctuating as well, right along with ours.

[00:47:54.550] – Ras
And then in my family, I've got another situation where my kids are in college. So my role as a mother has changed greatly. And so there's kind of like a perfect storm of situations that happen. And and how to get through all of these challenging moments is just difficult.

[00:48:14.280] – Allan
Well, that's why you run.

[00:48:15.890] – Ras
Yes, it is no doubt about it. it's why I run. And that's a good point, because for me, getting through all of these kinds of perimenopausal symptoms that I experience, running actually does make a huge difference.

[00:48:30.330] – Ras
And I notice on the days where I have too many rest days in a row or just can't get out to run because life gets busy, I can feel it. I can feel the change happening with my emotions. And I get tired and irritable for sure.

[00:48:45.210] – Allan
And so that's why you need to experiment with a lot of different things. Exercise, nutrition, in some cases, even hormone replacement might be something that's a fit for you. You've got to you've got to study this. You've got to do that N equals 1 experiment, and you've got to make some decisions. Your health care provider is a provider. They're not there to to make you do something. You have to be a part of that team. And so recognizing that if you're not exercising and you're not eating right and you're not feeling well, there might be a correlation there.

[00:49:17.430] – Allan
And you've got to solve those two problems. And even when I talk about men's health with guys are like, you know, yeah, you could you could do all this stuff. You could take all these hormone replacements. But they're not going to fix you if you're not doing the other things or other things have to come first. So if you get joy out of running, run. If you get joy out of lifting heavy things, lift heavy things, you should probably do a little bit of both, to be honest with yourself.

[00:49:45.480] – Ras

[00:49:46.050] – Allan
You're given your body, all of it needs. But, you know, just find the things that give you joy, find the things that make you feel good. And particularly during this period of time, if you know is do them together. If you can, you know, you and Mike run together. We do. Which, you know, that again is beautiful, you know, because that's that's where relationships are kept. That's where you have that in common.

[00:50:06.630] – Allan
And much like we talked about running clubs and how close you get to people, even when you're not running close to people these days, you know, it's just something, a bond that you have between you that that just keeps going. And so.

[00:50:20.220] – Ras
So true. AManda mentioned having a support group and that that community tie, whether it's with a run club or your spouse, it can be really helpful. And the tougher days, those days when your hormones are really out of control or you're just feeling emotional, it's good to have somebody to talk to or run with or whatever it might be.

[00:50:38.990] – Allan
Or lift with.

[00:50:39.960] – Ras
Yeah. Yeah.

[00:50:42.090] – Allan
All right, Ras, well it's good to see you again. And we'll talk next week.

[00:50:45.240] – Ras
You bet, take care.


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Another episode you may enjoy


October 21, 2016

Menopause advice for women and men with Dr. Tara Allmen

In this episode, we meet Dr. Tara Allmen to get menopause advice and solutions presented in her book Menopause Confidential: A Doctor Reveals the Secrets to Thriving Through Midlife.

Every man needs a gynecologist for menopause advice

An accountant and a gynecologist have in common when meeting a man at a party, the question ‘what do you do for a living' is a conversation stopper.  It shouldn't be that way.  At least not when you meet a gynecologist.  There is a lot to learn what the women in your life are (or will) experience.  Menopause advice works for both women and men.


The symptoms of perimenopause and menopause can cause sleep disruption.  It is important for women to focus on getting the best quality sleep.  A few sleep tips provided by Dr. Allmen include:

  • Go to bed at the same time each night.
  • Avoid stimulants that will disrupt sleep such as heavy meals, alcohol, and caffeine.
  • Cool, dark bedroom.
  • Don't keep your phone by the bed.
  • Eat healthy foods.
  • Exercise regularly.

Colon cancer

Dr. Allmen decided to design her own colon cleansing approach and has been successful in coming up with a way that is a lot easier.  She's shared this approach with her patients and they've had great results in colon screening prep.  While not menopause advice, it is something we face in mid-life and you may find Dr. Allman's recipe for colon cleansing easy and effective.

Weight lifting

It is very important that women work to maintain muscle mass and bone density by lifting weights.



The menopause solution | Dr. Stephanie Faubion

The estrogen window | Mache Seibel

July 8, 2016

The menopause solution | Dr. Stephanie Faubion

Dr. Stephanie Faubion is the Director of the Women’s Health Clinic in the Department of Internal Medicine at the Mayo Clinic. She is one of the country’s leading experts on menopause and is knowledgeable about bone and joint health. She is also the author of The Menopause Solution.

The Menopause Solution, is meant as a guide for women during menopause to help them be healthier for the rest of their lives. Women are living longer than ever before. In 1900, women did not live past age 50 and rarely dealt with menopause. Now, the average lifespan of a woman is approaching age 90, so menopause is something that most women will go through and live many years beyond.

In order to get a head start on menopause, Dr. Faubion explains that women need to be informed about what’s happening to their bodies and what they can do about it. By focusing on fitness, their overall quality of life will be better. Other areas of concern include sleep and stress management. Successfully managing both areas is key in the prevention of long-term diseases such as heart disease and diabetes.

Joint health is another important topic for post-menopausal women. Around the midpoint in their lives, women will experience more joint pain. Many women will start to develop arthritis after menopause. Dr. Faubion recommends that women recognize when they have pain, examine what triggered it, and stay tuned into their bodies.

Bone health is another area of concern. Many women are seeing bone loss around the age of menopause. This correlates with a loss of estrogen. In fact, women will experience the most bone loss of their lives within the first five years of menopause. To prevent bone loss, women should adopt a proper diet complete while maintaining a sufficient calcium intake. Resistance training and getting enough Vitamin D are also helpful in minimizing bone loss.

Be sure to check out The Menopause Solution to learn more about bone and joint health post-menopause. To connect with Dr. Stephanie Faubion, visit http://www.mayoclinic.org/.

The estrogen window | Mache Seibel