The following is a transcript of this episode. It has been edited for clarity.
Before you know it, fall will be upon us and it’ll be back to the daily grind. On the bright side, it’ll also be a great time to get back into a routine and set some intentions about your health in midlife. As you know, there’s a lot of change going on in your body, and the need for a reboot may feel especially pressing. If you haven’t been feeling like yourself lately, or if you’ve let good habits slide, it can be hard knowing where to start. Which is why on this episode I’m talking to a fabulous naturopathic doctor about how to reset your midlife health. She’s going to tell you what diagnostics to consider, what lifestyle tweaks to make, which supplements are worth your time, and how you can feel better, have more energy, and yes, start to get your groove back.
Welcome to More Beautiful, the podcast for women rewriting the midlife playbook. I’m Maryann LoRusso, and I invite you to join me in a guest each week as we strive for a life that’s more adventurous, more fulfilling, and More Beautiful than ever before.
Maryann: I am delighted to be here with naturopathic doctor Lisa Brent of Be Well Natural Medicine in Marin County, California. Lisa, welcome to the More Beautiful podcast.
Lisa: Thank you. Thanks for having me.
Maryann: Lisa. It would be so great if you could start us out by telling us what exactly a naturopath does, how it differs from an MD, and why you are excited about your practice.
Lisa: Naturopathic medicine is, I kind of think about it maybe as the OG functional medicine doctor, it’s been around a long time. It’s european roots, kind of old time water cure, those kinds of things that came from Europe. We are primary care natural medicine providers. We look at the whole person, we do labs, we do screenings, and then we use the most natural methods possible. Herbal medicine, supplements, lifestyle, diet, medications when indicated to remove obstacles to people feeling their best. How we differ from an MD is probably mostly in therapeutics. Our training is very similar. Our first two years are the same as MD training. We take the same board, but then we go into more, you know, the toolkit that we learn is more about herbal medicine. nutrition, stress management, you know, we learn pharmacology and those kinds of things, but we don’t, you know, do surgeries, we don’t in California at least. We don’t work in hospitals in other states. There’s a little bit more crossover and we do more probably chronic disease in general than acute care, although we do do acute treatment for olds and flus.
Maryann: Very cool. Would it be fair to say it’s more integrative medicine, which seems to be the catchphrase now, right?
Lisa: Yes, exactly. One of the tenets of naturopathic medicine is looking at the whole person. So that is integrative. How does, how does sleep affect digestion? And how do hormones affect brain chemistry and so on? And then we are also very committed to looking at the root cause, which I think is also a focus of integrated medicine, actually driving what’s going on.
Maryann: Lisa, anytime is a good time to take stock of your health, but this can be especially good timing for women out there. With kids going back to school soon, it means you will have more time to focus on yourself. For anyone who has strayed from healthy eating or exercising over the summer, guilty is charged. It’s an opportunity to refresh. Right. But no matter what time of year it is, is there a mental shift that’s necessary for you to be in the right place to make positive lifestyle changes and be more proactive about your health? And if so, how can you get yourself in that, in that space?
Lisa: That’s such a good question. I think the number one mental shift is bringing in the self compassion. Honestly, I think we are so hard on ourselves, and we have these expectations that we should be, you know, doing everything for our family, especially over the summer where you’re, you know, camps and vacations and managing everything, maybe while you’re still working outside the home or, you know, it’s just us. It’s such a combination, of moving parts for women, and then we think we should also then be working out all the time and eating perfectly when, you know, yes, traveling and that kind of thing. And so there is no benefit from more self judgment or flagellation. Like, we’re so good at that already. So, just remembering that we’re doing our best, and it’s always a good time to start over, right? Tomorrow’s another day, so what are the small things that we can do as a little bit more time might be available? Like taking a walk in the morning before you get to your chores or taking the stairs when you’re in a building, parking far away from Target if you’re running errands…You know, little things. I think we want to be careful. We don’t want to go from zero to 60…Let’s not jump into Crossfit or something like that, but just little pieces that start to feel good. I think also remembering that as far as mindset goes, our self care is pretty essential to the well being and functioning of our families, or whatever that is. Even if it’s just the care of our parents or our own lives or our professional lives, it’s not selfish if that means some laundry doesn’t get folded or somebody has to get a ride home with someone else because you’re going to go pop into a yoga class or something. That’s actually good for everybody else when we feel more resourced.
Maryann: Right.
Lisa: Or we go to bed earlier, and we’re not going to help with that science assignment because we’re tired. So self love, self compassion, and separating self care from selfishness opens the door.
Maryann: So to be self compassionate and just ease into it, that sounds great to me.
Lisa: Exactly. And finding something that’s fun. Maybe it’s like finally getting to go hike with your friend you haven’t seen all summer. Or taking a walk downtown to get coffee, or taking the dog out. Or finding that class to go try some Pilates or something you’ve been curious about.
Maryann: Just get moving. Just get out and get moving.
Lisa: Yeah, totally.
Maryann: Well, you know, Lisa, I think some of that mania that you’re describing about our health stems from the fact that midlife is a very confusing time when unwanted health issues can crop up, when red flags suddenly appear on our lab work—you know, stuff we’ve never had to contend with before. And during the menopause transition, it’s very common to notice some weird stuff going on. As I mentioned, the lab results, maybe you’re now in the pre-diabetes category. Maybe your cholesterol has shot up. Maybe you’re putting on weight for no good reason—well, there is a good reason: menopause [laughs]—and your metabolic health is taking a hit. And the list goes on and on. What are the most common health challenges that your midlife clients are dealing with right now? What are they coming to you with?
Lisa: Yeah, I mean, I think you listed a lot of the big ones, and it can be kind of alarming, right? When you’ve sort of been coasting along…Like before, if you wanted to lose a little weight, you just cleaned up your diet a little bit or exercised, and your labs have looked pretty good. Or maybe some things haven’t even really been tested because it wasn’t on the radar.
Maryann: Right.
Lisa: Maybe you haven’t been tracking blood sugar or cholesterol. and then all of a sudden, you start to look at those things and it can be very alarming, like, what happened? Am I falling off a cliff? And where is this going to end? Why am I holding on to weight? Am I going to continue to put on weight? Am I barreling toward diabetes or heart disease? So I think one important piece of that is, first of all, to just step back a little bit. The lab part, while alarming, is not necessarily indicative that something terrible is about to happen. Sure, some things can look a little wonky, but they might have been creeping up that way for a while and you didn’t even know it. You’re not necessarily going to feel high cholesterol or high LDL. It doesn’t mean you’re going to have a stroke. Tomorrow we start tracking these things because we want to prevent cardiovascular disease, metabolic diseases and so on 10 years or 20 years from now, that’s a big impact on women’s chronic health. But we have time. We can start with, I think, the symptoms that are in front of us, the things that might be the most alarming, and weight gain is a big one. Sleep changes whatever’s happening that you’re feeling. And then, there’s going to be some overlap with what your biochemistry is doing and what you’re seeing on labs. But we can work on that at a slow and steady rate. The main thing, I think, is to know that there are a lot of things that can be done. This doesn’t have to be the end of you knowing yourself, even though it can feel like, whose body is this?
It can be discombobulating, you know? Especially for women [who had children later in life]. I had a baby at 43. [One minute I was breastfeeding] and then I kind of rolled right into perimenopause with small children, and all these things are happening. Like, who am I and what vehicle am I living in? And then all of a sudden, am I headed towards chronic disease? But we can slow all of that down and start taking steps. It doesn’t have to be terrible.
[If your seeing signs of chronic disease crop up on your lab results], know that there are a lot of things that can be done. This doesn’t have to be the end of you knowing yourself, even though it can feel like, whose body is this?
Maryann: And I will say it seems like the minute you go through menopause, doctors start treating you differently. For instance, my OB-Gyn suddenly is talking to me about cancer screenings and genetic testing, and my dentist does now a cancer check every time I sit in her chair. And so it’s like you start to feel like, what, Am m I now at risk for everything? I’m now old just because I went through menopause. Even though my labs look good, I’m still feeling great. So I think, personally, that finding a doctor who is thorough but not alarmist is a good idea, especially if you’re a person like me. It’s a little bit of a neurotic about certain stuff, you know?
Lisa: Totally. Nobody wants to hear that, you know? It can make you feel very vulnerable.
Maryann: Or broken.
Lisa: Yes. Like, oh, I’m living on borrowed time now.
Maryann: Right.
Lisa: All I did was hit 50, and now I have an expiration.
Maryann: Yes.
Lisa: And we want to be smart about our screenings. We have these things for a reason, right? Like colonoscopy or Cologuard, breast screening, bone density. All the things. But they should be used in a way that is with the preventative lens. You don’t want you to have a hip fracture when you’re 85. We don’t want you to have cardiovascular disease, and we all want to prevent cancers, diabetes and any other chronic disease. So, let’s look at what needs some extra attention, which is going to vary with each person, and then let’s work on that. It can be very empowering to have that information if it’s held in a way that [allows you] to act on it.
Maryann: Absolutely. And you say there is no cookie cutter approach to optimal health that works for everyone. I agree. Tell us what a customized treatment plan looks like to you and why it’s important to integrate a patient’s health on the physical, emotional and spiritual levels.
Lisa: Yeah. I mean, we are all things, right. We’re very multifactorial. There are some constants about the human body that most people have similar functions, cardiovascular systems and so on. But our individual biochemistry is just that. It’s very unique to each person. And so I think it’s great that there is so much more out there now about the treatment of midlife women. It’s on Instagram, and you’re talking about it. This is so good. This gives women so much more access to information and things to ask their doctor about and to do themselves. And you can’t really treat your menopause from a book, right, or from an Instagram post. I’ve been in practice for 24 years, and I’ve probably never given out the same exact prescription to anybody in thousands of patients. Some have been similar. My tool kit applies to most women, but there’s going to be some variations based on genetics, current concerns, biochemistry, trauma history, socioeconomics, how much stress is in your life, how many pills you can tolerate taking. All kinds of factors go into what’s actually going to work for you. What are your concerns? What are you afraid of? What have people [in your family] been sick from? What have they died from? We can pull it all together to address your main concerns to set you up for healthy aging. [We also want to know] what things we want to keep an eye on.
Maryann: Yes.
Lisa: And then, also, what’s going to work for your lifestyle? There’s always some new great idea. But does taking 20 different supplements really serve you, or is there a program that applies to you?
Maryann: As you already mentioned, Lisa, it’s important to look beyond the symptoms of disease and to expose the underlying causes that can prevent you from optimal wellbeing. How can diagnostics help with preventing disease? And what are the tests that you feel every midlife woman should consider?
Lisa: Well, definitely, you want some good biochemical blood testing. So, a metabolic panel, CBC, chem panel, those are pretty standard. I like to do a more in-depth look at lipids. So, not just your total cholesterol and LDL and triglycerides, but what are the subtypes of those LDLs? Like, do you have a lot of sticky particles?
Maryann: Right.
Lisa: High cholesterol in and of itself is not an issue. But if you’ve got a lot of plaque-forming particles, then we want to know about that and address that. Is there a lot of inflammation? Again, blood sugar markers, hemoglobin, A1c, fasting insulin, fasting blood sugar…so that we have more of a story. Is there insulin resistance building up? Is there a potential for cardiovascular issues? Is there inflammation in the body thorough thyroid panel, really looking at how well the thyroid gland is functioning, because that plays a big part in our metabolic function and actually in our cholesterol, certainly our hormones, that’s its own area that changes as we move through different stages of the perimenopause to menopause. But assessing hormones, testosterone, DHEA, estrogen, progesterone, and then vitamin D, iron…All of these things that are really reliable through blood work. There are great panels out there. I think it’s really important to request a bone density scan early. In menopause, it’s traditionally not done until age 65. A lot of insurance won’t cover it until then. But at 65…it can be too late. I mean, we can still do something, but you’re already far into this period of the most dramatic bone loss. So it’s really great to get a baseline because some women might already be osteopenic by the time they hit menopause, from all kinds of things that led to that stage of life.
Maryann: Right.
Lisa: So we really want to have an idea of how much we need to intervene there. And then, you know, breast-cancer screening, whether it’s mammogram, thermogram, you decide with your provider. And then some kind of colon screening, Cologuard, colonoscopy, other things that you can kind of add on. Like you mentioned, genetic testing. There’s some good blood testing, like Galleri does a cancer screen blood test. There are some body scans out there now, and then some other genetic testing that can be helpful, like apoE status that predicts dementia and that kind of thing. I think what you touched on for those sort of add-on screenings is, you need to know yourself and what you’re going to do with that information—if it’s going to cause more anxiety or be empowering, which you touched on.
Maryann: I just want to circle back to the bone scan you mentioned. Now, what’s a Dexa scan? And isn’t there a new test that [reveals] both bone density and body mass index?
Lisa: Yes. Dexa is the traditional bone density scan that you would go to a radiology department and it assesses your spine and your hip and gives you a t score and z score and kind of age matches you for a bone density. Yeah. Now there are some of these portal machines I think there’s even a van that goes around, I think it’s called body spec, where you can get a bone density. And that’s especially if you’re going to need to cash pay for it, then they’re pretty affordable. I don’t know if that one also does the BMR and that kind of thing, but I know in body does. And, those, yeah, there are some exercise personal, ah, trainers who have those in their, you know, offices. I think we may get one in ours because they’re the. It’s valuable information when you’re assessing, like lean body mass. And, and then if you can get, I don’t know if you can also get a reliable bone density score for those, but.
Maryann: And it’s good to know how much muscle you have because we’re losing so much muscle after menopause.
Lisa: Absolutely, yeah. Right. Because that that does affect your fracture risk. Muscle…helps to maintain and build bone density, or bone matrix. And we want that stability in our skeletal structure as we age.
Maryann: So how far should we go down a rabbit hole? Say for example, your LDL cholesterol is a little high. So you do a CAC heart scan, which tells you how much hard plaque you have in your arteries. And so on and so forth…more detailed heart screenings, genetic blood tests, etc. How do you know when to stop?
Lisa: That’s a good question…I think the blood testing is a great place to start because if that’s all really looking good, you know, those are biomarkers that are telling us if you have a low LDL or not, a lot of small sticky particles and you don’t have inflammation. And there’s, there’s a panel that I use called the Boston heart diagnostic panel, and they’ve got kind of this breakdown with some markers that even would tell us if there’s inflammation in the arteries. That’s a little bit of a heads up that something’s happening there. So, you know, if that all looks really good, then I think that’s great. And then we just watch that, you know, we might run that every year, and, you know, we’re always doing things towards good heart health, but we don’t have to be super focused on that. If we see some alarm bells there, then it’s helpful to have the screening to see, like, okay, there’s the potential here on blood work, but is something actually happening in the arteries? Like, the calcium (CAC) score, the carotid scan, until it’s like, oh, is there actually something going on here that we need to really pay attention to? If there’s plaque starting to form or there’s a high calcium score, then we, you know, we do a stronger level of intervention.
Maryann: Okay. Gosh, it seems like we’re not talking about anything fun these days. Like, I go out to dinner with girlfriends, and we’re asking, how was your blood work? How was your Dexa?
Lisa: It’s no longer, where’d you get those shoes?
Maryann: Right.
Lisa: But we need to get those conversations back.
Maryann: Absolutely. We just need to spend the first five minutes of every dinner conversation [talking about] the not-so-fun stuff, and then move on to shoes or travel or whatever.
Lisa: But it is great, right? And you’re an example of this. Your’e talking about this. You’re sharing. We’re sharing, right? It’s like we’re around the well, and we’re sharing our [experiences]. We’re talking about what’s working, what’s not. Oh, I heard about this. You know, I saw this person. I think this is so empowering. And maybe what we’re trying to prevent are those conversations 20 to 30 years from now where we’re [talking about what diseases we’ve been diagnosed with].
Maryann: Those conversations are worse.
Lisa: Or I need surgery…We want to avoid that stuff.
Maryann: Say you do a complete blood panel and you get your results back. You know how, when something’s not right, they flag or highlight it? How do we know when something’s like, OK, let’s watch this, versus, oh crap, this is bad. Obviously your doctor should be guiding you. But how can you calm yourself and prevent yourself from overreacting?
Lisa: That’s such a good question. And then there can be the opposite. Sometimes things are normal, but they’re not optimal, right? That’s where it’s really helpful to have a partner, somebody, whether it’s your primary care or your gynecologist or an integrative practitioner or somebody who understands how to read lab work and how to look at it from an optimal point of view and to just kind of walk you through it. For example, something that’s flagged could actually be flagged on almost every woman over 50.
Maryann: Right:
Lisa: . Or, this number is the way it is because you’re doing this—so we’re not worried about that. Or this is low, but we want it to be lower, you know? So I think that again, it’s stepping back. Who is this person? What are we working on? What is the big picture? And then what are sort of things we need to worry about and things that we don’t, you know, and some reference ranges, you know, thyroid, for example. These reference ranges were set on men in the 1950s. They don’t really apply to what’s optimal for women. So you can be having hypothyroid symptoms, have a very normal lab, and just be told everything’s good, but actually, you’re having a thyroid problem. So I think it’s. Again, women are capable. We can learn a lot of things, and it’s kind of nice to have somebody else hold that for you.
Maryann: Yes. And you and I talked offline about how it’s so hard these days to find a primary care physician. People are struggling with that, and healthcare is taking a nosedive. You have to be your own advocate in this health journey, and it’s sometimes hard for women, whether they’re held back by fear, or just by lack of knowledge. It can be a confusing time.
Lisa: Yes. And it’s one more thing to do right now. I figure out, like, what I should be taking, or I got to transfer the family’s healthcare because this doctor just closed their practice, or. Yeah, no, it’s hard, It’s a tough time in medicine. I think a lot of. I think a lot of good doctors are frustrated by short visits and having to, like, do so much of the, you know, corporate kind of aspect of medicine. And so they’re leaving managed care, maybe going into concierge medicine or just, you know, leaving the area. So, yeah, I hear that. I see that a lot. I think if you can put something together, like, you know, it’s good to have somebody in the system, and whether you go with, like, one medical or some kind of part of the hospital system, somebody that you have, who’s part of a, hospital network for just, if you need that, you know, great. But then maybe the person who you have those conversations with, whether it’s, you know, once a year, every six months, or those managing your actual concerns, might have to be somebody else.
Maryann: Let’s touch on genetic testing, because that’s been a big topic of discussion lately. It’s come a long way. But I think your personality can affect whether you’re open to genetic testing. What’s your stance on genetic testing and how do you advise your patients to approach it?
Lisa: Yeah, I think exactly that for the first question is like, what is your intention around this information and how do you see yourself holding it? Is it because there’s something you’re really worried about? Is there breast cancer all over the family? Is there a lot of Alzheimer’s? is there a solid family history or other reason we want to know this, or are you just nervous that something’s going to get you? All of these are good, valid reasons to do it. But if this is just going to make you more anxious, that’s not good for your health. Stress [produces] cortisol, which is not good for your immune system. Is this going to be empowering to know? Which it really can be. ApoE status is a good example. People who have the gene for this genetic mutation could have a slightly higher risk for developing Alzheimer’s. Well, there’s a lot of great information out there for how an ApoE 4 carrier can modify their diet and, supplements and that kind of thing that are specific for helping to mitigate that risk. And remember that genetics are just a predisposition, it does not mean that those are going to express, that’s epigenetic.
Maryann: Right.
Lisa: We have the power to influence how genes express in our body. So in that way, too, I think that’s empowering, because there might be a lot of chronic disease in your family, maybe there’s a lot of cancer or there’s Alzheimer’s, and we don’t want to feel like oh, I’m just sitting around waiting for that to get me, because it gets everybody at 65 in my family. If you’ve got those mutations, maybe you find out on testing at 50, you can start doing things to help really mitigate the likelihood of those actually expressing. So I think for the most part, it can be really empowering. And I have had people say to me, about taking those add-on genetic tests, no, I don’t want to know that because [knowing is] just going to make me worried. And it’s really great to know that about yourself.
Maryann: Well, it’s funny with certain tests, like [colon] cancer, heart stuff, I always tell people, you have to know that that’s easily preventable, so take the tests. The Alzheimer’s thing gets me, though, because especially if you’re making all the lifestyle choices and doing all the brain-smart stuff, there’s not too much more you can do. There are no significant medical interventions to prevent dementia. So it’s a hard one for me.
Lisa: Yeah, but see, this is a good thing to know [about yourself]. If it’s not going to necessarily change what you’re already doing, and if you’re already thinking of yourself and you’re using your lifestyle choices and your diet and your self care and all of that towards healthy aging, then you’re already on that path of preventing Alzheimer’s or any kind of dementia and cardiovascular disease. So then you just keep doing your good stuff. And if more information comes out, or other interventions for certain genetic types [emerge], you might change your mind down the line. But we want to live in the now, right? We want to yes, take care of ourselves. We want to keep an eye on the long game for our health, but not at the expense of our ease and peace [of mind], and not in fear of what might happen. That kind of defeats the purpose.
Maryann: Well said. So Lisa, the decision to do genetic testing is highly personal, which can also be said about hormone therapy. Your practice helps women amplify their mood, their energy, their vitality and libido through bioidentical hormones. How often do you prescribe them for women who are in perimenopause and menopause? And how much of that talk about hormones is part of the conversation with your patients in midlife?
Lisa: I prescribe them a lot and might be somewhat of a pre-selected group because people might come to me because they know that I do prescribe them and that that’s part of my tool kit I really believe in. And the research supports the benefits of hormone replacement therapy when done appropriately and at the right time and monitored appropriately for women, the benefits far outweigh the risks for preventing chronic disease and also improving quality of life in the present. It’s not a “have to,” and there are other tools, and I never force it on anybody. And sometimes we might have the conversation about it and then a woman’s not ready and we might have that conversation three times a year for five years. It’s OK. I’m here to provide options and there has to be kind of an alignment or a resonance for what a woman wants to do. That said, when appropriate, bioidentical hormone therapy can be a game changer in the perimenopause period. That’s when progesterone really starts to drop, and that can affect mood and sleep and water retention and inflammation in the body. And so that’s not an uncommon intervention. I use bioidentical progesterone. Then testosterone also starts to drop in perimenopause. You can see like brain fog and loss of libido, and loss of lean muscle mass, and so many effects of that. At some point estrogen will kind of fluctuate, but then it’ll eventually drop off. And hot flashes, sleep disturbance, depression, lack of motivation, dryness, those are all classic signs of low estrogen. And yes, there are other ways [to treat these hormonal issues]. There are herbs, there are supplements, there are dietary [changes]. Those are all valuable and can be a great support, and just sometimes it’s not enough.
Maryann: One thing I didn’t know until I started doing this podcast is that I used to think that after menopause, after you reach that one year of no periods, your symptoms automatically subside. And I didn’t realize they could go on for 10 years after that.
Lisa: I know, it can be surprising. And again, it’s so good we’re talking more about it because it can be so confusing. “I thought I was done. I thought this would be over by now. I thought if I just toughed it out right, right here, then I would be on the other side again.” It varies, you know. Some women have a super easy time, they don’t notice much at all, they’re just not menstruating anymore and feeling pretty good. And then there are some women who have pretty severe symptoms that don’t go away. I think what is pretty common for most women is that symptoms like hot flashes might subside [after menopause], and sleep might get better; there might be some things that do just kind of regulate as the receptor sites in your brain adjust to this new biochemical landscape. Some symptoms will persist, though. Vaginal dryness is one that is maybe a little awkward to talk about, but is kind of a persistent symptom. Post menopausal, all of our tissues get drier and that can lead to some prolapse or urinary issues or more vaginal infections. So that kind of continues. And then, like we talked about before, there are kind of the silent things that are going to continue, like density decline and changes in lipids and metabolic markers and so on. So, yeah, it’s ongoing. It’s book two, right? We have so many answers, but we don’t yet have all the answers.
Maryann: You brought up women who aren’t experiencing many menopause symptoms. That is an interesting question: whether or not to go on hormone therapy when you’re not experiencing symptoms but doing it for preventative reasons, that’s a tough call to make. How do you help your clients make that call?
Lisa: It’s definitely a conversation. I call it the silent menopause. If you are having symptoms, it’s an easy call. If a woman is hot flashing 10 times a day and hasn’t slept in weeks…it’s pretty clear what we’re going to do. And so she’s going to get the immediate benefits [from the hormone therapy] and then she’s setting herself up for the long term benefits. That’s straightforward for that. More that conversation of like, yeah, you know, I feel pretty good, but I’m not sure if I should do hormones or not. Again, looking at risk factors, what, you know, are you at higher risk for osteoporosis, you as an individual? Is there a lot of heart disease in the family? A lot of dementia? Are there blood sugar abnormalities? What are the things that, where hormone therapy could play a part in preventing those from expressing? It’s also an important point that we don’t have good interventions for dementia, cardiovascular disease, osteoporosis once they happen, we just don’t right now. And so the seeds that we can plant now to prevent those things from actually showing up for us down the line have a high benefit-to-risk ratio. They are safe, they can be done safely, long term, and they may even surprisingly bring some quality of life. Even if you’re feeling pretty good, you might be surprised that you get a little extra skin moistening or something from HRT if you decide to do it. So I think it’s a very frank conversation that a woman needs to have with her provider, looking at, what are we trying to prevent? What are those options if those things happen, which right now are not great, and what’s the resistance to doing it now? I’m never going to make anybody do anything. You know, I work for you, right? I’m a consultant to your healthcare. But I will present the facts, and the facts are right now that bioidentical hormone therapy is a safe and effective method to prevent chronic disease for women.
Maryann: OK. Two questions about hormone therapy. One, does it ever have any side effects for women? And two, we hear a lot about the fact that you need to start hormone therapy within five years of hitting menopause. Why is that?
Lisa: So that’s when you have the biggest change. So I’ll answer that question first. And then, at the other one, in the first five years of that, that’s your biggest estrogen decline, right? So that’s when all of the consequences are going to really start, to take place. You’re going to have your biggest drop in bone density, the biggest shift in your lipids, in your metabolic markers. There’s this whole recalibration that happens because all of these receptor sites all over the body are losing this input that you have been making in your body for many years.
Maryann: So much fun being a woman.
Lisa: I know. It’s like you go through puberty and then [for a long time] it’s all kind of good and smooth and then…it’s like puberty in reverse. So, if you’re going to initiate hormone therapy, [within those five years] you’re going to get the best offset of disease processes taking place. There’s room to have the HRT conversation [anytime]. It’s never actually too late, but…during the first five years, you’re going to absorb the most benefit, and you’re going to have those benefits forever. Even if you stop [taking HRT] you’ll slowly start to lose those benefits, but you’ll have front-loaded them if you started closer to the time of your last period.
Maryann: In terms of the symptoms of hormone therapy, do any women feel side effects?
Lisa: Yeah, it’s funny, there’s my brain fog. I forgot to answer your first question.
Maryann: It’s OK!
Lisa: You know, sure, like anything there can be individual responses. It’s just as a matter of perspective, remembering that hormone therapy, whether it’s the estrogen patch or a compounded estrogen formulation and some testosterone, maybe some DHEA, progesterone. The way that we do hormones now, these are biochemical recreations of what your body made. So these are not anything new. It’s not like even taking an Advil or something; that’s a foreign substance that your body has to figure out what to do with. We’re basically augmenting hormones as a mimic of your own hormones. And I mentioned that because that sets the framework for this not being something weird or foreign that has a high potential for side effects.Your body managed estrogen at high levels all through your reproductive life, and progesterone and DHEA and testosterone. You had all of these things at very high levels if you were pregnant and so on, or in your peak reproductive years, you made very high, large amounts of these hormones. We’re giving you a very small amount just to get a chemical benefit..
That said, if it’s been a little while since the last period and all of a sudden we’re introducing some estrogen, there can be a little breast tenderness or a little wake up, like what’s happening? Your receptor sites are a little confused. So, I just always encourage women to stay in very close touch with me. if there are any side effects, I want to hear about them. There are always things we can change about how the HRT is being delivered, what the formula is. We will sometimes give a supplement that helps with the metabolism of hormones just to help it move through your body easily and get rid of the waste products. History can be helpful here too. If a woman has a history of endometriosis, fibroids, cysts, difficult periods, then we already know that her body had a rough time with her own hormones, and there’s a potential that her biochemistry may have a little rough time as we introduce these from the outside. So we just work with that. Eventually those symptoms may subside once you’re on the [hormones] for a little bit. And if your symptoms don’t subside, then we change what we’re doing. We don’t want to create more problems. This really should be something that you incorporate into your life and you benefit from it. You know, it’s not another “have to.”
Maryann: And just to piggyback on what you said about the very small amount of estrogen that’s given in this treatment, we need to be clear that hormone therapy is not going to bring back your pre-menopause body. It’s not going to bring back your period. It’s not a miracle weight loss drug. Do you sometimes need to manage expectations when your patients start their treatment?
Maryann: Yes. So true. And [on the flip side] some women are [afraid that they] might start menstruating again.
Maryann: Not getting your period is the one benefit of menopause!
Lisa: Exactly. We work toward that benefit. [Laughs] But we are giving minute amounts [of hormones] that just provide good bone density support to help keep that cardiovascular health and brain health in an optimum state. We are not trying to keep a woman menstruating. There is no benefit to that. No research has shown that that level of estrogen is of benefit. There is no miracle, unfortunately, for bringing back the pre-menopausal body. There are a lot of tools, and hormone therapy can be a part of that. Part of the weight gain of menopause is a bit of a sequestering of estrogen in the fat cells. And so when we bring on hormone therapy, there can be sort of a letting go of stored fat in the body. And so that’s a benefit. Testosterone, it helps with lean muscle mass. DHEA can be helpful with metabolism. Again, optimizing the thyroid, making sure that that’s working for you. Treating insulin resistance, shifting the diet, all of these things are important and can be helpful.
Maryann: And that’s why it’s important to know whether you’re insulin resistant too, because that could contribute to belly fat, right?
Lisa: Absolutely. And the truth is, I think it was Sarah Gottfried who said this, all menopausal women are insulin resistant, essentially. We are all carbohydrate intolerant. We’re just nothing designed to process carbohydrates in the same way, which is really bummer. So, at some point, it helps to kind of make peace with that reality and shift how we eat to be a more protein focused diet, lowering carbohydrates and if there is actually insulin resistance, using some tools to help, because insulin is inflammatory and we don’t want that.
Maryann: That’s a great segue, because I want to go over some of the lifestyle changes we could incorporate, especially for women who can’t or prefer not to be on hormone therapy, that can go a long way, not only for menopause symptoms, but for weight loss and disease prevention. So let’s dive into some of those?
Lisa: Yeah!
Maryann: Let’s start with nutrition. You mentioned a little bit of that with the carb thing. How do our dietary needs change after menopause and what actually works for weight loss these days?
Lisa: I sound like a broken record and you’re going to hear this everywhere, but we really do have to shift to a more protein-oriented, healthy, fat focused diet. There’s room for some carbohydrates, and we want some little bit of starch in the form of fiber. We also want pleasure in our meals and thence sensory experience. But we’re supposed to be getting 100 to 120 grams of protein a day, which means every meal and snack needs to have a protein, be protein centered. We also need a lot of healthy fats, avocado, olive oil, and so on, for our brain health, for our joint health, and also for that satiety to help us feeling full longer. And then our carbohydrates [should be] coming mostly from vegetables, a little bit of fruit and some grains: quinoa, brown rice, that kind of thing. There’s this term, no naked carbohydrates, right? Even if we’re having a piece of fruit, like an apple, we want to always counter the hit of sugar, even fruit sugar, into the bloodstream with some protein. So if you’re having an apple, have a handful of almonds with it, or some nut butter. We just don’t ever want to throw sugars of any kind on their own into our bloodstream, which will spike your insulin.
Maryann: That’s really hard when you’re at a barbecue and someone shoves a platter of watermelon in front of you.
Lisa: I know. It’s a hard season to not eat sugar.
Maryann: The beautiful cherries…
Lisa: And the acai lemonade and all these things. Again, though, [something like] watermelon is fine, especially if you just had dinner. If you’ve just had a burger, then great. Then you’ve got some protein and some fat in your digestive system. So having something sweet after that isn’t going to be the same hit as it would be on an empty stomach.
Maryann: OK, what about exercise? We’re hearing so many contradictory suggestions about how to exercise in midlife: more HIIT, not as much cardio, more strength training. We know strength training is the main thing we need to be doing. What else?
Lisa: I think that’s all out there because it’s really true. We do want to do more strength training. We want to keep our muscle mass strong and intact. I think what we want to shift away from is the intensive cardio of our younger years, like, intense long distance running. Some Peloton workouts are great, but we don’t want to be going 45 minutes straight on the Peloton or things like Orange Theory or those kinds of things. Because what can happen is when we do a lot of hardcore cardio, we’re going to be pushing cortisol pathways. Cortisol ultimately ends up in weight gain, more inflammation, and disregulates our adrenal system. We need [to do some] cardio. I think it’s important for our endorphins. We need to move. We want to keep our stamina and cardiovascular capacity strong. But it can be things like walking, hiking with a friend, a brisk walk, a little workout on an elliptical machine or a Peloton. But, you know, more a moderate workout.
And then, whether it’s HIIT or weights, we need to make sure we know what we’re doing, that somebody has guided us in our workout program. We don’t want to hurt ourselves. And then also finding something that’s fun, [that makes us] want to exercise. It’s one of those things. Yes, we’re supposed to do it, but [it’s nice] to want to do it. And then tracking how you feel afterward. Do you feel exhausted or do you feel energized? And how long does that last? Because that will tell you something. Like, did you draw on your reserves to go do that hot Pilates class and now you need to lie down for two hours? Or did you leave [the studio] feeling good? And does that energy sustains us for a few days, or a few hours? That’s important feedback and something that you may need to attend to. Also, if you’re eating fewer carbs, there’s no way we’re going to run a marathon.
Maryann: I’m a runner, but lately I’ve just feel better doing a couple miles at a very slow pace. If I’m going to run, I can’t do the five miles, the 10 miles, which is the loss.
Lisa: Right. Because that was your meditation, but you’re making a shift that’s better on your joints and your whole cortisol regulating system. But, if you are an athlete…you’re going to need more carbs, and that’s OK because that’s appropriate to your workout. You just need to figure out the timing for that. Do you consume carbs right before you go to the gym or on the trail or whatever? You know, I think you’re so right, and I think it can be overlooked in some ways. We can treat around sleep, right? We can, you know, people are tired, so we’re treating their fatigue or we’re. We’re caffeinating or, you know, trying to energize ourselves, but kind of forgetting that we may not be actually resting or kind of going to the core reason of why we’re tired. So, you know, there are the obvious things people know about sleep, hygiene and screens and shutting things down an hour before. And all of that, I think, is really important. I think there are some steps that can, you know, we use magnesium and, calming herbs, you know, valerian, lemon balm, those kinds of things can be helpful at night, really recognizing that, moving into sleep starts a couple hours ahead of time as we start to kind of wind down and head ourselves towards that zone. So getting stuff off of our plate and kind of, reducing stress and activities. We get to sleep and then, you know, again, I didn’t invent any of these things, but, like, a quiet space with the words dark. And if you need to have your phone that’s on airplane mode and just kind of away from you, and then, you know, if you’re still not sleeping well, like, asking for help around that, you know, again, there can be a hormonal piece there where some hormone, you know, whether it’s estrogen, progesterone, that can be a big factor in sleep quality and duration. Cortisol regulation. A lot of times, you know, especially if there’s that kind of two to 03:00 a.m. m waking that’s often like cortisol spike, where the, you know, it’s basically a sympathetic nervous system kind of, reaction. And so we need to work on reducing cortisol, like, you know, all the time, but especially in the evening. And, and then blood sugar plays a piece into that, too. So this is another place where protein makes a difference, where if you’re having, you know, protein rich dinner, your blood sugar is going to stay more steady through the night versus more carbs at night, where then your blood sugar can kind of crash and spike again.
Maryann: Everything’s connected.
Lisa: It really is. Our daytime self care influences nighttime and vice versa. But you’re right, sleep affects everything. Our metabolism, our brain health, our mood, you know, our mental focus…And regarding those tracking devices, that’s another one where you have to ask yourself, is getting like an Oura ring or something, will that data be helpful or will it make you more anxious? Like if the ring gives you a terrible sleep score, will that actually be empowering when you get to kind of see where you could do better? Another thing that gets kind of forgotten about and, you know, maybe more of a factor for men than women is, assessing for sleep apnea. That’s a pretty common cause of sleep disturbance. Some people don’t know that they’re waking frequently in the night, or they may even snore a little bit and don’t know it. And that can be a cause of not having very restful sleep. So that’s where, like, a tracking device can be helpful also.
Maryann: By the way, I love my Oura ring. I don’t have it on now, charging it, but, it helps. I like seeing my sleep score in the morning because it kind of, I don’t know, it just makes me. Okay, I’m doing well, I’m sleeping okay. It keeps me on track.
Maryann: And If you don’t get a good score, do you have things that you do, you’ll do differently the next night or it gives you kind of.
Maryann: Yeah, I think what I usually know when I’m not getting a good sleep score, like, you know, when you didn’t get a good night’s sleep and I’ll say to myself, okay, today’s not the day to do the big run, you know, or a ton of, you know, I’ll take it easy today in my workout.
Lisa: Yeah, yeah. Maybe take a rest later in the day if you can.
Maryann: yeah, because that’s so important. That’s something you don’t think about when you’re younger, that resilience and that ability to bounce back.
Lisa: Yes, and the nighttime is essentially the time when you’re parking your custom car in the garage for an overhaul. Our immune system, all of our inflammation regulating systems are getting a repair cycle at night. And if you don’t have enough time for deep restorative sleep, then you’re not going to get that same kind of cellular repair.
Maryann: Right. So, Lisa, just one final thing I would love to touch on is supplements, because, again, there’s so much confusing confusion around supplements. Which ones to take, how much. I mean, is there any way to whittle that down for us?
Lisa: I know, it’s very easy to let your collection expand. There’s always something. And when you hear about the benefit [of a supplement], you’re like, of course I want that!
Maryann: You go to Whole Foods and you’re like, “Oh, I want this and this and this.”
Lisa: Totally. Brain health and stamina and weight loss, all those things. So looking at biochemistry can be helpful. Labs can be helpful. For example, do you need vitamin D? Do you need iron? Do you need essential fatty acids? Some of those things can be measured, and then that’s an easy one. You’re taking this because you’re low in it, and that’s motivating, and that should stay in your regimen, you know, until you test again. Other things that may or may not be tested but are probably a good idea is for most people some degree of what we call like adrenal support, like something to sort of help kind of that sympathetic nervous system, a sympathetic parasite, sympathetic balance, whether that’s just straight magnesium or some Ashwagandha rhodiola, those, we call them adaptogenic herbs that just kind of help to regulate our cortisol output. I think regardless of our circumstances, nobody makes it to midlife without some degree of life stress. Right. And then that just gets compounded with aging parents. We’re raising children, our professions are questions about midlife and what am I doing and, you know, where am I going? So, I like to have something like that on board. It can be as simple as ashwagandha in the morning or just some magnesium at bedtime. Everything else, honestly, is sort of symptom dependent. Like if there’s some gut stuff going on, then maybe there’s a probiotic needed or something to help, you know, with cleaning that up. I personally like to keep the supplement regimen pretty simple. if there’s no estrogen on board and a woman’s post menopausal, we definitely need to be thinking about her mineral intake for bone health. And even with hormones on board, we want to probably have something for, and it’s not about calcium really. It’s about all of the minerals, boron. So there’s formulas for that. So something very basic. And then vitamin D is important might be vitamin D, a probiotic, a mineral formula, omega three fats, and maybe some extra magnesium.
Maryann: Are there risk associated with calcium supplements?
Lisa: I think that’s where a lot of those studies with calcium and heart health, and then calcium was sort of like taken off the table as being of any value. And then also some people can be at risk for kidney stones. Calcium, kidney stones. Calcium is a factor in bone matrix development. But really that level of calcium can be gotten from food. Right? Leafy greens are rich in calcium. If you’re doing some things like greek yogurt or, you know, if you do some dairy, you’ll get, there’s good calcium m. sources of, In dietary sources, really, it’s the other minerals that we are concerned about that will be. That are important for bone health. So, to answer your question, a straight calcium supplement. No, but something that is, you know, a bone. Bone matrix support. Yes. And then getting calcium from food. Yes. and definitely vitamin D.
Maryann: This was so much valuable information. And I just want to recap what women out there can do to get back into a groove and maybe start to reboot their health. Baby steps. Like you said, ease into it. Be kind to yourself. See your doctor for your annual checkup. be proactive and know that there is so much you can do in terms of lifestyle changes and other things to feel better. Lisa, do you have any other tips or words of wisdom to help women get motivated, maybe excited about taking charge of their health because it’s a gift we can only give to ourselves, right?
Lisa: Yes and yes. First of all, there’s no need to suffer. So if you’re not feeling great, then there’s probably something going on. So ask our help about that. I think we’re really adaptable, and we just sort of get used to things being maybe not how we want them optimally. I don’t think we need to keep doing that. We’ve all done that a lot in our lives, so that’s important. You don’t need to be feeling terrible. secondly, I think that, we want to watch for being treated for the consequences of our hormonal changes and not addressing the cause. So, again, you know, getting some, getting empowered around that and taking charge of our health now so that we age well and have. We reap all those rewards. Right? We raise these kids, we built these businesses. Whatever we did, we want to be able to enjoy them. If we’re going to live a long time, we want to live well. And then I think ultimately, like, you know, women, especially midlife, you know, this. You’ve talked to tons of them who are doing amazing things. I think we have so much to offer. Especially as we get freed up from maybe the hormonal fluctuations of our reproductive years. And maybe some of the hard stuff is behind us. We’ve raised children, or we’ve figured out our profession, or we’re finding the relationship and the friendships that we want, and then we have wisdom to bring and things to do. So it feels important to me that our physiology never hold us back. There’s a book you want to write, but you can’t get to it because you’re not sleeping through the night. The physiological part is addressable. And then when we put that foundation in, then I think women just have the platform to do what they’re here to do. I think the planet needs us. You know what I mean?
Maryann: Amen to that.
Lisa: We are here right now for a reason. And we all have something really brilliant to offer. You’re a great example of that. Like, you are doing something that is helping probably thousands, if not more of women, just by sharing information and bringing things out into a platform. Whatever our version of that is, small or large, it’s what we’re here to do. So we just never want to let our bodily obstacles get in the way of that.
Maryann: Well said. I couldn’t agree more. Well, Lisa, thank you for doing what you’re doing. It is priceless. And thank you for sharing so much incredible information. I’m sure everybody was out there taking notes. I know I was. Thank you. Please tell everybody out there where they can find you online if they want to get in touch.
Lisa: Sure. Our website, my practice is called Be Well Natural Medicine. It’s in Mill Valley, California. The website is Bewellnaturalmedicine.net. We have some good information on our website. And for any women who are around here, we’re going to have our second women’s health symposium in October. It’s a great place for women to come and sort of bring their questions and get information. It’s myself and an OB-Gyn and I work a lot with and a pharmacist and a psychotherapist, and we just kind of have an in-person conversation about midlife health. So, yeah, people can reach me there. And, I love to talk about all this stuff. So tank you very much for giving me the opportunity.
Maryann: Thank you. And if I’m in town in October, I’m going to stop by!
Lisa, Yes, please come. yeah, it’s fun. It’s a really great day.
Maryann: Thank you so much for being here today.
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