Menopause Metabolism: Why What Used to Work Suddenly Doesn’t

Hidden Stressors Beyond Busy Life

Stress. You know, we all think about stress, the regul the circumstantial stress, the work, all of that, you know. However, what adds to stress is um nutritional deficiencies, imbalances, nutrient deficiencies, metabolic stress. So blood sugar roller coasters, pre-diabetes, um, environmental toxins. That's a big thing coming, like all the phthalates, the parabens, heavy metals. I test all of my patients, um, plasticizers, um, mold, right? All of that is stress on the body. And then not eating enough. I said it already with these nutrients, but you know, there's different that nutrient part can come in different variations. It can come, you just have a nutrient-depleted diet. So this can still cause stress, even you might eat enough calories. And then there are many women who don't eat enough, and I'm gonna talk about that in a second. But the last piece is exercise. And it's exercise is of course not bad, but it's not like a cookie cutter approach.

I wonder

A Menopause Doctor’s 20-Year Shift

if you could kick us off by sharing. You've worked in the in, I call it the industry. Menopause isn't an industry, it's a subject, but it could be an industry. Could be how is your approach to menopause changed in the last 20 years?

Oh, oh yeah, that's a good one. So, you know, so I came, so first of all, so because listen, I'm gonna hear my accent. I grew up in Germany and went to medical school and then really family got me to, you know, family reasons got me to the yes, and we got stuck here. So then I had to kind of do my residency again. Anyhow, so once I came out of there for the first time, I'm not sure if I had so many midlife patients, but I just immediately felt, okay, I need some extra education here because I love hormones. I just we didn't get much of that in training. So I went to the Menopause Society and there got my certified menopause practitioner. So the menopause society used to be called the North American Menopause Society. They renamed themselves because they're really, I think they have more of this worldwide approach. And it's a great society. These were really the people who were early on, after that women's health initiative disaster, they were immediately saying, a moment, let's look at this data again. And they were the ones who, you know, who kept saying, no, HRT is safe for most women. Um so um, so I trained with them. So I always want to make sure people understand HRT is not a new thing. There are many people who have been trained who has been doing this since 20 years, but right now it's such a hype. However, they have, you know, a very um, I like it, it's a consumer protective approach. So they're very conservative, but still they say it's safe for most women. Um, but you know, very data driven. Um, so so what I used to tell my patients before I got myself into menopause, you know, there was a lot of reassurance about many symptoms, like, you know, yes, you gain weight, but you know, data tells us it's just an average of three kilos. So, you know, there were these things you would tell my patients, or you know, I did realize they have GI issues, but this was just not mentioned in no menopause guideline at all, or the palpitations or the symptoms, like in the last five years, you know, we have made people know that this is actually part of their transition. Um, but that information wasn't out there. So I was very, you know, um data driven. Um, and there was not much more information. And I think, you know, what happened as I transitioned through menopause earlier than, you know, a little earlier than I expected. But now you're an expert in something, you always think that's never gonna happen to you. And I thought I'm gonna be very late because I did like everything right, you know. Matter of fact, that I had a tremendous amount of stress, you know, I was like faculty at university, and I had my, you know, I separated my my um marriage fell apart. Yeah, all these things that we all go through. So my body didn't take well to that either. So then, you know, I went through, you know, first kind of it was fun. I had more like hot feet and couldn't wear my nice chic boots anymore because I just wanted to tear them off in my office because my feet were burning off. And at first I felt this was all funny because I also really didn't believe it's really perimenopause yet. You know, and then came, however, you know, like the menopausal rage. You know, again, now everyone has heard about it, but back then, you know, this was really something I had to Google. I was like, what's going on with me? And then, you know, as the GI issues and um, you know, the weight, I just wasn't okay with this, you know, with this conventional medical approach. Like, yeah, this is like this, you know, have some hormones, but there are some things you kind of have to accept, it's not so bad. So that went away once it hit myself. I was like, well, this is not good for me, and I don't think it's good for my other patients either. And that's when I really, you know, started out to look for that um functional medicine armamentarium or toolbox, as I call it. So this is not a board certification, it's not a specialty, it's certain training people can get. And this has really expanded, you know, my conventional medical approach. And I love it. So, you know, since then, I really have, I think I find an answer to nearly every problem my patients are facing. So it has just been so much more fun. And you know, and if we understand things, I think it just makes us feel better, right? That moment. If someone doesn't brush us off with this is just like it is, or oh, your labs look normal, you can't be fatigued and having all these symptoms. But the moment someone acknowledges that and can say, Oh, I actually do see, and I can explain you what's going on. So, did that answer your question? I tend to give you a whole run around the world.

It totally answered a lot of my questions, but um, and like we could go in so many different directions. I'm thinking, I'd love to hear more about your own experience. I'd love to hear about some of the symptoms and you you know, um whether they last and and like what the cause is and what's normal and what's not. Like um where do you think we should go first?

Well,

Why Hormones Stop Buffering Stress

I think let me give you a little bit of these functional medicine insights about some of the drivers of the symptoms in perimenopause and menopause, because I think that is interesting to your listeners, probably. Yes. So um, you know, what is really what we know now more and more is that effect of the stress access uh to this menopausal transition. So, first of all, I always want to start out saying the menopausal time is a fantastic time for us women. Like really, uh you know, you know, you can glorify your cycle as much as you want. And I might have thought, done this too, but now I don't have it anymore. It's so much better. And this is just for everyone, just so you look forward to it. Once you're on this other side, I wake up every morning the same person. It's not like one moment I'm sad or my, you know, my hormones are hijacking me to reproduce or whatever they want me to do or deal with all kinds of things. It's like always the same person. So that's good. However, so and that menopausal transition is not just hormones that is always like, oh, my hormones are wrong, and their hormones need to get tested, and they're causing all of this. Um, matter of fact, it's yes, you know, our hormones are, I call them like these fire extinguishers. They kind of keep us going because nature likes us to reproduce, it doesn't want us to have joint aches, or doesn't want us to get sick because we are still supposed to have probably children and kind of reproduce. So that's what these hormones are kind of doing for us. However, once we transition through perimenopause, you know, these hormones become very unreliable. I always say these are like two coworkers. They're supposed to show up at 8 a.m. every morning, and our progesterone doesn't feel like it for the next three days, and estrogen comes, whatever, at 10 and then at 12, and you know, then it comes at 4 a.m. So it just comes very unreliable. And with that, that many of these buffering of fire extinguisher function that these hormones are having are going away. And that most important buffering is estrogen on our stress axis, or we call it cortisol HPA axis stands for hypothalamus pituitary adryal axis. Way too long. We call it the stress axis. So now, you know, the stressors we dealt with before very well, you know, the children and the husbands and the works, but also, you know, not enough sleep, not enough nutrition, all of that. Now the signal gets amplified or it's not tamed down by estrogen anymore. So this becomes like a loud shrieking signal that doesn't turn off. So this now makes everything worse. And the progesterone usually, you know, helps our sleep architecture that's also going away or shows up whenever it feels like it. So now our sleep is fragmented, which also increases that stress signal, and estrogen doesn't buffer that stress signal anymore. So this is why the things we tolerated before, maybe we were even felt it was invigorating. You know, I was, you know, working on a level three hospital here in the US. The helicopters were dropping, you know, like the difficult cases on the roof. Literally, I found this was great for a couple of years, and suddenly I didn't really enjoy that anymore. So we just realized, or one of these nights on call, I just it took me days to recover. So, and this is what many women are describing, or exercise, you know, their usual run. You know, suddenly they're like, wow, that really I take a whole day or two to recover from that, or my exercise, or I can't build muscle. This is all when this holy soul, the stress access signal is turned up. It also suppresses our immune system, it interacts with our gut functions. So this is when we suddenly all get this diagnosis of IBS in midlife, right? Which the only someone said the only real thing about IBS is BS. You know, the rest is really just it's basically the brain gut axis. It's the vagus nerve that is suddenly the parasympathicus that is making us supposed to make us rest and digest and calm down. That is all not working anymore. Or it's dysregulated. Let's call it like this. Um, so this is important to understand because in the end, it leads to mitochondrial dysfunction, because we are just the cells don't get enough energy anymore. We have blood sugar roller coasters. In the end, again, mitochondria don't work well. This is when you are fatigued, and no matter how much you sleep and rest, that that goes on. So, you know, there are all kinds of access aspects to that cortisol stress access. But in my practice, I found this was really the missing link because yes, you know, I treated people for their gut and for the hormones if they wanted that, and we can work on the metabolic health. But my question always is well, what is driving this so differently in women? Because we have to understand there are many women, you know. I see many, my regular practice, I see women just for a checkup in midlife, and there are many of them, you're not gonna believe it, they have no major symptoms at all. So, and this is not to say to take things away from people who are very symptomatic, but it's just to for us to realize if you, you know, for some reason your life has turned out that you are relaxed and you know you have everything lined up perfectly, maybe you have a little better genes. This is not designed to be a time of you know disease or complaints or that our health degrades. It's a transition that nature has really designed for us to basically let go of that reproductive function, which you know is dangerous and it takes a lot of work, you know, producing this egg every month and preparing for potential pregnancy, you know, that is really crazy. And nature is just saying, no, you have something better to do now, you know, refocus, um, you know, whatever you want to say, you're smart, you have a knowledge, all of that. There are better functions for you in society. The dangerous stuff of reproducing, let the younger women deal with that. So this is how I see it.

I love that. I love the fact that you you're reframing that whole repro the reproductive years is the dangerous years because we the messaging we get given is like menopause is is like you get all of the warning signs, right? Warning, warning, you're going through this terrible change, all these bad things are gonna happen to you. Um, but what you're saying is actually no, this is like a gateway to something uh uh amazing. Yeah, really fantastic. So stress, I think I think I I mean you you talked about stress and all of the different forms, but could you go into it a little bit more? Because I really I work in the fitness industry. Yeah, and I really think that uh this idea of stress, we think of we still think of stress as those external factors, you know, being busy at work, having the deadline. Um but you you kind of mentioned a whole bunch of things, and I know that even exercise is stress, right? So like there are there are many different ways that our body can be impacted. Can you kind of break some of those down for us a bit more? Because I really just feel like this we need to drive this home.

Yes, we need that. I agree. So, yeah,

Exercise And Undereating As Stress

so stress, um, you know, we all think about stress, the regul the circumstantial stress, the work, all of that, you know. However, what adds to stress is um nutritional deficiencies, imbalances, nutrient deficiencies, metabolic stress, so blood sugar roller coasters, pre-diabetes, um, environmental toxins. That's a big thing coming, like all the phthalates, the parabens, heavy metals. I test all of my patients, um, plasticizers, um, mold, right? All of that is stress on the body. And then not eating enough. I said it already with these nutrients, but you know, there's different that nutrient part can come in different variations. It can come, you just have a nutrient-depleted diet. So this can still cause stress, even you might eat enough calories. And then there are many women who don't eat enough. And I'm gonna talk about that in a second. But the last piece is exercise. And it's exercise is of course not bad, but it's not like a cookie-cutter approach. So, what adds to stress stress, you know, the stress the body perceives is indeed some type of exercise. So, cardio can be very taxing in midlife. Um, and I feel like the patients who become most symptomatic and they're the most frustrated by that transition are like bigger runners, you know, the runners, the crossfitters, because that used to be their remedy for everything. And they, you know, and they would control their weight by even, you know, exercising a little harder, eating a little less, and the body is super sensitive to that running cardio exercise stress. And I think most people have heard it like we now really think build your muscle, and I think that's a good idea. However, they are then these women, they get up every morning at 4:30 to go to the gym and do one hour, you know, machines. Like, this is weight bearing, this is good, Dr. Ansman. I'm like, like, no, you know, this is not like an everyday thing, and you're basically now forfeiting sleep for X. That is not gonna work. So these are the women, they're literally saying, I barely eat, I and I still gain weight, I have this belly, I feel fatigued. And now we are talking about, you know, what's called like the energy availability, really. So

Refeeding And Restoring Metabolic Rate

what's basically happening, we women are so trained to always be thin and eat less and less. And many of us, I think myself included, I might not be the extreme, but you know, we learn decade after decade to eat a little less. And we know, well, you know, if we cut a little calories, you know, whatever these calculators online, you know, weight loss calculators tell you, you know, you have like a hundred calories less or so, then you're gonna lose that weight. And you can do that over time, works fantastic, but at your body is gonna adjust the longer you do that. So the amount of energy the body is gonna use up freely is gonna decrease because it's gonna start to hold on to every calorie you you eat. And so every time you cut calories, there's gonna be less and less, you know, it's gonna adjust to a less and less. So there comes the time in midlife compounded by hormone changes, right? Estrogen deficiency doesn't help with the insulin sensitivity. But now we are coming to the point where the body is just saying, like, no, you I am not gonna um so basically I'm gonna put you in a complete catabolic state, but not in terms of I'm gonna let you lose weight. No, it's a state where I'm just turning the oven down to the minimal to keep you going, to make sure you're basically not dying or can still function. So, and what's this is really a complex situation because these women barely eat and don't even realize that they are barely eating anymore. This is often, I have literally to get, you know, like an eating disorder, adult psychotherapist to help them to recognize that. And so, what we have to do with these women is they have, of course, to cut down a little bit the exercise, get it to a reasonable space, and then we have to refeed them. And basically, we have to the only way to get out of there is really to increase that basic metabolic rate again. And that works with refeeding, and at the same time, the women who need to exercise more, they have to exercise. And the ones, you know, who do way too much, they have to scale down a little bit. So we need exercise and we need food, and that goes over several weeks where we really re-feed this body very slowly. And that data actually comes from athletes. So this is not even a functional medicine thing. They really, I'm probably you know all about it. That's like how they refeed athletes. And you know, it's known they get gut issues, GI issue, they don't sleep well, and once you refeed them, that kind of re-establishes themselves. So, yes, so stress and it's a whole complex protocol to get these women out of there. And it's it's often a big psychological. I mean, they're really fighting like mentally, and they can, thanks goodness, they are like older now, so they can you know verbalize what they're feeling. And it's it's so telling, you know, that that whole how we are trying to be thinner and thinner, even you know, feeling very weak, like in my early 40s or late 30s. I'm like, I feel much better than back then. Do I have a couple of more pounds? Oh yes, but I'm also much easier to get up these stairs, and you can give me a couple of grocery bags, that's not gonna bother me at all. And that was different back then.

Yeah, I agree. I've uh I've increased my weight a little bit. And I said to my husband the other day, I don't really want it to keep going up. But if it stabilizes with this couple of extra kilos, and I do feel like I've got more energy, I'm more consistent throughout the day, like when I do exercise, I feel more energized, I feel stronger, I do recover better. Like all of these things. Yeah, I'm I'm like, well, I don't mind having that little bit extra, but there is that well working in the fitness industry um with you know a male counterpart, my husband also works with me. Um the perception that women should look a particular way. And when it starts to change, and I do to a degree feel like it's out of my control a bit, like it's happened, even though I don't seem to have changed any of my lifestyles after that much. It's kind of very interesting to to witness that experience of like how I should look versus how I should how I should feel just like what stories are mine and and what ones belong to someone else and what I'm okay with. But a lot of it's because of societal pressures.

Yeah, it's that, and I think that's the story we have to rewrite. Um you know, I think that is really

Body Image Pressures And Midlife Strength

important also, you know, and I'm gonna give you this the end of that story in a second. So there is a way to lose some weight again, okay? So there however, you know, I really think it's important for us to feel how we feel. You know, when my body started to change and suddenly, you know, I got more on my rear end. And actually I thought this was cool. I that's I didn't. realize initially what's going on. And you know, it's not that I have a belly, it's just everywhere is a little bit more. So and I was like, well, you know, it it feels good. And I think we should listen into that really. And you know, I started then working out a little bit and I got, I always had broad shoulders and I, you know, just being very thin, so it was okay. But now I get little upper body workout and immediately I was, you know, popping out of my blazers. I was very upset about it until I was like, Christina, are you stupid? Yeah, gave them away for donation. I was like, I'm never going to fit in there again because I just have, you know, now muscle on my already broad shoulders. Why would me, a five, 10 woman with like 178 centimeters, why should I fit like in a size small plaza? This was wrong to start out with. So that comes a little, you know, I think a mental readjustment. But, you know, this energy availability, that is in so once that body you have driven up this basic metabolic rate again and the body is like, oh okay, I'm you you know I'm safe. This is good. I'm building again I have enough uh you know I'm taking care of with my basic needs and I have enough then you can actually you know um you can start building you can start building muscle or you can you know for like two weeks reduce um energy intake like 100 200 calories and you're actually gonna lose weight but now you have to be careful you can't do this for a long time. We say two weeks on two weeks off it's called the Metador protocol you know there's a science behind it. So that's really to avoid that um that adjustment of the basic metabolic rate again. You know but in my heart you know I hope that we are all gonna you know just learn to embrace that strongness um and be a little bit more more generous with you know with with our bodies really um you know I'm not saying no we we want to be metabolic healthy of course but if you feel actually good you're metabolically healthy and um now you're just sad that you don't fit in a size four anymore but it has to be a size six I'm like we should be like you know this is good because the next thing is what is if you're gonna fall I'm wondering if this is what nature you know osteoporosis that's another one of my big topics so if there are only bones sticking out you're gonna break your femur in no time so what if you know nature just thinks I give you a little bit of extra um cushion here so if you happen to fall it's gonna be okay um so I think we should love that we have you know this the this the strength as we get older and there we can put things on our shoulders because we have that experience and not get you know get sucked into some of these you know um female beauty standards what whatever it is but I think we should reshape how these women look in postmenopause how you know how we really are driving that boat. So that's what I wish yeah I agree.

And like being in the experience helps you to see that from that perspective. I think even five years ago I would have felt a little bit differently about that. I would have been like no I'm gonna I'm gonna prove that I don't need to change anything and I'm gonna stay exactly the same. But now I'm like yeah a little bit well not just softer physically but probably emotionally as well and a little bit more compassionate with myself.

Yeah compassionate with yourself and you know because that's probably good because for everyone else we don't tolerate much nonsense anymore as you might know as we get it like no it's a BS detector. I'm like I'm not gonna go for none of this anymore I have zero tolerance. So I'm sure many of you feel the same. So however have a lot of tolerance with yourself. What about that?

Yeah yeah don't take any BS from anyone else and what they say about your body yeah there was a couple of I love um hearing about the science y stuff and like what's going on in our bodies and you mentioned um cortisol and that um stresses um but I think you mentioned that it's also temporary or that we this isn't something that is going to be with us forever it's it's a process. Can you talk a little bit about that?

Yeah you know I don't think we really have long-term data but you know we know of a fact there are many women you know in long

Why This Transition Is Temporary

postmenopause they're exercising they're feeling great so I think there is this this is a transition. As I said the body just notices that you know it's basically what's going on these stable partners you know progesterone estrogen now on top of everything else this crazy woman puts on me in midlife you know because we want to excel in everything we do. And you know midlife is the time when we many of us have you know careers and jobs and we have the children and you know and then maybe we get a new dog and maybe also two cats because life is so beautiful and we are so proud of ourselves that we can juggle this all instead of telling us this is crazy. So anyhow so the body just realizes this is get getting out of control now in addition to the hormonal changes. So however that transition is something natural. It's not a time of you know health decline um it's a time when health baggage that we have dragging with us for a long time and it has kind of been masked by our sex hormones, they're going to show up. But it's just for us to actually take a look and say, oh let me pay attention here now because there's something I need to adjust for my to you know to really live healthy from now on. So it's not a type of decline. It's just this very acute time. And once you know postmenopause comes and the first couple of years are over and everything has stabilized and hopefully we also have addressed you know the crazy midlife you know drivers that's the other thing. If we continue you know some of us you know can't pull ourselves out of our lives right you might have children with disabilities there might be partners we have to take care of or older parents but there are things we can control because as I mentioned earlier that's not the only piece of stress the other piece is do we sleep enough? Do we make time for ourselves every day? Very important my teacher said fun. Do you have fun 10 minutes a day? Do you make time for yourself whatever that is do you you know address your circadian rhythm make sure you get out in the light make sure you do some movement. If you're not a heavy exerciser go and take half an hour a walk clear your brain so think in that time we have to do these adjustments and then you know we basically really recover or refuel our system once it's stable again and it's like okay cool that woman is feeding me now enough and I'm getting the movement I need and I have you know the social stimulation I need maybe you took up a dancing class and then yeah because if you you know sometimes I'm go to these women club and these ladies they're like 70 or 75 and then I'm saying oh I'm a you know I'm a menopause spectation yada yeah they're just laughing they're like oh this is long oh this is long over oh this is a long time ago so they seem completely non-cons and you know now I know this but initially I was like really so I not that I was offended but it was an interesting insight that once you are really far beyond you're just laughing this off. So yes there is a time of vitality that comes you know absolutely after that we just have to readjust figure out who we are what do we want listen to our body very intently and just you know realize the things that we have been kind of you know dismissing for a long time because we had so many other things to do. Yes yes yeah we uh my husband trains some older women um like in their 70s early

How Long Perimenopause Can Last

70s mid-70s and it's kind of interesting to see because they're uh they're going through their new experiences you know that help with the with the transformation into older years I guess you know into that the wise person the wise woman are even wiser but when we're in the thick of yeah the golden years but when we're in the thick of the the the perimenopause and menopause that goes on for a long time doesn't it and you feel like it's never gonna end yes yes so it takes you know I always say like eight to fifteen years that doesn't mean this is all that time it's terrible but it just recognized it that women might have symptoms as early as like mid 30s right it's show show this you know these the hormones you know they start doing their thing very early on and it can drag on for a long time um however all this is can be you know potentiated by stress by midlife stressors by the over exercise all of that um so yes but then usually you know average menopause age is like 51 52 but everything after age 45 is perfectly okay between 40 and 45 it's still normal we call it a little early um I want to now mention because what I hear now a lot, you know, after no one ever talked about you know in the past it was like someone came with symptoms and they still had a cycle and they were 42 and then the practitioner would say no it can't be perimenopause you're too young and you have your cycle. Now I hear it often the way around that you know women have symptoms but now it's that oh this is just perimenopause. But then you know you might still want to make sure is it not a thyroid issue is it not an outing so again don't get dismissed right there is there are other things happening at the same time you definitively want to explore particularly if you are like you know between 40 and 45 if things really hit you a little earlier you really want to make sure there's nothing else going on.

I think your message there is really look at the root cause and find someone who can support you with finding

Insulin Resistance Explained Simply

the root cause can you talk about insulin resistance I think this is another interesting one that um women don't quite necessarily understand.

Oh yeah of course I love to talk about insulin resistance so insulin resistance means so what you have to understand when you eat carbohydrates doesn't matter if it's blame sugar or your your healthy ones they are going to be broken down in sugar or glucose and then it have they have to be shoveled into the cell basically because this you know you're hungry and the cell wants energy so this has to get in the cell and like the shovel who does that is insulin. That's now a hormone that's produced by the pancreas. So in order for the glucose to get in the cell the shovel insulin is needed. But now the cells are like well you know the the shovel is like this neighbor that comes every day and knocks at the door and wants to borrow some eggs. So if this goes on for too much and too long and there's never a break because you eat a lot of carbohydrate rich food or you snack all day long, whatever it is now the neighbor is saying I don't want to have this shovel here anymore. And now that that um blood sugar can't enter the cell readily so then what the pancreas is doing, it's like I'm still have all this sugar here in the blood I'm gonna send more shovels because I need to get this blood sugar into the cell. So more and more shovels are coming and you know in the end some of the sugar probably goes into the cells like stuffed in but most of is it kind of floating around and now our body is not wasting anything because we are just these prehistoric beings. So it's like oh no no you're not gonna waste this sugar floating in the blood. So it's going to be directly stored as fat. So as long as we have all this insulin floating around because we are just eating too much sugar or we're snacking all the time which was old you know nutrient advice. So now the signal is on that's telling the body the entire time well whenever you eat carbohydrates preferably stored as fat. Okay? So that's that's the first bummer that's going to come in midlife. And now imagine like in the US about 60% or more of adults are actually already prediabatic just by default. So this is so they're already in this extreme insulin resistance. However you don't even have to be that in order to not become a little bit insulin resistance in perimenopause because the estrogen helps with insulin sensitivity and when the cortisol level goes up it makes the insulin resistance worse. But now comes the second really bummer. So it's not only that if you eat carbohydrates they get blood sugar spikes they are preferably stored as fat. What as long as insulin is around it's also telling your body if you're exercising or you have a nutrient deficit because you're eating and skipping meals and do like 18 hour fast, the signal is saying, oh no, don't burn fat. We're going to break down muscle. So this is that midlife you know conundrum you're not only storing fat preferably but you're also breaking down muscle. And now imagine that woman who's first not fueling enough so not eating enough and exercising, which is also now increasing that cortisol cycle. So now she's even more insulin resistant. So it's like a relentless vicious cycle in addition if you don't sleep well. So we know one night of poor sleep can increase um your insulin resistance for up to three days. So now imagine if you're like a night worker, a physician a nurse or you know and we all have our jobs but I always tell my patients very clearly midlife might be a time to think about to go into day shift because it has such profound effects on our, you know, also longevity. So there's really hard data I think night shift workers it takes like five years of their life. So that is real hard data that we're kind of we are now we are like smoothing this over and don't want to talk about it. But I think you know it's important for you to know. So that is insulin resistance in a nutshell okay thank you. And so would you say that um a change in hormones during perimenopausemenopause make insulin resistance worse or yes yes yes yes so estrogen helps with that insulin sensitivity to so however there's now one thing I want to clarify. So because your question is what were we supposed to do? So first of all I want to clarify I'm not um supporting or you know like a keto diet this is long over we don't want keto our body needs carbohydrates don't get me wrong at all the thyroid needs it our metabolism needs it um I like to say well in perimenopause if you have this you know the middle fat you know um increase I want to call it like a low glycemic diet. And it's not forever you know again I don't want you to start cutting calories it's just be more aware you know if you eat straightforward you're a candy girl I'm like fantastic because you just stop that you're gonna be off so much better you know if you're like this healthy person who's already you know eating very you know very clean now you have to look at you know do you eat a lot of fruit on empty stomach? Do you you know your the healthy grains and the cereals might actually be not good for you during that time the oatmeal. So it's very noise. So I say the way to or plant that blood sugar spike is always eat your greens and veggies, nuts and seeds and fiber first and then protein and fat. And at the end you have your carbohydrates let's say it's you know some rice or maybe even some dessert. So basically create a bed out of greens and veggies and fat and fiber in your stomach because before you drop the carbohydrates on top of it because that's gonna plant that blood sugar spike tremendously and that might be all you need. And then what's important space out your meals. And again if we are very stressed we might need to snack a little bit but the idea is really to let the digestive system rest in between our food and let the blood sugar and the insulin go down to baseline which means three to four hours better four hours in between meals and then make sure you eat enough during each of these meal sessions so you're not getting hungry in between. That's also going to calm down your cortisol access. What is going to spike that cortisol access is long fasts. And I know this is you know fasting intermittent fasting well that's fantastic if you're 35 and you have you know like real just your pre-diabetic or really just have insulin resistance. Otherwise you're healthy because you're 35. Intermittent fasting fantastic you know for us in midlife it's a very delicate balance. So I say hey 12 hours maybe 12 to 14 is okay because you know you stop eating at 7 p.m and then eat again at 7 or 9 the next morning that is perfectly fine. However check how you sleep if you're not sleeping well you might not have eaten enough for dinner you might need to eat more carbohydrates a little bit extra at night to calm that cortisol. So it becomes very moss and there is no cookie cutter you know that we can apply to every woman so it's really important to have one if a woman is really suffering to that someone has really look at her and sees her what is going on in her life and gives her an assessment what she has to do. But that's kind of the rough strokes yeah that's great.

Would you um gosh what was I gonna say first of all I was going to ask about

Using A Continuous Glucose Monitor

whether someone um it would be helpful to wear a continuous glucose monitor for that you're saying all the good things yes um yeah so I love yeah sorry what did you want to no no just like um because foods behave in different ways and so you can really sort of get an idea of what's going on for you personally, can't you?

All my patients get one. So that is really because you know I everyone who comes with symptoms I look first at that average blood sugar in the blood work like a hemoglobin A1C it's called but that gives me just an average blood sugar over the last three months. So if this woman actually does long fasting or you know only eats one meal a day that's going to be a very low hemoglobin it's basically falsely low and it doesn't exclude that she's not the moment she eats she basically has high blood sugar spikes. So I like to do a fasting insulin which can be much more sensitive. However it can also be low in someone who's really severely undernourished. A continuous glucose monitor now is that little device a little button you pop in your arm and you don't feel it and it now it's connected to an app on your phone and it measures continuously your blood sugar. And this is a super important teaching tool particularly you know for either the women who are really need to see it and the other ones who are like I am eating already so clean and now we are trying to figure out what in your very clean food is actually spiking your blood sugar. So this is that information but then what you said like how because you can learn well if I eat rice like this on empty stomach I'm gonna have a big blood sugar spike. If I eat my protein you know my meat first nothing happens. So or I can eat some blueberries on on a salad but if I have them just a handful like this I get a blood sugar spike or I add some fat like coconut milk no problem. So this is I think and we are all different. So we can't write a book and say this is going to work for everyone. We know the rough direction but um I'm I'm very sensitive to oatmeal other people's people are not so that is something you have to try out and then in functional medicine we are very strict. So we are basically saying your blood sugar shouldn't spike over 110. You know this is much stricter than any CDC guideline because we want that insulin resistance to reverse. We really want these receptors to refresh and then if your problem is not so much genetic but it's really just lifestyle you are actually after four weeks keeping that blood sugar less than 110, the theory is that you really are going to tolerate more foods again. And that is true. Some women you know I have bad genes and I thought a sort of us have like very insulin resistant single nucleotide polymorphisms. I have always to be a little careful. But you know this is very um individual and so this continuous blood glucose monitor is very helpful. Every now and then I pop one back on again just when I'm really stressed or I change something and I'm just curious and want a little check-in. So yes absolutely um so data driven um that is really the best if you're just wondering what is going on. The other thing I want to mention that can be a deep insight from that continuous glucose monitor. So I hear a lot of people saying I'm getting so jittery and my my I'm so fatigued, my blood sugar must be low. And I'm like well put that continuous glucose monitor on let's have a look what's actually happening. And usually it's not that it's this they're feeling that spaced out way, you know, like the fog in the brain when that thing shoots Up really high. And at the very first moment when it starts to just get over that edge and comes back down. So, you know, they often get foggy. And then when it comes back down and it's still high, however, that's when, you know, like an hour after you eat, you just want to put your head on the table and sleep. That is insulin resistant. Or, you know, an hour after you eat, you have cravings again. You want to eat something. That has also to do that now that this overshoot in insulin has now slowly, you know, it's out there's so much insulin around. And now after everything has the sugar has already been packed into the fat cells, now it's like pulling your blood sugar down. And this is now when we basically see that your blood sugar drops slower than where it was before you ate. You know, it spikes up, and that's the other. Sometimes it's not a scientific uh name, but we call it like the pre-insulin resistance. That's kind of the first sign that your system is under a roller coaster and not really um responding normally anymore. So there are a lot of details to the continuous glucose monitor. I love it. I put this on everyone who needs some insights.

And it's um obviously it's helpful to have someone like you to help read the data once it's come through. But then they are you anyone can buy one, right? And use it and have a bit of a sense of like Yeah.

Yeah. I don't know how it's in Australia, but I'm sure it's the same. So, yeah, so all you know, there's the DEXCOM and the Freestyle Libre, and these were the main ones, and they both have now consumer platforms. So you can purchase one. But I do agree, and this is not to blow in my own horn, but I had had these on patients, and they just they don't understand what they are looking at. You know, they that is the thing, like you need someone to really explain what that means and what do you what what do I do next? What do I do with that information? So it can be helpful, but yeah, you know, start with something. Um any insight is good if you ask me.

Thank you. Um okay. We've been talking about symptoms, and the main ones that we've talked about are really um well, we haven't really talked about symptoms

Common Symptoms And What’s Normal

necessarily, but we've talked about things that could be going on. I wonder if like there are common symptoms, and these symptoms I am aware get used in marketing. Although I did say it at the beginning that I feel like that there's a little bit of industry happening with um definitively um so symptoms, but like I guess uh with the messaging is if you have these symptoms, it's bad news. But are they okay? Like what symptoms would you say are okay? What symptoms aren't okay? What symptoms will we move through? Okay, yeah.

So again, first of all, I want to tell you there are many women who are having it's not a time of disease or like we are falling apart. However, common symptoms are hot flashes, if we all hear, and they are driven by, you know, what really the first thing, even when women want HRT, and I'm glad to prescribe it. I'm saying if you're not fixing the underlying drivers, which a big one is actually cortisol and blood sugar. Blood sugar is actually number one. So uh we're gonna be at square one if you want to stop this one day. So that is really important. So check your sugar. So many people are saying I just with the sugar doctor Ansman and I'm fine. Hot flash is perfectly good. So yes, okay, really, it's because it even affects your sleep, these blood sugar roller coasters, because it affects the core, it's it's it's so interwoven. So yeah, blood sugar is my big one. The other one is um, okay, well, hot flashes. Then, you know, the brain. All right, let me back up. So HRT approved is for hot flashes. This is where we know it works reliably. So this is what I want to say, first of all, because then women come, but they read online again this you know, menopause marketing machinery, like it's for brain fog and and the and this and that, and sexual desire, and it fixes everything. And so that's just not the case. So it works really well for hot flashes, it's FDA approved for prevention of osteoporosis for women at high risk. So again, we're not gonna all break bones because we're not an HRT. And then it's FDA approved for gain it to for vaginal dryness, sex with intercourse, and changes in the, you know, in the bladder. Um, but if that's the only symptoms, we actually should use vaginal estrogen, which is not considered HRT. So that is that that's the first thing I need to say. So, other symptoms, brain fog, big thing like you know, forgetfulness, cognitive function is a lot affected. Many women complain about it. Um, insomnia is a big one. And then I would say fatigue is really the one that I hear a lot. And of course, that weight gain. So HRT is not going to fix all of these. It can help a little bit, but I see women mostly, I'm advanced in that, so who have been on HIT, and these things are not being, you know, it's not getting better because there are the underlying drivers. So, yes, but these are the most common symptoms. However, there are more than over 50 symptoms of perimenopause from, you know, gut issues, you know, suddenly gut irritability, you have food sensitivities, constipation, diarrhea, abdominal cramping, um, dry eye. Um, there you can become more sensitive if you are histamine sensitive. So they might have more itching, you might be more prone to autoimmune um symptoms or processes. So all that can happen because it's just a vulnerable phase where we are transitioning through. So this is how it has to be understood, not that we are falling apart. Um, so um these that was your question, right? So the main symptoms, right? Yeah, the main symptoms and like do we can't joint pains. Joint pains.

Joint pain. Join, sorry, joint pain. We kind of give this get given this messaging that it's like the end because of all of these symptoms, but you're saying that it's a sensitive time and we actually do move through them.

And you have to listen to your body. That is really the moment when I'm saying, again, that health luggage you have been dragging on with you and we're just forgetting about in the basement, it's gonna pop open. Okay. Um, so whatever that is, right? That insulin resistance, you know, it's not just developing them. Sometimes it does, but usually, if you're very symptomatic, you had, you know, your hemoglobin A1C has been elevated for a good while. Um, if you have, you know, GI issues, these are women who had always had a lot of stress. They are often already had, you know, once they start thinking, they're like, oh yeah, I always had a little bit sensitive GI, you know, systems like, oh yeah, really. Um these are women, you know, there are all the immune processes going on. They might have not known about it. But again, that's now a good time to look at it and figure out what's underneath, how we can reverse that. So again, some of us are luckier. We don't have so much that we have to suddenly face and look at. And other women, you know, you have a handful of things and you're like, okay. But again, my saying is this is perfect. Now we know, now we have time to have a look at that. Let's fix that. So you're not gonna start, you know, playing that conventional medicine whacking mold game, like wherever the mold pops up in your lawn, you're gonna, you know, pop something on it, like one medication or one procedure, and then it comes there and you do the. So, no, we want to find that mold and then basically, you know, put it somewhere else.

Okay.

I don't want to say, you know, kill it because people might get upset. So just get it somewhere where it's safe and doesn't bother you. So you can basically then, you know, literally enjoy your life. So working in functional medicine doesn't even want you to continue, you know, to come and see me all the time. I'm happy when I show you the roadmap, I make you better. And then from that moment, you know, oh, I have to pay attention there. Um, maybe there are some foods I have to be careful with. Um, this is my, you know, this is the things I have to take care of. My gut, this is how I really, you know, increase my, you know, whatever it is. I this is the nutrients I have to take, and it can be very individualized. So um this is what I I enjoy in my work. And I see, you know, I see many patients who have, I think that typical thing is, and I just want to mention it, that you know, women come to their gynecologist or their um um practitioner and they have all these symptoms and they get some basic blood work, and then they're being told, well, you know, your your labs are fine, right? And the woman is like, but I'm not fine, I still feel not well, I'm fatigued. And that that drives them nuts, of course, because they're like, I know I'm not fine. And everyone is telling me, you know, everything looks good because you know, they get their colonoscopy, which looks great. I'm very happy about that. You know, they get um the blood work looks great, you know, and they are like, but I'm fatigued, or uh I'm just not myself. And I always say it's because it's the problem is we continue to function as women. We are just not really falling apart and sick, we just continue to function. So this is why it becomes a functional problem, I'd say. So, but again, it's not at all in your head because if you do the right tests or you use the tests that you already did and actually look the right way at them, have the correct cutoffs, put them in relation to each other, or do some additional ones and you know, understand what's how they actually relate to each other. We can actually see that picture. Um, so that's what I do. That's where my work comes in. And you know, I look at the gut microbiome and the gut health and at the hormone breakdown. And I also do environmental toxin testing if needed, and you know, really look very deeply at mitochondrial health and oxidative stress. So this is how I found my formula to really get my my patients out of that and then you know drive out of there really feeling stronger and suddenly understanding um what has been driving their personal, you know, situation.

Yeah. I mean, I feel like ideally this would be the path for all women in perimenopause and menopause to really figure out where yeah, what's going on with their body and where they might need to um pay attention. You mentioned HRT and that you do prescribe it. Um I've talked about this

HRT As A Tool Not A Fix

in other podcasts with people, but I I guess my right with it. I have women who who I train who in the gym who have been prescribed. And they well, first of all, they say that they feel amazing when they take it. But they haven't necessarily addressed all of those root cause issues that may have been uh creating changes in their body, or you know, the fatigue, the hot flushes, the weight gain, whatever it is. Because they've been prescribed it, they feel better.

It's a fantastic band-aid solution. You know, I mean it's perfectly, I have no crawl. It's a fantastic band-aid solution. I tell my patients too. It's like it's great, it's covering these things up. Um but you still have to do the work. That is really my conviction. You have to do it. Um, so yes, so definitively. I I do prescribe it. If someone wants it, I'm noise. I'm you know, very noise. I, you know, I still not for everyone. Um there, you know, again, there are women coming, they're reading, they're by this online marketing industry, they are really upset. They are like, I need this right now because it's gonna fix my weight, and you know, this needs to go away. And and I'm also like, wait, you know, that is most likely not gonna happen. If you also if you have so severe symptoms, that's when I always say, hey, it works for hot flashes. However, there are a couple of other things I need to talk to you about, hot flashes, right? And it's it's like a life rest. I say, put it on while you're trying to swim to the other side of that lake. Um, that is perfectly fine. But just be aware. Um, I am not a supporter that this is something you everyone needs to take for the rest of their life. I'm still conservative. Yeah, I have patients. They are like 75, they're 80, they don't want to come off. We are not forcing no one. We are all emancipated and can make our decisions, and we have so low doses. I'm like, well, if someone made it to 85, you know, me stopping the HIT is going to be make no difference, really. However, if you ask me, like, you know, how long am I have to take this, Dr. Anspin? I'm gonna be like, look, you're 52. For now, don't worry about it. But maybe once you're 60, 65, you know, let's decrease the dose. Um, because there is still some, regardless of what politics are saying, there is very unclear long-term data. And many things I want to say depends on your personal physiology. You know, I do a lot of these um hormone metabolism tests, we call it a Dutch test, dried urine test of comprehensive hormones, so where you actually can see how different women metabolize their hormones, and there's the good, the bad, and the protective pathway. So I think you know, the these inconsistent data we see has just to do that we are just not all the same. We are not all the same. And we so I I always like to see, you know, if someone says, I really want to stay on it, or I'm older and would like to start it, you know. Again, I'm not a big pusher of that. But if someone insists and maybe they have osteoporosis and otherwise, you know, are healthy, I say, well, but let's have a look what actually how you metabolize your hormones, just so we understand what you're doing. And yes, you know, all tests we do in uh in functional medicine, it's not just to collect data, it's because it gives us information and actionable information. So then I know I have to help you with, you know, eliminating these estrogens, you know, all of that. So yes, I'm definitely wearing nuanced. Um so if someone is 70, I really don't recommend starting HRT, right? So these guidelines, they're softening a little bit. I think we are now comfortable, like up to age 65, starting it new. But I'm of course wondering well, if someone had menopause at age 52 and now that person is 65 and she has severe hot flashes, I'm like, well, what is that telling me? Right. So, you know, because her hormones have long stabilized. There, there's long no nothing going on anymore. So then I'm, you know, thinking stress, I'm I'm thinking um blood sugar. Morning coffee can be a tremendous bummer on your cortisol axis. We have to talk about that. But you know, there are then many things. Having said this, every now and then I'm you know, I'm surprised. You know, I have done everything else, and then in the end I say, okay, I give you now a little bit of estrogen. And there was someone I have in mind, I'm like, ooh, that helped her tremendously. So, so we are not all the same. They are always outliers. But um, you know, as a functional medicine practitioner, so my teachers and all these really hardcore functional medicine people, they none of them have been on HRT because that is really, I call it more like the longevity lifestyle. You know, it's a continuum. And these women are fantastic. They are strong, they haven't gained, you know, they're probably much better with exercise than I am. They have found, you know, they had found the balance. So I always keep that in mind, okay? And I try to encourage, you know, women to think about that. Um, so that that's why where I stand with that. Having said this, I have to tell you about my mom. She is like about 77 years old, and I have tried to re-now her off HRT a couple of times. I did not. She's like on half a patch of the lowest dose. I call it a homeopathic dose. She states this is what she needs. Okay, you know, there is there are some struggles, some some fights you just you you cannot win, and that's okay. Yeah, yeah.

And that almost becomes a bit of a that's habitual as well, isn't it? It's like, but that's part of my routine.

I can't break my routine. You know, it's a little patch, it's done, and you know, it's you know, and she has a lot of stress, of course, and all kinds of things. But whenever there's a hot flat, you know, I she's like, Oh, the hormones. What are we gonna do? Again, she is, you know, she has a golden age and clearly doing okay. So yeah, so yes, it's it's it there's a big human factor when it comes, you know, to these decisions.

And yeah. Thank you. Yeah, I appreciate your perspective on that, especially as uh um many of the people I've spoken to. Well, I have uh spoken to a couple of uh male doctors who are in different areas of health, but they kind of off the cuff, oh yeah, you should be taking taking HRT, you know, um because your risk factors for heart disease, osteoporosis, blah blah blah, all go up when you're in menopause. We are still men, so I'm kind of like, oh yeah, right.

We are still outliving men, you know, even with the menopause, we are outliving all the men. So no, nothing. And then I always say, you know, the data on the blue zones, you know, all the women, you're like with the well, because they are not on hormones, like, no, this has you know, so and again, that's where I'm thinking, no, that midlife transition is something natural. And you know, life has become more stressful, it's much more difficult than maybe it's more difficult than in the past, and we have great tools available so we can use them. But we shouldn't, you know, forget what this is really about. It's not, you know, so um, yes, that's how I think about it. But you know, there's one thing we should talk about, which is geneticurinary syndrome of menopause, since we are now really going through it because I think

Genitourinary Syndrome And Vaginal Oestrogen

that's important. It has something to do with hormones, but it's it's not hormone replacement therapy. So I think your listeners should understand that. Is that okay? Yeah, talking a little bit.

Tell me, no, no, yeah, we can go a little over. I'm happy with that if you are. But can you tell me again what what it is?

What what the so gained to urinary syndrome of menopause is a very technical term. We call it, it was use used to be called vaginal atrophy. Um and so basically that you know, it was, however, the term was expanded to acknowledge it doesn't just you know apply to you have a dry vagina and sex is painful because that was easily dismissed. It's saying no, it's also affecting actually your urinary function and so on. It has elevated that to a real, not that it wasn't a real diagnosis before, but something that has become more like more, you know, mainstream. So basically what's happening, your vaginal tissues, and again, it doesn't happen that way to all of us. So this is not like, but some of us, as we don't have enough estrogen for a while, these vaginal tissues become drier. So intercourse can be painful. Some women who don't have intercourse, they just say they're bothered by very dry tissue feeling in the vagina, and at the same time, it affects part of the bladder, who also are, which is also estrogen dependent. So now the bladder that used to be nice and stretchy, and you can, you know, hold like a liter of urine gets very sensitive to the smallest amounts of pee. So you feel like you have to pee all the time. It's called urinary frequency or urgency. So, but this is the easiest to fix. So this really responds super well to vaginal estrogen or testosterone preparations. And that is actually not considered systemic HRT. So I just want everyone to know that. So even if you're an older woman, you have long, no more hot flashes, or but really your vagina is bothering you, or you have recurrent urinary tract infections, you can perfectly take vaginal estrogen until the end of your days. It's not absorbed, there is no systemic hormone level. And even practitioners sometimes do not understand that. They're always, you know, in the past, they then gave, you know, women that talk about breast cancer. And I'm like, like, no, no, no, this makes no sense. Uh, and in the US, that label was actually removed from the vaginal preparations because it never made any sense. Um, so yeah, so just so you know, and if you have pain with intercourse, there is dryness, urinary frequency, recurrent UTIs, it's called genito urinary syndrome of menopausa and can be perfectly treated. That's it.

So is that something that uh I mean, obviously Australia and America are different, but is that something that someone can buy over the counter or online, or is it a prescription? It needs a prescription. Yeah, yeah.

And you have to tell your doctor you want that, and then if it's not getting better, I you know, usually it's because they don't give you enough. You know, often the prescription is like one tablet in the vagina, like twice a week. Okay. If you have severe dryness, that's not gonna do it. You really need like I always give a cream initially that you apply inside and outside. It has to be every night for three weeks. I call it up estrogenization of the tissue, and then you can space out like three times a week. So again, you might look for a practitioner who knows a little bit more about it, but don't give up on your, you know, on your vagina or on your bladder as you get older. That is an easy fix once you find the right person to help you.

I love that. And and that's um your messaging is just like this is all.

preventable but it's all okay it's not just how it is and like game over which is which is what we hear for the most part it's like no these are these are all uh symptoms that we move through that we can manage um and that we come out the other side potentially stronger better that's what we have modern medicine then for for these things a great prescription like no side effects use it get it insurance pays for it fantastic yes yeah we want the the best of both worlds right so that's what we want yes as we come to a close I appreciate that we have gone over a little um what would you say like the steps that a woman should take to be proactive in journeying through menopause okay okay good so first of all recognize where you

Proactive Steps For A Smoother Menopause

are and look at your stress level you know best when you are like your mid-30s to end 30s you know then have a little assessment maybe there are some things you have to do with your life maybe there are some jobs you have to change I did it twice right and now I'm working for myself so it took a while to figure it out and then you know nutrition you know start thinking about how do I stabilize my blood sugar there's lots of online information but use what I told you hey 80% of your plate should be greens and veggies, nuts and seed or otherwise plant-based which doesn't include gluten but fine you know do that and be you know cut out the sweets the other thing I would stop is coffee on empty stomach in the morning. In general if you have a lot of coffee I would definitely let that go for a while because that's stressing your HPA access. But if you have it an empty stomach additionally it's really messing with your gut microbiome. So that is the one that also gives you hot flash and the other one is alcohol you might realize you're becoming sensitive to that is with a reason and also going to give you hot flashes. If you want to have your glass of wine every now and then go for it. Just don't complain then that you had a hot flash don't be surprised so so I would say you know gentle nutrition look for a planned forward nutrition. I'm not for you know vegetarian vegan is very complicated in menopause because we have this need for choline on B vitamins so yes you can do it but there needs to be a lot of guidance. So however planned forward 80% greens and veggies the other 20% can be anything else. Be careful with the coffee and the alcohol make sure you move and have a very you know very close look at your life at your work at your um at your relationships um everything that you would like to work differently from now on now is the time to start working on it. Yes right brilliant tips thank you so much um and yeah it's I think that as I mentioned that the whole marketing around menopause um and HRT like I've even noticed posters up you know from our government you know on the in public toilets and stuff sort of maybe you've got this and I'm like oh they just I feel like they're that band aid is something that we're being the messaging is that that's the thing that we need first but we're talking about empowering women to take to manage their health to uh yeah truly well experience this journey and embrace the changes yeah embrace the changes take it as a moment to have a close look at what needs to be addressed and then if you want HIT that is like one tool you can use but this is really not that is not the solution to all these issues not at all it's a time that we should embrace um you know make some time for it maybe this is what I should call it like instead of rushing through it and make some time take a step back take a deep breather and say like okay I'm gonna look at this now what do I have to address here? And it's it's really our time I think our time to shine um to raise our voices.

Hey there Rebel thank you for listening to this episode of the Midlife Rebel Podcast. If you'd

Closing And How To Support

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