Dr. Sara Szal
Appearances
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
3 to 75% of women do not get the treatment for perimenopause and menopause that they deserve. And women are asking, why is it that I can't manage stress the way I once did? Why do I have this belly fat that appeared out of nowhere? And my usual techniques for how to deal with that aren't working. Why would I rather mop the floor than have sex with my husband?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
A selective serotonin reuptake inhibitor. That I go on the birth control pill because I sounded hormonal. And that I start exercising more and eating less. So that was his treatment. And that's typical mainstream medicine treatment. But I wasn't satisfied with that. I felt like that doesn't seem right.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I left his office and went to the lab, ordered my own hormone panel, and found that my cortisol was three times what it should have been. So there's the optimal range for cortisol in the blood. It's about 10 to 15 in the morning, 6 to 10 in the afternoon. And mine was 30. I also looked at my fasting glucose and insulin, and I had prediabetes in my 30s. I had no idea.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
No one was checking for this. So I'm answering your question about how these ACEs showed up in my body. We know that adverse childhood experiences link to blood sugar problems and a greater risk of prediabetes and diabetes, which I had. We know that they link to chronic stress and cortisol problems, high perceived stress, whether the stress is there or not.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It also led to, as I started using wearables, low heart rate variability, the time between each of my heartbeats. And that's a measure of the sympathetic nervous system, fight, flight, freeze, fawn, versus the parasympathetic nervous system, which is where healing occurs.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So in my 30s, This is a huge epiphany for me because I realized that I wasn't trained. I wasn't educated. Even though I had an outstanding education, I wasn't trained to help with this. No one taught me about education. Cortisol problems and how to manage that. I mean, I was taught about the extremes of Cushing's disease, which is really high cortisol levels, and Addison's disease, which JFK had.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And it's when your adrenals in your back above your kidneys don't make cortisol. So I was taught about the extremes, but I wasn't taught about all the people who kind of live in the middle with problems with their cortisol. So this is when I started to take the scientific literature and apply it to my situation and Because I wanted to feel better.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I felt old before my time and I had a lot of belly fat and I was on this path of aging at an accelerated clip. So I did it to help myself, but then I also wanted to help my patients and it felt like I needed to go deeper and understand what can we do to treat the trauma and also to treat
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
the more proximal measurements that we're making, like with cortisol, with heart rate variability, with blood sugar.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Step one was awareness.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I had no idea. These are not things that most doctors are checking for.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
That's a critical point. So I was taught at Harvard that if you have blood sugar problems, if you've got prediabetes and diabetes, the treatment is lifestyle. It's the most effective to change the food that you're eating, to increase your exercise, to manage your stress in a different way. And yet I wasn't taught how to help my patients do any of those things.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I was taught how to prescribe a medication for it, like metformin or some other treatment. But I wasn't taught how to do lifestyle medicine. I had 30 minutes on nutrition. So yes, it is pretty crazy.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
This is medical school. And I got about the same amount on perimenopause and menopause.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes, it does.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Step two was, what does the science tell us? And if we take what the science tells us, usually applied to a population, that then sets us up for step three, which is end of one experiments.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I used to think that too. And then I would come back from the holiday and I would still have cortisol problems. So stress is part of it, but cortisol is really interesting. These hormones that we're talking about, estrogen, progesterone, testosterone, cortisol, insulin, it's not a democracy. Like they don't have equal footing. Cortisol is more like a dictator, especially if it's out of whack.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So you need cortisol to live, whereas you could live without testosterone, estrogen, progesterone. Can't live without insulin. But cortisol is critical in terms of helping you with your immune system, helping you with your blood sugar, and just managing the stress response. So it's not quite as simple as thinking your way out of a high cortisol or a low cortisol.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And there are ways that your body can become stuck in a particular pattern of making too much cortisol or making not enough cortisol.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I'm a physician, so I work in academic medicine. I do research for people, I teach, and I take care of patients. So that's the official BBC answer, and the unofficial answer is I'm a healer.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
The harm is, it's associated with depression. It's about 50% of people with high cortisol. 50% of people with depression have high cortisol. It's used by some psychiatrists as a suicide marker. It's associated with more belly fat. And so the fat receptors, the fat cells in your belly have increased receptors for cortisol. So it's a way of growing your belly fat.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
We know that it shrinks the brain in women, but not men. Starting in midlife, starting in your 40s, it's not an old age thing. And this has been shown a couple of different ways. There was a study from the University of Texas in San Antonio showing that women in their 40s with high cortisol have a shrinkage of total brain volume.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And then Lisa Moscone at Cornell also just showed in a study looking at men and women that women with high cortisol also have shrinkage of their total brain volume. And they start to have a difficult time using glucose as fuel in their brain.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Well, it makes you tired. It gives you slow brain energy. And I can tell for the most part you don't have that. But if you do have it, there's a way that you kind of, your brain slows down, you feel foggy, you're not able to multitask and kind of keep up with everything.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Oh, yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So for people who experience toxic stress or trauma, what typically happens is cortisol goes up. That's part of the alarm, the body's stress response. What we know is that for people who've got more serious exposure to trauma and they have post-traumatic stress disorder, those people have probably gone through a period of high cortisol and now they can't keep up anymore.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And they are in a low cortisol state.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
No, it's important for men too.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So estrogen and progesterone are incredibly important for men. And it's involved in bone strength. Progesterone is involved in sleep in men. So the levels are lower in men and your testosterone is about 10 times higher. But in women and men, they're all important. So what's messing with our hormones? I would say toxin exposure. So there's endocrine disruptors.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There's more than 700 known endocrine disruptors, things like bisphenol A, like the plastic lining that you see in cans or in plastic containers, water containers. There's skincare products, which women are exposed to more. Things like moisturizer and makeup and other things that contain endocrine disruptors like parabens. And there's flame retardants that we get exposed to.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It means that my task is to connect to your innate healing capacity and to work with you to activate it.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So there's a whole class of endocrine disruptors. And then it feels right now like we are more dysregulated than I've ever seen. And I'm not sure what the cause is. I don't know if it's the post-pandemic experience or part of what we're experiencing in the United States with the change in leadership. It just feels like there's this hum of dysregulation that I haven't seen over my career.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Are you noticing that?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I see it in my patients I see it in their wearable data I see it in heart rate variability I see it in the cortisol levels that I'm measuring
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes. It's an attention economy. And the cost in that fight for attention is that often the nervous system becomes more dysregulated.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I'd look at your skincare. I'd look at your cleaning products. I'd look at your air quality. I'd probably install a couple of air filters if you don't have that. I'd want to know about your stress because you're someone who performs at such a high level.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So I do it for professional athletes, executives, and everyday people.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I would assume that you found the right level of stress where it's not so little that you're not productive, but it's not to excess to the point that there's a cost to it physiologically.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I'd want to look at your food. I'd want to know how much protein you're consuming. Are you getting the right amount of carbohydrates? Seems like you are. Are you utilizing those well? What's going on with the continuous glucose monitor? How are your nutrients? What's your vitamin D? Things like that.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I am. I think it gives real-time feedback, immediate feedback on the food that you're eating. I've seen nothing else change behavior like a continuous glucose monitor.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
But there's more than 100 plus symptoms that women aren't aware of.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I don't think sugar is the enemy. I think the enemy is the way that we eat it to excess, the way that we use it to change our emotional state. And we know people who have adverse childhood experiences, they're more likely to have disordered eating. They're more likely to have problems modulating the amount of sugar they consume.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I do because I think it's an important indicator of the way the biochemistry of the body, the metabolism is working. It tells me about their mitochondria. It tells me about the way that they're producing energy, ATP by ATP, this compound, this measure of energy that you produce inside of all of your cells.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
ATP is fuel. So it allows you to feel like you're fully energized, especially when you wake up in the morning.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Well, I'd have to look at your total picture, but most of us inherit somewhere around five to seven genomic vulnerabilities. And often we want to work around those. So for instance, for me, my vitamin D receptor, sucks. It just doesn't work very well. So I have to take increased levels of vitamin D to keep the kind of the baseline amount of vitamin D in my system normal.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
My answer is I don't heal people. To me, that's a patriarchal way of thinking about it. What I do is I work with someone who's got the capacity to heal, and we work to be in the service of that. So it's not me providing something that they don't have already.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So we would want to look for those. We'd look at your genomics to see what's your relationship to B vitamins. With the stress that you manage, do you have a deficit with B vitamins? For a lot of men, it doesn't show up until around age 40. So this is a good time for you to do a baseline.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Vitamin D is common. So somewhere around 70 to 80% of people don't have enough vitamin D. And one of the things that I think is so important to realize about vitamin D is that it's got 400 jobs in the body. One of them is keeping your boundary in your gut intact. So keeping tight junctions working so that you don't have leaky gut. So vitamin D is a common one.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I had an executive that I took care of on Tuesday, and he had a fasting glucose of 102, which is in the pre-diabetes range. No doctor has pointed this out to him before. His cholesterol was starting to climb. His blood pressure was borderline, not high enough to require a medication, but at the point where we want to turn that chip around before he needs a medication.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
He had a level of inflammation in his body that was causing aches and pains and, um, kind of like this silent condition that wasn't working well for him. So there's a couple of ways to measure that. For him, his homocysteine was elevated. It was 14.7. And that's one that's really easy to measure in a basic panel.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
What we want with homocysteine, which is heart-specific inflammation, we want that to be 5 to 7. And when it's elevated, that tells us that often part of the biochemistry in the body, your methylation, is not working well. Methylation is just where you add a carbon and three hydrogens to a molecule. And it's a way that we turn genes on and off.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And so in this person's case, he wasn't getting enough B vitamins, methylated B vitamins. So we started him on a supplement to help him with that. So that's a common one. His testosterone was good, so didn't have to address that. This guy was about 52. His cortisol was good. He was the chief financial officer of a company back east.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Well, he had a number of things on his genomics that we needed to pay attention to. What was interesting about this guy, Steve, is that he was an athlete. He played football in high school and college. He had this identity as an athlete. But when he came to see me at age 52, he was barely exercising. He would lift weights maybe once a week. He would go swimming for about 30 minutes once a week.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And so he wasn't leveraging weight. disposal of glucose the way that he could be, the way that he used to when he was in his 20s. So a big part of understanding what made him tick was to reaffirm this identity as an athlete and to use that to address this metabolic crisis that was starting to happen in his body before it was too late.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It's more understanding what some of the obstacles might be to their own healing, understanding what would allow them to be the best version of themselves, to feel fully alive.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
That's right.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And he said, you know, listen, it's been the Christmas holidays. I had a lot of pound cake. I had some cocktails. You know, maybe that's part of the problem. But we had measured his hemoglobin A1c, which is a three-month summary of what's happening with your glucoses. Thanks for watching.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Sure. So my training is as a bioengineer. I did the Harvard-MIT program, which is designed to train physician scientists. So the ethos of this particular program was to train the future researchers and academic physicians so that we could move the field forward.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you. Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And let's get into that.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And all along, I was really interested in how do you bring the best of conventional medicine together with more ancient ways of thinking about the body? Things like Ayurveda from India or traditional Chinese medicine. How do we take these wisdom traditions and use that to inform mainstream medicine? So that's the type of care that I learned how to do. I became a surgeon.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I did primary care after I finished a residency in obstetrics and gynecology. But I also realized pretty early on that I wanted to take care of men too. So I've done that for about the past 15 years. And I would say that that training in bioengineering
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It can lead to insulin resistance in some, but not all, but somewhere around 70% of people with PCOS have insulin resistance. So it leads to symptoms of excess androgen, acne, hirsutism. It also is associated with problems with the mitochondria. It's also linked to dysregulated stress response. That's something we see with people with PCOS.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It depends on how off it is. First place to start is your cortisol because cortisol has this... interdependent relationship with other hormones. So if you're someone who's making a lot of cortisol, you're going to make less testosterone.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So someone who's got a high level of stress, like I was talking about the NBA players in the bubble, maybe their stress was high and their cortisol was high, and that was why their testosterone was lower.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
No. In that situation, what we know is that food is probably the most important factor with someone with PCOS. And inside of seven days, by eating a lower carbohydrate diet, you can change your testosterone level. So you can lower it significantly.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Within seven days.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And a comfort with big data and with optimizing data sets to improve whatever the goal is, like performance or having the best conversations you can have on a podcast. That's what gets me excited.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Not necessarily because you're not someone with PCOS. So it's not quite translatable across sex and gender. But for you, with a ketogenic diet, what we typically see is that insulin levels are lower. So it does seem to help with metabolic health. It can cause some thyroid dysfunction, so it's worth tracking thyroid. We know that people on a ketogenic diet sometimes have increased inflammation.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There are some people who are super responders, and they just do super well with a ketogenic diet. But some people have about a 10% change in their LDL, their so-called bad lipoprotein. So if you stay on it for more than four weeks, I generally recommend that you look at some biomarkers.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Well, I would say it's more important for women because it regulates... the entire female body. So we have estrogen receptors throughout our body. When women, there's two different life stages where estrogen is low. The first is postpartum. So if you give birth to a baby, you go from sky-high estrogen levels down to almost nothing when you deliver your baby and you deliver your placenta.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And so for a lot of women, when they're postpartum, maybe they've got mood issues. They've got fatigue that is more than just the sleep deprivation. This can be a preview of coming attractions in perimenopause and menopause. So it's a window of opportunity that can tell you about the way estrogen works in your body. So for the female body, estrogen has hundreds of jobs.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It keeps her joints lubricated. We know that frozen shoulder is a really common problem. diagnosis in women who are in perimenopause and menopause because the estrogen receptors just aren't getting the estrogen. They're not having molecular sex between the estrogen and estrogen receptor. So estrogen is really critical in women. It regulates mood, breast development, development of hips.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It's a lubricant for your joints. It's also really critical for your skin. When estrogen goes down, you make less collagen, and that's why women notice that their skin ages. And in men, it's a little bit different. The dynamic range is more narrow.
The Diary Of A CEO with Steven Bartlett
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And what we generally want with men is for you to have enough estrogen to serve some of these bodily functions, like with keeping your bones strong, but not too much.
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So in men, I don't know. I don't know the answer to that. I'll have to look it up and get back to you. But in women, yes, absolutely. So one of the things that happens for women over the age of 40 is that they typically become insulin resistant. Their cells become numb to insulin.
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And what we know is that they gain about five pounds of fat and they lose about five pounds of muscle every decade after age 40. So there's this redistribution of fat, to your point, where they deposit less at their breasts and their hips and their buttocks and more at their abdomen. Does that happen in men? I think there's some version of it in men, but I just would have to confirm that.
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Probably about 40,000.
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No. No. No, you have a choice. So for women, I think what's important is to understand what are your estrogen levels that are associated with your best function. And that's why I think baseline testing can be so helpful.
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to know where your thyroid is right now, your cortisol, your testosterone, to know where you are with your metabolic health so that when you're in your 40s, you can look back and say, okay, I was in a state of optimization. I want to go back to something similar to that.
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So for women, what I would say is right now, 73% to 75% of women do not get the treatment for perimenopause and menopause that they deserve. They're not being offered, for instance, hormone therapy. And that has to change. But hormone therapy can help to reverse this so that you are more likely to not have some of these body composition changes as you get older. And it's not just hormone therapy.
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I would say it's beyond hormone therapy. It's estrogen, progesterone, testosterone, but it's also heavy weightlifting. It's cardiovascular fitness. It's disposing of the glucose properly, eating the right foods.
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Yes.
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So if you're, you know, like when I was in my 30s, my fasting glucose was very high. It was in the prediabetes range. And so I needed to change the way that I was burning through glucose, like using it with exercise. So disposing, it's like an input-output equation where you're inputting with your food and you're outputting with your exercise. And you want to get a good match between the two.
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Well, number one would be hormones. Hormones are the portal that most people start with me. It's a way of thinking about what drives what you're interested in. Most people have imbalanced hormones. I haven't detected that you do yet. But most people have an issue, say, with cortisol, either making too much of it or too little or even both within the same day. And it affects energy.
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I think it's a critical way. I mean, what we know with strength training is it builds muscle. And so the more muscle mass that you have, generally, the better your metabolism.
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Oh, we are, for sure. I mean, the average American gets somewhere around 14 grams of fiber a day, and we're meant to have about 30 to 35, 40 grams a day. Our Paleolithic ancestors got even more than that, 50 to 100 grams a day. So we are not getting enough fiber. It's critical for blood sugar stabilization, so is protein intake. But getting fiber from real food is
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You know, eating sufficient vegetables. We know from the microbiome studies that you want about 25 to 35 different species of fruits and vegetables in a week to be able to feed your microbiome.
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Most people have imbalanced hormones. Think of them as text messages that your body sends to keep everything functioning optimally. But for example, out of the 40,000 people I've tested and treated, around 90% of them have a problem with their cortisol hormones.
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It's playing a huge role. So your microbiome is one of the control functions for estrogen levels and maybe testosterone levels. So there's a bidirectional relationship, Steve, where... There are three bacteria in the gut that can take estrogen and make it keep recirculating. So you're meant to produce estrogen and then use it and then either poop or pee it out.
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But what happens with some people, if they've got these bacteria, is they keep recirculating the estrogen like bad karma. And so those people tend to have higher estrogen levels. It tends to be associated in men with this greater risk of metabolic dysfunction, prostate cancer. And in women, it's associated with more breast cancer and endometrial cancer.
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Yes. And the microbiome, their favorite food is fiber. So the way that you keep your microbiome, your microbes, happy and healthy is to feed them a fair amount of fiber.
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Yes. So broccoli, Brussels sprouts, cauliflower, cabbage, kohlrabi.
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So I'm a sensualist. So I love food. I love the taste of food. I love the smell of food. I love the look of food. I had a history of disordered eating. I had anorexia as a teenager and bulimia through my 20s and 30s. But now I have a more neutral relationship with food. I have worn a continuous glucose monitor almost continuously for the past seven years.
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And so I know a lot about the foods that serve me the best. So usually for breakfast, I love eggs. And so I eat fresh eggs, usually scrambled or lightly boiled. I like to have that with greens or some other leftover vegetable from the night before. I eat a lot of vegetables. I aim for somewhere around a half pound to a pound a day.
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It affects mitochondria. So I would say the number one thing I help people with is their hormones, getting their hormones back into balance, starting first with lifestyle medicine, not a pharmaceutical. So that includes breathwork, which I think is one of the most underutilized tools that we have in health. Number two would be Nutrition.
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So that's divided between salads, the vegetables I have at dinner, a smoothie. I put vegetables in smoothies along with a protein powder. I eat a lot of cruciferous vegetables. I have sluggish detox pathways. I know that genomically and I know it from my biomarker testing.
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It means that Maybe it's related to my sensitivity. I don't make sufficient glutathione, which is one of the ways that you detoxify. It's an antioxidant in your body. And so I like to close that gap by making sure that I'm getting sufficient cruciferous vegetables. I eat a lot of broccoli sprouts.
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I'm a fan of the ketogenic diet.
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Yes.
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Well, what I find with keto is that men tend to do better on it than women. And what I found with women is that maybe related to hormones and their sensitivity, they have more thyroid dysfunction. They have more menstrual irregularity, somewhere around 45% of women that are on a classic ketogenic diet. So women tend to have more issues with the ketogenic diet.
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It takes them longer to get into ketosis than it does a man. The average man, if they fast for somewhere around 14 to 16 hours, they start to produce ketones. And for women, it takes longer. It takes more like 18 to 20 hours. So probably that's related to fertility and evolutionarily there's some pressure for us to not go into a ketogenic state.
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But it makes it harder for women to get into ketosis and stay in ketosis.
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Not necessarily. I think depending on how you do it. You know, a lot of the data that we have on the ketogenic diet is in populations that don't apply to you or me. Because the bulk of the data that we have is in people with seizure disorders. So they're different. It's a different population. And they're also on a form of the ketogenic diet that is very strict about
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you know, no more than 10 to 20 grams of carbohydrates a day. So I think you can play with your carbohydrates and find out what your carb threshold is so that you can remain in ketosis, get the benefits of all the phytonutrients that you can get from vegetables, and play both sides so that you get the health benefits, you get the metabolic benefits, function improvement.
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You get the lowering of insulin without some of the side effects.
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The main ones that I see are the thyroid dysfunction. Yeah. Sometimes there's a rise in cortisol in people who are really limiting their carbohydrates. And then it can also affect serotonin so that people don't sleep as well on a ketogenic diet. Now, some people love that. They go on a ketogenic diet and they're like, oh, I only need to sleep six or seven hours a night.
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But over time, if you need more and it's the serotonin that is at the root of why you're not sleeping as well, that can cause a problem.
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So I think if you stay on it for more than a few weeks, you want to check your biomarkers and you just want to make sure that it agrees with the intelligence of your body. So do some molecular profiling and see if it's a good fit.
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Yes.
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And I think what's important to understand is that exercise performance sometimes can be adversely affected by the ketogenic diet. And that might be an interesting experiment for you to do, like with your running and your 5K time.
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But taken to the next level, not what you might think of that a nutritionist would advise you, but what specifically is the ideal food plan for you, for your goals? So whether you're an entrepreneur and podcaster and investor, or you're a professional basketball player, or you're a woman in perimenopause at age 42, what's the optimal nutrition for you?
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What a lot of athletes do is if they want to experiment with a ketogenic diet, say they're a cyclist and they're trying to get their weight down so that their power is up, what they tend to do before a race is they add carbs back two weeks before the race so that they're filling their glycogen stores. So that's another piece that you may want to be tracking is your exercise performance.
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What I like about the ketogenic diet for weight loss, and I'm really careful about weight loss because... It's problematic. It's problematic. And I think body shaming is a big problem. And so I'm really careful about this. But when it comes to a ketogenic diet, what I like about it is that ketones are really satisfying. So they increase your satiety.
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And I think it's much more effective than trying to limit your calories.
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and be in a calorie deficit so with a ketogenic diet usually you do a calorie deficit but you're producing ketones which are making you feel more satisfied so you're not standing in front of the refrigerator wondering when the next time is that you can eat and what about fasting you know there's been a lot of talk about autophagy and doing these kind of long fasts to heal the body what's your perspective on that
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I think there's a time and a place for fasting. I think these ways of activating some of the benevolent pathways in the body can be very good for you. So it can be good for mitochondria. It can be good for your hormone balance. It can help you with insulin, as an example. So you asked about someone who was wanting to lose weight and also wanting to address belly fat.
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I would say that's a situation where you really want to pay attention to insulin. So fasting can get you that. So can a ketogenic diet. Often we combine the two because you can induce ketosis faster by doing intermittent fasting together with a ketogenic diet.
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You could think of it that way. I mean, I would say it allows you to fast and it makes the behavior change easier. You know, the thing about fasting is there are some people who are really good at it and it doesn't raise their cortisol. It doesn't induce a stress response. And then there are other people who get very stressed with a ketogenic diet or with fasting.
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And so part of it is trying to get a sense of your own response to the food that you're eating to see, okay, what suits me the best? How do I feel the best? Where is my cognitive function at an optimal level? What helps me with brain fog? What helps me with allergies or whatever symptoms you're tracking?
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You know, one of the things we know with ketones, which are produced in your body, as you well know, is this. It's like a hybrid car that can flip between burning gas, which is like glucose in this analogy, or electric, which in this analogy is ketones. The thing about ketones is they're not just a satiety molecule that makes you feel satisfied.
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They also have anti-inflammatory aspects inside of the body. So they're an important signaling pathway. There's a reason why your body produces ketones. Now, do you want to do that for a year? We'd have to see. We'd have to look at your biomarkers. You know, the normal way that your genome developed was to flip in and out of ketosis based on the food supply.
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And now that food is abundant, most people are not going into ketosis. But being able to switch back and forth can be very healthy for you.
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And we can measure that, and we can look at the interaction of your genetics together with what you're eating to see how we could personalize that. Number three, I would say, is prevention. And prevention has been a hard thing to sell. It's, you know, a lot of people just don't want to invest in prevention.
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I would say for women, it's perimenopause.
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Typically begins between 35 and 45 for women. And it's the age at which your ovaries start to run out of ripe eggs and the mitochondria in your eggs are not working the way that they once did. And so your ovaries are aging and that leads to changes in your hormone levels.
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So a lot of people think of perimenopause as mostly being a hormonal situation, a change in estrogen, progesterone, maybe testosterone. And what I think is important to realize is it's much broader than that. It's your metabolic system. It's the way that your brain is responding to glucose. It's your immune system.
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It's a time when more women have the experience of autoimmunity and autoimmune disease. So perimenopause is this incredibly dynamic time. There's more than 100 plus symptoms that women experience. And it makes me crazy. I was just talking to my agent and my publisher a couple of weeks ago. They're both women in their early 40s.
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And they were having symptoms, you know, some of those 100 symptoms that... are characteristic of perimenopause. They went to their doctor and said, I've got these mood swings. I'm having trouble sleeping, having some night sweats. Is this perimenopause? And the doctor said, no, you're too young. So there's a knowledge gap.
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There's a research gap and a knowledge gap and a huge treatment gap for women who are in perimenopause. Most women are not getting the treatment that they need. So what are they asking about? They're asking about why do I feel so dysregulated? Why is it that I can't manage stress the way I once did? Why would I rather mop the floor than have sex with my husband? Why is sex painful all of a sudden?
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Why do I have this belly fat that appeared out of nowhere and my usual techniques for how to deal with that aren't working? Those are some of the questions that they ask, which map to your hormones.
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Well, I see women who have premature ovarian insufficiency, which is when you go through menopause before age 40. So I've seen a fair amount of that, you know, probably... 50 patients over the course of my career. It's relatively rare. And then I see women who have early menopause, which is when they stop having their periods or they have an FSH level of 25 to 30.
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Follicle stimulating hormone. It's one of the control hormones for your estrogen and progesterone in the body. So if that occurs, they have their final menstrual period between 40 and 45, that's considered early menopause. So there's this really dynamic time where your hormones are wildly fluctuating, especially estrogen. Progesterone is declining.
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And women have this increase in the symptoms that they experience. And no one is really tracking it carefully. That's what needs to change.
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Blood samples and connecting their symptoms to what is happening in their ovaries, in their immune system, in their metabolic system. And putting that together for them and offering them options.
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Yes. Yes. And by that, I mean using hormone therapy and using lifestyle medicine as early as possible to manage that transition.
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Or they might get started on a birth control pill. That's used a lot for women who are in perimenopause. And I don't think that's the right solution.
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I think if they help you avoid surgery... They can be beneficial, but I think they're way overused in our culture. And most people who agree to a birth control pill don't receive full informed consent. They're not told that it'll raise the inflammation in your body by two to three fold. It increases your risk of autoimmune disease, especially Crohn's disease.
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It makes your control system for your hormones less flexible. It can rob you of testosterone. It can lower your free testosterone. It can shrink your clitoris by up to 20%. I feel like if that was part of the informed consent, very few people would sign up for it.
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And yet I take care of people who are in this continuum from a state of health, often to a state of pre-disease, like pre-diabetes as an example. And if they don't do something about it, they then move on to diabetes. So I like to intervene there as early as possible to reverse disease. And most of that is lifestyle. So those are the things that I tend to work with.
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You know, I used to think that it was a feminist invention, that it was a way of putting your fertility in your hands. And I went on the birth control pill when I was 16. But I feel like there are some costs to it that a lot of teenagers and women in their 20s and 30s aren't aware of. And for me, I feel like that awareness is really critical because So who's it for?
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I would say it's a simple entree into contraception, but I would much rather people use things like NIUD or condoms or some other barrier method that doesn't mess with their hormonal intelligence.
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Oh, quite good. Quite good. I love that question. I went through a divorce two years ago. And I feel like, you know, I have two daughters. They both went off to college and were out of the house. And I realized that my time with my now ex-husband had run its course. And we came together to create this beautiful family, but we were no longer a good fit for each other.
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So a big part of my spiritual work has been coming to terms with that and really getting clear about, okay, for the second half of my life, what is it that I want? What is my mission? How do I support that? How do I only give a whole body yes to the things that I say yes to? How do I... Whole body yes.
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Whole body yes. So this is something I learned from... One of my mentors, Diana Chapman, she learned it from, I believe, Katie Hendricks, who's a therapist. The idea is that instead of saying yes to things that you're offered, Purely from a cognitive place. That sounds like a good idea. Sounds like a good opportunity. Let me do it. Instead, you check in with your whole body.
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You check in with your heart. You check in with your gut. Does this really make a difference in the world? Is this something that's going to make me jump out of bed in the morning? Is this something that is worth the time and the effort? I'm a little older than you. And so I hold these opportunities a little bit differently than I did in the past.
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We were together for about 22 years and married for 20.
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Well, I would love to riff on this with you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So I can tell you that Part of the challenge in my marriage was that we had difficulty talking about difficult topics. So highly charged topics were tough for us to be able to navigate. When we had a conflict or a fight, we didn't repair very well.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There was a partial repair where you would feel good enough to keep functioning and take care of the kids and do your householder stuff, but you didn't really feel seen or like you cleaned up the pain that was there. There was a way that I didn't feel fully understood or seen. And not that I require that from my partner, but I felt like there was a misattunement.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I'm in a relationship now where I have those things that I'm talking about. And it's someone that I have known for 30 plus years. We were interns together at UCSF. And I realize now that You know, I came together with my ex-husband, and I really am so blessed by the life that we had and the family that we had. But we also had a trauma bond.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I do a lot of metabolic health because it's so critical for the energy that you feel each day.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There was a way that his trauma kind of intersected with my trauma, and we hung in there for a very long time, probably longer than we should have. So how do you know? I don't know, Steven. I just can tell you that there was a way that our interactions was creating dysregulation in my body. And I'm not blaming him.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I, you know, it's a two, there's two sides of the street, but there was a way that we just, we didn't quite gel together.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I mean, you would hope so. But we spent about 10 years out of the 20 years of marriage in couples therapy. And it didn't really resolve some of these conflicts. We got better at I statements. We got better at saying what we were feeling and not blaming. We got better at going for a walk when we're talking about something difficult.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
But there was still a way that I felt alone and lonely inside of the relationship. And I decided, I think a fair number of women decide this, I decided I was better off alone than to continue in the marriage.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It wasn't proximity. I think it was, there was a way that we had a hard time expressing love and feeling and receiving love. There was an obstacle. And some of it was trauma. And the good news is there's a lot you can do to resolve trauma. But there was a way that I got to the point where I couldn't try any longer. I tried for a lot of years. And I just couldn't keep trying.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yeah, it's such a, it's a great question. You know, one of the things that I've seen that has helped to resolve trauma better than anything else is psychedelic assisted therapy. It's a way of looking at your story, a way of looking at the facts of your life with more objectivity. And it's a way of resolving the way that trauma becomes embedded in your system.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It's associated with more belly fat. We know that it shrinks the brain in women, but not men. It's associated with depression. But also, if you're someone who's making a lot of cortisol, you're going to make less testosterone. And that leads to a whole host of serious problems.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And so I started doing psychedelic-assisted therapy about five years ago with the hope that it would help me with my marriage. And what I had hoped over time is that I would do my part to resolve the trauma and signature in my own body.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And that maybe we would do psychedelic medicine together as a way of reconnecting to the love that we felt for each other and, you know, kind of get the noise, turn down the volume on the noise. And we weren't able to do that.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
He wasn't willing.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And not everyone is. I'm not blaming him for that. And I think there's other ways to create healing states of consciousness. Breathwork can do it. A near-death experience, peak experiences can do it. Flow states. There's lots of different ways to create these healing states of consciousness. But we weren't able to get into that healing state together.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It's quite different. So conventional mainstream modern medicine, I believe, is broken. I feel like there are so many people who are failed by our current medical system, especially people with chronic disease, things like diabetes, autoimmune disease.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So with mainstream medicine, generally what happens is that you develop a condition, say high cholesterol, and you get treated with a pharmaceutical, say a statin. And what we know is that we have to treat about 100 to 200 people for one person to benefit. So that I would define as imprecision medicine, whereas precision medicine is where we understand you as an individual.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you very much. Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
We look at your genomic blueprint. We look at your biomarkers. We look at your wearables data to determine end-of-one experiments where you serve as your own control and figure out what's going to be the most effective for you, depending on what your goals are.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And I do feel like we've got an epidemic of sexless marriage, people who are not having as much sex, who don't realize how important pleasure is, especially for the nervous system and for regulation. Orgasm is one of the most effective strategies for creating nervous system regulation.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There's a few things that are wrong. One is that it has become medicine for the average. And when you look at scientific evidence and you rank order it, what's considered the highest form of evidence is the randomized trial. But the randomized trial is mostly around using a pharmaceutical.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
We're dropping into your parasympathetic. And what we know is that with gender roles and with what's happened with work... We've lost some of the polarity between men and women. I mean, I imagine you also have listeners who are gay men or lesbian couples, so I want to be mindful of being inclusive here. But I think we've lost a lot of polarity.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It does, but sometimes you have to work at it. Sometimes you have to create the polarity.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I would say right now in my 50s, I'm having the best sex of my life, the best orgasms of my life. And there's a lot of polarity in my relationship. And I've learned that This is pretty controversial and edgy, so I'm just going to say it anyway. I feel like for women who are professionals, who work really hard, there are some ways that polarity can be really helpful in the bedroom.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And here I'm talking about gender roles and understanding sort of what is satisfying for you sexually and asking for it in your relationship. A lot of the professional women that I know, they enjoy vanilla sex, but they also like a weave of domination.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Both. I mean, it's a personal preference, but I think there's a way that it's a way of playing with power that I think can be sexually very satisfying. What do you think? Do you think it's important in sexual relationships? to have polarity, to have like the feminine and masculine attributes? Or do you think you both just come to a sexual connection equals and that's how it should always be?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Okay, now things are getting interesting.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It is. I totally agree with you.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So in the example I just gave, using a statin to help someone with their cholesterol, maybe help prevent a heart attack. The number one killer. The problem is we then, based on randomized trials, come up with medicine for the average. And it's not about optimal health. It's not even centered around health. It's centered around health. Okay, heart disease is number one killer.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
That's fantastic. It's a good strategy. And I appreciate how you are being very intentional about your sex life.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It fizzled. And I'm a very sexual person. Eroticism really matters to me. And to not have that be front and center felt like a death.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So let me feel a way into answering your questions. I feel like there's some sex differences too. Biological differences between what the male sexual response and the female sexual response is.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
and that needs to be understood i feel like when you have sexual dysfunction in a relationship it's a couple's issue it's never one person or the other it's it's a couple's issue that you want to address as a couple what we know is that men are a little simpler there tends to be desire um You know, this physiological change that occurs in terms of blood flow and an erection.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And then there's a plateau phase and then orgasm, ejaculation. We can talk about separating ejaculation from orgasm in a minute. But in women, it's more complicated. So that was the Masterson-Johnson way of thinking about the sexual response.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Masterson-Johnson. And now we know... What's that, sorry? Masterson-Johnson, they were sexologists that published this particular model. And it wasn't until maybe 15, 20 years ago that Rosemary Besson at the University of British Columbia found that women have a different response. It's more circular. And it has to do with,
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
feeling emotionally connected in order to be receptive to having sex with their partner. Whereas men in some ways do the opposite. And I'm curious if this is true for you. They need to have sex in order to feel emotionally connected. Women actually need the emotional connection first to be receptive to sexuality. And so this leads to a lot of disconnect. And it includes things like
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
How many times in the past week did you empty the dishwasher? There are things that create emotional connection that a lot of men don't realize. And then for women, they often don't feel like the sexual response will not happen unless they feel emotionally connected. And this was part of the problem in my own marriage was that I didn't feel that emotional connection.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I tried really hard to establish that emotional connection, but I didn't have it. I have it now. Is it related to the newness of my relationship? Maybe. And knowing that, knowing about the emotional connection in some ways changes your homework as a man. Do you know what makes your girlfriend feel emotionally connected?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
How do we help people prevent it? Oh, lifestyle medicine prevents 70% of it? Well, we're not going to do that because we can't make money off of it. There's no profit motive. So we're going to focus instead on these pharmaceuticals. Oh, GLP-1s. That sounds like a good idea. Let's try that and solve problems with GLP-1s. So to me, there's many layers to why the health care system is broken.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Oh, I like it. I'm probably a level three person.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I would imagine.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Can I see some of those level threes?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Oh my gosh. Sleep is as close to a panacea as we have.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It is the Holy Grail. It is so critical for functioning. You know, what I see taking care of a lot of executives is that they think that they're the exception, that they don't need 78.5 hours of sleep every night.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
but only about two percent of the population has the short sleep gene the rest of us need to optimize our sleep to the best of our ability so what we know is that it affects your hormones inside of 24 hours one bad night of sleep raises your insulin raises your cortisol the next day makes you more hungry makes you more likely to crave carbohydrates
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So just like you can create a negative cycle, you can create a positive cycle by optimizing your sleep. I'm a big fan of wearables because... especially if you wake up in the morning and you don't feel flush with sleep and fully restored and fully recovered, you want to understand the metrics. How much deep sleep did you get? How much REM sleep? How many interruptions did you have? Did you snore?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
What was your heart rate variability? What was your respiratory rate? So I feel like sleep is one of those lifestyle factors that we need to optimize.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Oh, yes. And one of the ways to measure trauma is the ACE test. It's a validated questionnaire. And they found that people who had one or higher ACE scores had a greater risk of 45 different chronic diseases. And my score is 6 out of 10. But those aces are living on in your body.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
There can be. I mean, I would look at some of the other variables as well. And one of the things I really like is the eight sleep. Have you used that at all?
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Did it help you with HRV? I...
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Sure. Well, I start with alcohol. So we know alcohol makes your HRV decline, not just for one night, but somewhere around seven to nine nights.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And that's exactly the kind of behavior change that I get excited about. So when you see the metrics and you see the reflection of, oh my gosh, my physiology is so much better off of alcohol, and there's better choices than alcohol, you want to make that swap. And the behavior change sticks. So I like...
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I like grounding, so I find when I get in the ocean, when I get in streams with bare feet, when I walk on the sand, that improves my HRV. The country that seems to improve my HRV the most is Costa Rica. There's something about the aliveness there where my HRV doubles to triples.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Microdosing mushrooms also raises my HRV quite significantly. Okay.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
But one key area is that 70% of the diseases we're facing right now are utterly preventable with lifestyle medicine. 70%.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
What I do every day when I'm home in Marin County is, is I go outside when I wake up in the morning and I look at the, I live on the ocean and I look at the horizon. Like I trace my eyes along the horizon. And I just was looking at the data on morning sun because I didn't quite believe it. Like supposedly it helps you with your circadian rhythm. It helps you with sleeping better.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It helps you with melatonin production. It helps you with mood. It's got all of these benefits. And some people say you only need five or 10 minutes of morning sun. That's sufficient. And so I started looking at the data and you actually need more than that.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Like you start to see a benefit around 30 minutes, but you need, you still keep improving some of these outcomes with longer, like up to two and a half hours. So the thing I do every day is I get morning light and I trace the horizon and I look at nature and I remind myself that nature is the best way to regulate. That helps my brain.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
My website is sarahzalmd.com and the podcast is called Treated with Dr. Sarah.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
That's right. And the podcast is called Treated with Dr. Sarah.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Thank you so much, Stephen.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
We can measure it in the blood. So it's not that hard to measure hormones, but I think there's a way that in mainstream medicine we're taught to tell people that their hormones vary too much, and so it's not worth measuring.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
It's what you've heard, but then if you're a woman who's 34 and you're trying to get pregnant and you're having trouble... In that situation, we'll measure every single hormone. We'll look at thyroid, cortisol, testosterone, estrogen, progesterone, the control hormones like follicle stimulating hormone.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And yet, somehow in that situation, testing is more reliable, but it's not in this other situation. That doesn't make sense. That's double standard.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
I would say it was growing up with a fair amount of trauma. And what I've learned about trauma is it's less about what actually happened to you. It's the way that it became embedded in the system of your body. So for me, my parents got divorced when I was really young. I grew up in a way that I became a helper. And I realized that by being someone who was really looking out for others and
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
and tuning into their energy and helping them achieve their goals, that kept me really safe. And so there's a way that that, it was very resonant for me to discover medicine. And one of the things we know about people who go into medicine is that people tend to have a fair amount of trauma that leads to becoming a helper in this way.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So there's a lot of different ways to measure trauma. One of the ways that I find helpful is something called the adverse childhood experiences. So ACE for short.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Oh, do you? It's a questionnaire. So my score is six out of 10. So childhood divorce, my parents got divorced when I was about a year old. That's one out of the six. Other things are abuse, neglect, emotional abuse, physical abuse, having a parent with a substance use disorder.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So things that, you know, it's not a complete list, but it's a validated questionnaire that was used in the 1990s and found among people who are middle-aged. You're not quite yet middle-aged. But for people who are middle-aged, 40 to 65. They found that people who had higher ACE scores, one or higher, they then had a greater risk of 45 different chronic diseases.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes. And that's the critical question. Yeah. So if you know that you have an elevated ACE score, and there's a lot of people who have a score of zero, about 40% of men, about 30% of women. And what we know is that if you've got this greater risk for 45 different chronic conditions, there's a way that those ACEs are living on in your body now. Unless you're addressing them.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
And it's the living on in your body that we want to pay attention to. So for some people, it's their immune system. And it leads to more allergies, more histamine overload, more food intolerances, maybe autoimmunity. where their immune system is attacking their own tissues, maybe autoimmune disease. There are other people who have more nervous system dysregulation.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Maybe they've got anxiety or depression or post-traumatic stress disorder, mental health issues. And for other people, it could be more endocrine. They've got chronic cortisol problems.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
Yes.
The Diary Of A CEO with Steven Bartlett
Menopause Expert: Belly Fat Grows During Menopause! Your Estrogen Levels Are Controlling You & This Hormone Is Quietly Killing Your Sex Life!
So I didn't start to detect this until my 30s. But what I found was that I had depression. I had premenstrual syndrome. I had my first baby when I was 32, and I couldn't lose the baby weight. And as all of this was happening, and I'm a physician, I went to my doctor for help. And he suggested that I go on Prozac for the depression and the mood issues.