← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Why Gut Changes Can Destroy Your Muscles in Perimenopause with Dr. Christine Maren
01:21:00
Feeling more sensitive to foods in your 40s? It’s not just you! Tune in to learn how hormonal changes impact your digestion and what you can do about it. Dr. Christine Maren shares tips on balancing hormones and boosting gut diversity. Watch the full episode at https://youtu.be/Ws6xyeh4EQQ
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- [00:00]
A
I see this in my patients over and over again where it's, you know, we're conditioned as children a lot of times in our culture to be hyper capable, uber responsible, able to take care of ourselves and suppress our own needs. And we show up for everybody else all the time for a really long time. And when we get to midlife and we have all these things piling up, you know, health conditions, psychological stress, work stress, aging parents, relationship stress, all of this stuff piles up, and then our hormones make us less resilient, and it's just like. It's like the straw that breaks the camel's back. And I think it's also an invitation to heal and become more of who we are.
- [00:48]
B
Hello, everybody, and welcome to another episode of better with Dr. Stephanie. It's me, your host, Dr. Stephanie Estima. And today we are talking all about the gut digestion and perimenopause and the menopausal transition. And this is gonna be an episode for you if you really wanna connect all of the dots. So you wanna connect your gut health to maybe you're suspecting some thyroid dysfunction, Maybe you're noticing that you're having more immune stuff. So maybe like this, the itchy eyes, the stuffy nose, you feel like you, maybe you constantly have a cold. This is the conversation that is gonna tie it all together. My guest today is Dr. Christine Marin. She is a medical doctor and a FUNCT certified practitioner, and she specializes in women's health, hormones, and gut health. Dr. Marin helps women navigate perimenopause and optimize their wellbeing by addressing the root causes of their symptoms through personalized, holistic approaches. And she's also the author of the Hormone Driven Gut, which is a book dedicated to exploring the connection between digestive health and hormonal balance. So what are some of the things that we talk about today? We talk about the difference in gut diversity between men and women. We talk about how gut dysbiosis and leaky gut increase increases in perimenopause as we begin to lose many hormones, but in particular estradiol. We talk about alcohol sensitivity changing, caffeine sensitivity changing, food sensitivities increasing. We talk about how a decrease in progesterone can actually ratchet up immune function and not in a good way. So we talk about histamines and the function and the relationship between progesterone. We talk about strength training and the role that it has on gut health. We talk about detoxification. And I will warn you, we go a little bit hardcore when we're talking about liver detoxification, so we are talking about some of the different stages of detoxification, but I feel like you can handle it. So some of it is dark rose Betty territory, but definitely take a listen to it. We'll also have some show notes for you supplementaries as you need it. We talk about something called the estrobolome, which is the area of the gut that is dedicated to metabolizing estrogen and how that changes in perimenopause as well. And we talk about some of the good and bad foods. So we talk about oats, we talk about the right kinds of carbohydrates, we talk about fiber, we talk about all of the different things that a woman in perimen perimenopause needs and how the there the difference between a therapeutic intervention of something like a low carbohydrate diet can be important as well as then reintroducing carbohydrates for thyroid function, for immune function, and a whole host of other things. I would say in general, Dr. Marin does a beautiful job of weaving together this story of the thyroid health, gut health and the immune system and all the changes that are happening concomitantly in perimenopause. So without further delay, please enjoy my conversation with Dr. Christine Marin. Perimenopausal women are notorious for being magnesium deficient, which can lead to lowered hormonal production. More than 80% of us are deficient and even just having suboptimal levels in the body can contribute to symptoms. And that's because magnesium is related to over 600 biochemical and enzymatic reactions in the body. Many of these reactions influence the production of these key steroid hormones in the body, like estrogen, progesterone and testosterone. Insufficient magnesium levels can also disrupt your thyroid function and magnesium breaks down cortisol and other stress hormones. So if you don't have enough, you are going to have poor hormone production and a poor stress response. Bioptimizers is my favorite magnesium supplement because it contains the seven best absorbed magnesiums along with cofactors like B6 that are going to help enhance the absorption of it. It's a simple, effective solution to a very big problem. I personally take two capsules every night for sleep support. For an exclusive offer, go to bioptimizers.com better and use promo code better during checkout to save 15%. And if you subscribe, not only will you get amazing discounts and free gifts, you will make sure that your monthly supply is guaranteed. Once again, that's buyoptimizers.com better and use promo better to save 15%. All right, Dr. Christine Marin, welcome to the podcast. I'm thrilled to have you here today.
- [05:28]
A
I'm excited to be here.
- [05:30]
B
We are going to talk all about the gut and perimenopause and all the things that we can look forward to during this transition and maybe more importantly, some of the action items and strategies that we can start putting into place now. Whether you are in perimenopause, you are already in the after party, you are already in the land of menopause. What are some things that we can do to improve our gut? And my first topic, one of the things that I hear the most from women in my community is that we do see noticeable changes in bloating, in constipation, distension, new food sensitivities in our 40s and 50s that we just never had prior to that. So can we talk a little bit about what is happening from a hormonal perspective in terms of our gut health? And I'd love for you to talk about certainly sex hormones, but also some of the other hormones around thyroid and some of the other hormones that are changing in midlife that affect the gut.
- [06:29]
A
Yeah, absolutely. I mean, as you said, women who are in perimenopause and menopause experience a lot of digestive symptoms. There was a study that came out earlier this year that quantified that, and I was even surprised to see it. It was one of the number one complaints of perimenopause was digestive symptoms. So whether that's constipation or loose stools or bloating or new onset of GERD or reflux or food sensitivities or all of the above, they can play really big role in how we experience this transition, and vice versa, in how our hormones are balanced. I mean, our gut plays a really big role in our hormone balance, and vice versa, hormones play a really big role in our gut. So let's dive into a little bit of research on what we're seeing that happens to a woman as she goes through perimenopause. So if we look at the studies, these just came out like as 10, 15 years. They're pretty recent literature, really. When we're looking at the microbiome, we can see that the female microbiome starts to decline in diversity as we age. The male and the female microbiome are really different. That's called sexual dimorphism. And the female microbiome starts to experience less diversity and plateaus around the age of 40, by the time we're in menopause, we often have much less gut diversity. And, and that has really big downstream effects on the way we experience menopause or perimenopause and even our immune system and thyroid function. So there's this bidirectional effect between hormones and gut health, for sure.
- [08:06]
B
And so do we know if that is a function of progesterone declining, which we know starts to sort of starts to decline in our mid to late 30s? Estrogen declining, is that affecting the gut diversity, the thyroid hormones? Maybe it's less T3, maybe it's more reverse T3. Or is it a combination of all of those things?
- [08:24]
A
I think it's a combination of all those things, but I think the number one is estradiol. I think as we experience less estrogen, less estradiol specifically, we have less diversity in our gut microbiome. Certainly testosterone plays a role in our gut, progesterone plays a role in our gut. Thyroid hormones play a role in our gut. But I think the number one player is estrogen.
- [08:46]
B
Okay?
- [08:46]
A
So I think progesterone really is more about motility than anything. I mean, it probably influences diversity to some degree, but I think really it's estrogen is the biggest influence there.
- [08:57]
B
And it's interesting too, because when we look at estrogen in perimenopause, the overall trend is down. But of course there can be months where there's wild vacillations in terms, and many women in their early perimenopausal years will say, I, it feels like I'm estrogen dominant, right? So they have some of these, what we'll say more accurately, estrogen dominance relative to progesterone in the luteal phase of the cycle. So it's not all cycle long, but it's in the second half after you ovulate, where you don't have enough progesterone to oppose estrogen. And then she just goes a little bit buck wild, right? So we get the tender breasts, we get the water retention, we get all of these different things. So as some women will say in the beginning that they feel like they actually have more estrogen, estrogen, and then, I mean, even though the overall trend is down, so it's really interesting that as we lose estradiol, then we also start to lose some of this diversity. And then would you say that that would also contribute to different cravings, different food? Like, one of the things I hear a lot from my community is like, I, I'll I was talking to you about tomatoes in the pre chat. It's like, I just cannot have tomatoes anymore. Or I cannot. I used to love onions. I cannot tolerate onions anymore. I used to love tomatoes, cannot tolerate tomatoes anymore. After 40, do we. Do we think that that is contributing in any way to food sensitivities, or is that more of a histamine? Is that a different system altogether?
- [10:20]
A
I think it's probably more than one thing. So our immune system changes. We've got some histamine issues that are changing tolerance. But I think the big deal is intestinal permeability. One of the really interesting facts that I love the most is that estradiol influences the tight junctions in our gut and plays a direct role in intestinal permeability. So as we lose that permeability and those tight junctions become more loose, our immune system starts to see things on the other side that we shouldn't really see. And we get more food sensitivities. But it also is this aspect of dysbiosis. So as we become. As our gut microbiome becomes less diverse, we're more likely to have gut infections. We have less of the good bacteria keeping the balance. I always say our gut microbiome is like a rainforest. And as you kill off some of the good bacteria, either because you have loss of diversity, or maybe there's also this interplay of taking more antibiotics because we have more UTIs or whatever it is, it's just like this bonfire of things that then contributes to more dysbiosis, less beneficial bacteria, more bad bacteria, perhaps also more infections like higher levels of H. Pylori or clostridia or fungal overgrowth, and candida and yeast, all of those things are going to contribute to increased intestinal permeability. And so your body is trying to protect you by reacting to those foods. But really there's this immune system interplay that happens with all of that. We see increased rates of autoimmune disease associated with that too. But the intestinal permeability issue, I think, really is at the crux of it, because that's when we start to experience inflammation. We start to react to those foods we didn't used to react to, like, you can't eat bread anymore, or you can't drink alcohol anymore, or like you said, you can't eat tomatoes anymore or onions and garlic. We know too, like women who go through perimenopause, if increased or worsening ibd. So inflammatory bowel disease, ibs, all of those are documented. And I for sure have seen this, like, clinically, where my patients will go through perimenopause and they'll be like, oh, my gosh, my IBS is so bad, or ibd. So they'll have Crohn's. It'll be like, in remission, they'll go through perimenopause and experience this big flair.
- [12:37]
B
And what about the other thing that. And I wasn't planning on talking about this, but I actually think it's a really great place to maybe bridge it is alcohol and caffeine. So again, lots of people say I used to be able to drink, have a glass or two with dinner, and now it just wrecks me. The other thing I hear is coffee. I used to be able to have coffee, and now I can't deal with it anymore. And I wonder. I've postulated this on a couple of other podcasts with a few other guests that maybe there is because of the decline of estradiol that we're seeing this change in our ability to detoxify in the case of alcohol and to actually move it to its intermediates and eventually expel it. And then just our sensitivity to caffeine seems to get ratcheted up in perimenopause and menopause as well. Has that been your clinical experience? Do you have any thought on the mechanism behind that?
- [13:27]
A
Yeah, I think we should talk about the caffeine one. Alcohol for sure. Like, that seems obvious to me. I mean, it influences detoxification, but also the way that we metabolize alcohol changes big time in perimenopause, and it can trigger a lot of histamine issues. So if we're talking about the gut microbiome and histamine and perimenopause, histamine symptoms are going to be like, you know, runny nose after you eat food, or maybe even like migraines or abdominal pain. But women experience heightened histamine issues in perimenopause, in part because what's going on in their gut, but also because the loss of progesterone. Progesterone stabilizes mast cells which release histamine. And so loss of progesterone is going to kind of do that double whammy, especially if you have underlying issues with your gut. And then, like you said, those chaotic. The hyperestrogenism. So high estrogen compared to low progesterone is going to destabilize histamines. And so when it comes to alcohol, that's kind of like a double whammy when it comes to histamine. Right. So a lot of alcohol is high in histamine, but then it also impairs your histamine detoxification pathways. So does Candida and other kinds of yeast and fungal issues. So I think the alcohol piece really makes a lot of sense. The caffeine piece, I'm not sure. I don't know. I don't see that one as often clinically, actually. So I don't know. Let's talk about it some more. What else do you think it is?
- [14:49]
B
I mean, to be totally transparent and. I don't know. I don't know what's going on, and it doesn't happen in everyone. And this is just another reason why perimenopause can be so individual. Based on your genetics, are you a fast metabolizer of caffeine? Are you a slow metabolizer of caffeine? Does that change? You know, your genetics don't really change, but your capacity certainly does.
- [15:09]
A
Yeah, well, it's kind of like with mthfr. Like, MTHFR might not be playing that big of a role in your life until it does. Or with. Okay, Celiac genetics are a good example of that. Somebody who has celiac disease has the genes, they're brewing, brewing, brewing, but they don't really, like, matter. You don't develop celiac disease until you get the gut infection. And then that's like the nitus, when those genes become more relevant. So perhaps that's the same thing with caffeine. Maybe perimenopause is like the nidus. When that gene comes on and your. That gene that's a slow metabolizer maybe becomes more relevant for you. I don't know.
- [15:43]
B
Yeah, yeah. I think that, I mean, partially is that there's just not a lot of women are just not as interesting to study historically. It's sort of like, I think we're harder to study.
- [15:52]
A
Right?
- [15:52]
B
We're. We're harder. And I'll say that, you know, research is kind of like me search, Right. So in, you know, in the past, it's usually men who are in. In who've been scientists and have. Or who've been medical doctors, and they just study men. For the point that you mentioned, women are certainly like, we're just like guacamole. We're just extra. Right. We're, you know, a little bit more complex to. To study with the varying, you know, hormonal milieu. But just think that there's. We've just always just kind of been looked at as smaller versions, like smaller archetypes of men. So I think that there's that as well. I wanted to just come back to a moment with the histamine issue. So that's not actually something that we've talked a ton about on the show. So maybe you can just for my listeners, just you mentioned runny nose first. What are some common histamine issues? Like, if someone is like, I just don't feel, you know, I just don't feel the way that I used to. How can she. Maybe just as a large broad. Obviously we're not making any diagnosis here. Dr. Marin is a doctor. She's not your doctor. But what are some of the clinical signs and symptoms of a histamine reaction?
- [16:56]
A
Yeah, so really obvious histamine reactions would be like, I eat sauerkraut and I get a runny nose or itchy skin. Itchy skin is actually a really common symptom for women in perimenopause, which can be very much histamine related. Hives, rashes, allergy type symptoms, itchy eyes, all that kind of stuff is a very obvious histamine symptom. Less obvious symptoms would be palpitations, brain fog, headaches or migraines, abdominal pain, visceral hypersensitivity. So that means like your belly is like really tender, really sensitive to certain things that can be a big, like, ooh. Like when I hear patients talking about that and they have this pain that doesn't totally make sense where it's like they're really. They get really bad abdominal pain sometimes when they eat that. Visceral hypersensitivity can be very histamine driven. And so, yeah, it can be really all over the map. It's really sometimes hard to identify. But in the course of kind of like talking with patients, I'll ask them, pay attention. If you eat a bunch of sauerkraut, does it trigger any symptoms? Also is sort of like this additive. I always say, like, it's a bucket analogy with histamine. So you can have a little bit, but when you have too much, you start to get symptoms. And that might be hormonally. Well, it definitely is hormonally driven as well. Because when you're gonna have like higher estrogen levels. If women can sometimes tell me, especially women who get migraines around ovulation or menstruation, I'm thinking like, ooh, what's happening with histamine there? Because they're having these, these fluctuations with hormones. I mean, there's allergens outside, obviously. Right. And so there's that. And then there's alcohol, and then there's eating a bunch of sauerkraut or kimchi or whatever it might be. And then there's ovulating. And so if that's the thing, if ovulation is the thing that drives or overfills the bucket. And so now it's pouring over and you have symptoms. That sounds very histamine to me.
- [18:49]
B
So let's talk a little bit maybe about the detoxification. So we're going to get into a little bit of dark, gross territory here. For my Betty's that are listening, let's talk about detoxification because you mentioned, as you know, you mentioned in the conversation with alcohol that as we see progesterone decline, that is what's going to keep our mast cells intact. But you also said that the way that we detoxify changes in midlife. So let's talk a little bit about what we would consider and understanding that there's three different. We're not going to get into all the hydroxylation, all the conjugation, all the elimination steps today, but talk to us a little bit about how some of our capacity to detoxify. And when I say detoxify, I'm not talking about the cayenne pepper and liver program that your favorite celebrity does every January. I'm talking about actual detoxification that your liver does to actually move foods that you've consumed or compounds like alcohol into intermediates, so that. And then into their sort of package them into these compounds for excretion. So talk to us about how that changes in midlife.
- [19:55]
A
Okay, so first, just to back up a little bit with the progesterone discussion, that's like more of an immune system function versus detoxification. So progesterone stabilizes mast cells, the immune system that are the immune cells that release histamine. So then when you talk about detoxification specifically with estradiol or estrogens, we've got these three phases of detoxification. And this is where liver and gut health really play a big role and where alcohol kind of comes into play there, because your ability to detoxify in your liver through pathway one is going to be a big deal. Also, CYP enzymes that influence caffeine potentially. So phase one goes through liver. These enzymes, called CYP enzymes, dictate how you metabolize estrogens and break them down. So then phase two is going to go through methylation. And so patients or people who are listening who know about like, COMT or mthfr, these kind of Things will dictate a little bit of how we're doing. Their nutrients are going to come into big play here. So if you don't have enough of certain B vitamins, magnesium, you might not break down or methylate your estrogens to prepare them for excretion in your gut. But phase two is through this methylation comt. Phase three is through your gut. And this is where gut health is uber important for detoxification, especially of your estrogens. I liken this to, like, flow. Everything in our body really benefits from flow. When we exercise, we improve flow. When we have a bladder infection or uti, like, we want more flow. Flow's a really good thing. So estrogen is that same way we want flow, we want estrogen coming in and going out. We want it to happen in a healthy way. And so part of that flow is then gut health, making sure you're pooping every day. For women who are constipated, they're not going to be pooping every day. But this is where the interesting stuff comes into play because your gut microbiome plays a really big role in how you break down and excrete estrogens or how you reabsorb some of them and essentially increase your levels.
- [22:03]
B
So let's talk about. So let's talk about beta glucuronidase, which.
- [22:06]
A
Is the end result. That's where I'm going.
- [22:08]
B
Yeah, I know. That's where you go on. I'm following you, I'm following you. So let's talk a little bit about what are some of the scenarios where. So beta glucuronidase basically very simply undoes. So if we have estrogen slated for removal, let's say beta glucuronidase comes in and is like, actually, no, we're going to keep her. So undoes the package and then gets reabsorbed back into the system. What are some of the conditions where we might want that, where we actually want to. And I know this is a bit of an odd question because we always think about, oh my God, beta glucuron is. It's bad. We don't, we don't want that. We want to get rid of it. Right? Use it and then lose it. But I think in perimenopause and menopause, as we have declining estroge, I do actually think that there's. And feel free to disagree with me here, by the way. I do think that there is a role for trying to preserve estrogens. If there is a requirement for it. So first, do you agree with that or not? And then the second part of the question is, what are some of the conditions where we might see an elevated level of beta glucuronidase? Good and bad. And then what are some ways that we might think. Think about decreasing it if we are running estrogen dominant?
- [23:24]
A
Yeah. I mean, you see me smiling back here because I'm like, yes, she gets it. Totally. So our bodies are so intelligent. We weren't. Like, we didn't. We didn't evolve to have beta glucuronidase that did nothing. Right. Like, we're not. We don't want to just excrete all the estrogen. I used to think of every time I would see a high beta glucuronidase on, like, a GI map, like, oh, I better give them calcium D glucarate. And now I think, why is that happening? What's the compensatory mechanism? So our body has this mechanism, just like you said. So, first of all, gut microbiome has this subset of bacteria. Let's talk about this word called the estrobolome. So the estrobolome is the subset of gut bacteria that make beta glucuronidase. And beta glucuronidase is the enzyme to turn off or turn on the switch that tells us to get rid of estrogen or let's conserve and bring it back in. And so when we experience perimenopause or menopause. Let's just go to menopause. When we experience perimenopause and our gut microbiome is really healthy, our body might say, hey, you know what? We've got low estrogen levels. Let's reabsorb some of that to protect you.
- [24:37]
B
Yep.
- [24:37]
A
On the flip side, when we experience, let's say, I don't know, some high estrogen state, maybe it's perimenopause, and our body's in a really good state and we've got really great gut microbiome. We turn off the switch and we say, okay, you can go. We don't need you estrogen. Like, we've got good balance. So it's the switch that maintains balance in our lives. And the switch or the mechanism is broken when we have gut dysbiosis. And so this is where gut dysbiosis or gut issues really influence the way that we experience perimenopause and menopause. And. And it can make those symptoms way better or way worse.
- [25:20]
B
Did you know that Collagen levels drop 30% in the first five years after menopause. So if you are noticing your skin becoming drier, duller or less firm, there is a scientific reason why this is happening. As estrogen levels decline during perimenopause and menopause, it is going to impact your cell's ability to produce collagen. Not only is that going to affect the appearance of your skin, but it's going to weaken your skin barrier so it changes how your skin functions as well. One Skin's topical supplements are proven to boost your natural collagen supply and strengthen the skin barrier. Unlike other products that focus on surface benefits, One skin works at the cellular level. In lab studies, their eye cream was shown to improve collagen by 130%, not a typo. 1, 30130 and their face cream increase increased collagen by 40%, similar to what you'd expect from a retinol. And they are powered by One Skin's proprietary peptide which will improve skin barrier and function. If you want to try their eye cream or their face cream or any of one skin science, use code better at Oneskin co better and you are going to get 15% off of your first order. That's oneskin co better and use code better at checkout. Hydration isn't just about how much water you're drinking, but it is how well your body is holding on to that water. And this is especially true in perimenopause and menopause because as our estrogen declines, so does our ability to retain key electrolytes like sodium. And then you add in exercise sessions and hot flashes and night sweats. And women in midlife can very easily get dehydrated and disrupt our mineral balance. This is one of the reasons why I love peak's deep Hydration protocol. It is a synchronized day to night electrolyte protocol to restore your nervous system to keep you hydrated. And it has the added bonus of being drinkable. Skin care. It strengthens your skin barrier and helps to unlock a luminescent youthful glow from the inside out. It's a two part electrolyte ritual. The first one is BT fountain. You take this in the morning to deeply hydrate smooth skin and fuel all day energy. And this electrolyte has clinically proven ceramides visibly to improve skin elasticity and reduce fine lines. It has the ceramides that support hair thickening, follicle strength, elasticity and shine hyaluronic acid which supports a youthful dewy glow. And of course electrolytes and minerals that provide that deep cellular hydration. The second part is re fountain taken at night. And this helps to calm the nervous system down and promote deep restorative sleep. It has magnesium, L3 and 8 glycinate and taurate. And this is going to help to calm your nervous system and your brain for rest and recovery in the evening. It's electrolytes and minerals that help to nourish hydration from the cells all the way up to the skin. So start your daily ritual today with 20% off for life plus a free gift to elevate your routine. Head over to peaklife.com Dr. Estima that's P I Q U E L I F E. This is hydration redefined. You're gonna feel it and see it. So would it be fair to say then that if we are in an estrogen deficient state, even like, you know, the late stages of perimenopause, you're sort of in the waiting room, you're like, am I gonna get another period? I don't know, it's been seven months. Would it be reasonable then to assume that you might see elevated levels of beta glucuronidase? And that might be a good thing because that's your body saying, hey, we have to actually hold on to all of the estrogen that we possibly can in order to preserve function, you know, systemically in, in the body. Would that be a fair statement? So we don't want to just, you know, shuck everybody with calcium deglutarate as you were saying?
- [29:16]
A
Yeah, absolutely. This is where it's like, our body is often doing us a favor now we have to look at the whole package, obviously, and like, well, what are your symptoms? What are your hormones really doing? What's going on like with everything else? And do you have digestive symptoms? Because probably that mechanism isn't working that well. But yeah, I absolutely think that's fair to say. And somebody who's healthy, who has good gut function that like, hey, this is a protective mechanism. It's kind of like with sex hormone binding globulin, like when we see shba shape go up high, it's like your body's responding and it's protecting you. If you're on birth control pills, you're gonna have a high shbg. Cause your body's like kicking in to help you out. So I think there's, I think we gotta look at it more holistically.
- [30:00]
B
You literally took the words right out of my mouth. I was like, like in the birth control pill, it's like perfect example. Okay, great. I actually have a question for you that I don't know the answer to, but it came up as you were talking. So this is again, just like for the nerds we have. This is like the nerd question for the, for the dark roasters who are like, I know everything. I wan. Everything. So with the estrobolum, so we have these changes, you can either ratchet up or down beta glucuronidase. My question as you were talking was, do we know if the decline of estradiol, let's say in perimenopause, can affect. So the gut is sort of phase three of the detoxification process. In phase one, this hydroxylation, you're basically adding an OH group. Okay. So you're just. Because you're either going down a couple of different pathways. When it comes to estrogen, you're going down two oh, which is what often is called the favorable pathway. Then we have four oh, which is where often you'll get like, DNA damaging, like quinones and all this kind of stuff. And then you have like the 16 alpha. Oh. So without going there, do we know. Without getting any more specific than that, I should say, because we're already in like nerd territory here. Do we know that? And whether when we are seeing a decline in estradiol, are we impacting more of the 2oh pathway? Because I know that it can also go down the four oh. Do we know that? If the pathway that the estrogen follows changes is what I'm trying to ask.
- [31:26]
A
Yeah, I get you. I don't think we know that. I don't know, though. It's a good question. Like, is our body smart enough to maybe upregulate a CYP pathway so that we preferentially go down the 2 hydroxy? I don't know. And I don't know that anybody knows. It's a good question.
- [31:40]
B
Yeah, it just, you know, this is what I.
- [31:42]
A
Cause I think really like our body craves balance and homeostasis. And if we remove a bunch of the triggers, like, we will go into balance and homeostasis most of the time. And so, yeah, I would, I would think, like, from a common sense perspective, maybe there's a mechanism at play.
- [31:56]
B
Yeah. And I'm. I'm selfishly thinking of this myself because when I, I know my own tendencies, my tendency is to definitely go down that four OH pathway where. And I used to really suffer from what we've been just like that estrogen dominant progesterone deficient in the second half of the cycle. Like the tender breaths and the water retention, the mood and the sleep and the affect, all that stuff. But I wonder, I mean, it's really gotten for me anyway, like a thousand times better in perimenopause. And I could just be an n of 1, but I just wonder if it's like, hey, we don't need to go down this pathway anymore. Maybe we're gonna select a different one. So just.
- [32:32]
A
You know what I think it is? I think it's fiber and exercise.
- [32:37]
B
Well, let's talk about those things. Since you brought them up. Those were on my list. How does exercise impact gut health? Fiber. And then, and then we'll talk about fiber as well, but talk about exercise strength. I'd love, I'd love for you to focus in on strength training, but I also would like to hear about different types of cardiovascular activity as well.
- [32:54]
A
Yeah, we're both big fans of strength training. I love exercise and how it helps us in so many different ways. But one of my favorite, favorite benefits of exercise at how it impact the gut is how it impacts the gut microbiome in a favorable way. So too much exercise, like people who ride in the Tour de France, they've got too much exercise and that's actually creating leaky gut, which actually high performance athletes know that and are doing things to meet, mitigate leaky gut. And then too little exercise also can create leaky gut. So we've got kind of both sides of the fence. But exercise in and of itself is really good for your gut microbiome. So do more of it. I also think if we just zoom out, like, exercise encourages flow.
- [33:39]
B
So there's that word again.
- [33:42]
A
It's just, it's a little abstract. But I think of it all the time when I see patients because I want things moving. It's when things get stagnant that we have problems like gallbladder issues and UTIs and all that kind of stuff. So exercise just reinforces that, like the flow.
- [33:58]
B
I also, I also wonder, and I'm in the middle right now of writing my book on perimenopause. And I just finished writing the. It was like chapter six. It's talking all about, like, how to strength train for women. I wonder if there's also something where, like, I was, I was looking at the, the, the evidence around HRT and strength gains, and it seems to be quite mixed. Right? So taking estrogen transdermal whatever way, a lot of, like at least the two meta analyses that I was doing on the weekend seem to show, like, mixed results. Like, one showed, like, sort of benefit, and then the other one didn't really show benefit, which, you know, led the authors to conclude that there's really nothing better than strength training. When we're thinking about the anabolic signals of growth and hypertrophy specifically, which are two different outcomes. But, you know, just, like, for muscle health, you know, strength training is going to be, you know, the best anabolic signal. And I wonder if it has to do with. With the transient rise that we see in testosterone and estrogen after training. Maybe it's a donation of satellite cells. There's, like, no one's gonna listen to the show now. Like, we're totally getting into, like, did we lose you?
- [35:05]
A
We're the nerds.
- [35:08]
B
But I wonder if there's, like, you know, the satellite donation that's helping to maintain, like, that straight. Because so many women will say in menopause and perimenopause, like, even before they started losing muscle mass, they'll say, I'm not as strong like I've been tracking on my app, or I've been tracking, you know, however much I can squat. And then I just can't seem to get that anymore. Which, again, to your original point around gut health, it's the loss of estradiol in the context of the gut. Loss of that gut diversity. And then in the context of the musculoskeletal system, which is where I like to play, is like, okay, it's the loss of the. Now the satellite cells that are sort of these, like, stem cells that essentially hover around the muscle. They're no longer able to donate. These cells that can go on to become myoc. On to become muscle cells. So what? Well, what do you think about that? What do you think about HRT and strength? What do you think about the impact that strength training has on the gut? Tell me what you're in. Just my long ramble.
- [36:03]
A
So hrt, I think it's sometimes hard to study, and I absolutely think that HRT has an important influence on our ability to build and preserve muscle. But I think as we zoom out and just, like, look at this, this big picture with common sense lens, it's like, HRT increases our resilience. It allows our body to put resources elsewhere, like into building muscle instead of keeping us alive and maintaining other sorts of areas. I always think about the big bucket of stress. What does all this stress look like? We've got stress from our life and our work and our relationships, but we also have stress from gut Infections and toxic exposures and all of that. And then we also then in perimenopause and menopause, have the stress of shifting hormones that influences our resilience. So I don't know the answer to it, but I think if we zoom out and just accept that hormones do help us to be more resilient, we know that maybe that's a piece of that puzzle.
- [37:08]
B
And at the very least, maybe it's just going to help you sleep if you can't sleep. That for me, that was the topic of one of the main takeaways of my first book was if you can't sleep, it doesn't really matter what diet you're. It doesn't really matter what you're eating or doing at the gym. Like, if you can't sleep, you can't function properly. So I think even if you're just taking oral micronized progesterone, let's say in your 40s, because you know that there's some, there's like a trend, like a predictable decline that we see. I think that that gives you more capacity and, you know, to use your word, more flow for you to be able to donate the, like, the energy that you were, what we'll call it, wasting or conserving on, you know, being sleep deprived. Now you can put that towards, you know, a 30 minute, whatever, you know, some type of activity at home or, or at the gym.
- [37:56]
A
Yeah, totally. I agree. I like the idea. I like the concept of, like, donating it. Like, all right, you've got a little bit more edge. Like, let's donate that to building some muscle. Because now we've got a little bit more edge or a little bit more like room in the bucket.
- [38:11]
B
Yeah, yeah. It's like, it's really about, it's about capacity because I think, you know, you, you, you hit the nail on the head before, like in midlife. It's a very beautiful and peculiar time because it is probably one of the busiest times of your life if you're a woman and you've chosen to have children. Your children are growing up and you are meeting the demands of their extracurricular activities and you're parenting them. And many women in midlife unfortunately go through some kind of change in family status. There's a divorce, let's say, or something, something of that nature. And so there's a lot. And then there's, you know, you're usually, if you, if you're a career person, you're usually also at the height of your sort of money Making, you know, you sort of spent your 20s and your 30s and your 40s, like, kind of climbing that. And so now in your 40s and your 50s and, and even into your 60s, you're sort of at the peak of that monetary, you know, your money making capacity. So there's all these different verticals that are vying for your attention. And all of them, of course, are very important. And then you have the other, you know, personal, you know, you have aging parents and there's all these different things that are happening at the same time, which even if you did, nothing is going to have some effect on your gut because there's so much stress, like there's so many demands in your life.
- [39:28]
A
Yeah, 100%. And I think most of the women I work with are high achieving women who are extremely capable and also very responsible and they have taken on so much in their lives and everybody around them has trained themselves well. I'll say it this way, women, I'll say, let me just bring it personal because I don't want to like rub anybody the wrong way here, but I personally trained everyone in my life that I could do everything. I could micromanage, I could multitask. I got this, I got that. Like I was doing so much and at a certain point I got. My breaking point was mold and I got to a point where I couldn't do it anymore and I just broke. And I'm so glad that happened because it really required me to also take some responsibility for the ways that I was training everybody around me to think I could do everything all the time. And so I had to then train them all that I can't do everything all the time. Everybody around me needs, needs to learn that this is going to be different. But I see this in my patients over and over again where it's, you know, we're conditioned as children a lot of times in our culture to be hyper capable, uber responsible, able to take care of ourselves and suppress our own needs. And we show up for everybody else all the time for a really long time. And when we get to midlife and we have all these things piling up, you know, health conditions, psychological stress, work stress, aging parents, relationship stress, all of this stuff piles up and then our hormones make us less resilient, and it's just like the straw that breaks the camel's back. And I think it's also an invitation to heal and become more of who we are.
- [41:17]
B
Yeah, I love that. Yeah. Thank you so much for sharing that. I think that sometimes it's really easy to look at a doctor who has a thriving practice and family life and all this, this, and to know that, you know, we all struggle in some way or another. So I appreciate your, your transparency there. And I agree. I think that perimenopause is a, you know, it's been referred to as a second spring, which I really love. You know, it's like, you know, you can become a queenager. You can really move into your, you know, queen era, but you can also sort of recapture that joy that maybe you had when you were, when you were a teenager. So I don't know where I heard that, but I love it. Queenager.
- [41:52]
A
Oh, yeah.
- [41:52]
B
Like my, my queenager era. So I, I, I do love that. But it does require you to say, hey, I am not superwoman. Like, I literally cannot do it all. I need some help. I know for me, for me it was like, you know what? I actually need more friends. And I know that that sounds just absolutely ridiculous, but there were many, many years where I was like, this is too much of a waste of time. Like, I have to just put my head down and achieve and do the things. And now I'm like, no, I actually really need friends. Like, I really need people that I can reach out to if I'm struggling, even if they don't give me a solution. I just know that someone has, like, space and an ear and a heart for me. So, yeah, I, that's sort of been a goal that I've had like, over the last five or so years is like, I really do need to deepen and invest in friendships because they are, you know, male, female, whatever. Because they are, they are so, so important and they really do fill my cup.
- [42:45]
A
So 100% I agree with you.
- [42:47]
B
Yeah. Yeah. So I wanted to, we talked about training. We didn't get to fiber. So I want to make sure that we don't forget about the impact that fiber has on the gut. Talk to us a little bit about that.
- [42:58]
A
Yeah, fiber is a really critical aspect for our microbial diversity. And so remember, gut microbiome impacts all sorts of things, from inflammation to metabolism to our immune system. And the way that we absorb nutrients and fiber plays a really big role in all of that. And I think is what I've, what I've discovered in my patients as I've started adding more fiber and more complex carbs to my own diet, is that they're way overeating fat and way under eating fiber. And so just kind of reestablishing that. A lot of my patients Are, you know, gluten free sometimes a lot of them are paleo or, you know, paleo ish, somewhere in that. That kind of dogma. And when we look at their macros, the amount of fat that me too and them are consuming is pretty excessive. And yes, fats are important. I'm not like going back to the 80s and doing low fat, but it really does add up and it affects our ability to maintain a healthy weight in perimenopause, which is a primary concern for so many women going through this phase of life. And so we eat, we really work on bringing in more fiber. I say 30 grams of fiber a day is the goal. It's hard to reach 25 to 30 grams. But some of my favorite ways are like, as fruit, you know, people often in my community don't eat a lot of fruit. So whole fruit, whole intact fruit. Berries are a great source. They also have polyphenols, which are really good for your gut. So they're often foods that can impact our gut in multiple ways and multiple beneficial ways. Oats, chia seeds, flax seeds, all of those are like literally things I eat every day. I start my morning with overnight oats with chia and hemp hearts and a date and I add fresh fruit and then I have some more protein because I'm still prioritizing protein.
- [44:52]
B
But Dr. Marin, don't oats run around your body and steal minerals from you?
- [44:57]
A
Oh my gosh. Every time I talk about eating oats, people tell me things like, like oats are for horses and all the other things. Listen, they are whole oats, they are organic, they are certified gluten free, and I love them. And they do not spike my blood sugar. And I have data to prove that. And I really miss them when I don't have them. So when I first was presented with the idea of eating oats, I scoffed. So I get it. If you're listening and you're like, think this is ridiculous. I get it and just have an open mind. Overnight oats are a great source of resistant starch as well. Resistant starch is one of my favorite kinds of fiber, especially for women who are struggling with blood sugar.
- [45:39]
B
I say that, of course, facetiously, because I love oats. I call them prote. So I will literally make oats and I'll put a scoop of protein powder in it. Berries, chia, maybe a little dollop of peanut butter. Whatever it is, it's one of the most studied. So if you. And maybe what we'll do for those of you that are interested and we'll put some links in the show notes for those of you that want to actually go and read the PubMed articles. But if we're talking about body composition, oats are a phenomenal way for you to improve your body composition to give you the fuel that you need to go to the gym and perform. And I always find it really interesting when. And you'll see online, you know, people online that are like, oats are going to kill you. Oats are for peasants. Oats have this, you know, they have phytic acid in it and the phytic acid runs around your body and just leeches minerals and it's like this is a fundamental misunderstanding of basic human physio, like basic human nutrition number one. But also like what's the end game? You know, like people already don't have enough fruits, they already don't have enough vegetables, they're scared to death of carbohydrates. And you know, you and I were talking in the pre chat, it's like the hill that you and I are going to die on is women need to be eating more carbohydrates, especially in, in midlife. So I get really, I'm quite agitated right now because I, I can't stand this fear mongering around normal healthy food. Yeah. Right before I get sick I get my late night FM DJ voice and that is what you are hearing right now. If flu season has you feeling dry, scratchy and run down, here is a simple morning ritual that is going to pull double duty for throat comfort and immune support. Manukora Manuka Honey Manuka is famous for mgo. It is a unique antibacterial compound that comes straight from the nectar. And Manukora third party tests every single harvest and puts the result right on the jar. So you can literally scan the QR code and you can see exactly what you're getting. And they just moved to a custom amber glass jar that shields the honey from UV so it'll help preserve its flavor and bioactive integrity for longer. And they even have this clever U shape so you can get every single last drop and then recycle the jar, which I love. This is not your regular grocery store honey. It is rich, creamy, wildly delicious. But it's also ethically produced by Manukura's master beekeepers. In the remote forests of New Zealand, the bees gather nectar from the Manuka tea tree which is naturally packed with bioactives. So this honey delivers the three times the antioxidants and prebiotics of average honey to support immunity and gut health, which is your body's defensive frontline. So here's the easy part. One heaped teaspoon every morning I swirl it into my tea or you can drizzle it on your yogurt. You can take it straight if you're doing sprints that morning to soothe that morning tickle or that dryness in your throat. And you can of course, add more through the day if you're swapping it in for other sweeteners. It's honey with benefits or honey with superpowers. And right now is the best time to try it. They're running their biggest, biggest sale of the year from now until December 2nd. So if you head over to manukora.com better you're going to get a hundred and fifty dollars off of your first order with their Black Friday starter kit, which comes with an MGO850 plus you're getting at least 850 MGO Manuka Honey Jar. You're going to get 35 honey travel sticks, a wooden spoon and a guidebook. That's manukora.com/better for $150 off your first starter kit. So with that little I will get off my soapbox now and I will ask you to tell so you mentioned complex carbohydrates. What is the impact that carbohydrates like oats like you've been discussing have on the gut? And then also wrapping it into what we've been talking about in terms of strength training, in terms of stress, in terms of sleep, in terms of mood and affect. What are the impacts that we know that consuming carbohydrates have? And then the maybe the follow up question is why do you think so many women are afraid of carbs?
- [49:52]
A
Okay, bookmark thyroid here because I really want to talk about carbs and thyroid health because it's a big deal and it's something I've seen clinically for sure. Fiber is going to help us be more regular, right? So we want flow. Bring it in, bring it out. If you're constipated and you're not having good healthy bowel movements, we've got a problem that might influence your hormone balance. It will influence inflammation and the way you hold onto toxins and all that kind of stuff. So like you should poop every day if you're not. Let's work on that. Adding fiber is really critical. So what's super interesting is to look at the studies on high fat diets and how they impact intestinal permeability. So a Higher fat diet. Specifically here, like, let's be fair, what they studied were more saturated fats. So especially if you go to like a fast food restaurant or you're eating fried food or something like that, that that will cause a transient increase in your intestinal permeability, which is not something we want. We want intestinal. We want less intestinal permeability. We want it to be tight. So also gallbladder. So gallbladder back to flow. Right. So there's so many people in the United States who have gallbladder disease and have had their gallbladder removed. So there's really only so much our gallbladder can take care of. Like when we eat food, our gallbladder squirts out bile. That helps us emulsify fat. Bile is also antimicrobial for our gut. So it's really important for gut health and gut microbiome. So gallbladder is a big deal. If we overburden it and we're eating high fat all the time, all the time, our gallbladder is going to feel that. And so my patients who have started to incorporate more complex carbs and less fat, even those with a little borderline blood sugar issues. So I work with like women who are under a lot of stress, high performers. They have borderline elevated blood sugar, not necessarily insulin resistance, but they have this high blood sugar. Sometimes they have low insulin actually, but this higher than expected blood sugar. They're not diabetic, but like their hemoglobin A1C is like 5.6. And it just doesn't really make sense because they're so health oriented and, you know, they're doing all the right things. So what's going on here? Anyways, that aside, their blood sugar is fine. When we start to incorporate more complex, we're talking about the right carbs, not the wrong carbs. And they experience much better gut health. They have less stress on their gallbladder, they have less intestinal permeability, and they have better bowel movements and butter. Gut health is really at the crux of a lot of things. You know, when we talk about gut health, we're talking about inflammation, immune system, all of that. Okay, thyroid, what's really interesting. So I do lots of thyroid management. I work with a lot of patients who have Hashimoto's and have hypothyroidism and prescribe thyroid medication. Right. So I'm always looking at TSH free T4, free T3, reverse T3, and women tend to under convert between T4 and T3 when they don't have carbs. So adding carbs is like this signal to our nervous system. I also think strength training signals the nervous system like, hey, we're good here. Everything's good. Go ahead, do your thing.
- [52:56]
B
It's a safety signal.
- [52:57]
A
It's a safety signal. Exactly. It's a safety signal. Our nervous system is like, oh, okay, I'm safe. Like, I've got some fruit and I've got some oats. Everything's good here. Life's abundant. I can go about my way. Like, your body is designed to protect you. So reverse T3, bring it back to SHBG and bring it back to beta glucuronidase. All these things are there for a reason. They are there to protect us. We just have to like hack the system sometimes in our modern day world. Or maybe it's really just about better understanding what's happening here and why we're under converting. Well, maybe it's because we're undereating and we're over exercising and we're under fueled. And so your body's shunting your resources to reverse T3 and going like, hey, put the brakes on. I don't have enough safety here. I need to hibernate in my cave because I can't find any food. Like that's what your nervous system sees. And so instead you want to signal, hey, I've got plenty of food, everything's abundant. I, I'm safe. Metabolism can work, like, go toward free T3. We're good here.
- [53:52]
B
There's gonna be a lot of people that are gonna feel called out by what you just said, but I think that it's like we're not calling you out, we're calling you up. We love we. You know, this is, this is a, a call for you to get back to and revere the temple, if you will. That is, that is your body. If you are over exercising and under eating, you can ignore it for only so long until like you were saying, the thyroid then basically just stops working. You are not getting that T4 to T3 conversion or your reverse T3 markers are going up and all of a sudden you've lost the lateral third of your eyebrow and you're gaining weight and you're always cold and your hair is falling out. Right. Which is kind of very classical symptoms of Hashimoto's thyroiditis. So I do think that especially in midlife. And I wrote a book on a female centric ketogenic diet. So it is a. And it was cycling, it was paired with your menstrual cycle. I actually still stand by that. For individuals who are metabolically unhealthy, for those of you like, as you were mentioning, who have blood sugar issues, who have a lot of weight to lose, I actually do think that it is incredibly valuable to pull back on the carbohydrates initially because you're probably over consuming them. And it's probably not just carbs that you're over consuming. You're probably over consuming. It's a carb and fat combo, right? It's like the very ultra processed, high, highly processed foods that cause you to, you know, they reach that bliss point in the brain. You can't. It's like the lay's potato chips. Like, can't you bet. You can't just eat one. You're over, over, over consuming in terms of calories. So I do think that there is a psychological and physiological benefit to abstaining from carbs for a transient amount of time. And that's the key, right? I think where so many women get it wrong is they go on a ketogenic diet. They lose a ton of weight, right? They lose a ton of water weight. In the beginning, it's dopaminergic, right? So it's like, you know, you're motivated. You see all these changes and then they're like, oh, you know what it was? It was the carbs. The carbs were the problem. And then they demonize carbohydrates and they never leave keto land. They never leave keto land. They are stuck in this prison forever. And then, you know, eventually, performance, as you were mentioning, thyroid, body composition, the weight starts coming back in. And what do women do with. They don't say, oh, maybe the diet's not working for me anymore. They say, oh, I just got to do it more. I gotta, I gotta keto harder. I gotta take out more carbs. Which makes it, you know, astronomically, like orders of magnitude worse, you know?
- [56:26]
A
Yeah, yeah, I agree with you on all of that. And I think also eventually it catches up with our stress and our nervous system. Eventually we're like, well, I can't go out with my friends because I can't eat anything on the menu. And so my goal is like, how do we build more resilience? And as you mentioned, like, everybody's different. Everybody's starting out somewhere different. And so if you are in a body that is metabolically broken and insulin resistance, we gotta an insulin resistant. We gotta fix that part first. And sometimes that's like a little bit it's tricky. It can be this little teeter totter kind of act for those women in my practice. I do really love microdosing GLP1s. We don't have to go there. So like. But it can be a really big gift for some of those patients. So.
- [57:10]
B
Well, it's another. It's just like we were talking about the HRT conversation, right?
- [57:13]
A
It just.
- [57:14]
B
If you're taking some progesterone so you can sleep, then you just have more capacity to give to the other, other verticals in your life that matter. And I think that the same is true with GLP1s, right? If you're starting, if you just get rid of that noise, a lot of, I mean, you know, I'm, I think about food all the time, right? So you just, I've, you know, if you are able to just downplay that rumination, let's say, or that food noise, it just gives you a little bit more capacity to look at some of the other areas of your life to ameliorate as well. And I think that that's, I'm a huge fan of both of those things if they're, if they're indicated where I think that we've gone a little astray with the GLP1 conversation. And honestly also with the HRT conversation is like, everybody needs it and the maximum dose and it's like not, we don't all, like, we don't all need it at all, at all at once. You know, I think that there is a bit of a, you know, because the, the Women's Health Initiative, which was like the biggest failure of, of a, of a study, I mean, I think ever, the, I think that the pendulum almost has swung to the extreme in the other way where it's like, give me all my hormones and give me them now. And it's like, okay. But you know, your, your HRT is not going to build a plate for you. Your HRT is not going to get you to the gym and lift the weights. Your HRT is not going to set boundaries with your mother. You have to do those things. While it can give you some capacity to start making progress in those things, you need the marriage of the two. So you need the HRT for the capacity and for the estrogen deficient state that you eventually will be in for all the things that estrogen does in the body. And there's. You can't replace strength training, you can't replace clean, you can't replace whole foods, right? Whatever, you know, in whatever capacity you're eating them, whether It's a paleo ish. It's a Mediterranean. It's Omnivore, whatever all the names are. I think that we need both of them. And what I'm finding, at least my observation, loose observation, is that online it's really gone the other way where it's like we all need every hormone under the the sun. It's like. Well, not necessarily.
- [59:21]
A
Yeah, I mean, I think to that point too much of a good thing is a bad thing. And it really. Everybody is so different. And yes, you can't. Yeah. Take estrogen and not strength train, not move your body, not get your sleep. Like, and estrogen might be the thing that helps you get sleep, so.
- [59:41]
B
Exactly, exactly. It's both of them. It's both of them. In all of them you mentioned, right. The right carbohydrates. Tell me what the right carbohydrates in your opinion are. Do we have. Is there like a good list and a bad list? Is there like a sometimes okay list? What are your thoughts on good carbs?
- [59:56]
A
I personally like to be in the sometimes okay list all the time. Like for me, sometimes. You know what I mean? I want more flexibility. I want to be able to go to France and have a glass of champagne and I might even eat a baguette, which is like very scary for me, actually, because I've been gluten free for years. But. But I believe that we should have more joy and freedom in our life, not less. Which is why, just like you mentioned with keto, restrictive dieting can be really difficult over the long term. Yes, there's a time and a place when it's short term, but eventually the goal is more resilience and more flexibility. So. Oh yeah, what was the point? Why did you even ask me here? Okay. Good carbs and bad carbs. So one of the things I like to talk about is oats, Those are good. Oat milk, bad. Whole fruits. Those are good. Fruit juice bad. Yeah, it's not so good. Like, let's not call it bad. Let's just call it like not so good. Do I have an oat milk latte every once in a while? Sure. You don't need to be perfect. But like, I wouldn't do oat milk every day of your life. I wouldn't drink fruit juice every day of your life. But I do eat whole fruit every day and I do eat whole oats every day. I also eat whole potatoes with the skin on. That's going to be a really great source. Source of fiber. I eat things like Basmati rice. And of course, like, you know, more starchy carbs or more starchy vegetables. Excuse me? Like, not just potatoes, but like beets and carrots and things like that are definitely gonna be good. I would say most people can incorporate things like that, but generally when I think about carbohydrates, I think about fiber. So a carbohydrate with more fiber is usually what you're aiming for. Bonus points if it has a lot of color. So color. Colorful fruits and vegetables are always going to be our friends. I mentioned chia seeds. I personally like chia. I think it's great. You know, I do like a tablespoon in my oats. Other complex carbs. Those are. Those are my favorite. That's my favorite list. What am I missing?
- [61:53]
B
Well, I'm following along with you. And these are all the things that I typically eat for as carbohydrates. It's like you have some type of vegetables like green beans or mushrooms or, or, you know, and any. You know, there's whatever I have in the fridge that I've, like, either sauteed or I can just quickly whip up. I also love, particularly in the wintertime, I love tubers. Like, I love parsnips.
- [62:13]
A
Parsnips. Yeah.
- [62:14]
B
I just love.
- [62:15]
A
I love parsnips. Sweet potatoes. Yeah. I didn't even mention sweet potatoes.
- [62:19]
B
Yams. Yes. All of these are fantastic. But potatoes and rice. I'm so happy that you. You mentioned these ones in particular, because I think that people are really. And for. And. And the baguette in, In. In France, when we go together, and we have. We have the Nutella crepe from the. The street vendor on the side. Because I. I think that there are so many people that are afraid of. Of bread in general. I have a piece of sourdough toast every morning. I. I love it gives me so much pleasure. Like I was saying to. I was actually, before you joined today, I was talking to my AV producer before we got going, and I was like, I don't even think I care about coffee as much as I care about the ritual of making my cup, my cappuccino in the morning. Like, I do the grind thing, and then I, you know, do the. The milk frothing. And it's just like so much pleasure in making the cappuccino. And then, of course, I enjoy the taste of it. But the same is true. The same is true here with the sourdough. Like, I actually enjoy making sourdough, and I. I enjoy the pleasure of having A slice of bread every day is something that I'm just not willing to like. You know, maybe my 20s, maybe my 30s, it was like, all about, you know, aesthetics. But I actually think I look better now than I even did in my 20s and 30s. And I'm eating foods that are a much broader range of foods than I, than I ever have. And I feel a hundred times better. So I do love what you're saying, and I love the idea of, you know, if you really love Nutella or you really love. I had Harley Pasternak on the show not too long ago, and he has a cookie every day. Like, his, his idea is like, I have a cookie every. I have one cookie. I don't have the whole box. I have one cookie every day. And that, just that taste, that little, little pleasure, you know, if it's something like I love, there's a chocolate hazelnut bar that I love. I have, I have some of that every day. I love it. I. I love it. I love to have, you know, my little chocolate and hazelnut.
- [64:11]
A
And the reason you can do that and that your body is, like, happy is because you strength train. You have so much muscle. This is like, I got to this point, so my husband's like a semi professional cyclist, so he competes in really high level cycling. And, you know, I got to a point after strength training, like, I had been training, I had so much more. I have so much more muscle mass than I used to have, and my metabolism is totally different. And there have been times where it's been really hard for me actually to get enough carbs. It's not easy. Like, I struggle to get enough carbs. I always default to, like, more fat. And so I have to pull back on fat and try to eat more carbs. And one of the best ways to get enough carbs is to eat a piece of bread. And there have been times, like, where my husband was like, you need to eat a piece of bread. Like, you just need more carbs. And that has been very helpful for me.
- [65:03]
B
Yeah.
- [65:04]
A
But, you know, people who are really struggling with metabolism and who have, you know, metabolically aren't in a very healthy place. They don't do great with, you know, bread.
- [65:13]
B
Agreed, agreed. And I understand that I'm, I'm coming from a place of, like, I've been strength training for a very long time and, you know, I don't have metabolic issues. My labs are always pristine. Like, I understand that and I'm trying to get other people to get there. You know, if we can get Everybody. Because one of the things I think that we're still failing women is this idea of lifting heavy weights and the idea of progressive overload. I think that a lot of women are hearing that they should go to the gym and lift weights. I don't think that they understand how, I don't think they understand how to progress. I think that they find a way that they're comfortable with and they do 15 repetitions at 10 pounds and they just kind of stay there. So I think that there's still some work to be done around dismantling this idea that strength training is not only like, okay, if I can sell you on the aesthetics, like, you're going to look, look amazing. Okay? So you're gonna look, you're gonna fill out your jeans, you know, you're gonna have glutes that walk out of the room like two minutes after you do like, you know, all that good stuff, right? And to your point, having more muscle, you're going to be a stellar, you're going to be able to dispose of glucose in a much more efficient way, both in an insulin dependent and independent manner. You know, all the things that muscle does, right? All the, you know, it's your mood and all the things that it does. So I think that without, you know, again, I feel I've gotten up on another soapbox.
- [66:34]
A
I know, but like, can we just go on the soapbox for one minute? Because you're talking about muscle and we talked about exercise and how it benefits your gut microbiome and how it benefits your insulin sensitivity. But what we didn't talk about is like, there's a side effect and it's your confidence. It gives you so much more emotional strength. And I don't know how to describe that or how much more I could tell you about that, but just trust me on, trust us on this. Like, it will help your confidence. It also is being studied in cancer, so it decreases cancer recurrence after chemotherapy and it improves autoimmune disease. So like, all these patients I have with Hashimoto's have this message of like, I shouldn't work out because I have Hashimoto's or I have hypothyroidism or whatever. And I'm like, wrong story. Like, working out and strength training is really important for your immune system and health helps decrease autoimmune activity. It's so good for you in so many ways.
- [67:28]
B
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- [69:51]
A
I agree with you. But what just came to me was like my patients have like too much grit sometimes. Like they have pushed on through the pain, they sort of like self abandon. And I mean that with such compassion because like I've been there but High achieving women who tend to put their knee needs on the back burner and like show up for everybody else. What my experience has been is that it was an act of consistently showing up for me when I go to the gym. And then you get to this point where you're like, oh no, I show up for myself just like the way I've showed up for everybody else for the last 25 years. Now I show up for me.
- [70:27]
B
Yeah, I love that. Amen. Let me, let me take a little bit of a, a hard left here because I want to. I think we could easily end the conversation there because I think that that's such a poignant point of discussion. But I do want to make sure that we discuss the birth control pill in midlife. Because that's another thing that I always hear with women is like, they start having symptoms, they go to their doctor, they say, oh, my cycles have become a little bit irregular and they walk out with a script for the birth control pill. I have made my opinion on this pretty well known. I would love to your opinion on the birth control pill for women in menopause who are maybe. Or perimenopause, I should say, and even menopause. I've had menopausal women been. I've heard of them being prescribed the pill and it's like, pardon me while I roll my eyes and give myself a lobotomy because what are we doing? So talk to me about the birth control pill. The indications for why it may be used in perimenopause for air quotes, treating irregular cycles. There's going to be women who are listening to this who have been prescribed the birth control pill for their perimenopausal symptoms. So speak to them, talk to us about what is happening and maybe what some alternatives might be as well.
- [71:42]
A
Yeah, yeah. I think the birth control pill is a huge under service to women who are perimenopausal. And I don't think it's a great idea. I look at everything clinically in terms of risks versus benefits. Supplements, diet, medication, like we can all measure risks versus benefits. And so one benefit of the birth control pill is that it does provide contraception. But can we find something that does that with less risks? Yeah, of course. An IUD or vasectomy or, you know, following like a natural family planning method or something like that. I think there are safer methods for contraception. Outside of that. The benefits I don't think are there. It's not regulating your cycle, it's shutting your hormones off. So that you have a withdrawal bleed, that's not your cycle. It's also coming with a whole bunch of risks. And so some of the risks that are not life threatening but super annoying are things like low libido nutrient depletions actually can mess your gut microbiome up. This is a huge one. So birth control decreases the diversity of your gut microbiome. HRT improves your gut microbiome. So I think there's no, like, there's really not a great place for the birth control pill in perimenopause. In my opinion. We have other kinds of options. Now the big risks that I didn't mention are things like birth or things like strokes and blood clots. Like that's real, that happens to older women. That's not super common, but it's common enough. And I, every time I lecture on this, somebody comes up to me and says, yeah, I was the one who got a stroke. Cause I was on birth, birth control pills in my 30s and you know, had some kind of blood clotting disorder. So we don't screen for a blood clotting disorder when we put women on birth control pills. I think we should be doing that, but we don't, we don't screen for Factor 5 Leiden and all the other things that can happen. If, yeah, I was going to say if I like if my daughter were ever to go on birth control pills, I would really actually send her to a hematologist first and say like do a full workup, make sure we don't have any blood clotting issues. Other are more common than you might think.
- [73:45]
B
Yeah, there's so many risks with the birth control pill. And I say this with love, right? Because I think that the whole point of this show, the reason why I even started the show was this idea of can we have more, can we have concrete conversations? Because I believe that the women who listen to the show can handle the science. Right. So often it's like, oh no, we're just gonna talk about like science light, right? So it's like, no, we can talk about all the science and we can make a decision based on our own familiarity and comfort level with risk. It's informed consent. Every single patient that came into my office for the 19 years that I was in practice, I had a one page. Oh, sorry, it was two pages double sided. It was one page, you know, written like whatever it was 18, 20 paragraphs on risk, on informed consent, around, you know, the rehab that we were going to do, the chiropractic adjustment, like literally everything and I would go over that form with them for like 10, 15 minutes before we did anything. And I understand that the medical system in many ways is broken. I understand that most, you know, medical doctors don't have that luxury. Like, I set my own hours. Like, my initials with patients were an hour in length, so I could do whatever I wanted because I'm not. I wasn't, you know, part of the. Part of the system. So I understand that informed consent can be very difficult with a patient, with a doctor who has like, you know, 40 patients that day, and there's. She's already like 45 minutes behind and she's just trying to, like, kind of give you what you want. I understand that. And I also think that when you fail, like, it's a failing of. It's a failing to our patients. If a woman. Why wouldn't you offer her hormone replacement therapy? I mean, maybe there's the contra. Like, use condoms. Family planning. As you were saying, vasectomy. These are things that are not often like. A vasectomy is often looked at as a very extreme surgery. It's not. It's like a afternoon. It's a, you know, the recovery rate is very. It's very quick. It has a very high success rate. And I don't understand why it's not offered as one of the top two or three things for. For couples that want, you know, some type of. Or, you know, you know, if you're in a committed relationship, if you want some type of assuming, you know, heterosexual. I'm assuming heterosexual. But, you know, if you. If you want to have some type of contraception, there.
- [76:04]
A
Yeah, I mean, I agree with all that. I don't think most women go to their doctor wanting that to be their option. They're not going to their doctor saying, I feel like I'm in perimenopause and I want to be on the birth control pill. I think most of them are like, I don't want that option. I want a better option than that. And I don't think women understand exactly what happens with their hormones when they're on combined oral contraceptives, that it's really like. It's shutting your ovaries down. If we go and test your estrogen level, your estradiol level in your blood while you're on a birth control pill, feel it's like, not there because you've shut your ovaries down. That's what birth control does. And you're on fake estrogen. So we can't test for the fake estrogen. In your blood because we just don't have that test. But that's what's happening. And so these cycles that happen in our progesterone, that rises in the second half of our cycle and helps us with sleep and anxiety and all that kind of stuff, we don't have those cycles anymore. And I don't think that's what most women are looking for. I think they want. Women are smart. We want better answers than them. That.
- [77:06]
B
Yeah, yeah. So give us the rundown, Christine. So you have someone who's listening to the show. She's been listening. She's still listening, you know, after we've been, you know, we're at an hour 10 right now. And she's like, yes, I have the gut distension, I have the change in food sensitivity and, or, you know, and I'm doing all the things. I am an achievement oriented person where I'm lifting the weights and I'm trying to get the sleep and maybe I'm on some, maybe I'm on some progesterone, let's say, but I'm still not feeling myself. My gut is not feeling well. I'm. Maybe I'm suspecting that I have some thyroid involvement. What would be the action items for her? Do we want labs? And if so, which ones do you like? Where would she, who should she go and see? What are some of the things that you would like to see from a lifestyle medicine perspective as well as a testing perspective, clinical perspective, and then maybe some, some, some applications from, from the test results?
- [78:01]
A
Yeah. I mean, I always start with a long conversation. My new patients are 90 minutes long and I start with getting data like goal number one. Let's get some data. Because you know what, a lot of symptoms of hypothyroidism overlap with symptoms of perimenopause. So let's see which one we're dealing with. Or maybe it's both. It's just like with perimenopause, are we dealing with low estrogen, low testosterone, low thyroid function? Like which one? Let's identify that. And in terms of gut health, you know, if you had access to a functional medicine provider, they might be testing your gut, doing more kind of detailed testing. So I do stool testing and urine testing and breath testing. One of the most common gut infections I see is sibo, so small intestine, bacterial overgrowth. I also see a lot of cfo, so fungal overgrowth. Sometimes there's other things, H. Pylori. But the whole point is like, get the data so that we know what we're treating because it's really hard to, to treat something that we don't, you know, if we don't know what we're treating. It's hard to treat whatever's going on with your gut. At the same time, there's a very bi directional influence between your hormones and your gut. So your gut health, your gut microbiome is going to be influenced by your hormones and your stage of life and the way that you break down your hormones and how safely is going to be influenced by what's going on in your gut. So we know that part. So let's kind of think about gut health real quick because the first steps I take are remove and replace. So when I say remove, I'm talking about like remove the infection and sometimes remove some of those foods. So there might be a time and place for a transient elimination diet or maybe a transient like keto low carb diet or something like that. A lot of my patients are gluten free if they have digestive issues or autoimmune disease. So there's a time for remove. But what's really left out here by a lot of people is they don't remove the gut infections. So they just work harder because initially when you remove some of those foods, they feel better. And so like you were saying with keto, they just like, they do it harder. But instead of doing that harder, don't forget to remove the gut infection. Like we gotta identify what that is and then replace. So replacing digestive enzymes can be really helpful. Some women need more hcl, which is like stomach acid. Some women need more, maybe ox bile, especially if they've had their gallbladder removed, or maybe bitters to support gallbladder function. Sometimes we'll use pancreatic enzymes, especially for older women. So the older you are, the more likely you are to have, have pancreatic elastase insufficiency. That means like when your pancreas doesn't make enough digestive enzymes and so you have to replace those. And you know, it's a spectrum, like you might be early in that or you might just need a little extra support with digestive enzymes. But remove and replace is a good place to think of that. Of course, diet plays a really big role here. The diversity of foods you're eating. The fiber. We didn't even really touch on protein. I think we're just assuming. Everybody here knows that we like prioritize protein for building muscle, of course, and now we're moving into fiber. So in terms of lifestyle, I Mean, that's huge alcohol. I would say, minimize alcohol as much as possible. It's not good for your gut. It increases your gut intestinal permeability. It can contribute to dysbiosis. It can contribute to histamine symptoms. It's also carcinogenic. I mean, to me, alcohol is like the new cigarettes, basically. Uh, so I think that's a really big change that women can make. Sleep, of course, like, prioritizing sleep. The way I frame all of this is my five foundational health habits in my practice. And so that's number one, protein centric, whole foods, high fiber nutrition. Number two, strength training and movement. So moving, getting, getting that flow, building muscle. Number three is low tox living. We really even talked about toxins, but, you know, we all get exposed to toxins every day. And so mitigating that, filtering your air force, filtering your water, it's the 8020 rule when it comes to that sleep, like, dial in the sleep piece, that's a really critical aspect. As you mentioned, sleep is everything. You can't exercise if you're not sleeping. Dial in the sleep first. And sometimes that's where hormones play a really big role. And then mindset. Mindset's all about showing up for yourself, making sure you know that you are worth it and whatever work you have to do around that to reinforce so that you're showing up for yourself and you're really stepping out of stress and survival mode mode, because so many of us are in stress and survival mode and we don't even know it.
- [82:15]
B
Just like you were saying before, when you start showing up for yourself the way that you've been showing up for everybody else in all the. All the various areas of your life. I mean, that's certainly. You know, I got into strength training for the aesthetics, and I stayed for, you know, what it did to my confidence and to my mental grit and my mental capacity. So I love that. Dr. Marin, this has been absolutely wonderful. I think that we've actually been talked about gut health in a way that I don't think that we've quite done in the show as of yet. Like, you had a. You have a very good way of breaking down some of the changes that we see in perimenopause on gut health and then looping in some of the other major players like thyroid. So I just want to thank you for your time, your focus, your energy today. I know this is going to be really useful for our Bettys.
- [82:59]
A
Thank you so much for having me.
- [83:03]
B
All right, welcome to the after party. The place and the part of the podcast where I tell you what I really, really think and you know, you probably already know what I really think of this conversation. It was fantastic. I was actually introduced to Christine from a mutual friend. We actually both graced the COVID of Strong magazine. And Jenny, who is the president of Strong Fitness, introduced us. And she said, you gotta have her on your show. And so she introduced us, she came on the show and this is the result. So I really loved this conversation because I think that it is the first time, as I said to Christine as we were wrapping up, it's the really first time we've talked about the gut and the thyroid and immune system in such a holistic way and how everything's connected to each other. I don't think we've really done that on the show before. And I did like a lot of the tidbits that she was giving around some of the specific changes for perimenopause so that we have these, these sex specific differences, right, in terms of gut diversity that happened before perimenopause. And that changes as we are moving through that midlife transition, eventually into menopause. And I loved how she explained the changes in our alcohol, our different capacity to metabolize alcohol in midlife. I really enjoyed her postulation around the caffeine sensitivity. It's something that I don't think we have the answer to, to yet, but it is something that certainly my community noticed. So a lot of women will switch from caffeinated drinks to decaffeinated, or they'll switch to Matcha or they'll, they'll switch to like a dandelion root style tea because they can't stand or they can't tolerate caffeine anymore. Gives them the jitters. So really love that. And I loved the, I have to say the histamine sort of signs and symptoms. Itchy skin, itchy eyes. You know, if you're getting migraines or heart palpitations, these are some of the signs that can, can occur over the course of the menstrual cycle that it can change a little bit. So sometimes it'll get a little bit worse around ovulation, sometimes they'll get a little bit worse right before you get your period. And this is usually a sign that we are starting to see some, you know, decreased progesterone, because progesterone tends to keep those mass cells in check, which is a part of the immune system that's involved in that histamine response, which I thought was really interesting. And as she was saying it, I was like, oh, yeah, I kind of get a little, like, I sort of feel like I have like a little cold right before I ovulate. And actually right before I bleed as well, like the day before, I'm like, oh, yeah, I'm a little like, sniffy. And you know, so just a little bit of a reinforcement. As she was talking, loved the conversation around strength training. I mean, of course, right? So, yes, all the things that muscles give you, but the improvement that it gives you in your, your gut and the gut diversity and your ability to, to digest and constipation and all the things that, that, that strength training can do to improve the digestive system. But I really love the part of the convo when she was saying there's so many women in her practice that give to everybody else and they never give to themselves. So that by when they start strength training, it's that 30 minutes or 45 minutes or hour or whatever that they can give to themselves. And then they learn that they can start giving to themselves on a regular basis in the same way that they've been giving to others, other people. I thought that that was so powerful and I hope that as you were listening to that, you were like, oh, yeah, that maybe that is the reason. Maybe that's the only reason that I need to strength train. You know, beyond aesthetics, you know, maybe that's the reason because often, you know, when you put in the work, when you do the work, like the aesthetics are just a bonus. Like they just happen, right? But that is a really powerful knowing and a really powerful why. So I really, really love that. And then of course, I couldn't even keep a straight face when she was talking about oats because, you know, then we have certain people on social media that love to demonize oats and kale and all the other things, which makes me think, like, maybe they have some gut problems. Maybe these people need to improve their ability to detoxify because everybody should be able to consume oats. Overall, I really enjoyed this conversation. And what I'm hoping that you're going to take away from it is action item items yourself. So it can be the very low cost. Like, maybe I'm just going to incorporate more fiber into my diet. Maybe I am going to try and maybe I'm going to get an air filter or I'm going to get a water filter or something in my home all the way up to the functional medicine testing, which certainly can be, you know, if you have the financial resources to do that. Like amazing, but not everybody does. And I think that she did a very good job of balancing like low cost solutions like strength training and stress management and sleep all the way up to some of these bigger tests and working with a functional medicine practitioner and of course everything in between. So let me know what you thought of this show. Let me know if what you're going to be doing, what the action items, what your biggest takeaway was. Leave us comments on Spotify, on Apple, itunes. We read them all and until next time, we will see you then. All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary health care provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.