← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
141. Dr. Amy Shah: Hormone Havoc, Gut Health, and the New Menopause Playbook
01:08:45
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- [00:03]
A
Welcome to Xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Perimenopause isn't a breakdown, it's a recalibration. And for millions of women, the frustration isn't just the symptoms, it's the lack of real answers. In this episode of Xtend, I'm joined by Dr. Amy Shah. She's a double board certified MD nutrition expert and author of the new book Hormone Havoc. And we're going to unpack why the strategies that worked in your 20s and 30s often fail in midlife and what actually works. Instead, we're going to dive into her 3033 framework. 30 grams of protein for breakfast, 30 grams of fiber daily and three probiotic foods a day. A simple but science backed approach that stabilizes hormones by repairing the gut brain hormone axis. We talk muscle preservation, mood regulation, inflammation, estrogen metabolism, and why gut health is the missing link in women's hormone care. If you've been told to just get through perimenopause, this episode offers a much smarter roadmap. One that's going to help you build strength, resilience and metabolic health for the decades ahead. Hey everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about. Your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running and all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics, then I tell them, go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our next health clinics. And if you try to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They could even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements, they don't have pharmaceuticals they're trying to get you to take. You're just getting the data and you're getting insights from the data. And you can bring this data to a clinic, ours, and we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com Dr. Shah and use the code DrShaw25 for a $25 credit towards your membership. Dr. Amy, thanks for joining.
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B
Thank you for having me.
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A
Oh, this is so awesome that you came here to join us. And we've been trying to do this for a long time.
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B
Yes.
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A
But it's a great time to do this because you are fresh into launching a new book.
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B
That's right. I actually. So basically what happened is I love nutrition and gut health and women's health, but what I was finding is that women were coming to me really confused patients as well as people online. On my social media accounts, people were messaging me, like, what about for women? Like, what about nutrition for women? What about perimenopause? What about menopause? So I saw that there was a big hole in that area in medicine. As you know, there's really nothing in that world that we give to patients to have kind of a handbook. So I wanted to write that. So that's what.
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A
Yeah, it's going to be a game changer for women that are going through the perimenopause time and menopause, because I Think to your point. You know, for decades we were taught in medical school that you want to stay away from hormone therapy.
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B
Yes.
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A
Not only that, you know, destroy hormone therapy, but any research around hormone therapy too.
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B
That's right. Like, it was basically when I think like 23 years ago we had the study come out and it said that basically that hormones cause cancer, hormone therapy is linked to breast cancer. And then it was like, shut down every single person, it was criminal basically to prescribe hormone therapy. And so for the last 23 years, pretty much all of our, you know, practice time things have been completely closed on the hormone therapy. And so now it's great that one we're having conversation about hormone therapy, but also, like, there is this whole population of people that we've kind of skipped over in medicine that it's the most understudied, under served area in a woman's life. So she gets a little bit of help in puberty and you know, in childhood, a little bit in pregnancy. Maybe when you're elderly, you get a little bit of help, but there's this huge gap between like 30 and 65 that you're not getting any guidance.
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A
Yeah, yeah, it's, it's really, it's really a huge problem because now we're seeing live today, in 2026, an entire generation of women that hormones were not addressed at all. And they, they're suffering the consequences now a hundred percent.
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B
And not only that, most people, I don't know about your parents, your mom, but even in traditional societies, like Indian families or people who have like these matriarchs, and they still didn't really talk about this time of life and what to do, how to deal with it. And so I think one of the things I wanna do is like, hey, here's a handbook. And you can use it for yourself, but your mom can use it and your daughter can use it. So when she needs to, when she's coming into that stage, we have something to like, look at.
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A
Right, right. And talk, have a conversation about. Because to your point, like, it's like suffering in silence is the norm.
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B
Exactly.
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A
Through this time of life.
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B
Exactly.
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A
And I just don't know why that is.
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B
And you know, I say this all the time, but it was when I was in High School, 1993, when NIH mandated that women be included in research. I mean, that's not that long ago that basically everything before that, everything we know is all based on a research on men.
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A
Yeah, it's so true. So finally we're in an age where now, this is, you know, people like yourself are, like, turning this mindset around completely, but in the meanwhile, like my mother, for example, she's about 6 inches shorter than she was when I was a kid.
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B
Really?
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A
Yes. She's had, like, every joint in her body replaced now, you know, and it's.
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B
Did she have osteoporosis?
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A
Yeah, that's.
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B
So she would have been, like, the perfect candidate for both nutrition intervention, which I talk so much about. Gut health intervention, but also hormone intervention.
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A
Exactly, exactly. And so unfortunately, here she's, you know, 80 now, and she doesn't have the doctor that will prescribe her hormones down is hard when you're 80.
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B
Yes.
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A
Right. But also, a lot of the damage has already been done. And so she's kind of trying to weigh whether it's even worth it to start now or not.
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B
I know that's a very tough. Because, you know, when you look back at the study, the. Really, the people that were more likely to get cancer from hormone therapy is really the people over 60. Yeah.
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A
They started old. Older, anyway.
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B
Yes.
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A
In a lot of, like, the cardiovascular complications were also due to people starting too old and they already had cardiovascular disease to start with.
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B
That's right. And I think the other thing people don't realize is that. And you probably talk to your patients about this all the time, that you get to peak muscle mass and peak bone mass at age 30. So that's men and women. And if you hadn't built it, then, it's like an uphill battle because now a lot of us women, we ate very little because everybody said, get smaller, get smaller. You know, diet, do this. And so you've already damaged the amount of muscle and bone that you have to start with, and then you don't know how to eat because nobody's really told you the nutrition that you need to support your bones and muscles. And then you don't know how to exercise to support your bones and muscles and brain. And so we get this huge pop. Once you're, you know, 80, for example, it. You can start then. But it really is much more effective, especially in that. That zone between, like, 35 and 50 is, like, the key time that you could be making these changes.
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A
Yeah. And I think what you're talking about is like, building up a physiological reserve.
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B
Right.
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A
Of muscle mass, bone mass, and VO2 max, which is a measure of cardiovascular fitness. Trying to get as high as you can of a number up to the age of 30.
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B
Yes.
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A
And then maintaining that number or continually improving afterwards.
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B
Like you, I think you Mentioned that you got better.
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A
Yeah, I did.
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B
So I think I. You know, I never lifted weights ever in my life. I was always, like, running or doing some kind of cardio. And it wasn't until I learned about protein, about lifting weights, all of this stuff that's happening. I mean, 50% of women over 50 get a fracture. I'm like, that's crazy. So I wish I knew that sooner. I think that's one of the messages I think we're trying to get out there is like, hey, you know, it's never too early to start, like, building muscle and bone. You know, you should be doing it from. Our kids should be doing it. And then you need to learn how to maintain that so that you can kind of not be 80, 90, 100 and not be able to, like, be functional.
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A
Yeah. And I love what you've done is you've made. You've come up with some really simple constructs about how people can incorporate this into their life. Because I think in our, you know, in this whole longevity space and whatever you want to call it, functional medicine, it gets really complicated for people because there's so many biomarkers you can follow, supplements you can take, and people lose the message and the noise. Right. And so I love that you've done that in your book. And I want to go over, like, the how a little bit later. But I still. I still think this. I want to dive in a little bit more into the why, and particularly I think this connection between gut health and hormone health.
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B
Yes.
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A
Like, those are two very unrelated topics traditionally. Can you connect the dots there for us?
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B
So I think you might know this, but I actually did internal medicine, and then I did immunology.
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A
You're double board certified.
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B
Yes. And so after internal medicine, I thought to myself, like, okay, where do I go with this interest in nutrition and gut health? And so first I thought gastroenterology. Then I thought maybe oncology, but I ultimately chose immunology. And what people don't realize is that this is, like, let's say 15 years ago.
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A
Yeah.
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B
I'm sitting at Columbia in fellowship, and we're doing journal club for those. For those of you who don't know, that's when you go over articles, scientific articles, and every article, Darshan, one after the other was how the gut bacteria was talking to the immune system as well as the hormones and the brain. Like, there's a hub there in the microbiome.
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A
Yeah. And that's incredible.
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B
It's a constant communication. Microbiome talks to your hormones, talks to your immune system, talks to your brain. And so there's. Every single article was like the. It's known that that's where the interactions happen. And so I thought to myself, how come we never talk about those interactions? We just talk. I. We just talk about them as separate things. Hormones are completely separate from immune system than gut health, but it's completely connected. So the gut bacteria actually play a huge role in deciding which hormones we should be producing, how much. How much should be reabsorbed and taken out of our body. And so I want women to know, like, if you actually want to improve your hormone health. Improve your gut health. Yeah, your gut health is the key to hormone health. And by the way, you're going to improve your brain health and your immune health, like, lower your inflammation in the process.
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A
Right, right.
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B
We even have gut bacteria. The estrobolome is a group of gut bacteria that help with estrogen metabolism. They will bring in estrogen, they will take out estrogen. And these guys are literally the hormone balancers that we always say, like, oh, hormone balance pill or whatever. They are the hormone balancers that we have inside of us.
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A
That's. This is crazy because, you know, this is all brand new science for the, for the most part. I mean, for me, yes. We never learned any of this in medical school. To us, the gut was just a place where you, you know, absorbed nutrients and created stool and got colon cancer.
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B
Yeah. And even now, I mean, gastroenterology is mostly focused on screening for colon cancer and, you know, irritable or inflammatory bowel diseases. There's not a lot of talk about the gut brain connection, the gut hormone connection, or the gut immune connection.
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A
Right. It's so true. I have good friends that are gastroenterologists and so sorry to them, but they really don't know much about this connection with the microbiome to our brain, to our immune system. And I'm always telling them, like, hey, you should read these articles that are coming out. Why do you think this is, like, evolutionarily? Like, why does a gut microbiome talk to our immune system and control some of our hormones?
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B
Well, I think about, like the analogy of the Amazon jungle. Right. We always learned that in the Amazon jungle there's like thousands of species and they're intertwined. And, you know, you see pictures and probably people have been there where they're like, the two organisms are like, intertwined with each other and they're two separate organisms, but they need each other to survive, you know, and that's exactly how it is with our microbiome. I don't think we realized that it was kind of coexisting with us. And sometimes, actually, most times, the gut bacteria are stronger in their signaling than our own cells.
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A
Wow.
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B
So we have trillions of them. Not just bacteria, but also viruses and fungi that live there like an Amazon jungle where they're, like, completely intertwined. They're communicating with our body. Even though they're not part of our body, they're communicating, and their voices are very strong. And so you think of them as like, kind of like army generals, and they're walkie talking the brain. They're walking, talking the hormones. And so it becomes like the central command center. And so when people say gut brain, it's really just one thing because, you know, when you're in utero, it's all connected, and then you separate, and the gut goes one way, the brain goes the other, and there's the whole spinal cord in between those.
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A
One of my favorite classes in medical school is embryology.
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B
I know when you watch it happen. So insane. So you are always connected. But people in the modern. In modern medicine did not understand this connection till very recently that you can actually take the gut bacteria, just the gut bacteria, not a human cell, you can transplant that into somebody else. So you take the gut bacteria from Darshan, you put it into Amy. Now Amy has Darshan's personality, Darshan's diseases, Darshan's, you know, mental health and athletic prowess. So athletic prowess, mental health, and inflammatory state, all can be transferred just by transferring gut bacteria. Oh, and hormonal states. There's a funny story of a man who was getting gut bacteria, so fecal transplants from his mother. Because you really want to screen very well, you want to make sure that it's. So he was getting them from his mother, and he started to develop hot flashes and night sweats. And they figured out that because they had transplanted her gut microbiome to him, that he was starting to get the hormonal effects and signaling that she had.
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A
That's crazy.
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B
It's so insane. I mean, we're just at the tip of the iceberg. We know from animal studies that you can literally transfer, you know, cure depression, cure adhd, cure schizophrenia. I mean, the, you know, the sky's the limit and, you know, about the athletic athleticism that people who are elite athletes have a very different microbiome than people who aren't. And so if you transplant the elite athlete bacteria into someone who's not, you can actually improve their athletic ability.
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A
So I actually met with a guy who is doing exactly this. So he's getting these elite athletes to give him stool samples, and he's culturing them and then putting them into, yes, actual, you know, little pills to transplant. And so, you know, how badly do
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B
you want to be, you know, like, faster and stronger?
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A
Right, right. And like, there's no anti doping agency that can test for that. Yeah, it's kind of like people are doing it.
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B
I mean, I. I feel like you're knowing what I know. Yeah, it's not a bad idea.
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A
Yeah. Yeah, it's. It's pretty. It's pretty incredible. I always say, like, you know, our microbiome is a billion dollar pharmaceutical factory that we're all born with.
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B
That's right.
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A
And so you have to treat it. Right. And it will take good care of you. Right.
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B
Well, one of the things I talk about a lot in general and in the book is like, you create these things called short chain fatty acids. Your gut bacteria, not you. Your gut bacteria create these things called short chain fatty acids. And that's like the equivalent of like an ibuprofen for your body. It is going all. It's like a factory of ibuprofen that's calming inflammation all around your body and your brain, and you can make it yourself. And it's because the gut bacteria do that when you feed it food that it likes, like fiber, probiotic foods and protein, it's when you exercise. The gut bacteria love that, and they love when you see light, like sunlight and during the day. So there's, like, ways to actually get that, like, plant of. Of of drugs kind of going. Yeah, by just changing the way you eat and live.
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A
Yeah. Even, like the GLP1s, people are buying these for thousands of dollars a month. And you can encourage the right kind of bacteria to produce these in your. In your own gut.
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B
Yeah, it's our gut bacteria has the power to produce dopamine, serotonin. You know, there's a short. These short chain fatty acids. So it is pretty amazing. When I started, so that was like 15 years ago when I was sitting in that fellowship, and I was like, that's crazy that it's so connected. And then when I went out into practice, of course there was no talk about that. There wasn't even an option to, like, provide solutions for people in that way. So we have a long way to go, because the research is there. A lot of that research is pretty well done. Like, we know that your diet can change rapidly, change your gut. We know that when you do change your gut. You have lower inflammation and lower inflammatory diseases. We know that you have boosted brain health. So I don't understand why, like, we live an entire whole lives without really caring about that gut microbiome.
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A
It's crazy, I know. Yeah, I think it's definitely coming to the forefront of people's attention now, but it is kind of a black box because, you know, there's all these companies offering gut testing.
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B
Yes.
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A
And then you get this gut test back. Either the results are so complicated you don't even know what to do with it, or they're just trying to sell you some, like, dietary program or supplement to, you know, based on that test.
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B
Yeah.
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A
And people know that that's probably not going to work.
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B
Yeah.
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A
For the most part. And so I think there's still, like you said, there's a lot of science that still needs to be done.
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B
Yeah. Because I'm sure your patients still do the same thing. They're like, okay, I'm sold. Like, tell me, you know what? I. How do I test for my gut? And it's like so hard because again, it's. If you think about it as the Amazon jungle, it's very difficult to go in and sample more than one little area. And so if you sample this one area, you're going to get these results, but if you sample the other side, you would get a completely different result. And then if you change your diet for two weeks, you're going to get a completely different result. So it's very difficult to really test and, you know, give us the answers like we have with other things in medicine.
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A
I love this Amazon jungle analogy because if you zoom out, like, you know what the Amazon jungle needs? Right. We need to stop cutting down trees. We need to not kill species of.
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B
Not set fire to the jungle.
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A
Yeah, exactly. Not encourage too many of one species that are predators over another species. Like, like, I think, like if you zoom out on your gut is the same kind of thing. Don't put into your gut the things that are destroying it, feed it the things it needs, and try to create a balance and a harmony between all the different species.
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B
That's absolutely exactly correct. And that's how I always think of it. So I think to myself, all right, if you had a barren jungle, which is what most Americans have, because we are just doing things unknowingly and to kill the gut bacteria, like antibiotics, eating ultra processed foods, alcohol, and then. So if you're starting from a barren land, you're gonna need a few ingredients to get it to be thriving again. And so that's why I talk about protein, fiber and probiotics, because those three things can help it grow, be healthy and lush again. Probiotics actually add more bacteria, so add more species to the jungle. Fiber is the food for it's like literally like if you're watering the plants and giving it sunlight and then protein and polyphenols, you really want to feed the gut bacteria so it can thrive.
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A
Right.
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B
And what we are doing in our modern world is killing them all the time.
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A
So, and I tell my patients this all the time, like if you want your gut to get healthy, 80% of the problem is solved if you stop eating a high amount of ultra processed foods. Right. Alcohol, yes. Also non straight into inflammatory drugs. And in about pretty much all pharmaceutical drugs are damaging to your gut. And so if you don't absolutely have to take them, please don't stop your prescriptions. But you know, like people take Advil at the first sign of even a slight joint ache. Or even some people take it preventatively. Like if they're going to go out to drink, they'll take Advil before. And it's just like you're adding insult on top of insult on top of insult to your gut and it's making it a barren land.
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B
Or there'll be, you know, taking antibiotics just in case, you know, a lot of people do that. You know, I, I have, I think I have a sniffle, I'm not sure. But like, let me just take it. So if you need antibiotics, they are amazing, but they're literally like setting fire to that jungle. And so especially the long term. And because some people say to me like, I need something for three days. No, you're fine. But if you're someone who's constantly taking antibiotics or you're someone who' taking it for long term, high doses, that's what it's doing to your kind of microbiome jungle in there.
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A
Right. I think the other thing that is really at the forefront of my attention all the time is the immune system. Basically I used to always think like the immune system lives in your bloodstream because it's constantly surveilling. But 80% of the cells are actually just around your gut for the most part.
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B
So the way I want you to think about it or the people who are listening or watching is like, it's kind of like a, again the army reference. Like the general is talking and the immune system cells are waiting there to hear. The hormones are waiting to hear and the transporters to the brain are waiting to hear, like, what do you have to say? Okay, you know, he just ate a whole bunch of ultra processed foods. I don't really understand what this is. I need your help to help me get rid of this. So the immune system comes in to help, the hormones come in to help. He says, you know, you need to send cortisol up because we need to be free, driving the inflammation up here so that we can heal what's happening. And it's sending signals to the brain like, hey, you need to slow down because we're dealing with this crisis here. And imagine that's happening all the time, every day.
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A
Right. That's a really good way of thinking about it. It just affects every system of your body mainly.
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B
And then women, especially when they're going through kind of this midlife hormonal change, I call it the hormonal continuum. Where they're kind of moving through the hormonal continuum, they start to see that their gut health is suffering more because some bacteria need estrogen to survive. So they don't have as many bacteria. Their hormone levels are declining naturally, their inflammation levels are going up because again, the body's sensing that the hormones are going down. So you're left with this very exacerbated condition. So if you started off in a place where you weren't eating very well, you weren't sleeping very well, weren't moving very well, when you move to this time of life, it is going to be very, very obvious. And so this is the time to really take care of your gut, to start to move your body, eat the foods that are going to grow that gut bacteria so that they can support your hormones and your immune system.
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A
Yeah, it's almost like, you know, going back to earlier, we said you want to kind of build up a reserve of skeletal muscle, bone, even VO2 max. You also want to build up a reserve in your gut of a really strong, healthy gut. So when you get to this point in life when your hormones are declining, everything else is functionally, optimally.
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B
That's right. A lot of people fix their gut. And, you know, the gut changes, by the way, gut changes within three days.
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A
Right.
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B
So a lot of times when women start to fix their gut, they start to eat better, they start to have more sunlight, more sleep. All of a sudden they're like, okay, perimenopause, not so bad.
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A
Interesting.
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B
I can do this. Like, I feel, you know, good. Everything's balanced. So it is definitely something that actually, especially in the transition from ages 35 to 45, like really close to menopause, those years where everything's kind of in flux. This can be something that can really stabilize things, really strengthen the communication between the gut and the hormones. And so then people feel better during that time and maybe even, you know, don't have symptoms.
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A
Right. So the estrobolome that you described earlier, I assume that's a name for all the bacteria in the gut that affect estrogen levels, is that right? That's right. Are there any specific strains, like name strains that you know of that are
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B
in the estrobalome or they're a special group and they're all in the, I wouldn't know the species name, but they're all in that estrobalum. And they're different.
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A
Okay.
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B
Than the other bacteria.
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A
So there's many different kinds of them.
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B
Yeah. So you can take. So the theory was that we could just like maybe hit people with a bunch of bacteria that could support their estroblome and the rest of the gut bacteria. But our body's really smart. So when you take bacteria by mouth, like a probiotic. A probiotic, it starts to destroy it right on the, right on the bat because it thinks that you're eating spoiled food or something, bad bacteria. It is very smart. It knows food based bacteria that it's supposed to let in versus toxic bacteria. And so the biggest problem that probiotic companies have is how do we pass through without getting destroyed?
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A
Our body's natural processes?
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B
Yeah, Right now the strategy is like just hit it harder, more and more because some of it will like eventually reach the colon. But that's why, that's the argument for having more probiotic foods, fermented foods. Somehow the net of the food seems to carry them through without them getting destroyed. And probiotic foods have been shown in studies over and over and over again to reduce inflammation to improve overall health. And I think it's one of the biggest ways to improve inflammation, like 18% from eating those foods. So those foods, body smart doesn't kill the bacteria in those foods, but if you try to just eat a bunch of bacteria and like, oh, hey, my estrobolome needs help, let me just take a bunch of bacteria. The body's like, no, these are foreign. I don't want this. This is something that's trying to attack my body and it'll destroy it.
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A
Ah, okay. So. And that was the purpose of my question. It's like, is there a probiotic someone can take to get them a better estrobolone? But it sounds like, sounds like everyone's trying.
- [29:09]
B
That's darshan. That's your job. It's a million dollar or someone out there, it's the billion dollar question is, how can we get our body to accept probiotics or fermented, you know, a probiotic pill without it getting destroyed? So that's why I'm such a big believer. I like probiotics because again, you can throw a ton of probiotics, you'll get a little bit left. But I really love fermented foods because I think it's a much easier strategy for most people to consistently get probiotics into their life.
- [29:41]
A
So what you're saying too, then, is very important not just to avoid the things that are destroying your gut, but also, especially if you're hitting perimenopause, add in these probiotic foods and fibers that will promote a good estrobolome. Right.
- [29:57]
B
And just to clarify, probiotic foods is not just kimchi and sauerkraut. It's also yogurt. It's also probiotic cottage cheese. It's also raw apple cider vinegar. It's also kombucha or kefir. So there's a lot of options now that once you know, okay, that's what a probiotic food is, okay, I can start incorporating it. Same thing with fiber. Think people, when I say fiber, they're like, what the hell is fiber? You know, like, it's like, is that metamucil or how do I get fiber? People don't know that. Avocados are a great source of fiber. Berries are a great source of fiber. There's sweet potato, pears, chia seeds, flax seeds, things that you would probably eat anyway, but you just didn't know how good they were for you. And so you can prioritize that now because you know that that's going to help your estrobolone. That's going to help your overall microbiome's ability to contact your hormones and your immune system and your brain. And so you want to eat that. And let's be honest, this message is not out there because 95% of people don't eat enough fiber and probably 100% don't eat enough fermented foods.
- [30:59]
A
I'll be honest. Like, I didn't even know what fermented foods were until like 10 years ago. And I'm like, oh, that's a fermented food. Okay. You know, my mom used to always give us, what's it called, the milk that's fermented, like the yogurt Chaos. Yeah. Right. That's right. Yeah. So my mom gave it to us every single day, and that's part of, like, Ayurvedic and Indian tradition. But I had no idea what it was. When I went off to college, I stopped drinking it, and I think that was a big reason my gut got destroyed.
- [31:25]
B
You know, you were eating ultra processed foods, probably drinking, and then, you know, all this stuff.
- [31:29]
A
No fermented foods at all.
- [31:31]
B
Exactly. And so for people who are, like, still unfamiliar with fermented foods, one of the entry points, I think is like, a sourdough bread. Because even though you cook it and the probiotics are dead, mostly they have an effect, a positive effect on our microbiome. It's called postbiotics. And so Indian food, it's like the idli and the dosa batter, and with, you know, American foods, it's like the sourdough bread. These are things that are cooked foods, but they have bacteria that acts as postbiotics, which can be very helpful to our gut as well.
- [32:05]
A
Yes.
- [32:05]
B
And so that's a great entryway to kind of getting more fiber, getting more probiotic foods. You can start with postbiotics.
- [32:11]
A
Yeah.
- [32:11]
B
And postbiotics like sourdough.
- [32:14]
A
Yeah, I love sourdough. Yeah. And whenever I have to eat a bread, I'll always choose sourdough and the postbiotic. What you're saying is these are dead bacteria, but they still induce for whatever reason. And this is why there's the science. We just need so much more science. We don't know why these postbiotic dead bacteria actually create a positive reaction in the gut to make our live bacteria there healthier.
- [32:35]
B
Well, and the postbiotic science is so exciting because if we don't need to worry about the bacteria dying and if you can just, you know, heat them, then we have no problems creating supplements and, you know, create products. Postbiotics are easy because they're not sensitive to heat and stress. And, you know, they don't. Who cares if they pass through our system? They're dead.
- [33:02]
A
Right.
- [33:02]
B
So that area of gut health and medicine, microbiome health, is really, really thriving. People are very excited because never did you think that you could put dead bacteria in something and then it would still help stimulate the gut in a positive way. So we have prebiotics, we have probiotics, and we have postbiotics. Prebiotics are kind of the fibers.
- [33:24]
A
Yes.
- [33:24]
B
That are feeding the gut. Probiotics are the actual bacteria. And then postbiotics are kind of the. The dead bacteria.
- [33:31]
A
Got it. So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances, I travel across many time zones to support my work, and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. It's about supporting my mitochondria, the powerhouses of my cells with the energy that they need to recharge my muscles and recharge my brain. Mitopure is a supplement that I take. It's backed by solid research showing that it can boost cellular energy, increase muscle strength, and support overall healthy aging. Personally, I take Mitopure every single day. It's helped me continue my active lifestyle, whether it's a high intensity workout or keeping up with my kids. So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com Dr. Shah to get started. That's timeline.com Dr. Your future self will. Thank you. Can we go to prebiotics a little bit more? The fibers. I know there's different kinds of fibers. There's insoluble, soluble. Can you talk to people? Can you give them advice on how to think about fiber and how much they should be taking?
- [34:51]
B
Yeah. So I love soluble fiber, for example, because what it does is if you put soluble fiber in a glass of water, eventually it'll become like gel, a gel. And that gel is awesome because it slows down the food that's going through your system so that your body has more time to extract nutrients and also to extract the glucose into the cells. Like, what we don't want is your food travels super fast. We don't have enough time to take out the nutrients, and your blood sugar rises super fast because it's traveling so fast. So this is a way. Soluble fiber is an amazing way to kind of, you know, slow things down and things like I always think of like blueberries traveling down your, you know, GI tract. That's like slowing everything down. You're getting a lot of time to absorb things. So it's a really, really great way to improve your diet and improve all of your insulin sensitivity, all of that stuff. Yeah, insoluble fiber is something that you cannot absorb or digest and it just kind of comes out, you know, from your stool. So insoluble fiber is also really important. It's great for if you're constipated and. But it has different effects on the body and we need all Kinds of fiber. In fact, there was a study that showed that the more diversity of food and fiber that you can get, the better your gut health. So those, it's bad news for those of us who kind of like the same breakfast, lunch and dinner every day. But the studies basically say you want to get as many different plant fibers as possible in a day. Because our body loves all the diversity. They like pre, they like, they like soluble, they like insoluble. It's, it's gotta be a mix. And the goal would be, when they looked at the study, the goals, 30 different plant foods every week should be your goal.
- [36:38]
A
I saw that. Right.
- [36:39]
B
But it's, but different plant foods could be even spices. So it doesn't have to be in herbs. So you know, you get the, get a mix of herbs or you get a mix of spices and you're like 15 in, you know, so it's not, it's just encouraging people to kind of eat more real foods. The food that doesn't have fiber is basically all the ultra processed foods. The shakes, the drive through meals, the desserts, all of the ultra processed things. They take the fiber out. So you can get a big dopamine hit as soon as you have it.
- [37:11]
A
Yes.
- [37:11]
B
So we are eating a very fiberless diet when we're eating ultra processed.
- [37:15]
A
That's so true. And I think another reason to take fiber out of ultra processed foods, it causes the food to spoil and it loses its shelf life a little bit as well. So I think, you know, the, the problem is if you have a mostly ultra processed food diet, then you need to supplement with fiber no matter what. Right?
- [37:32]
B
That's right.
- [37:32]
A
Are there fiber supplements that you like that are out there?
- [37:35]
B
You know, I like to stay with food because it's so easy. One tablespoon of chia seeds is five grams.
- [37:42]
A
Okay.
- [37:42]
B
So you can get just like a supplement would be 5 grams for a spoon. You can get that from chia seeds.
- [37:48]
A
Oh, that's great. And you should get about 30 grams a day.
- [37:52]
B
30 grams a day is the goal. For example, a cheat code is like pears. Okay. They have six grams of fiber. Again, just like taking a supplement. I'm not against supplements. Obviously we love supplements, certain supplements. But when you can get it from food, it's so easy that it feels like, well, try to get it from food as much as possible. Maybe you add a half avocado to your salad and you got a whole bunch of fiber there. So it's not that complicated if you actually know what has fiber.
- [38:21]
A
Yeah. So 30 grams of fiber a day is what you recommend for most women.
- [38:25]
B
Yes.
- [38:26]
A
And then you also recommend 30 grams of protein first thing in the morning, right?
- [38:29]
B
Yes.
- [38:29]
A
And so talk to us a little bit about protein and why you recommend that. And you know, a lot of women I know are like intermittent fasting, so they don't need protein in the morning. How should we think through that?
- [38:37]
B
Okay, so first meal of your day, early in the day. The data shows over and over again people that keep skipping meals all day long and having a meal late in the day as their only meal omad, you know, one meal a day, over and over we're seeing that that's not the. It's not good for our insulin sensitivity, it's not good for our inflammation levels. Our body is designed to eat during daylight hours. And even if we have jobs that are nocturnal jobs for our whole lives, our body still works on a day and night cycle. And so I always encourage people. Intermittent fasting is great, but do it the other way around. Eat an early dinner and then fast the three hours before bed. If you wanna fast, do that way the other way is not necessarily beneficial. You wanna start to have. It doesn't have to be. I never even like, you know, when we're traveling, I'm not eating, rolling out of bed, it's whenever you would have your first meal is when you actually add the protein in. And bonus points, when it's early in the day, like it needs to be, this whole thing of eating late dinner, 8 o' clock is your only meal is just not good for you.
- [39:48]
A
Yeah, I agree.
- [39:49]
B
So eating protein the beginning of the day, the things that it does is that it lowers your cravings, it stabilizes your mood, your focus, and it also sets you up for getting more protein throughout the day. Because when you start off with protein in the beginning of the day, you're much more likely to get more total protein at the end of the day. And the reason I chose 30 grams of protein in the morning is not only because of all the studies that show the benefit is because I think the total protein goals for people is very variable. Your gender, your age, your activity level, you know, how much you can't really tell every single woman that she needs to get a hundred grams of protein. That doesn't make sense. Especially we know over and over again that people have different needs at different points in their life if they're active versus sedentary. A sedentary individual needs much less protein than someone who's bodybuilding. So that's why I chose to speak about the first meal of the day because I can definitely know for sure that no matter what your total protein goals are, that getting that 30 grams in the beginning of the day is going to set you up for success.
- [40:54]
A
I love that. It just simplifies it because I think to your point, we've been told for like the last five years or so by many people in the health and wellness circles that it's 1 gram per pound of body weight a day. And I think when women and men do the math, they're just like, well, that there's no way I'm going to get that. I'm just, I'm just going to give up, you know. And so I think, right, that's too much for most.
- [41:15]
B
For many people, it's too much.
- [41:17]
A
Right.
- [41:17]
B
And it's too overwhelming and they're not that active. You know, you're, you have to weight train along with your protein. So, yes, it's amazing to get protein, but if you're not constantly weight training, consistently three times a week weight training, then at least two times a week, two to three times a week, you're not going to get the benefits of that.
- [41:37]
A
Exactly. And so, yeah, and then I think when you put it that way, that you just do it first thing in the morning, you got it done, number one. Number two, it sets you up for better blood glucose regulation and better mood. Right. And glucose regulation, also satiety for the rest of the day as well.
- [41:52]
B
That's all.
- [41:53]
A
And so there's so many benefits if you just simplify. You just get 30 grams first thing in the day.
- [41:57]
B
It's. It's the easiest way to improve your health in a short period of time.
- [42:02]
A
Yeah, yeah. I remember like, you know, about 12 years ago I went through my health journey. That was one of the first things I did, was add a lot of protein to my first. I was skipping my first meal and instead I went to a high protein meal with some vegetables and it made a lot of difference. Also help my gut health too.
- [42:18]
B
Yeah, it does help gut. It is a very big part of gut health, which is why I kind of put it in that same category, gut hormone brain health. 30, 33. And the reason I said 30, 33 is like, we can't tell as doctors, we can't tell patients, like, what diet to eat. I know there are doctors who do that, but in general there's so many different ways to eat that can be very healthy. A Mediterranean. You can be Mediterranean with red meat. You can be Mediterranean vegetarian. You could Be Mediterranean with fish. And so giving them a framework rather than, hey, this is the diet that you have to follow makes much more sense to me. And also diets to me because I've grown up as a woman in America. All it means is getting smaller and shrinking away because that's what diets have always been. And so really concentrating on how to build the microbiome, build, get stronger is something I think is a. Is a mindset shift.
- [43:13]
A
Yes, exactly. And I always try to make people have the realization that when you're losing weight, it could be a net negative if you're losing muscle too. Like you have to build muscle while you're losing weight.
- [43:24]
B
Yeah, like with GLP1s, you know, we talk about that all the time. One of the biggest issues is the loss of muscle when people are taking them and losing weight, but not weight training and not eating adequate protein. So it's more important than ever to really prioritize that.
- [43:38]
A
Right. You know, you like mentioned a few times that you spent a lot of time in the treadmill and running and so did I, because we were talking
- [43:45]
B
about, that's what we knew.
- [43:46]
A
Calories in, calories out. You eat a Snickers bar, then you burn it off. An hour in the treadmill kind of a thing.
- [43:51]
B
Yes, I literally, that's how I would think.
- [43:53]
A
Yeah, I would think the same exact way. And now what is your advice to women as far as how should they construct their exercise routine?
- [44:01]
B
So I was the patient and I'm the doctor because I was that person in my mid-30s. And I thought, okay, I've had kids, I'm trying to, like, get back into shape. Of course it was like, you know, everybody's pressuring you. Like, you feel all the pressure of like, you know, getting back to, you know, fit fitness right after having a baby. And so what I would do is I wouldn't sleep because you had young kids. And then I would like rush to a class, a high intensity workout, one of those, like a gym, like chain gyms. And then I would get coffee, a big, huge thing of coffee. And then I would go to work, go to clinic without any food with me, and I would just go there and start seeing patients. And then around 10 o' clock, I would start to crash and I would be super hungry. So I would go in the back room where all, all the snacks were and take a few snacks and it would hold me over till like 3 o', clock where I would like just go crazy, find some unhealthy food, and then I would Go home again. And I would be like, I can't go to bed. Because this was like, you know, I gotta, I gotta work. I gotta be productive. And so I would like skimp on sleep, stay up really late, eat snacks. And I would be like, that's okay. Cause I worked out so hard and I was really putting myself in this like, cycle. And at the end of it I was like, I don't feel good, I look terrible. Because I was like gaining weight around the midsection. I was fatigued all the time and I didn't love the work that I was doing. I like hated the person in the mirror. I literally was like, what am I doing? This is. I don't like the work I'm doing. I don't like how I feel, I don't like how I look. And it also affects your mood. Like, I was very irritable. My stress levels were out of control. So then I thought to myself, I have to do something. But I didn't do anything. And then I got into this life threatening car accident because I was rushing out of clinic and I was running late to pick up the kids. And the. My partners were like, hey, we need a quick meeting. And I couldn't say no because I was feeling like, oh, I can't say no. And I ended up getting into a really bad car accident, going to get them. And that was my wake up call. So I basically said, you know, I need to do something different. I clearly have not done a great job not working for me. So that's a long way to answer your question. That I started first by really reevaluating that high intensity workout that was every single day of the week for me without having proper recovery or sleep. And I thought to myself, you know what, my cortisol is just out of control. One of the biggest reasons. So I started to go for outdoor hikes and walks. And I started to notice that that was a great recovery. Because recovery to me cannot be sitting on a couch. No, you know what I mean? I was like, okay, you know what? On my recovery days, I'm gonna go for a sunny walk or a hike. And I started to see my mood starting to get better. And I started to notice, wow, I'm like wanting more healthier things. I'm not craving as many snacks because, you know, you do that high intensity workout, you're like riled up, then you're like craving unhealthy things all day.
- [47:14]
A
Of course, yeah.
- [47:15]
B
So for women, especially in that age range between, you know, usually it's your mid-30s into your 40s and 50s. It's very tempting to go on that paradigm of more is better, more is more. Intense is always intense. And then shifting to a, hey, maybe I need recovery to, you know, maybe I need more sleep. Maybe I wanna not do high intensity every single day. And I realize now that the best kind of training for that time of life is to stay on the edges. So you want walking and kind of like something that you love, whatever it is that you can do till you're old. You know, the people do things for 25 years, like that kind of stuff. And then the edge, other edge is sprints, like you know, high intensity. And in between you can have your strength training or whatever. But you really want like the edges more than you want that middle zone.
- [48:10]
A
Yeah, yeah.
- [48:11]
B
For, for a daily basis.
- [48:12]
A
It makes total sense. Yeah. So to just rethink your workout routine. Do work out smarter, not harder.
- [48:19]
B
That's right.
- [48:19]
A
And go with like you said, like the strength training when you're in the gym, but then have active recovery workouts as well. Right.
- [48:29]
B
The active recovery ended up being. What I realized is that you have to pick a workout that you actually look forward to and love. Otherwise if you're in a workout class or doing something where you're checking your like watch or phone every like couple minutes and you're like, oh, shoot, it's only been five minutes. I thought it was like 30. You know, that means you're probably in the wrong workout, at least for that longevity workout. You need to find something that feels so good that you actually look forward to it. And that's the right basis of your workout plan. And then you can add in sprints, you can add in weight training. But I always like, and for some people it is weight training, but I always like to emphasize that I change my whole view. Exercise is not a calorie burn. It's literally we are meant to move. And there are some movements that feel really refreshing and cortisol reducing. And those are the movements that you want to have at least four, four times a week.
- [49:28]
A
Yeah. I saw a study that was just published in this, in the media now that short, intense bursts of either cardiovascular exercise or even strength exercises done for like a minimum amount of time is just as effective as long drawn out workups.
- [49:47]
B
So it's like one, in that study, it's like one minute of high intensity is equal to almost eight minutes of kind of medium intensity or low intensity. There's a lot of flaws with that study, but. And, and we don't want to tell people, I don't want to tell people that, especially in midlife, that they should do the high intensity every day, because again, that's what happened to me. But really having at least one day a week where you put yourself on a treadmill or bike or run up a hill, where you're getting to 85% of your heart rate, that is something I think everybody in midlife, not just women, but all people in midlife should be doing. Because it's a muscle. Our heart's a muscle. You need that muscle to actually, like lift weights to be able to get stronger. So if you're never ever going to 85% of your max heart rate, you're never really pushing your heart to do anything more than, you know, just pump. So you want to make it so strong that as you get older it's stays that strong and, you know, the baseline is really, really strong. So getting one sprint workout a week is really important for that. And so that data is really great to know because in midlife, I think especially men and women, when you can do the longevity kind of training that you love and then mix it up with bursts of intense workout, I think that's a really, really great way to mix it up. And then the recovery, like the yoga, the like all of the things that you need to kind of break up those intense workouts you should do.
- [51:25]
A
Right, right. Okay, so we got exercise. We have your gut health with the pre post and fibers and biotics. And then we talked a lot about diet and nutrition just in general and say we're doing all of those things, yet hormones are still going to decline.
- [51:44]
B
Yes.
- [51:45]
A
Right. And when do you start talking about hormone replacement therapy if you do?
- [51:50]
B
Yeah.
- [51:50]
A
And how should women think about that?
- [51:52]
B
Yeah, that's a great question. Because I think all of us, most of us women, we're kind of in that gray zone. A lot of us are like, you know, you have some of the symptoms, but you don't know if it's. If it's perimenopause or am I just tired? Did I just not get a good night's sleep? Or is it. Maybe it's a vitamin D deficiency? So it's very gray whether you are in that state where you actually need hormones or whether you're in a state where you're just kind of tired or, you know. So the first step, I think, for all women is to change their nutrition and lifestyle to see what goes away with that. That's the foundation. And then get your lab checked because, you know, What? I know all the time you'll check someone's labs and you'll be like, well, you're vitamin D deficient. 80% of women in this age group are, oh, you know, your, your iron is low.
- [52:39]
A
Right.
- [52:39]
B
All kinds of things come up that people don't realize are happening that are contributing.
- [52:44]
A
I would say at least 50% of the women, I check their iron, which we measure ferritin levels. That's the important number for you to get measured as ferritin. In fact, it was so many women have a problem with this, and even men, that we added it to our normal baseline that we check on everybody now because it's that important. And people feel so much better just by taking a little bit of extra iron.
- [53:03]
B
Yeah, the iron thing is such a great point. I think the numbers are like, you know, 40%, 50%. So, yeah, this is very, very important to not only change your diet and lifestyle, but also check your labs. Not. I don't necessarily think that everybody needs hormone labs per se. It's more that you want to rule out all of the other causes because unfortunately, perimenopause doesn't have a lab test per se. It's like once you're either at the extremes, you have no hormones, or you have like complete excess, that's the only way you would know something was off. But usually perimenopause, they're just kind of within the range, but like fluctuating and roller coaster. So getting your diet and lifestyle in check, like most of us, when you look back at the foundation basics, you're like, okay, yeah, I probably need to go back to the foundation and like, for a month, you know, go. Go back to doing all the things 30, 33. Go do your workouts, go get your sunlight, get your sleep, hang out with some positive people and. And then you'll see some of this will go away. Then you get your lab work done, which can be at the same time, get your lab work done, fix your deficiencies, takes that vitamin D supplement, you know, whatever you need to get there, and then you're left with, especially in that perimenopausal range. Are you. Do you have osteopenia, osteoporosis? Do you have hot flashes and night sweats? Do you have vaginal dryness or discomfort? Those three things, clear cut, slam dunk, hormone therapy.
- [54:34]
A
Yeah.
- [54:35]
B
If you don't have a contraindication.
- [54:36]
A
Got it. Can you say those three again?
- [54:39]
B
So osteoporosis, hot flashes, or night sweats. And usually they're like, be the, like, moderate to severe hot flashes or night sweats.
- [54:48]
A
Okay.
- [54:49]
B
And vaginal dryness or discomfort.
- [54:51]
A
Got it. So those last two, I mean, you could feel those. But how does someone know if they have osteopenia or not?
- [54:56]
B
You can get a Dex scan.
- [54:58]
A
And so what age should every woman think about?
- [55:01]
B
Oh, my God, it's so pathetic. In the US People get it way too late. They get in their 60s and 70s. You need to get it at baseline. We should be getting one on all women at, you know, before they even enter perimenopause. So you're. You need to be getting it in your 30s, right, exactly. Know what your baseline is? Do you do that for patients?
- [55:21]
A
Yeah. And so the. The other thing that I always say is, you know, it's such a quick, easy test. It doesn't. You can get them now for, like, $30.
- [55:28]
B
Yeah.
- [55:28]
A
And it takes, like, you know, a few minutes to do is extremely low radiation. Why not get one every year?
- [55:34]
B
Yeah.
- [55:34]
A
From starting at the age of, like, 30.
- [55:36]
B
Yeah.
- [55:36]
A
And then just keep going. Because it gives you such incredible data, not just about your bones and. But also your visceral fat, which is a huge problem that sneaks up on people. Total fat mass and skeletal muscle mass, like, four incredibly important numbers. Everyone needs to know about themselves.
- [55:51]
B
And it's easy. It's easy. But it's never prescribed.
- [55:54]
A
Never. No.
- [55:55]
B
It's so good.
- [55:56]
A
Insurance doesn't cover it.
- [55:57]
B
I remember there was this, like, truck that was outside our gym one day, and it was like. I was like, oh, what's this? And they're like, oh, this is, like, a scan to see your body fat. And, you know, they didn't say for osteoporosis, obviously, but the report it gives is your lean muscle mass, your visceral fat, and your bone density. And I was like, this is the best thing ever.
- [56:18]
A
Yeah.
- [56:19]
B
Like, everybody should be doing this all the time.
- [56:21]
A
It's so funny because in medical school, I didn't even know this thing existed.
- [56:23]
B
I know.
- [56:24]
A
Even in residency and as a doctor in training, no one ever talked about this. And then, you know, you find out about it later, and you're like, this is the best test we have available medicine, and no one's using it.
- [56:34]
B
It's so true. I mean, who doesn't need to know their visceral fat, their lean muscle mass, their.
- [56:40]
A
Every human should know that.
- [56:42]
B
Exactly. And with bone density, it's really tough because it's exactly what you said. You can't feel that you're getting to osteopenia. Or osteoporosis, unless you break a bone and then you figure it out because it looks porous on, you know, you can tell from, by then it's too late.
- [56:57]
A
Right, exactly.
- [56:58]
B
So it's, you're trying to remineralize something that's already kind of brittle.
- [57:02]
A
Right, right. So those three conditions means hormone therapy.
- [57:06]
B
Yes, it means like a, kind of like a slam dunk.
- [57:08]
A
Right.
- [57:09]
B
So the other indications are still up for debate. So there is a group of people, you know, lots of experts that say, you know what, we don't have the definitive data but it's protective for the brain, it's protective for the heart, but we don't have the definitive data yet. So you can go by kind of, I wouldn't do it just for the soft symptoms. Meaning like it's not going to change your body fat levels right away, it's not going to help you lose weight, it's not going to be the panacea for your brain. You know, we don't have those long term studies yet. We do have inklings that this is going to help because we have estrogen receptors in our brain and our heart. But those are kind of the softer indications. And then it's just, I feel like then it's a decision between you and your doctor.
- [57:52]
A
Yes.
- [57:53]
B
Do you want to try it? Do you want to get to that, you know, give it a shot? No. What are the risks? What are the benefits? That kind of discussion. So I think the problem is you can start to have symptoms as early as 35 and you can go into your 40s on all the way into your late 40s and you might not really get these severe symptoms of hot flashes or night sweats, the severe type, until very late into that. And so that can be a point where you can transition to hormone therapy or even earlier. Some people say earlier the better. But I think it's a discussion with your doctor. I'm not convinced that it's the panacea. I mean it's not the panacea, but I'm not convinced that every single person should be on it and should be on it early. I think it's a discussion with your doctor. Like I've had that discussion with my doctor and basically what we said is, hey, I don't have the three indications like the top indications. I still have normal cycles. I feel like that lifestyle factors are helping so maybe I, you know, ride it out for a couple more days. I'm not opposed to it. I probably will do it but. And like you can Use progesterone here and there. If you're having sleep issues and anxiety issues, you don't have to do a full hormone panel, so. Or full hormone therapy in the beginning. You can start with just like a progesterone. I love progesterone. For everybody who has sleep issues and anxiety or especially around that perimenopausal age. So it's a very nuanced answer from me.
- [59:19]
A
Yeah, that's excellent. So just to summarize, for everyone listening, start with the lifestyle things that you talk about in your book. So if you're going through perimeter, well, start even before, get your scans done, get your blood work done, and really start building up a reserve, as we talked about earlier, of skeletal muscle mass, VO2, max bone density, gut health. All that should be built up prior.
- [59:40]
B
That's right.
- [59:41]
A
As you're approaching menopause, specifically at the age of 30, you start doing testing like blood tests and DEXA scan. Once you're getting to menopausal, really look into all the things that you talk about, optimizing your gut health, optimizing your workout routine, making changes to really start proactively addressing what's gonna be happening as hormones inevitably decline for every human on the planet. Right. And then once you get there, use these three big indications as the real indications that you should really start considering using hormones and have a risk versus benefit discussion with your doctor. Right. But also realize you don't have to go on all three hormones all at once.
- [60:21]
B
That's right.
- [60:21]
A
You can use progesterone for sleep issues. You can use, like, even vaginal estrogen
- [60:26]
B
for vaginal dryness or like testosterone. If your levels are very low. You don't have to do all of all or nothing.
- [60:32]
A
Right? It's not all or nothing. Right. Yeah, you just step into it.
- [60:35]
B
You summed it up so well. Yeah.
- [60:36]
A
I think it's really important for women to have, like, a pathway that they can follow through this entire journey. And, you know, you have this incredible guide that you put together in your book, and I think women can be extremely well educated on this whole journey and make have a completely different experience rather than just like stumbling through it.
- [60:56]
B
That's right.
- [60:57]
A
With bad advice.
- [60:58]
B
That's really why I'm doing it. We need to do everything we can to advance the care of women.
- [61:03]
A
Right.
- [61:04]
B
It's about time that we do that. And I think doing anything, all of our friends that are doing different things, different realms of trying to advance the care of women is so, so important.
- [61:15]
A
Exactly. I fully agreed. And it Needs to happen. Because at the end of the day, half the population.
- [61:22]
B
Right.
- [61:23]
A
We need to make sure that they're
- [61:24]
B
taking care of half the population that's not gotten care. It's not about like, oh, we want more like, it's not about giving them more care. It's about even like getting to even half the care that their male counterpart might get.
- [61:39]
A
Right, exactly. And to your point, most of the studies have been done on men and everything. And so, you know, we can go down rabbit holes of cardiovascular disease, go down the rabbit hole of even cancer. There's just not enough research on women. And I feel that the treatments that we're using right now, I'll use cardiovascular disease as an example. You know, right now, cardiovascular disease. Right. In the mainstream medical world is measure cholesterol levels. If they're too high, give statins. Right?
- [62:07]
B
Yes. And it's still like that. It hasn't changed in like 50 years.
- [62:11]
A
50 years, right. But thank goodness, like now people are getting more educated. They understand cardiovascular disease is multifactorial. But also like in men, it's large vessel diseases with large occlusions of their main arteries, whereas in women it's more small vessel disease. And that's treated completely differently.
- [62:29]
B
Completely differently. And they present differently. When women have a heart attack, they present very differently than men. And they get missed 50% of the time because people don't even know how to diagnose the small vessel kind of when they're having a heart attack. So these small vessels are either blocked or contracted. They feel different.
- [62:50]
A
Right.
- [62:50]
B
To the woman. So she might feel nausea, she might feel fatigue, and it might not be crushing chest pain to the left arm.
- [62:59]
A
Right.
- [63:00]
B
And so we need to recognize, I mean, people are dying because we can't recognize that they're having a heart attack.
- [63:06]
A
Yeah. The number of women that come in, you know, with some of the more traditional female symptoms of heart attacks like anxiety or nausea or faintness or, you know, brain fog or confusion, like these, these symptoms get ignored and they usually get sent home on like an anti anxiety medication.
- [63:22]
B
That's right.
- [63:22]
A
And they end up still having a heart attack at home because of the small vessel disease. And there needs to be a total rethinking about how we even train our medical students on like, these are the signs of a heart attack. Right.
- [63:33]
B
Yeah. And my, my other reason for even talking about this is I, as I started to move into my 40s, I started to see this societal messaging that was like, okay, women after, you know, when, when you're not, if Once you're out of your 20s, you're kind of done. You're, like, on your decline. But I kept seeing around me and you know this too, because we have lots of common friends. Women are thriving in their 40s, 50s, and 60s. And they're leaders and they're doing amazing things. They're writing books, they're on stages, they're discovering things, are leading companies. And I was like, I don't really think that that's like the decline maybe in, you know, for fashion, teen magazines. It's, it's. It's done. But like, there's whole other world out there and it. That plays out in. For thousands of years. Women for thousands of years have. Are the matriarchs of the family. They are taking care of their grandchildren. They're taking care of their communities. They are the beacons of, like, wisdom. Right. So we are supposed to be thriving in these years, and I think the narrative has to change a little bit.
- [64:39]
A
Absolutely. When does your book come out?
- [64:41]
B
February 24, 2020 of 2026.
- [64:44]
A
Since the name is Hormone Havoc. Hormone Havoc. What else will women learn besides the things that we talked about?
- [64:50]
B
So there's recipes in there, there's meal plans in there. Because whenever you talk about fiber and these, like, new concepts, really, for a lot of people, fermented foods and fiber, most people are like that. I've actually tested this on, have had amazing results. But their number one question is, can you just, like, show me an example of this? How does that work? Like, maybe show me breakfasts that have 30 grams of protein. Maybe give me some ideas, quick recipes. So we did that in the book. We really expanded on what it would look like if you actually did this. And so that's included as well as the science behind why we would want to do it. And so it's the exercise, the nutrition. We talk about hormones, we talk about mindset, community, you know, the power of friendships. All of that's in there. A handbook.
- [65:39]
A
It's gonna be an incredible, incredible book. So I really am excited for it to come out for you. I hope all of our listeners go online and buy it. Where can they buy it?
- [65:48]
B
Anywhere books are sold. So get it from your local bookshop if you can, because it's so sad. All these local bookstores that we used to see when we were kids are kind of not around, but place places like bookshop.org they actually give a portion of their proceeds to local bookstores. So these are all great places. And of course, the traditional places you buy books, Target, Barnes, and Nobles, Amazon, all of those places too.
- [66:11]
A
Oh, fantastic. And where else can people find you? You're. You have such a huge presence on the Internet. But just tell everybody.
- [66:16]
B
Yeah, so I'm on Social on Instagram @DoctorAmyShaw. That's Instagram and TikTok. And then I'm@AmyMDWellness.com website.
- [66:26]
A
Thank you for thank you so much for everything. And I can't wait to see your book. And I'm going to buy it for a lot of my friends. I'm going to read it myself because I find I learn a lot from my patients I can talk to as well.
- [66:36]
B
I'm so happy to hear that. Thanks for having me.
- [66:38]
A
Yep. So good to have you. Thank you. What a fantastic episode with Dr. Amy Shah. Here are my top five takeaways. Number one perimenopause symptoms are signals, not just something to endure Brain fog, weight gain and mood changes are signs that your body needs a nutritional and metabolic strategy, not just willpower. Number two the gut is a control center for hormones, mood and immunity. Gut bacteria directly influence estrogen metabolism, inflammation, brain chemistry and immune function. Number three protein timing matters more than most women think. 30 grams of protein at breakfast helps preserve muscle, stabilize insulin levels, and reduce your cravings all day. Number four fiber diversity is essential for hormone balance. 30 grams of fiber daily feeds gut microbiome that regulate inflammation, mood and hormone signaling. And finally, number five, probiotic foods work better than supplements. Fermented foods build gut diversity and reduce inflammation more effectively than probiotic pills. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance. Sa.