← The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show
Dr. Jen Ashton on Unimaginable Loss, Mental Health, and Post-Traumatic Growth
01:27:21
Loading summary
Transcript214 lines
- [00:00]
Gabrielle Reece
Your first husband committed suicide 18 days after your divorce was finalized. How did you manage that?
- [00:11]
Dr. Jen Ashton
On the day he died, when three police officers knocked on my door, my entire world shattered. My son said the most incredible thing to me not even two weeks after Rob's death, which was, you know, mom, dad had a disease like cancer and he said if he died of cancer, we wouldn't keep that a secret. This should be no different. Now I was dealing with this life altering, unimaginable tragedy. That was a headline. It was a national headline. My book, Life After Suicide, I did not want to write. I said no one cares about my story. 47,000 plus people in this country die by suicide every year. I'm one of those families. It taught me that you can be vulnerable and strong at the same time. You can be broken and still be a leader. We all have learned to prioritize our mental health and well being as much as our physical health and well being.
- [01:14]
Gabrielle Reece
Do you think that that's missing now?
- [01:16]
Dr. Jen Ashton
Oh, big time.
- [01:18]
Gabrielle Reece
What got you through?
- [01:19]
Dr. Jen Ashton
Now you're really gonna make me cry.
- [01:28]
Gabrielle Reece
Doctor Jen Ashton, welcome to the show.
- [01:31]
Dr. Jen Ashton
Thank you so much for having me. I'm so excited to be here.
- [01:34]
Gabrielle Reece
This is unbelievable. You so well respected and you've done so much. You're Ivy League educated, you are one of the OG medical correspondents and obgyn and just truly inspiring woman. So I'm, I'm really glad to hear that.
- [01:49]
Dr. Jen Ashton
Thank you. Ditto to you.
- [01:50]
Gabrielle Reece
There are many things that we're going to talk about and the first thing that I think is really important is happiness.
- [02:00]
Dr. Jen Ashton
Very important.
- [02:01]
Gabrielle Reece
And unhappiness. Your first husband committed suicide 18 days after your divorce was finalized. He was a world class thoracic surgeon. So I want to open with that because suicide, unhappiness, depression, all.
- [02:24]
Dr. Jen Ashton
Yeah, you first of all, thank you for being, having the courage and the bravery to talk about something that most people don't want to talk about. You know, I, I'm always, I wouldn't obviously say happy to talk about it, but very willing to talk about it because every time I do it is a guarantee that it will help other people. But it also helps me and it helps me heal every time I talk about it. Where do you want to start?
- [02:59]
Gabrielle Reece
Well, number one, I guess, personally, how did you manage that?
- [03:06]
Dr. Jen Ashton
Well, I think first of all, I still feel like I'm managing it. I feel like I will continue to manage it for the rest of my life. Rob did not have any of the typical in air quotes, signs of mental illness or depression. That we learn about in medical school. We had been married for 222 years. In retrospect, now, there were some red flags, like there always are in hindsight, but if you had known him, he did not have any of the glaring DSM criteria of depression or mental illness. And we had gone through a very amicable divorce. We had texted each other the day before he died. We had seen each other at our daughter's ice hockey game three days before he died. We lived across the street from each other. I mean, to say it was amicable is really an understatement. We did not have the type of marriage or divorce that was War of the Roses. In fact, it was the opposite. We were like best friends or great co parents or roommates. There was no fighting. We had just grown apart. And on the day he died, when three police officers knocked on my door, my entire world shattered into thousands or millions of pieces. And I was absolutely in the clinical definition of shock. I mean, I was unable to dial my phone to call someone to come and help me. I was incapable of driving an hour to get my daughter at boarding school to bring her home, which is something I will never forgive myself for. I had to send my brother to go and pick her up. I mean, I was literally in shock.
- [05:11]
Gabrielle Reece
Yeah.
- [05:12]
Dr. Jen Ashton
And what got me through, and to some extent what continues to get me through, by the way, my children were 17 and 18 at the time was them. And you know this as a mother, any parent listening knows this, that something happens to us when we become parents. I don't want to speak for the dads, but I think I can speak for the moms that I think there's something about being a mother that literally makes you. If you're going to draw your last breath, it would be to save your child. And I just knew at that moment that I had to put every single molecule of energy I had into making sure that my children not only survived this, but could heal through this devastating tragedy. And that's what, you know, got me. Literally, step by step, day by day, you know, through that initial period and continues to.
- [06:24]
Gabrielle Reece
Is that one of the reasons why you started a podcast or you spoke out about it and you wrote about it? Is that was. Do you feel like it was out of obligation?
- [06:35]
Dr. Jen Ashton
My book, Life After Suicide, I did not want to write. And in fact, about six months after Rob died, my publisher called me into HarperCollins, and there were a lot of people in the room and they said, we'd really like you to write a book about your experience. And I said, no chance. I said, there's no way I'm going to do that. No one cares about my story. 47,000 plus people in this country die by suicide every year. I'm one of one of those families. No one cares. And I'm not ready to do it. Thanks, but no thanks. And I walked out. It wasn't until I had to or was asked to cover Kate Spade's death by suicide for Good Morning America that my daughter Chloe called me and said, you have an obligation with the platform. You have to talk about something that no one wants to talk about. And in this day and age where optics are so deceiving because everyone has a great filter on their Instagram and everyone has a great story or post about how great their life is, you know, on the surface, my life looked that way also. But through all the great things that the public saw in my life, which was a great career, great children, great health, that I was all blessed to have all of those things, which, of course, as you know, came with a lot of hard work, but that was just what people saw as the product. What they didn't see is that for over 10 years, I didn't have a loving, fulfilling relationship or marriage. Now I was dealing with this life altering, unimaginable tragedy. That was a headline. It was a national headline that you did.
- [08:24]
Gabrielle Reece
And you do have a very public life. You know, when I was researching for this episode, initially when I met you, I was like, this woman's amazing. She's the OG medical correspondent, right? Studied nutrition, studied obgyn, menopause. But then when I started reading more, I realized that there was a whole underbelly of really an intense life, but that also that you really wanted to help and be of service.
- [08:54]
Dr. Jen Ashton
Well, I, I just, I felt like always. But my daughter and my son really helped coalesce this kind of mission for me, in my opinion, I don't think you can have all of the perks with things without, you know, some of the knocks. And I think that I've had a lot of amazing things in my life and do have a lot of amazing things. And I've kind of been at the highs as well as the lows literally that are imaginable for most people. And I just didn't feel like it was honest and authentic to only show people the good things and not discuss the hard things and the horrible things and the ugly things. The whole thing is real to me. So it was really my children who encouraged me to speak openly and publicly about it. And since Writing that book, which was, I think my fifth or sixth book, I can't remember, and doing a brief limited podcast about life after suicide. To this day. To this day we hear from people who say that they had lost a loved one from suicide and the podcast or the book helped them heal. And I think at a time where mental illness is not as sexy as longevity, we can't forget that you can't have a healthy body without a healthy mind. And not everyone who is a successful cardiothoracic surgeon is okay on the inside. And men, physicians, particularly surgeons, face a much higher suicide rate than the general population. And veterans, and veterans, unfortunately, like most people, had known friends and loved ones who had died by suicide, but we didn't never expected to be part of that statistic.
- [10:55]
Gabrielle Reece
You've heard me say it before, muscle is the organ of longevity. Now I'm putting the playbook in your hands. My new book, the Forever Strong Playbook, is your roadmap to building real strength, not just in your body, but in your health, your energy, your life. This is isn't theory. Inside you'll find the exact workouts, protein forward recipes, recovery strategies and mindset tools I use with my patients and live by myself. This book is for anyone and everybody who wants to age powerfully, stay vibrant for their family and show up strong every single day. When you pre order, you're not just getting a book, you're joining a movement. The link's in the show notes and I cannot wait for you to dive in. When you look out now, there is a lot more exposure. And when I say exposure, you know, there's social media, there's just a lot more information and I think a lot more comparing. For example, you said the things on the outside, the shiny objects. Do you think that now there is a lot more emotional volatility and mental health challenges? And maybe it's not the spectrum of full blown depression, but maybe it's the anxiety dysthymia kind of arena.
- [12:14]
Dr. Jen Ashton
Absolutely. And statistics bear that out, and data bears that out. I think that in the world of psychiatry and psychology, we are literally in the process of the largest human real time experiment ever with how media and social media are changing our neurochemistry, our mental health, our children's brains, adult brains. I'm sure you've read the Anxious Generation by Jonathan Haidt. I mean, if I had children your children's age today, there's zero chance I would put a phone in their hands till they went to college, not just wait until 8.
- [12:53]
Gabrielle Reece
No, no, we're with you.
- [12:54]
Dr. Jen Ashton
College. Yeah, we're with you. And I think that while that book and a lot of that data obviously focuses on children and adolescents, you can't be a human in this world without being subjected to unusual and really heretofore unknown stressors. And so how that manifests, I think, is going, is not really known. Well, now I know that, you know, from what I learned and my children continue to learn, we were so fortunate because we were in our therapist's office on a Sunday, 24 hours after Rob died, and we learned so much about healing and mental illness and suicide from that experience. But we are very fortunate that we were already plugged in with a mental health professional, and we don't have enough mental health professionals in this country, not even close. So people dealing with these kind of issues, dysthymia, depression, stress, anxiety, whatever you want to call it, on a whole spectrum, they don't really even have the resources that. To know who they should turn to for help. But we learned a lot. We learned so much through this.
- [14:10]
Gabrielle Reece
What got you through?
- [14:11]
Dr. Jen Ashton
Oh, God, so many things. I mean, for me personally, it was the role that fitness and exercise played and has always played in my life.
- [14:20]
Gabrielle Reece
I was actually hoping that you were going to say that, because looking back at all these pictures, you know, you're in people, and again, all these very public places throughout the immense tragedy, and then on the other end, this happy story of your marriage to this extraordinary man, you were extremely fit throughout.
- [14:39]
Dr. Jen Ashton
It's been probably a foundational principle and practice of my entire life. You know, when I was recovering from the immediate shock and trauma of Rob's suicide. When I say I was clinically in shock, I mean, I lost £9 in just over a week. I was at a dangerously low weight because I was so in shock. The only thing that made me feel not numb in those initial days and weeks was lifting weights, because it actually, I felt it in my body. It was the only thing that snapped me out of that numb, shock, feeling it also throughout my entire life, residency, medical school, where I had both my babies in medical school as president of my class. I don't know how that happened. I mean, it was the thing that was a through line that gave me the message subconsciously and consciously, that as erratic and crazy as life can get, I can always go back to the faith and confidence that I have in my body and my fitness. And if I can't give myself an hour a day, which of course, sometimes happens, but it's rare, something is seriously wrong, and it sounds contrived. Because it's been so overstated. But that line, like on the airplane, put your oxygen mask on first before you help others. I could not do my job as mother, chief medical correspondent, private practice, physician, sister, daughter, wife, friend, if I did not put my fitness first. And it's as simple as that. So, I mean, that was a major way that I got through. And your kids, now you're really going to make me cry. My children were and are the most emotionally mature and their emotional intelligence was high before their father died. They instinctively and instantaneously made a conscious decision to do several things. One, live their life in a way that honors their father's spirit, which they do every single day. Two, to not hide the fact that he died of suicide. And my son said the most incredible thing to me not even two weeks after Rob's death, which was, you know, mom, dad had a disease like cancer.
- [17:18]
Gabrielle Reece
It's so wise. That is so wise.
- [17:21]
Dr. Jen Ashton
And he said, if he died of cancer, we wouldn't keep that a secret. This should be no different. They have, you know, just taken that on full force. And the last thing is, is that they have this experience has made them through and me through the process of post traumatic growth, which most people don't know about, they only think of the negative. It's kind of the opposite of a trauma. You know, you can think of it as two forks. You can post traumatic distress or post traumatic growth. They have, through the process of post traumatic growth, we have achieved greater balance, greater sensitivity, greater perspective. It's hard for them or me to say, oh my God, this is the worst day ever. Because we've lived the worst day ever. That has given them such an incredible sensitivity. You know when they have a friend or a significant other or a relative who's going through a hard time and they ask, how are you? They really wait to hear the answer. It's not a flyby. And we all have learned to prioritize our mental health and well being as much as our physical health and well being.
- [18:38]
Gabrielle Reece
Do you think that that's missing now?
- [18:40]
Dr. Jen Ashton
Oh, big time, big time.
- [18:43]
Gabrielle Reece
And does that start with home conversations with family?
- [18:47]
Dr. Jen Ashton
Yes, a hundred percent. It starts with, I say we need a checkup from the neck up or the other line. It's true. The other line is it's okay not to be okay. You know, your body doesn't feel good every day. Why should your mood, your spirit or your mind feel good every day? And we just are so conditioned to not thinking or to thinking that if you can't See something, it must not be as serious or it must not be as important. And that's just not true.
- [19:20]
Gabrielle Reece
Yeah. You know, I really love what you said, that if someone dies of cancer, you talk about it and mental health is, and especially as significant as depression, it is, it's, it's a disease. It's not something that someone can think their way out of. And you know, finally, I love that you used your body, your musculature to be able to cope with such immense, you know, just trauma.
- [19:44]
Dr. Jen Ashton
I didn't know any other way, any other thing to do. I just, to me being physically strong, it's not just everything. It's the really the only thing if you can't do anything else unless you're physically strong. And I knew I was going through a mental crisis so I didn't want to compound that by also adding a physical crisis to it. And again, as doctors we know like the human body is an incredible miraculous machine. And whether it was having my babies in medical school or doing triathlons when I was 42 or, you know, I've always been athletic and it's always been important to me. I would have never imagined that it would be kind of my, my lifeline in a, in a setting of crisis. And whether that's, that crisis is something like what happened to us or it's losing a job or getting a divorce or whatever, a natural disaster, it's something that I really think everyone could tap into.
- [20:50]
Gabrielle Reece
I fully agree with you and I'm, I know you, I'm on board with that. In fact, we're probably going to be doing some sit ups after this.
- [20:56]
Dr. Jen Ashton
Yep.
- [20:57]
Gabrielle Reece
Oh, oh, sorry. It's time to record an ad for the show. Thank you to one of the sponsors of the show, Timeline and my kids still sleep with me. And after 470 nighttime snack requests, bathroom breaks, my husband snoring, my cells, they're like, yo G, we're tapped out. Enter Mitopure. Timeline Nutrition is one of the most thoroughly researched products I have come across in over a decade. Look carried in my purse. They have peer reviewed published science and this is where it gets really interesting. So for those of you who are following the the muscle centric lifestyle, when you increase bioenergetics, you improve muscle function and health in adults. 40 + timeline has been shown to increase muscle strength and endurance and no change in activity. So whether you've been active resistance training your whole life or you're just getting started or you're not getting a lot of sleep and you've Got a million requests. Your muscles and your mitochondria need help and they have just launched. They're low sugar, vegan, non GMO gluten free gummies, which by the way, I am eating by the handfuls, which I shouldn't, but they taste delicious. Timeline is offering our community 20 off your first order. Go to timelinenutrition.com DrLion and use the code DoctorLion to get 20% off. I recommend trying their starter pack with all three different formats and of course, their gummies, which are incredible. You found love again.
- [22:27]
Dr. Jen Ashton
Yeah, I mean, just file that one under, you know, miracles do happen. I used to walk around all the time. All the time, even before my divorce. And I used to say to myself, you know what? I'm really lucky. Even. Even when I had no good marriage relationship, I would say, I'm really lucky. I have two incredible children who are healthy. I have two incredible careers, full time careers as practicing physician and on national television speaking to millions of people, which.
- [23:04]
Gabrielle Reece
We'Re definitely going to talk about. Yeah.
- [23:07]
Dr. Jen Ashton
And I loved it. It was literally under the category of do something you love. It doesn't feel like work. And I have my health, so I don't have a relationship. I didn't draw that card like, okay, and I'm happy for my friends who did. I'm happy to see the people around me who do have that. That just wasn't in the cards for me. And I would say that to myself, Gabrielle, every day.
- [23:32]
Gabrielle Reece
Why?
- [23:33]
Dr. Jen Ashton
Because it was so important for me, even in that last 10 years, 13 years, you know, even after my divorce and Rob's death, to live with gratitude. So I did. And I never, you know, I had dated after my divorce and, you know, the last relationship before I met Tom, I think I was 50. I'm 56 now. And I mean, I know this is gonna sound melodramatic and crazy, but I literally thought I was gonna be single and alone for the rest of my life. And I was like, okay, you know what? Again, go back to those three things I was grateful for. I have great career, I have great kids. I have my health.
- [24:13]
Gabrielle Reece
Okay.
- [24:14]
Dr. Jen Ashton
And I have a dog. I have a great dog.
- [24:17]
Gabrielle Reece
Unfortunately, the dogs don't last the whole time. I had a dog for how did you meet your husband? And also I want to touch on, because he's extraordinary. I expected the person that you chose or that chose you to be amazing. However, I didn't expect him to be a Harvard grad who then went on to win. Was it like Emmys? Which by the Way you have four.
- [24:42]
Dr. Jen Ashton
We were set up by a friend. And my husband is even more high profile than I am. I did not know his name or who he was.
- [24:50]
Gabrielle Reece
You mean because people weren't Googling other people, right? Were they? I mean, I don't know.
- [24:54]
Dr. Jen Ashton
No, I mean, it's not even that. I just. My husband's in sports and television.
- [25:00]
Gabrielle Reece
Do you want to share a little bit about it?
- [25:01]
Dr. Jen Ashton
I mean, it's public. His name is Tom Werner and he's created some of the most successful American television of all time. He created the Cosby show and Roseanne and third rock from the sun and the Conners and that 70s show and that 90s show in a different world.
- [25:19]
Gabrielle Reece
He sounds like a real underachiever.
- [25:21]
Dr. Jen Ashton
No, he really is.
- [25:22]
Gabrielle Reece
And do something important.
- [25:25]
Dr. Jen Ashton
I mean. And he's legend and a titan in sports ownership. He's involved with Liverpool Football Club, which is the. Probably the largest football club in the world, and the Boston Red Sox and the pga and chairman of Fenway Sports Group. And I didn't follow those sports. I never watched those TV shows. So I didn't know who he was. And furthermore, I actually told my friend, I don't think I like businessmen. You know, I'm a doctor. Like, I like healers. And.
- [25:57]
Gabrielle Reece
And she was like, no, no, no, just go on a date with this guy.
- [25:59]
Dr. Jen Ashton
He said, look, he's an amazing person. He's fun and funny and who knows if you'll find love, but I think you guys would just enjoy each other. And Tom's 19 years older than I am. And when my friend, our friend described him to me, I said, he sounds too good to be true. How old is he? And he said, well, he's 70. And I said, well, I'm 51. And he said, I know you're 51. And I know he's 70. And I said you know what my greatest fear is? What if I fall in love with him and I have to live 20 years of my life without him? And he said, something could happen to you too. Maybe he'd have to live without you. And I said, you know what? You're frickin right. So. Okay. And we went on the date and we were engaged like 10 months later and married about a year and a half later or two, almost two years later. And he is the most incredible person I've ever met. And thank God he's 19 years older than I am because I can't keep up with him today. So if I can't even. He literally is out of bed before I am in the morning. He works out harder than I do. He does more in one day than I do in four days. But most importantly, he. This is, this is going to push me over the edge. With his huge and powerful heart that is so gentle, he really helped me heal by loving me. So it's been an incredible, incredible love story. I mean, just incredible. Now you've done it. Makeup?
- [27:44]
Gabrielle Reece
No, no, you're looking good. Very sharp. You know, I typically don't talk about personal stories, but I think there was just so much and is so much to learn from yours because as a physician, as a media person, as someone who is married to someone so public and you know, and also having been through some drama, it was. It's like it's a story that everybody can learn a piece from.
- [28:17]
Dr. Jen Ashton
I hope so. And you know, I think that we all have a lot that people can learn from. It's just that today it's so easy to be so self absorbed and so focused on appearances and, you know, things that I don't know in 5 years, 10 years, 20 years, or even tomorrow really are not that important. And when you deal with real lives like we've done and continue to do as doctors, and you've been through and seen horrible, horrible tragedies, if you're not living with a sense of responsibility to pass that information along to help other people, there really is a big problem. And it's why I went into medicine to help other people. And even though that may take different forms for us as kind of public figures, it's still at the core of everything I do and everything I want to do is, you know, whether it's to tell someone about, you know, a faux po hair ponytail that I'm wearing or the greatest tragedy of my life. It's all to help people. And I just don't know any other way than to be honest and transparent about it.
- [29:38]
Gabrielle Reece
And that is probably what drove you to become a correspondent. Yes.
- [29:43]
Dr. Jen Ashton
Yeah. I mean that and the fact that I could literally talk to this coffee mug about medicine and health and, you know, be interested in doing that. I always liked talking. I never wanted to have a television career.
- [29:57]
Gabrielle Reece
How did you get. Just take us through.
- [29:59]
Dr. Jen Ashton
It fell on me. You know, file this one under be open to new experiences.
- [30:03]
Gabrielle Reece
This is 2009. Ish.
- [30:05]
Dr. Jen Ashton
It was 2009 when I went to network television at CBS. 2006, when I started at Fox News Channel, I was two years out of residency. I had a six year old and a seven year old. I was, you know, two years into private practice. I was delivering 150 babies a year. I was doing close to 300 GYN major surgical cases a year. I just was so busy and never wanted to be on tv. It just was not on my to do list. Other things might have been. That was not one of them.
- [30:41]
Gabrielle Reece
And then what happened?
- [30:42]
Dr. Jen Ashton
And then I was asked by a friend who was into television. She actually said to me, you know, I think you'd be great on tv. And I said, you're so sweet. And she goes, yeah, I'm really not saying that to be sweet. I'm saying that because this is what I do, you know. One thing led to another. We I found out that Roger Ailes, who at that time was the president of Fox news channel, wanted to meet me. I went in and talked to him and he said, would you like to work with us? And I said, do you want me to like, take care of your female employees? What do you mean work with you? And he said, no, I think you'd be great on the air. And I was, you know, booked to be on for a segment. I'd never been on a live TV set before. I went in and did it. A week later I was offered a contract and I was at Fox for three years and then went to CBS for two years and then was at ABC for almost 13 years. And I just found that it's a real skill to be able to talk about medical and health and scientific information in general. As you know, doctors are pretty shitty communicators. To do it on live national television is kind of the iron man of medical communication. There are no do overs. And when 5 to 10 million people are listening to you, you better not like there's no oops, I forgot that wasn't the right word or stat or whatever. And I loved the kind of perspective task of it of saying like, well, okay, this is the headline, but what do I think are the three most important things that someone watching in Tennessee needs to know? And it definitely being current in what was coming out every single day made me a better practicing physician. And what I was doing in my office and my clinic absolutely made me better on the air.
- [32:43]
Gabrielle Reece
Wait, $3,000? Three. Wait, is that number right? I spent more money on skin care. My pores should be tax deductible. Maybe even have their own trust fund. And thank goodness that I found One Skin. Because one skin doesn't just make empty promises. It's research driven, minimalistic, and tested by for beauty, skin health and longevity. One skin is the first topical skin care Backed by peptide science that targets skin aging at the molecular level. I slather this on all day. They have a peptide that is designed to reduce the accumulation of dead cells or zombie cells that drive inflammation, tissue breakdown as we age. Now, this isn't about cosmetic quick fixes. It's about changing the biology of your skin. Strengthening the barrier, improving firmness, hydration, elasticity with clinically tested ingredients. So if you are focused on aging well from the inside out, it's time also to think about your skin. It should get the same level of care. Go to One Skin Co for 15% off. Use the code. Dr. Lion. It is amazing and it will not break the bank. And how about now? Because now. So as physicians and I think as medical educators, there was a lot. So 20 years ago, there was less information. We were not googling. We were waiting for these papers to come out and then we would go and we would get the medical journal and learn. And now we are almost at the opposite end of the spectrum.
- [34:21]
Dr. Jen Ashton
So true.
- [34:22]
Gabrielle Reece
And for someone who has been there from the very beginning to where we are now, if someone is listening to this and they're like, okay, well, I love nutrition and I love physical fitness, and I don't even know how to distill the information, what would you say if we start with nutrition?
- [34:37]
Dr. Jen Ashton
Oh, God. Well, first I would say credentials matter. Right. I'll tell you a funny story that I think illustrates this really well. And it, and it kind of brings together all of these issues that you're asking about which are so important. There was a book written by an economist professor from the University of Chicago. I'm sure you have it. It came out maybe 10 years ago when her book, it was about pregnancy and all of the myths, you know, exist in obstetrics and midwifery and that pregnant women have to kind of navigate. The author, as I said, was a full professor of economics from the University of Chicago, not an unintelligent or uneducated woman. I did a segment on Good Morning America about the book coming out of a tape piece. And I did the segment with George Stephanopoulos. And in this book, the author says, you know, I've evaluated the data. I can look at data. I'm an economist. I know how to look at numbers. And for example, there's no reason why pregnant women shouldn't be able to have safely three to five alcoholic beverages a week.
- [35:43]
Gabrielle Reece
Okay.
- [35:44]
Dr. Jen Ashton
As a board certified ob GYN and as a doctor who's board certified in obesity medicine and has a degree in nutrition, I really Believe in the motto, stay in your lane. So I did this segment with George about her book and I was just, you know, did it the same way I've done every single television segment in my life. Balanced. People will never know really how I feel about something unless the anchor or host asks me to share my opinion. So when we came out of the piece and we went into commercial, I said, you know, George, I can read English. I think I'm going to write a book about the Constitution. I know I'm not a constitutional attorney, but what the heck? Now, today, and that was 10 years ago, today you have people who, because they can read, think that they're in a position to make black or white edicts about all kinds of things. Nutrition being probably near top of the list because we all eat. And while I will say that having a master's in nutrition does not certainly mean I or anyone else knows it all about nutrition, because quite frankly, the level of sophistication of nutritional science is pretty poor compared to like medical science. It's better than nothing. And I think that, you know, that is a perfect analogy for where we are with all kinds of things in wellness and fitness and nutrition. People think because they can read or because they try something themselves, which in medicine and science we call an end of the one that that is written in stone. And I always say, whether it's nutrition, food science, women's health, obesity, medicine, weight management, menopause, you name it, I don't care. The same principle applies in my medical, professional, scientific opinion. It is not only wise but essential for us to have a humility as individuals and scientists and doctors and public figure, whatever you want to call us, to recognize that we do not know it all and things can be learned tomorrow that we swore today, where we know this hard and fast, we have a long historic precedent in medicine of being proven wrong.
- [38:05]
Gabrielle Reece
Like the Women's Health Initiative.
- [38:06]
Dr. Jen Ashton
Yes.
- [38:07]
Gabrielle Reece
Which, by the way, you were in residency when this came out. Can you touch on that? And have you, obviously, I'm sure that you've been staying up to date with the FDA touch on that as being someone who was there when it happened?
- [38:21]
Dr. Jen Ashton
Yeah. So, first of all, I'm the daughter of a registered nurse and the niece of an obgyn. My mother and my aunt, they both, when I was a resident and whi came out in 2002 with the so called shot heard round the world, both my mother and my aunt both were on hormone replacement therapy, big believers in it, feeling amazing, et cetera, et cetera, when that Headline came out. I was not taking care of my own patients in menopause because I was a junior resident. But it was a topic of grand rounds. Obviously, most people know that literally, like a light switch, the prescriptions to patients were discontinued. Women were taken off. They're like, immediate. Due to not only the media misinterpreting the data, but the study authors misrepresenting flawed data. So it was. You know, I have a saying in medicine that I think is so true, and I don't know if you've heard it. It's often not the first mistake that kills a patient. It's the second, third, fourth, and fifth. It's usually like a lot of things have to go wrong. Same thing with this. This was flawed methodology. This was a flawed press release that the authors didn't even approve. It was flawed media coverage and it was flawed interpretation by practicing physicians who did this.
- [39:41]
Gabrielle Reece
That's actually the surprising part.
- [39:43]
Dr. Jen Ashton
Yeah, I mean, it's. But again, it was a series of errors that led to 20 years of women largely not getting the management options and treatment options and counseling that they should have gotten. So, you know, fast forward now to the last couple of years, and I actually see a somewhat precarious situation that we're in right now because the pendulum. We have such a problem with moderation in life in this country, such a massive problem. And so we tend to do things at the extremes of a spectrum. And menopause care right now is no different. Just like obesity care is no different. It's at an extreme. And the reality is that the sweet spot exists in a much more nuanced, moderate position. And hormone replacement therapy is no different.
- [40:38]
Gabrielle Reece
You know, you said that we're in this kind of precarious situation. Where do you think we're going wrong right now with menopause therapy?
- [40:46]
Dr. Jen Ashton
Oh, I love that question.
- [40:48]
Gabrielle Reece
If you listen every week and feel like we are in this together, which I believe that we are learning, growing, and building strength, then I created a way for us to get connected even more closely. It's called First Forever Strong Insider, a premium community for listeners who want to go deeper. You'll get ad free episodes, which I know you'll love. Bonus Q and A's where your questions shape the conversation behind the scene moments, because, let's face it, I'm hilarious from my daily life and written takeaways to keep at your fingertips. But more than that, you'll be supporting the show so that we can keep creating content that matters. If you've ever wanted to feel part of the inner circle. This is your invitation. Join us at foreverstrong.super casp.com or through the link in the show notes.
- [41:33]
Dr. Jen Ashton
Let me take one word off your question, if I could. Where do I think we're going wrong with menopause before we get to menopause therapy? And where I think we're going wrong with menopause is. And this is not something that's discussed. So I'm so glad you're asking this question. It's a brilliant question. We have over swung our response to this stage in a woman's life to such an extreme hyperbolic degree that I think there's a real risk in putting out a message that women are passive victims. Once again that we have been pushed into a corner. We're adults, so if we're put into a corner, we have some responsibility in that you can choose not to go into the corner or you can be led like sheep. I don't believe that women are easily led like sheep to be put in a corner. Nor do I believe that women are so passive that we need to be presented with everything on a silver platter for it to be able to be utilized by us. And let me give you some pretty hard and fast examples of why I think that's not true. Puberty. What did we know about puberty? Did anyone. Did you ever take a class or read a book about how to insert a tampon?
- [43:04]
Gabrielle Reece
Actually, no.
- [43:05]
Dr. Jen Ashton
No one barely told us what a period was. Right. Because who, unfortunately. Don't even get me started on how we teach kids health and puberty. Right. But it's. For me, it was taught by a gym teacher who I'm quite sure did not want to be teaching that class to begin with. Right. So we didn't learn anything about puberty. Somehow I figured out how to insert a tampon and I learned about puberty just as my children did. Just as your children will. Hopefully better. It's just as millions and millions of women have done. Forever. Pregnancy. How much did you know about being pregnant before you were pregnant? I mean, a lot.
- [43:43]
Gabrielle Reece
And I still didn't even know what was happening while I was pregnant.
- [43:46]
Dr. Jen Ashton
Correct. Okay. I didn't know I was a medical student. Did I know? Was I an expert on pregnancy until I peed on a stick and saw two dots and was like, oh my God, I'm pregnant. Like, no.
- [43:57]
Gabrielle Reece
And then, oh my God, I'm pregnant again.
- [43:59]
Dr. Jen Ashton
Yeah. Okay. I learned about it when I went into menopause at 52. Gabrielle. As a board certified OB GYN, I didn't even recognize my plethora of menopausal symptoms until one of my best friends who's a cardiologist said, why don't you go on hormones? And I was like, oh, my God, you're right. Okay. So I bring up those three stages because I think they powerfully illustrate the fact that the narrative that we're hearing about menopause, like we haven't told you women have been kept in the dark, you know, is just. I think it's actually insulting to women. I think it's disrespectful, insulting and demeaning. And I don't think we're that meek and passive and timid. And I think ultimately it paints women as victims. I think it's well intentioned and poorly executed. And I think instead we need to say, yeah, look, has menopause not been taught well to doctors and in medical school and covered in the popular press? Of course that's true. Has it not been legislated? Well, of course. Has it not been researched? Of course. But that's very different than pointing this finger of blame. Because I will tell you one of my favorite sayings and feel free to use this with your children. It might come in handy.
- [45:30]
Gabrielle Reece
Is no.
- [45:31]
Dr. Jen Ashton
Oh, well, aside from that, that's a capital no. Is I think we should be careful when we point a finger of blame, of no one ever told us about menopause because as the saying goes, when you point a finger at someone else, there's three pointing right back at you. I don't believe in blaming anyone for what it is, what it is. It was what it was. Let's focus on today and what's ahead of us before we paint the, you know, menopause out to be a horrible thing that has victimized women. I just think that's so negative. And I am a glasses half full type of person.
- [46:08]
Gabrielle Reece
Clearly you are. How do you see a positive way of thinking about it? So let's say, because there's lots of information out there on hormones, hormone replacement, what we know, what we don't know, this resurgence, they just took the black box warning off, which is amazing. Which is amazing. How do you see it done? Well now from a practicing, from just.
- [46:35]
Dr. Jen Ashton
Like a practicing perspective, I think that the key and the way it's being done now. Well, is when it's holistic. And I don't mean holistic like I'm gonna swing a crystal over your head, please don't and chant.
- [46:48]
Gabrielle Reece
But I do have a lot non.
- [46:50]
Dr. Jen Ashton
Essential oil and I love a good Crystal. I mean, a holistic way that says what we're actually supposed to do as credible and credentialed physicians, which is talk about all options, including no treatment as an option. And those options, now, fortunately for women, are more numerous and more effective than ever. And it's not one size fits all. It's not robotic, it's not cookie cutter. Women should not feel, whether you're talking about menopause or obesity management, no one should feel that it's either a GLP1 or nothing. It's. That's one option for menopause. Hormone replacement therapy is one option. There are a zillion options that are FDA approved, off label, behavioral, you name it, for both of those conditions. But we have such a hard time in our world of being tempered and nuanced and we just want like an easy quick fix that conveniently fits in one box. And I just don't believe that, that the overall health of an individual, an organism as complicated and complex as human beings are, fits neatly into one box.
- [48:00]
Gabrielle Reece
Yes, because that would be really foolish. Yeah, it would be really foolish. And people are very multidimensional. In your professional opinion, do you feel that hormones are relatively safe? Yes, I'll just leave it there.
- [48:15]
Dr. Jen Ashton
I do. And I will say, you know, I can talk about treating, you know, again because I joined my aunt's practice, right. So my aunt was a real. She was one of the first women obgyns in her area, New Jersey. And she had a incredible reputation and a very busy practice. And I was the fourth doctor to join her practice. Right. When I finished residency, I really just wanted to take care of real people, real women. I had grown up the daughter of a cardiologist. So I saw my father have those special relationships with his patients and I really wanted that. And my aunt and her partner had always prescribed hormone replacement therapy to patients.
- [49:03]
Gabrielle Reece
And how was that done? Is it the same that what we're seeing now? Patch.
- [49:08]
Dr. Jen Ashton
There were patches. There were patches. The knowledge of having to balance estrogen with progesterone was obviously known then. Mostly it was in pill form. You know, pellets and creams were not really a thing in 2004 when I joined her practice. And bioidenticals, even though that's a marketing term, as you know, not a medical term, were a thing. But my aunt and her partner were very pro hormone replacement therapy. However, interestingly for me, I was really interested in adolescent gynecology. So while I did a lot of the obstetrics in our group, I was really interested in Taking care of teenage girls. So 50% half of my practice were girls and young college age women under the age of 21. So obviously I didn't have a strongly perimenopausal or menopausal practice until I had been in practice for 18 years. And those college age women who were, you know, coming to me as their first gynecologist then started to go into perimenopause. And as my patient population got older with me, I obviously started to see a lot more, you know, menopausal symptoms.
- [50:22]
Gabrielle Reece
How did you manage that at the time? Because prior to that it's difficult when you have a practicing physician, so your aunt and then the other partners who had already been prescribing hormones and then seeing the benefit having them pull off of that, and then your patients going through perimenopause.
- [50:42]
Dr. Jen Ashton
It actually was not a difficult thing for me because I put it into the category that I practice, used to practice and still do in terms of, you know, the medical information that I produce in a form of content for people and for Agenda, which is my women's health company, is what are the risks, what are the benefits, what are the options? And so when I would talk to a woman in perimenopause or menopause, I would say there's three tiers of options. There's hormone replacement therapy, there's non hormonal prescription medication because we've been using off label prescription medication to treat menopausal symptoms, for example.
- [51:24]
Gabrielle Reece
Which ones are you referring to?
- [51:25]
Dr. Jen Ashton
Effexor is the brand name of it drug that's an antidepressant in higher doses and in lower doses very effective for treating vasomotor symptoms. And we had been doing that for decades. It's not a new thing. And then I would say then there's some behavioral things. You know, you can do cognitive behavioral therapy, you can do acupuncture, you can try acupuncture. There's cytosolic bee pollen extract that's been used in Europe for again over 20 years. That can help with vasomotor symptoms. And I would give a menu of options. There's even more of a menu of options today. And again, whether it's menopause, weight management, if anyone is listening and you go to a doctor who doesn't, who only gives you one option, you should find another doctor. That's just not medicine, you know, and it's, I always would say it's my job to inform and educate. It's your job as the patient to make the decision.
- [52:16]
Gabrielle Reece
It is very empowering for patients when you provide options. And then I don't know how. So we. I still practice, and I'll usually lay out what I believe. You know, here are the options. And then, you know what? If this were me, this is how I would.
- [52:31]
Dr. Jen Ashton
It's perfect.
- [52:32]
Gabrielle Reece
We do prescribe hormones. We think that they're very valuable. And I remember, because I finished fellowship 2015, and obviously it was very difficult to get information on how best to prescribe estrogen, progesterone, and testosterone, especially for women.
- [52:51]
Dr. Jen Ashton
I mean, I will say, personally, when I started taking HRT, I felt like a new person in 48 hours.
- [53:00]
Gabrielle Reece
I mean, that's fast. It's pretty amazing.
- [53:02]
Dr. Jen Ashton
And my kids were like, mom, you need your abp. I go, what is that? And they go, your anti pill.
- [53:10]
Gabrielle Reece
And you're like, actually, it's a patch.
- [53:13]
Dr. Jen Ashton
No, I actually. I actually went for the pillow. But I was like, okay, fine. How bitchy was I? And they were like, pretty bitchy. I mean, it was really. For me, it was and is a great option.
- [53:29]
Gabrielle Reece
Is there a form that you like the best if, you know, we're talking about estrogen, progesterone, testosterone? Do you have a favorite delivery method?
- [53:36]
Dr. Jen Ashton
No, because I think it's, you know, it has to be right for the individual. You know, woman, I don't have a problem taking my pill every single night before I go to bed. I've coupled it with breast cancer, brushing my teeth, and the whole science experiment that I have to do now, like the lashes, the skin, the hair, the teeth, the. I mean, like, working my way head to toe. My hormones are part of that. For some women, they don't want to do that. And so a patch which also lowers the clotting risk is a better, you know, it's a better option for them, whatever. But I think it's. It's an exciting time, and at least there are these options.
- [54:12]
Gabrielle Reece
I couldn't agree with you more. You also have been doing obesity medicine and have a master's in nutritional sciences, which is, I would say, my first love. And you remember when GLP1s were not available, and then all of a sudden, GLP1s, which had been used for 20 years, for 20 years. These are not new medications, which I think that this is really important. If we were to say, what are the top three myths that you see with the use of GLP1s?
- [54:39]
Dr. Jen Ashton
Number one, risk, benefit. Because just as we always talk about with our highly polarized, hyperbolic kind of way of life, today you either see a headline that says this is the best thing on the planet or this is the worst thing on the planet and it will kill you. And the reality is it's neither, it's somewhere in between. So I think when people hear or talk about GLP1s, the first, second or third generation, whatever, you know, class you're talking about or generation you're talking about, it's really important to, to, as I like to say, think like a doctor. So what does that mean? That means how do we stratify risk versus benefit? And as you know, it's not just what are the risks? You actually have to ask four questions. What are the risks of the medication? What are the risks of not taking the medication? What are the benefits of the medication and what are the benefits of not taking the medication? And in some cases in medicine and life, you can actually put real numbers with that, which then makes it very easy, right? You can say if something's 1% risk versus 5% risk, you know, you're going to go with whichever is higher or lower, depending on the question. In some cases it's not going to be a number, but it'll be a statement. Right? So that's really important because it's not like should I take it or should I not take it? It's why are you taking it, what does the data show? And you know, I've heard you talk about it. I hope most people know this right now there are so many non weight related proven benefits to GLP1s that I don't think we've even seen the tip of the iceberg with their use, their indication and their benefits yet. But cognitive protection, cardiac protection, renal protection, body composition differences, cancer, immune system, I mean, the list keeps going on and on. I'm sure they're testing it for nail.
- [56:43]
Gabrielle Reece
Growth because sign me up.
- [56:45]
Dr. Jen Ashton
Yeah, right, me too. And so I think that's a big one. You know, risk, benefit. I think people need to understand some very simple math. And I am by no means a statistician, but you and I know because we read medical and scientific studies that it's all about how you get to that number. Right? And when you talk about something that let's say has a 1% risk of a bad side effect, which would be high by the way, in the world of medication and medicine, if 10 people are on that medication, you're going to see one of those cases. If 100 people are on that medication. Right, you're going to start to see more of that. If 100 million people are on that medication. Something that happens 1% of the time is going to affect a lot of people. And that's what we're seeing a lot of times with these media headlines of GLP1s and the last thing, meaning they're painting it in a very negative difference between an absolute risk and a relative risk. And they're profiling a worst case scenario that is still as, as the saying goes, an increased risk of a rare event is still a rare event. And I just think people need to understand that. It's numbers and math, right? These are now the, probably the widely, most widely used drugs in the world. So when you have a couple of billion people taking something, you're going to see a rare side effect more than if only a few people take something.
- [58:09]
Gabrielle Reece
What are your thoughts on safety of these medications? I'm happy to share mine. Long term usage. I think that number one, what I'd love to see is more mechanism of action. For example, I agree with your statements on it being good for cardiovascular cognitive. I think that there are a whole host of things that we're going to see from a positive lens. My question is, is it because of the improved body composition, is it because of this reduced inflammation that we're seeing? I don't know, but what I'd love to see. So do I think that they are safe? I think overall they're very safe and I think that they've been used for 20 years. We'll probably move into the ultimate mix of optimization which will be low dose GLP1 with low dose hormone therapy. I had to pause for a second because definitely there's going to have to be some kind of anabolic agent or something to affect muscle. Whether it's an anabolic agent or a myostatin inhibitor, something like that.
- [59:10]
Dr. Jen Ashton
I can't wait for the myostatin inhibitors.
- [59:12]
Gabrielle Reece
Yes, but I think that they are safe medications. I just don't think it's going to be something like fen phen where.
- [59:19]
Dr. Jen Ashton
No, no, you agree where for the.
- [59:20]
Gabrielle Reece
Listener, Fen phen is a medication that people put on to address obesity and.
- [59:26]
Dr. Jen Ashton
It caused pulmonary hypertension and valvular heart disease. I think here's the thing that people need to understand. And again, whether they're talking about GLP1s or hormones or any other medication, including an over the counter medication like aspirin, you have to know what the data is. You have to know what the numbers are. What's the incidence of pancreatitis, what's the incidence of blah, blah, blah, whatever. And that's nice to know that number. But understanding that if it happens to you, you really don't care whether it's 0.1% or 1% or 4%, it's 100% happening to you. So you need to make your decision about whether or not it's worth that risk and how high that risk is. Yes, I do think there's going to be a lot of interesting and exciting data that comes out in the future, including the short term future about mechanism of action, about the use of these drugs for prevention, about maintenance protocols. Right now physicians are literally diying maintenance protocols on these medications, which is fine, but it would be better if we had some actual data to say this is how you maintain on it to understand can choosing a candidate for it, especially in your sphere of interest, body composition, muscle changes, bone changes. You know, people hear like, you know you'll lose muscle mass in these. Well, what they're not hearing is if you have obesity or overweight, your muscle is dysfunctional. Yes.
- [60:57]
Gabrielle Reece
Tell me about your concerns or if you have concerns with GLP1 use. And you just mentioned muscle.
- [61:03]
Dr. Jen Ashton
I have a big concern with, specifically with the higher percentage of weight lost from muscle than for people who are not on GLP1s. Now again, what you do not hear when you hear this topic discussed by anyone anywhere usually is who are you talking about? Are you talking about someone with obesity or with overweight who's on a GLP1 or are you talking about someone who's already at normal body weight and is maybe taking a low dose of a GLP one for other off label longevity benefits, you know, body composition? I believe there's going to be a role of GLP1s for women going into menopause. So we're seeing a lot of those things occur on a DIY basis. Right. And when you hear a headline like you're gonna lose muscle mass. Okay, well that is true. First of all, it's not true for everyone. It depends. You know, there are a lot of women who take GLP1s and don't lose weight.
- [62:06]
Gabrielle Reece
And why do you think that is?
- [62:08]
Dr. Jen Ashton
Oh God. I mean, I think that it's, it's really because of that set, that hypothalamic set point.
- [62:14]
Gabrielle Reece
Can you expand on that just a little bit?
- [62:16]
Dr. Jen Ashton
As you know, there is a reason why 90% of diets and extreme weight loss fail at the two year mark. And that is not because people lack willpower or discipline or drive or determination. It's because our brain, and I love this because it's so easy and it could be a Hollywood movie, you know, explanation of the physiology. But our brain wants us in the most stable condition for the organism, which is us. And unfortunately, that most stable condition is often our highest weight. So the hypothalamus senses a loss of weight as a threat to the organism. And what happens when you lose 5 or 10 or more percent of your excess body weight is your brain starts saying, holy, we must be in a bad situation. So I'm sensing this as a threat to my survival. I'm going to compensate and restore to that equilibrium by making this organism feel less full. It drops the satiety hormone leptin, it increases the hunger hormone ghrelin, it slows your basal metabolic rate by about 15%, sometimes more, so you're burning fewer calories at rest. And what does that do? It drives the reward seeking behavior of eating so that the organism regains that weight many times more than the weight lost. And that leaves that person feeling, I'm such a failure. How did I, I lost all this weight, how am I now at the two year mark gaining it back? And by the way, any diet short term can be successful. Any diet. The key is at the two year mark. That's what the medical literature and the obesity medicine literature looks at. And so that set point, I think is so powerful and I think we do not understand every aspect of it by any stretch of the imagination yet. But I think when people who are already near or at their ideal weight take a GLP1, it works differently. And the parallel for this, and I'm really going to geek out, but you will love it, is in the world of pain medicine and the nociceptors that are pain receptors in someone who has true pain get upregulated. And so if they take. Now I think few people should be on opioid narcotics, but if they did take an opioid narcotic, that opioid works at those pain receptors. If someone does not have pain, what do those opioids do? They make someone high.
- [64:57]
Gabrielle Reece
Right.
- [64:59]
Dr. Jen Ashton
And I think there's a direct parallel to that. We just don't know.
- [65:03]
Gabrielle Reece
I haven't actually thought about that. You know, with the use of GLP1s, I've only seen, you know, we've been using them in our clinic for a long time. And then there was a medication before that. It was. Remember Saxenda?
- [65:16]
Dr. Jen Ashton
Yeah, of course. One of the other FDA approved.
- [65:19]
Gabrielle Reece
Yeah. I've only had a handful of patients not be able to lose weight on a GLP one, like one or two.
- [65:28]
Dr. Jen Ashton
That's Right. Well, I don't necessarily know that it's a matter of failing to lose weight. Although of course I think that's obviously a metric that I'm sure many of your patients are looking at. I think, though, there is a role for people who are at their ideal body weight, let's say within £5 or so, and will take a low dose of a GLP1 and they won't continue to lose weight. And why is that? Again, it goes to that set point. Why? Because they're where they should be. So that GLP1 is likely acting on other parts of the body to help improve body composition. That we don't know yet. We haven't studied it yet. We haven't really. We don't have that many people in that category of a patient population who are using it in that way. You know, the last thing that I think, you know, to get back to your brilliant question of what do you think people don't know? I still think we have a massive societal problem with GLP1s, particularly for people with overweight and obesity. You know, we put people who are struggling with weight issues in a near impossible position of being damned if they do and damned if they don't.
- [66:38]
Gabrielle Reece
What do you mean by that?
- [66:39]
Dr. Jen Ashton
I think that society and medicine clearly has a fat shaming bias and stigma. And we look at people who have weight problems like, that's, you know, they must be lazy, they must be undisciplined, they, you know, for 10 years I treated patients for medical weight management in my practice. I never saw one patient who was, who came in and said, yeah, Dr. Ashton, you know, I start my day with, you know, maybe a couple of waffles with some whipped cream and then I move on to, you know, a couple of Big Macs and then I'll have maybe like a, a pizza for a snack and then I don't know, like some lasagna or something. Never. Everyone comes in saying, I don't get it, I'm eating pretty well. Of course, you know, we can all always eat better.
- [67:30]
Gabrielle Reece
But no, that die sounded like my husband.
- [67:34]
Dr. Jen Ashton
He's obviously an exception to that. But like, you know, people know what they should be eating and what they shouldn't be eating. And I think that in general, even in the medical field, we look at people with weight problems like, you're clearly eating all the wrong things. Now, sometimes they are right, but most of the time it's a failure for everyone to realize that obesity is a complex chronic disease and there's not just.
- [68:00]
Gabrielle Reece
One Cause when you were doing the medical weight management. Tell me a little bit about the nutrition plan with that.
- [68:07]
Dr. Jen Ashton
So the whole reason that I went back to Columbia and got a master's in nutrition is because I found myself. It was the light bulb moment for me as a physician where I was talking to women, every single patient, about food and diet and nutrition. And I was like, it goes back to what I said earlier about credentials. I was doing my own little research on the side, and I realized I'm just way too type A for that. I really wanted to get some formal education and credentials in it. And when I then started incorporating that in my practice, it was because I kind of, you know, had the epiphany of something that I may have actually created this term. I hadn't found it anywhere else, but who knows, Called nutritional gynecology, where I realized that at every major reproductive stage in a woman's life, puberty, pregnancy, perimenopause, they all start with P's. That there is an associated significant metabolic and weight aspect to that. And so I used to be the type of doctor that would refer my patients to a nutritionist or dietitian to work with me. And what I would find is that they knew a lot about food, but they didn't know endocrinology and gynecology. And I knew a lot about endocrinology and gynecology, but I didn't know anything about food. And so I really wanted to connect the dots on that. So when I would see patients for medical weight management, it started with, you know, actually listening and not talking and finding out what is the person's relationship with food and eating been like, you know, what is their life like, what do they like, what don't they like, what works for them, what have they tried? And then trying to work with something that, as I say, like, meets the four S's. Safe, simple, sustainable, and low sugar. And that's technically an L. Yeah, but.
- [70:09]
Gabrielle Reece
Not an S. Yes.
- [70:10]
Dr. Jen Ashton
Little like in parentheses.
- [70:13]
Gabrielle Reece
When I started nutritional science, you know, there's this. You start somewhere and then you end up somewhere.
- [70:20]
Dr. Jen Ashton
Totally right.
- [70:22]
Gabrielle Reece
And when you started with your prescription for nutrition, where was that meaning? Let me ask specifically. So there's the protein sparing, modified fast. There was the ketogenic diet. There's all kinds of nutritional formulas out there.
- [70:39]
Dr. Jen Ashton
So again, this is probably not going to come as a surprise to you, knowing me a little bit. It was not the same for every patient. Just like their menopause plan was not the same for every patient. I would really after assessing the patient, which means knowing about their background, their ethnic background, their whole life, as well as their experience with food and eating and dieting and their weight trajectory, it would be different for everyone. And sometimes it was more of a paleo keto esque approach. Sometimes it was an intermittent fasting, time restricted eating approach. Sometimes it was something more structured, sometimes it was something less structured. Sometimes it was as simple as figuring out what their psychological drives were to eat and working on that, not this. And that's what I really loved about it and continue to love about just the approach. You know, anyone who says there's only one way to do something, I think is, is missing a lot, missing out on a lot of the fun, you know, that and the potential that exists.
- [71:52]
Gabrielle Reece
What about foundational principles? So for example, in my practice, from our perspective, we believe that the data would suggest that protein would be foundational for everybody.
- [72:05]
Dr. Jen Ashton
Agree.
- [72:06]
Gabrielle Reece
In weight management, in any kind of the P processes. So puberty, perimenopause, post menopause. What are your thoughts? Because again, I want to paint the picture that you've been involved in the information landscape since 2006 as a correspondent. So you have seen the gamut. So the question is, where do you think from a foundational perspective protein fits in?
- [72:32]
Dr. Jen Ashton
I think it's everything. I think it's everything, but it's not the only thing. And again, it speaks to our problem with avoiding the extremes. Right. And now everything is protein.
- [72:47]
Gabrielle Reece
Thank God. I mean, I'm just saying we talked about this for 20 years finally. And now, I mean, I feel like I have played a role, I'm ready to move on.
- [72:55]
Dr. Jen Ashton
You have, we are going to talk.
- [72:56]
Gabrielle Reece
About something else now. We're going to move on to anabolic.
- [72:59]
Dr. Jen Ashton
But yeah, but that's, I think that again, we haven't even scratched the surface of the principle of food matrix, which is, you know, that the same food can act differently in our organism depending on whether it's a smoothie, whether it's a solid, a liquid, a baked, grilled, whatever, whether it's mixed with something. We really haven't even gotten there yet. In the world of nutrition. I think that's a really interesting, exciting kind of area. But I think in terms of foundational principles, again, the data is not iffy on this. I mean, protein is not just about muscle mass and body composition. It's literally every process from a cellular hormonal immune function level in our bodies. And there's constant, it's just like bone, there's constant turnover. And so we need to fill the tank constantly. And I think just like we celebrated the FDA removing the black box warning from hormones, I cannot wait for the day. I'm sure you can either, and you can finish my sentence, But I cannot wait for the day where we revise the minimum recommended amount of protein, which most people don't know is the amount needed to prevent disease instead of to promote wellness that is long overdue.
- [74:24]
Gabrielle Reece
It's coming.
- [74:25]
Dr. Jen Ashton
It's coming.
- [74:26]
Gabrielle Reece
It's coming.
- [74:26]
Dr. Jen Ashton
Yes, it's.
- [74:28]
Gabrielle Reece
I'm probably not even supposed to say that.
- [74:29]
Dr. Jen Ashton
No. But I know it is, too.
- [74:31]
Gabrielle Reece
Of course you do. It is. It is coming. And I'm excited for that.
- [74:35]
Dr. Jen Ashton
Yeah.
- [74:35]
Gabrielle Reece
What do you think are some of the biggest myths just out there now in the nutrition space?
- [74:40]
Dr. Jen Ashton
One of the biggest myths is that women should never do intermittent fasting. I think there's a place for it. I think there are people for it. I think it doesn't have to be all or none. There's a massive amount of peer reviewed data that supports its metabolic and cellular benefits. And I think we need to pan out, so to speak, to use a camera TV term, from one little slice of an endpoint in terms of intermittent fasting to an overall, you know, again, holistic endpoint. Let's start with do you like it? How does it make you feel?
- [75:18]
Gabrielle Reece
I didn't know those were important questions.
- [75:22]
Dr. Jen Ashton
Right, let's.
- [75:23]
Gabrielle Reece
I like it. Yeah, it's all right.
- [75:25]
Dr. Jen Ashton
Talk about something novel like, does it even work for you in your lifetime, in your life style? And I think that we have a real problem with moderation. I think I am a big believer both in terms of obesity, medicine and women's health, in the concept of, like, metabolic and physiologic confusion. I think our bodies, on some level, like habit and stability, and on another level, and I get this from my athletic kind of fitness behaviors, like to be thrown, you know, a curveball every once in a while. I think it's good for us. I think that adaptation from us as an organism is very healthy. And I think when our body sees the same thing over and over again day after day, it starts to not do what our bodies really want to do, which is adapt and be nimble and flexible. And so I'm a big believer in occasionally doing a span of intermittent fasting. I do that in my own life, and I love it. And then there are times that I don't do it.
- [76:27]
Gabrielle Reece
So basically what I'm hearing you talk about is hormesis is applying pressure to the system to disrupt the current balance so that the body can go back.
- [76:36]
Dr. Jen Ashton
To finding strategically, intentionally, deliberately and mindfully, you know, just so that you're not doing it like as a knee jerk response or out of panic or desperation. And I think leaning into a sense of curiosity with your own body is the most important thing we can do. And you know, I don't, I don't think people do that enough. Again, I don't think people do that enough intellectually and I don't think people do that enough physically.
- [77:04]
Gabrielle Reece
You know, it makes me think about this concept of a stoicism. I've just been very interested in it lately. This idea of it's almost a level of neutrality and the comfort crisis. People are talking a lot about that, but the perspective seems to be largely male. I don't hear a lot of women speak about.
- [77:23]
Dr. Jen Ashton
I agree with you.
- [77:23]
Gabrielle Reece
It from a sense of, okay, well what does it mean to be strong? And just listening to you talk, I can't help but think that you must have some kind of mental framework for your internal strength.
- [77:37]
Dr. Jen Ashton
First of all, I agree with you. I think it is, it's more of a nail male narrative now. I think you're totally right about that. I went into women's health because I actually believe that women are more stoic than men. It's just that we don't often talk about it. And by talk about it, I don't mean to other people, I mean to ourselves. You know, whether it's what I learned after my ex husband died by suicide or what I learned today as a woman, 56, who is stronger and more fit than I was at 36, it's about kind of the line that I say to myself almost every day is resilience is not really a trait, it's a practice. So strength and power I don't think is a trait. I think it's a practice, a habit, something that can be cultivated, something that can be expanded and grown. And I think that we don't have that, we don't have that conversation with ourselves enough.
- [78:42]
Gabrielle Reece
Do you think, is there a way to add that in? If someone was listening to this and go, you know what? Jen Ashton has been through the wringer, but yet here she is doing amazing things in the world. What is her practice of mental resilience?
- [78:56]
Dr. Jen Ashton
I think there is something that, that a listener or a viewer can take from it and that's have gratitude, have curiosity, and have faith in your own strength. You know, that, that saying, whether it's Nietzsche or Kelly Clarkson, what doesn't kill us makes us stronger. Is really true. And I don't think that. Look, if I had never gone through the suicide death of my children's father, I would have said, you know, it was the hardest thing I ever did. Gave birth to two humans. And after that, I felt like I could split a nail between my teeth. And then I had three kidney stones.
- [79:37]
Gabrielle Reece
And I thought, oh, oh, no, this is even more painful. Gosh, yeah, that. I agree with you on that.
- [79:43]
Dr. Jen Ashton
Right.
- [79:43]
Gabrielle Reece
Yes.
- [79:44]
Dr. Jen Ashton
And then I really thought that. Or I thought. Actually, I thought I was strong. I'm really not so strong. But I think we all. It doesn't have to be the suicide loss of someone. It doesn't have to be a kidney stone or a vaginal delivery or a pregnancy or a triathlon. It literally could be something as hard as something that someone is doing today. It's different for everyone. But I think that we. How we talk to ourselves, needs so much resuscitation and we're just not getting it. And it. And we're in control of that. Right. I mean, you know, how often do you look in the mirror? I look in the mirror in the morning and we start with the. This isn't looking good. This isn't looking good. I don't do that. You know, whatever.
- [80:29]
Gabrielle Reece
No, I'm like, okay, who is screaming at who right now? Because this is ridiculous.
- [80:34]
Dr. Jen Ashton
Right.
- [80:34]
Gabrielle Reece
That's how I usually start.
- [80:36]
Dr. Jen Ashton
That's right. And, you know, whatever it is, it's just, I think we could all improve that. I like that.
- [80:43]
Gabrielle Reece
I think that you're right. You know, I've been, quite frankly, I've been thinking a lot about that. I'm working on my third book, and it's, you know, part of thinking about that is how we frame things up. There is a long way to go. And I think that there's a long way to go for the sisterhood of women.
- [81:00]
Dr. Jen Ashton
Yeah.
- [81:00]
Gabrielle Reece
To be able to come together and go, you know what? I got your back. You have mine. How do we begin to think about this together, collectively.
- [81:09]
Dr. Jen Ashton
Collectively, community is really important. And not community, that's, again, superficial and not transactional. Not. Because I'm going to help her so that she helps me. Because helping her helps you. That's.
- [81:25]
Gabrielle Reece
And actually, you have a. You do have a community.
- [81:27]
Dr. Jen Ashton
I have an incredible community that was really unexpected, unanticipated in agendas. And that's as, you know, agenda like Jennifer in our wellness experiment. That is really. It's women, 50s, 60s, and 70s that really love and inspire and support each other and learn together. And it's been unbelievable to watch it grow. But I have a personal community that has helped me and that I hope I've helped them as much as they've helped me. Whether it's former patients, patients at the time, who literally. Gabrielle helped me heal from my children's father's suicide. My patients helped me heal.
- [82:14]
Gabrielle Reece
And did they help you by just.
- [82:17]
Dr. Jen Ashton
They helped me in some cases by crying with me. One helped me by arranging my two dogs that were really my husband's dogs to be transported from New York to Florida to live with his best friend after he died. They helped me by remembering the anniversary of my husband's death.
- [82:39]
Gabrielle Reece
So they were really in it with you because, you know, in OB gyn you are the doctor that people go through these phases, just these life phases with. That's, that's extraordinary.
- [82:50]
Dr. Jen Ashton
They are extraordinary and I will never, ever forget them. I didn't know that I would be able to literally go back to my job after that happened. And I was now suddenly a single parent. I was financially the sole supporter of my children even before their father died. And I literally didn't know whether I was going to be able to continue working. And it really taught me talk about strength or resilience. It taught me that you can be vulnerable and strong at the same time. And it taught me that, you know, you can be broken and still be a leader. And I was broken and I still, after six weeks, I could not go on the air for six weeks. And when I went back on television, I think women, we are naturally good at compartmentalizing and multitasking. And that's what I had to do at the six week mark. I had to do it at the two week mark in my office with my patients because I didn't have the luxury of taking more than two weeks off. But when I realized that you can be broken and still be a leader, it was very freeing.
- [84:09]
Gabrielle Reece
Perhaps your next book.
- [84:12]
Dr. Jen Ashton
Oh God, that's like saying have another baby.
- [84:15]
Gabrielle Reece
Hey, anything is possible. Anything and everything is possible. Dr. Jen Ashton, where can people find you?
- [84:21]
Dr. Jen Ashton
Love you. On my Instagram rjashton and on our Incredible website is joinagenda.com and agendas like.
- [84:30]
Gabrielle Reece
Jennifer, thank you so much for spending the time. It is. It's just a privilege and just thank you.
- [84:36]
Dr. Jen Ashton
Well, thank you and thank you for making me cry. But I will say the credit goes to you because if you are not the kind of person that provides a safe space to have these difficult conversations that no one wants to have, I wouldn't have gone there either. So I hope a lot of people were helped by it. I know that you do incredible work and this was just an example. You're not a psychiatrist, but. Yeah.
- [85:04]
Gabrielle Reece
Do you know I trained in psychiatry for two years.
- [85:06]
Dr. Jen Ashton
There you go.
- [85:06]
Gabrielle Reece
Trained in psychiatry for two years.
- [85:08]
Dr. Jen Ashton
Well, this is why you're so talented at establishing this kind of safe environment and you do an incredible job of it.
- [85:15]
Gabrielle Reece
Well, I will actually take that compliment coming from someone who has been on air for an extraordinary career. So thank you. And also, just a side note, thank you to you and your husband for the work that you do. I would love for you very briefly to just touch on Home Base.
- [85:31]
Dr. Jen Ashton
It's his greatest proud legacy. Homebase.org is an organization that he started over 16 years ago to provide state of the art care for traumatic brain injury and the invisible wounds of war that our veterans face. And they are based in Boston, Massachusetts. As you know, they have an incredible partnership with Mass General Hospital and Home Base, which started from the Red Sox foundation, has cared for over 30,000 veterans, has saved countless lives and they really do unbelievable work that is now international and they have centers all over the country. But Boston is really the flagship. And as you know, they've done incredible, incredible things which really are not being done anywhere else.
- [86:30]
Gabrielle Reece
That is very true. So if some, if there's a veteran, veteran family listening to this, should they.
- [86:35]
Dr. Jen Ashton
Go to homebase.org homebase.org Absolutely. They can also look at their, I mean, they have all the information and they take a new class of veterans and their families every two weeks, intensive two week program to help people really at their lowest point, struggling from what these veterans have gone through. And it's a real honor for Tom to be at the head of that mission. And I'm so proud of him. That's just a real indication of the kind of person he is.
- [87:10]
Gabrielle Reece
Well, thank you and him for that. It's very important.
- [87:13]
Dr. Jen Ashton
Take care.