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- [00:01]
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- [00:34]
Dr. Marisa Snyder
Welcome to the you are not broken podcast.
- [00:37]
Dr. Kelly Casperson
I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader, and conversation starter on midlife living, hormones and sexuality. Enjoy the show.
- [00:48]
Hey everybody. Welcome back to the you are not broken podcast. I am here with friend Marisa Snyder and she is a prolific author. We're going to be talking about her ninth book. So for anybody who wants to write a book or fears writing a book or like has visions of writing a book, we're going to figure out how do you get to number nine. Currently coming out on October is the perimenopause revolution. Reclaim your hormones, metabolism and energy. Welcome to the you're not broken podcast.
- [01:15]
Dr. Marisa Snyder
Callie, honey, I am so freaking excited to be here. I have been dreaming of this conversation.
- [01:21]
Dr. Kelly Casperson
Oh, stop it.
- [01:22]
Dr. Marisa Snyder
I know I have. Are you kidding me? The conversations that you and I have had over this year have been so, so good. I just want to keep the conversation going.
- [01:31]
Dr. Kelly Casperson
Oh, you're so incredibly sweet. Okay, so your training is in chiropractic medicine and so people need to know like, you can't just go to a chiropractor and have them be an expert in perimenopause and menopause. So share your journey with us of how you went from like there to here.
- [01:48]
Dr. Marisa Snyder
Yeah, I had chronic migraines as a little girl and I'll reverse engineer that. I was abused as a child and the head trauma that I suffered drove migraines. And so I spent most of my childhood missing out on sleepovers and school and activities because I would spend days in a dark room and I went to every neurologist, every doctor. By the time I was a teenager, you could hear me walking down the street with a backpack or a purse full of medication. I ended up getting an ulcer because I was taking so much, so many pain medication for the chronic migraines. And I went to every doctor I could find. Finally, I went to this upper cervical practitioner who was able to basically get rid of majority of my migraines. And I was actually headed to UC Davis Medical School and diverted because I wanted to support other. I didn't want children to suffer the way that I suffered with that level of chronic pain. So I get into practice and it's mostly for migraines and pain. It becomes mostly women in perimenopause, in menopause, in midlife, so 40s and 50s, because 80% of migraine sufferers are women. And the majority of when women will begin to have migraines, if they hadn't had them before, is going to be in perimenopause when hormones begin to erratically decline. And you go through this massive neuroendocrine transition. And there's something about all of that that's driving inflammation. Thank you, Dr. Lisa Moscone, for continuing the research on this. Because we just haven't had this, the research and the understanding of what is going on in the brain fully throughout this transition. So then my, my patients were. They were on statins, they were. They were given metformin, they were on all these medications, they were being siloed in every different direction. They were on SSRIs. And I remember thinking like, there's a commonality here. There's a reason why these women are experiencing all of these symptoms and we're missing the boat big time. And I knew that it was hormones. And so I pivoted my practice very quickly to functional medic, became a functional medicine provider, started running labs, started bringing in lifestyle medicine, and my clinic became a women's hormone practice. I started treating women in perimenopause and menopause in 2009, 2010, and have done so ever since in my clinical practice.
- [04:10]
Dr. Kelly Casperson
That's incredible. What a story. So you basically had somebody change your life and from that you pivoted. Let's go back not to your current practice, but let's go back to like when you were a practicing chiropractor and these people came in with these issues and they're on these meds. What were they coming to you for help? What were they seeking a solution to that they came through your doors?
- [04:31]
Dr. Marisa Snyder
The pain, it was all migraines. I had a migraine practice. But then, you know, you do the full workup and women are like, I also, I can't sleep. The litany of symptoms, never are they in isolation. All of these women had a multitude of symptoms, often many brain related weight resistance. You know, I'm not going to pretend like I didn't have my own hormone issues. My mom at the time was going through perimenopause. And if you read the book or My last book, my mom is very open to talking about how it felt like a nightmare unfolding. And it was during this time. I was my first year in practice. My mom's going through perimenopause. She is continuing to get gaslit. This is what, eight years later from the Women's Health Initiative. She cannot get HRT to save her life, and she is going through the dark night of the soul. And so I ended up taking over my mother's care. And I think because I had a front row seat not only to my mom's personal experience, but also to all of these women that were going through it, I was like, I have got to be a part of this solution, because we are failing women left and right. That's all I see every day, is women being failed. And migraines are the tip of the iceberg of what is going on here. That was the pivot that I made. And, you know, I. I always say that I serve everybody by serving women, and I believe that wholeheartedly.
- [05:51]
Dr. Kelly Casperson
Yeah, no, that's totally true. I mean, that's why I joke. I joke. But it's actually like, the truth is, like, I change the world by getting smart women back out on the streets to change the world in their way. I change the world by helping women change the world. It just is a. It's a multiplier.
- [06:07]
Dr. Marisa Snyder
It's a multiple. It's the ultimate multiplier. You want to. You want to be a multiplier in this world, take care of women, because here we are, we're taking care of our families. I mean, you and I are both moms, right? So even within the family unit, we are leaving a legacy. And then we've got community. Right? Because what woman isn't impacting her community in a big way? Whether that's a church or that's community work that you're doing, or just being a part of groups, and then you've got the world when we're multiplying in that direction. Women are the world changers. They're the game changers. And it happens. You know, it happens in a very nuclear way and. And expands from there. And to have women go from barely functioning, not able to get themselves out of bed due to chronic migraines or severe depression and anxiety or whatever they're dealing with to get them back out into the world, functioning, feeling alive, impacting their community and families in a way that feels in alignment with them. Like, that is the greatest work that I could do.
- [07:06]
Dr. Kelly Casperson
I totally agree. And I think a lot of Women when you're not feeling good, you forget what feeling good feels like and that there should be. And again, it's hard when you're feeling sick and you're feeling run down. It's hard to even have the motivation to try to do something to feel better. So let's say, let's say a woman's like on the couch, it's bad. What are the baby steps that you would say? Hey, just try this to start to move towards that ideologic optimal health that, that we want people to have.
- [07:35]
Dr. Marisa Snyder
I was there, I was on the couch about two years ago. I had back to back concussions and that I ran to the, went to the ER because we really thought it was pretty severe. Was diagnosed with post concussion syndrome and my world stopped. It was mid July of 2023 and I was in a dark room or in brain treatments for over a month. I couldn't drive my car, I couldn't get my son ready for work. I could barely get myself ready for work. And the first two things that I did, number one is I imagined my future self. I imagined the version of her that was living the life that I wanted again. I imagined her training again. I had literally had just trained the days prior to getting hit in the head back to back within a two week span. I imagined her going to her son's events, I imagined driving a car. I imagined writing the proposal for this book because I was writing the proposal for this book. And then everything shifted. I imagined my being on stage. I imagined me just planning my son's third birthday party. He was two and a half years old when this happened. So I was imagining myself six months out. It was like the end of December or five and a half months out, that I was going to be a different version. And then I reverse engineered what that would look like. How do I even get to that version of me? So the first step was mindset number two. I would say if you can just get up and get some sunlight and maybe take a walk around the block, just some level of movement. If there was anything that I could bottle today, Kelly, besides HRT and get it to all the women that need it, it's going to be movement. And it can be any movement. It could be yoga in your living room, it could be squats after dinner, it could be a walk around the block, whatever it is, some level of movement. And for me, when walking was the staple, like I could walk, that's the one thing I could do. So every day I got my butt up and I Walked, I walked and walked until I was back to a version of myself that was functioning beautiful.
- [09:41]
Dr. Kelly Casperson
I think that it was the absolute perfect answer because it's like you've got to give people bite sized things to be like, don't reach for the stars. And again, we want to bring other people in on our health journey. We need a supportive physician who can prescribe things. At the same time, I love the future self and what is she doing and what do I need to do today to become that future vision woman that I have in my head that is absolutely brilliant. I love it.
- [10:10]
Dr. Marisa Snyder
It's a dark place when women are stuck, when they're stuck on the couch. I mean, what woman do you know wants to be on a couch? You know, we are, I mean we are the most, you know, high functioning individuals that I know of. Right. Is women handling stuff. And so it's like if you're in a dark place and you're thinking to yourself on those days that you don't know if you can even imagine a version of you living the life that you want, you have to just be willing to dream it or envision it. And the more that you can anchor to that, it shifts everything because at least you know, you have a North Star, you know where you're going.
- [10:45]
Dr. Kelly Casperson
Yeah, absolutely. Let's break it down for people because I find it very confusing. What is a functional health practitioner? These are like people with varying degrees. They might prescribe medications, they might not. I think we functional is kind, kind of the new buzzword. What does it mean to you and how do you help people navigate something where they don't actually know, like what these people do.
- [11:06]
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- [12:18]
Dr. Marisa Snyder
Yeah, no, I love this question. And you can call it root cause medicine or functional medicine. And basically as a functional practitioner, any functional practitioner worth their weight in salt. They're looking at a number of things. You know, one, they're looking at symptoms because symptoms are always going to be the window of what is going on. And that's the thing that we need to address. You know, women particularly, those are the people that I get to serve. You know, they're not coming to me because they feel great. You know, so first symptoms, then I want to understand what the goal is. I also want to understand their history, but also their family history. I want to try to piece together what's going on, but also how are they living and operating in their day to day life. Like the real talk, like what does the day look like for you? And then I often, I'll be honest with you, Kelly, I run, I mean, I'm not running insane extensive labs, but I want a good sense of what is going on. I want to be able to leverage labs to validate your experience. Most of the labs that I'm recommending you can get from a primary doctor. I can run lab slips. I run labs all of the time. I'm not trying to make women go out of pocket or spend excess amounts of money on labs, but some labs that I find I have to fight for a little bit with my primary doctor, I will just automatically run those things like highly sensitive CRP and fasting insulin. Maybe I'll be looking at more cardiovascular driven labs and even kind of diving a little bit deeper into is there any type of blood glucose deregulation, insulin resistance that could be driving more longer standing inflammation? So running those that level of labs. So many of my women are dealing with metabolic issues and we just, I want to identify what's going on. And then it's really working with that patient to kind of build out a protocol and that works for the life that they're living. You know, I can make a recommendation of resistance training three to four days a week, 30 minutes a day. And if my woman is not able to even make that happen, that doesn't show up to serve her. So working with my patients to really meet them where they're at, obviously move the needle in terms of lifestyle medicine that I think is going to actually get them out of these symptoms and to move them to a place where they're feeling more energized and they're feeling like their body's functioning again. But I would say it's those four components where looking at the whole person, I'm not just treating a very specific symptom. I'm trying to get to like, well, what's driving that to begin with? Is it a behavior, is it a lifestyle? Is it something that you're doing or something that's impeding how you are feeling? And so what I'm looking at the whole person. That allows me to say, okay, this isn't just mental health, this is actually hormones as well. So it gives me a broader picture of what is going on.
- [14:54]
Dr. Kelly Casperson
Love it. Okay, so the overworked woman, she prides herself in how high she can, she has capacity. Right. Like large capacity overworked woman. She, let's say she's flying for her travel all the time and she's like work, work, work, work, work. That's her life, is her work. And she comes to you, maybe me, maybe somebody for hormone balancing. But it's like hormones actually are building blocks. How do you get her to see like you are running yourself ragged but there she has pride in that. Right. So how do you. I'm throwing you a tough one.
- [15:30]
Dr. Marisa Snyder
Are you looking at my chart right now, Kelly? Am I looking at your chart right now asking for a friend? I think I know somebody who just did like a 10 city book tour.
- [15:42]
Dr. Kelly Casperson
Yeah, exactly. Don't look over here talking about.
- [15:47]
Dr. Marisa Snyder
So yeah, I, you know, one I'd love to uncover, you know, is there is some, is there some trauma there, you know, hand up, hand raised over here.
- [15:56]
Dr. Kelly Casperson
Meaning let's break that down for people we know that like, and we have, we see this in the long distance running and the like triathlete and like endurance community, that there is a large correlation with history of childhood trauma in people who have that kind of intense long sport. Correlation doesn't always equal causation. Don't confuse the situation. But there's a correlation to that. But also in the overwork area, there's also a correlation with history of trauma.
- [16:23]
Dr. Marisa Snyder
Yeah, absolutely. I mean I don't, I have, I know my ACEs score, my adverse child event score. And you know, I, I, I was brought up with the idea that as a woman, your worth is predicated on how much you do in your productivity. And I've easily shrouded it with purpose and mission. Sure. And I feel very purpose, purpose and mission driven. So if I have a woman who is very driven by her work, by her mission, her purpose, and I'm not really going to dissuade her from that lifestyle. I want to see how we can punctuate the wins. I'm not even going to call it self care because goodness knows that'll probably be a trigger word. So we're just going to. I remember when I was younger, I was like, I don't have time for self care. Like, who's got time for that? So it'd be more so punctuating. Like, how can we build in moments for you? Whether it's five minutes here, five minutes there. Let's take a look at what you're fueling your body. If your brain is running like it needs to be Ferrari, are we feeding it the fuel that a Ferrari needs, or are we feeding it a Mazda hatchback from 1993? You know, and so those would be the things that I would look at, like, how do I get her some wins out the gate? And maybe, maybe a little bit of supplement support, especially if she's having some sleep issues, like taking a look at some of those things. Recommendations also asking, is she getting, you know, support? How is she feeling in terms of her worth and her worthiness? Do we need to dive a little bit deeper? I cannot tell you how many times I'm prescribing cognitive behavioral therapy or internal family systems or just going a little bit deeper. When women. The prevailing thing that I hear most, Kelly, and I'm curious how you feel about this, is a lot of women will come into my office and they want me to understand that they are not lazy. They need me to know that they are doing everything in their power to move the needle for themselves. And then when I peel back the layers, it's obvious that there's beliefs that they're holding onto. There's trauma that's there. And I'm like, have you done the work of really, really tending to your heart and really taking care of you? And so it's. And I will tell you nine out of ten times when I'm. When I'm just. I'm saying, hey, I'm coming from a place where I know exactly where you're at. I've been there. I am you in so many ways. And I don't think I could get through this journey alone without support when it comes to my mental health or just having someone to just dump on. And I will tell you, nine out of 10, they have a therapist within about a month.
- [18:49]
Dr. Kelly Casperson
Month, yeah. It's awesome. Therapy for everybody.
- [18:52]
Dr. Marisa Snyder
Therapy for everybody.
- [18:53]
Dr. Kelly Casperson
Therapy for everybody. Normalize it Absolutely. I want to get. I want to get into this more because I see this conversation played out online and. And not online of, like, is adrenal fatigue a thing? No, it's not actually a medical thing.
- [19:07]
Dr. Marisa Snyder
It's. Unless you have Addison's.
- [19:09]
Dr. Kelly Casperson
Right. Unless you have Addison's. But what do people actually mean? What I think. What I think people mean and where I think people feel invalidated when they say, you know, I've got cortisol, I've got adrenal fatigue. And then the doctors are like, that's not real. It's not a medical diagnosis. But what I. Where I am, like, what's the truth? Where's the truth in this? And I'm, like, trying to figure it out as I'm talking out loud. So that's why this is good. But women are just go, go, go, go, go, go, go, go, go all the time. They're never off social media. They're never off consuming stuff. They're never off, like, brain input. So they're in their sympathetic system all the time to the point where, like, relaxing and resting actually feels really weird.
- [19:48]
Dr. Marisa Snyder
It feels unsafe.
- [19:50]
Dr. Kelly Casperson
Yeah, it feels unsafe.
- [19:52]
Dr. Marisa Snyder
That's what it comes down to.
- [19:53]
Dr. Kelly Casperson
So I think, like, it's. It's this. We invalidate people when we're like, no, your adrenals aren't.
- [19:58]
Dr. Marisa Snyder
Like.
- [19:59]
Dr. Kelly Casperson
Adrenals don't actually run out unless you have a. You know, but. But you can run out because you're in the sympathetic nervous system all the time and don't know how to feel safe in the rest. Digest. Rel. Caretake part, which we. I think we've lost that in our society.
- [20:21]
Dr. Marisa Snyder
Oh, yeah. Well, I would say. I would argue that caretaking is exhausting. It's a stress response system. That's what we're calling it. There's a research article in the Journal of hormones back in 2009 that talked about chronic stress. And I. I cannot tell you how many times I've really dove into the conversation of chronic stress because it's so insidious. Insidious. It's insidious because it's packaged as productivity. It's insidious because it's packaged as you are getting things done. You are handling business. It is success. It looks good on paper, you know, and. And we celebrate it, particularly women. And so I always say, like, are you saying things like, oh, I'm busy, or, I'm rushing out the door. I've got to go? Like, how do we pick up on some of the signs that we are in this Stress response system in a constant state. And when we're in that state, so often it's just default. We don't even recognize it anymore, and it kind of slowly crumbles you. So in the Journal of hormones back in 2009, they talk about chronic stress. It co elevates eating. It co elevates insulin resistance, and it drives inflammation and oxidative stress. Ultimately, it wears you down. And so it'll show up in other disruptive symptoms. It'll show up as sleep issues. It'll show up as low mental energy, low stress tolerance, irritability, migraines, you know, so it'll show up as a lot of other disruptive symptoms. But it's really hard to distinguish when we're in it. And unfortunately, in this society, particularly what we expect from women to show up in the household, in community, in work, to be able to do all of that and to do it well is quite an impossible task.
- [22:02]
Dr. Kelly Casperson
Yeah, I agree. And I think, like, when you were talking about how pervasive it is, I noticed this, like, on the soccer field, you know, when I go with my kids and people are like, how are you doing? How's your practice? Busy. And so I'm, like, actually very conscious of people saying that and saying busy and me being, like, as busy as I want it to be.
- [22:19]
Dr. Marisa Snyder
I say full. Everything's very full right now. Like, I'm really mindful of the language. This is a real good story about Bronx and his dad Ryan, Real United Airlines customers.
- [22:29]
Dr. Kelly Casperson
We were returning home, and one of.
- [22:31]
Dr. Marisa Snyder
The flight attendants asked Bronx if he.
- [22:32]
Dr. Kelly Casperson
Wanted to see the flight deck and meet Captain Andrew. I got to sit in the driver's seat. I grew up in an aviation family, and seeing Bronx kind of reminded me of myself when I was that age.
- [22:42]
Dr. Marisa Snyder
That's Andrew, a real United pilot.
- [22:44]
Dr. Kelly Casperson
These small interactions can shape a kid's future. It felt like I was the captain.
- [22:49]
Dr. Marisa Snyder
Allowing my son to see the flight.
- [22:50]
Dr. Kelly Casperson
Deck will stick with us forever. That's how good leads the way.
- [22:53]
Dr. Marisa Snyder
I will say, though, you know, particularly in a season, like you and I are in a season right now, we are promoting this book, baby, that you. Let's be honest, like, how many hours went into writing and researching that book? And how much is it gonna transform.
- [23:08]
Dr. Kelly Casperson
Lives if you took dollars and put it into writing a book versus just put it in the stock market, friends. Just put it in the stock market, Just put it in the job market.
- [23:17]
Dr. Marisa Snyder
So, yeah, I mean, you gotta honor the season, but I'm in the season. Yesterday. I just. I lived down the street from the beach. We kept my nanny on 30 extra minutes, which I am so grateful and privileged to have a nanny, but I kept her on for 30 extra minutes. I was on interviews from 9 until 4. 20. Like I could have easily. I needed to follow up on emails. It was a lot of things I had on my to do list. Here's my to do list from yesterday right here that I'm still finishing out. And I looked at that list and I was like, I am not. I'm not doing this list right now. And I went outside, I got my feet in the ocean because I knew I needed to raise my heart rate variability. It was tanking over the last couple of weeks. And I was like, if I can just get to the ocean and back, I can do this. And mind you, I'm timing myself, girl. I know how quickly I can get to the ocean, get my feet in ocean, and get my butt back to the house. Because my trauma response is efficiency, right?
- [24:09]
Dr. Kelly Casperson
Yeah.
- [24:09]
Yeah.
- [24:09]
Dr. Marisa Snyder
I have grown up timing myself, doing everything. There was a time where I. This was way back in my 20s, because I've been operating like this since I was a teenager. And this is when I did not eat well. I didn't know better. And I would have, like, a TV dinner, like, in the microwave for five minutes. I could shower in five minutes. So I was like, okay, in the time I'm heating this up, I need to be out of the shower and back in here. So I always joke that if you're in line in the bathroom next to me or behind me, it's your lucky day. But this is. This is a pervasiveness. I mean, I am constantly. I have all these. I send my brain a lot of safety signals throughout the day. Because the safest pattern my brain knows is to be in this response, this type of stress response system. And so I'm constantly sending myself. And that's what I recommend to my ladies that are operating like this, that are in perpetual rushing women's syndrome, as I like to call it. Because how many times have you driven to the store, driven somewhere, and you thought you were in a hurry and you didn't need to be there for like another 15 minutes. Like, I always feel like we're rushing to wait to get somewhere. And so I send my brain safety signals. I take a lot of walks. I go outside. I do breath work. I send voice memos. There's a lot of things that I do. I'll listen to a book. I just punctuate my day. I do squats so that I can help to reset my nervous system.
- [25:31]
Dr. Kelly Casperson
I love that. Let's talk about nutrition. It's so individualized, and I think everybody's looking for the perfect thing. And there is no, I believe now at this point, there's no the perfect thing for anybody. Some people do really better with plant based. Some people do really better with meat based. I think everybody agrees protein forward is the way to go. Let's talk about the big elephant in the room, which I think is so pervasive in our culture is just. Just processed white sugar.
- [25:59]
Dr. Marisa Snyder
It's everywhere. It's liquid sugars. It's marketed as I was and we were going to a pumpkin patch because, you know, mom life. Last weekend, I pack a lot of water for my family. I try not to drink out of plastic water if we can avoid it. And my son drinks water like it's his freaking job. And we're almost out of water. It's like 85 degrees there. And so I stopped by this big grocery store. Mind you, I am not in a food desert. I am in a really nice town. And I go into the store. And, you know, anytime you go to a new store, you're just looking for whatever you're looking for. You have no idea where it is. It's a new store. And I am going down aisle after aisle after aisle. I'm down like eight aisles at this point. And every aisle is like a mile deep of ultra processed foods. Every colors and flavors. Everything's synthetic, everything's artificial. Everything's got sugar in it. By the eighth aisle, I'm honestly, I'm like, I'm feeling anxious and a little bit overwhelmed. Still haven't found water yet. And I'm like, where did they hide it? And I'm like, how does any family, how does any mom navigate this? Like, that was the thing. And so finally found the water aisle, mind you, I had to go through all of the fake water to get there. Like the power aids and the electrolyte waters that are dyed in every color you could possibly imagine. And then finally I got to the water section and I just thought, like, holy moly, there are parents, there's moms in this store right now who are just trying to figure out what to feed their kids. And the marketing is insane. And most of this is really not. It's not even real food.
- [27:28]
Dr. Kelly Casperson
Yeah. You know, I have decent training in what I do and what I pay attention to. And I'm like, you have to, number one, look it out for it. Like you just said it's eight aisles before you find water. Like, it's so pervasive that the sugar forward processed food is at the front. They make that the quick, easy default. And it is so rewarding to our brain to eat that. But the processed white sugar stuff, like, it's the big elephant in the room of like, that's the heart disease, my friends. We always talk about it as like, that's the insulin resistance, that's the diabetes. But it's like, that is an independent risk factor for heart disease.
- [28:06]
Dr. Marisa Snyder
It's the number one independent risk factor for heart disease is insulin resistance. Let's just really quickly, based on the Nhayn study that's currently running right now, one in four children are full blown diabetic. One in three are pre diabetic.
- [28:21]
Dr. Kelly Casperson
Stop it.
- [28:22]
Dr. Marisa Snyder
That's the newest research that came out this year in 2025.
- [28:25]
Dr. Kelly Casperson
I mean, here I am like, again, my kids love sugar. Like every single soccer game is freaking donuts afterwards, right? And here I am kind of naively being like, it's fine. Like, bodies can run on sugar when they're young.
- [28:37]
Dr. Marisa Snyder
No, they can't. Not this level. It's kind of like that pervasiveness. It's similar to the pervasiveness of stress. Like, how long can your body run on that? You're gonna pay the price at some point. I have felt that price, and hence why I've done my best to clean that up. Same thing with ultra processed foods and added sugars and refined grains and refined carbs. Your body can only run on fake food for so long. You just can't do it. And what makes, you know, where we become more vulnerable? I would say the children are extremely vulnerable. You know, we're seeing that play out. But where we become especially vulnerable is in midlife for women in perimenopause when we start to lose estrogen. That profound. I would call body protector, you know, and highly, you know, drives beautiful insulin sensitivity. If you had been keeping insulin resistance at bay, once estrogen begins to decline, all of a sudden we begin to see climbing insulin, insulin levels. I see insulin in the teens, like 10, 15, 18, all of the time. And even five years prior, women, it was just a five or a six.
- [29:45]
Dr. Kelly Casperson
And let's explain that. So high insulin, it will actually make you hold onto weight.
- [29:49]
Dr. Marisa Snyder
Yes, it's a fat storage hormone.
- [29:51]
Dr. Kelly Casperson
It's a fat storage hormone. That's what, you know, I think a lot of people don't understand when people are like, insulin resistance, insulin resistance. What that means is more insulin has to be in your system to get the job done. And the more insulin you have, the more you're gonna pack on the pounds because it's a pro stor hormone. Am I getting that right?
- [30:08]
Dr. Marisa Snyder
That's absolutely true, yeah. So hyperinsulinemia is when we have that hormone inside of the bloodstream. We can't seem to get it down. That's when we see those levels are creeping. The cells at this point, they're so bombarded with the glucose that that hormone is constantly having to scream at your cells to get that glucose in the same way it used to, much easier. And as a result, when it's floating around, it is driving more visceral belly fat or more visceral fat along the live major organs. And that, in its own right, is a perpetual vicious cycle, because that begets even more insulin resistance. And so when we have the combination of body composition changes that are happening without permission in perimenopause and menopause, along with the decline in estrogen that's driving insulin resistance, it can feel like it is a feedback loop that you can't seem to get out of.
- [31:02]
Dr. Kelly Casperson
And I think that's why people are checking fasting glucose labs more now, because you can have a normal fasting glucose but still have high insulin. That's just you catching it earlier. Your glucose going up in the bloodstream is actually more of a downstream effect or chronic high insulin over time.
- [31:21]
Dr. Marisa Snyder
Right.
- [31:21]
Dr. Kelly Casperson
So if you're waiting to just catch the high glucose, you've missed this window of opportunity where you could have caught high insulin. Which kind of happens first.
- [31:30]
Dr. Marisa Snyder
Exactly. Up to 10 years.
- [31:33]
Dr. Kelly Casperson
Up to 10 years first. Okay, here's the other thing I see a lot on social media right now that I think is very unfair to women is in midlife, it's just calories in, calories burned. And to me, I'm like, okay, when you're pregnant, you can put the same calories in, but you're gaining weight because you are in a pregnancy state. Nobody disagrees. So in midlife, people are like, it's just calories in, calories burned. It's like, no, no, no. But the estrogen's going down, which is. Helps you process and helps the insulin resistance. And so it's. I don't want to say it's like a pregnancy state, but my metaphor is calories in, calories out is different when you're 47 than when you're 28, because metabolically, there's a different system at play.
- [32:20]
Dr. Marisa Snyder
Absolutely. Well, and we need to still look at all of this, we know that puberty, pregnancy, postpartum and perimenopause are all massive hormone shifts. And as a result, a lot of changes are happening in the body. Girls are a little bit more insulin resistant in puberty because they're growing. They're growing big time. We know that in pregnancy. The reason why we look at gestational diabetes in the third trimester is that we are relatively insulin resistant by default because we are 3D printing a human being. And then in perimenopause, what I always call the higher stakes game here, we're losing these protective shield hormones, hormones that have been rhythmically being dosed out every single month for decades. And now we're losing that resilience, that hormone resilience that trends to metabolic resilience. The BRO podcast are the ones that are talking a lot about. Women are just. It really feels like they're blaming women for being lazy or eating too many calories or thinking that they're eating less than they are, that they're not actually in a calorie deficit or that they need to be working out more. And it's just, it's that. That pervasive, toxic dialogue that isn't supporting any woman. I know you and I have been taking care of women for a long time. I have been watching women in perimenopause and menopause put on five pounds overnight in that transition, despite busting their butt. If anything, I see women overdoing to try to make up for what they're gaining in that phase.
- [33:51]
Dr. Kelly Casperson
Yeah, or they'll food restrict.
- [33:53]
Dr. Marisa Snyder
Yeah, food, calorie restrict and they burn out.
- [33:56]
Dr. Kelly Casperson
Have you ever actually tried to eat one gram per pound of body weight of protein? Like, it's.
- [34:02]
Dr. Marisa Snyder
I don't know if, you know, it's a second job.
- [34:05]
Dr. Kelly Casperson
It's work to switch from that mindset to like, I need to eat less and less to not gain on this weight is because you believe the calorie in, calorie out dogma, which I think really, again, blames women, but also doesn't validate the very strong data. Like, this is, what you and I are talking about is it's not up for argument. This is what happens. It's just that I don't think people understand because you can't see it. You know, you can't see it. Most people aren't even getting their glucose checked, let alone a fasting insulin. So it's like all you can see is the pounds.
- [34:38]
Dr. Marisa Snyder
Pre diabetics have no idea they're in pre diabetes. And what's so dangerous about pre diabetes? You know, we always think about it's being diabetes like 126 milligrams per deciliter. That's when we start to see the heart risk. But for women, it's actually 110 milligrams per deciliter that we start to see that risk. And that's because at that point we already are beginning to experience significant insulin resistance. And we are not small men. It just works different on us. One in three women will die of a mostly preventable heart attack or stroke. And it's developing often in midlife. It's not later in life that we're developing this. It's when hormones begin to decline. We start to see labs go in unfavorable directions. And if we're not not open to understanding what's going on with our bodies, it can feel like it gets out of control very quickly.
- [35:29]
Dr. Kelly Casperson
Yeah, absolutely. Let's shift and talk about nine books. When did you start writing books? That's a lot of books.
- [35:35]
Dr. Marisa Snyder
2009. This is when everything shifted for me in the practice where I was taking care of women. They were pre diabetic migraines. They were really struggling with weight resistance. And I was like, we've got to do better. We have to do better for women. I just thought not. I wanted to democratize information. I, I knew that not everyone could pay to come to me. You know, it was a cash based practice and I wanted, I was like, how do we transform lives? So I shared with you before I got on that I was. Well, I shared a little bit in the show that I was abused as a child and I ended up living with my dad and his evil wife for a time. And I remember moving into that household and them telling me they didn't care what happened to me. They were like, we don't care if you get good grades. We don't care. We just need you to behave and act right until you're out of our house. And I had a stepbrother who had straight A's and they were really disciplined with him. And I thought, well, maybe they didn't mean it. But a year goes by and girl, they meant it. They didn't want anything to do with how I did. And so I remember maybe I was a CD student at the time and I knew I needed to get out of that house. I needed to get like, they weren't banking on me. I needed to go pray to the stars that I was going to get out of that place. And remember Asking myself, I was on the floor one day and I asked, how do I get out of here? And the answer I got was, you've got to get smart. And then the next question that came to mind immediately was, well, how do you do that when all you've ever really known is failure? Like, no one's betting on you. And it was like a lightning bulb moment. Like I got hit by lightning. And it was, you have to read your way out of this. You have to read your read, read everything. And I did. I read everything. I read my way to straight A's. I read my way to being the saledictorian. I read my way to five full academic scholarships to college. I read my way out of that household. And book saved my life. That was all there was to it. I was 13 years old when I had this moment, this epiphany. And I just wanted to give back. And that's where book number one started.
- [37:35]
Dr. Kelly Casperson
Unreal. That is so good. I mean, people, you know, people look at me and they're like, you're a urologist who's interested in hormones and sex med and like, how did that happen? And blah, blah, blah. And it's like the data is, if you spend one year reading about any particular subject, whatever it might be, astrophysics, dog grooming, like, whatever it is, if you spend one year reading on that subject, by the end of the year, you'll be in the top 10 to 5% of experts in the world on that subject. And I just, like, became obsessed about it. Like, I just doubled down. Like, I read academic papers as much, if not more than I read in residency training.
- [38:14]
Dr. Marisa Snyder
Right.
- [38:15]
Dr. Kelly Casperson
Cause I'm obsessed with the subject. But it's like so many people are like, oh, I didn't get the training, or I didn't get the education, or I didn't get the blah, blah. It's like the amount that's available to us now. And if you just focus and read, you become pretty damn good a year in, let alone 2 and 4 and 5 and 7. Like, it just starts compounding. And then you can start, like, bringing different ideas together. And like, that's where the creativity comes from of like, dude, you nailed it and you nailed it early. And I love that inner voice that was calling you forward.
- [38:47]
Dr. Marisa Snyder
Yeah. No, I just knew, despite how often I was told I wasn't meant for anything, that I was. It wasn't gonna happen for me. I just had this feeling I was worth betting on. I was worth. It was worth trying. And I didn't understand fully the power of, of reading until then and how much it can transform any of our lives and moving forward. I get that sometimes. You know, I can't tell you how many times women have come to me and they can't afford their provider, they can't afford their labs, or they just, they can't afford to jump around. When it takes an average of four to six office visits, Kelly, to connect the dots between your symptoms and being in perimenopause and menopause. That's a lot of co pays, that's a lot of money spent, that's a lot of labs that you had to run. And so if I could shortcut that journey by moving the needle with a. Gosh, you can buy the book on Audible with a credit. For goodness sakes. You know, like I bought the book on Audible with a credit. I constantly have Audible credits. I read five, on average, three to five books on Audible a week. I am constantly consuming books on Audible. And so I, you know, to have it on Audible for a credit or for like 11 bucks to have it as an ebook, to have it as a hardcover for like $25. And I can put, put everything, I can shove everything. Labs, symptoms, what to be looking out for the most research, science backed lifestyle recommendations that I can offer you to move the needle for you, how to advocate for yourself so you can have that conversation that's going to move the needle for you. If I can put that into a book that is $20 some days or even just a credit on Audible and you have something to move yourself forward in a profound way. I don't know anything more potent than a book.
- [40:34]
Dr. Kelly Casperson
Yeah, books are absolutely game changers. I was actually sadly reading this this past week and the Economist, they were writing about how less and less people are reading. They were actually, it was like English majors, they asked them to interpret. I think it was like a Charles Dickens introduction or something. And these people who are going to college for English literature could not tell you what the first chapter was about in the book. And you're like, oh, that gets dark pretty quickly. Do not let reading become a lost art, people. It's incredibly, incredibly powerful.
- [41:10]
Dr. Marisa Snyder
If you're listening to this, you are a big Dr. Caspersen fan and you are also running on fumes and you want a habit stack. You know, I want you to get that. Walk outside, reset your nervous system and listen to something. Listen to menopause is having a moment. Listen to the perimenopause revolution. Listen to Unbreakable. Listen to the books that are out There. Listen to a fiction book. Like, you get in where you fit in. Like, you can have it stack on both. And that's what I do. I'm always. I'm listening to a book when I'm walking. I'm listening to a book when I'm taking my son to and from school. Like, get in where you fit in. You can get it done, I promise. Why don't we make. Why don't we commit all of us right now to a book? A book a month. How about that? I was gonna say a book a week, but maybe that's a little too much. But a book a month.
- [41:57]
Dr. Kelly Casperson
Yeah. 12. 12 a year is very, very doable. I don't know what average. I've read this statistic recently, but, like, average books a year is like seven. Seven or ten maybe, tops. But that's average per American, so some people read zero. I'm up in the $40. 40 a year category. You're clearly. If you're doing five a week. Oh, my God.
- [42:22]
Dr. Marisa Snyder
It's a lot. It's a lot of audible credits.
- [42:24]
Dr. Kelly Casperson
That's a lot of audible. You are a pro Audible. I love it. What did you put in the perimenopause revolution that you didn't put in any of your other books and, like, you're super excited about?
- [42:34]
Dr. Marisa Snyder
Here's to quitting.
- [42:36]
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- [43:06]
Dr. Marisa Snyder
I would say what we started with, which was imagining your future self. Imagine. I think one of the biggest lies that women have been told is that this is the beginning of the end. This is a decline. And it is so far from the truth. It doesn't have to be that story whatsoever. You get to decide what it gets to be for you. And I think the questions that we get to ask ourselves is, who do I need to be? Or who do I get to be in the second half of my life? What do I want to do? How do I want to live? How do I want to bring more joy into my life? Who do I want to spend time with? Where do I want to go? Like, get. Get super clear on what you want to be, who you want to be, what you want to accomplish, what you're going to step into in the second half of your life. You get to do this on your terms. It's all for the taking. You just have to decide if you want it. And so that was a big part of the mindset in this chapter, was like, we are at a defining moment, right? We are at a point in our lives where everything is up for review. This is a time of discernment, but it's a time of ownership and decision. You get to decide how you want to live in the second half of your life. Don't let someone else dictate that narrative for you. Don't let someone else say you can or can't do something. You get to decide what you want. And the questions in the chapter, I want to say it's chapter 11. It's the first chapter of the five week protocol. That chapter will give you everything you need. It will ask the right questions, will give you the right reframe so that you spend an hour with yourself. Go to a coffee shop, go to your favorite place, go to the beach, go to a park. Don't do it in your office. But honestly, if all you got time for is in your office, I don't care where you do it. But like, find somewhere that feels, you know, inspiring. Go somewhere that feels good. Grab a journal and just sit down with those questions in the book and write them out. Answer those questions for yourself. Take, take a couple, take a couple minutes for every question. Maybe even give yourself an hour or so to just get clear. And then paste that thing on the window of your, of your house or of the mirror in your bathroom, wherever you need to put it so that you're reminded of who the, the freak you are becoming in the second half of your life and then start to step into that.
- [45:16]
Dr. Kelly Casperson
I love all of it. That is a perfect place to end. I completely agree. It totally is on brand with the. You are not broken. Like I, I, I always tell people I'm like you. It's really horrifically optimistic that we call this time in our life mid. Take advantage of that. That really like, you're only halfway through this. Now you, now you know how to tie your shoes. Now you know how to wipe your own butt. Now you, you've been through your formal education, right? What do you want to do? The rest of this is yours.
- [45:44]
Dr. Marisa Snyder
It's all yours. Yeah. You are standing on your hard Won lessons. You are standing on all of your accomplishments. Why would we step back at this point? You've earned your place for right now. You get to claim that. Don't let anyone take that away.
- [46:02]
Dr. Kelly Casperson
I love that. Tell us where we can find you.
- [46:04]
Dr. Marisa Snyder
Yes, you can find me. Energized. I just had Kelly Casperson on the show. We got into the nitty gritty. If you want more of this this, you got to come over to EnergizedOctormarisa. The book is called the Perimenopause Revolution doctormarisa.com book for all the goodies. I have so many bonuses built in to move the needle for you and on insta at Dr. M A R I Z A especially if you want levity around Perimenopause because let's be honest, it's a journey for sure and I want you to feel supported in all the ways, including entertained.
- [46:37]
Dr. Kelly Casperson
Thank you so much for joining us on the podcast today.
- [46:40]
Dr. Marisa Snyder
Thanks honey.
- [46:41]
Dr. Kelly Casperson
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the Master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor but not your doctor in this form and and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember you are not broken.