And my philosophy is always if we're gonna be taking medications, we have to be eating what we should be eating. So we have to be nourishing our body and we have to be moving our bodies. I think that in conjunction with the medications and with the lifestyle, it can be really, really effective, and a lot of people can feel really good about them. Really, what any of us care about as patients, as consumers, as clients, is what really works. Is this gonna be worth my time and money, or is this a complete waste of my time and money?
And that's what we're focusing on in today's episode. I am joined today by our own nurse practitioner and we are using our boots on the ground experience taking care of women to share with you what we actually see working. So when a patient comes in and says, I tried this, we always ask them, did it work? And so we get to share all of that information with you. We're also sharing our clinical experience of what we recommend and how often we see it work.
You will not want to miss this because this is really what gets you those effective results that you're looking for. Jen is our nurse practitioner who specializes in perimenopause, menopause, hormone replacement therapy. She is certified by the National American Menopause Society and really stays current on all of the latest information, the latest and greatest we have around midlife care for women. And so we are gonna share with you all of our pearls today. Really, this podcast is for you.
That's the point of doing it. So if you like this type of episode, if you'd like to hear more like this, please leave us a comment wherever you listen to your podcast or send us a DM on Instagram. However you wanna get a hold of us, we'd love to hear from you. It's important to make sure that we are giving things enough time in general. We need, like, two to three months for the maximum benefit of our hormones.
It's a little bit different than functional medicine. But I also think that the reality of timing, it it really needs to be addressed and making sure that we we all have the same expectations, you know, with our patients and and providers as well of of when things should start working or maybe we need to try something else or maybe we need to go to the next layer. Alright, Jen. Are you ready for this? I'm ready.
I'm glad you came in. It's it's more fun than talking to myself, so we're just gonna have a great conversation. Jen and I have lunch together every day, and this is essentially just what we talk about. So let's start first talking about what works when it comes to weight loss. We don't wanna spend too much time talking about weight loss because we've done other episodes and we have other resources for weight loss, so check our website if you're trying to lose weight and you need any online resources, but, really, when I actually see patients, there are things that consistently work and things that consistently don't work.
I would say when patients come in having tried keto, for example, it works, but it doesn't last. They have a really hard time coming off of keto, and then they regain the weight. So I think there are times when that can work, but I wouldn't put that, you know, front and center. I would say macro counting usually does work, and if it doesn't work, oftentimes, it's because they need to tweak their macros or because there is something else going on. So it can be a really nice first step to say, I counted macros and the weight came off, or I counted macros and the weight didn't come off.
And that can give us guides to look for other things that may be causing weight loss resistance, like thyroid disorder or hormone imbalance or high cortisol levels or inflammation or something else that's keeping the body in that stuck state. So macros are an okay way to start. I do find they're very difficult for people to maintain. I have lots of patients who count macros consistently for years, but I have more patients who count macros for a time and then say, like, this just isn't sustainable for me. So Yeah.
We'll put that in the category of works, but is is difficult to sustain. Yeah. Absolutely. And that's been my experience with my patients as well. They say I tried it, didn't really stick with it, didn't really love it, or maybe it was triggering for them.
So not a good thing to do. Now I do think if you are thinking, okay. I really wanna get into my food and fix my food and fix the macronutrients so that my body is has what it needs in the right balance, then I would do do it with someone. We have a dietitian. We have a couple coaches, and they can help you through that.
There's also a lot of online programs that really teach you how to count macros, and I think there's something to be said for that. So I wouldn't say don't try it. I would just say it is difficult for some people, and if you are going to try it, I would do it with help because it is it's just a big change. It's a lot of energy and and mental energy put on food and measuring and weighing and all of that. Yeah.
And I think it's also hard to navigate on your own, especially because you're you're taking in so much information. What should I eat? What should I not eat? How much should I eat? What time should I eat?
And it's really hard to kinda figure out on your own, and it can feel overwhelming and then just it's easy to just kinda give up in that sense. Yeah. So I think working with someone at least to help create little actionable changes is is a great option for people. Yeah. Yep.
Exactly. And I will say our health coaches do really well with weight loss. I think they get really good results. It's slow, but it's sustainable, and it teaches people what their body actually needs. So I I think that can be what can work well too.
Jen, you see a lot of our perimenopause and menopausal patients who come in, and one of the things we see all over the Internet is that you're probably not losing weight or you're gaining that belly fat because your estrogen level is low. Right? Mhmm. And so what is your what do you tell people when they come in and they say, I can't lose weight. I think it's my estrogen.
Yep. This is something I see quite a bit, and I would say it it's more of a conversation than just it's estrogen. Yeah. Estrogen giving someone estrogen, giving them estrogen back through a patch or a cream is not gonna cause weight loss. It can kind of curb weight gain because it can help support metabolism, but it's not gonna cause weight loss.
And I think Sadly. I know. I wish it did. Yeah. Yeah.
But I do think that it's it's an important component to our metabolism health and then also helping with that visceral fat because that's what's dangerous, and that's what we wanna wanna really try to, hit when we were talking about weight loss. Yeah. Yeah. I do think we see people come in gaining weight as they go through the late stages of perimenopause and menopause. And when we put them on estrogen, like you said, I do think it can curb that weight gain, and I think it can make the body respond better to your efforts to lose weight.
So I think it can make your body, you feel better, and that's always easier to eat well and exercise when you feel better. And actually the metabolic health is better. So it does do some things to help your body, but I I wish it was true that when you start estrogen, the pounds just fall back off, and that's that that we would put in the doesn't work category. Yeah. Absolutely.
I think another thing also with my menopausal patients too, or in this transition is is maybe they've gained weight, but they haven't changed a single thing. Their diet hasn't changed. Their exercise routine hasn't changed, but then they still gained weight. So then maybe we tried exercising a little bit harder and eating a little bit less, and still they've either kept gaining weight or they haven't been able to lose weight. And I found that that definitely can be estrogen.
We don't we lose that, helpful metabolism hormone, but also at the same time with that, we're not being we're not getting our nutrients. You know? My my find that my patients aren't as nourished, and then that makes it really hard to lose weight when we're not nourished. So Yeah. And I would say, you know, from a nourishment perspective, again, what I wish was true is that if people get everything they need, they get enough protein, enough fiber, enough nutrients that the weight comes off, and I I wish I I wish that was true and it doesn't.
But I will say, and we'll come back to this later for fatigue, when people get the nutrients they need, they sure feel better. And and it it I do think it decreases inflammation, and I think it makes your mood better. I think it helps you sleep better, and all of those do help your body be more responsive to your efforts to lose weight. So I wouldn't put nutrients per se in the successful weight loss category, but I do think as you support your body, it can help your body lose weight better and feel better Mhmm. Too.
Yeah. Absolutely. Now this one is a good one to talk about because this one comes up all the time is these medications. Right? GLP one agonists and and the GIP agonists.
GLP one GIP is tirzepatide or Manjaro or Zepbound. Right? And then the other one is Ozempic and, semaglutide. Yeah. So what have you seen do you wanna start what have you seen with these medications and weight loss?
I found I use more Tirzepatide, and I would say people really like them. They people feel really good on them. So it's it's hard to, to kinda speak out against them. I get I think that there's different ways that we should do it. And and my philosophy is always if we're gonna be taking medications, we have to be eating what we should be eating.
So we have to be nourishing our body and we have to be moving our bodies. Mhmm. I think that in conjunction with the medications and with the lifestyle, it can be really, really effective, and a lot of people can feel really good on them. Yeah. I agree.
We started I started using these maybe two ish years ago now and started with semaglutide, which was more, it may have even been the it was the front runner at the time, and started with semaglutide according to the conventional dosing of weight loss, medical weight loss training and did have some success with that with patients. And then when tirzepatide stepped forward, I started transitioning more people to tirzepatide. And, really, I have some patients still who have done very well on semaglutide, but I have more that have developed a lot of side effects, some nausea, some constipation, some some GI grossness with the semaglutide, and also more patients who plateaued on the semaglutide, and when they transitioned to the tirzepatide, really experienced a lot of weight loss. But I do wanna talk a little bit more about this, because, tirzepatide in the works Yeah. Category.
I would put it in the in the gets results side for, weight loss, and but I have learned a lot and changed the way that I dose it drastically. So the starting dose is usually, depending on on the formulation, it's usually two point five milligrams. And I will now start patients at one milligram or less, So starting at point eight or one milligram per week. And what we're finding is these these really wonderful benefits for a lot of people are decreases in inflammation. So people will say right off the bat that my rings start to fit better or Mhmm.
That ankle swelling that's been annoying, that will start to get better. Some people notice improvements in mood before they've lost any weight, and they say, oh, it's just because I was worried about weight all the time, but they're noticing improvements in mood before they even lose the weight. They're also seeing improvements in energy, improvements in brain fog sometimes. Oftentimes, they will notice that sugar cravings or cravings for alcohol go away, significantly or all the way, And then we are seeing these tiny little drops in appetite and also decreases in food noise, which is what a lot of women really appreciate, especially if they've been struggling with weight for a long time and they end up thinking about food and thinking about food and, you know, what should I eat? But I'm hungry, but I shouldn't eat that, but I want that, but I shouldn't eat that.
You know, this this guilt and this shame thought process that comes up is it can be pretty all consuming for our brains. And a lot of people will say, I feel like I got my brain back. You know? I feel like I can just, oh, I'm hungry. I want food.
I go and eat food, and then I don't think about it again until I'm hungry again. And those are those are really wonderful benefits. So like you said, I don't put it in the magic bullet category of, like, everyone should be on these medications. I think of them more as a step stool. Mhmm.
If I have patients who feel like their weight is like they're stuck in a pit when it comes to their weight, and if I, as their doctor, just keep telling them, you know, you'll feel better if you're not in this pit? And they look at me and they say, right. I got it. Yeah. Like, I know that I would have gotten out of the pit if I could get out of the pit.
And I think a lot of times as doctors, we we use that, like, well, you should diet and exercise, and then, you know, you wouldn't be in this pit anymore. And at some point as a doctor, I really enjoy the opportunity of giving someone a step stool to get out of the pit, you know, to say, well, maybe I can get you out of the pit, and then you can do what you need to to stay out of the pit. And that's where using this this medication to decrease the the busyness of the brain, decrease the, food noise, decrease the sugar cravings Mhmm. Decrease the appetite just a little bit, and also then give you energy back so you're you're able to go do the exercise and do what you need to do to have it be effective. It can be very, very effective, and I do think that people can come off of these medications sometimes.
We have had some success taking people off, but that's a longer conversation, so I don't think it's a magic bullet. But for someone who's really, really stuck, man, it sure can be really effective. Yeah. And I think without when when I dose it low like this, I'm still able to get really good results with patients with almost no side effects. Constipation is the the naggy one that sometimes creeps up, but really not looking for headaches or nausea or, vomiting or anything like that.
Mhmm. And I would also say along those same lines that a lot of the data that we have showing risk in these medications is at really, really high doses. And so as we're using these lower doses, people really do feel quite good. I'm not saying everyone should go out and start them, but for people who really feel quite stuck, I think it can be really beneficial, and it will be really interesting to see over the next coming years these other there's lots of other small studies going on right now looking at benefits of lower doses of especially Tirzepatide and some some newer medications similar to Tirzepatide, looking at improvements in early stage dementia, cognitive health, depression, anxiety, autoimmune disease. Mhmm.
There's, kidney health. There's a study showing improvements in kidney health with these medications. So I think, I put it in the works category, and then we'll kind of see how it evolves. It's also kind of fun too. It's like, what what can what's gonna get better, I think, when we start these medications?
It's like we kind of it's a little bit of a mixed bag. Like, okay. Yeah. When it comes to weight, that's a little bit more we were Consistent. Yeah.
It's a little bit more consistent, but other things like, oh, my back pain's feeling a little better. I I had someone say the other day, and I'm like, oh, that's great. Yeah. Exactly. The knee pain or I've had plantar fasciitis go away.
I've had a few patients with plantar fasciitis that went away, and it is it's really nice to see these these, anti inflammatory effects. I think they're really nice. Mhmm. Absolutely. Awesome.
Now along those same lines, what about these weight loss supplements? There's all sorts of supplements out there that are saying they mimic the GLP one medications that say they are GLP one agonists of their own right, mostly plants or herbs, to support these GLP one receptors. I will say I have had a couple patients say that they've had benefit there. I don't think they're anywhere near as effective as the medications, and I think a lot of them are riding the coattails of these medications price wise. You know, a lot of them are pretty expensive.
What we're really looking for with these supplements would be a little quieting of the food noise, a little quieting of the sugar cravings, and then sort of return to normal of the appetite. A lot of us have a bigger appetite than we should. You know, you sit down and a group of people having pizza, and you feel like, gosh. I could literally eat six pieces of pizza, but there's no chance that my body needs six pieces of pizza. Right?
Our our hunger and satiety cues are a little bit messed up in a lot of us, and so that's where, in theory, these GLP one supplements as opposed to medications, that's what you would be looking for is does it cause some sugar craving, some lowering of the sugar cravings? I can't say that I've been super blown away by any. We've used here, the Orthomolecular Hyphenolic. I've heard of some other smaller brand names online, and I have not found consistency in them. Yeah.
So I do think they can help some people. I think sometimes it's placebo effect, and it can help with sugar cravings a little bit, but I haven't seen it to be nearly as consistent at least as the medications. And I would say, like, dropping actual pounds. I wouldn't say that it is it's definitely not as consistent there. When it comes to supplements, I like to look before I start recommending them to patients, I like to look at labs Yeah.
To be sure, like, are we sure we're hitting the inflammation portion of this or or nutrients or maybe it's an iron issue. So really looking at, you know, what's actually going on within the body. If if it's an insulin resistance, problem, then kind of hitting that with supplements rather than Yeah. Using specific supplements or steps or lifestyle changes to target that personal that body's deficits, you know, instead of just sweeping, like, maybe this will work for you. Yeah.
Yeah. Exactly. Let's go on now to what works in terms of different types of exercise or different types of movement. I would say one of my favorite types of movement is actually sprint interval training. So I think this is not where people start, and it's not where you have to start, but this is one that I would definitely put in the category of works.
Mhmm. So it can be really helpful for metabolic health. It can be really helpful for energy. It can actually be helpful for endurance even though it's sprinting. It can be really helpful for building muscle and for weight loss, actually.
And so this type of sprint interval training is where you sprint all out 90 to a % of your effort for thirty seconds, and then you're slowing it down for I say two minutes, but it depends. Some people will do different intervals there. But so you're doing full out sprint, then a full rest. And when you do that, you repeat it just four to six times if you're doing shorter intervals, maybe a a few extra times, up to 10 at most, where you're just doing these little tiny spurts and then rest and then sprint again and then rest. And those can be super efficient.
If you only have ten minutes for a workout or twelve minutes for a workout, it counts. Yeah. It's a very effective way. So that's one of my favorite Mhmm. Types of exercise that I I think really works.
I think you really get results with that two to three times a week. Yeah. And it really helps with metabolism as well. I've been doing quite a bit of research on how can we best move in the menopause transition or in midlife. And this one I've been reading has been really beneficial for a lot of women.
So and I've been trying it myself and sprinting for the first time in a couple years definitely can be sore, so be mindful of of how hard you're going in that that 90. Yep. Exactly. Another type of exercise that I think we hear all about on social media, but it's worth putting in the works category, is strength training. We need to build muscle.
We need to be stronger. We need to lift things. We need to bend over. We need to to be able to maintain our strength as we age to avoid frailty. We won't go into all the science, but it absolutely is in that works category of lifting and building muscle and continuing to move our bodies, not just as we age.
You know, I'm in my forties, and you're younger than that. But I think even just at any point in life, you've got to be building or else you are not building. You're you're not shrinking, but you're getting more frail. Mhmm. So we wanna make sure that we're actively staying proactively staying healthy.
Mhmm. Absolutely. I think another big component too is for bone density is jumping. Mhmm. Jumping rope, skipping, box jumps, however we can, to really put some pressure on our bones Yeah.
And help them, really bend without breaking that, you know, the tensile strength of the bone, I think, is really important to make sure that we're working as well. Yeah. And that can actually reverse some some phases of osteoporosis. You can actually see improvements with it. Mhmm.
Yeah. I'd also put walking in that works category. I'd say, it it's good for everything. You know, the less that we sit, the more that we walk, the better. But walking is so nice to be able to do it with friends.
You can do it with a podcast. You can do it with silence and sort of a meditative walk. Yeah. You can do it in nature. You can do it in a treadmill.
Like, it's so versatile, and it has so many benefits. So definitely goes in the works category. Absolutely. Is there any type of movement that you would put in the doesn't work category? I think all movements could move it.
So I think we do. I think so too. I'd maybe put in the not working, like, maybe inconsistent or, you know, being inconsistent with our routines is where we see people say, like, I've been trying this, and it's not working. Mhmm. I would put that in the doesn't work category is doing things a little too willy nilly.
Now you could still put that in the beneficial side of things because I like you said, all movement is good. But in terms of seeing results Yeah. I think having some sort of consistency in progression is where we're gonna see the biggest results with that. So I'd put inconsistent movement in the doesn't work category. Yeah.
I probably would maybe add two, like, lighter weights. Like, when we're lifting weights, you know, we should be lifting heavy safely, of course. Yeah. But, you know, almost going in two to three until failure Yeah. Is is to to be seeing results, I guess.
Like, if you wanted to build muscle mass in that sense. Yeah. Back in the eighties and nineties, there were all the aerobics videos that you had these little three pound weights, and they were just doing it over and over. And fine. It's good.
Like, do that. But I think that I would put the heavier weights into the more effective category. Yeah. And then the other type of movement that I would put in the doesn't work category would be, too much movement. I do think you can have too much movement.
I think if you're not fueling, if you're using movement as a stress reliever. So I wanna clarify that a little bit because I think a lot of people are like, what's wrong with using exercise as a stress reliever? And maybe nothing, but I would say some people use exercise to, like, get control of their stress. Like, I will drive my stress into the ground. Right?
With every step that I run, I am, like, slamming my stress away, and that's not really dealing with our stress. It's suppressing our stress. It's digging it, pushing it deeper down. And I would say the type of movement that I like for stress release is actually feeling like you're letting go of it. Like, I feel more free.
I feel lighter at the end of this, not I feel like I'm in more control. Right? I think that if we're using movement in that way, that can that maybe goes in the doesn't work category when when we're running our brains out trying to find peace and we don't find it. It's it's nuanced, but I'd maybe question whether that's the best thing. Yeah.
Absolutely. When someone in our questionnaire, one of them is, we ask about stress reduction activities, and if exercise is the only one, typically one of our first goals is finding another way at least that we can relieve stress. Yeah. Because that shouldn't be our only way. Yeah.
For sure. I love it. Now let's move ahead to sleep. So sleep is something we hear a lot about. We hear have a lot of patients who come in saying, I'm struggling with sleep.
I can't fall asleep. I can't stay asleep. What are some of the go tos for works, the works category for sleep? Progesterone. Yeah.
My favorite. Really it works really well. I would say most of my patients get some sleep benefit from it, and then very few of them actually have side effects. I would I don't know. I think progesterone is my is my best friend.
I say five percent of people have some side effects, and we have to kind of work with them a little bit. Yeah. But most of them get benefit. Others maybe don't see the benefit, but but not very many side effects. Yeah.
Exactly. I have to say, my sister went to see her gynecologist for perimenopause this week, and, she asked about progesterone because, of course, I she lives in a different state, so I couldn't help her. But I of course, I gave her the talking points. Like, here's what you need. Like, here's what you wanna ask for.
And I told her progesterone, and she asked her gynecologist, and her gynecologist said, progesterone's a waste of time. It doesn't do anything. And if you go to your gynecologist and they say that, I can almost guarantee you they've never prescribed progesterone because progesterone makes us look, as doctors, as as practitioners, progesterone makes us look so good. Yeah. It makes us look like we really know what we're doing because a lot of people will get so much benefit from it, and they say, wow.
Thank you so much. Well, it's not me. Like, I just I just gave you back what you were were lacking, but I don't know anyone who has prescribed progesterone with any consistency who doesn't absolutely love it Mhmm. As a tool because it's very effective for sleep. It's also effective for anxiety and that perimenopause and menopausal, transition.
But for sleep, taking it before bed. Now we don't use it necessarily for sleep in younger women. It's really kind of, younger women. It's really kind of, perimenopause and menopause. We're replacing that progesterone, and that's one of the reasons it helps with sleep.
Yeah. Exactly. And if I do prescribe it for my younger population as well, but that's usually related to vaginal bleeding. So the reason that we're using it for are a little bit different, but they it still works the same way, and most people feel still feel pretty great on it. Yeah.
And it's not a sedative, but it is very relaxing and very calming. Mhmm. So a lot of people will feel that, like, oh, I am ready to lay down and sleep because I am very calm. Yeah. Absolutely.
And they say I think the data says, like, four to eight to twelve weeks on any hormones we have to wait. But I would say progesterone is one of the ones that I'm like, you could feel a little bit better a little bit sooner, which is nice. I tell people a week though. Yeah. Yeah.
What are your other go tos for helping women who are struggling with sleep? I like magnesium glycinate. I think it works really well with progesterone. I don't know how well it works on its own. I think it's a little bit hit or miss.
Yeah. Some people it does amazing things. Yeah. Yeah. Exactly.
But then with progesterone, I think it works really well. And then, another thing that I also like is we have something here called cortisol manager and I found that it's worked really well for my patients that have they come to me and maybe their anxiety is is crept up more than it ever has been before. And this is a great one. I think that they they're sleeping better and also their mood is a little bit better too. Yeah.
I agree. I love Cortisol Manager, and it's it's just a random, like, blend. I I I don't know how we came across it, but, it it's a smart blend because it adds it adds a little bit for anxiety. It has an adaptogen, ashwagandha. It has l theanine, which we'll come back to in a minute, but that can help relax the brain.
So if you have a hard time turning your brain off, that can be really helpful. And then it also has a couple more calming, combinations. It has magnolia and passion flower, which leads me to my next, which is just passion flower tea is one of my favorite things for sleep. It's mild. It's not gonna knock you out, but I love that for I have a passion flower tea that's blueberry and passion flower, so it's very fruity, which is kind of the only tea that I really love.
So I brew it double. It tastes like juice. But that passion flower can be really relaxing, and I think you add to that a little ritual of some loose leaf tea and, you know, brewing your tea and sitting there and just waiting for it to be ready and then having your hot beverage. Like, I think that ritual combined with the little relaxation that comes with the passion flower, that can be super effective as well. Mhmm.
That's a great point. But tell me, when do you tell your patients to drink this? Because I have a hard time sometimes with, I'm waking up in the night to use the restroom. Yeah. So I I have a hard time sometimes recommending teas or even just ingredients has their nighttime relaxed, which I think works really well.
Yeah. But I also don't wanna increase liquids too late in the night. Yeah. I think it just depends. I think a lot of people don't struggle with it, but if you do, then, yeah, you you should find a different Mhmm.
You should find a different routine that's not gonna make you have to wake up and pee in the middle of the night. Yeah. Yeah. I agree. That's a good point.
And then when it comes to routine, I love circadian rhythm balance. I think this is really important. Yeah. Explain how we do it. Yeah.
So what are what we're looking for for our circadian rhythm is making sure that our internal clock, basically aligns with the outside world. So what I like to talk about is when the sun goes down, we really start to dim those lights. We, you know, we we draw our blinds, we dim the lights, and we start to limit screen time as well. And then I like about an hour before bed to have my patients start to create a routine. Doesn't really matter to me what it is.
It could be stretching. It could be reading. It could be journaling. It could be brain dumping to their partner. It doesn't really matter to me what it is.
Mhmm. But at least an hour. And then we're really at night, no light because that can suppress melatonin secretion. And then Or red light if you Yeah. Yeah.
Or red light. And then trying to limit noise as well. So some people do they they like to fall asleep to the the Calm app, but, I like no light and no noise. And then when the sun comes up in the morning, you know, we open up all the blinds, maybe we go for a walk, we get bright lights to the eyes right as the sun comes up. And then I also think there's something to be said about watching the sunrise and the sunset.
Mhmm. The colors of the sunrise and the sunset can just help help our brains kind of, okay. We're awake. Okay. Now we're winding down for for the night.
Yeah. Yeah. I think that's exactly right. I think so going back for sleep in the works category, I would put progesterone. I would put magnesium glycinate.
I would put cortisol manager or other similar formulations. Adaptogens like ashwagandha is are are in there, but, certainly, you could do that separately. Different herbal formulations like Passionflower, Magnolia, Valerian is another one. Hops is another one. Mhmm.
So there's plenty of different formulations that have those herbs in there, and then also that circadian rhythm balance, I would put in that works category. I would say if I was gonna have a third category of works but is annoying, I would put maybe circadian rhythm balance in there. Not annoying, but it's it's not easy to do. I think it's hard for me to turn my lights off, and it's hard for me to set aside that time, especially because that is my time, you know, away from work and away from kids, and that's kind of that time that I have to decompress. And sometimes our decompression is through watching a show or through, scrolling, heaven forbid.
I'm I'm it's I am big at scrolling at night, and I I'm working on it because I do think it gets in the way of everything. But there is a hierarchy there. I think having, you know, I think having all of those circumstances is wonderful, and we should strive for that, but I would experiment and find what works best for you. I think that dipping the lights and kind of we call it at my house, putting that putting the house to bed is what I'll tell the kids. Oh, it's cute.
It's like, what do we do just to kind of get ready to calm down? I think that can be helpful. And then there is a hierarchy to different types of lights. So our phones are the worst, because of the amount of blue light, but also because of the way we interact. So it's super quick and scrolly and and flashy and lots of information rapid fire, whereas an iPad has a a little less, and then a TV screen is gonna be a little bit better, partially because we don't interact with it.
So if you are going to, you know if you can't completely get rid of screens at night, could you watch a show or something relaxing instead of scrolling on scrolling the the news and the politics right now on social media? Definitely. And I also recognize too, there's plenty of people that work night shifts. I worked night shifts for Yes. For years.
So I do rec circadian rhythm isn't isn't everything. It's rough. But, but it I I still put it in the works category. It is very effective. It's just tricky to do.
Yep. Absolutely. The other thing that I would put in that category and I will say if people have trouble sleeping, there are really good resources for sleeping. I mean, sometimes it takes a while to get through which one works, but but we can usually get people sleeping. One of the things, we talk about magnesium glycinate, but glycinate is the glycine portion attached to the magnesium.
You can take glycine. You can just take glycine. That can be really helpful for sleep. Tart dairy juice is not my favorite. I haven't found it to be super, super effective, but some people will find that to be helpful.
And then I would also put, cognitive behavioral therapy. So CBT there are CBT programs specifically for insomnia. Mhmm. And they're retraining the brain's approach to sleep, and those can be very effective, for really terrible insomnia. I think where I think progesterone or magnesium are where people say, like, this has evolved in the last handful of years, and I can't turn my brain off at night or I just lay there awake.
Like, those are more, where I see those being in the in the works category. Yeah. Yeah. Anything that doesn't work? Oh, anything that doesn't work for sleep.
I will say I have some patients that when they're trying to get to sleep, they turn on an audiobook or a podcast. Mhmm. And I I do think it can work. It can bore you to sleep. Yeah.
But it's not my favorite because I really think we're aiming for less stimulation. And I think that boring yourself to sleep, it I think you're more likely to wake back up at some point. I think I would rather address some of the issue, which is, is your nervous system dysregulated? Is your circadian rhythm dysregulated? What's going on there that we can really work with?
So if some if it's working for someone, I won't tell them, like, you better stop that. But I wouldn't put it in my favorite category. It's sort of in the works category, but I'd put it a little closer to the doesn't works category. I would also put sleeping medications in that doesn't work category. Like, using Benadryl to fall asleep every night is I guess it shouldn't be the doesn't work category because it does work for a lot of people, but especially Benadryl can be associated with long term cognitive changes.
We don't really like that. Some of the heavier medications, like Ambien, they can be very difficult to get off of, and you can become a little bit tolerant of them, so you have to use higher and higher doses. And I also think that the sleep quality is not as good when you're on those medications. I don't think it's as restorative sleep. And then if you do go on a trip, you can't sleep at all.
I it's just not my favorite. I totally understand that some people are on them, and we do try to get people off of them. And they're not the worst thing in the world. I'd rather do that than not sleep. Yeah.
Exactly. Think we should be terrified of them, but it's never where I start with people ever. I mean, I I will have tried five or eight things before I recommend a sleeping medication Yeah. Unless someone is really struggling. So, occasionally, postpartum or mental health where it's just like, oh, we need sleep.
Like, this is not going well. This is spiraling out of control. Sometimes you do just sedate someone. You say, we will get you to sleep Yeah. With medication so that you can sleep and start to heal, and then we'll try to come off it.
So sort of in that doesn't work category. Yeah. I think kind of in the sort of doesn't work also is melatonin. Just just based on patients, reporting, like, patient experiences. With you.
Now some people call will tell me, like, I'm sorry. I take melatonin. Like, I don't care if you take melatonin. Yeah. I have zero problem with it.
In fact, melatonin has studies showing lots of good benefits for what we call oxidative stress. Yeah. Yeah. And we use it in fertility. We use it with antiaging.
So there melatonin is an interesting little ballpark, but I haven't found a lot of people I don't really recommend it very often because I haven't found a lot of people who are like, oh, that did it. Yeah. That really did it. So maybe the people who are having benefit from it don't come see us for additional help. So I'm sure it it does work for some population of people.
I will say, though, the data shows that lower doses of melatonin usually help more with sleep than higher. So, oftentimes, the adult dosing is, like, five to ten milligrams, and, oftentimes, people, when they take point five to three milligrams so you have to take the kids' gummies and vitamin half sort of thing. But sometimes those will work better than the higher doses. Yeah. I think I read too, like, we don't really need more than three, yeah.
For anti aging and for oxidative stress, we're using higher doses, but for sleep, yeah, the lower dose. Yeah. Yeah. Okay. Well, next up, anxiety and mood.
So what are the things that you see working really well for people with for women with anxiety? First, I we address nervous system regulation. So what are they doing to cope with their stress and kind of what what are we doing to wind down when we when we're feeling anxious? So always looking at those kind of things first. And I think there's two parts of that.
I think we talk about saber tooth tigers. Right? Like, what what is your interaction with saber tooth tigers today? Are you chasing a bunch of tigers? So part of that is can we decrease the number of tigers we're interacting with?
Can we decrease the stressors in our life? So if you're super anxious because you're listening to the news all the time, it's complicated because maybe you wanna follow the news. But for example Yeah. Could you cut that out? Like, could you could you cut that part out of your life?
If you have, you know, I'm trying to think what people you can get rid of in your life. If you have a coworker who's super obnoxious or who's causing a lot of stress, maybe that's the time that you change jobs or change departments or, you know, whatever it is. Is there some way that you can just decrease the amount of stress that you have? Very often not. Right?
You can't get rid of your children, can't get rid of your spouse, can't get rid of your boss usually. So we will acknowledge that that's not the only answer, but I think it's the first answer is what stress can you lower? And then on the other side is how do you cope with your stress, and can you improve that? So when we talk about nervous system regulation, that's sort of the first two steps that I think about is decreasing stress and then coping with stress. Yeah.
Absolutely. And then when it comes to things that work, first don't work, I think progesterone can help with mood. Absolutely. Because progesterone's calming in the brain, so it kind of help overall kind of rev you down a little bit. And especially if it's cyclic mood changes.
So for younger patients who have really terrible PMS or, like, PMS, premenstrual anxiety Yeah. I think also in perimenopause, that's one of the main symptoms we see earliest is these this, like, I feel anxious for no reason. Like, I'm just, like, stressed more than I used to be. Mhmm. That's where progesterone can be really helpful.
So track your mood symptoms. If you're feeling anxious only leading up to your period, then that's a progesterone. Yeah. I mean, we can fix it other ways than just with giving progesterone, but, yeah, that's when it can be the most beneficial. Yeah.
Absolutely. I feel like a a little buzzer goes off when they say, I feel like I'm normally a pretty chill person, and then all of a sudden I I don't think I'm as chill as I used to be. Exactly. And I'm 47. Yeah.
Yeah. And then other things I really I found really beneficial is l theanine. Yeah. I agree with you. I think l theanine can be super helpful for anxiety.
L theanine is an amino acid that we get in our diet and we break it down, but many of us either use it all up through our through our anxiousness, or we just don't get enough of it. And it's very safe. It can be used in a really wide range of doses, and there's actually pretty good data of using it in conjunction with depression or or anxiety medications, which is nice because oftentimes we don't have data to combine the conventional world with the holistic world. But this one, we actually do. So if you're already on a medication, we can add that to boost the anxiety support.
Sometimes we'll use this to transition off of anxiety medications, like benzodiazepines, and we can use pretty high doses. And like I said, it's very safe. We don't typically give it during pregnancy because of just no data, but I do think it's really helpful. It also, like we mentioned before, helps with sleep. So we give we start with a low dose, and then we can keep going up.
And then we can also use it for anxiety, in the middle of the day because it's not sedating. So it's calming, but not sedating. And I will say that women with ADHD, maybe men too, but I don't know, women with ADHD often find benefit from l theanine as well, whether it's that calming, the agitation, or whether you know, sometimes the anxiety comes from the distraction of ADHD. Whether it's calming that anxiety or whether it's helping actually with the ADHD depends on the person, but that's that's a really nice tool to have in your tool belt. I think it's also nice too because I'll I'll have patients take it at night Yeah.
And then they can also take it in the morning, and then they can also take it midday. Yeah. So it's it's nice to be like, oh, I I, you know, I have something that's helping me, and I can take it, you know, not just, oh, I have to wait till 9PM until I can take this. You know? So I also think that if we can get anxiety down a little bit Mhmm.
Then we can go back to nervous system regulation and learn how to cope differently and, you know, make those decisions fit in our lifestyle to help. But sometimes it's really hard just to do that on your own if you're already super anxious to be like, well, have you tried meditating? You know, like, listen. I don't meditate. You know?
You'll get that sometimes of, like, it doesn't work for me. So you really want sometimes we use other nutritional support or other, nutraceutical or even medical support to start getting the anxiety down, and then you can really start working on those coping mechanisms to to really make a difference in anxiety. Yeah. Exactly. That's I I use it more as a bridge.
Like, we're gonna get to a place where we can start maybe implementing the stress recovery mechanisms or the the, mechanisms that we use to kinda wind ourselves down. So they're a great little tool. I agree with you. I would also put in the works for anxiety category. I would also put a trial off of alcohol and a trial off of caffeine.
Mhmm. I recommend to almost all my patients that we do a trial for about a month, and I am really surprised how many people will come back and say, I didn't realize how much the alcohol was affecting me. And these are not usually not people who are drinking large amounts, but maybe a glass of wine at dinner, maybe two glasses of wine at dinner, maybe a handful of glasses of wine throughout the week. So it's not super high amounts, but especially as we get through perimenopause and menopause, lots of women will find that it triggers anxiety or it triggers sleep disturbance or it triggers more of a depressed mood. So I don't I don't care if people say, like, I tried it.
Didn't make a difference for me. Great. Don't care. But I think it's worth a trial if you're struggling with anxiety. Caffeine too.
I don't I'm not against caffeine. I think sometimes it actually helps a lot of people, and and I'm fine with it. But doing a trial with no caffeine, I think, can be really informative Yeah. To see if it's actually making things worse. I think that's a really good point.
I like that you bring up the alcohol as well just because if we're not sleeping well, then most people feel are gonna feel a little bit more wound up the next day and not be able to cope with their stress. Anyways snowballs. Yeah. So in the menopause transition, we know that that is a symptom of Mhmm. The transition of call tolerance changes.
So just something to be mindful of Yeah. Especially as an if a night, like, a nightly glass of wine or a nightcap is is a routine for you. Yeah. I also think it's really easy to use alcohol for the anxiety. Mhmm.
And it is the thing that helps you feel calm. And I've seen that run amok sometimes where they realize, like, oh, gosh. I am really using this to cope. And most people will be in tune with that, and once you kind of discuss it and and not really want to rely on alcohol to cope with the anxiety. So that can be a nice having an accurate perspective of that of, are you using alcohol to cope?
Because that can just sort of start to climb before, you know, you're not necessarily a raging alcoholic, but, you know, maybe you're having two glasses and then three and then four, and then you and your husband split split a bottle of wine every night. And, you know, that's pretty easy to get to that point. And, I just don't think people feel the best. And it usually doesn't really work. Yeah.
It works. Yeah. Exactly at ease. Yeah. Hey.
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Your support means the world to us. Now back to the show. Another thing that I like, tapping. I love tapping. I think it's really helpful in acute, stressful situations.
So, like, like, for me, driving like, being, like, somewhere and driving is a big stressor for me. So just kinda tap on my Yeah. So you can look this up on YouTube. There's all sorts of YouTube videos. I think the tapping solution is one of the easiest ones to find.
And you can sometimes add a mantra or add some thoughts to it, but you can also just do the tapping, and it stimulates the parasympathetic part of our nervous system. It kind of forces the body out of that fight or flight and just says, oh, we're tapping. I'm so calm. And so that, for some people, can be a really nice, accessible, easy tool. I found a lot of teenagers are willing to do tapping.
It's harder to get a teenager to do a meditation or even breath work, but for whatever reason, a lot of teens will will do tapping, and so that's a really great tool to give them. They can do it in the bathroom stall at school. You know? They can do it in the car. They're you don't need anything.
You don't have to be asleep. Like, it's very, very nice. Yeah. I had a patient who, developed some flight anxiety Mhmm. While the plane crashes that have been going on, and, she had to go on a flight, and she tapped almost the entire flight.
And she said, I I didn't have a breakdown. I didn't start crying to sell. Yeah. I was like, oh, a success story. So Yeah.
I put that in the works camp. Yeah. I I love that. I would put that in the works camp as well. You have anything that doesn't work?
Something that doesn't alcohol. Yeah. I don't think alcohol works. I would say marijuana too. I think that the with medical marijuana, a lot of people will use it for anxiety.
I just feel like it's a pretty mixed bag. I think marijuana is pretty easy to tip into more of a depressed mood. Yeah. I think that it doesn't have good long term cognitive effects. It can really mess with memory and focus and concentration.
So I'm I'm not necessarily, like, wildly opposed to it in general, but, like, as medical marijuana for anxiety, I think it has some downsides. I don't I I do think it can help with anxiety, but I don't think it's a win win. Yeah. I agree completely. I guess along the tails of that, should we talk about depression, is there anything else I would put all of those same things for depression.
You know, nervous system regulation, l theanine. I also think cutting out alcohol would go in that camp. I think a lot of people find their mood is worse because of that. Is there anything that else that you've said that you've seen work for depression for lifting the mood? I have.
I think the hormone replacement therapy, estrogen, progesterone, even sometimes testosterone can can really help with the fatigue. I think that could be really useful. Yeah. I wouldn't say that I found a lot of success with mood specific supplements. So supplements that specifically attack depression or anxiety.
You know? Yeah. I agree with you. There's some combo supplements, and and I do think some of them can work. Yeah.
I think depression, you really wanna find where the deficit is. You know? Nutrient deficiency? So along the lines of what does work for depression, I would put getting your nutrients in. So vitamin d, b vitamins, enough protein, I think, is really important because protein breaks down to amino acids, which stack back together to make neurotransmitters.
So if you're protein deficient, you're you're not gonna be as effective at making neurotransmitters. I think working on the gut and healing the gut, I would put that in the works category, but I will caveat that to say, in functional medicine, you hear a lot of people say this link between serotonin and the gut, right, mental health and the gut, and I I believe that. It's I agree. But I wouldn't say I have a lot of patients who do a gut rehab and their depression is magically gone. I think it's more complicated than that, and I think it takes some retraining.
I think one of the hard things about depression is when we start to feel a little bit down, then our behavior changes, and that makes us feel a little more down, and then the behavior changes and so on and so on. And so if we're fixing one part of that, then we have to retrain the behavior. So for example, if our behavior makes us more contracted, we're we're not as social, we're not we're saying no to more of our engagements, we're not interacting with people as readily. If we just boost your mood a little bit, but we don't retrain that habit, then that that can keep you stuck. Yeah.
So depression can take a little bit. It can take a little bit of of both boosting both boosting the body and the brain and then retraining a little bit to say, oh, right. Now I can now I'm I'm going to be social because I feel like I can instead of just staying in the habit of not being social. Yeah. And then, of course, I think it's always really important to notice these symptoms in in accordance with your cycle if you're still cycling because sometimes, you know, it could be a PMDD Mhmm.
And, you know, be a little bit more severe depression that that really needs to be addressed. And there's a couple different ways that we can do it either conventionally with birth control or or antidepressants or eat more a little bit more functional with maybe progesterone or or other supplements. So Yeah. I think that that that's important too. Yeah.
Also in the works category, I sort of started talking about it, but just making sure, I guess I already said it. Nutrient, nutrient, nutrients. But iron b twelve, vitamin d Mhmm. Protein, zinc, magnesium, these are all really important. Lithium orotate is another one.
Lithium is a a metal that occurs in the Earth, and, there have been studies showing deficiencies in, the the water of lithium compared to increased rates of suicide geographically. So that can be something that's helpful sometimes. And then looking for inflammation overall, and that's where we look for any sources of inflammation, like gluten sensitivity or celiac or mold or We talked even, about low low too low of cholesterol levels. Yeah. That too has been associated with with depression.
Yeah. And then there is also data about fish oil being helpful. Again, we have data with fish oil plus antidepressants, so that's nice because we can't mix very many things, but that one you can mix. And it's higher dose fish oil, most likely because of its anti inflammatory benefits. And then dietary changes, I would say, oftentimes do make a difference in mood.
You have to stick with them, but they can make really big differences. So doing some sort of elimination trial and just seeing if there's something that interacts badly with you to kick it to the curb, because oftentimes, if it interacts badly with your gut, it's giving you diarrhea or something, it can cause systemic inflammation as well, which can manifest as, depression. And, certainly, when you feel like garbage all the time, it's really hard to feel happy and upbeat. And so depression's more than we can go into here, but I will say there are ways to feel better, absolutely, and and just kind of thinking back to the building blocks. But I don't have a lot of, like, magic darts that are like, oh, everyone with depression Yeah.
Gets better with this. It takes a little bit more more involvement. More involvement, I think, just in more tools, more than just one tool. Yep. Exactly.
Well, let's talk about gut health. We have a lot of patients who come in with bloating and stomachaches and loose stools and constipation. What are some of the go tos that that are can get you some pretty quick results? When it comes to bloating, I really like, digestive enzyme. I think that can be really helpful for patients and then just to kinda make sure that they're breaking down their food and then also making sure hopefully, helping them with absorption as well.
Yep. And then another big one for me, is fiber. Yeah. Making sure that we're actually giving our our gut and our body what it needs. And then, of course, along with that comes the probiotics to make sure that we have the the good bacteria in our gut to break down that fiber so that our body can use it.
Yeah. I really would put all of those in the works category. It is tricky because I don't think it works for everyone. It the gut has a lot of different involvement, and so we have to kind of hit every phase of the the gut to really heal the whole gut, but they're all the right answer. Yeah.
Some of the quicker ones too for constipation, I would say magnesium citrate, and then magnesium citrate, and then magnesium citrate. Yeah. Magnesium oxide can work if you're if it's super stubborn, but you don't get the benefits of the magnesium as well, but it'll get things moving. And then fiber, again, for constipation as well. I think one of the things that surprised me that, you know, you read, read, read, and then you actually get one of the things that we're sharing here is our own experience with patients.
This is not just like a study showed this, but this is actually saying, like, we do this, and then patients come back and thank us, which is really what we want as well. We don't like it when patients come back and say, well, the data showed this would work, but it didn't work for me. We really care about, like, what actually is getting results. And one of the things that surprised me was fermented foods like sauerkraut. So I'm a big believer.
I've recommended it for years, but few people really take me up on it to do it with the consistency that I recommend, which is one serving twice a day. But I have a few patients who will come back and say, I did it religiously. I was having sauerkraut twice every day, and it's really impressive to see how much better they feel. So it's been encouraging to me to to remind myself to to take it in more often because it really is better than most probiotics. Really, you can you can get that through sauerkraut or kimchi or kefir better than most probiotics.
Now there are exceptions to that that we won't go into, but, like, fermented foods. Eat your fermented foods. Throw them in a smoothie. They disappear. Mhmm.
If you use a small amount, it doesn't have to be a large amount of fermented foods. Yeah. So, yeah, definitely, I'd put that in the works category. Yeah. Absolutely.
And I like it too because, I mean, just adding it to your diet. It's not like you have to take an extra supplement because sometimes Yeah. We we end up putting people on some a lot of supplements. And that's not what we love to do, but we want you to feel better. And, oh, that's one that we can kind of x out if you're willing to eat if you if you can eat, fermented foods.
Mhmm. So I put the, bovine immunoglobulins in there as well. There are some different brands and some that are more popular than others, but they really do work quite well, especially for diarrhea for for really loose reactive bowels. They they can help it get calmed down. Now they they're not the end all, be all, and that's where I think people go awry as there's some very popular brands on social media, and I think if we only do that Mhmm.
That's kind of the brands marketed as like, hey. This will fix everything. Just continue it for the rest of your life. I think that's missing the point, but it can get the symptoms calmed down enough that then you can work on rehabbing the rest of the gut. Yeah.
What about, how do you feel about gluten free, dairy free, elimination trials? Do you feel like that actually works when it comes to gut symptoms? Well, I think it's worth a try. I think it's a trial, and that's why I call it a trial and not a diet, because diet brings weird images to our head. I think that an elimination trial should be our own science experiment, and, absolutely, there are some people who will say, like, I feel way better with no gluten.
I feel way better with no dairy. I feel way better with no alcohol or caffeine. I include that in there as well. I have people who don't feel any better, though. I mean, most people, they're also cutting out sugars and they're cutting out processed foods, so most people will feel, like, healthier.
Yeah. You know, like, I feel like I'm doing something healthier. But, absolutely, there are some people who it it is not now it's still a problem. Right? None of us should eat tons of sugar and tons of fast food, but, yeah, there are some people who who don't feel any better with an elimination trial, and that tells me we have to go on and find something else, which is great.
It's a great first step. The other thing I would put in the works category of, gut health is movement and hydration and some of those and stress, chewing, you know, giving meditating, all of those things that calm our body reflect in the gut. And so if we're super stressed, if we're, not sleeping, if we're not, eating at regular routine intervals, the gut really is the barometer for all of that. Like, when the body is doing well, I think the gut responds, and if we don't take care of our bodies in general, then the gut will be the first one to raise its hand and say, excuse me. Yeah.
Not not okay here. Well, let's talk a little bit about low sex drive. Okay. This is another thing we see a lot with your perimenopause and menopause patients. What are some things you would put in the works category for low sex drive?
I would say testosterone usually works, but I would say it's a little bit more hit or miss, but I would say for the people that it works for, it really works Yeah. Which is great. But then I would say I have some people who are like, I didn't really notice a huge difference. And Yeah. So I think that's that's a little bit important, but I would say I agree with you, and I think that testing the level is really helpful there.
The level isn't perfect, so it doesn't exactly correlate. Like, thyroid is pretty specific. Right? Testosterone's not that specific, but most people will feel the best when their total testosterone is somewhere between thirty and forty is what I tell people. So if your level is six or undetectable Yeah.
There's a decent chance that you're gonna feel okay. Now if your level is 35 or 30, are you gonna feel that much better? I don't know. Yeah. But I agree with you.
I think it's fifty fifty even for the folks who are low. Some of them say, like, you changed my life, Yeah. And others say, like, I don't notice anything. So I I love testosterone. I don't think it's, like, the end all be all.
Everyone should absolutely be on it. I I think it's a little more hit or miss, but happy to try it for people because I think that's the only way to know. Yeah. And then when it comes to testosterone too, I think there is a lot of misconception too because it it it it's really safe as long as you're being dosed appropriately. Exactly.
It's it's it's a little tricky when when people are being dosed too high and then maybe they like the energy that they're feeling, but then they're having a lot of negative side effects maybe like acne or hair loss or, oily skin. You know? And I would put that in the doesn't work category is testosterone pellets, although I'll put an asterisk there. The testosterone pellets inherently are higher dosed because they give you a big bolus Mhmm. And then they stay in your in your muscle for three months, and then they slowly the dose goes down.
But in order to do that, you have to get this big bolus dose. And some people feel amazing for a little while, but then they can get hair loss, they can get other issues. So I do think the only, the only circumstance that I really like test that I would consider testosterone pellets is if you've been super stable on your testosterone level. Mhmm. And then you're transitioning there, and even then, I would be a little bit cautious with it.
But I think guessing at the dose with a testosterone pellet is not a good idea. Yeah. And I would definitely put that in the doesn't work category. Yeah. Absolutely.
I agree. What else do you put in the does work category for sex drive? I think some homeopathic tinctures. I think they're still a little hit or miss, though, too. Put it somewhere in the middle.
Yeah. Yeah. Somewhere in the middle. And then there are some medications, Addy or Vyleesi, but we haven't been able I haven't had a lot of people try them because they've just been hard to get covered and they're a little expensive. But I think the data has been has shown that they're pretty effective.
I just I mean, I I haven't had a lot of patient experiences. But if you I agree with you. They're they're a rough sell for me because the data is the data is consistently okay. Mhmm. So it's consistent that the results are okay.
And I don't think they're super risky. I think some of them are annoying. Like, the Addy is a daily medication, but I do think it can work. So for someone who who has access to it, whose insurance will pay for it or they get a reasonable price on it, I don't think it's a bad thing to try. The data shows that it increases the number of pleasurable sexual experiences by two to three per month.
So if you're having zero per month, then that two to three sounds okay. If you feel like your sex drive is low, but you're having sex four times a month Yeah. Or four times a week, then that might may be less of a worth it sort of situation, but I think it's a reasonable thing to try, especially if your insurance pays for it. I think Vyleesi is the same way. The the nicer thing about Vyleesi is it's just as needed.
Yeah. So if you're only planning to have sex every occasion, then then you can use it at the time. Mhmm. The downside, it's an injection. Yeah.
So some people get spooked by that of, like, giving yourself an injection to go get ready for sex, but, but just like an hour before. So there's a little bit of timing involved with it too. So Yeah. It could last a while. Yeah.
So you could you could kind of get ready. Definitely. But I'll put that in the works category, but I do think the cost of it is a little bit annoying. It's a it's a little bit more difficult. There are coupons and there are ways to get it from the company that are a little bit more affordable, so you have to play you have to dance around it a little bit, but but I I do put them in the works category.
I put estrogen there too. Definitely. So we think about testosterone. Some people will get big improvements in their sex drive with estrogen, some not, but some definitely do. And then I would also think about when we think about low sex drive, I would really think about the experience of sex.
You know, if it's a miserable experience, chances are it's not gonna help your sex drive, so I put vaginal estrogen there. If you're, having a lot of vaginal dryness as you're aging, but not just aging. There's lots of people who have vaginal dryness for low estrogen, like postpartum Yeah. Or, for other women whose estrogen may be low, who are struggling with their periods. Vaginal estrogen is very safe and very effective for vaginal dryness, and if you can avoid vaginal dryness, then that's not gonna hurt your sex drive.
That's gonna make it at least easier to to want to have sex if you're enjoying it, and I would also put in that category of a sexual lubricant that you like. I really like kokanoo. It's a really good sexual lubricant. It's a really nice consistency, and you don't have to worry about sensitivity to the skin or any gross ingredients. We looked at, some of the ingredients of some of the other lubricants the other day, and we put them through the, EWG app to really look at each ingredient.
And there is a startling number of terrible ingredients and sexual lubricants. You apply it directly to the vaginal mucosa, the the vaginal skin, and that absorbs really, really well. Mhmm. So it's a little bit it's a little bit scary to think that there are Yeah. Lubricants that have gross stuff in them.
So I really like Kokanoo for that, and anything that you can do, including vibrators or talking to your partner or really understanding what is it that I don't like about sex. Yeah. That can help with sex drive. If it's an unpleasant experience for you, it's not gonna increase your sex drive, so really looking at the experience there. You should talk about, gas pedal, brake pedal.
I love I love your analogy. There's a really great book. It's called Come As You Are, and it's by a sex scientist, and she uses analogy that I really find helpful. She talks about the gas pedal and the brake pedal, so really thinking about your sexuality. What might be keeping you from putting more gas on the gas pedal and then what might be putting too much on your brake pedal.
So brake pedal is a little bit easier to think about. It would be pain is a big brake pedal. Right? I think prior unpleasant sexual experiences can really put the brakes on. Fear tension stress all of those are gonna just lists yeah many things go here I tell people you know if your husband didn't help with the dishes that night that's gonna be a big old break pedal if there's something that bugs you in particular like if there's a you know, he uses a cologne that you don't like, and he he thinks he's doing great every time, and every time you're like, oh, I hate this.
Those are all big brake pedals, and you might not even notice that that those are that big of a deal. But if you can stop and think, what is, like, slamming on my brakes? And then the gas pedal would be things that, really, you can add more fuel to the fire. I would put testosterone there. I would put, estrogen there.
Yeah. But I would also this is sometimes hard for us as women. I think, stereotypically, men grow up feeling more sexual. Now that's, of course, not at all true across the board, but that's the stereotype. Right?
Men think about sex all the time, and women never do. Mhmm. Well, that's not true at all. But if you are a woman that feels like you don't know what pushes on your gas pedal, then that might be good for you to do some either talking to your partner, talking to a sex therapist, talking to girlfriends, and say, like, what do you do? Yeah.
A lot of us don't necessarily have endless amounts of things to try to find the push on or gas pedal. Yeah. And so it can be helpful to talk to other people and say, well, I did this, or I like this, and really just seeing what helps with that. That can be with regards to sexuality, but it can also be everything around sexuality. So that could be maybe you like to feel sexy and like lingerie.
Maybe you hate it because you're cold. You just wanna figure out what what does it for you. Yeah. I think as part of that, it's understanding your relationship and understanding your interaction with your partner. And so going back to, like, the grocery list, or does your does your partner help with the chores, or does he stimulate you in a way that you don't like?
Yeah. Well, if if that's the case that that's not working for you, what do you want? Do you want him to send you a sexy text message earlier in the day or compliment you or touch you in some form of intimacy more consistently? I think I've I've heard this from a lot of patients of, like, there's no touching and then there's sex. And for women, we often need more touch along the way.
Right? Mhmm. We need to be touched on our lower back while we're washing the dishes. And, sometimes we see I'm just thinking of a funny funny video that I saw, but it was it's this idea of very frequently the man thinks he's being romantic, and he'll, like, come up behind and grab your boobs or, you know, come up behind and do something, and you're like, woah. That doesn't necessarily feel as sexy to me.
But for men, they think they're really doing it. So your relationship may be different, and the key is to say, what really works for you? If that doesn't work for you, then what does? Don't just say, well, that doesn't work for me. Well, what do you want?
What do you want? And that's where things like vibrators, I would definitely put on the gas pedal side. There's lots of things to think about there. I think timing too can be helpful. Yeah.
Like, what what time of day, you know, if you at the end of the day, if you're exhausted, no one wants to. You know? Yeah. Absolutely. I'll also put in the works category for sex drive.
One of the most effective tools that I've found is timing or planning sex. Yep. This sounds very unromantic, and it's not for everyone. But for some people that feel, quite disconnected with their partner where maybe they have very different levels of sexual desire, it can be this constant background stress of he always wants to have sex with me, and now I'm just constantly, like, I don't even wanna get close to him because I'm always worried that it's going to turn into sex. Mhmm.
I a lot of my patients will say that. And so by scheduling sex, you can decide with your partner. Maybe it's once a month. Maybe it's twice a week. Maybe it's three times a week, but that in if this is causing you a lot of stress that you can really say to your brain, okay.
Thursday nights. I'm gonna have sex on Thursday nights, and then I can prepare myself. So if that means whatever hygiene you want or if that means getting your grocery list taken care of earlier in the day or if it means getting a babysitter or if it means, you know, going out to dinner and having some romantic time ahead of time. You can whatever it looks like for you, you can kind of create that a little more rather than random sex. It can be harder to do that.
Yeah. The other benefit is, oftentimes, if we're in a relationship where the sexual desire is pretty uneven, then it can actually legitimately cause the other partner a fair amount of anxiousness and a fair amount of stress to say, are we ever gonna have sex again? And so by giving them that, like, we have sex on Thursdays, they may want sex more often than that, but it still can help say, okay. Okay. Well, at least we've got Thursdays.
You know? So it can really help dissolve some of the stress for a little while, and the per the partner who maybe wants sex less can then have those other nights where they don't have to worry about sex trying to happen, and then they're gonna feel bad because they're putting it down. They could have a night where they can put their ugly jammies on, or they could have a night where they're reading a book or watching a show, and they don't have to worry about it. And so just creating those expectations sounds very unromantic but it can really work well and it doesn't have to last forever maybe you do it for three months or six months and then reevaluate and say actually I'm I want some more spontaneity now so this is this is now what we'll do. Mhmm.
It just opens that communication line, which I think is really helpful. Yeah. Absolutely. The last thing that I wanna talk about is just the functional medicine approach in general and what works and what doesn't work. I think in terms of what works, I would say expect slower.
Yeah. Expect more comprehensive. When we talk about doing things the functional medicine way, we have to peel back layers, and we have to kind of get everything pretty right, and that means hormones, that means exercise, that means food, that means sleep, that means nervous system regulation, that means getting stuff out of our body, like toxins that aren't supposed to be there, and that can take some time. It's very effective. I would absolutely put it most of the time in the works category, but you need healthy expectations there because it can be it can take a little while, and it can take some trial and error.
It can take steps of saying, you should feel better if you do this. Oh, you don't feel better yet? Okay. Now let's try this. Oh, you don't feel better yet.
Sometimes you're just fixing things as you go, and it's not until all of the things are pretty well fixed that you start feeling better. Yeah. But I also think it's important to make sure that we are giving things enough time Yeah. In general. Patients come back and, like, oh, that didn't work.
I'm, like, oh, it's only been a month. We need, like, two to three months for the maximum benefit of our hormones. It's a little bit different than functional medicine. But I also think that the reality of timing, it it really needs to be addressed and making sure that we we all have the same expectations, you know, with our patients and Yeah. And providers as well Yeah.
Of of when things should start working or maybe we need to try something else or maybe we need to go to the next layer. Exactly. What doesn't work in functional medicine? I think I would put on the doesn't work side, I would say taking an approach of everything all at once. Yeah.
I think there are some functional medicine providers who do tons of testing up front and then tons of treatments up front, and the body just can't really do that many things at once. So we want to actually have a period of time that we're going through this. Three to six months, I think you can get a lot done in three to six months. But if you're taking if you're treating these complex conditions all at one time, that's it's just too many supplements. I would also put in the doesn't work category.
There's some functional medicine, and I would put hormone practitioners. There's a lot of people out here doing this work now that really don't have a breadth of training. They really have this really narrow focus. And when you see someone with too narrow a focus, they're they only have that tool. So there's an expression in medicine that we use with surgeons, but when you're a hammer, everything looks like a nail.
Mhmm. Maybe it's just outside of medicine. I don't know. But I think that with some, like, hormone clinics or some functional medicine clinics that you'll see functional medicine clinics that only treat thyroid. Functional medicine clinics that you'll see functional medicine clinics that only treat thyroid.
Well, if that's all they treat, then they're gonna keep messing with your thyroid and keep messing with your hormones and hoping that that solves all of your problems. So you really want to find someone who can go with the breadth of information, who can kind of help chip away at multiple problems because, sadly, the body tends to kinda snowball. It tends to have one little problem that causes another that causes another that causes another, and the treatment of that is sometimes to unwind. You know? Okay.
Let's treat this last one and then the one before and then the one before. And so that I've definitely seen some frustration from people who go to clinics with really narrow focus. Mhmm. And if you think that's what the issue is, like, you think it's a hormone problem and they just keep saying, okay. Well, let's tweak this.
Let's tweak this. Let's tweak this. You should feel a lot better on try two. You know? Yeah.
Yeah. Like, it shouldn't take eight tries to get your hormones right. Maybe some tweaking over time, but, like Mhmm. You should feel as good as you're going to feel. I'm I'm saying this with, like, asterisks because bodies are different, but you should feel how you're gonna feel with that after a couple adjustments.
Mhmm. Yeah. Absolutely. I have a lot of thoughts. I I was thinking as you were talking.
I think it's really important to make sure that we're not just saying, oh, this is your problem and this is that we fix it. This is just in general forever for everyone. Because that can be really disheartening when when we think like, oh, that's exactly it. And then it's not that. And then the patient's like, oh, what do I do?
Yeah. Yeah. Well, I have and I've I've had patients, more so when the or the discovery calls. So, like, oh, I've tried this functional medicine doctor and we did everything at once and I'm still not feeling good. So now now what do I do?
Because I tried the I tried the gut rehab where I tried I've been tested for mold and I have mold, but what do I you know, I I don't know what to do now. Yeah. And and they come I think it's a little bit discouraging and it's hard and they really kind of reinforces that I feel broken and no one else can fix me. Mhmm. Yeah.
It's super hard. Mhmm. I would also put in the doesn't work category for functional medicine, but somewhere in there is DIY functional medicine. Yeah. You know, I think when people keep seeing these supplements online and these supplement companies are so convincing Yeah.
And they will say, you know, for this condition, use this. For this condition, use this. For this condition, use this. Or even worse, they'll say, for this condition, use these four things. And sometimes it will work for people.
Sometimes people can kind of bring together their own Internet research and find the right supplements. And I'm not saying this critically because, gosh, I would be doing the same thing for my own health, so I understand why people do it. But it can get really expensive, and just like you were saying, it can get really discouraging of, like, I have spent so much time and money trying to do this on my own, and I don't even know where to go. So I do put it in the doesn't work very well category, but but I do I mean, there's not enough people doing it. There's not enough practitioners doing it.
So I really feel for patients. I'm I'm really proud of the work that we do at Uplift for Her. I think we do a really nice job, as much as we can, of of helping slowly bring people through this process and getting really great results. Mhmm. But I do find myself kind of peeling back layers sometimes that people have DIY ed on their own.
Again, no criticism. I would never sit across from someone and be like, well, you shouldn't have done that. I totally respect that people are just trying to get better. Yeah. And oftentimes, people do come with the right approach.
You know? They've already hit some of the things that I would have them do. But if you're starting with DIY functional medicine, I would start with the pillars. I'd start with the foundations of sleep, see what you can do with what we've talked about with sleep hygiene and turning off the lights and circadian rhythm. I'd start with food and getting all the nutrients you can get.
I'd start with gut healing with sauerkraut, you know and fiber there's lots of things that you can diy on your own and I think those are my favorite patients when they come having done all of those diy on their own I would put that absolutely in the does work work category. It makes my job so much easier when they've said, like, I've already tried a gluten free trial. Didn't work. I tried a dairy free trial. Didn't work.
I'm eating fermented foods. I'm eating plenty of fiber. I don't eat a lot of sugar. I you know, I'm getting sleep. I've done all of these things, and then they tell me this is what's not working.
I love it. Some people are like, oh, they're gonna be so bugged with me. No. Give me all your complaints. Give me all of your symptoms.
Once you've done that, it just saves me so much time. Then I can just dive into the the medicine piece, the piece of, like, do you have a nutrient deficiency? Do you have, you know, mold? Do you have some dysfunction that we need to repair? Then I can just dive into that instead of starting with, like, well, have you tried eating more protein for breakfast?
Super happy to tell you that so if you have an appointment with me don't worry if that's what I tell you but it just saves time these are things that you can do to to you know start feeling better on your own that will make the functional medicine experience a little more efficient Yeah. And that's kind of what we've been doing. I feel like I've I've really been helping patients with foundations, and then if they need to transfer over care to you, then that that's been working, I think, really well for us. And I'd say too, our dietitian and our health coaches, that's what they're really, really good at is starting with those foundations of saying, how much better do you feel if we just do food? How much better do you feel if we're just moving and, meditating and eating and, you know, doing those basics?
And then whatever's left, then let's deal with with your doctor. You know? Let's let's really dive in further. Well, phew. I feel like we have more to go, but but we'll stop there because we're already over time.
But I want people to be able to come to us and say, you know, does this really work? And I think it's one of the biggest differences. You know, there's a lot of people who have research experience and maybe working in a lab, but nothing replaces talking to patients all day every day. And I love when patients share their experience with me of you know, they tell me, like, I tried this thing, and they think I'm gonna be mad. And I'm gonna say, like, well, did it work?
Like, I wanna know if it worked too. So we love hearing from our patients. We love hearing what works. We love hearing what doesn't work. Yeah.
It's really helpful for us if you say, like, I tried that. Here's what the problem was. This is one of the ways that I feel like I have become, hopefully, a good doctor. You know, what I think is a good doctor is I have always made it an effort as much as I could to really listen to patients and say what's working for you and what's not working for you because you our patients are the very best educators we can have because I have now, I don't know, tens of thousands of women that I have helped in some capacity throughout my career, I've learned from every one of them of, okay, that didn't work there, that didn't work there, that's working. I'm gonna put that in my pocket.
I'm gonna recommend that. And then I think what an Intune practitioner would do is then we try it with another patient, and they say, hey. That worked. And we say, okay. Now I've used it for three and four and five and twenty and thirty, and then you really get to have this toolkit that, you can utilize for other patients.
So always share with your doctor. Some doctors don't wanna hear it, but always share with your doctor if something's working or not working, and we will continue to research and continue to try things out. I think we we're always curious and open minded and try ourselves the new tests and the new supplements and the new devices and then we're on the same journey. You know, we're trying to feel our best and age well and be healthy and it's it's really fun to be able to experiment. Absolutely.
Well said. Thank you. Thank you so much for tuning in to today's episode. A huge thank you to our guest for sharing their insights and time with us. We are grateful for the incredible support from our sponsors and to all of you listening.
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