Episode 533: Dr. Amy Shah: What Changes in Perimenopause and How Cortisol Drives Belly Fat After 40

6:18Dr. Amy Shah:I think my biggest thing is that what I didn't realize when I was in training and myself is that there's so many things we could be doing proactively, nutrition-wise, lifestyle-wise, that can help us as we get older. But nobody tells us. There's no handbook. We're basically left to just like guess, look, Google, find people that we think we, that are telling us the right thing. Right. And so it's really, really complicated. Like the menopause thing, the hormone therapy thing, I think has been talked about enough. There's a lot of resources now, amazing resources. Yeah. If you want to take hormone therapy, if you don't want to take it, if you want to know the risks, the benefits, you know, like the whole thing.

6:58Jennifer Cohen:The whole thing. Well, now though, actually, since you, well, you, I want to ask you two questions, but first the black box thing has been taken off. So now there's like not that much of the, well, I still think there's still kind of like a taboo around it. People are still scared, but not as much because of it. Yeah. So we can talk about that. But what I wanted to ask you is given all the noise, why did you write a book? Yeah, because this is what happened.

7:22Dr. Amy Shah:There is absolutely no nutrition handbook for women. Okay. So when I looked at how are we supposed to eat as we age, and we kind of talked about that's a little offline, but we'll talk about online. We actually are changing as humans. And that's a good, it's a good thing, but it is, we have to change our habits and our food to kind of match that. And why is it a secret? Like, why didn't we, you know, when you got a health class and it was like really awkward in 10, you know, when you're 10 years old and like everybody laughed, but at least you started the conversation. What if we had like a class that was like, hey, this is what's happening to your body.

8:00Dr. Amy Shah:Like you should probably eat this. You should probably like change this or you could probably do this. These are some options. Just like start the conversation, but there's nothing. And even in the medical literature, there's nothing. Our menopause books don't have a section on nutrition lifestyle. So it's like, I felt like there was a big hole in helping women in this phase of life in that way. Because I think what most of us are at home, we're not at the doctor's office. We want to know like, what are we supposed us to be doing from day to night to optimize ourselves, our brain, our health. And it's not the same as men.

8:33Dr. Amy Shah:And it's not the same as when you were 20.

8:35Jennifer Cohen:That's exactly, that is true, right? Like everything does change decade by decade, I feel. And what you need today is not what I needed when I was 25. By the way, when you're 25, anything can kind of go.

8:47Dr. Amy Shah:Anything can go, any diet can go. Yes, you get away with murder. Yeah. And like your cortisol is like buffering whether, you know, we were saying like, you can party all night and then, you know, go to work the next day and you're fine and then do it again that night. And your body is like fine, but you try to do that in your forties and you're like, like down for the count or you get sick.

9:08Jennifer Cohen:Well, you know, what you said to me outside was really interesting because I was actually telling, just to kind of like fill you guys in behind the scenes, well, you know, in front now, but, you know, I got my blood work back and I was telling Amy that I was, I was, the people were shocked and I was shocked that my physical stress test was so high, which is not a good thing. The stress in my body is very, very high or my physical stress, but my resilience is what saves me because I was so high on the resilience that it's basically my personality that's pushing through it, but I'm really at burnout, right?

9:45Jennifer Cohen:And then you were saying to me, you asked me a question, you're like, at night, how do you sleep? And I said that I wake up - In the middle of the night. Yeah. I fall asleep okay. Yes. But then every night around 4.30 or 5 o 'clock, like clockwork, I like wake up panic.

10:00Dr. Amy Shah:Like, you know, like kind of like how a baby does when they're like small.

10:04Jennifer Cohen:And you said it's like because the cortisol. Can you talk about that? That's normal you're saying?

10:08Dr. Amy Shah:So everyone gets a little bump of their cortisol at night. But what I see in, and I said high functioning girl boss women.

10:18Jennifer Cohen:Well, thank you.

10:19Dr. Amy Shah:Yeah, is that they're doing all the things and then they wake up in the middle of the night because their cortisol bump is high enough that it wakes them up and almost like in a panic because it's a stress hormone. And it's thinking like you're like, oh my God, am I dying? Right.

10:37Jennifer Cohen:It's like a really, it's scary.

10:40Dr. Amy Shah:Yes. And so what that signals to you is that you have a lot of stress in your life, which you could have said that, but you have to do a better job managing that stress. Because what happens is as we get older, as we move through the hormonal continuum, our ability to buffer the cortisol goes down. And so the same things that didn't stress you out in your 20s or even early 30s start to really stress you out. So the same kind of, you know, those workouts where it's like high intensity training, whatever, you could, you know, maybe in your 20s, I know I did those all the time, like every day without any recovery.

11:20Dr. Amy Shah:And it was fine. Whereas when I started in my late 30s and early 40s, I started to notice like I was like not getting results from that. I was actually feeling like I was like gaining midsection fat. I was like feeling tired. And it's because they raise your cortisol so high. They make you crave like a lot of food. Yes. And then you're like counteracting the calories that you just burned, right? So it's almost like this cortisol cycle that's happening. So we really need to learn how to recover a little bit better. So more nature time, more sunlight, more sleep, more things that bring you joy because that counteracts the stress.

11:59Dr. Amy Shah:Yeah. And that's literally what perimenopause really to me is. It's not the sex hormones, really. For me, it's like we're moving through a hormonal continuum that's changing our brain, our body, and we need to just learn to adapt to it. It's a great time. Like you see all the CEOs and people living the peak of their lives in their 40s, 50s, and 60s, right? So it's not that it's the end. It's just that we have to learn to manage it. Like if you're this successful and this happy and this like fit, you can kind of go to that next level if you understand what's happening. So doing more recovery, like for you, that might look like, you know, any version of - Don't say yoga, please.

12:40Jennifer Cohen:Don't say yoga or meditation. Don't say either one or I'm going to be showing you the door.

12:45Dr. Amy Shah:No, you need moving things because you have that personality of like, you need to be moving meditation. So it's like anything that, I would say anything that collapses time for you. Like, is there, your daughter does dance. So I'm sure she's like my daughter. My daughter goes to dance rehearsal for four or five hours. And she's like, oh, it's like, it just passed by like this. Because you're doing something you really love and that buffers your cortisol so well. So what is it that you really love?

13:10Jennifer Cohen:I started something called Paddle. Have you heard of Paddle? Yes. I love it. Okay. It's very, very fun. And I'm terrible at it. So it's not rigorous or anything, but I move. Yes. And so I like it. But I was going to say something that was very interesting that you said that's so true. that what I've noticed in my more middle age is that these high intensity workouts actually work against me. Yes. Because of that exact thing. I end up eating 10 times the amount of food I would have otherwise ate because it makes me so hungry. And like, I'm also like more like tired of fatigue the next day. But like not like, I just feel, I don't feel energetic.

13:52I feel more like, like kind of like just sluggish.

13:57Dr. Amy Shah:That's exactly what happens because it riles up your cortisol and that cortisol makes you want to eat because you need quick sugar when your cortisol is high.

14:05Jennifer Cohen:Exactly.

14:05Dr. Amy Shah:So you feel like having that quick, sugary thing. And then you're tired because that cortisol being so high for so long, it's like your body thought you were being chased by like a tiger for hours. Yes. And so you're like fatigued. And so what I realized is taking away some of that stress and really going to the edges. So the edges meaning really short bursts and then lots of like low level activity, whatever you love, like hiking, walking, you know, things that aren't like, you know, strenuous. That's strenuous. Yeah. Something you love to do.

14:41Jennifer Cohen:Because like, because you also, the managing of the appetite is a massive, massive one, right? Yeah. Because like you will gain a lot of belly fat. I've noticed because of the fact that you are spiking that cortisol so high.

14:56Dr. Amy Shah:So somebody told me this, and this is like very inappropriate, but I was like, this is so true. They're like, go to a marathon and like watch a marathon and watch the people who are winning the marathon. They're very like slank, like, like very lanky and thin and whatever. But then watch like the very end of the marathon when people are like, like maybe first timers or maybe like People who are just working on it. And they don't always look fit. They often are, like people who do marathons for the first time tell me all the time that like I gained weight or I feel injured, you know?

15:27Jennifer Cohen:By the way, I talk about this all the time. Like if you look at, I mean, watch me get like completely, like let them come, let the comments come. If you see people who are marathon runners, they don't look fit. I never, I don't want a marathon body. I want someone who's like a sprinter body or someone who's like, really toned and tight because they're not doing those 20 hours of like, of running. But, but, but, but I find that running in general just breaks down your lean muscle mass so much and long, long endurance races is not going to get you there. Like you need to do strength training. I always say to get that kind of body composition.

16:06Dr. Amy Shah:Yeah. So I actually, okay. So I did a framework for women. Tell me what you think of this. Okay. Okay. Four, three, two, one. So women in middle age. I saw it.

16:15Jennifer Cohen:It's great. Yeah.

16:16Dr. Amy Shah:So it's like 30 and above really, you know, when you're 35 and above people, what I would consider perimenopause, premenopause, four days of that activity that you love. The one that like the paddle that you love, the hiking, the walks, the thing that like the time passes or you could do when you're 80 or you can do when you're 30, you know? Right. So four days a week of movement, just whatever you love. Three days a week of weight training because that's essential. We lose 3 % to 8 % of muscle mass every decade. And then for women, we go up to 1 % a year if we're not doing anything. So we got to counteract that.

16:53Dr. Amy Shah:So three days a week, and that can be at least three days a week. That's what the data shows. You can do two days, but that's really rare. It's more three to build. And then two days of hot therapy. And that's because I feel like the data on hot versus cold, the hot therapy data is so much better. And for women especially, like if you're someone who wants to boost your hormones, you are someone who wants to work on like brain health and it doesn't have to be sitting in a sauna. It could be like moving in a sauna. You know, he did Pilates, whatever. He did a workout. And then the one is a sprint every single week.

17:31Dr. Amy Shah:Meaning that most people after the, like after high school have never sprinted. Like they've never run to their maximal capacity. But if you're actually trying, our muscle, our heart is a muscle. And if you're trying to keep it strong, you need to exercise that muscle. And if you're always working at low level and, you know, to be honest, weight training, sometimes it can get your heart rate up, but not to the, like not to the max.

17:57Jennifer Cohen:No, it can't. I mean, not for me anyway. Maybe to some people.

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19:40Jennifer Cohen:So my question to you is this with your 4-3-2-1 framework. So of those four, for the four movement days, how long for the three strength training, how long? Give me the timeframe. Give me the duration of each.

19:55Dr. Amy Shah:So 30 minutes for everything minimum. Okay. And the sprint doesn't have to be 30 minutes. You can't do a sprint workout.

20:02Jennifer Cohen:But you go one minute on.

20:03Dr. Amy Shah:You know, the Norwegian four by four.

20:05Jennifer Cohen:Oh my God. I haven't heard that for so long. I have, remind me what it is. Okay. So I do, I remember. It's a sprint workout. Yeah.

20:13Dr. Amy Shah:So basically there was a study where they took people who were sedentary, like literally in midlife were sedentary. And that means that they didn't ever go to the gym, but they consider themselves like light movement, that kind of sedentary. And then they put them on a two-year exercise program. And they started with just walking and like really easy cardio. Then they added weight training and all that stuff. And then the one year, six month mark, they added sprint training and they added with Norwegian 4x4 once a week. And they tested their heart function at the end of it. And they compared it to the beginning and their hearts look 20 years younger.

20:51Dr. Amy Shah:Really? By adding that one sprint workout, like in addition to the regular working out. By adding just that one sprint. And that was a Norwegian 4x4. So if you wanted to like copy the study and do it exactly. Yeah. But it's really hard to do the Norwegian 4x4, maybe for you, not for you, but for most people. So I would say most people have to start with just sprinting for the first time in their life for 30 seconds and getting their heart rate to 85 % of their max and then work up. So Norwegian 4x4 is four minutes of working at 85 % heart rate and then taking a break.

21:26Jennifer Cohen:Wow. So a four-minute sprint.

21:28Dr. Amy Shah:Like a four-minute kind of high-intensity, maybe it's like biking or running or whatever. With no break. No break for four minutes. Yeah.

21:35Jennifer Cohen:Do you remember Tabata? Yes. Isn't that like, well, that's 20 and 10, but that's for a four minute or eight minute. I can't remember.

21:41Dr. Amy Shah:There's so many versions of that. There's so many versions. They just ended up picking that one, which I think is like the hardest one ever.

21:47Jennifer Cohen:Oh my God. Four minute sprint is very, very hard.

21:49Dr. Amy Shah:And then you take a break and you rest and then you do it again. And you do at four times, four by four. It's like a really hard. But you, if you think about it, 85 % of your heart rate.

21:59Jennifer Cohen:No, it's great actually.

22:00Dr. Amy Shah:Of your max heart rate is different for everyone, right?

22:04Jennifer Cohen:So, but that would also spike your cortisone.

22:06Dr. Amy Shah:But it's short. Four minutes times four is still 16.

22:10Jennifer Cohen:It's a lot.

22:10Dr. Amy Shah:For them, it was like, you know, they did that once a week. So I'm all for high intensity once a week or even twice or three times. As long as you're taking lots of recovery days. Right.

22:21Jennifer Cohen:So the rest of the days are not that difficult. So that doing that one day is probably way better than doing every day at moderate to intense. That's right.

22:32Dr. Amy Shah:So when you go to those workout gym, like the very popular, you know, chains.

22:38Jennifer Cohen:Like an Orange Theory or a Barry's Bookout.

22:40Dr. Amy Shah:You're like not really getting up to 85, but you're not like you're raising your cortisol.

22:45Jennifer Cohen:So like you're getting to like 70. Yes. And so you're just always going to be like kind of like kind of exhausted. Yeah. You're not on the edges. Like you want to be on the edges.

22:54Dr. Amy Shah:Right. So then, and then if you do want to do a place like that, I often will go for that one day, the sprint day because when I'm on the treadmill or whatever, you can kind of like push yourself to that 85 % as much as you can. Like I don't expect, I don't even think that most people can get themselves to 85 % of their heart rate for like four minutes straight for that many times. I think it's something you work up to. So I usually do like 30 second sprints, then you walk for a minute and then you do another 30 second sprint and then you do it eight. Have you ever heard of crazy eights? Yes. Yeah.

23:27Dr. Amy Shah:That's like what I do. You do it eight times. Yeah.

23:29Jennifer Cohen:And And that's what I do. What are your fitness instructor? You know, all these like different modalities.

23:33Dr. Amy Shah:I mean, it's like, I dabble. In your spare time. Yeah, exactly. I think that part, because I know that you're so into that, into the fitness world. That's why I wanted to share that with you. Because I think for the woman who is going into this next phase of their life that wants to optimize, it's not about doing more. It's really about recovering better.

23:54Jennifer Cohen:Yeah. Say that again, because for the cheap seats behind you, because I think that is so true. it's hard though, right? Because if you've, you know, like, I think people get really stuck. I'm talking for a friend doing, you know, with things like worked for you so well for so long, it's really hard to change that mindset and like, and do something different, right? Even though all the numbers and all the, all the evidence is pointing to that, right? It's so true.

24:23Dr. Amy Shah:Doing more is not doing you any favors. It's not about doing more, you know, doing, recovering better. So like, that's hard for people like you and me because we grew up, our culture, our society, everyone around us was like, do more, do more, you know, and get smaller, you know, like that was like the messaging that we were getting.

24:43Jennifer Cohen:And like, you know, like intense, intensity, intensity. Yes.

24:47Dr. Amy Shah:And to get stronger and to recover, it feels like so anti that. Yeah.

24:52Jennifer Cohen:It seems like there's like, it seems a very, it's like, it's so opposite. Yes.

24:56Dr. Amy Shah:And so that for you, like someone who has a lot of cortisol, like your spikes, especially when they're, it's like your life is spiking your cortisol. Your food is spiking the cortisol. Your alcohol is spiking your cortisol. Your caffeine is spiking the cortisol. And then your workouts are spiking the cortisol.

25:14Jennifer Cohen:There's a lot of cortisol spiking.

25:16Dr. Amy Shah:So if you actually put it all together, you're like, wow, your body is like amazing that it can even handle all that.

25:21Jennifer Cohen:100%. What's the difference between cortisol and your adrenal?

25:26Dr. Amy Shah:It's all part of the same cycle. So adrenaline comes from your adrenals. And so when you wake up in the morning, if your cortisol is working, your adrenaline is high. And that's why you feel awake. That's what wakes you up actually in the morning.

25:42Jennifer Cohen:How do you know if you have adrenal fatigue?

25:44Dr. Amy Shah:So adrenal fatigue is actually a misnomer because your adrenals are working fine. It's not, they're not fatigued. It's just that you're in this constant state of high cortisol. So like if you ask an endocrinologist, they'd be like, I'll cringe when you say adrenal fatigue because that's not really what happens. It's just cortisol dysregulation. Like what we're saying is like you're keeping, you're never in the parasympathetic mode. You're always having your nervous system and your hormones in the mode that they have to focus only on survival. and you need the mode of you're safe and I'm ready to digest, I'm ready to critically think, that's not gonna happen if you're always in that sympathetic mode.

26:29Dr. Amy Shah:So you have to learn. So sympathetic is talking about your nervous system being activated. So when your cortisol is high, it activates your nervous system. And so, you know, you feel like on edge when your cortisol is high. Yes, yes, yes, totally. Like you're like irritable and like on edge because that's riling up your nervous system to be like ready to go as if there's danger around. And so one of the reasons you wake up in the middle of the night is like to look for danger. And that's why you're thinking about like, oh shit, I forgot to do that thing. I like all the danger things that your body feels is dangerous.

27:02Dr. Amy Shah:They all come to you at that time. Did I lock the door? Did I unplug that thing? Did I send that email? Did I, you know, that's what you're thinking about. Cause your cortisol was like, hey, hey, we're in danger. Remember all the dangerous things like that? What? Like they're not life-threatening literally, but like our mind thinks that they're life-threatening. Yeah. And you think about all of them. A hundred percent.

27:21Jennifer Cohen:I totally agree. This makes perfect sense. So what are like some things, like what are some habits that people do that is actually aging them that they don't even, they're not even aware of?

27:33Dr. Amy Shah:Okay. So you said the first one that you don't do is alcohol.

27:37Jennifer Cohen:Alcohol. Yeah.

27:37Dr. Amy Shah:I don't know. I used to have a whoop. Do you have? I don't wear anything anymore.

27:41Jennifer Cohen:I wear this. I used to wear the whoop and the aura ring and all the things. Now I'm not wearing them. Yeah.

27:47Dr. Amy Shah:So I think it was really nice for me though, because I would say, oh my God, my HRV is like so low today. I don't know what I did. And it was like, it was just like in passing, I would have a drink at dinner, like, you know, just like nothing. And then it was like, every time I noticed my HRV, so that's like a measure of your nervous system, you know, how tightly wound your nervous system is. Yeah, exactly.

28:08Jennifer Cohen:Mine's very tightly wound.

28:10Dr. Amy Shah:Yeah, so my HRV would drop every time I would drink. So it's like, even like you're having one or two every night. Yeah. So now we know that that's even one or two every night is not good for our, it ages us basically in every single way.

28:25Jennifer Cohen:So the first, the one thing people, the first thing that people are doing that's aging them is alcohol. Yes. Number one. That's the number one thing that they should cut.

28:32Dr. Amy Shah:Number one thing that you is aging you is alcohol.

28:36Jennifer Cohen:I agree. By the way, that's why I look, I hate to say, look at JLo, right? Yeah. She hasn't had that. She doesn't drink at all. Yes. She looks like she's like 12.

28:43Dr. Amy Shah:No, 100%. And she says that's why she doesn't drink. Because she doesn't want to eat. 100%. Yeah.

28:48Jennifer Cohen:I'm like, I'll for this. Is that why you stopped drinking? No, no, no. I'm lucky because the one thing I never, ever, ever liked was alcohol. I never liked the taste of alcohol. I never drank in high school, college, whatever. I hate the taste of it. So I got lucky on that one. That's amazing. Yeah. Yeah. So, okay. Number two. But I like chocolate cake and french fries. Okay.

29:07Dr. Amy Shah:So that's number two. Oh, yeah. Number two is ultra processed foods, like especially high sugar foods. Yeah. Because what they do, the other thing that happens as we age is that our ability to process sugar, like so our insulin resistance goes up. So before you could eat something very sugary and your body quickly absorbs it into itself. And so that's why it's good to walk around after a meal because you want to quickly absorb all that sugar. But when -

29:35Jennifer Cohen:I'm going to ask you about that after. Remind me.

29:37Dr. Amy Shah:Yeah. So when we start to lose estrogen, we also lose a little bit of our ability to absorb that sugar. So it kind of sticks around a little bit longer. And so that - Oh, really? So wait, say that again. Yeah.

29:49Jennifer Cohen:So as we lose estrogen, that's when sugar kind of sticks on our body longer. Yes. Okay.

29:53Dr. Amy Shah:So our cell's ability, so our cell becomes a little more resistant to - To sugar. To sugar, right. To taking it in. As our estrogen drops.

30:04Jennifer Cohen:Yes.

30:04Dr. Amy Shah:So you'll see a lot of people, including myself, their hemoglobin A1C, like a marker of your blood sugar, will start to rise during that time. That's like a marker of perimenopause. It's like people who have a diabetes history, like my family, everybody has diabetes. You'll see like now you're starting to see even people who look healthy, your sugars are climbing up. And so the same, it's aging you because when that sugar kind of sticks around in your bloodstream, it is a very, like your body's doing everything it can to bring that in. That sugar that's there is aging you by the minute, you know?

30:41Dr. Amy Shah:So every - Really? And so that's why things like eating fruit instead of having a sugary thing is much better because it's slowing. Like when you have fiber with your sugar, it's slowly absorbed, right? But how about dried fruit? Dried fruit is not as great because you're getting the sugar in concentrated form. And so you're getting that spike that you don't want. And for, you know, for people who are really, really healthy, people are like, why would you care about blood sugar spikes? And you don't necessarily, but when you're getting to, when you're like over the age of 40, your ability to like process sugar changes.

31:15Dr. Amy Shah:And so, especially if you have a family history of anything, heart disease, diabetes, you really want to be kind of minimizing those spikes. And so that's why it's really important to eat fiber because like kind of blunt the sugar response, but all processed foods like devoid of fiber, right? So if you're eating ultra processed food, you're automatically eating a super low fiber, high sugar or high processed whatever diet. That's the number two.

31:40Jennifer Cohen:Sugar, okay.

31:41Dr. Amy Shah:And liquid sugar is the worst. So alcohol, liquid sugar, obviously that's bad, but like frappuccinos and da-da-da.

31:49Jennifer Cohen:Like never drink your calories. That's why, by the way, I'm not a big smoothie person. Yes. Because the amount of calories that people are piling on stuff and they're thinking they're doing themselves a service. And it's not as satisfying. I'm starving.

32:04Dr. Amy Shah:First of all, it takes you three seconds to drink it.

32:06Jennifer Cohen:I'm a volume eater. I like to have big volume because I feel like it's a whole thing. Yes, same. What do you call it? It's like a whole event when I eat.

32:15Dr. Amy Shah:And when you chew something, you get the signals to your brain that you're eating and that you have food in your system.

32:21Jennifer Cohen:And when you have a smoothie, in four seconds, it's like a finish. And I'm like, okay, now where's my meal? And then I just had a thousand calories.

32:28Dr. Amy Shah:So the sugary, these ultra processed sugary foods is like the number two thing you can do. And I don't mean like take it all out. Like if you're like eating a piece of fruit, I mean, okay. So for dried fruits, out of everything, dates are the best.

32:42Jennifer Cohen:Yeah.

32:43Dr. Amy Shah:I love mango. Mangos are amazing. I'll never, ever, ever vilify fruit. Like these people who are like, don't eat fruit. Like it's insane. Like what do you mean don't eat fruit? Like they have all these vital, they have all these nutritional value beyond just the sugar content. Exactly.

33:01Jennifer Cohen:And the fiber when it's fresh fruit. Yeah.

33:03Dr. Amy Shah:So you're saying that I can eat my mango? You can eat your mango, but you know, obviously -

33:08Jennifer Cohen:The dried mango?

33:09Dr. Amy Shah:Not the dried mango and not the mango flavored like drink or whatever. No, no, no. I wouldn't have that. No, no, no. But the minimizing sugar spikes also, you can have, there's tricks to do that. So like if you're eating a dessert, like if you eat something with fiber with it, it'll slow it down. So like don't, you know, eat your dessert after you've already had your meal so you're not like spiking your blood. It's much worse if you're eating it like on the go when you haven't eaten anything.

33:34Jennifer Cohen:Does that mean that you shouldn't, like if you eat fruit by itself, there's a lot of people who like eat fruit first thing in the morning and nothing else.

33:40Dr. Amy Shah:Yeah.

33:41Jennifer Cohen:Doesn't that just spike your blood sugar then? Well, fruit, depending on the fruit, has a ton of fiber. Yeah. Oh, yeah, you're right. You have the fiber too.

33:46Dr. Amy Shah:So raspberries have eight grams of fiber, which is insane. It's like a huge chunk of your fiber for the day. You just get from - The raspberries. A raspberry. So that is amazing. It's not very high in sugar. So berries are incredible because they actually give you all of the polyphenols and the fiber without actually giving you that blood sugar spike and tastes really good.

34:10Jennifer Cohen:Yeah.

34:10Dr. Amy Shah:I'm talking about like the straight up, you know, candy bar from your local, that's like devoid of fiber and it, you're like sugar, sugar, like junk food, sugar. Like saying like, oh, hungry for Snickers. What was I saying? Like, you know, like, yeah, I know what you're talking about.

34:26Jennifer Cohen:Yeah.

34:26Dr. Amy Shah:Because you would eat it because you're really hungry at like three o 'clock, but that's like the worst thing you can do because it's like spiking your blood sugar. It's ultra processed. And, um, you know, as, as we get, if we're talking about aging, that's like literally aging you.

34:39Jennifer Cohen:Can I ask you a question? What about this? Because this is what I do sometimes. So because I get super, I want that sugar craving, I'll have like an iced coffee with like a little bit of like sugar-free vanilla in there around 3 o 'clock. I love that.

34:56Dr. Amy Shah:Yeah, I do that too.

34:57Jennifer Cohen:You do? Yeah. And it just like kind of takes the edge off. Exactly.

35:01Dr. Amy Shah:And other thing you can do that I've been - But it's caffeine. Well, I mean, if you're not sensitive, people -

35:06Jennifer Cohen:I'm not sensitive. I can have a vat of caffeine. I can fall asleep. You're so lucky.

35:09Dr. Amy Shah:That's a genetic thing. Oh, really? Okay. Some of us don't have that, so we can't have a caffeine related day, although I did. One of the tricks I have, there's two tricks I have. So one is when you're having something, so say you have a yogurt parfait and you want to have something sweet, like crumble cookie or something on top of it. So you're having like your protein, your Greek yogurt, the protein, and then maybe some berries in it. So you get your fiber and then you're getting your treat. like it's there, it's just paired with a bunch of things that can like escort it into your body in the right way.

35:42Jennifer Cohen:Right. So the protein and the everything, the fiber, the fiber, the sugar, I like that. Yeah.

35:47Dr. Amy Shah:So that's a trick. And then the other trick, which is something I've used for years is if you really want your processed snack or like there's something you really want, put it in a really small bowl and then walk away from the kitchen, like go to your patio, go to the farthest place that you would go and like bring a glass of water and like just have it. Because If you're standing in front of an open bag or box, that's like the worst thing you could ever do. And, but if you give your, it's not about deprivation. Like if you're like, I really just want like one cookie and like, you know, whatever, a couple of chips.

36:17Dr. Amy Shah:You put it in a little bowl, you walk away, bring your water with you. And then you're not, it's like really, it's much less likely that you'll just, it takes a lot less willpower to just be like, okay, I'm done for right now.

36:29Jennifer Cohen:You know? So wait, so you're saying put it into the bowl. And then leave. And then leave. Leave the kitchen. Not leave. Close the thing. Don't eat it there. Yes. Take it with you. Yes. And that's your treat.

36:39Dr. Amy Shah:That's right.

36:40Jennifer Cohen:Because you're saying you're not likely to come back to the kitchen. Have you met me? Yeah. I'll go back 50 times.

36:46Dr. Amy Shah:And that's your dopamine pattern. So like put it back in the freezer, put it back in the, you know, put back the things in the pan. Yeah, like close it up. Yeah. And then go out, go somewhere where you feel really less stressed or -

36:56Jennifer Cohen:Well, have you ever not heard, like the big joke of the world or the times is like, you know, when you have like a big cake and people are like, oh, I'll just have a sliver. and then they put the rest in the fridge. Yes. But the person just keeps on going back. Yes. They go back. Yes. The whole cake is over. Yes. It's finished.

37:11Dr. Amy Shah:Did you see that one where they like threw the cake in the garbage? And then they ate the garbage. Yeah.

37:16Jennifer Cohen:By the way, that would be me. I hate to say it. So I don't know if that last trick would work for me because I start to obsess about something. I'm like, well, I might as well just go and have enough. I've already had it. So I might as well just have more now. And like you get into that crazy loop of like eating because you already like did the damage, you're going to continue doing the damage.

37:34Dr. Amy Shah:So the same they actually want. So, I mean, I don't want to say like, oh, this whole evil conspiracy theory, but about ultra processed foods, but the companies are looking to create foods that make you do that, that make you want to come back and you can't stop thinking about it. So if there are foods like that, that's like a sign you need to cut it out. It's like drugs. Yeah.

37:57Jennifer Cohen:Don't even bring it into the house. Yes.

37:59Dr. Amy Shah:It's triggering your dopamine pathway. Our dopamine pathway is so strong that you will get up out of bed into your car and go across town for something that stimulates that dopamine.

38:09Jennifer Cohen:A hundred percent. That's what's so dangerous about these things.

38:11Dr. Amy Shah:Yes. And so I feel like, okay, so ultra processed foods, I would put sugary, let's put sugary and fried like all in one category. Yeah, processed foods. Yeah, ultra processed foods. And then number three, sedentary. We are meant to be moving. Like our bodies, we are genetically and evolutionarily programmed to be moving like humans, moving things. And I think that we're not programmed to be sitting for eight hours a day. And when we do that, our body doesn't function as well. And that really, really accelerates aging over time. So it doesn't show up when you're young, but over time it actually does age you a lot.

38:51Jennifer Cohen:I agree. And four?

38:52Dr. Amy Shah:And number four is stress, which we kind of talked about. I mean, stress should be number one, probably.

38:57Jennifer Cohen:Is there ways that people like maybe are stressed and they don't even know they're stressed? Or does everyone just know when they're stressed?

39:03Dr. Amy Shah:Well, did you know that you were stressed?

39:04Jennifer Cohen:Yeah, but I didn't know I was that stressed. And the other test that they showed that you can do is that how your body manages stress. Did you know about this test? What's it called? I don't know what it's called, but they basically said, again, I have a lot of stress, but my body's good at deflecting the stress.

39:25Dr. Amy Shah:It's a very good thing to be able to be resilient to stress. But I honestly believe that a lot of us are holding stress. Like, okay, I'll give you an example, neck pain. People who have like a lot of like shoulder, neck, stiffness or pain, sleep issues, like you said, waking up in the middle of the night. Like palpitations or feeling like nervous about things like shouldn't be like, you know, anxiety provoking is like another sign that your, you know, cortisol system is really activated. Cravings, sugar cravings. Because if you think about it, if your body's preparing for to run away from like an animal, it needs quick energy.

40:06Dr. Amy Shah:And so you're going to be craving sugar. And so a lot of people, as soon as they bring down that stress, like the sugar cravings really subside, which is a huge thing that helps their life, you know? So I feel like stress is one of those things that ages you without you even really knowing that it's aging you. And it's, I mean, if you really want to know, we know evidence of this. It's like you look at people who have been through wars or really like stressful time, famines and wars, and you see how fast they age. It's insane.

40:35Jennifer Cohen:Look at the presidents, like not this one, but you remember like most other presidents. Yes.

40:40Dr. Amy Shah:When you say start.

40:40Jennifer Cohen:When they start versus when they finish, they look like they're like 30 years older. You know, like their hair is gray now. It's like, it's really unbelievable.

40:48Dr. Amy Shah:So if you think about it.

40:49Jennifer Cohen:This is the only president who looks younger now than he did before. You know, which is a whole other story.

40:54Dr. Amy Shah:That's hilarious.

40:55Jennifer Cohen:Yeah.

40:56Dr. Amy Shah:That's exactly right. So if we're talking about like aging per se, that stress will age you more than anything. Totally. The president example was so perfect. And like people that have gone through like really difficult, like, you know, come from a war-torn country, like they often are, um, have like a lot of signs of physical aging. Um, that doesn't mean that you can't do anything about it. It just means that the stress that you experienced is aging. You wore, you know, all this, um, things or even by the way, kids.

41:24Jennifer Cohen:Yes. I'm not even kidding. If you look at a woman who's 40 years old with kids versus a woman who's 40 without kids, without a doubt, the woman who's 40 with kids looks older because of the stress of taking care of other humans and the time restraint you have on your life. Your whole life is different, right? It's super stressful. The women who are 40 without kids, they don't really have a care in the world, right? They can just have to take care of themselves. It's much easier.

41:54Dr. Amy Shah:Well, I mean, I agree with you because kids are very stressful. Kids are super stressful.

42:00Jennifer Cohen:I'm super stressed out all the time. Like my friends who are my age, they look like they're 32, you know, who don't have kids, you know, the ones who already have kids.

42:08Dr. Amy Shah:And they often have like other life stressors, but it's just different. Well, different. But what I'm saying is like, I'm joking.

42:13Jennifer Cohen:It's kind of like - Yeah, yeah, yeah.

42:14Dr. Amy Shah:No, I know. But like they have, there's so many other life stressors that don't age you like having kids ages you. Right. Like that's what I'm saying.

42:21Jennifer Cohen:Like it's true though. Like when you have like to, And it's also not necessarily like bad stressors, but it's like having to deal with other people's calendars and schedules and driving and feeding them and moving. You don't have as much time. You don't have enough downtime. Yeah, that's right. You don't have any downtime. Yeah. So you don't have that ability. You're worried about them more than you were about yourself. Well, that's right. So like that stresses you. Yes. And actually that ages you, I should say. That does age you. It does age you. I'm just being real. Yeah. You know, so that's another one.

42:54Dr. Amy Shah:Number five is like the most -

42:56Jennifer Cohen:Kids, number seven. Well, it's true.

42:59Dr. Amy Shah:Yeah, good and bad. Good and bad. Yeah, number five is maybe, definitely should be number one in terms of like, you know, like the ability to age you. This one is like the most important. Can you guess? Smoking? Oh, well, smoking, I would put in that drinking category, but yeah, that's right.

43:16Jennifer Cohen:Okay, why the drinking category? I guess because it's a toxin you're bringing in each body. Okay, number five was,

43:23Dr. Amy Shah:I know you know it, but.

43:24Jennifer Cohen:I probably do. Okay. We talked about sugar. We talked about alcohol. We talked about junk food, processed food, stress, hormones.

43:35Dr. Amy Shah:Not sleeping enough. Oh my God. Of course. Yes. Like that's like number one. Oh my gosh. Of course. Duh.

43:42Jennifer Cohen:I should have been looking at your friend. She was probably, she was like Pictionary. Like she was doing like the.

43:47Dr. Amy Shah:Damn. Okay. So I literally think that -

43:51Jennifer Cohen:Of course sleep. Yeah.

43:53Dr. Amy Shah:Like if there's one thing that you could do to anti-age yourself is like start getting more sleep. Yes. Like more than you think. I think women tend to feel like they are lazy if they're sleeping like eight hours or whatever. Whatever requires you to feel refreshed.

44:12Jennifer Cohen:Yes.

44:12Dr. Amy Shah:It feels indulgent. It feels like - Totally. And it feels like that's one thing that's actually different between the genders. Men tend to need less sleep than women. And I don't know if most people like don't allow themselves as much sleep.

44:27Jennifer Cohen:But really you should sleep without an alarm and see how much sleep you actually need when you're not sleep deprived.

44:36Dr. Amy Shah:And then that's kind of your baseline of sleep that you need for recovery. And like when we're talking about working on stress and working on like part of, like you said, it's really hard for you to meditate. Just like sleep a little bit longer. That's like the perfect way to bring down your stress.

44:51Jennifer Cohen:I know. That's so true. But I'm not a great, like also your body has like an algorithm, right? Like I'm so used to sleeping like five and a half, six hours now. That's my baseline, even though I'm tired all the time. Yeah. Like I think that like my internal anxiety won't allow me to even stay asleep.

45:10Dr. Amy Shah:Yeah. No, so that's what you have to work on. So one of the things I did, I was the same way as you. I used to be like, I felt tired, but I would just have an alarm all the time to wake me up. Yeah. So one of the things I started doing is like really getting a lot more sunlight first thing in the morning, like within an hour of waking up, that is going to reset your circadian rhythm so that your body knows now, okay, in about 12 hours from now, I'm going to start really releasing melatonin. Like it rewires your brain. So if you're someone who like goes through a different time zone, like you're traveling, you're trying to rewire your sleep schedule, So getting a lot of concentrated light, natural light into your eyes, so not behind sunglasses, not behind a window, but actually direct.

45:56Dr. Amy Shah:It goes straight from your retina to your brain to your suprachiasmic nucleus and rewires everything. It's like one of the best ways to get better sleep and more sleep. And then the second thing I would say is the data shows that sleeping at the same time and waking up at the same time every single day, even as much as you can, even on weekends within 30 minutes can really improve the quality of your sleep that you're getting. So even if you're getting less, the quality, the restoration that you get from it is better.

46:25Jennifer Cohen:Yeah. I try to do that anyway. Also, like you said, I feel like I'm a creature of habit. Yes. So going to bed around the same time. Yes. But now because of this waking up in the middle of the night, that's the problem. I can't fall back asleep.

46:38Dr. Amy Shah:Yes.

46:38Jennifer Cohen:So now you're awake at five o 'clock in the morning. That's right. And I'm like, oh my God.

46:42Dr. Amy Shah:And then it takes you a couple hours to actually get yourself into a place where you can like function. Yeah, that's exactly right. So for you, I would say work on all the things. You need a cortisol reset. There's a cortisol reset in there. I know. Work on all the things to decrease cortisol. I would say, Jen, like that's like the number one thing that I see women struggling with as we're moving through like the hormonal continuum is having trouble figuring out how to like recover. not giving, we don't give enough permission and enough time to actually have recovery. So recovery doesn't always just mean like cold, plunge, and sauna.

47:22Dr. Amy Shah:It means also like sleep, and it also means nature, and it also means like turning down the volume on the training if it's draining you, you know, that kind of stuff.

47:30Jennifer Cohen:So recovery is not just about like these modalities of like the sauna and the cold plunge.

47:35Dr. Amy Shah:The red light and the, you know, it's also about like eating to support your gut bacteria because your gut bacteria actually makes your own ibuprofen. So our own stress-reducing anti-inflammatory compounds that we create in our body is created by gut bacteria. And so we can do things by eating food to support that that will stimulate. So they create these things called short-chain fatty acids, and they work like natural ibuprofen, calm down the cortisol, calm down the inflammation, go all over our body. Who doesn't want their own bottle of ibuprofen inside, right? But you have to build it.

48:14Jennifer Cohen:But how do you do that? I think right now everyone talks about gut health, right? Yes. But everyone says, oh, I have leaky gut. I have this, I have that. But it is like the gut really is like the brain of your body, right? It's not the brain, it's the gut. But if so many people have gut issues, isn't that kind of like, what are some key factors that people can even know? And is that also interfering with maybe the symptoms of perimenopause and menopause?

48:42Dr. Amy Shah:I actually think that if you fix your gut, you'll fix your hormones.

48:46Jennifer Cohen:Really? How? Tell me how.

48:48Dr. Amy Shah:Because our gut is constantly talking to our brain, our hormones, our immune system. And when you need more estrogen, there's actually gut bacteria. We call it estrobilome, like a bunch of bacteria that put estrogen back into your system. They take out estrogen from your system. They're like modulating your hormones. And the gut bacteria are like literally like the captains in charge. Like they're the walkie-talking your brain. They're walkie-talking the rest of your body to do what they, to send more hormone this way, to send more hormone. So if you really want to like get your hormones in check and balance, like you need more of that gut bacteria because the modern world, the way we live, it strips down our gut bacteria to like 50 % of what we actually need or we're supposed to have.

49:37Dr. Amy Shah:And so we're working with like less than we started with. And then as we move through perimenopause, our estrogen levels go down, our gut bacteria die. Some of them are dependent on hormones like estrogen. And so we need to do stuff to work extra hard to keep these gut bacteria alive and healthy so they can signal to all the places in our body. So like your hormones, a lot of people will tell me, as soon as I changed my diet, all of a sudden those symptoms that I thought I had because I was getting older went away.

50:09Jennifer Cohen:Really? So how would you do that though? Give me an example. Okay. So that 30-33 that I kind of developed, so it's 30 grams of protein in the morning,

50:19Dr. Amy Shah:30 grams of fiber throughout the day, and three servings of probiotic foods. So three fermented foods a day. If you start with the fermented foods, which every culture used to eat fermented foods. Now nobody eats fermented foods. It's like, you know, less than, I mean, 95 % of the population don't even eat enough fiber and they're definitely not eating enough fermented food. Fermented food is the one thing we know that can add bacteria. So like increase the bacteria in our gut and also lowers the inflammation. So it's the one thing that we know in diet through all the studies, if you want to lower inflammation and your stress levels in your body through food, you want to be eating more fermented food.

50:57Dr. Amy Shah:Yeah.

50:57Jennifer Cohen:Fermented foods are very, very popular now, I feel. Yes. It's getting more popular.

51:01Dr. Amy Shah:It's -

51:02Jennifer Cohen:Like, is that like sauerkraut?

51:03Dr. Amy Shah:Yes. It's sauerkraut, kimchi, but it's also like yogurt and probiotic cottage cheese and - Oh, I can have - Oh, yeah, yogurt. Yeah. And, you know -

51:11Jennifer Cohen:So I should be eating way more of that stuff. Yes. Yes.

51:14Dr. Amy Shah:So that can help kind of calm down the inflammation in your body and in your brain. So like, that's a great way to manage that gut-brain connection and get that stress down and also help your hormones. and then the fiber is food for the gut bacteria. So imagine like you're supposed to have an Amazon jungle in there because it's literally like that trillions, trillions with a T bacteria that live in there. We have just like the same amount of bacteria in our body that we have our own cells. So like there's a trillion of them. They are starving because all they can eat is certain foods like fibers, one of their main sources of food.

51:50Dr. Amy Shah:And when you're eating an ultra processed diet, which most of us are, you're not feeding your bacteria, anything. They're starving, they're dying.

51:58Jennifer Cohen:Wow. Yeah. So then what do you think of having, okay, so if it's fermented foods and everything that you just said, can that, you're going to say probably not, but if we eat better and then we are taking care of our gut, would that make us not have to take hormone therapy?

52:16Dr. Amy Shah:HRT? So I will say this, when you're in perimenopause and starting to get the symptoms, this will probably, this can often be enough. Because you can just say like, hey, I don't feel myself. My brain fog is a little high. So it's a Band-Aid. No, it's a foundation, meaning that you can't stop doing it even as you get older. That's true.

52:39Jennifer Cohen:Okay, fine. You're right. You're building a foundation. You're building a foundation.

52:42Dr. Amy Shah:A lot of us never had that foundation. I was in medical school and trained, I studied nutrition and we did not learned this. That's why I think it's so important to have a book like this for me, because I'm like, we didn't even learn this. How are people supposed to know this?

52:59Jennifer Cohen:Well, that's the thing. I always found that very interesting that doctors never get trained on nutrition at all. No.

53:07Dr. Amy Shah:And the thing is, the shocking, shocking thing is that not only do we not get trained on nutrition, we really don't get trained on women at all. Like women were excluded from - Right.

53:18Jennifer Cohen:Because they're training, it's all usually based on men, correct?

53:21Dr. Amy Shah:All the research, all the medical studies, everything was based on men. So not only do we not have enough nutrition knowledge, we really don't have any nutrition knowledge for women. And so all this stuff that I'm saying, for a lot of people, they're hearing it for the first time. I know. Isn't that crazy? Isn't that? It's so crazy. So I looked at the textbooks for menopause, for perimenopause, like where is the information about like, hey, we need more protein because we want to build the muscle. We're losing muscle. We need fiber. We need, the studies are there. but we don't have any instruction around it.

53:53Dr. Amy Shah:So that's really why I felt like I needed to talk about it.

53:57Jennifer Cohen:To talk about it. So let's talk about HRT because we're here anyway. So what's your take on it?

54:04Dr. Amy Shah:Okay. My take on HRT is that we're in a very unique situation in our world right now where we live well past menopause and we want to thrive well past menopause. So imagine there's every animal in the animal kingdom, if an organ dies in your body, you die. You can't live with something that's not functional in there. It's very critical. And so for us to be living 30, 40 years past an organ kind of involuting and not functioning properly is incredible. So we're in a very unique situation in history. We are living longer. We want to do things longer. And so I think that hormone therapy has a role, especially if you're someone who has osteoporosis, if you're someone who has major hot flashes or night sweats, because we know both of those things can be solved, like literally solved by hormones.

55:02Dr. Amy Shah:There are conditions that cannot yet be solved by hormone therapy. So osteoporosis can be, hot flashes, night sweats can be, and then vaginal symptoms like dryness and discomfort can be. Those things you can actually reverse completely. Hormone therapy, dot, slam dunk. What we don't have data yet on, clarity, weight loss, brain fog, gut issues. So all of this foundational stuff is still what we need to do for that.

55:29Jennifer Cohen:Wow. I didn't realize that. Yeah.

55:31Dr. Amy Shah:It's not a magic pill for everything.

55:32Jennifer Cohen:It's not a magic pill for weight loss or for brain fog. Or for heart health even. Or for heart health. So that's very interesting because I think that what the, I guess what people are just, they just assume really the assumption is that it's kind of the panacea for every symptom.

55:51Dr. Amy Shah:Well, I agree. So in their defense, like I think there's a lot of confusion, right? So if you're like, yes, it's good for this, but we're not sure about this. I think it's like more like, hey, you should talk about this with your doctor. It's a good option. But like the nuance I think is really important.

56:06Jennifer Cohen:Well, life is about nuance. Nothing is black and white. Yeah.

56:09Dr. Amy Shah:Like why, like if you're taking it for weight loss, like that is not the right reason to be on hormone therapy. And same thing with like dementia and heart. There's a lot of like new studies like that are like, we have estrogen receptors in our brain. That's amazing. But the data is not strong enough. There's not good data to say like you can reverse brain issues or you can prevent dementia or you can prevent heart disease. So what we're saying is like, yes, there's estrogen receptors everywhere in our body and there's some potential there. but we're not there yet.

56:40Jennifer Cohen:Interesting. So it's not like a panacea. It's not like a cure-all.

56:44Dr. Amy Shah:And I think that I'm super excited. I'm really happy for people that are embracing it more, but I think we need to talk about that other side. It's not like you're just going to take it in your life automatically. It's like shiny rainbows and butterflies and you just don't have to do anything else anymore.

57:04Jennifer Cohen:Well, that's the thing. And also they say if you take it too late, then you don't get any of the effects. Is that true? So kind of like this fear-based, like, oh shit, I better - If you miss the boat, yeah. If I miss that boat, so do I have to start taking it now if I don't want to basically shrivel up and die in 10 years? You know what I mean?

57:23Dr. Amy Shah:No, I think that's exactly right. The thing about taking it late though is more about the breast cancer risk. So when you looked back at that study where they saw a link with breast cancer, it was, there's a couple of reasons that came out is one was people taking it very late, like 10 years post-menopause in their sixties. If you're taking it, cause you already got used to kind of like not having the hormones and then you're adding hormones. It kind of like seems to be linked with higher rates of cancer. And then, you know, that's kind of the reason that even now, if you've kind of gone 10 years post-menopause, that's a conversation that you have to have with your doctor.

57:59Dr. Amy Shah:Cause a lot of times that's like an increased risk. um why we don't know we think that maybe your body got used to functioning without hormones then oh

58:07Jennifer Cohen:so then you kind of like introduce hormones again and you're it kind of puts into overdrive exactly

58:13Dr. Amy Shah:and then the old hormone therapy also used like synthetic progesterone but if you're not using synthetic and you're using bio yeah the the the micronized yeah progesterone that still can have the same effect you're saying well so that um if you started really late yeah late i'm saying like

58:30Jennifer Cohen:Like if you say 10 years late because your body's not accustomed to them at all.

58:33Dr. Amy Shah:And the thing is like the studies are still evolving and still, we're still trying to figure out like, okay, what is the right combo? What, how many years? So it's not something that's like a slam dunk. I said for those three conditions that I said to you, osteoporosis for vaginal symptoms and for hot flashes and night sweats, it's actually, there's good data to be like, yeah, the risks outweigh the benefits in most cases. But most people are doing it. Benefits outweigh the risk in most cases.

58:58Jennifer Cohen:Most people, I would say, are doing it for the other reasons.

59:02Dr. Amy Shah:It's become really in vogue to be like, oh, I'm like, it's almost like how people take peptides and testosterone. That was my next question.

59:12Jennifer Cohen:Well, testosterone is one of the things, right? They put you on estrogen and testosterone. There are people out there, again, like all they're doing, they're showing you their estrogen patch and testosterone. I'm like, lady, put it away. I don't need to see anymore. But that's what's happening. It's become like a badge of honor. You know, like, I just don't like, so it's not something that you feel is necessarily like.

59:34Dr. Amy Shah:It's not a slam dunk. It's not a slam dunk. I think it's a good, I think the reason why people are kind of going, going overboard on the other direction started out in a good, with good intentions. Yes.

59:44Jennifer Cohen:Like everything, the path, the path, what the road to good intentions or the, whatever that, the path.

59:50Dr. Amy Shah:That's right. The path to good intentions. That study was so flawed. The, you know, the women's health initiative was so flawed. everyone's so scared. And so trying to like turn the tide on that. Right.

1:00:00Jennifer Cohen:So we're kind of like the pendulum has swung so far the other way now.

1:00:04Dr. Amy Shah:That's right. That everyone thinks that they need to start at 40. At 40. Exactly. You should just be on it just in case.

1:00:09Jennifer Cohen:Exactly. Just in case. Exactly.

1:00:11Dr. Amy Shah:And I actually say in the book, I really say, like, I actually looked into it. Like I was like, okay, what are the pros and cons for me right now? Are you doing them? No.

1:00:20Jennifer Cohen:Okay. So you're a doctor and you're a real doctor, a double certified doctor. What kind of doctor, by the way.

1:00:25Dr. Amy Shah:Oh, so I did internal medicine. So that's like general medicine. And then I did immunology.

1:00:29Jennifer Cohen:So you're like legit doctor, doctor, and you're not on them.

1:00:33Dr. Amy Shah:Yeah, because I think it's a conversation that you have to think about the pros and cons. Like I think if I, once I have hot flashes, if I do, great, I'll do it. Once I have osteoporosis, I hope like knock on wood, like I would do it, you know, like vaginal symptoms that are like very out of the order, like I'm feeling discomfort or dryness and like a vaginal estrogen is perfect for that. So I would totally do that. Like I'm not against it, but I, when I was talking about it with my friend who was, we were just saying, okay, so the indications, I don't have any of the indications. Can I really uplift like my habits, my diet, my lifestyle, my, and really get myself to a place where I feel good?

1:01:10Dr. Amy Shah:Yeah, I've done it. And I think I'm getting to that place. Like if someone just asks you, like, do you need hormones? And like, the answer is not always yes. Yeah.

1:01:19Jennifer Cohen:I mean, I'm not taking anything. And people are always shocked. They're like, you're not taking it. I'm like, I'm not taking anything. And it's great.

1:01:26Dr. Amy Shah:I mean, and the thing is, Jen, if you need it, you should take it.

1:01:29Jennifer Cohen:Well, that's the thing. I'm not, I would take it. Like, that's why I'm asking you these questions. I'm like, listen, I'm more than okay. I'm happy to take it if I actually need it. Yes. But like, I've always had this, like, this idea in my head that I don't need it yet. So why would I do it? Just because everybody else is. Right. I'm not a believer in that.

1:01:49Dr. Amy Shah:If you're cycling, if you have periods, then you're obviously you're ovulation, that you're having ovarian function.

1:01:57Jennifer Cohen:Too much information for everyone. They're like, oh God, it's like a medical consultation here.

1:02:01Dr. Amy Shah:And also the progesterone, a lot of people, though, I would say the one caveat I will say is like a lot of people, maybe you too, including myself, the early signs of perimenopause is sleep disturbances. And so one of the things that is kind of aggravating your sleep issues is your lack of hormones, including progesterone. So having progesterone here and there, especially around certain times of your cycle, could help. So I would do that. Consider that if you want. So for example, right before our period, our hormone levels dropped to really, really low levels. And so that's why you feel a lot of that low energy.

1:02:41Dr. Amy Shah:And a lot of people have sleep issues right before their period. And so that is a sign that your progesterone is really low. Progesterone is like our sleepy anti-anxiety hormone. And so that can be used kind of as needed for people. And you can even cycle on and off of it. And that can help with just like the symptoms that are starting. But you don't have to be on the patch. You don't have to be in a combo. You don't have to be on the testosterone. Like that's kind of like maybe like a first step for people if they want to try it. And then the estrogen, really, you know you're in menopause when your periods are really irregular and you're skipping periods or you're going a full, when you go a full year without having periods, that's what's considered menopause.

1:03:24Dr. Amy Shah:That's what you know. Yeah.

1:03:25Jennifer Cohen:Well, all right, lady. I think I have enough information here. I mean, is there anything else I need to add here before I go watch my daughter do her dance recital? I know.

1:03:34Dr. Amy Shah:You need to go watch your daughter do her dance recital. I do. I think you need to just like every woman probably listening to this or most women listening to this, you need to give yourself permission to recover and get that cortisol down. Maybe go, do you know like when you go on vacation and how you sleep so well and you don't sleep well on vacation? Vacation?

1:03:57Jennifer Cohen:Oh, stress. Yeah, I'm teasing you. Yes, I know. I know I'm supposed to be sleeping well on vacation, all these things.

1:04:02Dr. Amy Shah:So like give your body a little vacation from everything you're doing. And even though like, and a vacation doesn't mean you're lying on the couch. It just means that, hey, I'm not going to like over-caffeinate. You don't drink. So like you're someone who's drinking, like you might want to cut down the alcohol. Maybe you really concentrate on getting more protein and fiber and fermented foods to like calm yourself. Maybe you allow yourself, you know, figure out how to take that little nap or add 20 minutes to your sleep schedule, however you can fit it in in the week. You can't really sleep more than 20 minutes at a time extra.

1:04:35Dr. Amy Shah:So like if you wanted to try to sleep a little extra, it would be like 15 to 20 minutes more than what you do. And that's how you kind of like retrain your body. What you should give yourself permission is like to recover. So give yourself a cortisol reset for three to five days and really get that cortisol under control. That's gonna change your life.

1:04:52Jennifer Cohen:My God. Okay, I'm gonna try that. Okay, Dr. Shah, where else do people find? Okay, first of all, the book again is called Hormone Havoc. People can find you on Instagram. You're like very, very popular.

1:05:02Dr. Amy Shah:Totally, very active on social. It's at Dr. Amy Shah on Instagram and TikTok. And then it's amymdwellness.com.

1:05:10Jennifer Cohen:I love it. Well, thank you for being here.

1:05:11Dr. Amy Shah:Thanks for having me. That was fun. It was so fun.

1:05:14Jennifer Cohen:Thank you. Thank you. Bye-bye.