The Hidden Hormone Shift Driving Chronic Disease in Women - With Dr. Jessica Shepard

0:00Shawn Stevenson:You are now listening to The Model Health Show with Shawn Stevenson. For more, visit themodelhealthshow.com. Welcome to The Model Health Show. This is fitness and nutrition expert Shawn Stevenson, and I'm so grateful for you tuning in with me today. On this episode, you're going to discover one of the hidden reasons for our skyrocketing rates of chronic diseases in the United States. according to the CDC's latest data, 75 % of American adults now have at least one chronic disease. Now, we know that this is a multifaceted issue, but there is a specific hormonal change that's contributing to specifically five chronic conditions that are, again, heavily influenced by the hormonal changes that happen in perimenopause and menopause.

0:55Shawn Stevenson:And today you're going to learn some practical ways to defend against them. And you're also going to learn the truth about some controversial treatments like hormone replacement therapy, aka HRT, and much more with our special guest. And she is one of the world's foremost experts in this subject matter. And without further ado, let's dive into this conversation with our special guest and our topic of the day. Dr. Jessica Shepard is a board certified OBGYN, chief medical officer of hers and author of Generation M, the chart topping book, Redefining Women's Health. A leading voice in women's wellness and longevity, she's a regular all over major media, including Good Morning America, The Today Show, Live with Kelly and Mark, Vogue, Cosmopolitan, and many other media outlets.

1:45Shawn Stevenson:With a no-nonsense approach and deep medical expertise, she's helping women cut through the noise, take control of their health, and feel their best at every stage of life. Let's dive in this conversation with the one and only Dr. Jessica Shepard. Dr. Jessica Shepard, thank you for coming to join us today. Hello, how are you? I'm doing fantastic. I'm doing fantastic. You're going to help us to answer the questions and understand the interworkings of the universe today. I am ready for this. I'm going to put that solely in your lap. Listen, according to the CDC's most recent data, 75 % of American adults have at least one chronic disease.

2:28Shawn Stevenson:And it's slightly higher prevalence with women. What do you feel from your experience, your clinical experience, and also just the emerging data is causing so much disruption specifically with women's health today? I mean, that could probably take the rest of our time here. But I think if I were to put it into three categories, is research probably the number one thing. It wasn't until the 90s that research really wanted women to be included in outcomes that impacted women. And so I think when you look at it from a perspective of if we have outcomes and we have data, we actually need to use the population in which it's serving.

3:09So there's that. Two, I do think that there is a gap in women, and I call it the magic of midlife from when they hit that perimenopausal menopausal state and where their hormones decline. it really is the starting cascade of how the body is able to respond and optimize itself. And then you have a good 20 years of where women go without these hormones. And then you start to see the influx of the chronic disease state. So it never happens overnight. Chronic disease doesn't happen overnight. It's in chronicity and it's happening over time. And that time span really is important. And we can get into that a little bit later.

3:50And then the third thing that I will say is stress. Stress impacts women differently. And many times they carry more stressors than we would see in men. Men typically, not to say that their stress is not as important, but it usually will be in very succinct categories of maybe financial or work stress. Whereas women typically will carry the stress from their families, their communities, their children. And that wreaks havoc on a woman much more than we know. And many times women are actually taught not to respond to the stress, suppress it. And when you suppress your stress, that increases inflammatory markers and the way your body responds.

4:37And over time, your body's like, I can't do this anymore. Yeah.

4:41Shawn Stevenson:Yeah. Thank you. I'm so glad that you brought up this stress component. And obviously there's a lot of emerging data regarding the stress and impact and inflammation and whatnot, but it's this overall life change really. The conditions that we're in now are so dramatically different from even a few decades ago. And with that being said, it's only recently that, as you mentioned, number one here, the lack of research and actually studying women, which is crazy that this was, you know, the nineties. Yeah. That is like, we were around in the nineties, right? We were, we were around. And this is when at the highest level of what you can see in science and representation of what that means was when they were like, let's include those people call women.

5:32Shawn Stevenson:Part of it was of course, the complexity of women. Like, let's just take this out because there's too much complexity here. There's cycles involved here. There's life cycles involved here. Let's just remove it. Or look at women as smaller men, basically. And, you know, thankfully that's changing right now. And you're one of the leading voices in this. So I'm very excited to talk to you about this. And so to pivot to that conversation around perimenopause and menopause, you know, right now, I mean, superficial goals are a driver for a lot of people, right? weight loss, having the body composition.

6:11Shawn Stevenson:We want energy, just feeling good in your body. And chronic disease is kind of the opposite of that. And this is the norm now. And so having that good state of health is actually you're in the minority, but we are seeking to change that. And to do that, if you could, can you help us to kind of just illuminate this, some of the missing pieces when it comes to perimenopause and menopause? In your book, you talk about like a dimmer switch. going on. Can you talk about that? Yeah, the dimmer switch is that perimenopausal phase. And even if you think about it in a gas tank analogy, a dimmer light, it's over this 10 to 12 year timeframe that women typically won't necessarily feel it, you know, catastrophically, they are like, hmm, something's going on, right?

7:01And so over the course of this 10 to 12 years, you start to see where our hormones and when I say hormones, throughout this segment, it's going to be estrogen, progesterone, and testosterone. And namely estrogen, because that seems to be the most profound and kind of gold star of hormones when we think of women and reproductive hormones, even though it's not truly a reproductive hormone. It's much more than that. Progesterone is actually the first hormone that starts to decline in perimenopause. And this dimmer switch of estrogen is it's just dialing down ever so subtly. Like you walk into a room and you have a dimmer switch.

7:37And if we were sitting here and just like over the course of our time, the light was getting just dimmer over time. You don't notice it right away versus if someone walked in the room and just like shut it off. That's a different experience. And so it's, again, this ability to notice it. That's why I really focus on body awareness. Like really what's going on in my body and actually embodying it to say something is that's where we want to meet women. in the perimenopausal phase is during this dimmer switch phenomenon. And because it's, that's where we have the most opportunity when we have the most opportunity to impact.

8:15I will always say this humans, we are like creatures of habit. And we know over time, what benefits us in the best is change of habit and lifestyle, right? And that could be a whole nother kind of segment of what lifestyle changes mean. But I would never expect someone to walk in and I'm like, okay, by tomorrow, we're going to fix all these things, which is going to give you the best, you know, sustainability in life ever. So that's where we want to capture women is during that dimmer, dimmer switch phase. So we have the best way to infiltrate with change in lifestyle, routine habits, what is going to work for me, what isn't.

8:54And that way, it's more of this integration of this beautiful life that you look forward to rather than what we do see in chronic diseases oh my god now your body organs are really failing we got to do something right now that's that's not how we should seek to live our lives and that's why i believe that perimenopause is a beautiful landscape for us to make some really big change yes i love this so much in the book.

9:22Shawn Stevenson:And just to tie this back to what we started with chronic conditions, we see a potential uptick in five specific chronic conditions as a result of, or just around the phenomenon, the changes that happened during menopause for women. And you detail each of these five conditions. And again, it's really important for us to speak this and to understand what is behind these changes. And one of those is cardiovascular disease uptick. And can you talk about that relationship with women, menopause, and cardiovascular disease? Yeah, cardiovascular disease, just even starting out as the number one killer of men and women, but women globally.

10:06And I think we don't focus on that a lot. We may say it a lot, but I don't know if it resonates because we do focus on a lot of other things when it comes to mortality and morbidity, namely breast cancer. And I'm sure we'll get into that later. But the what I had said before about estrogen being a reproductive hormone is that, yes, it is, but it's also so much more. And when you truly understand hormones and how they're messengers, and they are kind of the signaling of what the body is able to do and how it's best able to do that thing, estrogen receptors are all over our body. So we typecast it, literally typecast it to just the pelvis.

10:45We're like, it's just this little ovary that has estrogen. It's just about periods. When really we look at bone, muscle, brain, gut, and heart all have estrogen receptors. So if we think of estrogen as this messenger that is so prevalent throughout our lives, and then we have a complete shutoff of this messenger, the organ that it's sending a message to is like, um, so I'm gonna need that hormone here. And it's not being delivered. The heart muscle is therefore going to multiple things, it's going to decrease its contractility, the ability for it to do the main thing that I do, which is like push blood through that organ, so it can get it to the rest of the body, increasing significantly, we see this so much in women going through the perimenopause menopausal phases increase in the plaques in the atherosclerotic plaque in the vessels.

11:36So if you have an uptick in that, and then also the ability for just to us to perfuse the rest of the body, then you're going to start to see cardiovascular disease, not only from an aging perspective, because there's also aging as well. But now it's compounded with a decline in estrogen not being able to shuttle this message to the heart to being like, do your best thing. And so with that, that's why we start to see with women a lot of times is after that menopausal transition with no estrogen, their heart is like, well, now I'm really not being able to do what I need to do. And then in that we have cardiovascular disease, which leads to cardiovascular death.

12:16Shawn Stevenson:Wow, oh my goodness. Thank you for sharing that connection. Now, of course, we're gonna talk about some of these, some of the things that kind of jump out as top tier connected, which is like HRT, right? We'll talk about that in another chapter in this conversation. but within this context of you sharing this information you share why it's even more important to double down especially in perimenopause to set yourself up for a healthier transition and protect your heart health and you share some data regarding the mediterranean diet and really leaning into something closer to that with more intention to help to reduce the risk of cardiovascular events by like 28 yeah leaning into that and so that was number one number two is osteoporosis is another, you know, again, if we're looking at chronic conditions that millions of women are suffering with and understanding the connection with perimenopause and menopause and osteoporosis, enlighten us, please.

13:16Yeah. Osteoporosis is one of those diseases we always categorize as it happens when you're older. And I think we've said this before, as we've been speaking is nothing happens overnight. It's over the course of time, the body will still the body is so adaptable, the body's a beautiful machine, and it can adapt. But at some point, it's like, I've adapted for so much time, and I haven't really been giving given what I need. Now I can't function, right. So it's a functionality issue in aging in the ability to capture people in the perimenopausal phase for what's going to benefit them in the end. So we have bones without as who do have estrogen receptors now we don't have estrogen and so it doesn't have the ability to sustain the part of the bone that really gives it its strength and what happens over 20 years it just starts to deplete from the bone so you have decreased bone mineral density but also decrease in muscle mass which if you think of it as a complex together when you get older you don't have the strength in your muscle to give you the ability to withstand force or decline for or you know, prevent a fall.

14:24But then when you fall, your bones are like, well, I'm going to break because I'm like pretty much powdered bone at this point, because I haven't had whether it's estrogen from a receptor or receptivity standpoint, or lifestyle, no resistance training, no weight training, and all of these things come together, our bodies are all connected. And when we don't allow women to understand the appreciation of what happens in this decline in this dimmer light or this dimmer switch approach, then we're only setting ourselves up for 20 years from now where our body is like, I've been without for so long.

15:01I can't sustain at this point.

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16:36Shawn Stevenson:Oh my God. being more intentional about it than ever in that cycle of life. And again, it's just like, this wasn't a big part of our culture previously. And now thankfully that's changing, but this is like a double down message to strength training. And when I say double down, let's go with triple down. That's a triple down message because just kind of like framework of how society is really built in a patriarchal type of system where something is for men and something is for women. And so we're fed that message over time. And for a long time, it was women do cardio and men do weight training.

17:14And lo and behold, our bones and our muscle were like craving resistance training and weight training, because it needed that force that mechanical force in order to build the bone, sustain the muscle so that when we get older, then we have the ability to have the strength with not have falls. And resistance training is not only just for muscle and bone. I mean, that's like one of the primary benefits, but it also is for brain health as well. And what do we see that increases over the course of time, especially in women, is dementia, namely Alzheimer's dementia. Mainly women get Alzheimer's.

17:50Shawn Stevenson:hmm we're putting the puzzle pieces together we're trying we're trying to connect the pieces today number three yeah and this is something that again is more prevalent in women thyroid disease yeah thyroid disease is again a hormonal issue right so we have hormones which from the central part of our brain from the hypothalamus secretes all these hormones and it tells the body send the message to do this send the message to this and thyroid especially after the age of 40 really takes a hit primarily in women where we start to have dysfunction. And so with that comes again, this, these subtle changes where you have symptoms and you're not quite sure.

18:28I think, you know, even from a medical standpoint, we probably could do a better job at educating on how important the thyroid is and what subtle signs to look for and not to wait for disease. I'm really big on when you think the functionality of the body is not to wait till it's depleted to give it the thing that it needs, but help people understand as it's starting to decline, as there are subtle changes, what can we do both in your life, whether it's from a medication standpoint, to get you optimized before you get completely depleted and now we're fighting disease state.

19:04Shawn Stevenson:With the thyroid specifically, which some consider it like the metabolic hub as far as our our glands are concerned. I'm curious, and I have you here to ask this question, you know, because again, millions of women experience this with hot flashes. And I'm wondering if the thyroid has any influence on this because it's, you know, if we got this HPA axis, there's a lot of activity up and down that axis that's helping to kind of regulate temperature, you know, and your thyroid being a hub of just metabolic activity. You know, I'm curious, like what's causing these hot flashes? so hot flashes i i actually love explaining where hot flashes come from but i'll go back to your question again like is thyroid potentially a part of this what i will say is when we think of the hpo axis and like kind of the neighborhood of hormones from the hypothalamus they all integrate to some degree right it's like a neighborhood and they're all like friendly neighbors so when one is suffering the other typically will feel some of that that kind of um suffering and and take some kind of a hit.

20:08Now, does it directly impact hot flashes? Not necessarily, but you will find on the reverse women who are in the perimenopausal menopausal phase, also having some thyroid issues as well, some kind of like little abnormalities, maybe some dysfunction. And so that's why it's important when we're looking at women in that timeframe to look at all the hormones and not just focus on one. And the other thing with, you know, metabolic rate is a lot of people have said that women going through perimenopause and menopause it's the decline in estrogen which declines metabolism but that's why i like to kind of put it in two separate buckets of aging because we're all going to age unfortunately but the aging process is actually more responsible for decline in metabolism estrogen kind of fine-tunes into that for other different categories that can impact metabolic rate but metabolic rate is truly an aging phenomenon rather than just all solely from a menopausal standpoint but hot flashes listen to how smart the body is in the brain there is a receptor it's called the candy neuron and what it does is responsible for temperature regulation it's kind of like the thermostat on the wall but on that actual neuron is an estrogen receptor and so when you have a decline in estrogen which is not able to send the message to this neuron who solely responds, you know, is responding to estrogen is like, well, there's no more estrogen.

21:38So then you have an up regulation of the other part. And then that's when we're not able to temperature regulate. And so your body is not able to, you know, have the sensors to be like, Oh, we need to click on because we're too hot, or we're too cold. And your body responds to that. And in essence, then it's just like, okay, I guess we're heating up and we're having a hot flash. So that's why when it comes to hot flashes, one of the like most profound ways to decrease them is literally estrogen because it goes right to that candy neuron and goes to the receptor that it's needed to regulate that thermostat.

22:10Shawn Stevenson:Holy moly. Holy moly. And this is a good transition as well. Number four is metabolic syndrome and the uptick that we see regarding that. I mean, this is a cultural phenomenon with metabolic syndrome, but specifically with women. Let's talk about that really. Yeah, the engine of our bodies and what happens with input and output, what happens with expenditure, what happens with the body able to adjust and pivot and recover is based on insulin and glucose. Like that is the hub of how our body is able to do most of how we function. and insulin and glucose is a very intimate relationship which often is disrupted from other disease states from other things but aging is one of them but when women go through perimenopause and menopause obviously we know that estrogen declining is going to have an impact on how insulin and glucose are able to regulate respond glucose we know that so think of again looking at the body is this beautiful machine we have a decline by three to five percent per decade in our muscle mass right so our muscle is already on the way out from probably the age of 35 trying to decline per decade and muscle is the largest absorber in addition to the brain of glucose so if your muscle mass is declining and you're not absorbing glucose what is it going to do it's going to sit in the body and it's not going to be able to be used as fuel which is what it's for but we also then have this shift in estrogen which is declining and it's not able to meet the demands of helping this relationship between estrogen and glucose because it does depend on it and so it's this multifactorial thing that's occurring decline in muscle it's not being able to absorb it sitting in the body the the liver is not meeting the demand as well as being able to absorb it and store it but then estrogen is also declining and not being able to help optimize all of these functions that are going on in the body.

24:15So what do we see? Glucose sits around, what does glucose do? And it sits around, it converts to fat, then we start to have more of our peripheral fat and the fat around our organs. And the beauty of this is we all have the ability to see this coming, right? Because it's a part of aging, it's a part of perimenopause. So it's not like we can escape it. But what we do have the opportunity to do is understand it earlier, adjust, use some changes in our lifestyle, our food intake, considering HRT in order to help the body more.

24:49Shawn Stevenson:So again, we've got five of these that you cover and you mentioned a couple of other offshoots as well. You mentioned dementia, but one of them that isn't talked a lot about, unfortunately, is bladder health. You specifically highlight as increased incidence as a result of menopause. So talk about that relationship. Oh, I'm glad you brought that up. That means I get to say the word vagina. So parts of the body, I know, right, are impacted by this hormone decline. But like we know, reproductive hormones in the pelvis are one of the biggest absorbers of estrogen, progesterone and testosterone. But I feel that if I can give a depiction of what the bladder is and where it's surrounded by is if we were sitting in this room.

25:39So the room that you and I are sitting in right now, I'll label it the vagina. We are in the vagina room right now. Are you excited? And the floor above us is the bladder. And then the floor below us would be like what you would say is the rectum. And so basically, it's just showing the continuity between all of them in the close proximity. So the bladder really has a lot of function with estrogen. And so when estrogen declines, the bladder is like for bladder health continuity and what I'm able to do, I can't do it as well. And so you start to see increase in urinary tract infections. You also start to see increase in what we call urinary incontinence.

26:17So that's like leaking of urine, which by the way, is one of the biggest reasons you see women actually admitted to nursing homes is because they have urinary incontinence and it's really hard for them and for maybe their caregivers to keep a hold of and that's a big reason why you see women going into nursing homes. So when we think of quality of life, when we think of reasons that women die, a lot of it can be from urosepsis, urinary incontinence and if that's something that we can tend to early on, why not? Which is why we should be giving women vaginal estrogen which is different from systemic estrogen and is very safe earlier than later.

26:57Okay, great.

26:59Shawn Stevenson:Thank you for helping to unpack these issues. The rooms. Yeah, I love the rooms. This has also been a big point of controversy in relationship to how to treat this and hormone replacement therapy. And you really pull back the curtain and reveal like this was based on this kind of flawed data from a couple of decades ago. And you unpack all the different flaws, of course, and point to the value that it can hold. And you also are clear, like this is not for everybody, but you feel that it can help a lot of women in managing the symptoms, the transition, and most importantly, helping to reduce the risk of these conditions.

27:45Shawn Stevenson:So let's talk about hormone therapy and the value that it can have. Yeah. You know, like in a snapshot of, of where we are currently with hormone replacement therapy, or if you even call it menopause hormone therapy or just hormone therapy is that we are basically at this point where we are Olivia Popping what happened 20 years ago with this bad PR campaign of hormones are bad for you and it causes breast cancer. It was literally taking a message that was inaccurate. It was not provided by the people who should have provided that information and disseminating it to so many people who likely were going to be like, this is bad for me.

28:27I'm not going to do it. And now when we look back at that data, and we have known this for years, by the way, you know, in medicine is that the list of benefits of hormone therapy completely outweighs like quadruple outweighs the risk of hormone therapy. Because now as we're starting to, you know, counsel women and allowing them to feel safe with being like you are not going to die and you're not going to get breast cancer is allowing them to see the benefits. And we've already gone through a bunch of them, cardiovascular, bladder disease, all of that are the potential benefits by taking hormone therapy.