"Doctors Are CLUELESS About Women's Bodies" - How To Take Your Power Back & HEAL

26:56I think that allows her to flow and not be in pain or have PMS or be like cramping a lot or off cycles. You nailed it. I mean, you just gave the formula for oxytocin. Really? So she gets a lot of oxytocin is what I just heard. All day. Yeah. So it's balancing everything else out. Interesting. Yeah.

27:21I'm curious, how is this possible that there's only eight hours of, I guess, educational training for menopause, when I've also heard you say about a third of all women are in some stage of menopause right now? I think it's multifactorial as to how we got here. And I left, I was a program director in 2018. I left that job. So I was teaching at an academic institution. I had seeing patients, teaching med students, residents, but I was in charge of the curriculum for the residents as dictated by the American Board of OBGYN, okay? So I know exactly up until that point what was required. And menopause was required, but we didn't have menopause clinics.

28:00We didn't have more than just a few required lectures. It was really just menopause is the end of the period. You might get osteoporosis. It's just the most cliche kind of basic, basic learning. No nuances about treatment and training. And so, you know, how do we get to where this is a natural process, but it affects 100 % of women who live long enough, completely going into ovarian failure. Okay. Loss of all of sex hormone production from the ovaries pretty much. And then she's expected to live the last third of her life without the benefit of her sex hormones and no discussion around how that affects her heart or her brain or her bones or her general degree system or her mental health, you know, and, and how like we can shepherd her through this last third of her life to live as healthfully as possible, you know, by limiting these effects of the hormones.

28:52And so, I mean, I went through the training program. I was all on board till 2018 until I realized I went through menopause and was like, wait a minute, this is much bigger than we're teaching, than I was taught, than what I actually believed. As an OBGYN, And when you started entering menopause, did you think that you were prepared and educated? No, not at all. Even though you were treating women and helping women on menopause for years, you didn't feel prepared. So I gaslit myself for probably six months. So a lot of things were happening to me at once, as most women my age at that time. What was happening?

29:30So I was 48. I had been on birth control pills for treatment of polycystic ovarian syndrome, which worked great for me. It's not for everyone, but I was fine on them and had been on them for years and years. Decided to come off and to see where I was at hormonally. At 48. 48. And so average age of menopause is 51. So I figured it was coming. Okay. Let me see where I'm at. And I get off and I'm like, my brother gets really sick. So I'm from a huge family. I have six brothers and one sister. My oldest brother died when I was nine. my next brother bob the second in line um had hiv and hepatitis and so he i get a call from the hospital i was in the or and i get a call like an emergency call and they kind of put the phone up to my ear i was finishing a case that my brother had had a stroke and was in the hospital and he'd been kind of in and out of the hospital for a while so he was in the end stages and so i i just like went home he got discharged from the hospital to hospice and my sister and i did his end of life care and like everybody coming to that.

30:32It really was a beautiful way to die, you know, but I had just stopped my birth control pills and I just kind of forgot. Now remember, I had been on them for treatment of a condition where I didn't have periods. Okay. So me not having a period was not a red flag. So here I am months into this. I think I'm grieving, which I was, but every single thing that I'm going through, I'm attributing to my grief. Definitely there was something there, But then as the grief fog starts to lift and I'm trying to get back into my habits, I gained weight and I wasn't sleeping, you know, I realized, wait, when was my last period?

31:07This is a hot flash. You know, like I'm in menopause. Like I literally could not figure it out for months in myself. And so I always thought I would treat hormone therapy like an epidural in labor. Like we'll see how I do. You know, if I'm a good girl and I'm strong, I won't need it. Right. You know, and of course, I got an epidural at three centimeters, which is very early in the process because I was in so much pain. And so I felt like hormone therapy was an act of not being strong enough and throwing in the towel. I had no idea the protective benefits of HRT for my heart, for my brain. You know, all I knew was it was the last ditch treatment for debilitating hot flashes and that pretty much there wasn't much else it could do for me.

31:52And so I go on HRT because I can't sleep. And I know if I don't sleep, I'm setting myself up for failure and everything. Plus, I was working shift work at the hospital, very busy life, trying to raise teenagers, all the things. And immediately, I feel better. And all of a sudden, other things are getting - After therapy, after hormonal therapy. After starting hormonal therapy. Okay, I start sleeping. The hot flashes go away. But also, the weird joint pain I was having gets better. Some of the brain fog lifts. I'm like, whoa, this is a bigger deal. The same time, I was struggling to lose some of the weight I gained through the grieving process and what now I know is menopause.

32:29And I couldn't get it off. And I'd been thin. I'd had thin privilege most of my life. Like I, you know, could diet for a week and get back into whatever genes. And, you know, I just it was easy for me. It was like melting off. And it was not coming off. It was about 20 pounds. It was all in my midsection. and I was like banging my head against the wall, like getting up at 5 a.m. to go work out. I was doing two a days. I was calorically restricting to dangerous levels. I was doing all the negative, negative things. And my husband pointed out, your girls are watching. Your what? Your girls are watching.

33:03They're modeling after what you're doing. You're exhibiting behavior. I was like literally an almond mom. I was just judging them for their food choices. And it was all really about me. And so my husband was like, he was going on a trip and it was like a two week trip. And he said, so when you get back, I'll lose this 10 pounds or whatever. And he goes, I don't care what you look like. Like, I love you. You're beautiful, but you're not happy. Like you're, you're, you're getting up at night to pee and you're weighing yourself. You're constantly talking about your weight. You're, you're, you know, this isn't working.

33:34And what do you tell the kids when you can't exhibit, you know, you can't expect change if you keep utilizing the same behaviors. And he's like, figure it out. You're smart. You're a doctor. And so I took that as like a challenge. And so I went to the PhDs at the university I was employed at. And, you know, I was everybody's doctor at that point. I was like, what's going on in menopause? I can't lose weight. My patients aren't losing weight. What is this around my middle? And they're like, well, that's visceral fat. I'm like, what's that? I didn't even know. Right. You know, like I didn't even know the difference between subcutaneous and visceral fat.

34:03Like we learned nothing about nutrition in medical school. I mean, the minimum. And so they send me a few articles. I just started going down rabbit holes about inflammation and visceral fat and nutrition. And so that's where my first toe in the water with menopause was, let's get this weight off. And it was the pain point for so many of my patients. What is the number one pain point for women in menopause? Is it getting rid of excess weight? Is it dealing with hot flashes? is it dealing with? So when we look at, so for forever, menopause was only quantified by absence of periods and hot flashes.

34:36Those were the top two. But when you actually - And what is a hot flash? Good question. Just so I can be educated. So yeah, a hot flash is a thermoregulatory dysfunction. So there's a little temperature gauge in our hypothalamus, in our brain, and it has a really a set point. And when our estrogen levels decline, we end up with dysregulated serotonin, which then resets the temperature gauge. So what we used to just kind of go with the flow, all of a sudden we'll have this profuse sweating. Profuse, like most women, it'll start somewhere in their chest area and you'll feel this heat building and then it'll just rise up.

35:11I can probably make it happen. Go up into your neck and then your head starts sweating. It's going down your arms. I mean, some women will drench their entire clothes, but it usually starts central and it goes peripheral. It lasts seconds to minutes, but it is completely disruptive. Does it happen multiple times a day? Is it once a week? It depends on the patient. So it could be, some patients will have multiple times a day, like to the point where she, you know, so that's severe. Some will have it once a week. It really does vary from woman to woman and it's not really tied to exact estrogen levels.

35:44So it's more to do with neurotransmitters and how those are affecting her. But 85 % of women will have those. But probably 90 to 95 will have body composition changes. Almost 100 % will have fatigue, like differences in almost every single woman that I talked to was like, something wasn't right. I couldn't put my finger on it, but I felt different. And either it was through sleep or what her body was doing, But like she wasn't changing anything in her nutrition, in her exercise, in her stress levels. Like everything was stable, but her body was changing. And the thing is we have estrogen receptors in every organ system of our body and it will affect each of us differently.

36:27And so doctors love the duck. You know, walks like a duck, talks like a duck, walks like a duck. It's a duck, right? So we have these checklists of things. Okay, this is the flu. This is, you know, a broken leg. This is whatever, but menopause. Yeah, the symptoms of menopause. Right, are variable. So 85 % of his hot flashes, sure. 100 % of women will lose their fertility and their periods will stop. Normal regulatory periods will stop. But probably 90 % fatigue, probably 80 % sleep disruption. 50 % of women at any time will have sexual dysfunction. So changes in libido, pain. We see almost 100 % body composition change.

37:07So not just weight gain, but where we gain weight changes. So we stop depositing fat so much in the subcutaneous area. We can still do that, but we start shifting a lot of fat to the intra-abdominal cavity or that visceral cavity. You're talking about from the legs and the butt to the stomach. Yeah. Okay. Yeah. So what, when most women typically estrogen drives a more pear shape, which is natural and healthy versus all of a sudden you're having new fat in the abdominal cavity. Half pear. Yeah. Half pear. Suddenly you look pregnant. So, yeah. Or their pants are getting tight and they can't figure out why.

37:38It seems like there's a lot of challenges or changes that women go through during this period of time. And how long does menopause tend to last for? Yeah, great question. So menopause is actually one day. So let me walk you through all these definitions. It's so confusing. So menopause is medically defined, which I think is a terrible thing, one year after your last menstrual period. That is menopause and it's one day. Everything after that is post-menopause and everything before that. So you go normal reproductive cycles, that very predictable EKG-like ebb and flow of your hormones that happen each month in a healthy patient, very predictable, right?

38:15So we know she's going to peak on day 14 with estrogen, and then that's going to drop, and it's going to rise a little bit more, but then we'll have a surge of progesterone, and the whole thing starts over every month, and that's very, very predictable. Perimenopause is when that predictability starts declining until your period stops. So it could be once every two weeks. It could be... It could be 10 times a day. It could be... It's very, very variable. So here's why. Here's why. And what I think your listeners and followers should understand. Difference between us. I was born female. You're born male, right?

38:45You make your genetic material in the testes every day. And you can do that probably till you die. It might be a little harder as you get older, but you can do it, right? Females are born with all of their eggs. And it has to last them until they go away. So we actually reach our maximum egg count five months in utero when our moms are still pregnant with us. And then they decline. So we lose quality and quantity over time. How many eggs do you most women start with? At birth, one to two million. Two million eggs? Holy cow. And then by the time we're 30, we are down to 10 % of our egg supply, roughly.

39:20It's about 120 ,000. And then by the time we're 40, we're down to about 3%. and menopause is when you have no more eggs. You're done. The day all your eggs are gone. Yeah, and there's nothing else. No sex hormones are being produced by the ovaries anymore. Usually, what's the average age of that? Yeah, so menopause, 51 average. However, normal is still 45 to 55. PERI, and I'll walk you through that. PERI begins seven to 10 years before that. So the hypothalamus pituitary, right? Two glands in the brain. You probably know them well. The hypothalamus is constantly sampling our blood for estradiol.

39:56It is what drives that monthly period. Okay, so the brain is like, we're good. Estrogen levels are good. Oh, they're getting low. They're getting low. Sends something called GnRH, gonadotropin-releasing hormone, to the pituitary. Pituitary is like, all right, boss, I got it. Starts pumping out LH and FSH, which are stimulating the ovaries to ovulate and make those hormones, right? And so what happens when we start losing quality? We reach some critical threshold in the number and quality of our eggs. then the brain's then the ovaries like can't do it with the same lh and fsh it's not it's comes resistant to those signals so the brain's like where's the hormones i sent the signal and the material was like i try and he's like try harder so you get these bigger surges of those stimulating hormones almost like what we give in a in a fertility shot right and then the ovaries like okay fine look spits out an egg so we get these wild fluctuations super high surges of estrogen way higher than you ever had in your normal reproductive stage.

40:51Then these crashing lows. So what used to be this EKG predictable thing becomes a zone of chaos. Literally everything looks like this. It's trending down, but it is a roller coaster on the way down. And then you end up in menopause and it's like flat line. That doesn't sound enjoyable. Well, it's less tumultuous if you understand what's happening. So educating yourself is half the battle. If If you're educated and knowing when you hit these ages, there's going to be a lot of changes. I mean, you don't have to be afraid. Right. Don't be afraid. It's going to happen and we can coach you through it.

41:26And there's so many things, nutrition, exercise, stress, you know, all the pillars of health are helpful, but just understanding what's happening. And so you don't gaslight yourself and being able to stand up for yourself at your doctor's office. Because here's the problem. Like the first question you asked was like, how did we get here where a woman can't reliably walk into a doctor and get information? She has no idea what's happening to her body, how society views aging, how society views women in aging, how the medical profession deals with women. You know, in my training, there was this underscore of women tend to somaticize their symptoms, meaning giving a psychological reason instead of biology, just blaming it's all in her head, basically.

42:10And that's been going on for thousands of years. Called WW, right? The WW, the whiny woman. So the WW was a term used by my upper level residents for a woman who was coming to our clinic who had a laundry list of vague symptoms, some headaches, some fatigue, depression, libido, joint pain, whatever. Everything's an issue. It sounds like it's like a little bit of issues everywhere. This is Texas, so I have this long, tall Texan in his white lab coat with his cowboy boots, meaning well. Suck it up. It was taught to him saying, well, there's not much we can do for her. It's just that these women go through this at this age, and I just bought it.

42:54I bought into it. There was no education on, like, can you prevent some of these symptoms? Can you optimize certain things? No. And my last year of training was when the Women's Health Initiative came out, and HRT was taken off the table. So there was no education around perimenopause and how we can intervene and decrease symptomatology and improve. You know, then the other thing, so we have the chronic things, the hot flashes of the night. So it's the things that bring people to the office. But what I think the bigger impact is that if you look at men and their risk of heart disease, so there's things that lead to heart disease, hypertension, high blood sugar, you know, diabetes, stroke risk, et cetera.

43:34It's pretty linear with age. For the most part, as much as that could be biologically plausible. Women are pretty much lower than men until menopause. Then they shoot up and then they go past them. So menopause is a huge risk factor for chronic disease. The loss of estrogen affects the liver. Cholesterol goes up. It affects the intima of the artery. It's very, very protective of the lining of the artery. So much less atherosclerosis. You take age-matched women. Remember, it's normal 45 to 55. So if you go through menopause on the younger end, you are higher risk because your body's away from estrogen longer and all the protection that it offers.

44:10Don't women in general live longer than men? They do, but 25 % of that life is in poorer health. So their lifespan is longer, but their health span is horrible. Women are three times more likely to end up in a nursing home or three times more likely to end up with dementia and frailty. Whereas men, that doesn't happen. They kind of live, have a short decline and die, right? So they're way more functional in general. Of course, not every man, not every woman. But what we're seeing, the trends are women are living three to four years longer, but they're in nursing homes and they can't take care of themselves.

44:41Do women suffer dementia more than men? Yes. Really? Yeah. Two to three times more. Why is that? So there's a great book on this subject. Lisa Moscone wrote The Menopause Brain and The XX Brain, and she explores a lot of this. And we know that estrogen is really protective in the neurological system. And when those levels decline, we start seeing acceleration of disease. But what about for men if we have less estrogen, right? Yeah. So you actually kind of, your estrogen stabilizes. It's lower than women's. But once we go through menopause, you have more than me. Come on. You have more than me.

45:14Wow. Yeah. So you still have a little bit of baseline protection. That kind of stays most of your life. Now, with all these different, I guess, I don't know if you call them symptoms or challenges that women face during these years of menopause, I guess it's one day, but the years of experiencing Right. The post-menopause years. Yeah. What would you say is the biggest loss for women? Is it the gain of fat, the unwanted fat? Is it that they don't have the sex drive that they once do or it shifts and it changes? If they feel like, oh, now I'm actually getting older. Am I as valuable as a woman in society?

45:51I think all of it. I think it's all of it. Like it's all hitting at once. They are feeling so, you know, they're loose. Okay. So like at work, when you look at the economic impact of menopause, this is an age, so I'm 55, you know, I am at the top of my career and it's only going up. And had I been suffering from brain fog to the point, one in five women will quit their jobs because of cognition changes in menopause. This is at an age when we should be leaning into our careers. The kids are grown for most of it. We're just at that age where - You've got the most wisdom, the most experience, the most knowledge.

46:28And now they've lost so much confidence because they can't find their words or they can't calculate anymore. They're used to these high level cognitive function and they've lost executive functioning. So we see ADD, mental health changes, the dopamine changes, the serotonin, the norepinephrine, all of this is linked to our hormones. And when these changes happen, especially in peri, where it's so chaotic. The brain loves to know what's coming, right? So the brain really thrives for most of us in that estrogen is going to surge, progesterone is going to surge, it's used to it. And then when we get to peri and we see this chaos, mental health, I think it's 40 % increased risk of depression in perimenopause.

47:09Greatest risk of a female to commit suicide is between 45 to 55. I mean, just look at the numbers. We look at serotonin, SSRI use, so antidepressant use, doubles between premenopause and postmenopause. Okay. And then goes up after age 65. And these are things that don't have to happen, that we can actually intervene early and provide education, counseling, therapy, and decrease these risks as we age. Walk me through, because you've worked with a lot of, how many women have you worked with, like one-to-one privately? And since my menopause clinic? Like, oh, God, over a thousand. Yeah. So walk me through, if you can, and put me and anyone, man or woman, in the seat of what is a woman feeling emotionally, spiritually, and psychologically when they realize they no longer have any eggs left and they can no longer, even if they didn't want to have kids anymore, but they can no longer have the ability to have children themselves.

48:07ourselves, what emotionally goes on with women who experience that moment? There's no more. I think it's a fleeting moment. I went through it myself and I've talked to all these patients. You go through a little bit of mourning and then you're like, I don't have to worry about it anymore. We're done. I mean, I had my children. I purposefully did not have more. I wanted to focus on the two that I had and was happy with that. We did try one more time. It never worked out. But, you know, at a certain point I was like, we're done. Yes. But you had a rhythm of a cycle, you know, a physical cycle. But you go through this chaos, you know.

48:45So it's not like the door shuts one day. You go through months, years of what the hell is happening to me. So also, you know, they're losing confidence because of, you know, cognition changes. They're losing libido. Their, you know, marriage is affected. Their relationships, they're losing their resilience to anxiety and stress. And so, so many things are happening to this woman. By the time they get to my office, they've seen five or six, they've gone to one guy for palpitations, another woman for, you know, they've been dismissed, gaslit, told this is normal, this is part of your life, weight gain, eat less, you're just lazy, you're fat, you know.

49:20And then they get to me and I'm like, I got you, you know, and they're so great. Like the tears pour. I have Kleenex. I'm just, one that they're validated. And then, then we start talking, okay, what are our tools that we're going to use to pull you out of this. Someone, so imagine I'm, you know, you can imagine I'm a 49 year old woman or 50 year old woman that's gone through five, seven different doctors, finally gets your book and realizes, oh, I need to come see you. And I come and for two hours, I'm sobbing, I'm crying, and I'm telling you every symptom I've had. And I say, I don't know what to do.

49:52What's the next thing you say to me? And what will you do to support me or any woman watching who's uncertain on how they can feel safe and protected about what to do next? One, I listen to her and I believe her. And that is half of the therapy right there. So because of the way society perceives women, the way medicine perceives women, the way we're training our clinicians, by and large, at least in my generation, of this, it's all under head and women are just emotional. To have someone believe you and just say, and you say, yeah, yep, that, yes. yes, yes, yes, here's a study that proved, you know, here's that.

50:33Now let's talk about what we're going to do about it. And I mean, I could basically tell them to go home and do handstands and eat toast or something and they would feel, you know, and so, but we start with therapeutic options. We go through hormone, non-hormonal pharmacology, nutrition changes. I do so much blood work. I'm looking for autoimmune disease. I'm looking for hypothyroidism, nutrition deficiencies. I'm just trying to get a broader picture of her whole health. And so once we kind of get the acute things, taking care of, get the hot flashes under control, get her, get her, you know, brain working again, get the muscle pain back in order.

51:05Then we start plotting out the next 30 years. So they're focused on, like, tell me about your mom. Tell me about your grandmother. How did they age? Did they fall and break a hip? Were they incapacitated? How long were they in the bed at the end of their life? You know, did they have to, did you have to hire someone to come in the house? Were they in a nursing home? Like, what do you want? And they don't want that. So we start mapping out nutrition, exercise, you know, look at a risk for osteoporosis, look at a risk for heart disease. What can we do on what I call the toolkit, you know, to put some new things into place that are going to limit that time where you can't take care of yourself?

51:43If you weren't able to do blood work for someone, someone's watching and they're not, they're not able to come to your clinic. What would be the three to five things that you would say, if you can only do these three or five things during the menopause process. Right, and I can't write you a prescription. Yeah, I can't write you a prescription. But these three to five things will drastically help improve in any way possible. What would those three to five things be during menopause? So I would tell her she needs to watch her fiber intake. So she needs to be getting minimum 25 grams of fiber per day.

52:12More fiber. More fiber. Most Americans are getting, women are getting 10 to 12, and so maybe half of what they need. That fiber is going to feed our gut microbiome, keep it healthy. it is going to decrease the rate of which the blood glucose goes up it'll decrease the absorption of sugars into the bloodstream it will also decrease um keep us fuller longer so decreases some of those hunger cues that are going on which go absolutely cattywampus and menopause um it will um the foods that are rich in fiber are also rich in minerals vitamins co-factors you know all the things that keep us healthy so nutrition should come first okay guys number one second is limit added sugars.

52:54So added sugars are sugars added in cooking and processing, not fruits and vegetables. So much of the glucose, you know, the, the, um, my patients, A1C start creeping up, you know, in menopause, their cholesterol starts creeping up. Fiber will go a long way with cholesterol, but the added sugars are huge. So limiting those to 25 grams or less per day. Most people are getting about a hundred. They're getting that in like one drink. Right. So, and like starting to pay attention to that and be like, oh my God, you know, like I got 80 today and I didn't even think about it. So working on that. Okay.

53:27Prioritizing sleep. It's hard enough. So things like what many of my, and I'm so excited to see research come out on this, but alcohol consumption is so sleep disruptive for anyone, but it is literally debilitating in menopause. Like our ability to tolerate alcohol in the ways that we used to, if you're a drinker, change. And no one can tell me why yet. I know there's data coming. But, and we, and our sleep is so much harder as we get older because the hot flashes, the night sweats, the hormone changes. It is, you know, and then when you add in alcohol, like I know if I choose to drink more than a glass of wine, you know, then I'm choosing not to sleep.

54:09It is, it is just not going to work for me. Yeah, there's a study. I think Dr. Daniel Lehman has a study of, I think, over 100 ,000 brain scans. I don't know if you've seen this study. Maybe it's more than 100 ,000, but something like hundreds of thousands of brain scans. He wants to scan mine. Exactly. I did a scan. And I asked him about alcohol and many other things, like any types of drugs, cigarettes, alcohol. And I go, is there any benefit to drinking alcohol in the brain, the body, or anything? And he goes, I can't see any benefit. it. And it only depresses you and suppresses your ability to think, to recover, and to feel healthy.

54:45It makes you sick. And I get there's a culture around drinking. I've never been drunk. I've never had a glass of wine. I never had a can of alcohol. I've had like, it's sips in my life, but I've never had a full can. And I think life can be challenging enough without alcohol. It's like, why add a depressant, especially during a challenging season of life where you're already facing symptoms that are challenging. Why put more pain on yourself? And we see through the transition, because there's the lack of understanding, education, and women are desperate. They're turning to alcohol. I'm sure, because you want to have some relief.

55:23Right. And I get it, right? Sugar, alcohol, drugs, cigarettes, whatever it might be. But that's only going to hurt you even more, isn't it? Yeah, but the short term, it's hard to let that go. Somehow when I phrase it in terms of sleep, it makes more sense. And they're like, oh, well, I really, I know I need to sleep. I'm like, okay. When women aren't getting sleep during this phase of menopause. Everything goes bad. Everything goes bad. Yeah. I mean, it just, I describe it as a traffic circle. So we have like our healthiest traffic circle where good nutrition, good sleep, stress reduction, you know, all these things feed in.

56:00So we're just much more resilient. We can handle the viruses and the bad days and the parents dying, you know, all the things that life throws at us. And then we have the circle starts slowing down and then start spinning the other way. And that's, you know, the loss of sleep and it all kind of, and then the increase in visceral fat and then the weight gain and you feel bad about that, then your mental health takes ahead and now you can't think at work, you know, and it's just, you end up in the shame and whatever. Yeah. And so you're embarrassed, you're ashamed, your relationships are falling apart.

56:28You're, you know, just so, and so we talk about trying to slow that negative circle down and start getting it to stop and then spinning it the other way. Okay. So that's the third thing, prioritizing sleep. What would be one or two others? So movement, exercise. So most in my generation, we moved to be thin. Thin was a measure of health. And that is probably one of the biggest fallacies. Just moving your body to be thin, just eating to be thin was how we were raised. and I have had to do some massive self-reflection and some therapy to let that go. Really? And that number on the scale for so many of us was what, how we judged ourselves, how we set up, you know, get on the scale in the morning.

57:11It's a good day based on that number. That number represents water, visceral fat, muscle mass. You know, I could have gained 10 pounds of muscle, but I would have felt so horrible about myself. I did not understand that that muscle is what is going to keep me healthy as I age. If you could give one piece of advice to any woman in their 20s and 30s about their body. Strong over skinny. Strong over skinny. Nutrition over calories. And educate yourself about what's coming because it's coming. What is the biggest risk women have in their 20s and 30s about trying to stay thin and skinny versus strong and healthy?

57:48So it's hard for them to see it because they're 20, right? And they feel good and they look great. They feel like they look great because the clothes are, you know. But what they're not seeing is we peak our muscle mass and our bone density at about age 30. Wow. And that musculoskeletal unit is tied together. And so you have to, wherever that line is for you, we start losing muscle and bone mass after age 30. And menopause accelerates that when we lose estrogen and testosterone. Like, Matt, we start losing it really fast. How much harder is it for you to gain muscle now? Oh, my God. It is so hard.

58:25I mean, it's literally every day I'm like looking at my plate and I'm like, protein, plants, fiber. You know, I'm not even caring about calories and I'm totally changed the way I move my body. Really? Weightlifting. I mean, I used to like work out like, you know, in Zumba last year, a couple of years ago with the eight pound weights. I never got any heavier. I wasn't trying to be stronger. guard just, you know, and now I'm like trying to bench press my weight, you know, and, and do all these things because I sit there in the gym and it's all about me staying out of the nursing home when I get older.

58:55And that muscle mass determines your basal metabolic rate, determines your, determines your resilience to insulin resistance. Like it's everything. Yeah. Dr. Gabrielle Lyon has been a big proponent of promoting muscle. She's where I learned all this stuff. Yeah. And just really like, I think. She changed my life. the number one factor of aging, I think, is like a lack of muscle or just like, or of death. I can't remember what it is, but like one of the main reasons - Greatest predictors of early death. Yeah, predictors of like a lack of muscle. And mostly because you fall and you can't get up or you can't function after you break something and the muscle will prevent that from happening and keep you stronger and healthier.

59:30So what I tell my patients is osteoporosis is real and 50 % of women will have an osteoporotic fracture before they die. Okay. If you fall and break your hip, your chance of death in one year is 30 % with surgery. Why is that? If it's declined, you can't get out of bed. It's like the beginning of the end. And then if you don't have, if you're not healthy enough to have the surgery, 79 % will die in one year. Wow. Because you're bedridden. And so, and that year is horrible. Marked with decline. Now, some people, it's not everyone. Some people can recover from a hip fracture, but man, if you're over 60, 65, and you have a hip fracture, it is really a bell ringer for a very bad outcome for you.

1:00:11But this is preventable. And it can start in your 30s. That's what I'm telling the younger patients. Get to the gym, start lifting weights, focus on your vitamin D, make sure you're getting good dietary calcium, do everything you can to get strong muscle and bones, eat enough protein. Thank you, Dr. Lyon. And focus on that is going to keep you healthy and strong and also probably help you lose the fat. But you know what? Curves are beautiful and we all have different shapes and sizes. And subcutaneous fat does not necessarily mean that you're not healthy. Yeah. It's the visceral fat. Right. Exactly.

1:00:43Okay. So movement and then one more. What would be it? So stress reduction. And why menopausal patients are finding that easier now. Really? Because they are realizing that no one's coming to save them. And it's time to start prioritizing themselves. And that can look different for different people. But in menopause, women are really like, okay, this is it. if I don't do this, like they are really putting up boundaries. It's fun to watch. Really? They're like, it's my time. I'm done. Oh, wow. Feed yourself. Make your own food. Take care of that. I got to take care of me. So it's really, really awesome for me to see them really lean into this and like, you can make your own dinner.

1:01:22You know, like I'm meditating, leave me alone. So, but what that stress reduction looks like can be boundaries, can be meditation, can be journaling, can be a phone call, can be hanging out with a girlfriend, can be, you know, whatever, but like find that. Okay. Those are great. I think you gave me five different tools that women could do during this menopause phase to make it more enjoyable, make it less stressful.

1:01:50You've got so much information backed by research and science talking about how to to heal our bodies, how to heal our minds, how to reverse our aging, all these different things that I'm fascinated to go into. Because I think a lot of people don't believe that you can change your body and the pain within your body with your mind and your thoughts. And I'm curious, if someone is saying this is just a bunch of crap, you know, I don't believe any of this. I only believe that, you know, I have to take a pill or medicate myself to heal my body. What would you say to that? I'd say I feel sorry for you because you're missing out on a great opportunity to take care of yourself.

1:02:35It's interesting that we have a notion of mind and body as separate. And that's ruled for so long. That's why people think the only way you can heal yourself is by taking some medication. There's no reason to have a mind and body as separate. They're just words. and loss of this book is based on the idea of putting them back together, even just for useful purposes. And if you have a mind and body and they're one thing, then wherever you're putting the mind, you're necessarily putting the body. And so now I have decades worth of research showing that we can put the mind in very unusual places, take the measurements from the body, and indeed the effects are clear.

1:03:21I think that for this person, the non-believer, you might ask them if they've ever seen, this may be off color or whatever, somebody regurgitating on the side of the road. And how did they end up feeling? Because many people need to vomit just by watching somebody else. Nothing is happening to them. Maybe a less colorful example and better is you're walking down the street and a leaf blows in your face. you're startled by it just a leaf but you can feel the changes in your body you know my first experience with this mind body unity was many many years ago so i was married when i was very young and we went to paris on a honeymoon and i was now 18 19 going on 30 so it had to be very sophisticated And we're in this restaurant and on the menu was this mixed grill that I ordered.

1:04:17And on the plate came pancreas. So I said to my then husband, which of these is the pancreas? He points that one. So I eat everything else. And now comes the moment of truth. I have to eat it because after all, I'm married. I don't know how that followed, but it seemed to at the time. So I started eating and I'm literally getting sick. He starts laughing. I said, why are you laughing? He said, because that's chicken. You ate the pancreas a long time ago. Oh, man. All right. So I was thinking myself ill. Interesting. And all of the research supports that. You know, it's interesting. Again, I thought of this just the other day.

1:04:57I might have it in the book and have forgotten it. But I was in Missouri several decades ago, and a friend dragged me to an iridologist. And, you know, I'm up for anything. I mean, I'll go to, you know, that way. I went to see this iridologist who looked in my eyes and she says, I have problems with my gallbladder. Okay, fine. Just by looking in your eyes. Okay, so the game is over. And then eventually I go to the doctor and lo and behold, I had a gallstone. Really? Yeah. Now, do you think you thought that to occur or did you actually happen? No, no, no, no. That's a good question, but I'm going to go there.

1:05:35I don't know how it happened. Here, the point for me was by looking in my eye, she knew there was something in other parts of my body that were not right. And what people don't realize is that every thought, if I lift my arm, my whole body is different. Different in tiny ways that we haven't been able to measure, but it's all connected. And which, in some sense, lends more credence to this whole idea of mind-body unity. And the first study we did was a study where we took old men to a retreat that we had retrofitted to 20 years earlier. Right. What was this called again? We called it the counterclockwise study.

1:06:17Yes. So they were going to live for a week as if they were their younger selves. And they were in their late 70s, 80s? Yeah. Even older. 80s, 90s. Now, remember, that was quite a while ago. Okay. That was when 70 was in the new 90 or even 100 or whatever. I mean, they were really old. Like walkers, canes. They get younger as I get older, as I recall. So they're in walkers, they're in canes, they're immobile, they're very slow. Well, actually, you know that when I was interviewing people to do the study, so their adult daughter would typically bring them to the lab, and I see them tottering down the hall.

1:06:58And at one point I said to myself, why am I doing this? I don't know if they're going to live through the day. no less be able to live for the week. I took on something that only the younger of me would have considered taking on. I was in charge of their entire lives, these seven men, old men, every aspect of their lives for a week. At any rate, you looked at them and it didn't matter what number you attached to them, they were old. Now they were going to live for a week as if they're their younger selves. So they'll be talking about current events, things from the past, as if they're just unfolding.

1:07:40And other things as well. Like they would have newspapers from 30 years prior. And they were making their own meals and they would correct each other. So if you would say was, somebody would tell you is because the past was now the present for that. Wow. And they were listening to older music and watching older movies and everything. I could spend the whole time with you just so you know that study. So you want me to give more details? Just tell me. But let me tell you the results. Sure. Those were amazing. So they lived as their younger selves for a week. Without any medical intervention, their vision improved, their hearing improved, their memory, their strength, and they looked noticeably younger.

1:08:21And I must tell you that almost from the beginning, the changes were palpable. You know, and most people accepted the findings. There were a couple of people who said, you can't make people younger. And I'm not saying that chronologically we're changing your age. But it is the case that we associate certain ways of being with certain times in our lives. and that these men were living their lives now very dependent on their adult daughter, presuming that they can't do many of the things that they used to do, and they were wrong. And so that set the stage for a host of studies, most of which, well, all of them actually today, are in the mindful body.

1:09:08That's fascinating. What would you say are, you know, that study was a while ago, right? Yeah. Now that was, let's see, we designed it in 1979. Wow. Yeah, a long time before you were born. Yeah. Wow. So what would you say in the last 44 years, I guess, what is the new... Has the world changed? I mean, what are the new studies or research that you've done to show how to either reverse aging or to, I guess, create longer aging in the biological sense? Remember, it's all one, mind and body. So we don't have a psychological as opposed to a biological sense. So it's both. It's the mind and the body.

1:09:53But I thought you were asking me, so I'm going to answer the question I thought you were going to ask. Not the one that you did, right? Which was, how has the world changed? just a lot of years. And way back at the beginning, the medical model believed that psychology was more or less irrelevant. All right. Now, I'm sure everybody thought it was nice to be happy, but that wasn't going to affect your physical health. Now that's changed. And now what most people believe is a biosocial model. So these things like stress and so on matter, but they don't go nearly as far. And I'm saying down the road, psychology will be the most important aspect of your well-being.

1:10:34So that's a change that's come about slowly. Now, for me personally, once we had those data, I did several studies where we simply make elderly people every time i say the word i stopped not being older myself but um we make seniors more mindful and they live longer so it's important for you to know that mindfulness as i study it has nothing to do with meditation meditation is fine it's just different okay when you meditate you take yourself out of the world and you say your mantra to yourself over and don't you? Mindfulness, as I study it, couldn't be more in the world. That what you're doing is not a practice.

1:11:23It's a way of being. You actively notice new things about the things you thought you knew. You come to see you didn't know them at all. And then your mind naturally goes to them. Now, if we start off with the realization that everything is changing, Everything looks different from different perspectives. The idea of being certain of anything becomes silly because you can't know. It's not what it was the last time you looked. And if you could adopt just one mindset, and it's the only one I believe that is good for you, that uncertainty is the rule, not the exception, then you don't know. So then you tune in.

1:12:04the problem is our parents our schools the media virtually everything is trying to teach us absolutes and when you think you know something you don't pay any attention so i'll do what i do probably too frequently now let me ask you a simple question this is the one that everybody knows oh man how much is one plus one two okay and that's what everybody says i feel like this It's a trick question. Well, it is though, because one plus one isn't always two. That if you are adding one wad of chewing gum plus one wad of chewing gum, one plus one is one. If you add one pile of laundry plus one pile of laundry, one plus one is one.

1:12:42You add one cloud plus one cloud, one plus one is one. In the real world, one plus one probably doesn't equal two as or more often as it does. So now look at the difference. Somebody, it's unlikely, but after we finish, somebody comes over to you and says, How much is one plus one? You're not going to mindlessly say two. You're going to pay some attention to the context, and then you're going to answer more mindfully and say, it could be, and then you're going to say it could be one, it could be two. Interesting. It's all context. Yeah, exactly, exactly. Everything changes, and our minds tend to hold things still.

1:13:19We think we know. We want to know because we think that gives us control. But since things are changing, you don't want your mind to hold it still while in fact it's changing because then you're giving up control that you otherwise would have. Wow. This is fascinating stuff. Now, I'm curious about chronic health, thinking our way to chronic health. This is the subtitle of your book, The Mindful Body. You say we can think our way to chronic health. Yeah. Well, the reason I want to use the term chronic, just because it's a little startling because we only think of chronic illness, but people tend to assume that as you get older, you're going to fall apart.

1:13:58You're going to get sick. And sickness and aging are not the same thing. One can live their entire life without illness. And the way to live one's life is essentially the same when you're 10 years old or when you're 80 years old, just by knowing you don't know and tuning in. Now, people don't like not knowing because they think you can know. And what I'm here to tell everybody is you can't know. So what you need to do to live the kind of life that I'm suggesting is be confident and uncertain. All right. If you think you should know, then you pretend. But you can't know. Now, that makes everything possible.

1:14:49Now, I was at this horse event many years ago. After this, I'm going to use only news stories. And this man asked me if I'd watch his horse for him because he was going to get his horse a hot dog. Well, as you might know from the credentials you read, I was an A-plus student. So I knew, as well as anyone in this world, that's ridiculous. Horses are herbivorous. They don't eat meat. He came back with the hot dog and the horse ate it. Right. And at that moment, I realized everything I thought I knew could be wrong. Now, for me, that was actually exciting because that meant that everything was possible.

1:15:29All of those things that we were taught are impossible not to strive for actually became available in a whole different way. Wow. And the next step in the reasoning for me was to see that, you know, recognize that experiments, Science, science give us our facts mostly, right? But that science only gives us probabilities. There's no experiment that gives you anything absolute. So it's sort of most horses under the conditions that were tested didn't eat the meat, which is very different from all horses never eat meat. Right. And so it's very important for one's health because you have to realize that any information you're given is a best guess.

1:16:18Now, it's an educated guess, but it's still not an absolute. I hope you enjoyed today's episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today's episode with all the important links. And if you want weekly exclusive bonus episodes with me personally, as well as ad-free listening, then make sure to subscribe to our Greatness Plus channel exclusively on Apple Podcasts. Share this with a friend on social media and leave us a review on Apple Podcasts as well. Let me know what you enjoyed about this episode in that review.

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