Gut, Brain, and Hormones: The Menopause Connection with Dr. Amy Shah

17:33Dr. Mary Claire Haver:Yeah. Insulin and cortisol. So yeah, talk to me. There's so much on the internet. Cortisol, cortisol, cortisol. My feed is full of supplements for lowering, increasing. What is cortisol? Why do we need it? And how is the gut involved? Yeah. So cortisol is our stress hormone. Where is it made?

17:51Dr. Amy Shah:And that's the thing. It's an adrenal hormone. Okay. And it is a good thing and it's a bad thing. Like if we don't have cortisol, we die. Yeah. We need it. People who have Addison's disease are like need. Yeah. They need cortisol to just like stay upright because their blood pressure is dependent on cortisol. So like if you wake up in the morning and you feel motivated and happy and like ready to go, that is your cortisol. So like that's good, right? But we just wanted to kind of trend down towards the end of the day. And the problem with us in our modern society is that typically we get all these signs to trend down at the end of the day.

18:32Dr. Amy Shah:There's darkness and our bodies are programmed. Around sundown, you're kind of settling down for your last meal. you're kind of getting these clues to kind of calm down you're not really doing much many

18:44Dr. Mary Claire Haver:stressful things you can't there's no light right and so our cortisol is kind of trend down

18:49Dr. Amy Shah:and at the end of the evening you're like i'm tired i'm sleepy i'm ready to go to bed and your melatonin is up your cortisol is down okay you're able to fall asleep enter the modern woman and 7 p.m. is when the like marathon is going down you are giving kids a bath or you're putting helping them with their homework then you're trying to get your work done for the next day and you're maybe having a panic call with your mom or like some other sick relative and then you are trying to watch a show with your husband and then you're then you're trying to fall asleep and you're like I can't sleep like I or I fell asleep but I'm waking up yeah between two and five, like a couple of times.

19:32Dr. Amy Shah:And so that is your cortisol dysregulated. And I think a lot of women, especially women in perimenopause, will notice that they're having a harder time getting that cortisol down, both lifestyle and their own hormones are. So as you know, estrogen is really great at dampening cortisol. And so as you start to get erratic estrogen levels, you're going to have an issue with cortisol. And then on top of that, your progesterone is going down, which also helps with relaxing and anxiety. So you have like a double whammy. And then you have some dysbiosis in your gut, and we'll talk about what that is.

20:11Dr. Amy Shah:And that's kind of inflammation that's raising cortisol. And so your mind is just full because we have a lot on our plate all the time. And often people are taking care of both their children and their parents. And they're trying to get to rest. And we're just not biologically wired to be handling that much cortisol in the evening. So even when I talk to women, I always say your evening time, if you think about it, really has to be coordinated with circadian rhythms. That's why cortisol becomes a big issue. Because then people are like, oh, just take a cortisol-lowering supplement. But it's way more deep than that.

20:51Dr. Mary Claire Haver:Because people are being told, oh, all you need to do is take this bucket of stuff and we're going to fix this.

20:57Dr. Amy Shah:Yes. At the end of your evening, if you do a whole cortisol lowering protocol, which includes having some downtime from your phone, which includes maybe not having the excited conversation, happy or sad with your family members, maybe shutting off the emails before bed and having a routine, that all can help you bring that cortisol down. and also do things to increase your melatonin so that you naturally feel sleepy. These are eat good foods so you can make more tryptophan, goes to melatonin, get more sunlight so that you can start to get sleepy at the end of the day. And so those are kind of some strategies.

21:33Dr. Amy Shah:So cortisol is really, really tightly wound in this gut hormone brain thing. And it tends to be really problematic because this is a time of life where we're actually facing higher levels of cortisol, but we're also facing higher levels of stress. And that's why it was so hard to tease out. Which is which. What about insulin? So as you know, women become more insulin resistant as they move through the perimenopausal years. So that means that women tend to have a harder time keeping their blood sugars under control. There's a lot more women that are pre-diabetic and have issues with metabolizing their blood sugars.

22:12Dr. Amy Shah:My dad has five brothers. There are five. all five of them have diabetes and they were all diagnosed as skinny men like in their 30s with diabetes and so when I went into perimenopause one of the biggest signs first signs was my hemoglobin a1c for people who don't know that's like your average blood sugars over three months was creeping up the same and I was like what is I didn't know about the homo ior score

22:36Dr. Mary Claire Haver:back time. Yeah.

22:37Dr. Amy Shah:And I was like, what is happening? So insulin and blood sugar regulation also becomes a huge issue at this time. It has a lot to do with the dysregulation that's happening between that gut hormone brain connection also. But it's something that we all deal with during perimenopause. And this is a hot topic right now, but what about appetite? Yes. So that's another thing that estrogen helps regulate, right? Your hunger hormones. And so as you're moving through perimenopause, you're getting less of that satiety feeling and you're getting more cravings, which a lot of women will say, you know, your natural GLP-1 is going down.

23:17Dr. Amy Shah:And so you're really having more of an appetite to eat things lots of times that are unhealthy for you because you don't feel satisfied. And those are gut hormones in there. So there's a big crosstalk between what's going on in there and our hormones too.

23:41Dr. Mary Claire Haver:What do you think are the biggest sources of inflammation for women in midlife?

23:46Dr. Amy Shah:Well, one is just that estrogen is going down. Estrogen is an anti-inflammatory hormone. And I know you talk about it all the time because in various settings, it shows up. But this is one of the biggest reasons we are getting inflamed. And it's kind of a chicken and the egg because not only does estrogen cause higher levels of inflammation, it also causes dysbiosis, which is like your gut bacteria change and your gut is getting more inflamed. So not only is estrogen going down, but now your gut is more inflamed and making your estrogen, making the inflammation go up and the estrogens going down, making your inflammation go up.

24:25Dr. Amy Shah:Right. You're in this negative feedback. Yes. And then you're also maybe, you know, your dietary habits aren't the best. And so that's why. You kind of got away with it.

24:34Dr. Mary Claire Haver:Because my patients would come in and say, I'm not doing anything different. And I said, the system you built for your homeostasis worked great before your menopause. You cannot expect this internal system that you have to function the same way. So we need to make some tweaks here so that you can stay healthy.

24:55Dr. Amy Shah:100%. And so what that inflammatory state that we're in, so part of the reason I talk so much about nutrition is like one, we can control what we can control, right? We can control our food. We can control how much negative media and people we hang out with to lower our inflammation. And we can really do a lot of things to kind of go out in nature, get sunlight, lower our inflammation, get more sleep. But there's a real inflammatory state that's happening there. and it's part of the process.

25:27Dr. Mary Claire Haver:What are some of the biggest myths that you see pertaining to gut health in women in midlife?

25:33Dr. Amy Shah:That gut health is just gut health, first of all. That it doesn't have anything to do with your brain or with your hormones. And then that, you know, you can just take a probiotic or some kind of supplement to just fix it. So a lot of women don't realize that this is like happening in their bodies, like this big change that's happening. So when estrogen goes down, some of the bacteria that are dependent on estrogen die. And one of the things that happens is the tight junctions in the gut become looser. And so you get more of a leaky gut. What does that mean? Yeah. So it's like these tight junctions, they're not supposed to let anything in.

26:11Dr. Amy Shah:So they're not supposed to let any food particles.

26:13Dr. Mary Claire Haver:They're there to protect us, right?

26:14Dr. Amy Shah:They're there to protect the inside of our body. So our gut is the outside of our body because it is literally from the mouth to the anus. It is a tube. It's only supposed to let things in that we want, but we have a very tight barrier into our body. And the gut bacteria, by the way, that forms six to seven layers of protection. And so that's why we need them. Because imagine your six to seven rows of soldiers were gone. And now it's just you. And that's what happens when we have poor gut health. We're left with just our own gut lining, which becomes looser. The cells between themselves, they have these tight junctions, which like, you know, how it sounds, they're tight and they hold them together.

27:05Dr. Amy Shah:So nothing gets through. But as estrogen goes down, you have a poor diet, you're losing all this gut bacteria and all these like, you know, intruders are like, like trying to stab at you and trying to get in. And before you had like this big, long, like lots of lush people trying to protect you, like seven, eight rows of people trying to protect you. Now it's just you. Lots of people have something where things get into our bloodstream. Okay. So viruses, little piece of food, toxins. And so that itself creates a lot of inflammation in our body. So women will often feel things like intolerances.

27:45Dr. Amy Shah:So now gluten bothers them, dairy bothers them, certain foods that they couldn't tolerate before. Now your body, because a little piece of it got into your bloodstream and your immune system was like, oh no, we're going to build a whole system to keep this out next time. And so there's a whole inflammatory response that happens. So that's basically why you want to keep that thick gut lining with keeping your gut bacteria healthy and happy and present and ready to fight. So the strategies for nutrition, at least from all the bulk of research we have, basically says the healthier you can keep those seven, eight rows of bacteria, the better off your body will be because they not only produce those happy chemicals, they help regulate your estrogen levels and they communicate with your brain.

28:41Dr. Amy Shah:They're keeping the communication levels very, very strong and they're keeping you happy and healthy. So we need to keep that whole system, those trillions of gut bacteria, happy and healthy. So is that what dysbiosis is?

28:57Dr. Mary Claire Haver:Yes. Yes. So walk our listeners through how we get to dysbiosis. What happens? Is it something they ate? Is it something they did? And then how do we get back to normal, healthy gut?

29:07Dr. Amy Shah:Yeah, that's a great question. So dysbiosis, a lot of people don't realize what that means. It basically means that the gut bacteria are unhealthy. So that whole analogy that I was telling you with the six, seven rows of soldiers, it means that they're either no longer there or they're much less soldiers or they're injured, they're hungry, they're not fed. Like it's exactly the same analogy, like the Amazon jungle, like thinking of the lush green forest and then thinking of like a desolate jungle where half the organisms are dead. And now, you know, you're trying to work like you're not thriving with half of everything dead.

29:46Dr. Amy Shah:So the real dysbiosis is basically that your gut bacteria are injured, dead or not present. There's lots of leaky gut happening because they're not present. and you'll get a lot of symptoms, not only gut, but fatigue. You'll get hormonal symptoms. So this dysbiosis, because the gut talks to everything, will cause waves around your body. How do we make the diagnosis? So it's very, very hard. A lot of people that have SIBO, for example. What is SIBO? Small intestine. SIBO. Yes, SIBO, small intestine bacterial overgrowth. So we're supposed to have this amazing Amazon jungle in our colon, our large intestine.

30:25Dr. Amy Shah:We're not supposed to have a ton of those things in the small intestine. But when dysbiosis happens, meaning the wrong bacteria are there, less bacteria are there, they creep up into the small intestine and start to give you lots of issues, bloating, indigestion. And so SIBO is like one part of dysbiosis. But there's lots of dysbiosis that are not diagnosed at all. It's just IBS. What's the difference between SIBO and IBS? So irritable bowel syndrome is when they can't really find Crohn's or disease like inflammatory bowel disease, but you're having symptoms. You're feeling sick. You're feeling bloated.

31:07Dr. Amy Shah:You might not. Constipation, diarrhea. You're getting very constipated or you're having many bowel movements. And so a lot of times when you want to find dysbiosis, it's often just not even a diagnosis that you can find. It's just that it's happening. And the reason I'm telling you about it or telling the listeners about it is that a lot of times when you actually recognize that, you recognize that in yourself or in your patients. And you're like, oh, so if you start to change that whole gut bacteria Amazon jungle in there, you can actually really not only help treat their gut symptoms, but all of their other symptoms that are happening.

31:45Dr. Amy Shah:And then is there like a test?

31:47Dr. Mary Claire Haver:Like, is there stool sample that you can do? It's really difficult.

31:51Dr. Amy Shah:People have tried to do food sensitivity tests. People have tried to do leaky gut tests.

31:55Dr. Mary Claire Haver:What is a food sensitivity test? Do you do them?

31:58Dr. Amy Shah:Yes. Food sensitivity testing has had a very, very difficult time because we all have them or lots of people have them, but there's not a good test to look for them. Our immune system is very, very complicated. The tests we have right now are as good as flipping a coin. and a lot of people spend thousands of dollars.

32:24Dr. Mary Claire Haver:My friends have and been told they're allergic to all these things.

32:27Dr. Amy Shah:Yeah, and things that they're eating all the time. And often you'll build an IgG to something that you eat all the time and that's fine. And what is IgG? Immunoglobulin G is something like part of your immune system. So you'll have an immune response to a food that shows up on these tests and they'll be like, oh, you're having an immune response to this food. But what we found is sometimes an immune response is a benign response. And your body was just like, oh, you eat this food all the time. Let me just build some antibodies to it. It's literally not a negative thing and it doesn't act on it.

33:03Dr. Amy Shah:And so you're getting these test results that are 50-50 chance of being right. So no good food sensitivity testing as of yet. And no good IBS testing as of yet. No good dysbiosis testing as of yet. So kind of like perimenopause.

33:17Dr. Mary Claire Haver:We don't have a great blood test for perimenopause, but you just have to listen to the patient, believe them, rule out the other things. Absolutely. And have it in your clinical acumen to make the diagnosis. Yeah.

33:26Dr. Amy Shah:And if you arm women with this knowledge, right, then they can say, oh, wait a second. I didn't even ever think about my gut bacteria before. Like, I didn't even know they were connected to my happiness and brain. And I'm like, look, the bulk of the science says if you're eating probiotic foods, like fermented foods, you'll be happier. Maybe you don't care about your gut, but you care about being happier. You know, and so that's why you should start eating them. And so that's why like I created this like plan in the book. It's like 30-33. And it's basically 30 grams of protein in your first meal like breakfast, 30 grams of fiber throughout the day, and three probiotic foods.

34:03Dr. Mary Claire Haver:So I have a friend who listens to a certain longevity bro online a lot. And she's always quoting him to me. and through one of his podcasts, she did this test that looked at her genetics and like, you're looking confused. Like I had never heard of it either. And she's a smart woman. Like she's a dermatologist and she's gonna kill me for saying this. So she took some kind of a test, the blood test or something she sent in that looked at her DNA and said, oh, based on your genetics, you shouldn't be eating these foods. And one of them was gluten and she swears up and down now that she's gluten-free that she feels a lot better and her gut is healthier.

34:42Dr. Mary Claire Haver:And I was like, I need to ask Dr. Shaw about this.

34:44Dr. Amy Shah:There's no good DNA test. And I know that they're available. She does feel better not eating gluten. Yeah, and here's the thing. That's what I hear all the time. Because when we looked into this data and there's many, many reports on looking at how accurate these tests are, looking at, you know, are there any accurate tests? Like there's no accurate way of knowing what your immune system is doing inside your gut. This whole world that I told you about where they're talking to each other all the time, talking to the hormones, talking to the immune system, talking to the brain, we are just discovering that they even do that, much less what they're saying.

35:24Dr. Amy Shah:Like, we don't even know. Like, they're, I think - So save the money? Yeah. Like 2025 was the first time they even discovered that the gut bacteria have a unique language, unique way of talking to the brain that is outside of hormones. that's outside of immune system. What are they? It's like a new way of communicating. Some signal that they're screening. Yeah, that they have as, so not only do they talk to each other in like five different ways, now there's a unique other way. And we're just finding this out like in 2026. Okay, we can't predict what the immune system is gonna do with a particular food or our genetics don't decide what a particular food will do to our system.

36:04Dr. Amy Shah:You can tell your colleague that honestly, the best way to figure it out is by doing a food elimination diet like she just did. Eliminate a food from your life, the top foods, dairy, gluten, you know, and take them out for four to six weeks and then add it back and see if it comes back. That's intolerance. And that's the only, that's a gold standard is food elimination diet. So doing a food elimination diet will save you a lot of money and a lot of time and will prove whether or not you are sensitive to that food.

36:36Dr. Mary Claire Haver:I want to talk about your pillars, the big three. And we are so simpatico on this. Yeah. Protein, fiber and plant diversity. Yes. Are those the three you think most women should start with?

36:47Dr. Amy Shah:Okay. So actually my 3033 takes into account the protein, the fiber, but adds a probiotic component. Okay. And that is separate from the plant diversity because you, Yes, you want diverse plants, but you particularly want the fermented plants. Okay, why? Why? Because fermented plants - Such as kimchi. Kimchi, sauerkraut, and you can do fermented dairy too. Like yogurt is our favorite, easiest kefir, probiotic cottage cheese. Even raw apple cider vinegar is counted in that kind of probiotic food, fermented foods. So fermented foods are really special. Every single culture in the entire world has some form of fermented foods.

37:32There's even evidence that before there was like rotting fruit and we would go for it.

37:40Dr. Amy Shah:We would want to eat it because the fermentation that's happening in the rotting fruit, those bacteria actually go and help those that gut army that we have in there. And so fermented foods have been around for thousands of years, except that now there's no need for them to exist because fermentation is a way to preserve foods. And before we had refrigerators and before we had other ways to kind of hold foods safe in bottles and jars, we had to ferment them. And that was the only way we could preserve things. Yeah. And so every single culture learned how to do that. And it was really great for our gut because we need more microbes.

38:22Dr. Amy Shah:We need more bacteria. In fact, we have evidence that not only do you want to eat more bacteria, you want to be around more bacteria as much as possible because the more you can seed the gut, the more you can make it look like that Amazon jungle that's thriving, the better you will thrive. Okay. I think those are the fundamental things that you need to do in your diet to actually thrive. So the fiber, 95 % of people are not eating enough fiber. Okay.

38:51Dr. Mary Claire Haver:Yes. Let's break this down. How much protein? How much fiber?

38:55Dr. Amy Shah:Pre-fermented foods a day.

38:58Dr. Mary Claire Haver:Okay.

38:58Dr. Amy Shah:So in terms of how much protein, so I decided for my framework that I was going to stick to just the morning protein. And I'll tell you why. 30 grams of protein in your first meal, make it breakfast. It changes your brain. It makes you more motivated, more satisfied. Why? You get more leptin. You get more satisfaction. How? Protein at the beginning of the day actually has special impact. After a fast. Okay. So you wake up in the morning and you have protein at the beginning of the day. It has a great effect on your body. Not only will you have more likely to get the total protein for the day, you're more likely to feel satisfied and not craving.

39:46Dr. Amy Shah:Your blood sugars are regulated. So you're not super hungry. And then you're also most likely to feel energized for the day because protein actually helps your brain feel happy, satisfied. It's like those motivated, focused feelings come from having adequate protein in the morning. And then you're going to have fiber. Fiber is like, I think we get 12 grams on average. Yeah. So 95 % of people are not getting the 25 to 30 grams that are recommended. I say 30, 30, 33, because you're getting 30 grams of protein in the morning and then you're getting 30 grams of fiber throughout the day. And 30 grams of fiber, I believe can really transform your life and your hormones and your brain.

40:38Dr. Amy Shah:Most of us don't even realize what fiber, like what fiber is. Like when I talk, when I do speaking engagements, a lot of people are like, great fiber, like what supplement? And I'm like, what do you mean? Yeah. And it's good to, I mean, there's a place, there's a time and the place for that. Right. But most, we have not been educated enough about fiber, about that. Like when I say blueberries and raspberries have fiber, avocados have fiber. People are like, what?

41:10Dr. Mary Claire Haver:That's what I love about your social media content. You give these really snackable, no pun intended, digestible solutions. Like here is what this looks like. Here is how to get this in your diet. And here's why.

41:23Dr. Amy Shah:We don't need to have a very complicated diet plans or like, you know, longevity protocols. as we say, we need to have things that are going to make a big difference that we can do in our everyday lives. And I mean, the data on fiber is like, if you have one tablespoon of chia seeds, which is five grams of fiber, five grams of fiber added to an average person's diet is going to improve their longevity.

41:52Dr. Mary Claire Haver:And their cardiovascular health. I mean, it's really amazing when you look at the quartiles of like, how much fiber is a person eating and what is, how likely are they to get Alzheimer's? That article blew my mind because, you know, my mother and my grandmother spent, you know, my mother is in a memory care unit and she's about to go into hospice. Oh, I'm sorry. So you know what? She's had a great life. But this last few years has been a slog. And so I'm very invested in like, what can I do for Alzheimer's prevention? And what is the majors and what are the minors? Yes. You know? That's exactly right.

42:24Dr. Mary Claire Haver:And so fiber is a major. Yeah. Like huge. Also for my heart health, you know, and my gut health and all of it works together. And your hormone health. Keeping the estrogen, I'm sapping through my skin in my system.

42:35Dr. Amy Shah:Yeah, exactly. I don't think people realize also that even if you are taking hormones, like you say you're on menopause hormone therapy, you need to keep your gut in really great shape so that this can be absorbed so their body can interact with those. Estrobulome can get rid of what's not needed and add back what's needed to absorb, to thrive. you actually need a healthy gut microbiome. And so I think that is fundamental for brain health, for hormone health. And then the probiotic foods, I think is such a new concept, but it's not. It's like an ancient concept that's coming back. I always think of probiotic foods as like the sunlight thing.

43:14Dr. Amy Shah:Like it's simple, free, and it was so available all the time to everybody before. And now it's like, we have to seek it out, right? Like we have to seek out time to get sun. We have to seek out time to actually find fermented foods because we don't really eat them in our diet anymore. And getting, I picked three because that's what the research shows is you should be having three to five. And I'm like - So go through the list again of fermented foods. Yes, okay. So kimchi, sauerkraut, yogurt, probiotic cottage cheese.

43:42Dr. Mary Claire Haver:So like the Dannon, like strawberry flavored?

43:44Dr. Amy Shah:The one with the chocolate chips, like skip it. There's a lot of yogurts in the US that actually don't have probiotics in it. How do you read the label? Yeah. If you look at the back of a label in the U.S., it has to write if there is live bacteria in there because they need to disclose from their food rules. And it says acidophilus, right? It will say whatever bacteria. Acidophilus is one type. Bifidobacterium could be. It could be lactobacillus. It could be any bacteria. But it has to say that there is live bacteria and what the type is. It's a labeling rule. And so that makes it easy for us.

44:20Dr. Amy Shah:If you're looking for something probiotic and you look at the back and there's no bacteria in it, it's not probiotic. And so kombucha is a great probiotic. Raw apple cider vinegar, like I said, is a great - With the mother. With the mother is great. Yeah, you'll see the stuff floating on the bottom. Yes, those are great probiotics. I love yogurt and cottage cheese because they're so easily accessible. And cottage cheese also, you have to make sure you're getting probiotic cottage cheese. There's non-probiotic cottage cheese and there's probiotic.

44:47Dr. Mary Claire Haver:Again, you have to flip the label over and read.

44:50Dr. Amy Shah:And often they'll say probiotic cottage cheese when it's actual probiotic. And then kefir is like fermented yogurt, which is another thing that's very common in Europe, but not very common in the US. And so you can get that now from really any grocery store. I've seen it in basically every single grocery store. So there are some more options for people to incorporate. And honestly, three servings is like one spoon when you're doing like kefir. Yeah, it's not like you're eating a full huge bowl of kimchi. It's like one tablespoon of kimchi. You might be adding two tablespoons of kefir into your yogurt, half cup.

45:31Dr. Amy Shah:It's very, very easy once you put your mind to it to even get one or two. So getting three is kind of a goal. Same with the 30 grams of fiber. It's really a goal that you're working towards.

45:43Dr. Mary Claire Haver:Your probiotics is restocking the pond. Yes. You know, and then fiber is the food, right? It's the food for the fish. What's the difference between, I read about soluble fiber and insoluble fiber, and are they both important? Because I literally was at QVC with the weighted vest, and there was another physician there selling some supplements, and I heard come out of his mouth, well, you shouldn't be eating insoluble fiber. It's unhealthy for the gut. And, or, no, he was saying soluble was healthy because he had enduline in his supplement. and then, and you shouldn't be eating all this insoluble fiber.

46:14Dr. Mary Claire Haver:It's unhealthy. And I was literally in the green room going, no, no, no, no, no, no, no, I think you're wrong.

46:18Dr. Amy Shah:You want both types of fiber because, you know, you're insoluble. I'm like, did I miss something? I know. So your insoluble like makes you poop and the soluble one, like the one he was referring to, like the inulin or like the chia seeds, for example, what they do is they help regulate blood sugar and they help make you feel fuller. And they have a lot of roles. They even modulate cholesterol. So there's a lot of roles for soluble fiber that are great for you, but you need both. You need roughage and you need soluble fibers. Like think of your blueberries and raspberries and then the insoluble is like the rougher fibers, like the psyllium husk and things like that.

46:57Dr. Amy Shah:Okay.

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48:05Dr. Mary Claire Haver:So we both live on the internet. I have built followings, trying to educate. And I get tagged in a million things that I'm sure you do too. So walk me through the biggest nutrition myths you think are harmful. Because there's some things that are like, eh, neutral. But like, what do you think we're getting it wrong on the internet?

48:25Dr. Amy Shah:So there's a few things. there's I think the cleanse trend is really coffee in a man oh my god it's so crazy so I'm all uh yeah I think cleanses in general so like um I just did a whole thing on so there's senna in a lot of these cleanse pills and what is senna senna is a natural so it's a lot of these are natural cleanse And senna is a leaf. Basically, it gives you diarrhea. It just makes you poop. Senna cot, yeah. Yeah. And so it's great if you're trying to one-time poop. But what happens is when you're taking a lot of these cleanse pills, maybe for a week, two weeks, three weeks, you are actually causing a problem in your gut.

49:10Dr. Amy Shah:Because what it does, it actually forces the gut to contract. And when you start to force the gut to contract and you stop using it, your gut doesn't contract anymore. And so you're like, oh, shoot, I need that stuff again. I need the cleanse stuff again to go again. And then you're taking it again. And now you're dependent on it. If you looked at the inside of your colon, it turns black and it looks like a spotted, we call it a Louis Vuitton colon. It looks like a spotted Louis Vuitton bag. And basically because some of the cells on inner gut die and fall off and create this kind of dark area.

49:50Dr. Mary Claire Haver:And that's from chronic Senna use.

49:52Dr. Amy Shah:And so one time here and there, no big deal. But that is like a lot of the cleansing that we're doing, even the colon cleanses, the cleanses with Senna, the coffee enemas. I mean, that kind of stuff is really dangerous and can do a lot of damage to the body. Well, one nutrition myth I think is like that we are just talking about here is that hormones are completely separate from nutrition. That there is nothing you can do to help your hormones through nutrition. I think that it's its own little category is something that I think a lot of people need to understand. That, hey, like this is really, really important.

50:33Dr. Amy Shah:It's a fundamental thing that you need to be doing. We put food in our mouth at least three to five to seven times a day, and you have this chance to actually change the trajectory of your life because it's going to help your immune system. It's going to help your hormones, and it's going to help your brain. So that's a really big one.

50:51Dr. Mary Claire Haver:All right, let's talk about fasting. Yes. I think you were fasting MD for a long time. And I was a huge, you know, back when I was putting a toe in the water in nutrition and learning and looking at what studies were available, I was very positive about fasting. But I have to say, back then, my whole focus before I really understood nutrition and body composition was weight loss. You know, to be honest, women were gaining weight in menopause. I was getting weight in menopause. And there was decent data I felt on fasting. but I've not had a reversal, but I've had to like expand my understanding of aging and nutrition and what our goals are.

51:30Dr. Mary Claire Haver:But when is fasting good and why? Okay.

51:34Dr. Amy Shah:This is a great time to talk about circadian rhythms because I'm going to be talking about fasting in accordance to circadian rhythms. Okay. So circadian rhythms are our day and night cycle and our bodies, 75 to 80 % of the processes in our bodies take input from the circadian rhythm. So when our thyroid hormone gets released, when our melatonin gets released, basically every single hormone in our body depends on circadian input. And so we need sunlight and we need darkness. And we need to get that because we need to feel attentive. We need our hormones to work well. We need our gut to work. Even those gut bacteria that can't see the sun, they get input when you get sunlight and they get super happy.

52:18Dr. Amy Shah:So the sunlight is really, really important. We also need time to repair and renew. So we need darkness. And with darkness should come fasting. So the reason I say this is that, again, the way our bodies were programmed pre-internet, were programmed around eight o 'clock is, and you look at every study, it's around eight o 'clock-ish in your local time that your body starts to shift into a different mode. And so your insulin, your pancreas is told to turn down the insulin and to start repairing. Because you can't do everything all the time. If you were getting guests all day to your house, you would never be able to clean or repair anything.

53:02Dr. Amy Shah:And so this is a time that your body naturally says, all right, it's dark. The human probably finished their dinner. There's not going to be much coming now through. This is our time for us to repair, renew. So our gut is going into repair mode. Our muscles are going into repair mode. Our brain is shutting down and going into a different mode. It's still active, but in a different mode. And so when you order Uber Eats at midnight and you have this huge dinner with five courses, you are really giving your body a big, big load at a time that it's already shut down all its processes. It was like, if someone woke you up in the middle of the night and asked you to do a complicated math problem, you would be like groggy.

53:51Dr. Amy Shah:You might not be able to do it. You might be able to do it, but it might take a lot longer. And then in the morning, you're like annoyed and tired because you got woken up in the middle of the night. And that's exactly what happens when you're eating this huge meal super late at night when you should be sleeping and resting and renewing. So long story short, then if you're trying to time fasting, you should eat an early dinner, have two to three hours break before going to bed. Then you're sleeping and you're getting up and you don't need to roll over and have a pop tart. Like you can wait one to two hours.

54:26Dr. Amy Shah:Again, very, very evolutionarily, you would wake up in the morning, you might forage, you might have to make breakfast. You know, like there's a little bit of break between the time you wake up and you actually eat. And so that's a fast right there. Yes. Your fast is really based on circadian rhythms and based on your biology, not anything else.

54:49Dr. Mary Claire Haver:Is it different between men and women? Yes.

54:53Dr. Amy Shah:Women, we have a spidey sense for stress. Meaning that women, when they sense that our body is undergoing stress, it kind of shuts down. Fertility, it's going to shut down. There's a lot. Put you in free-term labor. Yes, exactly. Stress, women handle stress differently. And we think biologically it's because of our ability to carry children, our ability to get pregnant. You wouldn't want to get pregnant during a war or a very stressful time, right? So we're very attuned to stress. And so that's why doing stressful things, especially in perimenopause, because not only are you more wired to be stressed about things like this, you are also more likely to be stressed in perimenopause.

55:41Dr. Amy Shah:Your stress resilience goes down. And so the same HIIT workout that you were doing every day without enough sleep and you're fasting 16 hours, it may have worked for you back then and it's not working for you now.

55:54Dr. Mary Claire Haver:My most difficult patients, or at least the ones who have the hardest time to understand what's happening in their bodies and understand what's being rewired, are the athletes. Yes. who were like, uh-uh. Yes. I was always in control of my body. My body did what I told it to do. I was an elite athlete and they, especially the triathletes, you know. They have a hard time. Really hard time. I don't know if you found the same thing.

56:19Dr. Amy Shah:Yes. Women athletes. So there's a lot of people on the internet actually who say women must eat before they work out or they shouldn't fast at all. But I believe that biologically we're very varied and day to day in our cycle, we're very varied, right? So if you wake up and you're starving, yes, absolutely go and you don't have to fast at all. If you wake up and you're like, I could go for my walk, my morning walk and eat after. Great. Do that. There's a lot of people that think that like you cannot fast as a woman. that's not true, or that you should fast as a woman, that's also probably not true.

56:58Dr. Amy Shah:And so you want to be really listening to your own rhythms according to your own part of the cycle where you are in perimenopause. So what about postmenopause? Does that change at all? Yeah, you have a little bit more stress resilience at that point. Your hormones are more stable. And so if you want to try a lot of my patients who are postmenopause have an easier time doing a longer fast without as much of a pushback from their body. And so I think everyone should be doing a circadian fast. I think every single person, whether it's 12 hours or 14 or 15 hours, at some level. You're going to fast while you're sleeping.

57:35Dr. Amy Shah:You need to give your body a little break. I mean, when they looked at time logs and they looked at people's blood sugars and they actually saw how many hours a day people eat, most people are not stopping food for, they're only stopping for eight hours or seven hours. While they're sleeping only. Literally just they're eating right the second they go to bed and the second they wake up. So even if you stretch that out, like 12 hours sounds like easy peasy, but it is not based on what most Americans are doing.

58:04Dr. Mary Claire Haver:So I tell my patients, listen, you know, they're like, oh, I love fasting, I love fasting. But as long as you can reach your nutritional goals in that window, if you are struggling to get enough protein and get enough fiber and like give your body enough of all the vitamins and minerals and nutrients, you need to open that window. up to make sure you can fit everything in.

58:23Dr. Amy Shah:And Marie Claire, in the last few years, one of the things that's also changed my mind so much about like OMAD, which is one meal a day, is that study after study is coming out, whether it's intentional or not, the people who skip meals all day have worse health outcomes. Diabetes, cardiovascular disease, brain disease. It's hard to do causative. Like some people don't eat all day because, you know, their stress. So maybe like there's lots of other factors playing into it. But study after study that looks at people who skip meals all day, they just have worse outcomes. It's just you are meant to be eating when the sun is out, just like roughly.

59:03Dr. Amy Shah:We don't have to match it. You're roughly meant to have the biggest meals of your day in the daytime hours. And you're roughly meant to be fasting in the darkness and nighttime hours. And how you time that for me, the way I've told people to do it is at two to three hours before bed, just stop eating. It's great for your digestion, great for your blood sugar, great for your brain, great for your sleep, two to three hours before bed. So if you eat dinner at seven, you're going to go to bed at nine, probably want to take a walk or something before that, help your digestion, help your blood sugar.

59:35Dr. Amy Shah:And then you're going to wake up and you're either going to eat right at nine, which is 12 hours, or you're going to eat at 10 or 11, you know, stretch out that fast a little bit so that you have a great night of rest and repair. And that's how you should time it. And then if the next night you want to eat dinner at six and you get hungry right when you wake up, like go eat. If you're hungry, eat is what I tell my patients.

59:58Dr. Mary Claire Haver:Like listen to your body. Yeah.

59:59Dr. Amy Shah:And if you want to, you know, stretch it out to 15, 16 hours one day, go for it. As long as you're not stressing your body out too much. So like I feel the same way about high intensity exercise. So I used to go to one of those popular chains. Orange theory. And I would skimp on sleep. I just thought sleep was like for people who were unmotivated and that I would sleep when I was dead. I'm an obstetrician. I get it. And I was wearing this like title of like, I'm a martyr for my patients and my family. And like, I need to never sleep. So I would go to this workout every single day and I would have tons of coffee after.

1:00:39Dr. Amy Shah:And I would have a stressful day all day long, pick up the kids, super stressed. And then I would repeat the next day. And I was like, why am I not getting the results I want? Like I'm not getting stronger. I don't feel like my clothes are fitting better. I feel more depleted than ever. And that's the same concept. Like your body is needing a recovery from these kinds.

1:01:03Dr. Mary Claire Haver:I think this is where women are driving them. So I find there's like two camps and there's, there's very little middle ground. Some women are just like, I have no time for this. I have no time to work out. Like they're so stressed out that they are eating whatever's available and fasting quick because they're struggling to find the time to meal. You know, they don't know how to do it. And, you know, this is fine. It said healthy on the package. So here we go. And, you know, so hyper-scheduled with everything they have on their plate. There's no time to, like, focus on exercise. Or people who are, like, so rigid, driving themselves, giving themselves medals and badges for suffering, basically.

1:01:40Dr. Mary Claire Haver:What is the middle ground?

1:01:42Dr. Amy Shah:I know. And that's... I'm struggling every day. Honestly, I'll be honest with you. This is the reason I wrote the book. I actually looked at the Menopause Society clinician handbook, no chapter on nutrition. Okay. I looked at all of the information for women's health, no information about, it's like very general, like eat healthy. We have no, you know, like I was like, how are people supposed to know if they don't even know what healthy is? Like you said, like if it says healthy on the package, does that count? Like, you know, so what is healthy? So the 3033 is basically my attempt to say, hey, looked at all the literature, looked at everything that we could be doing.

1:02:22Dr. Amy Shah:These are the three things that if you had no time, you could try to get to. You don't have to get 30 grams every single day on your first try, you know, 30, 33. You can, at least you have a framework to work towards. And you can be vegan, you can be paleo, you can be carnivore, whatever you feel like doing, but get there. And that's why, because I thought to myself, I drove myself crazy. My patients drive themselves crazy. Nobody's giving us this information. And where are we supposed to go? There's no guidelines. There's guidelines for pregnancy. There's guidelines for children. And you said even the guidelines for pregnancy aren't great.

1:02:59Dr. Mary Claire Haver:Antiquated at best. At least the last time I did OB, which was about 10 years ago.

1:03:03Dr. Amy Shah:So there's no guidelines for women. It's really confusing because there's like a thousand other messages that we're getting in the meantime. So I was like, what if we like cleared out all the dust and like just said, where's the evidence the strongest? And that's there. And then you mentioned plant diversity. I talk about that in the book, but I didn't include that in the 3033. And the reason why, one, there's just, then it's just too many things. And two, it seems overwhelming. So the data, as you know, it shows that you should be having like 30 different plant foods a week. I mean, that came out of Zoe's data.

1:03:41Dr. Amy Shah:Yeah. And everyone thinks, oh my God, like I could never do that because they don't understand that like spices count and, you know, herbs count. And like you, if you use a Trader Joe's, like everything but the bagel seasoning I counted, there was like six in there, you know? So it's not so hard to get that, but it's real. I mean, you tell a very stressed out, like my old me would have been like, I'm not doing that. Like, there's no way I'm doing that. That just seems too much.

1:04:07Dr. Mary Claire Haver:I mean, my old me was like less. Everything is less. You need to eat less. Yes. Less, less. Like the concept of more is so new. Yes. And so free. Yes. How do you feel about body composition? Or do you use the scale?

1:04:20Dr. Amy Shah:Yeah. Okay. So lean, we know that we lose lean mass and gain adiposity in the wrong places. That would be fat. Yeah. Yes. For us. And we get fat around our organs. And we get fat around the midsection, which is the dangerous area. and we lose lean muscle mass, which is our little bit of muscle that we had that peaked, you know, at 30. And yeah, exactly. And then we've been kind of fighting against the loss of that. So I do think it's really important to know your bone density,

1:04:52Dr. Mary Claire Haver:to know where your lean body mass is. How early should someone, and I'm not talking about the guidelines. I think we're agree that the guidelines do not serve women for bone density as far as when to screen. When do you screen your patients?

1:05:06Dr. Amy Shah:I mean, I think nobody gets screened until usually like their 60s and 70s. It's like insane. Most women don't get screened at all. Yeah. And they get the first time they get until they break. Yeah. And so I think perimenopause.

1:05:19Dr. Mary Claire Haver:My mother has never had a bone density scan in her life.

1:05:21Dr. Amy Shah:Well, my mother only had it because her mother had multiple fractures from osteoporosis. And so they were like, oh, you might be at higher risk. But she didn't get it until she was in her 60s. So where should we should start this is perimenopause. Have you had one? I have had one perimenopause. Yeah, I agree. And we need to be watching that. Yeah.

1:05:44Dr. Mary Claire Haver:You need to know where you're starting. Yes. Because naturally we have our peak bone density in our late 20s. And then it just time aging process we lose. So if you were a child athlete or a gymnast or did something where you were constantly having resistance training. Of course, yeah. You're going to have higher bone mass typically. I have so many patients who were incredible long-distance runners and they are really struggling with their bone density.

1:06:09Dr. Amy Shah:Yeah. And the bone density thing. So tell me what your thoughts are. Because when it comes to exercise, for example, you know, we're always trying to tell people to really pull. You want to pull on your muscles because they pull on your bones and you get more bone density. And there's certain exercises that really help. Obviously, weightlifting.

1:06:27Dr. Mary Claire Haver:Yeah. So Lift More trial, they did squats. They did deadlifts. Yes. They did. They jumped and did jumping pull-ups and then let go and fell. And they did a couple of other things.

1:06:38Dr. Amy Shah:I think those are really great. But I think the debate happens when it comes to Pilates and yoga and all those things. And I think that there is a very good place for Pilates and yoga, but I think it has to be mixed in with the weight weight. Right.

1:06:54Dr. Mary Claire Haver:Variation is the key. It's like 30 plants a day. It's like 30 exercises a week. I've really had to rethink, and for my patients to, you know, really rethink exercise because again, before it was thin, thin, thin. So I did a ton of cardio. I was a runner. I walked, I, you know, those are all great things for my heart. Right. And so when I talk to my patients, I'm like, are we, what are our goals here? You know, so we need to have a strong heart. We need to have strong bones, strong muscles, strong brain. And those are all different things. Yes. Right. So in general, we say 150 minutes of some cardio around zone two-ish.

1:07:29Dr. Mary Claire Haver:Okay. We have great data on that. Great data on women, great data on women and menopause for heart health. However, for bone and muscle strength, we need to add to that at least two days, if not three, of really serious resistance training. We still need to do some sprints in there. Doesn't have to be much to get that VO2 max up. Like, this is what it takes. I like to habit stack. My daughter habit stacks, you know. And so, like I'll be walking on a treadmill while I'm working. I'm doing Zoom calls elevated with my weighted vest on so I can hit more of those goals all at once because I don't have a lot of time.

1:08:03Dr. Mary Claire Haver:Yeah.

1:08:04Dr. Amy Shah:I actually did a framework for exercise too, because I knew that if I was going to give nutritional framework, I have to give some kind of thought. And I basically said what I do. Basically what happened is when I looked at the research, it looks like you're right. Three days of weight training is ideal for women in perimenoma. So it's, I have a four, three, two, one. Okay. So four days a week, you're going to be doing the movement that you love, the walks, the hikes, the dancing, the thing that you can do well into your 80s and 90s, like the things that when we look at longevity and we look at people who are really thriving and they've, you know, swam all for 25 years or they've, so if you love nature walks, for me, it's nature walks or hikes, Like, great.

1:08:50Dr. Amy Shah:Four days a week, at least, you want to do that. And then, if not more. And then three days a week, you want to do the weight training slash resistance training. So three days a week, you want to definitely incorporate that. The two is new for me in the last couple of years. It's heat therapy, hot, either sauna or hot yoga or something that gets my core body temperature up for 20 to 30 minutes. What does the data say about that? Yes. So sauna, we have finished data. So in Finland, almost everybody uses a sauna and their healthcare system is great. They have data on hundreds of thousands of people and they have great data on the association of sauna use and cardiovascular disease on brain health and on longevity.

1:09:41Dr. Amy Shah:So what do you think? What is the physiology here? Why is me sitting in a hot box going to be helpful? So when you raise your core body temperature, something called heat shock proteins get produced. And when heat shock proteins get produced, it's usually after about 20 minutes. They think that it's not like immediately, but when your body's starting to really warm up in the core and these heat shock proteins, it's protective for our brain health, for our cardiovascular health. And they don't even know exactly why that would be. some people think it's like exercise where you know when you exercise you get this not only are you moving your muscles but you get the secondary benefit on longevity and heart health okay and so it's a secondary benefit anti-inflammatory benefit so that's the mechanism of action so what they found is even if you in japan they have um data on hot tops like in a hot bath 103 or 105 that was the same thing.

1:10:43Dr. Amy Shah:They show that they produce heat shock proteins and then that has a protective effect on their brain and their body health. And so, and then they found it with other various forms of heat therapy. So the data is pointing to the fact that there is some kind of association between heat and raised growth hormone, protective inflammatory, anti-inflammatory compounds, these heat shock proteins. And so incorporating this into your life two days a week is something that I've started to do over the last few years. How do you do it? Either hot yoga or sauna, dry sauna. Dry sauna is where the finished data came from, the dry sauna data.

1:11:26Dr. Amy Shah:So if you want to follow how they did the protocols, it would be like 167 degrees in a dry sauna. There's not a lot of debate now that there is good data on heat therapy and all these outcomes. The exact methods to do that is still debated. Like does red light, you know, infrared sauna count? Does, you know, going on a run in a hot like day count? You know, there's a lot of like that. We don't exactly know, but we do know that there's a lot of association between heat and longevity and better outcomes in heart health. So we want to do that. And then the last four, three, two, one. The last one is the sprint.

1:12:03Dr. Amy Shah:5 % of people, like 95 % of people don't sprint after school age, you know, after college. Isn't that crazy?

1:12:11Dr. Mary Claire Haver:The data around that?

1:12:12Dr. Amy Shah:It's crazy.

1:12:13Dr. Mary Claire Haver:They'll never run again.

1:12:13Dr. Amy Shah:Yeah. And I thought about it for a few minutes and I was like, you know, it's so funny because when I switched from my high intensity workouts that weren't working for me and I started to do more walking and like weight training, I wasn't really sprinting Me either.

1:12:28Dr. Mary Claire Haver:Yeah. I realized I wasn't my V and I went and got my VO2 max and it had dropped. And I was like, I'm not doing sprint training anymore. And you need that. Or the equivalent.

1:12:37Dr. Amy Shah:Yeah. And so women, we were getting more and more, you know, studies coming up that say like women actually benefit. So how much, how often, how long, what does the one mean? So one means just one day a week because I was like, everyone's doing zero days a week. So we got to do one. And because of the data, actually, I think it's out of UT Southwestern, the study that's you can reverse the age of your heart by 20 years, up to 20 years by doing a exercise protocol. Four by four. So it's the Norwegian four by four sprint that they put in there. So there's basically what happened for people who don't know the study.

1:13:10Dr. Amy Shah:They took people who are sedentary and they put them on a two-year exercise program. And for the first year, they just worked up. Like they just started to do little weights, little cardio. But at about the year and a half point, they started to add in one day of a sprint workout. And this was the Norwegian 4x4. And they, at the end of the two years, they tested everyone's hearts. And from the beginning of the study to the end of the study, they saw drastic differences in how their heart functioned. And it looked like their heart had anti-aged, like 20 years from this exercise protocol. And what the researchers kind of said, like that last little piece seemed to be, they think, was the thing that really pushed them to the next level.

1:13:59Dr. Mary Claire Haver:So what does a Norwegian 4x4 look like? Everyone's like Googling it right now.

1:14:03Dr. Amy Shah:Norwegian 4x4 is really difficult. Okay. I don't recommend that you start with that. Four minutes. Yes. It's four minutes of high intensity work at 85 % of your max heart rate. So that would be like running or, you know, doing some kind of heavy, high intensity workout, cycling, running, whatever for four minutes and then giving yourself a break for three minutes and then going back to doing the four minutes and doing that four times so that's a really really intense high intensity workout how i would start is i kind of talk about how i started because i was like i can't four minutes like running as fast as you can for four minutes that's like a lot yeah so what i did is um I went for my first sprint, like I did a jog walk sprint and I would do 30 seconds of the sprint and then take a break.

1:14:55And then I did that for eight minutes.

1:14:58Dr. Amy Shah:So you got four minutes of sprinting in there. And that's how I started to work myself up to that protocol. I still don't use that exact protocol.

1:15:07Dr. Mary Claire Haver:Yeah. I still haven't made four minutes, but I basically, you know, I do like a 15 minute warm up before I start hitting the weights. Not every day. And I will, you know, walk for the first lap, like on my treadmill. And then I'll always want to do it on an incline because I'm always trying to grow my leg muscles. And I will just sprint flat out until I think I'm going to die and then turn it down until my heart rate comes back down, stable for a minute and then go back up. That's exactly right. And I'll do that for four or five rotations. Yes. And that usually takes about 15 minutes. Yes.

1:15:36Dr. Amy Shah:I do this thing called crazy eights. I don't know. It's an old exercise, but it's the same thing. Do this sprint eight times for like 30 seconds to a minute, however long you can sustain it and keep it at 85 % of your max heart rate. So you're really pushing your heart to the max. That's the goal of this is trying to grow and strengthen that muscle that is our heart.

1:15:59Dr. Mary Claire Haver:Let's talk about hormones. Yes. You've said that lifestyle matters, but it's not a replacement for medical care. How do you help your patients and your followers understand the role of nutrition alongside with HRT? Because everybody wants a quick fix. Tell me what to take, tell me what to do, blah, blah, blah, blah, blah. But I think they're missing the symphony of this. Yes.

1:16:19Dr. Amy Shah:It's an and. Yeah. And you do this so well. I think for far too long, we were kind of like not given that option of hormone therapy. And so I think having that discussion with your physician is extremely important and to have that option and to know what your options are. And that goes along. That doesn't mean like you don't do the nutrition part. And it doesn't mean if, you know, you do nutrition, you can't do hormones because, you know, it's natural.

1:16:50Dr. Mary Claire Haver:Some women are being told all this, but I just want to lay that to the head right now. But I do want people to understand if you go on hormone therapy, it's going to stop your hot flashes. It's going to keep your vagina healthy. if you do that local and all that. But if you're really looking at longevity and you're not covering that lifestyle piece, the heart health, the bone health, the muscle health, the brain health, you know, through your nutrition exercise and your lifestyle choices and the like really intentional cortisol lowering thing. Yes. Then you're likely, hormone therapy is likely not going to affect your longevity more than 18 months or so.

1:17:23Dr. Mary Claire Haver:Yeah. At best.

1:17:25Dr. Amy Shah:And I think that's, I'm so glad you said that because I think there's a lot of confusion around, you know, do we do one or the other? Do we do both? Some people are very against doing, you know, hormone therapy, but I think there's a lot of swing the other way, meaning that a lot of people are very excited about hormone therapy, but then it's really hard to do the other stuff because, you know, you can take something.

1:17:46Dr. Mary Claire Haver:I can't tell you how many DMs I get. Like, I started HRT and I haven't lost any weight.

1:17:50Dr. Amy Shah:Yes.

1:17:51Dr. Mary Claire Haver:And I'm like, oh God, okay, we got to start over.

1:17:54Dr. Amy Shah:I think perimenopause is a really good time to optimize your diet and lifestyle and start to really dial that in so that you can actually separate what's happening from your hormones. Because going on a really healthy diet and changing your exercise protocol and even decreasing your stress is not going to stop hot flashes. They might get a little better, maybe, but yeah. Yeah, you're not going to stop, you know. You're not going to stop menopause. Yeah.

1:18:20Dr. Mary Claire Haver:And so like you can make it.

1:18:25Dr. Amy Shah:Your ovaries as possible during perimenopause. And you can make yourself, you know, give yourself the best chance to thrive. But you need both. And I think at, you know, perimenopause is the perfect time to prepare your body for that.

1:18:40Dr. Mary Claire Haver:What's one thing a woman can do this week to improve her hormone balance? Oh, gosh. Or five things.

1:18:46Dr. Amy Shah:Okay. Eat the 30-33. Okay. It just takes a couple of days. Like I said, your gut is super forgiving. It forgets. it actually dies off very quickly. Their half-life is very short. And so you'll start to get benefits right away. And then another thing that I think is surprising thing I'm going to say is that morning sunlight. Like getting your circadian rhythms in check is going to improve your hormones and your energy levels and your mood within days, if not a day. So getting that morning sunlight is something you can literally - What does that look like? Do you have to stand in the window? Do you have to go outside?

1:19:22Dr. Amy Shah:Do you have to, you know - Two to 10 minutes. Okay. You can do more if you have time. I love it when I have a little time to go for a walk in nature. But if I don't, it's brushing my teeth outside for two, three, four, five minutes, right? And you want to be outside. Glass blocks some of those rays that you need through your retina to your suprachiasmatic nucleus. So you want to get it straight. I've done it and I know other people will do it where I lower the window of my car for like a couple of minutes and I'm like, because that's all the time I have. But ideally it was like, it's, you know, get a couple of minutes, have some, do some mindfulness, do brush your teeth, do your stretches, do your jumps, just get your body moving for two to 10 minutes and that's it.

1:20:13Dr. Amy Shah:Morning's on light. And then you're done. You want to get total of one hour total a day for optimal health. But that can be broken up into pieces of 10, dog walk, whatever. So when you want to really optimize your hormonal function, your digestive function, your muscle function, try to get as much sunlight, natural light as you can. And you don't want as much as possible. You want that straight to your skin and your eyes, not through a glass or sunglasses as possible. Anything else you want to share with our audience? How can they find you? Okay, so the book is called Hormone Havoc. It is available everywhere books are sold.

1:20:55And my Instagram handle is Dr.

1:20:59Dr. Amy Shah:Amy Shaw, at Dr. Amy Shaw. And that's TikTok and Instagram, although I hang out more on Instagram. Me too now. Yeah, you're kind of fun both. And then amymdwellness.com is my website.

1:21:12Dr. Mary Claire Haver:Okay, thank you so much for coming on Unpause. We've learned so much today. I'm so grateful. Thank you for having me. You can find full episodes of Unpaused on YouTube at Dr. Mary Claire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauslife.com. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.