174 - Mastering Midlife Hormones with Dr. Christine Maren: The Truth About Perimenopause, HRT & GLP-1s

Be kind to yourself and don't think this is a time that you just have to put your head down and go and suffer through it. This is not a decade of suffering. This is a decade of addressing whatever underlying health concerns you've maybe put on the back burner. And really getting to this new level within yourself where you're empowered and like the brightest version of who you are. Welcome to the Find Your Strong Podcast. I'm Jennifer Van Barnabelle Pay, president of Strong Fitness Magazine, founder of Team Strong Girls and Fitness Coach turned Fitness Publisher. Each week I'm going to give you a thought or an interview of how to build stronger bodies, stronger minds and stronger relationships. Getting to where I am now has been nothing short of a journey of the ultimate highs and the deepest of lows. I've had my fair share of setbacks, near bankruptcy, and eating disorder and multiple miscarriages. You name it, I lost my way time and time again. But through it all I uncovered my purpose which gave me the perseverance to find my strong and stay the course. I've spent more than 15 years coaching women and I know that Fitness is a vessel to help you feel strong, confident and empowered in your body and your life. If you're looking for inspiration and motivation, you've come to the right place. You are not going to want to miss this. Hello and welcome back to the podcast. Today's guest is someone I've been so excited to speak with on the podcast. Her name is Dr. Christine Marin and she's also one of my dear clients, a strong girl through and through. She came to me wanting to build muscle build an X frame. We actually just shot for strong fitness magazine. But Dr. Christine is a board certified functional medicine physician and a true expert when it comes to women's health, especially during the paramedicolies. Dr. Marin brings a deep understanding of hormone optimization root cause medicine and modern solutions to support women through one of the most transformational phases of life. Whether it's navigating paramedicolies exploring hormone replacement therapy or evaluating the rise of GLP one medications. Dr. Marin has her finger on the pulse of what's really working for women today. So get ready for a powerful informative conversation. Welcome to the show. Dr. Christine, thank you so much for coming on today. I'm so excited to chat with you. I'm excited to be here. So you started in my world as a client still are happy to say your big goals were to put on lean muscle build an X frame physique. We just wrapped up a photo shoot with you for strong fitness magazine and you're published in the most recent issue, which is super exciting. How do you feel about everything like your own body transformation? I feel so good. I mean, it was so it's so much bigger than just like fitting back into your pants, right? Like, you know, I joke it's not even a joke. It's true, but like COVID happened and I wore yoga pants for like two years. And then when I put my jeans back on, I was like, it feels like I'm like trying to fit into a sausage casing and it's just like it's not comfortable when you can't fit in your own clothes. I mean, it feels really good because I can shop in my closet again, but it's just so much more than that. As you know, it's, it's like this deeper level of like self respect and self care. And for me, it was really like allowing myself that time and space to reach some of my goals. So yeah, it feels awesome. I'm a very busy practice that focuses on, you know, women in her pariamatopause years going through it all. We're going to talk about that today, which I'm super excited about pariamatopause, gut health, HRT, all of that because even with my coaching practice, that is coming up a lot in our community now. So I'm super pumped to talk to you. And not only that, you're also a mama three. It was so funny this morning I was getting the kids out the door. Two boys as you guys know, and I'm like, I don't know how parents do it with more than two kids because I'm pulling my hair out right now. Yeah, it's a lot. It's a lot. I'm not going to lie. It's a lot. Yeah, so like, you know, carving that time out or making the time for yourself builds so much like self respect, resilience, strength in all aspects of your life. And I think you're a living proof of that. And now you can kind of be an example of to your own patients as well. And to my kids, I mean, I have two girls, right? And I think one of the lessons I've learned in my life is like, it's okay to have needs. You should know what those are and ask for them. And it's it's a really good thing to take care of yourself. So I think it's a good example. I actually think, you know, the more I go to the gym and the more time I take actually away from my kids, it's like the more present I am when I'm with them. And I think it actually makes me a better mom. Absolutely. Say that again for the people in the back. Totally what we're all about here, you know, taking care of yourself. You're taking care of everyone else around you so much better and with more grace. Dr. Christine, for those of you that don't know your story, how did you become so passionate about women's health and also functional medicine? So I mean, you know, a lot of it stems from my own story. I had health issues when I had a hormone issues when I was like in college way back in the day. I was actually business major as a finance degree as my undergrad and I learned throughout that kind of experience and undergrad. I wanted to be a physician. That's what I was really passionate about was health and wellness and fitness. I used to teach group fitness classes and, you know, I just I remember being in my finance class and the this guy next to me was reading like those on newspaper. Right. Like, yes, in that early 2000s, and he was reading a newspaper and looking at the stock market and I was like flipping through my like health and wellness book and learning about like my certification to teach group fitness classes. And so I just like I literally remember that day thinking like what am I doing in here? Like this isn't what I'm super passionate about. So health and wellness has always been like a big part of my life and you know when I decided to go to medical school, I was also very much pulled in the direction of practicing more holistic medicine. I went to college and Boulder, I grew up in Colorado. My mom was sort of, you know, into like wheat germ and homemade yogurt when I was younger. So it was sort of like a natural part of what it was attracted to, but I went to medical school and I chose Dr. of osteopathic medicine because it was a little bit more holistic and like really matched more of kind of how I felt about health. And, you know, then fast forward, I went through a residency program and family medicine. That was very much conventional. It helped me like kind of swing from like everything alternative is good to like, okay, I get all the conventional stuff and now I'm like very much in the middle. But you know, it's hard. It was really hard because it was like prescribing medication and managing chronic disease and diabetes and hypertension and all these things I wasn't super into. Anyways, fast forward, you know, through residency and I struggled with gestational diabetes with my first child. And that was like really bizarre because I had no risk factors for that. And that's when I really dove into nutrition, you know, it's like drinking smoothies and eating like sprouted wheat bread at that time and I realized, you know, that wasn't going to work for me. So I got really into like blood sugar and following that. And then fast forward to when I tried to get pregnant with my second, I had recurrent pregnancy loss. And I was really dealing with a lot of digestive issues at that time. And I knew there was something going on with my body that was interfering with my fertility. And so then I did a deep dive into functional medicine and like, you know, like this is this is it like professionally and personally things just collide for me. My job is very much part of my identity in a good way. I love that. It's all very like there's a lot of flow between my personal and professional life. And so, you know, I really dove into functional medicine at that point and I just never looked back. And I was practicing functional medicine for a decade. And you know, given my own history of like preconception, fertility kind of path. Like that was huge. You know, and now in 44 and Perry menopause is like a really big part of my life now. Yeah, yeah. I love that it's kind of just come naturally. And then you know, you know, you know, you know, you can learn about it. But if you have gone through it yourself, there's just so much deeper understanding. Wisdom, you can offer your patients. I too, I was looking back. I'm like, you know what? I was struggling with hormones since the first day I started my menstrual cycle. I kind of wakes you up and you do you do end up diving deeper into things and, you know, having some miscarriages to it's like, well, this is our bodies telling us something. These are symptoms. And what really is going on is, you know, you have to figure out the root cause, which which you, which you help many of your clients do. So for the purpose of this podcast, we're going to talk all about Perry metapause. How would you define this stage and what makes it so unique to women? Yeah, kind of wakes up women because they're like, what the hell? Like I, everything that I was doing before I'm still doing and now nothing's working and I feel like crap. totally. Yeah, it's really like this loss of resilience. Like if we have some underlying issue, like maybe you had ADD or maybe you had like IBS or you know whatever it is, it tends to get worse in Perry, Menopause to a point where like yeah you have to address it now if you really want to like thrive at this point. You can't just like sweep it under the rug. And so you know it's kind of like this like a lot of times our daughters are going through puberty and like we are going through Perry, Menopause. So thank god I don't have a daughter by the way. It's a lot like there's it's kind of the same in many ways. But you know we experience these hormonal changes and so a lot of women I work with during Perry, Menopause overall there's a decline in hormones and and universally there's like this decline in progesterone. For estrogen there is this overall decline and some women do just have low estrogen throughout like that would be me. My estrogen was just kind of always low. But there are some women who experience these erratic estrogen spikes and dips and spikes and dips. This is like the gas tank is full empty, full empty and so they'll experience high estrogen, low estrogen, high, low, high, low. So it can be very chaotic but overall it's this decline in hormone function over time. And you know that can go for seven to ten years. I always say like Perry, Menopause is not a time to suffer especially if it's for seven to ten years. Have you seen that funny like there's a funny YouTube thing going around and she's like so apparently I'm going to feel this way for seven to ten years. You're like no you don't have to feel terrible. I know because when you're feeling when you're in it and you're feeling bad it's like okay one I'm going to so I'll feel better when I'm like 50. That's what goes through your head. Yeah yeah totally. Yeah so we'll talk more about that but it's definitely it doesn't have to be a time of suffering but it does have to be a time of like adjusting some of your routines and addressing you know whatever underlying health issues you have. What are some of the most common missed or under understood symptoms? I know we were chatting a little bit before we started about like gut health and be personally going through a gut thing for like almost a year. I'm questioning like was that paramedicause or did it swing me into paramedicause? Let's go over the symptoms and then we will touch on that. Yeah I mean there's a there's a whole lot of symptoms around paramedicause. Some of the ones that are less well identified or understood are gut health issues and then like palpitations. I mean women can have like you know the million dollar cardiac workup and really you're like oh it's paramedicause but very common symptoms are like mood disruption not sleeping as well. A lot of people tell me they wake up from like two to three in the morning and they just can't get back to bed. Weight gain is a huge one. Women who are like five to ten pounds out of nowhere. I didn't do anything differently. None of the things they used to do are working alongside with that. We see like metabolic issues. So maybe blood sugar is a little bit disrupted if I look on labs and things like that. Early in paramedicause women start to experience typically shorter cycles so like going from like 28 to 32 day cycle to maybe like 24 to 26 day cycle. Some women experience heavy periods not all but if they're experiencing that heavy estrogen relative to progesterone they're more likely to have a really heavy period. That's a lot of the times when women will like go on birth control pills or like consider an ablation or something because their periods are out of control. You know sometimes it's like just joint pain inflammation. We see a spike in autoimmune disease postpartum and during manopause. So that's definitely you know a piece of the puzzle for some women. I mean gut issues bloating like there's hormone induced dysbiosis. We'll talk more about that but it definitely affects the gut microbiome. You know the teag it could be hair loss some women start to experience acne depending on their their hormonal changes. So but I think they're you know there's some that are really not well understood or like frozen shoulder. You know we see it increase rates of frozen shoulder that's more in menopause usually but it affects every system of your body. Yeah yeah let's let's double click on the gut issues that can creep up. Yeah this is a big one. I hear of us a lot like even for myself I I used to joke and say like I have an iron stomach I can eat anything and then you could change. And then parietmenopause happen. Yeah. Yeah it's huge and there's there's a lot of emerging research here maybe in the last five to ten years but what we're seeing is that as a woman goes through menopause her gut microbiome so that collection of bacteria is closer to that of a man's gut microbiome. Prior to menopause a woman's gut microbiome has a lot more diversity than a male gut microbiome. So it's called hormone induced dysbiosis. So as we have loss of estrogen we have loss of some of those really good gut microbes that we want. And so alongside the hormone induced dysbiosis like when your good bacteria goes down bad bacteria tends to flourish or sometimes we see like Candida or yeast or fungal overgrowth because that's going to be more of a problem in somebody who has less good bacteria. Share that with taking antibiotics because you're having UTIs related to parietmenopause and you know that can be a recipe for trouble. So we see this spike in digestive symptoms like a lot of people who had IBS will have worsened IBS. The same is true for people who have inflammatory bowel disease like ulcerative colitis or Crohn's. It often flares in parietmenopause and menopause. And so a lot of it is just related to hormones but what's really important is there's this bidirectional relationship between the gut and hormones. So the gut also influences your hormones and how you break down and metabolize your hormones. So like specifically estrogen. The gut microbiome has this subset of bacteria called the astrobolo. And the astroboloves job is to metabolize estrogen. And it's really important there's there's something called beta glucoronidase and it helps keep this homeostasis. Like our body's so smart. We have these like little mechanisms in place to maintain homeostasis but they break when our gut microbiome gets into a bad place. So if we have dysbiosis that beta glucoronidase, that mechanism gets broken and so we could have worsening parietmenopause or menopause symptoms or we could have worsening high estrogen kind of stuff like endometriosis or even uterine cancer. Wow. So in a what would you tackle first? Would you do a combination? Like I want to I want to get into HRT but like and I think you and I both agree you know you're going to start with the lifestyle things first making sure that you're lifting weights you know or doing some form of resistance training getting your steps and making sure you're prioritizing protein, making sure you can sleep but I mean sometimes you can't because of hormones right. So like where do you start by like where would you start? Would you do a combination of hormones and all of this or or I mean concentrating on the gut first like where where would you go? Yeah I mean yeah foundational stuff always first and then I often will start with the gut first because sometimes if we fix the gut I mean if she's parietmenopausal probably be giving her progesterone also so you know there's not a wrong answer to doing a lot of things at once which you know it's part of why I love what I do because I'm not I'm not just doing hormones I'm like let's just got health and hormones and thyroid and whatever else we find right but um you know I kind of do both but I always like look at the gut and if there's an underlying gut infection it's really important to treat it. So if you take hormone replacement therapy that can help your gut microbiome but if you have some underlying gut infection going on and you're not addressing that it's you know you're just not getting the full picture. So you know I talk about it it's called like a five r or a four r approach when we talk about treating the gut and functional medicine. So like the first part is remove and that's like remove the gut infection remove some of those inflammatory foods like maybe gluten and alcohol and maybe high sugar foods for some people but really it's like you got to remove the gut infection and so that's where you know I test I do stool testing and urine testing and breath testing and all sorts of stuff to identify common gut infections. Small intestine bacterial overgrowth or SIBO is a really common one I mentioned fungal overgrowth earlier I mean sometimes people have parasites. So yeah that's kind of part one and then replace enzymes. So I'll use a lot of digestive enzymes I'll use like sometimes something called bitteen HCl to support stomach acid and I also put in that like my personal like five r approaches replace hormones. So I kind of do it all at the same time. The enzymes have been a life changer for me. Yeah like you know it's been I realized I was probably really low in stomach acid and that's kind of with all you know I don't know how it happened but in paramedicons probably but the the enzymes been a game changer and do you recommend like I know it's hard for you say maybe it's case by case but like would you still take enzymes without reading me out or do you want to you want to basically teach your body and how to make more enzymes or at this phase of life do is not even possible. Yes and no for some people so some people really do have hypochlorhydria or pancreatic enzyme insufficiency. So those are like more clinical terms that your gastro enteralgis may or may not diagnose you with because they're not always looking for it especially in someone your age. I find that a lot in older population for sure, but there are definitely people who have pancreatic enzyme insufficiency. And sometimes I see it come back. Like sometimes you know things kind of come back into balance and it's all good. I used to take a ton of HDL and enzymes. I don't really take them anymore unless I feel like really full like, "Ugh!" Like, you know, my digestion is going nowhere. It feels really sluggish. Like for people who are listening, if you eat a meal and like, especially if you're eating protein in like an hour later, you're just like, "Ugh! I'm so full." It can be a sign of low stomach acid, which you know, it's the opposite of what we think of in conventional medicine. But yeah, it really depends on the patient. I think a lot of people can do like a combination digestive enzyme long-term. I don't think it's unsafe, but if you're taking BTA and HDL and it's causing like burning or discomfort, don't take it. That's not safe because it can cause issues for sure. But yeah, I mean, you know, ultimately it does depend on the patient, but. Yeah. I think it was just important to chat about because now we're all, you know, I don't know, if you have this on your social media when you scroll, maybe it's my algorithm, but it's like more protein, more protein, more protein. It's like 1.5 grams of protein per pound of body weight now. And it's like, that's a lot of protein. That's a lot. I have it. Yeah. On your digestion, right? So, I digestive enzyme could be super helpful for that. You know what's really interesting? Like, I got to, I got to plug this in here because what I have found is like the amount of women in perimenopause who are on a low carb diet are inadvertently eating really high fat. And that becomes really hard on digestion. That high fat intake is hard on our gallbladder. And the high fat can also cause some issues with gut health and with actually like leaky gut. Now, it's more saturated fat and especially, you know, the bad fats from like fast food and stuff. But I still think like people in my population who are eating more paleo style diets are eating a lot of fat and it's hard on their on their digestion. That's a great, that's a great, great point. I was, I was listening to podcast the other day and they were saying that you should probably do some specific gene testing to see if you metabolize fats. Okay. Because a lot of people are maybe was what you're saying on more of a keto diet and their bodies or their system might not be able to metabolize that amount of fat. So yeah, they're eating. Yeah. That's definitely true. I mean, I think for people who are on keto, there is some genetic like neutrogeno, myxtesting, I'll pull up and I'll be like, oh, yeah, that's probably not a good idea. Your LZO cluster is like 250. And people who are not keto who are just like eating healthy, like a lot of women just like me, me a year ago, the amount of fat I was consuming, not even on keto. I mean, I was just like inadvertently kind of just eating a lot of fat. And I think, you know, it's just like, as you know, it's calorically really dense, but also hard to digest. Yeah. Yeah. That's something we've been working on getting a little bit more carbs in YouTube for your workouts because now you're stronger. Now you're putting on more muscle. Your workouts are way more advanced. And when you get to a point where your body is, you know, almost like training like an athlete, right? You need more carbohydrates to fuel your workouts. Yep. Okay. Let's talk about HRT. Big, big topic right now. I don't, is that the right term now? HRT? Here's the change. Yeah. HRT. Yeah. I mean, menopausal hormone therapy. We can call it HRT. Hormone replacement is fine. Yeah. Okay. Let's kind of go through where you would start with somebody who's maybe experiencing paramedicase and like just your take on it, like all of it. Yeah. Just drone, astrogene, astrogen and testosterone. Yeah. So, progesterone, I'll just start with first because I would say the majority of women in paramedicase benefit from progesterone. It's not for everybody. And there's different ways to use it if you don't do well with oral progesterone, but the majority of women love oral progesterone. It can be super helpful, especially if you have to offset those high estrogen peaks. I talk about estrogen and progesterone, like Yin Yang. It's very Yin Yang. That balance is super critical. And so if you're having these high estrogen spikes and it's not balanced by adequate progesterone, you'll have those symptoms of high estrogen, like a really heavy period, maybe some PMS and moodiness and inflammation and things like that. Astrogen is a really great hormone. So don't get me wrong. Like, I think some people are under the impression that estrogen is bad for us. It's not. It's great. It just needs to be balanced by progesterone. So, progesterone is a great first thing to bring in for women who are paramedicase, especially if they're struggling with heavy periods, sleep disruption and or anxiety. So it can be really calming. I use it orally at bedtime. And it's pretty awesome. There are a few women who will have the opposite effects from progesterone, maybe 5 to 10%. And so if you take progesterone and it's like making you feel more anxious or disrupting your sleep, we can always use it vaginally or some other way. But estrogen is also really important to protect the uterus because if you have unopposed endometrial proliferation from estrogen, you've got to offset that with progesterone. So anybody who's on estradiol will also be on progesterone to protect her uterus, but it protects more than the uterus. It also protects your bone, your brain and your breast. I want to be really clear that progesterone is different than synthetic progestins. So when you take a birth control pill or a synthetic progestin-only pill, that synthetic progestin works very differently. It works on different receptors. And it isn't my favorite. Like I always want micronized progesterone or compounded progesterone. There's also like topical, like go ahead. And that would be like a bio-identical progesterone. Yeah. Body identical or bio-identical progesterone is just like the one you make yourself. Testosterone is also one that I'll bring in for some women early in parimenopause. And it really depends. Your adrenal glands also make testosterone. So not every woman who's in parimenopause and menopause needs testosterone. If you look at the reference ranges on the lab and you have your testosterone drawn, it would always check it first. Like if you have high testosterone, that's common in women with polycystic ovarian syndrome. You probably should not be on testosterone. If you start out with high testosterone, but if you don't and you struggle with symptoms like cognition, trouble-building muscle, low libido, concentration is a big one. Energy. Testosterone can be super helpful for some women. But again, look at your labs. Just pay attention to the reference range because the reference range usually goes to about zero. And so it won't be flagged as low even if you have none. So the reference range isn't great. I always say like I'd like for women to be in the top half of the reference range and we look at both total testosterone and free testosterone. Free is more important because that's what's bio-available. And that is going to be influenced by something called sex hormone finding globulin, which is almost always high in a woman taking birth control pills, which is one of the reasons why birth control pills sucks for libido, because it decreases your free testosterone. Okay, so then there's estradiol. So not every woman needs estradiol in paramanopause, but sometimes women benefit from it a lot. And I'm a fan. A lot of people won't start estrogen until you're in full-blown manopause and I don't think that is like I don't agree with that approach. That's I think estrogen is awesome. You just have to have the right balance. So with estradiol, you know, we usually use it trans-dermally. So it's like a patch. There's also vaginal rings and creams and gels and stuff like that. But bioidentical or body identical estrogen is estradiol. So E2. And that can be awesome for also libido, cognition, brain fog, mood, sleep. Also, estradiol is really important for sleep. It's also really important for your immune system. So when we have really low estrogen levels, the immune system seats that. And I think that's part of the reason women have mood disruption and autoimmune disease postpartum, especially when they're breastfeeding and their estrogen is low. And then again, in menopause because they have these low estrogen symptoms, exacerbation of autoimmune disease, you know, libido, all that stuff. Estrogen is also really important for the genito-yurnary tract. So women in perimenopause often will experience recurrent UTIs. And that's where using estrogen can be a game changer. There's also local estrogen. So direct to the genito-yurnary tract. You can use tablets and creams and, you know, topical kind of stuff. And that's a great idea for a lot of women for a lot of different reasons, from sexual health to genito-yurnary health and UTIs and all that kind of stuff. It's just about balance, though. Like back to that guineaing, it's like, it's about balance. And you know, it's like not every woman needs the same thing. Yeah, I feel like you have to be open to experiment because everybody's different. I mean, I was, I started on the progesterone, and then I did a little TRT and I was thinking I was missing something. And this is what I was going to ask you. Estrogen levels, they're going up and down all the time. So are they really hard to, to test? It's because my blood work and most of all the clients that I've had, you know, get their blood work done, their, their doctors have said my estrogen looks fine. Yeah, but is that are you going more symptom-based then? Yeah, okay. I use both. I use labs for sure. I always test One thing you can see on labs with estrogen now this like the caveat here is like I go a little rogue That this isn't what every doctor does, but this is how I practice So I will check estradiol levels on day three to five of the cycle because that's usually when they're the lowest and sometimes we see them and they're like 20 They're like really low and then I'll check again in the luteal phase So after ovulation before menstruation somewhere in in between and you know Sometimes they're really high like sometimes they'll be up to like 400 I mean in pregnancy just to give you a little bit of reference like they're like 2000 sometimes so Anyways in pariamenopause if we see it like 20 on day three to five and then you're up to like 350 in the luteal phase Like that tells me some that's the woman who's going high low high low, right? But sometimes we check in the follicular phase day three to five and I'll check again in the luteal phase and they're still low And so I just try to get multiple data points and multiple points in the cycle So I always tell my patients like let us know when these were drawn luteal phase day three to five But let's get multiple data points before we make any decisions about where we're going with your estrogen And if you are high low high low Sometimes people do still benefit from a little bit of estrogen because it like fills the tank just a little bit And helps regulate things a little bit Yeah, that kind of keeps you a little bit more even Yeah exactly Now there's and I know this is something that you Kind of have gotten into recently and that is GLP ones Micro dosing them and the medication like let's get into that because there's there's such a It's a huge topic right now right yeah totally what's your take on it How can it and How can somebody benefit from GLP ones during paramedicause is it for everyone You know when would you prescribe a micro dose of GLP one yeah So if someone is really struggling with weight metabolic issues inflammation autoimmune disease A GLP one can be really helpful It can also hurt So if you are taking a huge dose of a GLP one like the pharmaceutical dosing That is generally for obese diabetics and most The women in my practice don't like if you gave them that dose It's like taking three grams of Tylenol like yeah, you're gonna have side effects. It's way too much So micro dosing it can be really magical especially when it's combined with estrogen So estardial and a GLP want a really synergistic and helping prevent things like type two diabetes metabolic issues and visceral Atopocity or belly fat So I'm a fan but it needs to be used in the right person at the right dose What I see is well, we'll start women on it at a very low dose and then have them increase slowly And if you increase to a point where you have food aversion and you can't eat You got to go back down and just like slowly tight-trade back up and see you know see where your your sweet spot is It can definitely cause nausea and food aversion and so the vast majority of people who are taking these medications at the regular pharmaceutical dose or essential starving themselves and Their muscle and their fat is melting off but when they go off of this medication they're then or And they have no muscle left and their metabolism is slower and as you know our metabolism adapts And so then they can't eat anything because their metabolism is really low and they're malnourished because I haven't been eating anything for a year So that's where it's like I think it can go really wrong So I think that lifestyle piece is definitely foundational like prevent muscle loss Preserve your muscle eat a lot of protein Make sure you're still eating three meals a day that are substantial so you can support your muscle and your metabolism teach your metabolism to burn And once you bring in like a little microdose it just can be this like little Like bow on top that helps women like lose the five pounds and decrease inflammation like I have patients who have You know autoimmune conditions that cause a lot of like joint pain and it can be super helpful for them well And so you want to Her scribe it as even the lower dose than the then the lowest dose That a typical doctor would give out so this is like yes, even This is like or lower like a quarter like a fifth to a quarter of that yeah So I start out at a very low dose and I keep it low depending on the patient There are some people who can like titrate up to So they can increase their dose to like whatever that lowest starting dose is of depending on which medication you're taking but There are a few patients who get up to that dose But it really does help with this like underlying insulin resistance the other thing I talk about a lot with my patients is like Insulin resistance is baked into our genes because it helped us survive famine when our ancestors survive famine You know like 500 years ago when there was No food they survived famine through having insulin resistance So it's this favorable thing that got baked into our genes and so you know with me having gestational diabetes It's like yeah, I've got some underlying insulin resistance. It's just there It's not because of my lifestyle. It's not because I'm eating junk food and like not moving It's just baked into my genes and it kept my ancestors alive and now I'm like okay. Well how do I deal with this? And so I really like a GLP one for just helping like With that insulin sensitivity Yeah, it's so interesting. There's just so much more Research on it now and you know, I think I think in the health and fitness industry when it first came out even including myself Including some of our coaches were like you know, it's so bad, but now that they're like certain more research coming out. Yeah I love doctor. I don't I'm sure you listened to her doctor Tina. She's in a more. Yeah Yeah, yeah, she's you know, she's outspoken about it and has done a little research on it on the micro dosing part so And from the women in our community that are a micro dosing, you know things like you know They wake up and their face isn't puffy anymore like they don't they're not holding onto that like five pounds of puff, you know so it's uh Yeah, it's really super interesting. What what laugh? This is another question we get in what labs would you run or like you know those First labs for a woman who might be experiencing paramedic pause So I do like to check extra dial levels and you know, I'll check like an LH and an FSH and an AMH sometimes just To see how high it is like I have this one patient who's I think she's 46 and she had been on birth control pills for like 20 years and She wasn't cycling on birth control pills and so you know, like do you need contraception? No, okay Like let's get off the birth control pill because the real benefit from that is contraception outside of that I worry about side effects and I mentioned libido, but like there's also risks like blood clot and things like that Anyhow So we got her off of birth control, but her LH and FSH was super high. She was menopausal like You know nobody had checked it, but like yeah turns out you're in menopause and 46 is on the lower, you know Like younger side for menopause, but it's not abnormal. So anyways, I do check an LH FSH sometimes an AMH But I like to check an extra dial level and free and total testosterone level sex hormone binding globulin and for sure I think it's important to rule out other issues because there's a lot of things that can coexist right like you might be in paramedic pause and You might have thyroid issues like you could have both So I'll check a TSH a free T4 free T3. I check reverse T3 That's a good sign like if it's really high. I know somebody's not eating enough generally Like you got to increase your calories because your your metabolism slowing down When I'll check thyroid antibodies that were glibulin thyroid peroxidase I check all sorts of nutrients like vitamin D vitamin A B2 homocysteine iron ferritin I personally my practice check other autoimmune markers outside of thyroid autoimmune disease like rheumatoid factor and some called ANA And I'll check of course like blood sugar markers. Yeah Like chemoglobin AM and C and fasting insulin and fasting lipid panel Sometimes I'll check like a leptin level or uric acid. So I mean, I do really comprehensive testing. Obviously I think if you were to go sort of bare bones like at the very least I check you know a TSH a free T4 of vitamin D Maybe a B12 HBA1C or hemoglobin A1C lipids You know CBC and CMP are like really basic labs that I check of course too And these this is something that a patient can ask their doctor for they may have to pay out a pocket like it I mean, I know that you're in the uS or in Canada. So we have Standard healthcare, but we have in a lot of these tests our doctors won't provide Yeah, they won't yeah, we have the same thing here especially like insurance companies So physicians who are in you know more conventional practices a lot of times they don't want to order that And I think like somebody's watching and digging them when they order too many labs So yeah, it depends on your physician sometimes they're not comfortable ordering it because they don't think it's necessary or they don't want to You know if you are a doctor ordering labs, it is your job to then interpret the labs And so if you order labs that you don't really understand what to do with them like that kind of creates a problem So if your doctor doesn't want to order labs you can actually order them on your own It's just what do you do with the results because then you have all these results and unless you're super educated about what they mean It's hard to find figure that out. There are some services out there where you can do these labs kind of out of pocket. And honestly, I think you could put them into AI and get some information. Yeah, that's true. You could run your labs through and say, what does this really mean? I'm going to ask you some rapid fire questions if you're cool about that. Yeah. Okay, so we just went over labs, but what would you say the one lab to test? Like you always run it. Oh my gosh, it's a hard one. I mean, no, because if I could only test one, I'd go on your symptoms for estrogen and maybe BTSH, I don't know. It's so hard. Yeah, that's a hard one. You really need a bigger picture than you can. And I have a panel. Yeah. One thing women should stop doing in their 40s. Oh, drinking alcohol. Okay, let's double click on that. What does alcohol do? It's literally poison. And I'm not saying like, you know, like you could never have another glass of champagne ever in your life. You know, it doesn't have to be like a total absolute. But I think this thought that drinking wine every night might be good for you and as good and like helps you relax is BS. Like it doesn't help you relax. It literally disrupts your sleep. It jocks you up. Yeah, it checks you up. Like it does the opposite. And so, you know, it's this conditioning we've had that like, oh, it's relaxing. But you know, put some sparkly water in a wine glass, drink that, sip on some tea, like have some other anchor that you can replace that with. And like, if you go out with your friends and you want to have a drink sometimes fine, but don't do it every night. That's a good one. That's a good one. My body just doesn't handle alcohol in the same way. Like me either you hit 40 in it. Yeah, it really just drops everything. Okay, like I have to plug to the histamine component. One of the things we see explode in perimenopause. Actually, okay, three things about the gut that I think are fascinating in perimenopause. One of them is histamine. So histamine can cause a lot of digestive symptoms. It also causes symptoms of like allergy and things like that. But alcohol is a huge trigger for histamine symptoms. So if you drink alcohol, you get fleshed or runny nose or something like that. That's histamine. It's also excitatory. So it's part of the reason why it interrupts sleep. Number two with the gut is this thing called hydrogen sulfide, which is really toxic to enterocytes, which is like your delineate of your gut, the cells of your gut. So hydrogen sulfide is not a good thing. It creates a lot of dysfunction and inflammation in the gut. And we see that it increases in menopause. And the third one is just that estradiol influences gut permeability. So it actually keeps your gut lining nice and tight. Whereas like gluten does the opposite, it causes a little bit of leaky gut and loss of estrogen, right? But if you use estradiol, it can really help the gut lining. So okay, just a little plug. Keep going. No, that's great because I when you know I was saying before when I was missing a little piece, I started using a real low dose of estrogen and helped big time with my gut stuff too. Like I noticed, like I can go back to eating things that I was completely, I had to completely cut out. So yeah, I love that you shared that. Okay, another rapid fire question. One thing women should should definitely be doing like to start doing in permeability, if they're not doing it. Lifting weights. Yeah. Yeah. I mean, really like I used to have hip pain and it was more like IT band stuff. And I had no like I was always stretching it. And really what I needed was strength. You know, so like the joint pain, all that kind of stuff, it's like everything gets better when you have muscle. Your metabolism gets better, everything gets better. posture. Yeah, posture. Yeah. Yeah. Yeah. If you could tell everyone been going through pairing, Madapaz, one thing, what would it be? Be kind to yourself. And don't think this is a time that you just have to like put your head down and go and suffer through it. And really like getting to this new level within yourself where you're empowered. And you know, like the brightest version of who you are, like we have 40 years of wisdom behind us. Like I'm not going to, you know, the next 10 years is going to be freaking amazing. So I just, there's so many women out there who think this is like crap. Now I'm old. Like, yeah, I'm over the hill. Yeah. Yeah. I love that. I love that. And I also think, you'll be an advocate of your own health. Don't just take one answer, you know, like we all have doctors. I know they're doing their job. They're doing the best they can. But we also have to play a role in our health, you know, our our GPs only know so much, you know, like go go deeper. Do your own research. 100%. So what is new for you in your world and where can people mind you connect with you? Now my gosh, there's so much happening behind the scenes right now. I know that. I'm like, where do I start? Can I shoot me? Coming out soon. Right? I will be writing a book. Okay. Yeah. I've been really drawn and pulled to write this book for a long time. But in the past year, it was like, I don't, I'm like trying to just chill out and I have something behind me like, like telling me like, I must write this thing. Like it feels like, I don't know, it feels like this other kind of calling. And I'm super excited about it. And it will happen. Yeah. So there's, you know, we're working on like a new website and building my team and all sorts of stuff. But yeah, find me on Instagram. That's where I'm mostly like hanging out. DrChristine Marin.com is my website. And DrChristine Marin is my Instagram handle. And I'm on Facebook, you know, too. I have not ventured into TikTok yet. Maybe I will. Thank you so much for taking time out of your busy schedule. I would love to have you back on for like just gut health on its own because they think there's so much to talk about. But yeah, thank you so so much. Thanks for having me. And that's a wrap on another episode. Guys, thank you so much for spitting this time with me. I just love being able to share these strong stories and thoughts with you. And I hope you were able to take away a piece of inspiration from today. If there's one favorite I could ask, please keep sharing. Post a screenshot. Share a direct link with a friend or post a review and help spread the word so more people can tune in and find their strong. And if you ever wanted to subscribe to our strong fitness magazine and get the physical copy, mail to your doorstep for more inspiration and motivation. I will include the link in the show notes and please feel free to use my strong girl 3 discount code to save. Guys, I cannot wait for the next show. I'm Jennifer Vambarnabel Pay. Take care and stay strong.