130: Unwanted Weight Gain in your 40s and Older with Dr. Nicky Keay

By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition and either yourself or others. Console your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lauren Brown. I'm a doctor, traditional Chinese medicine and a clinical hypnotherapist. I'm on a mission to explore all the paths to peak fertility and joyful living. It's time to learn how to be and receive so that you can create life on purpose. I want to welcome back Dr. Nikki Kaye to the Conscious Fertility Podcast. Now if you haven't already listened to her original episode with me, it's Episode 91, it's called the Female Hormone Odyssey, Paramount Paws Fertility and Beyond. And again, that's Episode 91. Check that out. Nikki, I had such a good time with you. I thought we should continue the conversation. Yep, absolutely. No, thanks for having me back. Looking forward to it. So I want to let our listeners know who you are because some of them may be hearing this for the first time and they'll go listen to Episode 91 after. And I'm going to do a very short recap because we're not going to go over everything we went in Episode 1. That was close to an hour. They can go listen to that, but I'll give them a two minute recap. But first, I'd like to just formally introduce our guest today, not Dr. Nikki Kaye. She is a medical doctor, specializing in exercise in her technology with expertise in hormone health or optimization for athletes, dancers, and individuals experiencing paramount pause and menopause. She integrates her clinical experience and medical research and in her chronology exercises for medicine to offer personalized approaches to hormone health. Dr. Kaye studied medicine at Cambridge University, became a member of the role college for physicians and contributed to developing an anti-doping test for growth hormones. She holds an honorary clinical lecture position at the University College of London where she researches the impacts of lifestyle, nutrition, and exercise on hormone networks. And she's the author of hormones health and human potential and editor of myths of menopause as well as a regular keynote speaker at international conferences. And on podcasts like the conscious of utility podcasts, so welcome to Dr. Nikki. Thank you. So this is what we talked about last time, just for our listeners. We talked about just you use this idea of the female hormone odyssey and that there's an orchestra. And you compared kind of the hormonal orchestra with a pituitary gland acting as the conductor. And sometimes we can get fluctuating symptoms or hormones in that paramount pause period, kind of resembling an orchestra that gets out of tune. As I mentioned to everybody, that's episode 91. I want to start with what the listeners have been asking me when I told them you're coming back on as a guest. They wanted to know about paramena pause and menopause unwanted weight gain. So I want us to talk a lot about that today because of your in the last episode in your experience with exercise and how to fix hormones. But first, maybe we should back up. Can you define or tell us what is paramena pause and menopause because I think they're being used interchangeably, but they are different? Absolutely. So menopause is like the full stop of a sentence, whereas perimenopause is sort of like a comma, sort of mean. So menopause is the full stop. It's the point in time when the ovaries retire. So going back to that female hormone odyssey, just to remind everyone, obviously as a child, as a girl, you're not having periods, the ovaries are asleep, if you will. And then the conductor of the endocrine orchestra gets going. Menically, that's when the ovaries wake up, you start experiencing periods, menstrual cycles. And this continues up until the ovaries retire at menopause. And now you're a barren hormone, so the estrogen and the progesterone go back down to almost child, like levels very low. So that's what the definition of menopause is. It translates to pause or stop of the mences, the period. So it means the time from which you have no further periods. But it's not an on/off switch. That's really the key thing. It's not that one day they're working and then the next day that's it. They sort of perimenopause, I describe it as the time when the ovaries are going part-time. You know, there will be some cycles when everything is fine. The orchestra is playing nicely, everything, you know. And then the next cycle, it's a little bit, yeah, out of tune, as you say. The ovaries are a little bit more reluctant. And so this is the perimenopause by definition, is the time of uncertainty and fluctuation. And that makes it really challenging time, because you wonder even if you're imagining it. It's like what's going on here, and it's so so variable. So that's really the definition. The perimenopause is the winding down in a slightly erratic way. If I can put it like that of the ovaries and menopause is the definite full stop when the ovaries are sort of stopped. And in that sense, once you've reached that point when the ovaries are officially and definitely retired, it kind of makes it a little bit easier to know how you know where you are in terms of your hormones. So hopefully that clarifies it. So they're very similar to sounding terms, obviously, perimenopause, menopause. But you're absolutely right that it's important to distinguish because they are characterized by different hormone signatures, if you will. And in menopause, the Western medical definition is one year after your ovaries retired, one year after you no longer menstruate. So for those women, they can kind of understand some of these vasomotosympitums, like night sweats, hot flashes, disturbed sleep, mood, waking, because they see their cycle. For the women, and I think, I don't know what the medical definition is of today. I think it used to be above 45 as perimenopause clinically. In my practice, it's 40 and above. And you can see even before 40, but definitely 40 and above. For them, it can be challenged. Like you said, they think they're going crazy because they're still menstruating, but they're having some really unwanted symptoms. Yeah, I think that's just a few points you made there to clarify. So menopause, it's a bit weird. It's what we say, a retrospective diagnosis. So say the average of menopause is 51. But you could only be certain you've reached menopause when you look back and say, "Oh, that's a whole year now I haven't had any periods." So now you're 52, you reflect back and say, "Oh, yes, it's exactly a year ago when I was 51 when I had my last period." So only then could you sort of absolutely say, that's menopause. And so officially, during that time, that sort of, you're in the waiting room, as it were, for that year. You're on tender hooks because you're still officially in perimenopause. Because you don't know, you might get another period, which goes back to this crucial thing about it being this time of uncertainty. So that was the first point about menopause strictly speaking as a retrospective diagnosis. And then when does so perimenopause only finishes when you've looked back and said, "No periods during that year?" And you go backwards. And when does perimenopause itself start? So when do the ovaries start going part-time? And as you say, that's a very variable feast, as it were. I mean, the age of menopause, average age is 51, with the range being from 45 to 55. So that's menopause full stop. And they say that perimenopause can start anytime, maybe up to six years before menopause. But you don't know, you can't foresee when your menopause will be in the future. So I agree with you. I tend to think of it more like 40. So from the time of 40, maybe you're going to have menopause at 45 for 46. So therefore you will start experiencing ovaries going part-time hormone fluxes from the age of 40, on the other hand. If you're destined to have a later menopause at 55, you might not start noticing symptoms of perimenopause until, what's that? But doing the math there. 49, you see what I mean? So we can't say there is a generic time for starting perimenopause, because unless we can see in a crystal ball and know when menopause is, we don't really know. But I tend to agree with you. And I've seen even some women of younger in their late 30s who have the odd cycle, which is a bit, I'm not sure about that one, that wasn't quite what we expected. So you know, it can even start before that, but generally I agree with you, I think, sort of round about 40. You're going to have a high index suspicion of the woman's coming saying, cycles have changed typically, they become shorter initially, maybe heavier, maybe like you say, not feeling so good, the occasional cot flush, we call them over here or whatever. So you know, things can start kicking off in those early 40s. So it's, this is why perimenopause is such a tricky one, because it's so, so variable. And that's what I want to talk about, though, is how to help women in that transitional period of their life. And right now it seems that there is celebrities and celebrity doctors are really pushing hormone replacement therapy, particularly estrogen hormone therapy. And now you're sharing in that perimenopause, let's say 40 and above, there's a huge fluctuation estrogen. And then when you're a menopause, there is a definite decline in estrogen, because you're no longer ovulating. And your progesterone is done as well, because you're no longer ovulating. But in the perimenopause phase, you are having a decline in progesterone, just not as much as menopause, because your ovulating may be less or the quality of that follicle that releases the egg isn't as youthful or has that quality like it did in the earlier years. Yeah. Therefore your progesterone output is not low. So there's the declining progesterone. But The perimenopause from our last discussion and from your colleague, Dr. Jermelon, prior. Yep, yep. I got out to her. She's Episode 89. And again, as I mentioned, Dr. Nikki here is Episode 91. She says that estrogen is not necessarily declining in that perimenopause. It's fluctuating and it can go really high. And it's my understanding from the Western paradigm because we have a whole Chinese medicine paradigm on this as well that we'll geek out about that. A lot of these symptoms of sleep disturbance, heavy bleeding in irregular cycles and weight gain is related to estrogen fluctuating. So I'm curious, your approach is estrogen therapy kind of the solution because it is being pushed a lot right now. And we're recording this in the spring of 2025. It's being pushed a lot. But if you're already having some high fluctuating levels of estrogen, I'm curious your approach. And then we're going to go into things outside of hormone therapy. But I'm just wanted to ask you about that fluctuating period in those 40s. Well, listen, I'm a colleague and a great admirer and friend indeed of Gerald and Pryor. So Professor, progesterone, as I call her. Anyway, I mean, yes, just the problem is this. I think that estrogen, everyone has, well, most people have heard of estrogen. But progesterone is always sort of played second fiddle and not been talked about so much. But you're absolutely right. If we look at the nitty gritty of this, of the physiology of these hormone fluxes, the first thing to sort of falter is exactly as you say it is actually the production of progesterone. Because as you say, you might not ovulate at all. So therefore you're not going to get a call for stiluteum. So you're not going to get even get progesterone off the starting block. Or as you say, the follicle maybe isn't quite up to what it used to be, what it was first made. And so the progesterone production will be, will be lower. And this often is the initial, explains the initial indication of parimenopause with the menstrual cycle length actually shortening because of lower levels of product of progesterone. But as you say, in contrast, estrogen is having a whale of time. If not, only is it staying at a decent level, it might even go spring up quite high. So as you say, it's sort of ruling the roost. And what's the effect of estrogen? It sickens the endometrium. And so this often is why women in parimenopause can not only get short cycles, but very heavy bleeding periods because there isn't that opposing effect of progesterone. And by the way, it's very interesting. And I probably no doubt Professor Praha mentioned this in her piece that this is exactly the mirror images of what happens to women teenagers when their periods first start. So when their periods first start, there isn't quite that coordination. There isn't quite that slick, you know, the conductor of the pituitary gland hasn't quite got its act together. So often when teenagers start their periods, guess what teenagers complain of often. Very heavy, painful periods, not feeling so good. Why is that? Because estrogen is ruining the roost and progesterone is a little bit not so great yet. And then things settle down. So if we reflect what the teenagers experience, what the parimenopause or women experience, is actually kind of similar because of the underlying similarity in the physiology. So we definitely need to be talking more about progesterone. So now if we say, okay, so early parimenopause is the progesterone that's going on, the estrogen is fine, maybe even high, then does it make any sense to give more estrogen? No. And indeed, officially, HRT or MHT, whatever we want to call it, I prefer HRT because sometimes we do use hormone replacement therapy and women who haven't knocked for menopause actually in young women whose over is our insufficient suffering, premature ovarian insufficiency or in athletes I work with or dancers where their menstrual cycles are stopped because they're under fueling their bones or suffering. So anyway, HRT, MHT, whatever we're going to call it, it's only officially licensed actually for menopause, right? Not parimenopause. So we've got quite a lot of problems here with doling out HRT and indeed certainly you should never give estrogen alone anyway for any woman who's got a uterus because that would be really dangerous. It's going to thicken that endometrium and potentially increase the risk of endometrial cancer. So we won't do that anyway. So I think we have to be very aware of what's going on and make appropriate choices. So I think that if one, so my approach is, if a woman comes to me and she's, she's impary menopause, she's really, you know, struggling with really challenging symptoms and impacting her quality of light, the hot flushes, the poor sleep, all this sort of thing, I would love to do what Jerelyn did in her great study in Canada, which is to give micronized progesterone first line because that will definitely help sleep in the hot flushes and everything. Although sometimes it can be a bit tricky because it's so traditional to give both of them together the estrogen and progesterone. So I get round that by giving that low as possible just a smidgen of estrogen just to smooth it out really. And then the, frankly, it's the micronized progesterone that's going to do, have the benefit there, you know. And so it is something that I would suggest to a woman struggling during parimenopause, but with that proviso, we make the estrogen as low as possible just to smooth things out. But definitely, ideally, the micronized progesterone is really going to help. And sure, once she's then gone through and now is menopausal and the estrogen definitely is low, then we can maybe slightly increase the dose of estrogen. So that's my approach and hopefully, well, I know that will reinforce hopefully what Jerelyn has discussed with you about the importance of progesterone. There are two hormones from the ovaries, not just one. For very similar than our clinic, who also follows the research of Dr. Jerelyn in prior to do the bio-dannical progesterone and for sure in those women who are still cycling the forties and then low dose estrogen. That study, as you mentioned, because we've got to give a shout out because I'm local Canadian. That's a Canadian study. And when I was in contact with Dr. Pryorges recently, it's evidence-based research showing that progesterone, so these oral progesterone, micronized progesterone, effectively treats parimenopausal night sweats and sleep problems. So that's data coming out of Canada, that's not just an adult, that's published. No, no, it's hard for us. And it is a lovely hormone. It truly does. You know, it's making from experience. You take it last thing at night, that's really important because it will make you feel a little bit dosy, which is good. So don't take it in the morning is number one. And it really does do the trick because it helps with sleep and also because it's helping also with hot flushes, then you're not going to have disturbed sleep because of hot flushes as well. So it's a really brilliant hormone. And the micronized progesterone you mentioned just to emphasize that is molecular identical to what you produce yourself. So this is totally different to the synthetic types of progesterone, or progestin, whatever you want to call them. This is the real stuff, if I can put it like that. Well, now let's talk about some of the symptoms. And as we shared in this parimenopausal phase, there's changing in cycles. So you can have lots of like lots of cycles in a month versus every 28 days. You can get very heavy bleeding. And then the common questions we had are about unwanted weight gain and sleep issues. So firstly, what's causing the unwanted weight gain and sleep issues? What is the hormonal, what's happening in the orchestra that you've talked about in the past that can lead to this and feel free to touch on like because you know, people are getting eggs and pains, people having brain fog. So what is going on that all of a sudden it feels like you've gone crazy? Well, yeah, exactly. Well, quite. What can I say? I described these symptoms as like, it's like Pandora's Box. There is a lot. But fundamentally, what is happening is the hormones are in a state of flux. And so the body is confused if I can put it like that. The 75% of women, the most common symptom are those vasomotus symptoms, the hot flushes. And that's because the temperature control system is located centrally in the brain, it now really narrows what we call it's thermonutrile zone. So if you just go a little bit outside of what it absolutely wants your body temperature to be, it effectively gets in a panic and starts causing you to have sweating and you know, vasolay dilation so you get hot and sweaty as though you're in a sauna, even though you're not, but the body kind of thinks you are. And this is really interesting because these hot flushes, obviously they're really annoying because if they happen during the day inevitably during a podcast or an important meeting or something, it's like, oh, not now. Anyway, but it's totally un-new, you can't control. And the other thing is if they occur when you're trying to sleep, this is going to disturb your sleep so they add compounds to the problem with the sleep patterns, which are also disrupted because of the change in the estrogen and the progesterone balance if I can put it that way. And the interesting thing you mentioned brain fog, it's thought that these hot flushes are linked, made me to problems with brain fog or cognitive impairment or whatever you want to call it because during a hot flush all the blood goes to the skin. That's why you get hot and sweaty, but actually during that time there's a restricted blood flow to the brain. So that's why you don't feel so good. And also by the way, it's just horrible because this affects your mood. You have anxiety and things like this. So that's all the sort of that piece of it, if I can put it that way, but coming round to other symptoms, the body composition changes and weight gain, that's a really tricky one. Why is this happening? because of these hormone fluxes and also not only women, we have it a bit tough. Not only we're having these big changes in the ovarian hormones but also something we share with men because by the way men get old as well. In both men and women an important anabolic hormone called growth hormone decreases. By the way growth hormone isn't just about children growing. We also produce some as adults and this hormone is very important for maintaining a favorable body composition, i.e. muscle mass versus deep position of fat, especially visceral fat around the organs that's not healthy. Growth hormone is really important for that but as you're getting older for a woman you've got the fluxes of the female hormones which in turn can potentially influence your sensitivity to insulin. Insulin, I think everyone has some herd of insulin resistance so we got that going on with the female hormones and we've also got on the backdrop of the growth hormone decreasing which also tends to favour the deep position of fat over muscle. So this is this combination, the storm of all these hormones changing during this time. That is why you can notice the scales, there's a bigger number on the scales now and also that you notice especially around the mid-riff things are a bit tighter around the waist area because that's where the visceral fat will be deposited. So these are things that you you know might start to notice but we're going to come onto it no doubt what to do about it but also other things just to mention typical symptoms. I think you mentioned aches and pains of sort of really kind of like random aches and pains not necessarily related to an injury but you think oh have I injured something but actually it's just that's what's happened because the estrogen is going up and down, what else can you experience? Actually digestive issues because estrogen is very important for the estroboloam, the microbiome specifically dealing with recycling of estrogen so you can get the digestive issues things like this. Urinary tract issues are needing going to the toilet more and the dyno dryness those tend to happen a little bit further away as you're going into menopause, official menopause but still these are all things combined what else is the headaches because maybe the cerebral blood flow like I mentioned have been disrupted, sometimes palpitations or them I would always preface that by saying if you are having palpitations you definitely need to make sure it's not the heart or it's just a temporary effect of the hormones changing. So there is a whole myriad of symptoms potential symptoms but I think this is why it's also really a challenging and confusing time for women because you literally wonder from one day to the next you think you're falling apart, all these various symptoms or there will be some women who don't seem to get so many and some who seem to get a lot and some women feel that they have to qualify to say all I've got perimenopause to have this full house so just to emphasise you don't have to have a full house of all these symptoms I've mentioned and it will be you know individual and personal to you of which ones are more troublesome than others so that's why it's really it's really tough. And now I want to talk about kind of our approach because you would think that okay I'm gaining weight here I don't want this one this way gain logically you say I'm just going to have to exercise more and eat less but in our last episode you talked I got introduced to a term by you low energy availability and you shared how under eating especially restricting carbohydrates negatively impacts hormone production and we're looking to balance that hormone production and you shared also you know you work with athletes you are a dancer yourself so can you share with what's going on and explain because there's women they're saying okay I'm eating less and better and I'm exercising more and I'm still not losing weight so what's going on and then what how do you address that then now I kind of want to know your approach oh quick tangent Chinese medicine paradigm this fluctuating estrogen we call it kind of a liver cheese stagnation liver mechanism nothing to do with the western liver and so if people have had a lot of PMS and really difficult painful PMS periods there that's a mechanism in the liver cheese system and we would expect that they would probably have a more challenging transition into menopause and we have herbal formula acupuncture approach to help regulate cycles and also help relieve those symptoms and pray menopause so that fluctuating thing is you know observed in the western medicine and it can be measured Chinese medicine kind of had an understanding of what's happening to the systems where one becomes deficient like you say in menopause yeah yeah but before when that system is retiring if the system that regulates it isn't healthy then it's chaotic which is why some women have bad paramedic paws and some sale right through it so that was my quick tangent I forgot to mention that oh no well actually let's just quickly go on on that before we get into the lifestyle approach so that's really interesting that the PMS symptoms can often get worse in paramedic paws because like you say the hormones are a little bit out of sync by the way remembering back to the teenagers often that's the case so that all sort of fits with them being out of out of whack so that's another sort of thing to put on the list that you might notice but some women and we've mentioned this just now some women might experience pretty bad paramedic paws or symptoms and others you know still some but not quite so bad so why is that what's the difference between these women you're right I really love that point that there is actually well I was going to say an official study but a western study if you see what I mean based which talks about this triad so if you're a woman that during your you know before you reach paramedic paws you have experienced PMS maybe you've suffered with postnatal blues or postnatal depression even it means this is indicating I'm afraid that you might be in for a rough ride when it comes to paramedic paws because it just indicates that your your personal system you're very sensitive your biological response to these hormones and as you say crucially the changes than these hormones so that's that's really interesting what you say about the Chinese of course are on to it already anyway so that's the PMS story and the sensitivity to your own hormones so going back to the sort of the lifestyle factors and there you are and by the way I've been here been there done it so I totally understand what how people feel you're in your forties you know you're suspicious that you are maybe going through many paws because of some of the things we've discussed the more worse PMS shorter cycles whatever maybe some a little bit of the hot flushes but some things like this and you've noticed this annoying chain shift on the scale and shift in your your your trousers the tighter and things like this and you really don't like it so your reflex reaction quite understandably might be oh so I need I should eat less and move more and burn up excess energy and then that will help and then you get really frustrated and upset because you do that purposefully and it doesn't work or worst case scenario it even makes things worse so what what the heck's going on and so this is because like you say you could fall into the trap of ending up in low energy availability so absolutely you probably need to be more mindful so let's focus on nutrition so what's what's what do we need to do there or consider there so absolutely you should of course be mindful that you're not eating surplus because that's not going to be helpful for your hormones but equally if you under eat and then that's also going to have a negative effect on your struggling hormones which actually needs some help so my top tip in terms of nutrition is please don't do anything crazy no crash diets no skipping meals no I lose track of the latest things you know is it intermittent faster I don't know what all these things it's like look just keep it really simple as I suggest stick to your three regular meals a day please do break your fast in the morning with breakfast and please do increase your protein the portion size of your protein intake so that's what you do so you keep everything it's all about keeping the fundamentals there in place but changing the proportion so you have your three regular meals increasing the protein the portion size of protein at each because you need to give those sort of slightly flagging and a bottle of hormones a helping hand but also the carbohydrates don't complex carbohydrates I'm talking about cereals bread, pasta rice all those things which people often associate with putting on weight you know you do still need some of those but the portion size I do you know that will vary if for example the today I did a swim so for my breakfast I had a you know a really good portion of cereal before I I did that but on a day when maybe I'm not going to be exercising in the morning maybe it's going to be slightly less cereal but it will still be the same amount of milk still be the same amount of protein you sort of mean so there's a you can be flexible with your carbohydrate but never I'm nice in it time and time again like you describe and I totally understand it and I totally appreciate that the intention behind it to restrict what you're eating to restrict the carbs and now you're going to try and exercise and you haven't got enough energy you're not going to do effective exercise so you're not going to get even the benefit from the exercise you're doing because you haven't got the energy to you know get the the benefits from it so that's the nutrition piece but as I mentioned here it is in combination with the exercise piece so again the tendency is I've got to do lots of cardiovascular exercise to burn these excess calories and people go you know on the treadmill or long runs or or you know all this sort of thing absolutely you should of course still do some cardiovascular exercise but just as with the nutrition you're shifting your focus to the protein with the exercise you're shifting your focus to the spot. strength work. Okay, so why? So strength work is brilliant is the most effective anabolic stimulus there is because when you do strength work you're engaging all the muscles in your body generally and muscles are really suck up the energy, right? So that's great they're going to use them up and also by doing the exercise, fueled appropriately, you're going to get the benefits because now the muscles are going to increase, right? Hyper-trophy of these muscles. So now you've already improved your body composition by doing this encouraging muscle overfat and also the muscles are very metabolically active. So now your metabolic rate is raised not only while you're doing the exercise but also for some time afterwards. So that I suggest is the the approach that people don't chuck out all the the things they have those fundamentals at their disposal of the nutrition, the exercise and the sleep, the recovery but it's just within each of those you've got to just change it the proportions or the emphasis. Just as your hormones are changing you have to respect the hormones are changing you have to change what you do to give them you know give them the sport they're looking for. Thank you for that. And so what's other things that you like to do? So we got weight training you talked about diet and then do you use progesterone therapy for these women in their paramedic and post phase and do you have supplements because they love that. People love to know there's a few supplements you recommend I can take that can help regulate my blood sugars or help with my hormonal balance or maybe it's so individualized you don't have something to suggest but I'm curious if you have a few of your faves. Yeah sure well definitely my approach is always all these lifestyle things we discussed and in terms and then on top of that sure then we're maybe going to discuss HRT if that's all sort of dealt with with the emphasis on the progesterone element of course. But in terms of supplements I mean it will depend but my go to which is sort of absolutely for everybody by the way of any age is vitamin D because although I commented before we started I've got some sunshired in the UK which is a rare event I can tell you nevertheless the source of vitamin D the main source is the action sunlight on your skin and certainly in the UK even if you want to wander around naked or winter you're not going to get enough sun on your skin to produce vitamin D so absolutely have to supplement the bare minimum of the winter months I mean personally I take it throughout the year so that amwise vitamin D why vitamin D well being but also for bone health muscle recovery and immunity so it's going and it's sought to work in synergy with a sex steroid hormone so the the eschrodal and the progesterone so vitamin D I think is an absolute go to must other things I think can be helpful there is some evidence now coming out about creatin for muscles and brain functions so that's a possibility if you are a vegetarian B12 vitamin B12 is a must go to other things that have been mentioned or I find sometimes useful magnesium I use magnesium spray because I try to not load the gut too much because that's the thing I find so many women or people in general they come with a whole shopping bag of supplements it's like number one how much did that cost and number two is it actually doing you any good and it's really confusing and lots of them are all so it's loading a lot of you know load for the gut so when it comes to magnesium I think the spray version it's well absorbed through the skin and it can also help sleep I spray personally I spray on my calf muscles before I go to sleep having my little retie take one progesterone spray my calf muscles with magnesium we can even get it infused with lavender and apparently it's meant to help so I think that would it's not an essential one but I think it would be a recommendation and then depending on your diet omega-3 maybe I mean personite quite a lot of oily fish so that that's another one I mean there's lots of other so many we could go on and make a whole list of other things vitamin D got it love that creatine interesting that's what my teenage boys used to take to bulk up yes exactly exactly B12 you mentioned vegetarian so I want to go back to that in a minute magnesium also another staple the adrenals love it as you said sleep calm that anxiety yeah yeah for aches and pains that it is just one of those staples I often like my nostril tall as well because I like sugar regulation do you like that one as well yes so that I think if the person really does have a problem with a blood sugar exactly that one is very helpful and you don't need a prescription and it's a lot frankly milder than something like metformin which is hell for the gut you know although sometimes you do have to use if the person is like officially type 2 diabetic you know but yeah my nostril I think they wouldn't be like the top one you'd work through your way through all the others but then if there was a particular individual actually I was concerned about blood sugar regulation despite doing all the the lifestyle things with the exercise the nutrition and all everything that we've discussed then sure I think that's that then that's got that's got evidence that that is helpful yes so and again talk to your doctor your Chinese medicine doctor your naturopathic doctor to get a supplement dosage and right for you what about you talked about the diet and increasing your protein yes but then you said complex carbs be careful of the simple carbs what about vegetarians because because protein a lot there are vegetarian proteins so but protein is easy for somebody who is not a vegetarian to eat beef for example yeah yeah but how do you help or can you advise around vegetarians because a lot of vegetarians are eating a lot of carbs that are not what you would call your complex carbs as well yes well they will be eating I mean it depends lots of those ones are although we say although vegetables got complex carbs in actually lots they're not very digestible lots I'm going to have fibroin so it's not so much the carb load I'm worried about it's it is the I mean facts effects it is harder and more challenging although not totally impossible to you know get an increase your protein intake using you know vegetable sources but you know it really depends you have to be really mindful of it and target and make sure you're hitting it and if you can eat fish for example some people some vegetarians are okay to eat a bit of fish or eggs or other things to get that protein because otherwise it's just quite a challenge in terms of volume so you know it's possible sometimes in our practice my focus in my early years of my practice been reproductive health fertility and we do so much around paramedic pauses and menopause and I'm often asked how how can you do both right well I'm like yeah when Chinese medicine perspective it's the same like yeah we're bouncing hormones we're improving our health and principles same principles one wants to have a baby but they both have irregular bleeding disturbed sleep night sweats so one is happy when the symptoms are gone and the other ones only happy when they have the baby but the treatment is very similar or the same so with women that are vegetarian that we see in Chinese medicine shui deficiency a blood deficiency not quite what we call anemia in the west but often we'll check in if they can eat meat and treat it like a medicinal like so I under like for a short period of time can we treat it like yeah yeah medicinal and if not then we find other ways and then in Chinese medicine gynecology so irregular cycles or cycle cycle issues fertility and this paramedic pausal symptoms that people experience urbels a big part of it and I mentioned that liver system again not your Western liver it's just how it translates into English it's responsible for the shift from follicular to auditory so yeah and it's also responsible from the shift from luteal to the next period yeah and so that's in a micro cycle and then in the macro cycle from it's the shift into puberty helps right yeah yeah yeah and then into menopause so yeah yeah yeah come with those two ends yeah yeah yeah yeah yeah yeah yeah so so that's why the acupuncture herbal approach is something that I will invite our listeners to check out locally your if your acupuncture also does herbal medicine it's something that may help you during this time of transition whether you're trying to conceive or not or whether you're experiencing these things and then we talked about supplements and we talked about diet and we talked about exercise and you talked about progesterone biodenical progesterone I would actually like to ask you a question being a medical doctor I'm very familiar with the lifestyle with HRT with some specific supplements like we mentioned the Vismandee etc you know from my reading and understanding I think there are probably some herbal supplements that can be beneficial for the individual woman I was I just want to ask you your experience what what do you find works what doesn't work yeah well you know there's a modern formula called for my colleagues Urshantong which is menopause high blood pressure syndrome is what it's mainly used for and there's multiple formulas so there is no he what's an herbal formula for night sweats or prayer menopause Chinese medicine is always individualized in taking the individual and finding their disharmony and treating that because both could have the same you could have the same symptom both could have hot flashes but their underlying imbalance is very different so get treated differently for example both have hot flashes but one's hot when they're not having hot flashes one's cold one has constipation one has diarrhea one is thin thin thin the other ones overweight one has really dry skin and brittle nails one has strong nails and glowing skin one sleeps like a baby one has insomnia so you start to see they would not get the same formula for hot flashes and then there could be people that have very different symptoms but their pattern the underlying imbalance is the same it's just based on their makeup up that it shows up definitely on their body. So one could have urinary incontinence, one could have insomnia, so different person, one could have brain fog, and they all have different symptoms, but their patterns are the same. So the formula would be very similar. So you would get like a key formula and then you'd modify it. Now myself and my practice and people that are seeing a lot of women and treat women for fertility or in the paramedic pose, menopause, you kind of have your five formulas that you kind of know you're going to go to and then you would modify it a bit based on the individual. And what I see most common is what we call kind of the liver liver heart syndrome in Chinese medicine. Those organ systems which are off. And so that's how we address it in myself and adultally clinically. The way I address it is if somebody's coming in and experiencing symptoms and their paramedic pose or menopause, I'm usually seeing them for acupuncture twice a week for about four weeks. And at the same time, they start their herbal formula. The goal is to the acupuncture to give them some symptom relief while their herbs are doing their thing. And then within that four week, I'm expecting change in symptoms. And then the acupuncture dosage can come back because I still they still have the herbal medicine they're doing. And then they're doing well. And then I reduce the acupuncture more maybe they're coming in twice a month for acupuncture still in the herbal formula. And then eventually they're doing the acupuncture once a month and they're on the herbal formula. And I would expect somebody to be on that formula for about six months. And then we see how they're doing. And then we could start to pull back the formula a bit. And then they may go on and off it as needed. And so that would be my approach. And you know, people like why or how could the acupuncture be working from a west. There's a whole Chinese medicine thinking. But the west and paradigm, it's releasing, helping you release endorphins. It helps regulate the hypothalamus, pituitary or varying axis. So you're talking about the orchestra that lost the conductor. So if we're able to bring some balance back, the usually the symptoms will shift. It's, you know, helps with that autonomic nervous system to get you out of sympathetic and to parisopathetic. We didn't really talk about it today, but stress aggravates all your symptoms of diseases and symptoms of hormonal imbalances. And acupuncture helps with blood flow. It helps with regulating inflammation, helps with mitochondrial on a cellular level. And I think really when you're if you're addressing the autonomic nervous system, if it's having a nervous system reset, if you're able to really go from high beta brainwaves to, you know, overwhelm to alpha, detached relaxation or some sympathetic and to parisopathetic, the body can heal. And so anything. So that's acupuncture. Look, if you do breathing and visualization and put you like, it's not like anybody has an acupuncture deficiency, just like for patients that are depressed, they don't have a pro-zac deficiency. Right. So I'm, there's many ways to engage the bodies in the at healing. And that's what the acupuncture is doing, which is why when you, if it is able to create the rebalance and your body regains its, its harmony, when you stop the acupuncture, the symptoms are not supposed to come back because the body is now maintaining homeostasis. We're not providing the body. We're supporting the body to regain its homeostasis. And then when it does, you're supposed to be able to pull back the acupuncture nerves. This is really interesting because now I'm trying to lighting this to my Western medical thinking, a medical approach that, of course, women, of course, you're going to have it different symptoms. Even if the your hormone pattern is the same because you've got different individual biological response to your hormones. You can have two women that exactly the same level of progesterone. One will say, I feel dreadful. I've got PMS and the other one will say, I feel fine. So that explains we are individuals, by the way, not clones. And we have our own biological response. And the other really important point you make there, I think is that there is this interaction with the conductor in the external world or more precisely how you process information. So the example I give is you can be sitting in a traffic jam and you almost have a choice how you respond to that. You can feel really stressed, get really annoyed, activate that fight or flight thing and get the call to the lap and get yourself into a real lover. Or you can say, look, this is really annoying. It's out of my control. I'm just going to accept it. I'm going to shut my eyes. I'm going to meditate. I'm going to listen to music. Well, actually, maybe don't meditate while you're trying to drive the car. But anyway, you know what I mean? You can, it's your choice how you respond to these things. And if you can, so that, and we know that this has an effect on how the hormone system works. This is why cognitive behavioral therapy, CBT works for some, for some women with FHA, functional, high-pitched, ameneria. You can't. You've done everything. I've done everything with them. The nutrition, the excite, I'm feeling pretty, you know, they're doing everything. They've ticked all the boxes yet. Why they're here is not happened. Started. And this is where acupuncture or CBT or something that is more like you say, just re-regidging or whatever at that cerebral level almost. That's crucial. And there's, by the way, it's no coincidence that the conductor of the endocryon orchestra, the particular clan and the Hyde family's spirit, is located deep in your brain just where the optic nerves cross over. So it's the, it's the seat of processing all the information from the outside and how you interpret that and then directing the appropriate response. So I think we've come full circle here. And it was interesting how you said the hypothalamus mituteurys, you said the optic nerves was crossed over there. Yeah, they're crossing over there and it's just, it's just literally there. So, yeah, and look what we're, yeah. So, and so when you change, because I use this wording, so it fits perfectly for this, I say you experienced the world through the lenses of your subconscious programming. And if you want to have a different experience of reality, then you change the lens of your lens. So you change your programs. And then now you're going to perceive that same reality differently because the reality you experience is different than somebody else, even though you're both looking at the same reality based on the lens of your subconscious. Yeah. And also this affects this. What we're talking about, how you perceive it or how you interpret or process, this also directly affects the hormone production. Yes. Incredibly. There's been a study by Mary D. Dessousa. I think she's in America anyway. And she found that going back to the red thing, the relative energy efficiency in sport, she found that, and also I found this in another study of a PhD, I, a student, I was supervising anyway. Just the cognitive, the, the anxiety of feeling I should restrict what I eat, even if you didn't follow through and restrict what you're eating, even if you're just thinking about it, the anxiety of it, that actually decreases the T3, the, which is an indicator of energy availability. So there we go. We have definitely come, as I say, full circle, not only how you process it, but how you process that information or interpret that, that actually we have proof that directly can affect some of those hormone systems and, and not just the neurological system. So there we go. As we wrap up, because you're also involved in the myths of menopause, is there anything you kind of want to share with our listener, just certain myths that you have seen over the years, hence you're involved in the book that can help these women advocate for themselves when they see their health provider and just also give them some comfort that they're not crazy. Yeah. Well, first of all, I think one of the main myths that we've already discussed and Geraldine, of course, wrote the chapter on that is that the, you know, Eastern is the the T-Hall moment and that's the one that drops first, so it's not. So we've sort of covered that progesterone story, but the main myth is really to reinforce what we've discussed just now that lots of people or lots of women, you know, it is a really confusing time. So number one, you're not going to be that crazy and it's very individual. So that's sort of the first thing, you know, you know, your body best. So don't question it. If you feel that something is off and something's going on and you're off that age, you're probably right because it's so variable, it's not helpful to do blood tests because people like certainty, I think this is the problem, this is the main myth. Everybody wants certainty, but perimenopause by definition is uncertain. So, you know, doing a blood test won't necessarily help because you might catch it, you know, the hormones in a good cycle or a bad cycle, but it doesn't really inform you what's going to happen next and you, you know, so that's the first myth I'm afraid you have to kind of go with it, but the most important thing is also like we discussed that you do have agency, you do have control of the situation, okay? And also it's not an illness, it's not a disease, it is a natural physiological event or be it challenging, you know, the female hormone odyssey, this is a challenging time, but women I know are up for this challenge. So, you know, take control, recognize it for what it is, take control of the situation, look to those lifestyle and, you know, those supplements that we've discussed, you can definitely make big improvements on that. And then yes, I think you should consider, at least consider and have that discussion about HRT because you can't really predict whether, because I have lots of, you know, some women say, oh, I'm never going to touch that stuff or some say, oh yeah, absolutely I'm going to take it, you know, so that it is very polarised, the view. In my book I describe it as "Cyllular and Corruptus", the two portrayed as two equally evil things, somehow you have to navigate, there's one camp saying definitely take HRT straight away, and the others say, no, no, no, don't take a tour, but I think you've just got to, you know, you've got to make that informed decision for yourself, having made all the lifestyle changes, we've discussed if, you know, you are still struggling, it is for quality of life, that's what it is, then absolutely I think it's totally reasonable to at least try and also beats us turning in your choice of HRT, like you've said, the molecular identical type of HRT is definitely the best one, so typically that is estrogen through the skin, I prefer the gel because it's more flexible in its dose and that bypasses the liver so we don't have any problems inducing enzymes and whatever, and then the micronized [BLANK_AUDIO] and we've mentioned as per Jeremy and Pry, that's really the best combination. But the guiding principle is always start low because the problem is sometimes, like you mentioned, at the very beginning, women are prescribed or asked for very high dose of estrogen and the micro-rise progesterone, but actually that could even make it worse, like you've said, because it's not really a problem with the estrogen, frankly, initially. So that's the other thing to bear in mind. Make sure you're asking for the good stuff and that you are asking for the lowest possible dose of estrogen, and then the progesterone is the really good one. And then also be aware that it will take time to have effect. I have lovely women who take the HRT, and then they send me an email a few days later, I don't feel any different. It does take time for the hormones to, you know, to smooth them out, so it will take time. And you might have to change the dose in the future. So that's the other myth that there is only one type of HRT, you have to take the maximum dose. This is the dose it's fixed, that's not the case. And also how long should you take HRT for? It's like how long is a bit of a string. You know, there is no absolute deadline. It used to be said, oh, you take it for five years, and then you stop. But the British Medical Society say that there is no arbitrary limit to how long you take it. So those are some things, and then the other thing, which is always an awkward point of discussion, that, you know, vaginal symptoms or the genital unresystem of the menopause, those symptoms can be awkward to discuss, but we will. You know, vaginal dryness, unretract, issues wanting to go to the lure lot. You know, that's easily reversible, or helps with vaginal estrogen. And this is just absorbed locally, so you can take it in addition or stand alone to the systemic HRT we've been discussing. And the chapter in the book, written by my colleague, is provocatively, I think the title is something like, no sex out of menopause, you know? So don't worry, that's not the case, as she puts you right on that. So I think those are the main ones, and I think that the main point is lots of women feel like, oh, that's the end of my enjoyable life. It's sort of like a really bad thing to happen. But I think a more positive outlook and saying it's just part of this female hormone odyssey, and actually it gives you an opportunity to maybe explore things that you haven't had time to ordain, think about before. And you want to make the most women, because of the increased life expectancy, we might be lucky enough to expect to spend a third of our life in menopause. So it's not just, oh, you know, I think, again, encouraging women to make the most out of all of their life, including this bit, there is definitely some positives to it. And it's a good opportunity to refresh and revise what you're doing to get the most out of your life. I always enjoy our conversations. I want to refer to where people can find you and let them know that again, we have a podcast, episode 91, with Dr. Nikki Kaye, and that is titled the Female Hormone Odyssey. So I invite you to listen to that. Episode 89 with Dr. Jarlyn Prior, decoding hormone balance, the power of progesterone, because we mentioned her. And we have a few other pediatric rights on here, and Larry Brighton and others that have talked about menopause and paramedicause to check out. And then Nikki's on Face. She's got a website. She's on Facebook. We'll put that in the show notes, but it's NikkiKFitness.com. And on Instagram is Dr. Nikki Kaye. It's on Facebook, NikkiKFitness. And she has, again, you can go to her website, NikkiKFitness.com to find her books as well. So that's all in the show notes. Dr. Nikki, I really enjoyed our conversation again today. Thank you so much for making the time to discuss what's happening to a lot of these women over 40 and that there's hope and solutions. So they can have, as you said, the later third of their life, it can be better than the first two. Yeah, that pretty, yeah, exactly. Exactly. Yeah, no, thank you so much for inviting me to discuss always a great conversation. So thank you so much. Thank you. Just a wrap up. I really enjoyed my conversation with Dr. Nikki. I hope you enjoyed it as well. And I mentioned a few resources that I'll repeat on the acuvalence.ca website. There are lots of blogs on menopause and menopause, paramanopause, so information for you there. We have a longevity diet, which is a anti-inflammatory low glycemic index diet, which should be excellent for those wanting to balance their hormones. And then check out other episodes on the Conscious Fertility podcast. We have several related to the paramanopause and menopause topic. So hopefully you'll find that of interest. And then conscious work part, I see people besides fertility that want to work on their inner healer, I guess. And there's lots of information on the acuvalence website regarding that if you're curious to know more about how to rewire or change outdated subconscious beliefs or limiting beliefs that are no longer serving you. If you're looking for support to grow your family, contact acuvalence wellness center. At acuvalence, they help you reach your peak fertility potential through their integrative approach using low-level laser therapy, fertility acupuncture, and naturopathic medicine. Download the acuvalence fertility diet and Dr. Brown's video for mastering manifestation and clearing subconscious blocks. Go to acuvalence.ca. That's acuvalence.ca. Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you. So please direct message me on Instagram at Lauren Brown official. That's Instagram Lauren Brown official. Or you can visit my websites LaurenBrown.com and acuvalence.ca. Until the next episode, stay curious and for a few moments, ring your awareness to your heart center and breathe. (upbeat music) [BLANK_AUDIO]