Hormones, Mitochondria, and Women’s Healthspan: Full Transcript

Transcript from Dr. Kara Fitzgerald FxMed, Longevity & Epigenetics. Timestamps open the original YouTube video at the corresponding moment.

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The cool fact is that the mitochondrial density in the ovaries is is greater than any other organ system. Greater than any other organ. Yeah. Mitochondria are the cellular powerhouses. But they're also very fragile and kind of a diva. So if inflammation, infection, [music] heavy metals, blood sugar issues happen to them, they shut down, kind of fall apart, have issues. Well, what we forget is that the first [music] step to making steroid hormones are in our mitochondria. I'm looking at this from just the grand lens of [music] women's health. If your mitochondria are faltering, they're going to falter at any like whatever age they're at. Like, it's going to affect you. If you're continuing to be able to produce [music] hormones, you're taking care of your brain, you're taking care of your heart, you're taking care of your skin, you're taking care of your bones, you're taking care of every other [music] system in the body. Welcome to New Frontiers in Functional Medicine, where we're exploring the cutting edge of what's possible in health span, lifespan, and the future of personalized care. If you're a clinician who's passionate about staying on top of the latest science and functional medicine, longevity, and clinical innovation, you are in the right place. Each episode we will deep dive with thought leaders, researchers, and clinicians who are moving the needle so you can translate emerging science into real impact for your patients. Let's get started. Thanks to our Diamond Level sponsors.

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Thanks to our Diamond Level sponsors. Precision Analytical, creator of the Dutch Test, is offering evidence-based training on key topics like hormone metabolism, interpreting Dutch test results and therapeutic strategies, including hormone replacement therapy, all aimed at improving patient outcomes. Become a registered provider to gain access to an expansive education hub with ongoing content, including webinars and case studies. Visit dutchtest. com / courses For over 40 years, the foundation of biotics research has been innovation and quality. Their goals remain unchanged. Innovative ideas, carefully researched concepts, and product development with advanced analytical and manufacturing techniques. Biotics nutritional products are superior quality and effectiveness. They are available exclusively to the healthcare provider. Find them at biionicsresearch. com. Thanks to our gold level sponsors. Timeline, fueling cellular energy for a lifetime of healthy aging. Find them at timeline. com. Vibrant Wellness, transformative lab tests for wellness. Find them at vibrant-wallness. com. Hi everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine. And today is no exception. I am thrilled to welcome back my dear friend and colleague Dr. Carrie

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my dear friend and colleague Dr. Carrie Jones. Uh many of you know her as the queen of hormones and for good reason. She is a naturopathic physician like myself and she's got over 20 years in women's health, endocrinology, and public health. She was the first medical director at Dutch Test and she helped shape education at Rupa Health. Uh she's now the chief medical officer over at New Ethics Formulation and she's the host of Hello Hormones, a podcast that if you haven't tuned into it yet, be sure to check it out. What I love about Carrie, what I've always loved about Carrie is that she's whip smart. She's got clinically relevant, actionable tips for us as doctors that we can use and practice immediately. and she's funny. She just brings the best analogies. She brings a good sense of humor and just a lightness on a topic that can be really challenging. We're talking about women's hormones today, you know, through the lifespan, but extra focus on pmenopause. So, take a listen and let me know what you think. Dr. Carrie Jones, it is such an honor, privilege, great time to get to hang out with you and just pick your brilliant brain for a little while. Thank you so much for joining me today. Oh my gosh. Well, thanks for having me. I always love talking with you, especially considering how long we've known each other. [laughter] I know. We're the OG. When I read in your bio that you've been around

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read in your bio that you've been around 20 years, I was like, we graduated together. I know. Me, too. I'm not quite ready for that mantle. I don't quite feel it, which is a good thing. Uh but nonetheless, here we are. And so when I was reflecting on your bio, I it just made me want to hear from you like you know with the experience of this time like deep in many phases of you know functional medicine, naturopathic medicine, industry, labs etc etc. you know, what's the state of the state with regard to um treating women or women's health as opposed to where it was when we first graduated? I felt like we were like the rebels, right? We were in the rebel team that were trying to help women as best we could. We were, I believe, second, if not third year medical students when the WHI, the Women's Health Initiative, came out. And my attending, Dr. Kimberly Winstar was like, "We're going to be careful, but we're still going to keep prescribing hormones." And that immediately was against the grain. But as a naturopathic doctor, I was ready. I was used to it. It's all right. And so I would watch and beg and get hate from all over of, you know, like those cause cancer, You can do the birth control pill, but hormones cause cancer. Like we don't do this. and the complete lack of care, the lack of studies, the just the lack of lifestyle,

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studies, the just the lack of lifestyle, the lack of the concern about health span and longevity. We were beating a very small drum way back then and that pendulum has swung. Now, we sure and I'm really excited to see it. Even like some of the crazy controversial parts, I'm like it'll balance itself out. You know, the pendulum was far one way. It'll it's moving the other way. And now the pledges for research, the amount of research that we have, the number of researchers who are dedicating themselves to women's health, the amount of education on social media, the amount of awareness for women over of all ages, let's be honest, but really over 40 on social media, the amount of books, all these pink books behind me are all women's health hormone related something, which just wasn't the case 20 years ago. Publishers didn't want to touch that with a 10-ft pole. And so, we've come a long way. And what's really fascinating is, you know, given our background in naturopathic functional integrative holistic medicine, I now see that moving so much more for the forefront. I now see very historically conventional doctors and researchers talking about make sure you eat protein and make sure you exercise and make sure you find your community and make sure you, you know, you like these key ingredients that have been researched. Make sure you remove endocrine disruptors, you know, just some of these tenants of our base of, you know, treat the cause and remove the barriers, the obstacles to healing. It took 20 years. [laughter] 20 years. But here we are. And as the OGs, it's

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But here we are. And as the OGs, it's it's really fun and fascinating and exciting to see. It really is. That's such a great point. You know, it's interesting these days when I open, I get Medscape. You know, I still and I'm still medape student. Are you're still medape? That's student. That's so funny. Wow. 20 years in. Yeah. Sorry, Medscape. You know, there but you're absolutely right. So, you know, when I get the um dump of the various um studies that have been published that week on uh you know, the various things I'm subscribed to over there. It's more and more sophisticated. It's more exposic environment to your point. Well, on that, I'm curious also, um, you know, it was horse urine back in the day, you know, like the the compounds that if they were prescribed, you know, if there were access to them were such poor quality and god forbid if you question that, you know, progesterines and estrogen sources, etc., they didn't. bio identical was was absolutely like frowned upon like you know and so that is starting to change as well although it's not far along enough but any any thoughts there when we were in school you know I learned a lot about hormones the bioidentical through the compounding pharmacies which was a huge um again like it almost felt like the dark underground because we I was trying to learn about progesterone one and

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to learn about progesterone one and estradiol and estriol and testosterone which I mean we didn't we don't have a testo FDA approved testosterone for women now we surely didn't back then and so I didn't want to use conjugated ecoin estradile I didn't want to use ethanol estradile if I could avoid it I mean I'm not saying I wouldn't or a woman wouldn't come to me already on it and feeling great but I thought where why can't we just make a hormone that looks like our hormone like why do we have to go through all these hoops why is it such a big And that has come that is coming around. Although I will say I just went to my own primary care last week who's in her 30s and she said um well I just went to a seminar and I'm learning about pmenopause which I'm grateful for. And she said you're that age. It's time to go on the birth control pill. And I was like oh so close. [laughter] No. [snorts] and she's like, "Yep, I think you should go on the pill until you're 52 and then we'll switch you to um you know, like Premro or or something progesterone and a estradile patch." And I was like, "Oo, nope. I mean, I'm super glad the pill exists. That's not what I need. That's not what I'm on. That's not what I want." You know, let's keep learning. Let's keep this conversation alive. So we still definitely have more education to go because she didn't realize all the options that are out there that wasn't explained to her in the seminar she went to. Right. But but at least she was offering you something and brought the word perry menopause. Yes. Right. That is a step forward.

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Right. That is a step forward. Let me just say on this, we have a lot to cover, but I um I remember treating women in pmenopause when I was in my 30s, and it's a lot different now. [laughter] It is a lot different when you're actually in it. My own Yes. We was going to say we used the lowest dose for the shortest amount of time. A lot of times it was DHEA, you know, pregnnolone and some herbs like you said earlier. And uh and now now given what we know it it's so much different. But also too not given what we know out there and and our toolkit. Oh and our own self. In our own self. [laughter] Yes. I think you know isn't that amazing? I mean I my approach to patients now is you know one of a much deeper empathy. having walking that journey myself. Empathy, especially if somebody's having the same symptoms you are. So, for example, ocular migraines are a new fantastic gift at 48 years old. Thank you, Perry Menopause. And a woman wrote me on Instagram and said, "I just started getting ocular migraines. My doctor told me I'm absolutely not a candidate for hormones." And I was like, "Let me voice memo you because I just feel like kindred spirits, girl. I can I I'm getting them now for the first time, too. Here's what I know." So you can educate your your doctor. But if you have no idea what it's you've never had hot out flesh, you don't you know vaginal dryness, you've never had itchy

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vaginal dryness, you've never had itchy ears, you've never you know like tinitis, you've never had some of these crazy burning tongue things that come and go or or the redistribution of your body weight from the back to the front. Like what the hell is that? What the heck is that about? I mean I know what it's about. like logically, you know, and logically [laughter] it happens and I'm pissed. Yeah. Like what the heck is this? And it just happen. And it's interesting too, going back to social media, there have been some influencers, some guys out there just really challenging that redistribution. And you know, if you ain't right, if you did enough protein, you know, this phenomena calories, calories out and that's just absolutely coming from someone who hasn't had the experience. Even even women, you know, you mentioned guys, but definitely women, you know, in their 20s and their 30s who've never had to manage hormonal dysfunction. Yeah. Not going through pmenopause. Once you go through, you fully understand. Yeah. You know, you'll be there. That journey is inevitable for you. It's not ine it's obviously not inevitable for the guys but yeah yeah certainly as women we'll we'll know it and and it's not that we can't do much about it because we can but the phenomena is there I mean I definitely was never one to gain weight in my middle until I started [laughter] gaining weight in the middle yeah right I did not yeah it was not a a thing for me it was just not my body distribution

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my body distribution but tell me then it was Yeah. Otherwise, like until you're like, "What the heck?" Yeah. [laughter] Um I want to hear about ocular migraines because people are going to be asking me. You just brought it up. You responded to this woman woman. What did you say? Oh, right. So, for people who don't know, and this is what happened to me about four months ago is I had eaten breakfast. I was sitting down to a meeting and in my right eye a gray pixelated area showed up and I had vision loss in I couldn't see through that gray pixelated area. Thank God I'm medically trained. If I wasn't, I would have completely freaked out. And I probably should have freaked out. You You should freak out when you have vision loss. But my eye didn't hurt. I literally performed eye exams on myself. I videotaped my eyes to make sure they were tracking. I didn't have nestagmas or like sort of the the bounce um rebound. And about 5 10 minutes later, it went away. And then I had a headache and I was like, "Dang it." And then the next and I was about day four of my period. And the next month, it happened again. And I'd called my primary care who is an ND and said here are my symptoms. And she said yeah sounds like ocular saw a eye doctor who said it your you know optic nerve looks great. It's nothing I can see in your eyes anyway. Got a whole bunch of blood work and everyone's like sounds like and I've had it four times since all during my period. Low estrogen states or estrogen shifting states. um blood sugar seems to play a role if my blood sugar is really low because I in meetings haven't eaten whatever and then boom I get this like little bit of gray

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boom I get this like little bit of gray pixelated or a shiny spot in my right eye. So that's an ocular migraine but you can it's not an aura and so based on the research I have found um you can do hormones. So you can do progesterone, you can do especially topical topical estradile um and I have a history of migraines but not migraines with aura that which is sometimes a concern with oral estrogen estradile like the birth control pill. They often say if you have migraine with aura you maybe aren't a candidate for birth control pill. Um but and I re checked with my doctor even though she's brand new. I said just in general with women and ocular migraines and she said topical. We can do topical but I'd be I'm okay with the birth control pill for me. And I was like, "No, thank you." [laughter] But um yeah, so I voice me with this woman and said, you know, I based on what I've researched, I'm okay with topical estrogens and progesterone. My primary care, both my primary cares, my ND and MD, we're okay with it. But do your due diligence. Go get worked up. Don't don't just sit at home and self diagnose off chat JPT. Yeah. Right. And since So you're are you still experiencing them? I mean, when you picked up the prescription last week and then immediately went out of town for because it's conference season, another conference and uh I haven't started it yet. Okay. All right. Well pay attention. Yeah. By the way, just for folks to know and we'll we'll link to it. You have a couple of books I don't want to forget. My team mentioned them to me. You've got estrogen detox and then the stages of pmenopause which you

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then the stages of pmenopause which you can like really speak to from a very authentic voice. I can especially because there's only two stages. I think that's very limited, but that's fine. I explain it. Cool. Yeah. Well, both of those downloads, I'm sure, are great. And then you've got a book coming out in 2026. But the reason I'm saying all of this is because if you follow Dr. Jones on social media, you won't regret it. She's funny and really, she's just like she is here. Nice, bright pops of color. Um, unlike yours truly. Uh, okay. [laughter] Exact opposite. Um, so science is getting exciting with regard to women's health. We're understanding more and more what makes us tick and we're caring about it and h god, you know, we're just doing more research in women and you know, thank God. Um, and you brought up mito you've been thinking a lot about mitochondrial health in the context of ovarian aging and I think just aging more broadly. And I just I want to get your thoughts on that. I want to hear about the role of mitochondria in ovarian aging and importantly too and I'll I'll circle you back to this if need be just how we as clinicians want to be thinking about this in our women you know going through transition you know we historically always say women will transition through pmenopause menopause assuming you still have your ovaries haven't had a hyctomy and it's the loss of follicles of you they go

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the loss of follicles of you they go down and eventually if none and left and poof, that's what makes you cross over into menopause. Years ago, I'd read an article about the mitochondrial theory of ovarian aging. And I started talking about it and I got a lot of push back of like, that's not it. It's not the mitochondria. You just lose follicles. Once they're done, they're [clears throat] done. And I was like, all right, well fine. Um, and then fast forward, I've been seeing a few articles come out here and there. And then in Frontiers this year, a whole article came out about like, yeah, we're pretty certain this is for real. Yes, the follicles decline, but at the same time, the mitochondria, which are very heavily concentrated in the ovaries, take a big hit. Mitochondria are, we all learned about them in school as the cellular powerhouses, but they're also very fragile and kind of a diva. So, if things not good things, inflammation, infection, heavy metals, etc., blood sugar issues happen to them, they shut down, kind of fall apart, have issues. Well, what we forget is that we actually make our steroid hormones. The first step to making steroid hormones are in our mitochondria. So, if you would like to make estradiol, if you would like to make progesterone, testosterone, cortisol actually starts and finishes in the mitochondria. It leaves for a minute and then comes back, then you're going to struggle to make hormones. So, not only you going to struggle to, you know, continue like have the health of the ovaries, you will struggle with hormones and and because they're so fragile and they they get attacked and assaulted very

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they get attacked and assaulted very easily, our body tried to give them a lot of self antioxidants to support them, but it didn't give them a very great DNA repair system, the mitochondrial repair. So, I I liken it to dog hair. Like you you we can keep up on our dog hair, but if you stop, you know, if you stop for a week, all of a sudden there's dog hair or cat hair just like everywhere and overwhelming. And that can happen in the mitochondria and all of a sudden there's dog hair everywhere and you just can't function and and they start to shut down. It affects our hormones. It affects our aging and poof, women are going through and having all these symptoms. Interesting. By the way, the cool fact is that the ov the the mitochondrial density in o in in the ovaries is is greater than any other organ system. Greater than any other organ. Yeah. We often think the heart everyone's like not the heart. I'm like in in women those ovaries just power pack them in there because we have to make so many hormones. I mean those that's literally those are the glands that pump it all out and then maintain fertility if that's a goal of yours. Even if it's not a goal of yours, it's not a goal of mine, but like the my ovaries still every month are saying, well, it might be. So, we have to maintain a level. Well, and not only that, if you're continuing to be able to produce hormones, you're taking care of your brain, you're taking care of your heart, you're taking care of your skin, you're taking care of your bones, you're taking care of every other, you know, system in

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care of every other, you know, system in the body. Every other organ system is influenced by these extraordinarily important hormones we're making. Yeah. This Yeah, I was going to say which is I think the when you asked the original question of what do I see shifting, we're shifting away from women are just their uterus and ovaries to we have 12 systems in the body that the hormones the ovaries are making are impacting all 12 systems. Some are a little more critical. Bone like you said bone, brain, heart is an example. Um as far as health span and longevity goes. I mean I want beautiful skin too. don't get me wrong, but I also don't want to break a bone. So, I would prioritize that. So, we for everyone's just like, "Oh, you had a hyerectomy. Like, you don't have a uterus. You don't No big deal. You don't need them." No, we we need to support all the other systems. We are much more than just ovaries. Yeah, that's right. That's absolutely right. Like we and we Yes. I don't and I think that that is still it's going to take a little while for that to really be understood that we need to support mitochondrial health. So my question is with this awareness it's it's pretty cool that you've been that you were inspired to really light on the importance of mitochondria way back in the day and now you're being validated. That's that's such a theme in our medicine. Um do you so so would you say one of the most foundationally important intervention in women's health therefore is like a good cocktail of mitochondrial nutrients. So I would combine yes and I would say

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So I would combine yes and I would say we know a lot interferes with the mitochondria. I said they're fragile beans. They can be. So a lot of that exterior um again exercise, nutrition, endocrine disrupting your exposure, how's your blood sugar and insulin, inflammation, you know, these things play a major medications you're taking a lot of medications unfortunately don't like mitochondria. Yeah. So that layered on top of I just read or somebody just sent me like a summary of an article talking about which of course will be right up your alley like like your polyphenols which are very pro mitochondria B vitamins very pro mitochondria gut health support pre-pro and postbiotics very mitochondrial supportive like when you layer the two of them together independent of hormones independent of going on hormone therapy they could really support the mitochondria and might for a lot of women make for a much easier pmenopause. Yeah. And actually any age if you're struggling with fertility, if you have PCOS, right? If you have PMS, endometriosis, like I'm looking at this from just the grand lens of women's health. If your mitochondria are faltering, they're going to falter at any like whatever age they're at, like it's going to affect you. Yeah. That's right. This is these are what you're articulating are, you know, just really profoundly important foundational interventions across, you know, across the lifespan of of women.

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know, across the lifespan of of women. Um, you know, I'm curious, you and I were both at a conference and we were just talking off offline. Peter Ratio was there and t talking about um you know his favorite topic cholesterol and and lowering cholesterol and you know kind of arguing that there's no necessarily I don't want to misquote him actually but um issue around lowering it very profoundly you know I think I profoundly dropping cholesterol and I am curious your thought being in the world of thinking all things steroid hormones um you know whether you would subscribe to this as an appropriate treatment approach for women or would you be concerned about the follow? Yeah, we I'll be honest. So, anecdotally in practice, I saw it more in men and testosterone than I saw it in women. So, men would come in and I didn't have a large male following. I predominantly saw women and then I saw the subset of their husbands, you know, where they didn't have a choice. You had to go see Carrie. Yeah. And so they would come in on heavy statin doses, very low cholesterol levels, and then very low testosterone levels. And so I often would communicate with their cardiologist who thankfully being in the Portland area were maybe a little more open to, okay, I'll I'll cut them back on the statin or maybe let's go ahead and put them on testosterone. And the reason we're bringing this up is because like a lipids, a lipid droplet

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because like a lipids, a lipid droplet is the backbone to all of these hormones. So a lipid droplet gets pulled into the mitochondria. Use a nifty little enzyme called the star protein and it turns that cholesterol into pregnenolone. That's the first step. It's a very controlled, highly guarded step. And then pregnenolone leaves and goes to the endopplasmic reticulum and becomes the other hormones. 11 deoxxycortisol comes back and finishes out in the mitochondria as cortisol. That's why I say cortisol starts and stops there. So if you don't have if you're on whatever combination of cocktail for cholesterol because there's a few now and you're very very low levels but you're also really struggling in the hormone department anecdotally I would see that especially in men specifically in men. Yeah. Now, with those same men, just out of curiosity, because I know that you also were the medical director, the first medical director over at um Precision Analytical, and you know, looking at many, many thousands of hormone panels in men and women. Um, these men could be converting their testosterone over to estrogen as well under the influence of inflammation. So, I'm wondering if you were able to determine whether it was the acute drop in cholesterol availability, precursor availability, or was it conversion to estrogens? That a great question. I don't think they have I don't think we looked close enough at that data. We could see it. So, one-on - one, let's say you and I did a consult and you were like, I have this

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a consult and you were like, I have this guy, he's 58, he's high cholesterol, high insulin, you know, obese, really inflamed, he's on a statin. I could look at the test and go oh yeah it appears these two things are happening yes I see that um but taking a step back and like collating the data I don't they have not done that but it's not a bad idea honestly for any lab who because people have to mark what medications they're on if they're on hormones or not what I did find especially in men is that their cardiologist if they were okay with testosterone would say well like well I'm not rais I'm not lowering their statin let's just put them on testosterone let's put them and a little bit as testosterone. So then we would just not need that pathway per se, that cholesterol to pregnenolone pathway and they would just circumvent it by taking testosterone. Taking testosterone and then they would take an aromatase inhibitor, right? So then they wouldn't at the same time often convert it to estrogen. So they wouldn't convert it to estrogen. Yeah. Interesting. I would as a functional medicine doc definitely be thinking we want to take care of the landscape in that arena. [laughter] you know, we can do it. We can do an aromatase inhibitor, but still, you know, we just want to tend to their diet and lifestyle and all those other pieces to make that intervention protocol as clean and high functioning as possible. And I think we're seeing it younger and younger. I don't know about you, but I feel like, you know, especially on on social, just watching casually, the number of men

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the number of men who report being on testosterone at a young age, the number of women who are um reporting their permenopausal and they're 33, 35. Now, anything's possible. I'm not denying that. But at the same time, when the you and I take a much bigger, grander, more functional approach, I'm like, are we sure it's permenopause or it's not something else? Like are we sure it's not a thyroid issue or any kind of nutrient issue or HPA sort of stress dysfunction sematic? Like is there anything else maybe going on that's just not getting looked at because everyone's just pigeonholing. Oh, you have parmenopause. Yeah, it's so popular right now with good reason, but also we have to use our critical thinking skills. Yeah, that's right. We really do. I know. I I think, you know, that's where a nice functional naturopathic evaluation is so essential. Yeah. To confirm or rule out all of those. Um, all right. the four horse women of aging. Unless you're really vigilant, these are, you know, we're going to fall prey to these cardiovascular disease, neurodeenerative diseases like Alzheimer's or Parkinson, um frailty, cancer, and um what else could be in here? I think I would mix metabolic with cardio cardioabolic given 93% of Americans unfortunately are not metabolically healthy and you we see it everywhere. Yeah, absolutely. I would say unless we're very intentionally sort of pushing up the stream, we're going to fall prey to metabolic dysfunction.

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dysfunction. Um, talk about the ovaries and their role like mitochondrial health, ovarian health and their role in bringing these upon us or not. Let's let's take frailty as an example because I was just in an airport traveling and I watched a very very at first I thought very cute older much older couple tottering along to their gate and I thought man she is so thin like she just bird thin very frail. I turned back around to look at my gate and she fell. I heard her thump behind me turned around everybody came rushing towards her. Um the airline rep brought a wheelchair and of course adrenaline kicked in so she was like I'm fine. She got herself back up and I thought, "Please don't have broken anything cuz you are really, really thin." And I'm thinking in my head, got on the plane. I'm in the emergency exit row, so I'm about middle of the plane. And when we landed, they said, "Please everybody stay seated. We're going to bring in personnel on the plane." And of course, we're thinking drama. I'm thinking arrest, right? I'm thinking we're all looking around like who got in a fight. Turned out it was the woman. She was on the plane. She was sitting way in the front. And she had just sat for five hours. Her adrenaline had worn off. And I don't know. I hope nothing broke, but they had to carry her off the plane. And we know that hormones besid weight bearing, exercise, protein, but also estradile, the rise and fall of progesterone, testosterone, like they play such a critical role in bone health. So, we don't think about that when we're in our 30s, 40s, 50s. We're maybe more

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30s, 40s, 50s. We're maybe more concerned about immediate symptoms like why do I have this belly fat? Why do I have hot flash? Why am I not sleeping? Why do I feel rageful? But we have to also be mindful of you don't want to be that grandma. Like you don't want to break a hip. You don't want to be unstable. You don't want to be weak. I want you to be able to pick up a suitcase if you need to pick up your grandchild. Get off the floor without having to have a, you know, a 15-point touch to just push yourself up. But we don't think about those things when we are young. And so longevity is one thing, but health span is a whole other. If you're going to live a long time because genetics or modern medicine, then I don't want you to fall in the airport because you don't have your feet under you and then unfortunately maybe break a hip or a femur or some get a concussion, something. And that's just one example of how we have to focus on the immediate. I want you to feel really good. I want you to be really excited about this next phase going through um the menopausal transition, but also look to the future in this one example. Yeah. No, that's great. That's very meaningful. I think is there a gap in your health and longevity strategy? Mitoq mitochinol is an advanced antioxidant that targets the inner mitochondrial membrane, reducing reactive oxygen species by 48%. This patented compound is backed by 30 years of research and 25 clinical trials by Harvard, Yale, and Oxford. Mito supports mitochondrial and cardiovascular health,

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mitochondrial and cardiovascular health, metabolism, and DNA stability. Learn more at mitoch. com / drara. You've likely heard about the longevity benefits of peptides. They're in skincare supplements. They're everywhere. But not all peptides are created equal. Developed by skin longevity scientists, OS1, which is found in one skin topical supplements, penetrates deeper layers of the skin, impacting cellular level biomarkers for visible improvements in lines, wrinkles, and thinning skin. Ready to experience OS1's benefits? Use code drara for 15% off your first order at onskin. co / dr a. We're we're putting more attention there as well, right? like women are getting that we need to be consuming sufficient amounts of protein that we actually have to engage in resistance training and not just you know my mom walks around the block. I mean you I mean she gardens she does she actually does a bunch of stuff but I would like to see her like you know doing some uh tabatas and [laughter] yeah squats. She's back at it. But I remember [clears throat] watching you. I mean, you were you've always been an exercise. You've always been, you know, like as as long as I've known you. And I remember thinking back then like, man, I wish I mean, you know, not to play victim, but I'm like, I wish I had the motivation car does. And now I am I mean, I'm definitely

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And now I am I mean, I'm definitely I weight train. I for sure I jump on things. I, you know, try sprint training. I mean, I'm definitely the last couple years I've I got to get it together. I'm in my 40s. I'm almost 50. I don't want to be weak. I I'm a carry-on travel girl, so I'm going to be lifting my suitcase over my head. I'm going to be running after grandchildren. Yes. So, I want to be healthy. Yeah. Oh my god. I know. I get it. And you do you just you look great. I just saw you in real life a little while ago and you just look so strong and gorgeous. Yeah. It's so And I appreciate that. You know, I I mean, I like cycling is my anti-depressant. though it wasn't difficult for me to do it because it had such a fundamental I still does. It still does. Like I'm still that same geeky sort of, you know, sweaty person on their bike. Like I'm still that person. But but you know, way back in the day, I I injured my knees. I was pushing too big of a chain ring. They say I was pedaling too too hard and injured my knees. And the orthopedist said, "You need to train your quads and your hands." And so that's when I started to get into weightlifting only because it influenced my biking. That's it. Like I had to do it for cycling. But and then I ended and then I just would throw in stuff for my arms and and um you know that. So so yeah, it just be it became early on for me it was a habit and it is reflected in my bone density but it was truly because of having a vulnerability towards

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having a vulnerability towards depression and wanting to remedy that without medication. And it's, you know, it's just continued to work. Well, honestly, I think depression is a good thing to talk about because a lot of women, we know the change in hormones, speaking of how do the ovaries play a role, it's not one of the four horsemen, but it definitely comes up for a lot. Anxiety and depression, I mean, the change in estradile as an example, huge. It impacts so many neurotransmitters. Yes. That women, first of all, are confused if they've never had this before. They're wondering what's going on. Um or maybe they had it mildly, moderate, mild to moderately growing up and had felt like they had under control and now it comes back or it comes with a vengeance. Women report panic. You know, their anxiety is out of control. And I just really want those who are listening to realize that it could be very ovarian related. It could be very hormone related. Yeah. Um how might we know that? Usually it sort of co coincides with the onset of pmenopause. I have found in perry menopause and you I'd love your opinion on this. So we start out in the definition of the first stage or the early stage of pmenopause is your cycles change by seven days. That's their like research. That's how they decide in research which stage you're in. But I find women don't change by seven days. They may change by two or three. But usually the big first signs are I can't sleep. I my mood is changing. Whether it's anxiety or depression, anger, rage, or all of the above. um where and they'll report more fatigue,

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report more fatigue, they will start to report the weight. So, these are kind of those early symptoms that I do see. So, if you're like listening and you're going, "Yeah, that's that's me. I'm totally in my 40s or maybe 50s or late 30s and all of a sudden, right? Like, I started I'm really just feeling I'm noticing more more depression, more apathy or the opposite, more rage, more impatience, more more empanic, more anxiety." And I've had women describe it as just like the panic or the anxiety just grips them. Like they it's something they've never experienced before. I'm like hormone hormone. You didn't grow up with this. This is a sudden sudden relatively sudden offset. And estradile in particular plays such a role in oxytocin like bonding. Women will say I don't feel like doing things like I don't want to hang out. I don't things that used to bring me joy don't bring me joy. I don't feel as connected anymore. more. I don't feel as loving. I don't have that empathy. In fact, I wish everybody would go away. I'm like, "Oh, oxytocin." Even serotonin, the creation of serotonin, which then goes on to make melatonin. Yes. Estradile plays a big signaling role there. Dopamine. I mean, it just really And then when it's chaotic up and down in the early parts of pmenopause, it that you feel chaotic. You're like thrust in, pulled out, and then all of a sudden it starts to settle out low. And now your symptoms are more consistent because you have less estradile all the time. It's I don't know who designed this. I would like a word. [laughter]

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So where are you at? Like like who's an appropriate candidate for hormone therapy and when do we want to be starting them? And are we going to be doing some kind of a toggle, you know, given the rise and fall of symptoms or would you do hormone therapy plus, you know, some key botanical interventions plus your diet? Like how do you think about the big picture in approaching women like lay it out there? Yeah. My big thing is always meet women where they're at because especially with the diet, lifestyle, supplemental. Some people can absolutely, they just need a little guidance on what to eat, how to train, you know, their sleep hygiene, stress, what have you. Other women are like, "Nope, I have a full-time job. I have three kids at home. Like, I'm barely keeping my head above water. Like, what what can I do?" So, trying to meet them where they're at because yes, my goal for sure, foundational stuff. Are you sleeping? How what are you eating? you know you're how you engaging with your community do you feel joy do you feel safe are you exercising are you you know training some lifting heavy things as they say etc then when it comes to hormone therapy there are a number of contraindications but not all contraindications are absolute and it depends on the type of hormone therapy so for example I get this a lot Carrie I have high blood pressure I can't take hormones I'm like oh not true high blood pressure that's controlled you can take progesterone as an example example and you might be a pretty good candidate for the topical estrogile, so a patch or a gel, and you're definitely a candidate for the vaginal. So, again,

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a candidate for the vaginal. So, again, all these these all have nuances. Um, somebody might say, um, I I have even fibroids. I have bleeding. I can't do estrogen. I'm like, but we can do progesterone. We can look at testosterone. Maybe we can look at maybe DHEA. We can maybe look at vaginal. So everything's kind of negoti negotiable is not the right word, but very personalized. Nuanced and personalized. Yeah. The only one that's like really really clear I mean there's a few, but like if you have active breast cancer like right now, they're not going to give you any hormones. If you have a history of breast cancer, you had it 10 years ago, 15 years ago, negotiable. what depending what kind of which you know hormone receptor or not what does your oncologist think what are the symptoms you're having weighing the risk benefits and I think that has come a long way yes whereas it used to be here are the 10 contra indications and every single one of them is a hard no and now we're like and now all the guidelines are like risk benefit talk to your practitioner it's a mutual decision you know there's different options swallow it slather it stick it you know [laughter] like we you push it up there. Like we have all these different options for hormones. And and then on top of that, then I layer in the supplemental piece. What are we missing? What do we need more of? Do you need more fiber? Do you need more B vitamins? Do we need to add like are you still not sleeping very well? We have great herbs for sleep. Do we need more minerals? Big fan of minerals like magnesium. Yes.

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Yes. Then we layer in that with it to get a really well-rounded plan. Fabulous. Are you leaning on botanicals as long? Oh, yeah. I'm such for sure for especially in the sleep department. Um, especially in the stress department. I use a lot of I still use a lot of adaptogens, a lot of sleep stuff. Um, most definitely. Yeah, most definitely. And you're a huge fan of melatonin. I am a huge fan melatonin. [clears throat] Oh my. And I have been for years. So melatonin, everyone thinks, "Oh, it's the sleep hormone." And it is. It's it's the other half of the circadian rhythm with cortisol. But melatonin is billions of years old. So it's like that car insurance commercial. Like we know a thing or two because we've seen a thing or two. Like that's melatonin. And melatonin is made in the in our brain in our pineal gland. And and it's not stored there. That's that's what's released and that's part of the circadian rhythm. But every single mitochondria has the ability to make mito um melatonin in the body. It's a powerful antioxidant. And the longest oldest melatonin researcher is Dr. Russell Ryder. He's been studying melatonin since the 40s. And I have been reading his papers for years. And I got to meet him in person a couple years ago. And I said, "I think melatonin is a stronger antioxidant than glutathione." And he was like, "Me, too. [laughter] This is great." And that always shocks people when I say that because glutathione is always touted as is the most potent antioxidant. And I'm like, "Have you met melatonin? Have you looked

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"Have you met melatonin? Have you looked at its mitochondrial benefit independent of the circadian rhythm? It plays a big role in the gut. It's heavily concentrated, the ability to make it is heavily concentrated in the ovaries. Thank you very much. And then, yeah, for sure. The circadian rhythm. Melatonin helps signal around to a lot of organs and glands. It's nighttime. What's it doing as an antioxidant in the ovaries? It acts like like my best analogy is have you seen those Russian dolls where you know they break apart to a or Pac-Man almost like melatonin will get a reactive oxygen species and then it will convert into a metabolite and that has the ability to get a reactive oxygen species and it turns into so it kind of has this like jumping like the dolls break apart and then like I'll get you and like eat it up and take care of it and then it's able to do it a couple of times so it can really you know quench When you've got free radicals, too much dog hair, as I said earlier, we got you way too much dog hair. Melatonin is one. We have other options, right? We have catalace. We have super oxide dismutace. We have glutathione. People forget about melatonin. We only link melatonin with the circadian rhythm. I don't know that we I don't know that we've really been sufficiently educated. [laughter] I'll raise my hand with regard to its role in this capacity. I'm telling you. And listen to that. Have you had Dr. Diana Menic on? Have her on. Like she is also a wealth of melaton. She's geeks out on it like me. Yeah. Um melatonin spikes in the middle of the

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Um melatonin spikes in the middle of the night somewhere between like 2 and 4 a. m. And part of that spike is to drop your core body temperature. Well, who doesn't sleep? Who doesn't who wakes up between 2 and 4 a. m. and doesn't have lower core body temperature? Women in their 40s and 50s and and you know like they wake up hot. So it may not be blood sugar. It might not be cortisol. It might not be snoring. It might be the fact their melatonin did not spike. Their core body temperature did not drop and they they wake up as a result. And that spike plays a role in in insulin. So you are more likely to be insulin resistant the next day, have higher ghrelin, be hungrier when you don't sleep and don't get that melatonin spike. Well, who's not getting melatonin spikes, complains of being hungry all the time, and hedging towards insulin resistance? Pmenopausal women, right? I'm like, oh my gosh. So then what do we do about it? I mean, are we taking a sustained release melatonin in or what the hell are we doing and why are we even going through that [laughter] to begin with? Wait a minute. Yes. So, I actually um sleep hygiene is obviously very important. And so, and it becomes even more critical, you know, like we're we're just a bunch of toddlers when we hit our 40s and 50s. Like, we need nap time. We need to wind down at night, somebody to brush our teeth, read us a story, and tuck us in with low light. Like, that's what we need. But instead, we're all on our phones and we're watching Netflix and we're up late and you know, people are heavy meals and sugar and drinking and then they're trying to go to bed, but they're trying to go to bed in their 40s and 50s. You can do it in your 20s, but in your 40s and 50s, you don't have the other hormonal stability that you used to have. Now, how do you make

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used to have. Now, how do you make melatonin? Well, you make it from tryptophan, which comes from protein, which then makes 5http. And a big trigger for that is estradile. A lot of women don't have estradi. And and there's some nutrients in there. and then five HTTP serotonin and then eventually we get to melatonin. So even do you have the co-actors in the first place? I will say though according to Dr. Writer he says the average human male or female their melatonin production naturally declines at 50. So just like freaking it feels like everything else in our body declines [clears throat] at middle age. Melatonin does too. is the the network the communication especially to the pineal gland seems to degrade or fall apart or be not be as great. We don't make as much melatonin in which case there is some interesting research on all the improvements if you give women melatonin and menopause on insulin weight sleep. Now there's a lot of nuance on melatonin because still people some people don't like it. They wake up drowsy. They get wild dreams. They get the opposite effect. They're awake all night. Melatonin can shift REM sleep and so for some people it face shifts them too much. So where we take melatonin you have to play with. You take it an hour before bed, two hours before bed, right before bed. It's not like vitamin C where you just take it like you you do have to kind of time it and play with it. Same with the dose. Humans only make about 0. 3 milligrams.

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milligrams. Are you therefore I know Tiana has talked about the amount of melatonin we should use is a micro amount. But then in the literature, you know, people are using or recom studying 10 milligrams and plus I think specifically in cancer that that reference, but like what where do you land with this? So I usually tell people I find a lot of women as they get older become a little more like a little sensitive bunny. So I'm like let's start with the micro and move up. You may start with a 0. 3 point maybe cut a one in half. That'll give you a 0. 5. How do you do? Don't like that? Not working? Let's go up to a one. And then let's try sustained release. Again, it's I wish it was as straightforward and simple as just take vitamin C, which is kind of non-complicated, but you do have to play around a little bit with melatonin. You know, what dose makes you too groggy the next morning? We either take it earlier in the night or cut the dose down. Yeah. That little wakeup window is a pain in the butt and it's hard to treat. I mean, I Yes. certainly have experienced it and then layer a kid on top of it. [laughter] Yes. You know, it can Yeah, it's pretty disruptive. Um, but then also treating it. I mean, I've done everything melat I do I prescribe melatonin frequently. Um, I will have people do a lozenge and then just take a microchip during that time so that they're not so it's late. I'm I'm not having them take it early to see and maybe they'll just

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and maybe they'll just sacrif they'll be groggy the next day, but it's like as we tweak what we're going to do about that window, but you think that little wake up time where we're like, "Yeah, just eat some protein before bed or like we have all these ideas. Have a fat bomb." Like, I mean, there's so many things that I've experimented with, but this sounds a little bit more compelling and it's pretty uniform. Like, I don't know that many women who who haven't gone through this wake up period. No. Gosh, no. That was my besides my first permenopausal symptom at 44 was I went to open a I had a brilliant idea. Brilliant. And I know it was brilliant because I thought that's brilliant. And I went to open a tab on my computer and by the time I opened the tab I couldn't remember what the brilliant idea was and I was like what [laughter] what just happened. My second symptom not cool. I was so mad. My second symptom was 3: 00 a. m. wakeups like clockwork and I couldn't break it and I was like um but yeah I don't I'm not opposed to protein. I'm not opposed to the fat bomb. I'm not because it could be those things. It could totally be blood sugar. If you have a continuous glucose monitor on and you can see, great. If you are doing middle of the night cortisol testing, as some of those companies, you know, haven't give you a a sample you can collect and you see that your cortisol is really high like well that's going to suppress melatonin. So, you know, it's a cortisol issue. So, like we have our answer. And other people they wake up I mean because their partner's snoring or their kid comes in or like their dog is barking you know there's there's a lot of unfortunate reasons for waking up but the melatonin between 2 and 4 and I read

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the melatonin between 2 and 4 and I read that pretty consistently in the studies like we have to have that spike and that spike also lowers blood pressure. So, the people who wake up and have high waking blood pressures, if you're monitoring your blood pressure, it could be because you don't get the spike of melatonin between 2 and 4 a. m. Mhm. And again, we seem to lose it as we get older. And we for sure feel it within a couple years of 50. I mean, 50 is just like an average. Some people will be later, some people will be four. But yeah, I'm not okay with uh this just happens because we're old, you know, we're deteriorating. So, we're old. if we engage in the lifestyle pieces that you've been um talking about here really for the entire conversation. If we're exercising, if we're, you know, engaged in decent sleep hygiene practices, turning off the the phone, um engaging in community, like all of the the sort of functional naturopathic pieces that we think are so essential, your 50 is um you know, somebody else's 70. I mean, you can turn these around. Like, so we don't we know it. How many people, myself included, have said if I wind down, drink tea, get in bed, lower the lights, read a real book, not my Kindle, yes, play nice music, and go to sleep, my heart rate variability is so much higher. I know I I it some of this is

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higher. I know I I it some of this is self-inflicted. Some of it's in my control, some of it's not, depending on, you know, family and circumstances. But I those are the nights that I sleep fantastic. If I'm in complete dark, if I'm camping, you know, and I don't have all the like light, but I get a lot of nature, my heart rate variability is great. I sleep great. Yeah. Like, I know it's just sometimes hard. Yes. Yeah. Absolutely. One of the things the crazy thing that has been very helpful in my sleep world is you know I basically go to bed when Isabella goes to bed. I mean we you know I just that has just dialed me into a whole that would never happen you know if I didn't have a seven-year - old who has to get up at 6: 30 you know and needs 10 hours. You know, there are many a night my husband and I look at each other and we're like, it's 8: 15 [laughter] in bed like that's right. I know. It's so funny. What is that? Not cool. Did we become these people? Like we cross over. Yeah, you did. That is really, really funny. So, let me see. What else do I want to ask you about? We seem to shy away from using oral estrogen. Although there are um a handful of docs, mine I one of my doctors actually would argue would would love for me to be on oral estrogen. She just she prefers it, but I use the patch and and I you know I mo I mostly love it. There's it's it's a

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mo I mostly love it. There's it's it's a little bit annoying, but um it's easy. You know, I can forget about it for a little while. Um there was an interesting paper that came out looking at it um again in Medscape and just you know comparing topical versus oral and they seem to serve uh different parts of the body and I want to hear you know what you think about and what you would go for. You're you've mentioned the patch a few times and and why we might be concerned about oral but like you know talk it through. You know, it's funny. I just had this conversation uh yesterday, the day before with a good friend of mine who's again in the longevity space, and she said, "Have you been reading all have you seen have you realized all the research especially on um you know, some of the lipid thing, the lipid aspects and brain health? It's it's all oral, Carrie. It's it's not topical. We're extrapolating to topical." And I was like, "I know. [snorts] I know." And I usually lean pretty heavily to the transermal, whether it's a cream, whether it's a patch. That's usually where I I lean towards just to reduce risk of the other cardiovascular, you know, the slight clot risk um as an example. Um but yeah, especially the brain health, the brain health stuff is on the oral. Mhm. And so my longevity friend was like, I think we really need to look harder at oral estradile and and really reconsider that. And so I literally have

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reconsider that. And so I literally have a to-do note. I have to go right back through that research and and see I and I think some of the people, you know, definitely have concerns when it's the oral like conjugated ecoin estrogen, you know, which CE, which is often studied, of course, and it's studied in the lower risk of breast cancer. And you look at the UK is this beautiful graphic. Um they have a sub the I don't even know what it stands for. And the NICE I don't even know what that stands for but they put out graphics for of for a thousand women that are 50 to 59 years old the average woman no hormone. There's 23 out of a thousand will develop breast cancer. And if you were on CE conjugated ecoin estrogen four less women get breast cancer. So they don't look at estradiol, they look at CE. So even that data, now CE can be inflammatory in some and has some issues for sure in some um in other markers, not breast cancer, but even just that I'm like, yeah, I think it's the the in the oral risk too, it's it's not as grand that's as it's often made out to be. When you see the diagram of the increased risk of clot, it's not like, oh my gosh, 400 more people develop clots. It's like, "Oh, it's two. It's it's three." And so I don't want it to be you, but also I would take a pretty in-depth history, you know, about clots and cardiovascular. We did oral. Yeah. So I also very recently am going back and forth between oral and transermal and and trying to decide.

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and and trying to decide. Yeah. No, that's fair. I think it's important and I'll stay tuned to hear what you where you land on that. I think it's an incredibly important discussion and I do suspect that probably oral has been unnecessarily maligned for that clot risk and you know we can do things about mitigating clot risk in in some women right I mean would that be would be we would we think about some of our usual interventions I mean top of mind is fish oil for example the first thing I thought of yeah and then maybe tracking some of those um biomarkers like ferrrenogen and and so on and so forth. So we could always create the most healthy environment in which to you know prescribe an oral estrogen. Okay. Really interesting. Yeah. I'll be curious to see where the dialogue goes amongst amongst you ladies especially when you look at it from just a conventional social media space. Transermal is is sort of the way that you hear all the time. Um, again, it's once you get into that like, well, what did the study really look at? Oh, it was oral. Like, oh, it was CE. Okay. And sometimes it was oral estradile. Um, that I think me personally, I'm like, yeah, I do need to go back and look at that again. Yes. It's not going to be just transermal all the time. Yeah. Although I personally have a prescription for the patch, the transermal estradile patch. Yes. Yeah. And that's Yeah. I mean, and there's Yeah. I mean, I've been using the patch and I

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using I've been using the patch and I like it because it's easy. But I did use oral for a while and it was fine and my lipids were perfect. Yeah. You know, impeccable. Yeah. I don't know. Maybe my brain was functioning a little better back then, but I don't know, you know. Well, that that So, speaking of brain, um FSH, follicle stimulating hormone being a potential marker to follow along with that. So FSH being the signal on the follicles to make estradiol when you're cycling. We thought for a long time FSH had one job and that was it. They just told the follicles do your job make estrogen and poof it did. And now research is going well actually the higher FSH is it seems to have a negative impact on bone brain and weight. more research is needed, but really fascinating and it makes total sense that FSH does not have just one job and it's an easy blood test. It's very cheap or covered by insurance. And so from a transdermal or oral perspective, I'm always like I'm curious like if we get that number down, FSH down, you know, under 50, under 30 on a blood test, how are your bones? How is your brain? How is your weight? So there I think we're going to find some new not new but markers we've been using apply even more so as we differently as we hit this age. Yeah. Fabulous. Very interesting. All right. So more to uncover here. Um

1: 00: 48

right. So more to uncover here. Um again I just want to mention you have some downloadables. One on estrogen detox, one on the whole the um stages of pmenopause. You've got a book coming out in 2026. You're fun fun to follow on Instagram. You are you're still fun for me and I've known you forever. [laughter] You're funny. You're just always you're just, you know, you have good energy and and you deal with the issues, I think, really straight on that, you know, that we care about as women and that we care about as clinicians treating women. Yeah. Um, we did a master class a little while ago and the master class was titled functional medicine is longevity medicine and it was for clinicians because we just want folks to know who are trained in this space that we think were the the best suited to be working with um working with those of us who are interested in longevity. Yeah. All of us. Yeah. Um and then and two things we wanted to do after the master class that we didn't have the space to do in the master class was a very specific treatment of hormones. Like we wanted a full hour. And so you're part you're basically an extension of this master class. We wanted you to be a part of it, but we really wanted to give it the appropriate attention. And we also have um Gabrielle Lions coming on in a couple of months to to fill in that piece as well. So, two pieces we wanted just good juicy hour plus long conversations um to round out you know our master class. And so again, we'll link to the master class recordings if anybody's interested. But thank you for just being

1: 02: 20

interested. But thank you for just being a good important voice in this space and just making it a lot of fun as well as you know very valuable. A thank you. I well I obviously adore you and all the work you're doing and um have so much respect for you and so I'm just so happy to be here. All right. Well, big hug, girl. To be continued. Cha. Thanks to our diamond level sponsors. Precision Analytical, creator of the Dutch test, is offering evidence-based training on key topics like hormone metabolism, interpreting Dutch test results and therapeutic strategies, including hormone replacement therapy, all aimed at improving patient outcomes. Become a registered provider to gain access to an expansive education hub with ongoing content, including webinars and case studies. Visit dutchest. com / courses to get started and grow your practice. For over 40 years, the foundation of biotics research has been innovation and quality. Their goals remain unchanged. Innovative ideas, carefully researched concepts, and product development with advanced analytical and manufacturing techniques. Biotics nutritional products are superior quality and effectiveness. They are available exclusively to the healthcare provider. Find them at biionicsresearch. com. Thanks to our gold level sponsors. Timeline, fueling cellular energy for a

1: 03: 52

Timeline, fueling cellular energy for a lifetime of healthy aging. Find them at timeline. com. Vibrant Wellness, Transformative Lab Tests for Wellness. Find them at vibrant-wallness. com. Disclaimer: This podcast is forformational purposes only. If you have a specific medical concern or if you have any questions, please speak with your healthcare provider.