Your Future Self: How to Make Tomorrow Better Today

Fascinating study and this one shot me out of a cannon emotionally was if you choose to become a caretaker of a parent with dementia you have a 60% increased risk. Now there's a genetic component, but when they took the genetics out of it and they feel like it's the stress of caregiving for that parent, you are signing your own death warrant because now you are increasing your risk of death. Am I cuz Yeah, cuz I'm right in thinking that women are still both caregiver and now in the corporate world. Yes. Yep. Yes, that's right. So it's both. Yep. Stress from both ends. Lactate production for the win. Get that glucose. You have to have an active plan to combat this, right? We're not going to live in a world that is stress free. If you're a woman in the world, you are likely to have a caretaking role in some fashion, even if you are chasing other dreams when it comes to professionally. Building good brain pathways is wonderful as far as a way to help start from a higher standpoint before you have brain loss. However, we've just like we've said on these other tangents, the brain is that too. We need to think about active ways we're going to combat what is happening in today's world naturally. And some of the factors are modern society that put us into this pro-in inflammatory state. But we need to think about making lactate. What you know what's important for us? And it really is a plan. This whole I'm going to figure it out when I'm 90 and the problems in front of me is too late for these medical problems. So, and back to your point about neuroplasticity, we're not reading as much. We're on our phones and so not in my house. Yeah. And so as as a culture there's there's this worry that all this time on the phone and these dopamine hits and but not creating stories in your head and and reading for pleasure at night. You know, a lot of women are on their phones now before bed rather than developing that neuroplasticity that we get from storytelling. I did something at 24 years old that has had a profound impact on my life. I set myself the challenge of posting every single day on my social media channels. And at the time, I was doing it to grow my following. But it had this profound impact on my life. And two remarkable things happened when I did that. I managed to learn faster because every single day, I'm capturing what is happening to me and trying to distill it down into something that I can share with the world. But more remarkably, it led me to building a following of many millions of people. And that's the basis that I used to launch the diary of a SEO. And that's why I want to tell you about our sponsor today, Adobe Express. They are the platform that I use to make all the posts across my LinkedIn and across my Instagram. It's a couple of clicks and you don't need to be an expert and that is why I love using it because I'm not an expert in graphic design. It's accessible to use for all of us even if we don't have the technical prowess to design great things. So if you want to start compounding both your reach and your knowledge like I did at 24 years old, then head to adobe. Steven and get started with Adobe Express. That's adobe. slashsteeen. The next question that came in from the audience, we we asked a thousand women to submit their questions. The next one is, what's the best and healthiest way for a woman to lose weight? Lift weights. Lift weights and eat. And eat. Yes, absolutely. And you could have a very slight calorie deficit towards the end of the evening. Running as a way of burning calories. The problem is people think that they can out exercise a bad diet and you can't. Composition of your diet matters immensely. And I hate calling it lose weight. I now call it recomposition. Yeah. But let me put it in context. Yeah. Go run. You're going to burn 100 calories a mile. Three Girl Scout cookies, three thin mints, US favorites, is 180 calories. My fave. So you have to run two miles to eat three cookies. Most of us, if you're going to eat cookies, don't eat three Thin Mints. You eat the whole sleeve. Right. To your point, it is impossible to out exercise food unless you're a high level athlete, thousand calories. Even then, no. Because we look at diet composition. And we see that um endurance athletes who use a lot of high sugary type carbohydrate like the gels and the sports stuff, they've interrupted their gut microbiome so much that they have sugar alcohols. Yeah. Well, it's not even that. It's the fillet change. We're seeing a decrease in the diversity. Even though they're exercising and we see that exercise increases the diversity of the gut microbiome, is what they're eating during the training with the heat and hypoxic stress that is creating the growth of the fermicis fil that's associated with o obese outcomes. So that's it changes the gut the gut bacteria. Yeah. if they are. So, we have this mis Yeah, we have this misconception that if you're an elite athlete and you're burning all these calories, then you're just eating to fuel, right? But it's not. It's the quality of the diet. If we want to perform well, whatever performance means, if you're Olympic athlete down to recreational person who just wants to accomplish a 5K, the composition of your diet is immensely important. What about Zmp? Everybody seems to be on a Zen GLP1s. I prescribe it and our clinic is all permenopause and menopause and so we always start with let's see how you do with lifestyle changes first. So we give that 3 to 6 months. When they come back, every time they come back, we're doing another body composition chen for probably 50% of the patients lifestyle plus or minus HRT. They're their body composition changes. They're happy. They're health, you know, they're much healthier. Everything's moving in the right direction. So now we're left with the people who are doing all the things. This isn't the typical story of people that start a Zen though. They see it on Instagram and then a week after I'll be at their house and I'll be like, "We" and they'll tell me, "Yeah, I'm on a Zen." And it's really it's usually just someone sees it online, they hear it on a podcast, and they're on it within a couple of days. That access is getting easier, the price is coming down. And there is for any medication, there are risks, there are benefits, and there's ways that will promote health. And with any medication, you can not promote health if you give I mean, GLP1s can be revolutionary for certain people. A lot of people are not training for a 5K, let alone anything else. And we know if we go very simply, fat cells, right, they make a different type of estrogen. They're inflammatory. You have insulin resistance. And all of this sets you up at a deficit to say, "I want to get healthier." It for women, we'll say who have PCOS who already have a predisposition for insulin resistance. Gio, they have a harder time losing weight because now they're also storing visceral fat. We know they get on this cycle with hormonal change. you know, being on ozimic allows them to lose weight and combat insulin resistance in a faster way than they've ever been able to do before. And especially when it comes to fertility and you're on a timeline, that can be really revolutionary when you lose weight because that estone decreases. Many women with PCOS if they were overweight will start ovulating again because that suppression from the additional estrogen is gone and their inflam inflammation markers go down their insulin resistance decreases. So there's a subset of people who have found their life changed by them and we never want to discredit that. Many people have had difficulty losing weight, chronic medical conditions have been able to reverse them and this has been a tool in the tool box because about 70% of Americans would fit in that category of chronic health conditions, difficulty losing weight. Yeah, 73% right now are overweight or obese. So should 73% of Americans be on GLP once and was higher in women? Yeah. Well, we always one common thing is having tools in the toolbox and being able to know when to use them, when to offer them. Just like when we have the HRT discussion, we don't want to see people, we'll say women for this discussion, not being offered a therapeutic option because or not choosing it out of fear. Well, when I hear that it's going to help me lose weight and I've got two options. I can go out and lift all these weights, Stacy, and I can which you know, one I don't Yeah, it's hard, isn't it? go to the gym, I have to put my shoes on or all these all these things. Or I can take this injection and lose all your muscle and lose your bone and end up like the little floating figure in Wall-E movie that I've talked about before, right? And that's that's my fear of just blanket people using you're also whether you mean to or not giving the illusion that, you know, willpower is all you need to lose weight by what you said, right? I can either do these hard things or I can choose this medication which appears to be the easier way out. And two things can be true at once. People can work extremely hard. Maybe they don't understand exactly what they should be doing and that's part of what we're trying to change the discussion on. But reversing some metabolic change even initially can make a big difference in their game plan. But you will lose body weight on these medications. And so you have to have somebody you know guiding the ship. I think what we all don't love is the access without oversight. Meaning, nobody's helping you say, "How are you not losing muscle? How are you doing this in a safe fashion?" You can just text somebody on an app and suddenly have the medication shipped to your house. You know, in our clinic, it is an hourong. Now, they're coming in to discuss the GLP1 option. It is an hourong visit of risks, benefits, side effects, protein intake, resistance training, mandatory. We will follow your bone density. We will follow your bone mass. I mean, your muscle mass. You know, we have these scanners. These are great available. And we're not going to get to a number on the scale and sacrifice your long-term health. And my patients are drinking the Kool-Aid. They're coming in. They they've found, you know, they're coming to you for a reason. Yeah. And so, I'm a little bit unique in my clinic in that I have a social media following and people kind of watch a few things before they come see me. So, they know my they're not shocked by me giving this advice because I give it all day on social media. So if you give them the ismpeek but they still don't go to the gym, they still don't do anything else, then we'll stop giving it to you. They won't be healthy and they know that. We've talked to them about that. We've explained it on the front end that this is a tool in your toolkit because we can see their muscle mass. We won't renew the prescription if they've lost the muscle. So if you are losing weight and not lifting and eating enough protein on ompic or any way else and you do a body composition, you may see total weight lost. You will see pounds of muscle loss, you may see body fat percentage loss. But if you do this correctly with enough protein in your diet and lifting weights, the amount of muscle loss will be very small versus amount of fat loss. So you we know we are going to lose a little muscle, but you can't lose 8 pounds of muscle. Right. Right. So we can tell and I give them the hard numbers like 10% is acceptable. We're going over that. We're getting into the danger zone. We're going to cut back on your dose. we're going to, you know, but they commit to the the work on the front end. I think that's the important point is that these GLP1 antagonists don't burn your fat. They burn they stop you eating as much. They stop there, which is going to mess up which is going to reduce everything. Cuz I was thinking about myself. I was thinking, well, I I go to the gym every day. I'm going to keep going. So maybe if I had a a little bit of a Zanek or whatever it's called, then my it would burn my fat. But actually, that's not it's just gonna stop me eating, which is gonna reduce my muscle, my burden. Right. Goodbye biceps. Yeah, that's the that's the thing. It's like I'll lose my subscribers and Exactly. Exactly. Yeah. Okay, that makes sense. So to this person asking what's the best and healthiest way to lose weight? The response is stop eating the cookies and start lifting some weights. Oh, the 8020 rule, right? So 80% of the time you're on it, right? You're paying attention to a high quality diet. You are eating according circadian rhythm. You are doing the strength training. You're getting the good sleep. And then 20% is life where I'm going to stay up late. I'm going to have some wine or whiskey. I'm going to go out. I'm going to be on vacation. So, you're not excluding all the fun things in life. If it comes to a point where you're like, I'm still not budging the needle, then maybe it's a 9010 rule where 90% of the time you're on it and 10% is the life factor. There's these hard and fast rules I've been accused of giving. I don't give rules. I give optimization ideas. So, it's not following strict 8020 or 9010. It's what fits in your life. And if you're really motivated on losing weight, the first thing I tell people to do is ditch alcohol. Mhm. Everyone wants to lose the the part on the belly. Sure. Is there not like an exercise I can do just to burn the part on the belly? Exercise burn. So visceral fat's a little bit different. It's like a whole different organ. So you know when we talk about visceral fat, it has different drivers. You know, we drive fat to the intraabdominal cavity. It has it creates different cytoines. Subcutaneous fat is a storage facility. It is when we overeat calories, we will drive fat under the skin. And it's kind of genetically determined. Females tend to gain about their hips and thighs. Okay. And actually that hip and thigh fat is protective for cardiovascular disease in a premenopausal women. Not in men but in women. And so it is so but when that fat shifts to the intraabdominal cavity, it starts that fat is metabolically active than the fat under our skin and it creates these pro-inflammatory cytoines. And then you end up in this negative feedback cycle of, you know, your liver starts becoming dysfunctional, insulin resistance increases, that drives more fat to the visceral cavity, increases inflammation, and it just goes on and on and on. So get liposuction. No, no, no. You can't lipo the viscra inside. That fat that's really inside the abdominal cavity is what we're talking about. That visceral fat, which is the worst kind. What about liposuction? Can't I just suck it out? People are doing all kinds with their under the skin. Under the skin, you can. That's an aesthetic decision. What was the stuff under the skin? Oh, lipo suction it out. Is that a good idea or a bad idea? No, it'll come back. All these things we're talking about, it sounds like a lot of instructions, and it is actually, but when you layer them on, it becomes your lifestyle. It's not a diet. It's not an exercise program. It's just how I live. Which brings me to my next question from the audience, which is, what is the best diet for a woman who is permenopausal? plant forward, plant heavy. Yeah. Yeah. Because you're getting you're getting So, when I'm talking to patients, we talk about the quality of their nutrition. So, is your is your pattern of eating I hate to call it diet because it's four-letter word now, but is the pattern that you're eating pro pro-inflammatory or anti-inflammatory? What's pro-inflammatory? So, meaning the things that you put in your body, are they likely to cause inflammation? And we know there are certain things that do that like heavily ultrarocessed foods, you know, in large amounts. Everybody can tolerate a little bit of everything. But if the majority of your diet, and for most Americans, the majority of their diet is 60% is ultrarocessed foods. Okay. Those are by and large plurinflammatory. What about red meat? Red meat in moderation and especially leaner ones seems to be a a very reliable source of protein. As far as inflammation goes, it seems to be neutral in small amounts, not heavily like highfat meats or processed meats. Then you're flipping over into pro-inflammatory. Is there a diet for fertility? It's very much what we're saying right here that plants have fiber that's going to feed your gut microbiome that's going to decrease inflammation. So fruits and vegetables, getting enough fiber is the number one change that most people need to make. From there, we want to of course decrease all your ultrarocessed foods, healthy fats. Fat is the backbone of chole like cholesterol is the backbone of your steroid hormones. So if you want to make hormones, we've got to have some cholesterol, some healthy fats coming in to provide the backbone for that. That's essential. So things like olive oil, nuts, your avocados, seeds, these are going to provide some of those healthier fats that are easier to use for you. And when it comes to protein, there's a lot of different protein sources. We know that the the data is so hard on nutrition because I can quote a study that says for every serving of plant protein that you take over animal protein, you have a higher chance of ovulating regularly. And that's true. A lot of that though is nuanced by the fact that people who eat plant-based sources of proteins tend to eat other plants in general and less ultrarocessed foods than people have the highest cortile of meat intake. If we go to a micro level though, not all meat, animal meat is created equal. Animal meat does not have fiber in it. So we know it's not feeding our gut microbiome. So if we want to talk about carnivore diet, things like that is definitely not microbiome friendly for you and not hormonally healthy. So we really want to really have those whole foods, the fruits, vegetables, the healthy fats, the proteins that are going to be good sources. And just like we talked about other things, it's not all or nothing. Red meat every day is probably going to be inflammatory. Having it on the weekend is probably okay. And the way I describe this to patients is let's imagine a scale where every decision you make can kind of tick up the inflammatory marker or bring it back down. If you are making active decisions that are more anti-inflammatory, you can tolerate the glass of champagne, the birthday cake, these little things that we know will cause inflammation in your body, but your body is meant to respond to inflammation and get back to normal. The problem is when it's constantly challenged, when 70% of the things that you eat cause this chronic inflammation inside of you, your body can no longer respond appropriately when it's challenged again. Things that are pro-inflammatory tend to also disrupt the gut microbiome. Tend to like it all makes sense when you think about it. And there's quite a few studies that are coming out in the four to five years before the one point in time called menopause. So in late pmenopause that there's a significant decrease in gut microbiome digest. Oh, Zoe did that work? Yes. Yeah. And it's really interesting because of the second pass and the way that hormones are metabolized. When we have uh our natural cycle and we have a an exposure of our sex hormones, yeah, the common cycle, then we have more of diversity because the gut bugs help unwind. I guess is that so we metabolize estrogen into inactive metabolites and then they get excreted in the feces. So it goes through the liver and then dumped into the bile. And does that mean that if I if my microbiome is likely to be less diverse as I age, I need to be thinking more about the divers diversity of your plant foods. And this is why it's really probiotics, probiotics, etc. Not over the counter. Okay, you first start with food, but not a pill that you're trying to take, but actually the food that you're putting into your body is the the best fiber. What about protein blunder? The way I like to approach nutrition for people is first having people notice what they're eating and then from that break it down into well, how much of it is protein, how much it is fat, how much is carbs. Without that kind of education, it's almost meaningless. So when we've done that and uh I'm making recommen recommendations for protein, we will not build the muscle we need to build. We will not get stronger the way we're capable of getting stronger. A if we're not eating enough and B if we're not taking enough protein. So the RDA recommendations of8 gram per kilogram is survival doses of protein like sitting on a chair like a mushroom preventing malnutrition is the goal of itable. It is not for active people. It is not for living your best life people eight the recommended daily intake is8 gram per kilogram of lean body mass. So it's low it's very low. So the research uh supports easily supports let's use pounds.86 grams per pound for lifting people. I recommend over a gram. A gram for ideal pound because I'm presuming that the people I'm taking care of are going to start being active, that we're trying to build muscle, that we're not in starvation mode. So 0.8 grams per pound. I recommend one um gram per ideal pound. So there's some other research that's come out looking at skinny fat. So that's normal weight obesity. So not as we're talking normal BMI, normal BMI, but internal high body fat. And then at the And what happens is they have low muscle mass. Low muscle mass. So they took a group of of women, split them up. So you had a control group and then you had this intervention group. And the only change they made, there's no exercise, and the only change they made was they brought the intervention group up to 1.6 grams of protein per kilogram. So this is8 per pound and over the course of 12 weeks of eating that protein intake, this intervention group completely recmped their body. So their muscle quality came up, body fat went down. Control group, of course, nothing happened. So it just shows the importance of having that higher protein intake just to support basic muscle function and the frailty data out of the WHI. So the women's health initiative looked at multiple things not just breast cancer and heart disease but you know they followed these women even off of HRT for decades. Y and when they looked at frailty scores in the elderly and protein intake above 1.6 six grams per kilogram had the lowest frailty scores just based on protein intake alone. Yep. What about fasting? I know so many people that are doing water fasts and juice fasts and it's impact. Have they told you why? I've had an evolution with the way I think about fasting. um when I first kind of you know was stepping out of the box and what's happening in menopause and why was my body composition I didn't know what to call it back then but what was all this going on that was new and all my patients were having it as well and these were my my girlfriends I worked in a small town with a big university and these were PhDs and we're running marathons we're doing all this stuff and everyone's kind of complaining of the same thing and so fasting seemed to be helpful and my girlfriends were trying we all kind of did this fasting thing and I was like super excited about it everybody felt better blah blah blah blah blah okay So, fast forward, I'm learning more about hormones, body composition, protein intake, all of these needs. And suddenly, as I'm counseling my patients, I'm realizing I can't meet my own protein goals if I'm trying to fast at the same time. And I quickly realized if we're looking at health span, if we're looking at body composition, there may not be a lot of room for fasting for these patients, you know, or for my girlfriends, you know, and it is really difficult for my patients to reach their nutrition goals. So, never at the expense of meeting your basic nutrition goals and your calorie needs. And it is really, really hard to do while fasting. So, you may get a short-term benefit with weight loss, but there really doesn't. Now Dr. Sims can get into the nitty-gritty of you know but the basic idea of fasting if we want to use the term fasting we have to look at it is are we talking about intermittent fasting or timerestricted eating. So intermittent fasting is kind of like you know your water fast your 5day 2day all that kind of crazy stuff which for the most part men can get away with and have a positive impact on body composition but women can't. If we want to talk about timerestricted eating and working with our circadian rhythm, which is optimal, then you have breakfast within or food within a half an hour of waking up that helps dampen that um geroline and cortisol response I talked about before so that everything is coming down. Your hormones are starting to work properly and your body's like great, I'm ready to go. I can I can handle this. And then you're eating at regular intervals. And I try to have people have protein and fiber at every eating interval so that they are maximizing protein and fiber intake. Then you have dinner and then you don't eat after dinner. Every eating interval. So breakfast, maybe you have a snack. If we're looking at training or exercise, if you're splitting your breakfast, then you're having some protein and carb before having the rest of your protein or more protein afterwards. And then you're having uh uh some protein and some fiber at lunch. So you're having maybe tempeh or tofu or salmon with salad or fruit and veg. So every time you're eating, you have a a protein and fiber focus. So timerestricted eating is within a 24-hour period. So you're looking at I'm going to eat during the day when my body needs it. Yeah. And I'm going to stop eating when I finish dinner. So I have about a two maybe three-hour break before I go to bed. So that when I go to bed, I'm not trying to digest food. my body can get into the parasympathetic responses it needs to to sleep well for reparation and then I eat again at what time when you wake up in the morning it's typically about 12 hours of eating and 12 hours of not so you're trying to follow that circadian rhythm and work with your hormones it can also when you do have that period of time which maybe that sounds very intuitive but a lot of people are eating at 1000 p.m. they're snacking on food, then they're trying to go to bed, and then they're getting up. When you give your body a little bit longer, so at 12 hours time is when your body will really efficiently be using up all your glucose, really dropping some of those insulin levels, but it's not so much that it's stressful. And we're using stress very generically here, but on a cellular level, long periods of fasting for women specifically can be very stressful to the body. And that's why if you think about Stacy's example of what happened in two fasting periods to, you know, a man and a woman, different things are going to happen to your body if it thinks it's being in starvation. So, we don't want to put your body in a starve state. We're just trying to give it a time period without food so that it can start to process the energy that's available differently. Why? Why not, though? What's going to happen? And I understand from what we talked about earlier that my fertility my my cycle is going to change. But is that well there's there's adaptive stress and then there's stress to the point of you're you're hurting yourself. Men can you said that men can do longer fasts. They can they can do longer fasts and it can show to actually you know be something that might be advantageous for them for how their body is made. Might increase their focus and some other metrics. But for women, these longer periods are actually going to promote more visceral fat storage and become pro-inflammatory. And you said it a little casually, but disrupting your hypothalamus and shutting off your hormone system will cause a low estrogen state. And that's very problematic as we've talked about. So thinking about your body should not be in a starved state. So utilizing timerestricted eating meaning I'm going to eat within my circadian rhythm the hours that there is sun outside back what how your body is made to function is working with your biology. If you're saying I'm going to not eat for 3 days because I'm doing this fasting period for women that's going to induce a stressful state where you're going to start to store more as visceral fat and cause more inflammation. And if we bring it into the, you know, people holding a fast till noon or after you're phase shifting. So it's like you're having social jet lag where if you're phase shifting your hormone responses, your appetite hormones, then you're not going to get into a good sleep because your body is like it's not time to go to sleep. Your melatonin peak in women usually peaks around 9:00. So you start to get sleepy. That gets shifted to 11, 12. So you're not actually going to get good sleep because you now have reset your melatonin responses. So we want women to understand that timerestricted eating when you're not eating when in the dark is really beneficial. Easiest way to say it. Easiest way to say it. Yeah. You're fueling for your body during the day because that's when it needs the fuel. That's when we want to be able to create uh an environment that's supportive to hormone health, supportive to muscle growth, to brain health, to all the things and reducing stress when we can control that stress. So when you start phase shifting and holding fast and creating this stress on a circadian level knowing that there's a circadian response on every cell as well as a total body circadian rhythm that if you shift that then we start seeing a lot of metabolic dysfunction poor sleep and unfortunately we see this in shift workers because that's what's happening. They're having circadian shift and they have significantly lower longevity. They live what? I I think I heard 14 years less if you're working night shifts. I don't know. You have higher rates of infertility, higher rates of pregnancy loss. You you're more metabolically unhealthy. Of course, we're generalizing a group of people. And sometime I think we've all had moments of time of life where shift work was part of what we had to do. But night shift work, most people are not getting enough sleep during the day and they're what we call flipping back and forth, right? because you want to be on a daytime schedule on your off days and live your life that you're constantly sacrificing what your body needs. And what I tell people is you may if you can get off of that, it it will be a healthier life pattern. But in moments where it's not, you need to really prioritize trying to get enough sleep, making sure that you're taking care of yourself in the other time periods because you're set up for a place that is going to cause hormone dysfunction and impact your metabolic health. Mhm. You believe the same. I believe I uh advocate uh feeding ourselves for optimum health. To be any kind of active, you must feed yourself. and um stop eating three time 3 hours before bed. So, what do you think of people that do these longer fasts? Do you think that they've just been given poor advice? Because I know I was talking about Mel and I know she does frequently does three-day fasts because I think people think they've heard this term autophagy. Autophagy is the term. Take it Stacy. So, this is the thing with autophagy. You get that with exercise. So the idea of autophagy is recycling the some of the parts of cells that have broken down or somehow become dysfunctional. So your body's really good at cleaning that out. We see with exercise, it invokes that autophagy. With fasting, it invokes that too, but not the severe fasting like three-day fast, that kind of stuff. When we're looking at the telomeir changes that people say with fasting, you get that with exercise. So telomeir is um points that we look on the DNA to see how you're aging. So we want longer telomeir length because that means you are more stress resilient. You get that with exercise cuz exercise is a big stress. It creates a a change within like we were talking about before. Yeah. Adaptive stress, epigenetic changes which improves all of those markers that people are so adamant fasting does. What about fasting and then doing exercise? So fasted exercise is that for women? No. That's what she taught me. For men, it I'm going to say no as well because when we're looking at the fueling mechanics of exercise, muscle is a very metabolically active tissue. If your body is trying to fuel itself, it's going to break down the very first thing that's creating a energetic need, which is muscle. We see in women, women, you're going to lose muscle. You're going to break it down and use the amino acids as fuel. You can tap into blood glucose and some fat, but when you aren't bringing blood glucose up through eating first, it's really hard for your body to understand that this is what you want it to do. So, it's like, okay, I need to conserve fat. I'm I don't want to go through all the glucose that I have because I need it for brain health. So, I'm going to start feeding more amino acids in to fuel what I'm doing. For women, we already use more amino acid than men. So, if we're looking at fasted training, then we're already increasing the amount of lean mass that our body is going to break down to use as fuel. I'm pretty sure it was you that told me there's this part of the brain that's kind of checking if there's energy in our blood, if there's glucose in our blood. That's part of our hypothalamus. And so, the hypothalamus is this sensor that's kind of checking. And in a woman, again, correct me when I butcher this, but if it understands that there's no glucose in the blood, then it's going to go into that survival state, which is going to start to shut things down, which means growth of muscle isn't going to be possible. Um, because once upon a time, I guess that stress without the fuel would have been a threat, especially in the context of like my menstrual cycle and my reproductive health. That's a good way of of wrapping it up. Yeah. It's not that we don't have blood glucose, it's low blood glucose and no nutrients coming in that the hypothalamus is sensing. So, we're looking at neuropeptide responses within the brain within the hypothalamus that controls appetite hormone uh the way that your body's using fuel. So, if we don't have stuff coming in, the hypothalamus is like, "Oh, wait a second. What's going on here?" Is it fair to say the woman's body is more I was going to say stubborn but that's a slightly negative word less flexible than than a man's more complex complex it's complex and more stress defend itself it's very much stress resilient so it's very defendable it's trying to protect you it really is looking at how what is it going to do to keep your functions happening balance in balance but because women can get pregnant and pregnancy is not a health neutral state it's a huge strain on the body that is an extra layer of one of the things that sometimes decides I'm going to put this to your side because I'm going to to protect keep you functioning. I want to work on all of our other body functions. We're going to shut off that side that's not sending out FSH and LH and making reproductive hormones cuz we can't afford to keep you healthy. Then we definitely can't afford to grow a baby and keep you healthy. If you are pregnant and go through times of severe stress, illness, injury, your body will eject what is in the womb through a miscarriage or, you know, early pregnancy loss or mis or preterm labor because it is always going to try to protect you first. So, you're at high risk of a failed pregnancy. I wonder if I could frame Mel's your question about Mel and the way I I frame all the advice whether it's research advice or internet advice is you have to know what your goal is. What is Mel's goal or your goal or because listen they're exclusive longevity if longevity is your goal like live longer at any cost well then there's a lot of research about severe calorie restriction and lifestyle and just lots of severe ways to live. Okay, if that's longevity is your goal that's your goal. If your goal is peak performance like a pro alete, that is a different kind of life and training and reps and peak performance at the pro level doesn't necessarily get you longevity. Proathletes live less, at least contact athletes live less than people focus on longevity. But the third bucket that most of us live in is health span and wellness. It's neither high performance live less time. And it's neither austerity live the longest possible. It is the middle ground. It's the homeostasis balance. And so when questions like that come up, the first question in my mind is which bucket are you in? Are you in a peak performance? You're going to do different kind of training, different kind of eating. We know you may have a decreased lifespan because of the stress you put on versus this. So, what are we working for? I think a lot of the people that talk about these fasts often say to me, especially when they're referring to juice fasts that it's kind of like cleaning out the system. They say it's like it's like cleaning house. You don't need to clean out your That's not how you clean out your system. Taking the fiber out of those fruits and vegetables, taking away all the things that you need. Juice is 500 calories of pure glucose. Yeah. What if it's vegetable juicing? Why not just eat the vegetables and get the fiber for your gut? But you have a liver. Your liver. I think it's marketing. I think they're falling prey to marketing. And that's a big wellness trend. I know. But it's it's massive. Honestly, you would. Yeah. I know so many people, so many of my best friends going on detox wellness retreats. Well, even when I ask them why they're doing a water fast, they say, "I'm just detoxing." Or when I ask them why they're grinding up this fruit and vegetable and, as you say, pulling out all the fiber from it. It feels more attainable to say, I'm doing this crazy thing for 3 days, then I'm going to make a life switch to just live a more preventive anti-inflammatory lifestyle. Before the Diario was what it is today, it was just an idea. And it started with me, a cheap plug-in microphone, and my Mac right here. And I have to say when I first had the idea for the diary of a CEO, my thinking was that the world might want to see into the diaries of some of the most interesting, successful people really in high places that were doing interesting things. So after recording that first episode under my duvet, I sat on my Mac by our sponsor Apple and spent hours editing on Garage Band and eventually uploaded it and honestly I thought that would probably be it. But a couple of my friends said they enjoyed it, so I kept on recording. And over time, the microphone has changed and we now have this incredible setup here. But the thing that has stayed the same is I'm still using the Mac. Even today, my entire team across our studio still uses the Mac. Our first few episodes maybe had tens of people listening, but now tens of millions of people tune in all over the world, which is still absolutely crazy to me. So, if there is an idea that keeps tapping you on the shoulder, this is your sign to start. Your great ideas start on Mac and you can find out more at apple.com/mack. Have you ever heard about this before? This thing I'm holding in my hands now. This is called Ketone IQ. The website is ketone.com. You've heard me on this podcast talking about the fact that I stay much of the year in a ketogenic state, which is a highly restricted diet. And the reason I do that is plenty. One of them is I spend hours and hours talking to people for a living. So I want to make sure my brain is firing in an optimal way. And the other reason that I do the ketogenic diet is because I just feel better. So when I discovered this, which is what they call an exogenous ketone product where you can drink it and it increases your blood's ketone levels, I was blown away. I contacted them, I met them, I invested extremely heavily into their company and I've become a co-owner of the company accordingly and they sponsor this show now. So if you want to try this out for yourself, I recommend you try it. Just visit ketone.com/stephven and you'll get 30% off your first subscription order. You'll also get a free gift with your second shipment. That's ketone.com/stephven. And in terms of supplements generally, do you know, again, not to bring Melon to this for the thousandth time today, but a couple of um couple of Christmases ago, I told her that she should be having creatine because I all these people on my podcast told me it and she said, "No, it's for bodybuilders." Yeah, that's the old school thought. When we're thinking about creatine and how it got its chops in the supplement world, we're looking at muscle performance and taking five grams four times a day with some carbohydrate to enhance muscle performance is how it started. But when you start really disseminating down into the health aspects of creatine, creatine is used in every fast energetic of the body. So that means your brain, your heart, your gut, muscle, everything that requires energy from 0 to 30 seconds, creatine is involved. Women have about 70 80% of the stores of men. And when we start looking at all the different types of diets that are out there, lots of exclusionary food diets, then the intake of creatine is lower. What we're finding in the research from health perspective is that it does so many positive things when you're able to saturate the tissues to bring it up with even a small dose of 3 to five grams a day. Our liver makes about three, but we don't necessarily eat enough to help supplement all of the tissues. How much would it take? Like 12 chicken breasts or something? 22. Okay. 22 chicken breast. A lot. So when we look at the supplementation and being able to saturate all of our tissues thoroughly to support those fast energetics, we see things like better cognition focus. We see a faster recovery from small brain traumatic like a friend's daughter hit her head on the um the laundry door of the dryer and got a TBI or a small concussion from that, started using creatine, came out of it a lot faster. I mean, there are things that help with brain metatasm. We see women who have incidences with IBS or gut issues and they're using creatine. It helps decrease the symptomology. We're seeing now studies coming out about fatigue. And this is where the 38 g per kilogram of body weight or the equivalent of 20 gram if you're 60 kilos helps with fatigue and focus. Especially if you're under a lot of high stress. Because if you're under a lot of high stress, your body's going through a lot of blood glucose trying to keep up with that stress. So creatine isn't just the bodybuilding set. There's so many different health benefits and it keeps coming out with more and more research to show how beneficial creatine is. Could you give me the menopause supplements, if there is such a Okay, so in general, um, we're not going to cure menopause with supplements. Let me just take straight up. Okay. Most women are going to be deficient in fiber and most women are going to be deficient in vitamin D. And vitamin D is hugely important in multiple enzyatic processes in our body. And it's really hard to get enough through our nutrition, even eating stacks of salmon a day, which is really high in vitamin D. So about 80% of my patients are not only just low in vitamin D, they're deficient. So, that is one that we can supplement safely up to about 4,000 IUs international units is how vitamin D is measured a day without worries of becoming toxic or having too much vitamin D, which is possible. And so, usually I'm having creatine. Absolutely. It's like a go-to. And we're looking at her nutritional profile. We're looking at her fiber intake. And then we're adding in a fiber supplement if she needs it. Natalie, in terms of fertility, what is the fertility supplement stack, Percy? And first and foremost, we're going to say that if you are trying to get pregnant, which by asking fertility, we're going to presume, we want to make sure you have folic acid on board. So folic acid is the essential component, one very important part in cell division, but it's essential for a baby when it comes to brain development and spinal cord development. We call these neural tube defects. And the reason why I'm bringing it up is that there's a lot of chatter about folic acid out there, but it is the only supplement folic acid in its folic acid form that is proven to prevent these neural tube defects such as your baby being born without a brain. And interestingly, in today's world, a lot of foods are also fortified with folic acid. But these are some foods that are often processed and people are consuming less. So we are having less consumption of folic acid in our diet. Therefore making it even more important that we are supplementing with folic acid. As Dr. Haver said, vitamin D, vitamin D is essential for your entire body. But when it comes to hormone metabolism and fertility as well, we even see women who are going through IVF with donor eggs and we know they're very good quality, have lower success rates if they have lower vitamin D levels. This is something that almost everybody is deficient in. We do test and then target treatment to try to get you to an optimal level. But also omega-3 fatty acids are really important in your entire body, but especially in your reproductive years if you might get pregnant. And I often recommend magnesium for most patients as well. And then from a fertility standpoint, if you have infertility, there are studies that show that co-enzyme Q10 can be highly beneficial when it comes to egg quality. This is important in our mitochondrial health. And for the sake of the one question you asked, remember when we talked about eggs, we've got our genetic health, which is largely dependent on age. We have our metabolic health. The mitochondria from the egg controls all development for the embryo. And in fact, the cellular functions for an embryo, the first three days of life, solely come from the egg. The male genome doesn't even kick in until day three of embryo life. So the function of the egg to be able to divide and do normal cell functions is very important. And sometimes we see that reduced in infertility patients and co-enzyme Q10 is an easy thing we can get over the counter. Doesn't appear to have any harmful side effects and has potential benefits in some subsets. So my infertility patients I add that on. Wonder all things aging, performance, strength, bone. Mhm. What is the supplement stack for for longevity? vitamin D, magnesium is critically important for a variety of uh metabolic functions. Omega-3 for anti-inflammation, creatine, I'm a big fan of. If we move looking at uh scinesscent cell load and inflammation, we haven't really talked about longevity, but scinsesscent cells are those B those cells left over from normal function that are so damaged that they can't flip into programmed cell death. So they circulate around and produce noxious um chemicals that can lead to a variety of disease. So we want to minimize those and one way to do it is lifestyle. Another way is to use an herb called fiseten. So I add that on and then also I do myself and check levels on my people of intracellular NAD+. NAD is a co-enzyme in 300 metabolic reactions. It's an it's an uh an energetic pathway. Now, it's very popular right now. And the critical differentiator for me is that taking whole molecule NAD such as in IVs, our body needs to make it. So for myself and for my people, I supplement with NMN, which is the immediate precursor of NAD+ so that my body can then turn it into NAD+ and it can work intracellularly. It can also be delivered two reactions out uh in the form of NR. These are in the B vitamin categories. So that in two reactions your body makes NAD+. So the data does not show that you can IV NAD+ for ac efficacy cuz it works intracellularly. So you supplement its precursor. I've heard so many people talking about NMN recently. Yes, that's right. That's what I'm talking about. Is there clinical evidence to show that it's effective? So you know those the lab that I work with uh I happen to know the scientist and he has hundreds of thousands of data points checking before NAD+ levels intracellularly supplementing and then after and he can elevate those levels and it's associated with longevity like intrinsically associated with longevity a lot of the the bro science I guess longevity well it's intrinsic intrinsically related to lots of normal metabolic function and uh energy in the body. Whether or not it makes you live longer, I don't have that data. Is it a tablet? It is a powder the way I take it. Mhm. What about collagen? People talk a lot about collagen. It's in all the protein powders now. I know, but it's not a protein as we think about it. Like you'll see all these collagen protein. It doesn't count as dietary protein for muscle development. Does it work as a supplement? There depends on what you're looking for. Yeah, exactly. and Mike Orsby out of um University of Southern Florida, he has been doing quite a bit of research on collagen and joint pain um and found that there is some efficacy in taking the type 2 collagen to reduce joint pain. It doesn't help with cartilage regeneration. It doesn't help with osteoarthritis, but it does dampen inflammation and joint pain. So again, it depends on what you want to use it for. In the first episode, we talked a little bit about environmental toxins and I wanted to before we talk about sleep and close off, I wanted to just mention environmental toxins and the role they play. The term microplastics has been very very popular of late. When we talk about environmental toxins, are we talking about microplastics in the air and maybe the water? What do we mean? Essentially, it's anything in our world that is impacting your body and how it functions. There's a few different types, right? So, we have endocrine disrupting chemicals. These are actual toxins in the environment, in cosmetics, cosmetics, our kitchen, our food that change how our endocrine system works, our hormones. There's also things like microplastics like you mentioned, which are actually going to deposit in our body and can cause fibrosis even in our ovaries, therefore changing how an organ's able to respond even if it is given normal hormone signals. And then I also lump into this category behavioral toxins, right? things like alcohol, marijuana, cigarettes, the the choices that are toxic in our world as well. So that toxins is kind of a large category. There are some toxins you can control. You can try to filter your water. You can learn what is in your water so that you can say at the, you know, EWG, this is my zip code. This is what's in my tap water. What type of filter might I need to try to have healthier drinking water in my home? You can change what you're cooking with, not using non-stick cookware or teflon. you can get rid of plastics and especially what you're putting hot foods and beverages in because the heat is allowing those toxins to leak into those things. And then as Dr. Haber said, our cosmetics, things that you use every single day that you put in and on your body are things that you're having a higher exposure to. And it's really important to decrease those because things like air quality, you might not have as much control over based on where you live. And there's so many toxins in our world in general that it's unrealistic to say, "Let's avoid all of them." And because of this, we have that same mentality that we see with exercise sometimes. Well, it's just there's too many. I can't avoid them all. So, I will ignore this category because it's easier to just do nothing instead of making active decisions to start to live a less toxic life. What changes have you made to remove pollutants and environmental toxins from your lives? Because we're in that fertility journey. I remember I came home in one day and like all my shampoo and stuff had gone. Yeah. So my nice stuff is starting to look through your products and get getting rid of things that have endocrine disruptors in them. You want to look the kitchen is probably the greatest source of exposure for most people. So there's really no need to have any plastics in your kitchen. So getting rid of them. But many people don't think about when you do have processed foods. The wrapping, the container, anything that's coming packaged likely has toxins in it. When you order Door Dash and it comes and you have it in a container, that's often hot food in a container that is leeching chemicals into it. So, a simple thing is take it out of that right away, even if you're not eating it. Put it into something glass or a different type of container. So, you can try to minimize that exposure. Thinking about hot beverages, things that go in the microwave or the dishwasher, especially, but then other things like thermal receipts. So, getting receipts, uh, thermal receipts have BPA in them. So, getting receipts or receipts. Yeah. So the airline tickets or that thermal paper. So just the receipt from the grocery store when they say, "Stephen, do you want your receipt?" You can just say, "No." And then if you work with thermal paper, maybe you're a cashier and you touch it over and over. I highly recommend you wear gloves because your exposure to that thermal paper is so much higher that it can become problematic for you. Does it really make a difference if I take the receipt or not? You know, there's a lot of things where you can do that say that person touched receipts all day and they still got pregnant or their sperm was great or they lived a long time. We can list a whole lot of negative behaviors or habits or exposures that one person might tolerate just fine. And for somebody else, the sum of all of these behaviors add up to be something that puts them in a place that is very pro-inflammatory, not healthy for the now or for the future. That to me is an easy dec on the scale of decisions that are hard or that are easy. Trying to change the things that you're exposed to in your world. You have to spend some time to learn about it. You might have to buy some new things. But over time, those decisions are ultimately easier than how you eat, your exercise. Those those take longer commitment. And especially if you're partnered, if you live with somebody, then the foods that you eat, your sleeping habits depend on them. You both have to be together on this. So sometimes I always say toxins are to one place a thing you can do. You can look at your products. You can start to when they run out say is this one healthy for me? Should I get something that's going to have less of an impact? That one time of using very scented hand wash is no big deal. But when you wash your hands with that highly scented hand wash five times a day over and over, it is just an avenue of endocrine disruption that can add up to the litany of the other ones that you're experiencing. So we're all saying these little changes on one hand singularly probably do not matter much, but together they do. And there's a link between environmental toxins and menopause or early menopause. Early menopause, we think so. So, you know, you were born with a shelf life, a genetically predisposition shelf life on the ovary. Okay? And we don't know a lot of things to extend that shelf life cuz we have a certain number of eggs. But there are a lot of things we can do to speed that process up. So, that's going to be smoking. Women who smoke cigarettes or, you know, um even we're looking at vaping now because it's a newer thing, but definitely tobacco consumption, you know, in the form of smoking. We see earlier menopause. um the so there was this incredible study where they looked at women who were sexually abused who then had children who were sexually abused went through menopause I think nine years sooner so and it's the only study that looked at this and it happened to be the stress they looked at was sexual abuse in the mother and the child and so they went through menopause nine years sooner so there is a component of emotional stress and long-term chronic emotional stress it does cause chronic inflam- And the ovaries are highly sensitive to chronic inflammation. We know that BPA exposure has shown that if you have a higher level of BPA exposure, you have lower ovarian reserve, meaning less eggs in your ovary will go into menopause earlier. And what is BPA? BPA is one of those environmental chemicals that we're exposed to largely through plastics, but it's also one that's in the thermal receipt paper that we're trying to avoid our exposure to. And that's where some of the data even when it comes back to food where soy intaking soy products can actually be very protective because it combats BPA. So how it works. So when people say, "Oh, you shouldn't have tofu. You're a man. Soy is so bad for you." That's actually false. And we found that people who had greater exposure to soy products actually had the lowest level of BPA and improved reproductive performance because of that. So there's definitely correlation with these toxins in our world and we might say, "Oh, is it linked to menopause? Maybe nobody's done that exact study, but it absolutely is. If you have lower eggs at an earlier time period, that's going to give you an earlier menopause going." You know, the flip side of fertility is menopause. So, and lastly, I wanted to talk about sleep. Well, it's all of our favorites and we're doing it last. So, yeah, Vonda, I've heard you refer to sleep as the pillar of everything. Mhm. And I say that because we think sleep is just passing out like we're not conscious. Well, that may be true from a from a uh our viewpoint, but it is the most regenerative period in our day. Actually, the brain is processing information, getting rid of toxins. The body is able to uh settle and again get rid of toxins. But many women in midlife have completely disrupted sleep because estrogen is critical. Yes, 80% very high. Um, estrogen is critical for uh sleep patterns. Um, many women wake up at 3:37 or thereabouts either with a plummeting blood sugar or that seems to be around the time in the middle of the night that the sleep disruption has. So this broken up sleep, if you don't do it, then all the lifestyle things Stacy and the rest of us have been talking about are nearly impossible to do if you're underreovered. And so I have made after nearly 11 years of not sleeping because of training and child a religion almost like I am dedicated to this function. I do not eat 3 hours before I go to sleep. Uh, it's one of the primary reasons that I made the decision to stop drinking alcohol because that completely disrupted my sleep. And I am more conscious of circadian rhythm than I've ever been in my life. Meaning I go to bed when I'm except except probably when I'm traveling, but at the exact same time every night, but more importantly get up at the exact same time every day to start my circadian uh day. um and to start my adenazine usage so that by 9:30 at night I'm ready to rest. It's that important. A woman's guide to a aging with power. Unbreakable. Yes. Unbreakable. And central to that is circadian rhythms and sleep, right? Yeah. It is because the premise of this book is that uh women are already winning the longevity race but we suffer longer and we have this vision of women aging which is usually a vision of frailty. But through the mindset changes through the behavior such as sleep and lifting and considering hormones we can age in a different way. So I'm trying to re-educate the world that a woman's destiny is not frailty. A woman can age powerfully but not if we sit around and wait for time to make us its victim. We must be proactive. And sleep is one component of that. This should be the very first thing you do. Sleep sets the stage for your entire day. It's really that foundation of your health. If you are going to start the day in a sleep deficit, you're starting out stressed, inflamed, insulin resistant. There's going to be no behaviors you can do during the day that are going to overcome the deficit. And we know that women who get less sleep, they take longer to get pregnant. They have higher rates of infertility. We know that men who get less sleep have lower sperm parameters and lower testosterone levels. So if we are saying you Stephen, you know, what's one thing you might be able to do? Well, are you sleeping well? That's one of the first things you can start to do to say, am I getting 7 to N hours of good quality sleep? That's not just time in bed because Mary Cla has her phone on her. That is actual sleeping time. And that makes a huge difference in trying to achieve, you know, a hormonal health, which is really what we're all saying here is how do we get our body in the best quote unquote balance that we can, which means working with the different building blocks of our body in the most optimal way for as long as possible to be healthy. And even if we're not looking from a fertility standpoint, you can't invoke any kind of metabolic or body composition change without adequate sleep. So that's what I mean. It's like when we're talking about the pillars and sleep being one of the first things we have to work on, you can't invoke any kind of change with we're not talking about ambient induced sleep. No, medication induced sleep doesn't count. This is not medication induced sleep. There's a huge percentage of patients out there who are addicted to these medications and it has become the only way that they can sleep. I've been really shocked at several of the women in my life that are between the ages of I'm going to say 35. Yeah. 35 and 45 who have like three to four hours sleep and they appear to be perfectly fine. They are not. They are not. Their cells are not fine, Stephen. No. Cuz obviously cuz I do this a lot. I I learned from all these scientists. But there's one partic there mean there's two particular women that I'm very close to that I actually work with in different capacities who showed me their Whoop data and would often tell me they would say I get three hours four hours sleep. And I thought there's no way because she did a 5K this morning at 6:00 a.m. So there's no way she's getting three to four hours sleep. to put a sleep tracker on her and she was getting 3 to 4 hours sleep and her restorative sleep is like 45 minutes but she's springing into the makeup chair next to me and she's all she's got all the energy I'm thinking what the hell is going on youth but I'm younger than her yeah I mean when I was in training I was getting 3 to 5 hours and getting up and operating but I cannot do that now if I got 3 to four hours I was good for the day how because I was 20 years 25 years younger Mhm. M I think we all got through like I was telling some of my earlier years breastfeeding mother is getting 3 to four hours you know that is part of the wow we're built we can function but age will take that resilience away from us because permenopause causes sleep fluctuations as well that because of the change in hormones right exactly and are women just assuming that's normal and rolling with it or is it okay I think we have more at public education about how important sleep is and and the number of hours you need and the quality of the sleep. So, I think years ago it was their normal and I'm just going to keep going, but now they're coming in saying, "This is a problem." Yep. I need help. And I would be interested to see your glucose monitor. When you first used it, because that's how we can kind of navigate sleep, too, is showing hypoglycemic effects for women who are exercising in pmenopause and not eating enough. Melatonin is that a solution? No, it can be a tool in the toolkit. Most of the time, you know, most people are taking too high a dose of melatonin, which is actually doing more harm than good. What harm is it doing? Well, it's actually shutting off part of the brain to be able to help control their circadian rhythm and then they're completely dependent upon it. And it's such an artificial induction, it's going to w wear out of their system. So your melatonin is supposed to rise, help you go to sleep, and then it falls at a rate for when you're going to wake up so that when it's lower, you're going to wake up and your cortisol will naturally rise. Melatonin can be helpful in very low doses, like three. Most people are taking 5 to 10. 10. Yeah. Yeah. So I often recommend, you know, the patients take maybe like a milligram, but you have to buy a children's melatonin very often for that dose of it because people are taking these huge huge amounts over the counter. You can just get so much. And so what you want to make sure is that if you're using it, you're going to take melatonin at a time where you're going to be able to go to sleep about 30 minutes afterward, too. Because people are also using melatonin and then not allowing themselves the restful moment when it's trying to kick in and then they're taking more or they're staying up later and they're suppressing their brain's ability to make their own melatonin. One of the questions we had from the audience was from a young girl that said, a young woman that said, "I'm 24 years old and I struggle so much to fall asleep. How can I fix my sleeping naturally if I have disturbed set circadian rhythm and especially during my menration my sleeping pattern seems to get worse. This one would be interesting to see like what is her daily like what are her daily habits if we can kind of bring calorie intake and all those things back into the day so she's not phase shifting and then use things like eltheanine which is a a nonproin amino acid that works the GABA right trying to bring parasympathetic activation back and making calm down yeah and seeing what is what are your sleep hygiene habits is your phone out of your room do you have um like a cool bedroom. Do you have earplugs to block out some of the extraneous noises that might partner doing? Yeah, sleep sleep is really a lifestyle problem for most people, isn't it? But magnesium can be advantageous as well, especially if you're on your menstrual cycle and you're having menstrual related sleep. So, I think that's an important thing. Well, it's just many women run low in magnesium, especially when your hormones are very low, especially when your estrogen and progesterone low, you're having, you know, contractility of your uterus, when you're having menstrual cramps. Magnesium can help counter some of that and can also help you, if you're taking it at night, get into a more restful pattern. So, um I've been working with a sleep medicine specialist um and one of the things she points out which I now discuss with my patients is listen if we're women wake up in menopause from hot flashes from night sweats and then the the relaxation we get from progesterone is gone so we can add that back in. So say we we've done all the things we've given her a touch of melatonin we've put her on hormones she is still waking up at 3 in the morning consistently. Mhm. She deserves a workup for sleep apnea because women disease differently than men. And men with sleep apnnea, it's a very common presentation of snoring. They're waking up the partner, you know, all these things. Women are much quieter about it. They still have the pallet that falls back and the relaxation. And that's hormonally driven for a lot of women. And so they're becoming hypoxic in the middle of the night from you know that's one of those side effects of of having sleep apnea is you stop breathing and you lo your oxygen levels decline you become hypoxic but we are not recognizing it in women more than 50% of women are going undiagnosed and are living shorter lives having more Alzheimer's because of this. So if I have a patient coming in and we've done everything and she is still consistently getting up I'm sending her for a sleep apnea evaluation. M I've also been reading literature on um CBT, so insomnia CBT that they've done with a lot of veterans and shift workers and that seems really interesting to help them fall back. Yes. To break the pattern because your body and your brain learn that wake up pattern. So if you can reset it, then that's very helpful as well. Yeah. What is the most important thing we should have talked about that we didn't talk about? Dr. All right. I think we covered an amazing array of information, but what I want women to walk away from this is with there's that there's a hope for feeling like themselves again. Yeah. and that they are worth investigating to the ends of the earth to find the answers they need and not simply giving up the first time somebody says no to them or doesn't hear them when they say that they don't feel like themselves. They must continue to pursue it. And number three, that they are worth the work that it takes to age with power. Beautifully said, Octavia, you really kn do need to be the CEO of your own healthcare. Um, we have a medical system that was not built to serve the aging woman. Um, after reproduction ends, it's just we become small men with rust and uteruses to quote Dr. Sims. And you, it's okay to educate yourself. It's okay to read the books. It's okay to go in educated with checklists and you're going to probably have to do that and to go find someone who's educated in the health of women after reproduction ends. And that could be your internist. It could be family medicine. But like there's no no one owns menopause life after reproduction ends. You know, no specialty really owns it. And so you are going to have to quarterback this a lot of it yourself until you find the right partner in this care. But it is worth it. Beautifully said as well. Yeah, I think when it comes to your health journey, nobody is really responsible for it except you. But there's this idea that we should wait until things are wrong to then go get them fixed. And what we are all trying to do across the spectrum of you know women's health and their lifespan is to say many of these things if we start focusing on them much earlier and take a preventive approach which is often against some of these recommendations about when you should screen or when you should do testing. But if we say, well, what is best for you as an individual? Focus on setting up a life that is going to help prevent some of these diseased outcomes. Start testing things earlier. You're going to be in a position of power to make the decisions that are right for you from a place of education and not be left making them out of fear or misinformation or not knowing because when it women will go through these stages. Time will make your fertility decisions for you if you do not. that that's a fact that your ovaries will stop functioning. You will go into menopause. So, we need to both prepare for our reproductive years, optimize our fertility the best we can if that's a life goal for us, but to realize that it doesn't stop there. That you're have to prepare for the next stage of the journey and what that's going to look like for you. But the steps to take care of yourself start well before if you're able to. I look at the the research and the health outcomes right now for women and it is a very confusing space. So I always preface with the fact that I want women to be empowered and how do you do that? You can't Google things and find out. So it's asking questions. It's sharing information. Most of all taking up the space because you've earned it. I get so tired of the rhetoric that women should be small and demure and be like a delicate flower and things are happening to them that they can't control. I want the narrative to shift. I want people to say I own the space. I'm taking up the space and it's my I don't like to use the word right because it invokes a lot of angst. But it is your ability to understand your own body and advocate for yourself that's going to allow you to take up that space and get the answers that you want. I've been advocating for so many women, myself included, and the push back that you get from the medical society is real. It's not that they necessarily are trying to gaslight you, but it's just a product of the system. So, you do have to push those boundaries. You do have to ask those hard questions. You do have to go in prepared to have that push back, but take that space because everybody deserves a place at the table and women's healthcare is being shunted in a way right now that is really unacceptable and we need to have ground swell movement to push back. Thank you all so much. Thank you. Thank you. I really mean that. I I'm thanking you on behalf of the many millions of people that are probably listening to to this conversation um because you know your conversations on this show have delivered more than 30 million downloads between you so across YouTube and across audio. I was looking at the numbers and it's staggering and you think about the impact of reaching potentially 30 million people just on this show in long form and then their friends and then their family and then the advice that they give to everybody they know and that domino effect is causing this wonderful ripple across the planet and it's turning the lights on in different households and within families and amongst business owners like myself so that we can all cater to the the plight I guess of women's health in a more effective way cuz you know even as a man I've learned oh god so much from you for great and the impact it's had on my life through improving how I show up for the women in my life but also the the way that I'm able to respond and support my partner, my sister, my mother in difficult times has been profound and I think some you know and well done to all the men that have listened to this conversation and have gotten to this stage because I know you don't kind of you often don't think it's a problem that you're going to deal with but when 51% or 52% of the planet are women is going to be a huge part of your life whether as a as you having daughters or sisters or or mothers and through all of the work that you've done I've been able to understand the women in my life better and actually that's protected my relationships and if it's protected my relationships it's protecting me and um I've really noticed that I've noticed how I've changed especially through understanding the menstrual cycle um how I treat treat my partner but but it's you four you are like the avengers of what you do. You're the you're the very best in your industries and um drink it. I highly recommend everybody goes and checks out. I'm going to link all of your books below. Uh Unbreakable, the fertility formula, the new menopause. I believe you've got a new book on the way menopause. The new permenopause. I'll link that as well if it's available for pre-order and raw, but also just your you'll make content, have Instagram pages, and have websites. So, all of that will be linked in the description below. And if you want to go deeper on these subjects that we've talked about today, then those are the doorways into a a deeper understanding. I appreciate you all so so much. We've been for what 9 hours now and uh I'm sure it's a lot of people. So thank you. [Music] Heat. Heat. N. [Music]