Gladden longevity — Episode #45

Steve Reiter: Welcome to the Gladden Longevity Podcast with Dr. Jeffrey Gladden, MD, FACC, founder and CEO of Gladden Longevity. On this show, we want to answer three questions for you: How good can we be? How do we make 100 the new 30? And how do we live well beyond 120? We want to help you optimize your longevity, health, and human performance with impactful and actionable information. Now, here's today's episode of the Gladden Longevity Podcast.

Dr. Jeffrey Gladden: Esther, it's such a great pleasure to have you on the show here today. I really appreciate you coming.

Esther Blum: Thank you, Jeffrey and Steve, for both having me here today.

Dr. Jeffrey Gladden: We're excited to talk about this. We talk a lot about longevity and health and human performance and life energy on the show, and we're a couple of guys, right? We don't mean to not talk about women's issues, specifically, but we've had a number of shows about it. But I never feel like we really do justice to it the way that we should be. So, that's another reason I'm really happy to have you on here. For the audience, why don't you give us a little bit of your background? How did you become this, I'm going to say, “menopause queen”, and I know you've got your tagline on the website that's pretty eye-catching. “Make menopause your bitch”, I believe, is what it is.

Esther Blum: You're damn right.

Dr. Jeffrey Gladden: Damn right. Okay, well, there we go. Good. Well, how'd you get started with all this, apart from being a female?

Esther Blum: Well, I definitely, I've been in functional medicine for 22 years. I was in hospital care for the first five years of my career, working with critically ill cardiac patients. We were seeing HIV and AIDS before anyone really knew what it was. We were seeing a lot of liver failure, just really acute care. I decided to spread my wings and go a little rogue and pursue functional medicine.

Dr. Jeffrey Gladden: If I can interrupt for a second, what pushed you to go rogue? What was the thing there?

Esther Blum: Not feeling like I was making a bit of difference after somebody had a heart attack, and I had 10 minutes at most to educate them on a diet they're supposed to follow the rest of their lives without any follow-up, without any continuity, nothing. Who is ever going to listen to that?

Dr. Jeffrey Gladden: Right, exactly.

Esther Blum: Without any reinforcement structure or accountability. I was also really irked because I had two degrees in clinical nutrition. I have a bachelor's and a master's. I sunk a lot of money into my grad school at NYU. And I literally took a course on vitamins and minerals, and I was so stoked. I was like, I'm going to learn about supplements. And literally, the instructor said, everything you need to get nutrient-wise, you can get from food. So, it's like: “you have got to be kidding me”.

Dr. Jeffrey Gladden: Exactly.

Esther Blum: And the other issue in hospitals is doctors did not listen to me. Some did and were open to it, but a lot just was very condescending toward nutritionists. I recently had a conversation with one of those doctors who was a resident when I was in the hospital working. He's a family practice doctor. And to this day, he said, you can practice nutrition, just don't call it evidence-based because there are no good studies on nutrients. And I was like-

Dr. Jeffrey Gladden: That's ridiculous.

Esther Blum: ... you've got to be kidding me. It supported my decision to leave. I certainly-

Dr. Jeffrey Gladden: Okay. So, you wanted to really have an impact, you had a great education, you were motivated, you really wanted to help people, and yet you were just being pigeonholed into a fly-by-the-bed, say a few words, and wish people well. So, you decided to actually try to make a real difference. What did that look like when you went rogue?

Esther Blum: Back in the day, Designs for Health had about four products. Robert Crayhon and Linda Lizotte taught. It was an intensive four-month class. It was eight hours a day looking through all the studies in clinical research and understanding diet therapy that I did not learn at all at NYU, even though the research studies were all there on paleo diets, autoimmune diets, diabetic diets, depression, learning about brain biochemistry, gut function, hormones, putting autoimmune conditions into remission. I left the hospital and worked for Ronald Hoffman in New York City for about two years and always had a side practice. So, after about two years, I was like: “It's really time just to do my thing and not work under anyone else.” It was great. It was really so nice.

Dr. Jeffrey Gladden: And so, when you launched yourself into the practice, what were you going after at that point in time? I take it probably wasn't menopause, it was maybe more helping people with a functional diet approach to their disorders. Is that where you started?

Esther Blum: It's definitely where I started, and I attracted a lot of autoimmune conditions. I did see menopausal mamas, but I didn't know how to treat them as well then as I do now. I also began seeing a lot of mystery, chronic illness, sick-building syndrome, and mold exposure. I was in practice, certainly around 9/11. I did some muscle testing for a while. I studied under Gary Lesneski, who taught me to do some muscle testing. So, it was really just everything under the sun at that time.

Dr. Jeffrey Gladden: Exactly. That's interesting. Let's touch on autoimmunity because we've touched on that before in the program, and I think people are sometimes confused by the idea that what they eat can have a direct impact on their autoimmune disorder. For example, Hashimoto's, thyroiditis, I think he got all these things. Do you want to walk us through some of the insights you have around that when it comes to diet and autoimmunity?

Esther Blum: It's a chicken versus egg situation because we don't know if people truly have gluten exposure or do they have a glyphosate sensitivity. Glyphosate is the roundup chemical that's sprayed on a lot of our crops. And even fields that are organic that are next to nonorganic fields are getting the down winds.

Dr. Jeffrey Gladden: The overspray, the downwind, right?

Esther Blum: And the overspray. But here in, I have so many clients who are autoimmune and can go to Europe and not have a problem eating the food there or having grain exposures because the nutrients that enable that naturally predigests gluten in the grains are still present in those countries. They're not genetically modifying their wheat. We've been modifying our wheat since the 80s, genetically. And certainly, Wheat Belly is a great book for the whole historical perspective on this. In this country, though, yes, I find that eliminating gluten and or dairy, it depends, but really optimizing the integrity of the gut wall is really important, and getting rid of environmental exposures is very important.

Looking at someone's history of Lyme mold exposure, Epstein-Barr, and now COVID, all of those can really impact the gut wall. And so, the goal is to eliminate those chronic stealth infections or underlying H. pylori, which can also cause autoimmune triggers to happen in dysbiosis. The goal is to really heal up the gut and make the body more resilient. If there is a gluten exposure or chronic Lyme, not every house is 100% mold-free, the immune system can handle it long term, and you can live with some exposures in your system really makes a huge difference.

Dr. Jeffrey Gladden: It seems like there are boutique farms and boutique ranches everywhere that are raising grass-fed, grass-finished, whatever it is, and wild-caught this and wild-caught that. Are people doing that with grains? Do we have people that are actually growing these heritage grains in the US in some context where somebody could say, there's a bakery where I can actually go and get the equivalent of European bread? Is that happening?

Esther Blum: Yeah. Gosh, I love that question. Certain bakers do use really good quality sourdough that we can tolerate. There's a baker near me, Wave Hill Bakery, and they do phenomenal. There's great, and I think there's in New York City, there's certainly Blue Hill, another good one. And San Francisco has some good sourdoughs, but it's not like it is in-

Dr. Jeffrey Gladden: In Europe.

Esther Blum: In Europe, where they bank all the seeds. Even Kazakhstan doesn't allow GMO foods. A tiny country like Kazakhstan. It's out of control here. And now, not to be gloom and doom, but it's like the world food supply is controlled by what? There are three large ventures, is it venture capital companies that control the food supply? I want to be accurate in my reporting here.

Dr. Jeffrey Gladden: That I'm not aware of, quite honestly.

Esther Blum: Just a few big companies that control all of our food supply.

Dr. Jeffrey Gladden: I'm sure that's true. Montana always-

Esther Blum: Microsoft.

Dr. Jeffrey Gladden: Well, Bill Gates-

Esther Blum: Microsoft and Bill Gates. He did. And he is making a lot of really processed plant-based foods, which are really even worse for the environment. Regenerative agriculture, which needs cows, is an important part of our ecosystem.

Dr. Jeffrey Gladden: It just strikes me that there's such a need for what I call nutrient-dense foods coming forward with the kind of, it'd have to be on some level boutique, but it could be larger than that. But having really strong nutrient-dense foods. I think part of that would be having some of these; I'll call them heritage-type, not modified grains and things like that. I just think there has to be a massive market for that, as much publicity as there is around all that. So, I don't know.

Esther Blum: I think I found your next business venture, guys.

Dr. Jeffrey Gladden: Probably need to go start a farm.

Esther Blum: It's brilliant. It's really brilliant. It's so important. I agree that nutrient deficiencies are so rampant when you look at our kids, but even adults, it's really epidemic the nutrient deficiencies that we're seeing and how it affects the gut. There's a real lack of biodiversity. I took a flight recently to a conference, and I texted my husband. I was like: “Every single person in line is eating candy with or without; it's either soda or Gatorade.” But everyone had a big size M&M'S, and obviously, they were not metabolically fit people, but I was like, what the heck is going on here?

Dr. Jeffrey Gladden: But you know what, what's interesting is they will be having a Coke Zero or a Diet Coke. Right?

Esther Blum: Yeah, well, that cancels out the calories.

Dr. Jeffrey Gladden: That's a saving grace right there. Well, let's move forward. You started off that way, and then eventually, you major your way into menopause. I don't know if that's figurative or literal, but we can talk that through.

Esther Blum: Yes, both. Yes. I'm currently perimenopausal. It's very interesting. I do cycle, technically, but I don't ovulate, and I'm on HRT. So, this is fun; it's a great place to be because I'm just really comfortable through the process. I'm really optimized. But I came to really focus on it because I was just seeing it more and more and more. I always saw menopause in practice, but I think I attract who I mirror. And so, once I really changed my own messaging to perimenopause and menopause, then the floodgates opened. In my younger years, I saw a lot more PCOS and fertility. But also, when you change your branding and niche down, then, of course, that's who you attract to. I wrote See ya later, Ovulator out of sheer passion. But also, I call it my meno rage because the back of the book has a banner that says gaslight-free zone.

The biggest disservice has been that damned women's health initiative study that jeopardized and deprived an entire generation of women.

Dr. Jeffrey Gladden: Or two.

Esther Blum: Or two, from receiving optimal menopause care. It's not studied in medical school. There's no menopause care. And women go to the doctor. There's not a day I don't hear this horror story of women going to the doctor saying, listing their litany of menopausal symptoms. And the doctor either says: “That's just menopause. That's what it is. So you're stuck with it.” Or they offer a prescription for a birth control pill or offer to insert an IUD. And menopause is not a birth control deficiency; it's actually a hormone deficiency. And replenishment can easily, easily smooth out the bumps, smooth out the ride, and get women sleeping again.

Dr. Jeffrey Gladden: Let's walk through this. You're a woman that's approaching menopause, and before people go through menopause, there's perimenopause, which is a little bit of a no man's land from the standpoint of almost anything can happen. You can have, as I understand it, two periods in a month, go three months without one. There can be hot flashes. It's really kind of anything-goes scenario, and it can be different for a variety of people. As people are going into that perimenopausal space, do you have particular food recommendations or diet or exercise? We can talk about HRT even at this point. Do you want to maybe touch on those things that you've figured out?

Esther Blum: Some of what I prescribe is in studies, and some of it is just having treated thousands of women over the years. I have three Meno-Laws for fat loss. The first is optimizing protein intake. People don't seem to know what optimal levels are. They seem to know what adequate levels are, and adequate levels are what my dialysis patients used to have in the hospital, which was about 60 grams of protein, maybe 70. I heard today on a podcast somebody was, a doctor was saying, take your body weight and divide it in half, and that's the amount of protein you should aim for. That works great if you're obese, to begin with, but not if you are trying to actually build muscle, meaning your optimal level should be one gram per pound of your ideal body weight. So, let's say your ideal body weight is 150; then 150 grams is going to be your target.

For most people, that works out to four to six ounces, three to four times per day. Intermittent fast, if you're only eating twice a day, for example, then you have to really bump up your protein intake at those meals, get 70-

Dr. Jeffrey Gladden: Is there something special about protein in the perimenopausal and menopausal place? Because there is data that shows that in high protein diets long term, people don't live as long because they activate more mTOR. mTOR is activated by amino acids. And so, when you're amino acid-rich, mTOR gets turned on, and then people die sooner and have more cancer. So, people are using rapamycin, of course, to control mTOR. But there is this, in everything in medicine there's always this economy of balance, or in biology, there's this economy of balance. So, what I'm curious about is whether or not a higher protein is something that you have found is particularly helpful in the perimenopausal, in the menopausal area, or what we're talking about here.

Esther Blum: Yes, definitely also follow; if you don't know, Dr. Gabrielle Lyon's work, follow her. I have seen those papers on mTOR totally demystified and debunked. The research I have seen and Dr. Donald Layman's work support higher protein, even as we age. The need is so great we develop sarcopenia and bone loss without optimal protein. And also, body composition research shows a tremendous amount of muscle loss for women once they do hit perimenopause and menopause. And as women, the most, even if we're working out regularly, we can build about half a pound of muscle per month.

Dr. Jeffrey Gladden: I think this is a really interesting point because I think that putting in precursors to body-building protein is one thing. And also, when you look at proteins in general, the vast majority of the protein doesn't actually turn into protein. So, for example, in egg whites, which are the quintessential perfect protein, albumin, only about 48% of the albumin that you ingest actually turns into protein in your body; the rest gets metabolized to carbohydrates. The body and collagen are much less, is like 22%, and branched-chain amino acid is like 6%. So, really, it's not just enough to put in the precursor. As you know, I think having the hormones there that actually activate the machinery that enables the anabolic growth of muscle becomes the other part of this equation. So, it's not just how much protein can you eat per se. And I know hormones are a big part of what you're talking about too.

Esther Blum: Well, and also, when it comes to dietary protein, you need about two and a half grams of leucine at each meal, which equates to at least 30 to 40 grams of protein. You need that minimum amount to convert to muscle tissue. But yes, you do have to have the hormonal support. Women not only need estrogen and progesterone, but in particular, they need testosterone.

Dr. Jeffrey Gladden: Exactly.

Esther Blum: And so, many women they're terrified. They're like: “I'm going to lose my hair. I'm going to grow hair on my chin.” So, I said: “Well, maybe if you're doing pellets or something in a very excess dose.” I, obviously, partner with doctors, and my clients' dosages are appropriate for a menopausal woman. They're at a baseline level enough to prevent osteoporosis, heart disease, Alzheimer's, and cognitive decline. But also, we don't need you to have the hormone levels of a 20-year-old. You don't need to ovulate and support childbirth at this point.

Dr. Jeffrey Gladden: Exactly. There was a really interesting study that I think Kaiser did on 500,000 women. 250,000 of them got any kind of hormone replacement, and 250,000 didn’t. It was interesting to me because, in this particular study, it didn't matter what hormones they got or for how long they took them. They were even using synthetic progesterone, which we know is really anathema, quite honestly, just because it has such great malignancy potential, particularly for breast cancer. But in that study, they showed that any hormone replacement of any type, whether it was estrogen plus progesterone, bioidentical, non-bioidentical, estrogen alone, or unopposed estrogen, which we're not big fans of either. And I'm sure you're not either. But, whether they got any testosterone or not, there was a 30% overall reduction in dementia just for having any hormone replacement at all, which I found really fascinating.

I think in women going through menopause, one of the complaints is: “My brain doesn't work like it used to.” Right? Brain fog and whatever else. Yes, I think diet is critical. I know you're a big proponent of this, is that the hormone getting the hormones optimized is another critical thing. Do you want to talk a little bit about when you think people might start hormone replacement? Is it perimenopause, or what are your thoughts there?

Esther Blum: The benefits of neuroplasticity and growing neurons are beneficial from estrogen, progesterone, and testosterone. All three contribute.

Dr. Jeffrey Gladden: That's right.

Esther Blum: Ideally, yes, perimenopause is what I am trying to get women to understand. Is it okay to bring in bioidentical progesterone as needed because, and again, I test, I don't guess, every woman who is in my practice gets a DUTCH test and a GI-MAP to make sure and blood work to make sure that she is methylating and detoxing these hormones in the liver and the gut. We partner with a functional medicine GYN or MD. So, they're getting their sonograms, they're getting uterine fibroids checked, they're really getting checked. This is not just slapping everyone on it. But bioidentical progesterone, in particular, hits up those GABA receptors in the brain for sleep and for quelling irritability, but also it helps oppose estrogen.

So, women come to me often hemorrhagic, bleeding, massive blood clots. It looks like a scene from a horror movie every month. That's really awful if you're trying to be professional at your job, if you're trying to travel, take care of a family, that's the last thing you need. So, progesterone really calms the situation down, whereas synthetic progestogens have those beneficial effects on the brain at all.

Dr. Jeffrey Gladden: Exactly. Now, in fact, they're counterproductive. So, really, what we're saying here is that, and it's intuitively obvious, but what's fascinating is it's not practiced in typical allopathic offices; their hormones are basically used to control symptoms. “Well, I'm having a hot flash”; take some estrogen. Right? It's like that. It's real; it's not looking at the underlying substrate of really what's going on and how this symphony of hormones is really required in order to have optimal health. And that's going to be controlling, I suspect, your menopausal symptoms, but also protecting your brain, your bones, your muscle, and everything else going forward.

Esther Blum: That's right. And the research shows bone density in particular. So, you can't get the same improvements in bone density without estrogen.

Dr. Jeffrey Gladden: That's right.

Esther Blum: You'll see some benefits with calcium and D and trace minerals, but without estrogen, you're really at very high risk for bone loss and fracture down the line.

Dr. Jeffrey Gladden: That's right. We even like boosting growth hormone intermittently in people with some growth hormone-releasing peptides because that will also build brain cells and neurons and boost bone density.

Esther Blum: That's awesome. The growth hormone is amazing.

Dr. Jeffrey Gladden: If you're listening to this, I think what you want to take away from this is that if your doctor says: “Well, you don't need anything”, that's probably the wrong answer too. If: “Well, we'll just put you on a little bit of estrogen just for a year or two, and then we'll take you off”, that's probably the wrong answer too. So, unless you've got some condition we're unaware of here, I think you want to look for somebody that can play this symphony with you because I think it's that important, quite honestly.

Esther Blum: Well said. Well said. Yes. I repeat, I'm a classic example, and I have many clients, colleagues too, who get their periods here and there, but their tests show it's really time to bring in estrogen, it's time to bring in testosterone, it's time to bring those in even if your periods are waning. It's okay to start as long as you test. You get checked three to four times a year, partner with your physician, and ensure your hormone levels are optimized and that you feel good. That's the key. Women who are in my practice in their 70s and they've been on bioidenticals for the better part of 20 years, and they're like: “I'm never coming off.” Or some have tried to come off and reduce their dose, and their hot flashes come right back. And their doctors check them out, and they're like: “You're in good health, you're a candidate, keep going.”

Dr. Jeffrey Gladden: I will say it is a process. We've treated a lot of women with hormone replacement therapy, and every woman is somewhat different in terms of how that symphony gets played. Some people respond well to DHEA, and some have low-dose testosterone. You put them on estrogen and progesterone for other people, and it throws them for a loop until you find the right combination and ratios, if you will. So, if you're a listener, it's not just walk in, and it'll be necessarily fixed in one visit. It's a little bit of a journey to actually get, and I don't know if you've gone on that journey yourself, but you might speak to that.

Esther Blum: Yes, I always tell people to give it a minimum of three months to really balance out, work out the kinks. Some people take a little longer, but usually, within one to two tweaks, you can surely find your magic cocktail. And if it isn't working, I do have some clients too that have such bad gut issues when they come to see me, a lot of inflammation, pathogens, a leaky gut. And if I put them on all the supplements to support hormones, too, they're going to be on a laundry list, a long list of supplements. I usually will start with the gut in those cases. I have helped eliminate hot flashes, literally just healing up the gut, because there is a subset of bacteria in the gut called the estrobolome. And the estrobolome help the body metabolize estrogen and detox it, so you're not continually reabsorbing it in the gut. Often just fixing the gut is really the start-

Dr. Jeffrey Gladden: How do you nurture that bacteria in the gut? Is there a probiotic that you're using or a prebiotic, or how are you going about that?

Esther Blum: Yeah, well, first, again, you want to kill off the pathogens. I treat everything from C. diff to E Coli to H. pylori. Usually, I will do a kill phase of getting rid of the the-

Dr. Jeffrey Gladden: What do you like to use for your kill phase?

Esther Blum: Oh my gosh. I use a lot of different things. I use mastic gum in high doses. I use a product called Probiotic Plus a lot, which is a broad-spectrum antimicrobial. I have a long list; forgive me, off the top of my head. See there's-

Dr. Jeffrey Gladden: That's fine. Okay. But it's a little bit-

Esther Blum: It's a very intense protocol. I use some Bismef. I'll use some Zinc carnosine. And then, if that doesn't work, sometimes I have to do it. A couple of times, I used biofilm disruptors, which will also help. Our black cumin-seeded oil is also very helpful. And then after that, I will help replenish the good bacteria. Is it just a probiotic? Not necessarily. Some people, for example, are very low in akkermansia, which really responds to. What helps grow akkermansia is those red, vibrant fruits and vegetables, cranberries, pomegranates, strawberries, raspberries, cherries, red peppers, and red apple skins. Some people have a low secretory IGA. And so, for that, Saccharomyces is really beneficial and immunoglobulin. It's really customized to the individual. Often throwing a probiotic really does nothing at the-

Dr. Jeffrey Gladden: Exactly. That's great. I'm really glad to hear you say this because I want the audience to understand that it's not: “Well, I'm just going to go down to the store and take a probiotic, and everything's going to be okay.” It really is a systematic approach, a cleaning out, a repopulating, a maintenance, a healing. All these different features go on to get to where your gut is actually working the way you want it to. That's great.

Esther Blum: And you have to rebuild that slimy mucus layer, which I'll do with a lot of our healing herbs. I love Zinc carnosine, even glutamine. So, feeding the gut is really important. Getting rid of inflammatory foods, sugar, and booze. A lot of people won't do well in this protocol because they don't want to give up booze. And I'm like: “Don't think you're going to heal your gut when you're literally poking holes in it every day with alcohol or grains sometimes for some people or gluten.” So, I try to be as liberal with people's diet as possible, but I'm like: “Learn to be fun at parties without alcohol.” It's really what you need to do to heal your gut.

Dr. Jeffrey Gladden: Yeah, exactly.

Esther Blum: I'd be like: “I would drink many cocktails every day if I had my druthers, but my gut does not want me to do that, so I got to listen.”

Dr. Jeffrey Gladden: I think it's a good point. I was even going to ask you about how alcohol fits into your gut protocols because whether it's autoimmunity or gut health in general, or certainly, menopause, what we find is that we've never been able to heal somebody's gut if they continue to drink. We just have never been able to do it. And that's even if they're drinking once or twice a week. It's one step forward, two steps back, or two steps forward, one step back. It's just like you can never really get them where they need to go. I don't have anything against alcohol at all, but I quit drinking some years ago, any alcohol, just because I didn't feel good the next day. It disrupted my sleep, and my runs the next day were not as fun or as good. So, I think it's really interesting that people have this relationship with alcohol. I would think that symptoms of menopause may be exacerbated by drinking. Is that part of what this is?

Esther Blum: Yes. I'm so glad you brought this up. Yes. So, alcohol increases your levels of circulating estrogen for up to six hours after each cocktail. And if the liver, so if you're on hormone replacement or if you're in an estrogen dominant state, you're going to be in an estrogen dominant state 25% of your day when you're just having one cocktail. So, it can absolutely exacerbate your symptoms. But then your liver also, your liver needs to decide in the pecking order, “am I going to detox alcohol, or am I going to detox hormones?” Well, alcohol is more damaging, so let me clean that out first. So, then your hormones are just lying around like: “What about me? Wait, I need to go.” And they're just stuck hanging out. So, it's really not beneficial. And you'll find if you're prone to breast tenderness or irritability on your hormones, it's going to totally exacerbate the situation.

And just so you all know, I'm a human, not a robot. I definitely got into bed with some diet Coke this summer. I'm not going to lie; it's just an old college favorite of mine. And man, come PMS, I don't know if there's a camera if you show this podcast online, but I'm putting my hands across my chest, ladies, okay? Because I'm like, my boobs killed me all summer, any week that I drank. So, I was like: “Forget that, man.” We all fall from grace, but then you just get back on the horse.

Dr. Jeffrey Gladden: Everybody falls from grace. Nobody's perfect. It's not about perfection. It's really about progress, really. I think that's really interesting. I think a lot of people, and here's the point, they get on a regimen for the gut, they get on a regimen for hormone replacement, and they're not getting the results that they want. And really, part of it can be self-sabotage, right? With alcohol, with the wrong foods, with the wrong things they're drinking, whatever else. And so, listening to this, you really have to think that you're going to partner up with somebody, and they're going to ask you to do some things or not do some things, and those are going to be as vital as what they give you. In fact, what they take out is going to be as vital as what they put in. So, just understand that that's the collaboration you're entering into here.

Esther Blum: That's right. I'll say this, too, I'm a real type-A. People think I'm very relaxed and low-key. I'm like: “You have no idea who I am.” But I'm very type-A. Well, now I'm on fire because, obviously, we're doing a podcast, and my energy is up. I'm not low-key. And so, for me, what I loved about alcohol was it got me to chill the F out. So, what I did instead was, right? I started using herbal tinctures, really calming tinctures, some lemon bombs, some lavender, and some holy basil, putting that in my wine glass instead. And doing a little thing called meditation has been transformative in stress management, sleep, creativity, and being really grounded and happy, and relaxed. That is something I really work a lot on with my clients. Here are the meditations I do, you're welcome to find your own. There are so many free apps.

I love Insight Timer, but you can use anyone you want. That's also important to reshape the fight-or-flight center in the brain so that you can manage your stress in other ways other than alcohol.

Dr. Jeffrey Gladden: There's another thing that happens for women, and what you're touching on here is important and triggered this thought for me. There's another thing that happens for women as they go through menopause that I've seen and heard is that they feel that they start to become both invisible and irrelevant because they feel like they're not as sexually attractive, necessarily, or they're not as relevant from the standpoint of being able to conceive or have children or their kids are growing up. And so, I've had numerous conversations with people around this because it's really a framing issue. It's like: “No, you can be more relevant than ever. You can be more attractive than ever.”

But there does seem to be a scenario here where people start to buy into that. I think that leads into a loss of purpose. And then it's like: “Well, what the heck? I may as well have that drink. I may as well do that. Who cares?” People get depressed, anxious, and all these kinds of things. I would also like to get your take on all that because I think it's important.

Esther Blum: I'm so glad you did.

Dr. Jeffrey Gladden: Okay. Well, great.

Esther Blum: I would say confidence is an inside job. No one's ever going to give it to you.

Dr. Jeffrey Gladden: That's right.

Esther Blum: You've got to really understand what makes you feel in your power. Maybe it's how you dress yourself at any size, even if your weight is not where you want it to be. There are plenty of amazing stylists or department store staff who are happy to help you rock yourself out. But also knowing your purpose in this world and what you're doing for yourself, your family, and your community, changing lives, really standing in your power, and owning who you are. And what I loved about the pandemic was a lot of women couldn't go to hair salons because they couldn't, hair salons were closed, or just everyone was too masked. And a lot of women started letting their hair go silver and being natural. I feel like that was such an empowering move for women; just really start reclaiming themselves.

I'm grateful for the platforms out there. There are now a lot of celebrities going big with their platforms through menopause. I think that's giving a lot of women permission to say: “I can redefine this. I don't have to look my age.” And as I always tell my clients, like: “You're 52; you're not dead.” I'm 52. I'm not sitting here thinking I'm old and washed out and dried up. I can't wait to be done with my period and have freedom and spontaneous sex and be able to not have to carry a menstrual cup with me every time I travel. It's really flipping it on its head and thinking not about what you're losing but what you're gaining and what you now have space to deal with. One other thing is, for me, the greatest gift has been losing my filter too and just being like: “I'm coming out. This is it. I'm not being shy about what I think or say anymore.” I think if every woman really embraced that, we'd all be in a really powerful place.

Dr. Jeffrey Gladden: I get that. I feel that energy for sure. I think what this is pointing to, if you're listening to this, is that you really need to have a comprehensive strategy. I think a lot of people probably go through menopause the same way that men go through andropause, which is, it just shows up, and they just weather the storm, as opposed to actually anticipating. Hey, this is coming. How am I going to deal with it? What am I going to do? How does my purpose change? How does my sex life change? How do I find love, joy, safety, peace, and everything that I want more than I've ever had in this new phase of my life? I think it comes down to if you're asking the right questions, you can find those answers. But if you're just going along riding the bus and you hit that pothole, it's going to feel pretty disruptive. I don't know.

Esther Blum: That's right.

Dr. Jeffrey Gladden: Do you have strategies for people about all that?

Esther Blum: Yes. Well, if I want to finish the last two Meno-Laws for fat loss, and then let's talk about strength training too. The other two Meno-Laws are on having. Earlier, we talked about optimizing protein intake. Law number two is to have your protein intake higher than your carbs. A lot of women come into menopause with higher carb, low protein, flipping those ratios really supports insulin sensitivity and ultimately fat loss, gets cravings under control, and the high protein does raise dopamine and serotonin for the brain: so better cognitive function, and better adrenal support, better energy throughout the day. So, if you're having, let's say, 150 grams of protein per day, you can have 100 to 120 grams of carbs per day, depending on your workout schedule, higher on your workout days, but just having the ratios be better.

If you track it in a food logging app after three days, you'll understand that I'm either hitting my targets or not, and I need to flip my ratios. And then law number three is to have carbs at night. And most people are horrified when I say this; they're like, are you kidding me? I'm going to get so fat. I'm going to gain all this weight. The research actually shows that protein by day and carbs by night is beneficial because you're more insulin sensitive at night. But I love to use carbs at night because they give you, and I'm talking quality carbs, right? Sweet potatoes, winter butternut squash, some quinoa, vegetables, fruits, and nutrient-dense foods. But we are more carb-sensitive or insulin sensitive at night. I mentioned that, sorry.

The bump in insulin is going to tamp down cortisol. And a lot of women in menopause go through cortisol spikes at night with their insulin resistance. So, it makes a big difference in their sleep. So, locking in your diet is really important. Weight loss can be a little more challenging in perimenopause than in menopause because your fluctuating estrogen levels are going to change up to 30% on any given day. So, you are on a bit of a rollercoaster ride, but you can absolutely get a handle on the situation. And then walking to lower cortisol, ideally outside first thing in the morning, to really regulate your circadian rhythms and help bring your stress down. And then strength training two to three times a week is really, you don't need to do four to five times a week like you did in your 20s. The recovery just isn't as quick in your 40s and 50s.

But strategic strength training can do wonders for also boosting your testosterone levels and really optimizing your blood sugar control. So, to me, weightlifting is, and I've seen research to support it, it's better than metformin, so it's a no-brainer.

Dr. Jeffrey Gladden: I think resistance training is important. We also like cardiovascular training in our world simply because VO2 max is directly associated with longevity, decreased risk of cancer, heart disease, et cetera. So, making sure that people get cardio in there as well. I think many people like to go to the gym and have a trainer that likes to put them on the weights, but we test people for VO2 max and anaerobic threshold routinely. It's really interesting to see that people will say: “I'm getting plenty of cardio. My trainer has me doing this. I'm in Orange theory; I'm doing that.” And it's like: “Okay, great, well, let's see what you're doing.” We put them on the bike, and their VO2 has gone down. And it's like: “Well, I don't know if this is exactly what you want.”

Building that VO2, at the same time, you're building muscle, building that heart muscle, and that vascular resilience is absolutely critical. Because heart disease is still the number one killer, and it's the number one killer of women after menopause. Strength's important, but cardio is critical, too, from our perspective.

Esther Blum: Part of me, too, wonders if the statistics on women and heart disease and mortality also aren't correlated with a deficiency in estrogen because women are not getting it. I would love to see women who are on HRT study to see what their cardiac risk mortality is.

Dr. Jeffrey Gladden: Well, it's a good point. Vascular senescence, which is a driver of atherosclerosis, is worse without hormone replacement. But, interestingly, glucose and insulin drive cellular senescence, as does growth hormone. Really it's playing this symphony. It's not being doing one thing all the time. It's almost like your menstrual cycle. Your estrogen's high, your estrogen's low, your progesterone's on, and your progesterone's off. And so, really cycling through these phases even after menopause can be helpful in terms of giving your body, right? You're on it; you're off it kind of thing. We think that there's wisdom in that. Cool. I'm intrigued by the tagline on your website: “Make menopause your bitch.” I guess the question is, I'm sure that resonates with your audience pretty strongly. They must really get a kick out of that. Do you feel-

Esther Blum: Most do, although I did get some hate mail about it. I was like: “Clearly, I'm not for you, honey, because this is always me.”