How Insulin Resistance Affects Women in Perimenopause

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Lara: This sort of idea that it's absolutely fine to routinely put young women on a medication that suppresses their hormone production. I mean, for decades now, I've just found that astonishing, that that's where we ended up. It would be like saying to young women, you don't need ovulation. Basically, you don't need your own hormones until you're ready to make a baby. It would be like saying to men, look, you don't need testicular function or testosterone until you're ready to make a baby. So we're going to shut that down. And then we're going to replace your testosterone with this medication that's kind of like testosterone, but really more like estrogen. And it's going to affect everything in your body, including your brain and your metabolic health. And it's fine because that's what we do. So that's where women are at at this point.

Nikkiey: What's going on, everybody? Welcome back to The WarriorBabe Show. Or if this is one of your first episodes, hey, you are here on a good one. I'm really honored to have Lara Briden joining us here today. She is a renowned naturopathic — I always stumble on saying that word — naturopathic doctor, author and women's health advocate. She's got over 25 years of experience in women's health, and she's become a leading voice on the power of natural solutions for hormonal health and menstrual wellness and all of that good stuff. You know we like to talk about all of this stuff on this podcast. So I'm really excited to have her here and to dive into her wealth of knowledge on how women can navigate hormonal changes and thrive at every stage of life. So, Lara, first, welcome to the show.

Lara: Hi, thanks so much for having me. It's great to meet you.

Nikkiey: Likewise. So you've been a naturopathic doctor — see, I just have to say it once and then I can say it.

Lara: Yeah, you've got it.

Nikkiey: You've been a naturopathic doctor for over 25 years, and you've become a strong advocate for empowering women and getting them to understand their bodies more. So what sparked your interest in this field, and how has your approach evolved over the years?

Lara: Yeah, that's a great opening question. I started out as an evolutionary biologist. So way back, I actually published a peer-reviewed paper on sex differences in foraging behavior. Looking back, I realized I was very interested in female physiology from almost day one as a biologist. And then I realized at some point I really wanted to work more with people. So I trained as a naturopathic doctor in Canada. I'm Canadian, even though I live in New Zealand, so it's a little bit confusing for people. And when I started in general practice, 25, 27, whatever years ago it is now, I was in a small town in Canada just treating everyone.

And I still treat everyone potentially. But over the years, I had more and more experience with women, and particularly with women with menstrual problems, with perimenopause, hormonal problems. As you can imagine, because back in the 90s, they really weren't getting solutions from anywhere else. So I got to learn early on that what I'd learned as a naturopathic doctor, a lot of the nutritional approaches, work incredibly well for female health. So then I was able to eventually harness that into the three books that I have. My first one was Period Repair Manual, which was almost 10 years ago now.

Nikkiey: Yeah. Thank you for sending me those books too. I can't wait to dive into them. So you mentioned a nutritional approach. I cannot wait to pick your brain on that because, as I shared with you very briefly prior to us hitting record, women that listen to this podcast are 45 to 65 years old and they're going through menopause or are prior to it. And I always firmly say nutrition is king and exercise is queen. But a lot of people really struggle with the nutritional aspects, so I can't wait to pick your brain on that.

Lara: Mm-hmm.

Nikkiey: So let's talk about metabolic health first to kick it off. You often talk about metabolic health as a whole-body project. So can you explain why addressing metabolic dysfunction requires a holistic approach?

Lara: Yeah. You must have read my mind, because it's early morning here in New Zealand, and as I was getting up and having my coffee, I was thinking, I need to do a social media post on whole body versus a very prescriptive approach. Because of course we do see out there, it's like, all you need to do is boom, boom, boom, one, two, three, and you're good. And then people do those and they're like, hmm, actually I'm not good. There's still something going on.

So a whole-body approach is very much in Period Repair Manual, my first book. I put forward the concept of fix your health and you'll fix your period. Basically, menstruation in many ways is an expression of general health. I would say that's true also for perimenopausal symptoms to some extent. And that's definitely also true for metabolic health. I've been having conversations with fellow naturopathic doctors lately, just talking about how it's like every other condition. You treat the person and you treat metabolism.

By metabolic health, in my book Metabolism Repair for Women, which is really all about metabolic health, I'm primarily talking about the very common problem of insulin resistance or metabolic inflexibility. That's what I mean by metabolic health. The term is much broader than that, and it does encompass a lot more than just insulin or the specific metabolic hormones. But I do take the approach in that book of, okay, you need to look at the whole person. And I list about 24 different metabolic obstacles. For that individual, what is the thing that's standing between them and their current position of potentially metabolic inflexibility or difficulty losing weight or chronic fatigue, fatigue symptoms, whatever you want to call it, tendency to low blood sugar? What's standing between where they're at and their birthright, where the body wants to be, which is to be metabolically flexible, to be metabolically healthy? There's always a way back. In the book, I call it the road home, and it's there for everyone, and it's not going to be the same road for everyone.

Nikkiey: Yeah. So there are traditional ways you could go about it, but what I love about naturopathic doctors is you guys focus on the holistic side. Like what you just said, there could be disruptions in certain processes in our body that are causing the whole body to be out of kilter. Why would addressing these metabolic dysfunctions require a holistic approach?

Lara: I'll give you a really concrete example, straight out of my work with patients — all my books came straight out of a couple of decades of conversations with patients. A big metabolic obstacle is gut health. So people can be perfecting their diet, dialing in whatever they've decided is the best exercise for them. And meanwhile, they've got something called SIBO, or small intestinal bacterial overgrowth. And that generates a lot of inflammation. That situation in the gut causes something well known in science called metabolic endotoxemia, which is a gut inflammation driver of insulin resistance.

So certainly I've had patients for whom maybe they're doing everything else right, and I'm just like, let's just fix your gut. And we do that. And then, in one of the patient stories in the book, she's like, oh, my afternoon sugar cravings that plagued me for years, that I was having to use willpower for years to withstand, have just disappeared. In her case, that's what it can be like when fixing one thing reverberates through the system and fixes the whole system.

And it's not always that simple. I'm certainly not saying for every single person it's a gut issue. This is what I mean by troubleshooting. Some people, their gut is fine. Some people, it's going to be something else entirely. But gut's a really common one, which is why I often do talk about it in interviews. And also an interesting thing about gut problems: it's one mechanism by which ultra-processed food, particularly ultra-refined carbohydrates, tend to drive or promote insulin resistance or metabolic dysfunction. Of course, there's the way they stimulate blood glucose, but it's more than that. I think it's actually that ultra-refined carbohydrates can ferment in the gut during SIBO and generate a lot of intestinal permeability and inflammation. So I actually think for some people, if they go lower carbohydrate or cut some of those refined carbohydrates, they're treating their gut as the primary mechanism by which they're treating their metabolism. That's just one example.

Nikkiey: Got it. I love that example. I think a lot of people can totally resonate with that. It's like, okay, if I'm dealing with gut issues, or I recognize that my gut is off, then I take a holistic approach, which kind of comes into this next question that I have for you. Because it is a complex interplay of lifestyle factors that can correlate to metabolic dysfunction in a human being. So this is where I want to pick your brain: how do nutrition, exercise, sleep and stress management all work together to create a foundation for metabolic health, and why is it so critical to address them as interconnected pieces of the same puzzle?

Lara: Yeah. Well, I'll talk a little bit about the nervous system now as another example. Obviously everyone agrees diet is important, but it's important for various reasons. I'm sure we're on the same page. It's not purely just calories, obviously, and it's not even purely just macros. There's a lot going on with diet. So I do talk about food sensitivities in the book. And of course, many people don't have food sensitivities, so that's not an issue for them, but some people do. And for people who have, for example, a dairy sensitivity, which I do talk about in the book, that could be creating some mast cell activation or histamine response, and that interacts with the immune system. And that can, in part, dysregulate — it's sort of a two-way street, actually — something called the autonomic nervous system. I'm currently working on some new content on the autonomic nervous system. Your listeners probably know a little bit about that. This is the parasympathetic versus sympathetic balance in the body.

Nikkiey: Meaning like fight or flight.

Lara: Yeah. And we need both sides, actually. In fact, the sympathetic nervous system, or the adrenaline part of the nervous system, is actually quite important for metabolic health and fat loss as well. So we need both, and we need this kind of balanced oscillation between them. People might be tracking their heart rate variability. That's what this is a marker of, right?

Nikkiey: I love my HRV. I got it up to 160 when I sleep.

Lara: Okay. Right. So HRV is a pretty close to direct measure of the state of your autonomic nervous system. And a lot of people have things going on with their autonomic nervous system. There'll be things upstream that have dysregulated it. I used food sensitivities as one example, but there are lots of others. And that actually has a huge impact on metabolic health, and certainly on blood sugar balance.

A lot of young women in particular can get blood sugar crashes from mild autonomic dysfunction. I sort of knew, but until I started working on some of this recent content, I didn't actually realize how widespread mild autonomic dysfunction is in women, especially in girls, young teenagers, and then into women's early 20s. They do get a lot of blood sugar instability from the autonomic nervous system. And that's very different from what 45-year-old men might be getting from insulin problems. They're very different situations.

I forget your original question, but the autonomic nervous system is another really good example of a place where diet affects it. Stress affects it. Circadian rhythm affects the autonomic nervous system. Lots of things do. And then that, in turn, definitely feeds into blood sugar control and energy balance. It actually directly feeds into how much energy you burn on a day-to-day basis. It affects hunger to a large extent.

So in chapter four of my new book — because I'm a biologist, I had to explore the biology of metabolic health, of course, even though it's complex — early in that section, I talk a little bit about embracing the complexity, in the sense that no one, not even practitioners, has to fully understand every single nuance or gear that's happening in this complex thing that is metabolic health, because that would be impossible. And we can't micromanage every single aspect of it, every single hormone. We talk about leptin and glucagon; there are just so many hormones. But by embracing the complexity, we can take away this understanding that by addressing one thing, like avoiding a food sensitivity, for example, you can have all these knock-on effects. You affect your autonomic nervous system, and you therefore affect your energy-burning systems. You affect your sleep. You affect everything else downstream from that. So that's the idea.

Nikkiey: Yeah. So to unpack that a little bit, you mentioned the nutritional aspect of things. It's not just calories, it's not just macros. It's also understanding that if we have sensitivities to things, becoming aware of them means we can remove them, and that can play into the fix, essentially. So that would be one stream of the nutritional approach: trying to figure out the puzzle pieces, which symptoms are occurring in somebody that they can address to make their metabolic health better.

Lara: Yeah.

Nikkiey: I'm going to get to this maybe in the next question, but there are some things people should start to recognize if maybe something is off. How would somebody know their gut health is off or they have SIBO?

Lara: Yeah. Well, some of it will obviously be from symptoms. I have quite a big section on SIBO in my new book. I mention it in all my books, but in my latest one I do the biggest discussion because it's just so common. A lot of people with irritable bowel syndrome possibly have SIBO as the underlying diagnosis really. Irritable bowel is such an umbrella diagnosis. It's really describing all sorts of different things.

So some people can just tell by symptoms, and I do list the symptoms of all the different potential metabolic obstacles in the book. But some people may also need the help of their clinician to troubleshoot or dial in what might be the best place to start. As in all my books, I have little sections on how to speak to your doctor about a particular issue, or how to find out if you have gluten sensitivity. And I don't want to overplay the food sensitivity thing, because it's probably not even the most common obstacle. But it's one that gets missed, and it's one that I've had good results with in my patients.

Nikkiey: Yeah, totally. I would love to continue down that path, but I'm going to make sure all your books are linked, so everyone can go in if they're interested in reading them and diving into a little more of what you're saying here, and be able to read the symptoms or have confidence talking to a doctor if they recognize anything that seems to be a little bit off. But one last question on this topic, because I think this is a good example. A lot of people always ask me, Nikkiey, bring more gut health conversations to the podcast. If somebody has SIBO or irritable bowel syndrome or something that's off in their gut, how can that play a factor in them not getting the results they want? You mentioned insulin resistance. You mentioned metabolic inflexibility. If those things are off, it's going to be harder for somebody to lose weight, right?

Lara: Well, yes, quite simply. Anytime we try to really simplify something, it's to some extent oversimplified. But I will just say the main feature of insulin resistance, which affects at least 40% of the general population, and certainly a much higher percentage of older people, is chronically elevated levels of the hormone insulin. And one of its many, many effects is that it basically prevents fat loss. It makes it much, much harder for the body to access body fat for energy. And that has a two-pronged negative effect: one, it's harder to burn fat, and two, it's harder to get that body fat for energy between meals.

And one important thing is that, as humans — our mitochondria are another player in all this — our cellular energy's preferred baseline, fasting energy source is fat. Obviously, after a meal, we're going to burn whatever was in the meal, including carbohydrates. And we do have glycogen, or carbohydrate stores, to tap into, especially with more strenuous activity. And as you know, we're always burning a mix of fat and carb. But in a healthy, metabolically flexible, non-insulin-resistant state, we should be burning about 80% fat in the resting, fasting state. We should be tapping into body fat, like, no problem, I've got all this. Even someone who's not overweight has a lot of fat stores to burn for energy. That's how we're designed, and that's how we're built.

So to lose access to that — that's one of the main ways I would characterize insulin resistance. It's the state of being trapped in carb burning, not able to access the fat that your body would really like to have, not just for body composition reasons, but because it needs that energy. And so one of the symptoms of insulin resistance is not being able to go very long between meals, getting quite fatigued and reliant on carb snacking just to get through the afternoon, or potentially to get through the night.

Like I said, I'm working on some new content around such a common problem of people getting hypoglycemia overnight and needing to snack at midnight. If that's what's happening with your physiology — I'm sure you know this from the work you've done with women — when someone's having hypoglycemia or is really hungry or really fatigued, willpower cannot help them at that point. They're past that point. The treatment needs to be upstream from that, to improve the energy supply to their cells in the first place.

Nikkiey: Totally. It's like a cry from the body that it needs to address something internally.

Lara: Yeah. You can't withstand it. We're animals, right? This is where my work as a biologist comes in. When your cells are starving for energy, as they can be in insulin resistance, and they need you to eat a granola bar, that can become pretty much non-negotiable at that point. That's not something people can resist by saying, oh, I really shouldn't. The cells are like, we're in trouble here. We need more energy.

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So going off of this, if women want to improve their metabolic health, how do they start? I mean, people should get tested first and foremost. I just got tested recently, and I'm hopping on a podcast in an hour and a half where we're going to read my results. It's really important to get tested, first of all if you're recognizing the symptoms that you're having. But from there, how can somebody improve their metabolic health, and where would you recommend they start? What should they prioritize first, even if they don't get tested?

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Lara: Right. So I agree. I do a lot of testing with my patients. You have to know what you're testing for, have specific questions. One of the things I talk a lot about in the book is how to test whether you have insulin resistance, which is essentially the metabolic condition we've been talking about. I'll just make one takeaway for everyone: a normal blood glucose, even a normal HbA1c, cannot rule out insulin resistance, because it's actually a condition of chronically elevated insulin. So there are other ways to look for that. That would be step one, to figure out if you do have insulin resistance.

And then I'll talk through what I would say are the next couple of steps. Step two would be to accept, or truly believe, that it is possible to have more energy and feel less hungry. That's the metric, that's the goal. That's the proximate goal people are aiming for, even before the number on the scale changes or anything. I think the only way back — the road home to metabolic health, as I call it — is to fairly early on in the process have more energy and naturally feel less hungry. And you'll have seen that working with women: if you're doing the right things for that individual, that will kick in, and people will be like, oh, this is actually — that's why it's sustainable, because actually I feel a lot better.

And then step three, which I had to spread out over two chapters, would be getting what you need. We are biological creatures. All of us do have a number of non-negotiable requirements. That would include social connection of some form — it looks different for different people. That would include a healthy circadian rhythm. There is a lot of science suggesting that a misaligned circadian rhythm is a major driver of insulin resistance. So that's an easy one: using light and the timing of meals to make sure you're aligned with the 24-hour cycle of your time zone.

And then I have a whole section on getting what you need nutritionally. We talked about all the different ways that food will influence metabolic health. Another big one is actually getting enough of the micronutrients. Macros are important as well. I'm a big fan of getting enough protein. My section on food starts, very early on, with get enough protein. That's an easy way to give your body something very important that it is looking for and needs. But even beyond that, there are all these missing micronutrients in our modern diet. And arguably that's potentially a big part of the problem for a lot of people: our diet is to a large extent stripped of nutrients that our fairly recent ancestors had. And a number of them directly support metabolic health. So again, I would consider them non-negotiable. I do talk about supplementation. I call them the five missing metabolic nutrients. There are more than five that are missing, but those are the big ones when it comes to insulin sensitivity, I think.

Nikkiey: Which ones are they? What are they?

Lara: Yeah, I'm happy to give the five. People don't have to buy the book to get the five. Magnesium; the amino acid taurine; choline — choline was a big one we used to get from organ meats. I'm old enough to remember back when liver was on the weekly rotation in my home when I was a kid. Inositol is another one we would traditionally have had from organ meats. People might know inositol; it's a very popular supplement for insulin resistance and polycystic ovary syndrome, or PCOS. And number five is glycine, which is also from animal foods. Glycine is the main amino acid in collagen, so a lot of people take glycine as collagen. You can also just take glycine on its own. So all five — magnesium, taurine, choline, inositol and glycine — support mitochondria, directly support metabolic health via several mechanisms, and also support sleep and do other good things.

Nikkiey: Love that. Thank you for sharing. I'm excited to dive into your books, and like I said, I'm going to link them. There's so much I'm hearing from you now, saying it's in the book, it's in the book. I'm really excited to see the specifics on the topics we're talking about and dive a little deeper into them.

So I'm going to put a pin in metabolic health, because I want to chat a little about something I think will resonate with some of the listeners. The books you've written are really impactful in helping us better understand our bodies, and one of them is your Period Repair Manual. There are so many myths and misconceptions around menstruation that women have grown up with. So from your perspective, what are the most harmful myths about periods that you've come across, and how can you debunk them here with us on the podcast and help women understand their menstrual health a little bit better?

Lara: Yeah. Great question. Well, the number one thing is a weird paradigm that we've got locked into in the last 70 years: this idea that ovulation is not important. Ovulation is obviously the release of an egg, and we think about that for making a baby, of course. But it's the main event of the menstrual cycle. The bleed that comes two weeks later is really just an inevitable result of ovulation. Once you ovulate, you're either pregnant or you have a period.

And ovulation is not just to release an egg, though. It's actually the engine of the menstrual cycle. It's how we make our two main hormones, estradiol and progesterone. Men are quirky in that they make their testosterone every day. Reproductive-age women make their hormones on a monthly cycle. And when I say 70 years, that's really how long the pill has been around. It switches off ovulation and replaces menstrual cycles with this induced withdrawal bleed, which means nothing. Actually, there's no medical reason to bleed monthly on the pill, because it's just mimicking something.

So this idea that it's absolutely fine to routinely put young women on a medication that suppresses their hormone production — for decades now, I've found that astonishing, that that's where we ended up. It would be like saying to young women, you don't need ovulation. Basically, you don't need your own hormones until you're ready to make a baby. It would be like saying to men, look, you don't need testicular function or testosterone until you're ready to make a baby. So we're going to shut that down, and then we're going to replace your testosterone with this medication that's kind of like testosterone, but really more like estrogen. And it's going to affect everything in your body, including your brain and your metabolic health. And it's fine because that's what we do. So that's where women are at at this point. I know that's maybe quite strongly worded, but —

Nikkiey: I'm just like, what are we doing? What is happening?

Lara: And so of course, I'm curious to get your feedback, but I think we're now finally breaking through. There are more and more young women just going, no, I'm not shutting down my ovulation. Fortunately there are other methods, and more methods are coming, where women can both reliably avoid pregnancy and also keep their own menstrual cycles, their own hormone production, which, to put it in context from a metabolic perspective, is beneficial. Our own estradiol that women make is anabolic. It enhances insulin sensitivity. As I talk about in my third book, estradiol is to a large extent a metabolic superpower, and young women have it naturally. That's to a large extent what actually shelters young women from insulin resistance — unless they shut it all down with the pill. And I'll just say the medications in hormonal birth control are usually not estradiol and progesterone. They're never real progesterone. There are a couple of pills that use body-identical, or real, estradiol, but most of them use a different medication called ethinyl estradiol, which does not have the same benefits for any part of the body, really.

Nikkiey: First of all, I commend you and welcome those strong opinions on this podcast. I am down to have conversations, and if we have opposing views, you have your opinions, I have my opinions, we both have perspectives, and we can have a conversation around it. But this perspective I completely, 110%, agree with you on. From a very young age, I watched my stepmom struggle with getting pregnant, and we thought one of the reasons was that she'd been on birth control. It could have been other things too, but she was on birth control from a very young age. And from that, I remember I was probably 14 years old, maybe even younger, and I made the firm decision right then: I'm never going on birth control at any point in my life. And I never have.

Actually, I lie. I had to take it, and I nearly had a conniption. I had to take it because I froze my eggs, and it was part of one of their strategies. I didn't have to do it the second time, but the first time I had to take it for seven days. The first day, I recorded on social media, I was like, I am freaking out. I promised myself when I was 13 years old I would never take this. But I firmly agree with what you're saying, because you're putting fake hormones into your body when, on a monthly basis, we already generate so many of these amazing hormones that we need to produce. So I hear you, and I agree with you 110%.

I actually did a solo episode where I talked about this, and I had a lot of feedback. People are, I think, waking up a little bit more to this perspective, and many women struggle with symptoms when they're discontinuing hormonal birth control. So from your perspective, first of all, what's happening during this transition, and how can women best support themselves through it?

Lara: Well, first of all, I wrote a whole book on that. Period Repair Manual is basically how to get your own cycles back without the pill. So what's happening? Again, there's always a danger in saying something simply, because there are always other aspects to it. But in simplest terms, a takeaway would be: pill bleeds are not menstrual cycles. Whatever the regular pill bleed has looked like for the last 10 or 15 years, however long people have been on a combined estrogen pill producing regular bleeds, that means zero in terms of what the underlying menstrual cycle might be like.

So with my own patients, if they're wondering what their periods are going to be like when they come off the pill, my first question is, well, what were they like before you went on it? Because that's essentially what we're going back to, keeping in mind they're older and their diet may be different, and there may be some things that have changed. But we do have to unmask the real menstrual cycle and see what is happening there.

One of the concerns people might experience is that they stop the pill and then their induced pill withdrawal bleeds stop. And they're like, oh, my period stopped. But it's like, no, you're now just giving your body a chance to see whether it can have a menstrual cycle. So lack of cycles or irregular cycles is one of the possibilities coming off the pill. Others are pain or premenstrual mood. We could spend a whole episode talking about all the troubleshooting you can do around that.

But taking the example of the period not coming, when I'm working with my patients, one of the most useful things I find is to ask how many years of cycling did you have before you went on hormonal birth control? Because it does take a number of years, actually up to 12 years, which is quite interesting, to fully mature the menstrual cycle. In the first couple of years, a 12-year-old girl's bleeds can be quite irregular. That's sort of normal. They're usually what's called anovulatory. In those days there'd be a lot of estrogen, but no progesterone coming online, so they'll often be heavier. But over time, if all is progressing normally, they should become regular and start making a lot of progesterone, which lightens them and reduces pain and various things.

And that maturation process is important. So I'll ask, how many years of actual cycling did you get under your belt before it was all put on pause? Because that will help tell us what it's potentially going to be like now. And even though I've just said it takes 12 years to mature the cycle, the body's pretty resilient. I have found that for patients who've had even two or three years of cycling as a young teenager, coming off the pill at 32 or so will be a much easier road. Their body will often figure out what it's supposed to do a bit more easily.

Nikkiey: Awesome. I appreciate that insight. I know that's going to help a lot of people who may be in that stage of life, or questioning or wondering if they should come off it or not.

I want to come back to insulin resistance really quick, because a lot of women experience hormonal changes during perimenopause and menopause, and those often affect insulin sensitivity and metabolic health. So specifically, how do these hormonal changes during that time affect insulin sensitivity?

Lara: Yeah. So the perimenopause transition, especially the later phases of it, when cycles start becoming genuinely quite far apart, is associated, according to the scientific literature we have so far, with major metabolic upheaval. In my perimenopause book, Hormone Repair Manual, I talk about the recalibration of the whole system. There's definitely a recalibration underway with the metabolic system. It does push everyone towards insulin resistance. How deeply they go into it will depend on all the other factors, like how at risk of insulin resistance they already were.

The mechanisms by which that happens are, again, several. It's first losing progesterone — progesterone is a player in all this too. And then losing our main estrogen, estradiol. Not losing it entirely, but it does reduce significantly. And that's a double whammy, because we just talked about how estradiol normally enhances insulin sensitivity. It's a superpower that women of reproductive age have. And the drop in both estradiol and progesterone also lets testosterone shine through a lot more.

So I will just say, for what it's worth, there's a sweet spot with testosterone. Testosterone is an important hormone that women have as well. But we do have a sweet spot, and there can be too much testosterone in women in a couple of scenarios. Polycystic ovary syndrome, or PCOS, is one example. There's also a kind of relative testosterone excess that happens in perimenopause. That directly promotes insulin resistance in women and promotes hypertrophied visceral fat. So there's this redistribution of fat from the bum, that kind of estrogen fat, to the inside of the belly, up under the rib cage, that visceral fat. I talk about that quite a lot in my third book. So that is happening to everyone to some extent. There can also be changes with thyroid hormone.

And there's one other mechanism, just to tie it back, because we talked about the gut quite a bit earlier in the interview. One of estradiol's many, many benefits is that it reduces intestinal permeability. It actually thickens the mucus lining in the gut and changes the microbiome. So another effect of having to adjust to a lower amount of estradiol is increased intestinal permeability, or metabolic endotoxemia — that thing I mentioned at the beginning where inflammation from the gut drives insulin resistance.

So the struggle is real. It's definitely real. Some women in their 40s get lucky, I think — and maybe it's not just luck — if they're super healthy already, like maybe athletes, they potentially won't notice this as much. And I also talk about in Hormone Repair Manual that our ancestors probably didn't have to worry about this too much. A lot of the shift into insulin resistance is in the context of our modern environment, including environmental toxins and the modern food environment, which is already pushing the whole population collectively into insulin resistance. So then you combine that with what happens in perimenopause, and yeah, it's very real.

Nikkiey: Yeah. First of all, the focus on hormonal changes has become so much louder over the last couple of years, and I love that so much, because I think women specifically need to understand this a little bit deeper and what's going on with their bodies so they can take a little more control. For so long, personally, the narrative and the testing and all the things have been around men. There are so many studies around men, and it's like, about time women are stepping up. And I appreciate you and the work that you do, because it's bringing more of this insight and knowledge to the table, so women can better understand this, learn about it, and take action on whatever they feel they need to do for themselves.

So with that being said, you mentioned lifestyle factors, toxins and all that stuff. What role do all of those lifestyle pressures and stress play in driving insulin resistance? Because I think women think, oh, I have insulin resistance, this is my fault, this is what I did to myself. There's self-blame. But what role are all these other things playing?

Lara: Yeah, for sure. Great question. You'll notice chapter one of my latest book is called Metabolic Dysfunction Is Not Your Fault. The role the modern environment plays is massive. But I do want to put that in context. It's not just in the current moment. Unfortunately, it's been happening for a few generations. There's exposure to environmental toxins — one scientist estimated environmental toxins probably account for about 15% of the epidemic of insulin resistance we're seeing now. The food environment is probably responsible for a lot of the rest of it. Some of that food environment could be things like emulsifiers and ultra-processed food, which I go into in some detail, and high-dose linoleic acid, which is another concern I have. That's more on the topic of what this massive shift to vegetable oil has been doing over the past few generations.

So over the past few generations, something's been going very off the rails with metabolic health. And that is being passed on to future generations by something called epigenetics. I don't want to get too complicated, but what happens to us in utero, even what happened to our parents or grandparents before we were born, from a metabolic perspective, does get passed on. This is why we now have kids with insulin resistance and teenagers with fatty liver disease, which was unheard of even one or two generations ago. So it's amplifying every generation.

This is what I mean by it's not your fault. Some people have unfortunately been born very metabolically challenged in this respect. Their blueprint was laid down to be more vulnerable to insulin resistance, not through anything they did wrong, or really through anything their ancestors did wrong. The food environment you live in is the food environment you eat. That's what we consider normal food. So it does mean some people have to work a lot harder at it now, which, as I acknowledge in the book, is just not fair. It's not fair when you see some people walking around saying, oh, all you have to do is this little bit of exercise and you're fine, and you can have a little bit of junk food and it doesn't matter. Some people are facing a lot more. Some people have to make stronger choices going forward. And there's a chapter quite late in the book on food addiction. That's probably about 20% of people, maybe, really struggling, who have some degree of challenge with their brain and nervous system that they potentially have to overcome. So I hope that answers your question. I forget what the question was.

Nikkiey: Yeah, just about how it's not your fault.

Lara: It's not their fault. People haven't done this to themselves. They've been born into a world where this is happening.

Nikkiey: No, that's a good answer. I believe that too. It's generational and it dates back, and taking things on in the uterine environment totally makes sense.

So we touched on a lot here. We touched on metabolic health and nutritional approaches at the beginning. We talked about periods. We talked about a lot of good stuff. I have your books here — I didn't get the period one, so I'm going to try to find it, because I'm interested in that. We went through various different things here, and we all present unique shifts, whether it be hormonal or dealing with insulin resistance or what have you. So there have got to be some foundational habits or practices that serve women well across their entire life. What are some key routines, dietary habits, lifestyle adjustments or self-care practices that you believe every woman should prioritize to maintain hormonal balance through the different phases of her life?

Lara: Well, as you say, there are so many. A lot of this is in my latest book, in the getting what you need chapters. I'll start with social connection, because we are social animals. We really are. And that's true even for those of us who are introverts. Our body really loves to spend time around people and get that interaction. So I think that's important for a lot of people to prioritize.

For other lifestyle things, I'm choosing some of the ones that in my book I talk about as the easy fixes. I rank every metabolic obstacle by high or medium priority and difficult or easy. So with anything that's high priority and easy, I might start with that, because you can get a lot of mileage. And once you start feeling better by correcting one of those metabolic obstacles, the feeling better makes it a lot easier to tackle some of the harder ones.

So, again, I mentioned it already, but circadian rhythm is just such an easy — I don't really use the word hack — such an easy thing normally. Depending on what latitude people live in, getting outside in the morning, getting some outdoor light, is huge for people. It can be hard if you work full-time. I get that. But if you have time, take your coffee outside on the deck, or take your dog for a quick walk before work. Or in winter — I know you guys are heading into the shortest days there — I think there is potentially value in getting a full-spectrum light of some kind. Certainly when I'm back home in Canada in the winter months, I like having that hit of full light, preferably by seven or eight, to signal to the whole body, including the nervous system, the mitochondria, the microbiome, everything, that it's daytime now.

So that's an example. Sheltering from blue light at night, timing meals, protein. The timing of protein can really signal circadian rhythm as well. That's one of the many values of having protein in the morning. This is why I'm a little bit nervous about fasting through the morning hours, because then we miss that opportunity to get that protein —

Nikkiey: Preach that.

Lara: — to tell our nervous system.

Nikkiey: Loud and clear here, Lara.

Lara: Yeah. So I'll just share with you, I'm a meat-for-breakfast person. And I have been seeing feedback from a lot of people saying that one thing, finding a way to eat proper protein in the morning, can be a game changer. You probably find that with your clients. I realize steak for breakfast is kind of one of the latest things out there.

Nikkiey: Yeah. Steak and eggs, baby.

Lara: And I would agree with that. I'll offer some troubleshooting tips around that, because I eat leftover meat for breakfast, whatever's in the fridge from the night before. That's usually what I'll have. The timing of that is going to depend so much on chronotype. Some people are ready for breakfast at 7 a.m. Some people are not. It depends on your lifestyle. If you work from home or have the time for a slower start to the morning, then meat by 8:30 or 9 might suit — that's what suits my nervous system.

But some of my patients and followers, when I say meat for breakfast, are just horrified. They're like, I can't face that in the morning. And then it's usually one of two things. Either you're trying to do it too early — I don't think most people want meat at 6:30. And the second thing is the state of the digestion. When the digestion is healthy and the circadian rhythm is aligned, then digestive enzymes kick in. So being hungry for some animal protein, or being able to eat that in the morning, is actually a good sign. So sometimes with my patients, I'll be like, well, let's troubleshoot your digestion, or your nervous system, and find out why you're not ready for protein in the morning. If people really can't face meat, they could do protein powder or something like that.

Nikkiey: Egg whites?

Lara: Yeah.

Nikkiey: Love that. Good stuff. So I took away connection with people, circadian rhythm, and potentially putting in some meat, or definitely getting some protein first thing in the morning, not intermittent fasting or fasting in the morning. It's good when we're all on the same page, talking to other experts like yourself — that's what you see works for people.

Lara: Yes. Totally.

Nikkiey: So as we wrap up here today — again, thank you so much for the work that you're doing. I appreciate all that you're putting out into the world. It's so important for women to understand their bodies more and more. As we close, what is the core message you hope readers and listeners take away from your books and everything you share about women's health?

Lara: One of my takeaways is that women's health is not as complicated or mysterious as we've been led to believe. As I said, I'm a biologist, and I started out looking at female physiology pretty much as the normal version of human physiology. So female physiology is logical. It works. And understanding that can help us trust our bodies. That's actually one of the final lines of Period Repair Manual: trust your body, play the long game. Your body wants to be healthy.

Nikkiey: Oh, that's beautiful. I love that. Well, Lara, thank you so much for coming on to the show today. I'm going to link all your books below. Is there anywhere else anybody can find you?

Lara: Yeah, I'm easy to find. My blog, which is also the home of my podcast — just short, 10-minute explanations of things — is at larabriden.com. And all my social media is @larabriden.

Nikkiey: Awesome, Lara. Thank you so much for your insight, your knowledge and your education on this topic. I appreciate your time being here with us.

Lara: Thank you. Thanks, Nikkiey. It was great to meet you.

Nikkiey: Bye-bye.

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