How to Navigate Menopause: Protein, Carbs, HRT and Lifting

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Esther: Eating carbs at night, and whole food carbs. I'm talking sweet potatoes, some rice, lentils or beans if you tolerate them, or white potatoes. I'm a real food gal. But pairing those with protein and fiber, A, you're going to get a lower insulin bump. But the goal is to get a little bit of an insulin bump because it's antagonistic to cortisol, and it will raise your serotonin and dopamine and really help you feel calm and relaxed and sleep. The benefits are this, right? If you're not sleeping, if you are waking up like a lot of perimenopausal women do, especially the second half of your cycle, because your progesterone really takes a nosedive. So you're lying awake, your cortisol is up, and your blood sugars are all over the place. You will be insulin resistant and pre-diabetic within two weeks. I mean, it really happens quickly.

Nikkiey: What is going on, everybody? Welcome back to the show. Today's episode is one you surely do not want to miss out on. Joining us is a well-known integrative dietitian, holistic nutritionist, and a recognized authority on women's health, especially in navigating the complexities of menopause. She's a bestselling author whose books, including the acclaimed Eat, Drink, and Be Gorgeous, have transformed the way we think about nutrition, wellness, and living life to the absolute fullest. Her approach is not just about eating right. It's about embracing a lifestyle that brings balance, joy, and vibrancy, especially during the menopausal years.

So I am super stoked to introduce the wonderful Esther Blum. Am I saying that last name right, Esther?

Esther: You nailed it.

Nikkiey: Amazing. A true menopause expert and guiding star in the world of holistic health. Esther, welcome to The WarriorBabe Show. I am stoked to have you on here, and excited for you to share your wisdom, your insights, and all of the things around menopause.

Esther: Thank you. Thank you so much for having me, Nikkiey.

Nikkiey: For sure. So let's dive right into it. Like I was telling Esther right before we hit record, I just selfishly want to know more about you and your journey. Why did you get into the field of nutrition and holistic health, and what inspired you to pursue this type of career?

Esther: It's pretty wild. I came from a long line of physicians and nurses and dietitians. My grandfather, Harry Blum, who lived till he was 105 and a half, was the tonsil king of Brooklyn. He did surgery till he was 80 and practiced four days a week as an ENT in Brooklyn till he was 95 and a half. He had an operating room in his house in Flatbush, Brooklyn, and that is where I had my tonsils taken out. He had a 12-bed pediatric recovery room, and he had two adult beds where Al Capone's henchmen would regularly come to him and get their noses fixed after they'd been knocked out. So he had an incredible career and was such an amazing healer and did house calls. My father was a dermatologist, also a good country doctor who did house calls. And my mother was a nurse and worked with postpartum women.

So health was just part of my vernacular, in my DNA. We grew up at the dinner table talking about anything and everything. But I didn't want to go to medical school. I was like, the hospital's a jealous mistress. I could not handle four more years of medical school plus residency. I definitely wanted to balance life. So I pursued a degree in clinical nutrition because it is pre-med undergraduate minus the physics. I suck at physics. And it's a little less chemistry. My grandfather was like, what the hell are you doing? What do you mean you're not going to be a doctor? You're never going to be a success. You're never going to make any money. I was like, you watch me, man. You watch me. So he was alive to see some of my early success, which was great.

So that's my story. That teardrop-shaped thing on my bookshelf behind me is my father's lifetime achievement award that he got when he was 89. Every day I walk in and see that teardrop, and it's nose to the grindstone. You're here to help. You're here to show up. You're here to serve. So that's what I do. It's very humble, but also very powerful to be serving women in this incredible time when menopause is finally getting its due.

Nikkiey: Oh, man. Full body chills there. I love that. As you mentioned, it was ingrained in your DNA and it's just passed along, just wanting to fill the need of helping people in the world.

Esther: Yeah.

Nikkiey: I love that. Okay, so let's dive in. You're super well-known and highly respected for helping women navigate the challenges they experience with menopause. Can you share with us your nutritional approach specifically for menopausal women? How do you make them feel like rock stars through menopause?

Esther: Okay. First of all, if you're listening to this and driving, I just want you to know I have a book out called See You Later, Ovulator, which really highlights how to master menopause through nutrition, hormones, and self-advocacy. So if you don't remember all this, it is in the book.

But first we start with diet and lifestyle, because you cannot out-hormone a poor diet and lifestyle. You cannot out-supplement a poor diet and lifestyle. And let me tell you, in midlife you can no longer write checks that your body cannot cash. Nikkiey, you're the queen of macros, so I know you get the importance of macros in a woman's diet in midlife.

Estrogen and progesterone start to decline. Your ovarian reserves are winding down. Eventually your production of hormones, of DHEA, testosterone, progesterone, estrogen, switches from your ovaries to your adrenals, where they eke out just a very small baseline of hormones to keep you actually moving out of bed and thinking somewhat clearly. So you cannot screw around with diet and lifestyle anymore. You have to do everything you can to support your adrenal health, to help your ovaries push out that last amount of hormones. And you also want to make sure that you're preventing the insulin resistance and the premature heart disease and loss of bone and gray matter in the brain that happens with the decline in hormones. So diet is a really natural, simple, easy way to start.

What most people don't realize is that from perimenopause onward, we lose the most amount of muscle in the shortest amount of time if we're not optimizing dietary protein and doing strength training. Most women are very challenged in this arena. They're actually really under-eating protein and overeating carbs, and we have to flip those ratios. Most women in my practice come in eating 60 to 70 grams of protein a day, tops. And I'm like, you do realize this is what my dialysis patients ate in the hospital? This is by no means going to build muscle or help sustain bone density or your mental health.

So I really like to get women up to 120, 130, 150 grams of protein. That is the goal. But even getting women to 100 grams a day is where we first start, because it's so intimidating. They're like, I can't eat all this food. It's too much for me. I'm like, just try. Just start tracking and let's see where you go. The myths around protein intake and bone loss and kidney disease have all been debunked. You can read about that in my book, Cave Women Don't Get Fat. I have all the research and studies in there.

So just make sure that you're optimizing your animal protein as well. Now, a lot of people who are plant-based say, well, what? I'm a vegan or I'm a vegetarian. I do not work with vegans in my practice because I cannot get the clinical results and the muscle-building effects the way I can with animal proteins. And I have found most women who were previously vegan do resort to eating some eggs or dairy, at least in perimenopause, because their blood sugar can no longer stabilize without the presence of animal protein. So we do want to get animal protein. There are so many amazing companies now that sell pastured organic meat and eggs. You can get sustainable seafood online as well.

So you want to make sure that you're getting at least 30 to 40 grams of protein at every meal. That is the minimum threshold you need to get enough of the amino acid leucine to support muscle growth. Quite simply, 30 to 40 grams is roughly four to five ounces at a meal. So take the palm of your hand, get a food scale. You buy a pound of meat or chicken or fish, divide it in thirds. That's your portion size. It's really pretty simple. That's step one.

Step two, my second mental law for fat loss, as I mentioned before, is making sure that your protein ratios outweigh your net carbs. We don't penalize for fiber here. Most women, when they come to me, are eating 150 grams of carbs and 60 grams of protein. If we flip those ratios, I like women to get, pardon me, 120 grams of protein and 100 net carbs. That's when you see a really favorable situation for fat loss and the burning of fat, because your blood sugar is stable and your insulin is stable. Now, let's say you're a really lean person or you're doing heavy, heavy weightlifting. Then you could do a one-to-one ratio of carbs to protein quite easily, or have more carbs on your lifting days. And if you're not sure what your blood sugar and insulin look like, you can wear a continuous glucose monitor and start really playing. But what gets measured gets managed. So tracking macros is key. Again, I know I'm preaching to the choir.

The third piece of the mental laws for fat loss is having carbs at night. Most people are like, what the hell? I can't do that. I'm going to gain all this weight. I'm not having carbs near my workout window. For menopausal women, with progesterone and estrogen and testosterone declining, comes a bump in cortisol, and often that bump in cortisol comes at night. Especially if you're a screen surfer at night, or you've got teenage kids who have a ton of drama, your cortisol can bump at night.

So eating carbs at night, and whole food carbs, I'm talking sweet potatoes, some rice, lentils or beans if you tolerate them, or white potatoes. I'm a real food gal. But pairing those with protein and fiber, A, you're going to get a lower insulin bump. But the goal is to get a little bit of an insulin bump because it's antagonistic to cortisol, and it will raise your serotonin and dopamine and really help you feel calm and relaxed and sleep. And the benefits are this. If you're not sleeping, if you are waking up like a lot of perimenopausal women do, especially the second half of your cycle, because your progesterone really takes a nosedive, you're lying awake, your cortisol is up, and your blood sugars are all over the place. You will be insulin resistant and pre-diabetic within two weeks. It really happens quickly. So I'd much rather you get ahead of it, have some carbs at dinner, sleep through the night, and have your blood sugar course correct that way.

And my ladies still lose weight this way all the time. They're so terrified to eat carbs, especially if they've gone keto to get the fat off. But most women I've seen, and I've been doing this almost three decades, do great on keto for about three months. It gets some of the hot flashes under control. And then they do need to add in some carbs long term. The adrenals just can't handle it. The thyroid just can't handle the lack of carbs at this point in time.

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Amazing. Thank you so much for sharing those three points. There's so much in the industry about which carbs, and women fear carbs. They look at it as it's going to make them fat or derail their progress in terms of getting the composition that they want. I wonder if so many people's heads are going, carbs at night? You're telling me carbs at night? I don't think many people have ever heard that before. So I appreciate you elaborating on that.

Esther: Well, you know who taught that to me was the late Charles Poliquin. He taught me this back in the late '90s. He was like, no, you have to have carbs at night. And I was like, well, if the world's greatest strength coach is teaching me this, I'm cool with it. But it really makes a big difference. And I eat honey on rice cakes with salt before I go lift. You've got to fuel your lifting sessions. Then you have a better lift. The insulin goes right in, so you're set. It's amazing.

Nikkiey: Amen. You're speaking my language. When you say all these things and then you have an amazing guest come on the podcast saying the same things, it's like, yes, everyone's going to hear it. Fuel your workouts. Do not starve your body and think you're going to feel good. You're not. You're just not.

So to that one point, really quick, to unpack it even more. There are tons of women in our community who are morning lifters. They wake up and go to the gym within an hour, and they're like, I don't want to eat anything because I'm not hungry, or I feel like I'm going to get sick when I'm working out. What would you advise those women to do to still get that food in their system for the lift?

Esther: If you make a protein smoothie, I would have half of it. Smoothies are great because they're just really digestible and easy. Put in a banana and some protein powder and just get something in. But I agree. I switched my lifting to afternoons now. I'll do an hour walk in the morning and then around 4:35 go hit the gym, because I can get way more food in my system before then. But if you really don't have time and you don't have flexibility in your schedule, then I think half a protein shake is great. Or whatever your breakfast is, just have half. If you have eggs and oats, that's fine. Or if you really can't, just a couple spoons of honey and some salt. Just getting something in you will be helpful.

Nikkiey: Amazing. Love that. And I love that you touched on the protein intake too. There are a lot of women who come into our community at 60 grams a day and they're not getting the results that they want. And then they're saying that it's so hard to get in the protein. I'm like, well, choose your hard here. Do you want the decline of muscle mass to continue as you age, and not fuel your body with what it needs in order to maintain and build muscle mass, and all the things that come along with that? So I appreciate your tips on that.

I want to dive into one more thing. Can you elaborate on the hormonal changes that happen, and the symptoms, so that women are aware of when perimenopause happens? So many women are like, well, am I going through it? I don't know if I'm going through it. So what are the symptoms they're experiencing and the hormonal changes that are happening? And then how can nutrition help to mitigate some of the symptoms associated with these changes?

Esther: What women don't realize, and what we're not taught, and what our doctors aren't teaching us, is that perimenopause happens 10 to 15 years before menopause. The average age of menopause is 51 years old. So women in their mid-30s. I've had women go from literally having a baby right into perimenopause. And so we are undertreating women. When I say we, I mean the collective medical society, not me personally, obviously. Practitioners are putting women on Zoloft, putting them on birth control pills, because they're having either postpartum depression or PMDD, or they're just having a lot of sleep issues.

If you find that the second half of your cycle is radically different than your first, you're probably in perimenopause. If you find you have insomnia that second half, hot flashing, some vaginal dryness, extreme irritability, I call it meno rage, or extreme sadness or depression. If your boobs are killing you, if you're having crime scene periods, super heavy clotting, those are all symptoms of perimenopause. Joint aches and pains, brain fog, any cognitive changes. Also noticing if you were pear-shaped before and all of a sudden you're turning into an apple, and your muffin top has turned into a cake top, without you changing anything in diet and workout. Intolerance to HIIT training or really long, hard cardio sessions. All of those can indicate, hey, you know what? I'm starting to go into early perimenopause.

And diet can certainly combat it. Those three days in your cycle where you feel like you could eat anything and anyone, line up steaks on the counter and snort them all up, or line up chocolate chips and snort those all up. When you double your protein on those days, when you really have a giant steak or a big piece of fish at your meal for those three days, that's going to absolutely get you over the hump of those blood sugar swings, the irritability, the insomnia, because a lot of insomnia is blood sugar issues. That makes a big difference.

Cutting out alcohol. Most people think, oh, it's one o'clock and I've got PMS, so I can have my wine and chocolate. That's actually going to worsen the situation. And believe me, you're talking to the girl. My first book has a picture of a lady in a cocktail glass. I have a whole chapter on hangover recovery in Eat, Drink, and Be Gorgeous. So I'm always in a cocktail state of mind. But alcohol is just such a bitch with hormone changes and menopause and your liver. Anytime you have a drink, you remain in an estrogen-dominant state for 25% of your day. Your liver is like, do I detox alcohol or do I detox hormones? Well, alcohol is a class one carcinogen, so I'm going to hit that up first. So it's like, okay, hormones, pause, please. I've got to get alcohol out the door first, and then I can go back to moving hormones through your liver again. So all of those diet and lifestyle things can make a huge difference.

And also managing your stress. As little as 10 minutes of deep breathing or meditation every night can actually lower your cortisol at night. When my clients are like, oh my God, I can't sleep and I'm on my hormones, I'm like, well, are you even breathing? Have you even calmed down your nervous system and told your nervous system it's safe to just breathe and relax? We have to incorporate all of these things. It's never just the hormones doing the heavy lifting.

That being said, for those of you mamas who are in perimenopause or having wicked PMS: A, getting your diet straight can do wonders for your blood sugar. B, you can add in something called vitex, or chasteberry, weeks two to four of your cycle. This is a natural herb to get your progesterone levels up. That can sort of hold you until you actually need to start progesterone. That can also be super beneficial. Or there's another herb called maca, which can also help with hot flashing and adrenal support. So there's a lot you can do through lifestyle to mitigate your symptoms.

Nikkiey: So good. Back to the alcohol thing. We could totally unpack that and have a whole other podcast just on that topic. But thank you for pointing that out, because there are women who have a glass of wine every single day, or they're great with their workouts and their nutrition throughout the week, and then all of a sudden it falls off kilter on the weekends and they're having more than one glass of wine or vodka or tequila, and they wonder why they're not getting the results. So pinning that. I'll have to bring you back on the podcast and we'll do that in the future.

But what I want to segue into next is HRT. Could you elaborate on the benefits of hormone replacement therapy, HRT, and what positive impacts it can have on women, particularly during the menopausal transition?

Esther: First, I'm going to teach you how to find a hormone-literate MD, because only 4% of women, Nikkiey, are on HRT worldwide. There's going to be over a billion women in menopause by 2030. So it's really simple. If you're listening to this in the US, Google compounding pharmacy for your state or compounding pharmacy for your zip code, call the pharmacy and ask what hormone-literate doctors are running hormone prescriptions through your pharmacy. That's a really great way to do it. You can also go to ifm.org, the Institute for Functional Medicine, and check for a hormone-literate doctor. But call the office and make sure they're giving bioidentical hormones.

I'm not a fan of pellets. There are some research studies on them, very few, and the side effects are many, and it's very hard to control and regulate pellets. Most women don't need that high of a dose. We need microdoses.

What is crazy about HRT is that the benefits are so many, and doctors are taught, and I know this because I've heard it from doctors at my functional medicine conferences, to fear hormones. Which is crazy, because the FDA has approved bioidentical hormones that you can get at your pharmacy. So it's really bizarre. The gap is so strange.

It started from the Women's Health Initiative study that was done 20-plus years ago, and it was done using conjugated equine estrogen. So synthetic estrogen derived from the urine of pregnant horses was given to women 10 years post-menopause, who already had an increased risk of coronary artery disease, were overweight, and had many health risks, and they were not given any opposing progesterone or testosterone or DHEA. Well, hormones are a symphony. They're not a solo act. So the study was so poorly designed, and the interpretation was even worse. The study said, oh, the risk went up from four women in 10,000 to five women in 10,000 who can get cancer and blood clots from this. So they pulled all of it off the market. They pulled women on HRT off their hormones, and decades of women have been deprived of hormones since then.

So we're finally getting it back. The data has been re-evaluated and reinterpreted, and hormones have been shown to be safe for a minimum use of 10 years. I do believe the wall is finally falling on that limitation, where people are using them long-term, because when you take a woman off hormones, often all her symptoms come back. All the vaginal dryness, all the hot flashes, all the changes.

So the benefits of hormones are quite simple. Cognition. Estrogen, progesterone, testosterone all contribute to different aspects of cognitive function, memory, and mood. So imagine what the implications are for keeping women, and it's mostly women, out of memory care units. Brain degeneration starts 20 years prior to Alzheimer's symptoms showing up. So what happens 20 years prior to a woman's 70s? Her 50s. Menopause. And she's not put on hormones.

By the way, you don't have to wait until you've been menopausal for one year to start hormones. I get my perimenopausal women on hormones, some of them in their 30s. And I'm certainly not fully menopausal, and I've been on hormones for years. I'm very late perimenopause, but I've still been on hormones for years. So A, cognition, preservation of gray matter in the brain. You think about a woman's quality of life.

Number two, cardiovascular health. Hormones in women and men prevent plaquing in the arteries. They keep insulin levels stable. They control cortisol levels as well, because again, you're in a place of homeostasis. And I want to talk about intermittent fasting and homeostasis too, but we can come back to that. So again, keeping vascular health solid and offsetting the risk of coronary artery disease. And women are so frequently misdiagnosed when they're having a heart attack or a stroke because they don't present with the same symptoms as men.

Number three, bone density. Women who do not receive estrogen replacement therapy within the first 10 years of menopause have a tremendous risk of bone loss and fracture. Hip fractures are one of the leading causes of death in people over the age of 65. So you think, how can I give someone strong bones, prevent hip fractures, keep them out of a nursing home, and reduce long-term costs? I could put them on hormones that are approved by the FDA. My progesterone is less than $4 a month. So $36 a year to help me have quality of life. It's so ridiculous versus the cost of a hip fracture, the surgery, the rehab, the long-term infections, death. It's so silly. It's so backwards how we don't have this right.

The other piece of hormones that I want to mention is preventing the genitourinary symptoms of menopause. And this is through the use of vaginal estrogen. Number one, pelvic floor. Certainly no one taught me about pelvic floor health after childbirth. My bestie was like, yes, sex is going to hurt for a year after you have a baby. I was like, oh, okay. And it did, because guess what? My pelvic floor was completely screwed up. No one told me anything about it or taught me how to relax it, for God's sake. Or a lot of women get a very weak pelvic floor. They pee the rest of their life when they sneeze and cough after childbirth. That is not right.

Number two, you can get clitoral atrophy. No, thank you. I actually want to have an orgasm past the age of 55. And all you need to do is put topical estrogen on the clitoral and urethral areas. And number three, you prevent UTIs. Think of your grandmothers and your mothers in nursing homes with UTIs, with dementia, and then they die. This is all preventable with a little swab of some vaginal estrogen and systemic estrogen.

Nikkiey: My mind is exploding right now. A little background: I spent nine years in the healthcare field. I spent five years working as a CNA inside of a nursing home, taking care of every patient that you're speaking about right now. And then I spent four years working in the emergency room. It blows my mind. I had Dr. Cabral on the podcast a couple of weeks ago.

Esther: Me too. So much.

Nikkiey: And I was just unpacking his brain about the traditional, conventional way, and it was very insightful to hear his responses. Like you said earlier, it's just so backwards. How are we not diving into the science more around the hormonal aspects of people, especially women, and working from the inside out to heal those, so that the longevity of life is there and prime for people, rather than the traditional conventional way of just shoving medicine down people?

Esther: Yes. Well, the first thing you have to do is remove barriers to access, because there are still black box warning labels on estrogen saying it causes cancer. So let me clear up that myth too.

Nikkiey: Hey, just want to drop a huge appreciation to you guys listening to the show. It means a lot. I hope you're enjoying it, and there's so much more to come. If you are enjoying it, hit the subscribe button. I'd appreciate that tons, and it would help this podcast reach others who need to hear these messages too.

Esther: That's oral estrogen, synthetic estrogen and synthetic progesterone, AKA the birth control pill. Number one, that is not treatment for menopause. Neither is an IUD. Because the synthetic estrogens, yes, do have a higher risk of stroke and clotting. However, transdermal estrogen does not, and you're on a microdose. And vaginal estrogen: the Framingham nurses study looked at women using it for 18 years, with zero increased risk for cancer. It is safe for women getting cancer treatment because it's such a microdose that stays localized. So getting women topical estrogen, you can have it compounded at a pharmacy as a biest cream, or you can get it covered by insurance as an estrogen patch that you change twice a week. Easy peasy.

And then oral progesterone is a far better solution than a synthetic progestogen. Synthetic progestogens are found in IUDs and birth control pills. Well, what mechanism of action do they have in the body? Their mechanism of action is to suppress ovulation. That means they keep your progesterone levels rock bottom. So you take a perimenopausal woman who's already dying of PMS, feeling like a psychotic bitch, and then you keep her progesterone low. Forget it. It would be a murder scene in my house with that situation every month. And they don't hit the GABA receptors in the brain. You need bioidentical progesterone to really light up the GABA, the serotonin, the dopamine in the brain to keep your mood happy, to keep you calm, and to keep you sleeping.

It also tames estrogen, so you're not getting those blood clots. You're not getting those crime scene periods. If you're having crime scene periods, your progesterone production is not robust enough in the second half of your cycle. So it's a real biomarker. That's why when doctors say, just stay on the pill all month, I'm like, you actually need a cycle to understand what's happening in your body. It's actually a marker of health. And again, you can get this at a regular pharmacy. It's covered by insurance. It's called Prometrium. It's that simple.

And then option three is transdermal testosterone. Now, testosterone is not FDA approved for women. Right now you have to have it made at a compounding pharmacy, unless, here's the loophole, your doctor approves your use of testosterone, and then your doctor can use it as an off-label use. So you can get it at about a tenth of the dose of what is prescribed to men, like a testosterone gel or cream that you can run through the pharmacy. That's kind of a backdoor loophole. And vaginal estrogen is also FDA approved, so you can get that from a regular pharmacy too. All of this is here for us, and we're not utilizing the system.

Nikkiey: Wow. Thank you for elaborating on that and sharing those insights. So one follow-up question: obviously, to know how to treat anything that is low, if someone has low estrogen, low progesterone, low testosterone, DHEA, cortisol, blood sugar, A1C, what are the essential tests you would recommend women undergo so that they understand their hormonal baseline going through this phase of life?

Esther: Yes. Again, I do have this all in my testing and treatment chapter in See You Later, Ovulator, but I'm going to lay it out for you. I run three tests in my practice. Number one is blood tests, and you can run these through your insurance company. I look at inflammatory markers. I've worked in cardiology units for five years, so I'm going to check out your A1C, your fasting insulin and glucose. I'm going to look at your homocysteine, your apolipoprotein B, and your lipoprotein(a). I want to see what your cardiac risk is like. If your insulin levels are starting to creep up with a deficiency of estrogen, what's happening? Of course, I'll look at cholesterol and triglycerides too, and particle size matters. It does.

I also love to run a complete thyroid panel. TSH is a very poor excuse for a thyroid panel. You still need T3, T4, reverse T3. You need TSH. You need to see if you have antibodies, any Hashimoto's, because the thyroid can get really wonky during perimenopause. Hormone replacement therapy can change thyroid function. So you want to make sure your thyroid is really checked out. I will look at red blood cell magnesium and zinc. I'll look at B12 and folate.

You can also check your FSH and LH to see where you are in perimenopause or menopause. A lot of doctors are like, I'm not going to bother checking your hormones in your blood because they're going to fluctuate all over the place. And they are. You're going to have a 30% differential in hormones on any given day. Doctors at the functional medicine conferences I go to go back and forth on whether you should test blood versus urine versus saliva. Blood is still a decent standard, in my opinion. It's a way to look at where your hormones are at least circulating in your bloodstream. Saliva is great at looking at tissue saturation.

I use the DUTCH test. That's a dried urine test for comprehensive hormones. I like this test because it gives me an idea of your ratios of hormones to each other, and it lets me know how estrogen in particular is moving through your liver. If you're having any issues with phase one or phase two detoxification, I want to support those. If your methylation is poor, I want to support that. It helps me understand: do I need to support you with B vitamins? Do I need to support you with glutathione? Do you need taurine, trimethylglycine? There's a whole treatment pathway correlated with your test results.

And that's really important, because women who have a family history of cancer are terrified of hormones. They've been taught to fear hormones and not go near them. That doesn't need to be the case, actually. If you think about it, these hormones have been in your body your whole life. So just because you have cancer doesn't mean you can never look at a hormone again. It means you've got to support your detox pathways. You've got to look at your lifestyle. You've got to look at genetic pathways. And obviously work with a really hormone-literate practitioner. I have plenty of women who've gone through cancer, who still have a tremendous family history, and they still go on hormones because they're monitored carefully, looking at their labs.

And this is why I do the third test also, which is the GI-MAP. That is a stool test that looks at your microbiome and at phase three detoxification in your gut. You don't only move hormones through your liver. You've actually got to poop them out through your gut. If your beta-glucuronidase is high and you're recycling your hormones in your gut and you're not pooping every day, guess what? You're going to have real issues with estrogen dominance, bloating, breast tenderness, irritability, weight gain. So you've got to make sure you get all your checkpoints done.

I do this on every client who comes into my practice, because I'm like, don't even think of starting hormones until we figure this out. If you've got poor detoxification, if you've got fatty liver, if you don't poop every day, fix those first. You don't just say, start hormones, this is going to solve all your problems. If you poop once a week and you go on hormones, guess what? You're going to feel a hell of a lot worse. You're going to have a lot of side effects. Or if you don't detox well, listen, your breasts will never feel more tender and enlarged. They're going to walk in the room five minutes before you do. So you've got to make sure that you're detoxing well.

Nikkiey: The imagery, right?

Esther: Yes. Picture walking in first. Tits up, tits up, got to get them up. And the other thing is, I'm losing my train of thought, but you really want to make sure that your hormones are moving through. They should be coming out every day. What goes in goes out every day.

Nikkiey: Yeah. I love that you touched on that: you first have to highlight what's going on before you treat. You can't go into treating something when you don't know the whole story behind it. You can't put someone on hormones without knowing exactly what you're treating. So I love that you brought that back. And it's pretty cool hearing you say how everything's all connected. Hormones are connected to the gut. This is really the way my brain works. You're really healing from the inside out. If you heal from the inside out, you get the results that you want to experience, but you've got to focus on the internals first to get everything working for you instead of against you, especially in this phase of life.

So, I know we wanted to put a pin in intermittent fasting and homeostasis, and I want to bring that back. But first I want to talk about supplements. It's all connected. You spoke to the nutritional aspects and HRT. And you get tested to figure out which hormones are off kilter and how to treat from there. And nutrition is just hands down above anything and everything. If you can pinpoint that and be consistent with it, it can solve many, many things. But with all that said, when you have the results of anything that may be off kilter, what are some supplements that you generally recommend?

Esther: The first thing I do is treat the gut. If someone has hormone dysregulation or poor detoxification pathways in the liver, I may treat that first, but ultimately I heal the inflammation in the gut because that solves a lot of problems. Number one, you're digesting and absorbing your nutrients. Leaky gut equals leaky brain. A lot of women are like, oh, I have all this brain fog. It's easy to think, well, she's estrogen deficient, so she has brain fog. But if we don't heal our gut wall, our intestinal wall, you're not going to make the neurotransmitters. You're not going to think clearly because you're not digesting and absorbing your nutrients, and you're just going to feel really uncomfortable and sluggish. And it's very hard to lose weight. I picked up three parasites this week in one client. I was like, I've never seen this many at once in one of my clients. She's loaded with H. pylori in addition to that and has a real leaky gut and a lot of inflammation. So I work on healing the gut first.

Number one supplement: I really love red polyphenols, because they feed a bacteria in the gut called Akkermansia. Akkermansia is a bacteria responsible for insulin regulation and blood glucose control. If you look at studies done on the microbiomes of obese people, they are usually deficient in Akkermansia. So Akkermansia is a wonderful one. I love mucilaginous, or slippery, herbs for a lot of gut inflammation. So products with aloe or slippery elm or deglycyrrhizinated licorice, DGL, or marshmallow root. Those really heal a lot of inflammation in the gut. Glutamine, of course, is another great one. I love glutamine because it also really helps build muscle and it curbs cravings too. So that's really nice.

People are always asking, well, should I take a probiotic? Not everyone actually needs a probiotic. It's really individual. I do like Saccharomyces boulardii because that really supports immune function. It supports your secretory IgA, which really regulates your immune function. Most people don't realize that 60 to 70% of your lymph nodes lie in your intestinal tract. So if you're getting sick all the time and you're run down in the winter, make sure your inflammation is under control. I give digestive enzymes when I need to, also, to help people digest and absorb their food and keep parasites and pathogens at bay. Most people don't realize hydrochloric acid is a real firewall. It's really hard for pathogens to grow in an acidic environment.

But again, please test, don't guess, and work with a practitioner on this, because it's really nuanced and individual. If you take a probiotic or some greens, nothing bad is going to happen. I just don't know if you're going to be wasting your money or not, and I like to put people's money in a good place.

Some overall generalities. Vitamin D and magnesium are very, very important for bone density. When you take magnesium, a great form in midlife is magnesium glycinate. It's really easy to absorb and it addresses anxiety specifically. Most women, when their progesterone is fluctuating wildly, really struggle with anxiety specifically, and depression. So magnesium glycinate is wonderful. Ashwagandha and maca are very good adaptogenic herbs if your cortisol is super low or super high.

And last but not least, one of my all-time favorites is glutathione. I'm actually launching a supplement line for menopausal women, probably in Q2 of this year. I designed it based on the thousands of tests that I have seen, looking at DUTCH and GI-MAP, and really helping women move their hormones through the liver. Glutathione is one of the liver's most important antioxidants. I use it when treating people with Lyme, chronic mold exposure, or just for hormone detoxification, because I often see glutathione levels very low in midlife women, and it supports methylation naturally. But I love it for energy too. A lot of women take creatine for energy, but I'm like, don't forget about glutathione. It's a really important supplement to take.

Nikkiey: Awesome. Amazing. Celebrating you with the supplement line.

Esther: I'm excited.

Nikkiey: Yeah. So cool. Okay, before we move on to strength training, I want to bring back that pin. Talk to me about intermittent fasting and homeostasis.

Esther: So here's the cool thing. Back when I wrote Cave Women Don't Get Fat, it came out around 2015 to 2017, I looked at 73 studies on intermittent fasting. Only 13 were done on women. The research is always done on men because men don't have a monthly cycle. We're like a giant chemistry set. Dr. Mindy Pelz and Cynthia Thurlow both talk about intermittent fasting, and how you can cycle on and off it.

If you're a menstruating woman, the first half of your cycle is when you're going to be the most insulin sensitive. You're going to be able to handle carbs the best. You're going to have your best workouts during the first half of your cycle. The second half of your cycle, that damn luteal phase, is when everything goes wonky. Your hormones go to shit. Your insulin is all over. Your temperature's through the roof. And so if you are menstruating, the best time to do intermittent fasting... And intermittent fasting just means having a shorter eating window.

There are two ways you can do it. You can have a shorter eating window. For some women it's 12 hours: they finish dinner by 7 PM and they don't have breakfast before 7 AM. Other women can do an eight-hour window or a six-hour window, so 10 to 6 or 12 to 6. And some women do what I like to call the 5:2 method, where you eat normally five days, and two days a week you drop down to 500 calories for dinner. But that's a tough one for a lot of women to do, and it is tough to hit your protein macros. The shorter your eating window, the more protein you have to eat at meals.

In menopausal women, however, you don't have a monthly cycle. These are the women who, in my practice, and my practice has been my study, tolerate fasting the best. They can really go long periods of time without eating and feel great, feel positive energy, feel mental focus, and see the fat loss results. It's really individual. If you're someone with hypothyroidism, if you have cortisol and adrenal issues, if you've had a chronic illness, or you have a history of eating disorders or disordered eating, really check in with yourself. This may not be the appropriate plan for you. It is not one size fits all.

But if you want to try it, play with it. Just start with 12 hours. Give your digestive system a break. A great time to try this is actually when you're a little under the weather. Try some fasting and see how you do. And I would not extend your fasting if you're really active and lifting heavy. Some people do fine not eating, but the menopausal women I see in my practice typically really need to fuel their workouts and not skip. So if you notice you're feeling great, go forth. If you find you're fatigued, irritable, shaky, it's probably not a fit for you. It's definitely trial and error, but there is something to be said for not having a cycle and fasting. It's just better tolerated overall.

Nikkiey: Interesting. Cool. Okay, let's dive into strength training. In addition to all of the amazing advice you've shared so far, how do you incorporate strength training into the routine of someone experiencing this transition in life? Especially anybody who may be new to strength training, who's done boot camps and cardio at 45, and hasn't really been under a barbell or touched some dumbbells. What are some recommendations for newbies starting out?

Esther: Newbies starting out. First of all, walking is the most underrated fat loss activity in the world.

Nikkiey: Amen.

Esther: It just regulates your cortisol. If you have high cortisol, it lowers it. So many of my clients are wearing glucose monitors, and we have them walk for 10 minutes after a meal and it brings their sugar right down. Their numbers get so much tighter from 10 minutes. I'm like, I don't care if you go up and down the stairs of your house. I don't care if you walk the block. Just put on a 10-minute timer after a meal. It truly is transformational. So that's step one. And being outside in nature really lowers cortisol. And if your cortisol is rock bottom, I remember the years I could barely get out of bed. I was so sick, and I would force my ass to walk an hour every morning. It didn't matter that I was exhausted. I was like, I am not lying in bed all day. This is crazy. And it's something that you can do.

Step two, high intensity interval training. Some women tolerate it in midlife, but more often than not I see very altered cortisol curves, in particular very, very low cortisol. If that's the case, high intensity interval training may not be a fit for you until your cortisol curve is regulated, your adrenals are supported, and you're on hormones. So get your heart rate up through strength training.

Now, if you have never picked up a dumbbell, you can start with bands. You can start with light weights. You can start with Pilates. And again, Nikkiey, this is really your zone of genius. I'm not a strength coach, but this is just what I see in practice. As long as you add to the resistance. Heavy for you, the listener, is not the same as heavy for me. And progress is progress. It doesn't matter if you start with a three-pound dumbbell. I can do Pilates and destroy my biceps and shoulders with a three-pound dumbbell. I can also go to the gym and curl a 17-and-a-half-pound dumbbell. Different exercises use different muscles. So don't focus on the number, just focus on your progress. Make sure you're adding resistance, even if it's for one set, and then you drop down to the lower weight for the other sets. And just the consistency.

For menopausal women, a minimum of twice a week will still get you the results. And you do have to have a lot more recovery time in between. Your hydration has to be on, your carbs need to be on. You can use creatine. You can use glutamine. There are Epsom salt baths, saunas, cold plunges. There are a lot of ways to help your recovery. You can do three times a week if you feel great. You can do more if you feel great. But the science shows there isn't a lot of clinical difference between women who lift twice a week versus three times a week.

Nikkiey: Amen. Let's go, Esther.

Esther: Did I pass the test?

Nikkiey: I appreciate that insight so much, because there are so many women who come to WarriorBabe and they're like, oh, I need to train six days a week. And I'm like, let's unpack that. Why do you need to train six days a week? As you're sharing, with the clinical studies and all things, you don't need to train six days a week. You need more rest in this phase of life to revive and rejuvenate. I always say you break down muscle inside the gym and you build it afterwards. You're breaking down the fibers. You're building it with nutrition, with the rest and the recovery and the sleep that your body needs. So I appreciate that insight.

Wow, this has been so freaking good. Your zone of genius is amazing, and I appreciate the insight you've brought to the listeners and the community. With everything you've shared so far, what are some key takeaways? People are going to get off this podcast and be like, oh my God, I need to go follow Esther. I'm going to link all of your things and all of your books in the description below. But what are some key takeaways you'd like listeners to remember around navigating nutrition, HRT, testing, and strength training?

Esther: Okay. First things first, really spend time prioritizing your protein. Log your food for three days. Just log everything you eat. There are so many free apps out there. Make sure you're getting a minimum of 100 grams of protein per day. Do not think you're going to go to the gym and build muscle on less than that. It's very difficult, unless you were a vegan and all of a sudden you hit 100 grams. But for most women, we do need more.

Number two, don't be afraid to advocate for yourself at the doctor's office. I have a hundred studies in the back of my book. A lot of my clients give their doctor my book and say, I've done the research. A lot of doctors say, I don't know. Hormones are dangerous. They're going to cause cancer. No, that's actually outdated. I've done my research. Put me on it for three months. Let's give this a go. Why don't you try it with me? I'm not sleeping. I have vaginal dryness. I want to kill my husband. I'm not old and dead. I'm just 50 and in need of hormones.

If your doctor doesn't do that, or is just an asshat, or any provider, I don't mean to pick on doctors, anyone who's an asshat, go call your compounding pharmacy and find a hormone-literate doctor. Know that it will probably be out of pocket, but the time and mental real estate and sanity you will save for yourself will pay for itself. There will be a huge return on your investment in getting your life and yourself back. And it's cheaper than that fractured hip hospital bill. So that's step two.

Step three is please walk. Walk every day. If you can walk an hour every day, that's not even 10,000 steps, but at least an hour a day, and get strength training in twice a week. There's Nikkiey's online programs. There are so many ways to access it, or you can join a gym. It doesn't have to be complicated. You don't have to stand on Bosu balls with one leg up at a time doing all those ridiculous moves. You literally can do some gentle curls and tricep extensions and a couple of squats and lunges and you're good. The basics are the basics because they work.

And certainly grab a copy of my book. It will really support you, and support your sleep and your lifestyle. Really watch the booze too. Have a healthy respect for booze and caffeine. Healthy respect. Just balance.

Nikkiey: Balance. Amen. I love that word. And the Bosu balls, you mean I can't do... You know what my favorite is? Getting on the StairMaster and doing kickbacks on the StairMaster.

Esther: Oh, I just see it. What is that? What is that?

Nikkiey: I saw that for the first time a long time ago, and then I saw it at the beginning of this year and I was just like, oh no, it's back. I haven't seen the Bosu standing in a while, though.

Esther: Oh yeah. The Bosu ball ones kill me. I just laugh at all the fails. I'm like, oh, these people are seriously injuring themselves, but it is really comical.

Nikkiey: And that'll lead to the hip fracture.

Esther: That will lead to the hip fracture. And really, what I adore about you is you're legit. You walk the walk, and you're just following the foundations. The foundations work. People overcomplicate things.

Nikkiey: They overcomplicate things.

Esther: Ladies, none of this is complicated. It's just the foundations of self-care: putting nutritious food in your body, doing some deep breathing at night, and not doom scrolling at night. And this is what I love about midlife, and we were talking about this before we got on: if it's not a hell yes, it's a fuck no. Say no more. I make a lot of videos about saying no more. Make it an asshat-free zone in your life. Dr. Will Cole put up a post that said, let no be your multivitamin. That is what midlife is about.

Nikkiey: I love that.

Esther: I know. I was like, yeah.

Nikkiey: I love that so much. Thank you. I appreciate you being here. For all the listeners who want to follow you for more tips, your books, and all your social links, it's going to be down below. Is there anywhere else they can follow you or check you out?

Esther: Join my community at estherblum.com. That's E-S-T-H-E-R B-L-U-M dot com. On Instagram, I'm Gorgeous Esther. My email list gets priority notifications. There are often posts that I don't put online. We're really building a great community. We're building out group coaching in addition to one-to-one, so we're really trying to give people as much access to menopause care as possible.

Nikkiey: Heck yeah. Love it. Esther, it's been an absolute pleasure having you on here and incredibly enlightening speaking with you today. Like I said, your zone of genius is a beautiful thing, and more people need this in the world. I think it's definitely on the up, with everything you're sharing and a lot of other people who have this zone of genius too. So thank you for your work and what you do. I appreciate you sharing your expertise here on this podcast. Thank you for being here with us.

Esther: Right back at you. Thank you for having me.

Nikkiey: Real quick, the only ask I could ever have of you guys is to help spread the word so we can help more women lose body fat, build muscle, reach their goals, and feel insanely confident. And the only way we can do that is if you rate, review, and share this podcast. So the single thing I ask you to do is leave a review. It will take you 10 seconds, and it will mean the absolute world to me and may change the world of someone else.