Navigating The Complexities of Menopause with Esther Blum

00:00Real 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 for you to do is if you could 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. 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.

00:52The 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, right? 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. What is going on, everybody? Welcome back to the show. And today's episode is one you surely do not want to miss out on.

01:31So joining us is a well-known integrative dietician, 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.

02:08So I am super stoked to introduce the wonderful Esther Blum. Am I saying that last name right, Esther? You nailed it. 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. Excited for you to share your wisdom, your insights, and all of the things around menopause. Thank you. Thank you so much for having me, Nikki. For sure. So let's dive right into it. Can you just tell me and the listeners, and again, like I was talking to Esther right before we launched and hit record,

02:43but I just selfishly want to know more about you, your journey, you know, why you got into the field of nutrition and holistic health, and what inspired you to pursue this type of career? It's pretty wild. I came from a long line of physicians and nurses and dietitians, and my grandfather, Harry Blum, who lived till he was 105 and a half, he 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.

03:17And he had an operating room in his house in Flatbush, Brooklyn, and that is where I had my tonsils taken out. And he had a 12-bed pediatric recovery room, and he had two adult beds where like 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. And my father was a dermatologist, also like good country doctor, did house calls.

03:52And my mother was a nurse and worked with postpartum women. And so, you know, health was just part of my vernacular in my DNA. We grew up at the dinner table talking about everything and anything. 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 was like, no, I definitely want to balance life. So I pursued a degree in clinical nutrition because it is pre-med undergraduate minus the physics.

04:24I suck at physics. So, and it's a little less chemistry. And my grandfather was like, what the hell are you doing? Like, 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. But so, yeah, I mean, that's my story. And my father's, that teardrop shape thing on my bookshelf behind me is my father's lifetime achievement award that he got when he was 89. And so, yeah, I mean, it's that is that that teardrop every day I walk in and see it.

05:02It's like nose to the grindstone. Like you're here to help. You're here to show up. You're here to serve. So that's what I do. It's like very humble, but also very powerful to be serving women in this incredible time when menopause is finally getting its due. So, yes. Oh, man. Full body chills there. Like I love that. It's already you as you mentioned, like it was ingrained in your DNA and it's just passed along of just wanting to fill the fill the need of wanting to help people in the world. Yeah.

05:32I love that. Okay. So let's dive into your, you know, you're, you're super well-known and highly respected for helping women navigate the challenges of what they experience with menopause. So can you share with us like your nutritional approach specifically for menopause women? And like, you know, how do you, how do you make them feel like rock stars through menopause? Okay. So, and 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 nutrition through, master menopause through nutrition, hormones, and self-advocacy.

06:12So 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, poor diet and lifestyle. You cannot out supplement poor diet and lifestyle. And let me tell you in midlife, you can no longer write checks that your body cannot cash. So diet and Nikki, you're like the queen of macros. So I know you get the importance of macros in a woman's diet and in midlife, right?

06:42Estrogen and progesterone start to decline. Your ovarian reserves are, are winding down. And eventually your production of hormones of DHEA, testosterone, progesterone, estrogen switch from your ovaries to your adrenals, where they eke out just a very small baseline of hormones to keep you like 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.

07:19And 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 starting 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.

07:52So most women are very challenged in this arena. They're actually really under eating protein and overeating carbs. And we do have to flip those ratios. So most women in my practice, like they come in eating 60 to 70 grams of protein a day at tops. And I'm like, you do realize this is what my dialysis patients ate in the hospital. Like this is by no means going to build muscle or help sustain bone density or your mental health.

08:23So I really like to get women up to, if I can get them up to 120, 130, 150 grams of protein, that is the goal. But even getting women to 100 grams a day is like 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 just see where you go. So I know the myths around protein intake and bone loss and kidney disease have all been debunked.

08:56You 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, if they were previously vegan, do resort to eating some eggs or dairy,

09:30at 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. Again, there's so many amazing companies now that sell pastured organic meat, 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.

10:07Quite simply, 30 to 40 grams, that is roughly four to five ounces at a meal. Okay? So take the palm of your hand, get a food scale. You buy, you know, a pound of meat or chicken or fish, divide it in thirds, right? That's your portion size. It's really pretty simple. That's step one. Step two, my second mental law for fat loss is, as I mentioned before, making sure that your protein ratios outweigh your carbs, your net carbs.

10:38Okay? We don't penalize for fiber here. Most women, when they come to me, they're eating 150 grams carbs and like 60 grams of protein. If we flip those ratios, I like people, women get, you know, 120 grams of carbs, 100 grams of protein, pardon me, 120 protein, 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, your insulin is stable. Now, let's say you're a really lean person or you're doing heavy, heavy weightlifting.

11:11Then you could do a one-to-one ratio of carbs to protein quite easily, or on your lifting days, you have more carbs on those days. But, and if you're not sure what your blood sugar and insulin look like, start, you can wear a continuous glucose monitor also and start really playing. But it's what gets measured gets managed. So tracking macros is key. Again, I know I'm preaching to the choir. But the third piece of the mental laws for fat loss is having carbs at night.

11:44And 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 the decline in hormones, with progesterone and estrogen and testosterone declining, comes a bump in cortisol. And often that bumping cortisol comes at night. And especially if you're like a screen surfer at night, or you've got teenage kids who have a ton of drama, you know, your cortisol can bump at night.

12:19So 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, right?

12:50If you're not sleeping, if you are waking up like a lot of perimenopausal women do, especially the second half of your cycle, right? Because your progesterone really takes a nose dive. So you're lying awake. Your cortisol is up, right? 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. 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.

13:24And you still, my ladies still lose weight this way all the time. And 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, like they 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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14:33Look, don't wait anymore. Take charge of your health and join our community of strong, empowered women. Visit WarriorBabe.com forward slash apply today to start your transformation. That's WarriorBabe.com forward slash apply. All right, let's get back to the show. Amazing. Thank you so much for sharing those three points. I think that like a lot of listeners, like, you know, there's so much in the industry of which carbs, women fear carbs.

15:05They look at it as it's going to make them fat or it's going to, you know, derail their progress in terms of getting the composition that they want. And, but I love that you, like, I, so many people, I wonder if their heads are going like carbs at night. Just telling me carbs at night. Like, I don't think that many people have ever heard that before. So I appreciate you elaborating on that. Well, you know who taught that to me was the late Charles Poliquin was like, he taught me this back in the late 90s.

15:35And 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 yeah, I mean, I eat, you know, honey on rice cakes with salt before I go lift. Like, you've got to fuel your lifting sessions. And then you have a better lift. You get your, the insulin goes right in. So you're set. It's like amazing. Amen. You were speaking my language. Like, you know, when you say all these things and then you have an amazing guest, like you come on the podcast and just saying the same things.

16:08It'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 pull apart and unpack that even more. Like, there's tons of women in our community that don't want to lift in the morning because they're morning lifters. They wake up and they pretty much go to the gym right away within like 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?

16:45I would do like if you make a protein smoothie, I would have half of it. You know, as 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. Like I switch my lifting to now afternoons. I'll do an hour walk in the morning and then around 435 go hit the gym because it just I can get way more food in my system before then. But if you really don't have time and, you know, you don't have flexibility in your schedule, then I think half a protein shake is great.

17:19Or whatever your breakfast is, just have half. If you have eggs and oats, that's fine. Or if you really can't, you know, just again, a couple spoons of honey and some salt, just getting something in you will be helpful. Amazing. Love that. And I love they touched on the protein intake, too, as well. There's a lot of women that come into our community or are at their 60 grams a day and they're not getting the results that they want. And then they then they're saying that it's so hard to get in the protein. I'm like, well, I mean, choose your heart here. You know, do you want the decline of the muscle mass to continue to happen as you age and not feel your body appropriately with the with what you your body needs in order to maintain and build the muscle mass?

18:00And then all the things that come along with that, too, as well. So appreciate your tips on that and speaking to it. So I want to dive into one more thing. Can you elaborate on how the hormonal changes that happen, one, to the symptoms of what women so that they're aware of, you know, premenopause happen? And so many women are like, well, how am I going through it? I don't know if I'm going through it. So what are the symptoms that they're experiencing and the hormonal changes that are happening?

18:31And then how can the nutrition aspect help to mitigate some of those symptoms associated with these changes? So 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. Well, the average age of menopause is 51 years old. So women in their mid-30s, right? I've had women go from literally having a baby right into perimenopause, right?

19:05And so we are undertreating women. We're putting, when I say we, I mean the collective medical society, not me personally, obviously, but like 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, right?

19:37If you find that your second half of your cycle is radically different than your first, probably in perimenopause, if you find you have insomnia that second half, hot flashing, some vaginal dryness, extreme irritability, I call it minnow rage, or extreme sadness or depression. If your boobs are killing you, if you're having crime scene periods, like super heavy clotting as well,

20:09those are all symptoms of perimenopause, joint aches and pains, brain fog as well, any cognitive changes. And then also noticing like if your weight was previously, if you were pear-shaped before, and all of a sudden you're turning into an apple and you're like your muffin top has turned into a cake top, you know, without you changing anything in diet and workout, intolerance to HIIT training or like really long hard cardio sessions,

20:40all of those can indicate, hey, you know what? I'm starting to go into early perimenopause. And so diet can certainly combat it. Like those three days in your cycle where you feel like you could eat anything and anyone and like line up steaks on the counter and snort them all up, you know, like we're line up chocolate chips and snort those all up. When you double your protein on those days, when you really have like a giant steak and,

21:11you know, a big piece of fish at your meal for those three days, that's going to absolutely get you over that 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 like, 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, like you're talking to the girl. I mean, my first book has a picture of a lady in a cocktail glass.

21:44Okay. And like, I have a whole chapter on hangover recovery and eat, drink and be gorgeous. So I, I'm always in a cocktail state of mind, but you know, the alcohol is just such a bitch with hormone changes and menopause and your liver. However, 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 hormone? Well, alcohol is a class one carcinogen.

22:14I'm going to hit that up first. So really, you know, and so it's like, okay, hormones, pause, please. I got to get alcohol out the door first. And then I can go back to get, you know, moving hormones through your liver again. So all of those diet and lifestyle things can make a huge difference. And also, you know, managing your stress, like as little as 10 minutes of deep breathing or meditation every night can actually lower your cortisol at night. So when my clients are like, oh my God, I can't sleep and I'm on my hormones.

22:48And I'm like, well, are you even breathing? Have you even like calmed down your nervous system and told your nervous system it's safe, right? To just like breathe and relax. Like 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, right? A, getting your diet straight can do wonders, your blood sugar.

23:22B, you can add in something called Vitex or Chase Tree, weeks two to four of your cycle. This is a natural herb to get your progesterone levels up. That can sort of hold you till 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 that you can do through lifestyle to mitigate your symptoms. So good.

23:53Back to the alcohol thing. I mean, not back because I mean, that's just like a, we could totally unpack that and have a whole nother podcast, like just on that whole topic. But thank you for pointing that out because people, there's, there's a, there's a woman that have a glass of wine every single day or they're great with their workout and their, and their nutrition throughout the week. And, you know, then all of a sudden it falls off kilter from the weekends and they're having more than one, you know, drinks of wine or a glass of wine or vodka or tequila over the

24:24weekend. And I wonder why not getting the results. So pinning that, how to bring you back on the podcast. We'll just do that in the future. But what I want to move and segue into next is HRT. So could you talk a little bit and elaborate on the benefits of hormone replacement therapy, HRT, and what positive impacts can it have on, you know, women, particularly during the menopausal transition?

24:54First, I'm going to teach you how to find a hormone literate MD because only 4% of women, Nikki, 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, call Google compounding pharmacy for your state or compounding pharmacy for your zip code and call the pharmacy and say what hormone literate

25:26doctors are running hormone prescriptions through your pharmacy. That's a really great way to do it. You can also go to ifm.org. This is the Institute for functionalmedicine.org 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. And most women don't need that high of a dose.

25:57We need microdoses. So what is crazy is that about HRT is that the benefits are so many and doctors are taught, and I know this because I've heard this from doctors at my functional medicine conferences, but doctors are taught 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. Like the gap is so strange.

26:27It started from this women's health initiative study that was done 20 years ago plus, 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. So they already had an increased risk of coronary artery disease, overweight, many health risks,

26:58and they were not given any opposing progesterone or testosterone or DHEA. Well, hormones are a symphony. They're not so low act. So the study was so poorly designed and an interpretation was even worse where the study said, oh, well, the risk went up from, you know, four women in 10,000 to five women in 10,000 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 hormones

27:31since then. So we're finally getting it back, and 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 finally, like, the wall is falling of that limitation where, like, 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.

28:01So the benefits of hormones, quite simple. Cognition, right? Estrogen, progesterone, testosterone all contribute to different aspects of cognitive function, memory, and mood, right? So imagine what the implications are for keeping women, and it's mostly women, out of memory care units because Alzheimer's starts 20 years prior. Brain degeneration starts 20 years prior to Alzheimer's symptoms showing up.

28:35So 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 till a year being menopausal for one year to start hormones. I get my perimenopausal women on hormones, some of them in their 30s. So, and I'm certainly not fully menopausal, and I've been on hormones for years. So I'm very late perimenopause, but I've still been on hormones for years. So A, cognition, preservation of gray matter in the brain.

29:08You think about a woman's quality of life, okay? 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, okay? And I want to talk about intermittent fasting too and homeostasis, but we can come back to that.

29:39So again, keeping vascular health solid, 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. Um, so number three, bone density, right? Women who do not receive estrogen replacement therapy within the first 10 years of menopause have a tremendous risk of bone loss and fracture.

30:09Hip fractures are one of the leading causes of death in people over the age of 65. So again, you think, how can I give someone strong bones and prevent hip fractures and keep them at nursing home and reduce long-term costs? I could put them on hormones that are covered by the FDA. My progesterone is less than $4 a month. So $36 a year to help me have like quality of life for my progesterone. I mean, it's so ridiculous versus the cost of a hip fracture, the surgery, the rehab,

30:42the long-term infections, death. It's, it's so silly. It's so backwards how we don't have this right. But 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, right? And so number one, pelvic floor, right? Most women after childbirth, certainly no one taught me about pelvic floor health. My bestie was like, yes, sex is going to hurt for a year after you have a baby.

31:13I 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 sakes. Or a lot of women get a very weak pelvic floor. They pee the rest of their life after they sneeze and cough after childbirth. That is not right. Number two, you can get clitoral atrophy. Uh, no, thank you. I actually want to have an orgasm past the age of 55. Um, and all you need to do is put, um, topical estrogen on the clitoral and urethral areas.

31:48And number three, you prevent UTIs. So again, you think of your grandmother, your mothers in nursing homes with UTIs, with dementia, then they die, right? This is all preventable with a little swab of some vaginal estrogen and systemic estrogen. I, my mind is like, it's exploding right now. Like, so little background. I spent nine years in the healthcare field. I spent five years and working as a CNA inside of a nursing home and taking care of every which

32:24patient that you're speaking about right now. And then I spent four years working in the emergency room and it blows my mind. I had Dr. Cabral on the podcast a couple of weeks ago. Me too. So much. And I was just unpacking his brain as to like the traditional conventional way and how like, and it was very insightful to hear his responses, but like how they are, it's like you said earlier, it's just so backwards. And how are we not like, you know, uh, like diving into the science of more around the hormonal

32:59aspects of people and especially women and working from the inside out to heal those so that, you know, the longevity of life is there and prime for people rather than like the traditional conventional way of just shoving, you know, medicine down people. Yes. Rather than this way. Well, and the first thing you have to do is remove barriers to access because there's still black box warning labels on estrogen saying it's causing cancer. So let me clear up that myth too.

33:30Hey, Hey, just want to drop a huge appreciation to you guys listening to the show. It means a lot. I hope you guys are enjoying it and there's so much more to come with it. If you are enjoying it, hit the subscribe button. I'd appreciate that tons. And also it would help this podcast reach others who need to hear these messages too. Is that oral estrogen, right? Synthetic estrogen and synthetic progesterone, AKA the birth control pill. Number one, that is not treatment for menopause.

34:01Neither is an IUD. Um, because the synthetic estrogens. Yes. Do they do have a higher risk of stroke and clotting? However, transdermal estrogen does not. And you're on a microdose and vaginal estrogen. Also the Framingham nurses study looked at women using it for 18 years, 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 biased cream,

34:39or you can get it covered by insurance as an estrogen patch that you change twice a week. Easy peasy. And then, um, topical, uh, pardon me, oral progesterone is a far better solution than a synthetic progestogen. So synthetic progestogens are found in IUDs and birth control pills. Well, what mechanism of action do they have in the body? Mechanism of action is to suppress ovulation.

35:09So that means they keep your progesterone levels rock bottom. So you take a perimenopausal woman who's already dying PMS, like feeling like a psychotic bitch. And then you keep her progesterone low, forget it. I mean, it would be a murder scene in my house without, with that situation every month. And, um, they don't hit up the GABA receptors in the brain. You do need bioidentical progesterone to really light up the GABA, the serotonin, the dopamine

35:45in the brain to keep your mood happy, to keep you calm and to keep you sleeping. So, and it also tames estrogen. So you're not getting those blood clots. You're not getting those prime scene periods. If you're having prime scene periods, your progesterone production is not robust enough in the second half of your cycle. So it's a real biomarker. It's why I'm like, doctors like, just stay on the pill all month. I'm like, you actually need a cycle to understand what's happening in your body. Like it's actually a marker of health. Um, and then, um, and again, you can get this at, at a regular pharmacy.

36:19It's covered by insurance. It's just called Prometrium. It's that simple. And then option three is, um, transdermal testosterone. Now, testosterone is not FDA approved for women. You have to right now have it made at a compounding pharmacy, unless here's the loophole. You ask your doctor, if, if your doctor approves your use of testosterone, then your doctor can, can be, can use it as an off-label, off-label use of testosterone.

36:55So you can get it at about a 10th of the dose of a, 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 then 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. Wow. Yeah. Well, thank you for elaborating on it and sharing those insights for sure. So one follow-up to those questions, to those insights would be this question, obviously

37:34to know how to treat anything that is low, right? If someone has a low estrogen, a low progesterone, a low testosterone, what are, what DHEA, cortisol, blood sugar, A1C, like what are, what are the essential tests you would recommend women to undergo so that they understand their hormonal baseline, you know, all going through this phase of life? Yes. So, and again, I do have this all in my testing and treatment chapter in see you later and ovular, but I'm going to lay it out for you.

38:07Number one is I do run three tests in my practice. One is blood tests and this you can run through your insurance company. I do look at inflammatory markers. I've worked in cardiology units for five years. So I'm going to check out, right? 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?

38:41Yes. Of course, I'll look at cholesterol and triglycerides too. And, and particle size matters. It does. And then I will 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, which the thyroid can get really wonky during perimenopause. Hormone replacement therapy can change thyroid function.

39:11So it's really, 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. But you can also check your FSH and LH to see like where you are in perimenopause slash menopause. Because 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.

39:43But it doesn't, you know, doctors, when I go to functional medicine conferences, they go back and forth on should you test versus 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.

40:19And it lets me know how estrogen in particular is moving through your liver. If you're having any issues with phase one or two detoxification, I want to support those. And your methylation is poor. I want to support those. And 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? Like there's a whole treatment pathway correlated with your test results. And that's really important because women who've had a family history of cancer are terrified

40:51of hormones. They've been taught to fear hormones, not go near them. That doesn't need to be the case, actually. Because if you think about 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. But I have plenty of women who've gone through cancer who still have a tremendous family history.

41:22And they still go on hormones because they're monitored carefully, looking at their labs. Well, and this is why I do the third test I do also, which is the GI nap. That is a stool test that looks at your microbiome and it looks at phase three detoxification in your gut. You don't only move hormones through your liver. You've actually got to poop them out in your gut. If you are, if your beta glucuronidase is high and you're recycling your hormones in your gut and you're not pooping every day, guess what?

41:53You're going to have real issues with estrogen dominance, bloating, breast tenderness, irritability, weight gain. So you've got to make sure that you get all your checkpoints done. And 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'll poop every day, fix those first. You don't just say, just start hormones. This is going to solve all your problems. You're not pooping.

42:23If 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. So, or if you don't detox well, listen, your breasts will never feel more tender and enlarged. You're, 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. And the other thing is, right? If the imagery, right? You just, yes. Picture, you know, walking in first, walking in first, tits up, tits up, you know, got to get them up.

42:58So, yeah. And the other thing is, you, I'm losing my train of thought, but you, you really want to make sure that your, that your hormones are moving through. They, you, they should be coming out every day. What goes in goes out every day. Yeah. I love that you touched on that, that you have to first highlight what's going on before you treat, right? You got, you can't like, you can't go into treating something that you don't know the, the whole, the whole story behind the whole thing, right? It's like, you can't put someone on hormones without knowing exactly what you're treating.

43:31So I love that you brought that back. And it's pretty cool to like hearing you say how everything's all connected. You know, it's a hormones are connected to the eye, to the gut. But so it's a, this is really the way of my brain. It's like, you're really healing from the inside out. And if you can heal from the inside out and you get the results that you want to experience, but you got to focus on the internals first to get everything working for you instead of against you, especially in this phase of life. Um, so, okay, let's, let's, uh, I do, I know we wanted to put a pin in, in intermittent fasting

44:03and homeostasis, but I want to, and I want to bring that back. But first I want to talk about supplements. So, right. Kind of is all connected. You, um, spoke to like the nutritional aspects, HRT. And then when you have an awareness of which hormones are off kilter, you obviously will, you, you get tested to figure out which hormones are off kilter and how to treat from there. Now, when you do have the results of which ones are off, and then of course, you know, nutrition and eating right and getting that to work.

44:35Uh, I mean, nutrition is just hands down. It's, it's definitely outside of every, anything and everything. If you can pinpoint that and you can be consistent with it, it can solve many, many, many, many things. Um, but with, with all that said, what was supplements and you have the results of anything that may be off kilter, what are some supplements that you generally recommend for people? So the first thing I do is I treat the gut first. If someone has, um, hormone dysregulation or poor detoxification pathways in the liver,

45:07I may treat that first, but ultimately I heal the inflammation in the gut because that solves a lot of problems first. Number one, you're digesting and absorbing your nutrients. Um, leaky gut equals leaky brain. So a lot of women are like, oh, I have all this brain fog. Well, it's easy to think, oh, well, she's estrogen deficient. She has brain fog. Um, but if we don't heal, uh, 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, absorbing your nutrients

45:41and you're just going to feel really uncomfortable and sluggish. And it's very hard to lose weight. Um, I picked up three parasites this week in one class. I was like, I've never seen this many at once in, in one of my clients. She's loaded with H pylori in addition to that and has a real leaky gut, a lot of inflammation. So I work on healing the gut first. Um, number one supplement. I really love red polyphenols because they feed a bacteria in the gut called acromantia.

46:13Acromantia is a bacteria responsible for insulin regulation of blood glucose control. And when you look at obese, if you look at studies done on the gut walls of, or the microbiomes of obese people, they are usually deficient in acromantia. So acromantia is a, is a wonderful one. Um, I love, um, mucilaginous or slippery herbs for a lot of gut inflammation. So, uh, products with aloe or slippery elm or deglycerinized licorice, DGL.

46:44Um, those all do wonders at like, or marshmallow root. Those really heal a lot of inflammation in the gut. Glutamine, of course, is another great one. And I love glutamine because also it really helps build muscle and it curbs cravings too. So that's really nice. Um, yes. And people are always like, well, should I take a probiotic? Like not everyone actually needs a probiotic. It's really individual. I do like Saccharomyces boulardii because that really supports immune functions.

47:15It supports your secretory IgA, which really regulates your immune function. Most people don't realize like 60 to 70% of your lymph nodes lie in your intestinal tract. So if you're getting sick all the time, you're run down in the winter, like make sure your inflammation is under control. Um, I give digestive enzymes when I need to also to help people, um, you know, digest and absorb their food and keep parasites and pathogens at bay. Most people don't realize like hydrochloric acid's a real firewall.

47:47It's really hard for pathogens to grow in an acidic environment. But again, please test, don't test, work with a practitioner on this because it's really nuanced and individual. If you take a probiotic or, you know, 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, you know, in a good place. Um, some overall generalities, okay. Vitamin D and magnesium, very, very important for bone density.

48:18Um, when you take magnesium, a great form in midlife is magnesium glycinate. It's really easy to absorb and it addresses anxiety specifically. And most women, when their progesterone is fluctuating wildly, really struggle with anxiety specifically at depression. So magnesium glycinate is wonderful. Um, ashwagandha and maca are very good adaptogenic herbs. If your cortisol is super low or super high. Um, and last but not least, you know, one of my all-time favorites is glutathione.

48:54I'm actually launching a supplement line for menopausal women in probably Q2 of this year, but I designed it based on the thousands of tests that I have seen to, you know, looking at Dutch and GI map and, and really helping women move their hormones through the liver. So glutathione is one of the liver's most important antioxidants. And I use it when treating people with Lyme, chronic mold exposure, um, or just hormone

49:25detoxification because glutathione levels are usually, I often see them very low in midlife women and it just supports methylation naturally. But I love it for energy too. You know, 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. Awesome. Amazing. Hey, celebrating you with the, uh, supplement line. Hey, I'm excited to be awesome. Yeah. Yeah. Yeah. So cool. Okay. Before we move on to strength training, I want to bring back that pin.

49:57Talk to me about intermittent fasting and anesthetist. So here's the cool thing, right? Back when I wrote cave women don't get fat, um, probably in like 2015, 2017, it came out. And at the time I looked at 73 studies on intermittent fasting. There were only 13 done on women, right? The research it's always done on men because men don't have a monthly cycle, right? We're like a giant chemistry set. So, um, the first half of the cycle is really, and Dr. Mindy Peltz, uh, and Cynthia Thurlow,

50:32they both talk about, um, intermittent fasting, uh, and, and you can cycle on and off it. The first two, if you're a menstruating woman, first half of your cycle, 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. Okay. Second half of your cycle, that damn luteal phase is when everything goes walkie. Your hormones go to shit. Your insulin is all over. Temperatures through the roof.

51:02Right. And so if you are menstruating, the best time to do intermittent fasting and intermittent fasting just means having a shorter eating window. There's two ways you can do it. You can have a shorter eating window. For some women, it's 12 hours, right? They finish dinner by 7 PM. They don't have breakfast before 7 AM. Other women can do an eight hour window, 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

51:33two 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 hate your protein macros. The shorter your eating window, the harder, you know, 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 I have seen in my practice. I mean, my practice has been my study. They tolerate fasting the best, where they can really go long periods of time without

52:05eating and feel great, feel positive energy, feel mental focus, see the fat loss results. It's really individual. If you're someone with hypothyroidism, if you're someone with cortisol and adrenal issues, or you've had a chronic illness, or you have a history with eating disorders or disordered eating, really check in with yourself. This may not be the aggressive 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.

52:35Give your digestive system a break. A great time to try. This is actually when you're a little under the weather. Try some fasting. See how you do. Um, and I would not extend your fasting. If you're really active and lifting heavy, like you, some people do fine not eating, but typically menopausal women in my practice, I see really need to fuel their workouts and not skip. So if you notice you're feeling great, go forth. If you find like, I'm fatigued, I'm irritable, I'm shaky, it's probably not a fit for use.

53:08But it's, it's definitely trial and error, but there is, there is something to be said for not having a cycle and fasting. It's just better tolerated overall. Interesting. Cool. Okay. Let's dive into strength training. So in addition to all of the amazing advice that you've definitely shared with us so far, how do you incorporate strength training into someone's routine that is experiencing this transition with life? And especially to anybody that may be new with strength training, like they're like boot camps,

53:41you know, cardio at 45, you know, all of those things. And they haven't really been under a barbell or touched some dumbbells. Um, how, what were some recommendations for newbies, um, starting out? Newbies starting out. First of all, walking is like the most underrated fat loss activity in the world because it really, amen. I mean, it just regulates your cortisol. If you have high cortisol, it lowers it. If you walk, we have so many of my clients who are wearing glucose monitors and we have

54:14them walk for 10 minutes after a meal and it brings their sugar right down. Like 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 really, truly is transformational. So that's step one. And outside in nature really lowers cortisol. And if your cortisol is rock bottom, I mean, 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.

54:48And it didn't matter that I was exhausted. I just was like, I am not lying in bed all day. This is crazy. And it's something that you can do and match. Step two, high intensity interval training. You know, some women tolerate it midlife, but I see a lot more than not very altered cortisol curves, in particular, very, very low cortisol. So if that's the case, high intensity interval training may not be a fit for you until your cortisol curve is regulated, until your adrenals are supported and you're on hormones.

55:20So get your heart rate up through strength training. Now, again, I think 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, Nikki, this is really your zone of genius. I'm not a strength coach, but this is just what I see in practice. Um, and as long as you add to the resistance, right? Heavy for you, who the listener is not the same as heavy for me, right?

55:56And 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, right? Different exercises use different muscles. So don't focus on the number, but just focus on your progress. Make sure you're adding resistance, even if it's for one set, right? And then you drop down to the lower weight for the other sets and just the consistency.

56:28For 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, right? So, um, your hydration has to be on, your carbs need to be on. You can use creatine. You can use glutamine. There's Epsom salt baths, saunas, cold plunges. There's 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 show, there isn't a lot of clinical difference between women who left

57:01twice a week versus three times a week. So. Amen. Let's go, Esther. Did I pass? Did I pass the test? I appreciate that insight so much and just sharing that because there's so many women that come to Warrior Babe 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? Because, you know, as you're sharing clinical studies and all things, you don't need to train six days a week. You need more rest period in this phase of life to revive and rejuvenate and to allow your,

57:38I always say like you build muscle inside the gym and you break down muscle inside the gym, you build it afterwards. You're breaking down the fibers. You're building it by the nutrition. You're building it by 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 your insight that you brought to the listeners and the community that are going to listen to this podcast. So with everything that you did share so far, what are some key takeaways that like people

58:11get off this podcast? You're like, oh my God, I need to go follow Esther. One, I'm going to link all of your things in your social description below all of the books. Um, but what are some key takeaways from what you shared today with us that you would like the listeners to remember around navigating nutrition, HRT, testing, and strength training? Okay. So first things first, really spend time prioritizing your protein. First things first, right? Log your food for three days. Just log everything you eat.

58:43There's so many free apps out there. Um, log what you're eating. Make sure that you're getting a minimum of a hundred 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 to, unless you were like a vegan and all of a sudden you hit a hundred grams, but for most women, we do need more. Okay. Number two, don't be afraid to advocate for yourself at the doctor's office, right? I have a hundred studies in the back of my book.

59:16You get a lot of my clients give their books, their doctor do and say, I've done the research and a lot of doctors who say, I don't know. 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, right? 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 and, um, I'm not old and dead. I'm just 50 and need of hormones. Okay. If your doctor doesn't do that or is just an asshat or any provider, I don't mean to

59:50pick on doctors. Anyone's an asshat. You go call your compounding pharmacy, find a hormone literate doctor. Know that it will probably be out of pocket and that the time and mental real estate and sanity you will save for yourself. Well, it will pay itself. There will be a huge return on your investment in getting your life and yourself back. So, and it's cheaper than that fractured hip hospital bill. Okay. So, um, that's step two.

1:00:22Step three is please walk, walk every day. Like if you can walk an hour every day, that's not even 10,000 steps, but just at least an hour a day and get strength training twice a week. There's Nikki's online programs. Um, you know, there's so many ways to access or you can join a gym and you know what? Um, it's really, it doesn't have to be complicated. You don't have to, you know, stand on Bozu balls with one leg up at a time doing all those ridiculous

1:00:54moves. You just literally can do some gentle curls and tricep extensions and a couple squats and lunges and you're good. Like the basics are the basics because they work. So, um, uh, yes. And certainly, you know, grab a copy of my book. It will really support you, uh, and, and support your, your sleep and your lifestyle. Like really watch the booze too. Have a healthy respect for booze and caffeine. Healthy respect. Just, uh, just balance, you know, just balance.

1:01:25Balance. Amen. I love that word. Yeah. To the Bozu balls. You mean I can't do, you know what my favorite is? Um, getting on the Stairmaster and doing kickbacks on the Stairmaster. Oh, I just see. What is that? What is that? You know? I saw that for the first time and actually a long time. Uh, and I was gay. I was really proud, but then I saw it the beginning of the year this year and I was just like, Oh no, it's back. I've yet to see. I haven't seen the Bozu standing though in a while.

1:01:56So I don't see it. Oh yeah. The Bozu 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. And that'll lead to the hip fracture inside of the. That will lead to the hip fracture. And really, yeah. I mean, you, what I adore about you is just, you're legit. You walk the walk and, um, you know, you're just following like the foundations. It's just the foundations work. People overcomplicate things.

1:02:28They overcomplicate things. Ladies. It's none of this is complicated. It's just, you know, foundations of just self care, just like putting nutritious food in your body and doing some deep breathing at night and not doom scrolling at night, you know, just like setting. And, and this is what I love about midlife. If it's like the month we were talking about this before we got on, it's, it's a fuck. Now, if it's not a hell yes, it's a fuck. No, say no more. Say, I make a lot of videos about saying no more.

1:03:00Nope. Make it an ass hat free zone in your life. Like just that to me is, uh, Dr. Will Cole had put up a post. He was like, let no be your multivitamin. Like that is what midlife is about. I, I love that. I know I was like, yeah, that's just, that's going to be like, you know, some, I love that so much. Yes. Um, yeah. Yeah. Thank you. I appreciate, um, you being here and for all the listeners that are listening and they want to follow you for more tips, your books, all your links for your social, it's going

1:03:31to be down anywhere else that they can follow you or check out at. Join my community at estherblum.com. It's E S T H E R B L U M.com. Instagram, gorgeous Esther. Um, and yeah, my, my email list gets priority notifications. There's often posts that I don't put online. It's just a great, we're really building a great community. We're building out group coaching in addition to one-to-one. So really trying to give people as much access to menopause care as possible.

1:04:04Heck yeah. Love it. Love it. Well, you know, Esther, it's been an absolute pleasure, pleasure having you on here and incredibly enlightening, you know, speaking with you today and all of your, like I said, your, your zone of genius. It's, it's a beautiful thing and more people need this in the world. Um, and I think it's definitely on the up with, with everything that you're sharing. A lot of other people that have this zone of genius too, as well. So thank you for your work and what you do. I appreciate you. Um, and you're sharing your expertise here on this podcast.

1:04:36So thank you for being here with us. Right back at you. Thank you for having me 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 for you to do is if you could 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.

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