Transcript of Episode 533: Dr. Amy Shah: What Changes in Perimenopause and How Cortisol Drives Belly Fat After 40

Hi, guys. It's Tony Robbins. You're listening to Habits and Hustle. Crush it.

All right. Today, you guys, we have Dr. Amy Shah, who is not just one-time certified, but you're a double board certified doctor. I'm really old.

You're really... Oh, my God, please.

I did a lot of training. Well, you look really young, actually. How old are you?

I'm 48.

You're 48? Yes. God, whatever you're doing, same age. Okay.

Well, you look amazing, too.

No. But by the way, whatever you're doing, I want to know exactly what that is because whatever is working for you. Really. What do you do? What do you mean? What do you're doing?

All the things. All the things that we're going to talk about, I do.

I mean, I'm- Wait, by the way, her new book is called Hormone Havoc. We're going to talk all about it. And we're starting off with what your daily routine is to look this young and fabulous.

Okay, so sunlight every day. Even if it's a cloudy day, I try to, at least in the beginning of the day, try to get some, usually some movement, even if it's 15 minutes. I think today I did 15 minutes. Really? Because it was... Even that day when we ran into each other, I literally had done 15 minutes because I knew that I had to get ready to go. And so when I saw you, I was like, Oh, let's chat. But I had to go because I literally had only planned a 20-minute workout.

Right. So even that 20 minute or that 15 minutes makes a major difference.

Totally. If I can go for a walk, I can't hear when I'm traveling or whatever, but if I could go for a quick walk, you can get the sunlight in and a little bit of movement in the morning. Yeah, absolutely.

In LA, you can typically... It's easier here. Although you're in Arizona, right?

Yeah. So it's the same thing, good weather. I feel like also getting a slight bit of bumper to the day in the morning. So I'll talk to you about that because we're going to talk about cortisol. But I feel like my cortisol is always out of control. So in the morning, doing something to calm myself for the day to come. So a little bit of bumper. So it's not I'm just jumping into the first thing of my day.

What do you mean by a bumper? What do you mean by a little bit of bumper?

Do you know David Guiam, Kabala?

Yeah, I do. He was actually supposed to be on this podcast many times, and he had to reschedule. So David, if you're listening, honestly, no more rescheduling.

It literally changed my life because he said, your best ideas never come when you're overwhelmed and stressed out. You need to give... There needs to be space in your day. He's like, You need to keep 20% of your day free. And I'm like, That's a lot of hours. And he's like, No, but it's like your workout counts as a little bit of time. If you're going from thing to thing without a break, you're never going to be able to get that, one, cortisol down, so biologically, But to process what just happened. Or if you're having a great conversation, you can't go a little bit longer because you're booked back to back.

It's so true. Yeah, it's so true.

If we're working on our cortisol, we're working on anti-aging, we have to put bumpers on our day a little bit, even if it's five minutes that you have extra in the morning to whatever. I don't know, if you want to meditate, whatever, sunlight, gratitude.

You call it bumpers.

Yeah, like a bumper in your day.

So it's just basically building in these time slots where it's not just overlap, overlap, overlap. Right.

When you're booking your day, maybe there's at least a good amount of time where you're not on a podcast, you're not on a call. You can all of a sudden have an amazing conversation like we were having before this podcast. And it's not like you're running late because you already built in a little bit of your time.

You're building it into your day. So that's interesting. You know what I do because food is so important to me is that I make sure I have lunch every day. I try to make sure that I'm not just running over that time. And that's a bumper for me.

That's a bumper. And the biggest thing is when I came from the medical world, in medical school, college, even our lives, we've always been told that unless you're booked and busy at every moment of the day and weekend, you're not really performing in life. Yeah.

It's so true, especially our background. Yeah.

And so when he said that, and he's like, oh, yeah, the best idea is the best business deals, the best thoughts All of that things happen when you have that little bit of space. So I do that now, and it made it a huge difference, not just in my business or whatever, but for my cortisol, because our cortisol is on fire because we're always late and always rushing.

I And by the way, I'm still always late and rushing, but I actually totally agree with that because then you always feel on edge. And it's like a horrible... The anxiety is a horrible feeling to live in all the time.

All the time. And when someone's talking to you, all What you're thinking is like, I got to go. I got to go. That whole thing. It is so awful.

I got to go. I got to hurry up, hurry up. I'm not listening. I got to just be polite. Yes, yes, yes. I know.

That whole slow morning thing, having a little bit of a slower morning with a few bumpers is a game So anyways, that's that. And then the water. And for me, I do the IMAID in the morning, then I'll do coffee a little bit later. And I usually have 30 grams of protein in the first meal. So sometimes the first meal is delayed a little bit, but I try to get that protein in that first meal. I used to love intermittent fasting, but what I realized it was raising my cortisol, especially when you wait till late, late, late, late in the day.

I'm glad that you just brought that up. Okay, so let me just say... Okay, so I'm going to introduce your book. I went like I went deep dive in to you the second before you got over here. I wasn't expecting you to say... I thought you were going to say 38, so I got very excited. Oh, I'm so happy. Yeah, it's true. So the book is called Hormone Havok, and it's a science-back protocol for premenopause and menopause. And I'm going to say something to you that I actually just said to you before we started, was when I first saw the title of the book, I was actually not going to have you on because I'm already... I'm over it and super tired of the a pause talk. Because I feel like it's already been there, done that. And there's so much noise, there's so much information, and I'm quite frankly over it. However, I really like you. And I know that when I went through the book, there was a lot of things in it that I have not seen before, and I want to focus on those things.

I think my biggest thing is that what I didn't realize when I was in training and myself is that there's so many things we could be doing proactively, nutrition-wise, lifestyle-wise, that can help us as we get older. But nobody tells us. There's no handbook. We're basically left to just guess, look, google, find people that we think that are telling us the right thing. It's really, really Complicated. The menopauseing, the hormone therapy thing, I think has been talked about enough. There's a lot of resources now, amazing resources. If you want to take hormone therapy, if you don't want to take it, if you want to know the risks, the benefits, the whole thing.

The whole thing. Well, now, though, actually, since I want to ask you two questions. But first, the black box thing has been taken off. So now there's not that much of the... Well, I still think there's still a taboo around it. People are still scared, but not as much because of it. So we can talk about that. But what I wanted to ask you is, given all the noise, why did you write a book on it?

Yeah, because this is what happened. There is absolutely no nutrition handbook for women. Okay, so when I looked at how How are we supposed to eat as we age, and we talked about this a little offline, but we'll talk about online. We actually are changing as humans, and that's good. It's a good thing, but we have to change our habits and our food to match that. And why is it a secret? You know when you got a health class and it was really awkward when you were 10 years old and everybody laughed, but at least you started the conversation? What if we had a class that was like, Hey, this is what's happening to your body. You should probably eat this. You should probably change this, or you could probably do this. These are some options. Just start the conversation, but there's nothing. And even in the medical literature, there's nothing. Our menopause books don't have a section on nutrition. So it's like, I felt like there was a big hole in helping women in this phase of life in that way, because I think most of us are at home. We're not at the doctor's office.

We want to know what are we supposed to be doing from day to night to optimize ourselves, our brain, our health. And it's not the same as men. And it's not the same as when you were 20.

That's exactly. It is true, right? Everything does change decade by decade, I feel. And what you need today is not what I needed when I was 25. By the way, when you're 25, anything can go.

Anything can go. Any diet can go. You can basically- You get away with murder. Yeah. And your cortisol is buffering, we were saying, can party all night and then go to work the next day and you're Fine. And then do it again that night. A hundred %. And your body is fine. But you try to do that in your 40s, and you're down for the count or you get sick.

Well, what you said to me outside was really interesting because I was actually telling... I was just to fill you guys in behind the scenes. Well, in front now. But I got my blood work back, and I was telling Amy that the people were shocked, and I was shocked that my physical stress test was so high, which is not a good thing. The stress in my body is very, very high or my physical stress. But my resilience is what saves me because I was so high on the resilience. That it's basically my personality that's pushing through it. But I'm really at burn out, right? And then you were saying to me, you asked me a question. You're like, at night, how do you sleep? And I said that I wake up- In the middle of the night. Yeah. I fall asleep okay. Yes. But then every night around 4: 30 or five o'clock, like clockwork, I wake up panicked. Kind of like how a baby does when they're small. And you said it's because the cortisol. Can you talk about that? Is that's normal, you're saying?

So everyone gets a little bump of their cortisol at night. But what I see, and I said high functioning, girl boss women. Thank you. Yeah. Is that they're doing all the things, and then they wake up in the middle of the night because their cortisol bump is high enough that it wicks them up. Almost like in a panic because it's a stress hormone. And it's thinking, you're like, Oh, my God, am I dying?

It's like a really... It's like a hole. It's scary. Yes.

And so what that signals to you is that you have a lot of stress in your life, which you could have said that, but you have to do a better job managing that stress. Because what happens is as we get older, as we move through the hormonal continuum, our ability to buffer the cortisol goes down. And so the same things that didn't stress you out in your 20s or even early 30s start to really stress you out. So the same those workouts where it's high intensity training, whatever, you You could maybe in your 20s, I know I did those all the time, every day without any recovery, and it was fine. Whereas when I started in my late 30s and early 40s, I started to notice I was not getting results from that. I was actually feeling like I was gaining mid section fat. I was feeling tired. It's because they raise your cortisol so high, they make you crave a lot of food. Then you're counteracting the calories that you just burned. It's almost like this cortisol cycle that's happening. We really need to learn how to recover a little bit better. So more nature time, more sunlight, more sleep, more things that bring you joy because that counteracts the stress.

And that's literally what perimenopause really to me is. It's not the sex hormones, really. For me, it's like we're moving through a hormonal continuum that's changing our brain, our body, and we need to just learn to adapt to it. It's a great time. You see all the CEOs and people living the peak of their lives in their 40s, 50s, and 60s, right? So it's not that it's the end. It's just that we have to learn to manage it. If you're this successful and this happy and this fit, you can go to that next level if you understand what's happening. So doing more recovery. For you, that might look like any version of- Don't say yoga, please.

Don't say yoga or meditation. Don't say either one. I'm going to be showing you the door.

No, you need moving things because you have that personality of you need to be moving meditation. So it's like anything that... I would say, anything that collapses time for you. Like, is there... Your daughter does dance. So I'm sure she's like, my daughter. My daughter goes to dance rehearsal for five hours. And she's like, oh, it's like it just passed by like this. Because you're doing something you really love, and that buffers your cortisol so well. So what is it that you really love?

I started something called Paddle. Have you heard of Paddle? Yes. I love it. It's very, very fun. I'm terrible at it. So it's not rigorous or anything, but I move. And so I like it. But I was going to say something that was very interesting that you said that's so true, that what I've noticed in my my more middle age, is that these high intensity workouts actually work against me.

Yes.

Because of that exact thing. I end up eating 10 times the amount of food I would have otherwise ate because it makes me so hungry. And I'm also more tired of fatigue the next day. I don't feel energetic. I feel more just sluggish.

That's exactly what happens because it riles up your cortisol And that cortisol makes you want to eat because you need quick sugar when your cortisol is high. Exactly. So you have tons of sugar. So you feel like having that quick sugary thing. And then you're tired because that cortisol being so high for so long, it's like your body thought you were being chased by a tiger for hours. And so you're fatigued. And so what I realized is taking away some of that stress and really going to the edges. So the edges meaning really short bursts and then lots of low level activity, whatever you love, like hiking, walking, things that aren't like- That's strenuous. Yeah, something you love to do.

Because also the managing of the appetite is a massive, massive one, right? Yeah. Because you will gain a lot of belly fat. I've noticed because of the fact that you are spiking that cortisol so high.

Somebody told me this, and this is very inappropriate, but I was like, this is so true. They were like, go to a marathon and watch a marathon and watch the people who are winning the marathon. They're very lanky and thin and whatever. But then watch the very end of the marathon when people are maybe first Timers or maybe people who are just working on it. And they don't always look fit. People who do marathons for the first time tell me all the time that I gained weight or I feel injured.

By the way, I talk about this all the time. If you look at me, I mean, watch me get completely... Let them come. Let the comments come. If you see people who are marathon runners, they don't look fit. I don't want a marathon body. I want someone who's super- A sprinter body. A sprinter body Or someone who's really toned and tight because they're not doing those 20 hours of running. But I find that running in general just breaks down your lean muscle mass so much. And long, long endurance races is not going to get you there. You need to do strength training, I always say, to get that body composition.

Yeah. I did a framework for women. Tell me what you think of this, okay? Okay. 4, 3, 2, 1. So women in middle age- I saw it.

It's great. Yeah.

So it's like 30 and above, really. When you're 35 and above, people, what I would consider perimenopause, premenopause, four days of that activity that you love, the one that... The paddle that you love, the hiking, the walks It's the thing that the time passes, or you could do when you're 80 or you can do when you're 30. So four days a week of movement, just whatever you love. Three days a week of weight training, because that's essential. We lose 3-8% of muscle mass every decade. And then for women, we go up to 1% a year if we're not doing anything. So we got to counteract that. So three days a week, and that can be at least three days a week. That's what the data shows. You can do two days, but that's really rare. It's more three to build. And then two days of hot therapy. And that's because I feel like the data on hot versus cold, the hot therapy data is so much better. And for women, especially, if you're someone who wants to boost your hormones, you are someone who wants to boost your hormones. You are someone who wants to work on brain health.

And it doesn't have to be sitting in a sauna. It could be moving in a sauna. He did Pilates, whatever. He did a workout. And then the one is a sprint every single week. Meaning that most people after high school have never sprinted. They've never run to their maximal capacity. But if you're actually trying... Our muscle, our heart is a muscle. And if you're trying to keep it strong, you need to exercise that muscle. And if you're always working at low level, and to be honest, weight training, sometimes it can get your heart rate up, but not to the max.

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So for the four movement days, how long? For the three strength training, how long? Give me the time frame. Give me the duration of each.

30 minutes for everything, minimum, okay? Okay. And the sprint doesn't have to be 30 You can't do a sprint workout.

Where do you go one minute on?

You know the Norwegian 4x4?

Oh, my God. I haven't heard that for so long. Remind me what it is. Okay. I remember.

It's a sprint workout. So basically, there was a study where they took people who were sedentary. Like, literally in midlife, were sedentary. That means that they didn't ever go to the gym, but they consider themselves light movement, that sedentary. Then they put them on a two-year exercise program. They started with just walking, really easy cardio. Then they added weight training and all that stuff. Then the one year, six month mark, they added sprint training, and they added the Norwegian 4 by 4 once a week. They tested their heart function at the end of it, and they compared it to the beginning, and their hearts looked 20 years younger.

Really?

By adding that one sprint workout, in addition to the regular working out.

By adding just that one sprint?

And that was a Norwegian 4x4. So if you wanted to copy the study and do it exactly, but it's really hard to do the Norwegian 4x4, maybe not for you, but for most people. I would say most people have to start with just sprinting for the first time in their life for 30 seconds and getting their heart rate to 85% of their max and then work up. Norwegian 4x4 is four minutes of working at 85% heart rate and then taking a break.

Wow. So a four-minute sprint.

A four-minute high-intensity. Maybe it's like a biking or running or whatever. But no break. No break for four minutes.

Yeah. Do you remember Tabata? Yes. Isn't that like, well, that's 20 and 10, but that's for a four-minute or eight-minute. I can't remember. Yeah.

There's so many versions of that. There's so many versions. They just ended up picking that one Which I think is the hardest one ever.

Oh my God. Four minutes sprint is very, very hard.

Four minutes, and then you take a break and you rest, and then you do it again, and you do it at four times, four by four. It's really hard. But if you think about it, 85% of your heart rate- No, it's That's great, actually. Of your max heart rate is different for everyone.

But that would also spike your cortisone.

But it's short.

Four minutes times four is still 16. It's a lot.

For them, it was like, they did that once a week. I'm all for high intensity once a week or even twice or three times. As long as you're taking lots of recovery days. Right.

So the rest of the days are not that difficult. So that doing that one day is probably way better than doing every every day at moderate to intense.

That's right. So when you go to those workout like the very popular chains.

Like an orange theory or a Bookbury's workout.

You're not really getting up to 85, but you're not... You're raising your cortisol.

So you're getting to 70. Yes. And so you're just always going to be exhausted.

Yeah. You're not on the edges. We want to be on the edges. If you do want to do a place like that, I often will go for that one One day, the sprint day, because when I'm on the treadmill or whatever, you can push yourself to that 85 % as much as you can. I don't expect, I don't even think that most people can get themselves to 85 % of their heart rate for four minutes straight for that many times. I think it's something you work up to. I usually do 30 second sprints, then you walk for a minute, and then you do another 30 second sprint, and then you do it eight. Have you ever heard of crazy eights? Yes. Yeah, that's what I do. You do it eight times. Yeah. And that's I do.

You're a fitness instructor. You know all these different modalities.

I dabble. In your spare time. Yeah, exactly. I think that part... Because I know that you're so into the fitness world. That's why I wanted to share that with you, because I think for the woman who is going into this next phase of their life that wants to optimize, it's not about doing more. It's really about recovering better. Yeah.

Say that again, because for the cheap seats behind you, because I think that is so true. It's hard, though, right? Because I think people get really stuck, I'm talking for a friend, with things that worked for you so well for so long. It's really hard to change that mindset and do something different, right? Yes. Even though all the numbers and all the evidence is pointing to that, right? It's so true.

Doing more is not doing you any favors. It's not about doing more. Doing, recovering better. So that It's hard for people like you and me because we grew up our culture, our society, everyone around us was like, Do more, do more, and get smaller. That was the messaging that we were getting.

And intense, intensity. Yes, totally.

To get stronger and to recover, it feels so anti that.

It seems like it's so opposite. Yes.

For you, someone who has a lot of cortisol, like your spikes, especially when they're... It's like your life is spiking your cortisol. A food is spiking the cortisol. Your alcohol is spiking your cortisol. Your caffeine is spiking the cortisol. And then your workouts are spiking the cortisol.

There's a lot of cortisol spiking.

So if you actually put it all together, you're like, wow, your body is amazing that it can even handle all that.

A hundred %. What's the difference between cortisol and your adrenaline?

It's all part of the same cycle. So adrenaline comes from your adrenals. And so when you wake up in the morning, if your cortisol is working, your adrenaline is high, and that's why you feel awake. That's what wakes you up, actually, in the morning.

How do you know if you have adrenal fatigue?

Adrenal fatigue is actually a misnomer because your adrenals are working fine. They're not fatigued. It's just that you're in this constant state of high cortisol. If you ask an endocrinologist, they'd be like, I'll cringe when you say, Adrenal fatigue, because that's not really what happens. Oh, really? It's just cortisol dysregulation. What we're saying is you're never in the parasympathetic mode. You're always having your nervous system and your hormones in the mode that they have to focus only on survival. You need the mode of you're safe and I'm ready to digest, I'm ready to critically think. That's not going to happen if you're always in that sympathetic mode. So you You have to learn. So sympathetic is talking about your nervous system being activated. So when your cortisol is high, it activates your nervous system. And so you feel on edge when your cortisol is high.

Yes, totally.

You're irritable and on edge because that It's riling up your nervous system to be ready to go as if there's danger around. One of the reasons you wake up in the middle of the night is to look for danger. And that's why you're thinking about, Oh, shit, I forgot to do that thing. All the danger things Things that your body feels as dangerous, they all come to you at that time. Did I lock the door? Did I unplug that thing? Did I send that email? That's what you're thinking about. Because your cortisol was like, Hey, we're in danger. Remember all the dangerous things? They're not life-threatening, literally, but our mind thinks that they're life-threatening, and you think about all of them in the middle of the night.

A hundred %. I totally agree. This makes perfect sense. So what are some habits that people do that is actually aging them that they're not even aware of?

Okay, so you said the first one that you don't do is alcohol. I don't know. I used to have a Whoop. Do you have a wearable?

I don't wear anything anymore. I wear this. I used to wear the Whoop and the Oura ring and all the things.

Now I'm not wearing them. Yeah. Then you just went on detox. I think it was really nice for me, though, because I would say, Oh, my God, my HRV is so low today. I don't know what I did. And it was just like in passing, I would have a drink at dinner, just like nothing. And then It was like, every time I noticed my HRV, so that's like a measure of your nervous system, how tightly wound your nervous system is.

Yeah, exactly. Mine's very tightly wound.

Yeah. So my HRV would drop every time I would drink. So it's like even like you're having one or two every night. So now we know that that's even one or two every night is not good for our... It ages us basically in every single way.

So the first thing that people are doing that's aging them is alcohol. Yes. Number one. That's the number one thing that they should cut.

Number one thing that you is aging you is alcohol.

I agree. By the way, that's why I hate to say, look at JLo, right? She hasn't drink at all. She's like, 12.

No, 100 %. And she says that's why she doesn't drink because she doesn't want to eat.

A hundred %. I'm like, I'll for this. Is that why you stopped thinking? No, I'm lucky because the one thing I never, ever, ever liked was alcohol. I never liked the taste of alcohol. I never drink in high school, college, whatever. I hate the taste of it. So I got lucky on that one.

That's amazing. Yeah.

Okay, number two- But I like chocolate cake and French fries.

Okay, so that's number two. Number two is the ultra-processed foods, especially high sugar foods, because Because what they do, the other thing that happens as we age is that our ability to process sugar, so our insulin resistance goes up. Before you could eat something very sugary and your body quickly absorbs it into itself. And so that's why it's good to walk around after a meal because you want to quickly absorb all that sugar.

I want to ask you about that after. Remind me.

Yeah. So when we start to lose estrogen, we also lose a little bit of our ability to absorb that sugar. So it sticks around a little bit longer. And so that- Oh, really?

So wait, say that again. So as we lose estrogen, that's when sugar sticks on our body longer. Yes.

So our cell's ability, so our cell becomes a little more resistant to To sugar. To sugar, right. To taking it in.

As our estrogen drops. Yes.

So you'll see a lot of people, including myself, their hemoglobin A1c, a marker of your blood sugar, will start to rise during that time. That's a marker of perimenopause. It's like people who have a diabetes history. My family, everybody has diabetes. You'll see now you're starting to see. Even people who look healthy, your sugars are climbing up. And so the same, it's aging you because when that sugar sugar sticks around in your bloodstream, it is a very... Like your body is doing everything it can to bring that in. That sugar that's there is aging you by the minute. So every- Really? And so that's why things like eating fruit instead of having a sugary thing is much better because it's slowing. When you have fiber with your sugar, it's slowly absorbed, right?

But how about dried fruit?

Dried fruit is not as great because you're getting the sugar in concentrated form, and so you're getting that spike that you don't want. And for people who are really, really healthy, people are like, Why would you care about blood sugar spikes? And you don't necessarily. But when you're over the age of 40, your ability to process sugar changes. And so especially if you have a family history of anything, heart disease, diabetes, you really want to be minimizing those spikes. And so that's why it's really important to eat fiber because it blunt the sugar response. But all processed foods devoid of fiber. So if you're eating ultra-processed food, you're automatically eating a super low fiber, high sugar or high-process, whatever diet. That's the number two.

Sugar. Okay.

And liquid sugar is the worst. So alcohol, liquid sugar, obviously, that's bad, but like frappucinos and da da da. Yeah, frappucinos.

They never drink your calories. That's why, by the way, I'm not a big smoothie person. Yes. Because the amount of calories that people are piling on stuff and they're thinking they're doing themselves a service.

And And it's not as satisfying.

I'm starving. First of all, it takes you three seconds to drink it. I'm a volume meter. I like to have big volume because I feel like it's a whole thing. What do you call it? It's like a whole event when I eat.

And when you chew something- And chew and all that. You get the signals to your brain that you're eating and that you have food in your system.

Exactly. And when you have a smoothie in four seconds, it's like a finish. And I'm like, Okay, now where's my meal? And then I just had a thousand calories. Yeah.

So the sugary... These ultra The worst sugary fruits is the number two thing you can do. I don't mean take it all out. If you're eating a piece of fruit... I mean, okay, so for dried fruits, out of everything, dates are the best. Dates are low... I love mango. Dates are low I see. Mangos are amazing. I'll never, ever, ever vilify fruit. These people who are like, Don't eat fruit. It's insane. What do you mean, Don't eat fruit? They have all these nutritional value beyond just sugar content. Exactly.

And the fiber when it's fresh fruit. So you're saying then I can eat my mango?

You can eat your mango.

But obviously- The dried mango?

Not the dried mango and not the mango-flaved drink or whatever.

No, I wouldn't have that. No.

But the minimizing sugar spikes also, there's tricks to do that. So if you're eating a dessert, if you eat something with fiber with it, it'll slow it down. So don't eat your dessert after you've already had your meal so you're not spiking It's much worse if you're eating it on the go when you haven't eaten anything.

Does that mean then if you eat fruit by itself, there's a lot of people who eat fruit first thing in the morning and nothing else. Doesn't that just spike your blood sugar then?

Well, fruit, depending on the fruit, has a ton of fiber. Yeah.

Oh, yeah.

You're ready to have the fiber too. Raspberries have 8 grams of fiber, which is insane. It's a huge chunk of your fiber for the day. You just get from- The raspberries. A raspberries. That is amazing. It's not very high in sugar. Berries are are incredible because they actually give you all of the polyphenols and the fiber without actually giving you that blood sugar spike and tastes really good. I'm talking about the straight up candy bar from your local... It's devoid of fiber and you're- Like sugar sugar, like junk food sugar. Remember when we were saying, oh, hungry for Snickers, what was the saying?

Yeah, I know what you're talking about.

Because you would eat it because you're really hungry at three o'clock. But that's the worst thing you can do because it's spiking your blood sugar. It's ultra-processed. If we're talking about aging, that's literally aging you.

Can I ask you a question? What about this? Because this is what I do sometimes, and So because I get super... I want that sugar craving, I'll have an ice coffee with a little bit of sugar-free vanilla in there around three o'clock. I love that.

Yeah, I do that, too.

You do? Yeah. It just takes It gets the edge off.

Exactly. And other thing you can do- But it's caffeine. Well, I mean, if you're not sensitive, people- I'm not sensitive.

I can have a vat of caffeine. I can fall asleep.

Yeah, you're so lucky. That's a genetic thing. Some of us don't have that, so we can't have a caffeine little bit, although I did. One of the tricks I have, there's two tricks I have. So one is when you're having something... So say you have a yogurt parfait and you want to have something sweet, like crumble cookie or something on top of it. So you're having Like your Greek yogurt, the protein, and then maybe some berries in it. You get your fiber and then you're getting your treat. There, it's just paired with a bunch of things that can escort it into your body in the right way.

So the protein and everything, the fiber or blood, sugar. I like that.

Okay. So that's a trick. And then the other trick, which is something I've used for years, is if you really want your process snack or there's something you really want, put it in a really small bowl and then walk away from the kitchen. Go to your patio, go to the farthest place that you would go and bring a glass of water and just have it. Because if you're standing in front of an open bag or box, that's the worst thing you can ever do. It's not about deprivation. If you're like, I really just want one cookie and whatever, a couple of chips, you put it in a little bowl, you walk away, you bring your water with you, and then you're not... It's much less likely that you'll just... It takes a lot less willpower to just be like, Okay, I'm done for right now.

So wait, so you're saying put it into the bowl and then leave. And then leave.

Leave the kitchen, close the thing.

Oh, so don't eat it there. Take it with you. And that's your treat. That's right. Because you're saying you're not likely to come back to the kitchen? Have you met me? Yeah, you're less likely. I'll go back 50 times.

And that's your dopamine pattern. So put it back in the freezer, put it back in the... Put back the things in the- Yeah, close it up. Yeah. And then go out, go somewhere where you feel really less stressed.

Well, have you ever not heard the big joke of the world or the times is when you have a big cake and people are like, Oh, I'll just have a slipper, and then they put the rest in the fridge. But the person just keeps on going back. They go back, the whole cake is over, is finished.

Did you see that one where they threw the cake in the garbage? Yes. And then they I hate the garbage.

I'm like, by the way, that would be me. I hate to say it. I don't know if that last trip would work for me because I start to obsess about something. I'm like, well, I might as well just go and have enough. I've already had it, so I might as well just have more now. And you get into that crazy of eating because you already did the damage, you're going to continue doing the damage.

The same they actually want. I don't want to say this whole evil conspiracy theory about ultra-processed foods, but the companies are looking to create foods that make you do that, that make you want to come back, and you can't stop thinking about it. A hundred %. If there are foods like that, that's a sign you need to cut it out. It's like drugs.

Don't even bring it into the house.

Yes. It's triggering your dopamine pathway. Our dopamine pathway is so strong that you will get up out of bed into your car and go across town for something that stimulates that dopamine.

A hundred %. That's what's so dangerous about these things.

Yes. And so I feel like... Okay, so ultra-processed foods. I would put sugary. Let's put sugary and fried, all in one category. Processed food. Yeah, ultra-processed. And then number three, sedentary. We are meant to be moving. Our bodies, we are genetically and evolutionarily programmed to moving like humans, moving things. And I think that we're not programmed to be sitting for eight hours a day. And when we do that, our body doesn't function as well. And that really, really accelerates aging over time. So it doesn't show up when you're young, but over time, it actually does age you a lot.

I agree. Number four?

Number four is stress, which we talked about. Stress should be number one, probably.

Is there a way that people maybe are stressed and they don't even know they're stressed? Or does everyone just know when they're stressed?

Well, did you know that you were stressed?

Yeah, but I didn't know I was that stressed. And the other test that they showed that you can do is that how your body manages stress. Did you know about this test?

What's it called?

I don't know what it's called, but they basically said, again, I have a lot of stress, but my body is good at- Oh, resilient. Of deflecting the stress.

It's a very good thing to be able to be resilient to stress. But I honestly believe that a lot of us are holding stress. Okay, I'll give you an example, neck pain. People who have a lot of shoulder, neck, stiffness or pain, sleep issues, like you said, waking up in the middle of the night. Palpitations or feeling nervous about things shouldn't be anxiety-provoking is another sign that your cortisol system is really activated. Cravings, sugar cravings, because if you think about it, If your body is preparing to run away from an animal, it needs quick energy. And so you're going to be craving sugar. And so a lot of people, as soon as they bring down that stress, the sugar cravings really subside, which is a huge thing that helps their life. So I feel like stress is one of those things that ages you without you even really knowing that it's aging you. If you really want to know, we know evidence of this. It's like you look at people who have been through wars or really stressful time, famines and wars, and you see how fast they age.

It's insane. Look at the president. It's not this one, but you remember, like most other presidents. Yes. When they start- When they start, first, when they finish, they look like they're 30 years older. Yeah, totally. Their hair is gray now. It's really unbelievable.

So if you think about it- This is the only President who looks younger now than he did before.

Totally. Which is a whole other story.

That's hilarious. That's exactly right. So if we're talking about aging, per se, that Stress will age you more than anything. The President example was so perfect. And people that have gone through really difficult, come from war-torn country. They often have a lot of signs of physical aging. That doesn't mean that you can't do anything about it. It just means that the stress that you experience is aging you more, all these things.

Kids, by the way.

Kids, yes.

I'm not even kidding. If you look at a woman who's 40 years old with kids versus a woman who's 40 without kids, without a doubt, the woman who's 40 with kids looks older. A hundred %. Because of the stress of taking care of other humans and the time restraint you have on your life. And your whole life is different, right? It's super stressful. Yes. The women who are for you without kids, they don't really have a care in the world, right? That's right. They just have to take care of themselves. It's much easier.

Well, I mean, I agree with you because kids are very stressful.

Kids are I'm super stressed out all the time. My friends who are my age, they look like they're 32 who don't have kids, the ones who have kids.

And they often have other life stressors, but it's just different. Well, different.

But what I'm saying is, I'm joking.

It's- Yeah, no, I know. There's so many other life stressors that don't age you like having kids ages you.

I totally agree. That's what I'm saying. It's true, though. But when you have to... And it's also not necessarily bad stressors, but it's having to deal with other people's calendars and schedules and driving and feeding them and move. You don't have as much time. You don't have enough downtime. Yeah, that's right. You don't have any downtime. So you don't have that ability.

You're worried about them more than you worry about yourself.

Well, that's right. So that stresses you. Yes. Actually, that ages you, I should say. That does age you. It does age you. I'm just being real. So that's another one.

Number five is the most- Kids.

No, I'm joking. Well, it's true.

Yeah. Good and Good and bad. Good and bad. Yeah. Number five definitely should be number one in terms of the ability to age you. This one is the most important. Can you guess?

Smoking?

Well, smoking, I would put in that drinking category, but yeah, that's right. Okay.

Why the drinking category? I guess because it talks and you bring it each time. Okay, number five. I know you know it, but- I probably do. But now, we talked about sugar, we talked about alcohol, we talked about junk food, processed food, stress, hormones?

Not sleeping enough.

Oh, my God. Of course not sleeping. Yes, that's the number one. Oh, my gosh. Of course. Duh. I should have been looking at your friend. She was like, pictionaring. She was doing like the... Damn.

No, I literally think that- What was I...

Of course, sleep. Yeah.

If there's one thing that you could do to anti-age yourself is It's like start getting more sleep. More than you think. I think women tend to feel like they are lazy if they're sleeping eight hours or whatever. Whatever requires you to feel refreshed, it feels indulgent. It feels like And it feels like that's the one thing that's actually different between the genders. Men tend to need less sleep than women. I don't know if most people don't allow themselves as much sleep. I don't. But really, you should sleep without an alarm and see how much sleep you actually need when you're not sleep-deprived. And then that's your baseline of sleep that you need for recovery. When we're talking about working on stress and working on... You said it's really hard for you to meditate. Just sleep a little bit longer. That's the perfect way to bring down your stress. I know.

That's so true. But I'm not a great... Also, your body has an algorithm, right? I'm so used to sleeping five and a half, six hours now. That's my baseline, even though I'm tired all the time. I think that my internal anxiety won't allow me to even stay asleep.

No. So that's what you have to work on. So one of the things I did, I was the same way as I used to be like, I would like... I felt tired, but I would just have an alarm all the time to wake me up.

Yeah, and just wake up. Yeah.

So one of the things I started doing is really getting a lot more sunlight first thing in the morning, within an hour of waking up. That That is going to reset your circadian rhythm so that your body knows now, okay, in about 12 hours from now, I'm going to start really releasing melatonin. It rewires your brain. So if you're someone who goes through a different time zone, you're traveling, you're trying to rewire your sleep schedule, getting a lot of concentrated light, natural light into your eyes, so not behind sunglasses, not behind a window, but actually direct. It goes straight from your retina to your brain to your suprachia's nucleus and rewires everything. It's one of the best ways to get better sleep and more sleep. Then the second thing I would say is the data shows that sleeping at the same time and waking up at the same time every single day, even as much as you can, even on weekends within 30 minutes, can really improve the quality of your sleep that you're getting. So even if you're getting less the quality, the restoration that you get from it is better.

Yeah, I try to do that anyway. Also, like you said, I feel like I'm a creature of habit. Yeah, So going to bed around the same time. But now, because of this waking up in the middle of the night, that's the problem. I can't fall back asleep. So now you're awake at five o'clock in the morning, and I'm like, Oh, my God.

And then it takes you a couple of hours to actually get yourself into a place where you can function. Yeah, that's exactly right. So for you, I would say work on all the things. You need a cortisol reset. There's a cortisol reset in there. I know. Work on all the things to decrease cortisol. I I would say, Jen, that's the number one thing that I see women struggling with as we're moving through the hormonal continuum is having trouble figuring out how to recover, not giving... We don't give enough permission and enough time to actually have recovery. So recovery doesn't always just mean cold, pungent sauna. It means also sleep, and it also means nature, and also means turning down the volume on the training if it's draining you. That stuff.

Right. So recovery is not just about these modalities of the sauna and the cold plant.

The red light. It's also about eating to support your gut bacteria because your gut bacteria actually makes your own ibuprofen. So our own stress-reducing anti-inflammatory compounds that we create in our body is created by gut bacteria. And so we can do things by eating food to support that that will stimulate It's like they create these things called short-chain fatty acids, and they work like natural ibuprofen. Calm down the cortisol, calm down the inflammation, go all over our body. Who doesn't want their own bottle of ibuprofen inside? You have to build it.

But how do you do that? I think right now everyone talks about gut health, right? Yes. But everyone says, Oh, I have leaky gut. I have this. I have that. But it is like the gut really is the brain of your body, right? It's not the brain, it's the gut. But if so many people have gut issues. Isn't that... What are the some key factors that people can even know? And is that also interfering with maybe the symptoms of perimenopause and menopause?

I actually think that if you fix your gut, you'll fix your hormones.

Really? How? Tell me how.

Because our gut is constantly talking to our brain, our hormones, our immune system. And when you need more estrogen, there's actually gut bacteria, we call it astroblome, a bunch of bacteria that put the estrogen back into your system. They take out estrogen from your system. They're modulating your hormones. And the gut bacteria are literally the captains in charge. They're the walkie-talking your brain. They're walkie-talking the rest of your body to send more hormone this way, to send more hormone. So if you really want to get your hormones in check and balance, you need more of that gut bacteria because the modern world, the way we live, it strips down our gut bacteria to 50% of what we actually need or we're supposed to have. And so we're working with less than we started with. And then as we move through perimenopause, our estrogen levels go down, our gut bacteria die. Some of them are dependent on hormones like estrogen. And so we need to do stuff to work extra hard to keep these gut bacteria alive and healthy so they can signal to all the places in our body. So your hormones, a lot of people will tell me, as soon as I change my diet, all of a sudden, those symptoms that I thought I had because I was getting older went away.

Really? So how would you do that, though? Give me an example.

Okay, so that 30-33 that I developed. So it's 30 grams of protein in the morning, 30 grams of fiber throughout the day, and three servings of probiotic foods. So three fermented foods a day. If you start with the fermented foods, which every culture used to eat fermented foods. Now, nobody eats fermented foods. I mean, 95% of the population don't even eat enough fiber, and they're definitely not eating enough fermented food. Fermented food is the one thing we know that can add bacteria. So increase the bacteria in our gut and also lowers the inflammation. So it's the one thing that we know in diet through all the studies. If you want to lower inflammation and your stress levels in your body through food, you want to be eating more fermented food.

Yeah. Fermented foods are very, very popular now, I It's getting more popular. Is that like sauerkraut?

Yes, it's sauerkraut, kimchi, but it's also like yogurt and probiotic cottage cheese. Oh, I can have you.

Oh, yeah. Kefa.

Oh, yeah, yogurt. Yeah.

I should be eating way more of that stuff. Yes.

So that can help calm down the inflammation in your body and in your brain. So that's a great way to manage that gut-brain connection and get that stress down and also help your hormones. And then the fiber is food for the gut bacteria. Imagine you're It's supposed to have an Amazon jungle in there because it's literally like that trillions, trillions with a T, bacteria that live in there. We have just the same amount of bacteria in our body that we have our own cells. So there's a trillion of them. They are starving because all they can eat is certain foods, like fiber is one of their main sources of food. And when you're eating an ultra-process diet, which most of us are, you're not feeding your bacteria, anything. They're starving, they're dying.

Wow. Yeah. So then what do you I think of having... Okay, so if it's fermented food and everything that you just said, you're going to say probably not, but if we eat better and then we are taking care of our gut, would that make us not have to take hormone Yeah. Therapy, HRT.

So I will say this. When you're in perimenopause and starting to get the symptoms, this will probably... This can often be enough. This can suffice, yes. Because you can just say, Hey, I don't feel myself. My gut's not My brain fog is a little high.

I'm not- So it's a bandaid.

No, it's a foundation. A foundation, okay. Meaning that you can't stop doing it even as you get older.

That's true. Okay, fine. You're right. You're building a foundation.

You're building a foundation. A lot of us never had that foundation. I was in medical school and trained. I studied nutrition, and we did not learn this. That's why I think it's so important to have the book like this for me, because I'm like, We didn't even learn this. How are people supposed to know this?

Well, that's I always found that very interesting that doctors never get trained in nutrition at all. No.

Ever. The thing is, the shocking, shocking thing is that not only do we not get trained on nutrition, we really don't get trained on women at all. Women were excluded from- Because they're training...

It's all usually based on men, correct? Yes.

All the research, all the medical studies, everything was based on men. So not only do we not have enough nutrition knowledge, we really don't have any nutrition knowledge for women. And so all the stuff that I'm saying, for a lot of people, they're hearing it for the first time.

I know. Isn't that crazy? It's so crazy.

So I looked at the textbooks for menopause, for perimenopause. Where is the information about, Hey, we need more protein because we We're going to build the muscle. We're losing muscle. We need fiber. The studies are there, but we don't have any instruction around it. So that's really why I felt like I needed to talk about it.

To talk about it. Let's talk about HRT because we're here anyway. We might as well. So what's your take on it?

Okay. My take on HRT is that we're in a very unique situation in our world right now where we live well past menopause, and we want to thrive well past menopause. Imagine there's every animal in the animal kingdom, if an organ dies in your body, you die. You can't live with something that's not functional in there. It's very critical. And so for us to be living 30, 40 years past an organ invaluting and not functioning properly is incredible. So we're in a very unique situation in history. We are living longer, we want to do things longer. And so I think that hormone therapy has a role, especially if you're someone who has osteoporosis, if you're someone who has major hot flashes or night sweats, because we know both of those things can be solved. Like, literally solved by hormones. There are conditions that cannot yet be solved by hormone therapy. So osteoporosis can be, hot flashes, night sweats can be, and then vaginal symptoms like dryness and discomfort can be. Those things you can actually reverse completely. Hormon therapy, done. Slam dunk. What we don't have data yet on, clarity, weight loss, brain fog, gut issues.

So all of this foundational stuff is still what we need to do for that.

Wow. I didn't realize that.

Yeah, it's not a magic pill for everything.

It's not a magic pill for weight loss or for brain fog.

Or for heart health, even.

Or for heart health. So that's very interesting because I think that I guess, what people are just They just assume, really. The assumption is that it's the panacea for every symptom.

In their defense, I think there's a lot of confusion, right? If you're like, yes, it's good for this, but we're not sure about this, I think it's more like, hey, you should talk about this with your doctor. It's a good option. But the nuance, I think, is really important.

Well, life is about nuance. Nothing is black and white. Yeah.

If you're taking it for weight loss, that is not the right reason to be on hormone therapy. Same thing with dementia and heart. There's a lot of new studies that are like, We have estrogen receptors in our brain. That's amazing. But the data is not strong enough. There's not good data to say you can reverse brain issues or you can prevent dementia or you can prevent heart disease. So what we're saying is like, Yes, there's estrogen receptors everywhere in our body, and there's some potential there, but we're not there yet.

Interesting. So it's not like a panacea. It's not like a cure all.

And I think that I'm super excited. I'm really happy for people that are embracing it more. But I think we need to talk about that other side. It's not like you're just going to take it in your life automatically. It's like shiny rainbows and butterflies, and you just don't have to do anything else anymore.

Well, that's the thing. And also they say if you take it too late, then you don't get any of the effects. Is that true? So it's this fear-based, like, Oh, shit. If you miss the boat, If I miss that boat, so do I have to start taking it now if I don't want to basically shrible up and die in 10 years?

No, I think that's exactly right. The thing about taking it late, though, is more about the breast cancer risk. So when you You looked back at that study where they saw a link with breast cancer. There's a couple of reasons that came out. One was people taking it very late, like 10 years postmenopause in their 60s, if you're taking it because you already got used to not having the hormones, and then you're adding hormones. It seems to be linked with higher rates of cancer. And then that's the reason that even now, if you've gone 10 years postmenopause, that's a conversation that you have to have with your doctor because a lot of times that's an increased risk. Why? We don't know. We think that maybe your body got used to functioning without hormones then.

So then you introduce hormones again, and it puts into overdrive. Exactly.

And then the old hormone therapy also used synthetic progesterone.

But if you're not using synthetic, if you're using bio- Yeah, the micronized progesterone. That still can have the same effect, you're saying?

If you started really late.

Yeah, I'm saying like, if you say 10 years late because your body is not accustomed to them at all.

And the thing is, the studies are still evolving and we're still trying to figure out, okay, what is the right combo? How many years? So it's not something that's a slam dunk. I said for those three conditions that I said to you, osteoporosis for vaginal symptoms and for hot flashes and night sweats, it's actually there's good data to be like, yeah, the risks outweigh the benefits in most cases. But most people are doing it. The benefits outweigh the risk in most cases.

Most people, I would say, are doing it for the other reasons? Yes.

It's become really in vogue to be like, oh, I'm like... It's almost like how people take peptides and testosterone.

That was my next question. Well, testosterone is one of the things, right? They put you on estrogen and testosterone. There are people out there, again, all they're doing, they're showing you their estrogen patch and their testosterone. I'm like, Lady, put it away. I don't need to see anymore. But that's what's happening. It's become like a badge of honor. I just So it's not something that you feel is necessarily like- It's not a slam dunk. It's not a slam dunk.

I think the reason why people are going overboard on the other direction started out with good intentions. Yes.

Everything, the path, the road to good intentions or whatever, the path.

That's right. The path to good intention. That study was so flawed. The women's health initiative was so flawed. Everyone's so scared. And so trying to turn the tide on that. Right.

So we're like the pendulum has swung so far the other way now.

That's right. That everyone thinks that they need to start at 40. Exactly. Or you should just be on it just in case.

Exactly. Just in case. Exactly.

And I actually say in the book, I really say, I actually looked into it. I was like, Okay, what are the pros and cons for me right now? Are you doing them? No.

Okay, so you're a doctor and you're a real doctor, a double certified doctor. What doctor, by the way?

So I did internal medicine, so that's like general medicine, and then I did immunology.

So You're like, legit doctor, doctor, and you're not on them.

Yeah, because I think it's a conversation that you have to think about the pros and cons. I think once I have hot flashes, if I do, great, I'll do it. Once I have osteoporosis, I hope, knock on what I would do. Vaginal symptoms that are very out of the... I'm feeling discomfort or dryness, and a vaginal estrogen is perfect for that. So I would totally do that. I'm not against it. But when I was talking about it with my friend who was... We were just saying, Okay, so the indications, I don't have any of the indications. Can I really uplift my habits, my diet, my lifestyle, and really get myself to a place where I feel good? Yeah, I've done it, and I think I'm getting to that place. If someone just asks you, do you need hormones? And the answer is not always yes.

I'm not taking anything. And people are always shocked. They're like, you're not taking? I'm like, I'm not taking anything. Yeah. And it's great.

And the thing is, if you need it, you should take it.

Well, that's the thing. I would take it. That's why I'm asking you these questions. I'm like, listen, I'm more than okay. I'm happy to take it if I actually need it. But I've always had this idea in my head that I don't need it yet. So why would I do it? Just because everybody else is. I'm not a believer in that.

If you're cycling, if you have periods- Yeah, I do. Then you're obviously your ovulation, that you're having ovarian function.

Too much information for everyone. They're like, Oh God, it's like a medical consultation here.

And also the progesterone, a lot of people, though, I would say, the one caveat I will say the one caveat, I will say, is a lot of people, maybe you two, including myself, the early signs of perimenopause is sleep disturbances. One of the things that is aggravating your sleep issues is your lack of hormones, including progesterone. So having progesterone here and there, especially around certain times of your cycle, could help. So I would do that. Consider that if you want. So for example, right before our period, our hormone levels dropped to really, really low levels. And so that's why you feel a lot of that low energy. And a lot of people have sleep issues right before their period. And so that is a sign that your progesterone is really low. Progesterone is our sleepy anti-anxiety hormone. And so that can be used as needed for people, and you can even cycle on off of it. And that can help with just the symptoms that are starting. But you don't have to be on the patch, and you don't have to be on the combo, you don't have to be on the testosterone. That's maybe a first step for people if they want to try it.

And then the estrogen, really, you know you're in menopause when your periods are really irregular and you're skipping periods or you're going a full... When you go a full year without having periods, that's what's considered menopause.

That's when you know. Yeah. Well, all right, lady. I think I have enough information here. I mean, is there anything Anything else I need to add here before I go watch my daughter do her dance recital?

I know. You need to go watch your daughter do her dance recital. I do. I think you need to... Here's this, you. I think you need to... Just like every woman probably listening to this, or most women listening to this, you need to give yourself permission to recover and get that cortisol down. Do you know when you go on vacation and how you sleep so well? No. You don't sleep well on vacation.

Vacation? Stress. Yeah, I'm teasing you. Yes, I know. I I'm supposed to be sleeping well on vacation, all these things.

So give your body a little vacation from everything you're doing. And a vacation doesn't mean you're lying on the couch. It just means that, Hey, I'm not going to over-caffenate. You don't drink. So someone who's drinking You might want to cut down the alcohol. Maybe you really concentrate on getting more protein and fiber and fermented foods to calm yourself. Maybe you allow yourself to figure out how to take that little nap or add 20 minutes to your sleep schedule, how however you can fit it in in the week. You can't really sleep more than 20 minutes at a time extra. If you wanted to try to sleep a little extra, it would be 15 to 20 minutes more than what you do. That's how you like, retrain your body. What you should give yourself permission is to recover. So give yourself a cortisol reset for three to five days and really get that cortisol under control. That's going to change your life.

My God. Okay, I'm going to try that. Okay, Dr. Shah, where else do people find... Okay, first of all, the book, again, is called Hormone Havok, where people can find you on Instagram. You're very, very popular.

Totally. I'm very active on social. It's at Dr. Amy Shah on Instagram and TikTok, and then it's amymdwellness. Com.

I love it. Well, thank you for being here. Thanks for having me. That was fun. It was so fun. Thank you. Thank you. Bye-bye.