Guess one of my other messages with the book and the message to my patients and to my readers is it's not normal to feel, like, super hungry all the time and be having sugar cravings all the time. That's very distracting, difficult way to live life.

Welcome to Fempower Health. This is Georgie. You may have heard of best selling books, Period Repair Manual and Hormone Repair Manual. Well, today, I am thrilled to welcome back the author of these best selling books, Dr. Lara Briden, a naturopathic doctor known for her groundbreaking work in women's health. Through her books, she actually empowers us to troubleshoot and have better conversations with our clinicians. So today, we actually dive into her latest book, Metabolism Repair for where we explore how metabolic health is crucial for women, especially during perimenopause and menopause. I am excited to hear what you all think of our discussion because I won't lie. It was a little frustrating to see that the top search terms in perimenopause and menopause have to do with weight gain and weight loss.

And we do help you understand today why that actually might be a top search term, but we're really here to approach it from a health perspective. Because at end of the day, let's face it, we all just wanna feel good. Yes. Of course, we wanna look good too, but at the end of the day, we want to feel good. And today, you will understand how can be done, and I will say I found the book incredibly helpful. I think we should all have it on our shelves because it really is a troubleshooting guide. And, I was going through some stuff right before this interview, and I couldn't believe how quickly, I was able to to integrate this into my life and how much it helped me. So I hope it helps you too.

One quick note, we did not touch on the tie between hormone therapy and metabolic health. We will do that in another episode. So take a listen and email me your questions at info at fempower dash health dot com. You can get that email in the show notes as well. Send me your questions, and we'll be sure to cover hormone therapy and metabolic health. Enjoy this episode. Look forward to hearing from you. Lara, it is so nice to have you back on Fempower Health.

This is now, I think, our 4th interview together, and I am I'm so honored to even call you a friend now. We've had such a great time getting to know each other all of these years ago. And I think, embarrassingly so, I might have, like, done a prayer sign and bowed down to you the first time I met you because I read your book, and it was, like, insane. So I'm, like, chuckling over that. Boy, have times have changed, since since 2020. But I'm so happy to have you back, and I'm just gonna show this for anyone who's looking at this on YouTube. The metabolism repair for women, your new book. So welcome, welcome, welcome.

Oh, of course. So I am Canadian, but I live in New Zealand, and I'm a naturopathic doctor. I I trained in Toronto, Canada many about 25 years ago for that. Before that, I was an evolutionary biologist. But in the last 25 years, I've spent most of my time treating patients, treating them with, you know, diet, supplements, herbal medicines, and I've I've written a few books. So as you said, I've got period repair manual for women of any age about periods, hormone repair manual about perimenopause, and now this one, metabolism repair for women, all about metabolic health.

So tell me why you were inspired to write this book in particular. And by the way, I I do want to say for those who have not read your books, what I love is you come at everything from a very research driven perspective, always even keeled, not making, like, headline type statements. These are definitely, like, refer like, books to read and say, holy cow, and then something to go back to to refer and figuring out how to to solve the problem. So I commend you for that. But why this book and why now?

Yeah. Why this book? That's a great question. For me, this was about going deeper into health because as, you know, as as as sort of obscure as metabolic health might sound, it's actually very integrated into general health, including mental health. There's a lot going on with what's called metabolic psychiatry right now, but it's also metabolic health and the way our body uses energy is very involved in women's health as well, particularly around PCOS and perimenopause and menopause, but really, I think it plays a role in premenstrual mood symptoms as well and a tendency to hypoglycemia and just like so many symptoms that affect women. So and I knew this from my work with my patients and I just really wanted to try to bring this into greater awareness, demystify it if possible, and just make people understand that it, you know, it applies to all of us.

Yeah. No. It really does. Why should women care? And here's why I say this.

Yeah.

I've been doing this podcast for years, and you've seen many patients over the years. So maybe we can address this first is, again, why do women care? So we know that women will go to the doctor, to get birth control. We know women will go to the doctor when they're struggling with infertility. We know they go to the doctor when they have their baby. But the in between, there's inconsistency and the consistency by which someone sees their doctor. And so often, something has to go wrong.

Yeah. Metabolic health seems like a fuzzy term, so does insulin resistance. I know from 25 years of trying to communicate about insulin resistance, and in a few minutes, I can define what that is. But people just tend to like their eyes glaze over. It's like, oh, that sound that sounds complicated. But why this matters? I guess I'll just speak from in my consulting room with my patients when they this comes up, then yes, they will have come in with some symptoms that they like, premenstrual mood symptoms, for example, that they they need help with or irregular periods. And then, it'll often be, oh, and I'd also I've noticed that I've gained, you know, 5 kilos in the last 6 months and I'd and it it's like they'd like to lose weight, but they're all very apologetic that they know they shouldn't want to have to lose weight, you know, sort of like this. I I wanna lose weight, but I know I shouldn't be focused on that.

But they also could just have this, it sense, which is quite accurate in some cases that it's like it's because it's a sign that something's not right, right? Like if they've noticed this shift in their body shape, and they're feeling a lot hungrier all the time, and they they just feel different. They know intuitively that hormonally, and something is different, and they're trying to articulate that. And, of course, they'll say, I put my ask my doctor, and they check my thyroid, and everything's fine. So everything you know, I'm told everything's fine, but they know something's not right. So that's where yeah. So in some ways, this book is about helping people to lose weight, but, of course, it's much more than that because, importantly, it is possible to have insulin resistance with a small body size as well, which kind of flies in the face of, you know, the old narrative that the old narrative as I described in chapter 1 was that metabolic dysfunction or insulin resistance is is a symptom of weight gain when in actual fact the research shows it's the other ways the other way around. The metabolic dysfunction, the insulin resistance likely in most cases comes first, and then increased fat gain can be a symptom of that, but not always. I'll just briefly describe what, you know, insulin resistance is.

It's it's I think another way to reframe it is it needs a rebrand. I've been asking people on Twitter or x what they what what we should call this because insulin resistance is not working as a term. It's chronically elevated insulin. It's having chronically high levels of insulin, And insulin is a crucial hormone. We definitely need some of it, and we need it to be going up and down when we eat meals, but it shouldn't be sitting at a chronically elevated level. And, when it is chronically elevated, that can create inflammation for one thing, but it also, like, directly impairs the body's ability to access fat, store body fat for energy, which not only means it's harder to burn fat, that's like one thing, but and lose fat, but it's also you're not getting the energy you need between meals because we're actually our baseline healthy state, which is called metabolic flexibility, we're supposed to be burning kind of majority fat just in our, you know, going about our day baseline level, and mostly fat, a little bit of glucose as well. Of course, the brain needs glucose, but it's it's a common situation with insulin resistance that we kinda get locked into more into carb burning and then just suddenly get these blood sugar crashes and feel we have to, like, eat a granola bar just to keep going through the afternoon. That's and a lot of women will just think that's how it is.

That's normal. Like, that amount of hunger, they feel that must be normal because that's what they're experiencing or maybe have been experiencing for years or even decades, but I guess one of my other messages with the book and the message to my patients and to my readers is it's not normal to feel, like, super hungry all the time and be having sugar cravings all the time. That's a very distracting, difficult way to live life.

Absolutely. And by the way, just to clarify for those who may have heard about the weight loss is you are not promoting that we should all have 6 pack abs and wear a bikini even when we're 70. That is not what this is about.

Actually, I think there's a quote,

and I I I put it in a big square because I wanted to make sure that I I stated it. It was, don't break your heart over a big bum. So so you talk about, like, the normal things of what our hormones do to define our body, and you speak about different body types and things like that. This has nothing to do with being thin. This is about being healthy and having the right fat where it needs to be to feel good.

It's a really good clarification, and I know it's a really touchy subject for that reason because we've all been bombarded by decades of, oh, you should look this certain way, and, yeah, that's obviously, yeah, not what we're saying exactly.

You know, there's so many things happening with the changes in our hormones leading up to when we reach menopause. And as you are mentioning, the hormones do have an impact on on how our body works and the metabolic health, etcetera. So, I wanna make sure we we better understand why this is the case, what's happening. And and I'll give you a couple of illustrative examples for those who are listening. So, you know, like, I think of use cases, like a friend, is on the hormonal IUD and was mentioning, gosh. I'm really having struggle, a struggle losing weight in the middle, because of the IUD. She's not getting her period, so it's unknown whether it's perimenopause, menopause. It's a hormonal IUD, lots of things swirling.

So it's like, how do you unravel that? And the hormones clearly have an impact. And I think there's a lot of people in this phase where different things are happening, and you can't really unravel it.

Let's start with estradiol. So that's our main estrogen, our main ovarian estrogen that we make with natural menstrual cycles is metabolism enhancing. It it truly is. It certainly had the levels like the natural the normal levels that you'd get during a menstrual cycle. It is anabolic, so it promotes muscle gain. It improves insulin sensitivity which is why women of reproductive age are somewhat protected from metabolic disease compared to men the same age. Of course, with everything that's nuanced so as I talk about in the book with even with estrogen there are some, like, very high levels of estrogen will switch roles and promote insulin resistance. Some of that will be the physiological insulin resistance of pregnancy actually which is quite interesting.

But at a at a in a normal natural menstrual cycle level, estradiol is quite beneficial. Estradiol also suppresses appetite. So, during the preovulatory few days when estradiol peaks, women will just naturally feel less hungry and wanna move their body more. Yeah. Estradiol also, wants to makes you wanna get outside and do stuff and makes you kinda more outgoing. So it I mean, it actively promotes kind of a a weight loss part of the cycle. And then, progesterone, the hormone we make after ovulation Well, to start with, progesterone has had a very bad reputation in terms of metabolic health. I but I wanna say, and I say in the book, I do have a section called in defense of progesterone.

It is a little more complicated. It's more nuanced than that. So this is our progesterone that we make or that we can take as body identical progesterone, but real progesterone doesn't enhance, it doesn't improve insulin sensitivity the way estradiol does. It perhaps promotes a little bit of mild insulin resistance, again, sort of a physiological or sort of normal shift to insulin resistance. But at the same time, it also increases metabolic rate, by quite quite a lot actually. It stimulates body temperature, it stimulates thyroid, and it has both estradiol and progesterone have an anti testosterone effect. Okay. So there's a sweet spot.

So, the certain amount of testosterone is is crucial for, muscle and bone health and mood. Testosterone is quite a boosting effect on mood. Obviously, testosterone is also the precursor for estrogen. So there's we're meant we have quite a lot of testosterone normally. Not like about 10 times less than men, but we still have quite a bit. But there is a a sweet spot, and so a common metabolic problem for women, a common driver of increased visceral fat, which is that kind of hard inflamed solid fat that you get that you can get inside the abdomen. It's not the jiggly kind or that you see on the outside of the rolls around your belly button. There's nothing like that.

It's actually inside. It's like a hard shelf under your rib cage. That's, hypertrophied or enlarged visceral fat. That's promoted by different things, but it is in part promoted by excess androgen. So that's why you see increased visceral fat with PCOS, polycystic ovary syndrome, when the in the presence of excess androgens, and you also, can can start to get that with perimenopause and menopause because estradiol and progesterone, both are are 2 main female hormones, normally have an anti testosterone or kind of androgen suppressing effect which is beneficial. This is why women have more of an hourglass shape because as they'll they'll reduce visceral fat or the belly fat and and at the same time estradiol will promote bum fat. And I'll just give it in defense of bum fat and subcutaneous. Well, subcutaneous fat in general and bum fat in particular has been found in the research in women to be actively anti inflammatory, which is so interesting.

So the hypertrophy or enlarged visceral fat if what they found in the research is that if someone has that, the enlarged visceral fat, and they can't always tell by looking because it's inside. You can sort of tell by waist measure and other factors. If they have that, the negative they'll have fewer negative health effects from that if they also have quite a lot of bum fat. So bum fat seems to kind of have a mitigating or improving effect on inflammation, which is so great. And the as you say, there's a section of my book called Don't Break Your Heart Trying to Lose a Big Bum because Bum Fat's Healthy, and it's it's also just varies hugely with genetics. So some women just have more gynoids, what they call gynoid body shape or bigger bums and hips, that is, that's just built into your DNA to some extent. On the topic of bum fat though, I'll say there is also something called lipedema and there's a section in my book about that which affects about 1 in 10 women. So it's worth mentioning.

It, it's a different, it's different. It is often lower body fat, it can sometimes be upper body, but it's usually lower body and it's painful fat. It's it's different. It's it's so normal bump fat and even cellulite shouldn't be painful. So if it's painful, look at the lipedema section in my book and, you know, do more research.

Well, so now that we know about the hormones, can we do, like, a mini course on what's happening in perimenopause and how the hormones are shifting, and why this is, like, such an important time to be. Is it metabolically flexible, is how Mhmm.

How you put it? Yeah. Yeah. So metabolically flexible, I'll just quickly say it just means you're able to access and burn your own body fat quite easily for energy. And the way to be metabolically flexible is to not have insulin resistance. So that's how those kind of two things intersect. So with perimenopause, we basically well, we lose first progesterone and then estrogen in that order. So, but even in the early phases of perimenopause when we're mainly losing progesterone, we already start to get some pretty serious, like, changes going on with metabolic health. 1 group of researchers called it the the metabolic upheaval of perimenopause.

It's a you look at the biochemical level, you know, insulin levels potentially going up. There's more inflammation, some triglycerides and cholesterol might be going up, that sort of thing. And then there will be a start to be a redistribution in body fat from the bum to the visceral fat, from the bum to the belly, basically. So you get the you lose the hourglass shape and start to get a more of a square shape, a thickening through the waist. That's relative androgen excess. That visceral fat is also called androids fat because it's promoted Okay. By testosterone. So, it's not that it's not that testosterone goes up with perimenopause, although it does actually weirdly just go up ever so slightly.

What's happening with androgens or testosterone generally through our lifespan is they're on a a linear just slow gradual decline through life, like, they peak when we're teenagers and then they just start to go down. And that's true for both men and women. And but what happens is when because through our reproductive years, progesterone and estradiol are having this actively every cycle and especially during pregnancy kind of anti testosterone effect. You testosterone is we're we're exposed to relatively little. Enough, you know, for all the things the muscle and bone and mood, but not too much. But then with perimenopause that changes because progest mainly starting with losing progesterone. And so we start to be more at risk of insulin resistance. And then in later phases of perimenopause when estrogen drops as well, then we there really is like a a potentially a shift to insulin resistance or a much greater risk of insulin resistance associated with increased visceral fat.

There was one statistic that on average, I think women on average gain like 50% more visceral fat, which is incredible. Like with the pair with the menopause transition, it's a lot. So when women are like, you know, saying, okay, my this feels weird, like my body is changing shape. What is this hard ridge under my rib cage? Like, you know, where what's happening here? That's, yeah, that's hormonally what's going on.

You've got these hormone changes, greater risk for insulin resistance, and all these different mood changes and other changes that are happening to our body. Is that why it's so important to be more careful about what we're doing is because there's all this imbalance, and it's really about the insulin resistance that we're trying to avoid. And I say this because I guess, the way it's been discussed in a lot of the conversations I've seen or been a part of, it's very much symptoms hormone therapy. Right? There's this very correlation or like or don't drink wine, or why don't you get more sleep? But I don't think this whole metabolic health has been, like, a a big part of that discussion, and it's like they're really all kinda tied together. Right?

It's a huge part of it. So there's a so as I talked to my in my perimenopause the hormone or perimenual, it's a recalibration. Because it's second puberty. So in first first puberty, there's a lot of recalibration of the nervous system and the metabolic system for sure. Actually, that's a massive recalibration time. And same in the same, you know, postpartum and same perimenopause. So, the nervous system is recalibrating and during recalibration time there can be symptoms can arise, but also it's as I described in that book is that perimenopause can be a tipping point. So because it's such a a a time of such change, kind of small deviations from normal or, you know, sort of going off the rails a little bit can actually turn into a much bigger problem long term, if that makes sense.

Like, a bigger problem long term than would happen is if if it if the same challenges had happened during a more steady state. So Okay. And so their nervous system is recalibrating and so is the metabolism. And so here's a really concrete example. So people would have are becoming more it's in my in it's in my first in hormone repair manual. It's in that book. I do talk about, Lisa Musconi and Roberta Brinton's research around the brain energy crisis in Mhmm. The later phases of perimenopause and in into menopause when estrogen drops, brain energy reduces.

And so a couple of things, that can directly lead to symptoms because you just you don't have as much your brain cells do not have as much energy. That's partly the kind of temporary cognitive impairment that can happen. It can also unfortunately, like, it it's supposed to be temporary, so that that energy crisis, we we should be able to recalibrate our energy systems, our metabolic systems, and come out the other side and be healthy going forward into the next few decades. But if if people are metabolically challenged, which essentially means insulin resistance or metabolically inflexible, those that brain energy crisis can unfortunately, at least according to Lisa Musconi's research, kind of put women on the road to Alzheimer's, like to dementia for example. I mean, just as a Okay. Not in every case, obviously, and there's different risk factors and Right. You know, not to overstate that, but that that is one of the concerns is what's happening metabolically in the brain at menopause is potentially going to have long term consequences. And the re in terms of metabolic recalibration, what has to happen to the with the loss of estrogen and and the kind of shift to insulin resistance, the brain is less good at, you know, extracting energy from from glucose, and it needs to start to rely more on, energy from fat or not and ketones, not exclusively ketones, but just, you know, energy from fat in general.

And that should be not a problem like that metabolic recalibration should be very possible for people who are metabolically healthy, who don't have insulin resistance because there's even a healthy body, like even a not overweight body, there's lots of body fat stores, you know, there's lots of energy to feed the brain. You know, from an evolutionary perspective because I just wanna get just get the word in there that menopause evolved. It's not an accident of living too long. There's quite a bit of evidence that not only did our ancient ancestors go through menopause but that menopause in a way may have been the driving force for evolution of a longer human lifespan because women in their post reproductive years were so beneficial for the whole family group that long longevity in women specifically was selected for and men just got to come along for the ride. So, perimenopause is a it's a transition state. It's a calibration recalibration state.

You explained the science behind different conditions someone may have. You talk about lab results and which labs you can use, what they say, mistakes that may or misunderstandings that may be, had with certain lab results. And then it's really all about empowering women to investigate what might be going on with them and what might work. So that is all in the book. So I highly recommend people need to just have it on their shelf. I know if I ever have another problem, I'm going to turn to said chapter and read it. So that that so we can't do it all here because it really is individual, and that's what I love about the book.

Yeah. I'll just share it. It just yesterday, I did an interview, and I I shared it on social media today that was another podcaster observed that with this book, with my metabolism book, because it is so kind of has has something for everyone. As you say, like, this you know, it's troubleshooting and you are you fear in this situation or this situation? And she said no one is left behind, which I just thought was so great. It's Yeah. Like, no one's gonna be left behind. Like, trust me, there are these 10 patient stories and everyone is really quite different. And so certainly if you're in the position, anyone listening who's like, well, I've tried things for metabolic health before and it didn't work for whatever reason.

It's like, well, there's there's always a way. Like, there's always a way forward because, being being metabolically healthy is our birthright. Like, that that's how, you know, we're we're meant to be. The body wants to get back there, and it's always possible. Yeah.

You know, I started, I guess, being more aware of my metabolic health when I was undergoing fertility treatments 10 years ago, and it's been an experiment over time. But I will say Yeah. I feel so good. It's worth it. So the hormones are changing. We need to be metabolically flexible in this stage of life, but then there's hormone therapy. There's Yes. Hormonal birth control and all of these things that that come into play.

From the main things that we need to watch out for, like, what are the considerations of things people are doing?

The first consideration with hormonal birth control, depending on the type, we can I I will talk about I I do wanna get to the hormonal IUD because I think people a lot of people listening are gonna have questions about that? Oh, yes. But depending on the type, which is most types apart from the hormonal IUD, you know, it it switches off ovulation. So this is one of my key messages. One of my main concerns for different aspects of health with hormone birth control is that it switches off the hormones we normally make. So I've just spent, you know, 10 minutes talking about estradiol and progesterone and how beneficial they are for metabolic health and lots of other things. Well, hormonal birth control switches those off, and it doesn't replace them. You know, it it replaces them with, contraceptive medication that is kind of similar to estradiol and progesterone, but really in some ways quite different. So the first one so the and I'll just acknowledge to some types of hormone of birth, some some pills do use, but what's called body identical estradiol, so real estradiol.

That's there's only a couple brands that do that. No brands use body identical progesterone, but, arguably, from a metabolic perspective, the ones that provide body identical estradiol are gonna be a little bit friendlier to metabolic health because there is some suggestion that the synthetic estradiol that's called ethanol estradiol does not have the same insulin sensitizing muscle building benefits as real estradiol, which is very unfortunate. It's sort of we that's not what we wanna see coming out in the research, but there's and it hasn't been that well researched, but there's that's starting to be suggested. And then, of course, you know, the progestins that are given, which are sometimes called progesterone which makes it very confusing because people say, oh, it's a progesterone only pill. But if it's pro progestin, it's not progesterone. Right. This might help people is that estrogen the term the word estrogen is a generic term that can apply to both it can apply to estradiol or natural occurring estrogen. It can apply to ethinylestradiol, the estrogen in the pill.

That's a valid way to use the word estrogen. Progesterone is not that it's not a generic term. So progesterone is only the hormone we make or that we take as body progesterone. But progestins should never they should not categorically be called progesterone because they're not. And progestins vary a lot in their metabolic effects. Like, they they're quite a diverse motley crew as I say. So depending on which progest in particular people are taking, they're gonna be different metabolic effects. So it really breaks down into how androgenic or testosterone like the progestin is.

So the the really there are, a group of them that are quite anti testosterone. That would be drospirenone. That's the big one in Yasmin. That one consistent with what I've just been talking about how, you know, testosterone in women excess testosterone in women will promote belly fat, like visceral fat and insulin resistance. Drosparend on the anti testosterone progestins do tend to promote weight loss, especially weight loss around the middle, or they tend to obviously improve testosterone symptoms, PCOS symptoms, that kind of thing. They can cause other problems, but they from a metabolic perspective, they're, you know, arguably beneficial. Obviously not as beneficial as estradiol and progesterone but still they're not neg they don't have a negative metabolic effect. Whereas the androgenic ones can.

So, the big one, is the most probably the one of the more androgenic or testosterone like progestins is levonorgestrel. That's it's derived from testosterone. It's in many ways structurally, it looks more similar to testosterone than to progesterone, and it is in the hormonal IUD. So it is in some of the implants, the hormonal IUD. So that is why, you know, people who say they gain weight on hormonal birth control, it's almost always gonna be from an androgenic one like levonorgestrel or norethyspirone or there's a few others. So but not to be fair, not everyone notices weight gain on the hormonal ID. Of course not. Like, there's always gonna be individual variation, but some people do, and, certainly, they might notice more even more on like a bigger dose, levonorgestrel medication.

One thing about the hormonal IUD, I always do like to mention, it's a little different from all the other types of hormonal birth control and that it does not suppress well, it does not routinely suppress ovulation. So just really depends on the woman and her age and various factors, but and how long she's had the IUD because the dose is bigger in the early months and slowly, you know, reduces over time. But Right. Maybe later into the life of the IUD and especially in an older woman, she's probably able to ovulate regularly even if she's not bleeding which is a little quirky, but, yeah. So, she might be still making her own estradiol and progesterone which is, yeah, which is good and will, I think, potentially mitigate some of the negative metabolic effects from levonorgestrel. The other sorry. The other side effect of androgenic or the other side effect of testosterone like or androgenic progestins is hair loss as well. It is worth mentioning that.

Okay. How much does it impact the insight we have on what's going on with our body? So someone's trying to solve for all of that plus no when they've hit menopause, because if you have bleed into menopause, then you need to get tested for uterine cancer. So you kinda need to know all of these phases of where you're at, and I feel like Yeah. You're almost getting a lopsided view of what's happening to your body while trying to stay healthy so you have longevity.

Well, Well, I do actually do troubleshoot some of this in hormone repair manual about, like, how to know when you've reached menopause or if you're getting close and what do you do with different types of hormonal birth control. So on the top on the I guess sticking with the hormonal IUD again because it's so different than the other ones. Your women are a lot of women are they'll still be cycling with it. So even if they're not bleeding. So that's just a really important point, and you can technically I mean, if you wanna get fancy, which is not that fancy, like, you could pick up people could pick up cycling with one of the wearable devices like a, you know, Oura ring or whatever, like the temperature tracking devices because they'll still be if any of your listeners probably know about fertility awareness method and the fact that our temperatures go up with ovulation and you can still see so a couple of situations where you can still see that would be one with the hormonal IUD where bleeding is suppressed but cycling is still happening, and the other is hysterectomy. Ablation, so uterine ablation, like, and other situations where bleeding is not happening but it's like there's no bleeding but there's still cycling. So you can potentially, you know, track your cycles basically and know if you're cycling, which is quite helpful with any of those situations. You can also keep an eye on FSH.

I'll just say I'm sure you've had other experts, you know, explain that the this pituitary hormone we have called follicle stimulating hormone or FSH, it fluctuates a lot during perimenopause. So the state of perimenopause itself cannot be diagnosed by FSH. But at a certain point once we graduate to menopause or cycling, you know, the ovaries are well and truly done, then FSH is elevated, at least above 40 and usually like above a100. And it'll be like that it has to be like that on a couple of occasions. So, I think in the case of the hormonal IUD, if someone's just like I really don't know if I've achieved menopause or not, they can look at a blood test like that. You can also go by symptoms to some extent. So again, with the hormonal IUD, there's no bleeding to signal what's happening or no pattern of bleeding, but there's still estrogen. So they will kind of Right.

Go from, oh, I used to get breast swelling every month and kind of feel like a bit premenstrual to, like, oh, now I've got vaginal dryness and, like, you know, my skin like, I've you can definitely notice when you shift to the lower estrogen phase. So, that's with the hormonal IUD or ablation or hysterectomy. With on the combined method, like a combined pill or patch that is inducing a bleed every month, Like, there's no way to you can't like, just to be clear, like, the pill is like a a high dose, not very nice type of hormone therapy. So, like, so it's it's totally suppressing. Like, it's suppressing the ovaries. It's forcing a blade. It's provided synthetic estrogen. So, you know, you're not gonna be able to know you know, read your body to understand.

Like, it masks it, basically.

Interesting. So then would you say in this stage, like, that, you know, like, for example, in the case of the hormonal IUD that the really managing your metabolic health is, like, even more important, or is it just you're having a a a different reaction because of the hormonal IUD, and we're all status quo needing to manage our metabolic health. Like, I just didn't know if that per someone in that situation would have to work harder at it. Little.

I mean, the hormonal IUD is gonna be a it's gonna be one negative factor against working against metabolic health. One of many. Like, it you know, it's not the only factor. So, certainly if women are very metabolically healthy in every other way it's unlikely in their case that that androgen effect coming from the hormonal IUD is maybe not a big deal.

So then what would be your top suggestions for managing metabolic health? Because, again, in the book, you kinda have to go in and review, like, what specifically is happening to you. But are there, like, consistent themes that you want people to know if they, you know, wanna get started as soon as they listen to this episode but don't have the book yet?

People are probably hearing a lot about it in the news now, ultra processed foods, and there's different components of ultra processed food that is probably causing the problem, but a couple of the big ones would be, you know, heavily refined starches, not friendly to the gut or the hormonal signaling and, high dose like, a high dose sugar is definitely a problem, high dose fructose. And, potentially, vegetable oil, I know that's controversial, but, like, my read and I I keep I stay pretty low key about it in the book, but my read of the science is that, like, the high dose kind of corn oil, soybean oil, this omega 6 oil is not friendly to metabolic health. And, really, the only way to shelter from it at the moment is to mostly cook at home. So I do make a case for trying to cook at home even if you don't like to. And I'll full disclosure, if it's helpful for anyone listening, I really hate cooking. Like, I really do not like it.

One thing I do have to ask you about is the weight loss drugs.

I have

to ask you. I I know that we have discussed offline as well that you did not wanna make the book about that, and I'm so glad you did not. You do talk about some perspectives on it. So I would just love for you to share your perspective because right now, I think that's where a lot of people are trying to go as far as managing their health and sadly more so around their weight. So tell us what we need from your research.

Me as a biologist, and also I've had as I share in the book, I've had some patients try Vasemaglutide and that category of medication. What's interesting is how much it the the fact that they work so well tells us really confirms the thesis of my book, which is that it's all about the brain. Right? So they are working on the brain essentially. They're work and what's interesting about those medications is they, they're working on the brain. They're working on the reward system. They they have this unexpected benefit of also reducing craving for alcohol and gambling. Like, they just they just seem to reduce desire in general, not just for food, which is I think just really speaks to the power of the nervous system and the brain in all of this. And I guess, yeah, my position I don't have a strong position in terms of what people should or shouldn't do.

I mean, so I'll give the example a couple of patient stories of people who used it. I get including one patient story who used the medication and then didn't like it because it made her kind of lose desire for everything, like she just kind of got this flat feeling from it. So that, I mean, and they have other side effects, but, the important thing I guess to know is that once you have that understanding in place that it's about these signals that you're sending to the brain and then the brain deciding how hungry you should be and how much energy you should burn unconsciously, then you realize there's lots of other ways to do the same thing or send those signals and pause you know, in a more gradual gentle way. But I do think I mean, some time will tell, actually, but the science shows. I I think, I think that medications are great and that certainly if they're helping people who just didn't feel like they had other options, that's, you know, that's fine. I think also going forward, we're gonna learning from how successful those medications have been, we're gonna learn a bit more for specifically around a low carb diet and how it can actually also affect the reward system and dramatically reduce cravings and increase the satiety hormones. So the main those medications are an analog system called GLP 1, which is a satiety hormone coming from the gut that I speak about in the the book. And, it's affected by having a healthier gut for one thing and and being sheltered from, some of the refined starches and sugars that can distort that hormonal signaling, satiety signaling that's supposed to be coming from the gut.

Okay. I haven't, like, done intense research on it, but it's just something on my mind, which is I hope people don't think I can still eat the same way and just take this.

Well, they're not gonna they're not gonna eat the same way because they're not gonna they won't be craving so one of the things one of the takeaways from my book, and a lot of people as a symptom of metabolic dysfunction, a symptom of insulin resistance are really, really hungry, like, abnormally hungry. Like, have this ravenous kind of ongoing just seek food seeking feeling of where's my next snack. I need something more. I need something get my blood sugar up, I need to eat more. And I know from my work with my patients, they if if you've been in that state for years or maybe decades in some cases, you're just gonna understandably, you're just gonna think, well, that's how the body is. So that's how I guess, that's how biology works is like just feel, like, hungry, like, this all the time. And then people look around and they must be thinking, well, everyone else must just be withstanding that with willpower, but that's not how it is. Like, so that, like, that crazy just feeling hungry all the time is not how it's supposed to be.

That's an abnormal situation, and so that's the point of my book is, like, all the different ways to naturally feel less hunger, to achieve ongoing satiety I talk about in the book. And, well, that's what the medications do as well, you know, via GLP 1 and Right. But, so they're not so in terms of, like, people won't be they're just that that circuit it's a circuit breaker. Right? Like, they're not gonna be incessantly, like, looking for carbs the way they were. It they those medications seem to specifically reduce the craving for carbohydrates for what it's worth, sugar and starchy foods. And for what it's worth and just to caveat, like, I'm not my book is not about a low carb diet. I think there's lots of ways to do it. It's just not everyone has to do low carb, but a low carb diet is a very powerful intervention and also reduces cravings for carbs.

So when you stop having them, you stop craving them to a large extent, plus, you know, what other other supportive measures. So hopefully, it frames the medications. I know they're very controversial. I suspect they're around for forever, like I suspect, you know, we're gonna always have them, but I suspect the super popularity of them will wane and people there'll be a group of people who, you know, find they wanna do a different way.

Okay. Well, I I again, I just wanna reiterate. I I really strongly recommend people get this book because even, when I read it, there were things I noticed about either past behaviors or current behaviors when I'm off? Because I was like, oh, yeah. I notice I'm suddenly not wanting to snack at 10 o'clock at night. And then or, oh, now I suddenly notice I wanna snack again. And just reading this, I'm like, oh, now I know what's going on. So it's just these things we are not aware of, and it just kind of really brought to light a lot of that. And so, yeah, I really, really, really appreciate that you put this together and that you made time to talk to us about this today.

Yeah. Definitely. So thank you

so much for being here. I really appreciate. We could go on and on, but I just wanna make sure we've at least covered these points so people get a good idea. And I really appreciate it. Thanks so much, Lara.

Always good to talk to you, Georgie.