Welcome to Huberman Lab Essentials,
where we revisit past episodes for the
most potent and actionable science-based
tools for mental health, physical
health, and performance.
I'm Andrew Huberman and I'm a professor
of neurobiology and opthalmology at
Stamford School of Medicine. And now for
my discussion with Dr. Sarah Gotfrieded.
Dr. Gotfrieded. Sarah, welcome.
>> Thank you. So happy to be here.
>> Yeah, I'm delighted and very excited to
ask you about an enormous number of
topics. You are expert in so many
things, female hormones in particular.
Is it ever informative for a woman,
regardless of age, to know something
about her mother's, perhaps even her
grandmother's experience visav hormones?
What sorts of conversations should women
be having with themselves and with
family members to get a window into what
their specific needs might be?
>> So, my work is really at the interface
between genetics and environment. And I
think it's essential that you understand
what your grandmother went through and
especially your mother. So I would
probably start first with trauma and
intergenerational trauma because I think
that affects the endocrine system so
hugely especially cortisol signaling.
And then there's certain female
conditions that have a very strong
component genetically, most of which run
in my family. So that includes
endometriosis, fibroids, and polycystic
ovarian syndrome.
>> Maybe we could march through and just
say for a woman in her teens who's
already hit puberty, what sorts of
biomarkers should those young women be
paying attention to? Likewise for women
in their 20s, 30s, maybe we could take
it more or less by by decade at starting
at puberty.
>> In your teenage years, what I think is
really interesting is to look at
cortisol, to look at the dance between
estrogen and progesterone in those years
is less helpful because I think there's
a lot of variability due to the
immaturity of the system. If you've got
someone who's got really regular
periods, it's probably better to do some
benchmarking at that age. But generally,
I find that benchmarking is best
performed in your 20s or 30s.
>> Are periods not that regular in terms of
duration of the menstrual cycle? When
the menstrual cycle first sets in?
>> For a lot of women, they're not regular.
And then there's the whole piece of oral
contraceptives and other forms of
contraception where you have no idea
what the normal cycle is. But getting
back to your original question, which is
about biomarkers per decade, in your
20s, that's when you want to do some
base casing with estrogen, progesterone,
and testosterone. What happens a lot of
the time is that estrogen dominates in
that tango. And when that happens, it
sets you up for greater risk of
fibroids, endometriosis.
I'd want to know about DHEA and sort of
the whole androgen pathway. I'd want to
know about the metabolites of estrogen
because some of them are protective and
very helpful. Others are a bit like
Homer Simpson. I mean, they are just
like causing all kinds of problems in
your body. I'd also like to know about
their stool. So, I want to know about
the microbiome.
>> In terms of blood testing or various
tests for these other biomarkers,
getting estrogen, testosterone, and
other ratios, women will need to do it
at different stages of their menstrual
cycle. if they had to pick one either in
the follicular phase and or in the
ludial stage of their ovulatory
menstrual cycle, when would you suggest
they do that?
>> So, if you forced me to pick one, I
would say probably day 21 to 22 for
someone in her 20s. So, for most women,
they've got a menstrual cycle date that
averages out at 28 days. So, this is
about a week before they start their
period. For women who are more
irregular, it's harder to do that. As
women get older, usually the cycle gets
a little shorter. So, as they start to
decline in their progesterone
production, their period gets a little
closer together. At that point, you want
to test sooner, like day 19, 20. Blood
test is the cheapest thing. It's usually
what's covered by insurance. But my
preference would be to do dried urine so
that I get metabolomics in addition to
the levels of these hormones. And if I'm
forced to, I'll use blood testing. It's
not as comprehensive and as you know
it's a quick little snapshot while the
needle's in your vein for you know 30
seconds. Let me go back and say one
other thing about biomarkers. A big part
of the testing that I do in phenotyping
my patients I practice precision
medicine. I like to almost start with
nutritional testing. That would be
potentially a helpful thing to do in
your 20s. Becomes less important as you
get older and you develop more
micronutrient deficiencies. But
micronutrients play a huge role in terms
of hormone production. Magnesium is
hugely involved in the way that you get
rid of estrogen as an example. So
micronutrient testing, what I usually do
is a combination of blood and urine. And
so I'm looking at all of the
micronutrients that we can measure that
have some clinical scientific basis
behind them. intake of vegetables,
polyphenols, is such an important
predictor of future risk of breast
cancer, like when you're 50, 60 plus.
And the most important time is when
you're a teenager. If you have evidence
that you could show a 17-year-old that
they've got micronutrient gaps, I think
that would be a motivator for them to
eat differently at a time when it's so
critical, even though it's 25 years in
the future, that it's going to
potentially change this arc that they're
on. What do you do for a young woman who
doesn't like vegetables is or is not
somehow able or willing to to get those
five colors a day of vegetable to help
support the microbiome? What other sorts
of tools, behavioral or otherwise, are
useful?
>> What I try to get them to do is to have
a smoothie. If I could get them to have
a smoothie three times a week and to
throw some of these vegetables in, that
makes a huge difference. I mean, we know
that makes a difference in terms of
microbiome change. Like I have them do
steamed broccoli that's in the freezer
because it's got very little taste. They
could do that in a chocolate smoothie.
They could add some greens. I like
greens powders are super convenient. So
that with you know kind of a a taste
that they like whether that's chocolate
which is what most of my clients want or
you know vanilla with berries and that
sort of thing. So that can go a long way
if you don't like vegetables. And short
of that, I would say some supplements,
but I would say that's a distant second
to making a smoothie.
>> What is going to be the best way to test
the microbiome?
>> What I like to do with nutritional
testing is run a panel that's looking at
antioxidants. So like vitamin A, vitamin
C, alpha lipoic acid, plant-based
antioxidants, because you can measure
that in the blood. I like to look at
some of the key vitamins, especially the
B vitamin range, because as you probably
know, if you've got particular genetic
polymorphisms, you might be less likely
to be absorbing the right level of
vitamin B9, folate, vitamin B12, etc.
I'm also looking going back to the
antioxidants at glutathione because I
think that's such an important lever.
And then I'm looking at some of the
minerals. Magnesium is really the most
important and we know that somewhere
around 70 to 80% of Americans are
deficient in magnesium. That's like the
the lowest hanging fruit.
>> I would be curious for instance like
with magnesium if that number of people
are deficient does that mean that that
number of people should be targeting
their nutrition towards foods that
contain magnesium andor supplementing
with magnesium? And if so what forms of
magnesium? You have to measure red blood
cell magnesium like whole blood. And
with deficiency, it's interesting with
supplementation
for my patients who tend toward
constipation, and that's frankly about
80% of the women that I take care of.
>> Really?
>> Yes.
>> Wow. I'd be curious as to why that that
is.
>> Patriarchy,
rage, the pine system,
>> right? psychology, immunology, neural
and endocrine factors combined. Is that
>> Yes. And then I would say there's
another factor. Being female is a health
hazard. So we have twice the rate of
depression, insomnia. We've got 3 to 4x
increased risk of multiple sclerosis.
We've got 5 to eight times the risk of
thyroid dysfunction. So if you just look
at that and you look at subtle
preclinical thyroid dysfunction, a large
number of the women that I take care of
have thyroid dysfunction that's
contributing to constipation. And if we
go back to that control system, the
hypothalamic pituitary, adrenal,
thyroid, canatal, gut axis, and they
have a lot of perceived stress together
with this borderline thyroid function
that no mainstream medicine doctor has
told her is a problem. And then she's
got a problem with the tango between
estrogen and progesterone. She's going
to tend toward constipation. Women have
a lot more constipation than men. The
gut is about 10 ft longer in women
compared to men. And they are much more
likely to have a torturous colon. And
the way you know that is you get a
colonoscopy. Women experience more
trauma than men. This is well
established. If you look at the ACE
studies that were done by the CDC and
Kaiser in 1998, we know that men for the
most part, middle-aged men have about
about 50% of them experience significant
trauma as defined by the ACE
questionnaire. Women are at 60%. And
that's pretty durable since 1998. They
have different forms of abuse, much more
likely to have sexual abuse. They have a
different HPA response than men.
their perceived stress tends to be
higher. And I'm generalizing for a
population. And so if you look at the
physiology of a female, I think that um
constipation and that need to like
control and restrain and hold things in,
I think that's part of the physiology.
So I'm veering away from the science,
but I do think that it is a really
important signal to pay a lot of
attention to. What sorts of tools do you
recommend people use to relieve
constipation? Sounds like reducing
stress is going to be a huge one.
>> Yes.
>> What are your favorite stress reduction
tools? Things that can really lower the
baseline.
>> So, I'm not a fan of lowering stress.
I'm a fan of lowering perceived stress.
I think all of us need an allocart menu
of what is most effective.
So what works for me now at my age is
different than the TM I did as a college
student transcendental meditation. I
became a certified yoga teacher when I
was in my 30s. That is very effective
for a lot of people. I do holotropic
breath work.
>> I think people are starting to
appreciate that there are ways that they
can relieve their stress that that don't
all only fall under the categories of
vacation,
>> right,
>> and meditation. But I want to say that
meditation is obviously a wonderful
tool. Well, certainly it's a great tool
and it's got such a scientific basis
behind it, but there's so many things on
this allocart menu. Sex, orgasm,
um, connection, feeling heard and seen
and loved. I want to use this as an
opportunity to a keep this in mind as a
return to a a question that I didn't uh
close the hatch on earlier and it's my
fault which is I'm now clear on the fact
that a woman in her late teens early 20s
ought to know something about her
testosterone estrogen thyroid cortisol
levels should start at least thinking
about her microbiome
should be thinking about how many bowel
movements and the timing of those bowel
movements per day and I'm assuming that
what I just described is also true for
women in their 20s, 30s, 40s, 50s on up
to hundreds. Is that correct?
>> That's correct. But I would say that
there are differential opportunities by
decade. So, I'm glad you circled it back
to teenagers and testosterone because I
think if you know, for instance, in your
teenage years that you have high
androgens and that you've got this
potential phenotype way into the future
that you may not even notice. I mean,
maybe you notice you got a few extra
hairs on your chin or something. If you
know that your testosterone is elevated
or some other androgen, it might change
the arc of how you take care of
yourself. So I think that could be very
helpful in your teenage years. In your
20s for people who are a stress case
like me, so age 27 on the wards at UCSF,
if I had known that I was such a high
cortisol person, I think I would have
done things differently. I would have
changed my behavior. Your testosterone
can decline starting in your 20s, kind
of depending on how much stress your
matrix is under. So for women, that can
start as early as 28. Usually your
testosterone declines by about 1% per
year.
>> What level of testosterone do you like
to see in a woman once she's sort of
post let's say after age 25.
>> So the way I tend to describe this on
podcasts is the top half of the normal
range.
>> I get a lot of questions about PCOS.
>> Yeah. So PCOS is one of those really
poorly understood conditions. It kind of
flies below the radar until a woman
wants to get pregnant or she's got some
other issue that drives her to a
physician. The problem is that it is a
syndrome, right? So, polycystic ovary
syndrome, sometimes polycystic ovarian
syndrome and syndromes don't necessarily
fit together into a really clear
diagnostic criteria. So, in this
instance, there are three different
criteria that we look for. cysts on the
ovaries having clinical manifestations
of hyper androgenism. So that could be
hercetism, acne, other things and then
usually irregular periods and the way
that that's defined at least by the
latest criteria is having a period every
35 days or less. So typical cycle length
28 days, 35 days, you know, you're
skipping a period here and there. So
those are the criteria that we use to
diagnose PCOS. There are about four
different systems out there in the
literature for diagnosing PCOS, which is
where it starts to get confusing. So
there's some women who have no cyst on
their ovaries, but they've got heretism
and they've got irregular periods.
>> Could you define heretism?
>> Here is increased hair growth, usually
in places that you don't want it. So for
women, it can be, you know, kind of male
pattern. They might notice it on their
breasts, on their chest. What we know is
that PCOS is not just a problem in terms
of irregular periods and then difficulty
getting pregnant. So those are mostly
problems in your 20s, 30s, early 40s.
But it is a massive risk factor for
cardioabolic disease as you get older.
So many people tend to pigeonhole PCOS
as a problem of reproductive age. We
have to be thinking of it over the
entire female life cycle. And I would
say it's even more important to consider
it over the age of 50. You know, average
age of menopause is 51 to 52 because we
know that that elevated testosterone,
the high androgens
are probably the greatest card metabolic
driver of disease for women with PCOS.
The thread we haven't talked about is
the role of insulin and glucose.
So for some of the phenotypes of PCOS,
the problem is hyperinsulinemia,
high insulin in the blood is driving
those theta cells in the ovaries to
overproduce testosterone.
>> Are you a fan of continuous glucose
monitors?
>> The hugest, most gigantic fan of CGMs.
I've never seen any tool that I've ever
used in medicine change behavior the way
that CGMs do. Like I think really
understanding what the mediators are of
your glucose control is essential. Now
that said, it's also kind of a later
effect. I mean, I'd rather know your
insulin and we know from uh the
Whitehead White Hall study that insulin,
especially postprandial insulin, fasting
insulin too, can change years and years
before you get a change in glucose. So,
um that's more for pre-diabetes and
diabetes. Third thing is it democratizes
data. One of the most hopeful and
exciting things that I'm seeing right
now in the health space is that we're
going from this patriarchal relationship
where doctors hold the power and are the
gatekeepers of data to patients and
clients having much more access to that
enchantment about their own chemistry
and their own biology. teaching the
patient to be their own clinician. To
me, that is a loop of benevolence and
integrity that I think is essential to
creating health. We've got a disease
care system. We need the democratization
of data to become a health-based system.
If you had a magic wand and you could
give like two or three don'ts to
maximize vitality and longevity. Let's
focus first on female patients, but if
it extends to male patients as well,
what would you like to see them not do?
>> So, I would say sleep, alcohol, high
perceived stress, eating the wrong
foods, toxic relationships, and
isolation. And then number six, not
moving enough or not moving and
exercising in a way that really fits
with your body.
>> Can we start with that one actually just
cuz it's such a and then work backwards?
>> Yeah. Well, I think for me, because I
have a phenotype that produces a lot of
insulin, kind of depending on how I'm on
my game, I have a lot of glucose. So, I
have to exercise a lot more to dispose
that glucose. So, I think you then have
to move from medicine for the population
or prescriptions for the population to
what works for the individual. One of
the mediators that I think is important,
especially for people who do what I call
chronic cardio, which is what I did,
is cortisol. So, we know that runners,
especially marathon runners, people who
do a lot of cardio and don't do much
resistance training, they tend to have
much high cortisol levels. And you can
buffer that with vitamin C. Vitamin C
can decrease the effect. But chronic
cardio doesn't always serve people. When
I first started measuring hormone panels
in myself, I went to my physician and I
said, "I'm 35. I've never been so
exhausted in my life. I just feel like
I'm pushing a rock up the hill. I've got
this belly fat that I don't like and I
don't want to have sex with my husband.
What can we do about this?" And he
offered a birth control pill and an
anti-depressant.
>> Oh, goodness. So, I left him and I went
to the lab and I ran a hormone panel and
my cortisol was three times what it
should have been. My insulin was in the
20s. I was fasting. My glucose was 105.
My thyroid was mildly abnormal. My
progesterone was low. And that set me on
this course of realizing that what I was
doing as a physician, taking care
especially of women, was not getting to
some of these root causes that are so
essential. And I would say I had to
start first with cortisol.
At that time, I was running four miles
three times a week, four times a week.
That was just raising my cortisol
further. So that was not the right
exercise for me. I needed more adaptive
exercise. I started doing Pilates, more
yoga. That helped to lower my cortisol.
I mean, it started me on changing the
way I was managing perceived stress and
it also changed my supplement regimen.
>> I'd like to make sure that we circle
back to birth control in particular oral
contraceptive birth control. What are
your concerns? What do you like about
oral contraceptives? What do you dislike
about them?
>> In terms of benefit, I think that
especially when they first came out and
even now, it gives women reproductive
choice and that's essential. So I'm a
big fan in that regard and we've got a
lot of data to show both the risks and
also the benefits of it. So I'll speak
first into the benefits because I'm
going to get on a soap box a little bit
about the risks. So we know that it
reduces the risk of ovarian cancer. So
there's something about this idea of
incessant ovulation that is not good for
the female body. So if you look at for
instance women who are nuns who don't
take oral contraceptives and they have a
period every single month of their
reproductive lives, they have a greater
risk of ovarian cancer. So if you look
then at women who have several babies
and they've got a period of time when
they're pregnant that they're not
ovulating and then they breastfeed for
some period of time, they have a lower
risk of ovarian cancer. So oral contra
contraceptives help with reducing
ovulation and reducing risk. We know
that if you take the oral contraceptive
for about 5 years, it reduced your risk
of ovarian cancer by 50%. And that's
significant because
we're so poor at diagnosing ovarian
cancer early. There's really no method
that's really effective. We use CA125
and ultrasound screening, especially in
women who are at greater genetic risk.
But even that often we diagnose it you
know in a later stage.
>> Maybe just because that statement is
going to highlight for a number of
people um the question of what are some
of the earliest symptoms that people can
recognize without a blood test. So is o
ovarian cancer is it going to be pain?
>> So the problem is the symptoms are so
vague and they're so non-specific.
One of the most common symptoms is
bloating. And we've already talked about
constipation. We've talked about how
women have this longer track, GI track,
and so bloating is a really common
experience for most women. You can have
bulk symptoms, you know, feeling like
your your lower belly is kind of pressed
out. The way that we inform women in
terms of watching for this is to get
regular gynecologic exams for women who
are at high risk where they have, for
instance, an ultrasound for some reason
and it shows a mass that we're concerned
about. there's a way to triage that in
terms of what kind of evaluation that
they need and that's a situation where
you might get a blood test called the
CA125.
>> Taking estrogen and thereby reducing the
frequency of ovulation
lowers the risk of ovarian cancer.
Should women that are even women who are
not sexually active, so they're they're
not actively trying to get pregnant or
avoid getting pregnant, but if they're
not sexually active, would they be wise
to suppress ovulation for periodically
using hormone-based contraception just
so that they can offset the risk of
ovarian cancer? That's a very rational
question and I would say that's what
mainstream medicine has had at its back
to recommend oral contraceptives not
just for women who are seeking
contraception but for acne for painful
periods for really kind of the drop of a
hat. They're prescribing oral
contraceptives. That's what I was taught
to do. And I think a lot of that is
pharmaceutical influence. The oral
contraceptive is two hormones. It's
ethanol estradile and it's a
progesterine. So it's not the normal uh
progesterone that your body makes that
your ovaries make and your adrenals
make. It is a synthetic form of
progesterone and it is the same
progesterine similar same class that was
shown to be dangerous and provocative in
the women's health initiative. So I'm
not a fan of progesterines.
I do not recommend them for any woman
unless it it gives them some freedom in
some way. So like with almost any
pharmaceutical, the oral contraceptive
depletes certain micronutrients,
magnesium, there's certain vitamin B's
that are depleted. It also affects the
microbiome. That data is not as strong,
but there seems to be some effect. And
there's also an increased risk of
inflammatory bowel disease and
autoimmune condition. It increases
inflammatory tone. So the studies that
I've seen increase one of the markers of
inflammatory tone high sensitivity CRP
by about two to 3x. It seems to make the
hypothalamic pituitary adrenal axis more
rigid so that you can't kind of roll
with the punches and wax and wayne in
terms of cortisol production the way
that you can off the birth control pill.
It can affect thyroid function. Anytime
you take oral estrogen, it raises sex
hormone binding gabbulin. And you've
talked to other podcast guests about
this, Kyle. I think
>> sex hormone binding globulin I think of
as a sponge that soaks up free estrogen
and free testosterone. So when you go on
the birth control pill, you raise your
sex hormone binding globulin. It soaks
up especially free testosterone.
And for some women, it's not a big deal.
they don't notice much of a difference.
But then there's a phenotype maybe
related to CAG repeats on the androgen
receptor who are exquisitly sensitive to
that decline in free testosterone. So
this then opens the portal of talking a
little bit about testosterone in women.
It's the most abundant biologically the
most abundant hormone in the female
system. It is so important for women. It
is essential to so many things, not just
sex drive and muscle mass and seeing a
response to resistance training, but
also confidence and agency. And so those
women who are so sensitive to their
testosterone level, they've got this
high sex hormone binding gabbulin, their
testosterone declines.
What they describe is vaginal dryness,
maybe a decline in sex drive. But
there's also this bigger issue related
to confidence and agency, even
risk-taking from studies that we've done
with MBA students that I think is a
serious problem.
Maybe the most important out of all of
these things, is that it can shrink the
clitoris by up to 20%. 20%. And if I've
got a woman that I think should not be
on the birth control pill, maybe she's
taking it for acne or she's taking it
cuz her periods were a little painful.
What I'm going to do is say, let's
leverage these other ways of making your
period less painful. Let's take the
message of your painful periods and
figure out, okay, is it your
inflammatory tone and we give you some
fish oil and SPMs, maybe a little
aspirin when you've got your period?
like let's find some other ways to deal
with it than to take the oral
contraceptive which you have not
received informed consent about because
it can trick your by up to 20%. Now
that usually convinces most people to
come. The data that we have is limited.
There's one woman who uh Claudia
something something who looked at sex
hormone binding globulin a year out from
stopping the birth control pill and it
was still elevated. It wasn't as high as
it was when they were on the pill, but
it was still elevated. So, your question
about reversibility, I don't know if we
know the answer to that.
>> What are your thoughts on menopause?
When should people start thinking about
it? And I'm guessing based on everything
you've told me today that there are
women in their 30s that while they may
be 20 years out from menopause, probably
should be doing things now in
anticipation of that. The more you know
about your phenotype, your hormonal
phenotype when you're in your 30s,
you're set up in terms of what to do in
the future, especially things like your
thyroid, your estrogen and progesterone
levels cuz you can replace to a state of
you thyroid. I don't usually go exactly
back to where the estrogen and
progesterone levels were were, but we
can get pretty close. So, in your 30s,
having a base case, I think, is really
essential. What's more interesting is to
talk about pmenopause.
So pmenopause is the the period of time
before your final menstrual cycle. And
for most women, depending on how attuned
you are to the symptoms, it can last for
10 years. So I'm still in period
menopause. It's been like 20 years
because I've been tracking it so
carefully. It usually gets kicked off by
having your cycle get closer together.
So that can happen in your 30s or your
40s. you go from 28 days to 25 days,
that sort of thing. You may notice it as
more anxiety, difficulty sleeping, and
that probably is related to the estrogen
receptor. So, there's this whole period
of permenopause. And what's most
fascinating to me is that there is this
massive, massive change that happens in
the female brain that people are not
talking about enough. And so looking at
the work of Lisa Mosonei at Cornell,
starting around age 40, there is this
massive change in cerebral metabolism.
So you can do FDG PET scans, you can
look at glucose uptake, and there's
about on average a 20% decline from
premenopause up to like age 35 to
pmenopause to postmenopause.
The women who are having the most
symptoms in pmenopause and menopause,
the hot flashes, the night sweats, the
difficulty sleeping, those are the ones
who have the most significant cerebral
hypom metabolism.
>> So, it's almost like a um I don't I
don't want to scare people with this
language, but it's it's a low-level or
let's call it pseudo dementia of sorts.
Yes, it it seems to be a phenotype that
you can then map to Alzheimer's disease
because that's Lisa Muscone's work.
She's looking at, okay, Alzheimer's
disease is not a disease of old age. It
is disease of middle age. What are some
of the biomarkers that we can define
that can tell you what your risk is?
I've got a mother and a grandmother with
Alzheimer's disease. You can believe I
am all over this data.
>> And insulin resistance, insulin
sensitivity, as we talked about before.
um seems to be somewhere in there which
I think when that first when that idea
first surfaced a few people are like
really but then of course right I mean
the brain is this incredibly
metabolically demanding organ you
deprive neurons of fuel sources they or
you make them less sensitive to fuel
sources they start dying they they
certainly start firing less it makes
perfect sense and I think now it's
thanks to Lisa's work work that you've
you've done and have talked about quite
a lot is um in your books and elsewhere
I think has really you
highlighted for people that metabolism
and metabolomics is going to be as
important as genes and genomics when it
comes to that's right
>> dementia
>> perhaps especially in women is it safe
to say that
>> I think so because we believe that this
system is regulated by estrogen
so the decline in estrogen starting
around age 40 43 is kind of the average
seems to be the driver behind cerebral
hypom metabolism the I describe it to my
patients is it's like slow brain energy.
So you walk into a room, you can't
remember why. Like you just notice that
you can't manage all the tasks the way
that you once could. Like things are
just a little slower. And I say that to
women and they're like, I have that like
help me. We've got all of these women
that are marching toward potentially a
greater risk of Alzheimer's disease. And
they have this opportunity in their 40s
and their 50s to take hormone therapy.
and they may not be offered it because
the typical conventional approach based
on whi is to say unless you're having
hot flashes and night sweats that are
severe, I'm not going to give you
hormone therapy. And I I just want to
call that out. I would say no, that is
not the way to approach it. The concept
right now in conventional medicine is
that hot flashes and night sweats are
these nuisance symptoms that we will
take care of temporarily. Doesn't matter
that you're not sleeping anymore. Turn
down the temperature in your room. And
that's not right because hot flashes and
night sweats are a biomarker
of cardioabolic disease. They are a
biomarker of increased bone loss. They
are a biomarker of changes in the brain.
So many of these symptoms that occur in
pmenopause are not driven by the
ovaries. They are driven by the brain.
>> I just want to say you've taught me a
tremendous amount. the amount of
knowledge that you shared is is immense
and is going to be very useful and
actionable for women in particular.
>> Can I just add one last thing because I
didn't talk about it since we didn't get
to the 40s and the 50s in this list of
biomarkers.
>> Please do.
>> If women went away with one thing today,
>> it would be to do a coronary artery
calcium score
>> by age 45 and sooner if you've got
premature heart disease.
>> How is that taken? So, it's a CT scan of
the chest. You can self-order it. It
almost gives you this fork in the road
in terms of how much you need to pay
attention to cardio metabolic health as
a woman. It's so fascinating because,
you know, there's some women who have a
zero. So, my score is zero. But if
you're 45 and you're starting to be
elevated or you've got, you know, maybe
you've got PCOS or you've got some other
biomarkers tending you in this direction
toward the number one killer that allows
you to really start to make changes. And
I I think it's essential to know that
data. Most conventional doctors are not
going to do it.
>> So if I were to go to my doctor and I
just say I want a a cardiac calcium
score. That's what people
>> coronary artery calcium score.
>> Okay. There are certain people they are
exceedingly rare but you are one such
person that when they speak knowledge
just comes out of them and it's
incredibly useful and helpful knowledge.
So
>> thank you.
>> Thank you.