In this comprehensive discussion, Dr. J and Rob Edwards delve into the complex topic of perimenopause and menopause, focusing on the physiological root causes of common symptoms such as mood swings, fatigue, irregular periods, hot flashes, weight gain, and sleep disturbances. They clarify terminology, distinguishing between PMS, perimenopause, and menopause based on hormonal changes and menstrual cycle patterns. The dialogue emphasizes the intricate hormonal interplay involving estrogen, progesterone, testosterone, DHEA sulfate, cortisol, and neurotransmitters that heavily influence mood, energy, and overall health during this transition.
Environmental factors and lifestyle stressors significantly influence hormonal imbalances and symptom severity. The speakers highlight the impact of chronic stress, poor diet, toxin exposure (including plastics and mold), and insulin resistance on hormonal health. They underscore the importance of functional testing (such as hormone panels, Dutch testing, and blood sugar monitoring) to identify imbalances and guide personalized interventions.
Nutritional strategies, including adequate protein, healthy fats, micronutrients (vitamins D, C, B-complex, magnesium, zinc, calcium), and hydration, are presented as foundational for hormone synthesis and metabolic support. Exercise, especially walking and resistance training, is recommended to improve insulin sensitivity and reduce symptoms. The discussion also touches on the limitations and risks of hormone replacement therapy (HRT), advocating for addressing underlying causes before supplementation.
Gut health and liver detoxification pathways are emphasized as critical in hormone metabolism and toxin clearance. The speakers advocate a holistic, individualized approach to managing perimenopause and menopause symptoms—integrating lifestyle modifications, targeted supplementation, environmental toxin reduction, and appropriate testing—to improve resilience and quality of life during this hormonal phase.
Dr. Justin Marchegiani: [00:00:00] Hey guys, it's Dr. Justin Marjani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justin health.com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
J, and or our colleagues and staff to help dive into any pressing health issues you really wanna get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family and enjoy the show. And we are live. It's Dr. The Jay in the house with Rob Edwards. Today we're gonna be talking about all things perimenopause, mood fatigue, irregular periods potentially hot flashes, all those good symptoms that most women don't wanna avoid, right?
We wanna get to the root cause of why this is happening. So whether it's PMS or perimenopause, or maybe you're getting close to menopause, we're gonna dive into the root cause of this physiology and what you can do. My man, Rob. How we doing, brother?
Rob Edwards: Good. Been a long time. It's been a couple months anyway.
Yeah.
Dr. Justin Marchegiani: Yeah. [00:01:00]
Rob Edwards: We gotta connect a little bit before, talk about some of this stuff, which is great. Yes, of course. Our stuff being in our forties and there's people in our own lives that are in their forties, they deal with some of this perimenopausal, menopausal stuff. If it's on the early end, typically.
A lot of people say in their fifties. But yeah. I'm excited to dive back into this topic again and get things rolling here.
Dr. Justin Marchegiani: Absolutely. So big symptoms we're gonna see are fatigue, mood swings, irregular periods. Sometimes you can also see hot flashes, weight gain's, a big one, sleep disturbances.
So these are all on the table as issues, right? So first off, let's define terms. I think it's good to do that. Perimenopause, peri means around, it means around menopause. And so let's just start with menopause. Menopause typically starts somewhere between 48 and 51, where that's average.
You could, I see women with their hormones beaten up and they're dealing with this in their thirties. Or you can just have a surgery hysterectomy and be in it right away surgically. But. So the average is 48 51. But you could, this can happen earlier because there's so much hormonal stressors in our environment.
And so when you don't have a cycle period for [00:02:00] 12 consecutive cycles, now you're technically, menopause, you're in menopause, right? And then usually that menopause, that menopausal timeframe of symptoms can last anywhere between five to 10 years where you're having more hot flashes, low libido, vaginal dryness.
Hair issues, skin elasticity issues, and these can all happen when you are perimenopausal too. The difference is you're still having a monthly cycle, so menopause, no cycle for 12, no cycle for 12 different cycles, 12 months perimenopause. You're starting to have a lot of menopausal symptoms that I mentioned, but you're still having a cycle.
And the cycle symptoms are happening randomly throughout the entire cycle. Or if we go to women who are PMS, how is that different? 'cause PMS can still overlap. You can still have irregular periods, you can still have. Bloating, mood issues, depression, anxiety, irritability, water retention. Typically, PMS is gonna be more in that seven to 10 window day before you actually menstruate.
So think about it like day 20 to 28 or so is where you're gonna see the big hormonal [00:03:00] symptoms, where a perimenopause, you're starting to get older, and then it starts to happen randomly throughout the entire month. But there's some overlap there. It's people, it can be a little bit confusing. So I like to really lay it out and then we'll test these hormones.
We'll look at. Estradiol. On day two or three, we'll look at progesterone in the heart of the luteal phase. On day 20, we'll look at DHEA sulfate. We'll take a look at FS, H and LH if we need. These are our pituitary brain hormones. These start to go higher as we get closer to menopause 'cause it's the pituitary, screaming to the ovaries, make more hormone and make more hormones so it starts to get higher and higher.
And. And that's part of what drives some of the hot flashes is that FSH can create some flushing and that increase in body temp. And so it's good to look at those too, because that can give you a clue of how close into menopause you are. And so these are all important things to look at, from a hormonal standpoint, just from the testing.
But I'll let you go.
Rob Edwards: Yeah. No, it's true. And I think like touching back on the stressors, right? That's really a big deal. People women tend to lose their resiliency, right? More difficult to deal with stress, crazy [00:04:00] mom starting to come out and and they recognize it.
They notice it. And I think for a lot of people when they get into the peral pauses stage they are noticing big shifts heavy bleeding, irregular bleeding, the brain fog. Constipation, irritability, and it really starts to affect their life, both, I think, from a personal perspective with their husband or their spouse, and then also, downstream with their kids.
And so a lot of people that I see, they, that's one of their biggest complaints is they're not who they quote unquote used to be. So that's a big thing, I think.
Dr. Justin Marchegiani: And if you go read Dr. Jonathan Gray's book men are from Mars, women are from Venus. He talks about cortisol in women and cortisol in men.
Cortisol is a stress hormone. It impacts the frontal cortex, ruminating thoughts, dealing with stress. The biggest buffer on stress that men have is testosterone. Testosterone can help buffer stress in men, and that's why when a man deals with an emotional stressor, if that testosterone's there, it can create a buffer and how that frontal cortex processes it.
It's easier, I think, to compartmentalize it. When that [00:05:00] testosterone kind of drops, it's easier to more ruminate, and we have lots of guys with lower testosterone today because of. The estrogen in our environment, the plastics, the pesticides, the chemicals, the glyphosate, the mold. And so even though we're talking about women here, men can still be impacted by the same hormonal physiology that women have too.
And so it's not like an either or here. Plus with men, if they eat lots of. Excess carbohydrate, processed food, they upregulate an enzyme called aromatase, which causes more estrogen in them. And so men can still have these same issues. So it's not just a female thing. But getting back to that, why is that an issue with stress?
Because when a woman goes closer into perimenopause. That testosterone drops. So if they had more testosterone, let's say in their twenties and thirties, now that testosterone's dropping. Now the stress is gonna impact their brain, how they feel, how they respond, their resiliency, so it can intensify it.
And part of the things that keep testosterone and this also estrogen two up as we get closer to perimenopause. And I always say it like, like [00:06:00] I'm in that state, but it's just. It's just me being in that first person. The thing that helps that is DHEA sulfate, DHEA is that precursor sex hormone building block for our sex hormones.
And that can also multitask towards estrogen, and it can also multitask towards testosterone. So the same physiology that helps men with the t, we can still support that with women as well. And people don't realize it when I say, Hey, think of a woman's most predominant hormone. What hormone does a woman make the most of?
Just say it right now. What's your guess?
Rob Edwards: Yeah. It depends what we're talking about. We're talking about upstream pregnenolone, but no, but just,
Dr. Justin Marchegiani: just downstream. Yeah.
Rob Edwards: Estrogen. Yeah, estrogen, yeah.
Dr. Justin Marchegiani: But it's actually no, testosterone is two to three x more than any other female hormone.
Yep. The only exception is like progesterone for a few days in ovulation, but outside of that average, throughout the month, it's testosterone. People don't know that. They're like, what? Like testosterone's like a guy thing. It's it's the most predominant hormone in women. Yeah. And so DHEA plays an important role for that in women.
And so the more stress we are. Testosterone will drop and then also estrogen will drop too. It [00:07:00] that's, so when it comes to mood, hormones are a big part of it. This is why men are different in regards to dealing with stress and dealing with mood. And so we gotta look at that. And so the more balanced we are with our hormones, the more resilient we become.
This is about being resilient.
Rob Edwards: Yeah, I think just to hit on that cortisol, DHEA relationship. So yeah, if cortisol, high stress environment, high stress capacity to deal with things, if we're at a high level we're not gonna have as much DHEA production, which is our rest and repair hormone and we'll be able to create more of the estrogen and estrogenic balances and things of that nature. Correct. And then just to hit a little bit on that progesterone that goes into that steel, right? Is that the progesterone steel that it can convert itself into cortisol if it's a high stress environment.
So your hormones get all outta whack if we're high stress, high strung on top of the perimenopause, which is gonna create stress inside of the body anyhow. But if we've got all these other external factors of stressors in our life, or infections in our body, or other things that are putting our body into that stress state or cortisol dominance or hormones are always gonna.
Be affected by that. [00:08:00]
Dr. Justin Marchegiani: Correct. And also, women have habits from their twenties and thirties of what they can eat, what they can do activity wise, and then they start to hit their forties, they start to gain weight. It's like why? It's as we go into perimenopause and those hormones drop, one of the biggest correlations we see is we become more insulin resistant.
So the carbohydrate threshold that we had, the amount of carbs or processed food or alcohol that we could do twenties or thirties, or the amount of exercise we needed, all those things now change. It's a moving bullseye. Like my wife, for instance, had put on a little bit of weight and she had she's in that perimenopausal timeframe and she we tweaked her macros in the last couple weeks.
Got her carbs down got the protein and fat up, just tweaked her exercise a little bit, and she's lost over 10 pounds in two weeks. Yeah, that's great. And I told you, I'm like, you're just going a little bit more insulin resistant and you just have to adjust things. What you could do a decade ago, you can't quite, you can still get similar results.
We just gotta tweak it a little bit and it worked. And so I see that a lot. And so one of the bigger things that we see with perimenopausal women is insulin resistance. And so I like to always have an objective tool. [00:09:00] My blood sugar meter is great. So a functional glucose tolerance. Test your blood sugar before you eat on fasting, one hour, two hours later, we wanna be a below a hundred, an hour two.
If you're still above a hundred hour two, test it an hour. Three. But that's a good way to start looking at blood sugar issues. And you could also have good blood sugar, but if you're bouncing around too and you're reactive. Hypoglycemic that could also contribute more to the mood stuff, the irritability, the heart stuff.
Maybe sleep stuff. So it can create a lot of mood issues too. If your blood sugar's not stable, it could be good levels, but it could be bouncing around a little bit too. I.
Rob Edwards: Yeah, and I think that's a good point, Justin. 'cause we create these sort of patterns in our life and these things that we get used to doing.
And then as we get older and or we get more oxidative stress on the cells, we start to get more stressed in general. We have more kids, we have more different kind of things. We've gotta adjust some things, our macros, our micros, make sure that we got enough minerals and things like that coming into our body.
But I know you're breaking off that tool it looks like. I think that's an underrated tool if you're post. 40 it's gonna be a big benefit to [00:10:00] learn about your blood sugar, how your body responds to. These different things. And so he's doing some ninja stuff over there and we're gonna look and see where he's at.
Dr. Justin Marchegiani: Let's see. I wanna be below a hundred. Getting ready to eat. Come on, baby below 194. Nice. She passed. I passed. She passed it? Yeah. I'm not chugging Coca-Cola here in the background. My blood sugar will be sky high.
Rob Edwards: It was that, that Keto Mojo.
Dr. Justin Marchegiani: Yeah. Keto Mojo is great 'cause it connects to your phone and then it graphs it all out so you can create a little graph and look at it later.
So if you forget, it'll say, oh, you took it at this date, this time. And then you can do two or three in a row and then you can see that graph, which is nice.
Rob Edwards: Yeah, that's great.
Dr. Justin Marchegiani: And I know a lot of women may be listening and saying like men are so lucky they don't have this issue. It's if you're thinking that, I see so many men today.
We test their hormones. They're in the tank, like 67-year-old testosterone. It's so bad. Yeah. And part of this is. Both sexes are impacted by the milieu of hormones that we swim in, and so it, it's, it [00:11:00] negatively impacts everyone. Women have this monthly cycle, so the analogy I've always given is women's hormones are like a beautiful orchestra, and all it takes is the horns of the strings to be off.
And that music. Can sound like noise pretty fast. Men's hormones are like, it's like playing one single note. Eh, you got your, e eh, like I call it the Foghorn. So it's, it's easy. It's not as, it's a little more straightforward. Yeah. It's not quite as, concerned. It's not quite as detailed. Yeah. And so because of that, when the things start to go awry a little bit, we can have problems. They become a lot more noticeable. Yeah. And so it, it's there. And so the, I tell people that why? Because if we don't talk about the environment that we're in and how much of an input on our hormones that is, it impacts all of us.
Rob Edwards: We've got
Dr. Justin Marchegiani: Moms that have, that, have husbands and kids and all this. And plus, if you're still wanting to get pregnant. If these are factors you have to be aware of and if you wanna sail into perimenopause and menopause, we have to make sure our water's clean. Clean, filtered water. No, microplastics, don't be storing your bottle, [00:12:00] your water in plastics.
If you're just drinking out of it, you're putting water in a plastic thing and you're drinking, not a big deal. It's when you're putting it in for hours upon hours, it's heat, it's going outside. That's where you want a stainless steel bottle. But if you're in your house and you're just getting a glass plastic, that's not a big deal.
It's just, that's fast, right? Especially if the water's like room temp. Not a big deal. But in general, get used to glass, get used stainless steel. Make sure your food's more organic. Make sure you're getting good proteins and good fats and good cholesterol, because that's the building block of your hormones.
Yeah, if you want good hormones and your hormones are being depleted. If I need to put this addition onto my home, I need to have enough drywall, lumber, concrete. If there's a deficit there, I can't put that addition on. Same thing with your hormones. So we have to make sure that raw material that we need to make those hormones is there, but not only is it there, can we digest it?
Can we assimilate it? Can we break it down? Can we absorb it? All those things are so important.
Rob Edwards: Yeah, there's on the one side when we talk about like environmental toxins affecting like endocrine, right? Endocrine disruptors, particular phalates, plastics, these kind of [00:13:00] things, yes, that's gonna create a block.
It's gonna create hormonal disruption within the body. And I think that's what we're trying to say. So both, you're gonna see it in both men and women, not just one side, even though they affect 'em differently. And then when we talk about gut and gut absorption, there's also disruptors there too.
Right, which could be mold or dysbiosis and things like that, that can happen in the side of the gut that's keeping you from absorbing the things that you are eating. But then the first place, I always tell people, I'm like, here's the thing though, like one of the things that your cell does is it absorbs the nutrients in your gut.
Your epithelial cells absorbs nutrients. But if there's no presence of those nutrients, there's not a whole lot it can do other than Rob Peter to pay Paul. It's gotta start eating itself. That's it. If you're not eating it.
Dr. Justin Marchegiani: And if we consume lots of glucose and excess carbohydrate, those foods have an expensive transaction fee.
It takes magnesium, it takes B vitamins, it takes a LA, it takes amino acids to process excess carbohydrate. The more processed. It is high fructose corn syrup added sugar. The more expensive it is to take the, those nutrients in, it'll [00:14:00] take more nutrients out of us to process it than we get from the food.
Yes, that's what we call nutrient debt, right? That's nutrient prison right there. You never get out.
Rob Edwards: Yeah. And that sort of goes into, like when I, whenever I talk to people about weight gain, that weight gain is a metabolic dysfunction, right? It's like your body's putting away excess materials.
Not that we don't, if we gain weight, that can be a healthy thing too, but when we're getting more in the obese state. That's a metabolic dysfunction, right? It's a metabolic function. Correct. We have too much glucose, we have too much too much of the stuff that we're eating is being converted and made into fat and stored up in our cells.
Correct. And then likewise, the double compound that issue. Fat is also where our toxins like the story or at least many of them. And so then your body even has a harder time of wanting to release those. You know the fact, correct.
Dr. Justin Marchegiani: Correct. And that's part of just the insulin resistance. And also our body doesn't want toxins flowing around.
So if we don't have the detox nutrients there, we'll trap away some of these toxins. That's why we wanna make sure we have the good sulfur and all those powerful antioxidants. So all [00:15:00] that makes sense. So in general, big mechanisms, big biochemistry behind these symptoms, right? Estrogen dominance is one that could be more estrogen relative to progesterone, but it doesn't necessarily mean you have to have high estrogen, so just don't confuse that.
High estrogen. Yes, my last patient. Had high estrogen and she had middle to low progesterone, right? But you could also have lower estrogen and then just lower progesterone relative to that, and you could still be estrogen dominance. So that's more of a ratio thing. Low, DHEA and low testosterone can be a thing.
Cortisol imbalances either overly high, overly low. Cortisol also mobilizes sugar, right? So you can be stressed. You could be making a whole bunch of glucose because of that cortisol. You're mobilizing it from the muscle, from the tissue, from breaking down amino acids, and you could be mobilizing a candy bar worth of glucose even though you're not eating the candy bar, right?
So this is why stress stinks, is it's like you ate the candy bar, it's flowing through your bloodstream. You didn't get the [00:16:00] enjoyment of actually eating the candle bar, candy bar, right? So it stinks, but you're dealing with the side effects of it. So that's why walking and some movement and exercise can be helpful, especially when you're stressed.
'cause it cleans up the extra glucose that your body spills over when you get stressed. Yeah, and I'll add one more component there. Then we have neurotransmitter changes. So when we get stress, we convert dopamine to adrenaline. Dopamine's an important feel, good neurotransmitter connection focus. And so when we start to have this brain feeling inability to focus, brain fog, part of it can be that stress driving dopamine down to adrenaline.
Just like you mentioned earlier, progesterone goes to cortisol. On the neurotransmitter side, dopamine can go to adrenaline. Yeah.
Rob Edwards: And I think a kind of a big takeaway as a whole is really the conversation around homeostasis or balance in the body. So what we're talking about essentially is different ways that your body can get I imbalanced, right?
Whether it's excess carbs or it's excess toxins, or it's excess whatever it happens to be. And that's what we look at within people, right? [00:17:00] So the reason we do testing is to figure out where are there imbalances in the body? Where is the body unable to create homeostasis? And where are the potentials hidden potentials, that hormones are being affected, neurotransmitters are being affected, and all these other kind of things that we're talking about.
And yeah, I think everything affects everything. Like our body doesn't exist in a single, in a single straight line. So it's when cortisol's high, you are going to have sex hormone issues, right? You're gonna have DAGA issues like that's gonna happen. You're gonna have stealing happens, you're gonna have.
More free radical production or reactive oxygen species.
Dr. Justin Marchegiani: And the issue is more chronic because everyone's gonna have stress. It's the chronicity of it that creates these problems.
Rob Edwards: Yeah. And the accumulation. So chronicity and accumulation 'cause of some toxins have half lives that are longer. And you just start accumulating, and we start showing problems there.
Dr. Justin Marchegiani: Yeah. So let's talk about some more hidden clues, right? Fatigue's a big one. Now again, this is where it gets. In female world, it gets really tough because I see lots of women with these same issues who don't have [00:18:00] perimenopause. This is where it gets so tough, right? And so you have the right, you could have PMS and overlap with perimenopause, right?
The solution a lot of times is gonna be very similar. The difference is if you're up against not having a cycle, then things start to change a little bit. This is where the art and the science of what we do collide, right? And women's hormones are, can be so intricate. You really gotta look at the pattern, but fatigue's a big one.
Now, why are we fatigued? We're fatigued because of these cortisol imbalances. 'cause the blood sugar. Also, if we have. Let's say dysmenorrhea. And we have, we're estrogen dominant and we have a lot of blood flow. Like a patient we were talking about earlier. We can be anemic. And when we have low iron, now we don't have the ability to cr generate aerobic energy.
Well, electron transport chain and generating a TP is now lower. So energy's in a drop, right? You do go back to the science experiment in middle school where you take the candle, you put a glass jar over it, what happens to the candle? The light goes out. Why? Because that candle needs oxygen. For metabolism, for heat, for energy, same thing metabolically inside of us, [00:19:00] we have the mood swings because of the progesterone.
Because of the dopamine, because of the cortisol, we have anxiety issues because progesterone also is a GABA chloride channel opener. Progesterone drop less GABA in the brain. GABA is a inhibitory neurotransmitter. So if you find yourself excessively ruminating, not being able to turn off your stress, you're.
Your husband gets over the stress, but you're just still on it, right? That's gaba, that's progesterone, right? That's glutamate in the brain, right? So there, there's reasons why this happens. Irregular periods, like I mentioned, the estrogen dominance. That's gonna, you're gonna lose the iron that way. And then of course, that can cause sleep issues.
You're not able to wind down. Maybe you're waking up and such, maybe you're waking up to pee a lot because the hormones are creating elasticity issues. With the bladder and some of those muscles that help make nutrition and empty the bladder. And then of course, like breast tenderness is gonna be a big one.
Maybe you have fibrocystic tissue there. Headaches, bloating, maybe migraines, right? If you could still have some PMS issues where that timeframe right before you bleed, you're gonna have some of those PMS symptoms. All the [00:20:00] things I mentioned all come up in that couple of days before you menstruate.
All those are things to look out for that may tell you there's some perimenopausal stuff. And of course the biggest thing is just your age, but women in your thirties, you're still not immune. Even women in their twenties. I see levels that are just so low. It's just shocking.
Rob Edwards: Yeah, we definitely see it's hormone, hor hormone related issues at very young ages, in particular thyroid, even though that's not this topic.
Correct, but it's still a hormone, right? It's affected by all the other hormones. Correct. And so you, I typically see, and I'm sure it's the same with you, you see a progression, there's a progression, the thyroid issues, there's an insulin resistance issue, there's sex hormone issues. Not uncommon for me to see people that have hysterectomies at early ages, and it's in their thirties.
And you ask 'em why, and they say 'cause I had fibroids or I had endometriosis, or I had an overgrowth, or I had bleeding that wouldn't stop. And so the answer was a hysterectomy. When in the reality, the hormones, it's always sad to me because the hormones can actually. Fixed. Like we can actually Yes.
Work on the body. In many cases we can fix these things. Yes we can. But yeah, there's a, go ahead. Go ahead. Keep [00:21:00] going. I was just saying there's a hormonal cascade to this whole thing and your primary ones, if you're cortisol dominant, cortisol's gonna, be dominant.
You're gonna have a dominant you're gonna have a dominant issue with insulin sensitivity, most likely for most people, which gets into energy production. 'cause again, if we can't get insulin inside of that cell, we're not using glucose to produce energy inside that cell. And the weight gain, what I see with like T three, which tells the cells to let go of fat, right?
We start having issues with weight loss issues in other words, difficult for women to lose weight.
Dr. Justin Marchegiani: Yeah, interesting study here too, the importance of nutrition in menopause and perimenopause. So interesting study here. This is the Journal of Nutrients. It's number 2023. They talk about certain nutrients that get depleted.
Perimenopause. Making sure we're hydrated, make sure we have good electrolytes making sure vitamin D, calcium, vitamin C, b vitamins, making sure protein intake is up. Women get very concerned about osteoporosis. But if I just, tell you, oh, think of the number one nutrient [00:22:00] connected to osteoporosis.
What is it, Rob?
Rob Edwards: Pro. You talking about protein?
Dr. Justin Marchegiani: Just the average person, if I say, hey. Oh, calcium. Calcium, yeah, calcium. People think calcium, right? Calcium. It's if I say potassium, you say
Rob Edwards: sodium. No. Calcium. Calcium, yes. Sorry.
Dr. Justin Marchegiani: Yeah. So there's certain things, right? If I say bones, you're gonna say, oh, it's calcium.
If I say potassium, you think banana, right? Yeah, banana. There's a lot of preconception, there's a lot of preconceived conceptions. But in, in general, like potassium, for instance. Avocados have twice the amount of potassium than bananas do. But bananas get thought of. We talk about bones. One of the most important thing in your bone that makes up the raw material is protein.
But we don't think of protein with bones. We think of calcium, we think of milk. It's a lot of that kind of brainwashing from years of TV commercials.
Rob Edwards: Industry. Industry trying to sell milk.
Dr. Justin Marchegiani: E. Exactly. So protein, big deal. And. If you're on an acid blocker as well, oh my gosh, you're set up for failure.
So we have to have good digestion, we have to have good protein. And then of course, look right here. Lifestyle factors, type two diabetes. And again, [00:23:00] just because you're not going and getting detested and coming back with diabetes does not mean your blood sugar's. Okay? Many conventional docs will say, oh your blood sugar's fine.
It may not be. A lot of the testing that we use for hormones are gonna be what's called a functional range. So lab ranges typically work for conventional MDs. It's a two standard deviation to the left and to the right of the mean. So that means the average. Two standard deviations left and right is about a 95th percentile.
Fits in this what's called the bell curve. That's a lot. As people get sicker, what happens to the bell curve? It gets wider and wider, and more people get stuck in it. You go to the airport, 95% of people aren't healthy or aren't normal, right? There's typical and there's normal. Most doctors confuse typical.
Normal. Yep. So that's why we use that first standard deviation so that maybe middle 50%, that's a more optimal range. And so we'll look at things in a more sensitive way, like I gave you an example with the functional glucose tolerance. We're never gonna say, oh, let's take this test 12 to 16 hours after you eat in the morning [00:24:00] and see where your blood sugar's at.
That will never. You'd have to be sick for a decade for that to show a problem. Yeah. So we do this 'cause it'll show up much faster and we'll see improvement faster too. So those are some big nutrients that are important. And I love the protein part, I love the blood sugar stuff. All very important things.
Rob Edwards: Yeah. And I think to your point, Justin, that's one of the benefits of technology, right? It's like we, we can do this stuff in our home, right? So the reason you go to the doctor's office, you go in to take LA blood draws or things like that, you can't do that every four hours. You can't do that.
Correct. Two hours after to eat. That's just not feasible. But getting a keto mojo, you eat something, you can see shortly thereafter, what did that do to my blood sugar? And now, that's a more functional approach. That's something that knows more functionally what your body's doing versus I'm gonna fast overnight, then I'm gonna take a blood glucose and see what happens.
That's, it's, there's so many variabilities that can get that wrong.
Dr. Justin Marchegiani: Plus going for a big needle draw that, that, that's a stress response right there. That creates cortisol adrenaline that increases the blood sugar right there, the little. Finger prick isn't as bad.
Rob Edwards: Yeah, a hundred percent.
And that's the [00:25:00] glycolysis in the liver, right? So it's like cortisol is asking for more glucose to deal with the to deal with the issue at hand. Yeah, it's I wanna
Dr. Justin Marchegiani: highlight this right here. Look at this. The specific hormones involved in perimenopausal mood changes are numerous recent investigations that suggest that the influence of cortisol and the HPA adrenal axis.
We talk about this all the time in functional medicine, right? That's the brain feedback loop, inflammation, testosterone, and the hormone influences of estrogen and progesterone, which
Rob Edwards: makes sense. Come on it,
Dr. Justin Marchegiani: it's like we've actually been at the library, Rob, like studying this stuff, right? It's like this is what we actually do.
Rob Edwards: And then the most important thing on there is it says, which has been extensively studied. So people that always ask where do I find this information? It's like literally go, pubMed, Google, wherever you're gonna find this. This isn't like new information in terms of that, but,
Dr. Justin Marchegiani: and it talks about the estrogen decline right here.
It talks about how that can create some of these mood issues. And then it talks about, some of the other things here we're trying to take a lot of this information and distill it into [00:26:00] what's actually actionable, because there's a lot of scientific jargon here that doesn't really equate to like, Hey, I just got a.
Maybe eat organic or work on my digestion or take some nutrients that have some of these additional bees or work on my gut. So there's a lot of things, and again, when we talk to patients and we work with them, we make a list and we look at things and we individualize it. 'cause everyone's priorities may be a little bit different.
So it's gonna be customized. We're just giving you general stuff. But when we work with patients, it's gonna get very nitty gritty into the specifics.
Rob Edwards: Yeah, a hundred percent. That's where you can get into specifics in terms of what specific kinds of stressors are affecting the body, what specific kind of things, the body's doing with detox pathways and all those different kind of things like liver, phase one, phase two.
We can look at a lot more things that's more nuanced to your point, Justin for somebody that's coming in. 'cause there's, but the biggest thing to your point, I think you're hitting on that is going to be lifestyle. Lifestyle is gonna be 70, 80% of this. I think sometimes supplementation therapeutically is needed to get somebody out of a hole, right?
Because you're in a hole so far. It's absolutely needed, I think for [00:27:00] some people because you've gotta, it's if if you dislocate your arm or something, eventually you gotta go to PT and you're gonna circle your circle cir, circle your arm more than you ever have before because we're therapeutically working on things that happens inside of our body too.
When somebody comes to us with all these signs and all these symptoms and cortisol dominance and I'm perimenopause and I'm destroying my family 'cause I'm erratic, crazy lady and I can't remember my keys every single day. Correct. All those things.
Dr. Justin Marchegiani: And look right here. It talks about some of the functional neuroanatomy.
It talks about the menopausal transition may activate different parts of the brain, the ventral limbic regions, the medial temporal zone, and that may influence negative emotional information, right? So this is important. Also, it talks about the drop in estrogen. This is talking about a mice study that furthermore over optimiz mice have been found to increase serotonin production after estradiol administration.
So what they're saying is when they drop the estrogen, their serotonin goes down. And that can have a major impact on radio major depressive [00:28:00] disorders too. So it's important hormones have an impact on your mood, on your brain. The neuroanatomy changes based on how these hormones are fluctuating. And so it's important, right?
Yeah. It just means. For my women who are listening to this, it just means what you are feeling is not an opinion. It's real. It's connected by your hormones. It's connected by neurotransmitters. And so we wanna get to the bottom of it. 'cause you can feel better, right? It's not, this is not just random stuff, it's not all in your head.
Rob Edwards: Yeah. And I kinda wonder what your take is on like hormone replacement therapy. 'cause I know for a lot of people, even in the functional medicine community, we're just seeing people going straight to that. Let's replace hormones, let's replace hormones, let's replace hormones. And a lot of people that I'm seeing are like, they're in a worse place sometimes than where they first started.
Correct. 'cause there's other things that, there's other reasons your hormones are outta whack. There's other, yeah. Other things going on.
Dr. Justin Marchegiani: I see it a lot. And again, in the female community it's there. I see it a lot in the male community where it's like you got a guy, he's got low t, he's in his thirties or forties, he's [00:29:00] drinking outta plastics.
He his aromats to the roof. 'cause his insulin's high. Maybe he's consuming soy. Maybe he's not even lifting weights. Maybe his sleep's not dialed in and you're gonna go dump a hundred, 150 milligrams of testosterone on this guy a week. That is just not smart. 'cause you're not. Fixing the underlying root cause of why that T is low.
And maybe when you fix it, maybe just, maybe the testosterone comes back up and most of his symptoms go away, but let's say they don't. Now you're at least working on a cleaner canvas. You don't have all these other underlying physiological imbalances in the background moving. It's like working on a computer that's full of viruses.
Let's get the viruses all cleaned up and defragged, and then let's install the software, right? But I find most of the time. You don't even need the extra tea. Now with women it's different because you have a follicle reserve, right? Your ovaries are full of all the follicles. You have all the potential babies or follicles are all there at birth.
It's crazy. I saw it's like a see picture of a woman and then you see the baby inside. Of [00:30:00] that woman and just knowing that baby has all the follicles in it. So all of the future potential grandbabies are already in that woman inside that baby. It's just crazy. It's whoa. It's nuts.
Rob Edwards: Mind boggling
Dr. Justin Marchegiani: it. It's mind boggling to think like that. It's like that's maybe 60, 70 years down the road there. It's crazy. So when those follicles start to run out. The LH and the estradiol that's being produced by those follicles drops. And so that's a big thing. And so there may need to be estriol or estradiol into menopause.
In perimenopause, we typically use more DHEA. We typically use more progesterone at the right time of the cycle in that follicular phase. And we use herbs that work on the upstream FS, H and lh, the brain. Hormones and we work on herbs that help with the HPA axis. So we do all of those things to help reset.
It works on receptor sites, works on hormonal output, and we try to make sure the what's in the environment hormonally is not screwing us up. And we make sure that if things are coming in, 'cause we live in a toxic world, that we're able [00:31:00] to clear them out as well. That's really important.
Rob Edwards: Yeah. And I think also opening up the estrogenic pathways in terms of being able to metabolize.
Old estrogen, whatnot, and get it outside the body as well. Liver phase one, phase two, phase three support. Correct. To make sure that your body's building this up. So
Dr. Justin Marchegiani: a hundred percent. I think we went over symptoms. We talked about neurotransmitters. The big ones that come in here are gonna be progesterone's impact on gaba and.
Estrogens impact on serotonin and how that can create depression and mood. And then of course, gaba, the ability to move on, be more resilient, shut down what you're thinking about. That's gonna be gaba, progesterone, and then some of the nutrient depletions we talked about.
Magnesium B six, zinc. Calcium, vitamin C, and then now testing. So we can do blood testing around day two or three for estradiol on the conventional medicine side. We can do progesterone in that luteal phase, like around day 20. We're gonna definitely wanna run a Dutch test and look at free. And total hormones.
And the Dutch looks at cortisol wonderfully, which I love. And it also looks [00:32:00] at how we're detoxifying estrogen. So we're gonna look at E one, E two, E three, right? Estro and estradiol estriol. And we're gonna look at two methoxy, two hydroxy metabolites to see how we're clearing out our estrogens. And then we also wanna be able to look at DHEA sulfate.
We wanna look at testosterone, we wanna look at progesterone. But I'll, if someone's really in the thick of it, hormonally, I want to compare blood to the Dutch as well. So I like to do both on that.
Rob Edwards: Yeah, it makes sense. I think the Dutch, I really love the Dutch breakdown especially of the, the different estrogenic conversion sites from the metabolites, the two oh H, four oh H, and 16 oh h.
Because it gives you an idea like which are they going down the safe pathways? Are they going down more of a, potential pathway? Correct. You want to go.
Dr. Justin Marchegiani: And you got 2, 4, 16. Two. We want two. Two. Too much. Too much too. We want more too. Four and 16 tends to create DNA damage, oxidative stress, not good.
Four and 16 things that cause more. Two are gonna be B vitamins, folate, choline. And acetyl cysteine a lot of your proteins, a lot of your B vitamins, a lot of your [00:33:00] antioxidants. And so if you have good nutrients there, dim diol, methane into all three carbinol calcium, the glide that's gonna push the two pathway, which is more cancer protective.
And then four and 16 are more cancer promoting DNA damaging. And that's just the opposite. Doing the opposite things go that way. Yeah. Alright, cool. So we hit that stuff. Lifestyle changes, right? Get the blood sugar in check. Good proteins, good fats. Make sure your digestion's dialed in. Be careful with alcohol and caffeine.
Make sure sleep is dialed in. Look at all the toxins from the water. Are you living in a moly environment? Mold is estrogenic, right? Look, yeah, if you're in a moly environment, we gotta look at mold. And again, like your average doctor isn't even gonna know what to do with that.
Rob Edwards: They won't look. It all had patients go
Dr. Justin Marchegiani: over to go over to last year to Mayo Clinic and once they brought up mold to Mayo Clinic, they pushed them.
No we don't, they, people will like, they will do this. If you bring up mold, they'll pull up the garlic and the crosses seriously. It's one of those things, but it can be an issue and we are [00:34:00] equipped. To talk about it and deal with it. So we talked about the liver stuff and then getting the gut dialed in.
The gut is a major means of detoxification. So without good gut health, we can reabsorb a lot of toxins there. So when you think about toxins, people go liver, but we also look at the gut that's so important.
Rob Edwards: Yeah, a hundred percent. And that's also your absorption area too. So if we've got, yes, we've got ification or overgrowth or dysbiosis in the gut, you might be eating great, you might be eating all the right foods, but if we don't address those things, then you're gonna have a hard time absorbing them in the first place.
And create a dysbiotic environment there too. Yes.
Dr. Justin Marchegiani: And sometimes the thyroid can overlap when women are like is it a thyroid issue? Is it this? I go. You have the right to have more than one issue going on at the same time. Absolutely. You could have a, you could have high TSH, low T three, poor T four, T three conversion.
You could have Hashimoto's antibodies in the background. You could have low DHEA sulfate. You could be, have a reverse cortisol rhythm, estrogen dominance with low progesterone. You could have all of those things and live in a moldy home. It's holy smokes. It gets overwhelming. I get it. But we have approaches where we look at [00:35:00] everything and it's it's like a captain that gets into a 7 47. They have their checklist and they go over everything. 'cause everyone's life depends on it. We operate the same way. We have our checklist, we make sure we don't miss anything, but thyroid can be a thing. So we're looking at tsh, T four, T three. If we have low iron, you probably have low thyroid because iron is really important for thyroid.
Synthesis. The enzymes that make that thyroid hormone are gonna rely on ferritin and selenium and glutathione. So we gotta look, we gotta keep an eye on that. We may look at fasting insulin too, because insulin resistance junks up every single hormone pathway. Yep. And then again, the big things you're gonna hear, you go to your conventional doctor, fatigue and mood are just brushed off as aging.
You're just aging. Get better sleep. Here's antidepressant. Here's antidepressant. Or if your cycles are still erratic, right? Here's a birth control pill. It's like this is what happens, are unique. None of that is fixing the underlying cause, right? They're basically putting it back on you like, this is just your issue.
You gotta deal with it. It's no, but there's actually a [00:36:00] reason why you feel that way. Let's put our focus instead of covering it up on what we can actually do to fix it.
Rob Edwards: Yeah, I think I was looking at my numbers the other day and I've talked to at least a thousand people over the last year. I think I eclipsed that number and just about every single time it's the same thing.
I went to, this doctor, went to, that doctor, went to that doctor, they said, take this medication and maybe get better sleep. And it's just kind, they brush off actually the major components of getting your health back. Just to touch on that real quick, our lifestyles compound upon each other.
The way I act today, if I act that same way every single day over the next year, the 365 days of plastic exposure, 365 days of more mold exposure, whatever that looks like, it starts to compound. But health does the same thing. If we start reducing the stressors, we start inre increasing the nutrient and the nutrient absorption inside of our body, we start giving the body what it needs.
Then to Justin's point, even though everything seems so complicated inside the body, it also has a way to fix itself. It's way beyond what any doctor could explain to you exactly what it's doing. When we give the body [00:37:00] what it needs, it's going to be the smartest doctor. It knows how to heal itself.
It's really removing the interferences and then giving it what it's missing.
Dr. Justin Marchegiani: Correct? Yep, a hundred percent. So if you're a female listening to this. What are action items you can do? Start tracking your cycle. If you haven't been right, get a kandara app, a flow or one of the ora rings that you can track it.
You can throw a temperature testing in with it. Usually right at the start of ovulation we have a drop in temperature followed by a 0.3 degree rise into our ending ovulation. So you can add a temperature while testing your cycle and we can run testing, we can do all the testing I mentioned, whether it's.
Dutch hormone testing, whether it's blood testing whether it's thyroid, whether it's we're looking at adrenal, whether we're looking at cortisol looking at gut, looking at different nutrients, looking at toxins. These are all good things to look at. And again, everyone comes in different places, right?
And so we always try to meet people where they're at so we can always do something over nothing. Couple other things here. We talked about lifestyle, right? Eat the hormonal building blocks. Don't, be this person who's worried about going low fat or avoiding animal protein. These [00:38:00] are important building blocks that you need.
Focus on healthy quality. Focus on nutrient dense, anti-inflammatory, low toxins. And then once you have that dial, then you can get nitpicky and start adjusting your macros. Maybe adjusting the carbs, eating more healthy cruciferous veggies to help with estrogen detoxification. These are all good things, at least.
Hitting your 10,000 steps. 'cause your steps are gonna help with insulin resistance moving is gonna help with insulin resistance. Again, you can add in interval training, you can add in lifting, you can add in yoga, Pilates are all other good things that you can throw in there too. But at least have a foundation of walking 'cause it's just, it's easy to do and it's good for you.
Rob Edwards: Yeah. Anything else Rob? I think we've covered quite a bit and and I got a patient here in about four minutes.
Dr. Justin Marchegiani: There's a lot of stuff to think about. Just try to think of one thing. Once you get that, do the next. If you get overwhelmed or you're ready for that next step and you wanna go into testing, feel free.
You guys can reach out to Rob at Heritage Health. Do life. Heritage Health Life. There'll be a link right below in the description or myself, Dr. Jay, at just in health.com. We see [00:39:00] patients worldwide, we look at hormones, we do look at all the things we chatted about, neurotransmitters, environmental even mold and things like that.
And we come up with a comprehensive plan that gets you to the root of what's going on. So hope you guys enjoyed today's podcast. If you did, let us know. Put it in the comments. We'll see it there. And again, share with friends or family that could benefit too. We really want this information to be out so you can be empowered and you can be taking your help back.
Anything else, Rob?
Rob Edwards: That's it. Thanks for having me again. And we should do this more often. I know we're trying to plan it. We gotta get our schedules tied in together, but let's do it. Great.
Dr. Justin Marchegiani: Let's do it. Awesome. Let's go brother. Alright guys, you have an awesome day. Take care everyone. Bye now.
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