In part five, the final transcript in our 5-part series featuring Dr. Rebecca Dunsmoor-Su's interview with David Steward on the SuperAge podcast, “HRT, Estrogen and Menopause, New Scientific Findings”, we’ll learn Dr. Rebecca’s take on whether intermittent fasting is beneficial, why strength training is key for women, and why it’s so important to support your bones starting in your 30s. Plus, Dr. Rebecca shares what she wants every patient to know about hormone replacement therapy. You can listen to the full podcast by visiting SuperAge.com.
David: I've had some questions from some of the people in our community about intermittent fasting, stress, and women, how they may react differently to this. And then, does that change with changes in estrogen levels or do we not know anything about that?
Dr.Rebecca: We do have some data on that. Remember, when we were talking about sleep and that metabolic rate change? Part of that discussion was that, when you're not sleeping and your cortisol is not dropping to its lowest point in the middle of the night like it's supposed to, then you end up putting yourself into a state of somewhat insulin resistance. So, not fully pre-diabetic, but there's just a little more insulin resistance, which means you don't process sugar as well. So, we know that happens. Step one is not so much hormone therapy directly changing that resistance, although, there is probably some interaction between estrogen and cortisol that we don't fully understand, and so that is contributing, so estrogen can help. But the biggest thing is, when I start someone on hormone therapy and they start sleeping again, then we're improving their metabolism. Does it mean that when we start hormone therapy and the weight drops off? No. Unfortunately, not. One thing we know from all of our studies is that, women who are perimenopausal or menopausal can lose weight, but it takes a lot longer and a lot more work. Unfortunately, some of these metabolic changes that occur are permanent.
I think intermittent fasting can be very helpful for people who are insulin resistant. For some women in menopause, intermittent fasting is a structure that can work for them. What I tell all of my patients however is what you need to do long term is make changes that you're going to be able to sustain. So, if this is something that feels good to you, and natural, and normal, and it's something you can sustain long term, great. That's a great thing to try. But if you are struggling through each morning to not eat until 11, then, this is probably not the right pathway for you. There's another way for you and everybody is different, as there is no one diet plan that works for everybody. People need to find what works for their body, and their lifestyle, and their system, and understand the underpinnings of their eating. A lot of what I do in my clinical practice is talk to them about this. What are you eating and why are you eating? Is this emotional eating? Is this bored eating? What are the things that we need to maybe think about and how do we substitute those things out?
David: I just want to go back to that the relationship between the cortisol question. So, does intermittent fasting in women cause a cortisol response that doesn't happen in men?
Dr.Rebecca: We don't know - that is my answer. I don't know. I think, we haven't studied it well enough yet to really understand how that might differ between women and men. I think that a lot more depends on other impacts on cortisol. So, whether it be sleep or the drop in estrogen, which also impacts cortisol levels, probably, more than the intermittent fasting itself.
The thing is cortisol is not a simple thing. The way our whole endocrine system is interrelated is very complex and not always all that well understood. We think of the endocrine system as multiple different systems. Think of the thyroid, the adrenals, the ovaries, but these are one big system that all interrelates in a way that we haven't fully defined.
David: I'm a big proponent of strength training. But especially for women, there seems to be this delusion that they're going to turn ArnoldSchwarzenegger without anabolics. I don't think that's going to happen.
Dr.Rebecca: No. Although, if you get testosterone pellets that may.
David: Yeah, that's an anabolic. Right. If you're not doing that, so talk tome about is there any counter indication to strength training for women?
Dr.Rebecca: No. Strength training is key for women for a multitude of reasons. One of the things that the drop in estrogen also does is it makes it harder for women to maintain their lean muscle mass. As we all know, lean muscle mass burns calories. So, you have to build that muscle mass back. Even if we put you on estrogen, you still have to build it back and maintain it. That's just basic health. The second reason is strength training in the big muscles supports your bone. So, as women go through menopause, and they head towards osteoporosis, strength training in the core muscles, the upper body, the lower body, it's key for maintaining bone health and bone strength and it also helps with balance and strength long term, so that even if you do get into a region of osteopenia or osteoporosis, if you have strong muscles and good balance, you're going to be better off and less likely to fall unbreakable.
David: Are you having your patients do bone density scans, DEXA scans?
Dr.Rebecca: Oh, yes. In my patients, I do DEXA scans. The current national recommendations are to do a DEXA at 65. I often do it much earlier than that because I feel like by 65, they kind of miss the boat. So, I often will use them in my newly menopausal women who have a strong family history and who want to use that information to help them decide about hormone replacement therapy. So, that's a good point to do it. I certainly use it anytime someone has fragility fracture, so, like a wrist fracture or refraction. And then, in general, I tend to get one somewhere in a woman's 50s, just so we know where she is in the pathway to osteoporosis, and so she can start to make excellent changes early on. The recommendation to do it at 65 is really more about the medications, so the bisphosphonates and the MADs, and the medications that can rebuild them, but if we can prevent that bone loss, even better.
David: What's the delta, what's the change? That's important thing, right?
Dr.Rebecca: Right, exactly. I tell my patients that I don't care what your bone mass is, you should be taking vitamin D and getting enough calcium in your diet or between diet and supplement - and magnesium. Support those bones, we should be starting that in our 30s, because women build bone until they're 30s, and then they start to lose.
When the Women's Health Initiative came out in 2002 and everybody got scared away from hormones, it left this huge vacuum in the market where all of us physicians were saying, "Nope, we don't do that anymore." So, people stepped up and stepped into the breach, and started promoting things they called safer, or better, or more natural compounds, what they call bioidenticals. These are not safer, they're not more natural, they're made from the same synthetic hormone from the same pharmaceutical companies, just ground up and mixed into new bases that are unregulated. Therefore, unregulated in dose. This is not a safe pathway.
Please come talk to us. There are plenty of us out there who are North American Menopause Certified. We will happily talk to you about hormones. We were not afraid of them. But we use FDA regulated products which are safe and body identical.
The more we can get information out to women that this is a pathway they can explore safely with their physician, the better. A lot of physicians are still stuck back in 2002. They don't understand all the data that's come since. Find yourself a doctor who has actually read it all.
Don’t miss the entire series of Dr. Rebecca’s interview with SuperAge on HRT:
And be sure to listen to the full podcast episode at SuperAge.com.
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