Breaking Down The Hormonal Transition of Menopause – With Lara Briden

Dr. Mindy
I want to really start off with like this idea about perimenopause being the second puberty. Because I wish somebody had told me that when I hit 40, that I was in for a massive change. And I don’t feel like it’s been discussed enough. So Can Can you start off and explain why you call perimenopause, the second puberty?

Lara Briden
Yeah. As you saw, this is a diagram in my book that shows, I’m really like this the sort of mirror image of the hormones like in our childhood, we have low estrogen and progesterone, of course, that’s normal. And then, in first puberty, estrogen fires up quite dramatically, quite a few years before progesterone manages to get going. And then the reverse happens in second puberty, which is actually anywhere from about age 35, some women will start having these changes at age 35. And it’s literally a mirror image of that progesterone starts to go away first, estrogen spiking up so that combination of high estrogen and low progesterone is a lot of what’s going on in our 40s. And that continues for up to a decade. And then finally, with the final period, about a year after the final period, we dropped back down to that stable state of relatively low hormone levels. And the thing that’s important about second puberty is that it’s temporary. Right? I can’t tell you how much messaging I see. Confusing, like just in the mainstream media like confusing perimenopause, which is this time of transition ton of symptoms, time of turbulence with menopause, which I use menopause. And so people say post menopause, but I use menopause to mean the life phase that begins one year after the final period. So those and that’s three decades of our life, and that should be fairly stable state and fairly healthy and not a problem. It’s these 10 or so years, and are 14 years. And I think if a lot of women knew that that was temporary, yeah, they would feel a lot differently about it. And in chapter one of my book, common repair manual, I give the example of women being diagnosed with things like fibromyalgia in their 40s thinking, Oh, that’s how I am always going to be now and actually, it’s really just part of this somewhat inflammatory somewhat, you know, anxiety producing sleep, disturbing hormonal change.

Dr. Mindy
It’s so do you think it’s normal for a 35 year old to go into perimenopause? Are we seen the changes, hormonal changes at younger ages now?

Lara Briden
Okay, well, I think so how we define perimenopause is really based on symptoms, right. Like when we start to experience symptoms from that drop in progesterone, arguably, like from a perspective of evolutionary mismatch. I don’t know how much if your listeners if you talk about that on your podcast, but go for it through the lens of evolutionary mismatch? You know, I think I think paramedic puzzles I think that I think perimenopausal symptoms in general are not normal, I think they’re, you know, a downstream effect from lots of things going on in our modern environment, including food environment, environmental toxins, things we don’t necessarily have control over. But there’s no reason like, biologically why this change should cause so many symptoms. It’s, so I guess we can talk more about that. Yeah, answer to your question like, how early does it start? Well, it’s normal for the final period to be anywhere from age 45 to 55. And I don’t think that’s changed very much. I mean, I know yes, there’s some evidence that smoking or environmental toxins can bring the timing a little bit earlier, but in general, through my biologist lens, because my first degree my first career was an as an evolutionary biologist. All the evidence points to the fact that we are genetically programmed to stop ovulating in our late 40s, early 50s. That’s not I mean, that’s a normal thing. So then the question is, in the years leading up to that, I would say it’d be normal to start that years leading up to that process by your late 30s.

Dr. Mindy
Do you just just like we look at just like we’re seeing, I mean, this was my thought process was just like we’re seeing teenagers go into puberty earlier, you know, nine year olds, eight year old seven year olds, I feel like I’m hearing more 35 year olds experiencing Peri menopausal symptoms, missing cycles, spotting. And I just keep asking myself, if that’s if that’s normal. Is that what’s supposed to add?

Lara Briden
Well, I haven’t seen any evidence that it’s coming earlier. I might be wrong about that. I might have missed some of the studies. But again, I’d say I think this, the severity of the symptoms, is not normal. It’s common. And so if anyone’s listening and having symptoms in your late 30s, it’s not that you’ve done something wrong or this is a common thing that’s happening, which is why I wrote the book about it. I think you have a book too. But this process, it can be very symptomatic. Yeah, and I guess I’ll just say again, I think the severity of the symptoms is probably linked to a lot of things in our modern environment, including environmental toxins. Yeah, I might speak to one of them that just wanted an example of that. Just go for it, a teaser of what I’m talking about. There’s lots lots to talk about, but I include these citations in my book. So there’s a couple of papers suggesting or you know, building the case that some of the neurological symptoms of perimenopause and a lot of the symptoms are neurological, you know, sleep reduced ability to cope with stress, brain fog, migraines, all of these hot flushes are hot, hot flashes, as we say, in North America. I love my I’m currently in Canada, I’m Canadian, but I am I’ve been down under for a long, long time. Oh my gosh. So

Dr. Mindy
you have like a hybrid accent?

Lara Briden
I do I start to have the lingo of Australia, New Zealand. But yeah, it’s about this evidence about body burden of lead, which is fascinating, which is a little bit scary, because you think about it. I mean, when I was a kid, I’m 51. When I was a kid, there was leaded gasoline, you know, there was lead in how to paint you know, this is in so by body burden, as I’m sure you know, like when we’re exposed to certain kinds of toxins particularly led, the body sequestered in this skeleton. So it’s been in our bones been in my bones for 45 years. And then there’s some evidence that when, with the drop in estrogen, which is normal. And the mobilization of bone, that increased bone turnover that starts up because of that, that releases lead into the system and hits the brain that that could be responsible for some of the anxiety and neurological symptoms. And when I read those papers really rang true to me. That’s it. That makes sense. So that’s an example. That’s just one example of evolutionary mismatch, right? Like, here we are attributing all these symptoms, just to the hormonal change, but I think there’s other things going on intersecting with that hormonal change. Well, I

Dr. Mindy
am 100% with you on the lead. I know my story, going through perimenopause, and I’m I’m like three months without a period right now. So yeah, God only knows where I am. But, but was that I, I felt really healthy at 40. I was working out all the time. I was on the Paleo diet. I wasn’t fasting i i was eating all day, I still thought breakfast was the most important meal of the day. And if I ate more, my metabolism would speed up. And like about 43, all my perimenopausal symptoms came crashing down on me. Yeah. And one of the big things I found was exactly what you just said, was led, and that how it had been stored. And then I went on to discover that it’s actually can be generational, and it can get actually passed down in the womb and get stored in your tissues. But it’s the swing of estrogen. That releases it like you said,

Lara Briden
right. So you you measured your lead your serum levels. Oh, I want.

Dr. Mindy
And I actually Yeah, I actually watch it and detox it a lot. It detoxing led gave me my sleep back.

Lara Briden
Yeah. So what do you I mentioned a couple things in my book about detoxing, lead. I mean, I talk about glycine and acetyl cysteine. What do you and selenium? Calcium, what do you what do you use?

Dr. Mindy
Well, so yeah, it’s a great conversation. So we we go through three steps we do we prepare the body. So we do a set of supplements that support liver health, kidney health, high powered probiotic. And then we get nutrients to mitochondria, the proper Omega 369 balance for the outside of the cell. So we usually spend about a month like preparing the body and then we have a whole system where we pull it out of the body first. And that will pull it out of our brain out of the brain.

Lara Briden
So you’re doing like a correlation kind of thing, right? Yeah. Can

Dr. Mindy
you think of it like key elation, but we use a lot of binders, activated charcoal zeolites because as stuff comes out, we want to make sure it gets out the gut. And we’re very slow and systematic. I it took me about six months of detoxing before I started to see my sleep come back. But it was such a game changer. Like I literally went at 43 from being depressed and anxious and not sleeping and hot flashes. Discovered lead in my Mercury was a little bit but lead was my biggie. spent six months detoxing and all those symptoms went away.

Lara Briden
So yeah, yeah, I’ve been I’ve been sort of plodding along with a sort of a continuous gentle, like pulling trying to pull the lead out, you know, through the gut and the kidneys. It’s but yeah, it’s it’s certainly something I mean, that’s and that’s just one example, right things that can be going on. And I want to actually one thing I’d like to talk about now if it’s Yeah, okay. I really want to debunk the narrative that menopause is unnatural because we now outlive our ovaries. Like that particular narrative is really I find, let’s just just

Dr. Mindy
since really want to tell us more, yeah,

Lara Briden
yeah, cuz as an evolutionary biologist and what I’ve, you know, through that lens and a lot of interesting books, there’s a book called, I always reference her book called The Sloman, Sloman clients by Susan Mater. And she builds the case from a kind of from a good looking way back Paleolithic all the way through, you know, all the way through historical and using evidence from modern day, hunter gatherer forger people looking at building the case that menopause is not new, that in fact, quite the opposite, that she builds the case that human longevity for both sexes evolved or was selected for, because a couple of decades post reproductive for women, it’s so incredibly valuable for looking after descendants and passing on those long lived genes. So it’s a really intriguing, it’s based on this idea yet basically building the case that for really, as long as we’ve been human, however long, that is a couple 100,000 years, it seems likely we’ve been, at least those women lucky enough to escape, you know, dying in childbirth, and accidents and infection, all that, like if you could get past all those hazards, then you live, you would live to 70, like that 70 or 80. That’s not new. And so that really and also that potentially, that was a very valuable time of life that these post reproductive women were valuable non reproductive members of our human groups, which we really need it as our evolution. And so that just basically tells the story that post reproductive is inherently healthy, you know, there’s life after the reproductive years. I’m actually now that I’m in menopause, myself, I’ve sort of reframed, I’ve got this whole thing going on in my book about, you know, second girlhood this, sort of making this analogy with childhood, which is kind of interesting. So you, I now kind of seen any female physiology, the baseline is actually the low, relatively low levels of hormones, we’re making our estrogen inside cells with aromatase, you know, we’re built, we’re doing it that way. And that the, the three or four decades of reproductive years are amazing and important for building metabolic reserve. And, you know, really great, but that’s always meant to be temporary, like, you know, pregnancies and cycles, and all the hormones that come with that, we get a big dose of that. And then we revert back to our more kind of lean conservative metabolism, because the thing about non reproductive phase or post reproductive phase, from an evolutionary perspective, we require fewer calories, which is kind of, you know, good and bad, like, but if you think about it, from an evolutionary perspective, that would have been a superpower, like your metabolism is a little bit lower. So you can still get a lot of stuff done, and actually eat less, which means there’s more food for the children and the reproductive women, which you require. It takes it’s calorie intensive to be reproductive, basically to even be cycling, certainly to have babies. And then, so I don’t know, I kind of feel like I think we have this to acknowledge our metabolism shifts with menopause. And we always think of that as a bad thing. But from an evolutionary perspective, that would have been pretty great, actually. Yeah. Okay. So

Dr. Mindy
I’ve so many thoughts on that. So that would tell me then, postmenopausal women are more in alignment with their design, their physiological biological design, when they’re fasting, because you know, I love fasting.

Lara Briden
We’re supposed to be I think our post reproductive I think we’re supposed to be an ideal world. metabolically, leaning more to ketones. I think that would have probably been because we do have this shift. And we talk about this as relates to the brain like, basically, as you probably know, as to dial our main ovarian estrogen enhances the mitochondria, his ability to burn glucose preferentially to ketones, like it makes it much more efficient at burning glucose, which kind of makes sense. I mean, I think when you’re reproductive, you’re gonna need a lot of calories coming in. And there is as we do for lots of reasons we can talk about we there is an imperative to be more metabolically flexible. With menopause that’s called menopause or post menopause and more adept at using ketones for energy. Whether that’s with fasting or lower carb, I mean, as you know, there’s lots of different ways To encourage that kind of metabolic flexibility, a lot of work to do with microbiome health and circadian rhythm and giving all the mitochondria the neutral the nutrients they need, like including things like magnesium can really help with that. I took the angle in my book of metabolic flexibility rather than Yeah, cuz cuz I’m not keto myself, although I do definitely harness some, an eating window and some overnight fasting and kind of lower carb in the morning like I’ve got a few things going on for myself, and then from but then that’s all different for because I don’t have insulin resistance. But I think this now kind of brings us into the conversation about for people who do have insulin resistance,

Dr. Mindy
well, you know what?

Lara Briden
Go ahead, No, you go and re going with insulin resistance that metabolic flexibility is impaired. So that’s when you really do I think, need some stronger interventions to regain the body’s ability, the mitochondrial ability to burn ketones. That’s something I talk about in my book quite a lot.

Dr. Mindy
Yeah. And your your books excellent, by the way, and yeah, guys listening, I really encourage you to get it I you know, what I love about it is so I that I dove into a couple chapters easy to read, but you also it’s like a great resource to have a to go back and be like, this is the symptom I have. Okay, what am I doing? I’m all I’m such a fan of checklists, like, are you doing this? Are you doing this, especially for the menopausal woman? Because, you know, yeah, we can get a little crazy at times. So but But back to your point. So, you know, the interesting thing about fasting, and I’ve been teaching fasting on YouTube for several years now. And I think what happened in the fasting world, is that everybody, once they discovered fasting, intermittent fasting, longer fasts, they thought that was the answer. But if you look into the research, especially the New England Journal of Medicine, the most one of the most popular meta analysis on fasting, it’s exactly what you just said, it’s the switching, it’s the metabolic switching is where the magic happens, which means we got to love food, we got to eat great food, but we also need to practice different styles of fasting. And what I’m hearing from you right now, and the thought that you kind of elevated for me is that if a postmenopausal woman is biologically designed to have less calories, if she’s doing standard Western diet, she is setting herself up for more disease because she’s working against her biology. Absolutely.

Lara Briden
So if the food environment talks about food environments from a, I think, because it also just takes a bit of pressure of people feeling less guilty about what they’ve been eating, like, yeah, it’s our we’re like animals. We live in a food environment that unfortunately, as everyone knows, is excess calories and empty calories and probably way too high carb and like trans fat it like, you know, there’s lots of things working against us in our food environment. And if you Yeah, potentially, it with the because with menopause, in very simple terms, there’s a shift to insulin resistance, we lose insulin sensitivity. So estradiol during our reproductive years gave us an edge over men in terms of maintaining insulin sensitivity, obviously, you can still become insulin resistant, even when you’re in your reproductive years, but it’s, it’s less likely. And then with the drop in estrogen, which actually happens kind of later in the perimenopause transition, but with the drop in estrogen, there’s a shift insulin resistance and that you won’t go all the way to insulin resistance. If you have put in place a good food environment. If you’re moving and maintaining muscle mass and fasting overnight and you know all the multiple things, then you’re going to come through it. Okay and not have insulin resistance. But if you if you do develop insulin resistance during menopause or heading into menopause, or at some point, it has real consequences, I would argue that’s where a lot of that it can one it can worsen the symptoms of hot flashes and sleep it is really kind of scary things going on with the brain. We can talk about that. Yeah. And to the other thing, the shift with insulin resistance, shift to insulin resistance with menopause is where a lot of the downstream health risks come from. So we hear this narrative that menopause increases the risk for cardiovascular disease, that’s 100% True. But I would argue again, evolutionary mismatch that our ancestors didn’t have that risk are that even today, women who get through like get into menopause, metabolically very healthy and with a great deal of metabolic flexibility and no insulin resistance. They’re not going to have the downstream cardiovascular risk that is typically kind of associated with menopause and also just on that topic. One thing I’ve kind of come to understand and I’m certainly happy to get you know, feedback from other people, I think, and one of the so you know how the research around us estrogen, and menopause and cardiovascular risk is all kind of mixed. Like it’s like it’s great. Like it’s like a man. Yes, it yes, it protects or No, it doesn’t. I mean, there’s tons of things going on with that, including, of course, the types of hormone therapy that they used previously oral estrogens cause clotting risk all these things. And you know, transdermal estrogen is safer. So there’s all that, but also, I think one of the things that’s going on, is that put it this way, women with, okay, if if for women who have insulin resistance, taking estrogen is going to improve insulin sensitivity and reduce their cardiovascular risk. Women with normal insulin sensitivity are probably not going to get the benefits from estrogen in terms of those things. Interesting. Would you agree? Does that mean I would

Dr. Mindy
sit there I would absolutely agree and where my brain goes with that is, but insulin resistance can be overcome with Yes, what we eat and when

Lara Briden
we ensure it’s reversible. It’s reversible. Yeah. So estrogen therapy is potentially it’s having a arguably, it’s helping to reverse insulin resistance. But it’s not the only thing that can do that. Right. Like there’s tons of other things. Other Is

Dr. Mindy
there a drawdowns? Yeah, is there a downside to HRT is what I assume you’re chatting about?

Lara Briden
Well, I’m fairly agnostic, when it comes to not a lot of my patients take transdermal estrogen and I think well, okay, put it this way, on the HRT topic, like, if you’re gonna take it, take body identical, which in the state is the natty term for the progesterone component and take if you’re gonna take estrogen take body digital and transdermal, like through the skin, a patch or a gel or something that’s way safer. And fortunately, body identical, unlike even 10 years ago, body did go hormone therapy. Now it’s very easy to access because it’s kind of the mainstream prescription now. But you have to specifically know, in my book, I get a list of brands and awesome. I mean, I don’t know, I think I don’t know, I’m happy to hear your thoughts. I mean, I guess I don’t see if you’re using lower dose and bodied into hormone therapy? I don’t see. I don’t see many downsides. I’m pretty okay with it for my patients to use them. What are your thoughts?

Dr. Mindy
Yeah, I mean, my my approach to health always has been tried to solve it naturally. First, look at your lifestyle, make those changes, look at how you can supplement with something that doesn’t have any risk factors to it. So typically, the herbs and supplement vitamins typically don’t. And then if that’s not working, then that’s when you have to lean lean into more medication. I am not a fan of HRT. I see too many. I see when people say here are the benefits. I’m like, I get that. But the risks are too big. bioidenticals. Totally Yes. If you can’t solve it with lifestyle, I can. I can see a case for bioidenticals. But I think it’s in light of what you’re telling me right now. I think it’s a little bit like exogenous ketones. When we first had exogenous ketones, people were like, well, I don’t need to fast I don’t need to go into a ketogenic state, I’ll just take the ketones, and I’ll get the benefits. So what you’re saying is that if you are supplementing in with estrogen, and it’s the lack of estrogen that’s making you more insulin resistant, is what I’m hearing, drop dropping, drop, okay, so then we got to look at if we’re going to metabolize and produce estrogen at its highest, we really also want to make sure we’re staying in an insulin sensitive state. Whether we’re doing this through diet or medication, we insulin sensitivity is still at the root issue of menopause, regardless of the path that you take.

Lara Briden
I would agree. I think taking estrogen doesn’t mean you don’t have to do anything else. But exactly sensitivity. What about estrogen? So now I’m now I’m being sort of the the devil’s advocate or I’m sort of go for it as a piece of information. This is because there is a lot of fear on taking estrogen. Like I said, I’m fairly agnostic about it. I think, you know, if you want to, if you feel better on it, that’s fine. A lot of my patients don’t take it and that’s fine, too. One interesting statistic is in terms of the breast cancer risk, yeah, this is gonna lead us into another topic here. But the risk from a low, you know, a modern transdermal estrogen patch plus Promate trim plus the bioidentical progesterone, that the breast cancer risk associated with that is actually lower than moderate

Dr. Mindy
alcohol drinking. Oh, interesting.

Lara Briden
I am just putting that out there in terms of right assessment, because and this is leading us into alcohol because Alcohol is not friendly to the perimenopausal brain. And I say that I actually did have a drink last night. So I’m not often. Yeah, I mean, I have I’ll go months without it. And then because I’m visiting family and like I have the occasional, very occasional. But I find that with myself and with my patients and many people that I’ve talked to putting alcohol like seriously, you know, eliminating it, at least for a little while can eliminate some of the symptoms like including hot flashes and sleep disturbance. And it makes sense, right, because changes are happening with the brain. So let’s kind of loop back. Yeah, let’s go into that. Yeah, yeah. Because, ultimately, there’s a paper I said in my book, basically, where the basically the basic premises perimenopause is predominantly neurological, I mean, it’s also heavy periods, other things going on in your 40s. But let’s just from the brain perspective, there’s a recalibration of the brain. This is analogous to first puberty where there’s a recalibration of the brain because hormones have a huge effect on the brain. So it’s undergoing quite a profound the brain has undergone quite a profound recalibration process in our 40s. And that’s, we know that’s happening, because it’s actually what’s called a critical window or tipping point for neurological conditions. I mean, the risk is too low. But basically, we know like for the onset of serious mental health conditions, there’s certain windows, there’s puberty, there’s postpartum. There’s perimenopause. These are all very similar things that I call in my book I talk about as a tipping point, or kind of an inflection point, because this is like, like a computer software update basically is going on. That’s another good analogy. Like, you know, when your computer software is updating, you’re not supposed to turn it off or do anything, you need to just let it happen as best it can. And I think if that’s one of our jobs in our 40s, is to try to, as best we can support our brain health while it undergoes this recalibration, and then we’re potentially you know, going to pop out the other end once we get in, achieve menopause or graduate to menopause. One year after our final period, the brain will be in its new steady state and should be a lot more resilient really than it would be during these years. I love those risks. Yeah,

Dr. Mindy
keep going. No, so Okay, so let’s start off with this. Because one thing that I feel like women are not hearing enough is the anxiety, the depression, your inability to handle stress. This is because of what you just said, I love the idea of it’s a brain recalibration, but what women are are doing when those symptoms appear is they’re turning to SSRIs. They’re getting divorced. They’re, you know, leaving jobs because they feel that it’s there. It’s the problem is outside of them. But if they understood that the brain was recalibrating, they may have a little more compassion for themselves and the people around them. So give me some examples of like, what are the major symptoms? And then how can we assist the body in that reallocation?

Lara Briden
Absolutely. So the symptoms is it triple, three times higher risk of anxiety and depression during our 40. Amen. Keep in mind, we’re talking about perimenopause, we’re talking about the up to 10 years before the final period or maybe up to 10 years. Before the 12 months after the final period, kind of that that’s the the period of perimenopause and the just to see again, it’s the risk is temporary and it’s hard when you’re in the middle of it you think okay, I’m anxious now it’s hard to remember you’re not always going to be like that for one thing and also there’s things you can do so increased risk of anxiety, depression, resurgence of migraine frequency, this is a this is usually people who had migraines before but they will that’s a classic symptom of a start because you’re getting these monthly migraines again, sleep disturbance is probably right up there. The other neurological symptom is the night sweats often in the earlier Premier, perimenopausal years, those will be pre menstrual night sweats. So it won’t be like you’re having hot flashes all the time, but you do you potentially can go through. Yeah, a few days, you know, a few days of that. Okay, that’s, that adds up a lot. And then from the sleep disturbance, you can get fibromyalgia. This is where I sort of talked about this, you know, downstream from that you can start to get pain syndromes, and absolutely where women resort to is SSRIs, which I’ll just point out like, I have lots of worries about SSRIs. The biggest one actually, is that they have an osteoporosis risk. So that’s not a good time to be. The research I’ve seen I mean not and again, not to scare people, because it’s certainly you don’t want to make any rapid changes is like a long term thing to think about. But the research that I’ve seen is that the bone risk from SSRIs is equivalent is as bad as corticosteroids is So, wow, it’s not it’s not insignificant, potentially, I mean, the research is still being done. Yeah. And then also, of course, women are turning to alcohol and I get it because you’re anxious and you need to calm down, you know, at the end of the day trying to sleep, but I’m saying to everyone, I’m just like hand on heart. Alcohol is not the solution. It’s, it’s just not it’s a brain. It’s a brain top poison. And I mean, not to overstate it, it worsens intestinal permeability, it’s just not helpful. So those are some of the symptoms. The other thing that’s happening with the brain recalibration we alluded to this earlier is a, what I call an energy crisis of the brain. So this is later in the process later, around the time of the final period, when estrogen is really going down. You get this reject reduction of metabolic functioning, you get up to what the researchers have found is a couple of researchers that I quote in the book and most people have probably heard of them. Roberta Brinton and Lisa Moscone from my epigenesis, my menopausal brain was able to

Dr. Mindy
retrieve or when

Lara Briden
it’s working. They, they’re a couple of neuroscientists, they’ve teamed up on this. So what they have discovered is with the drop in estrogen, there’s an up to 25% Drop in brain energy, and that they’re picking up brain energy by doing these scans where they see like the brain lighting up as it’s producing ATP, basically, is it’s, you know, producing energy. And 25% drop is quite a lot. Yeah, I mean, that’s quite, it’s quite scary. And it’s because the mitochondria have temporarily lost well, they I mean, they’ve not temporarily they’re less, they’re less able to use glucose for energy, there’s an imperative to start to use ketones for energy. Preferably ketones from diet or from the burning, the body’s burning the body bodies on fat, as you know, like that’s the best way mobilize them and then the brain can use those ketones. Roberta Brinton in one of her papers, and I can provide the citation for this she talks about. If the brain can’t do that, if it can’t readily access ketones, usually because of insulin resistance, it will resort to cannibalizing the myelin crazy of the nearby cells crazy. Which if you just think about that, it’s not good. And that is potentially where the met one of the mechanisms, probably one of several mechanisms, that what both these researchers and the Scanian Brinton have proposed that menopause is, is when dementia starts at menopause base. Right. Right. Um, the risk, as you probably know, I mean, dementia, women are three times more likely to get dementia compared to men. There’s probably several reasons for that. But one of them is I think one of the reasons is, is menopause is an evolutionary mismatch through menopause, is this brain crisis that the if you can successfully navigate that and gain, you know, regain metabolic flexibility and brain health, you are on the track to dementia that could probably not manifest for another 10 or 15 years, but the stakes are high, right? That is not a small thing. Oh, this is why so now in our household, I mean, I do. Like I said, I don’t have insulin resistance. So I’m not super strict with my diet. But occasionally if there’s like a dessert on the on offer, and I’ll say to my husband, yeah, I’m not gonna have that because I don’t want my brain to eat itself.

Dr. Mindy
That’s actually probably helpful because to overcome a temptation, if you understand that the consequence of it Yeah. Would you say then that the most important thing that a perimenopause menopause postmenopausal woman could do is make herself do everything she could to become insulin sensitive.

Lara Briden
I’d say it’s pretty it’s right up there. I guess the way I phrase it in my book is its priority to identify insulin resistance and reverse it. Because it

Dr. Mindy
was the second thing instead of rehearse it. I know and reverse it. Oh, reverse it. Like how do we? How do we rehearse it more desert?

Lara Briden
Identify insulin resistance with proper testing, we could talk about I don’t know what you do, but I could talk about how I assessed for it and then reverse it and make that a priority. Yeah.

Dr. Mindy
Yeah. Talk about how you test because I’ve had, I don’t know if you know, Ben bickman. He’s a PhD researcher out of Utah, and his specialty is insulin resistance. And when I asked him about hemoglobin a one c, what did you think of that? He’s like, I don’t think that’s a good measurement of what your insulin Yeah, so you agree. So talk about what how would one like listening to this podcast? Is there blood work that they could go and have done? Can they go look at the blood work, and interpret it Yeah.

Lara Briden
So so what I do, I have to say that Well, I set the gold standard from a clinical perspective, that is a glue an oral glucose tolerance test with insulin, which is also called a glucose insulin response test. It goes by different names of different countries. But basically it’s a test where you take a faster take a fasting sample, blood sample of where they’re measuring both glucose and insulin, this is the key part and many do a glucose challenge drink. And then at the one and two hour marks, you’re measuring both glucose and insulin hormone insulin. So that’s fairly sensitive, I sometimes try to fudge it by just doing a fasting insulin like I think with someone with severe insulin resistance, fasting insulin will be elevated and then that’s, you know that

Dr. Mindy
what and that we would see that either in fasting insulin or we’d see it in hemoglobin a one C. Is that kind of man, I

Lara Briden
don’t know. I think you can have pretty strong insulin resistance and still fairly normal. Yeah. hyperinsulinemia, right. So it depends, at some point. In the progression glucose is going to go high as well. And there’s the whole issue of glucose control, but I guess I still find value in testing insulin, the other just for anyone listening like you could probably already use your existing bloodwork. So that’s what I’m thinking. Yeah. So we’ll Clue Number one is weight gain around the waist so that Apple shaped obesity is weight gain is pretty classic. Yep. So are things like skin tags are pretty and they actually form because insulin hyperlinks, you know, insulin is high insulin is a growth hormone. So you start getting growth like skin tags and fibroids and, you know, things like that. So, um, also triglycerides are typically high with insulin resistance, yeah. And Al T the liver enzyme al T, especially if the other liver enzymes are not high. So this is fatty liver, basically, fatty liver is downstream. From insulin resistance it can be can be because of other things, too, but it’s both sort of fatty liver is both caused by insulin resistance and causes insulin resistance. It’s part of the

Dr. Mindy
part of the process. Yeah, yeah. Okay, so what let’s help, let’s address the woman who’s going through this process. She’s listening to this. She’s like, Okay, I gotta get insulin resistance under control. But when the waves of depression and anxiety hit, we know the brain is trying to recalibrate itself. We shouldn’t be drinking alcohol. What What are, what are other channels that we have? Like, where does cannabis fit in? Where does THC fit in? Whereas Sammy, like, what can we do to help women as their brain is recalibrating, knowing that they need to make sure that they’re handling insulin resistance?

Lara Briden
For sure. So I have in my book, I call it the basic action plan for brain rewiring our brain which some patients so pretty much I always start with magnesium and Tory, we have these beautiful magnesium touring powders. In Australia, New Zealand, I haven’t really been able to find something quite equivalent in North America. But those two nutrients plus accessory B vitamins and zinc and can really support the mitochondria support the hippocampus and the brain, you know, support GABA receptors. So let’s talk about progesterone.

Dr. Mindy
Because

Lara Briden
we’ve talked a lot about estrogen. Yeah, actually, progesterone. And the reason I’m segwaying to this is because of the brain. So progesterone is the hormone we make after ovulation. And with pregnancy, it’s quite a special hormone that is not that easy to make. And we don’t make that much of it normally, but what we do make is quite precious. And it acts on GABA receptors in the brain. So progesterone, arguably and is quite a few papers about this has a regulating effect, a calming effect on the brain, and helps to regulate the HPA axis the hypothalamic pituitary adrenal axis and so, losing progesterone, even in the early phases of perimenopause, that’s where the migraines anxiety, sleep disturbance typically comes from so with my basic action plan, it’s kind of got multiple problems. The first is just go in and support the GABA receptors just give them what they need, you know, magnesium and taurine and glycine. I do talk about CBD oil for perimenopausal sleep there’s at least one study on that that could be awesome straight CBD or mixed with THC for sleep. And then all the other things that you can do for brain health. So getting outside supporting circadian rhythm, eating protein in the morning and giving your brain enough amino acids and breathing exercises and I’m a big yoga fan yoga is one example of kind of movement synchronize with breathing that helps to stimulate the vagus nerve. We can we can harness the vagus nerve to have a calming effect on the brain, we can cut alcohol, especially like it’s much, much easier to cut alcohol if you are on magnesium and taurine, and some CBD oil and some Anglia, lytic, herbal medicines to help reduce stress, regular movement. So those are all those are the basic. Yeah,

Dr. Mindy
so what I what I yeah, what I hear I want, I’m hoping people caught this. Yeah, I really feel like the way our healthcare system has trained us is there’s one pill for one symptom. And my own menopausal journey has taught me that is not the case. And that you need an arsenal of things to work on and know when to pull these tools out. But what you’re even elevating that to the place of like, if you supplement with these with these key nutrients that will support GABA receptors. And yeah, and keep an eye we can also chat about how do we keep progesterone at its best? Yes, yes. Then you’re going to not need to turn to the alcohol as much because you’re dealing you’re you’re working in alignment with what your body needs as it goes through this recalibration, which I love.

Lara Briden
So yeah, yeah, keep going. Yeah, no. So

Dr. Mindy
project. So what can we do? So we open up we love all those nutrients. Is there a way to maximize progesterone production as it’s plummeting through menopause?

Lara Briden
To a point? I mean, eventually, no. Eventually, it’s gone. Like, you know, the way I talk about it, I have a chapter in my book called cycle while you can like as long as you can still ovulate, do it, because that’s how you make progesterone. So that usually requires removing an obstacle to ovulation. That’s the way I think about it, which I’ll point out. contraceptive drugs are a major obstacle ovulation and there’s no progesterone in any form of hormonal birth control. Then, you know, the next kind of obstacle to ovulation would be a fire, right like thyroid disease. So if you have thyroid disease, then address that and that will enable you to ovulate and make more progesterone if you have again insulin resistance or like a PCOS type state, then correct that and you can regain some years of ovulation and just drone for some women at some point. It can be helpful to take progesterone so I have personally taken progesterone so I’m happy to disclose that you know, I certainly let my patients do not everyone. But it can be for sleep in particular because progesterone capsules and we’re talking now body identical just thrown in the US it’s eat most easily obtained as prometrium. It is for the well. It’s usually tranquilizing and sleep promoting. There’s the about one and 20 women have kind of a different reaction to it, which we can go into early for another interview, but it’s most of the time it’s yeah, it’s quite calming. And so a lot of my in my book, a lot of the writing I’ve done about potentially taking progesterone comes from Professor Geralyn Pryor had you know, have you heard of her? Do you know her she’s at University of British Columbia. She’s got a an organization called the Center for menstruation and ovulation research. I’m actually on their scientific advisory board. So she’s a clinician, an endocrinologist and a scientist and she’s done dozens of studies over the years on progesterone. She’s a big fan of it, you know, for those women who need something support through the perimenopause transition, and she totally acknowledges that not everyone does. But she is a big advocate for progesterone alone. So progesterone without estrogen and real progesterone and using it for the brain to support the brain to promote sleep, but also potentially lightens period lightens periods quite dramatically, which is another thing that could be going on with with perimenopause. So progesterone is sometimes part but one of my recommendations for my patients if if I can see they need something because of the sleep because of the migraines. Yeah, so progesterone, GABA is a big part of the brain recalibration. Okay. Take something else into it.

Dr. Mindy
Yeah, yeah. So are there like one thing that I’ve discussed is that there if you look at certain foods that help with progesterone production, what I find is so interesting, is they’re not keto foods. If you like dive into food sources, you’re looking at squashes and potatoes, and there’s some evidence around citrus fruits that can actually help with production of progesterone. Do you feel like that’s, that’s accurate?

Lara Briden
Yeah, I don’t think there’s any foods I mean, we of course we all of us have a baseline kind of chatter level of progesterone. It’s one of our hormones that’s kind of there everywhere but it a very small But the the levels of participation that we were used to from our reproductive years I don’t think there’s like there’s no way with food to replace that it’s either coaxing your ovaries into ovulating if they can still do it. Talk even into that.

Dr. Mindy
Don’t get down there. Come on. Yeah. Activate

Lara Briden
for a month in cycling or taking it potentially, yeah. Okay.

Dr. Mindy
And what about what about stress? So yeah, you know, we know when cortisol comes up that that can tank down tank progesterone. So Do do you think for the menopausal woman, that stress is going to be contribute to the loss of progesterone?

Lara Briden
Yes, probably not because of that pregnenolone progesterone steel thing. Okay, that’s actually that’s actually not quite what’s going on. But certainly stress can impair ovulation. So all comes back to if you’re trying to make your own progesterone, it all comes back to can you ovulate and for how long like like my for how long I mean, the duration of the luteal phase, if your listeners know what I mean, like that post ovulatory phase like when we’re young, that should be about 14 days, it starts to shorten as we get older. So we’re just making fewer days of progesterone every cycle, you can track that with basal body temperatures to try to understand if you’re ovulating,

Dr. Mindy
but the the postmenopausal woman she’s got last progesterone, so it’s just it’s just the riq what I’m hearing is it’s recalibration is where we get caught the most

Lara Briden
Yes, so the brain is trying to get used to its new, lower hormone state. And again, like circling back to the beginning of our conversation, where, you know, arguably menopause evolved is natural as normal women were even traditionally quite healthy for you know, several decades post reproduction. Brain can recalibrate to that. And if children are healthy, have healthy brains with low levels of hormones, like I think the brain is plastic it can get it can get back there. It is a change, though, it’s quite a challenging change. And one thing that does I’ll just differentiate between progesterone and estrogen is that it sounds interesting in that it has less of it’s less addictive, but estrogen is actually quite addictive. And in what way, in terms of the brain, like if the brain gets used to it will really feel you know, the dropping is an estrogen kind of, arguably more dramatically, which is actually just white. The reason I’m using this as an example is a professor prior makes this point, you take progesterone through the perimenopausal years, and then just stop at any time. Like, you know, eventually your brains like that’s fine, like I’m good without the pedestrian. But if you take if you get on this is one thing about hormone therapy. So if you get on estrogen therapy, you will and you eventually want to come off, you will have to taper it down. Because if you just went from a sort of higher dose patch to nothing you would 100% go into like hot flashes and the whole thing like so. The in that sense, estrogen is addictive. Right? I wouldn’t say just what I’m thinking of it actually on terms of brain and mood. And I really want to make sure I touch on another aspect that’s going on is high estrogen and histamine. So, in especially in the earlier phases of perimenopause, like I said earlier, estrogen can be up to spiking up to three times higher than during our 30s. And you know earlier like it’s so a lot of that’s to do with just the drop in attorney increasing FSH and, you know, stimulating the ovaries to make more estrogen and when estrogen is high, depending on the immune system or the individual that can stimulate a histamine response. So a lot of what I see is, so here’s to be in with people now. Yeah, so hi. So this would be mast cell activation. Mast cells release a lot of inflammatory compounds, actually, including Heparin, which is why histamine and muscles play a role in heavy bleeding because there’s a lot of muscles in the uterine lining, but there’s mast cells everywhere like in the gut. And then and when they release histamine. Histamine is a neurotransmitter that causes you know, fluid retention, anxiety, sleeplessness, so I’ve had a number of patients and readers give me the feedback that they actually feel like the highest surgeon high histamine is a big factor in their sleep disturbance, intermittent cause as well which is why antihistamines can work quite well for loving they do work for sleep but you know, for calming for mood for some of the dialed up premenstrual mood symptoms from migraines also have a histamine components. So that’s definitely something that’s going on for some women during these

Dr. Mindy
and what’s Is there a natural solution to histamines?

Lara Briden
Yeah, well my number one thing is well no alcohol that’s another place where alcohol is not friendly is it activates you know releases Nestle’s. No dairy so we can talk about this a little bit you know, I think I will I would estimate that amongst my patients about one in four one in three are fine with totally fine with cow’s dairy like no reaction at all. I think it’s the, the maybe more like two out of three people seem to be reacting to some extent and I think it’s a lot to do with the Awan casing and the the opiate you know about this right, the little peptide that it forms in certain people in their guts that people don’t form it at all. So so that’s why some people are just, I can imagine they some people are fine with calendaring and think what’s the big deal? Like? It was 100% fine and some people get a strong inflammatory reaction to dairy and part of that is via the mast cells, which is why I Yeah, dairy free, or at least trying a few months, cows dairy free or avoiding a one casein specifically, is one of my go twos for Petey periods and pre menstrual mood symptoms. can be quite a game changer. Yep.

Dr. Mindy
If what if I do sheep or goat? And what if I do RA or I do a two cows?

Lara Briden
Yeah, so sheep goat and a two are usually fine. So ah, so none of those have a one casein, right? Yeah, I usually with my patients. Yep. sheep or goat or even like butter is fine. Or potentially like sort of a heavier cream like a full like the more fat there is. less protein there is. So the less room there is for the A one casein to be there.

Dr. Mindy
And but and I would think with RA it doesn’t it really doesn’t matter. Because you’re still oh, I want to know, I guess Drago might be the best.

Lara Briden
Oh, yeah. So it just depends on the animal, right? Whether they’re male. And a lot of my understanding is a lot of dairy farmers at least downunder are quietly all switching to a to b. They didn’t want to kind of acknowledge the some of the research around a encasing being inflammatory, but they must see the writing on the wall. And then some point, most probably dairy will not be inflammatory. Once it’s all switched over into parts of the world. My understanding is, you know, some parts of the world. Most of them are even cows dairy is a to

Dr. Mindy
explain the difference just real briefly, because I think when I first learned a one versus a two, I was like, what, there’s different milk coming out of different cows, like, isn’t it all milk? And I think the listeners might need to know that. Right?

Lara Briden
So it’s just, it’s just the presence of, it’s only Holstein, or what we call down into Friesian cows. Only that breed which is unfortunately the main dairy breed, they make a one casein in the milk is actually quite a recent evolutionarily. It’s it’s actually only in the last, you know, several centuries that it’s sort of been bred, selected for, for whatever reason, and cows and so yeah, they just basically a to animals are just well, like said, like, you have to be a cow to make a wooden casing for starters. And then not all cows make it so you just said they did what they do is the farmers just genetically test. They can tell from a gene test if the cows make that or not.

Dr. Mindy
Yeah, yeah. And I I’d like to say here in America, we’re switching to a two but I don’t know. I am seeing it more in the in the grocery stores. So you guys, if you’re listening, go to your grocery store. A lot of a lot of people will there are a lot of options now for a two that are in there. Yeah. It would be great if everybody switched over. So yeah, I

Lara Briden
love that. Yeah, it’s just kind of simple change, and that I see quite dramatic results with patients sometimes just making that change. Yeah,

Dr. Mindy
amazing. Amazing. Well, I have about 100 and 1000 more questions for you. But I just want to respect your time. And I think we got to bring you back. Because this is you know, hormones is I can never talk about it enough. I think it’s really interesting. And you know, menopause with menopause. What I found going through the whole experience was just women aren’t talking about it. And I and I love what you said today about the need for women, postmenopausal women to the community, and how primal like that alone, I would hope would help women see that going through this process as smoothly as you can because the world needs you on the other side of it. It’s so true.

Lara Briden
It’s beautiful way to put it the world needs us. Yeah. Yeah. It’s always been like that. As long as we’ve been human. We have been very important members of the group and yeah, people are, you know that intuitively. I mean, you just look around it. You see, like women in there, you know, 50s and 60s Just getting stuff done. Like Oh, yeah. Taking care of business. Got some. Yeah, no, it’s

Dr. Mindy
they’re less. They’re like they They’re less tolerant of, you know, adverse behaviors. And don’t worry as much like I’d rather hang out with a 60 year old on most days than a 30 year old. So that’d be just saying depends on the person. So it depends

Lara Briden
on the person. Yeah,

Dr. Mindy
let him let’s I want to finish up with with five questions for you. Okay. Okay. And some of them are unique to you. Some of them are just we ask everybody in gathering some good information that the first one I’m really gathering, I’d love books. And I’m gathering a book list, like a book club of all of our guests and what their favorite books are. So if you had one to two books that you were like, every person, it doesn’t have to be women centric. Every person should read this book. What would it be? It could be one, it could be hormonal related to? You know, that’s,

Lara Briden
that’s a good question. I mean, I was I think I’m gonna mention again, I mentioned it earlier, this woman climbs I’m a huge fan of that book, if you’re at all interested in human evolution, or women or, you know, just this is the one that reframes basically makes the argument that human longevity evolved because of, um, oh, my goodness, I don’t know. In terms of other books, I read a lot of books on I read a lot of fiction. Oh, yeah. What do you read? I’m currently reading I’ll say that because I can it’s called Hamnet. It’s about Shakespeare’s children, wife and his children. So it’s sort of a start off. And I also read a lot of books on paleontology and biology. That’s because the biologist first so Oh, you know what I would say, one. I mean, this is just, this is the great thing about these rapid fire questions, you just don’t know what book that comes to mind is called the hidden life of trees. And if anyone’s interested in the natural world, it’s by Peter. I forget his last name. It’s a German forester, and it’s translated it’s it’s one of those books where I feel like if you’re interested in the natural world, this kind of a before and after reading that book, like after you’ve read it, you can never look at forests. The same he basically is kind of arguing that there’s a degree of consciousness, I guess, retreat, which is

Dr. Mindy
quite not on my list. Oh, yeah. I love that. Okay, if you could go back to your 20 year old self. And yeah, give her hormone advice. Oh, wait, what hormone advice would you give her?

Lara Briden
Yeah, to slow down. Take really just stress less. Just restless, you know? Yeah. Yeah. I mean, I guess in retrospect, I think, yeah, I had more time than I, I don’t know. I always always quite a tidy kind of really worrying about things and trying to get things done. And in the end, you know, from the perspective of 30 years later, probably a lot of that didn’t matter. I should have just kicked back,

Dr. Mindy
right? Yes. I would probably tell my 20 year old self the same thing. Yeah. So yeah, okay. In the pandemic, we’ve had a lot of, you know, bashing of 2020 and 2021. But there’s also been a lot of real gems for people and you’ve been in New Zealand, that the lockdowns have been big, but there were gifts that people had so what are some of your aha or gifts of the last year year and a half?

Lara Briden
I get no for me that again. The thing that comes to mind is just prioritizing what’s important like I guess the thing I’ve done I can I mentioned this I live in New Zealand but I traveled to Canada this year to see my parents are still alive thank goodness and you know, my immediate family and some friends here and so just prioritizing that over almost anything this year was just made me realize that that some of those relationships are very important.

Dr. Mindy
true, so true. I would I would agree. Overall family you know, I’ve always prioritized family but I feel like they took a whole nother level of of like honoring over the last year and a half from everything from my children to my parents and just yet how precious time with them is so I was

Lara Briden
yeah cuz I went from this mode of I’m sure we all were in 2019 planning all just international you know, speaking engagements I’ve got Yes, and this and ticking off all these things to like, the like this year, I said to my friends, like I’ve got a singular like one goal in 2021, which is to get to see my the people I love in Canada, like, like nothing else matters. I just let all the other some of the work, things just fall away. It’s like I can’t I have to just do this one thing. So that was that’s important. Love

Dr. Mindy
it. Okay, what if you could define health? What, how would you define it? Like, one thing that I’ve been thinking about is that we tend to think of health as like a noun like or like a destination, but I look at it more like a verb. Like it’s an action. I think if we’re all trying to get healthy Well, what does that mean? How would we define that?

Lara Briden
Well, I guess in simplest terms, that would be, you know, having the ability to do what you gives you joy to do like, and of course, that will change over time. And that sort of just like if you’ve got some people have, particularly health challenges that they may never totally overcome, but like, they’re still looking for maximizing, you know, what, what they the amount of joyful, like, you know, existence that they they can and so a lot in this, it’s good question because I’ve talked about it with my audience a little bit. Health is not a destination, if you think of it as, as perfect health. If you’re always going for perfect health, you’re never going to get there actually. Amen. It then I’ve had patients, I’m sure you’ve had the same work, actually, trying to achieve some kind of perfect health becomes their life work, which is actually really sad to see because then they’re not doing the other thing. So sometimes I say, you know, even to myself to patients, look, I think you’re good enough, like this is pretty good. Like, you’re good. And like you can go, like in my case, it’s like I’m healthy enough to go on a walking holiday or, you know, to travel to see my family and other guys, certainly I don’t. I’m not perfect, but I don’t need to be perfect. Yeah.

Dr. Mindy
So it’s like a state is what I hear. It’s like when you’re in a state of health, you the joys you want in life, whether it’s vacationing connection with people exercising, you’re able to do all that and with without discomfort without anxiety, depression, but when we look at it, like somewhere, I’m getting something I’m trying to get, or something, I’m where I’m trying to go. That’s where I think we constantly set ourselves up for failure. Is that would you agree?

Lara Briden
And if anxiety predict, yes, it’s producing too, because you’re just always worried about I could be healthier, I could be doing this thing. It becomes this lifelong self improvement project, which is yeah, not not a good place. Right. Be

Dr. Mindy
totally agree. Okay, last question. If you had one message for the world, that you could get into everybody’s brain, what would that message be?

Lara Briden
Windy, that’s hard.

Dr. Mindy
I know, you can It’s okay. You can pick one today and your message guy

Lara Briden
just say honestly, I would just say, life is short. I mean, that sounds a little pessimistic, but like, life is precious. And you are the life that we have. And that the time we get to spend with our companions. We talked about that a little bit. But also, I guess more broadly, I guess from speaking from a biologist like like, you know, life is precious, like the biodiversity the plants and animals that we were so lucky to be on the planet with, I’d like to see some of them stay around. I mean, I guess I would like to see a lot of the conservation. I mean, I think climate change is important to you like I’m just in terms of the conservation message. I’d like a lot of it to kind of shift to promoting biodiversity because that’s what’s the health of the ecosystem right is lots of different help plants and animals. Yeah.