Gut Health and Hormone Imbalance in Peri/Menopause

Sarah Milken  00:00

Hey peeps, it's me I just wanted to pop in here before this amazing episode starts and talk to you about a new offer. Okay, so I often talk about creating your midlife table. If you're new here. Let me tell you what the midlife fucking table even is. In my mind. It's a literal and metaphorical table, we create a light vibed high vibe women. These are the women we want at our midlife brunch tables. They're not the mean girls we all faced in middle school in high school. You know, those girls who sat at the cool lunch table and told us we couldn't sit with them. As I say one of the amazing aspects of midlife is that we've earned the right to pick the who the what and the where we don't have to wait for an invite to the cool lunch table, we can create our own fucking midlife brunch table. What's cool about this time in life is that we can do a friendship audit of sorts and decide who's sitting at our table and who is not. So my big announcement is that I am launching an eight week virtual midlife remix table experience. It's sort of like an eight week course but I'm not calling it a course because I'm not lecturing like school. This is going to be an immersive experience where for two hours a week for eight weeks, you're going to sit with me at my midlife brunch table and we're going to actually do what we're all craving. We're going to connect with other midlife women. We're going to talk about midlife topics that only we can and it will be an intimate experience. Everyone will know each other's names we will participate in the conversation. Let me tell you about my real life experience that was like my spiritual download as to why this midlife brunch table virtual thing even happened. Okay, you guys so all of these women showed up at my house in June for my first live event. It was magical, amazing, amazing catering, Crystal goblet sound baths, customize aroma fragrance bars, the whole thing. And we all had such an amazing day we didn't even want to leave. And the best part of the whole day every single woman told me in person and message me was the magic of the conversation at my curated midlife brunch table. So for the 480 of you that individually DM me to tell me that you couldn't come to my live event and you were waiting for a virtual one. It's fucking here. It's rad. Okay, you guys go to www the flexible neurotic.com forward slash waitlist. When you sign up, you will be the first to get the launch email and qualify to get 30% off the full price again, www the flexible neurotic.com forward slash waitlist. Okay, the episode is starting Hey, peeps, welcome to the flexible neurotic podcast. I'm your host Dr. Sarah Milken. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago, like last fucking year. I was sitting in the midlife funk wondering, was this it for me? That day, I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD wipe the menopause, sweat off my forehead, grabbed my golden shit shovel and started digging deep to all my midlife bitches. It's not just love coffee and hormones that get you through your midlife remix. It's action steps. Let's do this. Hi, good peeps. This is the next episode of The flexible neurotic Podcast. I'm Dr. Sarah Milken, the flexible neurotic today I have a guest who many midlife hotties know. This gas is a fellow midlife her she's the best selling author of cave women don't get fat, eat, drink and be gorgeous. And Her most recent book see a later Aveo later that I consumed all weekend. She is an integrative dietitian and menopause expert who has a huge thriving practice where she helps women in all aspects of menopause the good the fabulous, the bad and the Oh my fucking god. This guest who has been on Dr. Oz the today's show, and is even called Gwyneth Paltrow is menopause coach. I think I might have piqued your interest. Her name is Esther Blum her Instagram handle and she is affectionately known as gorgeous Esther. Hi gorgeous Esther. Hi gorgeous, Sarah. Thanks for having me on. I need to go. Oh, you're sure I know. I always like to write my own because I'm like that at least it's like it's like a little Sarah eyes.

Esther Blum  04:46

Do you know? Absolutely.

Sarah Milken  04:50

I'm so happy to have you here. We already talked about how we're both swatting so that's good. I have a fan blowing up basically on your back and up your ass and I have a pillow and a blanket under me. Like the sweat which is awesome. We got to get through like this sweaty midlife shed. So the intention of this episode and the reason I have you here is I want to dig deep with our golden shit shovels. I'm sure you have one. Oh, man.

Esther Blum  05:18

I've got I've got a glitter tested tool belt thing.

Sarah Milken  05:23

It's so good, isn't it and we're gonna dig through all the key components for midlife perimenopause, menopause, the whole journey of hot sweaty muffin toffee and re G.

Esther Blum  05:34

Oh, we're gonna forget that Dr. ABS situation. Oh,

Sarah Milken  05:38

oh, yeah, for sure. You kidding. I'm already on vaginal estrogen girl insertion time. And it was funny because I dropped one the other day. And I was like,

Esther Blum  05:48

Is this the three second rule? Yo, it's so labor three. That's what I did I use it. As long as you're not dropping in the toilet.

Sarah Milken  05:55

No, no, no. clean floor. And I don't really wear shoes in my bathroom. So it was like the three second rule right? Like work, because they're kind of expensive. And I was like, and there's a system to them. So I didn't want to lose one. But anyway, that is way too much information. Thank God my kids don't listen to this. And we're gonna talk about food, lifestyle moss and the two key tests that you use in your practice to assess almost everything possible, related to the midlife woman in our brains bodies, and that can help us solve the menopause puzzle, aka the clusterfuck. Okay, anyone listening is probably on the menopause spectrum between perimenopause, menopause and post menopause, or you're my fucking husband who's listening to it. Because you know that I'm going to test you on whether you listen to the episode. Or so many specialists and doctors on this topic it goes on for days. What I love about your expertise is that you are an integrative nutritionist, you specialize in this, and you have 1000s of female patients. So you're working from research, but you're also working from anecdotal information. And I feel like everyone wants to research. Yes, we do. But there's also the little nuances that women bring to your office. And they're like Esther, oh, my God, this didn't work, or this worked. Or, I felt really weird when this happened. And I think that you have this amazing kind of corner on the market where you get to kind of gather all of this anecdotal information.

Esther Blum  07:28

Yeah, I'm very blessed. The women I work with, I'm so honored and privileged to witness their journey, and that they put their trust in my hands to guide them through and be like, Listen, this is we're gonna get through this, there is hope. Everything is figured out well, but first, we're going to fix a, b, and c, and we're fix the big rocks like all then the weight loss falls into place, then the sleep, the happy mood, all the things So now

Sarah Milken  07:55

do you feel like because we're so used to instant gratification right now that you have to sort of explain to women like, Hey, guys, this is not like, I'm going to give you this pill. And tomorrow, you're going to feel like a kick ass woman like this is going to be a little bit of journey, a little bit of trial and error. And it's a project.

Esther Blum  08:16

Yeah, I mean, a lot of my clients, I would say, are not expecting miracles overnight. I joke that I'm a dietitian, not a magician. But, but the thing is, when you're not sleeping, and when you're really irritable. And when you have brain fog and vaginal dryness, painful sex, like, of course, you want things to happen sooner rather than later, which is very normal. It's really uncomfortable.

Sarah Milken  08:43

All of us know all of it. Believe me last night, I couldn't sleep. I was like, Am I hot, I'm freezing. I'm taking my sweater off. I'm putting it back on. And my husband's looking at me like what the fuck is going on with her, you know, no mic, and I took my magnesium and I still can't sleep. But I want to talk about the two tests that you have all of your patients do because I have not done these tests. And I feel like I've done a lot of things. And I've always been sort of on the fence about them. Until I read your book and started doing research on you. I was like, Am I like missing the boat here? Because you know, I've heard mixed things on both sides. But I want to hear it from you because it sounds like they're actually tools that are giving you so much information about the woman who asked to see you. Oh, well I was gonna say to I don't want to skip over blood tests. I have three tests that I do in practice. I do bloodwork a Dutch test and a GI map. So the blood panel, you know, what's such an egregious oversight in medical practices is just a simple insulin, glucose and a one C panel. Most women I see have an insulin of nine on average, where insulin should really be five or lower.

Esther Blum  10:00

Are your glucose should not be in the 90s 90s is not normal, normal is not optimal. The standard for normal in this country is Homer Simpson that is like, Hey, you're not that so you're fine, exactly not fine. So your blood sugar should not be in the 90s, it should be in the 80s. And your agency should also be below 5.5, ideally. So I look at that and do comprehensive thyroid panels. And I have this all in chapter two in my book, see later, Avi, later, comprehensive thyroid panel, I check auto immune titers, I checked vitamin D, magnesium and zinc. And I looked at a lot of cardiac inflammatory markers, because as estrogen declines, your risk for cardiovascular disease goes up to the same as that of a man. So if you were previously hourglass shape, and obviously your apple shaped, and you have all this visceral fat close to your heart, and your insulin resistant, maybe your blood pressure is going up, then you are going to increase your risk for cardiovascular disease. So I rule those out first. Yeah,

Sarah Milken  10:59

I've done all of those, including like the calcium scores, and all of that. And the only thing I haven't done are the two other tests that you talk about.

Esther Blum  11:10

Okay, so let's get to the meat potatoes. So the first is a Dutch test, it's a dried urine test for comprehensive hormones. Both of these tests can be done in the privacy of your home, which is great. If you're still cycling, they should be done days 19 to 21 of your cycle. And if you don't know, if you're cycling, and just cycled all over the place, you can do an ovulation predictor kit. And if you get a positive ovulation, you test five to seven days after that. And if you don't get an ovulation after 60 days, it's let it all flawed.

Sarah Milken  11:42

If you're like me, and you take birth control pills seven days a week.

Esther Blum  11:46

Yeah, that's a different story. Because your hormones are so suppressed and chemically controlled. You know, you're you could probably take the test in a time because you're

Sarah Milken  11:55

not if I if I take, like, is it the kind of thing where I would come off birth control pills for two weeks or something and then take the test or it doesn't really matter?

Esther Blum  12:06

You'd have to be off at least three months for your hormones to come off.

Sarah Milken  12:10

You wouldn't want to live with me if I came off. Yeah.

Esther Blum  12:12

I don't recommend like doing something like coming off birth control at this point in life without a safety net in place. Yeah. So you take the test. And what does it look at? It looks at how well a your production of hormones and yes, your progesterone is going to be suppressed. And because that's how the pill works. You suppress ovulation by suppressing progesterone. And your estrogen could also be suppressed or it could just be low. So it's not a true value. But at least we know, we can get a picture of where you're at hormonally, we'd look at how hormones move through your liver. So it tells me about your phase one and phase two detoxification in the liver. It also looks at your cortisol production. And so I can get a real window into your adrenal function, your sleep, your energy, your brain fog, your thyroid function, that tells me a lot. And then I look at the neurotransmitters in your brain. Also, because I see a lot of women on antidepressants, and it's just like, it's not really doing the job. And a lot of women come to me like, Well, I've been on the low dose of Prozac for so many years. And I don't think it's doing anything and they actually come off, we work with their doctor and help them wean off because they don't need it anymore. And we also look at melatonin, and we look at your methylation and see just how you're detoxing hormones in general. So this is important because number one, I fear poor methylator

Sarah Milken  13:44

which I which I am yeah,

Esther Blum  13:48

and your estrogen dominant. And yes, you can be estrogen dominant, even in menopause ladies where your liver just doesn't clear out certain forms of estrogens, then if you go on hormones, you're actually going to feel worse, you'll have a lot of breast tenderness. You can be really sad, you can be more irritable, you can be puffy have some weight gain. So you want to make sure that you're supporting methylation first, and this goes back to the blood test it too if a woman has a fatty liver and I do check liver function tests. A woman has a fatty liver and she's a poor methylator. We do not do hormones until or even consider hormones until we clean up the liver and we clean up the insulin and we clean up detoxification pathways and then we go on hormones and how do you do those three things? Hmm. So really working on diet controlling insulin for some women, a hardcore plant based diet is needed for other women. It's more like a carnivore diet to clean out excess insulin and heal a fatty liver that way. So it really really depends on the individual. But both methods work beautifully and also supplements putting you on methylating nutrients or nutrients that support methylation and herbs to clean up a fatty liver really make a difference there too.

Sarah Milken  15:10

Would you end up with like 74 different things to take? Like, do you feel totally overwhelmed?

Esther Blum  15:16

Not 74

Sarah Milken  15:18

you're like 26

Esther Blum  15:22

I try to take into account the longevity, how much money and time somebody has gives them popping pills before I prescribe. But if I tell people listen to short term, give us three months give it you know, most people are like, that's fine. Because it they come to me to get better. Yeah, that's and I'm very transparent, upfront, like, this is what the healing path looks like, you've got to invest some time, gotta invest some finances, and you've got to be committed set alarms on your phone, take your supplements

Sarah Milken  15:50

go through that. I'm the queen of like taking supplements, like religiously for three months. And then they stare at me for two weeks. And then I'm like, Okay, I gotta do this again. You know, my husband's like, you keep buying shit. Like, are you ever gonna stop? But I don't know. I think it also just like, kind of depends on your mood. But I have to definitely recommit to it sometimes.

Esther Blum  16:12

Yeah, and you know, I packed like, once a week, I just packed my supplement cases, I have an am 2pm case. Yeah. And, you know, think about this way. Like, if you're, if you're really suffering, it's just, it's just like medicine and like, just you would take an antibiotic, religiously? Or if you have blood pressure medicine, you would take it, take the supplements, they are not essential. They really are. Totally. Now, do you find that with the Dutch test? Well, first of all men can do it too. Right? Absolutely. Because I read that. And I was like, wow, that's kind of cool. Yes. And obviously they don't need to wait till or if you're men and menopausal women do it. You could take the cycle. The test at a time you are you're obviously not cycling. But I see a lot of men, they are having issues detoxing estrogen, or they have an excess of estrogen and and you don't need to completely eliminate estrogen for men. You just need to get the ratios of estrogen, testosterone and a healthy range. Yeah, because it's interesting

Sarah Milken  17:12

because my husband went and had his regular annual exam. And you know, they test testosterone and it said, like, nor you know, the famous like, normal range. And then I was talking to my brother about it. And he was like, Sarah, my doctors so much more specific that Matt that is not, you know, like, Yeah, might be normal range for someone but not everyone. And a lot of men start feeling like kind of tired and lethargic and all the things and it's because of that.

Esther Blum  17:42

Yeah, Sandra posits, yeah, estrogen. Yes. And also men don't realize, you know, wheat products like beer are incredibly estrogenic. The products that men and women are using should be clean. They should be, you know, new ingredients. You can't recognize naturally based ingredients that are not endocrine disruptors. We are seeing the lowest fertility rates among men and women that we have seen in a long like teenage boys have the testosterone of what a 60 year old man should look like. So you don't want your phone in your pocket near your reproductive organs. You know, you're storing food in glass instead of plastic, a lot less wheat and really not using endocrine disruptor products and they're great natural deodorant for men and women is beauty counter. I mean, there's so many good natural products for women, there's like no reason why we can't what about

Sarah Milken  18:42

what about men and women who are using like minoxidil or in some cases finasteride does not kind of go does that go into your

Esther Blum  18:52

anything you put on your skin does go into your bloodstream? So yes, I don't know. I haven't seen the research on minoxidil and and it couldn't.

Sarah Milken  19:00

I don't know if that one is or if it's more like the finasteride and dutasteride because they're like blockers.

Esther Blum  19:07

Yes. I mean, if you can, if you can afford it and have the time to do PRP, that's platelet rich plasma injections.

Sarah Milken  19:14

I've done that. And how was it for you? You know, I think that it's hard for me to say because you're so put, you can't just do it one and done. No. And so I think I like did it once or twice, but I didn't stick with it because you're like, oh, it's kind of expensive. It's kind of annoying, but I'm on this new kick right now where I'm like, Okay, I'm 48 years old, almost 49 I've got to like do certain things and like stick with them even though they seem like the biggest pains in the ass and they're expensive.

Esther Blum  19:47

Yes, you just have to schedule them in totally every woman scheduled in Botox. So as you guys scheduled the PRP by now

Sarah Milken  19:54

I'm like, Oh yeah, let me have my scalp, you know, stabbed with a needle 10,000 times Let me and my thing is I'm like, oh my god, I have to schedule it around my blow dry. Yeah, because it talks of your hair because they put all these like weird liquids and it's very high level Ester very okay,

Esther Blum  20:13

I ventured there yet.

Sarah Milken  20:17

Yeah, exactly. You look like you definitely have a full full head of hair gala hair growing right now. Wow. Now for the Dutch test. So it's basically determining also your adrenals, your hormones and your gut health. Right.

Esther Blum  20:32

So there is one marker on the Dutch test called indica can which really can give you a window into your gut inflammation, but it's not a detailed gut test. The detailed gut test is the GI map, which is a stool test again, you can also do it at home. And it looks at the integrity and the composition of your microbiome. So it looks at whether you have pathogens, parasites, viruses, it looks at the number of commensal bacteria you have like it literally counts the cell numbers.

Sarah Milken  21:04

So do you have like a poop party and you just like put little poop pellets in little boxes and send it back? Like how does that work? Who

Esther Blum  21:12

know you take a dump right in a french fry tray. And there is like a little screw top jar with oh my god and you have to scoop out cross sections of your stool from different surface they want like as much surface area as you can get. If you're having diarrhea, like wait till you have a solid stool because you gotta collect something solid. And you ship it off. Ship Your ship, as I like to say

Sarah Milken  21:37

no, it can't hit the water. No, and you can't like dig it out of the water.

Esther Blum  21:41

No. And it's like a big steaming pile of steak. Ah, ah, yeah, but you gotta do it. I mean, listen, I have celebrities like A listers. They do it too. They just got celebrities and

Sarah Milken  21:54

I did a colonoscopy. I get it.

Esther Blum  21:57

Yeah, you got it. So no shame in it, you know, it's just listen, it's gonna help you right? And so it looks at your commensals. It also looks at all the pro inflammatory bacteria. It looks at Muthi antigens, it looks at histamine producing bacteria or LPS producing, which is Lippo polysaccharide. These are bacteria that have biofilms around them. It checks for h pylori, and it also checks your sensitivity to gluten. It checks whether you're detoxing estrogen in the gut, whether you have a leaky gut, whether you have pancreatic dysfunction or a hydrochloric acid deficiency. So it's super comprehensive. So let's say here's how I put that all together, right? Let's say a woman comes to me and she's having real estrogen dominance symptoms, right? Brass tears, irritability, puffiness, crying, you know, really unhappy, and can't lose weight, and bloated and we do her testing and come to find out hey, you know what, she's only pooping like every other day, it's me. Really hard to poop, right? So what happens is you're not actually detoxing your hormones like pooping every day is taken out the trash every day, we say you wouldn't leave a smelly bag of trash in the middle of your living room or the middle of your front hallway to take it out every day. So you do have to poop every day. That's another big important piece of you know, healthy hormone balance and moving your hormones through and out of your body. So we'll look for the root cause. Well, why aren't you pooping everyday for some women, they have extra Candida. For other women. They're low hydrochloric acid because they have H Pylori and h pylori loves to turn off the production of stomach acid. So it can set you up as a as an alkaline host. So once we clear out the offending bacteria once we weed and then we received with probiotics, some some women also aren't pooping everyday because their commensal bacteria are the foundational bacteria of the microbiome are just so depleted. Right? Maybe that antibiotics years ago, or their stress is phenomenally high. So in that case, we do a lot of repeating but also stress management, adding in digestive enzymes, you know, and hormones, too. I had a client just last week, who came to me we were working on her constipation. We were working with food and we were working with nutrients. But when she added in her hormone replacement therapy, because by the way, hormones are motility agents. So when we added in the estrogen in particular, she's like, I have poops I'm proud of every single morning. Wow. And I was like, damn, I love these results.

Sarah Milken  24:49

And what's interesting is I also read in your book that you felt like you should be the optimal thing is to sort of be pooping around this same time every day, and kind of like creating a schedule. And I'm like, That's so weird, like, but what's funny about it is my husband does and I do it. Yeah. Why is that? Is it because he's like, he's not stressed?

Esther Blum  25:13

Yeah, they know they just gotta sit and wait for it. And ladies, you know, we're all like, Shaq. I gotta get the kid. I gotta get breakfast on tape. I got it. You know, we end up being the providers. I don't care what anyone says working women are still doing a huge share of the work more than the share. They're doing probably 7030 split. And so you know, we don't have time.

Sarah Milken  25:37

Wow. No. Do you think that most people poop before they work out? And before they eat? Or do you think workouts and food kind of push the poop?

Esther Blum  25:47

I mean, ideally, you just wake up and have a bowel movement. Like that's what I do. I just wake up IP I Pope

Sarah Milken  25:55

and then I always like to.

Esther Blum  25:57

Yeah, I'll sit. I'll read some news articles.

Sarah Milken  26:01

Oh, my god. I can't.

Esther Blum  26:05

You can and you will, you will totally. I get emails or DMS ladies all the time on Instagram. I read your book, and I'm hoping every day I could like copy and paste the one I got. Oh my

Sarah Milken  26:16

god.

Esther Blum  26:18

Yes, Queen. Yes.

Sarah Milken  26:20

So what about the squatty potty,

Esther Blum  26:22

that's great too, especially if you have a torturous colon or, you know, anatomically like it relaxes the pelvic floor. So here's another really important thing and I was peeing like five to seven times a night. Oh my god, perimenopause. And I was like, what, how, and my pelvic floor was so tight, most women's are too weak. Mine was so tight. Either way, if you don't relax the pelvic floor, or if your pelvic floor doesn't have the muscles to physically push stool through your colon, you're gonna have a harder time pooping. So make sure and I call her my vision, my pelvic floor therapist. So if your if your pelvic floor is having issues, a Squatty Potty can really help but also like taking deep breaths. Don't force anything out that actually weakens your pelvic floor if you have a hard time when you're peeing, to get all the urine out fully empty your bladder because your pelvic floor is too tight. Lean forward or like, do a little round situation. Do it? Yeah. Wait,

Sarah Milken  27:24

let's explain to people what the Squatty Potty even is because people are probably listening and going What is she talking about? Yeah,

Esther Blum  27:31

it's a step stool that's you shaped and fits around the base of the toilet so it prompts your feet up. This mimics squatting like, what have you done when you go camping? And there's no like Porta Potty. You squat on the ground because that puts your pelvic floor in perfect alignment for poo and pee to come out.

Sarah Milken  27:50

Do you ever get addicted to the Squatty Potty where like you're using the Squatty Potty at home, and then you like go to a hotel and you're like, Fuck, I don't have the Squatty Potty.

Esther Blum  27:59

So if that's you, I don't personally need it. But sometimes when I'm in a hotel, I'll like put my feet on tiptoe. Or you can empty you can take the trash can and put it upside down. And just

Sarah Milken  28:13

so you're basically a poop specialist as well.

Esther Blum  28:16

That's a poop queen. It's

Sarah Milken  28:17

unbelievable. My kids are like, Why are you always talking about poop? I'm like,

Esther Blum  28:24

I know. Yeah, it's like one of the big biomarkers of health is pooping every day.

Sarah Milken  28:31

I know I floss twice a day, but for some reason I can't I can't poop every day. Well,

Esther Blum  28:37

we're gonna get to the root of that lady because then you're gonna be like staying in it from the rooftops

Sarah Milken  28:42

Oh my god. Okay, let's talk about cortisol for a second. I had my cortisol checked, I get it checked every year or twice a year. I think last year the year before it was literally four times my husband's Okay, and when the time of day was that it was the morning and the guy was like, what the doctor was like, What the fuck is happening? Life and I'm like, Ah, and then he went on to give me this like saliva test because he wanted to test it. But you know what it was so annoying is because I floss. I guess there was like literally like one trace of blood in it. So it became like invalid say I said he gave me like a six gallon thing to pee in. And I was like, fuck that. I don't have time for that. Right? Yeah,

Esther Blum  29:29

yeah, exactly sloshing around with a big. Oh, yeah. It's

Sarah Milken  29:32

like this giant orange container.

Esther Blum  29:34

I'm like, Yeah, sure us. Yeah. Gross. So what about so are you drinking coffee in the morning? Because caffeine can do that. I

Sarah Milken  29:42

just drink one. I just drink one coffee in the morning. And that's the only caffeine I have in the day.

Esther Blum  29:47

Yeah. Is it like an eight ounce or like a 16 ounce?

Sarah Milken  29:51

Oh, no. eight ounce for sure. I make it home.

Esther Blum  29:53

Yeah, that couldn't be doing it sometimes, but you're overnight whereas that wasn't high.

Sarah Milken  29:59

That I don't No, because it's just one shot in time. And that's what I was gonna ask you is because the blood test is like one moment in time, that Dutch test is giving it to you. What are you having? laughs Yes, you're doing it four times in a day, right?

Esther Blum  30:16

Yeah, even five if up overnight, you have a fifth sample. So you get a full cortisol curve. That's why blood and saliva saliva can be good if you take multiple samples throughout the day. But if you're only taking one cortisol sample, you're missing, you know, all the other data points throughout the day.

Sarah Milken  30:33

And I also heard this weird thing that if you're on birth control pills, it can fuck with your cortisol numbers.

Esther Blum  30:41

Possibly, because when your hormones are suppressed, you can have a very low as dragging cortisol curve.

Sarah Milken  30:50

Yes. Interesting. Now with birth control pills, like you some people say, well, birth control pills is like six times the estrogen of HRT. So does that mean that when I go from birth control pills to HRT, I'm going to basically be lowering my estrogen.

Esther Blum  31:12

If you're with a good doctor, that doctor should ensure that you are on the highest dose of HRT transitioning off the pill. And even then, you may experience and it's about a two week transition for most but you may experience hot flashes or challenges but I think when you add in so bioidentical hormones are typically not solo artists, they're usually a symphony, right? So you want to give a balance of progesterone, estrogen and testosterone. If you need it. That's again, that's

Sarah Milken  31:49

why we test don't get my testosterone was like zero, but I still don't take it.

Esther Blum  31:55

Yeah, so that can be really, really beneficial in all three work together to support cognitive function and all sorts of cognitive function, right? memory processing, verbal language, cognitive function, you know, all of those pieces together. Testosterone really is such a missing piece for women and the most egregious thing is it's not FDA approved. You have to have a doctor unless a doctor deems you you know a candidate which are all candidates. Yeah, we're all boiler alert. Rockin it's so when you go off the pill, if when, you know, a lot of women add in, you can add an HRT first I've allowed women in practice who are on the pill or an IUD and their doctor still adds in bioidentical progesterone because pill and the IUD have synthetic progestins. Right. They're not bio identical.

Sarah Milken  32:53

Yeah, I was reading all about that in your book. I'm like, I need the progesterone tro key that I'm talking about.

Esther Blum  32:59

Well, the trophy is great for anxiety. But if you're really having trouble or it's great if you're not a good detox or hormones, because it bypasses the gut and liver, if you're really struggling with sleep, certainly prometrium which is bioidentical progesterone doesn't have to be compound, you can get that at a pharmacy. I get mine for three bucks a bottle could help

Sarah Milken  33:20

us with the bio identical thing because I feel like there's a lot of confusion like I think, yeah, I don't even understand it. Like in my mind, sometimes bio identical means that you're going to a compounding pharmacy. Like what's the story?

Esther Blum  33:35

Not necessarily you can get bioidentical hormones at a pharmacy. So they may not be on your present bio identical like so. Okay, first of all, bio identical hormones are biologically or physiologically compatible with your body. Your body cannot distinguish the difference between bioidentical hormones and its own production, right, an external source versus its own production. The studies that have been poorly interpreted with their data and scare the crap out of people, including doctors who are terrified to prescribe hormones. Were done with synthetic estrogens. Right.

Sarah Milken  34:08

That's like the horse the horse here Yeah,

Esther Blum  34:12

equine, equine, progesterone, equine estrogen, but are conjugated as equine estrogens. But they also were not given any opposing progesterone. Remember what I said earlier, progesterone. Hormones are a symphony. They're not so low itis. So it's a very poorly designed study. And the results were not statistically significant. It was like the risk went up from four out of every 10,000 women to five out of 10,000 women to developing a stroke. And that was only in the first year of administration. And it was just it was so silly. So decades of women were yanked off hormones, ridiculous, bioidentical hormones you can get it from a regular pharmacy in the form of a patch. If you want a cream a compounded And then that has to be gotten from a compounding pharmacy. You can get a patch. In the regular pharmacy you can also get prometrium in the pharmacy, which is bioidentical progesterone. If you want testosterone, you do still have to go to a compounding pharmacy because what is available at a regular pharmacy for men is not physiologically compatible with our bodies. The best way to do it for women is a cream may not be a gel the way men haven't gel as questioned about efficacy and absorption anyway, so And men are meant to apply it to the testes, women, we can apply it you know, the inside of the elbow or behind the knees where the skin is thin.

Sarah Milken  35:45

But don't some people do clitoral application?

Esther Blum  35:48

Yes. So then there's also I'm glad you asked. There's vaginal estrogen. You can also get from your pharmacy. It's all of these are FDA approved. And yes, you should put it internally twice a week. And on the urethra slash clitoris and the vulva. Also be that

Sarah Milken  36:07

you're seeing vaginal estrogen, but not testosterone. I thought there was

Esther Blum  36:11

an abuse of testosterone to Oh, you can i Oh yeah, I get Well, mine's compounded but I use vaginal estrogen and testosterone. Oh, and for me, yeah, because I was getting some UTIs and I was having a lot of discomfort, a lot of burning. My GYN told me I had a depressed vagina. So I was like, alright, well, we need to make my girl happy. So you know, I really am very careful, make sure I load up on cream because otherwise sex is painful. But once I use it regularly, it's like

Sarah Milken  36:44

braid. Now I use the vaginal insert for the estrogen. In sort of my reading and researching this. There are people who are saying that I could be doing that and a cream on the outside because the inner thing get to the outer parts.

Esther Blum  37:02

Correct? Correct. And you know, there was the Framingham nurses study looked at women who use vaginal estrogen for 18 years. It stays localized. It's a microdose. It does not raise your blood levels of circulating estrogen. And how long should you use it until you're dead? Right? Never stop using vaginal estrogen. If you don't want to atrophy if you don't want to tear if you want sex to be joyful. If you don't want a GYN exam to hurt, always, always use it and also it helps prevent the collapsing of your pelvic floor it prevents UTIs urethra atrophy and it prevents clitoral atrophy. It's like I don't know why this is so complicated to get the medical curriculums to change this. Like there's so much evidence I have 20 pages of studies in the back of my book I have about I just shy of 100 studies in the back of my book and I'm a dietitian. Why aren't doctors looking at these? I found these days I had some doctors who generously shared them with me Dr. Doreen saltiel I salute you. But you know, a lot of doctors just aren't looking at the research. They're just stuck to the stupid medical school curriculum, which is by the way tied to Big Pharma Did you know your doctor can get money when they prescribe birth control pills from drug companies, but there is not allow me to be made on bioidentical hormones. And so there we are that

Sarah Milken  38:33

Welcome to women's health care's but I was just gonna say like, I think with you, you provide the nuance of Yeah, how much like in combination with what other things like other doctors are broad strokes,

Esther Blum  38:48

law doctors are broad strokes. But to be clear, I

Sarah Milken  38:50

don't I know you don't prescribe, but you work with the doctor as

Esther Blum  38:55

doctors. Yes. And it's funny, I was speaking to a doctor who, you know, I was like, at your patients not on the right dose of bias cream, she really needs to be on this, you know, this formulation. And the doctor gets me to death, and then never changed it. And I sent my client to a new doctor.

Sarah Milken  39:15

Oh, you have to

Esther Blum  39:17

like I was like, thank you. I feel so much better. Wow. All right. I'm like, I know why was it so hard?

Sarah Milken  39:23

I don't know. And that's the other thing I was going to ask you is, most traditional MDS are not using the Dutch test and the GI map. So it's is it basically functional medicine doctors and people like you who are doing it?

Esther Blum  39:42

Yes. And if you look at very traditional and even some functional MDs, but mostly traditional, absolutely slam the tests I'm doing there's no evidence and it's like, you can look in PubMed and find a study on the Dutch where they were like this is actually just as effective as zero I'm testing. So there is validity to the test, I'm not out to make money, I give it to my people at my practitioner cause I have zero markup on the test. I'm just here to help you and doctors will dismiss but I'm like, let's see the results, are you getting results with your people? Because you're not fixing the adrenals, you're not fixing their detox pathways. So even if you put them on hormones, and they still feel crummy, at least now you know why? Or you can prevent them from feeling crummy on hormones.

Sarah Milken  40:32

Right? And the,

Esther Blum  40:34

I think part of the tricky part is that it's not covered by insurance. That's right. And so that is the part where I'm trying to honestly figure out how to reconcile how do I make this more affordable for underprivileged people. And so you know, at the end of the day, and I did a great IG live with Suzanne Penske on this, and she's one of the doctors I refer most people to, and she was like, she does the Dutch in her practice, but she was like, you don't have to test you can go by symptoms, too. And you can go by the missed periods, and just start to bring in hormones and see how a woman feels. So let's say the testing is out of reach. And your functional medicine doctor is too expensive, then you can go to a traditional doctor, and the traditional doctor is probably going to say, don't do hormones, no, you don't need them. And this is the part where you can advocate and say, hey, you know, what, what have you got some loose? Give me three months on this. I've read through these, even if you haven't, I've read these research studies. I know the benefits. I have a history of heart disease and osteoporosis, and more, I just want to optimize my bones and my brain. And I want to offset the risk of heart disease. What have you got to lose? I won't sue you. You could say I'll sign a waiver. It says I won't sue you if something goes wrong, you know? And then like, at that point,

Sarah Milken  41:58

how can they say now? Yeah, and if they do, you should be somewhere else?

Esther Blum  42:01

If they do, you should be somewhere else? And ideally, yes, you get your blood work tested and rechecked on your hormones. And how much

Sarah Milken  42:07

is the Dutch has cost? It's yeah,

Esther Blum  42:10

maybe a little less than 400. And the GI map, too. So I mean, I think when I ran the two tests, it ends up being shy of 700. But

Sarah Milken  42:20

like, if you think about the 700, and yes, it's a big number. But then you think about all the time, the stress, all the sort of over the counter things, the extra therapy sessions, you know, because you're losing your fog bear isolate. Yeah. Yeah, if you can kind of, yeah, if you can kind of justify it and make it work kind of on the front end, you're probably buying yourself more money and like losing less money.

Esther Blum  42:49

Well, and you think about how many billions of dollars are lost in the workplace, from women not being able to function at their jobs, or just sweating through their work clothes out for sure I'm changing in the bathroom or having horrible brain fog or not sleeping and not being productive. Like it is such an investment in yourself and getting your life back.

Sarah Milken  43:11

I was talking to this woman the other day, and she's an executive at a huge company. And she was like, Sarah, I do these presentations for like decades in my sleep. And like one day I stood up and I was going to give the presentation. I was like, what, what the fuck? Like, she's like, I couldn't even string sentences together. Yeah, it's real.

Esther Blum  43:33

It's horrible. It's really real. Yeah,

Sarah Milken  43:35

it's so real. And it's crazy. So it's crazy. If insurance companies don't cover it, it's kind of on us to do it. But do you when you're looking for a functional medicine doctor? This sounds stupid. But like are there functional medicine, OBGYN?

Esther Blum  43:53

Yes, there are? Yes, Suzanne Penske is one of them. You can look at go to ifm.org. That's the Institute for Functional Medicine. Use Google search right functional medicine GYN with your zip code. You can also call a compounding pharmacy in your state ideally near you and say, what doctors do you know, yeah, prescribing hormones here who you got for me? They're all they know all the doctors. And then menopause.org You know, there's lots of good ways to find practitioners and empower yourself and just, to me, feeling seen and heard is about us. Yeah, it's worth and by the way, a lot of doctors and even my sessions, you know, I'm an out of network dietitian, but I have an NPI number. And I get with people who have FSA or HSA. They can get it covered or they can submit. We give super bills and they can submit for reimbursement. So there are ways around it. for coverage?

Sarah Milken  45:01

Yeah, after researching to talk to you today, I was like, oh my god, I'm totally signing up for this. But the question, the question I have is like, I have a son going to college for the first time in August and so much going on. Is it better to do a test when you're not in like a crazy, like stress time? Or do you think it doesn't matter? Like, What's the story on that?

Esther Blum  45:25

Doesn't matter because your life is always going to be crazy and have a lot going on? I mean, hopefully not always. But you know, exactly. Let's just meet you where you're at right now. Are you gonna sit and wait another six months and keep suffering? Or can we cheat you and get you out of dodge and support and hold your poor adrenals while you're going through this, I will be calling you when my son goes to college. Like, please, whoever's listening somebody if there's an author in the audience, can somebody write a book about how to process the grief you have and the challenges in the mixed which you do so beautifully? Sarah, but your kids go to college? I mean, I read your posts, and I'm like, yes, yes. That's me. That's me. Yeah. Like your heart. It's like chart like a third degree burn. I'm grieving my son now and he's only going into his junior year and Oh, my God, this is gonna be gone. I

Sarah Milken  46:16

know it. My daughter is starting junior year this year. So I'm like, fuck, like, this is like crazy Ville.

Esther Blum  46:22

I know. Time Stands. Still.

Sarah Milken  46:24

It does.

Esther Blum  46:25

I wish I wanted to stand still. No, believe

Sarah Milken  46:28

me. No, they say that saying like, the days are long and the years are short.

Esther Blum  46:33

Yes. And I feel like this is the part when it's just getting so damn good and rich. It just gets richer as the kids get older. I don't

Sarah Milken  46:40

know. But he's going so far away. I'm like, Oh, you're killing me. But he's turning 19 In two days. And I'm like, how did he get to be 19? And how did I get to be that woman with like, you know, you go to a family party, and you're like, my son is to my son, or my daughter, for I'm like, he's 19. I'm like, How did I become the family member with the old kids? We're

Esther Blum  47:04

all i just I don't I remember my mom. She She is no longer with us. But I remember she looked at me and like, in the last couple years, and she was like, I looked at this picture. And I was like, Who's that old lady in the picture? And then I was like, it's me. Ah, you know, she'd be like, I'm the oldest one at these family parties. I'm the matriarch, you know, and I was like, Look, you get to give all the advice. You don't filter anymore. Are you?

Sarah Milken  47:30

Your awesome self. So I know that my brother had a third kid. And so he has like a five year old, like a 14 year old and a 16 year old and I'm like, oh my god, I can't believe he has a kid who's literally starting elementary school this year. And I have a kid going to college and another kid almost at college. And my husband's like, Sarah, we're going to be 50 and have the rest of our lives and I'm like, okay, okay, I'm not saying it's bad. I'm just saying it's an adjustment, you know, huge

Esther Blum  48:01

adjustment. It's very defining who you are, how you spend your time. You know, I am excited something like I am going to work on my body like two hours a day. I sculpt and be really fit and travel and I said to my husband, we need to book a trip. When Oh, you have son goes to college. I'm like, two weeks later, we're gonna be in your I want to make sure he's adjusting and settled in and then we go to Europe. Yeah.

Sarah Milken  48:29

Do that. Because I have a 16 year old daughter starting junior year shoot me. Yes. Yes. Yes. I can't just like leave her in the lurch. So um, no,

Esther Blum  48:38

no, but maybe you get a massage. And maybe you you know, and you take a really kick ass dance class or, I mean, what would you want to do? Like, what's something that you're

Sarah Milken  48:49

I'm doing I mean, I'm doing it right now. I'm like, I've created this platform. I'm, you know, putting out you know, it is we're sick because it's, it is work, but because it's so new, relatively new. Got it. There's like, you know, there's kind of like, for me, there's still kind of like innovation and surprise. And you know, I just did my first live event. So it's still it's not run of the mill yet. Right? Good. You know, so it's for me, it's still fun, even even though even though it's really hard. Now, if a woman is going to a doctor who's not, you know, super functional medicine knee. Like, it's basically testosterone, like the things to bring up. Testosterone, vaginal estrogen, HRT,

Esther Blum  49:39

yeah, I would progesterone, estrogen patch, oral progesterone. And by the way, if your estrogen is still really spiking if you're getting, you know, like the real mental rage and the achy boobs and the flow, and the real crime scene periods So you probably don't need estrogen yet. It that you can just start bringing in progesterone and probably a little testosterone, that progesterone is going to tame the tiger, it's going to offset that out of control unleashed estrogen that you've got going on. And it will help with sleep and it will help offset the hot flashes. Then ultimately, when you bring in estrogen, you know, progesterone helps you fall asleep and estrogen really helps you stay asleep. So then the two can work, you know, synergistically together. But estrogens, usually the later one. But here's the cool thing about estrogen is the research shows that No, I mean, vitamin D, calcium, boron, Vitamin K, magnesium trace minerals all really help to support bone health, as does strength training and a high protein diet. But estrogen has phenomenal results at optimizing bone, bone loss. And you know, I've been on my mother had a pretty wicked history of osteoporosis and took all these shots. And I went and had a bone density test done. And like my bones are so gorgeous. And I've been on estrogen for a year or two. I'm turning 53 now, and I still get cycles randomly, by the way. So you know, and here's another interesting thing, I just want to shout out to the bone density test because my GYN I said I want to get bone density tests because Oh, you don't need that till you're 60. I've already done two. Yeah, it is too late. By the time you're 60. And the ladies, I told that to the ladies at the bone density to like, Oh, good. You're 52 like you should be getting your testing done. I said, tell that to my doctor. And they were like, What is wrong with your doctor? You should absolutely be getting baselines, you know, late 40s, early 50s. And if you are a woman who has had a hysterectomy or even a partial hysterectomy early on, you should absolutely be getting your bones checked and getting on hormones ASAP.

Sarah Milken  52:12

Yeah, every time I schedule a mammogram, I scheduled the bone density Nurse. Yes, it's in the same place. Yeah. And I'm like, Okay, check, check, check, check. Check. Check. All done.

Esther Blum  52:25

Yeah, lay on a table then get your boob squeezed. Yeah,

Sarah Milken  52:27

it's jelly. Yeah, your boobs and like the refrigerator, plastic trays, all smushed around. It's so hot. I love it. I feel like once you do the colonoscopy, the mammogram. It's just like routine. It's like not a big deal. It's not fun. But it's it's definitely not a big deal. Now from a personal perspective, is the estrogen that I've been taking in birth control pills for 1000 years. Helping my bones the same way HRT estrogen is is it different estrogen?

Esther Blum  53:00

That's a great question. I would have to honestly ask a colleague, who's a physician,

Sarah Milken  53:05

I want to know that Well, you asked for me. Yes,

Esther Blum  53:09

I will. Because I'm dying to right now. I'm

Sarah Milken  53:11

dying to know and I feel like no one can answer that. For me. I'm like, Have I wasted all this fucking time on birth control pills trying to save my self and my soul? And it's all the wrong shit?

Esther Blum  53:25

Yes. Okay, still, I'm texting her right now.

Sarah Milken  53:30

I love it. It's so good. You're like me, you're like, I gotta you just get this done. Or I'm not I gotta get a number. I'm not even gonna remember. Now the doctors that you collaborate with? Are most of them functional medicine doctors, or will traditional MDS kind of get with it to

Esther Blum  53:47

most of them are functional. Okay. Yes. Because regular MDs, I mean, give you an example. I worked in hospitals for five years, I had a really good friend who was he was a family practice resident, I met when I was at the hospital. So I had known him a long time by now. And he said, and he's really a very, very competent doctor who sent a lot of people to me, including one of his own daughters. So clearly, he thought highly of my services. And yet, he said, I said, you know, what's the deal? Like, why won't doctors run all the labs that I that you run for me? He said, I run them for you, because you're my friend, I would never do that for regular patients. Because a if I find something wrong, I have to be responsible for that. What? Like, what, that's your job, fella. And number two, he's and I said, Well, why don't doctors believe in nutrition? And he said, because there's no published research studies on nutrients. Right. And I asked me, have you heard of a field called Functional Medicine? He said, No, what's that? I said, My God is a field dedicated to Thought treating the whole person and nutrition plays a huge role. And I've seen 1000s of stays, he said, they're not well designed, none of them are valid, and they will never be put into medical school curriculum. So you can keep practicing the way you practice, but don't call it evidence based medicine. And I was like, I think we're done here. Yeah, I was so disgusted. And I wasn't this I was disgusted personally, but I was more disgusted on behalf of all the humans out there not getting good care who are eating, you know, the standard American diet of corn syrup and salt. Right. And I'm

Sarah Milken  55:42

not getting it even like processed turkey. Everyone's like, eat protein, but they're not saying like, don't eat the fucking Turkey from the package.

Esther Blum  55:49

Yeah, I mean, you know, I choose battles. I get people to buy organic turkey but sometimes, listen, I don't always let perfect be the enemy of done. I'm not gonna lie, I'm lacs about certain things. You know, there are doctors proselytizing that you should only eat grass fed protein, anywhere and I'm like them. That is not that is not even realistic.

Sarah Milken  56:10

No, I know. I'm like, give me some Chipotle. Sometimes there's no way I'm going to go looking for Mary's organic chicken every day.

Esther Blum  56:19

No, and not all restaurants have it. And guess what? The research shows that the benefits of protein can outweigh now, yes. conventionally raised meat does have a higher inflammatory profile. It's a very high ratio of omega six to omega threes. But again, I choose my battles and control inflammation by eliminating sugar foods, gluten, or dairy. If you're sensitive, you know and really think about

Sarah Milken  56:46

well, I feel like before anyone's like wait, why didn't she talk about lifestyle with Astra I feel like I have to cover those topics. So basically, you're a dietitian, you're not a magician. But you do say something. One of the interesting things I read was your like carbs before dinner or later, you know, kind of like later on the day?

Esther Blum  57:07

Yes. Protein that day car team carbs at night. Yeah. So that's like the opposite of what people say. Explain. Right. So this was taught to me by the late great, brilliant Charles Poliquin, who was an incredible strength coach and coach hundreds of Olympic athletes, and he had us off flip the switch because, number one, you're much more insulin sensitive. Later in the day, when you wake up and have your bowl of cereal or your toast or a bowl of oats. Oh my god shoot me.

Sarah Milken  57:41

That's me. That's me. Terrible. Oh

Esther Blum  57:42

my god. Yeah. So you're just getting a huge shot of insulin into your bloodstream and then you're gonna crash and at 3pm You're gonna be exhausted and irritable and reach for more sugar and more caffeine. Whereas if you have a real high protein breakfast and my breakfast is always four to five ounces of protein. I've everything from crab meat, to eggs to protein powder, cottage cheese, I'll have leftover chicken. I don't often eat red meat in the morning but sometimes smoked salmon but you can't eat red meat in the morning. You start off that way. And you have some a little bit of fruit or a very, you know, portion controlled amount of carbs like 20 grams or so unless you're working out hard but you can go up to 40 grams but always pair with a protein and then at night have an lunch can be protein and veggies and then dinner. You can have you know a cup of cooked start some rice, potato, lentils or beans if you tolerate butternut squash, any of those are going to give you a slight bump in insulin which tamps down your cortisol and helps you sleep. Most women I see who are not sleeping there's a real cortisol issue at night. And so carbs really nourish the adrenals some women and help you sleep some women I have eat honey with salt before bed or rice cakes with honey just to tamp down that cortisol. They sleep through the night and the sleeping through the night correct insulin resistance. It only takes two weeks of poor sleep to be insulin resistant. So when you tamp down your cortisol Yeah, your blood sugar may go up temporarily but you're sleeping through the night which enables you to produce more growth hormone house with testosterone helps with inflammation and repair and adrenal function. So it really course corrects

Sarah Milken  59:42

a lot of little all these like little secrets. Yeah, I love it. Now tell us about the protein calculation that you have.

Esther Blum  59:54

So in general, it's one gram per pound of your ideal body weight. So ideal body weight is for a woman five feet tall. For every five, for every foot, you know, up to five feet, it's 100 pounds, and then every inch is five pounds additional. So if you're five foot three, you'd be 115, your ideal consumption would be 115 grams of protein. Even if you don't weigh that if you weigh 160, you could meet in the middle and say, I want to infer 130 grams of protein. Most women are not over eating protein, I can barely get the average woman to eat 100 grams of protein, what that looks like is it looks like 35 grams of protein and meal. So like four and a half ounces at breakfast, lunch and dinner. If you're someone who is intermittently fasting, then, you know, you really need like six to eight ounces of protein at those two meals to really organize, you have to really pack it in got a packet in Yes. And why is that? That's because we are at the time in life where we lose the most amount of protein in the shortest amount of time. But the good news is you can turn that around between strength training, getting your protein and this is not the time to go plant based ladies or if you're plant based, figure out other protein sources get in branched chain aminos from either pea protein, or if you can get some dairy and eggs if you can take a straight up branched chain aminos. That's helpful. But ultimately you do need protein. And that's why I'm the application page. I

Sarah Milken  1:01:35

say I do not work with vegans, because I can't get you results. It's impossible for me to correct blood sugar, heal your adrenals and build your muscle on no protein now. Yeah, cuz in your book, you said like somebody would have to eat like five cups of keen Wah to get enough protein at that one meal, and then you're in like caloric overload,

Esther Blum  1:01:59

caloric and fat overload. Kima has fat too. So and this goes against Now earlier in this pot, you may be thinking if you're really good, listen, yeah,

Sarah Milken  1:02:07

no, I was thinking that too. I put

Esther Blum  1:02:09

people on PLANT BASE temporarily, you know, short term for a couple months to clean up a sluggish liver. Like I have a client who had such severe lymphedema and lipo light budget. So I you know, she required a plant based and she instantly last week and you know, her swelling or inflammation was so severe. So in certain cases, I will do plant based short term, but long term leaves. If you want to build myself, by the way, support the collagen in your face, so you don't start aging like crazy and losing your hair. That's another thing. Hair loss is a combination of getting off protein, getting your hormones balanced, fixing your guts, you absorb your nutrients. It's pretty straightforward. Wow.

Sarah Milken  1:02:55

And the what's the probiotic situation? I know that you mentioned your book akkermansia

Esther Blum  1:03:01

Huh? Yeah, so akkermansia is one of those beneficial bacteria that is responsible for blood sugar balance and help support fat loss. If akkermansia levels are low, it can be a missing piece in your weight loss puzzle. It's not the only piece. There are straight up akkermansia supplements that are expensive and you have to dose way higher than what the bottle

Sarah Milken  1:03:25

says. Oh, really? I just bought it the the one from pendulum chillum

Esther Blum  1:03:30

Yeah, you've gotta take like pretty much double what they tell you.

Sarah Milken  1:03:33

I think it literally I'm like, yeah, $75 might say one or something I

Esther Blum  1:03:39

don't know really go way higher. Or you can also get supplements with red and blue concentrates or eat you know, pomegranate, cranberry, strawberry, raspberry cherries, wild blueberries, you know, those foods, those reds and blues feed akkermansia

Sarah Milken  1:03:59

in the cow. Is that different than taking like a probiotic?

Esther Blum  1:04:03

Yes, a probiotic is often lactobacillus or bifidobacteria.

Sarah Milken  1:04:09

Right. Which one do you which one do you like? Is there like a daily that you

Esther Blum  1:04:13

recommend? There are so many I know so specific. You know, Claire makes some very good ones that I like and recommend. It really depends on the individual. I do love sacrifices a lot to sacrifice. This is a yeast that acts like a probiotic. And IQ can have heard of that. Yeah. And it can help with your when your Secretory IgA is low or you know, you have immune dysfunction or Hi my fan engines

Sarah Milken  1:04:42

so my gosh, I'm gonna have to I know I'm like I haven't even heard that word before. But in terms of me, you're basically saying in your book that people are afraid it's going to raise cholesterol, they're gonna afraid it's going to do something to their kidneys. And you're basically saying, Hey, you guys, it has Z Think in all of these things that our bodies need iron, and it doesn't cause inflammation like we've been told for decades. Well,

Esther Blum  1:05:08

yeah, I mean, if you're eating, try to get some grass fed meat in there, but yeah, the inflammation is from gut inflammation. The inflammation is from sugar, a lack of phytonutrients a lack of plants. We do want plants I, I do see women on the carnivore diet, and I do see some pretty unfavorable results with the GI nap. So I will just say that and I think the carnivore diet, listen, there's women, colleagues of mine, dear friends who have healed their MS on a carnivore diet. It's so unique. Our bio individuality is so unique. You really do have to work with someone fresh to figure out what works for you. But yeah, me is not the villain at all. And please follow the work of Diana Rodgers. She has a podcast sustainable dish she's been on Joe Rogan talking about I mean, she has books, documentaries, she is the queen of explaining how meat has been vilified and how important what a cornerstone of foundation meat is to our ecosystem, we cannot survive without animals grazing our lands and fertilizing it.

Sarah Milken  1:06:24

It's so hard as like a consumer because there's so much conflicting information out there. Yeah, sort of have to figure out like who your messenger is, and who you know, sort of you buy to and trust because you could drive yourself to the brink of insanity.

Esther Blum  1:06:41

Well, the thing is, is that the Unpopular Opinions are often correct. And the fact is, when you're looking at a food that supposedly healthy, that is so manmade, like those plant based burgers, the way they can't even handle the smell, the whatever, it's it's pea protein and canola oil, which is both of which canola oils genetically modified. And by the way, lots of animals die in the harvesting of plants, although the rodents and the field nice and the gophers and they all die during the threshing. So there's no system that is without harming animals, number one. And number two, you know, Bill Gates has a huge investment in pea protein. I mean, there's he really controls a lot of our world food supply. So when its profits over people go back to our ancestral roots, right? That's why I wrote my book cave. Women don't get fat because I'm here to teach you like, go back to the basics, right? Chaka, the outer aisles of the grocery store, you'll never be sick a day in your life, right in your veggies, your proteins, your real eggs. Eggs actually help you live or break down cholesterol, they don't raise it. And they're so important for brain health. So you know, real butter, like look at where we ate in the 50s, even the 20s, we had the highest intake of whole milk and butter and red meat and we had the lowest rates of heart disease is when the 50s when all the vegetable oils and the the seed oils and all the inflammatory oils started to be introduced. less meat, low fat milk, margarine. That's when we started getting really sick. And now it's corn syrup. That and the huge portion sizes that's like fattening and all the processed junk. So go back, go back to your roots like you don't, you actually don't have to try very hard to be lean. Most people think you do you actually just have to eat real food and move your butt.

Sarah Milken  1:08:42

Now what about greens supplements? I've heard you talk about something called brocco support and all of those kinds of radical protects Oh, yeah, so protect. Yeah,

Esther Blum  1:08:51

yes. I know. I said to my husband, I thought of a new song lyric. I'm like, every day I'm wrestling. And he was like, Get away from me get away from me now. Like I don't that's now just don't stop. Yeah, the brassica family of vegetables, broccoli, cauliflower, Brussel, sprouts, artichokes, all of those naturally support estrogen detoxification. Now often you have to eat wheelbarrows full to really get the desired result, which is why I have my ladies take them in supplement form when indicated when they're just not pushing estrogen down the right pathways in the liver and they're getting inflammation and they're having estrogen dominance symptoms, then I'm like takes up Rachael protect,

Sarah Milken  1:09:34

right really supports do you find that the green powders and things have I don't know any some kind of benefit because like, to be honest, I'm not like, I'm not one of those people consume tons of vegetables.

Esther Blum  1:09:49

Yes, they can help with inflammation. I don't love ones with high amounts of chlorella because that tends to pull out Mercury across the blood brain barrier. I'm not a fan of chlorella for that reason. So, um, and you know, kale, it makes sure it's really organic like kale has one of the highest pesticide loads of any vegetable right now, because it got so popular. So try to eat you know the real thing when you can. I don't mind some barley grass powder or wheat grass juice powder, that's fine. Those do a great job at detoxing. I don't love the broad spectrum powder. And they're often really freakin expensive. Like, look at the price of athletic greens is like 50 or 70. Something like that. I was like, Are you kidding me? Ahead of broccoli is $1.50

Sarah Milken  1:10:37

All right. Just say your broccoli kids. Yeah, exactly. Just figure out a way to make it taste good. Just don't cover it in butter.

Esther Blum  1:10:46

But no, put some butter and olive oil. You need butter fat how that soluble absorption of nutrients or the fat soluble nutrients be absorbed. A little butter or olive oil, garlic lemon juice salt, it will taste the delicious or put in the airfryer

Sarah Milken  1:11:01

delicious. Oh yeah, that's a good idea. I never thought about the airfryer. Yeah. Now in terms of like your midlife journey, I know that you you talk about how you felt like should for a really long time. Yes. And I was trying to figure it out.

Esther Blum  1:11:16

Yes, I was really sick. I had no cortisol curve, my cortisol was flat. I couldn't work out without having to nap immediately after I'm feeling nauseous and exhausted for two days after. couldn't figure out why had a horrible debilitating insomnia for so many years. I mean, it was probably 14 years. Sorry, when my son was born, couldn't figure it out, couldn't figure out and initially I it was the trauma of childbirth. And I was like a nursing Nazi. Like I cried if I had to give him a bottle because he was going through a growth spurt and I couldn't I ran out of milk. I was devastated. I was like not in my right head. I was also not getting more than two to four hours of broken sleep a night. And still working writing books, raising a kid I mean, I really had very post bad postpartum depression. No one diagnosed me or picked up on it. And looking back, I'm like, oh my god, I really had suicidal ideation so I could sleep. And then I, we moved to Connecticut, and we hiked in the woods all the time. I got very bad lime, and our house and our house had mold. So it was just this awful, awful storm. So I finally I went to many doctors. And one of them referred me to Dr. Tom Moorcroft. He's in upstate Connecticut, but he's licensed in Utah. And he has, he's just an incredible healer. And he, I had done three Lyme tests. Two or negative one was inconclusive. He was like, do my test, which was I did the Galaxy test. There's also real time labs, they do good Lyme tests. And of course, I showed up with lime, and Bartonella, which is an ugly coinfection. And I had bald and he was like until mold is ground zero, you don't get the mold that your house you're not going to get bear on the lime tree. So first, I traded I had did to home or mediations and everything Oh my god, we ripped up ducts and put in an air filtration system and got you know, the moisture issue in our garage that we put in a massive dehumidifier like our basement looks like the set of ET at the end. So cleaned out the molds, took a lot of binders, took medicine took nasal sprays, all of a sudden my brain fog started to clear up, treated the line. We still every time we go for the Barton. We zeroed out all of it all the mold online Bartonella still stuck. And every time we treat it. My body goes nuts and I feel like death within 20 minutes of treatment. So I said can we just leave this alone because I feel great. And I also went on hormones at the tail end of my treatment because I was in perimenopause. So all of that so I totally got my cortisol curve back, I could show you the before and afters of my Dutch it's miraculous. And think clearly sleep pretty darn well through the night. And you know, it's all incredible. And I feel like just so damn grateful every day that I feel every day I'm wrestling, you know, really, really, really good. So how

Sarah Milken  1:14:33

do you how often can you do the Dutch test? And are there kind of mini versions of it if you're just trying to check in on certain specific numbers versus doing the

Esther Blum  1:14:45

whole Yeah, you don't need to do it more than once every six months. I mean, some of the Dutch team would recommend when you first start hormones, you redo it after three months or if you're you know you go off the pill and then you want to get your baseline INR. Yes. Um, but other than that, you know, you can test with blood in between the Dutch 's Okay. Especially once you're on hormones, and once you're in menopause, it's really makes more sense to do serum because but, again, if you go by Dr. pecky she says theorem is not reliable. And so I, I have very mixed opinions on that.

Sarah Milken  1:15:25

What I mean, can you do Cemex? Can you do both and like, kind of compare them where you get different results?

Esther Blum  1:15:32

If you compare the Dutch tests,

Sarah Milken  1:15:36

if you're doing things right, the goal is to improve it. Yeah, no, but I'm saying if you compare the serum test to

Esther Blum  1:15:44

well, they're testing two different things. Oh, so you can urine metabolites? So it's totally different markers. So for best results, you know, my suggestions, yeah, baseline that then you get treatment. And if that's lifestyle, if it's sleeping, reducing stress, lowering your cortisol taking hormones, then you retest in like six months.

Sarah Milken  1:16:08

Do you think I should have t shirts made that are like, hormone adjustment and process? Plan? Excuse? It's like, you know, when like, there's construction? Yeah, exactly. Like, I feel like we need like an excuse, like, I'm not a fucking raging psychopath. I just happened to be going through right now. Well, I

Esther Blum  1:16:30

do have a bag that company veracity that who makes gorgeous skincare products. They gave me a tote bag that says it's not me. It's my hormone.

Sarah Milken  1:16:38

Totally. Yeah, I think it's perfect. Yeah. Now in terms of self advocacy, and menopause, is there like one key piece of advice you would give to women who are going to their providers? Where you're like, do this for me right now?

Esther Blum  1:16:53

Yes, is you understand, go in with the understanding that, number one, you're not just advocating for yourself, you're doing it for women everywhere. Because when every imagine for the 6000 women who go through menopause every day, imagine if all of them ask their doctors at the same time, every day. Imagine a doctor sees 20 patients a day and all 20 patients say I want you to put me on hormones, I want you to put me on hormones, I want you to put me on hormones. The doctor is either going to say I very good hip to this, what's the deal, I'll start talking to other colleagues. Or they're going to have an empty waiting room when the doctor turns down all 20 women and they go and find another doctor. And that's your plan B. Right is no, like, have another doctor in place lined up and say, If your doctor won't help me say, if you can't help me, I will seek medical care elsewhere now that can feel really confrontational for people. So again, you can go back to hey, you know, the chill approach, hey, you know what? Give it a try for three months, what have you got to lose, I'll sign a contract that says I won't sue you. But I'm really dying here. And I know I'm going to feel so much better. And I've got this horrible vaginal dryness. And by the way, hormones are FDA approved. They're FDA approved, so they're safe to prescribe. And like birth control pills have way more hormones than hormone replacement. So what's the deal, and doctors are willing to prescribe those seven days a week, which is an off label use.

Sarah Milken  1:18:29

Right? And I think he also talked about in your book about how doctors are giving a lot of SSRIs. Yes, suppose they're not the birth control pills. I think you said in there. Yeah, they're not touching the brain. The birth control pills aren't touching the brain. So they might get sort of sort of fake hormone control like me, but their bodies aren't being addressed,

Esther Blum  1:18:53

right? Or they'll adjust the heavy bleeding, like the IUDs can address real heavy bleeding and so can ablations. But again, do you need all that or do you just need some opposing progesterone? I mean, I had a client I was working with, she was an attorney. she bled so heavily it pooled in her shoes. Can you imagine that? He is God. And you know what? We put her on progesterone, and it stopped. I mean, enough to do an ablation. She didn't and lots of women have ablations Oh, I

Sarah Milken  1:19:21

know. I've been there. Like I mean, I've been to almost to that point. Because over the last two years, I have had, like month long, crazy ass bleeds where doctors have been like, you can get an ablation. I'm like, I don't want that.

Esther Blum  1:19:39

Yeah. And ablation for those who don't know is when you cauterize the, the vessels, the blood vessels inside the uterine wall, so and it's supposed to stop the bleeding and there's medications that you can take trans

Sarah Milken  1:19:51

that don't ask me to say yes,

Esther Blum  1:19:55

but again, how about getting some progesterone first? That was it.

Sarah Milken  1:20:00

Let's see. That was what was about liver support. Yeah, what was interesting is one of the doctors gave me I think it was like 10 days of progesterone or it has it's, I think it was called Yeah, you can do it in or I don't know, synthetic. Well, maybe that I don't have to look, go back and look, but I took it for 10 days, and that bleeding stopped. Boom.

Esther Blum  1:20:24

So then for a menstruating woman, you can certainly do progesterone the last two weeks of your cycle to and a lot of doctors are comfortable putting women IV progesterone is ridiculously safe.

Sarah Milken  1:20:35

But why do they say it's going to make you gain weight and feel sleepy?

Esther Blum  1:20:39

Well, it's supposed to make you feel sleepy because it's a precursor to GABA, which is a very calming neurotransmitter. So that's why you take it at night. Don't take it. Because the

Sarah Milken  1:20:49

one no, because when I had the two weeks of it, you had to take it a few times a day.

Esther Blum  1:20:54

No, that's not how it's supposed to be. Oh, interesting.

Sarah Milken  1:20:57

Great. Well, I was fine with it. I was like, it's not making me tired. And it sure stopping the bleeding. So I really don't give a shit. Yes, yes, yes. Oh, my God. Oh, my gosh, Esther, I feel like I could talk to you for five hours. So if before we wrap up, what's your key piece of advice for women who are facing a struggle or wanting to find their health and well being a second half of life?

Esther Blum  1:21:19

Yeah, is that it's totally possible. It's absolutely doable. And just because your doctor shrugs you off and dismisses you and gaslights, you doesn't mean that it's not possible. It just means you have to find a new doctor. And all of you I mean, seriously, this is not about the salespeople trust me. I invested far more in this book than I have seen the return on. So let me just tell you this, please buy my book. It is the best thing you can do. I speak to you like a girlfriend, I wrote it with one of my besties in mind, like I just pretend she's sitting right in front of me. It's really easy. I explain it really easy. And you can take it I've given it to my doctor, right you can give it to your doctor and it's going to empower and educate you and there is nothing more dangerous than a woman who is empowered and educated and is an advocate for herself and is a dangerous tongue in cheek but you know, it's that's how we are going to change the world. Do not expect medical school curriculums to change anytime soon. We the system has to change from within it begins with us.

Sarah Milken  1:22:24

I love that and I love the book too, because I actually texted a bunch of friends over the weekend while I was reading it. I know you because nobody wants to read like a medical school encyclopedia. Yeah, like you pick up a book and you're like, fuck this is 300 pages like your book is like short to the point ran kind of like a girlfriend format but with real information.

Esther Blum  1:22:48

Yes, you can read it in one day. I didn't I didn't know I ran out of words. I was like I'm done. Let's get this out.

Sarah Milken  1:22:56

I love it. Now if listeners want to know about your coaching program, because you do provide, I think it's a six month coaching program.

Esther Blum  1:23:05

I do and we have also group coaching programs. So go to Esther blum.com you can surf I have coaching application page, I have about 150 podcasts you can listen to you can listen to my book, get my weekly newsletter. And if you want I have a gift for you. It's my happy hormone cocktail, which is going to help you sleep get rid of your hot flashes feel a lot more energized. So you can go to Esther blum.com forward slash cocktail. And come hang with me and Insta at gorgeous Esther.

Sarah Milken  1:23:40

I love it and I love all your reels too. It's just like a fun educational place to be. It's very cool. I want everyone to start thinking about what should they can start doing today. One small step and reversing the menopause game and living our prime and midlife. I want to thank Esther Blum aka gorgeous Aster for saying yes and becoming a new friend of the flexible neurotic podcast. Thank you.

Esther Blum  1:24:06

Thanks, Sarah.

Sarah Milken  1:24:07

I'm so happy you came Hey, peeps, it's me again. I listen to this episode with Esther Blum, integrative nutritionist menopause bestie and best selling author so I could summarize the golden nuggets for you to have actionable items to start using today. I know that when I listen to a long episode, I'm like, oh my god, I love that. But then I can't even fucking remember the specifics. This is why I come back and do a golden nugget summary. In this episode we dig deep with our golden shit shovels in a conversation that's called gut health and hormone imbalance in Perry and menopause. Golden Nugget number one bloodwork testing and getting to know your been life health. So many tests. I know don't worry about taking notes here who really has time for that. I have all of this in the show notes for you as yours practice is built on testing research and drawing conclusions to fix big blocks that can be getting in the way of weight loss, sleep, mood and a whole lot more. Esther will draw results from bloodwork thyroid panels the Dutch chest and a GI map. Blood panels will show what's missing as well as insulin and glucose levels. Thyroid panels will show where you can add in supplements and which ones to add as well as cardiac inflammatory markers. Now the Dutch test is a dried urine test. I know that sounds lovely, but it shows your adrenals your hormones and your gut health while the GI map will show you a super comprehensive report of your gut health and can show you any pathogens parasites and viruses that you might have. Both the Dutchess and the GI map can be done in the privacy of your home. Golden Nugget number two bowel movements poop. Yay. Teen son and teen daughter would say this is probably my favorite other topic other than the midlife vagina. Just kidding. Okay, although the GI map sounds a bit intimidating to send in, like poop in a box or something of that sort. I mean, it's no worse than a colonoscopy. I probably will have to do this one soon. Esther emphasizes the importance of daily poops for anyone, especially midlife women, because this is how we are moving hormones throughout the body and detoxing hormones is a huge part of menopause and perimenopause. This test will open up so many questions it consider like Hmm, why aren't I pooping every day? Some women may have a Candida build up others may have low caloric acid because they have H Pylori I know I know a long story short, take the test and start pooping every day. Based on the results of this test. Astra may actually recommend adding hormones for some of our clients. And it's totally life changing, the more you know, okay, all right, Golden Nugget number three hormones, testosterone and options in midlife. Again. When it comes to adding hormones or testosterone. Esther relies on the data from the testing. She recognizes that adding bio identical hormone should be like a symphony, not a solo act, meaning that it should be a mix of estrogen progesterone and testosterone. And just a reminder because I know I need it to bio identical hormones are physiologically the same as the production of hormones naturally produced in the body as opposed to synthetic. These bioidentical hormones can be found at your pharmacy and are FDA approved, unlike testosterone, which is why patients need to be deemed quote a good candidate by their doctors. Although astir kind of claims that we're all good candidates for it, you still have to check with your doctor. Golden Nugget number for testing and functional medicine versus traditional practitioners. astir operates in the functional medicine field and recognizes that not everyone has access or reach to testing or a functional medicine doctor. And if you don't, you can still advocate for yourself for your doctor's office. If you are wanting to try hormones and your doctors against it, advocate to try it for three months and see what happens. And then come back to reassess it together. Get educated on the benefits, the side effects and how they play into your personal medical history. approaching your doctor from an informed perspective can open up conversations that can lead to an array of solutions or possibilities. Astro stresses that there are so many good practitioners out there and when you empower yourself to feel seen and heard by the right ones, it's all worth it. You deserve it. Okay, quick reminder, my big announcement as you know is I'm launching an eight week virtual midlife remix table experience. It's sort of like an eight week course but I'm not calling it a course because I'm not lecturing like school. This is going to be an immersive experience where for two hours a week for eight weeks, you're gonna sit with me at my midlife brunch table, and we're going to actually do what we're all craving. We're going to connect with other midlife women. We're going to talk about midlife topics that only we can. Okay you guys reminder go to www the flexible neurotic.com forward slash waitlist. When you sign up you will be the first to get the launch email and qualify to get 30% off the full price. Okay, you guys the gold is dripping off these nuggets, rabbit use it there are three things you can do. First, subscribe to the fucking podcast. Second, share it with some friends who like midlife shit. And third, write an apple review. writing reviews is kinda annoying. It's an extra step. But guess what? It really helps the podcast grow. You think your little review will matter? But it does. If you went to a show and everyone said my clap doesn't matter. There would be no clapping. You all matter. DM me, you know I always respond. Oh, and of course follow my instagram at the flexible neurotic Dogs love you talk soon