Healthy Aging Means Having Healthy Hormones

Kashif Khan

All right, everyone, welcome back. So today we’re gonna dive into something that direly needs to be dove into deeply. And I say this because the work that we do, we experience that of all of these sort of patients and different problems that we have to work with, the area that straight out sucks the most is female hormone health. It’s taken for granted that, well, you’re supposed to have problems, it’s your hormones. What are you worried about? And over and over and over again we hear this and then we take this very gray stuff, and it could actually be very black and white to somebody who knows how to work on it and truly help somebody and understand why these things are happening. And so we’re joined today by Kristin Johnson, Maria Claps, it’s a tag team today. Thanks guys for joining us.

Kristin Johnson

Thank you for having us.

Kashif Khan

It’s a bit intimidating, I have to admit, I’m talking to two women about female hormones. But we’ll get through it somehow. And it’s awesome because you guys have this perspective for all these women that are out there that are just sitting there waiting, what is menopause gonna be like? It was horrible for my mom how bad is it gonna be? So, if we dive right into it, why does this happen? Why do women get into this sort of stage of what is this painful aging and painful, call it menopause, and hormones change and what’s going on there?

Maria Claps

Well, I think it’s a mix of things, for sure. So we’re not gonna deny the biology of change that happens in the female body, for sure, but if you speak to say, positive women who say, “Well, my grandmother went through menopause “and she did just fine.” It could be that your grandmother grew up in a different environment so, 21st century living certainly doesn’t make it any easier. But that’s something we all just have to contend with instead of just fixating on the fact that that’s where we are. We just have to realize that that is where we are and then the changes in the functional declines of organ sufficiency they happen, and I think that’s something, Kashif, that nobody really wants to acknowledge is that the body does change with age and if we’re speaking from a purely physiological perspective, it’s certainly not for the better and I think that’s where Kristin and I just bring this sense of gritty reality to healthy aging instead of just fluffy, positive. We’re positive women and we always believe that you can do many wonderful things on a spectrum of, kind of low intervention, low cost to medium to high. So you can always do something we just worked with a client who was 85 years old and she was interested in improving her health, like yay her, but the reality is, aging takes a toll, so.

Kristin Johnson

Yeah, I think a lot of women think that their body is failing them or rejecting them, or somehow, kind of revolting against them and Maria and I just try and get the point across, this is normal, the ovaries age, our hormone rhythms of our youth change, they go away, and I think the biggest problem is that women do not realize what a homeostatic regulator our female hormones are way beyond fertility. We’re focused on kind of the fertility piece or some of the other vibrancy that comes with that youthfulness of having sufficient hormones. But then our hormones disappear and it’s a bumpy transition to go from having hormone replete body to a hormone deficient body and we focus on that as this failure of some sort. And sure it’s ovarian failure but we would see it as not that your ovaries are supposed to remain vibrant and producing in age, it’s a normal aging and so getting women to understand what is going on, helps them understand what they can do about it and that’s the biggest piece that we try and fill in the blanks for.

Kashif Khan

Yeah, that makes a lot of sense and that a lot of women, well, in general, people are unaware that women have to face this other load of toxic estrogen that, for the most part, men don’t. There are some men that are estrogen dominant and have some estrogen toxicity, but even then it’s a drop in the bucket versus what the female profile has to deal with. And it’s almost a protective measure, you’re past this fertility stage where you don’t necessarily need the hormones to the level you did that many decades of exposure to this level of toxicity it’s almost a relief to the body to get rid of that and you wonder why mother nature does it thing the way it does. But meanwhile, you guys talk about, okay, forget about postmenopause where you’re able to now deal with that ’cause hormone levels are lower, but prior to you talk about estrogen detox where a lot of people don’t think about that where you can actually mitigate what we’re talking about right now.

Maria Claps

Yeah, the body has to make an estrogen or in, for postmenopausal women, or take it, ’cause we’re really not making much at all from the ovaries. So once we’re postmenopausal and then it has to signal at the receptor, and then it has to go through a process of detoxification in really kind of the liver is primarily where that happens and then we excrete it in the stool and the urine. So that’s actually a really important process and it kind of can determine our feeling of estrogen in the body depending on how well the body handles it.

Kristin Johnson

Yeah estrogen’s super potent. Look at all the things that it does and maybe some of your listeners aren’t familiar with all the things that it does but it literally is triggering everything from our bone remodeling, to our heart health, to our cognition, beyond just what’s happening in our ovaries and uterus. And so that’s a pretty powerful molecule in the body and it needs to be broken down and gotten out and I think women focus on these early years where they think they make too much of it, and then in the premenopausal and postmenopausal years, we’re not making that much of it, if any, but the problem is we still have to kind of make sure that that liver is able to interact with estrogen in the same way that it did when we were younger and let’s be honest, lifestyle choices add up, and chemical exposures add up and if a woman’s drinking alcohol, the liver kind of has a priority and unfortunately over time, this really potent estrogen metabolite needs to be detoxed. But if we’ve kind of messed up the system, we’re gonna end up with these metabolite circulating that are not going to serve us well.

Kashif Khan

So how does a woman know because there’s so much, so everybody sounds like they need to pay attention to this, but there’s also a lot of variability like not every woman is the same hormonally. So how do you know that this should be a priority? Or is it a priority for everybody?

Maria Claps

Well, it’s definitely, well we tend to focus on midlife women, so it’s definitely a priority. We think it is a priority for everyone if they can afford it but for midlife women who are many of who are taking estrogen, especially if you’re taking estrogen you do wanna make sure that you are able to handle it correctly and if you’re not, and most women are, but if you’re not, then you wanna take some steps to correct that because that’s important and that can determine your kind of experience with hormone therapy which we are very much in favor of. And really the way to know for sure if you are handling it correctly is looking at metabolites and we can’t see that in a blood test, we really see that best in a urine test.

Kristin Johnson

Yeah, I would say any woman who has GI upset, who doesn’t have regular bowel movements, who drinks alcohol regularly, who isn’t using clean skincare and clean cosmetics and things like that, maybe has a smoking history, any sort of mold exposure toxins, it’s almost a given that you’re gonna struggle a little bit with your estrogen detox. The bare minimum is if you’re not, sorry to be TMI, if you’re not pooping daily, you probably have an estrogen problem and it’s not the estrogen problem that caused it, but it’s the lack of essentially getting rid of your excrement that is gonna cause the estrogen problem.

Kashif Khan

So it’s kind of like assume that there’s this foundational estrogen problem, meaning that everyone was, but now it’s the coal factor of, are you also increasing the environmental load? Are you also not clearing it? Are you also exposed to, like you said, mold or lime or whatever it is? Any other inflammatory insult and that combination takes you over that sort of threshold.

Kristin Johnson

Yeah.

Kashif Khan

Yeah, that makes a lot of sense and then we understand that genetically, you can look at profiles and understand who is more estrogen dominant like what is the actual pathway, who produces more of a toxic metabolite versus like a two hydroxy, like a clean estrogen, and be a little predictive about it. But even then, you could have this clean profile, like you said, the reality of how we live today and what we’re exposed to and all those hormone disruptors are pushing us over the edge anyway, even for the cleanest profile out there.

Kristin Johnson

Yeah, and we rarely see women ’cause we run a Dutch test on every client and Dutch test is a dried urine analysis looking at these metabolites, looking at phase one and phase two, we rarely see someone who doesn’t need a little bit of support and it can be, as Maria said, low hanging fruit such as just better be complex sufficiency and magnesium. But some women either have that toxic load or they need the digestion support and bowel support, or there’s just basic things like, are you a com tea slow methylator so that’s an enzyme snip that some of us have and little things like that we have to look at because I, wouldn’t you say Maria, unless a woman who’s been using like liver herbals and compounds like dim, we rarely see someone who comes through with a great profile.

Maria Claps

Yep.

Kashif Khan

So I know you mentioned that you’re a big proponent of hormone treatment or hormone replacement therapy, so the typical first question I always here is what is it for? Why do I need it? Not me, but a woman.

Kristin Johnson

You might need it too if you’re married to a woman. You might need her to take it.

Kashif Khan

Well, for men, it’s funny because it’s so, it’s kinda called rudimentary, it’s like, I want bigger muscles and I need a libido. And that’s why men are taking hormone therapy and there may be other benefits that they don’t even realize, they don’t care. But for women it’s so much more complex so why do women need it?

Maria Claps

Well, that’s a very nuanced question but Kristin and I actually bring women through sort of like, what do we call it? Like a hierarchy of evaluation, a lot of what is focused like so there’s a big push for the I-space of menopausal women. Okay, Kristin and I have always thought that but we just read something that confirmed that the venture capital community, Kashif, is very interested in marketing to menopausal women so therefore, a lot of it is gonna be focused on symptom management, which is not bad, nobody wants hot flashes or low mood or things that kind of classically accompany menopause. What we really like to focus on is to go beyond just symptom management because symptom management could be this, you’re 51 years old, you have hot flashes, you’re menopausal or your premenopausal, it doesn’t matter, you can do HRT either way in premenopause or menopause, meaning you don’t have to wait till you’re fully menopausal 12 months without a period to commence hormone therapy. 

Okay, so you do the HRT because you wanna get rid of hot flashes because they’re very life disruptive, but you know what, doc says five years now, you’re 55, you’re 56, let’s come off the HRT because you’re kind of experience with hot flashes is probably over with if you’re like 80% of women. Okay, but you know what just happened? She comes off the HRT, maybe doc wings her off because we should never stop estrogen abruptly, and she doesn’t have hot flashes, all good, she thinks everything is fine, but she’s lost like the other protection that continued HRT usage is going to give her, so we focus on like, how can we be healthy and vibrant for the lifespan versus just like symptom management. Like I said, nothing wrong with symptom management, but we want women to think beyond just that.

Kristin Johnson

Yeah and there’s a huge reason why, if you look at the statistics, women outnumber men when it comes to Alzheimer’s almost four to one. That there’s, hopefully this shouldn’t be news to anyone, but that has a hormonal component, it’s a huge piece of our cognition is dependent upon our sufficiency of estrogen and progesterone. Same thing with cardiovascular disease, we’re always hearing about men, men, men. Well, if you look at the stats, by about 50, 54, women catch up to men and eventually exceed them when it comes to cardiovascular disease. Same thing with osteoporosis, how many osteo product men do you know? Not many right? It’s always women that we hear about and these are the imperatives that we try and get across to women is that this is all related to your hormonal sufficiency. 

So while that hot flash at night or the lack of libido or the crepey skin, or, again, dry vaginal tissue which is why you don’t find intercourse satisfying. These things are relevant, they deserve your attention. But what really deserves your attention is locking in that health for your 60s, 70s, and 80s. And that’s what doctors are not talking to women about that and that’s unfortunately what this venture capital boon into menopausal marketing is not going to capture either.

Kashif Khan

Yeah, there’s no concern over arching wellness, it’s more like, resolve that symptom, this silo done bucket removed, that was, move onto the next one. We see that all the time and even the sad thing is the women that we see believe that that’s also the way it should be, because that’s what… And it’s unfortunate, not understanding that you can ask for more and you can look for more.

Kristin Johnson

Well, like you started out saying, maybe they associate kind of how their mother experienced menopause and so it’s like, oh, here I go, this is my turn. And Maria and I called BS on that. Nobody has to live that way just because it became so common that it’s defined now as normal, does not mean that that’s your only option. And that’s the biggest thing is, particularly women of our age, our mothers were the ones who were essentially started on an imperfect hormonal therapy and kind of abruptly taken off of it because of some science that came out in the WHI and they suffered, they suffered horribly and so any woman who’s in that kind of premenopausal transition, or postmenopause, she’s looking ahead at her mom just thinking like, ugh, argh, here I go. 

And we’re here to say, no, there are, so much has changed, we understand the whys, we understand the what forms better and we have options but, we also have to make sure that we’re living a life that is going to be a healthy host of those hormones and that’s the part of kind of that toxic burden that we’re bringing into this phase of life and everything else that should be addressed. Women cannot be sitting up on their phones all night and not sleeping, and having a glass of wine three nights a week and everything else and expecting any experience with hormones, whether from her own, or from hormones added is gonna be pleasant.

Kashif Khan

So when you mentioned toxicity, does a woman have to consider, okay, I’m not going through my natural cycle of hormones going down so less, sort of risk from estrogen toxicity. Now, I’m keeping the levels high, is that a concern? Is there something that needs to be done in tandem with it like supplementation or something to manage toxicity? Or is that not something we have to think about?

Kristin Johnson

You mean if she’s taking HRT?

Kashif Khan

Yeah.

Kristin Johnson

Yeah, no, it absolutely has to be considered. Maria and I kind of say, you look at things from where you’re starting and you try and address those with targeted lifestyle interventions, which may include some supplementation, but many times there’s low hanging fruit with diet and exercise and sleep and stress management. But then once you add HRT, we’re always of the mindset that just check it once a year, look at how you’re metabolizing these things. None of our lives are kind of lived in a static silo, we’re always engaging with stress and toxins and whatnot on a regular basis. Hopefully a woman has tools that she uses on a daily basis to sort of mitigate the effect of those, but either way checking once a year is always a good thing.

Kashif Khan

Okay. And just, I have to ask you one dumb question, HRT, hormone replacement therapy, then there’s BHRT, bioidentical hormone replacement therapy. What’s the difference, and does it matter?

Maria Claps

Okay, so we just call it HRT, but for us, hormone replacement therapy, there’s so many ways to say it there’s HT, there’s MT for menopausal hormone therapy, for us, it’s just kind of a big 10 HRT but we are fans of bioidentical hormones, absolutely, so when we say HRT, we do mean BHRT and that’s bioidentical it’s a molecular kind of identical copy of what your ovary made.

Kashif Khan

Okay so there’s some work done preliminary to figure and try and personalize a little bit?

Maria Claps

In terms of what a woman might be getting from her physician?

Kashif Khan

Sorry, when you say that you’re sort of mimicking the natural hormones alone and that’s what you mean by bioidentical.

Maria Claps

Sure.

Kashif Khan

Okay, understood. Okay, so have you seen adverse outcomes where women don’t feel right after, or is it pretty consistent that this is like the fountain youth and it’s gotta happen for everybody?

Kristin Johnson

Yeah, that’s another nuanced question because HRT can be done, as we call it, kind of on a spectrum. There’s imperfect and inferior forms of HRT even BHRT, and that’s the biggest problem is that too many providers they’re either afraid of it so they kind of dabble in it and, it’s almost a worst experience to give a woman a little bit of hormones, but not enough because her body’s kind of like starting and stopping on these breaks, but, if you go back to how did we produce hormones, we produced hormones as women in sort of this rhythm over the course of 28, roughly days. And it wasn’t progesterone and estrogen every day, all the time, we have this nice, beautiful flow with peaks of estradiol and then we have progesterone kind of coming in in a different part of the phase, it’s not every day. 

The problem is too many doctors they approach HRT by using it as symptom management and so let’s say a woman’s not sleeping, he’ll say, here, I’ll give you some progesterone, oral progesterone and that’ll help you sleep. But they don’t ever necessarily add the estradiol or they’ll just give them a cream progesterone which women can almost buy over the counter in most places so they start self dosing. But what women don’t understand and what too many providers don’t understand is that there’s sort of this triggering of receptors and there is this interplay, this sort of gas and breaks response between estrogen and progesterone that needs to be honored. We need to be honoring the body not just with chemicals that molecularly look identical to what we produced, but also that reproduce the rhythm that we had and that we honor when we were exposed to these hormones at what times during the cycle. 

So, women unfortunately they hear BHRT or HRT and they go to their provider and say, I want some, and their provider might say, oh gosh, okay, sure, here’s a patch or some progesterone, or here’s some cream, but they don’t monitor them, they don’t dose it according to let’s say their body fat, which does have a lot of relevancy for women, they don’t follow that rhythm so they just kind of flood the system and so women may have adverse experiences, they might get water weight, they may not have receptor health that’s ready for this and we have to build those receptors through that rhythm and those peaks and valleys. And so women tend to, when not using an HRT provider who has skill in that artistry and nuance of HRT kind of application, women can have adverse outcomes and it makes Maria and me incredibly sad because what happens is they say, I tried HRT and it did not work for me. And that just means you had a really poor HRT provider.

Kashif Khan

Yeah, that makes a lot of sense. That’s something that’s nuanced and complex but also if you have enough experience, pretty glaringly obvious the profiles and what that person needs, but if it’s like a mixed sort of family practice where this is 1% of what you do, you don’t ever get those nuances or concern over those profiles and it’s a “One size fits all” approach and I could clearly see why it would lead to the kind of problems you’re seeing. So you mentioned something there which I hadn’t heard before which is managing or preparing receptor health, and that’s a really cool concept. We’ve seen that we do some work with athletes, and we’re often working with the androgen receptors to help them bind more testosterone and something as simple as stretching, for example, literally activates the androgen receptor and all of a sudden these people are doing better. So what are you doing there? I’ve literally never heard this before.

Maria Claps

Receptors are kind of the forgotten aspect of the hormone replacement therapy conversation when it comes to midlife women for sure, and we cannot micromanage receptors so we have two main receptors for estrogen, alpha and beta, so alpha receptor is gonna be the growth receptor, the proliferation, and then the beta receptor is gonna be the brakes receptor, let’s put the brakes on that proliferation. And quite frankly, we need both of them, you’ll find, Kashif, that there are doctors who will give biased which is a combination of estradiol and estriol usually in a cream, it can be compounded into a capsule as well and they like it because estriol stimulates the beta receptor and we want beta because we don’t want too much growth from estradiol. And this is probably a little bit more than you bargained for, in terms of an answer, But the truth is that, we need to signal both the alpha and the beta receptor and receptors in general, as a woman ages, will, probably the best way to put it is, flatten and kind of become deactivated. And when that happens, HRT is just not as effective. So how we can build back up receptors is using the right amount of hormone therapy and as Kristin was describing, in a rhythmic fashion.

Kristin Johnson

So dosing, this is where I guess we get into when doctors are kind of this low dose, almost afraid of HRT, that’s when that’s not going to be sufficient physiologically to build back up those receptors and so these women sort of dump hormones into the tank, but there’s no place for those hormones to go. And they either have a net neutral no effect, or they can have a negative effect and so finding a provider who’s willing to address your physiologic needs, and every woman comes into it a different place, this is where that individuality becomes relevant and why a doctor needs to be really digging into what is her health history? How were her cycles when she was younger? How long has she been without these hormones? That’s all gonna kind of determine what her receptor sensitivity is starting HRT, and then it should dictate does she need to start out at a lower dose and build up slowly? 

Is she someone that you can just kind of pour on and put a lot of estrogen into the tank and she’s gonna take it up really quickly? All of that is really determined by sort of the health of the body coming into HRT. Now, women aren’t gonna necessarily know that out of the gate, and so that’s where Maria and I say, look, you have the opportunity to influence the way your body is poised to receive these things and these are the low hanging fruit, this is where the nutrition and the lifestyle factors come into play. You can’t necessarily wake up receptors through great nutrition, but you can sure as heck make your receptors, your body have fewer priorities and allow the priority to be receptor growth and waking up if that makes sense.

Kashif Khan

It does, so you’re essentially saying, there’s a bit of a hack where you can actually do things to change the expression of your chapters and it may not necessarily be like a supplement or a food, but activity just like we-

Maria Claps

It really mostly centers around usage of hormones and usage of hormones in the right amounts and in the right rhythms but I’ll kind of introduce one other receptor thing into the conversation, which I think is fascinating and I think more women need to know about, and that is so the main HRT for midlife women is gonna be estrogen and progesterone, testosterone can certainly be part of it but that’s a different conversation let’s just focus on estrogen and progesterone for the moment. Okay, a lot of women, well say 47, 48, premenopausal, symptomatic, they’ll start with progesterone. Because, that seems to be the the good thing to do or an applicable thing to do for a lot of women of that age group that doesn’t mean that they won’t benefit from estrogen as well, at that age, but that’s a different conversation, a bit too nuanced, but so they’ll start with progesterone and they may feel great on progesterone for a year or two. 

And then they hit 50, 51 and again, these ages are variable so no one should take this as ultra specific, but now their menopausal and that progesterone it just flat out does not work anymore. Wow it works so amazing! In the beginning it doesn’t work. The reason is because progesterone needs to go into a receptor to work and what creates that progesterone receptor is estrogen and estradiol specifically and when we don’t have that estrogen in the body anymore, the ovaries have stopped making it and whatever is made by peripheral conversion from the adrenal glands it’s just not adequate enough. So, now we have a woman who’s 50, 51 taking progesterone, she’s discouraged, just not working anymore it’s ’cause she doesn’t have any, she doesn’t have estradiol to create those receptors. So, Kristin and I, this is in the scientific literature, we know it by working with tons of women, Kristin, I don’t know about you, but it kind of surprises me how many physicians don’t know this makes sense.

Kristin Johnson

Yeah, and then what happens, Kashif, is they’ll start ’em out with this low dose estrogen, they’ll kind of take it as like, oh, now might be the time that you could use estradiol. So then they’ll start ’em out, but it’ll be super low dose. Well that’s not enough to stimulate the progesterone receptor. And that’s the part that then now we have estrogen in the tank and progesterone technically going into the tank but no receptors to take it up and so now we’ve lost that yin and yang sort of relationship between the hormones and that’s why, we always refer to HRT is it’s an artistry and you need someone who’s skilled in those nuances because any doctor who’s willing to shove a pellet in you, stick a patch on you and hope your hot flashes go away, they’re not serving you and they’re not understanding the kind of physiology that needs to be honored within the female body with these two hormones.

Kashif Khan

Yeah, and you’re right, this is not something you hear, even in people that focus on this like HRT is a big part of their work. The preparation through sort of managing the receptor and making sure even binding and utilizing the hormones you’re putting into the body, I guess, in the proper doses, it just happening anyway, it’s kind of a fluke, randomly they got it right, but when you’re actually, proactively thinking about it, it’s part of your plan, your plan may be a little different and that’s really awesome you guys are doing that. I think about everything we’ve been talking about is about the estrogenized woman and last week we were speaking to this young lady who, I think she was 21 or 22, cystic acne, hardly ever has a period, she was ripped, like she had a six pack, her arms looked like, I was intimidated, I wouldn’t want to go into an arm wrestle with her, and she had no clue that she was highly androgenized and her testosterone levels, maybe even DHT were really high her hair was horrible, skin was horrible. But like I said, like ripped, like not a drop of fat on her. So, we have an industry that’s all talking about the estrogenized woman, does this profile need something else? Is the right tool even available?

Kristin Johnson

For someone who’s highly androgenized?

Kashif Khan

Yeah.

Kristin Johnson

Well, she probably needs some body fat to be perfectly frank. Yeah, she would be someone who would benefit from understanding the testing, like, is it her DHA? Is it her androgen profile generally? Is her estrogen and testosterone kind of interplay downregulated or too upregulated depending on which way the arrow is going? And then what is the health of the hormones that she has in there? How is she detoxing them? And yeah, I mean women like that, I hate to say it, they’re usually too low calorie, they’re overexercising, they may be exposed to some things that, whether it’s alcohol in their life or other things that are creating this sort of toxic environment, but, it’s really, really important if a woman is 21 years old and has this sort of dominance with testosterone and low estradiol. She doesn’t understand that she’s gonna have brittle bones by the time she’s 30. And all the exercise in the world is not gonna stave off the fact that her estradiol is insufficient.

Kashif Khan

So is that somewhere where you would uniquely put somebody onto hormone therapy at that youthful age or that they would need that support?

Kristin Johnson

There are providers who will do that definitely that can be an intervention, but usually there’s some basic lifestyle interventions that can help kind of nurture ovarian function to be more on point, but, people like that sometimes they get wedded to their physique and this kind of identity and it’s going to take some change. We like to stay to women, you have to change to change, but yes, there’s women who they never quite get their period, or they’re just always so thin and you can nurture the ovarian function through the use of a well designed HRT and they may only need to be on it for a few years, but they need to finally get back into that rhythmic production at physiologic levels of those hormones and so figuring out why this is happening would be the first step, but yes, HRT can help in a case like that.

Kashif Khan

Okay. I’m gonna ask you about another lady that walked into the office. So, another profile that we hear about often, and I don’t even know if there is a relevant sort of intervention, but I just wanted to ask. So we have women that come in that have breast cancer, and that breast cancers hormone positive cancer, and so they’re put on treatment to block their estrogens and to prevent that binding the cancer feeding off the estrogen. So for that woman, obviously there’s damage being done, beyond, yes there’s this acute response that’s required to help her get past this potentially terminal condition, but then there’s all this other damage that’s gonna ’cause and then you kind of left with a bag and I go deal with it. So is there an equally acute HRT protocol to resolve what she just went through and get her back, or is that kind of like damage done and her life has changed?

Maria Claps

I think we’ll both have something to say about this except to say that, that’s just definitely a challenging situation. Kristin and I know of several, well actually let me back up, let’s just say that ’cause the biggest elephant in the room with HRT and maybe just with being a female in today’s society is, whether one uses HRT or not, is the fear of breast cancer. It is unfortunately very common. Women using HRT will get breast cancer and women not using HRT will get breast cancer. So it’s, we don’t believe it’s the HRT that causes breast cancer, we do know women that have had breast cancer, some on HRT some not on HRT and even the women on HRT will come off for a season and take care of the cancer and then they will go right back on their HRT we’ve known several actually. Sadly, and again, this is not kind of wide birth recommendations, but sadly, so many women think, oh my God, I either have cancer in my family or I had breast cancer and they think HRT is not for me. And that is an over generalized recommendation. That is not true for all of those women. I will say that we know many women, including one of our mentors who is a breast cancer survivor who now actually credits hormone therapy usage from preventing breast cancer reoccurrence.

Kristin Johnson

Yeah, so this topic is always acutely personal to me. My mom had breast cancer three times bilaterally two different types. And young, not the old lady, 70 or old breast cancer, but 40s. And so this was something that I always felt the gun was loaded, pointed at my head and what would be the trigger sort of thing. I went through all the genetic counseling, I considered a prophylactic mastectomy, and I had what we refer to as busy breasts, I had the microcalcifications, in my 30s and 40s I had over seven biopsies where they left clips in and took material out I was watched every six months on breast MRI, as well as mammogram, like high risk considerations. The irony is as nobody paid attention to the fact that I was also on a Mirena IUD, I was essentially shutting down my own hormone production, and that it was when I came off my IUD and started HRT, that my breasts became “not busy” suddenly. 

And now it’s to the point where when I go in for my six month checks, they actually flag me because they don’t see any changes and they’ll come back and say, not only do we not see any changes, we don’t see the microcalcifications, we’re gonna do another scan and we’re gonna look closer. And now it’s been enough years on HRT where they realize that activity in my breast has stopped and in fact, I have fewer concerning tissue spots than I used to and now I just have these stinking clips sitting in there. And this has always intrigued me, and so getting into it, there’s a wonderful book called “Estrogen Matters” by Avrum Bluming that we think most women should read. This is a doctor whose wife had breast cancer and he looked at the impacts of HRT and the loss of estrogen and how it may actually be problematic for breast cancer. 

We also have one of our mentors who’s of the opinion that breast cancer, as Maria loves to say, if you have boobs and birthdays, you’re gonna have risk of breast cancer period that, whether you use HRT or not. But one of our mentors will say that she believes there’s sort of a dysregulation in hormones that predates the development of this damage that triggers the breast cancer. So, yes there is obviously a need to shut down some production or shut down receptors when a woman has estrogen positive breast cancer, but did her estrogen cause the cancer, or was it a problem with her, excuse me, regulation or ratios of her hormones that were the issue. 

And I think, if you look at what we’ve learned about estrogen treatment for breast cancer, there are doctors or programs in Boston even where they’re using high dose estrogen as a treatment in intervention for breast cancer because high doses of estrogen were actually shut down the receptor. So instead of shutting down the estrogen production, we can shut down the uptake of estradiol and sort of close down the food, so to speak, for that breast cancer, but yet not turn off a woman’s estradiol. And so, there’s some wonderful oncologists who work in this space that Maria and I know, and we would say, just don’t assume that you don’t need your estrogen just because you have breast cancer. There are some big picture considerations for kind of a short term, maybe shift in things while you’re undergoing treatment, but long term, we all need that estrogen.

Kashif Khan

Yeah, the outcome it’s horrible that women have to go through this but the fact that there’s new interventions like adding estrogen and having a completely different experience it’s really cool that that work is being done. So everything we’ve talked about up until, well not everything, but most of it has been about, HRT and hormone replacement therapy which was eye-opening, there’s a lot of things that people have been, I’m sure wondering, which you’ve helped them now understand. Outside of that, what else should women be thinking about as they age, to age gracefully and the way they want to age, what else could they be thinking about or doing?

Kristin Johnson

Well, these are the things we say are right in their control. Super first thing is we would say, ditch the alcohol, women don’t like to hear it it’s a great coping mechanism as we age but it’s not serving you. And, alcohol ages you on top of everything else, physically in appearance, but it does really impact the way your body’s handling your hormones and your liver health is key for so many things. But then we would say, stop over exercising, start sleeping, start managing your stress, and then nutrition is a huge part of it. And Maria and I got loud about some of these issues because we see too many women trying to address the body composition and some of the vanity changes that come with aging, and they do so in ways that actually exacerbate it. So they’ll go plant based, and they’ll up their cardio, and they’ll essentially create this sort of calories in, calories out punitive cycle of just chasing these numbers and depriving themselves and that is aging you, we hate to say it. 

We need to start doing the things that the guys do, which is lifting heavy weights, we need to be eating animal protein, that means a steak, we need to be eating enough calories, if Maria and I had a dime for every woman who comes in and we look and we’re like, how are you not starving, when we look at your food journals, to death and they’ll say, but I need to lose weight and women don’t understand that when we under fuel our body, we trigger responses within the system that actually will add weight because our body is under stress, it’s protecting us. So things like that, these are all within our control, whether or not you use HRT, we want women to be, eating enough, eating optimal animal protein, strength training, ditch the peloton and the orange theory fitness and all of that stuff. Get your sleep dialed in, turn off the phones, and we have clients who are like, but I can’t, we’re like, yes, you can, all of us can work on our sleep hygiene. And then stress is obviously a huge place and the last couple years have been stressful for everyone, but we can’t get rid of it so we need to learn how to kind of embrace it and manage it better.

Kashif Khan

And you mentioned overexercising, that’s a concept that’s maybe new to some people. How do you know what’s too much?

Maria Claps

I can speak to that from personal experience, it just was a time in my life when I was just not fueling right and getting to the gym early and I was like, absolutely like crutching on a midday nap and I don’t think a midday nap is wrong, if you feel tired take a nap but, I had a feeling that that was like driven by improperly fueling and just, maybe just a little bit too much exercise. But yeah, and if you’re feeling like really more depleted after exercise, then energized, then I think that would be a pretty good clue as well.

Kristin Johnson

Yeah, I think sleep disruption is usually the number one kind of flag to be looking for. And like Maria said, the recovery piece is huge and I think it’s not just, if you’re depleted, if you also feel like the Energizer Bunny and you just got jump started, that’s kind of a sign that your body’s on this really dysregulated roller coaster of ups and downs. We should not be having these almost manic forms of energy after exercise, you may have just overdone it a little bit. So, we look at, are you recovering? You really probably don’t need more than four days a week in the gym, so to speak, focus more on those other restorative practices, do some yoga, take walks, take a nice bike ride that isn’t geared towards any metric, but it’s just for a lovely day, to go outside and look. But usually, the thinning hair, the undersleeping, the kind of up and down energy, those sorts of things are usually your first clue that you’re overdoing it. And then also if you feel like you’re eating or you’re working out to eat, is that you kind of have these like almost manic food moments too that’s usually a pretty good sign.

Kashif Khan

That makes a lot of sense and I’m resonating with that a little bit myself. I think I hit it a little too hard it’s also the way my brain’s wired, I’m reward seeking so when I feel like I gotta do something, I overdo it. So it’s good to be reminded. I almost wish that I was a menopausal woman so I could work with you guys ’cause you sound that you have it figured out so well. But I guess I’ll never get that experience. So for the women out there that do want to work with you, do you actually work directly with the public? Or how do they engage with sort of your learnings?

Maria Claps

We do, so we have a six month program where we will do testing, lots of coaching and support, a really deep one on one session. We used to have a business model that was just testing and results and recommendations and then we found that that just wasn’t serving women and it didn’t kind of feel like we were sitting in integrity ’cause we really wanna kind of change lives, not just sell tests. So yeah, we have a six month program, and then we have a, what else, some free resources as well.

Kristin Johnson

Yeah, we try and be really education forward because in our opinion, women, A, they need usually a little mindset shift and that can be tough sometimes we’ve kind of become wedded to our identity of being either overworked and overtired or facing what our mother’s life sentence was, et cetera. And so we find that if women understand the why, what is happening, why it’s happening, why it’s important to you, accepting the what to do becomes so much easier for them. And we’ve seen too many of our own colleagues and we probably could have been guilty of it in the past too, of just telling them what to do and perfect example is we’ll have women say, I just want you to give me a seven day meal plan so I can follow it. And Maria and I have to step back and say, that’s all sexy and great marketing and it sells and it sounds easy, but again, you’re just hitting the easy button. How much skin are you putting in this game? 

And at the end of the day, I don’t live in your house, I don’t know your schedule, I don’t know who else might be being fed at your table, I don’t know what foods you like, I can help you once I know those things, but if we just give you something that’s prescriptive, have we really served you? At the end of the day, you need to sort of build your toolbox up, understand what’s at play and then act accordingly and that’s what we try and do with women is just really teach them so that they feel empowered because if there’s anything that every single woman would agree upon in this midlife transition, it’s this overwhelming sense of loss of agency. And we want to give women that back because, unfortunately, our medical providers sure as heck aren’t doing it.

Kashif Khan

Yeah that’s amazing and that why part you said, again resonates because that we experience this so much, somebody feels something and they’re looking for the bandaid almost because that’s what they’re told they’re supposed to do. “Go do whatever you want, “when you break yourself, “call me and I’ll fix you.” That’s kind of the medical experience. But when you start to get into the why and somebody understands that they can actually understand what causes, why is it happening and control that part. And you’re not told to control that part ’cause that happens outside of medical care. That’s the, in between the visits, the, all that why stuff is, do you have to manage it yourself? Otherwise you end up dealing with the what. You break yourself and someone’s gotta fix it so, this was awesome, guys, I thank you for your time because, eye opening and you answered what to you, maybe basic questions but people need to know, and it was very helpful and I thank you for giving your time and for both of you joining us, that was amazing.

Kristin Johnson

Thank you.

Maria Claps

It was our pleasure.