141. Dr. Amy Shah: Hormone Havoc, Gut Health, and the New Menopause Playbook

Most women are taught to accept fatigue, weight gain, brain fog, and mood changes as a normal part of aging. What if the real issue has been overlooked gut health, muscle loss, and a medical system that failed to prioritize women's hormones. In this episode of Extend, we sit down with Dr. Amy Shah, MD, double board certified physician in internal medicine and immunology, to unpack the powerful connection between the gut microbiome, hormone balance, and long term health. We break down the estrobolome, why fiber and fermented foods regulate estrogen metabolism, how 30 grams of morning protein stabilizes insulin and cravings, and when hormone therapy truly becomes indicated. We also explore strength training for midlife, sprint intervals for cardiovascular resilience, early DEXA scanning, ferritin testing, and how small daily inputs build the physiological reserve that protects bone, brain, and metabolic health through perimenopause and beyond. Dr. Amy Shah is a physician, nutrition specialist, bestselling author of I'm So Effing Hungry and I'm So Effing Tired, and founder of a global wellness education platform focused on evidence based lifestyle medicine. Through clinical practice, research translation, and her new book Hormone Havoc, she empowers women to take control of their health using nutrition, movement, and targeted medical intervention when necessary. What We Discuss: (02:15) Why perimenopause is underserved in medicine (06:40) The estrobolome and estrogen metabolism (11:20) Pre, pro, and postbiotics explained (18:05) 30 grams of fiber and morning protein (24:30) Protein timing and insulin sensitivity (30:10) Strength, sprints, and midlife training (36:45) Cortisol, recovery, and overtraining (42:20) Ferritin and vitamin D testing (47:55) Early DEXA scans and body composition (52:10) Clear indications for hormone therapy (57:30) Women's heart disease differences (01:02:15) Redefining midlife performance Thank You to Our Sponsors: Function Health: Learn more and join using my link. Visit www.functionhealth.com/drshah http://www.functionhealth.com/drshah and use gift code DRSHAH25 for a $25 credit toward your membership. Timeline: Go to timeline.com/drshah http://timeline.com/drshah to get 20% off your order. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:@darshanshahmd https://www.instagram.com/darshanshahmd/ Learn more about Dr. Amy Shah: Website: https://amymdwellness.com/ IG: @dramyshah https://www.instagram.com/dramyshah TikTok: @dramyshah https://www.tiktok.com/@dramyshah Youtube: https://www.youtube.com/@dramyshah LinkedIn: https://www.linkedin.com/in/amyshahmd/ Podcast: https://amymdwellness.com/pages/podcast

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Perimenopause isn't a breakdown, it's a recalibration. And for millions of women, the frustration isn't just the symptoms, it's the lack of real answers. In this episode of Extend, I'm joined by Dr. Amy Shah. She's a double board-certified MD, nutrition expert, and author of the new book, Hormone Havoc. And we're going to unpack why the strategies that worked in your 20s and 30s often fail in midlife, and what actually works instead. We're going to dive into her 3033 framework, 30 grams of protein for breakfast, 30 grams of fiber daily, and three probiotic foods a day. A simple but science-backed approach that stabilizes hormones by repairing the gut-brain hormone axis.

• 1:34Dr. Darshan Shah?

  We talk muscle preservation, mood regulation, inflammation, estrogen metabolism, and why gut health is the missing link in women's hormone care. If you've been told to just get through perimenopause, this episode offers a much smarter roadmap, one that's going to help you build strength, resilience, and metabolic health for the decades ahead.

• 2:00Dr. Darshan Shah?

  Hey everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about, your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day, patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor, and the doctor tells them all their blood work is normal. But the problem is, this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. And all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my

• 2:43Dr. Darshan Shah?

  NEX Health clinics, then I tell them, go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our NEX Health clinics. And if you try to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They can even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements, they don't have pharmaceuticals they're trying to get you to take. You're just getting the data, and you're getting insights from the data. And you can bring this data to a clinic like

• 3:28Dr. Darshan Shah?

  ours, and we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio, or go to functionhealth.com/drschah, and use the code drshah25 for a $25 credit towards your membership.

• 3:56Dr. Darshan Shah?

  Dr. Amy, thanks for joining today.

• 3:58Speaker 01

  Thank you for having me.

• 3:59Dr. Darshan Shah?

  Oh, this is so awesome that you came here to join us. And we've been trying to do this for a long time.

• 4:03Speaker 01

  Yes.

• 4:03Dr. Darshan Shah?

  But it's a great time to do this because you are fresh into launching a new book.

• 4:08Speaker 01

  That's right. I actually, so basically what happened is I love nutrition and gut health and women's health. But what I was finding is that women were coming to me, really confused patients, as well as people online, on my social media accounts. People were messaging me like, what about for women? Like, what about nutrition for women? What about perimenopause? What about menopause? So I saw that there was a big hole in that area in medicine. As you know, there's really nothing in that world that we give to patients to have kind of a handbook. So I wanted to write that. So that's what.

• 4:42Dr. Darshan Shah?

  Yeah, it's gonna be a game changer for women that are going through the perimenopause time and menopause. Because I think, to your point, you know, for decades, we were taught in medical school that you want to stay away from hormone therapy.

• 4:55Speaker 01

  Yes.

• 4:55Dr. Darshan Shah?

  Not only that, you know, destroy hormone therapy, but I need research around hormone therapy, too.

• 5:00Speaker 01

  That's right. Like, it was basically when, I think, like, 23 years ago, we had the study come out, and it said that, basically, that hormones cause cancer. Hormone therapy is linked to breast cancer. And then it was, like, shut down. Every single person, it was criminal, basically, to prescribe hormone therapy. And so for the last 23 years, pretty much all of our, you know, practice time, things have been completely closed on the hormone therapy. And so now, it's great that, one, we're having conversation about hormone therapy, but also, like, there is this whole population of people that we've kind of skipped over in medicine, that it's the most understudied, underserved area in a woman's life.

• 5:43Speaker 01

  So she gets a little bit of help in puberty and, you know, in childhood, a little bit in pregnancy, maybe when you're elderly, you get a little bit of help. But there's this huge gap between, like, 30 and 65, that you're not getting any guidance.

• 5:56Dr. Darshan Shah?

  Yeah, yeah, it's really, it's really a huge problem, because now we're seeing, live today in 2026, an entire generation of women. That hormones were not addressed at all and they they're suffering the consequences now.

• 6:09Speaker 01

  Hundred percent. And not only that, most people, I don't know about your parents, your mom, but even in traditional societies like Indian families or people who had like these matriarchs and aunts, they still didn't really talk about this time of life and what to do, how to deal with it. And so I think one of the things I want to do is like, hey, here's a handbook and you can use it for yourself, but your mom can use it and your daughter can use it. So when she needs to, when she's coming into that stage, we have something to like, look at.

• 6:42Dr. Darshan Shah?

  Right, right. And talk, have a conversation about because to your point, like it's like suffering in silence is the norm.

• 6:48Speaker 01

  Exactly.

• 6:48Dr. Darshan Shah?

  Through this time of life.

• 6:50Speaker 01

  Exactly.

• 6:50Dr. Darshan Shah?

  And I just don't know why that is.

• 6:52Speaker 01

  And you know, I I say this all the time, but it was when I was in high school, nineteen ninety-three, when NIH mandated that women be included in research. I mean, that's not that long ago, that basically everything before that, that everything we know is all based on a research on that.

• 7:13Dr. Darshan Shah?

  Yeah, it's it's so true. So finally, we're in an age where now this is, you know, people like yourself are like turning this mindset around completely. But in the meanwhile, like my mother, for example, she's about six inches shorter than she was when I was a kid.

• 7:28Speaker 01

  Really?

• 7:28Dr. Darshan Shah?

  Yes. She's had like every joint in her body replaced now, you know, and it's.

• 7:34Speaker 01

  Did she have osteoporosis?

• 7:35Dr. Darshan Shah?

  Yeah.

• 7:35Speaker 01

  So she would have been like the perfect candidate for both nutrition intervention, which I talk so much about, gut health intervention, but also hormone intervention.

• 7:45Dr. Darshan Shah?

  Exactly, exactly. And so unfortunately, here she's, you know, eighty now and she doesn't have the doctor that will prescribe her hormones now. And it's hard when you're eighty.

• 7:54Speaker 01

  Yes.

• 7:54Dr. Darshan Shah?

  Right? But also, a lot of the damage has already been done. And so she's kind of trying to weigh whether it's even worth it to start now or not.

• 8:02Speaker 01

  I know, that's a very tough, because you know, when you look back at the study, the really the people that were more likely to get cancer from hormone therapy is really the people over sixty.

• 8:12Dr. Darshan Shah?

  They started old, older anyway.

• 8:14Speaker 01

  Yes.

• 8:15Dr. Darshan Shah?

  And a lot of like the cardiovascular complications were also due to people starting too old and they already had cardiovascular disease to start with.

• 8:21Speaker 01

  That's right. And, and I think the other thing people don't realize is that you, and you probably talk to your patients about this all the time, that you get to peak muscle mass and peak bone mass at age thirty. So that's men and women.

• 8:33Dr. Darshan Shah?

  Right.

• 8:34Speaker 01

  And if you hadn't built it then, it's like an uphill battle.

• 8:39Dr. Darshan Shah?

  Right.

• 8:39Speaker 01

  Because now, a lot of us women, we ate very little because everybody said, get smaller, get smaller, you know, diet, do this. And so you've already damaged the amount of muscle and bone that you have to start with.

• 8:52Dr. Darshan Shah?

  Yep.

• 8:53Speaker 01

  And then you don't know how to eat because nobody's really told you the nutrition that you need to support your bones and muscles. And then you don't know how to exercise to support your bones and muscles and brain. And so we get this huge pop, once you're, you know, eighty, for example, it, you can start then, but it really is much more effective, especially in that, that zone between like thirty-five and fifty is like the key time that you could be making these changes.

• 9:22Dr. Darshan Shah?

  Yeah. And I think what you're talking about is like building up a physiological reserve, right?

• 9:26Speaker 01

  Yes.

• 9:26Dr. Darshan Shah?

  Of muscle mass, bone mass, and VO2 max, which is a measure of cardiovascular fitness. Trying to get as high as you can of a number up to the age of thirty.

• 9:35Speaker 01

  Yes.

• 9:35Dr. Darshan Shah?

  And then maintaining that number or continually improving afterwards.

• 9:39Speaker 01

  Like you, I think you mentioned that you got better.

• 9:41Dr. Darshan Shah?

  Yeah, I did.

• 9:42Speaker 01

  So I think I, you know, I never lifted weights ever in my life. I was always like running or doing some kind of cardio. And it wasn't until I learned about protein, about lifting weights, all of this stuff that's happening. I mean, fifty percent of women over fifty get a fracture.

• 9:58Dr. Darshan Shah?

  Yeah.

• 9:59Speaker 01

  I'm like, that's crazy. So I wish I knew that sooner. I, I think that's one of the messages I think we're trying to get out there is like, hey, you know, it's never too early to start like building muscle and bone.

• 10:09Dr. Darshan Shah?

  Right.

• 10:10Speaker 01

  And, you know, you should be doing it from, our kids should be doing it. And then you need to learn how to maintain that so that you can kind of not be eighty, ninety, hundred, and not be able to like be functional.

• 10:22Dr. Darshan Shah?

  Yeah, I love what you've done is you've made you've come up with some really simple constructs about how people can incorporate this into their life because I think it are, you know, in this whole longevity space and whatever you want to call it, functional medicine, it gets really complicated for people because there's so many biomarkers you can follow, supplements you can take, and people lose the message and the noise, right? And so I love that you've done that in your book. And I want to go over like the how a little bit later, but I still, I still think this, I want to dive in a little bit more into the why.

• 10:55Speaker 01

  Yeah.

• 10:55Dr. Darshan Shah?

  Particularly, I think this connection between gut health and hormone health.

• 11:00Speaker 01

  Yes.

• 11:01Dr. Darshan Shah?

  Like, those are two very unrelated topics traditionally. Can you connect the dots there for us?

• 11:07Speaker 01

  So I think you might know this, but I actually did internal medicine and then I did immunology.

• 11:13Dr. Darshan Shah?

  You're double board certified.

• 11:14Speaker 01

  Yes. And so after internal medicine, I thought to myself like, okay, where do I go with this interest in nutrition and gut health? And so first I thought gastroenterology, then I thought maybe oncology, but I ultimately chose immunology. And what people don't realize is that this is like, let's say 15 years ago.

• 11:32Dr. Darshan Shah?

  Yeah.

• 11:33Speaker 01

  I'm sitting at Columbia in fellowship and we're doing journal club for those you, for those of you who don't know, that's when you go over articles, scientific articles. And every article, one after the other, was how the gut bacteria was talking to the immune system as well as the hormones and the brain. Like, there's a hub there in the microbiome.

• 11:54Dr. Darshan Shah?

  Yeah, and that's incredible.

• 11:56Speaker 01

  It's a constant communication. Microbiome talks to your hormones, talks to your immune system, talks to your brain. And so there's, every single article was like the, it's known that that's where the interactions happen. And so I thought to myself, how come we never talk about those interactions? We just talk, I, we just talk about them as separate things. Hormones are completely separate, then immune system, then gut health, but it's completely connected. So the gut bacteria actually play a huge role in deciding which hormones we should be producing, how much, how much should be reabsorbed and taken out of our body? And so I want women to know, like, if you actually want to improve your hormone health, improve your gut health.

• 12:39Speaker 01

  Your gut health is the key to hormone health. And by the way, you're going to improve your brain health and your immune health in like lower your inflammation in the process.

• 12:49Dr. Darshan Shah?

  Right, right.

• 12:50Speaker 01

  We even have gut bacteria. Uh, the estrobolome is a group of gut bacteria that help with estrogen metabolism. They will bring in estrogen, they will take out estrogen. And these guys are literally the hormone balancers that we always say like, oh, hormone balance pill or whatever. They are the hormone balancers that we have inside of us.

• 13:09Dr. Darshan Shah?

  That's, this is crazy because, you know, this is all brand new science for the, for the most part. I mean, for me.

• 13:16Speaker 01

  Yes.

• 13:16Dr. Darshan Shah?

  We never learned any of this in medical school. To us, the gut was just a place where you, you know, absorbed nutrients and created stool and got colon cancer.

• 13:25Speaker 01

  Yeah, and even now, I mean, gastroenterology is mostly focused on screening for colon cancer and, you know, irritable or inflammatory bowel diseases. There's not a lot of talk about the gut-brain connection, the gut-hormone connection, or the gut-immune connection.

• 13:42Dr. Darshan Shah?

  Right, it's so true. I have good friends that are gastroenterologists and so sorry to them, but they really don't know much about this, uh, connection with the microbiome to our brain, to our immune system. And I'm always telling them like, hey, you should read these articles that are coming out. Why do you think this is like evolutionarily? Like, why does a gut microbiome talk to our immune system and control some of our hormones?

• 14:07Speaker 01

  Well, I think about like the analogy of the Amazon jungle, right? We always learned that in the Amazon jungle, there's like thousands of species and they're intertwined. And, you know, you see pictures and probably people have been there where they're like, the, the two organisms are like intertwined with each other. And they're two separate organisms, but they need each other to survive, you know? And that's exactly how it is with our microbiome. I don't think we realized that it was kind of coexisting with us. And sometimes, actually, most times, the gut bacteria are stronger in their signaling than our own cells. So we have trillions of them, not just bacteria, but also viruses and fungi that live there.

• 14:52Speaker 01

  Like an Amazon jungle where they're like completely intertwined. They're communicating with our body, even though they're not part of our body. They're communicating and their their voices are very strong. And so you think of them as like, kind of like army generals and they're talking the brain, walking, talking the hormones. And so it becomes like the central command center. And so when people say gut-brain, it's really just one thing. Cause you know, when you're, when you're in utero, it's all connected. And then you separate and the gut goes one way, the brain goes the other, and there's the whole spinal cord in between.

• 15:27Dr. Darshan Shah?

  Those are my favorite classes in medical schools, embryology.

• 15:30Speaker 01

  I know when you watch it happen, it's so insane. So you are always connected, but people in the modern, in modern medicine did not understand this connection till very recently. That you can actually take the gut bacteria, just the gut bacteria, not a human cell. You can transplant that into somebody else. So you take the gut bacteria from Darshan, you put it into Amy. Now Amy has Darshan's personality, Darshan's diseases, Darshan's, you know, mental health and athletic prowess. So athletic prowess, mental health and inflammatory state, all can be transferred just by transferring gut bacteria. Oh, and hormonal state.

• 16:11Speaker 01

  There's a funny story of a man who was getting gut bacteria, so fecal transplant from his mother. Because you really want to screen very well, you want to make sure that it's, so he was getting them from his mother. And he started to develop hot flashes and night sweats. And they figured out that because they had transplanted her gut microbiome to him, that he was starting to get the hormonal effects and signaling that she had.

• 16:38Dr. Darshan Shah?

  That's crazy.

• 16:39Speaker 01

  It's so insane. I mean, it, we're just at the tip of the iceberg. We know from animal studies that you can literally transfer, you know, cure depression, cure ADHD, cure schizophrenia. I mean, the, you know, the sky's the limit. And you know about the athletic athleticism, that people who are elite athletes have a very different microbiome than people who aren't. And so if you transplant. The elite athlete bacteria into someone who's not, you can actually improve their athletic ability.

• 17:12Dr. Darshan Shah?

  So I actually met with a guy who is doing exactly this. So he's getting these elite athletes to give him stool samples and he's culturing them and then putting them into

• 17:21Speaker 01

  Yes.

• 17:22Dr. Darshan Shah?

  actual, you know, little pills to transplant. And so, you know,

• 17:25Speaker 01

  How badly do you wanna be, you know, like faster and stronger?

• 17:29Dr. Darshan Shah?

  Right, right. And like, there's no anti-doping agency that can test for that. So it's kind of like people are doing it.

• 17:35Speaker 01

  I mean, I, I feel like, you know, knowing what I know, it's not a bad idea.

• 17:39Dr. Darshan Shah?

  Yeah, yeah, it's, it's pretty, it's pretty incredible. I always say like, you know, our microbiome is a billion dollar pharmaceutical factory that we're all born with.

• 17:47Speaker 01

  That's right.

• 17:47Dr. Darshan Shah?

  And so you have to treat it right and it will take good care of you, right?

• 17:51Speaker 01

  Well, one of the things I talk about a lot in general and in the book is like, you create these things called short chain fatty acids. Your gut bacteria, not you. Your gut bacteria create these things called short chain fatty acids. And that's like the equivalent of like an ibuprofen for your body. It is going all, it's like a factory of ibuprofen. That's calming inflammation all around your body and your brain. And you can make it yourself. And it's because the gut bacteria do that when you feed it food that it likes, like fiber, probiotic foods and protein. It's when you exercise, the gut bacteria love that. And they love when you see light, like sunlight and during the day. So there's like ways to actually get that like plant of, of, of drugs kind of going

• 18:36Speaker 01

  by just changing the way you eat and live.

• 18:38Dr. Darshan Shah?

  Yeah, even like the GLP-1s, people are buying these for thousands of dollars a month. And you can encourage the right kind of bacteria to produce these in your, in your own gut.

• 18:49Speaker 01

  Yeah, it's, our gut bacteria has the power to produce dopamine, serotonin. You know, there's a short, these short chain fatty acids. So it is pretty amazing. When I started, so that was like 15 years ago when I was sitting in that fellowship and I was like, that's crazy that it's so connected. And then when I went out into practice, of course, there was no talk about that. There wasn't even an option to like provide solutions for people in that way. So we have a long way to go because the research is there. A lot of that research is pretty well done. Like we know that your diet can change rapidly, change your gut.

• 19:27Speaker 01

  We know that when you do change your gut, you have lower inflammation and lower inflammatory diseases.

• 19:33Dr. Darshan Shah?

  Right.

• 19:34Speaker 01

  We know that you have boosted brain health. So I don't understand why, like, we live an entire whole lives without really caring about that gut microbiome. It's crazy.

• 19:46Dr. Darshan Shah?

  I know. Yeah, I think it's definitely coming to the forefront of people's attention now, but it is kind of a black box because, you know, there's all these companies offering gut testing.

• 19:55Speaker 01

  Yes.

• 19:55Dr. Darshan Shah?

  And then you get this gut test back, either the results are so complicated, you don't even know what to do with it. Or they're just trying to sell you some, like, dietary program or supplement to, you know, based on that test.

• 20:08Speaker 01

  Yeah.

• 20:08Dr. Darshan Shah?

  And people know that that's probably not gonna work.

• 20:12Speaker 01

  Yeah.

• 20:12Dr. Darshan Shah?

  For the most part. And so I think there's still, like you said, there's a lot of science that still needs to be done.

• 20:16Speaker 01

  I, yeah, because I'm sure your patients do the same thing. They're like, okay, I'm sold. Like, tell me, you know, what I'm, how do I test for my gut? And it's like so hard because, again, it's like, if you think about it as the Amazon jungle, it's very difficult to go in and sample more than one little area.

• 20:35Dr. Darshan Shah?

  Right.

• 20:36Speaker 01

  And so if you sample this one area, you're gonna get these results. But if you sample the other side, you would get a completely different result. And then if you change your diet for two weeks, you're gonna get a completely different result. So it's very difficult to really test and, you know, give us the answers like we have with other things in medicine.

• 20:54Dr. Darshan Shah?

  I love this Amazon jungle analogy because if you zoom out, like, you know what the Amazon jungle needs, right? We need to stop cutting down trees. We need to not kill species of...

• 21:05Speaker 01

  But not set fire to the jungle. Yeah.

• 21:08Dr. Darshan Shah?

  Exactly. Not encourage too many of one species that are predators over another species. Like, like, I think, like, if you zoom out on your gut, it's the same kind of thing. Don't put into your gut the things that are destroying it. Feed it the things it needs and try to create a balance and a harmony between all the different species.

• 21:25Speaker 01

  That's absolutely exactly correct. And that's how I always think of it. So I think to myself, all right, if you had a barren jungle, which is what most Americans have, because we are just doing things unknowingly and to kill the gut bacteria, like antibiotics, eating ultra-processed foods, alcohol. And then, so if you're starting from a barren land, you're gonna need a few ingredients to get it to... Be thriving again. And so that's why I talk about protein, fiber and probiotics, because those three things can help it grow, be healthy and lush again. Probiotics actually add more bacteria, so add more species to the jungle.

• 22:05Speaker 01

  Fiber is the food for, it's like literally like if you're watering the plants and giving it sunlight. And then protein and polyphenols, you really want to feed the gut bacteria so it can thrive.

• 22:18Dr. Darshan Shah?

  Right.

• 22:19Speaker 01

  And what we are doing in our modern world is killing them all the time.

• 22:24Dr. Darshan Shah?

  So, and I tell my patients this all the time, like if you want your gut to get healthy, eighty percent of the problem is solved if you stop eating a high amount of ultra-processed foods.

• 22:34Speaker 01

  Yep.

• 22:34Dr. Darshan Shah?

  Right, alcohol.

• 22:35Speaker 01

  Yes.

• 22:36Dr. Darshan Shah?

  Also, and non-steroendocrine inflammatory drugs and in about, pretty much all pharmaceutical drugs are damaging to your gut. And so if you don't absolutely have to take them, please don't stop your prescriptions. But you know, like people take Advil at the first sign of,

• 22:51Speaker 01

  Right.

• 22:51Dr. Darshan Shah?

  uh, even a slight joint ache, or even, some people take it preventatively, like if they're gonna go out to drink, they'll take Advil before. And it's just like you're adding insult on top of insult on top of insult to your gut. And it's making it a barren land.

• 23:05Speaker 01

  Or they'll be, you know, taking antibiotics just in case.

• 23:08Dr. Darshan Shah?

  Yeah.

• 23:08Speaker 01

  You know, a lot of people do that, you know, I, I have, I think I have a sniffle, I'm not sure, but like, let me just take it. So if you need antibiotics, they are amazing, but they're literally like setting fire to that jungle.

• 23:20Dr. Darshan Shah?

  Yeah.

• 23:20Speaker 01

  And so especially the long term, um, and it, cause some people say to me like, I need something for three days. No, you're fine. But if you're someone who's constantly taking antibiotics, or you're someone who's taking it for long-term, high doses, that's what it's doing to your kind of microbiome jungle in there.

• 23:37Dr. Darshan Shah?

  Right. I, I think the other thing that is really, um, at the forefront of my attention all the time is the immune system, basically, like, I used to always think like the immune system lives in your bloodstream, because it's constantly surveilling, but. Eighty percent of the cells are actually just around your gut.

• 23:53Speaker 01

  Yeah.

• 23:53Dr. Darshan Shah?

  For the most part.

• 23:54Speaker 01

  That's so what the way I want you to think about it, or the people who are listening or watching is like, it's kind of like, again, the army reference, like the general is talking, and the immune system cells are waiting there to hear, the hormones are waiting to hear, and the transporters to the brain are waiting to hear. Like, what do you have to say? Okay, you know, he just ate a whole bunch of ultra-processed foods. I don't really understand what this is. I need your help to help me get rid of this. So the immune system comes in to help, the hormones come in to help. He says, you know, you need to send cortisol up because we need to be driving the inflammation up here so that we can heal what's happening. And it's sending signals to the brain like, hey, you need to slow down

• 24:38Speaker 01

  because we're dealing with this crisis here. And imagine that's happening all the time, every day.

• 24:44Dr. Darshan Shah?

  Right. That's a really good way of thinking about it. It just affects every system of your body mainly.

• 24:50Speaker 01

  And then women, especially when they're going through kind of this midlife hormonal change, I call it the hormonal continuum, where they're kind of moving through the hormonal continuum. They start to see that their gut health is suffering more because some bacteria need estrogen to survive. So they don't have as many bacteria. Their hormone levels are declining naturally. Their inflammation levels are going up because, again, the body's sensing that the hormones are going down. So you're left with this very exacerbated condition. So if you started off in a place where you weren't eating very well, you weren't sleeping very well,

• 25:31Speaker 01

  weren't moving very well, when you move to this time of life, it is going to be very, very obvious. And so this is the time to really take care of your gut, to start to move your body, eat the foods that are going to grow that gut bacteria so that they can support your hormones and your immune system.

• 25:49Dr. Darshan Shah?

  Yeah. It's almost like, you know, going back to earlier, we said you want to kind of build up a reserve

• 25:54Speaker 01

  Yeah.

• 25:54Dr. Darshan Shah?

  of skeletal muscle. Bone, even VO2 max, you also want to build up a reserve in your gut of a really strong, healthy gut. So when you get to this point in life, when your hormones are declining, everything else is functionally optimally.

• 26:07Speaker 01

  That's right. A lot of people fix their gut and, you know, the gut changes, by the way, gut changes within three days.

• 26:14Dr. Darshan Shah?

  Right.

• 26:15Speaker 01

  So a lot of times when women start to fix their gut, they start to eat better, they start to have more sunlight, more sleep. All of a sudden, they're like, okay, perimenopause is not so bad.

• 26:25Dr. Darshan Shah?

  Hmm, interesting.

• 26:26Speaker 01

  I can do this. Like, I feel, you know, good, everything's balanced. So it is definitely something that actually, especially in the transition from ages 35 to 45, like really close to menopause, those years where everything's kind of in flux, this can be something that can really stabilize things, really strengthen the communication between the gut and the hormones. And so then people feel better during that time and maybe even, you know, don't have symptoms.

• 26:57Dr. Darshan Shah?

  Right. So the estrabolome that you described earlier, I assume that's a name for all the bacteria in the gut that affect estrogen levels, is that right?

• 27:07Speaker 01

  That's right.

• 27:07Dr. Darshan Shah?

  Are there any specific strains, like name strains that you know of that are in the estrabolome?

• 27:12Speaker 01

  They're, they're a special group that, and they're all in the, I wouldn't know the species names, but they're all in that estrabolome and they're different.

• 27:21Dr. Darshan Shah?

  Okay.

• 27:21Speaker 01

  Than the other bacteria.

• 27:22Dr. Darshan Shah?

  So there's many different kinds of them?

• 27:24Speaker 01

  Yeah. So you can take, so the theory was that we could just like maybe hit people with a bunch of bacteria that could support their estrabolome and the rest of the gut bacteria. But our body's really smart. So when you take bacteria by mouth.

• 27:39Dr. Darshan Shah?

  Like a probiotic?

• 27:40Speaker 01

  A probiotic.

• 27:41Dr. Darshan Shah?

  Yep.

• 27:41Speaker 01

  It starts to destroy it right on the, right on the bat because it thinks that you're eating spoiled food or something, bad bacteria. It is very smart. It knows.

• 27:52Speaker 01

  Food-based bacteria that it's supposed to let in versus toxic bacteria. And so the biggest problem that probiotic companies have is how do we pass through

• 28:04Dr. Darshan Shah?

  Yeah.

• 28:05Speaker 01

  our, without getting destroyed.

• 28:07Dr. Darshan Shah?

  Our body's natural defenses.

• 28:09Speaker 01

  Yeah, right now, the strategy is like, just hit it harder, more and more, because some of it will like eventually reach the colon. But that's why, that's the argument for having more probiotic foods, fermented foods. Somehow the net of the food seems to carry them through without them getting destroyed. And probiotic foods have been shown in studies over and over and over again to reduce inflammation, to improve overall health. And I think it's one of the biggest ways to improve inflammation, like 18% from eating those foods. So those foods, buy smart, doesn't kill the bacteria in those foods. But, but if you try to just eat a bunch of bacteria and like, oh, hey, my estrobolone needs help, let me just take a bunch of bacteria.

• 28:53Speaker 01

  The body's like, no, these are foreign, I don't want this. This is something that's trying to attack my body and it'll destroy it.

• 29:00Dr. Darshan Shah?

  Ah, okay. So, and that was the purpose of my question is like, is there probiotics someone can take to get them a better estrobolone?

• 29:06Speaker 01

  That's right.

• 29:07Dr. Darshan Shah?

  But it sounds like, sounds like-

• 29:08Speaker 01

  Everyone's trying. That's, that's your job. It's a million dollar or someone out there. It's the billion dollar question is, how can we get our body to accept probiotics or fermented, you know, a probiotic pill without it getting destroyed? So that's why I'm such a big believer. I like probiotics because again, you can throw a ton of probiotics, you'll get a little bit left, but I really love fermented foods. Because I think it's a much easier strategy for most people to consistently get probiotics into their life.

• 29:41Dr. Darshan Shah?

  So what you're saying too then is, is very important, not just to avoid the things that are destroying your gut, but also, especially if you're hitting perimenopause, add in these probiotic foods and fibers that will promote a good

• 29:54Speaker 01

  Yeah.

• 29:55Dr. Darshan Shah?

  estrobolone, right?

• 29:57Speaker 01

  And just to clarify, probiotic foods are not just kimchi and sauerkraut. It's also yogurt. It's also probiotic cottage cheese. It's also raw apple cider vinegar. It's also kombucha or kefir. So there's a lot of options now and that, once you know, okay, that's what a probiotic food is, okay, I can start incorporating it. Same thing with fiber. Think people, when I say fiber, they're like, what the hell is fiber? You know, like, it's like, is that Metamucil or like, what, how do I get fibers? People don't know that avocados are a great source of fiber. Berries are a great source of fiber. There's sweet potato, pears, chia seeds, flax seeds, things that you would probably eat anyway, but you just didn't know how good they were for you. And so you can prioritize that now.

• 30:38Speaker 01

  Because you know that that's gonna help your estrobolone, that's gonna help your overall microbiome's ability to contact your hormones and your immune system and your brain. And so you want to eat that. And let's be honest, this message is not out there because 95% of people don't eat enough fiber.

• 30:54Dr. Darshan Shah?

  Right.

• 30:54Speaker 01

  And probably 100% don't eat enough fermented foods.

• 30:58Dr. Darshan Shah?

  Exactly. I mean, I'll be honest, like, I didn't even know what fermented foods were until like 10 years ago. And I'm like, oh, that's a fermented food. Okay. You know, my mom used to always give us, what's it called? The milk that's fermented?

• 31:11Speaker 01

  Like the yogurt?

• 31:11Dr. Darshan Shah?

  Yeah, tasse, right. That's right. Yeah. So my mom gave it to us every single day.

• 31:15Speaker 01

  Yeah.

• 31:16Dr. Darshan Shah?

  And that's part of like Ayurvedic and Indian tradition. But I had no idea what it was. So when I went off to college, I stopped drinking it. And I think that was a big reason my gut got destroyed, you know?

• 31:25Speaker 01

  You were eating ultra-processed foods, probably drinking and then, you know, all of a sudden.

• 31:29Dr. Darshan Shah?

  Fermented foods at all.

• 31:30Speaker 01

  Exactly. And so for people who are like, still unfamiliar with fermented foods, one of the entry points, I think, is like a sourdough bread. Because even though you cook it and the probiotics are dead, mostly, they have an effect, a positive effect on our microbiome. It's called postbiotics. And so Indian food, it's like the idli and the dosa batter. And with, you know, American foods, it's like the sourdough bread. These are things that are cooked foods, but they have bacteria that acts as postbiotics, which can be very helpful to our gut as well.

• 32:04Dr. Darshan Shah?

  Yes.

• 32:05Speaker 01

  And so that's a great entryway to kind of getting more fiber, getting more probiotic foods. You can start with postbiotics.

• 32:10Dr. Darshan Shah?

  Yeah, and postbiotics.

• 32:12Speaker 01

  Who doesn't like sourdough?

• 32:13Dr. Darshan Shah?

  Yeah, I love sourdough. Yeah, whenever I have to eat a bread, I'll always choose sourdough. And the postbiotic, what you're saying is these are dead bacteria, but they still induce, for whatever reason, and this is why there's the science, we just need so much more science. We don't know why these postbiotic dead bacteria actually create a positive reaction in the gut to make our live bacteria there healthier.

• 32:35Speaker 01

  Well, and the postbiotic science is so exciting.

• 32:37Dr. Darshan Shah?

  Yeah.

• 32:38Speaker 01

  Because if we don't need to worry about the bacteria dying, and if you can just, you know, heat them, then we have no problems creating supplements and, you know, create products. Postbiotics are easy because they're not sensitive to heat and stress and, and, you know, they don't, who cares if they pass through our system, they're dead.

• 33:01Dr. Darshan Shah?

  Right.

• 33:02Speaker 01

  So that that area of gut health and medicine, microbiome health is really, really thriving. People are very excited because never did you think that you could put dead bacteria in something and then it would still help stimulate the gut in a, in a positive way. So we have prebiotics, we have probiotics, we have postbiotics. Prebiotics are kind of the fibers.

• 33:23Dr. Darshan Shah?

  Yes.

• 33:24Speaker 01

  Um, that are feeding the gut. Probiotics are the actual bacteria and then postbiotics are kind of the, the dead bacteria.

• 33:30Dr. Darshan Shah?

  Got it.

• 33:36Dr. Darshan Shah?

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• 34:18Dr. Darshan Shah?

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• 34:40Dr. Darshan Shah?

  Can we go into prebiotics a little bit more, the fibers? I know there's different kinds of fibers, insoluble, soluble. Can you talk to people, can you give them advice on how to think about fiber and how much they should be taking?

• 34:51Speaker 01

  Yeah, so I love soluble fiber, for example, because what it does is if you put soluble fiber in a glass of water, eventually it'll become like gel, a gel. And that gel is awesome because it slows down the food that's going through your system so that your body has more time to extract nutrients and also to extract the glucose into the cells. Like what we don't want is your food travels super fast, we don't have enough time to take out the nutrients and your blood sugar rises super fast because it's traveling so fast. So this is a way, soluble fiber is an amazing way to kind of, you know, slow things down and things like, I always think of like blueberries traveling down your, you know, GI tract that's like slowing everything down.

• 35:36Speaker 01

  You're getting a lot of time to absorb things. So it's a really, really great way to improve your diet and improve all of your insulin sensitivity, all of that stuff. Insoluble fiber is something that you cannot absorb or digest and it just kind of comes out, you know, from your stool. So insoluble fiber is also really important. It's great for if you're constipated and, but it has different effects on the body. And we need all kinds of fiber. In fact, there was a study that showed that the more diversity of food and fiber that you can get, the better your gut health. So those, it's bad news for those of us who kind of like the same breakfast, lunch and dinner every day.

• 36:17Speaker 01

  But the studies basically say you want to get as many different plant fibers as possible in a day because our body loves all the diversity. They like pre, they like, they like soluble, they like insoluble. It's, it's got to be a mix. And the goal would be, when they looked at the study, the goal is 30 different plant foods every week should be your goal.

• 36:38Dr. Darshan Shah?

  I saw that, right?

• 36:39Speaker 01

  But it's but different plant foods could be even spices.

• 36:42Dr. Darshan Shah?

  Yeah.

• 36:43Speaker 01

  So it doesn't have to be in herbs. So you know, you get the you get a mix of herbs or you get a mix of spices and you're like fifteen in. You know, so it's not, it's just encouraging people to kind of eat more real foods. The food that doesn't have fiber is basically all the ultra processed foods.

• 37:01Dr. Darshan Shah?

  Right.

• 37:01Speaker 01

  The shakes, the drive through meals, the desserts, all of the ultra processed things. They take the fiber out so you can get a big dopamine hit as soon as you have it.

• 37:10Dr. Darshan Shah?

  Yes.

• 37:11Speaker 01

  So we are eating a very fiberless diet when we're eating ultra processed.

• 37:15Dr. Darshan Shah?

  That's so true. And I think another reason to take fiber out of ultra processed foods causes the food to spoil and it loses its self life a little bit.

• 37:22Speaker 01

  Exactly.

• 37:22Dr. Darshan Shah?

  As well. So I think, um, you know, the, the, the problem is if you have a mostly ultra processed food diet, then you need to supplement with fiber.

• 37:30Speaker 01

  That's right.

• 37:31Dr. Darshan Shah?

  No matter what, right?

• 37:31Speaker 01

  That's right.

• 37:32Dr. Darshan Shah?

  Are there fiber supplements that you like that are out there?

• 37:35Speaker 01

  You know, I like to stay with food because it's so easy. One tablespoon of chia seeds is five grams.

• 37:41Dr. Darshan Shah?

  Okay.

• 37:42Speaker 01

  So you can get, just like a supplement would be five grams for a spoon, you can get that from chia seeds.

• 37:47Dr. Darshan Shah?

  Oh, that's great. And you should get about thirty grams.

• 37:50Speaker 01

  Yes, thirty grams, thirty grams a day is a goal. For example, a cheat code is like pears. Okay, they have six grams of fiber.

• 37:56Dr. Darshan Shah?

  Oh, okay.

• 37:56Speaker 01

  Again, just like taking a supplement. I'm not against supplements. Obviously, we love supplements, certain supplements. But when you can get it from food, it's so easy that it feels like, well, try to get it from food as much as possible. How, maybe you add a half avocado to your salad and you've got a whole bunch of, of, of fiber there.

• 38:15Dr. Darshan Shah?

  Right.

• 38:16Speaker 01

  So it's not that complicated if you actually know what has fiber.

• 38:21Dr. Darshan Shah?

  Yeah. So thirty grams of fiber a day is what you recommend for most women?

• 38:25Speaker 01

  Yes.

• 38:25Dr. Darshan Shah?

  And then you also recommend thirty grams of protein first thing in the morning, right?

• 38:28Speaker 01

  Yes.

• 38:29Dr. Darshan Shah?

  And so talk to us a little bit about protein and why you recommend that. And you know, a lot of women I know are like intermittent fasting, so they don't eat protein in the morning. How should we think through that?

• 38:37Speaker 01

  Okay, so first meal of your day, early in the day. The data shows over and over again, people that keep skipping meals all day long and having a meal late in the day as their only meal, OMAD, you know, one meal a day.

• 38:51Dr. Darshan Shah?

  Yep.

• 38:52Speaker 01

  Over and over, we're seeing that that's not the, it's not good for our insulin sensitivity. It's not good for inflammation levels. Our body is designed to eat during daylight hours. And even if we have jobs that are nocturnal jobs for our whole lives, our body still works on a day and night cycle. And so I always encourage people, intermittent fasting is great, but do it the other way around. Eat an early dinner and then fast the three hours before bed.

• 39:21Dr. Darshan Shah?

  Right.

• 39:22Speaker 01

  If you want to fast, do that way.

• 39:23Dr. Darshan Shah?

  Yeah.

• 39:24Speaker 01

  The other way is not necessarily beneficial. You want to start to have, it doesn't have to be, I never even like, you know, when I'm, we're traveling. I'm not eating rolling out of bed.

• 39:33Dr. Darshan Shah?

  No.

• 39:34Speaker 01

  It's whenever you would have your first meal is when you actually add the protein in. And bonus points in when it's early in the day, like it needs to be, this whole thing of eating late dinner, eight o'clock is your only meal is just not good for you.

• 39:48Dr. Darshan Shah?

  Yep, I agree.

• 39:49Speaker 01

  So eating protein in the beginning of the day, the things it does is that it lowers your cravings. It stabilizes your mood, your focus, and it also sets you up for getting more protein throughout the day. Because when you start off with protein in the beginning of the day, you're much more likely to get more total protein at the end of the day. And the reason I chose thirty grams of protein in the morning is not only because of all the studies that show the benefit, is because I think the total protein goals for people is very variable. Your gender, your age, your activity level, you know, how much, you can't really tell every single woman that she needs to get a hundred grams of protein. That doesn't make sense, especially we know over and over again that people have different needs at different points in their life.

• 40:32Speaker 01

  Uh, if they're active versus sedentary, a sedentary individual needs much less protein than someone who's bodybuilding. So, um, that's why I chose to speak about the first meal of the day. Because I can definitely know for sure that no matter what your total protein goals are, that getting that thirty grams in the beginning of the day is going to set you up for success.

• 40:53Dr. Darshan Shah?

  I love that. It just simplifies it because I think to your point, we've been told for like the last five years or so by many people in the health and wellness circles that it's one gram per pound of body weight a day. And I think when women and men do the math, they're just like, well, that there's no way I'm gonna get that. I'm just, I'm just gonna give up, you know? And so I think, right?

• 41:13Speaker 01

  And that's too much for most, for many people, it's too much.

• 41:16Dr. Darshan Shah?

  Right.

• 41:17Speaker 01

  And it's too overwhelming and they're not that active. You know, you're, you have to weight train along with your protein. So yes, it's amazing to get protein, but if you're not constantly, you know, consistently three times a week, weight training, then at least two times a week, two to three times a week, you're not gonna get the benefits of that.

• 41:36Dr. Darshan Shah?

  Exactly. And so, yeah. And then I think when you put it that way, that you just do it first thing in the morning, you got it done, number one. Number two, it sets you up for better blood glucose regulation and less, better mood, right? And glucose regulation, also satiety for the rest of the day as well.

• 41:52Speaker 01

  That's right.

• 41:52Dr. Darshan Shah?

  And so there's so many benefits. If you just simplify, you just get 30 grams first thing in the day.

• 41:57Speaker 01

  It's, it's the easiest way to improve your health in a short period of time.

• 42:02Dr. Darshan Shah?

  Yeah, yeah. I remember like, you know, about 12 years ago, I went through my health journey. That was one of the first things I did was add a lot of protein to my first. I was skipping my first meal and instead I went to a high protein meal with some vegetables and it made a lot of difference. Also helped my gut health, too.

• 42:17Speaker 01

  Yeah, it does help gut. It is a very big part of gut health, which is why I kind of put it in that same category, gut, hormone, brain, health, 3033. And the reason I said 3033 is like, we can't tell as doctors, we can't tell patients like what diet to eat. I know there are doctors who do that, but in general, there's so many different ways to eat that can be very healthy. A Mediterranean, you can be Mediterranean with red meat, you can be Mediterranean vegetarian, you could be Mediterranean with fish. And so giving them a framework rather than, hey, this is the diet that you have to follow, makes much more sense to me. And also diets to me. Because I've grown up as a woman in America, all it means is getting smaller

• 43:01Dr. Darshan Shah?

  Yeah.

• 43:02Speaker 01

  and shrinking away because that's what diets have always been. And so really concentrating on how to build the microbiome, build, get stronger is something I think is a mindset shift.

• 43:13Dr. Darshan Shah?

  Yes, exactly. And I always try to make people have the realization that when you're losing weight, it could be a net negative if you're losing muscle too. Like you have to build muscle while you're losing weight.

• 43:23Speaker 01

  Yeah, like with GLP-1s, you know, we talk about that all the time. One of the biggest issues is the loss of muscle when people are taking them and losing weight, but not weight training and not eating adequate protein. So it's more important than ever to really prioritize that.

• 43:37Dr. Darshan Shah?

  Right. You know, you like mentioned a few times that you spent a lot of time on the treadmill and running, and so did I because we were talking.

• 43:44Speaker 01

  That's what we knew. Yeah.

• 43:45Dr. Darshan Shah?

  Calories in, calories out. You eat a Snickers bar, then you burn it off an hour in the treadmill, kind of a thing.

• 43:51Speaker 01

  I literally, that's how I would think. Yeah.

• 43:53Dr. Darshan Shah?

  I would think the same exact way. And now what is your advice to women as far as how should they construct their exercise routine?

• 44:00Speaker 01

  So I was the patient and I'm the doctor because I was that person in my mid 30s. And I thought, okay, I've had kids. I'm trying to like get back into shape. Of course, it was like, you know, everybody's pressuring you. Like you feel all the pressure of like, you know, getting back to, you know, fit, fitness right after having a baby. And so what I would do is I wouldn't sleep because you had young kids. And then I would like rush to a class, a high intensity workout, one of those like a gym, like chain gyms. And then I would get coffee, a big huge thing of coffee. And then I would go to work, go to clinic without any food with me.

• 44:44Speaker 01

  And I would just go there and start seeing patients. And then around 10 o'clock. I would start to crash and I would be super hungry. So I would go in the back room where all all the snacks were and take a few snacks and it would hold me over to like three o'clock where I would like just go crazy, find some unhealthy food. And then I would go home again and I would be like, I can't go to bed because this is like, you know, I gotta, I gotta work. I gotta be productive. And so I would like skimp on sleep, stay up really late, eat snacks. And I would be like, that's okay, because I worked out so hard. And I was really putting myself in this like cycle. And at the end of it, I was like, I

• 45:25Speaker 01

  don't feel good. I look terrible because I was like gaining weight around the midsection. I was, I was fatigued all the time. And I didn't love the work that I was doing. I like hated the person in the mirror. I literally was like, what am I doing? This is, I don't like the work I'm doing. I don't like how I feel. I don't like how I look. And it also affects your mood. Like I was very irritable. My stress levels were out of control. So then I thought to myself, I have to do something, but I didn't do anything. And then I got into this life threatening car accident because I was rushing out of clinic and I was running late to pick up the kids and the, my partners were like,

• 46:06Speaker 01

  hey, we need a quick meeting. And I couldn't say no, because I was feeling like, oh, I can't say no. And I ended up getting into a really bad car accident going to get them. And that was my wake up call. So I basically said, you know, I need to do something different. I clearly have not done a great job, not working for me. So that's a long way to answer your question that I started first by really reevaluating that high intensity workout that was every single day of the week for me, without having proper recovery or sleep. And I thought to myself, you know what, my cortisol is just out of control, one of the biggest reasons. So I started to go for outdoor hikes and walks.

• 46:49Speaker 01

  And I started to notice that that was a great recovery because recovery to me cannot be sitting on a couch.

• 46:54Dr. Darshan Shah?

  No.

• 46:56Speaker 01

  I was like, okay, you know what, on my recovery days, I'm gonna go for a sunny walk or, you know, a hike. And I started to see my mood starting to get better. And I started to notice, wow, I'm like wanting more healthier things. I'm not craving as many snacks because you know, you do that high intensity workout, you're like riled up. Then you're craving unhealthy things all day.

• 47:14Dr. Darshan Shah?

  Of course, yeah.

• 47:14Speaker 01

  So for women, especially in that age range between, you know, usually it's your mid thirties into your forties and fifties. It's very tempting to go on that paradigm of more is better. More is more intense is al- always intense. And then shifting to a, hey, maybe I need recovery to, you know, maybe I need more sleep. Maybe I wanna um not do high intensity every single day. And I realize now that the best kind of training for that time of life is to stay on the edges. So you want walking and kind of like something that you love, whatever it is that you can do till you're old. You know, the people do things for twenty five years, like that kind of stuff.

• 47:57Speaker 01

  And then the edge, other edge is sprints, like, you know, high intensity. And in between, you can have your strength training or whatever, but you really want all uh like the edges more than you want that middle zone.

• 48:09Dr. Darshan Shah?

  Yeah, yeah.

• 48:11Speaker 01

  For a for a daily.

• 48:12Dr. Darshan Shah?

  Makes total sense, yeah, so to just rethink your workout routine, do workouts smarter, not harder.

• 48:18Speaker 01

  That's right.

• 48:19Dr. Darshan Shah?

  And go with, like you said, like the strength training when you're in the gym, but then have active recovery workouts as well, right?

• 48:28Speaker 01

  The active recovery ended up being, what I realized is that you have to pick a workout that you actually look forward to.

• 48:38Speaker 01

  And love, otherwise, if you're in a workout class or doing something where you're checking your like watch or phone every like couple of minutes and you're like, oh shoot, it's only been five minutes. I thought it was like thirty, you know, that means you're probably in the wrong workout, at least for that longevity workout.

• 48:56Dr. Darshan Shah?

  Yeah.

• 48:56Speaker 01

  You need to find something that feels so good that you actually look forward to it. And that's the right like basis of your workout plan. And then you can add in sprints, you can add in weight training, but I always like, and for some people it is weight training.

• 49:10Dr. Darshan Shah?

  Yes.

• 49:10Speaker 01

  Uh, but I always like to emphasize that I change my whole view. Exercise is not a calorie burn. It's literally, we are meant to move and there are some movements that feel really refreshing and cortisol reducing. And those are the movements that you want to have at least four, four times a week.

• 49:28Dr. Darshan Shah?

  Yeah. I saw a study that was just published in this, in the media now, that short intense bursts of either cardiovascular exercise, even strength exercises done for like a minimum amount of time is just as effective as long drawn out workups.

• 49:46Speaker 01

  So it's like, um, one, in that study,

• 49:49Dr. Darshan Shah?

  Yeah.

• 49:49Speaker 01

  It's like one minute of high intensity is equal to almost eight minutes of

• 49:55Dr. Darshan Shah?

  Right.

• 49:55Speaker 01

  Kind of medium intensity or low intensity. There's a lot of flaws with that study, but and, and we don't want to tell people, I don't want to tell people that, especially in midlife, that they should do the high intensity every day because again, that's what happened to me. But really having at least one day a week where you put yourself on a treadmill or bike or run up a hill where you're getting to eighty-five percent of your heart rate, that is something I think everybody in midlife, not just women, but all people in their life should be doing because it's a muscle, our heart's a muscle. You need that muscle to actually like lift weights to be able to get stronger. So if you're never ever going

• 50:36Speaker 01

  to eighty-five percent of your max heart rate, you're never really pushing your heart to do anything more than, you know, just pump. So you want to make it so strong that as you get older, it's uh, stays that strong. And it, you know, the baseline is really, really strong. So getting one sprint workout a week is really important for that. And so that data is really great to know because in midlife, I think especially men and women. When you can do the longevity kind of training that you love, and then mix it up with bursts of intense workout, I think that's a really, really great way to mix it up. And then the recovery, like the yoga, the like,

• 51:18Speaker 01

  all of the things that you need to kind of break up those intense workouts you should do.

• 51:25Dr. Darshan Shah?

  Right, right. Okay, so we got exercise. We have your gut health with the pre, post, and fibers and biotics. And then we talked a lot about diet and nutrition just in general. And say we're doing all of those things, yet hormones are still going to decline, right? And when do you start talking about hormone replacement therapy? If you do, and how should women think about that?

• 51:51Speaker 01

  Yeah, that's a great question because I think all of us, most of us women, we're kind of in that gray zone. A lot of us are like, you know, you have some of the symptoms, but you don't know if it's if it's perimenopause or am I just tired? Did I just not get a good night's sleep? Or is maybe it's like vitamin D deficiency? So it's very gray, whether you are in that state where you actually need hormones or whether you're in a state where you're just kind of tired or, you know. So the first step, I think for all women, is to change their nutrition and lifestyle to see what goes away with that. That's the foundation. And then get your labs checked because you know and I know, all the time you'll check someone's labs and you'll be like, well, your vitamin D deficient, 80% of women in this age group are.

• 52:35Speaker 01

  Oh, you know, your, your iron is low.

• 52:38Dr. Darshan Shah?

  Right.

• 52:39Speaker 01

  All kinds of things come up that people don't realize are happening that are contributing.

• 52:43Dr. Darshan Shah?

  I would say at least 50% of the women I check their iron, which we measure ferritin levels. That's the important number for you to get measured is ferritin. In fact, it was so many women have a problem with this and even men, that we added it to our normal baseline that we check on everybody now because it's that important and people feel so much better just by taking a little bit of extra iron.

• 53:02Speaker 01

  Yeah, the iron thing is such a great point. I think the numbers are like, you know, forty percent, fifty percent. So yeah, this is very, very important to not only change your diet and lifestyle, but also um check your labs. Not, I don't necessarily think that everybody needs hormone labs per se. It's more that you want to rule out all of the other causes. Because unfortunately, perimenopause doesn't have a lab test per se. It's like, once you're either at the extremes, um you have no hormones or you have like complete excess. That's the only way you would know something was off. But usually perimenopause, they're just kind of within the range, but like fluctuating and a little closer. So getting your diet and lifestyle in check.

• 53:45Speaker 01

  Like most of us, when you look back at the foundation basics, you're like, okay, yeah, I probably need to go back to the foundation and like, for a month, you know, go, go back to doing all the things, thirty, thirty-three. Go do your uh workouts, go get your sunlight, get your sleep. Hang out with some positive people and uh and then you'll see some of this will go away. Then you get your lab work done, which can be at the same time. Get your lab work done, fix your deficiencies, take that vitamin D supplement, you know, whatever you need to get there. And then you're left with, especially in that perimenopausal range. Are you, do you have osteopenia, osteoporosis? Do you have hot flashes and night sweats? Do you have vaginal dryness or discomfort?

• 54:30Speaker 01

  Those three things, clear cut, slam dunk, hormone therapy.

• 54:34Dr. Darshan Shah?

  Yeah.

• 54:34Speaker 01

  As if you don't have a contraindication.

• 54:36Dr. Darshan Shah?

  Got it. Can you say those three again?

• 54:38Speaker 01

  So osteoporosis.

• 54:40Dr. Darshan Shah?

  Mm-hmm.

• 54:40Speaker 01

  Uh hot flashes or night sweats.

• 54:42Dr. Darshan Shah?

  Mm-hmm.

• 54:42Speaker 01

  And, and usually they were like be like moderate to severe hot flashes or night sweats.

• 54:48Dr. Darshan Shah?

  Okay.

• 54:48Speaker 01

  And vaginal dryness or discomfort.

• 54:50Dr. Darshan Shah?

  Got it. So those last two, I mean, you could feel those, but how does someone know if they have osteopenia or not?

• 54:55Speaker 01

  You can get a DEXA, DEXA scan.

• 54:58Dr. Darshan Shah?

  And so what age should every woman think about getting a DEXA scan?

• 55:01Speaker 01

  It's so pathetic. In the US, people get it way too late. They get it in their sixties and seventies. You need to get it at baseline. We should be getting one on all women. At, you know, before they even enter perimenopause.

• 55:14Dr. Darshan Shah?

  Yeah.

• 55:14Speaker 01

  So you're, you need to be getting it in your thirties.

• 55:18Dr. Darshan Shah?

  Right. Exactly.

• 55:19Speaker 01

  Know what your baseline is. Do you do that for patients?

• 55:21Dr. Darshan Shah?

  Yeah. And so the other, the other thing that I always say is, you know, it's such a quick, easy test. It doesn't, you can get them now for like thirty dollars.

• 55:27Speaker 01

  Yeah.

• 55:28Dr. Darshan Shah?

  And it takes like, you know, a few minutes to do is extremely low radiation. Why not get one every year?

• 55:33Speaker 01

  Yeah.

• 55:34Dr. Darshan Shah?

  From starting at the age of like thirty.

• 55:36Speaker 01

  Yeah.

• 55:36Dr. Darshan Shah?

  And then just keep going.

• 55:37Speaker 01

  Yeah.

• 55:37Dr. Darshan Shah?

  It gives you such incredible data, not just about your bones, but also your visceral fat, which is a huge problem that sneaks up on people. Total fat mass and skeletal muscle mass, like four incredibly important numbers everyone needs to know about themselves.

• 55:51Speaker 01

  And it's easy, it's easy, but it's never prescribed.

• 55:54Dr. Darshan Shah?

  Never, no.

• 55:55Speaker 01

  It's so crazy.

• 55:56Dr. Darshan Shah?

  Insurance doesn't cover it.

• 55:57Speaker 01

  I remember there was this like truck that was outside our gym one day.

• 56:00Dr. Darshan Shah?

  Yeah.

• 56:00Speaker 01

  And it was like, I was like, oh, what's this? And they're like, oh, this is like a scan to see your body fat and, you know, they didn't say for osteoporosis, obviously, but the report it gives is your lean muscle mass, your visceral fat and your bone density. And I was like, this is the best thing ever.

• 56:18Dr. Darshan Shah?

  Yeah.

• 56:18Speaker 01

  Like, everybody should be doing this all the time.

• 56:20Dr. Darshan Shah?

  It's so funny, because in medical school, I didn't even know this thing existed.

• 56:23Speaker 01

  I know.

• 56:23Dr. Darshan Shah?

  Even in residency and as a doctor in training, no one ever talked about this. And then, you know, you find out about it later and you're like, this is the best test we have available medicine and no one's using it.

• 56:33Speaker 01

  It's so true. I mean, who doesn't need to know their visceral fat, their lean muscle mass, their, you know,

• 56:41Dr. Darshan Shah?

  Every human should know that.

• 56:41Speaker 01

  Exactly. And with bone density, it's really tough because it's exactly what you said. You can't feel that you're getting to osteopenia or osteoporosis unless you break a bone and then you figure it out because it looks porous on, you know, you can tell from.

• 56:55Dr. Darshan Shah?

  By then it's too late, right?

• 56:57Speaker 01

  Yes.

• 56:57Dr. Darshan Shah?

  Exactly.

• 56:57Speaker 01

  It's, you're trying to re-mineralize something that's already kind of brittle.

• 57:01Dr. Darshan Shah?

  Right, right. So those three conditions means hormone therapy.

• 57:06Speaker 01

  Yes, it means like a, kind of like a slam dunk.

• 57:08Dr. Darshan Shah?

  Right.

• 57:08Speaker 01

  So the other indications are still up for debate. So there is a group of people, you know, lots of experts that say, you know what? We don't have the definitive data, but it's protective for the brain, it's protective for the heart, but we don't have the definitive data yet. So you can go by kind of, I wouldn't do it just for the soft symptoms, meaning like it's not going to change your body fat levels right away. It's not going to help you lose weight. It's not going to be the panacea for your brain. You know, we don't have. Those long-term studies yet. We do have inklings that this is going to help because we have estrogen receptors in our brain and our heart, but those are kind of the softer indications. And then it's just, I feel like then it's a decision between you and your doctor.

• 57:52Dr. Darshan Shah?

  Yes.

• 57:53Speaker 01

  Do you want to try it? Do you want to get to that? You know, give it a shot? No? What are the risks? What are the benefits? That kind of discussion. So I think the problem is you can start to have symptoms as early as 35 and you can go into your 40s and all the way into your late 40s and you might not really get these severe symptoms of hot flashes or night sweats, the severe type, until very late into that. And so that can be a point where you can transition to hormone therapy or even earlier. Some people say earlier the better, but I think it's a discussion with your doctor. I I'm not convinced that it's the panacea. I mean, it's not the panacea, but I'm not convinced that every single person should be on it and should be on it early. I think it's a discussion with your doctor.

• 58:38Speaker 01

  Like I've had that discussion with my doctor. And what basically what we said is, hey, I don't have this three indications, like the top indications. I still have normal cycles. I feel like that lifestyle factors are helping. So maybe I, you know, ride it out for a couple of weeks. I'm not opposed to it. I probably will do it. But and like, you can use progesterone here and there if you're having sleep issues and anxiety issues. You don't have to do a full hormone panel. So or full hormone therapy in the beginning. You can start with just like a progesterone. I love progesterone for everybody who has sleep issues and anxiety or especially around that perimenopausal age. So it's a very nuanced answer from me.

• 59:19Dr. Darshan Shah?

  Yeah, that's excellent. So just to summarize for everyone listening, start with the lifestyle things that you talk about in your book. So if you're going through perimen- well, start even before. Get your scans done, get your blood work done, and really start building up a reserve is what we talked about earlier of- Skeletal muscle mass, VO2 max, bone density, gut health, all that should be built up prior.

• 59:40Speaker 01

  That's right.

• 59:40Dr. Darshan Shah?

  As you're approaching menopause, specifically after the age of 30, you start doing testing like blood tests and DEXA scan. Once you're getting to menopausal, really look into all the things that you talk about, optimizing your gut health, optimizing your workout routine, making changes to really start proactively addressing what's going to be happening as hormones inevitably decline for every human on the planet, right? And then, once you get there, use these three big indications as the real indications that you should really start considering using hormones and have a risk versus benefit discussion with your doctor, right? But also realize you don't have to go on all three hormones all at once. You can use progesterone for sleep issues.

• 1:00:24Dr. Darshan Shah?

  You can use, like even vaginal estrogen for vaginal dryness.

• 1:00:27Speaker 01

  Or like testosterone if your levels are very low. You don't have to do all of all or nothing.

• 1:00:32Dr. Darshan Shah?

  Right, it's not all or nothing, right? Yeah, you can step into it.

• 1:00:34Speaker 01

  You summed it up so well.

• 1:00:36Dr. Darshan Shah?

  I think it's really important for women to have like a pathway that they can follow through this entire journey. And you know, you have this incredible guide that you put together in your book, and I think women can be extremely well educated on this whole journey and make, have a completely different experience rather than just like stumbling through it with bad advice.

• 1:00:57Speaker 01

  That's really why I'm doing it. We need to do everything we can to advance the care of women. It's about time that we do that, and I think doing anything, all of our friends that are doing different things, different realms of trying to advance the care of women is so, so important.

• 1:01:15Dr. Darshan Shah?

  Exactly, I fully agree, and it needs to happen because at the end of the day, half the population, right? We need to make sure that they're taken care of.

• 1:01:24Speaker 01

  But also, it's like half the population that's not gotten care. It's not about like, oh, we want, like, it's not about giving them more care, it's about even like getting to even half the care that their male counterpart might get.

• 1:01:38Dr. Darshan Shah?

  Right, exactly. And to your point, most of the studies have been done on men and everything. And so, you know, we can go down rabbit holes of cardiovascular disease, go down the rabbit hole of even cancer. There's just not enough research on women. I feel that the treatments that we're using right now, I'll use cardiovascular disease as an example. You know, right now cardiovascular disease, right, in the mainstream medical world is measure cholesterol levels. If they're too high, give statins, right?

• 1:02:06Speaker 01

  Yes.

• 1:02:07Dr. Darshan Shah?

  And

• 1:02:08Speaker 01

  Yeah, still like that. It hasn't changed in like fifty years.

• 1:02:11Dr. Darshan Shah?

  Fifty years, right. But thank goodness, like now people are getting more educated. They understand cardiovascular disease is multifactorial. But also like in men, it's large vessel diseases with large occlusions of their main arteries, whereas in women, it's more small vessel disease. And that's treated completely differently.

• 1:02:29Speaker 01

  Completely differently. And they present differently.

• 1:02:31Dr. Darshan Shah?

  Right.

• 1:02:32Speaker 01

  When women have a heart attack, they present very differently than men and they get missed fifty percent of the time. Because people don't even know how to diagnose the small vessel kind of, when they're having a heart attack. So these small vessels are either blocked or contracted. They feel different

• 1:02:49Dr. Darshan Shah?

  Right.

• 1:02:50Speaker 01

  to the woman. So she might feel nausea. She might feel fatigue and it might not be crushing chest pain to the left arm.

• 1:02:59Dr. Darshan Shah?

  Right.

• 1:02:59Speaker 01

  And so we need to recognize, I mean, we're, people are dying because we can't recognize that they're having a heart attack.

• 1:03:06Dr. Darshan Shah?

  Yeah, the number of women that come in, you know, with some of the more traditional female symptoms of heart attacks, like anxiety or nausea or faintness or, you know, brain fog or confusion, like these, these symptoms get ignored and they usually get sent home on like an anti-anxiety medication.

• 1:03:21Speaker 01

  That's right.

• 1:03:22Dr. Darshan Shah?

  And they end up still having a heart attack at home because of the small vessel disease. And there needs to be a total rethinking about how we even train our medical students on like, these are the signs of a heart attack.

• 1:03:32Speaker 01

  Yeah. And my, my other reason for even talking about this is I, as I started to move into my forties, I started to see this societal messaging that was like, okay, women after, you know, when, when you're not, if, once you're out of your twenties, you're kind of done, you're like on your decline. But I kept seeing around me, and you know this too, because we have lots of common friends. Women are thriving in their forties, fifties and sixties and they're leaders and they're doing amazing things. They're writing books, they're on stages. They're discovering things, they're leading companies. And I was like, I don't really think that that's like the decline.

• 1:04:10Dr. Darshan Shah?

  Right.

• 1:04:11Speaker 01

  Maybe in, you know, for fashion teen magazines, it's, it's, it's done. But like, there's whole other world out there. And that plays out in, for thousands of years. Women for thousands of years have, are the matriarchs of the family. They are taking care of their grandchildren. They're taking care of their communities. They are the beacons of like wisdom, right? So we are supposed to be thriving in these years. And I think that narrative has to change a little bit.

• 1:04:38Dr. Darshan Shah?

  Absolutely. When does your book come out?

• 1:04:41Speaker 01

  February 24th.

• 1:04:42Dr. Darshan Shah?

  Great.

• 1:04:42Speaker 01

  Twenty twenty six.

• 1:04:43Dr. Darshan Shah?

  Of twenty twenty six, since the name is?

• 1:04:45Speaker 01

  Hormone Havoc.

• 1:04:46Dr. Darshan Shah?

  Hormone Havoc. What else will women learn besides the things that we talked about?

• 1:04:50Speaker 01

  So there's recipes in there, there's meal plans in there. Because whenever you talk about fiber and these like new concepts, really, for a lot of people, fermented foods and fiber, most people are like, that I've actually tested this on, have had amazing results, but their number one question is, can you just like, show me an example of this? How does that work? Like, maybe show me breakfasts that have thirty grams of protein. Maybe give me some ideas, quick recipes. So we did that in the book. We really expanded on what it would look like if you actually did this. And so that's included as well as the science behind why we would want to do it. And so it's the exercise, the nutrition, we talk about hormones, we talk about mindset,

• 1:05:33Speaker 01

  community, you know, the power of friendships, all of that's in there. A handbook.

• 1:05:38Dr. Darshan Shah?

  It's gonna be an incredible, incredible book. So I really am excited for it to come out for you. I hope all of our listeners go online and buy it. Where can they buy it?

• 1:05:48Speaker 01

  Uh, anywhere books are sold. So get it from your local bookshop if you can, because it's so sad. All these local bookstores that we used to see when we were kids are kind of not around. But places, places like bookshop.org, they actually give a portion of their proceeds to local bookstores. So these are all great places. And of course, the traditional places you buy books, Target, Barnes and Nobles, Amazon, all of those places too.

• 1:06:10Dr. Darshan Shah?

  Oh, fantastic. And where else can people find you? And you're, you have such a huge presence on the internet, but just tell everybody.

• 1:06:15Speaker 01

  Yeah, so I'm on social, on Instagram at Dr. Amy Shah. At, that's Instagram and TikTok. And then I'm at amymdwellness.com, uh, website.

• 1:06:26Dr. Darshan Shah?

  Thank you for, thank you so much for everything. And I can't wait to see your book and I'm going to buy it for a lot of my friends. I'm going to read it myself because I find I learn a lot from my patients I can talk to as well.

• 1:06:36Speaker 01

  I'm so happy to hear that. Thanks for having me.

• 1:06:38Dr. Darshan Shah?

  Yep. So good to have you. Thank you.

• 1:06:44Dr. Darshan Shah?

  What a fantastic episode with Dr. Amy Shah. Here are my top five takeaways. Number one, peri-menopause symptoms are signals, not just something to endure. Brain fog, weight gain, and mood changes are signs that your body needs a nutritional and metabolic strategy, not just willpower. Number two, the gut is a control center for hormones, mood, and immunity. Gut bacteria directly influence estrogen metabolism, inflammation, brain chemistry, and immune function. Number three, protein timing matters more than most women think. 30 grams of protein at breakfast helps preserve muscle, stabilize insulin levels, and reduce your cravings all day.

• 1:07:28Dr. Darshan Shah?

  Number four, fiber diversity is essential for hormone balance. 30 grams of fiber daily feeds gut microbiome that regulate inflammation, mood, and hormone signaling. And finally, number five, probiotic foods work better than supplements. Fermented foods build gut diversity and reduce inflammation more effectively than probiotic pills. Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational

• 1:08:09Dr. Darshan Shah?

  purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or are on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.