Pod Insights Extend Podcast with Darshan Shah, MD 89. Sara Szal, MD: Why 80% of Women Experience Brain Fog in Perimenopause (And How to Fix It) About this episode What if the depression, brain fog, and weight gain you're experiencing isn't "just aging" but actually a treatable hormone deficiency? In this episode of Extend, I sit down with Sara Szal, MD, a Harvard-trained gynecologist who has revolutionized how we approach women's health.
We dive into why 80% of women experience brain dysfunction during menopause, the shocking failure of conventional medicine's "birth control and antidepressants" approach, and Dr. Sara's "hormone therapy plus" model. Whether you're 35 and starting to notice changes or 65 wondering if you've "missed the boat," this conversation will transform how you think about aging as a woman.
Sara Szal, MD is a Harvard-trained gynecologist, New York Times bestselling author of four books including "The Hormone Cure," and a leading authority on hormone optimization. With over 25 years of experience treating 25,000+ patients, she specializes in root cause analysis and personalized protocols for peak performance.
We Also Discuss:
The 100+ Symptoms of Perimenopause Most Doctors Don't Recognize
Why Your Doctor Says Hormone Testing Is "Useless" (And Why They're Wrong)
Bioidentical vs. Synthetic Hormones: What You Need to Know
The 80% of Women Who Experience Cerebral Hypometabolism During Menopause
Why FSH Levels Predict Alzheimer's Risk in Women
Testosterone for Women: When It Helps and When It Hurts
The "Cheating Nature" Argument Against Hormone Therapy (Debunked)
Mitochondrial Health: The Key to Reversing Biological Age
Hot vs. Cold Therapy for Mitochondrial Optimization
Thank You for Our Sponsors:
Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/
NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/
Learn more about Dr. Shah:
Website: https://www.drshah.com/
Clinic: https://www.next-health.com/
Instagram: https://www.instagram.com/darshanshahmd/
Learn more about Sara Szal, MD:
Website:https://www.saragottfriedmd.com/
Instagram:https://www.instagram.com/saragottfriedmd/
Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:03 Dr. 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.
0:49 Dr. Darshan Shah? 80% of women notice that their brain is slowing down during menopause, but most doctors are dismissing it as normal aging. Millions of women are told that their symptoms of brain fog, waking, and crushing fatigue are just part of getting older. In this episode, I'm going to break this down with Dr. Sarah Godfrey. She's transformed her own health crisis into a mission to revolutionize women's healthcare. We explore why conventional medicine is failing women in perimenopause, and how studies like the Women's Health Initiative created decades of fear around hormone therapy. She has a comprehensive approach that goes far beyond prescribing estrogen and progesterone, and she's going to give us a look under the hood of what that approach is today. Dr. Sarah Godfrey is a Harvard-trained gynecologist.
1:32 Dr. Darshan Shah? She's a New York Times bestselling author of four books, including The Hormone Cure, and she's a leading authority on precision medicine and hormone optimization. She has over 25 years of experience treating 25,000-plus patients. She specializes in root cause analysis and personalized protocols that help women reclaim their vitality during perimenopause and beyond. Welcome, my friend, Dr. Sarah Saul-Godfrey, to the Extend Podcast. I can't wait for you to hear everything that I've learned from her today.
2:04 Dr. Darshan Shah? Dr. Sarasal, thank you so much for joining me on the Extend Podcast. It's such a pleasure to have you here.
2:10 Speaker 01 I'm so happy to be with you.
2:12 Dr. Darshan Shah? You know, one thing I've noticed about you is that every time I see you, I talk to you, no matter how busy we are, you're always so present. And it's so inspiring to me just to be around you in that present state. How do you do that?
2:27 Speaker 01 Well, I would say the same is true of you.
2:29 Dr. Darshan Shah? Oh, thank you.
2:30 Speaker 01 You have deep presence. Yeah, how do you, how do you architect that? I think it, for me, it happens. Like, it's just part of being awake.
2:39 Dr. Darshan Shah? Yeah.
2:40 Speaker 01 You know, I had this experience, I'm curious if you had this too, at medical school, where I could feel my presence dimming, kind of under the weight of so much training.
2:50 Dr. Darshan Shah? Yeah.
2:50 Speaker 01 And so I would go from Boston to Kowloon at least once a quarter to detox.
2:57 Dr. Darshan Shah? Oh, wow.
2:58 Speaker 01 And to just hear my voice again. So I would imagine it's, it's part of the contemplative practice that I've had throughout my life, starting about age five with yoga and with meditation.
3:11 Dr. Darshan Shah? Age five?
3:12 Speaker 01 Yes, I had a great grandmother who taught me yoga.
3:15 Dr. Darshan Shah? Oh, that's incredible. Yeah, so it was kind of something that you brought with you from childhood to go back to your inner self in a kind of a routine fashion, almost, as part of your routine and your habits to do this.
3:28 Speaker 01 It's a daily practice. And I feel like it's so important for patient care.
3:34 Dr. Darshan Shah? Yeah.
3:34 Speaker 01 You know, to, to be so grounded in who you are and also to have that boundary with another human, to be able to, to motivate and connect to their innate healing.
3:48 Dr. Darshan Shah? Right.
3:48 Speaker 01 So I think presence is a tool.
3:52 Dr. Darshan Shah? Yeah, absolutely. How do you bring yourself there now?
3:56 Speaker 01 Morning practice.
3:57 Dr. Darshan Shah? Morning practice.
3:58 Speaker 01 So, you know, you were, we were having a conversation about some of the systems you have in your life.
4:04 Dr. Darshan Shah? Yeah.
4:05 Speaker 01 And you were talking about 10 minutes of strength training every morning.
4:09 Dr. Darshan Shah? Yes.
4:09 Speaker 01 And I have something similar. I do the same thing for my heart and for my sense of mission and who I want to be in the world. So I try to start each morning with, you know, some sort of sacred reading and reflection before I check my iPhone and before I kind of dive into other people's agendas. I try to hear that voice and just, you know, that touchstone inside.
4:35 Dr. Darshan Shah? You know, I think that's so important. I was just talking to the podcast producer before we started talking about, your morning is really your sacred time when you actually can spend time on yourself before life kind of takes over, right? And then anything after the morning, for me, there's a 50/50 chance it's going to happen, right?
4:52 Speaker 01 Right.
4:53 Dr. Darshan Shah? And I feel like the more I can kind of pack into a morning routine, the more I kind of stay in the mindset of getting those things done. So for me, it's, you know, exercise, it's also reading, it's also some gratitude practice as well. What other things do you put into your morning routine? I wasn't going to go here this quickly with you, but I'm so glad you brought it up.
5:13 Speaker 01 I love this question. So, you know, I hope that we get to riff during our entire session together. You know, one of the things that I used to start my day with was shining my love lights on my children.
5:26 Dr. Darshan Shah? Oh.
5:27 Speaker 01 And I always tried to center that as a morning practice. Now my kids have left the house. One of them is off of payroll, at least until she goes to graduate school. The other one is off to college. She's got into USC, so I'm going to be visiting you a lot.
5:45 Dr. Darshan Shah? You're going to be here a lot.
5:46 Speaker 01 Yes.
5:46 Dr. Darshan Shah? Fantastic.
5:47 Speaker 01 So. Now that I don't have my children to shine my love lights on, there's a way that I want to shine my love lights on the people that I serve. So that's a big part of how I start my day. You know, I try to design things so I sleep well. And I've got that full complement of energy and mitochondrial function that I can direct toward, how can I be the best version of myself today? How can I let these kind of petty little things that happen to us, the exigencies of life, not get in the way of this bigger, more committed purpose? So, you know, right now I'm reading Rick Rubin's book, The Creative Act.
6:26 Dr. Darshan Shah? Right.
6:26 Speaker 01 I find that so helpful in terms of staying on task with creativity and purpose. And I often practice yoga first thing in the morning. I'm going to be teaching yoga next month at a retreat. And so I'm preparing my practices and apex poses for that. And I've got a new partner that you know, Brad Jacobs. And so I shine my love lights on him.
6:51 Dr. Darshan Shah? I love that. Shining your love lights, I've not heard that before. And
6:57 Speaker 01 I heard about it on Oprah.
6:58 Dr. Darshan Shah? Oh, it's incredible.
6:59 Speaker 01 So long ago, my kids are young.
7:03 Dr. Darshan Shah? Unpack that a little bit for me.
7:04 Speaker 01 You can steal it.
7:05 Dr. Darshan Shah? I'm going to, I'm going to shine my love lights tomorrow morning on my kids.
7:09 Speaker 01 Yeah, well, I feel like there's a, there's a way that we, when I was in my 30s and I was having children, you know, I was working full time. I was seeing 30 to 40 patients a day. This is sort of before I started turning left and taking care of patients in a different way. And I was, it was a lot. It was a lot for my system. I was stressed a lot of the time. I was stress eating. I wasn't, you know, doing some of those things that fill your tank. And so I realized that my most important job in my 30s.
7:46 Speaker 01 Was being a clean mirror and serving my children. And so that, I heard something on Oprah. She had a guest who talked about, you know, making this, having this intention to really, when your kids were coming down the stairs or, you know, coming into the room, that you just engage with their eyes, you see them, you tune into them in a way that really allows them to feel held and seen and loved. And so that made so much sense to me. It was something I didn't experience when I was growing up. And I, I thought, you know, if I have the opportunity to do that, that is my most important task of the day.
8:29 Speaker 01 So it became, you know, this cornerstone of each day. And it's still important to me. I mean, now I text my daughters in the morning. But it's, you know, there's other pieces to a morning routine that I also think are important, like getting morning light.
8:46 Dr. Darshan Shah? Right.
8:46 Speaker 01 And some sort of form of reflection, whether that's morning pages or some other practice.
8:52 Dr. Darshan Shah? Right. That's so powerful. I, I'm definitely going to steal that, not just the saying shine your love light, but I'm going to start doing that more with my children because it's so easy to get distracted in your, either your own morning routine or what you have to do for the rest of the day, or getting them ready for the rest of the day, right? And so for the parents out there that are listening with young children, this could be something super powerful to engage with them. And you're right, it changes the entire dynamic of how you raise your children too, by, by doing something like this.
9:22 Speaker 01 Well, it maps to something bigger, which I think is important, that is connecting the dots with what you're describing. And that is, you know, there's a way that the pursuit of health and the pursuit of longevity and health span can be a very solitary activity. And I really believe that social longevity is such an important concept that I don't want to live to 90, 100, 120 to be alone.
9:53 Dr. Darshan Shah? Right.
9:53 Speaker 01 I want to see how my children turn out. I want to be able to dance at my grandchildren's wedding. I want to be like my great grandmother, maybe even dance at my great grandchildren's wedding. And I think that so much of longevity is sort of this, what I affectionately call bro-science.
10:11 Dr. Darshan Shah? Yeah.
10:12 Speaker 01 And I think the more that we have this sense of connection and love and purpose, I mean, really, that's kind of the most important thing in life.
10:19 Dr. Darshan Shah? Yeah, I totally agree with you. It's, number one, the purpose of longevity kind of erodes when you don't have that social connection, but also the social connection leads to better longevity and health span as well.
10:31 Speaker 01 It does.
10:32 Dr. Darshan Shah? So it's very-
10:33 Speaker 01 It's bidirectional.
10:34 Dr. Darshan Shah? It's very bidirectional. And unfortunately, you know, this era of social media and just getting more and more disconnected from in-person contact, we've lost a lot of this, right?
10:45 Speaker 01 We've lost a lot of it. You know, the former surgeon general talks a lot about loneliness.
10:51 Dr. Darshan Shah? Right.
10:52 Speaker 01 And, you know, when you look at the data on loneliness and how it maps to things like autoimmunity and depression and some of the mental health challenges that we have, we've got to do everything we can to build up the other side of that, you know, to build these connections, strengthen the connections, develop secure attachment, model that for our children, support them in developing secure attachment, to create the kind of hormonal balance-
11:17 Dr. Darshan Shah? Yes.
11:18 Speaker 01 -that allows us to have that health span and to feel our absolute best.
11:22 Dr. Darshan Shah? Yeah, and social connection does lead to all sorts of, and this is scientifically proven, actual health benefits. Your hormones are better.
11:30 Speaker 01 Huge, huge.
11:31 Dr. Darshan Shah? Right? Your gut health actually has been shown to be very impacted by social connection as well. People who are lonely actually have different microbiome than people that don't. It's incredible.
11:41 Speaker 01 And your genome changes, the way your genome is expressed. That's a whole aspect of social genomics.
11:47 Dr. Darshan Shah? Yeah.
11:48 Speaker 01 So you can either have your genome expressed differently in a negative way, or you can choose and make decisions and structure your day so that it's improving your social genomics.
12:00 Dr. Darshan Shah? Right, right. So let me ask you about kind of your personal story. It sounds like you were raised with yoga and you were raised with meditation in your life. And then, just like many of us, you know, we're, we kind of get derailed somehow.
12:14 Speaker 01 Yes.
12:15 Dr. Darshan Shah? So I would love to hear how that happened for you and how you brought yourself back into this state of health that you're in right now.
12:21 Speaker 01 Yeah, it's a good question. So I would say I still kind of stayed on task with-
12:29 Speaker 01 A contemplative life through college. I was doing TM mostly in college and practicing yoga, not because it was optional, but because I really needed it for nervous system regulation. So I practiced yoga through medical school and as much as I could through residency. You know, those hours, I think you and I were part of the generation that was still working 120 hours a week.
12:53 Dr. Darshan Shah? Absolutely.
12:54 Speaker 01 Yeah, so, and I, I think that when I got into practice is when I started to lose my connection to spirit and yeah.
13:03 Dr. Darshan Shah? Me too.
13:04 Speaker 01 And so I, you know, a lot of it was for good reasons because I, I wanted to so deeply serve my patients. And it was when I remember in medical school, I asked a faculty member I really admired, when is a good time to have kids? And she said, never, there is no good time. You just have to pick a time and start having kids.
13:24 Dr. Darshan Shah? Right.
13:24 Speaker 01 And so I was a year into my first faculty job when I had children. And yeah, that starts to shift things where you, this idea of like putting the oxygen mask on yourself before you put it on your kids, that just seemed wrong to me.
13:41 Dr. Darshan Shah? No.
13:41 Speaker 01 And so it led to a state of stress, high cortisol, insulin resistance, and kind of all the sequelae that you and I talk about a lot. And that was a stuck place, a stuck place of accelerated aging, of hormones wildly out of whack. And I, I didn't quite see it, like I didn't see a snapshot of it until I was 35 and I was sitting in my primary care doctor's office and I had my list of woes. You know, I've got premenstrual syndrome. I can't lose this weight I gained with my baby. I don't want to have sex with my husband. I'd rather do pretty much anything else.
14:23 Speaker 01 And I feel way too young to feel this way, to feel so old and so stressed. Like this doesn't seem like the way it's supposed to be in my 30s. And so that was a moment where he offered me a birth control pill and an antidepressant.
14:39 Dr. Darshan Shah? Of course.
14:40 Speaker 01 And he told me, exercise more and eat less, you know, and even sort of shamed me. He said, you know the math, Sarah. You just have to exercise more and eat less. And so I looked at him and just thought, wow, if I'm being told this, there are millions of women who are being told this very same thing. And I feel in my bones, it is wrong and there's got to be another way. So I left his office, I went to the lab and I scienced myself. And I found my hormones were a hot mess. My cortisol was three times what it should have been. My estrogen was high, my progesterone was low, my testosterone was low, my thyroid was low,
15:22 Speaker 01 my insulin was sky high, my fasting glucose was elevated, I have pre-diabetes. So that's what started me on this whole path.
15:29 Dr. Darshan Shah? Wow, that's so incredible. And you know, what's really poignant for me there is the millions of women that are being told this. You know, I feel like sadly, we grew up in a generation where we were exposed to studies that really villainized any type of hormone replacement therapy. But even before that, just the notion of putting someone on a birth control pill and an antidepressant was a solution to everything for women. It was just so backwards from the way we practice, you and I practice now. But this was our generation, the generation before us. And I still see the same advice being given now, right?
16:08 Speaker 01 Well, one in four women is on an antidepressant. So the advice is still there, it's still happening.
16:13 Dr. Darshan Shah? How long do you think it's going to be before medicine changes this mentality around how we deal with this part of life for women?
16:22 Speaker 01 It's hard to say how long it's going to change. I mean, what I love is that the change is nonlinear. And we're in a phase right now that I find super exciting, where I've noticed especially among the millennials, that they're watching what's happened with Gen Xers and maybe even Baby Boomers. And they're like, wait, this idea that I'm going to go through perimenopause and menopause and be dismissed and gaslit and told, not even counseled about hormone therapy? That, I'm, I'm not participating in that. Like, I deserve to get my hormones checked. I deserve to have accurate counseling about the risks and benefits personalized for me. So it's the millennials that are pushing for this.
17:05 Dr. Darshan Shah? Yeah, thank goodness.
17:05 Speaker 01 Thank goodness. So they're pushing for medicine 3.0, menopause 3.0, perimenopause 3.0. And I am here for it.
17:13 Dr. Darshan Shah? I love that. I love that. So going back to 35 year old Sarah, so you're 35, you're struggling with, you said premenopausal syndrome, you're struggling with depression, you're struggling with weight. What other symptoms were you experiencing? And how would you advise a 35 year old woman listening to this podcast today, if you're feeling these same symptoms, what to do next?
17:37 Speaker 01 Oh dude, I had so many symptoms. So there's more than 100 that are attributed to perimenopause. I feel like I had about 60 of them.
17:45 Dr. Darshan Shah? Oh my gosh.
17:46 Speaker 01 So it's a, it's a long laundry list. I think they fit under, you know, there's a timeline for the type of symptoms that women experience. So I started in my mid 30s. For some women, it starts at 40 or 45, and it tends to begin first with low progesterone symptoms. So you and I are both systems thinkers, so, so let's try to do it according to systems.
18:09 Dr. Darshan Shah? Yep.
18:09 Speaker 01 So low progesterone, usually your sleep is disrupted, you may feel more anxious, you might have difficulty soothing yourself, kind of the old methods that used to soothe you no longer work. You may feel more rage and irritability, more PMS. PMS is a little more complex than just low progesterone. There's allopregninolone and GABA and all these other serotonin involved. But those are, those are some of the symptoms I was experiencing. But there's a whole other set of metabolic symptoms that I think are important to mention. And nine out of 10 of the top killers are mapped to metabolic problems. So it's such an important one to emphasize. So I was noticing that I couldn't lose weight
18:54 Speaker 01 like I did in my twenties. I'm someone who goes up and down on my weight a fair amount. I had some disordered eating when I was younger. And so for me, it showed up as not being able to lose baby weight. But I would say it even goes back further because when I was pregnant, I gained about 65 to 70 pounds. I was, I was so insulin resistant. My test for gestational diabetes was about one point from the cutoff. And so, you know, my OB GYN was like, don't worry about it. Don't drink juice. But the truth was, I had this whole metabolic frat party that was happening in my body that I was completely unaware of. And I'm a doctor, so this is a problem.
19:35 Speaker 01 So metabolic symptoms, and that also maps to mitochondrial function and ovarian aging. I had mood swings. I had some mild depression. I didn't have much in the way of anxiety. That's not my story so much. I had a lot of gut issues, intermittent constipation. That can happen as estrogen levels start to decline. So then there's the estrogen declining symptoms. And those are things like vaginal dryness, hot flashes, night sweats. I was having night sweats the week before my period. So for the 35 year old to the 45 year old, night sweats is something to track. And then there's brain symptoms. So I mentioned low libido. That's an important one.
20:20 Speaker 01 But I also had just kind of this brain slowdown that I couldn't quite grok. I couldn't quite understand why this was happening. I drank more caffeine. That didn't seem to help. You know, my executive function was still quite good, but I was noticing some changes in my memory, you know, the walking into a room and not remembering why. Couldn't find my iPhone until, you know, thankfully Tile came out and I could figure out where it was. So, so this is a constellation of symptoms that are really common 35 to 45, often misdiagnosed by conventional medicine.
20:54 Dr. Darshan Shah? Yeah, I feel like these, the diagnoses are put into buckets like depression, you know, being overweight. And then the solution is always like some other pharmaceutical to cover up that one symptom.
21:05 Speaker 01 You're not sleeping well, so instead of addressing the root cause, which is low progesterone, we're going to give you some Ambien or some other sleeping pill.
21:12 Dr. Darshan Shah? Exactly, right. Okay, so you're a woman and you're, whoever, one of the people listening to this podcast is a woman experiencing all of this. What is the next step for her? Where should she go? How should she be evaluated?
21:26 Speaker 01 Well, this is where I think you need testing.
21:29 Dr. Darshan Shah? Right.
21:29 Speaker 01 Ideally, find a clinician who's collaborative, who's aware of the symptoms of perimenopause and menopause, who can help guide you and collaborate with you. But, you know, we're in an era of femtech and entrepreneurship where it's become a lot easier to get the kind of care that I think women need in perimenopause. And so the good news is you can do a blood panel and see where your hormones are. Now, I was taught to tell people that your hormones change too much to run a hormone panel, that it's just, it's not worthwhile, you're not going to change what you do based on those levels. And I want to call BS on that because if you're trying to get pregnant and you're
22:11 Speaker 01 having trouble, we check every hormone. We look at your day three estradiol and your FSH. We look at your day 21 progesterone. We'll look at your cortisol and your fasting insulin and glucose, see if there's some polycystic ovary syndrome happening or insulin resistance. We'll look at your thyroid function and the kind of thyroid therapeutic range is more narrow when you're trying to get pregnant. So why is it a good idea to test your labs when you're trying to get pregnant, but it isn't when you're in perimenopause? That doesn't make sense.
22:45 Dr. Darshan Shah? Yeah, absolutely. And, you know, I always wondered this too, because until you complain about not being able to get pregnant, no one even checks your hormones.
22:53 Speaker 01 Totally.
22:54 Dr. Darshan Shah? It's like not even, even if you came in with these symptoms, these hormones are not checked normally, right? And so, yeah, I fully agree with you.
23:00 Speaker 01 Unless you come to you or me.
23:02 Dr. Darshan Shah? Yeah, unless you come to an enlightened physician or a functional physician that understands. And so if your doctor is not willing to participate in this request of yours to check hormones, what should someone do?
23:15 Speaker 01 Well, I always like to work with a physician to see if we can convert the physician to a broader perspective.
23:23 Dr. Darshan Shah? Right.
23:23 Speaker 01 So I often encourage my patients to gift my book, The Hormone Cure, to them. So, you know, the pushback from conventional medicine, and I get it, they're exhausted, they're burnt out, they're seeing, like you and I were, 30 to 40 I get it. They are pushing back against this concept, but I've got 2,500 citations in pretty much all of my books that document the benefit of doing hormone testing and randomized trials that support lifestyle-based approaches first as a way of managing hormone dysregulation. So I would say that's the next step. And if that doesn't work, then let's find a new clinician
24:03 Speaker 01 who is collaborative and open-minded. And I think for women, often that's another woman who is going through this, like a perimenopausal or menopausal physician. But I would say, present company accepted the kind of work that you do, you would be taking care of that 35-year-old or 40-year-old in a way that is much broader and is looking at their hormones.
24:24 Dr. Darshan Shah? Right, right. I think also, unfortunately, you and I went to medical school of the time of the WHI study, the Women's Health Initiative study, and we were taught that hormone replacement therapy will lead to higher rates of breast cancer and heart disease, right, for women. And unfortunately, we now know that that's incorrect and completely wrong. But many physicians that were trained at the same time that we were still have that mindset.
24:50 Speaker 01 They do.
24:50 Dr. Darshan Shah? Right?
24:51 Speaker 01 Yeah. You know, I feel like the Women's Health Initiative was the wrong study at the wrong age for women with the wrong medications. And we're still trying to deal with the misinterpretations that came out of it for the past 20 years.
25:06 Dr. Darshan Shah? Right.
25:07 Speaker 01 Now, I also, I need to do a little correction because I'm older than you, Darshan. And so when I did my training in obstetrics and gynecology from 94 to 98, my residency training, we were still proselytizing hormone therapy.
25:21 Dr. Darshan Shah? Oh, really?
25:21 Speaker 01 We were like shoving it down the throats of women, trying to convince them to take hormone therapy. So that's how I learned to do hormone therapy.
25:29 Dr. Darshan Shah? Got it, okay.
25:29 Speaker 01 Which I think was actually too aggressive. And it was, you know, it was the tail end of 59 years. Of Premarin conjugated equine estrogen being pushed on women. And it was the number one prescription in the United States for decades without a randomized trial showing if it was a good idea. So I was grateful for the WHOI in that sense that we kind of ended this vast and controlled medical experiment. But when WHOI came out, it felt to me like the pendulum swung too far away from hormone therapy. And I think what happened with a lot of those busy, burned out physicians, they saw the study results and they're like, oh, good.
26:14 Speaker 01 I don't have to worry about that anymore. I don't have to counsel anybody about hormone therapy. I can just say, do you have severe hot flashes from night sweats? No? Okay, well, let's move on to the next thing. How about a statin? And so I think it, you know, there was a cultural response to it that was way overblown.
26:31 Dr. Darshan Shah? Yeah, and the media too. The media just ran with it.
26:35 Speaker 01 Yeah, I mean, it's like clickbait and sold newspapers.
26:39 Dr. Darshan Shah? Right, exactly. Back before there was clickbait, there was newspapers. It was Front Page and Time Magazine, every newspaper, everything. And just completely like overnight hormone replacement therapy got shut down. But to your point, it did, like you said, there was a wrong medication as well. Right? It was all Premarin all the time.
26:56 Speaker 01 It was all synthetic hormones, which we know are dangerous and provocative.
27:00 Dr. Darshan Shah? Right, exactly.
27:01 Speaker 01 And we needed that study to show it.
27:03 Dr. Darshan Shah? Yep.
27:07 Dr. Darshan Shah? This episode was brought to you by Nex Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Nex Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded Nex Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Nex Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Nex Health measure thousands of biomarkers
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28:58 Dr. Darshan Shah? So, modern hormone replacement therapy, can you kind of take us through your thought process on how you manage a woman? And what drugs are you using? And how you kind of implement a protocol for them?
29:08 Speaker 01 So, what I, what I learned in medical school and residency is that I think bio-identical hormones are the right fit. Like, it never made sense to me that you would take a hormone that a woman normally makes, or a man, and chemically alter it, and then patent it, and make a profit from selling it. That never made sense to me. So, it always made more sense to me that if you're starting to run low in progesterone, you replace the progesterone. And we have the PEPY study from the 1990s, showing that that's a good idea, and it doesn't adversely affect your cholesterol, your lipids. So, the way that I approached it is I like to give bio-identical hormones.
29:52 Speaker 01 I know you do too. And I typically start first in the first half of perimenopause, which is usually a low progesterone state. I replace just what's missing. So, we'll often start with natural progesterone. Maybe you take it cyclically, like from day 12 to day 26. See if it helps your sleep. See if it helps your anxiety or your soothing. Most women do really well on it. There's a small minority that have adverse effects with it. But that's typically where I start. And then, once there are low estrogen symptoms in the second half of perimenopause, that's when I will add some estradiol. And then...
30:33 Speaker 01 I wanted to make sure that we're also talking about hormone therapy plus. So I don't think that it's here's some progesterone, here's some estrogen, see you later. It's a much bigger conversation about lifestyle medicine. What's going on with your sleep and your relationships and your nutrition and your exercise and what are you doing to connect to spirit? Like that starts, that's foundational. And estrogen and progesterone, I think, you know, it helps to elevate women who are going through perimenopause, menopause, those who are good candidates. Not everyone is, not everyone needs it. And then there's this whole other massive metabolic and musculoskeletal syndrome of
31:16 Speaker 01 perimenopause, menopause that we also want to address.
31:19 Dr. Darshan Shah? Yes, absolutely. It's such a beautiful model and I just wish all of medicine was practiced this way. Sadly, it's not. And we talked about this in my episode with you on your podcast, how GLP-1s are now, just like hormones, are just being given to everybody without any counseling. And it's what else are you doing while you're on the GLP-1s to help? Number one, reduce the dosage, but also to change your lifestyle while you're on these medications and the same kind of structure I feel holds true with hormone replacement therapy. It's not just about the hormones, it's everything else around your lifestyle that needs to be modified.
31:57 Speaker 01 That's exactly right. I mean, the way I think of it is that you have to meet these medications in the middle.
32:04 Dr. Darshan Shah? Right.
32:05 Speaker 01 So it doesn't work to just use it as a crutch. You know, I got my estrogen patch, I've got my micronized progesterone, I'm good, that's all I need. No, you need to meet them in the middle. And I think the same is true with GLP-1s.
32:19 Dr. Darshan Shah? Right, exactly. Hormone therapy plus, can we dive into that a little bit more?
32:22 Speaker 01 Yeah.
32:22 Dr. Darshan Shah? Because I just think that's so important. So you're seeing this 35, 40-year-old woman complaining of these symptoms. You get them on estrogen and progesterone. Describe to me some of like the top four or five things they should be thinking about on top of the hormone therapy to help with their symptoms.
32:40 Speaker 01 Well, first, dialing in lifestyle, I think, is so critical. And you can't, you know, the, the women who try to go on bio-identical hormone therapy with estrogen and progesterone and try to skip some of the other pieces like nutrition or, you know, not sleeping sufficiently, short sleep, they're the ones who tend to feel better for maybe two weeks and then they backslide. So if you really want the best result with hormone therapy and age as gracefully as possible, you have to, you know, part of meeting the hormones in the middle is to dial in this lifestyle piece. Right. So I think that's really important. I like how your verticals kind of look at these in sequence. Yes.
33:23 Speaker 01 And then, you know, I feel like I agree with Gabrielle Lyon that muscle is the currency of longevity. Right. So we have to be looking at body composition, figuring out within the context of someone's lifestyle and values, how do we, how do we optimize muscle mass as someone gets older? For some women, that includes adding testosterone to the estrogen plus progesterone. Not everybody needs it. I'm not a huge pellet fan. I don't like super physiologic testosterone levels in women. I think it has adverse effects. You don't want to create a PCO-type syndrome in women by going too high.
34:04 Speaker 01 And then, you know, you, you don't want to just give testosterone again and sort of say, see you later. Yeah. You want to use that in the context of heavy weightlifting and having an exercise plan that's designed to help you age the way that you want to age. Right. So those are some of the components of hormone therapy plus. And then there's the whole layer of functional medicine. What's going on with your gut? You know, when we think about the hormones, we back up for a minute. To the control system for your hormones. And this is true for men or women. There's this, I'm gonna go full bioengineer on you.
34:38 Dr. Darshan Shah? Yes, please, please.
34:39 Speaker 01 So there's this control system, the brain, hypothalamus and pituitary, talking to your adrenal glands on top of your kidneys that release all these sex hormones. The brain is also talking to your gonads. So ovaries in women, testes in men. It's talking to your gut. There's this bidirectional relationship, especially when it comes to estrogen and detoxification of estrogen. There's your genome and how the genome influences the way that you use these hormones and metabolize them. And you wanna, you know, sort of shepherd these hormones in the right direction so that it's not putting you at a greater risk of estrogen dominance and disestrogenism
35:21 Speaker 01 and breast cancer and emetrial cancer, prostate cancer in men. And then there's also the role of, I think we got your gonads. There's three G's. There's genome, gut, and gonads.
35:35 Dr. Darshan Shah? Got it. Oh, I love that structure to think about. Because you're absolutely right. The conversation does need to expand beyond just the hormone replacement therapy. I think that's where people get stuck, where they feel like they're getting it now and like they're good and they're not good. They slide backwards or they still have. What I see a lot, especially in the women that we're treating, is many of them are undermuscled and they have a lot of metabolic disease that is not being addressed.
36:02 Speaker 01 Totally.
36:02 Dr. Darshan Shah? And so they end up, you know, just going down, even being on hormone replacement therapy, which is a huge advantage. They still get worsening metabolic disease because they just don't address that at all. And I feel like-
36:13 Speaker 01 And I think another piece here that's important is that, you know, there's the rise of telehealth for women getting peri-menopausal and menopausal care. And hooray, I'm so glad that more women are getting access to this. But it's often just a hormone therapy approach.
36:29 Dr. Darshan Shah? Exactly.
36:30 Speaker 01 So they get started on the estrogen progesterone. No one is really looking at their metabolic function. Maybe they get started on a GLP-1, but not with the kind of ecosystem that you and I are talking about. And so- Is that progress? I think we could debate it.
36:46 Dr. Darshan Shah? I completely agree with you. I mean, I think, you know, the telehealth companies, some of them do it right. Many of them is just a race to the bottom with how cheap they can make it and how quickly they can disconnect from the patient and just ship them their hormones. Right? And that's very unfortunate because hormone therapy is, you need someone that's looking at your overall 360 health.
37:08 Speaker 01 That's right.
37:08 Dr. Darshan Shah? Right? It's so true. Let me ask you, for the women that are maybe in their 55, 60, 65 age group, and they're just listening to this podcast and they're feeling like they've kind of missed the boat on hormone replacement therapy, what would you say to them?
37:26 Speaker 01 So I've got my above ground sort of official party line, which is North American Menopause Society, which is you, by the time you're 60 or 10 years post-menopause, it's too late. But that's really mostly looking at the Women's Health Initiative.
37:41 Dr. Darshan Shah? Right.
37:42 Speaker 01 And that's looking at population-based health, which is very different than the kind of medicine you and I practice, which is N of one care.
37:53 Dr. Darshan Shah? Exactly.
37:53 Speaker 01 So that we're personalizing. So that's kind of the official party line of the North American Menopause Society. I don't agree with it.
38:01 Dr. Darshan Shah? Right.
38:01 Speaker 01 So my approach, and what has always made more sense to me, is that regardless of your age, it's never too late to have a conversation.
38:09 Dr. Darshan Shah? Right.
38:10 Speaker 01 And to talk about the risks, benefits, and alternatives of hormone therapy, whether you're 58 or 68 or 78. So yes, there's more risk the older that you get. Tends to be that there's more cardiovascular disease, coronary heart disease, small vessel disease that's established. But there's also a way to work around it. So I would say it's never too late. For my patients who are older, it's an ongoing negotiation with the latest evidence that we have. You know, we've got new evidence that came out in the past year showing that you can reduce biological age with hormone therapy. So to me, that's another potential indication.
38:51 Speaker 01 You know, and with most conventional gynecologists or people who prescribe hormone therapy, they think the only indication is for hot flashes or night sweats that are severe and maybe for people who want to prevent osteoporosis, but not treat osteoporosis.
39:10 Dr. Darshan Shah? Yes.
39:11 Speaker 01 That's kind of the official party line.
39:12 Dr. Darshan Shah? Right.
39:13 Speaker 01 And I think that's way too narrow.
39:14 Dr. Darshan Shah? Mm hmm.
39:15 Speaker 01 I think we should be giving it for sleep. Women have double the rate of insomnia as men. I think we should be giving it for brain health, and there seems to be a critical window.
39:24 Dr. Darshan Shah? Right.
39:24 Speaker 01 That's even more narrow than it is for cardiovascular disease. It might be more like five years from menopause, not 10 years. I think we should give it for sexuality, for libido and sexual interest and having robust orgasms for the rest of your life. I think we should consider it for biological age, for longevity, for health span. So I think the number of indications, depression, we know in perimenopause, there are small randomized trials that show that it helps with depression and mood. So I think there's a lot of indications beyond just hot flashes and night sweats.
39:58 Dr. Darshan Shah? I completely agree. And so, you know, I think also to your point of N of one, let's have a conversation. Maybe let's stair step or slow our way into hormone replacement therapy and we can monitor things. We can monitor your sleep. We can monitor your cardiovascular health using calcium scores. We can monitor, obviously, breast cancer risk using mammograms, MRI. And so let's just kind of see what happens in your one N of one scenario here, right? Because also, one thing that we do for a lot of our patients as well is we do a DEXA scan every year. And I can't tell you the number of people, even people in their late 50s that get put on hormone replacement therapy, that improve muscle mass, improve their bone health.
40:39 Speaker 01 Yep.
40:39 Dr. Darshan Shah? By being on therapy as well. So, I mean, we know that muscle mass and osteoporosis, those are key indicators of your longevity and frailty as well. And To me, that's a huge win, not being frail when you're 75, 80 years old, right?
40:56 Speaker 01 It's a huge win and it's, you know, it reminds me to invoke some of the work of Lisa Moscone. And she's shown in the last couple of years that 80% of women notice the slowdown in their brain function. So 80% of women, the women who are having the most symptoms through perimenopause to menopause, have about a 30% decrement in their brain's ability to use glucose, to uptake glucose. And so the official name for it is cerebral hypometabolism. But what we know is that the entire system is related to the mitochondria in the brain not working the way they once, it once did. So mitochondria is starting to falter. The primary regulator is estrogen.
41:39 Speaker 01 So when you start to improve estrogen, so someone is starting to run low in estrogen, you give them estrogen therapy if they have a uterus, together with progesterone. What we know is that it seems it may make a difference. It may help with the brain function and the brain phenotype. And it may potentially reduce the risk of developing Alzheimer's disease, which we know is twice as common in women versus men.
42:06 Dr. Darshan Shah? Absolutely.
42:07 Speaker 01 The other thing she's found that I think is important is that for women who have higher follicle stimulating hormone levels, so FSH levels, which are part of this feedback loop with estrogen, those are the women who seem to have the worsening phenotype heading in the direction of Alzheimer's disease.
42:23 Dr. Darshan Shah? Interesting.
42:24 Speaker 01 So it's another one at the labs that I think is important to track.
42:26 Dr. Darshan Shah? Got it. And by giving estrogen replacement, you can lower the FSH as well.
42:31 Speaker 01 That's right.
42:32 Dr. Darshan Shah? Right, got it. I mean, it's such a powerful tool that unfortunately way too few of us use. As physicians and also as people, patients are not using this tool as part of their overall health and wellness journey. And it's so available. A lot of my patients that I have this conversation with a lot of my patients, it is, well, aren't we cheating nature? Aren't we supposed to have our estrogen and progesterone, testosterone go away as we age? Is there something that we're doing by giving these hormones that is against what nature intended for us? What do you think about that?
43:06 Speaker 01 Yeah, I've heard that argument for a long time. I would say, you know, the way that my body has changed over the course of my life, because I'm 58 now, you know, nature would have me have much less mobility at this age. I probably wouldn't sleep as well as I do, taking estrogen and progesterone. I feel like so many of these factors that map to health span would not be in my favor. So, yes, the natural course of things would be that I die in my 70s and that, you know, I'm not able to do the yoga poses that I know are so regulating for my nervous system. So, I don't buy that argument. So, to me,
43:51 Speaker 01 it's a, it's sort of a philosophical hands-off approach, which is not the way I want to live my life.
43:58 Dr. Darshan Shah? Yeah, that's, that's a great way of explaining it. And
44:02 Speaker 01 What do you think? How do you counter that?
44:04 Dr. Darshan Shah? I counter it by saying, if you look at the women that are living into their 70s and 80s right now, most of them look like and act like and move like and think like a little old lady, right?
44:17 Speaker 01 Yes.
44:18 Dr. Darshan Shah? And so frailty is so common that we actually have many papers written in medicine about it, because it's, it's very common. You know, humans have not lived this long, and without hormones, they turn into a frail little old lady or little old man. And so, if you want to live this long and add health span into those years, we need to have hormones to make that happen. They're natural biological signals that promote health.
44:44 Speaker 01 I mean, it, it relates to your why.
44:46 Dr. Darshan Shah? Right.
44:46 Speaker 01 You're, you're absolutely right. And my why is that I want to be twerking at my grandchildren's wedding.
44:54 Dr. Darshan Shah? I love it.
44:54 Speaker 01 When I'm in my 90s. And I feel like hormones help me with that.
44:58 Dr. Darshan Shah? Yeah, absolutely, absolutely. You know, this is such an important topic for men as well, because I feel, I'm so happy about the interest in
45:08 Dr. Darshan Shah? Perimenopause treatment right now for women. And I just hope more physicians that are listening to this podcast really bring it to the forefront of their attention and bring it to their colleagues' attention. But I also feel that for men as well, testosterone has been also kind of villainized as a brohormone that's used in the gym to get buff. And once again, you know, a lot of talk around testosterone causing cancer, just in general cancer, not just prostate cancer. And so I'm always fighting those talk tracks as well in my male patients. Do you find that to be an issue or what are your thoughts around that?
45:47 Speaker 01 Well, yeah, I mean, this is one of those places where I feel like the black box warning from four very flawed studies looking at testosterone cardiovascular disease has set us back. And so a big part of the marketing message that I think is important for you and me is that we're talking about the truth and what the evidence shows. And the best evidence that we have shows that men who go through andropause and have a decline in their testosterone production, maybe they've got some erectile dysfunction, which in my mind is cardiovascular disease until proven otherwise.
46:26 Speaker 01 Those men are on this path toward metabolic dysfunction and cardiometabolic dysfunction. And unless you do something about it, you're heading toward chronic disease. And so I really believe that we've got to, often we have to get in the weeds and talk about these four flawed studies that are still invoked by conventional medicine and saying that testosterone therapy is a way of, you know, sort of vanity medicine. I don't agree with it. I feel like, you know, what I see as a gynecologist who also takes care of men is that women
47:05 Speaker 01 with polycystic ovary syndrome and high androgens and metabolic dysfunction are very similar to men with hypogonadism who have metabolic dysfunction from low testosterone. So they're, the phenotypes are very similar. And so. I don't think every man needs testosterone. I think you have to have criteria and a protocol to approach it. I also think that lifestyle medicine goes a long way to address some of these problems, and that's part of meeting these molecules in the middle.
47:36 Dr. Darshan Shah? Right, right. No, it's so important. I just wanted to bring up the male part of this too, because if you're a woman listening to this, your husband is probably struggling with this and vice versa. So it's important for both sexes to really make hormone therapy, or just looking at your hormones. It doesn't need to be hormone therapy, like to your point. Not every man needs testosterone, for sure. I have many male patients in their 60s that don't need a drop of testosterone.
48:00 Speaker 01 Yeah, their T is great.
48:01 Dr. Darshan Shah? Exactly. But their lifestyle is also great.
48:04 Speaker 01 That's right.
48:04 Dr. Darshan Shah? And so, you know, these are men that are strength training. These are men that are really making sure they have good protein intake. They're avoiding ultra-processed food. They're having sex. They're doing all the things, and they are maintaining, some of them are even in the 600s with their testosterone level.
48:20 Speaker 01 Yeah, totally.
48:20 Dr. Darshan Shah? But they're doing a lot of things right. And so I think, you know, for men, there are other solutions. Women, unfortunately, I feel that, you know, many women, there's really no natural way of creating estrogen, right?
48:33 Speaker 01 Well, I mean, you can modulate it a bit with nutrition. But yeah, I mean, it basically comes down to a prescription.
48:42 Dr. Darshan Shah? Basically, right.
48:42 Speaker 01 And one other caveat that I think is important here is that when women go through perimenopause and menopause, they like fall off this very steep cliff.
48:51 Dr. Darshan Shah? Absolutely.
48:52 Speaker 01 When it comes to progesterone production and then estrogen production, whereas with men, it's a much more gradual decline. And so, you know, when I think of couples sort of facing the aging process and thinking about hormone therapy, I just want to make sure that we're loving up those women who are going through a much more dramatic process than the men.
49:14 Dr. Darshan Shah? That's exactly true. And I see this every single couple that comes to me. It's a much, that steep curve is often, you know, the men are always looking at their wife like, what's wrong with you?
49:27 Speaker 01 What happened?
49:28 Dr. Darshan Shah? What happened, right?
49:30 Speaker 01 I'm gonna go on business trips more often.
49:34 Dr. Darshan Shah? Well, the wife has been dealing with that for a decade, watching you go down that slope too, right?
49:39 Speaker 01 Right.
49:40 Dr. Darshan Shah? It's so true. This is such a fantastic conversation. I can't wait to continue it with you. I know we have so much more to talk about around longevity, around so many other things. But, you know, I wanted to kind of wrap it up with just asking you, what are you most excited about in your career and what you're seeing out there for the next couple of years?
50:00 Speaker 01 What I'm most excited about right now is really mission. You know, I, I love taking care of patients and that's my bread and butter. I also feel like we're in a time where we need cultural leadership and we need for people to stand up for what they believe in. And I've always lived a committed life. A big part of my commitment is noticing from early on in medical school, the way that women are underserved. And so what I'm excited about is sort of the next evolution of how I deeply serve women, given that there's more conversation now about hormone therapy.
50:40 Speaker 01 But I think it's reductionistic when it's focused just on estrogen and progesterone. So I'm excited about, you know, how do we form the counter narrative to the conversation? How do we change the conversation? So I'm always excited about that. My next book is about the female life cycle and what we can do about it, kind of the central role of the mitochondria, how that's related to ovarian aging, how the, the eggs in your body are the ones that are the richest in mitochondria. And that's where ovarian aging starts in the female body. It also happens in the male body, but for the female body, I think a lot about that. And also, how can we modulate it?
51:20 Speaker 01 Cause this idea that your mitochondria start illin and don't have the function that they once have, like you don't have to accept that.
51:29 Dr. Darshan Shah? Right.
51:30 Speaker 01 You can turn that ship around. There's so many ways to turn it around.
51:32 Dr. Darshan Shah? Yeah, so many ways in lifestyle that can turn it around. I think there's incredible new technology that we're seeing that's coming too. Have you been tracking any of this on medical?
51:40 Speaker 01 Oh, for sure. Well, you have a lot of them at Next Health.
51:43 Dr. Darshan Shah? Yeah.
51:44 Speaker 01 Yeah, I mean, it's, I think the lifestyle pieces you have to dial in first.
51:47 Dr. Darshan Shah? Absolutely.
51:48 Speaker 01 And it's, you know, whether that's the way that you're eating, managing your glucose, optimizing your mean glucose and your standard deviation, dialing that all in along with your exercise and your morning light and your connections, getting your, you know, all those lifestyle pieces. And that's when we can start to look at some of these other practices, other modalities that can be helpful. Do you have some favorites?
52:16 Dr. Darshan Shah? Yeah, for me, sauna therapy is one of my absolute favorites. I get a lot of personal benefit from it. I've, I've.
52:23 Speaker 01 Infrared?
52:25 Dr. Darshan Shah? I use.
52:25 Speaker 01 Because the data's better with infrared for medical.
52:27 Dr. Darshan Shah? Yeah, I definitely use infrared sauna for sure, because you get the additional benefit of mitochondrial activation with the, with the light, if it's at the right wavelength. That's what's key.
52:36 Speaker 01 Yes.
52:37 Dr. Darshan Shah? But yeah, you know, that's one of my favorites. For me personally, I do like the cold plunge and cryotherapy.
52:43 Speaker 01 Yes.
52:43 Dr. Darshan Shah? That really helps me. I've seen my HRV jump 10 points just from doing a hot, cold contrast therapy as well. But these are all things that I think, to your point, are additive after getting the lifestyle piece in place. So.
52:57 Speaker 01 That's right.
52:57 Dr. Darshan Shah? Yeah. So you can really accelerate the journey. And then, you know, with the current status of science, I feel that there will be molecules coming out that will be able to help. I mean, there are already some supplements that help our mitochondrial age. And that's also extremely exciting, too. So it's an exciting world. And my advice to patients is just stay healthy long enough to kind of participate in what's coming.
53:21 Speaker 01 For sure. Yeah. I mean, it's not, a lot of people, I think, gauge their sense of how they want to age based on what's available now. And the truth is, this is going to continue to unfold and evolve. And you want to be there for it.
53:35 Dr. Darshan Shah? Yeah, exactly. Well, thank you so much, Dr. Sarah, for coming. And where can people find you?
53:40 Speaker 01 The best place is to go to sarazolmd.com. I went through a divorce a couple of years ago, so the name has changed. It's about sovereignty and kind of reclaiming my maiden name. So that's the best place to go.
53:53 Dr. Darshan Shah? I love it. What's your social media handle?
53:55 Speaker 01 At Sarah Gottfried, M.D. We're in the process of changing that.
53:59 Dr. Darshan Shah? Let's get that changed to Sarah's all.
54:00 Speaker 01 Yes.
54:02 Dr. Darshan Shah? I have a connection for you. I can help you with that.
54:03 Speaker 01 Oh, thank you. I need it.
54:05 Dr. Darshan Shah? Fantastic. Thank you so much for being on my podcast.
54:07 Speaker 01 My pleasure. Thank you so much, Dr. Shaw.
54:12 Dr. Darshan Shah? 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 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 on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.
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