Dear Menopause
Are you experiencing changes to your physical, mental and emotional health you find hard to explain?
Have you tried talking to your doctor/partner/employer/best friend and been left feeling unsupported?
In this weekly show, host Sonya Lovell interviews a range of experts and shares the stories of everyday people to help you understand what the hell is going on, why and where you can find support, empowerment and most importantly, a like-minded community.
Dear Menopause
115: Creatine, Blood Tests & Supplement Hype with Sarah Gray
Supplement confusion is at an all-time high, with social media feeds flooded with miracle promises targeting menopausal women. But how do you know what you actually need, what works, and what's just expensive snake oil?
Pharmacist and nutritionist Sarah Gray brings her dual expertise to this conversation, offering practical guidance for navigating the overwhelming world of supplementation.
Unlike most health professionals who specialise in either conventional medicine or natural approaches, Sarah bridges both worlds, providing uniquely balanced insights into what supplements might actually benefit women in midlife.
This episode delivers specific, actionable advice you can use immediately. Learn the simple trick for identifying quality supplements (look for the AUST-L or AUST-R code), understand which baseline blood tests you should request from your doctor, and discover why blindly following supplement trends can waste your money and potentially harm your health.
Sarah warns against the common practice of continuously adding supplements without removing any, explaining how this can lead to accidental overuse of certain nutrients.
We take a deep dive into the essential blood work every midlife woman should request annually. Sarah explains how certain symptoms commonly attributed to perimenopause could signal nutritional deficiencies that won't necessarily improve with hormone therapy.
And you don't want to miss our discussion about Creatine - arguably the most evidence-backed supplement for women in midlife - which offers benefits for muscle strength, mood regulation, and the immune system.
Take control of your health by understanding exactly what your body needs rather than what clever marketing suggests you buy. Your journey through perimenopause and beyond deserves an evidence-based approach to supplementation that works.
Links
Sarah Gray - Nutrition Pharmacist website
Sarah on Instagram
Sarah on Facebook
The Benefits of Creatine by Dr Mary Claire Haver
Why Creatine Matters for Women 40+ by Harvard Lifestyle Medicine
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Welcome to the Dear Menopause podcast. I'm Sonya Lovell, your host Now. I've been bringing you conversations with amazing menopause experts for over two years now. If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them. This way, more people can find these amazing conversations, needs to hear them. This way, more people can find these amazing conversations. Welcome to Dear Menopause this week. I am delighted to be joined today by Sarah Gray.
Sarah:Welcome, Sarah. Thank you so much, Sonya.
Sonya:Thanks for having me Really excited to be here on this wonderful podcast. So let's jump in. Why don't you do a much better job than I did and explain to everybody who you are and what you do?
Sarah:Yeah, absolutely, I'm a nutritionist and a pharmacist.
Sarah:I started by studying pharmacy in my first degree out of high school and I learned a few years into working in community pharmacy that there was just a bit more I wanted to be able to help people with. I felt like I would give them things to fix their problems, but not necessarily try and prevent things so much so I had a really interested in nutrition. So, being the curious person I am, I went and did a master's of human nutrition at Deakin University and so now I hold both those degrees and it's really interesting. Actually, I thought I'd actually hang my pharmacist hat up and put my nutritionist hat on, but as time went on, hang my pharmacist hat up and put my nutritionist hat on, but as time went on I realised the two actually went really well together and there's more and more I explore about this every day. Yeah, they work well together in terms of being able to look at someone holistically and think about medicines, supplements, lifestyle, having that pharmacy background of medical conditions. It's actually turned out to be perfect.
Sonya:Sarah, that's amazing and I can absolutely see how, working in a pharmacy, you would especially if you're someone that was quite kind of holistic in your approach to health really feel that there was areas where you could be able to expand on that advice. And I've actually come across a pharmacist and a nutritionist before. My local pharmacist was a nutritionist as well, so it totally makes sense and I think that's a beautiful use of all of your skills and probably all your interpersonal skills as well. So how do you support women today as a nutritionist and a pharmacist?
Sarah:I don't still work in a pharmacy. I do the odd shift to help friends if they need some help. I do love working there, but I'm probably much too talkative and want to have a full consultation with people, so I'm not probably the fastest as they would like. But what I do now is I have an online clinic where I help all people, but I tended to get lots of women booking in and I was getting lots of women coming with low energy.
Sarah:It was a common theme.
Sarah:That was just time after time after time and then when you do further exploration, you'd find there's the brain fog, the stubborn belly fat and hormonal symptoms and not saying it was every time, but tended to be around these kind of hormonal changes.
Sarah:So I now say that my mission is to help women better navigate the really confusing health and wellness space, because this then means you're sort of empowered to make those great choices and you can spend your cash on things that will work, based on science. You can get cut through the overwhelm, because the biggest thing that happens is they come to see me and they say I've eaten eight different types of supplements, I've tried intermittent fasting, I've tried all types of different things, I've cut out carbs. But when I asked them, well, have any of those things made you feel better? The answer is generally no. So my mission is to try and help people use things or try things that work, and if they don't work, know that it's okay to sort of trial things, but doing it with a systematic approach is better for you and you'll feel better because of it.
Sonya:Yeah, that's so awesome, so important and so needed. So one of the things that we agreed when we sat down and chatted about recording an episode was what aspect of all the amazing work that you do can we really narrow our focus on and speak specifically to, a topic that I know is really top of mind for a lot of people when they are trying to feel better and they're on that elusive search for whether it's supplements or nutrition advice. But today we decided we were going to really focus in on supplements. We're going to deep dive into some of the things you touched on then, which were really beautiful around.
Sonya:How do you not waste your money on supplements, which is super easy to do. We've all done it. How do we know what is a good supplement to take, versus the marketing hype that exists and is just being further amplified now that menopause in particular, and perimenopause is this hot topic, and how do we know when we actually need supplements? So they're the kind of conversations that you and I are going to dive into today. So, sarah, why don't we start off with? How do we know what is a good supplement Like? How do we know we're not just flushing our money down the toilet at the end of the day.
Sarah:Yeah, such a great question and I do have some tips I give people. I'll go through them in a really sort of simplified way because we don't want to have a science lesson today, but I'll give you some tips that are kind of practical that you can use next time. You're kind of staring at that mega aisle of supplements or online choosing or being recommended. So the one thing I do want to start with is it is best to get personalized advice, because I often hear, oh, my friend used this, or my neighbor used this, or my Pilates teacher used it and I overhear it, probably very tuned into these conversations. But just because it works for you and it was safe for you doesn't mean it will work for someone else or be safe for someone else. So it's very personal.
Sarah:I tend to find women are taking a whole bunch of things just because people have told them and they just add and add and add. So my first recommendation is if you want to treat or alleviate a symptom or prevent a disease, you'll need a therapeutic product. So you can get foods that are kind of I call them kind of dressed up in fancy marketing packaging to make them look like supplements, and some of them. A few of them are actually compliant with the claims they can make, but some of them often go a bit off kilter on being a bit exaggerating on things they can do. It's hard to be able to tell that. So the first thing to do is say, well, I'm treating something therapeutic, I should get a therapeutic good. And the way you can find that is by looking on the label for a little OST-L or OST-R on the bottom right-hand corner of the label. So that's your first tick to say this is actually a supplement.
Sonya:So sorry, Sarah, is that OST-L?
Sarah:And why so sorry Sarah is that OST, a-u-s-t-l yes, okay, and then R? Now, the reason that that's a good idea is because foods don't usually have the right dose of an active ingredient at the right amounts and formats to give a therapeutic outcome. Because they're foods that are functional, they boost and support the diet. So they still have a place. But if you want to improve your sleep, you may need a dose of magnesium of a certain format that's proven to help you with sleep in certain conditions. That's why you can do that. It doesn't mean it's perfect, it just means it's the first thing that you can look at and in a space where it's so hot this topic right now, it can be overwhelming with what you get served up. So that can be your first thing. Then the second, which I wish was much more wide, but it's particularly only for sports supplements is there a third-party certification that tells you tick, this product is and you probably know about this well, sonia in your space like is this a high-quality, high-potent product? Is it something I can rely on? So a third-party comes in that has nothing to do with the supply or manufacture or selling of the drug or the supplement, I should say, and they put a stamp on it. Independent, more for sports supplements, but super relevant because things like magnesium and creatine, which are becoming popular in this space because of their efficacy, will often have those. So it's another thing you can look for.
Sarah:The third is the claims. Can you trust the claims? Now, this is what I say is the ultimate can of worms, and I wish I had a really easy way of telling you what you could and couldn't trust. I will say the TGA products can only contain ingredients that are approved by the TGA and only list claims that are from a set of claims the TGA allows you to select from, so that's a good thing. However, not every single product is detailed reviewed by the TGA allows you to select from, so that's a good thing. However, not every single product is detailed reviewed by the TGA before it goes to market.
Sarah:You sort of apply for it, you get a number and then they may check you afterwards. So there may be some claims that are exaggerated, but it's less likely for the therapeutic good. So this is my kind of pragmatic way of how you should check this, based on what I've seen Look at the label, which is usually really compliant because it's highly regulated and if the label is completely different to what's on the Instagram page and the website, that's a red flag. So the label says it may support energy levels. If the Instagram page says you're going to go from one to 10 out of 10 energy levels in two days, well, that sounds a little bit exaggerated. So that to me, is a red flag that you may want to choose a different brand in that case, just because you can't be confident that's truthful information, because it's exaggerated.
Sonya:I think that's a really good point to dwell on for a moment and that is that exaggeration of claims in marketing. And I've actually seen a few examples of these recently crop up in my social media feeds of particular products. And there was one recently that caught my eye. I'm not going to name what the product was, although I don't know.
Sonya:Sometimes I am tempted to name and shame, but I'm not going to today and it had a image of a probably middle-aged woman and she was standing side on so that you could see her shoulder and she had like a tank top on.
Sonya:I think she looked like she was at the gym, maybe exercising, and she had her hand up and written on her hand with a marker looked like she'd written it on there said frozen shoulder disappeared in and this isn't going to be correct, but it was something like five days or two weeks it was an actual time and it was quite from my perspective, very short period of time and it was an advertisement for a particularly well-known menopause related. It really caught my eye because I thought that is hugely exaggerated, because I know that you are not going to fix a frozen shoulder taking this particular product in that period of time, and I think that's really good to point out to people because it is a really easy way to identify. Does this claim that the product is making seem exaggerated? Does it seem a little like they're expecting great things in very short periods of time?
Sonya:yeah I'm glad you brought that up, because I think that's something we need.
Sarah:We can easily look for, but we can also really easily fall prey to yeah, and my common saying is and this is in everything in life, not just this space if it sounds too good to be true, it probably is. And um, but the reason why I anchor you back to looking at the label is they are often very compliant on the label. So if you see an ad like that, think, oh, I'm not sure if the label doesn't say it's going to remove your, alleviate your frozen shoulder in three days, it's probably not something that they were probably allowed to say within their claim. So use the label as your guide. That's a really kind of you know less markety type piece that tells you what it might do, so that hopefully they're helpful.
Sarah:The next one is around safety. So, although this is not how you can choose one, just being more conscious when choosing, just because a supplement's natural or herbal, it doesn't mean it's 100% safe. Often can interact with other supplements, medication, foods, certain diagnosed medical conditions. You shouldn't take them. So be very careful to read the warnings or speak to a health professional and be conscious of that. Don't just think if I can bite so easily, it must be safe. It's not the case, and we see things like ashwagandha, a very commonly used adaptogen herb, which does have its place for some people, being used really a lot at the moment, and then studies showing that higher level doses over extended periods may actually impact our liver. So remember that they are still active substances most of the time, so just bearing that in mind is really important.
Sonya:I think that reminder as well of interactions with either other conditions or other medications or even sometimes other supplements that you're taking, can be really problematic, which is why I think your very, very first advice, of seeking advice from an expert first, is actually so beneficial and highly suggested 100%.
Sarah:And I end with that one again just to kind of double up on the importance. But the reason why I end on seek advice at the end is just check who you're getting the advice from too. So is the person. Not all health professionals do the same thing. We all do different things. So I sort of put the analogy like I wouldn't tell somebody how to manage a chronic dental issue, I would refer them to a dentist. Or how to manage their frozen shoulder'd probably send them to a physio and a doctor. So just be conscious that just because you have one qualification doesn't mean you know so good things to look for. Are they sort of pharmacists that generally have the knowledge? Have they got added like lovely to hear that you're older. Where you used to live the pharmacist there was also nutritionist degree qualified naturopaths. So just checking, they've got a degree. Lots of the ministry have wonderful health science degrees now clinical nutritionists and integrative doctors. So have they got that expertise? Because they're more able to support you in a more rounded way as well.
Sonya:So yeah, and do you happen to know where GPs would fall into that? Obviously, we see our GPs to prescribe medications, but many women and I think I've probably done this myself at some point in time has been having that conversation with the GP and what supplements should I take as well? My girlfriend's taking creatine should I? So are GPs likely to be as educated in supplements?
Sarah:Good question. It again depends on the GP. They'd have a very good knowledge of the things we're talking about. Whether or not they're experts in specific types of supplements would be another question. So it really is dependent. There is also GPs you can find that have done a lifestyle medicine degree and you can find that on the lifestyle medicine website and also integrative doctors, through the Australian Institute of Integrative Medicine, I believe. So you can actually check for doctors who have done additional study. That's more about lifestyle and supplements. So that's the case. But you may also find there's a GP in your area who really has specialised in this and looked into it. So just look into it, because they'll often say, on the hot doc or wherever you book, they'll say what their specialty is.
Sonya:Yeah, fantastic.
Sarah:Then you're more likely to get a sort of more well-rounded response, I guess.
Sonya:Yeah, great advice. And while we're talking about healthcare practitioners, let's dive into. One of the most common questions that I imagine comes up is how do I actually know what I need to take? You touched on earlier like everyone at the moment is talking about creatine, and personally I think that's for good reason. I think creatine is amazing. I've been taking creatine daily for about five years, but I just continue to see more and more studies come out. Isn't it the most researched supplement that's on the market? So you might be someone that's heard a lot of buzz about creatine and so you're thinking, oh, do I need to take creatine or do I need to take magnesium? Do I need to take vitamin D? Like there are so many questions around, just because someone else is taking it or because it's getting a lot of media attention, how do I know if I need it? So what's your recommendation in getting to the bottom of that?
Sarah:Yeah, I do agree with you on creatine. I think it's as wonderful, as you say as well. I guess. A couple of things. Firstly, we mentioned blood tests earlier when you and I were talking before this session was recording. So blood tests are really great.
Sarah:Once a year Check for any, or if there's any specific symptoms. First we want to say, well, do we have any deficiencies or sort of at-risk areas that might need a bit more of supplementation? That's the first place, because you want to correct anything that needs correcting. The other thing then is symptoms. So are there specific symptoms that you can't manage with diet and lifestyle? So I have this analogy.
Sarah:It's about a cake. I know not all cakes are healthy, but I love cakes, so I use the analogy of cake. So when you've got a cake, you've got the flour, the eggs, the butter, the base of the cake. For me, that is if you've got any symptoms. You've corrected nutritional deficiencies through blood work. You've got symptoms. Is your diet optimized? Is your lifestyle optimized? Are you doing all those good things movement, mindfulness.
Sarah:Then supplements are kind of like the carrot and walnuts or the chalk chips or whatever the flavor is. It makes the cake taste better. You don't really need it, but in some cases it makes the cake better and it actually boosts it. And then, for me, then, the icing on top, which I know we'll talk about later, is that hrt or mht, which you know not all cakes need. It is that HRT or MHT, which not all cakes need it but often taste better with it and make them easier to eat. So it's kind of a weird analogy that I've built up over time to explain that.
Sarah:But supplements you need are things to help you treat symptoms. So if you're let's use an example so when you sit down and think about what symptoms you're having, you've corrected your nutritional deficiencies, let's just say, with blood tests, so your iron's back to normal if it wasn't, et cetera, but you still cannot sleep. That's where we think, okay, what can we do before we go to? Maybe sleeping tablets? Or if you are on HRT, we can talk about that. But what can we do to try and support your body to sleep? So we look for something like a magnesium glycinate or bisglycinate, which is a relaxing form of magnesium. We try that, but we don't just keep taking that forever. We try that for three, four months. Is it making a difference? No, it's not making a difference, then we might try something different. So it's about treating the symptoms and if they don't work I often ask this question if it's not making a difference, you shouldn't continue taking it.
Sarah:Some things you can't feel, for example, caveat with if you're using certain types of omega-3s to manage your cholesterol levels and your HDL and LDL, your good and bad cholesterol. You won't feel that, but you will know if that's having an impact when you have that next blood test, which may be more frequently than 12 months if you're treating a cholesterol imbalance. So that's sort of the way I look at it. You know, is it a deficiency or do you have symptoms? And the other one would be. Then I have kind of a set of general supportive supplements that are really great for women in this phase of life. Creatine is one of them. Probiotics are another really good one. But again, firstly, have we looked at how you might get some of those pre and probiotics through diet? Firstly, have we looked at how you might get some of those pre and probiotics through diet? Not possible for everybody, so there's some that I sort of have as kind of general supportive supplements that I'll recommend. But generally you want to look at symptoms and see how you can support somebody.
Sonya:Okay, cool, doing some blood panels with your healthcare practitioner to get an idea of those, the big identifiable markers. Like you mentioned, iron, I know vitamin D is one of those ones that you can test on a regular basis, looking at where those are sitting with your health practitioner, but then also going through that symptomology. And I loved your suggestion of just because you start taking something doesn't mean you keep taking it forever, checking in every 12 weeks, six months, whatever it is, and saying, okay, but am I actually noticing a difference? Because of this, I think that's really good advice.
Sarah:And also what happens is sometimes people layer things on, layer things, and I'll just give an example where that actually might be not great.
Sarah:So vitamin B6 recently has been in the media with the TGA. So if you have too much vitamin B6, it actually can cause things like tingling or numbness in your extremities and a range of symptoms because it can cause kind of nerve sort of type damage. But vitamin b6 is actually sort of thrown into a lot of supplements, like if you're taking a women's health blend or a greens or this or that, it can often be added in. And what the tga were finding is people were taking lots of different things, just kept adding and adding and adding oh, I'm not sleeping, I'll add the greens, I'm not doing this or that, and that cumulative increase in the b6 was actually causing almost a toxicity. So it's not about one's not working. Add another, put, put a Band-Aid on that, it's about well, I don't like recommending more than one or two supplements at a time for someone, because if you add five and it's working, what do you do? You stay on the five.
Sonya:Well, yeah, it's a great point, isn't it? Like how do you then join the dots of which one is actually having the most impact? So I think that's good advice too.
Sarah:Yeah yeah, that's good advice too.
Sonya:Yeah, yeah, that's how I see it. Awesome. Now, I did ask my Instagram community for any questions and, while we're talking on this topic, I think there's one that is relevant to this. I'm going to throw it in right now. So, whilst we're talking about diet as well as supplementing on top of that, if we looked at the population in general, how many of us are actually getting what we need from our diets on a day-to-day basis without then the need for additional supplements?
Sarah:Yeah, and I haven't looked at sort of any evidence to respond to this one, but in terms of like statistical views, because really our national nutrition survey is pretty dated so we probably don't really know how well people are eating, I would just say, anecdotally, you'd be surprised like most people are actually getting a lot of what they need. So if you're eating, you know you may not be eating that great in terms of snacking and things in between, but if you're getting sort of three decent meals and you're generally getting most of what you need, I do find that people who don't get what they need, they can't even a buckets, so they might have a chronic disease where there's impact on the way that they can eat. If you've got an ulcer or something, it may impact the amount of food you have, or maybe it's somebody who is eating more plant-based, so therefore they're really going to have trouble with our iron, our B12 and some other things and creating deficiencies there. So, without having a statistic, I'd probably say like seven or eight out of 10 people that I see I generally feel pretty comfortable that they're getting the right type of food. It's just are they getting it in the right quantities to optimize their health.
Sarah:So and we'll talk about blood work later but you know you get that range of okay if you get your iron tested. It can be from the low range to the high range and a lot of people, yes, are in the middle of that average, but many people sit right at that bottom edge. So they might be getting enough, but are they getting enough to actually optimize their energy levels and ensure that they're in a really optimal range? So it's that view of you know the doctor's view more is it outside of the range? It's a traditional view, whereas a more integrative practitioner might say well, actually towards the bottom end, so let's actually give you some now to improve your outcomes later. So without a percentage, that's my kind of best guess at that one.
Sonya:Yeah, that's great, and I think it's also really encouraging to hear that, from your perspective and the anecdotal evidence that you're kind of got available to you at your fingertips, that there is a higher percentage of people that are actually getting a lot of what they need from their diet. And yeah, which, again, if we go back to that marketing kind of hype, it can be a trope that gets rolled out there, isn't it that you know, like you're not getting this in your diet, so therefore, you should, you know, be topping it up with our wonderful supplement.
Sarah:And maybe I have a skewed view of the world because people come to me want to work on their health. I don't know, maybe they're already doing that, so at a population level I wouldn't know. But yeah, I do often think, you know, are we sort of making people fear they have to have these powders and things daily to top up their nutrition, where they're probably not doing too bad a job anyway, yeah, awesome, yeah, if you're really getting your, your serves of veg and your fruit and, like you said, you're dripping your protein out throughout the day and all those things.
Sonya:I think one of the things you touched on there which is so important, because it doesn't just come down to protein, but that plant-based diet versus and even for someone like me who eats everything that's on offer, except I am not a big seafood eater and so therefore, I use an omega supplement because I know that I don't eat anywhere near as much seafood or fish as I would need to get that naturally. So that, for me, has always been something I've been really cognizant of. Yeah, but I think, yeah, there's many people that perhaps aren't as aware of how much they're eating of certain things across their day versus their week to understand what they should and shouldn't take.
Sarah:Yeah, don't get me wrong. We do, as a nation, need to eat more vegetables, but we've always needed to eat more vegetables ever since I've known. So you can always throw in a few extra serves of veg in. Yeah, but yeah, on the whole pretty good.
Sonya:Awesome, fantastic. Thank you for answering that question and I hope that it answers the question for the listener that sent that through. So let's talk about blood work, because we have touched on it a few times already. I am a huge believer and if the government follows through on their promises, we will be getting a specific Medicare code for this. But I'm a big believer that there should be a midlife health check for women that they go in and they have, whether it's when they turn 40 or when they turn 45 or somewhere in those fees that triggers this checkup. That is really broad. I firmly believe everybody should get a DEXA scan and know what their bone density is at that point in time. But let's focus on blood work. So what blood work do you recommend for women that fall into, let's say, this midlife health check?
Sarah:Focus in on more is what are those kind of general things you want to get checked. When I'm saying, oh, go to the doctor and get your annual blood test, well, what do you need? And if you go to the doctor and ask for that, they're probably just going to give you the basic stuff, which is fine. But it can be a good conversation to have with them about some of the other things that you might like to have tested as well, and I can give you examples of what I usually recommend. And the good thing as well is I have this other sort of full of analogies, but full of like sort of analogies, but like we shouldn't have tunnel vision on this either, because even though we're in our midlife phase and we are likely to be going through hormonal changes as we transition into menopause, there may actually be something else going on too. So it's important that we don't just assume that our brain fog or our low energy is because we're in perimenopause. That could be things like low iron or issues with thyroid levels. So that's why, also, like I really I'd love that idea what you said there, sonja with the dexa and everything else being incorporated, because there's other things at play that you may just pick up as well um in this and be able to sort of treat those. So then you can treat the hormonal stuff kind of separately. So I have a few things I recommend. So a full blood count. What that just means is it's called an FPC. That just means they're going to look at your red blood cells, your white blood cells, your platelets, checking all your immune cells. Already you've got enough red blood cells. It's a pretty kind of baseline test that you'll do and most blood tests would have this. And the second would be a comprehensive metabolic panel. So this one looks at things like your liver function, your kidney function, really want to know how they're operating. Also, that impacts the types of medicines and herbs you can use, because if it's not optimal some things won't work as well or aren't as safe. They'll also look at your hydration level, so look at electrolytes like sodium and potassium and sort of give you an idea about that. So they're the first kind of almost like the baseline.
Sarah:Then the next, most important I think, is the lipid profile. So your doctor will test your levels of hgl, your good cholesterol, which takes the cholesterol out of the body, the bad cholesterol, triglycerides and total cholesterol, just four different ways of talking about cholesterol. The doctor will give you an indication, but essentially you want more of the good, less of the bad, and we especially want this because estrogen works really hard during our lives to earlier lives to help us control cholesterol. And then we're losing that amount of estrogen, getting to very low, if none, towards very low, I should say, in menopause, and therefore you know your risk of heart problems actually rises, particularly see some dyslipidemia or lipid changes.
Sarah:The third is around diabetes. So fasting, blood glucose and what we call hba1A1c. What are we looking at here? So we know that as we transition, we can actually see some women experience what's called insulin resistance, which just means your body doesn't respond. You have sugar, your body, your pancreas, shoots out some insulin to help you get that sugar and use it up for energy. Essentially, in a nutshell, as you transition into this phase of life, your body's not as responsive to insulin for some people. So tests like these can help you understand. Is that a problem for me? And it's not a problem for everybody. You might read it is, but it actually may only impact some people more than others. So you want to test fasting, which is kind of like random, if you. And then hb1c, which actually looks at your average blood sugar control over the past two to three months.
Sarah:Then nutritional deficiencies we spoke about a couple of these. These are where it gets a little bit, I wouldn't say, confusing. But vitamin d great one that you brought up before. So you're really good because it's important, especially with our bone health and immune health and a bunch of other things and things like zinc, you know and check if you how you're going with that, because it can health and immune health and a bunch of other things and things like zinc, you know and check how you're going with that, because it can impact your immune system and things like that. Then the one that I say is interesting is magnesium. So there's lots of studies when it comes to magnesium For the example I used earlier to keep that kind of story going with magnesium glycinate for sleep that show that you really get most benefit out of that for that particular indication. If you're deficient in magnesium, however, the magnesium blood test isn't as accurate as we would like, so we're actually only about one percent of all the magnesium in your body is in that blood serum oh, wow yeah.
Sarah:So even though you want to get it tested to have an idea, I often recommend with magnesium that trial or error kind of thing that I spoke about before. So try it for a few with sleep. It's about a month or two if you're not getting any benefits.
Sonya:Yeah, and that's a good thing to note with magnesium, isn't it? I actually had this conversation with my husband the other night. There is a compounding effect with taking the magnesium glycinate to when you are trying to get it to help for sleep. And this comes almost into what you were saying before about take something for 12 weeks or before you judge whether it's something you need to continue with or not. And I'm going to assume that magnesium is not the only supplement that this is the case with, where you do need to build those building blocks to build to a level and then maintain that level, and that can take a little bit of time. It doesn't happen the first night that you take your magnesium.
Sarah:That's a really, really great point, sonia, and I've actually thought of explaining that. So thank you for asking that question. It's not like a Panadol that you take two Panadol and your headache goes. A lot of these nutrients and supplements herbal supplements take time. Another one is iron, for example. You don't just take iron. It's actually a very slow process to use iron supplements and increase your iron.
Sarah:But then even things like you can talk about ashwagandha, which I recommend for some people therapeutically. You don't necessarily need it every day in a hot chocolate, but we can park that. But the ashwagandha, which is quite an adaptogen helping with your nervous system response, like even that one system response, like even that one. You're not going to just buy the ashwagandha gummies and feel calm that evening. It's actually going to have a cumulative effect. So it's actually a great point. So that was it. Nutritional deficiencies then. I know this is a lot, but if you just try and bucket them into I've sort of tried to bucket them into six for us all. So the fifth is iron studies, which is pretty standard in an annual blood test as well. You want to know how your iron stores are going, because iron is one of those things I've found with my clients and over time it actually can really mimic that brain fog, energy level and dizziness that is quite well-known with perimenopause menopause.
Sonya:And really important, and you may be going to touch on this anyway but specifically in that perimenopause phase, if you are having heavier bleeding than you might normally have or you're having more regular periods at some point, then the iron becomes really important, because we don't always link the fact that we're bleeding with we're losing iron 100% and I think it's something like you only lose about 80 mils of blood, so you don't have to lose a lot more for it to start to having that impact on iron.
Sarah:That's 100%. In this age it becomes quite common to see iron issues because of that. So in that case of course we want to treat that and you've got a wonderful episode I just listened to about heavy periods and what to do around that as well, and I often find the brain fog is really common with iron deficiency anemia. So that means your iron's got such a low point that the amount of oxygen that's attached to every one of your red blood cells is reduced. So you've got not as much oxygen kind of circulating in the body and that can actually really lead to brain fog. That's a real big one that I like to have checked for people, and especially plant-based as well. So again, it's a bit harder to get the iron absorbed in those cases. And then thyroid so a couple of reasons Like thyroid disorders are really common in women and a lot of us aren't aware we even have them.
Sonya:So first of all, and a lot of the perimenopause symptoms can mimic thyroid problems. Yeah, a hundred percent.
Sarah:It's like a kind of double-edged sword. They can mimic it, but then changes to estrogen might alter the thyroid hormone levels, so like it's really very important. My tip for this one is, if you can ask for a full thyroid function test the whole panel you want to see your thyroid stimulating hormones, the one that normally gets checked and that's kind of looking at.
Sarah:It's kind of the opposite. So a higher level of TSH says you're not producing enough thyroid hormone and a low level says you're producing too much. It's kind of opposite. But you also want to look at T4 and T3, which are the different types of thyroid hormone. But then there's some anti uh sort of I should say antibodies, anti-tpo and anti-thyroid globulin, being technical. But just ask the doctor for a full panel if you can, if they're open to that, because they actually give you not just the tsh, sort of says, okay, you either got too much thyroid hormone or not enough. These other tests on the panel give you a more specific diagnosis that make treatment of those things just change or tweak slightly.
Sarah:So for the panel once a year, I think is a reasonable thing to be asking for. And then you know they're the main ones. If you've got other symptoms the doctor might also want to do things to look for inflammation, so ESR or CRP, but that's usually if something's going on and those six are probably enough anyway. But they're pretty standard on kind of an annual test to check that everything's happening within your body the way that you would like.
Sonya:Yeah, great. So your recommendation, with these blood panels and all those pillars that you've just talked about ticking off with that, would be to keep that an annual exercise, at the very least.
Sarah:Yeah, it is. And my other big tip is when you get the results, or if you get told, oh, your results are normal, you don't need an appointment, my high recommendation is that you please ask them for a copy of your blood test results that you keep for yourself and you may share that with your nutritionists or personal trainers or other relevantly qualified health professionals. I've got a wonderful personal trainer that has done a bit of extra training in this as well to understand it. So if you have that, then if you go and book an appointment with a naturopath or a nutritionist, they've got that information, which is really useful for them in the way they're looking at your health, and then you've got a copy of it for yourself. My Health Record should make that easier over time. Yeah, health, and then you've got a copy of it for yourself.
Sonya:My health record should make that easier over time. Yeah, over time. But not everybody is subscribed into the my health record, so that does become a little bit problematic for some people. I'm one of those people, but I've always always asked for my copies of my blood works. It is actually quite easy, if you you do a little bit of research, to understand what. And I think the most important thing and you mentioned this earlier is that some medical practitioners will literally just look at the baselines this is what's low, this is what high, and you fall within those, so you're okay. But if you do see a naturopath or a dietician or an integrative doctor and a lot of GPs now are becoming more educated on this is if you are still at that bottom or even the high. You need to address that. It can't just be well, you fall within this, so you're okay. If you are on that low end or the high end, you need to be looking at the why behind those and is it something that needs to be addressed?
Sarah:100%. It's certainly very important to contact the doctor and speak about it for them to give you the top level if there is things that are out of range.
Sonya:Oh yeah, always Of course.
Sarah:but having it for yourself that means you've got a copy of that, and usually if you go back to the same GP then we'll get sort of columns of the blood tests that will kind of show the dates.
Sonya:I know I love that.
Sarah:Well, you may also may not this day and age. You may not have a regular GP either, so make sure, if you've got it, then you can keep that yourself.
Sonya:Yeah, that's right. Awesome, that was wonderful. Thank you so much for covering off all of that and questioning around blood work and pathology, and I think that's awesome information. So if we throw hormone therapy into the mix, just for a moment, so if somebody is also using HRT or MHT however they prefer to refer to it one of the things that I think we need to talk about consistently is that that's not a silver bullet to anything other than topping up your hormones.
Sonya:So, on top of that, you need to still always be addressing your nutrition. You need to be looking at your exercise. You need to be looking at sleep and stress management, that lifestyle medicine degree that you talked about before, which I love so much. I have a friend who's doing her master's in it at the moment and I think it's just amazing. I'm tempted. Yeah, I know, don't worry, it crossed my mind too, and then I was like no, sonia, you don't need to do anything else right now. But so if we consider hormone therapy in that same kind of like holistic approach, where do supplements sit within that?
Sarah:yeah, I love that question. It's sort of my cake that I spoke about. But you know, hrt, or mht as you mentioned, tops up the hormones and should mitigate most of the hormonal symptoms you've got and then does a really great job, as you would know too, sonia of sort of preventing that kind of helping prevent the longer term kind of risks of heart disease and bone osteoporosis etc. But first I would say, if you're taking HRT and it's not really making things better, the first thing I would do is go back to speak to the doctor or specialist because it might not be the right dose, like I actually was writing an article the other day about the types of HRT and I can't, even as a pharmacist, keep up with the different formats, types that come out all the time. So there's different ones you can try.
Sonya:And it is very much something that, like we were talking about with supplements before, needs to be tweaked, takes a little while to kind of get into your system and start working on that compounding kind of effect. Yeah, but yeah, and you know, I think that's so important that you must always remember that it is a therapy that is going to be unique to you 100%. It's got to be tweaked and you should be going in and having regular checks, particularly in those early few months when you start on it, to make sure that you are getting the right dosage that you are absorbing. There are so many different little nuances with it. So supplements, absolutely the same.
Sarah:Yeah, so if the tick box is go check, everything is good with that, then you may actually need some supplements, as you mentioned, sonia, like HRT is not going to solve everything. So back to that kind of iron example if you're deficient in iron, hrt is not going to fix that, you will need an iron supplement. Or if you want to try creatine for the muscle, health and other benefits, that's not really going to be something that HRT is going to do for you. So you again look at those symptoms or things you want to prevent or support and you may add them on. The other thing that I also find interesting is something that remember at the start I was saying take off the pharmacist hat, throw on the nutritionist hat, but now I think I wear both hats is there's some nutrient depletions that drugs can cause as well. So I just wanted to touch on that briefly. I do want to caveat with it doesn't happen for everybody, but it is a possibility that some of our hormone replacement therapy medicines might actually impact us and deplete our body of certain nutrients. So just something to bear in mind. Give some specific examples here Estrogen therapy therapy and I believe this is similar for bio body identical and synthetic estrogen, again being quite the same possible in the literature. So it means it could happen may actually deplete your magnesium levels, which, if we know we spoke about before, it's kind of hard to know what your magnesium level is, so again, we might be compounded by having less magnesium. So trying some might be a good choice. Again, the right format. So I spoke about glycinate, but there's lots of other formats for different things.
Sarah:Then vitamin B6, another one we've spoken about. It can impact that metabolism, either making you more likely to have low or high levels. So again, that's something else. If you're having sort of weird kind of neural symptoms, it could be you've got too much B6. So I find that super interesting.
Sarah:The B6, I should caveat to say that's more so with the oral contraceptive pill. It often has more synthetic forms but also a lot higher dose than HRT. So that's, if you put on an oral contraceptive pill which generally I see happen, as we mentioned before, to help with those heavy periods and for contraception, that can actually have a depleting effect on the B6. Increased calcium needs in this age of life I think it's 1,300 milligrams a day for a lady in menopause and so therefore you know the fact that it might impact. That makes it even more important to get your regular tests around your vitamin D, but also making sure your calcium levels are being topped up, dietary as well. Your doctor or nutritionist can help you navigate that if you think or want to ask questions about that for your personal situation.
Sonya:Yeah, brilliant. Thank you. That was some really good information. Okay, I want to end on a positive note. My first question is if you had a magic wand, what would you change about the supplement industry?
Sarah:Yeah, yeah, I think this will be positive. I would like there to be a world and we're imagining it's just complete free reign here that there's a world where every single supplement that comes to market has gone through a rigorous process of being tested Does it actually work, are the claims right? Is it suitable for all the things it says it's going to do? It's all checked thoroughly. And then we see really huge sort of restrictions, which exist, but like huge penalties that happen really fast when they do the wrong thing.
Sarah:There are things that TGA are trying to do about this, but there are only so many people and there's so many things happening. And I will say, in a positive note, we are really lucky in Australia. So we might think that these things frustrate us, that we see these claims they can't make, but compared to other countries, we've actually got a pretty good handle on this stuff and the TGR are doing a really good job. The magic one give them more resources, time and money to be able to make it even better, so people get what they need, it works and they're not wasting their money. That's the bit I hate.
Sonya:These things are expensive, so that would be a perfect world, in my opinion, amazing. All right, we talked about it right at the very beginning and I think it's a really hot topic right now. But what makes creatine such a great supplement? Not looking at athletes, necessarily, but specifically for women in this midlife phase?
Sarah:I was actually hoping this question would come up, I just think because it has the evidence that supports so many different things, which is and you mentioned before it's so well researched. I feel like it's having its time in the sun, but I've been talking about ages, I'm sure you have been too. So if we think about, yes, it helps with your muscle mass and strength, which is a huge thing in this phase of life, we're losing our muscle tone, our muscle strength. We want to make sure we do strength training and all that sort of stuff to do that. I personally love strength training, optimizing that. But the thing that I love about it is what's coming out around how it can actually improve mood and actually really help with that.
Sarah:Some of those hormonal things and for me, also very, very minimal side effects I'll mention one shortly but and also really only if you've got severe kidney problems, you can't take it. So it's pretty great for most, most of us in this phase of life and it helps with our muscles, it helps with our hormone balance, it helps with our mood. So really it does a lot of things with one scoop and often it's unflavored, so you can add it to things or add a few electrolytes or add it to whatever you can you can add it to your coffee yeah, add it to whatever the brand suggests you can on the back of the pack, because they'll know whether it's heat tolerant, whichever one.
Sarah:That it is right. But what a great thing. And look, if you hear that it may cause weight gain I'm sure you've heard this sonia like. It pulls water in, which is one of the things it does. So at the start you might feel a bit more sort of bloated or puffy. That will go away and I can guarantee I think you may have seen all these things on social take it every day for 30 days. That's three to five grams, and then you make it. You make a decision and remember we're saying don't take things if you don't notice a difference. You will notice a difference, I think, with this, and most people tell me they do. So I love that it actually does what it says it's going to do yep yeah, and, as I mentioned earlier, there's just so much research.
Sonya:even though it's already so well researched, there is so much research consistently coming out about it. The one one that blew me away recently is I think I've mentioned on here I've had COVID recently for the first time. One of my biggest fears is getting long COVID and I definitely want to do everything I can to avoid that the way I'm feeling right now. I'm pretty sure I've managed to do that. But a lovely friend, angelique Clark, who is a dietician and nutritionist, she sent me some research whilst I was ill showing that four grams of creatine taken daily for six months was showing was researched evidence that it was helping prevent or helping to recover from long COVID. I'll send you the research paper and for anyone listening, I'll also link it in the show notes because it is quite a new piece of research and it just really shows the breadth of the supplement.
Sarah:Sometimes it can be a bit. You get a bit stuck in the social media and think these things are being recommended, but this is one that makes me smile, I think. Oh, it's having its time in the sun and it should be having it, so it's a good thing of social impact.
Sonya:Yeah.
Sarah:This one really is the one that you can get on board.
Sonya:Awesome. I'll link through in the show notes just some general information on creatine Wonderful From great evidence-based sources, as well as that paper that we just talked about, and I'm going to link through to your website as well so that if anybody that's listening is as intrigued as I am by all of this conversation and they want to know more about you and perhaps potentially look at how they could work with you, they'll have all the information they need in today's show notes.
Sarah:Very kind, thank you.
Sonya:Absolute pleasure, Sarah. Thank you for being my guest today.
