The Vibrant Wellness Podcast

The Truth About Perimenopause, Hormones & Brain Fog | Dr. Elena Zinkov, ND

• Vibrant Wellness • Season 1 • Episode 119

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Why do so many women in their 30s and 40s feel anxious, foggy, exhausted, or unlike themselves — even when their labs are “normal”?

Dr. Elena Zinkov sits down with Dr. Alex Carrasco to discuss the real drivers behind perimenopause symptoms, hormone imbalance, ADHD-like symptoms, brain fog, and metabolic changes in women.

To learn more about advanced hormone testing and personalized health insights, visit 👉 https://vibrant-wellness.com.

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🔗 Dr. Elena Zinkov, ND

https://www.drelenazinkov.com/

https://www.instagram.com/drelenazinkov/

🔗 Dr. Alex Carrasco, MD

https://nourishmedicine.com

https://www.instagram.com/dralexcarrasco

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It's really important to get the story and identify, hey, what information can we get from the basic baseline like bloodwork, gut test? Those are the fundamentals. We got to be focusing on the quality of life so that when we're 7080, we are running after our grandkids and our grandkids and our kids are able to look at us and say, whoa, where did you get all of that energy? And you're so sharp and you can recall things and you can do the things that you love and still be just an active member of the community. It's really important to have this more holistic approach to brain health. Peptides are amazing, but we gotta look at diet. We gotta look at how else can we support the overall mitochondrial function of the brain? Today, we're excited to welcome Doctor Alaina Zink off to the podcast. Doctor Zink is a respected expert in her field. Known for her thoughtful research, real world impact, and ability to make complex ideas accessible. Her work sits at the intersection of science, innovation and human experience, and she brings a perspective that's both rigorous and refreshingly practical. We're thrilled to have her here to share her insights and expertise. I am so excited to be here today with Doctor Lena Zink. She is a dear friend and a brilliant clinician, and I just can't wait for our audience to hear all about the wonderful insights that you have. About medicine. Thank you so much for having me. I'm so excited. That's wonderful. So, okay. I would like to hear first maybe about your story and how you got to where you are, because right now, what I see in your work is that you really focus on the intersection of women's hormones, brain health, longevity medicine and cellular medicine, and then you're using tools that are more up and coming like peptides in your work. You're kind of integrating it all. And that's so exciting because that is what we need. So how did you get to where you are? Yeah. Well, like many women, I struggled with hormone imbalances and it took me to go through medical school to understand my body and see the gaps in our healthcare system, where frequently a lot of women will experience normal labs. But certainly their life is not normal. And what they what their daily experience is like is not normal. And I was on my own perimenopausal journey. I struggled with pretty severe hormone imbalances postpartum like many women, hair loss, sleepless nights. And you pair that with a very busy career and your hormones start to take between cortisol imbalance and sex hormone sex hormone imbalances. So from a hormone perspective, brain health perspective, I really had to not just help my patients, but really help myself. And along the way, of course, discovered what was working, what was not working, what was working for my patients, what was working for me, and then how could I channel even my personal story toward a lot of the women who are struggling with similar things? Yeah, well, I guess that's how a lot of us start, right? We have a personal experience, and then it makes us dig deeper. Yeah, definitely. And I have a lot of women in terms of like social media. They complain about the current health care system. And I said, oh, look, there are many physicians who are doing their best and trying to understand all the different therapies that we have out there and how we can support each and every person individually. But it takes conversations like these to really kind of get to the root of what really works and how we can support people better. It does. And I also think that physicians in general do their best within the system that, you know, they work within. And I think the system just kind of against them, you know, and of course, education as well. I mean, you're very lucky that you were able to and you chose a natural Catholic education, but, you know, conventional allopathic, it's you know, you don't learn anything about nutrition or, complexities or the interplay of many systems together. Everything is siloed. Well, you know what's interesting? My mom was an MD, and she was trained as a family physician. And when it came time for me to decide what I really wanted to do with my life and what what I was passionate about, my undergrad training, actually in business, I went to business school, but I graduated and I said, you know, this is so soulless. Like, I'm not excited about this. And at that time, my mom started to show some signs of what I would call perimenopause, some of the typical symptoms. And she was prescribed anti-anxiety medication, birth control, antidepressants, blood pressure medication, cholesterol medication, statins. And she really encouraged me to pursue the natural ethic field. I actually was thinking about going into emergency medicine. I'm like, man, if I can bring someone back to life or if I can fix a broken arm, I'm an excellent doctor. And obviously the good doctors are the ones who are present with their patients, right? They go an extra mile for their patients, etc. but she's the one that really encouraged me to pursue the end route and really women's health and endocrinology. Yeah. And looking beyond just a diagnosis, right? Yeah. Yeah. Because we're so much more than just the number on a piece of paper. Right? Yeah. And I and I, I think that a lot of times when I have patients come to me, you know, they have like, you know, 15 diagnoses and then sometimes they identify with their diagnoses, and, and it's easy to fall into that trap. But then but but the question is why do you have these things that we define as diagnoses. Can we shift them? Yeah. And walking around with a label I know people get attached. I think a diagnosis from a clinician standpoint, if I hear a diagnosis, it automatically tells me, okay, potentially what system. Right. We need to target what kind of symptoms the patient might have. But patients don't think that way. They're thinking of this as a label that they're walking around with. And that's why I'm really careful with things like PCOS as an example, or even endometriosis or any other diagnosis that we choose to provide our patients with. I'm really careful about that, because I want patients to know that it doesn't have to be that way, and that there's it's it's more from a clinician standpoint gives us an idea of what's going on. But we don't have to live with that as our label. Right. It's a launching pad. Yeah, yeah, exactly. So I really am interested in learning about how how do you, in your clinical practice meet, you know, say women between 35 and 45 that are starting to step into perimenopause. They have body composition changes that feel negative. They have brain fog. Many of them are probably postpartum or have had children or are having children within that decade as well. And they just don't feel like themselves. And how are you using, you know, hormones, peptides? How are you supporting cellular health? Because, you know, that is an emerging topic, in, you know, it's it's more trendy now than it used to be. It's supporting all these all these different, anchors. Definitely. I think it's important to start with a baseline and really important to focus on the patient's story and experience. And even in natural empathic school, you know, we're taught as physicians to listen to the patient. But then what happens? You graduate and you're so fixated on what the lab show. So you you're listening to the patient, but you're looking at the labs. So for perimenopausal women, one of the biggest issues is that their labs are normal, right? Their FSA, LH is in range. Their estrogen, their progesterone looks fine, but they're not sleeping well. They're gaining weight. They're anxious, they're depressed. They're libidos down the drain. So we have to look beyond the labs. And even a 24 hour urine test can be limiting. We really have to focus on what is that unique patient's presentation. And so of course, you know the standard lab range versus the optimal lab range. We know that optimal can also vary person to person. And I've had women who, let's say have fertile levels of progesterone, but maybe they're still experiencing spotting or irregular cycles or they're still anxious and can sleep at night. So I will always take and trust what the patient says first and foremost, and then use labs as my guide. And when it comes to hormone replacement, we're just very careful in what we prescribe. I never prescribe synthetic hormones unless it's absolutely necessary. I use it as a bridge until we can get symptoms symptom stabilized, until we can get someone to feel better. We're always leading with bioidentical hormones with the minimum effective dose. There's just no reason why we need to start on a very high dose when it comes to hormones. And there's a lot of education that happens around hormones because so many women have been burned by the Women's Health Initiative. And I also read a lot through different menopause organizations. They're still mixing progestin with progesterone. I've noticed that estrogen there's no different differentiation between oral estrogen, transdermal, vaginal, like when we're talking about research, when we're talking about hormone safety, we have to be so clear about what hormones, what routes, what dosing that we're talking about. And so I start with a baseline. And that's usually looking at their current hormone state their nutritious state. So like vibrant has amazing testing that we can do, especially the nutrient profile and everything else. And looking at metabolic markers inflammation is huge. And what we see with hormonal change and metabolic changes is that insulin can go up and can stay up. Yeah, crp can go up and stay up. And once we start improving, whether it's diet, lifestyle, nutrient deficiencies, as well as get the right hormone replacement on board because hormones regulate inflammatory pathways, we see their inflammatory markers improve and as we correct different imbalances, I start to weave in peptides as needed. I'm not the one to just throw a bunch of peptides the first visit, unless it is necessary, and I see the need for it. I use them very carefully in an as needed basis to really optimize specific systems. Do you want to explain what peptides are? So they're like amino acid sequences that are less than 100. Right. Something I believe. 818 okay. So they basically function within the body already. We make them they're endogenous. But then they can decrease over time. Yes. Just like everything else. Right. And I think we're used to hearing that hormones that align with age, everything else declines too. Yeah. So it's even our GLP one sensitivity and receptor health number that declines too. Which is why the GOP wants become so important. But peptides are branches of amino acids. And depending on the amino acid formula that dictates the sort of the peptide and the system that it can benefit. So, for example, growth hormone peptides, they stimulate growth hormone release. They stimulate IGF one release. Very important for bone health, muscle health recovery, collagen production. This is a very important hormone that frequently gets missed and it's not properly evaluated. We've got BPC 157 can actually upregulate growth hormone receptors can make you more receptive to growth hormone. Can also help with gut health guidelines. So anything that requires repair and an uptick in growth hormone signaling like BPC 157 is fabulous. And when it comes to inflammation, we've got the thymus gland. And that is the master regulator. And just like everything declines with age, stress, even disease, different disease states exposures. Right. Absolutely. Which impacts endocrine function. Thymus and peptides are incredible there. Actually we did some research where people who are prone to autoimmune conditions have a lower amount of thymus and alpha one and times and beta four peptides. And they're very important in regulating the T rex cells so that we stay in balance and homeostasis. But those are just some of the examples of what peptides are and how they can be really system specific. What are peptides that you use for brain health? I love that Hexa. It is an orally available peptide. It used to be by prescription only mostly. Now there are definitely some companies that have made it available to an average consumer patient. It is very important in protecting the serotonin and dopamine producing neurons as well as so neurogenesis and synaptic genesis. So we can improve the communication between neurons as well. And it can also preserve the hippocampus. So for a lot of women who are struggling with dementia or memory issues, and we know that most women, unlike men, are predisposed to Alzheimer's and dementia. As we got older, sleep estrogen declines. So important for women, especially who are maybe not candidates for hormone replacement for whatever reason or scare to start hormone replacement. The Hexa can be a really good peptide to consider because of just how neuroprotective it is. Yeah, and there's some other ones like Sam Ax and Salang. Those are some of my favorite peptides as well. They're just not as readily available. Yeah I think there's some regulation changes that are always happening with peptides. But yes, and I love those peptides. And unfortunately they used to be so much more available. Yeah they're not anymore. But the Hexa thankfully is available. And it is one of my favorite peptides to include. Yeah. For all brain health I would say when it comes to brain health, just peptides aside, I also like to consider ketones the role of ketones because that just direct fuel, our brain is a huge caloric consumer, glucose consumer and ketones is that direct fuel. So anytime a brain function is compromised, ketones is that immediate fuel that can really help our brain function more optimally. I also love plasma elegans. I love them right. And the fact that they're available in this day and age for us to supplement with which on the topic of decline, yes, we need peptides because they just naturally decline with age, time, stress, endotoxins, plasma, allergens. Technically, we can get them through the omega fatty acids that we get from our diet. But again, it really depends on liver function, depends on metabolic health, estrogen signaling. So it's really important to have this more holistic approach to brain health. Peptides are amazing. But we got to look at diet. We gotta look at how else can we support overall mitochondrial function of the brain. Yeah, I think that that's such a big question in my practice, because I see so many patients who are coming in with brain fog. It's a little bit of cognitive cognitive decline. You know, nothing where it's, you know, quite a, you know, a dementia diagnosis. But, you know, you just you're processing speeds slower or you're not remembering things as fast. A lot of those patients also do fall in postpartum categories. And so there's just kind of like this big, I guess, confluence of events that can happen in patients lives where, you know, they're more inflamed, maybe because their hormones are shifting. They're also exposed to toxins, which is, you know, impacting and or can organs and inflammatory processes. They're probably micronutrient depleted because if they're postpartum, maybe they've lost choline or if they've given it to their mother in their breath in their breast milk. Then on top of that, you know, we're pinged with stress all day long. We're living these 24 hour, you know, 24, seven lives that were not meant to live. You know, we're living these very unnatural lives. And then and we're always afraid that something bad is going to happen, like, we're, you know, we're always like, fight or flight. So it's it's just a very it's a really I think it's a hard time. I mean, it's an amazing time to be a human. But also, I don't know if we've ever been so aware of all of the stressors and dangers. And, I don't know. I know there's been so many people over the, you know, millennia who have gone through famines and hardships and wars. And I'm not discounting that. But I also think. There's never been a moment in time where we've been so aware of all of the horrible possibilities. Right. Well, if you think about the people who have gone through, like our ancestors, the hardships and the difficulties, they were also in terms of women, actually both women and men, but women were likely to live into menopause 100 years ago. So I like to use that sometimes as an example because people will say, well, why do we need hormones? And how did my grandparents live and my great great grandparents and I will they it to 52, honey. Exactly. And we are living and this is an average person 20 to 30 years more with the same biology because it's not like as we've had access to antibiotics, vaccines, emergency medicine interventions, water, clean water, clean warming. Exactly. Right. It's not like all of a sudden our body's like, you know what? We need to produce 20 to 30 years more of estrogen and progesterone. Right? And this is the conversation I like to have, because yes, we had different stressors back then and it was hard. And it's also reflective in our lifespan during that time. Point is that we did not live very long. Now we are able to live longer, but we're not living as quality of a life. So it's our health span is compromised. Right. And this is what I like to focus on. This is what a lot of clinicians like yourself and many others are trying to shift the perspective and have these more of healthspan conversations about we ought to be focusing on the quality of life so that when we're 7080, we are running after our grandkids and our grandkids and our kids are able to look at us and say, well, where did you get all of that energy? And you're so sharp and you can recall things and you can lift heavy weights and you can do the things that you love and still be just an active member of the community. But going back to brain health and the different even tools that we use, because we are bombarded with so many different stimuli throughout the day, from our kids to the task fatigue that we experience, it actually becomes really important to remember that your body cannot heal in a fight or flight state. And this is where even vagus nerve might have of sizes. Vagus nerve stimulators. You know, I've worked with enough neurologists, functional neurologists where a vagus nerve stimulator becomes essential in helping people post-traumatic with post traumatic brain injuries with PTSD. For anyone who's had a really stressful experience and is having a hard time bouncing back, such as trauma, you know, all roads lead to the vagus nerve 100%. And and honestly, like I have been personally using one for a while and also recommending my patients and, right now I'm a big fan of the Palmetto because it's so easy to use. I feel like a lot of other vagal nerve simulators are a little bit harder to use. I mean, they're not hard, but that's like the low hanging fruit is just put a headband around, you can just turn it on. Yeah, but I have patients sleeping through the night. I have people the yesterday I had a patient that told me their anxiety had transformed. The whole family could tell just from using, you know, vagal nerve stimulator regularly. And I think the studies with it are so interesting because I think what happened and how they figured this out is that they put an implantable vagal nerve stimulator in patients with intractable seizures, just with the hope that that would decrease their seizure threshold. Amazing. And they did these studies maybe in the mid 90s and the the seizures decreased by more than 50%. But then what they realized about a year after the implantation is that anxiety, depression, chronic illness decreased. And so then they started looking for other ways to, you know, maybe bring that to the to the public, because we can't all just have a surgery and have an implant, even though maybe it's tempting, they just have the constant stimulation, especially as a mother. Totally. But it's a long game. And now that these are available, I think it's amazing. Like, I highly recommend them to all my patients. Yeah, well, the vagus nerve, it is one of the most important nerves and the impact that it has on the gut. So when we think about even disease prevention and it comes down to, you know, everything else that goes starts from the gut. Yeah, it starts at the gut and ends in the gut. Is so important. Yeah. It's one of my favorite tools. Yeah I love that. And it's really great that the you know, I love using tools that the whole family can use. So this goes down to even like red light therapy, sauna, vagus nerve stimulators of course, like kids. I'm Eastern European, so I was exposed to the sauna. Very. That's really cool. Very early on, I started hydrotherapy, I think, when I was like six years old. Amazing. Yeah. And I've, you know, I've done it for so many years since then. But something like vagus nerve stimulators are, they're so helpful for young kids, teenagers, young adults because, you know, we see anxiety on the rise. We see depression on the rise. I mean, so much of it is, yes, of course, due to school dynamics and social media exposure. But how can support even our kids? And like a vagus nerve stimulator is such a great tool? Yeah, that to your point, this patient that I was telling you about yesterday, she said my teenager started using my set and he feels so much better too. So it's it's pretty cool. And it's like it's it's easy, you know, that's such an easy tool. Well, and you bring up a really good point. You know, we have patients and our patients have families. A lot of them do the impact of what they're learning from us. And the impact of my mothers fathers being healthy. Yeah it is. It affects the entire family. And I see this happen all the time. Hey, if the mom is not feeling well and the mom is sort of, you know, I mean, we know that a lot of women have a lot of responsibilities that if the mom is not feeling well, the kids are upset or sad, right? And the partners are wondering what's going on. And then the second that the woman starts to feel better, it's like the rising tide lifts all boats. Everyone else is happy. Yeah, yeah. It's true. I mean, it's a familial experience. And so yeah, now, if we can help, you know, our patients feel better, their families will be healthier and then maybe by extension, their own families when they grow up, will be healthier. So it's a butterfly effect I would say. Yeah, definitely. Yeah. So let's talk a little bit about mitochondria because yes it's like you know everyone's talking about it now which is awesome because ten years ago no one was talking about mitochondria except for us nerds, except us. And we like to have a little mitochondria talking over. Yeah, yeah, but let's talk about mitochondria and about, you know, how do we support mitochondria? Because that is a big place where we make energy. Yeah. And you know, obviously we know there's different parts of the body that have more mitochondria like our brain and our ovaries and our heart. Yes. Depending on the energy expenditure that that then leads to the number of mitochondria. Right. So like the brain being a huge energy consumer. Some huge amount of percentage of our caloric intake actually goes toward supporting my brain. Actually had one of my followers on Instagram asked me once, so can I just lose weight by thinking harder I wish, I wish right, but to get you can make you hungrier for sure. Yeah, exactly. Hey, you know quantum physics, it works all the time at these many times, but it really depends on right, how active that organ is and what the energy expenditure is. And some neurons in our brain, depending on their function, they have up to 2 million mitochondria. Purcell like that is a staggering number. Mind blowing. So when you think about mitochondria being this power plant and you got to be able to, yes, fuel that power plants. So, right, the carbs, the proteins, the fats, the nutrients, you also have to protect the power plant because they're fragile. They're so fragile and they're very sensitive to both internal and external stress. So this is where antioxidants become very important. Like any C glue to thiamin, hydrogen. You know, now we have access to hydrogen tablets. Yeah. The smallest molecule can cross the blood brain barrier and support those up to 2 million mitochondria and protect them from both internal and external stress. But when it comes to mitochondria and cellular health, like you mentioned, endotoxins, that's the number one thing that we have to do is, of course, be able to limit I don't want people to live in fear, right. You know, that's one of the things I work with my patients is like, look, we can't put you in a bubble, and you would not like it if you were in a bubble. It's very limiting. But we have to be able to control our controllables. And if that means we limit our alcohol intake or even stop consuming alcohol. Right. That's one of the biggest toxins out there. That's it's legal. It's very social. It's very easy to acquire, but it is very taxing on overall cellular health that that energy demand that goes into then detoxing and supporting detox pathways to clear alcohol. It's enormous. But controlling our controllables right from food, from exercise, and the other different stressors that we're, we're exposed to. What's your favorite way to decrease endotoxin? Gosh. Well, first gotta we should talk about what is endotoxin because maybe our our viewership might not know. Right. So endotoxin is anything that can interfere with proper, proper cell signaling. So a lot of toxins out there mold, heavy metals, xeno estrogens that are frequently found in both food and cosmetic products. They compete for similar receptors as hormones. As an example and when you have plethora of these endotoxins in whatever shape or form they enter the body, whether it's from food or cosmetic products or the air that we breathe, water that we drink it for infections or infections. Right? Yeah. Because actually, some of the similar receptors of the same receptors that viruses and bacteria can bind. And so here you have hormones that are trying to tell the cells what to do to then impact brain function, metabolism, reproductive health. But they're competing with these endotoxins. So what we have to do is get a baseline first. Like what kind of endotoxins are we dealing with? Are we dealing with heavy metals or are we dealing with mold exposure or are we dealing with, potentially petrochemicals? Like what is it that we're dealing with? And then, I like to start gentle calculation protocol. So for me sauna is huge and your skin is your biggest organ and it is one of your main detox organs. So sweating is important. Gentle binders, optimizing gut health. We want to make sure that people are staying regular and going back to getting the baseline. It's not just the endotoxins that we're looking at getting the baseline, but we're also looking at gut health. Right. And what is potentially contributing to leaky gut or is, you know, what is potentially contributing to increased gut permeability, which is, you know, yes, leaky gut. But viruses, other pathogens, parasites which also affect our genetic blueprint and then microbiome issues. Right. Yeah. Absolutely. Yeah. It's it's a complex it's a very complex puzzle. Yeah. And very individualized. Very individualized. Like I don't look at everyone as walking around with this loaded toxic bucket because I've had patients who, let's say they've had a severe mold exposure but the rest of their families fine. So then we have to consider liver detox pathways, the other detox pathways that we have respiratory, kidney, right. Liver, gut and genetics, of course, and their overall nutrient status, their oral antioxidant status, things that we can look at and test actually and identify. But I don't throw a bunch of testing at my patients at the first visit. First, it's really important to get the story and identify, hey, what information can we get from the basic. Yeah, absolutely. Baseline like bloodwork, gut test. Those are the fundamentals. Yeah. At some point I usually have a patients. We got to do the gut test anyway. Yeah. Because it is a road to to health. You know we have to address the gut. But then if we're not feeling better and it's really a classical sign that someone has potentially a toxin load is, you know, we start them on a really good protocol. Yeah. We found out their imbalances. We get them on the HRT. Yeah. We get them on iron, get their ferritin back up, all these other things that we do. But they're not feeling better. Yeah. And that makes me think about what is happening to those receptors and why are they not getting the message right. And then we start exploring deeper toxic exposures. Yeah, that's very interesting. I, I really love that. And then in to your point about gut and circling back to peptides, now that we have peptides available for gut health, like Cfpb and La Raza Tide and you know BPC 157 and then we have things like butyrate like we just have so many more tools. And we did ten, 15 years ago. So I feel like yeah, it's we can help people faster. At least that's what I'm seeing in my practice. Oh, absolutely. Instead of it taking years right to unfold and chasing one symptom at a time, we do. Our clinical toolbox has become so much bigger. Yeah, and deeper. Yeah. That's from the more you are in practice and a practicing clinician, the more you see what works, what works better, the patterns, you see the patterns, and you're able to get people better results faster. Okay. So now I want to circle around to back to IGF one because you mentioned that earlier. And that's interesting because, you know, maybe in the last 5 or 10 years I've heard about it a little bit and thought it was interesting, but then I forgot and clinically, I think that that is a very important marker that we should all be testing. Absolutely. Yeah. So what happens when we produce growth hormone? Growth hormone stimulates the secretion and production of IGF one in the liver. So we can use IGF one to understand what our growth hormone is doing, how well how much we're producing it. And are we producing optimal amounts. It's hard to measure growth hormone directly just because it has such a short half life. And it it's get it gets produced in this pulsatile manner throughout the day that's impacted by exercise, fasting. Right. Exactly how many naps you take during the day. So protein. Yes, exactly. But growth hormone starts to decline around the age 20. So well before our sex hormones start to decline it is also suppressed like and I should back up a little bit. You know birth control especially oral birth control suppresses our ambulation suppresses our endogenous hormone production. Well what's interesting is that birth control can suppress IGF one not growth hormone. Right. Growth hormone can actually go up but it can suppress the IGF one production. So we're not getting the benefits that we're supposed to get from growth hormone. So it is a really critical hormone to consider and to address. And not many physicians unfortunately test this or they don't really know what to do about it. Let's say if it's low normal or high normal, what do we do with that information. And there's definitely a lot of mixed data about on what it means when it's elevated. Doesn't mean what our first thought does not have to be like cancer, right, necessarily, because it actually has a protective mechanism. So I do think it's extremely important, especially in both men and women and especially in women going through perimenopause. If we are seeing hormonal shifts, whether it's in the labs or the patient stories, we have to test IGF one to better understand what's happening with growth hormone. And in that perimenopausal like female group, are you typically seeing low normal IGF one or low IGF one or mid-range or what are you seeing a little bit of both. Yeah. So the the optimal range because, you know, the range can be huge from 0 to 250. The optimal range for IGF one where I see the most benefit is between 150 to 215, nanograms per deciliter. What I see in a lot of perimenopausal women, some of course, have you know, within, within that optimal range. And that means that we've got to be looking at something else, right? We don't need to plump them up with some more, lean into some more. And some of these growth hormone peptides, but a lot of them are at 100 right or 80 right, 90. So they're below that optimal range and they're having a hard time gaining muscle. They're more injury prone. This is where I'm even starting to see more inflammation around the major joints. Okay. Or even frozen shoulder like symptoms because we have receptors for growth hormone in the major joints in the different connective tissue that we have. So what I like to do is I don't I test IGF one, but I don't start on growth hormone peptides unless, you know, unless they're suboptimal. Yeah. And then are there any other strategies to increasing IGF one. Yes. Beyond that that aren't peptides. So if someone and I see this more in my younger population, if we can get the person to be more metabolically healthy, right. Of course that's the case with pretty much anything but lifting weights heavier weights, fasting, intermittent fasting, going to bed on time because one of your biggest growth hormone releases in pulses happens when you're sleeping right at night. That's when your body recovers. I remember a few years ago when people were trying to buy a hug their sleep, and I'm like, that's going to backfire. You know, as much as advanced humans are, right, we're trying to fight biology in nature, and it's like sleep. We need sleep, period. Yeah. So lifting weights, eating a higher protein diet, intermittent fasting, those are all great ways to support growth hormone. Of course, L-arginine, glycine those are important amino acids that we can incorporate to support growth hormone production. Yeah. All right so I have another question for you. So right now on social media, I feel like every woman in their 40s is saying I think I have ADHD. And you know, everyone is saying maybe I've been this high achiever in my whole life. And now I can't wait to, like, get things done as efficiently or I have all these tabs open in my brain. In my mind, I feel like I have a ping pong ball. And so everyone is saying, do I have undiagnosed ADHD? Do you have an opinion on that? I see a lot of women in their 40s and older, and of course there's obviously younger women who experience this as well who have been going through hormonal changes. And there's an overlap that happens where declining estrogen, testosterone growth hormone, and suboptimal thyroid can lead to ADHD like symptoms. You don't feel like yourself. It's harder to focus. You don't have the energy to focus as much during the day. And the anxiety piece, actually, because a lot of times, you know, there's an overlap. But ADHD, what's ADHD, is actually simply or what gets labeled as anxiety can actually be ADHD. Okay. But we have to be very careful to again, put that label on the patient. I think it's really important when it comes to ADHD and women in particular. First of all, when we're in our 20s, one, we potentially have obviously more hormones, but we're able to sleep it off, run it off, we're able to push through it in our 30s and 40s, especially as we're building families, building our practices, and the stress levels are much higher. And the hormonal landscape is different. ADHD symptoms can be more pronounced. So potentially, yes. Maybe you were not diagnosed with ADHD earlier on in life. And look, I don't think everyone is born with perfect neurochemistry. I do think some of us do have some underlying ADHD. I look back at my own childhood and I'm like, oh, that makes sense, you know? But back in the day when I was growing up, there was no there was no ADHD. There's no ADHD. You push through and your brain adapts. Yeah, there's or I don't know if you saw the new, Marcelo, Hernandez special on Netflix, but he talks about how, like, he thought he had ADHD, but his mom said no, he didn't, so he didn't have it. Mom's opinion is all that matters, right? Yeah. Similarly, I can relate to that. So yes, maybe the woman or the man has had some sort of undiagnosed ADHD in the past that has now become more apparent with the hormonal changes potentially, and life stressors, because you can't just push your way through life anymore. Right. And it becomes more apparent. And I've had patients who, let's say they get a promotion and they go from managing 80 people to 300 people, and all of a sudden they feel like they have a firehose of information. Yeah. And tasks that are flowing their way and they can't handle it. Yeah. And for some of my patients who are on hormone replacement, I know their hormones are optimized. They're taking every possible supplement to help with their brain function. And even peptides, let's say they access exceptional for ADHD, for memory and focus, but they still have the classical ADHD signs. So this is where we get a good psychiatrist on board. And to make sure that they do their due diligence. Because if we can balance the hormones. Yeah. And if we can improve your sleep and if we can get the right supplements to help support the brain and reduce inflammation and your focus and memory and everything else improves, then you don't have ADHD. It was simply a metabolic and endocrine imbalance. Yeah, but if you do all of those things and you're still struggling yeah, then potentially it could be ADHD. Yeah. Yeah yeah. So I think so if you are someone, you know, in your late 30s or 40s and you're wondering where do you think the best place to start is to support your brain to see, you know, do you think that that's me mainly starting with hormones. You're looking at metabolic health first or inflammation. I know all of it is the right answer. But, you know, there's one place hormones. Yeah. And unfortunately, if I'm struggling with focus and energy and motivation. Yeah. And I go to my primary care doctor or even my psychiatrist and I list those symptoms out, they're not going to test my hormones. They're not going to talk to me about different strategies that I could implement during the day. Yeah, they're not going to look at my adrenal panel. They're going to put in a prescription for Adderall or Vyvanse or any other ADHD medication, because that's what they're the framework that they're used to seeing it through. When I have a woman in, in their 30s or 40s, you know, I was gonna say, come to my office, but I do telemedicine to my virtual office and she's complaining about anxiety or depression or low motivation or doing everything right from exercise to meditation. And she sits down and she can't get work done. Yeah. My first thought is hormones. I want to check her thyroid. Thyroid is extremely important and especially T3. Yeah, for proper brain function. Yeah. For neurogenesis. Synaptic genesis very similar to De Hexa. And there are many times when we optimize thyroid function energy improves, memory improves, focus improves. So going back to was it actually add ADHD or was it add ADHD like symptoms that were due to a hormone imbalance. So the first place I would start is actually looking at hormones. Yeah, I think I think what I've noticed in clinical practice is that a lot of symptomatology falls in this subclinical category. You know, where you have maybe subclinical thyroid levels, you know, you've got subclinical, you know, estrogen, progesterone, testosterone levels. And but that doesn't really fall into a definitive like medical category. So I think that's why so many patients get kicked. You know, down, you know, down the curb like, you know, it looks fine. So you should be fine, but you don't feel fine. So something's happening, right? You know, and it goes back to everyone has their unique normal or optimal. Unfortunately an average physician just doesn't have the time. What can you do in 15 minutes? 15 minutes is enough time for me to ask you about how your weekend was. How's your family doing? I believe it's really important to establish a good relationship with my patients because if I can understand what's happening in their life, I can also be a better health care provider. But in our just traditional model of care, and I know it's not because of what doctors do, and this is just how our health care system is built. We don't have enough time to do a deep dive and to evaluate because one, yes, we don't have the time, but to a lot of practices, our insurance dependance and you're at the mercy of insurance companies and we're fortunate right to where we can actually help our patients with the time that we can give them, as well as the testing that we can do and our treatment options, regardless of what insurance company dictates. We work for the patients, right? Not for the insurance company. So unfortunately, it is important to have a health care provider on board who is willing to work with other physicians, health care providers to where? Let's not be so trigger happy to put someone on an anti-anxiety, on an ADHD medication, or an antidepressant. Let's actually look at behind the scenes at what are these key hormones are doing to our brain chemistry? Yeah, I agree with that. I feel like a lot of times it's let's look at, you know, hormonal markers. It's genetic predispositions. Let's look at my urinary, you know, this whole confluence that we talked about of, of things that intersect. Yeah. And then we can kind of piece it apart and come up with a very specific and personalized plan. And I think it's very important to look at trauma. You know, we talk about like, traumatic brain injury, but traumatic brain injury I feel like can happen both direct and indirect emotional trauma. You can technically show up in almost like a physical traumatic experience because we can see with trauma different changes in the brain that happen. And it's a protective mechanism. And our brain has a very good way of adapting and building different pathways that become more dominant, while the other pathways become a little bit more dormant. Right. And one of the things that I like to do is I'll actually, for my patients for more functional brain testing, to then see what patterns are we noticing? Where's the dominance happening. Yeah. And what potentially even parts of the brain are becoming more dormant because, you know, these more dominant pathways are active. And then we'll work with like a functional neurologist to undo some of those patterns. And this is where even like the vagus nerve stimulation comes in occupational therapy, red light devices and these different ways that we can actually help our brain bounce back and recover. So I think it's important to consider just that the day to day trauma, besides just the something horrible happened in the past and you kind of compartmentalize it, but just the day to day stressors sometimes of being a woman. Yeah. And the burden that we carry are important to consider. Yeah, I agree with that. What do you see as the landscape of medicine in the next ten years? What's exciting to you? I think having a lot of these tools more readily available. I would like to see medical professionals taking patient experience more into consideration versus just looking at the labs. I still feel like there's so much room for improvement. I think the hormone space and the peptide space has just blown up in the last few years. I feel like ten years ago and more than ten years ago, there are still so few of us who were in this space. And now it's like Starbucks and every corner there's a telemedicine practice specializing in hormone replacement and peptides, but a lot of them are still missing the patient story piece. There's we're still looking at labs. We're still somebody is prescribing synthetic hormones. So I think we still have some ways to go. I like the trajectory of it. I just feel like we can still do better in actually taking our personal day to day experiences into consideration, and not just look at the labs. I also want hormone replacement and peptides just to be prescribed more safely. Yeah, and with more evidence based, because it's exciting that the hormone space in the peptide space has blown up and we have access to more information and health care providers who do all these therapies. What's concerning to me is we've gone from hormones are bad to eight, hormones are amazing, and now we're prescribing hormones. It's different than supplements, right? Supplements it is different. We can support hormones in those ways. But when you're not using labs and you're being kind of frivolous with hormone replacements and you're just prescribing hormones and peptides without having the evidence to why you might actually need to prescribe them. You know, we're kind of playing with fire. Yeah, I agree with that. I feel like there's been such a big dichotomy change where we went from absolutely not to 100%. Yes. Yeah. There's the probably the the truth or the, the maybe the wise step is somewhere in between both of those the extreme nature of humankind. Gosh, yes. Black, black or white. Right. It's either all or nothing. Yeah. Oh, it's been so nice having you on. I'm so glad that you're able to join us. Can you tell the audience how they can, follow you, get to know you and, you know, kind of stay up with all the exciting things that you do. Well, thank you so much for having me. It's always such a pleasure to connect with like minded individuals and be part of something big and great. And health care. I'm frequently on Instagram so you can find me under Doctor Elena Zink of. You can also go on my website Doctor Lena, Zinc Ofcom. So you can also join my email list from our website. I like to share all my insights and knowledge and everything that I see in my professional life and personal life. I like to share that with my audience. Oh, okay. Wonderful. Thanks so much. Thank you. Before we wrap up, we want to thank Doctor Elena Zanka for such a thoughtful and honest conversation. If today's episode reinforced anything, it's how important it is to truly understand what's happening beneath the surface, especially when it comes to hormones, inflammation and aging and women. That's where vibrant wellness comes in. It vibrant. We're focused on giving practitioners and patients access to advanced, clinically relevant testing that helps connect symptoms to systems. One of the tools we often reference in conversations like today is the hormone Zoomer, which offers a comprehensive look at hormone metabolism, balance and patterns that standard testing can miss. Whether you're a practitioner looking to bring more clarity to your protocols or someone on your own wellness journey who wants better answers, vibrant Wellness is here to support smarter, more personalized care. Visit Vibrant Dash wellness.com. Follow us on Instagram at Vibrant Wellness and be sure to like and subscribe to the Vibrant Wellness Podcast for more conversations with leading voices in health, longevity and personalized medicine. Thanks so much for listening and we'll see you next time.