55. Heal Faster Naturally: Integrative Medicine with Dr. Victoria Maizes

What if your body already knows how to heal and you just need to support it the right way?

In this episode of Nourished with Dr. Anikó, Dr. Anikó sits down with internationally recognized integrative medicine expert Victoria Maizes, author of Heal Faster: Unlock Your Body’s Rapid Recovery Reflex, to explore evidence-based strategies for healing, resilience, menopause, chronic pain, surgery recovery, sleep, and whole-person wellness.

Together, they discuss how integrative medicine blends conventional medicine with lifestyle medicine, mindset, nutrition, sleep, stress reduction, and personalized care to support the body’s natural healing abilities.

Dr. Maizes shares powerful insights on:

• how mindset affects surgical outcomes and healing
• why sleep is essential for metabolism, immunity, inflammation, and brain health
• the latest evidence surrounding hormone replacement therapy (HRT)
• the difference between intermittent fasting and time-restricted eating
• how chronic pain changes the brain
• why individualized medicine matters more than ever

This conversation is filled with practical tools, compassionate wisdom, and empowering information for anyone navigating menopause, chronic illness, surgery recovery, chronic pain, inflammation, or simply wanting to better support their health naturally.

About Dr. Victoria Maizes:

Dr. Victoria Maizes is a pioneering leader in integrative medicine, founding executive director of the Andrew Weil Center for Integrative Medicine, professor of medicine at the University of Arizona, and bestselling author of Heal Faster: Unlock Your Body’s Rapid Recovery Reflex. She is internationally recognized for helping people harness the body’s natural ability to heal through evidence-based integrative approaches.

At the University of Arizona, Dr. Maizes helped create the world’s leading integrative medicine fellowship and residency programs, which have helped train clinicians now impacting more than 20 million patients worldwide.

A board-certified physician in Family and Integrative Medicine, Dr. Maizes is an internationally respected speaker, author, podcast host, and passionate advocate for lifestyle-based healing approaches including nutrition, stress reduction, restorative sleep, environmental awareness, and evidence-based complementary therapies.

She is also a founding member and former education chair of the Academic Consortium for Integrative Medicine & Health, a founding board member of the American Board of Integrative Medicine, and an award-winning physician recognized for advancing integrative healthcare into the mainstream.

Connect with Dr. Victoria Maizes:

Dr. Victoria Maizes Website: https://www.drvictoriamaizes.com/

Book: Heal Faster: Unlock Your Body's Rapid Recovery Reflex: https://www.drvictoriamaizes.com/resources

Body of Wonder Podcast: https://www.azcim.org/podcast hosted by Dr. Victoria Maizes and Dr. Andrew Weil and produced by the Andrew Weil Center for Integrative Medicine. 

Andrew Weil Center for Integrative Medicine at the University of Arizona: https://awcim.arizona.edu/

Connect with Dr. Anikó:

Instagram: https://www.instagram.com/dr.aniko/

Website: https://www.draniko.com/

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Disclaimer:
The content of this podcast is for informational and entertainment purposes only and does not constitute medical advice, diagnosis, or treatment. The views expressed are those of the host and guests and do not substitute for professional medical advice. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay seeking it because of something you heard on this podcast.

Transcript

Dr. Anikó: [00:00:00] You're listening to Nourish with Dr. Aniko Gregor. This podcast is all about the many, many ways you can support your health and your family's health. I'm an integrative physician, and I am so passionate about helping people find their pathway to their very best life. I hope you enjoy.

A reminder that this podcast is for informational and entertainment purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding your health or medical condition.

Dr. Victoria Maizes: Never disregard professional medical advice or delay seeking it because of something you heard on this [00:01:00] podcast. Take very good care, y'all. 

Dr. Anikó: Hello. Hello, y'all, and welcome back to Nourished with Dr. Aniko. Today's guest is the wonderful Dr. Victoria Maizes. Dr. Maizes is a pioneering leader in integrative medicine and the author of the Amazon bestseller Heal Faster: Unlock Your Body's Rapid Recovery Reflex, which explores practical evidence-based strategies to strengthen resilience and accelerate recovery.

She is the founding executive director of the Andrew Weil Center for Integrative Medicine and a professor of medicine, family medicine, and public health at the University of Arizona. She's internationally recognized for her work at the intersection of science and health, and she focuses on the body's ability to recover, heal, and thrive.

Dr. Maizes is the editor of the Oxford University Press textbook Integrative Women's Health and the author of Be Fruitful: The Essential Guide to Maximizing Fertility and Giving [00:02:00] Birth to a Healthy Child. She also co-hosts the popular podcast Body of Wonder with Dr. Andrew Weil and was named one of the world's 25 intelligent optimists by Ode Magazine.

Welcome, Dr. Maizes. 

Dr. Victoria Maizes: Thank you. I'm so delighted to be on with you. 

Dr. Anikó: I'm so happy to have you on, and we were just talking before we started recording that I haven't seen you in like your face in so long. So it's so lovely to see you. Um- 

Dr. Victoria Maizes: Same. 

Dr. Anikó: Thank you. Um, so I wanted to start by sharing how much I really enjoyed and really appreciated your most recent book, Heal Faster.

Um, and I found, we talked about this in our conversation before, that I found it to be quite a feat that, you know, though you are a specialist in integrative medicine, you're also a generalist, meaning that anybody with anything could come to you. You're not just working on the GI tract or the, uh, allergy system or anything like that.

So your scope of knowledge and what you could have written about was enormous, so I thought it [00:03:00] was quite a feat that you were able to kind of whittle it down to what really feels like healing fundamentals. Like, it, it really feels like you nailed it. 

Dr. Victoria Maizes: Thank you. Thank you so much. You know, I think, um, one of the things people really want, and often they come to an integrative medicine physician, is to be seen as a whole person.

So we have these amazing advances in medicine, um, and therefore we have sub-subspecialists. You know, we have the oncologist who only takes care of colon cancer, and we have the endocrine doctor who only takes care of thyroid disease, and it's wonderful to have that specialization, but sometimes we lose who's looking at the whole person, and that's something you and I greatly value in integrative medicine.

Dr. Anikó: Yeah, very much so. Well, and I also found your book... I'm just gonna keep talking about how much I love your book for a little while, um because I love how you organized it. Like, I feel like, you know, [00:04:00] you're... I'm obviously biased. You're one of my teachers, and you're one of my teachers that I really delighted in.

I feel like the way that you teach and the way that you think is very complimentary with how I think. Um, but it felt so intuitive and logical the way that you structured your book because you divided it into short-term conditions, long-term conditions- Mm-hmm ... recovering from surgery. And then even each chapter starts with a- Mm-hmm

vignette, you know, which really lets the information land. Mm-hmm. And then you start by talking about the condition, and then you go into a very organized discussion about treatment modalities from conventional to supplements to lifestyle. Um- Mm ... and then you close with, you know, a, a toolkit or a rapid recovery sort of prescription for everybody- Uh-huh

like a plan. And that felt to me so intuitive and also manageable because, you know, in medicine, it is almost like an endless amount, not just- Mm-hmm ... of topics, but an endless amount that you could explain. Right. And it really feels like you hit that Goldilocks just right place of [00:05:00] it doesn't feel so brief that it's just bullet points, like it's just a list.

Mm-hmm. It's not so extensive that it's overwhelming. Like, you were able to, to find the flow while still being brief and still being engaging, both for the layperson, I have to say. And I'm a practitioner, not just a- Right ... practitioner, but an integrative practitioner. Right. And I found it so engaging the whole way through.

Like, it wasn't, it wasn't boring or anything where you think like, "Oh, it's a book for laypeople who aren't in the medical world." It was engaging for so many people in so many different levels, so I really enjoyed it. 

Dr. Victoria Maizes: Thank you so much, Aniko. It's very, very meaningful, uh, to have praise coming from you, who is an integrative medicine physician.

Uh, and I think people do read it differently. Uh, there are people who read it cover to cover. I think more the doctors. That's been more, uh, what I've experienced. And then there are people who dive in. They say, "You know, my mother just got diagnosed with heart disease, or diabetes, or is wrestling with depression.

What [00:06:00] might there be in Heal Faster that would help her? Uh, and, uh, I'm about to have surgery. What can I do to prepare so that I'll have an easier time, I'll recover faster?" Uh, that's more, uh, the, uh, regular people in the world as opposed to the practitioners. 

Dr. Anikó: Right. Right. Well, and I have to say, I was also really struck by the part specifically about surgery- Mm-hmm

both in the preparation for surgery- Mm-hmm ... that was so much more profound than sort of the convent- Obviously, I knew about it, you know, learning about it- Right ... from the integrative fellowship and just living an integrative-minded medical life. But just the preparation that is within your power to do and that healing power that you can harness from even before you get the surgery.

Right. And then also the fact that you so, again, sort of peacefully, calmly described what the surgery was going to be- Mm-hmm ... what the hospital stay was going to be like. You know, it just reminded me of how much we take for granted as [00:07:00] medical professionals- Right ... that we know what to expect. We know what the- Right

hospital stay will be like. We know the diet, what the diet advancement will look like. Right. But a person that's not in the medical world going into the surgery, to be able to read that account from you, that sti- again, delivered in this very calm, reassuring way, I can just imagine it providing so much comfort and reassurance, not just to patients, but also to families, to be like- Yes

what are we in for right now? Right. How can I support my family member? Because it is so... It can be so scary to have- Mm-hmm ... even minor surgery, you know? Mm-hmm. It's a, it can be a really big deal. Um- Yeah ... and so it's just such a resource for both patients and families- Mm-hmm ... to feel more empowered and to feel like they have some tools that they can use, and some expectation of what my role is going to be, even if it's not- Right

you as the patient, but a support team member. 

Dr. Victoria Maizes: Right. And having realistic expectations when you're going into surgery is really important. Um, [00:08:00] I am not a surgeon, but I have been giving people advice about preparing for or recovering from. We have a special term, prehabilitation, because there are things you can do, whether it's, uh, eating a diet that's richer in protein than you usually eat because maybe you need a little more protein than you were aware of, uh, because surgery in and of itself puts you into what we call a catabolic state, where you break down protein.

Because when your tissues are healing, you need more protein, making sure you get the right micronutrients. But then there are interesting other things. Psychologically, most of us feel anxious if we're gonna have surgery. So how about using guided imagery or aromatherapy or other things that you know soothe you?

Making sure you have a good companion, 'cause, you know, someone who's super anxious may not be the best companion when you're about to go into surgery. So these are things we can think about, we can understand, and we can [00:09:00] make plans for, and then the outcome on the other side is often much, much enhanced.

Dr. Anikó: Yeah. And it really reminds me, 'cause I also do work in the perinatal and the postpartum world. Mm-hmm. And we do a lot of preparation. Right. You know, getting your house ready. Right. What is this gonna look like? Right. And obviously, you know, I think both birth and surgery have similarities, and sometimes birth does happen surgically.

Right. But yeah, you sort of... I- it's, it's gonna be what it's gonna be, you know? Right. And so you kind of have to ride that wave and be open to whatever's going to happen- Right ... um, and be prepared for that. But there's so much you can do beforehand to prepare- Mm-hmm ... both your mind, your space, your people.

Um- Mm-hmm ... and I don't think we f- I know we don't think about that as very much in the perinatal world, and we certainly- Mm-hmm ... don't think about prehabilitation Mm-hmm ... very much in the general conventional surgical world either. 

Dr. Victoria Maizes: Yes. 

Dr. Anikó: And it's, and it does remind me too where we always talk about, you know, the surgeon or the, you know, the, the doctor can, you know, do the [00:10:00] surgery or give the medicine, but it's the body that heals, you know?

And it really, that emphasis on, that heavy emphasis on mindset going into surgery- Mm-hmm ... and that very powerful part where you talk about the, you know, the longtime physician who ended up joining the fellowship- Mm-hmm ... and said, you know, when people say, "I'm not ready"- Yeah ... I honor that, and we come back to it when they are ready- Right

because the outcomes are worse. Right. And sometimes devastating when the body, the mind, the spirit isn't ready for this. 

Dr. Victoria Maizes: Right. Now, with childbirth we have no choice, but- Right. ... often with elective surgeries we do have a choice, and then there's getting oneself ready. So I, I have one story in the book about a woman who really needed back surgery, but she was convinced it was gonna fail.

That's not a great way to go into surgery. And so she and I did a lot of work together about- Could we reframe? Could we shift this from [00:11:00] back surgeries always fail to I've chosen a surgeon really carefully, I have a problem that's fixable, everyone seems to be quite clear that this will get me back to my life where I enjoy hiking and I haven't been able to hike.

And in shifting her mindset, she went into surgery in a totally different place than if she had gone in with it always fails. 

Dr. Anikó: Right. Yeah. And she 

Dr. Victoria Maizes: did really well. Yeah. 

Dr. Anikó: That's wonderful. Well, and you know, and again, I, I think many people don't know this, we obviously know it, but, you know, affirmations being said before surgery- 

Dr. Victoria Maizes: Right

Dr. Anikó: during surgery in the operating room- Right ... has a direct impact on the amount of blood that's lost. You know- Right ... it's not just all mystical, everybody felt better. Literal outcomes that we measure in surgery are better with- Correct ... things like affirmations. Right. It's really powerful. 

Dr. Victoria Maizes: Right. And so the book is really full of things that reduce [00:12:00] the need for pain medicine after surgery, uh, that have people have a shorter hospital stay, that have people heal more quickly.

And like you said, there's the whole mindset, affirmations, guided imagery, social support, having a friend there with you, but then there's also the appropriate food, the appropriate supplements, um, sometimes things like what will I use to manage my pain after? There are choices besides opioid medicines, which, you know, for some people are problematic.

So can I use ice? Can I use heat? Can I use a vibration tool? Can I use a TENS unit? There's just much more than people know, and having some of these ideas, and sometimes even the tools at hand, um, very common for people if they're having an orthopedic surgery to order the ice machine to arrive as they're getting home so that they can, you know, easily ice, uh, with the [00:13:00] help of that machine.

Dr. Anikó: Mm-hmm. Yeah. And I, you know, although I know you partnered with AARP to write the book, it's definitely not just for the 50 plus or 55 plus crowd. There's so much in here like PMS pain, which all ages, I mean, it really feels like it's written for all ages 

Dr. Victoria Maizes: Yeah. Well, actually, that was my goal. That was definitely an AARP goal as well.

So one of the things that I worked to discern is what are the conditions, what are the situations where integrative medicine really has something very substantial to add that many people don't know about? And so that was one of the filters I used in writing a very broad book. Uh, for example, there is not a chapter on Parkinson's.

Parkinson's is a really serious condition. It's a common condition, but we don't have wonderful answers. We have some answers. We have some strategies that may not be widely known, but we don't have [00:14:00] enough to sort of bring to that level of here's a comprehensive integrative medicine plan that is really going to lead to a different outcome 

Dr. Anikó: Yes.

That makes a lot of sense, and I think one of the beautiful things about integrative medicine that isn't always clear to people when they hear integrative medicine is that, you know, we use conventional approaches when they are appropriate. Mm-hmm. And there's many, many conditions in which the conventional approach is the best one- Right

for most people. Um, but I do feel like your, your book is just sort of chock-full of pearls of wisdom, and I know that in my personal life, and also in my professional life as a physician providing care, sometimes it is just these ideas that shift your way of thinking a little bit- Yes ... that either plant the seed or water the seed- Right

that's already within. Mm-hmm. That creates change, you know? Mm-hmm. Even the, the information you were giving about Esther Gokhale about walking backwards, you know? 

Dr. Victoria Maizes: Right. 

Dr. Anikó: I've, I've shared that with people, and it is, it's life-changing, you know? Yes. Um, or sleeping with a pillow between your knees- [00:15:00] Right ... or, or reframing pain.

I mean, just using different language. Right. There was one quote that I'm going to look up because I just, I just thought it was so great. Um, um, where the, the zen quote where it said, you know, if you, I recommend you meditate every day for 15 minutes, unless you don't have time- Right ... in which case you should meditate for an hour.

Dr. Victoria Maizes: Right. 

Dr. Anikó: Just those things that you're like, "

Dr. Victoria Maizes: Wait, what?" I love that quote. I use it when I teach because, you know, it's surprising, but it is, uh, contains a truth which is when the going gets rough, often we lose our practice, whether that's yoga or meditation or a daily walk or cooking yourself a nourishing meal, and yet that's really when we need to double down and treat ourselves even more, with more nourishment because the going is rough.

And so, uh, the, the, you know, Western society doesn't always support that, but that is really important [00:16:00] for healing of many different conditions. 

Dr. Anikó: Absolutely, and I, I love how much you focus on sleep, you know? Yeah. Because it is such a fun... I even said it to my husband the other day 'cause he stayed up late.

Uh-huh. And I was like, "Sleep is important to reduce pain- Mm-hmm ... and inflammation- Mm-hmm. ... and depression," and, you know? And my, my family knows I'm the, the preacher of sleep. Yeah. But even that little reframe of think of- Right ... sleep as the first thing you do in your day rather than- Right ... the last thing, you know?

Dr. Victoria Maizes: Right. Right. Right. And for your listeners, a lot of us think of sleep as a waste of time. Uh, in fact, uh, there's a, a saying that's, uh, tributed to Thomas Edison, who invented the light bulb- ... which is, uh, sleep, uh, is, uh, heritage from our cave age days, our caveman days, and a criminal waste of time. And there's a lot of people who feel that way, like, wow, I could be doing so much instead of being somewhat [00:17:00] unconscious, you know, lying horizontal.

But that completely di- Dis- distances ourself from what's happening during sleep. So what's happening during sleep is we are rebooting our metabolism. So if you don't get sleep, you may wrestle with obesity. We are laying down memories. If you don't get sleep, you may suffer from difficulty thinking, not only in the short term, but an increased risk over time for dementia.

Uh, we are rebooting our immune system, which is going to make us more resistant to the viruses and infections that come our way. And so it turns out that sleep is not a time of nothing happening. It's full of things happening to make sure that our systems run well. 

Dr. Anikó: Yes. Yes. Well, and I'm thinking, gosh, Thomas Edison sounds like he had a lot to unpack.

And invented the [00:18:00] light bulb on top of it, where he's like, "Nobody sleep." 

Dr. Victoria Maizes: Yes 

Dr. Anikó: But it is, you know, I, I love that you explain the... 'Cause you often cite research- Yes ... which obviously, as a physician, I love. Um, and then you also sort of give the reasoning, like why is this important- Right ... and then how to implement it, right?

Right. Because sleep, too, impacts our glucose metabolism- Right ... so it increases your risk of diabetes. There's sort of nothing that sleep doesn't make better, you know? Right. Right. Um, and so really, but shifting our relationship with sleep, especially in this go, go, go, hyperconsumerism, hypercapitalism environment, um, it reminds me of, you know, what, you know, we said a lot in the fellowship of, you know, don't just do something, sit there.

Dr. Victoria Maizes: Right. And 

Dr. Anikó: there's so much- Yeah ... truth to that. 

Dr. Victoria Maizes: Yes. Yes. It's, it is true. And, um, I appreciate you bringing up the fellowship. That is, um, you know, for anyone [00:19:00] who's listening, the way we train people in integrative medicine. So we do have a two-year training program, and I think we're up to around 2,500 physicians.

We also have nurse practitioners, and physician assistants, and dentists, uh, come into the fellowship. And it's, it's been really awesome, uh, for me, who's been there, you know, from the very beginning, I, I helped start that program, to just watch how much of a meaningful difference it makes in the physician's life, the practitioner's life, as opposed to the patients they care for, who of course are also then receiving, hopefully, wisdom and skills from that, from their provider.

Dr. Anikó: Absolutely. And I, and I have shared in previous episodes where I talked about my journey into medicine, my journey into both- Yeah ... integrative medicine and postpartum work and perinatal work, and I joined the University of Arizona family when I was in residency, when I did the elective and [00:20:00] residency. And I often share the story of that that was the first time in my life that I was around physicians where I saw them and they seemed vibrant and well.

Yeah. And I thought, "Okay, I, I could do this." Yeah. Because other physicians that I'd met in the conventional world were all lovely human beings, amazing physicians, but they were all run-down. Yeah. They were all- I'd lost that kind of vibrancy. It kind of felt- Yeah ... like, gosh, this work is amazing, but I, I don't wanna end up like you, actually.

Right. You know? Right. And it felt like in the world of integrative medicine, and not that people were necessarily doing less, but they were finding the balance, they were having the conversations, they were doing all of the work- 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: to make the, the continued consistent work of the sacred- Right ... work of medicine possible for them to offer people.

Dr. Victoria Maizes: Right. Right. Yeah. Well, I mean, we have that expression also that you can't pour from an [00:21:00] empty cup. And so nourishing the people who come to our training program to learn integrative medicine, and as you say, having that self-care become a practice, I think you become a much more compelling role model then for the patients you care for.

Because it's not like you don't have a full busy life, and yet you then make sure to find the time for that self-care that keeps you healthy and vibrant. 

Dr. Anikó: Exactly. And, and learn, you know, again, different modalities. I was exposed- Yes ... to a lot of different modalities that I didn't even... I remember an equine therapy session that was very fun and very powerful.

Um, and you know, reading through the book for me was, it was almost like an Easter egg hunt for me, 'cause there were, there were portions where you would say something. I remember specifically reading the putting the pillow between your legs when you sleep for back pain. Yeah. And I thought, ooh, Esther Gokhale.

Yeah. I wonder if she's gonna mention her, and then not two pages in, there was a whole thing- Yeah ... on her and her healing [00:22:00] back method. And then I was thinking, oh, I was like thinking about Julia Rucklidge, Dr. Julia Ruckridge- Yes ... Rucklidge, and her, you know, micronutrient, um- Right ... preparation and treating mental health that way, um, in one of the sections.

And then, you know, not n- in the next chapter you mentioned her. So it was also... I just, I can't overemphasize how comprehensive it is- Yeah ... without being overwhelming, that even I as a reader, as a practitioner, I'm almost like, yeah, no notes. Like, I have nothing to add. It was so complete without feeling like, oh, now I'm drowning in information, you know?

So just brava. Like, just- Thank you ... such a wonderful job. And then also, I think such practicalities as, and we talked about this too, that you even talk about the doctor-patient relationship, that I feel like sometimes- you know, maybe your doctor isn't necessarily giving you the care that you want, that it's not bad care.

Mm-hmm. It's just not necessarily as personalized as you would like it. Mm-hmm. You really give some tools for how to improve that [00:23:00] relationship. Mm-hmm. Because so much, uh, advice that I feel like is given in, you know, family situations or even on social media is like, "Oh, just get a new doctor. Just get a new doctor."

Yeah. And the reality, uh, especially in the US, it is not very easy to get a new doctor. It's not easy to get a primary care physician. 

Dr. Victoria Maizes: Right. 

Dr. Anikó: Of course, there are absolutely situations where people are receiving bad care, where they absolutely should- Mm-hmm ... change their physician, but there's also so much room to work with what you have.

Right. And I feel like you give both encouragement and some really good tools and advice for people to be able to do that. 

Dr. Victoria Maizes: Thank you. Yeah. Thank you. 

Dr. Anikó: Um, so, I, you know, again, we chatted this week, and I was like, "I don- I don't even know where to start," 'cause there's so many things we could talk about. But one of the things that I think is really relevant right now and really important, and I think is really special for listeners to hear from you about, because you're so experienced, um, you have this integrative medicine wisdom as [00:24:00] well, is HRT or hormone replacement therapy.

Yeah. Yeah. Because there is a whole chapter on mastering menopause and perimenopause. And HRT, I was talking to an OBGYN just yesterday about it. Just feels like a, a little bit of the Wild Wild West in the sense that all of a sudden it's like everybody's recommending it for everybody. And there is so much that we need to know about the patient history before we even know if it's appropriate for that person.

Mm-hmm. And then also so many different ways to deliver hormones that might be better for one person or another person. Mm-hmm. So I think hearing about all of that from you would be really wonderful for, for our listeners, especially in this time, when it's so wonderful that people are using HRT much more widely than they used to, because they used to sort of not be letting people use it.

Right. And even before that, they were, they were sort of overusing it, and then they went to- Right ... the other side, where they weren't prescribing it for anybody, and now it seems like everybody's on it. But you do need to be thoughtful about it, and it is not for [00:25:00] everybody. 

Dr. Victoria Maizes: Yeah. Um, it is, um, I think a really important conversation to have with a doctor, and the reason is, is that, uh, hormone therapy For a long time was used for symptom management.

And it is true, it's very effective at helping with what we call vasomotor symptoms, which are hot flashes and night sweats. And it's also really helpful for vaginal dryness, which can happen as you get, uh, into perimenopause, menopause, and even, like, years later it can sometimes manifest as the most troubling symptom that women have.

So there's a whole conversation about, "Do I need it for symptoms?" And you're right, up until recently it was like, "No, your symptoms aren't bad enough, so you don't need to take it." And now we're much more ready to prescribe it because the women's health initiative that sort of put the kibosh on hormone therapy for a long time has been [00:26:00] reanalyzed, and we understand things we didn't understand, uh, at the onset.

So one is what we call the timing hypothesis. And it turns out that if you give women hormone therapy at the time of menopause, so when she's having symptoms, then it's actually associated with a reduced all-cause mortality. Let me say that another way. People are l- women are less likely to die of all causes if they go on hormone therapy at the time of menopause.

Now, that's to distinguish from going on in your mid-60s or your 70s, which they also did in that study, and that increased your risk of dying of heart disease. Heart disease is the number one thing that causes, that, that kills women in our society. So reducing the risk of heart disease is really powerful.

There is some evidence that you might also reduce the risk of, uh, cognitive decline, uh, if you do it within five years of starting menopause. So that's [00:27:00] the timing hypothesis. It's also supports bone health, so you're less likely to end up with weaker or brittle bones. You're less likely to get colon cancer.

You're less likely to get diabetes. So there's a whole prevention conversation that's quite different from the symptom management, and that's why it's really worth talking to a doctor because you might say, "I'm managing my symptoms okay," and that's awesome. But there may still be a reason. Say, you have a strong family history of heart disease or colon cancer or osteoporosis.

You might still decide that it is wise for you to, to use hormone therapy. And so this now becomes a, a, an, an important conversation to have in midlife with your physician. 

Dr. Anikó: Yeah, absolutely. Well, and you do also mention in the book that, you know, there has been some increase of the risk of breast cancer, which is scary.

But you also make the point that actually heart [00:28:00] disease is the number one killer of women, not breast cancer. Of course, breast cancer is terrifying. Nobody wants it. Right. But heart disease is actually the one that's looming for- Right ... the majority of us. 

Dr. Victoria Maizes: Right. Even breast cancer is being, um, very carefully analyzed because in that women's health initiative, the women who only got the hormone estrogen, and they got a synthe- they got a form from horses.

Premarin is pregnant mare's urine, and that's because we didn't know how to make a bio-identical estrogen. So they got Premarin only because they had had a hysterectomy. They did not have an increased risk of breast cancer. It was really the women who got Premarin and Provera. Provera is a synthetic progesterone, and it was being on that synthetic progesterone that was associated with the increased risk of breast cancer.

So there's still some unanswered questions actually, and, [00:29:00] um, you know, this will continue to evolve and we'll continue to understand it. But I, I, I do want to say for anything that has potential benefit, hormone therapy, um, being on a, a statin, which is a cholesterol-lowering medicine, taking, uh, an antiviral medication, like whatever it is, for anything where there's potential benefit, there's also some risk.

You know, you could be the one person who has an unusual reaction. You could be the person who it didn't do any better, uh, any good for you. So it's, it's, there's nothing that's 100%, and we are biologically individuals, and we respond to things differently. We're not one Joe Average. You know, we're all a bit different.

Dr. Anikó: Right. Well, and much of the medical research, as you know, not for the Women's Health Initiative obviously, but- Yeah ... much of the medical research that we have that guides our treatment is on men, and usually on white men. You know, so it's certainly we're not, literally not everybody is [00:30:00] Joe, right? 

Dr. Victoria Maizes: Right.

Right. Right. A- absolutely true. And, you know, women, uh, have, tend to have more side effect from medication probably because they weren't in those studies for many years. It may be because we metabolize drugs differently. It may be because we have, uh, you know, a lower, in general, lower body weight where, where our makeup, our body composition is different.

And so for many, many reasons, the dosing may need to be different for a woman than a man. And yet often it's a sort of, well, you're a, a pediatrician by training, but often it's a one-size-fits-all for adults as opposed to children where we do it by body weight. 

Dr. Anikó: Mm-hmm. Right. And there is- And age. Yeah ... and age, and there's a case- Yeah

to be made to do it by gender or by, you know- Yeah ... especially after puberty Um, I think we're just gonna discover more- Right ... and more about this- Right ... which is wonderful. Um- 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: you know, I- I'd 

Dr. Victoria Maizes: love to say one other thing, which is, um, I make [00:31:00] a point in the book about, uh, circadian medicine, and this is a, a new area that's evolving.

And, uh, one of the things we're learning is a medicine may have a different impact at night or in the morning. It sort of goes with that, that sleep is important. Well, different systems of your body are functioning more or less at different times, and therefore, the ideal time for chemotherapy may not be a one size fits all from 7:00 AM until 5:00 PM.

It may actually be much better to have it in the morning. Blood pressure medicine may work better before bed. And so these are things you may want to ask your doctor or your pharmacist, "Is there an ideal time to take this medicine?" 

Dr. Anikó: Right. Right. And you also make the point about vaccines being more effective when you get them in the morning versus at other times.

Yes. I mean- 

Dr. Victoria Maizes: Yes ... 

Dr. Anikó: yeah, this, this chronotype and sort of circadian- Right ... rhythm-based [00:32:00] medicine, I... It makes so much sense, you know? Yes. And it's, and even the differences between different bodies who are different types. Yeah. I think we really- Right ... celebrate, you know, morning people in this society, and there's a lot of, lot of not morning people in the world, but your individual chronotype- Right

may affect how you absorb medication- ... or vaccines or, or whatever it happens to be. So yeah, I think it's a really exciting field and is only going to give us more opportunity to individualize medicine further. Right. Um, and so but if you are a good candidate for HRT, if you and your doctor determine that- 

Dr. Victoria Maizes: Right

Dr. Anikó: you also have some recommendations around the, the type of HRT you prefer to use for your patients. 

Dr. Victoria Maizes: Yes. So there's a few things there. One, I think bio-identical is really important. That means that the medicine you receive, the hormone you receive, is identical to what flows in your [00:33:00] veins. And, um, that's really a, a feature of modern life because as I said, at first when we prescribed hormones, we were using, uh, horse hormones, not human hormones, and they're not identical.

There was enough similarity that it did help with the symptoms of menopause, but it also could increase the risk of blood clots. It could increase the risk of raising your blood cholesterol and triglycerides. So they're not identical. So you want to ask for what we call bio-identical. Now, some people think that means you have to get it from a compounding pharmacy.

That, that's not the case except for testosterone. For estrogen and progesterone- Big pharma makes bioidentical hormones, and so you could get it from a compounding pharmacy as well. But if you get it from big pharma, there are some advantages. One, it'll probably be covered by your insurance. Two, it'll be much more of a [00:34:00] standardized process.

So I'm, um, a fan of compounding pharmacies, but I think people want to use their insurance if they can. So, um, those are the hormones you want, and for, um, for most women, I prefer that they use what we call transdermal, which is usually gonna mean that you're using a patch. Now, why do I prefer that? The reason is, is that when you take a medicine by mouth, it goes down into your stomach, and then it actually is transported to the liver, where it's metabolized before it gets into what we call your systemic or your total body blood flow.

Well, in that breaking down process, in that metabolism, there is actually a little bit more risk than if you take the, uh, hormone therapy via the skin. You can use a much smaller dose, typically a 20th of the dose, and it goes directly into what we call your [00:35:00] systemic or total body circulation. So in integrative medicine in general, we like the smallest dose that does the job because you're less likely to have an adverse effect with smaller doses.

So estrogen, transdermal, bioidentical. Now, progesterone is available as a bioidentical, but only by mouth. And so the progesterone we usually do, it's a capsule. Uh, you do it, um, at bedtime, and you do it at bedtime because it actually has, for many women, some lovely relaxing and sleep-promoting effects, which, you know, can be sometimes a challenge at menopause.

And so why not have this h- help from the progesterone to help you sleep better? So that's also a bioidentical, but that will not be transdermal. Um, and there are some different ways we do it right around, uh, perimenopause, menopause. We do it, um, [00:36:00] what we call in a cyclic way. So you'll still have a period.

Uh, the progesterone is what will lead you to have a period. Once you get a number of years out from menopause, we will do what we call continuous, and there you'll take the progesterone every day, and you'll no longer have a period. Whether or not you need testosterone, um, is an interesting question. Both estrogen and progesterone decline pretty precipitously at menopause.

Testosterone does not. Testosterone is made in the outer part of the ovary, what we call the ovarian stroma, and it has a much, much more gradual decline. And so many women never feel the need to have testosterone, but if you're noticing a loss of libido, uh, if you're, uh, having a dramatic bone loss, then you may want to.

And I usually do send women to a compounding pharmacy for their bioidentical testosterone [00:37:00] because Big Pharma makes testosterone in doses appropriate to men, not women That was a lot. 

Dr. Anikó: No, that was great, and I was like, "Of course. Of course they only make testosterone for men." Um, but so do you find that your patients stay on their HRT kind of forever, or do people taper off?

What are you- Um- What do you find in your practice? 'Cause obviously- So- ... I don't treat a lot of people for menopause. 

Dr. Victoria Maizes: Right. Well, it's another great question. Um, you know, we used to have this attitude of you should use it for the shortest amount of time possible because we were worried about this increased risk potentially of, of breast cancer.

And, um, now that is shifting, and it's shifting because of the preventive qualities of hormone therapy in terms of preventing heart disease, diabetes, cognitive decline, colon cancer. And so now it's really [00:38:00] much more in this category of have regular conversations. So every year or two, you're gonna have a conversation with your doctor, "Do you think I should still stay on hormone therapy?"

That way, you'll be getting an update about the research and where things stand, and you'll be able to make that decision together. Um, some people prefer not to be on any medicines. Well, we, we honor people's preferences. Uh, some people, maybe there's no history of breast cancer personally, but they have a sister or cousin or someone else, and they really wanna use it for a shorter amount of time just to manage symptoms.

So it's really, uh, very much individualized because we do not actually have a science-based answer right now for what's the ideal duration. 

Dr. Anikó: Mm-hmm. Yeah, something that we're still discovering. Yes. And what, just so our listeners know, what are the contraindications to HRT? Who should not take it? 

Dr. Victoria Maizes: Yeah. So we do not recommend [00:39:00] HRT if you have had breast cancer, endometrial cancer, um, ovarian cancer, if, you know, if you've had hormonally driven cancers.

So that's one big category. If you've had a blood clot, we don't usually recommend it. Sometimes there are exceptions. You know, if you were immobilized during a surgery and you had a blood clot and you really are having a difficult menopause, it might still be, uh, recommended to you. But in general, you know, if you had a stroke, if you've had a heart attack, those are what we call contraindications.

And the good news is, in integrative medicine, we have this large toolkit, so there are other things we can use. We can turn to acupuncture and Chinese herbal medicine. There's Western herbal medicine, like black cohosh, and St. John's wort, and other things that can be helpful. We have cooling mattresses that can help with the hot flashes, especially at night when you're trying to sleep, so you don't have that sleep disturbance.

Uh, we have some [00:40:00] non-hormonal medicines that can help with hot flashes. So If you're listening to this and you're not eligible, please know that there are many other things that we can do to help if you're struggling with symptoms. And in terms of prevention, there's all the lifestyle things. There's getting a good night's sleep.

There is making sure that you're getting physical activity. There's managing your cholesterol and your blood pressure. So there are many other things that you can do to reduce your risk of heart disease. 

Dr. Anikó: Right, right. And they're all in, they're all in her book- ... Feel Faster, including what Dr. Mazis just talked about in terms of other modalities that can treat these symptoms if you- Mm-hmm

either prefer not to use HRT- Mm-hmm ... or it's actually contraindicated. And I did wanna just make another quick sweet note about just, you know, just I feel like your wisdom and your compassionate and your encouraging voice in this book and in life, but there's this part about vaginal estrogen. 

Dr. Victoria Maizes: Yes. 

Dr. Anikó: It can be used for, you know, vaginal [00:41:00] dryness and painful- 

intercourse, and it really stays, you know, localized, so that doesn't really get absorbed systemically very much into the bloodstream. But one of the things you say is, you know, if your doctor doesn't ask you about sex, be brave and bring it up. Yeah. You know? I feel like, again, just, like, another voice to help encourage you and also plant the seed 

or again, water the seed that's already there to say, "Hey, like, this is a, this is a valid thing that happens to a lot of people. It makes a big difference. It's important. Bring it up. There's treatment for it," you know? 

Dr. Victoria Maizes: Yes. And people often are not aware. So what happens is you go through menopause, and maybe you've sailed through, and you've had minimal symptoms or no symptoms, or you even had symptoms, but you managed them.

And now you're 70 years old, and you're having frequent urinary tract infections, and you're going, "What's going on? I've never had a urinary tract infection. Why am I getting them now?" It may be because of this thinning of the tissues that can happen post-menopausally with [00:42:00] aging. It actually happens also as you're in the breastfeeding period of time.

That can be another time when you get this, uh, vaginal dryness and some thinning. And in those cases- Using vaginal estrogen, it's one of the few anti-aging medicines that I completely believe in. You put that estrogen in the vagina and the outer tissue, that's called the vulva, and if you look under a microscope, it goes back to a more youthful stage of life.

And so it plumps up the tissue, it reduces the risk of getting urinary tract infections. And so something to keep in mind, because a lot of people are, you know, they're a bit shy. We haven't been taught to t- to talk about sex. We're a little bit uncomfortable. But as my OBGYN, uh, colleagues say, "We're the vagina doctors.

You should talk to us about your vagina." They're not uncomfortable. They may be busy, maybe they didn't bring [00:43:00] it up, but your family doctor, your OBGYN, women's health specialist of whatever background, please bring it up. Because even women who have had breast cancer are allowed, it's not contraindicated, to use vaginal estrogen.

And it's not, like we talked about earlier, something you're gonna use, like, for years on end. You're gonna use it, you're gonna treat the tissue so it gets healthy, and then you're gonna set it aside. And maybe like a year later, you're gonna go, "Oh, where is that in my, in my bathroom drawer? Because I think I need it again."

So it's not a continuous forever. 

Dr. Anikó: Right. Right, which I think is also an important point, especially now that people are starting to use it cosmetically. Mm-hmm. Consistently. Um, this is not intended to be used consistently or really cosmetically. No. I haven't seen a lot of evidence around that, but I've seen a heck of a lot on social media about it.

Um, and so one thing I did wanna [00:44:00] talk to specifically you about, and we chatted a little bit about this in our call, was time-restricted eating. Yes. And I'm gonna give a little bit of background, which is that a lot of times when people reach out to me to be a guest on the podcast, a lot of people wanna talk about intermittent fasting.

Yeah. And so, but in my practice, I have treated a lot of people with disordered eating. Uh-huh. So intermittent fasting has been sort of like a, almost like a thorn in my side. Yeah. And time-restricted eating is different than intermittent fasting, so we'll clarify that in a bit. But, you know, it, uh... There was one point I feel like a couple years ago where it was everywhere.

Everybody was talking about intermittent fasting. Yeah. Jimmy Kimmel was talking about intermittent fasting. And then meanwhile, you know, I do work with some folks with disordered eating. 

Dr. Victoria Maizes: Yeah. 

Dr. Anikó: And introducing an extra external control- Mm-hmm ... over what you eat and how you think about food Is just typically doesn't take people [00:45:00] to good places.

Because what we wanna do is to reconnect with the body, to listen to the body's hunger signals, to honor your body's signals. So I feel like I became kind of overprotective of my people. 

Dr. Victoria Maizes: Yeah. 

Dr. Anikó: And, and became very resistant to even having a conversation about intermittent fasting, much less using my platform to talk about fasting or time restricted eating.

Uh-huh. 

Dr. Victoria Maizes: Yeah. Yeah. 

Dr. Anikó: But, but that being said There are a lot of advantages and benefits in certain folks, in certain groups. Yeah. Um, and I feel like I would actually love to have this conversation with you, who has a lot of nuance, a lot of wisdom, um, a lot of background. And also, you know, as you made the point in your book so many times, integrative medicine is individualized.

Right. It's not one-size-fits-all. So the thing that could be absolutely devastating for my patient with disordered eating, would send them into an obsessive spiral- Right ... could be freeing [00:46:00] for somebody else. Right. Right. And, and it felt a little bit unfair of me to be like, "Boo, I'm not gonna talk about this"-

when there could really offer a lot of benefit for a lot of folks. Yeah. Especially people who struggle with their glucose control. 

Dr. Victoria Maizes: Right. 

Dr. Anikó: Um, br- in situations in breast cancer. So can we talk a little bit about time restricted eating and fasting? 

Dr. Victoria Maizes: Yes. Yes, I'm happy to. Well, first, you know, I really honor, you know, you have to know who you're working with, and if you're working with someone with disordered eating, as you said, this could almost be a trigger, so it may be off-limits.

Having said that, let's talk about broadly what the evidence shows it's useful for. So intermittent fasting is the big umbrella, and that can mean a lot of different things. Uh, sometimes with intermittent fasting, people, two days out of the week, so it's five two, two days of the week, they eat only 500 calories.

So if you have someone who's already wrestling with restricted eating, that [00:47:00] could be not good. Time restricted eating essentially means that you're gonna have a longer overnight fast. And, you know, think about our word breakfast. We break our fast, right? We have not been eating while we've been sleeping, and then we get up, and at some moment we eat, and that breaks our fast.

So time restricted eating is really about having a period of time when you do not eat. Now, for some people, this is a terrible thing. You say, "I don't want you to eat for 12 hours," you know, from say 7:00 PM till 7:00 AM and they're starving and it doesn't work for them. For other people, it is so useful, and this is where we individualize.

We figure out who it's useful for and who it's not. There is evidence, you mentioned diabetes. When people don't eat for 12 hours, sometimes 14 hours [00:48:00] overnight, they get better blood sugar control. So this goes back to that circadian medicine and chronotherapy, and the idea that- We didn't evolve to be eating in the night.

In the night, we were sleeping. Uh, in the night we were, you know, hunkered in a cave or wherever we were during our evolutionary period as humans. And so we have other systems that are working, but our digestion is actually meant to be at rest. And for digestion to be at rest when you're sleeping, you need to stop for two to three hours before you go to sleep.

So if you're going to sleep at 11, that might mean you stop at 8. If you're going to sleep at 10, you might stop at 7. So that's one piece. One piece is to have this window where you finish digesting before you go to sleep so that while you're sleeping, the other functions, the reboot of your metabolism so your blood sugar is normal, the reboot of your immune system, the laying down of memories, all of the [00:49:00] other useful health-promoting factors that normally happen at night are happening.

There's evidence of a lower risk of breast cancer coming back or recurring when women fast for 13 hours overnight. That's really interesting. So again, that effect on immune function. For some people who need to lose weight, an longer overnight fast helps them lose weight. So there's a lot of potential benefits, and we're all individuals, and it's, it's not the same for all of us.

One more thing to point out. There was some really interesting research that was done with firefighters. You know, firefighters are what we call shift workers, right? They have to be up at night. They're working at night. If there's a fire, you know, they're out there doing what helps all of our society. But they had firefighters do a longer overnight fast, this time-restricted eating, and they found that their blood pressure [00:50:00] and their blood sugar got better.

So for heart disease, it may also be a very useful strategy. So we're really in a, I'd say, beginning phase. We have a certain amount of evidence to show its value. And, um, outside of the group of people who either the minute you say, "Don't eat something," they're starving or have some other challenge, you know, where they have disordered eating and it's gonna trigger obsessiveness around food or something else like that, it is something that you could consider that could have really significant health-promoting value for you.

Dr. Anikó: Well, and it, it makes sense too. I mean, even in Ayurveda, you know, we talk about, you know, the time of the day- Yes. Yes ... and you eat the most when the sun is highest in the sky at lunch, and then you eat a little bit less- Mm-hmm ... as in once the sun goes down, you're not eating anymore. And it makes- I-

evolutionary sense, right? Right. You're supposed to be sleeping at night, not having a [00:51:00] fresh s- you know, supply- Right ... of glucose to go run from a lion or go, you know- Right ... hunt for some berries or something. It makes a lot of sense. And I, and I do think that, you know, reading in your book too about how people were saying, you know, "It's easy for me to follow.

I can eat what I want." For, for the right person, it's empowering. It's a- Right ... freeing experience- Right ... rather than sort of putting you in this jail of, "Okay, I can only eat these times of the day." 

Dr. Victoria Maizes: Right. 

Dr. Anikó: That's not how everybody experiences it, you know? 

Dr. Victoria Maizes: Right. Right. So there's really understanding people's beliefs and preferences.

You know, I think we've made people so, I'm just gonna use a generic word, crazy about food in our society. Uh, eat this, don't eat that. Do this, don't do that. I mean, it's so rules-based. And so in some ways, time-restricted eating takes away all the rules about what you should eat, and it focuses [00:52:00] on when to eat.

And that is freeing for a lot of people, that they are not being told not to eat their favorite foods because they have diabetes or need to lose weight, but rather they're just being encouraged to stop at a certain time and then wait. And for some people, this is really actually quite easy. There was a study that was done in southern California with Hispanic women who were overweight and wanted to lose weight, and they used time-restricted eating.

And one of the things that the women really appreciated about it, and they did lose weight, is they got to eat the same family meal. They didn't have to have like, "Okay, this is what I'm eating 'cause I have to lose weight, and everyone else is eating this other thing." So everyone got to eat the same meal, and the women who were doing the time-restricted eating just stopped and then restarted, and it didn't interfere with family life.

So it, it is something that's good to know about, and the evidence [00:53:00] supporting it is, is really blossoming. 

Dr. Anikó: It is. It is. And it, and that is a big part about changing how you eat, what you eat, is that sometimes disconnection from family- Mm-hmm ... perceived as rejection at times. Like, it- Mm-hmm ... it is a lot more complex than just- Mm-hmm

like switching up what you eat, you know? Mm-hmm. Mm-hmm. So it can be really empowering. Um, and I did wanna say, someone recently was like, "I don't even feel like people have that much disordered eating." I mean, obviously they were not in the disordered eating world. And I was like, "Well, you know, sometimes disordered eating is like being masked as intermittent fasting."

Um, 'cause it's sort of a culturally appropriate- Right ... way to kind of- have an eating disorder- Yeah ... at times. For some people. Again- Right ... that is not everybody by any means. Yeah. Um, but, you know, I, I think, like you said, knowing your patient and knowing what would be an appropriate recommendation for them, and just offering it as a tool because it is- Right

it is freeing for so many people. Right. Right. How wonderful that those women in [00:54:00] that study were able to improve their health and still continue to be a part of their family. 

Dr. Victoria Maizes: Yeah. One of the tools we sometimes use in integrative medicine practice is motivational interviewing, and there we sometimes give people what we call a menu of options.

So for example, we were talking a little bit earlier about diabetes. We might say something like, "There are a number of things that people do to help manage their blood sugar." And we're talking about someone now who's not got sky high, out of control, but let's say they're inching towards diabetes, or they, they just got diagnosed.

Well, we might say, "You could increase, uh, the amount of movement you do every day. You could add vitamin D," 'cause vitamin D has been shown to prevent the development of pre-diabetes into full-blown diabetes. You could potentially Eat a vegan diet. Not everybody's choice, right? But that also has been shown to prevent.

You could eat a paleo [00:55:00] style diet, where you're gonna really reduce the amount, especially of simple carbohydrates, because that has been shown to prevent diabetes. There are some dietary supplements that may be useful for managing blood sugar. And so we give people a whole menu of different things that they may find of value, and we say something like, "Do any of these appeal to you, or is there another way you'd like to go?"

And, you know, some people say, "Doc, just give me the drug I didn't mention," or, "You could take this medication." Some people are just like, "I am so busy. My life is really challenging. You know, I have all this stuff going on. I just... Give me the pill. Don't, don't ask me to do these other things." Other people are like, "I didn't know that if I take a walk, uh, right after dinner, it's gonna help me manage my blood sugar.

I didn't know if I add some vinegar, uh, to my meal," this could be in the form of salad dressing. It's not just, like, sh- a shot of vinegar, right? "But I didn't know if I added some vinegar, that that was going to, uh, help me manage my [00:56:00] blood sugar." So giving people this menu of a variety of things that could potentially manage it, and someone says, "You know, don't talk to me about diet.

I've been on a million diets. But, oh, I'm interested in, uh, that exercise, or I could take vitamin D, or even, you know, yeah, maybe I could stop eating at 7:00 PM and not start again till 8:00 AM." So it's giving the power over to our patients to make a decision that's evidence-based, because there's evidence that this works.

Will it work for them? We'll see. But we know that in studies it has worked for other people, but it allows them to choose what is best for their life. 

Dr. Anikó: Yeah. Yeah, and it also, I, I love the offering of the menu in my practice- Yeah ... as well, because it really allows people to- Listen to their guts. And a lot of times- Mm-hmm

I kinda, I kinda already know what- Mm-hmm ... is going to appeal to them. Um, but you know, again, putting the power in their hands. Mm-hmm. Because whether or not I think it's the [00:57:00] best treatment option-the key is for them to think it's the best treatment option for them. That's what's really unlocking, to use your words, your body's- Right

rapid recovery reflex. Right. And, you know- Right ... having said all of this, like boo fasting, like, you know, my like anti-fasting attitude, I did a, an amazing, beautiful fast And it was a, an incredible time of clarity and- Uh-huh ... spiritual focus. I mean, I did it more for like a spiritual reason than- Yes.

Uh-huh ... uh, you know, a physical health reason. I mean, obviously- Right ... those are one and the same as well. Um, but you know, there are so many traditions and so many cultures where there is fasting. Yes. I mean, in, in most of the main religions, Islam- Right ... Judaism, Christianity, there's fasting involved. 

Dr. Victoria Maizes: Right.

Dr. Anikó: So there can be a really powerful role for fasting, even if it isn't from a, you know, physical health, glucose management. 

Dr. Victoria Maizes: Right. Right. 

Dr. Anikó: There's also the spiritual part of it. Right. So, you know, having been like, "Fasting's so lame," um, I actually had a beautiful fasting experience. No, I, [00:58:00] I see the value. Yeah. I just was, I think I was feeling very- Yeah

mama bear- Yeah ... around my patients and just- Right ... being like, "Oh, the whole world is-" Right ... "talking about intermittent fasting," and it's like not- Right ... for everyone. Right. Agreed. And I think that was my issue, is that it was- Right ... sort of being touted... Because nothing is for everyone. 

Dr. Victoria Maizes: Right. 

Dr. Anikó: Nothing. Right. If you get migraines triggered by not eating- Right

probably don't wanna fast, you know? Right. Right. And in your book, you talk about, you know, exercise being both a relief for headaches and in some people, a trigger for migraines. Right. Like, you, you have to tailor it to your own system and be open to that reality, that it is individualized. Um, well, I did wanna touch on pain maybe if we have just a couple minutes.

Uh-huh. Only because I feel like the way that you talk about pain in this book is probably the first time a lot of people will have encountered this kind of discussion about pain. So you talk both about acute pain. You sort of revolutionize, let's move from RICE, that classic rest, ice- 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: [00:59:00] compression, elevation to peace and love.

You talk about central sensitization, which I think is super brand-new information for a lot of people. And you also talk about- Welcoming pain as a message- Mm-hmm ... instead of a signal to fear. And you talk about- Right ... your own back pain and say, you know- Mm-hmm ... when I start to have a flareup, it's my signal- Mm-hmm

to pay better attention and slow down. Right. Right. So in the last, like, oh, I think we have about, like, six minutes or so left, and I wanna also talk about how people can get in touch with you, can you just tell us a little bit about pain and this sort of different mindset around pain? 

Dr. Victoria Maizes: Yeah. Well, first, you made a really important distinction between what we call acute pain and chronic or longstanding pain.

So you know acute pain, your hand on a hot surface, and you immediately yank it away. So pain is a signal. There's danger here, and you need to attend to that danger. And then we have what we call longstanding pain, where the danger [01:00:00] often has completely passed, and yet the brain is still sending that danger message.

So there's no more hot surface, and yet still somehow there's this perception that, um, there's something that is not okay going on. And so Our society is really wrestling with that chronic pain, and we have treated acute and chronic identically until very recently. We've, we've basically used opioids, which is, uh, you know, pain medicine that sadly can be addictive and that can lead to overdose and death and destroy people's lives.

So this is not an anti-opioid message. Th- there's absolutely a use for them in acute pain, but it turns out it, they don't actually work that well when your pain becomes long-standing. And so then you have to think about, well, what are all of the other things that I could do to manage [01:01:00] a more long-standing pain?

And once again, this is like a lovely thing about integrative medicine. We have a very big toolbox because one size does not fit all. So if you have central sensitization, which is when the brain, it's almost like the brain area, the pain sensing area of that brain enlarges and something very innocuous.

For example, when my back was really in trouble, if a, a breeze hit the skin on my back, I could have really bad pain. Well, that's silly in a sense, right? Why would a breeze cause really bad pain? It was because my brain was just overly sensitive to any kind of message. So how do you do that? Well, one is you almost talk back to the pain.

Uh, I put in the book a really lovely brief, you could call it an affirmation, um, from John Sarno, and it goes something like, um, um, "You have physical pain, but there is nothing wrong with your [01:02:00] back." You know? So you're having this perception of pain that's real. There is nothing not real about the feeling that you're having pain, and at the same time, there is nothing structurally wrong.

It's not broken. There is not, uh, nerve damage. I mean, it is an okay back. And so the same pain is a signal that might mean that there's something that you're stressed about, that you're afraid of, and therefore managing that. And so I sometimes say that to myself when I have some back pain. I say, "There is nothing wrong with my back."

And then I say, "Can I kind of relax my muscles? Can I send breath to that area? Do I need to use heat? Do I need to use ice? Do I need to get on a foam roller and stretch those muscles?" It doesn't mean that there aren't ways to manage it, but the management is probably gonna look different than opioid medication.

Dr. Anikó: Yes. Yes. Well, and it reminds me of, so I also have had a back [01:03:00] pain journey. My back and I have been doing this- Mm ... for quite a while now. And, you know, and things that were life-changing for me were things you mentioned in the book, McKenzie Method- Mm-hmm ... Esther Gokhale. Mm-hmm. Um, and then also this befriending of the pain.

And I recently- Right ... had, it was at the beginning of the year, I had a back massage, and I'm very finicky about who I let massage my back, 'cause I have a lot of fear around it- Mm-hmm. Right, right ... because I've had experiences where they set off- Right ... trigger points and things like that- Right ... which you could argue is maybe my fear manifesting.

Who knows? But regardless, um, I had trip- I'd fallen on the ice, and I had ki- Uh-huh ... I actually had landed on my back. Um, and so- Wow ... I went to him with some acute back pain. Yeah. 

Dr. Victoria Maizes: Right. 

Dr. Anikó: And then after the massage, he said, "You know, do you, do you get chronic back pain?" Right. And I was like, "Oh, I, I didn't even tell you.

Absolutely, I do." Yeah. And he said, "Well, next time you get some back pain," he's like, "I know this may sound weird." And I was like, "You don't even know who you're talking to." Like nothing- ... nothing is new to me. I'm open to it all. But he said, "Next time you get back pain- [01:04:00] Tell your pain thank you. 

Dr. Victoria Maizes: Ah. 

Dr. Anikó: And he said, "A lot of my clients have had a lot of success with this."

And he said, you know, "And I was a therapist for many years." And so not the next day- Right ... did I have an opportunity. It wasn't back pain- Right ... but I turned my ankle- Uh-huh ... again, in a parking lot, which is where I slipped on the ice. Uh-huh. Mm-hmm. But I, I was going to go hike, and I, I f- I turned my ankle in the parking lot, and I had so much pain.

And then I kinda limped across the street, and I was going, "Thank you. Thank you." Thank you. And I really was listening. I was like, "What is this message?" Right. And I was really feeling like my body was saying, "Slow it down." Like, the reason- Right ... I tripped was 'cause I was putting something in my bag- Right

while I was walking, and I ended up just hiking down, very short hike, 'cause that was all my body wanted to do. Put my foot in the river, and it ended up being not just this lovely day, it was probably- Uh-huh ... one of the bright spots of my entire trip, but my ankle healed so fast. Wow. It was like by the next evening, I was basically pain-free.

I still had swelling and [01:05:00] stiffness, but really not a lot of pain, and it really... You know, I'd be curious to hear your thoughts on it, but it really felt like, wow, when I could eliminate my fear response- 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: and my panic response- 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: it changed my body's immune response - Right. 

Dr. Victoria Maizes: Right ... 

Dr. Anikó: to my injury. Right.

Dr. Victoria Maizes: Right. Well, I love that story. Thank you for sharing it, and I think that, um, uh, it's not always easy to say thank you to pain, but it is really helpful to consider, is there a message here? And like you found the message was slow down, and then it sounds like you actually had a really lovely experience putting your, uh, ankle into the cold water and being in a beautiful place.

And so, um, often holding something with curiosity rather than just pushing it away, 'cause most of us, when we have pain, we just want it gone. We just wanna push it away, as opposed to, what's the signal? What can we understand from this, and what can we do that would be [01:06:00] life-affirming, health-promoting?

Dr. Anikó: Right. And, and as you said, you know, obviously acute pain is, is coming from the injury, and there's ways that we- Right ... can manage that. Right. And since may- maybe being not such a great part of the equation anymore- Yeah ... but when you have chronic pain, and it reminds me of, you know, the disorders of gut-brain interaction- Uh-huh

where there's really no organic, like, disease anymore. Right. It could've been triggered by something- Right ... but now it's a pain pathway issue. Right. Right. And the way you treat a pain pathway issue is different from how you treat a physical injury, like injured tissue. It's just different treatment.

Doesn't mean the pain's- Right ... any less real. 

Dr. Victoria Maizes: Right. 

Dr. Anikó: But the way we treat it is different. Right. So what are some of the modalities that can work if you have chronic pain? 

Dr. Victoria Maizes: So it is gonna differ for different people. Uh, John Sarno, uh, was kind of a purist. You know, he's like, "You just need to tell yourself there's nothing wrong with you.

You know, this is, as you say, you know, [01:07:00] a, a neural pathway problem. You just change that neural pathway by talking back to it, by saying there's nothing wrong with me." But Often people do have some muscle tension, so heat, ice, stretching, uh, Esther Gokhale, who has you walk backwards to kind of realign, yoga, Pilates that strengthens your core, um, all of the kind of guided imagery which helps you to do internal healing.

Sometimes a device like a little TENS unit because, uh, this is the same way in a sense that heat and cold work, the, or one of the ways, it, it, the pathway by which the tingling moves is faster than the pa- pain pathway. Same thing for temperature, so heat or cold. It's gonna move faster, and you're gonna feel heat, cold, tingling, as opposed to pain because they have a quicker way of, of moving along the nervous system.

[01:08:00] So the book is really full of a variety of things, and as we've been talking all along, this needs to be individualized. You know, one person's gonna say, "I can't see a massage therapist. I can't afford it." Well, you know, could you do your own foam rolling and see if you can work out some of the trigger points or some of the tight points?

Could you work on your posture, which may be one of the underlying reasons why you're, uh, not doing well? And so there's a lot of different strategies, and it depends a little bit. Migraine headache is different from arthritis pain, which is different from chronic back pain. 

Dr. Anikó: Absolutely, and, you know, gosh, we could talk forever about what's in your book.

But y'all need to get this book. It is so amazing. It's called Heal Faster: Unlock Your Body's Rapid Recovery Reflex. But I did want to mention, we didn't even get to this, but there's also the whole environmental exposure. Yes. There's not one but two people- Yes ... that get acute conditions because they're drinking hot beverages out of a plastic container.

Right. There's a [01:09:00] woman who has, uh, you know, migraines that end up being triggered by wildfire smoke. Like, there's- Right ... so many things that sometimes we, we don't expand our thinking enough to be able to really see the full picture. Mm-hmm. And what's beautiful about integrative medicine and about you as a physician in particular is that you really have this expansive view and are able to kind of see it all and integrate it all.

Dr. Victoria Maizes: Thank you. Yeah. Thank you, Indico. Thank you. And thank you for your practice of integrative medicine. 

Dr. Anikó: Oh, well, thank you. Thank you for training me. It'll just be like an endless back and forth of thank you. But so, so if people are interested in learning more from you, where can they find you? 

Dr. Victoria Maizes: So I have a website.

Uh, it is called drvictoriamasais.com. Um, I do a podcast together with, uh, Dr. Andrew Weil, and that's called Body of Wonder. Um, there's the Andrew Weil Center for Integrative Medicine website, so that's, um, we have the acronym AWICIM [01:10:00] @arizona.edu, awcim.arizona.edu. Um, and those are all good ways to find me.

Dr. Anikó: Yeah. Well, and again, if any of our listeners have been inspired by this way of thinking about medicine, would like to learn from Dr. Mazas, she is a professor at University of Arizona, and she does teach, um, residents and also in the Integrative Medicine Fellowship. And you were saying that that fellowship is more than just MDs, right?

Dr. Victoria Maizes: Yes. So we accept MDs, DOs. We have dentists and PharmDs, nurse practitioners, and PAs. Yeah. It's 

Dr. Anikó: a really wonderful program. Life, life-changing, I think, for everyone that participates. I feel like, you know, between the community and the self-care and then the incredible knowledge that you gain, um, for how to care for your patients.

But like you said, it all starts with yourself, right? You're the first human being that you have a relationship with, and the kind of relationship you have with yourself and your body and your [01:11:00] spirit kind of determines- Mm-hmm ... how you're gonna be able to support people out in the world." Well, thank you so much for being here today and sharing your work and your wisdom and your wonderful self and your book, and for reminding us that we have far more capacity for healing than we often realize.

Dr. Victoria Maizes: It's been my honor to talk with you today, Anniko. Thank you for having me as your guest. 

Dr. Anikó: Thank you for being here, and I hope I see you soon. 

Dr. Victoria Maizes: I look forward to it. 

Dr. Anikó: And see y'all next week. Take care.

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