Episode #6 Nutrition and Menopause: What You Need to Know

In this episode, Dr. Green, Dr. Cat, and the Nourish team dive into the powerful connection between nutrition, menopause, and hormone replacement therapy (HRT). They explore five key areas impacted by menopause—heart health, metabolic health, bone health, weight management, and symptom development—while sharing practical tips on balanced meals, essential nutrients like omega-3s and phytoestrogens, and lifestyle strategies for hydration and stress management.

The episode also tackles audience questions on topics such as bloating, mood swings, blood sugar fluctuations, and the benefits and challenges of popular diets like keto and intermittent fasting. Tune in for expert advice on optimizing your health and nutrition during menopause.

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Transcript

SPEAKER_04 0:00

Welcome to the Menopause Hour, your go-to source for empowering answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, Menopause Care Made Easy, and hosted by our experts, CMO Dr. Michael Green, and Medical Director, Dr.

SPEAKER_05 0:18

Kat Brown. I'm really excited. I've been looking forward to this forever. Just getting to have this conversation. It's always a great team and a great time. So whether you're kind of, you know, tuning in on Livestorm, I know some of you might be in our Winona Women's Group, WWG, if you've been in there a while enough, long enough to learn the acronym. But we're so glad that you're here and you're joining us. And I think it's just going to be a great conversation that we have today. So in a moment, I'm going to pass it off to the doctors just to introduce themselves. But just as a reminder, we're going to go ahead and have like a little bit of conversation first. And then we're also going to have a time, of course, for you to ask all your questions that you might have. We're here to answer anything and everything you that might be on your mind that might be burning in your head. So go ahead and you can start putting those in the chat. And then we'll be able to come back to them in a little bit and like really get to answer those. But I'll go ahead and pass it off to the doctors to introduce themselves and we'll go from there.

SPEAKER_00 1:16

Great. Thanks so much for having us here. I'll introduce myself first. My name's Dr. Ajay Haryani. I'm a primary care physician by background and I'm the head of clinical quality here at Nourish, which I'll tell you a little more about in just a bit, and I'll pass it over to Zoe to say hello.

SPEAKER_06 1:35

Yeah, thanks. I'm Zoe Halbert. I'm a clinical manager and registered dietitian with Nourish. I've been with Nourish three years, and I'm based in Austin, Texas. But yeah, I'm here to just share a little bit more about what dietitians are doing and a lot more on nutrition interventions for menopause. So super excited to be here. And I have a background in chronic health and women's health. So just really excited to share more on this topic.

SPEAKER_02 2:00

So I'm Mike Green. Many of you know me. I'm the chief medical officer of Winona. I'm super excited to have our friends from Nourish here. So this is going to be a little bit different than what we normally do. Usually I stall for a few minutes while you get some questions in to answer. But we're going to do a lot better than stalling. And I've asked them to talk a little bit about what they do and also just about nutrition and menopause and how it all interrelates. And so they're going to take some time doing that, which I think is going to be incredibly valuable. While they do that, please put your questions in. So we have something to do for the second half. Otherwise, we can just chat and have a good time. But it'd be much better if you have questions. So really we uh appreciate your questions. We'll take questions on every anything, but um uh particularly um as it relates to you know diet and and nutrition will be particularly viable so we can pick the brains of the experts that we have um today. So um with that, I'll turn it back over.

SPEAKER_00 3:03

Awesome. Um well I'll I'll kick us off and just tell you a little bit about what we do as an organization, kind of what our mission is, um, and a little bit about what working with us looks and feels like. Then we'll move into some of the content about specifically the nutritional aspects and kind of pillars of managing menopause. Um, a bit about Nourish. So Nourish is the largest food as medicine platform. Um, we believe that poor nutrition is driving some of our biggest difficulties in healthcare today, and we're making it easier for patients to eat well by expanding access to high-quality nutrition therapy. So, what we do is we match patients in a one-on-one relationship to a registered dietitian who's a fit for their needs. They'll work together both in that relationship, and the patient has access to access to Hello.

SPEAKER_05 4:00

Hey Dr.

SPEAKER_01 4:01

Kat. How's it going?

SPEAKER_05 4:04

It's going pretty good. I know that I think the nurse team has given a little bit of their spiel of what they're working on. Yeah, nurse team, I think you can I think you can keep on going. Yeah.

SPEAKER_00 4:21

Great. Sounds good. Um Right, so we we match patients in a one-on-one relationship with uh a dietitian, um, and that person is there specifically to help them throughout their journey in every avenue, um, from messaging their dietitian or access to the app where you have a library of food recipes and other tools that we'll talk about shortly. We are particularly excited to partner with organizations providing high-quality, personalized clinical care, uh, especially where as a healthcare system, we've historically, you know, missed the mark. And that's why this partnership with Winona on menopause is very important to us, and we're we're super, super excited to be here. Um, I'll pass it over to Zoe to talk a little bit more in depth about um, you know, what the work that we do and what it is to work with a dietitian with us.

SPEAKER_06 5:06

Thanks, Sajay. Yeah, so um as he mentioned, we are pairing people with dietitians via telehealth. Um and I always like to start off just to explain a little bit what a dietitian really does and what they are. Um so, of course, they're a healthcare professional that specializes in food and nutrition, um, but it's easy to get it kind of confused with nutritionist versus dietitian. Um, so what I like to always kind of remind people is that all registered dietitians are nutritionists, but not all nutritionists are registered dietitians. Um, so registered dietitians have special training so that they can administer something we call medical nutrition therapy or MNT, which essentially is a method where we can provide interventions for specific disease conditions, in addition to also, of course, teaching about general healthy eating as well. Um, and MNT is a personalized and evidence-based approach, so it's really individual to each patient, and it's a process that follows a really specific format where we really get a thorough assessment of a patient to really understand their lifestyle, their diet, their background, to really understand someone holistically, so that we can then identify what nutrition concerns and problems are going on, and then approach it with that patient to collaborate on goals and provide tools, resources, and strategies to then help them meet their health goals. Um, and that's the long answer of what a dietitian and MTR. I would say the short answer is dietitians are just a bunch of foodies who are just passionate about health and wellness, um, almost by coincidence. But we love food and we love to talk about it and educate on it. So that's the that's the quicker answer.

SPEAKER_03 6:38

Awesome.

SPEAKER_00 6:40

Awesome. Thanks, Zoe.

SPEAKER_03 6:41

Um dive in. Perfect.

SPEAKER_00 6:44

Yeah, so what I'd love to do is just start the conversation a little bit. And as Dr. Green mentioned, please, as as you have questions that come up, send them in. We're excited to have it have a discussion with you. You know, nutrition as a topic in itself is so complicated, and there's so much information out there uh that we have access to, and it's hard to tell the good from the bad and uh and what might be useful for you. So we're happy to help be kind of a first pass and just help you think through that that entire landscape. Um, so obviously, here as we're talking about specifically the intersection of nutrition with menopause. And what we're gonna be focusing on is, you know, and kind of the framework for the discussion here is the different ways in which menopause can affect the body through a few different things that I'll go through in just a second here. We're gonna talk about both how um we're talking about things that can help you in your life feel better and things that can help you in your life live longer and kind of improve your lifespan, um, you know, in addition to improving your the quality of your life. Both of those things are very important to us, and I think you'll hear both of them kind of come through here as we talk about this thing. In any kind of clinical situation or any clinical diagnosis, you know, we believe nutrition is a core pillar of managing those symptoms. Um as it comes to menopause, nutrition can be both an adjunct to hormone replacement therapy if that's what you're currently receiving, but also it can be a really powerful thing for you and a powerful tool, even if you're not currently on hormone replacement therapy, to try to help you with some of the other things that are happening in your body. Um, in either case, it's a powerful clinical intervention in the management of menopause. The five kind of subjects or topics that we're gonna talk about today are, and this is of course not you know a fully comprehensive view on all of the changes that are happening um in the body during menopause, but it's our kind of initial framework here that will share some of the nutritional takes on how to manage each of these conditions and each of these concerns, and then we're happy to kind of take your questions from there. So the five buckets for us here today are number one, heart health, number two, metabolic health, number three, bone health, number four, weight management, and number five, symptom management. Those are the five that we're gonna go through today. Um, just to start here, as to kind of to get the conversation going and get questions going, I'm gonna hand it over to Zoe in just a second to go through what some of our strategies are for thinking through each of those buckets and um and then would would love to take your conversations from there.

SPEAKER_06 9:33

Awesome. Thanks, Ajay. So yeah, I'm gonna take a little deeper dive into all of these things and all the interventions and nutrition strategies we are really focused on, especially when someone's going through menopause with all of these different issues that we want to be thinking about. Um so I appreciate you kind of introducing that. The first thing I always want to mention is one of the most important things is we always want to set up a really strong foundation for our nutrition. Um, and that's really through eating solid, balanced meals. I think that term is thrown around a lot. And so I do want to always address that important factor that we want to start with that strong foundation. And then from there we can really individualize things, look at more specific key nutrients. Um, but when we're talking about balanced meals, right, that's talking adding adequate food protein to meals, right? Our lean proteins are what we're looking for there, whether that's through chicken, turkey, fish, our legumes, right? This is gonna really just be a foundational uh nutrient that we want in our diet to make sure we're preventing muscle loss, um supporting joint health, and just long-term activity in the long run. We're also gonna be wanting to include fiber in our meals, right? This is gonna support our heart health, um, may help with weight loss as well, if that's something we're working on, and digestion. It's also gonna include healthy fats, right? So our unsaturated fats, olive oil, avocado are those foods that always come to mind, um, along with complex carbohydrates to help balance our blood sugar. And of course, hydration. I always mention that water is a really important component. So I always start with that because I think that balanced meal is just one of those foundational key components we want to make sure is a part of our lifestyle. And then we can dive into some of these kind of key nutrients and important things we need to pay attention to for each of these health concerns as well, which maybe might someone might have more uh, you know, heart health be more of a risk factor than another person. So we're always kind of individualizing this too and looking at what the big focus is. Um, but for someone who where heart health is a big focus on, we're gonna be looking at um making sure we're eating adequate fiber, but also the right types of fiber. We know that soluble fiber, such as an oatmeal, for example, can help reduce cholesterol. Um, so we're gonna really be maximizing these foods. We may also be thinking about fats like omega-3 fatty acids. We find these in fish, um, but also chia seeds and flax seeds. These are gonna be amazing for reducing inflammation in the body and also have additional heart health benefits. Also can even contribute to mood regulation, which is also a really important thing during this time. So, this is another nutrient we're gonna pay a lot more attention to. Um, and then of course, if we're thinking about just our overall metabolic health, we're gonna also be thinking about balancing our blood sugar. Um, so that's where those like complex carbs I mentioned really come in in fiber, making sure we're eating right starchy vegetables instead of refined grains, more whole grains instead of those white breads and things like that. These are gonna really help not only keep us with great energy throughout the day, stable energy, but really help our metabolic health overall. Um, and we may also maximize some of, you know, pay attention to some of these more uh small vitamins and minerals, things like B vitamins play a really big role in our metabolic health. So making sure there's no B12 deficiencies, um, B12 and B6 particularly play a lot of really big role in energy metabolism and mood regulation as well. Um, the other things we'll mention is bone health. This is a big one because with these hormonal changes, that risk of osteoporosis increases a lot. Um, so we might pay more attention to vitamin D and calcium. Those nutrients in combination are really important for maintaining and supporting our bone health. Um, so we're gonna be looking at getting more of those foods in things like our dairy products, but also maybe some of our soy products that are fortified with calcium. Nuts and seeds are another great source, our leafy greens. And vitamin D is a good one. This is actually a pretty common deficiency, even in places that are relatively sunny, which we know we often always think of sunshine comes along with vitamin D. Um, but this is an important one to check in on because we do see this deficiency, regardless, sometimes even in different environments. Um, so sometimes we may even need to supplement if we can't get it through those fortified food sources or safe sun exposure. And then, of course, we're going to be looking at our weight management. This is a very common problem that a lot of people are reporting during this time in life is struggling with more weight gain or struggling to lose weight. Um, and there's a lot of things we can do to address this. Those balanced meals I mentioned are definitely a big part of this. One of the key things we want to be thinking about is how can we make sure we're staying satiated, having good energy, right? Not getting overly hungry, so that we can manage our appetite and man and really keep stable uh intake throughout the day and still get that adequate nutrition. Um, so those balanced meals are gonna come in really handy to help us with hungerfulness. We're also gonna really look at protein. It's particularly satiating, so that's definitely something we're gonna make sure we're getting enough of. Um, but also if someone is trying to lose weight, we want to protect their muscle mass as well because we don't want to lose a lot of muscle tissue. That's really important as we age to keep as much as we can. So I also really want to emphasize that protein for that purpose as well. Um, and then I did want to mention on the symptom management side, we get a lot of questions on this as well. And there are some really great things we can do. One balancing our blood sugar, like we mentioned before, is actually a big part of this because this can help with preventing uh sleep issues if we're having stable blood sugar, um, can also help with our mood regulation. But there are some nutrients that also play a role in this as well. One I like to mention is something we call phytoestrogens. So these are plant compounds that we find in foods like soy, but also like chickpeas and black seeds have these as well. Um, but I'm always thinking like tofu, tempeh, soy milk, these are all great sources. And these have been shown to help with some symptoms, especially things like hot flashes. Um, and one of the reasons is because they are actually kind of asked, they mimic estrogen in a sense. So if we have low estrogen, they have an estrogen boosting effect essentially. So they can work really well in tandem with other therapies and things that people are doing to help with symptom management. Um, so that can be a great food to be incorporating. Also, antioxidants, I always bring up. So these are found in a lot of our fruits and vegetables, but also things like green tea, even dark chocolate has some great antioxidants. Um, I always have to bring it up because that's my favorite food. Um, but we want to always be uh eating the rainbow. I know it's a cliche thing to say, but it's really applies to antioxidants when we're getting a variety of colorful fruits and vegetables. We're getting tons of different antioxidants that are going to help reduce inflammation in the body, fight off chronic disease, um, and even support things like skin health and joint health as well. And let's see, did we cover a big one to make sure I got the big ones here? Um, yeah, these are the major ones I like to talk about. The one other thing I wanted to highlight though is we talk a lot about what to eat, and that is super important. Um, but what's also important to dietitians is how we eat as well. Um, and I never want to forget to leave that out that our eating practices, our you know, how we're timing our meals so that we're actually feeling satiated, um, or we're eating mindfully. These are all things that also play a huge role in how much we eat and the satisfaction of our food, and that all leads up to our health as well. So these are also important things that we want to be implementing. You know, and I always say the magic, we're with dietitians, we can talk about phytoestrogens all day, but I always say the magic is really bridging the gap between education and action. Um, and so that's my favorite part of the work we do is we can really translate all these nutrients into everyday recipes and everyday meals. Um, because most of us aren't writing phytoestrogen on our grocery list, we're right writing tofu or an actual food product. Um, so I always like to give that example. You know, if we're planning a breakfast, you know, I might be saying, like, okay, we're gonna eat some oatmeal today, but um, and that's gonna have that amazing soluble fiber, but let's add some antioxidants. Okay, we're putting berries on that meal now, right? Oh, let's add in some nuts and seeds. We're gonna get some healthy fats and protein in there. Um, maybe we're putting some soy milk to add a little bit of phytoestrogens in there, um, you know, and a little bit of honey just to make it taste better because why not? That that's always uh enjoyable meals are important. Um, so these are all just kind of how we might take, you know, all these different nutrients and actually put them into an everyday meal. And yeah, I think of that. I know we're I want to make sure we have plenty of time for questions, um, but I just wanted to give that little overview of nutrition. Um, we'll get into all the nitty-gritty, but um, Ajay, if you want to take it over to talk a little bit more about our approach and personalization.

SPEAKER_00 17:52

Yeah, I think the last thing just to mention there is that, you know, of as kind of Zoe went through, there are of course a ton of different guidelines to follow for nutrition, but that much of our focus here at Nourish is that, you know, if you sign up and you're working one-on-one with a registered dietitian, it's about how do we make these changes in your life today in a way that feels sustainable for you. And so then we we're thinking about, you know, who else is in your household, right? Who are you sharing meals with? We're thinking about where you're getting your food from on a day-to-day basis. Um, and we're thinking about, you know, what it, what has your relationship to food been in prior times in your life versus now? It's um, you know, it's about the it's the this thing that that Zoe mentioned of kind of bridging education to action and then also personalizing it to you so that you not only have a plan that feels um achievable for you, that feels effective for you, but you also have somebody on your team kind of coaching you and kind of rooting for you uh along the way to help make some of these changes. Um and I think it's it's worth acknowledging that um, you know, with with all of these behaviors that we've held our whole lives, um it is difficult to start making some changes, even when there's a really strong motivation to do so. Um, you know, our our a lot of our habits are hardwired, um, and it's it is uh it's a complicated process, but it's it's one that we take really seriously and and we're we're excited to to help you out with. So maybe we'll pause there. And I don't know, Dr. Green or Dr. Brown, if there's any other thoughts you wanted to add there, we can we can open it up for questions.

SPEAKER_02 19:37

Uh I think we should go straight. Let's go, let's go to the audience.

SPEAKER_05 19:41

Straight to the questions. All right. Um, well, I love this part, getting to like see everyone's questions. And thank you so much, also Nourish team. That was so insightful and helpful just to like hear a little bit kind of about that and like getting into like the nitty-gritty a little bit. And I love what you were saying too about like bridging the gap between you know, like education and action. I feel like that's such like an important um aspect. And I love that, I love how you said that. Um, but so one of our first questions that we have um is from Stacy Smith. And she says, um, I'm a few weeks into menopause. It was medically induced, and she's wondering if there are any foods she should she should seek out or avoid to help with mood.

SPEAKER_06 20:22

Yes, I'm happy to kick off this one. Um, this is a great question. And there are a lot of foods, thankfully, that actually do have some benefits on our mental health and mood. I say they may not replace every other intervention, but they can be super supportive. Um, I know I mentioned omega-3 fatty acids. That's one I like to talk about a lot. Um, but the foods we're gonna find those in is gonna be our fatty fish. So things like salmon and mackerel, um, some tuna would be a great option, but also things like chia seeds, flax seeds, uh, walnuts are another great source. So those are ones I like to kind of uh talk about a lot. Um, I will say, like sometimes that uh omega-3s can be a tough one to get through diet for some people, especially for someone who's maybe not into fish that much, I find it's a little harder. So supplementation can be an option for some people as well, and sometimes that's a better option. Um, but definitely that's one I would highlight. Um, I generally would say one thing I would avoid more of is more like refined carbs, not from the standpoint that them and themselves are going to cause a lot of mental health harm, but blood sugar crashes throughout the day is something that can impact our mood greatly. Um, so sticking with more complex carbs combined with protein in particular can be really helpful for keeping our energy stable and then therefore our mood stable as well. Um, so those are really big ones that often come to mind for me.

SPEAKER_00 21:44

Yeah, the only thing I'll add to that is, you know, even within Nourish, when we're talking about nutrition counseling, one of the things that this dovetails really closely with is also physical activity and kind of what our relationship is to the world there. So that's one of the things that I think about. Quite often when it comes to mood. Notwithstanding, obviously, all you know mood concerns are worth bringing to your clinician to talk about all of the different routes that might be useful for you. But in our world, where you know we're also thinking about getting outside, you know, regular kind of daily exercises, even if it's 15 to 20 minutes of going on a walk, uh, really building that in as a consistent routine uh has been kind of a healthy prophylactic measure for a lot of our patients.

SPEAKER_05 22:29

I love that. I think those are those are really helpful answers on that on that front. Um we have a question from Sarah. And Sarah's wondering, she says, suggestions on how to reduce gas and bloating. Um, and I think that she's wanting to um have that tied in a little bit with nutrition as well and what that kind of looks like.

SPEAKER_06 22:50

Yeah, great one. Um there's I always say gas and bloating, I always think it's important. I always just preface work with your healthcare priors because there's so many causes of gas and bloating. But some simple things that I do tend to like look at and just think about. Um, sometimes it's simple as paying attention to like what type of fibers we're eating. Um, so even looking at is there a difference between raw vegetables and cooked vegetables? Sometimes we do kind of experiment with that with patients. Sometimes cooked vegetables just cause a little bit less bloating. Um, if you've recently increased your fiber intake, I always, you know, look at has there been a drastic change? Because that can also lead to more gas and bloating. So sometimes more gradual increases in fiber versus a big change can be really helpful just to kind of build up some tolerance to that. Um, of course, there can be things like intolerances or other things going on as well. Um, and that's something I know at Nourish we do a lot is really look at food logs and do a lot of documentation with our patients. We look over their food logs and see if we can help identify triggers as well. Um, you know, there's the obvious culprits for some people, like lactose intolerance can cause this, right? There's some that are sometimes really easy to spot, but some can be a little trickier. Um, and so sometimes also just tracking can really be helpful just for that little bit of self-monitoring to see if we can identify some big triggers there, too. Um, this one's always a big one because there's so many foods that can possibly cause this, but those are always my first kind of interventions and thoughts that I'm often looking into.

unknown 24:16

Yeah.

SPEAKER_02 24:16

Let me uh jump in uh with a basically a follow-up and a question for you. Um, often when um people first start HRT, um, the estrogen in particular can slow the gastric and the GI emptying and um initially cause a lot of bloating. So it's a pretty common side effect we see at the beginning of HRT. It usually goes away after a month or so, but nobody wants to have to get through that month. So um for for that specific thing, is there are there some dietary changes that can help as their kind of their body is is uh you know uh accommodating to the new hormone levels and getting used to it.

SPEAKER_06 24:52

Yeah, definitely. I would say in this case, usually when especially more medication induced, we sometimes look at spreading out meals, so doing smaller, more frequent meals, so we're not eating so much at one time, and that can be a little bit easier on our body to digest as well. Also, staying really hydrated is really important, just keeping make sure we're like well adequately hydrated. But you may even consider if there's a lot of bloating, you might drink in between meals a little more than with meals, um, just again to make sure you're not getting so much at one time. Um, so that would probably be the recommendation I'd give in that case.

SPEAKER_05 25:27

We have a question next from Julie. And Julie says, um, as with the extremely dry skin I've experienced with menopause, I find that the intestinal tract is also the same, dry on the inside and out. I think this constipation is a big problem due to lack of water, not fiber. Will the HRT help this? And what can be added to my diet to address this?

SPEAKER_01 25:50

Well, the first thing is water, more and more water, right? Drinking so much, I mean, basically, when we get constipated, um, think about your body. Like the last place your body can resorb water before waste exits your body is in your large intestine before the stool exits your body. So if you are dehydrated, your body will absorb every bit of water from your stool. And then you have these hard stools that can't come out. And so if you're constipated, the first thing to do is to drink more. I mean, that's that's my number one answer to patients. Um, but then I'll let the nutritionists take over if they want to talk about foods and stuff.

SPEAKER_06 26:27

Yeah, I would say that would actually be my top recommendation as well. So I would never forget hydration, that is so important for skin health. Um, there can be other things that just can be helpful, making sure we're getting adequate vitamin C that plays a big role in skin health. Um, vitamin E as well. So these are just some vitamins to focus on. So things like um, of course, with vitamin C, we're thinking our citrus fruits, um, strawberries, bell peppers, broccoli, these are all really high vitamin C foods. Um, vitamin E, I'm looking more at a lot of nuts and seeds are great options. So making sure we're getting a lot of those whole fats in our diet can definitely promote skin health. Um, but I think it's always important to come back to that without water. We probably won't see that helpful result because hydration is going to come first. Um, the only other thing I think I mentioned is if we are reducing inflammation in our body like through antioxidants, like mentioned, or those omega-3 fatty acids and healthy fats, that can help with uh skin health as well. Um so that's definitely another kind of thing I'm thinking about as well.

SPEAKER_02 27:24

And estrogen can help uh with skin health as well. Um, it can help plump up the skin, make the skin younger and healthier. So um uh, you know, you ask about HRT, and definitely that is one of the benefits that people often see uh when they start HRT. I'm gonna be a bad example because I got my diet coke.

SPEAKER_05 27:48

Come on, Dr. Green. Um, it looks like our next question is from Megan. Um, and she says, it seems like food cravings and appetite seems to completely fluctuate throughout the month in perimenopause, particularly if you still have your period. Is this something you all see? Is this normal?

SPEAKER_06 28:08

Yes, absolutely. Um, yeah, I would say this is very, very normal to be experiencing um and definitely difficult. Um, I kind of want to actually see if there's maybe from the doctors first and more of the mechanism part of this, but I definitely want to address the what we might can do about it, but I want to address her direct question first.

SPEAKER_02 28:26

So um one of the big issues really with the menopause transition is the sort of spiky nature to the hormones, so to speak. Um, the ovaries don't sort of just go down gradually. Um, they're really working to try to get your hormones out there, but they're sort of old and you know, don't have the ability. And so they kind of spit hormones out when they can. And so you get these really big up and down um, which is what causes a lot of the symptoms of the metapostroid hot flashes basically are caused by this. That's exaggerated even more when you're still going through menstrual cycles because you have the natural fluctuations in hormone levels as well. So the two things together can really escalate this. Um, and so that's one of the ways that hormone replacement therapy helps. So it kind of increases the sort of baseline level of hormones so that when your body throws out a little bit more, it doesn't really change as drastically. Um, and so at least from the HRT point of view, that that is this is definitely a real phenomenon. It's really one of the basic reasons that HRT works so well at helping with the symptoms.

SPEAKER_06 29:38

Absolutely. And I I think just to add on to that, I sleep and stress um are big factors in all of this. And having an adequate sleep can definitely increase appetite. Um, stress can also trigger appetite as well. So these are just good things to also look into management around as well and get support on, because if we're working on our sleep, working on stress levels, that can also help stabilize appetite, along with again, like regulating our blood sugar throughout the day to make sure we're not having these energy crashes. Um, I always say if we're having big, you know, getting a lot of uh refined carbs and all of a sudden having a sugar crash, that can also stimulate our appetite again to get our blood sugar back up. So the more we can kind of also stabilize that blood sugar will help with that too.

SPEAKER_05 30:21

And it looks like our next question is a little bit connected to this one as well, though maybe on kind of the other end a little bit. But Danielle's wondering, she says, I've not had my period in over a hundred days, but I still have carb cravings and feel more emotional around the same time I was supposed to have my period. Is this normal?

SPEAKER_01 30:40

Yes, very much so. Even though you're not having a cycle, you're still having those fluctuations in your hormones, and so you're still gonna have similar symptoms to when you had your period. So um, you know, that that is very normal to go through that for sure.

SPEAKER_05 30:56

Awesome. And then our next one question is from Amy, and she says, What are your thoughts on intermittent fasting versus keto and perimenopause?

SPEAKER_02 31:06

Yeah, I can I can That's a limited question.

SPEAKER_06 31:11

There's a lot here. Um, you know, I always I always look at this as, you know, there everyone is very individual, and we're always gonna, you know, I say dietitians, we always start with what someone's what's working for someone and go from there. Um, just from like an evidence-based standpoint, you know, we don't necessarily see that these eating patterns are necessary for um menopause. They may have certain benefits and downsides, is kind of the way we look at it. Um, with intermittent fasting, right, and that time constraint, um, that may work really well. I know some people that's just kind of their lifestyle. Um there, I would say it's not is it's not sustainable for every person, um, especially if it's causing overeating later in the day because we're not getting enough nutrition earlier on. This is a common trend we see. Um, and so for that person, we might be, you know, we might want to spread out our meals, make sure we're getting that consistent blood sugar to prevent those crashes. Um, you know, with the keto diet, you know, there again, we see some research that shows, you know, some improved with insulin sensitivity and things like that, but we don't see as much long-term sustainability on that diet. Um, and especially when we're kind of cutting out those carbs, sometimes we see people get more carb cravings in the end, or um just have trouble really keeping up that lifestyle. Um, or they're not getting enough nutrient density, I think is one of my bigger concerns. Maybe there's nutrient deficiencies that come from that, um, not enough fiber intake, things like that. So, you know, I say people can play around with their meal timing. There's sometimes, you know, finding what fits your lifestyle is important. Um, but I think it's good to know that neither of those are necessary to still get benefits when you're going through perimenopause. Um, you can eat consistently and just focus on more eating whole foods, balanced foods, getting the right nutrients, and still have similar effects as you could on maybe some of these diets in a more sustainable way. Um, but I know there's so much out there on all of these, it's a lot to dive into. Um, and they each do have their kind of benefits and downsides. But I love if anyone else has some thoughts they want to share on this, please, please jump in.

SPEAKER_00 33:08

Oh, go ahead, Dr. Brown.

SPEAKER_06 33:09

Oh, go ahead.

SPEAKER_01 33:10

You can go ahead.

SPEAKER_00 33:11

No, no, I was just gonna say I think, you know, this is the type of situation where we'd really want to get uh we would want to drill down to what the goal is specific to you, which is you know, these diets typically come up in a conversation around weight management, I would say, or improving metabolic health, something in this realm. And and in in that realm, we have different methods to, you know, but ultimately we it's about energy balance there. And we've got to, you know, be reducing the number of calories that we're taking in compared to what we're burning. And there's different uh kind of flavors of reducing that energy. And time restriction is one way to reduce the energy. We can reduce by doing keto, we're reducing one of the main nutrients here to kind of reduce the total energy that that you're bringing in. Um but there's there's all sorts of routes there. But uh yeah, I think I would just want to be, we just want to be careful there that you know we we want to be specific about exactly what the goal is we're working on together. Because if it's if it's not necessarily weight management and it's about feeling better on a day-to-day basis, those two are gonna be unlikely to be things that are gonna just naturally make you feel um kind of much better or much you know regulated as in the way that Zoe was describing.

SPEAKER_01 34:26

Yeah, I was just gonna say I'm not a big fan of things that are so restrictive, um, especially, and also you have to reframe eating. Like you want to make changes that are sustainable, that are gonna be lifestyle choices that you want to continue throughout your lifespan. You know, things that are gonna make you healthier, live a better life. And so doing like a restrictive diet like keto or intermittent fasting, is that something you're gonna sustain the rest of your life? Does it does it make your body feel good? You know, and and if it doesn't, like how easy is it gonna be to continue doing that? Um, you know, I think that those might be good things for some people in the short term, but I've never met anyone that's been able to stay on either one of those plans long term and do it well and stay happy in the process.

SPEAKER_02 35:13

And I was gonna say also, um, there's a big personality thing here, I think, um, in individualization. Um, I know like my wife and I, I do best with like if I don't have to worry about social issues with eating or time pressures, I do best with a little snack, big meal around two, and then maybe a little snack after that. My wife would not survive that way. She needs to eat small amounts throughout the day. Um we're just different, and it's been that way. We've been married 37 years, it's been that way the whole time. Um, so I think there's also you've got to see what works for you and what works for your friend or your spouse or your neighbor just may not work for you. It's really very individual as well, especially with those kinds of um diets, I would think.

SPEAKER_05 35:58

Well, thank you all, yeah, for those amazing answers. Um, and we have another question from Laurette. Um, and she's wondering what should a menopausal woman be eating to affect a successful sleep cycle?

SPEAKER_06 36:14

Yes, this is a great question. Um, as I say, there's a lot of things going on with I know sleep disturbances are really common to come up due to hormonal changes. So, one of the first things I'll always mention is making sure we're eating enough, right? That we're eating adequately throughout the day to keep our blood sugar stable. I know I'm probably gonna hone in on that a million times, um, but that's gonna be a huge part that's actually gonna help with sleep. Um, we also don't want to eat too, too close to bedtime. I will say, like, there's, I know you've heard sometimes weird rules or people put really specific time constraints, but generally we just don't want to eat so close to bedtime that we're still going through a big part of that digestive process that can actually keep our body temperature up and actually disrupt sleep some. Um, I know we all have had that experience of having a gurgling stomach while trying to go to bed and it's no fun. Um so I do emphasize that as well. Um, there are additional things that can be helpful. Um, there's even some supplements that have some research that can be supportive. Um, there's of course things like potentially melaton for some people or um ashwakonda if anxiety is an issue. Like those are things to always discuss with your healthcare providers and see if those are additional support. Um, but I usually more focus on just generally getting our blood sugar managed so that we're not having again these energy crashes or having that disrupt sleep even more so. Um I was gonna mention too LC and Ian, that was the other ones I was trying to mention too. But these are all ones that may potentially help with just stress and sleep together.

unknown 37:40

Yeah.

SPEAKER_01 37:41

I also think you need to monitor your caffeine intake throughout the day. And the other thing I see a lot of people drinking now, especially before working out, is like energy drinks.

SPEAKER_03 37:49

Right.

SPEAKER_01 37:49

Um, and those drinks like Celsius and similar, they have like 200 milligrams of caffeine. And I think that we underestimate how much those substances can affect us and affect our ability to wind down at the end of the night, especially if you're having the midday or even in the afternoon.

SPEAKER_00 38:05

Yeah. Yeah, there's actually really interesting research that's come out recently that actually folks metabolize caffeine at different rates. And so some people can have that 3 p.m. espresso and it doesn't disrupt their sleep at all because they metabolize it in three hours. Other folks are much slower metabolizers of coffee. And so, you know, you sometimes hear this anecdotally where people are like, I can't have a glass after noon, otherwise, my sleep is disturbed. And other folks have a very different experience, and that experience is true. Um, and so if you are, you know, if you notice that, even if it's that early afternoon cup of coffee, um, it's a thing to keep an eye on for everybody because it seems like it should be out of your system, but for some folks, the caffeine molecule is actually still hanging around. Um, the other thing I always bring up here is um, and you know, this is one that we always bring up, but alcohol late at night is one of the main disruptors of sleep in in folks that I talk to. And this is always tricky because it's the glass of wine with dinner, and if it's especially if it's a later dinner, um, it it is uh one of the kind of single most powerful disruptors of sleep. So if it is an issue that's getting in your way, um I it's definitely something to try cutting back on or potentially having moving it all a little bit earlier. I've had some patients who then, if you know, if they're gonna have the glass of wine, have it at 5 instead of 7:30, and move along with what Zoe was saying too about moving the meal up so you're not having a meal within a few hours of bedtime. Um, you know, these are some of the the tweaks that we can make. Most folks would say even that 5 p.m. glass is is gonna be in you know, decreasing your sleep quality overall. But, you know, we're we're kind of trying to find the right trade-offs for everyone here and and and see what makes sense. Um and then the other couple of like you normal sleep hygiene things that I bring up all the time, you know, as much as you can, maintaining a consistent sleep wake cycle every day, um, not getting into bed until you're ready to go to sleep. Um, I think we kind of the common adage here is you know, bed is for sex and sleep, nothing else. So if you're doing work, stay in your desk before you get into bed because it disrupts that kind of mental connection you have of being in bed as a place of rest and a place of winding down. Um, avoiding daytime naps when you can, and then you know, keeping the bedroom dark at a comfortable temperature, things like that.

SPEAKER_02 40:34

So you heard it here. Day drinking is the uh the key of sleep. It's five o'clock somewhere.

SPEAKER_05 40:43

Oh my goodness. No, those are all very interesting for me to hear as well. So thank you all for like going very into depth into that. Um, let's make a question next from Jana. And this is a question I see all the time in our communities, and I think is just a really big focal point for a lot of women in menopause. Um, but she says, Why does menopause have me stuck and unable to lose any weight? I'm not gaining, but I just can't lose. Even the strategies that have worked well for me prior to menopause aren't working.

SPEAKER_01 41:12

We've talked about this before on other webinars, but basically it's because you're in a high stress state. Um, because there are so many fluctuations in your body, your cortisol levels are high, your body is in a fight or flight mode and you're going to retain every calorie. Um, especially if you have insomnia and night sweats that are affecting your sleep, you're not getting restorative sleep, your body cannot kind of accommodate the next day. There are so many different reasons, but mainly it's because you're in a heightened stress response because of all the hormonal changes that you're undergoing. So that's the main thing. So, whatever you can do to reduce your stress levels, um, whether it be, you know, incorporating more exercise, improving your nutrition, adding HRT into the mix can help as well. Really focusing on your sleep hygiene, reducing your screen time before bed too is important, you know, in addition to the nutritional changes too. Um, but I think that all of those things, if you can reduce your stress level and reduce your overall cortisol levels, you would do better. And then your body can start, you know, the metabolism could kick in better and things can start moving in the direction you want it to.

SPEAKER_05 42:20

Absolutely. Thank you so much for that, Dr. Kat. Um it looks like we have a question from Missy. And Missy says, Do you have any different dietary recommendations for women who go through menopause earlier in life versus later or naturally versus surgery?

SPEAKER_01 42:41

I don't know if my advice as a doc would be any different depending on you know when you go through. I think that, you know, the benefit that women have going through menopause naturally is that it's a gradual process and so it gives their body some time to accommodate. Um, and sometimes it's a wake-up call that we have to make some changes in our nutrition, you know, to help balance with symptoms. Whereas a woman going through surgical menopause, things happen kind of overnight. Um, and so you have you're you're faced with a lot of symptoms very quickly unless you're you know on hormone therapy to help combat those symptoms. Um but I don't know, I mean, I think if anything, with the patients I've talked to, trying to incorporate healthy lifestyle changes and better nutrition earlier in life, even before you go through any transition, is going to help you be more prepared and more armed to deal with this. Um I think that we don't think about that a lot in our 20s. We think we have all the time in our world, you know, to deal with that. But I think that, you know, focusing on self-care and your own nutrition, mindful eating like Zoe talked about earlier, um, really paying attention to like what your body feels like after you eat certain foods, you know, if you feel like crap after eating a meal, mark that off. Like that's not something you want to eat that often. I mean, I love pasta just as much as the next person, but I have to expect to have a huge crap. Afterward, you know, if you eat a huge plate of pasta, you know, it's like I'm ready for a nap afterward.

SPEAKER_02 44:07

Yeah, surgical menopause is is really a different beast than natural menopause. And there's actually some very good data that women that undergo surgical menopause, especially young, you know, like 40 or even younger, uh have a much higher risk of cardiovascular disease, heart attack, stroke uh than women that go through natural menopause. So HRT can help with that. Um, but you know, if you go through surgical menopause, especially at a younger age, you really, I think, you know, want to be careful about how you eat for heart health and stroke prevention and these kind of things. Nutrition becomes even more important because your baseline risk has gone up so much from the surgery. So HRT is very important, but you also want to think about all these other um lifestyle things that also can modify your risk. It's something that I don't think gets talked about very often, um, but is actually very important.

SPEAKER_03 45:04

Absolutely.

SPEAKER_00 45:05

Yeah. The only other thing I think about in these scenarios is you know, adding on the recovery from surgery as well is just another complicating factor in these in these scenarios, and let alone the the reason for the surgery, which could be any number of things that are also affecting your ability to take care of yourself. Um the in the in all situations with natural and with surgical, in you know, I I as much as we can, we try to get involved as early as we can in the process, months before we think so. So we can start thinking about what some of the life changes will be for you. And um, you know, of course, that that tip is not necessarily helpful for any folks who are already past the transition, but but it's a big hope of us having this community as we can start having these communicate, these conversations and communications um, you know, more prophylactically and preventatively as we can.

SPEAKER_03 45:58

Absolutely.

SPEAKER_05 46:00

Looks like we have a question from Tessa next. Um, and she says, we are a lectin-free home. That being said, as of three years ago, I started putting on weight and has gone directly into my tummy, back, breast, and thighs. I'm a marathon runner and I am at the gym six days a week. Just recently had a partial hysterectomy. I feel like perimenopause has snuck up quickly. Should I change my diet back to pre-lectin?

SPEAKER_06 46:33

I mean, I think when I, whenever I'm working with anyone, the first thing I'm gonna ask is why did we take it out in the first place? What were our observations with these foods? Um, you know, I think high lectin foods do can potentially have some benefits. Um, and if they're not causing us harm, they potentially, I'm thinking especially things like our legumes that do have some phytoestrogens that we know can be supportive of hormonal balance, um, right? Thinking some of our whole grains that have those complex fibers. Um, but I'm always gonna dig into how this food makes someone feel, right? What they're noticing, because I always say if there's a reason we took out in the first place, that's what I want to dive into and understand. Um, but those electron foods may have some potential benefits for menopause as well. Um, you know, and I know the other thing I'll always mention is I know um there are these, you know, changes in body uh fat distribution and things that I know HRT can support and help with. Um, and there's just some of those are just subnatural changes as well. Um, so sometimes just focusing too on, you know, resistance training, you know, continuing exercise, stress management, as mentioned before, I think is a huge one that we can't ever look past as well. Um, but that's kind of how I would approach that.

SPEAKER_05 47:42

Absolutely. Thank you for that. Um and it looks like we have a question, the same question from both Chris and Stephanie next. Um, and they're both wondering do you have any specific foods to help alleviate joint pain?

SPEAKER_02 47:57

Alleviate what? I'm sorry.

SPEAKER_06 47:58

To alleviate joint pain.

SPEAKER_02 48:00

Joint pain.

SPEAKER_06 48:02

Yeah, this is a great question. Um, I would say this is where we're gonna be focusing on a lot of our anti-inflammatory foods. Um, so things we're gonna be looking at are high antioxidant foods. So berries are a great source. Um, our fish with omega-3s again, I love those. Um, I know I've been to them a lot. Um, nuts and seeds are a great source. I would say the primary goal is getting more whole foods in our diet and less processed foods, though. Um, that's what's gonna help reduce inflammation in our body, which can support our joint health, along with that chronic disease prevention as well. Um, you'd also be thinking about, I think, our bone health too, because that can support our joints as well. So making sure we're getting adequate calcium and vitamin D, getting whether that's through plant-based, um, you know, leafy greens, legumes, that sense, or more of our dairy products, um, or even fortified sources like tofu are a great source of that as well. Um, so those would be the primaries ones I think of. Um, I know there are some um other nutrients that could play a role, like getting in some collagen. There's some research shows that can be helpful, um, whether that's through supplement or through food sources as well.

SPEAKER_05 49:08

Absolutely. And it looks like our next question might be a little bit more winona adjacent, but um they're wondering, they say, I'm concerned about low libido. What and how does Winona assist with that?

SPEAKER_02 49:24

So libido is almost always multifactorial, so they're very well maybe a dietary uh help with that as well. Um, but certainly um as you go through the menopause transition and your hormone levels drop, um that can affect libido. So um one of the things that we often offer is DHEA, which helps raise testosterone levels. Um, and we we do it at a very careful dose, um, you know, 25 to 50 milligrams, enough to get you into a normal female range, not enough to turn you into a competitive bodybuilder. Um, but that's you know, we're we're going, we're talking about libido, so um it definitely can help with that, but estrogen can as well. Um, also um, you know, looking at vaginal health, um, one of the common changes in the menopause transition are changes in the vaginal health, so you can have pain, dryness, uh, and you know, if inner course doesn't feel good, you're not going to want to do it, and that's going to affect your libido. Um, so working on all those things um can can definitely be important. And then, you know, always, you know, there's always the relationship issue as well. Um, so you know, as you're going through changes, you're you're going through a different stage of life, that can affect your relationship. Um, and you know, these things are obviously incredibly important to libido. So it always you want to look at it from multi-angles or multi-facets, um, but certainly uh HRT can definitely be part of that that can help with uh with increasing libido.

SPEAKER_05 51:06

Looks like we have a question from Sharon. And Sharon says, uh, my HRT and DHEA ships tomorrow. After I start it, will my sugar cravings decrease?

SPEAKER_01 51:23

I think in time, as as the you give your body a chance to acclimate to the medicine, it it definitely should help. I've heard I've heard that from my patients, that it definitely has helped with cravings over time.

SPEAKER_02 51:37

But don't expect it to help with the first application. So uh Right.

SPEAKER_01 51:42

It's not gonna happen overnight.

SPEAKER_02 51:44

Right, yeah, this is a this is a long game. Um, and honestly, often um for some women things actually get worse over the first few weeks as your body adjusts to the new medication. So you kind of got to get through that that adjustment period can last weeks or even a month or two while um you know things stabilize out. So, you know, don't be on it for a week and say this isn't working. Um, you got to hang in there and and really, you know, this is a long-term thing that you're really looking for, your long-term health. So um, that's the other thing. And I I hear kind of in the question this excitement anticipation, which is great, um, but don't let it turn into disappointment when the you know the first application of the cream or the first THEA pill doesn't do much. So we do we do see that a lot.

SPEAKER_00 52:35

Yeah, the the one thing I'll add here, just about in sugar cravings in general, regardless of the time of life you're in, but these tend to be a bit of a vicious cycle. So if there's something that's kicked that off, whether, and this could be hormonal changes that have kicked off, having some cravings, and then you know, having large amounts of foods that have high glycemic index at a time, and then having crashes, and then having more cravings, and we can really find ourselves in a kind of dregulated state when it comes to our sugar metabolism. Um, and so we these are situations where we do kind of we take a step back, and sometimes it requires a bit of a reset in that cycle. And I think as Dr. Green mentioned, the hormones can certainly be a helpful catalyst in that process. Um, but it is, it can be an uncomfortable reset as you're kind of removing yourself from that cycle of sugar and trying to reset the way that your body has kind of made that relationship.

SPEAKER_05 53:32

And it looks like our next question is from Laura. And Laura says, I was diagnosed with lupus uh SLE when I was 18. It's been in remission since my mid-20s, and I've not had any um been on any hormones since. Can bioidential hormones potentially cause a flare? Also, what is the risk of blood clots with HRT creams?

SPEAKER_01 53:56

I haven't had, I've had a few patients with lupus um that do fine on HRT and that have not experienced a flare with starting treatment. Um, so I don't think I would be afraid of that. Um and ultimately, when we think about the risk of blood clots, if we're thinking about DVTs, um, which is a deep venous thrombosis, or a PE, which is a pulmonary embolus, typically your transdermal applications of hormones like your patches, your creams, incur a lower risk of these clotting events than taking a pill. Um, because they don't have to be processed by your liver, um, and it's a tech usually a lower dose that we require you that we use to be able to give you symptom relief, tend to be um lower risk of blood clots than the other forms of hormone therapy.

SPEAKER_02 54:43

So the other thing, you know, the risk of blood clots with HRT, it's not zero, but it's really small. And I think um it's a big fear people have that I think is usually the fear is bigger than than the real risk. If you look at it, I mean the risk is much higher for with birth control pills than it is for HRT, for example. Um I just I don't know, not too long ago I said that to my wife, and she was she's like, really? Um I was kind of surprised that she was surprised. Um, but the the risk uh uh blood clots from HRT, the problem is the downside risk. I mean, if you get a book out of it it's a big problem, so um it's pretty dramatic. But the actual chance of that happening is is actually very small. So um certainly not zero, um, but it's it's it's pretty small.

SPEAKER_01 55:36

Yeah, I think far more women have blood clots every year with birth control than we ever hear about from HRT. Yeah.

SPEAKER_05 55:45

We have a question from Genesis, and Genesis says, Um, does perimenopause affect your sugar levels? She says, I'm having highs and lows during the day, 45 to 180. Um, A1C is 5.8, diet isn't different, doctor doesn't feel seem worried, but I feel horrible.

SPEAKER_01 56:10

I mean, I I would go back into my spiel about your heightened stress response and heightened cortisol. I mean, that can affect your metabolism and your body's ability to keep your blood sugar more regulated during the day. Um, and if you're going through symptoms and if you're dealing with insomnia, you're dealing with hot flashes, night sweats, all these things are throwing challenges at your body, which is putting your body under more stress and putting your body under more difficult circumstances to do the job that it needs to do, you know, with your metabolism and your sugar metabolism, especially. But I'd be interested to hear what our nutrition specialists have to say about it too.

SPEAKER_06 56:46

Yeah, I was just gonna add to that. Um, definitely, you know, we know that when there's hormonal imbalance in menopause, but I also see this in like the PCOS, even just that their our cells become less sensitive to insulin, um, which can lead to higher blood sugar. So that definitely can become a little more of a concern along with that cortisol. And I think that's definitely a huge impact. So I always am glad you bring that up. Um, you know, and so I think that is something we have to pay attention to. Sometimes a little more focus on blood sugar interventions can be helpful along with those other interventions that are supporting that hormonal balance. Um, but that's where we'd really look into that consistent intake. I think it's great if you're already monitoring your blood sugar really closely and knowing what's going on, because that allows you to then go in and kind of make those tweaks. Maybe it's your meal timing, we're spacing out our carbohydrate amount, how much protein we're adding to meals, right? We can kind of play around with those numbers and see what helps you kind of keep your blood sugar stable. Um, so that's great to always hear. I love to hear when someone's monitoring closely and paying attention to these things.

SPEAKER_03 57:46

Absolutely.

SPEAKER_00 57:47

And there is just one quick thing to add there is that you know, this is also there's a bit of a limitation to the lab value of the hemoglobin A1C that's being demonstrated in this situation, which is that the A1C is an average value of glucose over the last three months. So for folks that are having high highs and low lows, it's giving us the middle read there. So that's just something I always recommend um speaking with your your provider about. Um, you know, it's great that you have this data to to kind of talk with them about it, but I really try to focus on that and and kind of look for providers that are willing to see the whole picture here in thinking about glucose um metabolism.

SPEAKER_05 58:36

And it looks like we have time for one more question. Um, and this one is from Stephanie. Um, and she says, Could you please give a few examples of complex carbs? Yes, absolutely.

SPEAKER_06 58:52

Happy to. I always get to. I love, you know, I love when I get to just like talk about foods. Uh, and it's the yummy part of education, I always say. Um, but yeah, so complex carbs, these are gonna be um our whole grains. So we're thinking oatmeal, quinoa, um, our brown rice compared to white rice, right? Our um whole grain breads, those are really are gonna be our complex carbs along with our starchy vegetables. So sweet potatoes, um butternut squash that we're thinking of, um, you know, our corn and peas, those are all gonna be our more complex carbs because they're a lot higher in fiber. Um, takes more work for our body to break them down, they keep us more full and give us less of these blood sugar spikes.

SPEAKER_05 59:36

So that is a perfect answer. Thank you so much. And um I just also want to say thank you so much to the Nourish team today for like being on with us and answering all these questions. Um, for those of you who are watching, I'm also gonna drop a link in the chat where if you want to make use of the amazing dietitians and team that Nourish has, you can definitely check them out at that link. Um, but we have loved having you all. Thank you so much for your time. And um thank you also, Dr. Green and Dr. Kat for being here to answer some of the HRT questions and kind of what that looks like. And then just also a reminder to everyone who's watching, I know we didn't get to all the questions, and we love seeing this many questions because that means you're curious and kind of really leaning into your health and taking the ownership of it. We love that. But um, your doctor is available 24-7 in your patient portal. So please ask those questions to your doctor. They will love to assist you. Um, that's what they're there for. Um, but thank you again, um, everyone who's watching for just attending um the event. And thank you, Nurse team, thank you, Anona team, um, for kind of being the people to answer these questions and give everyone um some of your time as well. Um, this has been a great event, and it's been great to have another one of these. But um I hope everyone has a great night. Um, and we'll hopefully we'll see you all next time.

SPEAKER_00 1:00:53

Great, thanks. Thanks so much for night, everyone.

SPEAKER_04 1:00:57

Thank you for joining the Menopause Hour, brought to you by Winona, Menopause Care Made Easy. To learn more, find Winona at bywinona.com and on Instagram at bywinona. Want to have your questions answered next? Register for our upcoming live QA. Linked in the show notes.