I’ve shared on the show before that starting menopause radically changed my body. And we’ve talked about how hard it is to find smart, supportive, and true information about health, hormones, and HRT in midlife.
But now there is finally a book that shares everything I wish I knew five years ago! And I’m thrilled to talk about it with the authors today.
In this episode, I’m joined by Kristin Johnson and Maria Claps of Wise and Well, who wrote The Great Menopause Myth: The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive.
We Discuss:
- How health declines during menopause
- The impacts of hormone loss as we age
- Deciding if HRT is right for you
- How to prepare yourself for HRT & manage your expectations
- Why you might need a new doctor in mid-life
- Weight loss during menopause
- The relationship between stress & weight gain
- Why “you have to pick your hormones or your alcohol”
- The importance of critical thinking & self-advocacy
- Why you probably don’t need to be on DIM
More About Our Guests:
Maria, an FDN practitioner, and Kristin, an NTP Board Certified in Holistic Nutrition, are plainspoken friends and practitioners who share a passion for women’s health, especially women’s health at midlife. They are the authors of the widely acclaimed book “The Great Menopause Myth”, a comprehensive, science based, yet easy to read guide for women who want their best chances at healthy longevity. As both are themselves menopausal, they’ve refined the art and science of thriving as a midlife woman based on both clinical and personal experience. They combine individualized nutrition and lifestyle changes tailored to midlife women’s needs with mindset coaching, lab testing and hormone replacement therapy education to help women thrive so that they can stop or prevent their health from spinning out of control.
Connect with Kristin & Maria:
- Get The Great Menopause Myth
- Learn more about Wise and Well
- Explore the Mastering Midlife Mentorship
Connect with Ali & Insatiable:
My Conversation with Kristin & Maria (Transcript)
Ali Shapiro [00:00:00]:
Welcome to Insatiable, the podcast where we discuss the intersection of food, psychology, and culture.
Kristin Johnson [00:00:08]:
Sadly, your OB GYN is about as equipped to give you menopause advice as your orthopedic is to give you nutrition advice. And so we just need to kind of accept the fact that we’re not demonizing doctors, but this whole menopause space, because of the control of medical societies, because of the control of the FDA, because of the control of pharmaceutical companies, because of the control of the insurance regulatory platform, etcetera, they are hogtied as to what they even know about menopause hormones and HRT. And so you probably have to opt out of the system a little bit.
Ali Shapiro [00:00:48]:
I’m your host, Ali Shapiro, an integrated health coach, 32 year and counting cancer survivor, and have radically healed my relationship with food and my body. And for the past 17 years, I’ve been working with clients individually, in group programs, and in company settings to do the same. Welcome. The information in this podcast should not be considered personal, individual, or medical advice. Hello, insatiable listeners. Allie with a cold here. Esa brought it home from daycare and had it for about a day, and then gave it to me. And here I am 6 days later.
Ali Shapiro [00:01:29]:
So excuse the congestion, but I have a great episode for you today. Before we get there, happy fall equinox to everybody. Or if you’re in the Southern hemisphere, spring is on the way, but you will be listening to this the week of the equinox when it gets released. Well, you may be listening at a different time, but you know what I’m saying. So just wanna acknowledge the fall season. It’s my favorite time of the year. My birthday is October 1st. Es’s is the 28th.
Ali Shapiro [00:01:56]:
My dad’s is the 29th. A lot of my friends are in October. I just I just think it’s the best month. So couple things before we get into today’s episode. I wanna thank everyone who’s left reviews. If you remember, I had a goal of 200 by the end of summer. We’re at a 196. Okay? So everything takes you longer than you think it is.
Ali Shapiro [00:02:19]:
So still gunning for that 200 and I wanna read some of the recent ones that people have left. So Carrie s s s s says, a great resource for midlife women. I came across Aly’s podcast last year when I was looking for ways to become healthier. My metabolism slowed down in my late thirties and I needed insight and guidance. I’ve learned so much already about nutrition, behavior and different approaches to feeling better inside and out. Thanks, Allie. And Carrie gave us 5 stars. Jess Pico also gave 5 stars so many moments listing.
Ali Shapiro [00:02:55]:
Ali presents information in a way that reframes a lot about health and wellness and makes you think differently. I’ve had so many moments listing where things click. We’ve been told a lot about these topics and Ally does a great job navigating you through all of it. It’s one of the few health podcasts that doesn’t make me more anxious about health or make me feel there’s an overwhelming amount I need to do to claim my health. She focuses so much on getting to the basics in a way that really isn’t basic. And from sjntheb, she writes an interesting perspective in 5 stars too. After a lifetime of struggling and success and then not success with an abstinence program, Ali’s perspective gives me hope. I’ve struggled with so many quote programs because they ultimately don’t resonate with what I know to be true in my deepest self.
Ali Shapiro [00:03:44]:
I look forward to continuing to hear her work and see how it works for me. So we’re far away from my goal. If you have ever gotten something from this show and have yet to leave a review, please do. It literally takes less than 30 seconds and it is a huge way to help the show and there will be a link in the show notes. And speaking of reviews and kind of voting, remember if you’re in the states or if you’re an American citizen abroad, that we have a very important election coming up. And if you could see my eyes, eye roll, some people have mysteriously been taken off the voting rolls. Okay. And mysterious is where I I might roll my eyes.
Ali Shapiro [00:04:24]:
But I just wanna make sure that you know if you’re registered to vote. I know here in Pennsylvania we have till the end of October. I’m already registered to vote. Have never missed an election my entire life. I think it’s really important. It’s a part of a healthy democracy. Democracies take work. So voting is a privilege and I want it to be one you don’t take lightly.
Ali Shapiro [00:04:45]:
So I will include a link to vote.org which is a nonpartisan nonprofit to help you ensure that you’re registered to vote. And if not, they’ll show you how to do it. It’s really important. Okay. Now, on to the show today. So it is just crazy to me that in the last few years, the menopause space has completely blown up. I mean, I went through it myself just 4 years ago and I had to piece together so much. And in that time period, right? I’m almost glad that there wasn’t as much because it can be so overwhelming.
Ali Shapiro [00:05:19]:
Right? I think everybody who has been around a minute understands that you need protein, you need to lift, and you need to get sleep. Right? So but there’s a lot of other information out there. And frankly, a lot of it isn’t that great. But people claim, I’m like, okay. However, I think there’s a lot of great stuff that we covered on Insatiable earlier that helps you understand the fundamentals. So definitely look at some of those past episodes that started with me talking about my story and how I gained £30, combination of postpartum, but it was just a real shock to me because I insomnia was my main symptom and I didn’t know that was a symptom at the time. But those 7 episodes, the midlife reckoning, they’re what I wish that I would probably known at 40, not when I was in the thick of it. And those episodes really go over the fundamentals.
Ali Shapiro [00:06:14]:
And then once you get the fundamentals, you can fine tune. And that’s why in this episode, I wanted to have on Kristen Johnson and Maria Claps of Wise and Well who wrote the new book that is out now, The Great Menopause Myth, The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive. It is out now. I cannot recommend it enough. It is really looking at menopause not just through symptom management but the health effects of it. And they lay it all out in their book so well. I mean, even our hearing, our teeth, I’ve had so much extensive and expensive dental work in the last 2 years because of 2 teeth infections. And I am now thinking it’s because of menopause and how it changes our microbiome in our mouth.
Ali Shapiro [00:07:06]:
But we’ll get more into that, and their book gets more into it. But Kristen and Maria have been in this space before it became trendy. And you know, we all need to start out somewhere as practitioners. But when you’re new to something, you often don’t have quite the discernment that people who’ve been around for a while have. And Kristen and Maria had that discernment. And they work with midlife women who want to optimize their chances for healthy longevity, and have a special knack for focusing on the basics, plus a little extra. But what I love is they help women avoid distracted and expensive shiny objects. This happens in the wellness space.
Ali Shapiro [00:07:43]:
The fundamentals are hard to do. Right? Getting sleep, getting sunlight, eating mostly whole foods, walking. All these things, they take effort. Right? They’re not quick fixes because our lives are not set up for help. But then we end up spending money on stuff that distracts us from this, and then we’re like, I’m doing all the things, but we’re not doing the things that really move the needle. And so that’s a lot of their message. But they have discernment about when do the extras really help. So I love that they understand what is essential, and they balance this wonderful line too that I think is really hard in this space is that you are going to age and you’re not gonna look like you’re 25.
Ali Shapiro [00:08:22]:
I know some people are trying to and that’s okay. No judgment. This culture is brutal on aging women. And so they’re they’re gonna be like, look, you have to be realistic. Right? And the current expectations for women health are so low, it’s outrageous. And in their book they get into, and we talk about it a little bit more today, the difference between health span and lifespan. And I think that’s a really important term to understand. But there’s 2 other reasons I wanted to have them on was they understand how the North American Menopause Society is funded.
Ali Shapiro [00:08:56]:
Right? There isn’t a lot of expertise to guide us. So it can be really easy to go to the one place that is giving us information. But we talk about why it’s really under important to understand who funds NAMS and why they’re not big fans of it, frankly, and why it really matters for your approach to aging to have this understanding. Part of what really fired me up early in my career was how corporate interest dictated my health options. I didn’t know that. I just thought, hey, these are the options. I didn’t know what I didn’t know. But understanding this political corporate interplay really made me realize that, oh, most of the solutions out here are band aids and trying to put out fires.
Ali Shapiro [00:09:35]:
And we need that, and there’s a whole other side to the continuum. It’s also why I doubt questioning authority into my work. Because while these organizations can be helpful, I never want you to take what anyone says, especially these big organizations that are so heavily funded by those with profit interests as the answer. I mean, I even look at discernment with the American Cancer Society, right? I mean, they’ve just recently, I think, come out about nutrition being helpful in cancer prevention, right? It’s like, what? Okay. 2nd, I really wanted to talk to them about their approach to HRT, hormone replacement therapy. We’ll get into it because let’s just say that their approach is a little bit controversial. And it’s controversial because there isn’t enough science accumulated for more traditional practitioners, shall we say, to be comfortable with it. But the science also doesn’t exist because it hasn’t been researched.
Ali Shapiro [00:10:31]:
Right? It’s not like they’ve researched this stuff and they’re like, no. The way that they talk about HRT doesn’t work. It just hasn’t been researched. So I wanted to ask them how they balance this because they are very research based. Especially because, you know, 20 years ago when I went to reverse my own IBS, acne, and depression, via blood sugar balance and gut health, it wasn’t quote proven by science. Yet it made logical sense and worked for me. Right? This was 20 years ago. People still believe depression was a serotonin deficiency.
Ali Shapiro [00:11:03]:
And I found budding research that said, hey, You know, first of all, depression can be caused by multiple things. It’s not always the same in everyone. And it might be an inflammation issue. Right? This was radical at the time. But I’m so glad I didn’t wait for the science to prove it. I don’t know where I would be. Now, of course, there’s a ton of research to prove some of, you know, some of what they’re talking about, but they talk about where they’ve learned their approach to HRT. And I think I want all of us to remember that at its best, science is a continuing search for knowledge.
Ali Shapiro [00:11:37]:
The science is rarely settled. So understanding this often opens us up to trusting in our own experience If we understand science is a continuing quest for knowledge and perhaps apply to this episode, what sort of HRT options we want to explore. Okay. Almost onto the show. 1st, a quick bio. Maria is a FDN practitioner, and Kristen is an NTP board certified in holistic nutrition. And they are plain spoken friends and practitioners who share a passion for women’s health, especially women’s health at midlife. They are the authors of the widely acclaimed book, The Great Menopause Myth, a comprehensive science based yet easy to read guide for women who want their best chances at healthy longevity.
Ali Shapiro [00:12:25]:
As both of themselves menopausal, they refine the art and science of thriving as a midlife woman based on both clinical and personal experience. They combine individualized nutrition and lifestyle changes tailored to midlife women’s needs with mindset coaching, lab testing, and hormone replacement therapy education to help women thrive. Enjoy the show today and let me know what you think. Kristen and Maria, thank you both so much for being here. I have read your book, The Great Menopause Myth, The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive. And I feel like this book is right on time. Although, I wish I would have found it 5 years ago when I was going through early menopause, but, you know, I guess, we’ll trust in timing. So thank you for being here.
Kristin Johnson [00:13:16]:
Thanks for having us.
Ali Shapiro [00:13:17]:
I wanna start with, how did you find yourself writing this book? Right? There’s so much about menopause out here. Writing a book is a labor of love. It’s not something that you’re just like, oh, I wanna write a book. It’s it’s a real commitment. So how did you find yourself writing this? What are your stories?
Kristin Johnson [00:13:34]:
The funny thing is is the book found us, to be perfectly honest. Maria had always she kinda had this list of things that she’s like, I want us to do a TED talk or I want us to write a book. And she kinda had these, like, aspirational things. And I was like, girlfriend, we’re so busy. We do not have the time to do this, and we’ll get there. You know, it was kind of our attitude. And then, you know, the world of publishing, we weren’t that familiar with. We had a lot of peers in this space, in the industry just generally of, you know, holistic health practitioners who’d self published.
Kristin Johnson [00:14:02]:
And so we understood, you know, that kind of path to getting published. But we just, again, weren’t putting a lot of attention and time into, you know, knowing more of our options. But in traditional publishing, what they do now is it used to be they got approached with a book proposal, and then they’d sort of review it, and then they decide if they want to do it. Publishers don’t work that way any longer. They actually look at sort of the landscape of what’s trending, what’s kind of forecasted to trend, then they identify as a corporate team where and what subjects they wanna have an imprint in. And then they go and approach people after kind of surveying the landscape and saying who might be positioned to do this. So that’s how we got approached. And to be perfect, Gladys, we actually said no to start because we were too busy.
Kristin Johnson [00:14:48]:
And Maria and I just sort of naively thought, well, we’ll just tell them, like, in September. Yeah. Just like 6 months, you know. No problem. Just wait. And they were pretty blunt. They’re like, no. No.
Kristin Johnson [00:14:59]:
You’re not getting it. We’re getting a book in this space and it’s happening now or it’s not you. And we were like, oh, well, that changes things because and this kind of goes to some of the stuff we were talking about before we started, which is this is a huge groundswell around menopause. We totally understand it. We’re glad for the better attention to it. We’re not so thrilled with sort of the pivot of a lot of new menopause experts, you know, OB GYNs and different doctors who just 2 years ago were handing out birth control pills as hormone replacement therapy or telling women to white knuckle it through, suddenly they’re your girlfriend and they’re suddenly the menopause expert. And and what Maria and I get frustrated with is they don’t have a ton of experience in the space, and so they lack a lot of nuance. So they’re saying things to women that, unfortunately, it’s just starting to make it very noisy again.
Kristin Johnson [00:15:48]:
And it’s hard for women to sort of dissect what’s helpful, what’s adequate, what’s not. And that’s where we just were like, okay, Gosh darn it. We’re gonna have to do this darn book now. So we ended up, you know, kind of pitching a revised timeline to the publisher. It really only changed things by about a month, but it allowed us to get our ducks in order. And so that’s that’s about what we did.
Ali Shapiro [00:16:10]:
Well, that’s so interesting from a like a there’s a market need. Right? Because it tells me that the market is starting to mature, and so we need more mature conversations. Right? Like, you know, the customer journey is now not just like to your point, like, okay. I’m just gonna take birth control to to manage my symptoms, and we’ll get into kind of the 2 camps I love that you lay out. But I think that’s hopeful, and it’s also overwhelming if you’re probably just entering the space. You’re like, I’m not a mature customer yet. I’m just like I know for me, I was like, I’m just not sleeping, and I had a newborn. So I was like, maybe it’s that.
Ali Shapiro [00:16:44]:
Like, I was just like, what is happening? Right? So, hopefully, people coming in now have an easier time. But I think one of the common pain points I hear from my clients and listeners is just like overwhelm. And so I what I love about your book is it’s it’s clarifying what’s essential and what we need to know. So I love that someone on a corporate team had some good instincts because corporate’s a little behind the times, but it sounds like you’re in good hands. So speaking of kind of this groundswell of menopause, I love how in your book, you lay out that there’s 2 camps. You say there’s one camp where menopause is a time for empowerment and rejection of this patriarchal menopause is pathological. We should be invisible. Right? And then the other camp is, like, embrace your aging, focus on your innate wisdom while letting the symptoms pass.
Ali Shapiro [00:17:35]:
And my and my work, it’s all about finding a third option. Right? Is that what I call it option c out of the binary thinking. And I love that you said there’s this third camp we should consider, which is menopause can be an amazing time, and nothing about menopause makes women healthier. Can you unpack that third statement? Nothing about menopause makes women healthier.
Maria Claps [00:18:00]:
Well, when you realize that when you lose hormones, you’re not just losing a menstrual cycle. And that’s unfortunately what so many women kind of equate menopause with is I don’t menstruate anymore. Obviously, what comes with that is I can’t get pregnant. And, you know, whether or not they ever say wanted children, most women absolutely celebrate the end of their menstrual cycle. And when you understand that that signifies hormone loss and how significant those hormones are for health and vitality at every stage of life, even after they are gone, even though it’s natural, you don’t celebrate that. So that’s underlying what we say. Nothing about menopause makes women healthier. And, I mean, I I have gotten a little bit of pushback on that.
Maria Claps [00:18:55]:
And and one woman was like, well, I don’t have my flooding periods and anemia anymore. I’m like, okay. Again, I understand you thinking that that makes you healthier, but, you know, there was a reason for that when that was happening as well. So the absence of it doesn’t mean you’re healthier.
Kristin Johnson [00:19:13]:
Yeah. And the statistics play out. I mean, we know that women are living longer. I mean, this just goes to a lot of people are like, you know, this women are out living menopause is bunk. There’s there’s a kind of influencer out there who likes to say that. Like, no. No. No.
Kristin Johnson [00:19:28]:
We just, you know, suddenly it’s now a problem. Like, no. Actually, if you look at the statistics of lifespan, we were dying shortly around the time of menopause in the early 1900. So, you know, fast forward a 125 years, here we are and women are living 20, 30 years of their lives within the menopause paradigm. How are we living that life? We’re living it fairly unhealthily. And that’s one of the problems that women are sort of, you know, being told this is just natural part of aging. Well, okay. Is it natural at 70 to be on 12 different prescription meds? You know, is it natural to need to have a statin, an antianxiety med, a sleep medication, a bone builder, and all of these things? That might be normal, but that’s not natural either.
Kristin Johnson [00:20:16]:
And so we have to kind of dial back this whole notion of, you know, women that don’t wanna do HRT because they wanna do it naturally. I’m like, well, how natural are all those prescription meds?
Ali Shapiro [00:20:28]:
Yeah. Well, in your book, I love how you laid out. I mean, I because I came into this, I would say, like, you know, I’m through menopause. I’m I recovered from what I didn’t know and being postpartum at the same time and all this stuff. But I was even connecting. I have never had really teeth problems before. And then I had an infection in a tooth, and then it spread. And I go to a biological dentist, they don’t do root canals.
Ali Shapiro [00:20:50]:
I’m like, oh, my god. Is this, like, $12,000 that I just spent to have these teeth, like, you know, implant and crown? Because you talk about, like, our microbiome and our mouth changes, our hearing. Like, I think what I love about your book and what I’m always trying to do in my work with my clients is developmentally get them to be like, there is not this all knowing authority out there. There are experts, but you have to advocate. And I think your book, in the beginning, just, like, lays out the dilemma that we’re facing as we age. And I love in the book how you bring up, like, hey, before menopause, women are, like, so much healthier than men. But then 10 years out, it it is the opposite. I well, I don’t know if it’s the opposite, but what we how would you explain, like, what happens It’s
Kristin Johnson [00:21:33]:
the opposite. I mean, you know, you men aren’t getting autoimmune diseases at the same rates. They’re not getting dementia at the same rates. They’re not getting osteoporosis at the same rates. We catch up with them and ultimately surpass them in heart disease. I mean, it’s not a fallacy. Like, we truly are and and the statistics show that if you took, you know, centogenarians and you’re saying, okay, we’ve got these 100 year old men and women. So men who managed to live to a 100 and women who are at a 100.
Kristin Johnson [00:21:58]:
Who’s healthier? It’s the men every time. So this isn’t, you know, something that’s kind of being concocted. The the data is there and women’s health span has suffered, notwithstanding benefiting in a longevity and lifespan.
Maria Claps [00:22:10]:
So I will I will throw this in and, Kristen, I’m not I’m not sure if I mentioned this to you, but I know you kinda agree with me. And I know this is just anecdotal, and this is just a visual kind of representation of what Kristen just said. But I’ve been noticing, say, male and female pairs that are, for better or for worse, I’m thinking they’re husband and wife or they’re they’re partnered. Right? And they’re probably not brother and sister. And I have been noticing that they’re probably age matched or we’ll say closely age matched. Right? The man or I would say the woman sometimes looks like the man’s mother as they age. And, again, this is not shaming women for their looks. It has to do with the aging process in the body.
Maria Claps [00:22:56]:
And, yes, before anyone attacks me, we’re all gonna age. We will all show visible signs of aging at some point, but there is an acceleration for women of aging when the hormones decline, when the ovaries are no longer producing robust amounts of estradiol and progesterone. So that has been, I mean, again, I feel like I’ve known this theoretically for a while, but, like, I’m visually noticing it. It’s it’s just kind of a reminder of the importance of hormones.
Ali Shapiro [00:23:27]:
What I’m thinking too, because I know at least with, like, my mom and dad and my husband and I, like, I’m the one that’s healthier too. Like, I’m always the one trying to get them to be healthy. So to then see that kind of contrast. Right? It’s like, what’s happening? The fact that women in general and I’m making mass generalizations here. But what I’ve seen anecdotally is women tend to take better care of themselves all along. And then so to see that drop off, it’s it it makes you wonder even more, like, what’s happening.
Kristin Johnson [00:23:55]:
I think a lot of women don’t understand too that men don’t lose their hormones at the same time as women or at the same rate as women. So we have a fairly precipitous drop off of our progesterone and our estrogen starting between 3555. I mean, one of them drops about 25%, the other one drops about 75%. So we, by 55, which I’m hope none of us here would even consider that old. Right? Because that’s where Marie and I are. But, you know, it’s it’s it’s still a youthful time of life, and yet from kind of a physiologic standpoint, it it entails significant aging of body functions. Whereas men, they’re holding on to their primary hormone, testosterone, well into their seventies. So we’ve got this, like, 20 year gap between hormone loss of the sexes, and unfortunately, that starts getting reflected in how we’re living and how we’re aging.
Ali Shapiro [00:24:47]:
And I love in your book how because, I mean, I I do wanna sort of go down the hormone path, but I love in your book that I I can I was like, they’re bringing nuance? You you do talk about how, like, the stress and how diet and lifestyle and how the stress can ultimately, like, lead to kind of this acceleration and everything. So it it it is the hormones, but it’s also the physiological effects that they create that then make us perhaps you know, I know for me, like, not sleeping. It’s like and then you don’t really, like, feel like cooking, and then you’re like, oh, you know, like, it’s this it can be this spiral. So it’s all the pieces. But the underlying mechanism of action, I guess, you’re saying, is the decrease in hormones that that kicks all this off. Again, what I loved about your book was you talk about the hormonal decline, but you bring the other pieces in of sleep, nutrition, exercise. Because when you open up the ins it can be Instagram. Oh, my god.
Ali Shapiro [00:25:41]:
I’m calling it, like, the Google, the Barnes and Noble. I’m not generating it. That’s okay.
Kristin Johnson [00:25:46]:
Don’t be a boomer.
Ali Shapiro [00:25:48]:
The Instagram, there just seems to be a lot of people acting like HRT is kind of this magic bullet. And I know that a lot of people who have listened to some of my previous podcast, they get on HRT and they’re like, it has helped with certain things, but it’s like, oh, I still need to be doing all the other things. So I just love that your book emphasizes that because I don’t feel like it’s getting emphasized in the space right now.
Maria Claps [00:26:10]:
Yeah. We we say that it’s you cannot you really should not put HRT into a body that’s not prepared for that is at least reasonably healthy. That means, like, having a bowel movement every day, eating well, sleeping, yes. Or if you can’t sleep, which is always an understandable thing, at least you have sleep hygiene into place. Right? You’re not someone who’s staying up till, you know, midnight and scrolling your phone and stuff like that. Those things all do factor in. And, Ali, as far as those women who are like, oh, I did HRT and it helped with some things, yes. There’s several reasons for that.
Maria Claps [00:26:44]:
One of those things is, like, lifestyle. Right? The lifestyle things are still very impactful. But another reason is a lot of women are on really substandard HR 2 regimens as well. So that’s completely different topic, but I just wanted to throw that in there.
Ali Shapiro [00:26:58]:
Well, I I I would like to talk about. That’s a great segue. Of my sense and, again, I’ve only been paying attention to this for, like, 4 years, and I was only sleeping for 2 of them. So it all gets kind of jumbled. But my sense is there’s this kind of sort of camps forming around the HRT discussion, and it’s part of why I wanted to have you on because I think you’re offering this this third way, is that, like, many there’s many providers who still think it causes cancer, and then there’s others who are embracing more of this, like, symptom management. And then I feel even a few less even understand the health benefits. So they still prescribed under the symptom management philosophy, which is kind of lowest dose possible. And what I really appreciate out about your book and your work is you understand the historical, political, and profit motivated intersection of why people think this way.
Ali Shapiro [00:27:52]:
And for listeners, when you have this lens, you start to realize that science isn’t this, like, absolute certainty that we all want it to be. Right? We know in theory, science is a continuing quest for knowledge, but you start to understand how the science could go down one path and maybe perhaps not other paths. So, for example, you taught me in your book that why pharmaceuticals fund the North American Menopause Association known as NAMS. And they’ve done a great job of trying to discredit compounding pharmacies, which you’ll need if you want that more tailored approach and traditional perhaps isn’t working for you, like Maria said, is maybe you’re on suboptimal. So a lot of people listening on on this podcast are very open to HRT. And yet what most people hear and are open to are the lowest dose possible and maybe for symptoms or are comfortable with staying on them continuously, you know, until further notice. So in your book, you lay out the option of physiologic doses, which means hormones at the level of when we were menstruating. And rhythmically, meaning not set it and forget it, but rather mimicking the cycling of progesterone, especially like when we were menstruating.
Ali Shapiro [00:29:05]:
Is that an accurate assessment I made of
Kristin Johnson [00:29:08]:
It’s close. I I yeah. You did really good on almost all the points, but rhythmic really responds to both estrogen and progesterone or corresponds to that. What we’re saying is if you anyone could pull up on, you know, doctor Google a graph of the menstrual cycle and the hormone release over the course of the menstrual cycle. As anyone will see, it’s not like, oh, the ovaries release something, and then we have this nice steady level over 28 days. Instead, we have this very kind of peaks and valleys and rhythmic dance that happens for each of the hormones over the 28 day cycle. And that peak and valley, that rhythm that they all have is relevant biologically to women. And that’s what a lot of women don’t understand is that it’s not going to be optimal to just put some hormones in the tank and think that this particular level or whatever is sufficient because we didn’t do that when we were younger.
Kristin Johnson [00:30:00]:
Both we didn’t do that as cycling women, but also if you were a younger woman, say 33 years old, and you lose your cycle, they don’t just tell you live with it. You know, this low level of hormones is biologically has some imperatives and it puts her at risk. And so they restore her hormones. To what? They restore them to her premenopausal levels. That’s not just so she can get pregnant. They’re they do this whether you’re interested in having children or not. So if we recognize that when we’re younger, that levels of hormones and the way we give the hormones matter. Why do those same things not matter when we’re postmenopausal? And so that’s what we’re trying to get women to kind of recognize is that it’s not just having hormones, it’s having the right hormones at the right times and the right levels.
Kristin Johnson [00:30:54]:
Because those peaks and valleys, they they were catalysts for things. You know, we have bone remodeling that depends upon this sort of handoff between estrogen and progesterone. We have our vascular arterial maintenance depends on that. Our tau protein deposition and clearance depends on that. Our p53 tumor suppressor in cancer, highly dependent upon that. We need a peak of estrogen, not just a level of estrogen in order to achieve some of these biological things. So that’s what we’re trying to get women to see is that when they say HRT didn’t work for me or HRT didn’t do it all, you know, yes, there are things in your control. And as Maria said, healthy vessel for healthy hormones, you need to take intentional actions in your daily habits to create an environment for the best HRT experience.
Kristin Johnson [00:31:49]:
But then your HRT, it’s not the same for each woman. I mean, it’s not the standardized compound, pull a bottle of Advil off the shelf and we all take a 100 milligrams. This is about saying, you know, your HRT experience is going to be dependent upon the level of hormones you’re given, the way in which you’re given them, the manner in which they cycle or don’t cycle against one another, etcetera. And we just posit that if you look at the premenstrual cycle, why isn’t that our guide for our HRT study?
Ali Shapiro [00:32:19]:
And how did you guys start thinking about it this way? Because, again, I follow you guys on Instagram, and your Instagram is great. Like, it’s very informative. And I approached my doctor at the the midlife center here at the hospital, you know, about, like, hey. What about these physiologic rhythmic doses? She’s like, I’ve never heard of that. And then someone else was like, there’s no research. Right? And I’m I’m I’m used to, like, as a first generation childhood cancer survivor, I’m used to having to, like, piece together my own health. Right? So I’m just curious though how you came to think about this this way because it is out of the box. Right? A different way of thinking about it.
Kristin Johnson [00:32:55]:
Yeah. I mean, it’s it’s the clinicians in the field who have been doing this for 3 decades. And that’s the thing is you’re gonna hear there’s no research behind it. Well, we do have the human female body’s entire life experience to have the research behind it, but we also do have clinicians who’ve been dosing and and using HRT in this particular regimen for over 30 years. And so there’s this unbelievable wealth of clinical outcomes. You know, I would say that you really don’t have to look much further than say like the 63 year old woman who was put on a patch at 50 when she went through menopause. So she’s had hormones and she’s had HRT, right? And whether she’s cycling her progesterone or not, meaning she’s taking it 2 weeks of the month instead of all 4 weeks of the month, really doesn’t matter. She’s got this HRT and then she gets diagnosed with osteoporosis and she’s like, woah, woah, woah, wait a minute.
Kristin Johnson [00:33:47]:
I have been doing HRT. I’ve even been resistance training. I’ve been doing all the things and I’ve had hormones in the tank. And it goes to show it’s not just having hormones in the tank. It’s having the right levels of hormones in the tank. And, you know, we’ll see it with changes in blood pressure. We see it with changes in lipid clearance. So there’s all of these things that we don’t relate to hormones so that we can have these people who’ve been on this low dose kind of NAMS prescribed regimen who aren’t really thriving, but they kind of dismiss it as aging.
Kristin Johnson [00:34:22]:
Right? And they accept it as okay. And Maria and I are saying, actually, if you look at the women who take physiologic levels of hormones, they’re not having those same health outcomes that the women who are on lower, you know, lower hormones. And that’s not to say everyone has to do it. This is where Marina are trying to make the point in the book. Just be an informed consumer. Right? Know what you’re being offered, know what you want. And if those two things don’t match up, find another provider.
Ali Shapiro [00:34:51]:
I love how in your book, you’re like, there’s no right or wrong because I always said that to my clients. I’m like, it’s everything’s about a risk profile, like pros and cons. And so what do you think someone pushing back on this idea? And, again, it’s I’m really curious about this because, you know, again, I knew to heal my gut 20 years ago, and there was not all the data that we have now. But I was like, this just makes sense. And if I would have waited 20 years, I would still have IBS and depression and be emotionally eating. You know? And then I think of, like, when my son was born, we didn’t do those, like, antibiotic eye droplets. And then it’s like now, last year, the APA, American Pediatrics Association, came out and was like, we should probably be more discerning with this. So I’m just curious what might be some of the risks of of doing it this way that people may want to to know about.
Ali Shapiro [00:35:40]:
And, again, in your book, you lay it all out, and I love that you’re like, there’s no right or wrong. Just no. But what are some of the things that there might be concerns about doing it this way or the the arguments, whether they’re founded in research or not?
Maria Claps [00:35:54]:
The main concern from the point of the safe physicians is that if a woman is doing cyclic progesterone, she will. The goal is actually to have a withdrawal bleed, is to have a period like bleed. Right? And doctors have already decided for women that they don’t you don’t want it, and they don’t want it. So that’s we would say that’s a pretty big part of the resistance to this. I would say another risk, I’d say that very, very tongue in cheek, is that it could stimulate fibroids. It’s not a guarantee. So there could be heavy periods because when we do have this withdrawal bleed, it is supposed to be easy. Like, sometimes women hear, oh, I’m gonna have a period.
Maria Claps [00:36:49]:
Like, why the hell would I wanna bring that back? My periods were miserable. It’s not supposed to be that way. If it is that way, you’ve got work to do with your prescribing practitioner in terms of adjusting the hormones or investigating the causes why. So there you know, it’s it isn’t for every woman. It it isn’t, but it is something that we wanna make available. It’s for women to learn about. Well, I was gonna
Kristin Johnson [00:37:15]:
say, you just mentioned the point about the APA kind of shifting its stance on just the eye drops.
Ali Shapiro [00:37:19]:
There’s a lot of other things I have not listened to with them, but that’s what I’m willing to disclose on air.
Kristin Johnson [00:37:25]:
Yeah, yeah, yeah, yeah, yeah. Totally respect that. But it’s it goes to the point that even today, with all the information that we have, there’s still kind of reevaluating some of these standard conventional practices. And I would say women need to understand that a 125 years ago, it was seen acceptable, normal and natural to restore a woman’s hormones after menopause because it was accepted by every major medical society, American Cancer Association, made her heart association, like, physic everything that menopause posed a severe risk to diseases of aging and that hormone replacement therapy could and should be used as preventative medicine. So we had decades where this was actually the standard of care. Now, why did we get derailed? Well, there’s some bad studies out there. There’s also pharmaceutical interest because the reality is is that to individualize and personalize hormones for women, we can’t be dependent upon commercial products. Commercial products are gonna be standard, single dose, one size fits all sort of thing.
Kristin Johnson [00:38:31]:
So we need to have compounded medicine in order to, you know, really individualize women’s hormone care. Compounded medicine is wildly attacked. There might be people here saying, isn’t it dangerous? No. It’s not dangerous. In fact, they are highly regulated that a lot of lot of NAMS and conventional docs wanna say compounded medicine is dangerous because it doesn’t have FDA approval. Well, k, we won’t get into the whole how valuable is FDA approval because we all know some drugs and FDA approval list that have killed people. But, you know, FDA approval is not actually entirely incorrect when it comes to compounded hormones because the constituent ingredients, the the medical pieces of the hormones themselves are FDA approved. The the sourcing is FDA approved.
Kristin Johnson [00:39:15]:
There is incredible intense regulation from both state pharmaceutical boards as well as federal agencies. They have to follow certain practices, etcetera. So it is a highly regulated thing. Have there been a couple bad actors out there that, you know, sort of fed into this negative connotation? Yes. There have been, but we could say the same for drug companies. Let’s be honest. So okay. So why is any of this even relevant? It’s because compounded hormones are not patentable.
Kristin Johnson [00:39:39]:
When we don’t have a patent, we don’t have profit, folks. And so at the end of the day, there’s been this sort of movement to suppress compounded medications and individualized medicine because of the lack of money making opportunity. They’ll spin it as because of the lack of oversight by the FDA, but the reality is it’s really about kind of taking money out of the pockets of the pharmaceutical companies. And that’s not to be conspiratorial. That is just fact. You know, it’s an unfortunate reality of our medicine system. So I think, you know, when people then say, but there aren’t studies. There aren’t studies.
Kristin Johnson [00:40:10]:
Well, again, who funds studies? Right? There there’s a there’s a financial interest behind most studies today and that’s just also a sad reality of our our modern life. So when we don’t have studies, it’s partly because we can’t be giving compounded hormones in a study because compounded hormones have been poised as dangerous. So we’re never really gonna see anything like this. Now there is a grant application at the NIH that looks as though it’s going to get approved and very promising. That is actually gonna finally take compounded medicine dosed in a physiologic manner, which means replicating that cycle of the ebbs and flows, cycling progesterone, etcetera. And they’re gonna put it head to head against the standard of care, which is a patch in from atrium and, you know, everyone gets the same thing. And it’s gonna be eye opening because they’re looking at really important things, hippocampal volume of the brain. They’re looking at carotid plaque deposition in the arteries.
Kristin Johnson [00:41:04]:
They’re looking at bone remodeling. They’re gonna look at lipid clearance. So it’s not just symptom suppression. We’re really starting to go back to say, hey. Maybe like a 100 years ago, we actually had it right when we saw HRT as preventative medicine. Can we get back to that, please? And so that’s, you know, kind of what’s behind a lot of this. But, you know, this wasn’t doctors operating in some back dark secret room. This was accepted medical practice and then, you know, they kind of got shut out from the conversation.
Ali Shapiro [00:41:34]:
That’s another thing. I mean, I just can’t recommend this book enough. I just love the historical context of even, like, wasn’t just Western medicine. It was Chinese medicine, you know, doing doing all of this. And I think sometimes we think, you know, evolution like like, evolution’s happening and there’s progress. And it’s like, that doesn’t always that that those are two assumptions. Right? There’s there’s a lot of ways that the times we’re living in aren’t the most advanced, I guess, is what I’m it’s kind of the TLDR of that that statement. So one of the things though I think is really interesting that you get into in your book is is, like, a lot of the this stuff.
Ali Shapiro [00:42:11]:
Because when you typically take HRT, they’re like, we treat the symptoms. Right? So, like, when I first started, it was like with progesterone. My sleep got better. And then I wasn’t sleeping so well, and my doctor was like, oh, we’ll up your dose. Right? But these things that you’re talking about, bone remodeling, your arteries getting hard, you know, your, you know, dementia risks, all that stuff, you can’t really know. So, like, you don’t feel that per se. I mean, I’m assuming you don’t. And so if someone wanted to experiment with rhythmic dosing and this this approach, because I’m really curious about, especially, I think, anyone who’s gone through early menopause like me, it’s like it’s almost like a no brainer.
Ali Shapiro [00:42:49]:
Right? But how would they know that it’s, quote unquote, working if you’re not able to feel like, oh, do I feel differently on this? Do I not? What are your thoughts on that?
Maria Claps [00:43:00]:
But that’s, that’s that’s a challenging question. I think that’s the first time we’ve been asked that. I mean, do I would just push back a little. Do you know that you’re getting those protections from your patch and kind of daily static progesterone? You know? And you you bring up a really good point, Dali. We cannot feel the lining of our arteries becoming stiff. We cannot perceive the deposition of tau protein in the brain. We do know that these process are happening. And in terms of feeling these things, well, not these things per se, but just, you know, an avalanche or, you know, a pile up of symptoms, speak to the women that are around.
Maria Claps [00:43:42]:
Give them 62, 63 years. Give them about 10 or maybe 12 years postmenopause, and they’re feeling a lot. I will tell you, again, I’m gonna kind of answer around that, but I will tell you that for Kristen and I, unless we achieve a certain level of estradiol in the blood, we will absolutely feel symptoms. So symptoms are we don’t you know, we we do decry sort of, like, the doctors that just use HRT to manage symptoms. That’s just limited. Okay? And because women wanna feel good, like, that’s part of the whole journey of aging is we should feel good. We just like to say it’s symptoms plus, like, looking at whatever research we currently do have that says we need to get approximately this level in the blood. And then but what’s happening and I think we saw something recent that was, like, 20 years old, Kristen, that was saying, you’re not gonna get those benefits till you reach about a 100 picogram.
Kristin Johnson [00:44:39]:
It was 150, actually. Yeah. And it was like a 90 1996 study.
Maria Claps [00:44:43]:
For argument’s sake, let’s just say it’s a 100. Okay? So here’s the thing. You measure the blood sugar dial level of a woman on, say, a mid dose patch of 0.05, highly unusual that you’re gonna even get above, say, a 50 picogram level. Out of 50 picograms, looking at most, I looked at a lab range the other day. It was a little different. They do vary, but there was a lab range that showed postmenopausal range of estrogen from, like, around 0 or 5 up to about 54.7. So you’re basically a lot of women on their HRT therapies are being maintained in a postmenopausal state. They’re not getting any protection.
Maria Claps [00:45:24]:
So I
Ali Shapiro [00:45:24]:
just think that’s important for people to know. Even if you can’t, quote, unquote, measure it in physiological rhythmic doses, you also who’s looking at it like it’s on these other doses. Right? Like, I’m just assuming I’m getting heart protection. That’s part of why I went on estrogen. Right? It’s like, I want I don’t know what the radiation and chemo did to my heart. So I’m like, oh, I want this insurance. But it’s a false sense of insurance is what I’m hearing you say. Unless you’re measuring and making sure you’re absorbing and and and you talk about in the book, like, the first couple years you’re working with the provider, you should be tested and followed.
Kristin Johnson [00:46:02]:
Yeah. I would say don’t like, you might use the word experiment. I would say HRT is not a DIY. Nobody should be suddenly being like, I’m gonna start cycling my progesterone. You need physician oversight. We do love good, nuanced, deeply skilled, highly trained HRT providers. Unfortunately, a lot of the talking heads are out there don’t hit any of those boxes. They’re just an HRT provider.
Kristin Johnson [00:46:24]:
And remember, you can be an HRT provider as long as you got a script pad. That doesn’t make you a good, you know, person to go to. But I would say, you know, we need to start taking responsibility for our health, to be perfectly frank. Like, direct to consumer labs exist all over most of 50 states in the country. Go measure your lipids regularly. You know? Go look at your thyroid regularly. Go look at your inflammatory markers regularly. Go look at your iron regularly.
Kristin Johnson [00:46:47]:
You know, you don’t even have to know which markers to to pull. A lot of these direct to consumer, even Quest and LabCorp, you can go in and say, I want the iron panel. And, you know, they they give the markers for you. So I would say, 1, ladies, you need to be responsible for your own stuff. I don’t care how functional your doctor is and how many letters they have after their name. It’s still your responsibility to oversee these things. So that’s 1. And then 2, kind of the how do I know? You know, we need to be careful with using symptoms as the benchmark for these things because as women, we normalize a lot.
Kristin Johnson [00:47:21]:
Right? And so you’ve got a lot of women who are on suboptimal HRT. They’re on, like, a point 25 or point 0 25 or point 0 5 patch. Maybe they’re taking a little prometrium and they’re like, yeah, I’m good. You know, got rid of my hot flashes and it’s it I’m not, you know, staying up all night. Maybe I only wake up once a night or something like that, you know? And so they they kind of couch everything as because it’s better than it was that then it’s good enough and it’s okay. And they think that their joint’s aching. It must be osteoarthritis. Right? Or they think that their, you know, bladder leakage is maybe because they had 3 babies.
Kristin Johnson [00:47:58]:
And this is where Maria and I wanna go, stop. Stop gaslighting yourself. These things all did sort of get worse for all of us through the forties and the fifties. Therefore, maybe we look at the hormonal component at play and we stop sort of living with good enough and we live with thriving. You know, Marie and I are, like, bound and determined to be doing amazing things in our eighties. That’s kind of the goal here, you know? And I think we owe that to ourselves because as women, we sort of persist in incredibly difficult environments, taking care of careers and families and parents and all of these things. You know, this is the time of life we take care of ourselves, and it doesn’t mean being selfish and it doesn’t mean shirking any other responsibilities, but it does mean making a commitment to yourself to be really healthy. And, you know, we’re of the opinion that that’s gonna include some really good HR too.
Ali Shapiro [00:48:45]:
I love that you brought that up because I know people listening. A lot of them like raising kids or carrying aging parents. And I loved in your book, you talked about inertia. Right? Like, around taking care of ourselves because I feel like I wanna get on I wanna and I meant experiment, not like do it yourself, but, like, try it and then see, like, that sense of it. Right? But that inertia and I’m someone who’s, like, totally type a about my health given my health history and and and the the whole I’ve gotten myself out of several times from infertility to early menopause to IBS, all this stuff. But I think so so many women who come to my programs, I work with people on their relationship to food and and consistency and nutrition. It’s like, oh, I’m finally doing this for me. Right? And I think that you bring up that point.
Ali Shapiro [00:49:31]:
Like, this is a time where that’s that’s nonnegotiable, I think, if if you want to age well. And it’s it can be hard if you’re not sleeping and all this stuff, but I’m just I’m glad you plugged that because I think you know, I was reading because I take prometrium and it’s like, you in the book, you’re talking about, like, the dyes in it. And I’m like, I make sure my son gets none of this shit, but then I’m taking it in prometrium every night. Not today, Satan. Booking a call with Maria and and Kristen because this is, like, I I don’t want him, you know, because I’m like, oh, his body’s so young. It’s it’s more toxic. But it’s like, my body’s getting insulin sensitive. It’s aging.
Ali Shapiro [00:50:11]:
You know, it’s like the same, like, the opposite end of the bell curve. So I’m glad that you said that. And so much of the reason I created my model the way I did is it’s rooted in developmental psychology so that people realize, look, no one no one has all your answers because it’s so easy. Like, you know, I have clients who are like, I went to my doctor and they’re they don’t wanna do this. They don’t wanna do that. And, like, I know it’s annoying, but you gotta find a new doctor. Like, you’re not wrong. And and and I’m trying to teach them that they may have gone to medical school, but that doesn’t mean that they’re an expert in necessarily wellness.
Ali Shapiro [00:50:43]:
Right? Western medicine tends to be an expert in disease management. And we’re just at this interesting inflection point where if you are pay because I think so many people listening to this podcast are paying attention and they’re trying to do the right thing. And it can be like, but what one of the tips that I love that you gave people is I’m gonna quote from your book. You say and you kinda mentioned this, Kristen, a good HRT provider is not just about finding any provider willing to give you HRT. Start with choosing what type of HRT you want to meet your goals, then find a provider aligned with you. And then you offer some provider discernment clues in the book, which I love when they say bioidentical as a marketing term because I’ve heard that. And they offer statins, SSRIs, or sleep meds as a first approach. I love that you flipped that.
Ali Shapiro [00:51:33]:
Like, that’s kind of the leadership that I’m trying to even though it’s about I work with my clients around, like, you know, food and everything. The underpinnings are you’ve gotta take the lead. You’ve gotta lead. So I love that you give that, like, read their book, everyone. And then you’ll get a a sense of the lay of the land. And then you can align to find a practitioner who will support you. Is that’s that’s what you’re saying. Right?
Maria Claps [00:51:55]:
Let’s let’s underscore that you actually just said something that we’re really, really passionate about. And we, you know, we do work with physicians, and we have a wonderfully kind of over 6 or more years now curated list of doctors that we refer clients to who work with us, who have worked on their health, who’ve prepared themselves to be as healthy a host as possible, looking at gut health, nutrition, mindset, managing expectations. But, you know, we do often have happens about once a week, maybe every other week. We have women who are like, can you give me a referral for an HRT doctor? Because people know. You know? Non clients who ask it. We get emails and Instagram messages. And when I had the time, I used to answer people, but I still try to do I still do try to answer people. But the bottom line is it’s like, okay.
Maria Claps [00:52:47]:
Well, what do you want HRT wise? I don’t know. I’m like, oh, okay. Well, you need to know that. What are your goals for HRT? Do you wanna just be symptom free? Do you want to I mean, are you willing to bring back a cycle? Do you understand the implications of that? And then that’s when you get to look for a provider. Not before.
Ali Shapiro [00:53:12]:
Yeah. I love that you have that because I don’t know. It’s just putting the ball in someone’s court versus kind of like
Maria Claps [00:53:19]:
We get a little hate. I I get we get a little hate. I had a woman who said, well, this is what the doctor should know. And I’m like, no. You really do. We need a level of involvement. You need a level of involvement because, again, yes, the doctor the HRT doctor will know their method or 2. What if that’s pellets? What if that’s, yeah, birth control? Because you know what? You’re 52 and and still menstruating, so we’re not gonna give you real bioidentical HRT.
Maria Claps [00:53:50]:
We’re gonna put you on the birth control pill until you stop menstruating, which is we’ll never really know.
Kristin Johnson [00:53:55]:
Ellie, you have to see it as an RD. Like, how many people honestly still believe that their doctor can give them good nutrition advice? Right. There’s I mean, sadly, they still go to them for that. And I’m like, I get it. We’re not discounting what they’ve done. They’ve amassed unbelievable knowledge. They’ve put incredible investment, both personal, financial, sacrifice time. Like, doctors are amazing.
Kristin Johnson [00:54:19]:
We love doctors, but know what they’re capable of. And unfortunately, in the US in particular, we have such a siloed medical, you know, kind of construct that sadly your OBGYN is about as equipped to give you menopause advice as your orthopedic is to give you nutrition advice. And so we just need to kind of accept the fact that we’re not demonizing doctors, but this whole menopause space because of the control of medical societies, because of the control of the FDA, because of the control of pharmaceutical companies, because of the control of the insurance regulatory platform, etcetera. They are hogtied as to what they even know about menopause hormones in HRT. And so you probably have to opt out of the system a little bit. And I can hear it already. Pippa, I’m gonna be like, oh, Kristen, that’s so privileged, blah, blah, blah, blah. There are perfectly fine ways to get low cost effective HRT if you know how to look for it and you understand what you’re seeking.
Kristin Johnson [00:55:19]:
So, you know, we’re, we kind of push back and many insurances will pay for HRT. They don’t necessarily pay for compounded all of them. Some do shockingly, but you know, there’s, there’s a process and you have to own that. You can’t just go to the person who delivered your babies and think that she or he are equipped to carry you into your eighties. They’re they’re 2 completely different things. So, you know, we we kinda wanna push back on this whole, like, well, I don’t I just wanna trust my doctor. We’re like, we’re not saying don’t trust your doctor. Just don’t trust them with things they’re not capable of doing.
Ali Shapiro [00:55:52]:
Yeah. Yeah. And just for the record, I’m actually not an RD. I considered that path, but I found the conflicts of interest to be great. I didn’t wanna spend more money. So I think in fact, reading your book reignited, like, when I first left my corporate job I mean, I’ve been doing this for 17 years, but part of what motivated me was such the political and corporate corruption. I was like, how do people not know this? And I’ve kind of gotten tired over the years. And I’m like, alright.
Ali Shapiro [00:56:19]:
I’m gonna I I am so I am so grateful. I know how to navigate things, but it’s been less and less with kind of
Kristin Johnson [00:56:24]:
Yeah.
Ali Shapiro [00:56:25]:
But your book got me be like, yes.
Maria Claps [00:56:26]:
People need to know this. Like
Ali Shapiro [00:56:31]:
so one of the the things I wanna talk about is as we age, weight can really snowball for many reasons. Right? Especially stress. When you see that someone would stand to benefit from weight loss because of their testing, their health markers, How do you approach this conversation away in a way that makes it about the physiological realities versus a potential failing or, like, a shame induced conversation?
Kristin Johnson [00:56:57]:
Yeah. I mean, most women don’t put on weight, unfortunately, without kind of some mistakes along the way. Doesn’t mean that they’re they’re you know, they should have known better. That’s not what we’re saying. But we also then they they overlook things like hormonal decline affects their gut microbiome. Our gut microbiome is heavily influential on our metabolic health, our fat deposition, our, you know, where we’re gonna put weight, but also how much weight we’re gonna put on, etcetera. So we try and just educate. Right? A really like empowered woman is an informed woman and she needs education.
Kristin Johnson [00:57:34]:
So we try and say, forget about why you’re in this spot to begin with, like trying to unpack all of that and understand the stresses of life and, you know, things that were thrown at us and whatnot. It’s just it’s kind of like slamming your head against the wall. There’s really not a lot of point to that. So now we wanna say, okay, what can we do? Right? What what is within our control? And the reality is we do make daily choices every single day, 3 times a day in particular that matter. You know, we have 21 opportunities each week to sort of get things right. Do we need to be perfect? No. But we do need to practice and we knew do need to kind of aim for progress. That’s all we try and do.
Kristin Johnson [00:58:11]:
But where are the hormones that relevant here is, you know, as we lose our estradiol, we start to change how we are able to utilize carbohydrates in the gut that brings on insulin resistance. Now whether you get fully in real insulin resistant or not, you are lower in your tolerance to carbohydrates. A lot of women don’t wanna give up their carbohydrates. We’re not saying you have to go low carb or, like, extremely low carb. Not saying you have to go carnivore, but you do need to recognize that you probably have to do things differently than you did in your thirties and forties. That’s just sort of an unfortunate reality, but the sooner we start to accept that, the sooner we can kind of unpack some of this weight that we’re carrying. You know, looking at stress is huge. You know, women we’ve we’ve seen women who are, you know, 4 foot 11 £200.
Kristin Johnson [00:58:58]:
That scares us from a metabolic standpoint and we, you know, really dive in and get in the trenches with them. But then we get their food journal and they’re drinking a cup of coffee with a cup with a scoop of collagen and maybe a chicken breast the rest of the day. And that’s it. So this these are moments where we say, okay, that’s like almost impossible. Not to say we don’t believe you, but to say there’s something else going on. So do we need to look into past trauma? And I know some people might roll their eyes. Marie and I aren’t skilled in, you know, unpacking trauma, and we would refer someone out. But that is a reality.
Kristin Johnson [00:59:33]:
Unfortunately, whether we like to hear about it or not, that is a reality. What the body holds onto and, you know, sort of is harboring, we need to free it of those things. And so whether it’s stress I mean, I know that at one point I had a kid leaving for college, a kid who was in college who was dealing with some health issues, and a younger kid who was getting what was gonna be a life or death diagnosis. And that same day that we were waiting for his diagnosis, my dad calls to tell me he has terminal cancer. Like talk about stress. Right? And I could have starved myself and I guarantee you I would have packed down pounds. We as women think I must have done something wrong. It’s like, no, just life happens.
Kristin Johnson [01:00:12]:
And so we need to sort of start to kind of realize there are things that happen that are out of our control that may have led to weight gain, but there are things in our control that’s in sort of blunt that weight gain. And so, you know, for me it was choosing how I was going to kind of surrender up this stress. And, you know, Maria and I are very Christian women. And so, you know, we rely on a higher power for some of these things. But, you know, making sure I was getting outside and getting sunlight. It’s easy to lie in bed when you’re super depressed and things aren’t working well for you. You know? It’s easy to sort of tell yourself, well, I’ve got all this weight on me. I might as well enjoy the dessert sort of thing, you know, and we got to get rid of that might as well sort of concept.
Kristin Johnson [01:00:47]:
And so there’s just every woman is different. Any woman struggling with weight gain has a unique recipe or mixture that got her to that place. And so you really need a provider who’s willing to sort of step back, you know, help you kind of unpack some of these things and then look into them. But at the end of the day, the strategies start to be all the same. We need to be intentional with what we’re eating and we need to move our bodies and we need to sort of, you know, blunt the stress. Those three things we need to have happen. So the weight piece, Maria and I hate it when people are like, I gained £10 and I really want HRT. We’re like, woah, woah, woah, woah, woah.
Kristin Johnson [01:01:21]:
That’s not the same thing, you know? You know? So we just try and say we get it. We understand aesthetics, but health is really more important. So let’s get you healthy. Whatever the scale says, we’ll let it stay. Most women find that once they sort of focus on health and stop focusing on the scale, some of that internal stress starts to let things fall a
Ali Shapiro [01:01:41]:
little bit. I mean, the research shows the more that you just focus on weight, the harder it is to lose. Right? That’s paradox. Right? So much of my work is getting people to unlearn, you know, that food is only about weight and it can be medicine, but it is also joy. And what are the stressful reasons they’re turning to food? So I I love that you navigate that because I I was just meeting up with a friend who’s in in the midlife space as well. I mean, she’s more around, like, self leadership like me. But we were talking about how the conversation again, it’s become polarized. Like, it’s either diet culture or she’s like, some people I feel like are advocating for obesity.
Ali Shapiro [01:02:16]:
My work is so much also about clients un like, untangling their worth from their weight so that they can actually look at it, like, logically instead of so like, oh, this is because I’m not disciplined or because I don’t have willpower. It’s like, no, there’s physiologic realities. And I think people’s ears are gonna perk up when you’re like, wait, when you’re not eating enough, you gain weight? And so people don’t even understand really holistically how weight gain happens is is kind of the first thing. So I’m glad that you you brought that up. You did bring up stress. And I know and a lot of people who come to this podcast, they’ve recently gotten sober or and now they’re turning to sugar or something. And there’s a lot of evidence that women’s drinking increases dramatically in midlife. And in your book, you say you have to pick your hormones or your alcohol.
Ali Shapiro [01:03:03]:
Can you delve into that a little bit?
Maria Claps [01:03:06]:
Yeah. So alcohol is a risk for breast cancer, and alcohol takes up real estate in your liver. Right? And so by that, you know so any hormones that we take, it doesn’t have to just be oral estrogen, but hormones will eventually get processed by the liver. This is not a bad thing at all, but why why would you why would you put stress on the liver by making it also have to detoxify alcohol? Why would you it’s a pre again, pretty well known risk factor that alcohol increases breast cancer risk. Okay? But, also, what increases breast cancer risk, not hormone therapy, but it’s just being a female and growing older. And then we also lose a critical enzyme needed or it reduces as we age alcohol dehydrogenase to process that alcohol efficiently, adequately. So you’ve just got you you’ve got, like, a deck stacked against you for sure as you are aging and drinking alcohol. It’s dehydrating.
Maria Claps [01:04:04]:
It’s bad on the skin. I’ll appeal the vanity. You know? It’s just there’s just so many reasons why not to have it. Sleep, everything, you know, gives you the munchies. You know? You so it’s choose 1 or the other. And, again, the kind of whole choose 1 or the other with HRT or alcohol is, again, you’re just kind of you’re working that liver. That’s not necessarily it’s not a bad thing when it comes to HRT, but it is kind of a bad thing when it comes to alcohol. So
Ali Shapiro [01:04:32]:
Thanks for saying that because it’s recently come out more and more how these studies that alcohol was healthy were funded by big beverage. I don’t what what do we call them? So I’m glad you brought that up. Okay. So we covered a lot of ground today. And two final questions is where do you think we are headed in this menopause conversation as it matures?
Kristin Johnson [01:04:54]:
You know, menopause is really big business, and I think that we’re distracting women with the shiny objects. The supplement market is huge. We’ve got doctors who label their own supplements and kind of sell them alongside this messaging about menopause. And so women think they’re essential and required to go through these things with or without HRT. They want the supplements. You know, now we’ve seen venture capital get behind menopause with femtech and creating these online telemedicine platforms that are doling out HRT like Tic Tacs. And, you know, the unfortunate thing is they’re not developing really a true patient relationship. You really need to have a doctor who’s asking you, are you pooping? You know, how’s your energy? Are you sleeping, etcetera? And these aren’t there.
Kristin Johnson [01:05:41]:
They’re often looking at labs or talking to the patient or the the woman and that’s it. You know, and then we’d still have doctors who are saying, okay, HRT is good, but by the way, we never need to test you. That one’s really confusing. We would never tell a diabetic that we’re never going to look at their insulin. So why are we going to tell a woman we’re not going to look at what her hormone levels are? They’re both incredibly powerful hormones. So I honestly I think there’s a lot of future awareness that’s happening. I think there’s going to be more self advocacy. I think that we need to support the organizations that are sort of I would I don’t wanna use the word pioneering, but in this landscape, it feels like pioneering what used to be the approach to menopause care, which was to provide hormones to prevent diseases of aging.
Kristin Johnson [01:06:26]:
And, you know, women need to just get smart and demand more and better from their doctors. Unfortunately, the landscape right now is a lot of doctors have discovered social media. And whether it’s TikTok or Instagram, they’re putting themselves out there as these experts, and women are yet again falling prey to blindly following whatever they’re telling them to do. That’s where Maria and I just kind of, like, have concerns about where we’re headed as the future. Because until women are willing to put their big girl pants on, learn for themselves, and it might mean consuming 5 different books. It might mean listening to this podcast and listening to someone who says that what we say is dangerous. We don’t care. Consume it all, get informed, and then decide what you want and demand that from a provider.
Kristin Johnson [01:07:17]:
Because if we continue down this path of providers repackaging themselves as your girlfriend who’s gonna usher you through menopause and women just sort of fall in line, that’s not gonna end end up advancing the ball. And so I think that’s kind of our concern. I don’t know, Maria, if you wanna add to that at all.
Maria Claps [01:07:35]:
Yeah. I I think we’re gonna probably see a little bit more of a proliferation of what Kristen said, which is the femtech platforms and kind of the doctor guru menopause experts who, by the way, generally tend to keep women at low levels. But women love them because they’re, like, worried about you know, they’re they’re they’re teaching about HRT. You know, they’re raising awareness to that. We say that’s good. But in our opinion, they don’t really go far enough. They’re still very kind of adherent to medical society talking points, which are, again, they are maybe advancing, you know, the the cause forward to a certain degree, but we think they’re falling short. So
Kristin Johnson [01:08:19]:
because they’re they’ve got pharmaceutical capture. I mean, at the end of the day Yeah. Yeah. The the pharmaceutical capture is always gonna keep a lid on how much progress we actually see out of this movement until women start to get mad, stomp their feet a little bit, and say, either you give me what I want or I’m going to find someone else. Because, you know, doctors like to have more patients, more patients, and more money. So if women, you know, kind of start to dangle their desires in front of these doctors and demand better, maybe that’s gonna do it. I think grassroots, you know, usually wins every time. So it’s gonna take all of us ladies to make the change, not doctors who cater to ladies to make the change.
Ali Shapiro [01:08:59]:
Thank you for that. And for everyone listening, I would just recommend looking at how long someone’s been in this space too because I I see this with functional medicine. Again, and and I love functional medicine when I first found it. Now I see it as a tool, not the answer, but you can see someone who, you know, just got into functional medicine and then they’re promoting this stuff that I’m like, what? You know, like and it’s like, oh, okay. And and everyone has to start somewhere. But I just think for listeners, think about people how long they’ve been in the space. Because I’ve seen some doctors turn into, quote, unquote, menopause experts. And I’m like, I feel like I know a little bit more than you, and I don’t know that much.
Ali Shapiro [01:09:36]:
Like, I’m new here. You know what I mean? So just because someone has an MD at the end of their name, you know, it doesn’t don’t think of that automatically as this is the answer, you know, capital t.
Kristin Johnson [01:09:48]:
Or a $100,000 or a podcast or a supplement line or, you know yeah. That that we need to be really careful sort of extrapolating skill and depth and knowledge from reach. And then that’s, you know, good and bad about social media. It’s getting awareness, but it’s also sort of repackaging people as having depth in a field that they’re quite new to. And and you can see it even. Marie and I love to push back. We have doctors who will be like, this study says this. Why haven’t women been told this? And it’s a great rallying cry.
Kristin Johnson [01:10:21]:
Right? It makes women think, like, she’s on my side. Until Maria and I point out, yeah, but that study was dated 2003, and you ignored it for 21 years. Right? Those of us in this space a little bit longer knew about that study. We haven’t been ignoring it. We’ve been trying to extol its virtues, but you’ve, you know, told us to sort of sit down. So it’s definitely a difficult landscape to navigate. We will acknowledge that. We’re We’re not saying trust us.
Kristin Johnson [01:10:48]:
We’re just saying be smart in whom you follow, understand kind of what they’ve got behind it. You know, if they’re hooked up with Gwyneth Paltrow and doing, you know, summits in Manhattan, maybe they’re not actually in the clinic, in the trenches dealing with women.
Ali Shapiro [01:11:05]:
Yeah. And one thing I loved about your book was you really explain studies and how they’re run and then you list a bunch. So again, you’re empowering the reader, the woman to be like, wait a second. I can go in here with more confidence because I have probably read more studies if you read your book than maybe perhaps some of the providers. So thank you for that. So we’ve covered a lot of ground today. And I know other than, of course, someone going out and getting your book and we’ll link to it in the show notes. What do you think is the first step for someone to increase what you call in your book your health span, not just your lifespan?
Kristin Johnson [01:11:41]:
You know, your daily choices are gonna be your number one lowest hanging fruit and biggest lever that we all have. You know, starting to kind of live authentically in this modern world is is a challenge, but something that I think we’re all up to the task. Right? This morning, I did not have a good night’s sleep. My husband left a crack of stupid in order to go play in a golf tournament. And I was like, god, I could just lie here for a while and scroll on my phone. And I’m like, and if you do that, Chris, you’re gonna sleep for crap tomorrow night too. So it was up out of bed with the dogs, go out in the yard, etcetera. We’re not gonna be the ones advocating ever for the cold plunging sauna, red light waving, you know, etcetera, etcetera.
Kristin Johnson [01:12:22]:
There are really basic things that women can start doing, which is eating whole unprocessed foods, nourishing your body, eating enough food, eating optimal amounts of protein. And we explain why in the book for those of you who still are kind of like, I don’t know. Everyone’s saying eat high protein. I don’t get it. We’ll give you an explanation why. But, you know, that that’s a basic thing. And we you know, no one’s shoving food into our mouth. We’re picking up that fork.
Kristin Johnson [01:12:46]:
Right? So make intentional choices with that. Start to recognize the light cycle of our day and how it affects our energy, our mood, our sleep, etcetera. Start to honor that. Stop eating dinner at 8:30 at night for goodness sakes. I don’t care how late or, you know, summertime has late sun. That’s not what your body is sensing. You know, recognize your stress. Embrace it.
Kristin Johnson [01:13:08]:
I mean, you went through something incredibly challenging with a cancer diagnosis. That’s something that, you know, most people fear. Okay. Well, maybe there’s something behind taking empowerment from, you know, that risk. Right? What can you do? Put down your glass of wine. You’re really scared about breast cancer. Why are you still drinking wine and doing, you know, margs and and nachos on the weekend? Like, there’s just women have so much more in their control to age healthfully than they’re willing to recognize. And we get it.
Kristin Johnson [01:13:38]:
It’s it’s it’s a lot of work. You know, women will say, it takes so much time and it’s expensive. And we’re like, no doubt, but so is illness. Right? Illness is more expensive and more time consuming and whatnot. So I think, you know, starting to kind of step back and ask yourself a really realistic question. Do I do what I possibly can each day with basic tools? Again, not the not the Mito Pure supplements, not the saunas and whatnot. Basic daily choices. Are you doing enough with those? And then when and if your hormones or I should say not if because we all lose our hormones, but when they are gone or if they are already gone.
Kristin Johnson [01:14:18]:
Understand what that might mean to you in terms of your long term prospects and, you know, get educated and decide what you wanna do.
Maria Claps [01:14:25]:
I’ll bring in a slightly additional side. I think, like, community connection with others, sense of purpose, nature, breaking bread, gathering with people, and getting off the damn phone.
Kristin Johnson [01:14:43]:
She’s not wrong. And I think that community and mindset piece is something that Maria and I have come to recognize is so important. And it’s why, you know, we have a private client group that’s an online kind of community. No. It’s not Facebook for anyone listening. It’s it’s a very closed private network. And recently we’ve started doing retreats. And these aren’t like, you know, woo woo, we’re all gonna do a sound bath retreat and and talk about our feelings.
Kristin Johnson [01:15:08]:
This is just get together with women in a place that’s outside your normal environment, have some really good food, take some walks, listen to some things together, and connect because it’s a natural unfortunate transition in this time period to become isolated. As women, we don’t wanna talk about the things that are happening to us. Some of us might find them somewhat embarrassing or we feel a little bit shame behind them. Maybe your relationship’s starting to struggle, etcetera. That’s not uncommon, but it doesn’t have to be that way. And when you’re able to connect with other women going through this, it’s incredibly sort of like not just empowering, but sort of lifts the burden off of you. So I think Maria’s points on that are really, really important.
Ali Shapiro [01:15:53]:
That you bring that up because my work is all about belonging and how we actually turn to food because food is coupled with attachment. And so as adults, when we’re stressed, what we really need is belonging and community. So I love that you brought that up because it’s so primal. But in America, especially where we’re this, like, independent, you know, where we value independence, it it can be an easy thing to forget. So or not take seriously. So I love that you brought that up. And I just also, another plug for the book, if you’re someone spending, like, like, you think health is expensive because you’re buying all these supplements, read their book and find out what supplements actually will be interfering with your HRT. So this is about a lot of times, it’s expensive because we’re not actually we’re wasting money.
Ali Shapiro [01:16:38]:
So I just wanna add that a lot of times. So Maria,
Kristin Johnson [01:16:40]:
do you wanna make the one plug for the one supplement that so many women are taking while on HRT?
Maria Claps [01:16:46]:
So, DIM, diendolemethane. A lot of women are told that they need to be on it to kind of make sure that their estrogen goes down the healthy pathway or to just keep it safe. And, you know, it’s it’s going to and especially, Ali, considering that most women are on lower dose therapies, the DIM is kind of blunting that and and maybe just reducing that. So sort of like they’re paying for their estrogen, they’re paying for the DIM, and it’s not a good outcome. It’s just it’s lowering the level. So yeah. Now it does have a used dim, but you you really have to know why you’re using it. So and, again, it’s things like we, we we get into these details in the book.
Ali Shapiro [01:17:26]:
Wonderful. So is there anything that we haven’t recovered or you’re surprised you haven’t been asked yet that you want to share before we close?
Maria Claps [01:17:35]:
You have some pretty good questions. I mean, I will share that we we we actually haven’t covered this, but I will share. You know, Kristen and I do mentor people. It was you know? So we work with clients, but we also mentor other professionals. We’re working with a group of nurse practitioners now, health coaches, dietitians, nutritionists, physical therapists. So we mentor them in and we have a program that focuses on midlife women’s health, and we teach all about HRT and metabolic health and how to coach midlife women. So we only do that twice a year. So
Ali Shapiro [01:18:12]:
that’s actually how I found you. My sleep coach, Kelly Murray, like, most said about you. So that’s how I actually got in a lot of practitioners and providers listen to this podcast. So I’m glad that you that you mentioned that. Awesome. Yeah. Anything new, Kristen, what you wanna add?
Kristin Johnson [01:18:30]:
No. I think Maria covered it. I mean, you know, working with us, we’re, you know, we’re gonna try and increase our offerings recognizing that, you know, some women don’t want testing or they don’t want a group situation or they just want the information. And, you know, so we’ve got some new things coming out for women about that. But otherwise, you know, just again, take it slow, consume the information and, you know, whether it’s us or anyone else, just make your own decisions. You really need to be your own advocate in this one. We’re not prescriptive with anything that we tell our ladies to do. And I would say anyone who’s kind of prescriptive about how you look at HRT and what you do needs to maybe be pushed
Ali Shapiro [01:19:12]:
off to Though well, those are the people I trust the most, paradoxically. The people who say don’t trust us, those are the people that I trust. Okay. So, again, everyone and we’ll have links to this in the show notes. But the book is The Great Menopause Myth, The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive. And, you know, one of the things we’re always talking on this podcast is about how to think about food outside of weight. And I think this book does such a great job of really getting you to care about your health. Sometimes that includes weight, but it also transcends weight.
Ali Shapiro [01:19:48]:
And I just think this book is I wish it came out 4 years prior, although I don’t know if I would have known to look for it. But for anyone who wants to save money, time, and their health span, I just can’t recommend it. So thank you for for making the time even though you’re really busy to come here to write the book and do all the things that go with the book. So thank you for your work.
Kristin Johnson [01:20:08]:
Thank you. You’re welcome. Thank you.
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