ATHE_Transcript_Ep 579_Esther Blum
JJ Virgin: [00:00:00] I'm J. J. Virgin, PhD dropout, sorry mom, turned four time New York Times bestselling author. Yes, I'm a certified nutrition specialist, fitness hall of famer, and I speak at health conferences and trainings around the globe, but I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information I uncover with as many people as I can, and that's why I created the Well beyond 40 podcast to synthesize and simplify the science of health into actionable strategies to help you thrive.
In each episode, we'll talk about what's working in the world of wellness from personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness. Join me on the journey to better health. So you can love how you look and feel right now and have the energy to play full out. At 100.
All right, this is a fun one today. I have someone [00:01:00] I have known for gosh, 20 plus years in the nutrition field. She was actually the first person I connected with as I started to move into that field. We got connected through a client and she has gone on to do such cool work. She's written, Cave Women Don't Get Fat, Eat Drink and be Gorgeous, Secrets of Gorgeous and the Eat Drink and be Gorgeous Project. And then most recently this title is so good. See You Later Ovulator and she is all New research on how to master menopause so clearly I knew she had to be on the show she is an integrative dietician and menopause expert and has been all over the media, she's been on Goop, Dr. Oz, The Today Show, ABC TV and Good Day New York and was voted Best Nutritionist by Manhattan Magazine.
So it's very funny. I was in Palm Desert. I had a client. This client said, you have to talk to my nutritionist in New York. I'm like, all [00:02:00] right. Called her on the phone and then she connected me up with another nutritionist who was her mentor, who became my mentor, Robert Cran, who then connected me with a company, Designs for Health.
It's one of my favorite supplement companies of all time that I've been working with now for, gosh, decades. So, it's just wild how this, It's all comes around. So I'm very excited to share Esther with you. We've got really cool show notes, freemians and all that. She's going to be giving you a special guide on mastering menopause called the happy hormones cocktail guide.
And I'm going to put that all at JJvirgin.com/Esther. So be sure to check that out too. I'll be right back with Esther. Stay with me. Esther Blum, my longest friend in the nutrition space by accident, a happy accident. People are like, what are you talking about, JJ? I got introduced by a client when I was in Palm Springs to the book.
I got introduced to you actually, not to the book. You introduced me [00:03:00] to the book. I was in Palm Springs. I had a client. She said, you need to talk to my nutritionist in New York. I'm like, okay. And it was you. That's so still so funny. And then you introduced me. I don't remember. Carol something.
Esther Blum: See, I thought we met when I was doing the designs for health clinical support line and
JJ Virgin: no, it was no, it was a client and then you turned me on to Robert crayon and then I got turned on to design for health and then it's been a, it's been a long road here and which is why I was like, how old are you now?
Because you're doubling down into menopause. So I'm like. I bet I could guess. I'm
Esther Blum: 100 JJ.
JJ Virgin: No one really starts to talk about menopause till they get to menopause and they're like, what the heck is going on here?
Esther Blum: Yeah. Fortunately for me, I actually had been treating menopausal women in practice a long time before I, you know, I'm still going through it.
I'm still in the peri phase. I'm, My period likes to show up when it likes to show up.
JJ Virgin: That's the most delightful, [00:04:00] isn't it? What's this? I kept thinking I was pregnant the whole time. I was like, am I pregnant? No. And I think it's very weird this whole peri and post that there's just this magic day after a year of not getting your period that all of a sudden you're postmenopausal.
It's, it's weird. It just doesn't make sense to me. So. You've been treating people in menopause, women in menopause, but haven't you found it very different now that you are experiencing yourself?
Esther Blum: I always loved to be the science experiment or the beta for anything that I put my clients through. So now being on hormones, being on a full cocktail, Of estrogen, progesterone and testosterone, even though I'm cycling, like I feel better than I have felt in so long.
I lift weights, but I was sick about a year and a half ago. I was still really recovering from Lyme and mold. Tom Moorcroft was treating me. And so I couldn't lift. I had no cortisol curve. So I hired this incredible woman who does Pilates and [00:05:00] stretching and Reiki. And after a year and a half of working with her, literally yesterday, she high fived me, she said, congratulations, you finally had your first serious workout.
And I was like, damn, it really took me a long time. And I said, girl, the only thing I've done different the past month is adding in. I mean, I'd been on smaller doses of testosterone, but Tom. Finally ramped me up and I was like, girl, it's that testosterone. It's so amazing. And the cocktail of hormones and my sleep and libido.
Oh my God. Like I just feel better than I felt in so long. The mental clarity, the energy, like it's so fantastic.
JJ Virgin: I think the big takeaway, if you're listening and you are in the Perry phase or even in the post phase. Is we're going to talk strategies today to go through this and feel better than you did before because it is possible.
And that's the big takeaway of what you just said. I will tell you once you get into post where everything's level, it's even easier. You will feel the best you ever felt in your life. [00:06:00] So let's talk about like strategies and break them down perimenopause. What are the things that you guide them through?
Esther Blum: So first and foremost is diet and lifestyle because you can't out hormone or out supplement your lifestyle. If you're somebody who's drinking four nights a week and really hitting the caffeine hard by day and wine by night, no amount of hormones are going to fix this. JJ, for those of you who don't know, wrote the forward for my book, Cave Women Don't Get Fat, a paleo diet book for women.
So yes, protein is everything. Women don't realize they're at the greatest risk for muscle loss during this time than any other time in their lives. With the decline in progesterone, estrogen, and testosterone, you're going to lose some muscle mass if you don't optimize your protein and strength train, not to mention bone density too.
JJ Virgin: Let's break that down because I am. I'm on a like routine mission, I'm kind of jumping up and down over here and What's [00:07:00] so interesting is just making sure you're getting optimal protein can help maintain muscle. Now, obviously you should lift too, but maybe someone would have some situation like you just went through where they couldn't.
So we've got to optimize protein. It's how we carry our hormones and make them. So what do you consider optimal protein?
Esther Blum: Yeah. For the average woman, you know, I've done the math 10 times sideways and it works out to about four to six ounces of protein three times a day. Or if you're intermittent fasting, seven to eight ounces of protein twice a day, but getting in minimum of a hundred grams of protein a day.
I really love to push women up to 120, 150. I have some clients who work out heavy and their weight is around 170. I have the amount of 170 grams of protein. And so it, it really depends on the individual, but most women really struggle with it because they're used to eating like birds and eating super low calorie, you know, they're subsisting calories a day.
It's really hard to get all your needs in on [00:08:00] so little calories.
JJ Virgin: Plus you're set up for big problems in your sixties when you're doing next. You're going to eat like a bird. You're going to look like a bird in terms of your muscle and bone density, and then you're going to have major problems with frailty as you get older.
Esther Blum: Yeah, that could be the title of your next book, Don't Look Like a Bird.
JJ Virgin: What a compelling headline, okay.
Esther Blum: The subtitle to Scare the Crap Out of Every Woman Over 60. So yeah, so that's step one is really optimize your protein. Now, the other thing is you want to make sure that you're getting Equal amounts of protein throughout the day.
Don't eat one egg at breakfast and three ounce can of tuna at lunch and then a steak at dinner you to optimize protein of research really does point to having 30 to 40 grams at every meal, breakfast, lunch and dinner.
JJ Virgin: What would you say to, cause I got this one and I've, I've been really insistent that the hard line bare minimum is 30 grams at your bumper meals.
And really at every meal, but I [00:09:00] had this woman DM me on Instagram, basically it was one of those, my manicure said that we can only take in 26 grams of protein. Now I'm like going, okay, so we meaning men, women, kids, any age, no matter what I'd like. Where does this, why wouldn't you even question that statement?
It's bizarre, but I know that it's all over the place with how much we can actually assimilate at any point. What would you say to someone who's worried about getting too much protein?
Esther Blum: I get that question all the time and I debunk it. I have all the research to support this and cave women don't get fat, but your kidneys do adapt, first of all, if you increase your dietary protein, you're not going to overload your kidneys unless you went into it with some sort of compromised renal function. But step two, yes, the research I have seen says that you can assimilate 40 to 50 grams a meal. The key is to really get, I believe it's three grams of leucine at each meal. [00:10:00] Correct me if I'm wrong.
JJ Virgin: If I lose three grams, it's two point five, like I've heard 2. 5, but somewhere in the 2. 5-3. I think the big thing is. If you get a little too much protein and that's the real important thing to debunk. And literally I did this talk a couple of weeks ago at an event and someone walked out with me afterwards and said, these two things, I heard this was hard on your kidneys.
And number two is I thought this was bad for your bones.
Esther Blum: I know there's such an anti meat agenda there really is. There's a lot of hate about meat and the carbon footprint and. We actually need, if we practice regenerative agriculture, that's really the way to save the planet, capture the carbon in the soil.
It's a really responsible and ethical way to use meat. That's just a sidebar. But the other piece is, yes, in order to get that minimum leucine threshold, you do need a minimum of 30 grams of protein at a meal. So yes, go forth, eat protein, hydrate yourself and eat your greens. I'm not a fan of the carnivore diet.
I look at GI maps [00:11:00] on a lot of my clients and the ones that do have altered gut function and altered gut microbiota and not in a favorable way. So you really have to know your body and monitor your own gut function and your microbiome to see if you tolerate it. But most people do thrive well on veggies.
And that's how you balance it out, don't only eat one food group at a time and think you're going to be balanced that way or that's safe either. I don't think that's a great idea.
JJ Virgin: So is a protein to feed your muscles and Non starchy vegetables to fuel your gut microbiota, a little bit of fruit. All right, so diet part, and you mentioned lifestyle as well, which I always find it's super, I wish there was a test.
I know we've got an adrenal salivary index. I know we've got an HRV, but I wish there was something like. Something that was really predictive where you could test your nervous system.
Esther Blum: Call [00:12:00] up Dr. Amen. He must have something up his sleeve.
JJ Virgin: He doesn't. I swear. He's working on it. He's a close buddy.
Esther Blum: What I look at is I really just look at someone's cortisol curve and their HPA function and you just. Listen to them. How's your stress? How's your sleep? What's your life like? Who are you? Are you taking care of sick parents? Are you taking care of teenagers? What's your work stress like? So it's really learning who someone is as a whole person that you don't even have to move to an ashram and redo your whole lifestyle, just like, just add in.
10 to 20 minutes of breathing. There's so many great apps. There's insight timer. There's calm. There, there's so many. And I like to joke, I'm like, if you can fight with your spouse and meditate and go to sleep, like that's how you know, you're dialed in. But most people, what happens is they just say, I'm not good at it.
Or they do it like two times a week. Understand you have to do it every single day. For eight weeks minimum, that's 56 days. That's less [00:13:00] than two months, but you've got to do it that minimum amount to even start to reshape the amygdala and the brain. I put my clients on meditation challenges and start with 30 days and they're like, Oh my God, I feel better.
I'm like, great. Now do another 30 days, do another. And if you're sick, if you're struggling with menopause, right? The key is during those meditations to envision your body as if you're already whole and healthy. Your illness is behind you and your body will catch up your symptoms, you know, your healing is inevitable at that point.
JJ Virgin: It's very Dr. Joe Dispenza right there. Love Joe. Yes. So he was at MindShare Summit this past year. You missed it.
Esther Blum: I know, JJ. Forgive me. Oh my gosh. Forgive me, JJ. I was like, writing my book, man, that was a lesson in meditation.
JJ Virgin: Book Schmook. So, but I will tell you, starting with Dr. Joe. During the pandemic, April, 2021, going to his first meditation retreat, realizing that this was like the most impossible thing I ever tried to do in my life.
All my friends [00:14:00] were like right out there in the quantum. I'm like fidgeting. It took me nine months to notice a difference. And the difference is profound. It's like crazy to the point now where it's just a daily routine thing. And even my whole team, we tracked you from the time you started this, we want you to keep doing it.
Esther Blum: I'm like, okay. I remember you was it on Dave Asprey's podcast? You were talking about how you spent like a week with him. I did. That was before you met your husband, right? Yeah. Didn't you start meditating then?
JJ Virgin: That was one week. It was supposed to be 40 years. It's called 40 years of Zen. And the whole point, I'd love to go back.
I should do it again now with all these techniques because I actually went with Vishen Lakhiani. So I went with like the meditation master and me go to do this and Dave's meditated at a time. And so we're there doing it and I had no tools. I had no clue what I was doing. And you're supposed to work with this machine.
You have electrodes on your head and you're supposed to raise your alpha never happened for me [00:15:00] for a week. It never, nothing happened except that the, the Darth Vader one, the one where you're super manifestor and you can control everything that went out through the roof, like I can, I'm a good manifestor, but it would be, it's supposed to give you like a 40 years of meditation in a week.
That's why I went, it's a perfect thing for the overwhelmed person. It's like, I'm just going to get this done. But the reality is. You can't get it. That's not the point. That would be like going to the gym for a week and doing a really hard, intensive training camp and thinking you're done for the next five years.
It's actually the real value of that 40 years of Zen is really learning how your brain works because you can see what's working, what isn't, because the tones tell you if you're going there or not. So now with the tools that I have after doing Dr. Joe's meditations now for gosh. Coming up on, is it coming up on two years?
That's wild. Now it would be a great thing to do. Cause I actually, it's like you've been working out really hard. [00:16:00] You go do a DEXA scan to see how your skeletal muscle has changed. It would be the same thing as to really be able to see the profound effects of meditation.
Esther Blum: Why do you think it took you nine months to get that change?
JJ Virgin: I was so up in my head with and so driven and so thinking and it just was ridiculous. It was gradual improvement, but it really took the Nine months to really,
Esther Blum: so. But that, see, but that's awesome too, for people to know. Cause I'm always like, Oh, give it eight weeks. But for some people it does take longer.
So.
JJ Virgin: Yeah. I just equated it to going to the gym and I went, you see some changes, but gosh, you look back over a year and you're like an entirely different body. And I think most people in life just don't give things enough time and they don't track well enough to go, we really started to track. All of our metrics, our sleep, our HRV, our recovery, just so we could go, all right, what part is this [00:17:00] playing?
If I go to a Dr. Joe retreat, my HRV during the retreat's like insane, but then I have to go back into real life, but it's definitely better than it used to be. But it's like that with all of our different things, you know, as you first go on hormones, it's. You're going to have some messing about, right, before you get them tweaked.
All right. So we have the diet lifestyle. I guess too, for someone listening, wondering when they really need to start focusing, I always say the earlier you start to focus on the things, the better off you'll be. But at what point does someone, can someone really start to tell they're in perimenopause?
Esther Blum: And it's interesting because the symptoms of perimenopause and menopause are really not too different, but.
A lot of times your PMS window starts to extend and get longer. So it's almost like for a lot of my clients, the first half of the month, they're like calm, smooth sailing, everything's happy. And all of a sudden a switch flips in the second half of the month. It's irritability, it's [00:18:00] insomnia, it's bloating, breast tenderness.
Some weight gain, also like the dropsies getting a little more clumsy as your progesterone falls. So, those are all part of it, sometimes spotting, cramping, vaginal dryness, that can all start to ramp up. Some of my women notice they're more hot at night and they're not necessarily flashing, but they are more hot at night.
And the other big thing is heavier periods as there's less progesterone present to oppose estrogen, you get a heavier flow. You're getting clots. You're crying at a Kleenex commercial, or you're feeling like fits of absolute meno rage is what I call it. Those are all really big symptoms that you're in the perimenopausal phase.
JJ Virgin: So you talked diet, you talked mindfulness. What are you telling exercise wise what's your recommendations?
Esther Blum: I am looking at my client's HPA axis. So that's the hypothalamic pituitary adrenal axis. So if someone [00:19:00] has very, very low cortisol, like a very poor cortisol curve or very high cortisol at night. We switch up the workouts and again, more weight focused, slower tempo, weightlifting.
If you're fatigued and exhausted, yoga, walking outside in nature. And if you're doing cardio or high intensity weight reps to really have. At least two minutes of rest in between, or wait till your heart rate drops to 100 again. And really just watching your HRV throughout and listening to your body. If you've been up all night and you're hot flashing, you're exhausted, that's not the day you're going to want to hop on your Peloton and do a high intensity spin class.
You're going to just want to walk, rest your adrenals, rest based exercise, basically rest your adrenals. Keep your strength up. If you strength train twice a week, it's okay. Like the clinical research doesn't show much of a difference between lifting weights two versus three times a week. [00:20:00] Once you're in menopause, it's a time to work out smarter, not harder and not kill yourself anymore.
Your body's just in a different place.
JJ Virgin: And that's during perimenopause, not postmenopause.
Esther Blum: Yes. Usually postmenopause, like you say, when things are like, Oh my God, yeah, like getting your energy back makes such
JJ Virgin: a huge difference. That's why if you are in perimenopause right now, just know that it is so much better when you cross to the other side, I can't even tell you.
So you just talked about adrenals. How important is it to look at adrenal function as someone's heading into all of this? Because I feel like this is a place that gets forgotten when it's so key important.
Esther Blum: It's everything because what people don't realize is that once you go into menopause and even starting in perimenopause, the ovarian party is winding down.
So your ovarian production of hormones is on the decline and so your adrenals are going to be the next endocrine organ to [00:21:00] really pick up the slack from here on out. So if a woman goes into. Perimenopause, already adrenally exhausted or dysfunctional, trauma plays a huge role in adrenal exhaustion also.
You're going to want to really make sure that you give your adrenals support. Otherwise, hot flashes will be worse. You will feel a lot of fatigue. brain fog, exhaustion, weight gain, because you're not going to have the energy to have a good, robust, productive workout on the days you are lifting and also regulating your sleep and cortisol.
It's really everything. And again, diet makes a big difference. I get as many people as I can off alcohol and. Really having them be very judicious with their caffeine. If they tolerate caffeine, great. I'm not one of those people who says everyone has to be off coffee, but if you're not tolerating caffeine, maybe switching to an adaptogenic drink in the morning instead, like a, a mud water or a four [00:22:00] signatic, something without caffeine that still has adaptogens in it.
JJ Virgin: I really feel like. We don't focus on adrenals enough as people are going in this and if your adrenals are not working well while you've got these things pushing on them, you won't be able to fix the rest. You have to get them done. Would you agree? Yeah, I do. So coffee wise, when you said not tolerating coffee, would that be more showing up in your sleep?
What are you
Esther Blum: talking about? Yeah, sleep irritability and fatigue. If you're adrenally exhausted and you're putting extra stimulants in, sometimes it can make you feel more irritable and jittery, can make you feel like you're revving up an engine that has no gas in it. Try it and see. Again, for some people it really doesn't make much of a difference, but I would say 70 to 80% of my clients feel better energy off caffeine at this point in their life or drinking it later in the morning, sometimes like 10 a.
m. That is a better time window than like first thing in the morning, just jolting you out of bed. [00:23:00]
JJ Virgin: If they're now meditating first thing in the morning, that solves that problem.
Esther Blum: Exactly. And drinking, I put a big adrenal cocktail up on my Instagram account, drinking some water with salt and lemon. That can also give you a nice adrenal burst.
It's like a margarita without the tequila, but that can be really beneficial. But yes, if your sleep improves, then you're going to know it's caffeine withdrawal or elimination. And if you're someone, a lot of women get a lot of migraines in perimenopause and menopause. So if it's. It's going to trigger your headaches to withdraw.
Just go do a very slow taper. Don't do it overnight. When
JJ Virgin: I was doing 40 Years of Zen, one of the rules was you couldn't have coffee. I tapered for three weeks because coffee is one of my favorite food groups. I was like, okay, that this is going to be a slow rollout. Yeah. Immediate race to the barista after that, but I did it.
What about, besides the adrenal salivary index, which I wish would be used way more often, what are some of the other tests that someone should be [00:24:00] using at this time to really help them figure out where they are?
Esther Blum: I do love the Dutch Complete because it looks at your downstream metabolites of your hormones so you can see how your hormones are moving through your liver.
Something people don't realize is that they can actually be estrogen dominant, even in perimenopause and menopause, we have many different estrogens and some can be relatively higher than others, which can make us feel again that breast tenderness, irritability. And if you go on hormone replacement and you're not detoxing your estrogen, well, you can feel worse.
There are many women who don't feel well when they start bringing hormones into the picture and they feel like they're going crazy. Their words, not mine, feel like they're going crazy. They can't stop crying. They're fantastically depressed. Often, that is a methylation or detox issue. So you do want to make sure you're supporting all the pieces you need in your liver for your hormones to come in and gently move out.[00:25:00]
And I also do the GI NAP test because again, I look at how you're detoxing estrogen in the gut. While most people don't realize you are reabsorbing it. And if you're not pooping it out every day or you're very inflamed or your detox pathways are off. And I do like to look at gut microbiome as a whole, because again, better your microbiome is the better your menopausal journey will be.
I mean, you can remove or eliminate your hot flashes just healing up your gut and people don't put the two together and you can reduce that meno bloat and you can really. Optimize your absorption of nutrients, too, because without proper stomach acid, you're not going to absorb. The nutrients, for example, that support bone density, calcium, your magnesium K, your D.
So you want to make sure that all systems are go and that you have checkpoints along the way. And often when I address the gut health, when I clean up the liver, like, and get people on hormones. Magic happens. [00:26:00] Magic.
JJ Virgin: And I think one of the things that's coming up is. As you go into perimenopause, all those things you could get away with in the past, just there's no margin for error anymore. So you just, it's really a time when you just want to start looking at everything and just optimizing everything. And I love the GI map test.
Assume that people have no idea what it is and tell them what they'll learn by doing it. Cause I think it's such a valuable test to do. Yes,
Esther Blum: and both of these, by the way, the DUTCH and the GI MAP are at home tests. Your doctor can run them, but it doesn't mean your doctor knows how to interpret them. So work with a provider, could be a nurse practitioner, a naturopathic doctor, a functional medicine MD or RD.
But the GI MAP, it's just a stool test you do at home, and it looks at your whole microbiome. So I can look at your levels of beneficial bacteria. I can look at if you have parasites or pathogens. I treat a lot of people in H. pylori, which again [00:27:00] causes this downstream effect of dysbiosis and bacterial overgrowth because it knocks out your production of stomach acid.
And so I really work on healing inflammation, healing up a leaky gut, killing off bugs that should not be there and then really repairing the gut wall. So people who You know, look at a piece of gluten and feel sick. In many cases, we can heal up the gut wall. So if there's some level of exposure, it doesn't take them down the same way.
But also like, let's say that you develop thyroid issues and perimenopause or menopause, I can look at whether or not you have inflammatory producing bacteria or autoimmune triggers for thyroid issues. Anytime you have an autoimmune issue, it's often a gut issue underlying or what's triggering. Your genes to express themselves now at this point in your life.
So I really love both tests. And then I love retesting and seeing how far [00:28:00] we've come. The most interesting thing is like some people it's like, yes, we knock things out, everything's great, I send them on their merry way, other people I have to sometimes treat two to three times to really clean everything out, but they're feeling better after the first round.
We're sleeping better. Because gut infections also are raising cortisol levels. And are fatiguing the adrenals too. So I always give adrenal support when I'm treating gut infections. Cause otherwise you feel a lot more tired, but within a couple of weeks, people are usually like, wow, my bloating is so much better.
I'm not irritable. My sleep is better. So it really makes a very big difference very quickly, which I love.
JJ Virgin: I wish that like, when you look at your annual, what you need to look at. Like, a stools test should just, this GI map should just be one of the annual things you look at. And again, you may correct all of it, but maybe you went to a foreign country.
Some things can come up, or you were under a tremendous amount of stress, and something shifted [00:29:00] in your gut microbiome, or you got a parasite or something. So, it's a great tool. If you're listening, going, what the heck is that? We'll put info on it in the show notes. I just got one for my hubby. I
mean, exactly. We check, we check all these things once a year. My whole family got to go on a very African plant juice. Parasite cleanse. I had them all testing and doing stuff.
Esther Blum: And how did it work? I know. Who's that doctor? He's like in New Mexico, right? Yeah.
JJ Virgin: It's Glenn, Dr. Glenn, my buddy, Dr. Glenn. So he actually works with a, a medical school in Africa.
I can't remember which country it was, but this medical director in Africa, who has a medical school in Africa. And a lab, we did our poop test and we also did another live blood test, sent it to Africa and they do dosing based on what they get from all of this. It's pretty interesting because this is what they use in Africa to deal with the things that come up there.
The results were pretty astounding, fairly
Esther Blum: quickly. People think parasites are a third world problem, [00:30:00] and they're not. In this country, I see a lot of GRDI, I see a lot of E. coli, I have a case of C. difficile. A patient of mine got C. diff from being in the hospital. She was being treated for breast cancer, had An infection in her chest where the expanders or the implant was being placed and then develop chronic C.
diff. Yes. It picks up things that a regular stool test might not.
JJ Virgin: Well, let's talk, cause you started kind of going there with when you were talking about testing, but supplements that can be helpful as
Esther Blum: well. Yeah. So I have what I call my core four supplements for just overall menopausal support. This is if you don't know where to start.
First of all, a good B complex works wonder at supporting methylation, helping you move estrogen through the different phases of detox in your liver, but also it's a good adrenal supplement, energizing most people. Deficient and I look at organic acids tests in the dutch complete. So I can see a lot of people are deficient in B6 and [00:31:00] B12.
JJ Virgin: It's rare to see someone who's not, honestly, you know, who's not supplementing.
Esther Blum: Yes. And again, it goes back to you really needing to fix the gut where your B12 is made in the first place. But this is a nice bandaid in the meantime. Glutathione, which is the liver's most important antioxidant because. Again, that helps you move hormones through, but again, I see a lot of glutathione deficiency with inflammation caused from gut dysbiosis or chronic infections in the gut.
And then I love a good cruciferous concentrate, which again, you can get cruciferous vegetables from the brassica family, brussels sprouts, cauliflower, broccoli, radishes. But a good concentrate will give you just a higher dose, again, to keep things moving through your liver. And then magnesium glycinate, this is a magnesium specific to supporting sleep, relaxation, it's easily absorbed and doesn't cause GI [00:32:00] distress.
So I have people take that at night for better sleep and that's just a good foundational overall supplement
JJ Virgin: protocol. So let's talk HRT. I still think back, I was in the pool. Outside my gym with my kids and these women were sitting in this was, I think I was in my early forties. And these women in their fifties were standing around in a circle talking.
So I, of course, I'm totally listening to everything they're saying, right? I'm looking at the kids when I'm like ear in and they were talking about menopause, PMS, depression. And one was telling me, not telling me, I felt like it, but one was saying, Oh yeah, my doctor put me on birth control pill. Now these are women in their fifties.
Doctor put me on a birth control pill. Another doctor put this woman on Prozac and I'm like, huh. And now that was years and years ago, but it sounds like not a lot has
Esther Blum: changed. Correct. That is because 59%, only [00:33:00] 59% of medical schools have menopause care in the curriculum, but it's not even mandatory that it's taught.
And so this question is so timely, JJ, because As we're recording this, that wonderful New York Times article just came out that was also in the Sunday Spread about how little progress has been made in menopause care for women and. When you think about the fact that 6, 000 women go through menopause every day, right?
Every single woman goes through menopause. It's either chemically through breast cancer medications, right? Letrozole or tamoxifen, right? Or they're surgical. Menopause, if someone's had a hysterectomy or at least had their ovaries removed, and then there's the traditional menopause where the ovaries just wind down on their own.
And so no, the doctors are just not given options, number one. Number two, drug companies are going to make a lot more money. When doctors are prescribing the pill or the IUD, and they're not making money with bioidentical [00:34:00] hormones, which you can get a bottle of progesterone at the pharmacy for 3. It's just a huge, egregious,
JJ Virgin: shameful.
It is egregious when you, especially when you look at like the massive amount of misinformation that's still abounds about this, that these hormones cause breast cancer. No, they do not. And you still look at all the emphasis with women on breast cancer and the misplaced emphasis there when we die of heart disease, that is our big and what, when do we start to get weak bones, weak brain, weak heart, when our estrogen goes down, it just drives me nuts.
And there's still, I just was hearing another one about you can only use estrogen this long or you can, no, and you can't start it later. So let's go through. Best types, how long, when can you start all of that? Cause we've had a couple great doctors on recently to debunk a lot of this information. We actually had one at Mindshare.
Do a future of health talk just about why she's not doing [00:35:00] mammograms anymore. And this was a very traditional doctor for years who came out and said this. And I was like, Oh, amen. And then she's now working with another mindshare doc who was a breast cancer surgeon. And they're all, they're very clear on breast cancer risk, why we need to be on estradiol, et cetera.
I just want to see no more suffering women because of misinformation.
Esther Blum: Well, hallelujah, JJ. And also think of all the money we can save from memory care units if we just put women on estrogen, right? And so they don't lose their gray matter in their fifties. So let's talk about when, as early as
JJ Virgin: possible.
Yeah, you don't have to wait till your period stop. That's the important piece here, right? You
Esther Blum: don't have to wait till your period stop. Most women I've looked at hundreds, if not thousands of Dutch tests by now, and most women progesterone is often. And most of the time, the first to go, why? Because. Your body does not need to be fertile at this age.
Often your adrenals are too tired anyway. Your HPA [00:36:00] axis is exhausted. So your body doesn't even have the ability to make progesterone anymore to the levels you need it. And that is when your sleep starts to go and the hemorrhagic period start because there's no progesterone to oppose that. Estrogen run wild women in their thirties to mid forties can probably get away with some chase tree to boost their progesterone levels.
But past that, you can absolutely bring progesterone into the picture, even if it's only the last two weeks of your cycle. And again, this is why I test, I don't guess. So obviously talk to your practitioners on this, but in theory, you can absolutely bring in progesterone last two weeks of your cycle. And if someone's really deficient, their doctors agree and say, yeah, they can take it every night.
Very little downside. You should also begin bringing in vaginal estrogen because this is the time when vaginal atrophy starts. And if you follow the urologist, Dr. Rachel Rubin, she says women should be on estrogen [00:37:00] vaginally age 45 on. You prevent atrophy, you prevent dryness, you prevent UTIs. Because it really keeps the vaginal environment very healthy and very acidic.
That is
JJ Virgin: not, never talked about. You're actually the first person who's ever brought that up on the podcast.
Esther Blum: Yeah. And women, they're not, no one's having sex, right? None of my friends are having sex. They're like, Oh my God, don't even, I don't even want my husband to come near me. No wonder because your loins are like as dry as the Sahara desert.
It's painful. No one feels sexy and attractive. When you're having dryness like that and you're not lubricating naturally, so vaginal estrogen is so important and people need to remember it's a microdose. These hormones we're recommending are a fifth of the dose of birth control pill. That's why I don't like pellets.
I really like the delivery system like progesterone. You can get it orally at your pharmacy in the form of prometrium a base of peanut oil. I [00:38:00] do have a couple clients with allergies who don't tolerate it. In that case, you would need to get it compounded as a trochee from a compounding pharmacy.
But vaginal estrogens, I'm going to get my list of some trade names, there's the Femring, there's Vagifem, there's the Estring, there's Estrace. Some of these are rings, they're tablets, they're creams, but that can all be inserted vaginally.
JJ Virgin: Would a typical doctor know about this, or does this need to be more of a functional medicine practitioner?
A
Esther Blum: regular GYN should know about this. This was sent to me. It's, this is a table of FDA approved bioidentical hormones that was sent to me by a GYN. They should know about this, and they are FDA approved. So, you're not going off label, you're not going with… Compounding pharmacies are wonderful if it's a really good one and they get the dosing consistent, but there is the potential for a regular, for less consistency in dosing.
And then, as you go further down the menopausal pipeline, right, once you start hot flashing, [00:39:00] You may want to think about, or if you start out blushing, you may want to start bringing in estrogen to the picture, and if you're having brain fog, and you walk into a room and don't remember what you were there for, you're forgetting names all the time, you're like, you're really just not doing well there, then, again, you can do transdermal estrogen, and transdermals are nice because they bypass the liver and the gut, so if you're a poor methylator, then you should start with analgesics.
It really lifts the burden. There's topical gels, there's patches, there's Allura, Clamara, there's the EstroGerm patch, there are sprays, there's EstroGel. I've been
JJ Virgin: using a patch for years. It's been the greatest, like it's the greatest thing.
Esther Blum: Right. And a patch is applied twice a week. Every three days you change it.
Easy peasy. It
JJ Virgin: doesn't get on anybody else. That's the one thing I don't like about some of the creams and stuff. You have to be very careful. You do have to be very careful. Get estrogen on your son or your husband. That would not be a good thing. That's
Esther Blum: right. [00:40:00] That's exactly it. Or with a trochee right?
I'm very careful. I kiss my husband goodnight before I put the Trochee. Although he might sleep real well. And then the only rub here is the testosterone, which is, again, ridiculous. Not FDA approved for women. So that you do have to get in a compounding pharmacy. Testosterone
JJ Virgin: is not FDA approved for women, despite the fact it's the biggest hormone we have.
Esther Blum: Exactly. JJ. It's not FDA approved. That's the thing. No, it's so screwed up. Men
JJ Virgin: should be so much happier if testosterone was FDA approved for women. That's right. It would make everybody happy.
Esther Blum: That's right. Wow. And you can use it vaginally. If it's compounded, you can use it vaginally, you can use it topically.
You can even use progesterone vaginally if you've had your
JJ Virgin: uterus removed. There's a variety of different ways that you can do this. The important thing is you're not doing oral estrogen. Don't do that. That was one of the big things we learned from the studies is that's a bad thing to do, but that there are different things, basically, what's going to be [00:41:00] the best thing for you.
How are you having people, when they're doing this, figure out the right dosing?
Esther Blum: I partner with functional medicine doctors because I can only recommend, but I certainly can't prescribe.
JJ Virgin: You're watching their symptoms like, so I think there's a big disconnect between lab values and how you feel. For my
Esther Blum: clients.
I mean, literally some of them, they live in parts of the country where I don't know doctors per se, let's say in Iowa. So I will go to ifm. org and find a good functional doctor there. And often I call the office. I ask questions like. What form are you using? You'll notice I do not mention pellets. That is because pellets, imagine you're driving, and this is no disrespect to any of these car brands.
Okay. But imagine you're driving a Kia, right? And then all of a sudden you buy a Lambo, right? And the driving experience, the engine power is phenomenal. And a Lambo versus a Kia, you get a lot more horsepower. You go a [00:42:00] lot faster, more quickly. When you put pellets in it's like you're putting your body into a Lamborghini mode like you Jack up your hormones to these super high levels almost overnight the women I've seen in practice I do have some women that swear by their pellets and love them, but for the most part they have pain At the insertion sites inserted under the skin, there's a little tunnel dug in your butt muscle and gets dropped in.
Yeah, that just doesn't sound good at all. You cannot adjust, and their libidos either go so high that they're like scaring the crap out of their partners, or they're getting facial hair on their face and hair loss on their head, which is not necessarily reversible. Ooh. And they put on like 10 pounds overnight, which please, that's a woman's worst nightmare, right?
A pound overnight is, Yeah. A woman is going to be unhappy. Then you add in 10 pounds. Forget it. So again, the testosterone dose topically, you can use it as creams. You can use it vaginally, it's [00:43:00] gentle. It's low dose and you can titrate the dose. You can customize. So you would just slowly and gently. I
JJ Virgin: will tell you when I first started using testosterone, I.
Use the cream. I've switched to an injection so I can control it better. Cause I had the experience of what happens when you use too much testosterone, which I was like, I understand how men feel now. I was like, I totally get like a teenager college boys mind now. I'm like lived in it for a very brief amount of time.
That was all I needed to see. Maybe it's helpful for women to see that there are a couple doctors in MindShare who have launched. More national hormone types of clubs so that women can get access who don't have doctors in their areas, which it's amazing to me still that we don't have coverage like this, but there are a couple, which I'll put in the show notes.
What is your happy hormone cocktail guides? And she just, it's like, oh, off alcohol. Are they mocktails? What are they?
Esther Blum: Yes, it's things we talked about today. Optimizing your protein, there are mocktails [00:44:00] in there, lifting heavy weights, to really go into menopause prepared, these are things everyone should be doing anyway.
JJ Virgin: Nice, I mean I think that's the thing is, this is stuff that You should be doing in your twenties and thirties. It's just all of a sudden you're forties when things start to go sideways and you can't get away with what you used to. I remember just being at the gym going, why can't I recover? What is going on?
Just weird stuff that you start to notice that it's really a great time. To say, Hey, I'm going to put myself first and prioritize because you actually don't really have an option anymore because you'll want to unzip yourself and crawl out of your skin and leave.
Esther Blum: That's it. And the other thing, just another biohacking tool, let's just throw this in there while we're talking is to really throw on a glucose monitor and really see now how your body's metabolizing those carbs, because also in an estrogen deficiency.
That can also cause a great deal of insulin resistance. And so again, you want to look at, [00:45:00] okay, how does my body do on this diet, on a higher protein, moderate to low carb diet? How do I do when I'm lifting weights? All you have to do, or even moving your body more like walking 10 minutes after a meal can lower your blood glucose.
CGMs.
JJ Virgin: And I actually do them when I'm going on vacation too, or traveling just so I can watch things. So I always throw one back on, so I always have a stash of them at home to be able to do that. Really with a tracking sleep and tracking body composition, all of these critical things. So I'm thrilled. I was like, happy hormone cocktail guide.
What the heck? So that's fantastic. We will put that at JJVirgin.com/Esther for that. And we went through a lot of resources too, so we'll throw those into the show notes. So do not worry if you're like, what were the creams? And also through alternatives, if you need hormones and you don't have access to them in your area, which hopefully will be changing.
Esther Blum: No one should suffer and definitely read my book. See you later. [00:46:00] Ovulator. Cause I do. Yes. It's in there too. And there's clinical research studies. So I always tell people, give us book to your practitioner if they're not. Listening to you, there's clinical research to support what you're doing.
JJ Virgin: I don't think it's, it's the patient's job to educate the doctor on these things.
I totally understand how you can get trapped in the system, but there are enough doctors now who've stepped outside the system and are doing amazing stuff. So we'll put a couple of those in the show notes. And by the way. You were so good at naming things. It's crazy, but the See you later ovulators. Come up like that.
That was like, I looked at that one. You've gotta be kidding me. That's the best name ever. .
Esther Blum: This is the first book title I came up myself, tj. So yeah, well whole Hide Health. Yeah, this
JJ Virgin: is your best book title of they're. They're all good, but this is the best. It's so good. Thank you. So thank you for all that you do.
I look forward to seeing you soon. And again, we will put that at [00:47:00] JJvirgin.com/Esther, all this good stuff and link to the book, et cetera.
Esther Blum: Thank you, JJ. You're the best.
JJ Virgin: Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great.
And more importantly, that you're built to last. And check me out on Instagram, Facebook, YouTube. And my website, JJVirgin.Com and make sure to follow my podcast. So you don't miss a single episode at subscribetoJJ.Com. See you next time.

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