Transcript EP 300 – How to Heal Menopause’s Worst Symptoms with Nutrition, Hormones, and Self-Advocacy with Esther Blum

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Dr. Taz: I really do believe we need to take the men out of menopause and the pause out menopause. Maybe DM me if you’ve got a better name for this. I don’t like perimenopause and menopause as a name for this phase of life when so many of us are stepping into our power. If you’ve got a great idea, maybe email me, send me an email, hello@doctortaz.com, and let’s rebrand and rename this phase of life where we get to write our next chapter.

Dr. Taz: Welcome back, everyone. Welcome back to another episode of Super Woman Wellness, where we’re determined to bring you back to your super power self. And joining me today, I have a guest and we are going to tackle a topic that you guys are frustrated with, menopause. I get questions about menopause all the time. We see tons of patients and practice at CentreSpring MD tackling the issue of menopause. I personally believe we need to take the word men out of menopause, but that’s a whole different conversation. But join me in welcoming Esther Blum.

Dr. Taz: She’s an integrative dietician, a menopause expert, and the best selling author of Cavewomen Don’t Get Fat, Eat, Drink and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. Her latest book will be out soon. She’ll tell us more about that. It’s called See ya later… I can’t say it with a straight face. I’m sorry. It’s called See ya later, Ovulator! I love it. That will be on sale October 4th. I do have the date. Welcome to the show, Esther. We’re so glad to have you here.

Esther Blum: Thank you for being here. Maybe we should call it femapause, right? Maybe that would be.

Dr. Taz: I don’t like the pause either though. I think that’s my other issue. I don’t like the men and I don’t like the pause. Which one of us are pausing? Nobody’s pausing.

Esther Blum: Nobody’s pausing. The period is pausing. That’s about it.

Dr. Taz: I know. I still haven’t landed on what I like there, but talk to us about how you got into the topic of menopause to begin with and what inspires you to maybe talk and write about this particular subject.

Esther Blum: Well, really my clients have grown with me when I started private practice. I was in my twenties when I wrote Eat, Drink, and Be Gorgeous, and the whole motto of the book was your body may be a temple, but who says it can’t be a nightclub? I was writing all about life in New York City and dating and sex and PMS and breakups and hangover recovery and all the fun stuff that you go through in your twenties. And then the next book followed through the thirties and forties. And now that I’m in my fifties, my clients have grown up with me. The average age of my clients is probably 40 to 55, 45 to 55, and story after story came in of women being medically gas lit by their doctors.

Esther Blum: There’s going to be 1.2 billion women in menopause by 2030, and the only options of menopause care women are frequently given is either the pill/IUD or told, “Good luck with that. Take some Benadryl shots and suffer through and just normalize suffering.” That made my menorage fly off the charts. I was like, I have the knowledge and the platform to be the voice and the advocate for all of these women. I’m going to take it on, all 1.2 billion of you. But honestly, I wanted to give women the exact tools and treatments that I use in practice, and I wanted to give them the medical research studies to back up all the good practices that can be incorporated into their menopausal care. Pardon me.

Esther Blum: So when their doctor says, “Yeah, good luck with that. That’s what it is, or here’s the pill,” they could say, “You know what? Here’s a book with actually all the research studies to support potentially hormone replacement or better menopause care overall.” That’s why I wrote it. Every woman listening to this, please know, I had you. You’re my avatar, you’re my ideal client. I had each and every one of you in mind. I too am going through perimenopause, I really was like, let’s just crack open the conversation. No shame. And really we address everything from sexual health, pelvic health, pelvic floor therapy, libido, hot flashes.

Dr. Taz: There’s a lot there, right? Our body’s change. We’re such hormonal creatures and our bodies change so much through each of these shifts, right? Through your twenties, through your thirties, through your forties, into your fifties and beyond. I think not being prepared for these shifts and not understanding what’s happening is such a disservice because people think they’re going crazy, or they’re old, or it’s in their head, or all this other stuff, or there’s only one solution and there are no other answers. I love that we are continuing to shed light on this topic and talking about how it really isn’t the last chapter.

Dr. Taz: It really is actually probably supposed to be your best chapter. By tackling head on some of these things, I think they are really important. What does this book do? Because I still want to shed some light on your previous books and then we’ll go a little bit more deeply into this particular book. I listed out some of the titles just a second ago. What were those books doing that this book maybe isn’t? What is this book tackling specifically?

Esther Blum: Well, Cavewomen Don’t Get Fat was a paleo diet book for women, because again, there was a huge gaping hole in the market. All the paleo diet books are primarily written by and directed to men. I wanted to bring women into the conversation and talk about the importance of optimizing protein intake, helping women find their own unique carb tolerance. Because in the late thirties, early forties is really when we see metabolism start to shift, we can enter into perimenopause by that time. The average age of menopause is 51, but in the forties. That’s when estrogen and progesterone and testosterone can start to decline and with that can come muscle loss.

Esther Blum: We’re working very hard. This is kind of a great time in our careers, but we may be more sedentary as a result because we are dedicating less time to movement and more time to our career. I really wanted to educate women on the importance of protein in the diet, and I really cracked open thyroid and adrenal function and how that’s important. The other two books, the Eat, Drink, and Be Gorgeous Project and Secrets of Gorgeous, those really talked about lifestyle factors that you can do to optimize diet. There’s different meal plans in there. There’s a food log in there.

Esther Blum: Both are very well rounded approaches to optimizing your health and saying, “Okay, after you eat, drink, and be gorgeous, then what happens?” I gave lots of different recipes and meal ideas to really optimize your body composition.

Dr. Taz: I love that. Let’s talk about, See ya later, Ovulator! and let’s break this down into maybe some actionable things that anybody listening or watching can take away. Can women go through menopause without suffering, so to speak, without just being miserable and wiping away sweat and feeling like they have to gain the 10 to 20 pounds that so many women complain about? What can they do to really embrace this phase in a way that’s empowering and actually where they feel really good in their bodies versus feeling like there’s a fight against their body constantly?

Esther Blum: Let’s talk about the lifestyle pieces, and then we’ll talk about the hormone pieces. This is the perfect time to really dial into your lifestyle and let go of what no longer is serving you. A great example of this is alcohol and caffeine tolerance. A lot of women find that even one glass of wine is a killer. It really disrupts sleep and causes a lot of bloating and inflammation the next day and just not really metabolizing it the way we did in our twenties. I recommend really scaling back if you can’t completely cut out, but scaling back to really optimize your sleep. Why is sleep so important?

Esther Blum: Because again, with declining estrogen and progesterone levels, and if you’ve gone through PMS, you know what that feels like with sugar cravings and fatigue and irritability, a lot of that can be course corrected by optimizing your sleep, which really optimizes your insulin sensitivity and your blood sugar handling. I always say you can’t out hormone lifestyle choices. You’ve got to really dial in the lifestyle choices. You need to prioritize your sleep. Create a ritual around it. Don’t have a threesome with your phone in bed or even a twosome. Leave the phone out. Really make a commitment to just quietly read or take a bath before bed, not scrolling through social media or watching the news.

Esther Blum: Those are real killers for melatonin production and a restful, relaxed sleep. We also want to think about not only optimizing your protein, and that would be to the tune of… On average, it works out to about four to six ounces of protein at meals. If you can get a little more snacks, that’s great. If you’re someone who is intermittent fasting or eating twice a day, then you want to make sure those two meals have about six to eight ounces of protein. You want to distribute your protein evenly throughout the day. That is the greatest response for building muscle mass. You also want to make sure your protein ratios are higher than your carbs.

Esther Blum: Most people who come to me are… I call them postitutes, right? I’m like, instead of being a postitute, why not be a carniwhore? Get your protein intake up. Get protein and intake up. That means scaling back on carbs. Use a measuring cup. I mean, measure like a cup of fruit with breakfast and a cup of starch at dinner. Be it rice or sweet potatoes. If you want some pasta, make it like a garbanzo bean or a high fiber pasta. Quinoa is great, beans or lentils. It’s going to give you a good night’s sleep and it’s also going to balance your blood sugar. Think just protein by day, some carbs at night. Those are really great lifestyle pieces, along with…

Dr. Taz: Wait, let me stop you for two seconds, because the protein thing comes up over and over again, especially with the plant-based movement and the vegan movement and things like that. How do we get these protein grams in if someone’s going to say they don’t want to eat meat or they’re not digesting meat well?

Esther Blum: Yes. If they’re not digesting meat well, then you really need to look at your gut microbiome and replenish your hydrochloric acid levels, which also declined during menopause. If you don’t eat meat, bear in mind that you’re going to have to eat six cups of quinoa to get the same protein in a four ounce piece of chicken, beef, or fish. Just bear that in mind. If you won’t eat meat, get some whole eggs, get some cottage cheese or dairy. You could get some pea protein. You can supplement with branched-chain amino acids. But the goal is to get about two and a half grams of leucine, which is that incredibly beneficial amino acid.

Esther Blum: You get that by eating six ounces of protein at your meals. That’s the way not to atrophy and lose muscles. I’m sorry to say it, but it’s really a point where you say, “Okay, my body isn’t thriving anymore and I can’t function this way anymore.” There does come a time where we want to rethink what we’re currently doing with our food habits.

Dr. Taz: Yeah, absolutely. It’s such a struggle for people, but there are some people that philosophically do not want to eat meat. I think for them, I think just tracking, understanding where you are, like how much protein are you really getting, and then maybe supplementing. Do you agree with supplementing with protein powders and branched-chain amino acids and those types of things?

Esther Blum: I do. I mean, I will say, and please don’t bring on the heat here, people, but I don’t even take on vegetarian or vegan clients because I can’t help them. They don’t get results in my practice. One of my prior clients, she was frustrated. She was like, “God, you have me on all this protein powder and all I’m eating is eggs.” I was like, “You’re giving me literally no other options for you. This is all I have.” Yes, you inadvertently end up eating more processed foods and taking supplements, but again, your body keeps the score and plant proteins do not convert as efficiently to muscle mass as animal proteins.

Esther Blum: I have zero agenda. I have been vegan at points in my life, and it’s the science I look at. The science wins. This is not my personal opinion or agenda. I just look at the research.

Dr. Taz: I feel like that’s where science is universally. We have more and more people coming out saying it’s 20 to 25 grams of protein every four hours to preserve muscle, to build muscle. It’s really what you need. Anytime we’re falling below that, then we see a lot of the fallout, especially for women in this age range and demographic for sure.

Esther Blum: And yes, it’s really 30 to 40 grams of protein in this age range per meal. Per meal. We’re seeing that aging adults actually need more protein, not less. You’ll see the research is really going to keep… There’s going to be more and more on that.

Dr. Taz: Is that the cause of menopot, as you call it?

Esther Blum: Menopot.

Dr. Taz: …everyone’s worsening at.

Esther Blum: That’s right. Menopot is caused by a perfect storm of insulin resistance, high cortisol or, for some women, very low cortisol, depending on their stress or exposure to mold or chronic illness. But again, it really does point to hormones. Declining estrogen, progesterone, testosterone does lead to far less sensitivity to insulin. Optimizing your protein intake just writes that ship very quickly and can combat so much. I mean, your diet is so antiinflammatory and can be so sugar stabilizing. The coolest thing I saw this week was that walking 10 minutes after a meal, just for 10 minutes, lowers your postprandial blood sugar, that’s the sugar after a meal, by 17%.

Esther Blum: Just taking your dog out for a walk and you may pick out doing nothing, like I’m just strolling. I’m telling you, the movement is so beneficial. That’s another great way to really offset the menopot is a lot of women I see have been doing a lifetime of cardio. They grew up in the ’70s and ’80s and aerobics and step aerobics was like the thing. We got so trained to do aerobics. What happens is over time as your insulin levels become less and less stable and you have sleep disruptions due to declining hormones, there’s less and less reserves in the tank. We really want to make sure that we support our bodies. Do not underestimate the greatest activity of all time, which is walking.

Esther Blum: Walking burns fat, lowers cortisol. If you do it in the morning and get broad spectrum light on you, it regulates your circadian rhythms. And then lifting weights, picking up heavy things and putting them down. There’s so many classes online that you can do. There’s trainers that work virtually all over the country. There’s online classes. You don’t even need much of a gym. I mean, we have a 150 square foot loft in our bedroom, if it’s even that big, and we have a weight bench, we have a mirror, we have weights, and we just get it done and a couple of bands and that’s it. We just get it done.

Dr. Taz: After dinner, 10 minutes of anything?

Esther Blum: Yeah. After any meal, 10 minutes of anything. Just walking is great. Go play basketball with the kids. Toss a Frisbee around. Yeah, just get out and move.

Dr. Taz: I love that. I know some of us have that emotional fatigue or that decision fatigue. By the time we get home and finish, we just want to chill on the couch. But just getting yourself out, my husband and I have been doing that, just getting out after dinner. We have to motivate each other because we’re both like, “I’m tired, you’re tired.” But just kind of getting out makes such a difference with everything. There’s so many things to talk about and I’ve done a lot of episodes on labs to check, and symptoms.

Dr. Taz: I actually want to get into an area of menopause that we don’t talk about enough, I think, and that’s hormone replacement therapy, because I feel like that’s something that there’s a lot of confusion about, I get asked questions about all the time, and we always run out of time when we bring amazing people on to really break it down. Let’s talk about hormone replacement therapy. For many of you out there, you might be going through perimenopause or menopause. You might have gone through early menopause. Hormone replacement therapy is a reality for you or a need.

Dr. Taz: You’ve done the supplements. You’ve done the herbs. You’ve done the lifestyle thing, and you’re still not where you need to be. What is your philosophy on HRT?

Esther Blum: I test, I don’t guess. I make sure people are really good candidates for HRT. Make sure that their liver and their gut function is optimal and their detox pathways are supported so that hormones can move through. They’re not backing up. I like to make sure people are eating plenty of fiber like flax and chia that’s going to bind any excess estrogens and help you poop them out every day, because you do need to poop out your hormones every day. I also love the delivery system from a bioidentical hormone replacement versus pellets or synthetic hormones.

Dr. Taz: Speaking the language, I love it. I love it. In line, for sure.

Esther Blum: Yes, yes, yes, yes. The thing is a lot of people are very scared. The information is very outdated. The information came from a study called the Women’s Health Initiative that really scared the crap out of women. The urine of pregnant horses was the derivative of the hormones that was used in postmenopausal women and the data was not interpreted correctly. The study came out claiming that hormones cause cancer, hormones cause blood clots. They’re going to raise your risk of heart disease.

Esther Blum: Thank goodness, somebody revisited that data and the North American Menopause Society updated their position papers on that, you can Google it online, in 2017 and 2022 to say not only are bioidentical hormones safe, but they’re beneficial. They have cognitive benefits like Alzheimer’s prevention, heart disease prevention, bone loss prevention, and they’re safe. Right now the current recommendations say use them for up to 10 years post-menopause, but I think those guidelines are going to extend longer the more time we have to do more research on that. I have women in their seventies in my practice who are like, “I am never giving this stuff up. It saved my life.”

Esther Blum: When they try to cut back, they still get hot flashes. So far, the safety and the efficacy is really wonderful. But of course, you can’t go rogue and do this on your own and get it once a year from your doctor. You have to get monitored three, four times a year. Get your labs drawn. You can make sure if you still have a uterus that the tissue isn’t thickening. You really do want to monitor carefully. By the way, bioidentical hormones are very biocompatible physiologically, but you still want to make sure that you’re on the right track and the right dose.

Esther Blum: You don’t want to overdose because a little goes a long way. I mean, the dosages given are a fifth of the dose of birth control pill. We’re not trying to bring your period back or get you knocked up in your 60s and 70s.

Dr. Taz: Right, right. I’m a huge believer in microdosing, that’s the word that comes to mind, where when your gut’s working, your liver’s working, your nutrients or where they need to be, you don’t need a lot of hormones. You just need a little bit to get you in a quality of life standpoint, and even then, from an anti-aging standpoint. I feel like it keeps everything nice and steady rather than having this dramatic decline and then starting to see everything shift and change. You and I both are in agreement, we like bioidentical estrogen and progesterone and testosterone. Pellets, let’s break that one down. I think I’ve voiced my two cents before, but I’ll let you give yours. What are you thinking about?

Esther Blum: Oh boy. Well, pellets, there’s no clinical research on pellets, number one. Number two, it’s a surgical procedure. I mean, you have to have an incision in your tush and a little tiny tunnel dug out and the pellets are stuck in there. And then good luck. You have no control over their release. Whenever I look at the labs on clients who have had pellets, their hormone levels are jacked up so high, they’re out of range completely. Some people feel really good. A lot of my clients felt really awful and gained 10 pounds what felt like overnight. Some of my clients do feel good.

Esther Blum: But the minute your levels start to fall, even if they’re well above the range they need to be, you can still feel like you’re going through a withdrawal. They’re expensive as well. They’re more expensive than bioidentical. I’m all about, like you are, microdosing, controlling the dose, titrating the dose up by very tiny amounts at a time. Just gentle loving care. You don’t need a Ferrari. A Jeep is really pretty solid.

Dr. Taz: Yeah, totally. And then I think that preserves the skin and the hair and everything else as well. Has that been your experience too? You don’t need these mega doses. You just need very small doses to preserve the collagen in the skin and hair and some of these other beauty elements of what many women go through.

Esther Blum: Yes. The thing is too, we also want to think about vaginal estrogen, bringing that into the picture to prevent atrophy and dryness and painful sex and bladder and urinary symptoms and incontinence. That’s also really, really important. But let’s say you’re listening to this and you’re like, “Yeah, I don’t want to use hormones, but I’m having vaginal dryness, or I’m peeing all the time at night. I can’t sleep,” then you can think about laser therapies. There’s FemTouch. There’s the Mona Lisa. There are so many I lists in the book, but laser therapy is also really beneficial at thickening the collagen and restoring tone and flexibility and hydration to the vaginal walls too.

Dr. Taz: The women that have had breast cancer or hormone-based cancers, what do you say to them?

Esther Blum: It’s really interesting, because I have my clients circle back with… I give them their labs back and say literally my women on Tamoxifen or some of the other drugs, their estrogen levels are 0.0 on the DUTCH Test. The drugs work, but I have them go back to their doctor. Oftentimes the doctor says… It depends on the cancer, right? But the clients I’ve seen in practice, the doctor says, “You know what? You’re suffering so much with depression, insomnia, brain fog. Your cancer, your margins are good. We’ve determined your risk. It’s 5%, 10%, 17%, and the benefits of hormones are going to outweigh the risks associated with it.”

Esther Blum: I’m pleasantly surprised. Now, a lot of doctors will still say no, but I’ve also seen a lot say yes. It boils down to a quality of life issue, and it’s a really personal choice. If I had cancer, what decision would I make? Would I change it? I don’t know, right? You don’t know until you go through it. But work with a doctor who’s going to give you peace of mind, who’s really going to assess your cancer risk so you can make an informed choice in matters.

Dr. Taz: I love that you are saying going into your sixties, into your seventies, it’s okay as long as you’re being monitored. Again, I warn patients, if you’re accumulating this stuff, if you’re starting to build it up, then we need to know. There’s no way for us to know that unless you’re actually checking your levels on a consistent basis of some kind. What other sort of things do you feel like gets missed in the conversation… Again, I knew we would run into time here, but what other things do you feel like get missed in the conversation around menopause? What are the biggest misconceptions? I think HRT is one and I think that there are no options, is two. What do you think some of the other misconceptions are?

Esther Blum: The fact that no one is mentioning the mental health changes that women go through, the severe anxiety and depression due to progesterone and estrogen and testosterone decline. It’s very real. These poor women are coming to me in droves saying, “I feel like I’m crazy. My family thinks I’m crazy. I yell at my kids all the time and my husband’s like, ‘What kind of mood are you in today?'” Please know, it’s really not your fault. Not only does education need to happen for the women, but it needs to happen for the men too, so that our partners can give compassionate care and say, “Wow! I get it now. I’m so sorry for what you’re going through.”

Esther Blum: When you replenish progesterone, especially bioidentical progesterone, it really hits up those calming neurotransmitters in the brain that make GABA, which help you fall asleep, help you stay calm, and also opposes estrogen that can be fluctuating wildly and running rush all over your body. In its absence, we can really feel anxious. A lot of doctors will put women on the pill, which has synthetic progestin, but progestin does not hit up those same receptors in the brain that bioidentical progesterone does. Estrogen also. I mean, all of them.

Esther Blum: I read so much research on cognition and neuroplasticity and really just being able to form cohesive sentences and thoughts and have our memories intact, it really is beneficial to have those hormones there to support you.

Dr. Taz: Very much. Well, I think we could talk about those forever. I think there are so many pieces. I think it’s important to understand all the hormonal stages, for everyone listening, they do really impact every system. They impact your joints, your brain, your skin, your hair, your mental processing, your mental acuity. It really impacts all of it. There’s no way to walk into any practitioner and just get kind of a bandaid approach to this. It really does need to be looked at kind of holistically so that all the different pieces could be put together. All right. Your book is out October 4th. Where can everyone find your book, See ya later, Ovulator?

Esther Blum: See ya later, Ovulator! Well, please get on my priority notification list and please download your Happy Hormone Cocktail at EstherBlum.com/cocktail. You can find it in major retailers. You can find it on Amazon. I really can’t wait to hear from all of you listening how you enjoy it. You can follow me on Instagram @gorgeousesther. I love to put up content and have a lot of fun with the subject. Tell you all, listen, this can be such a fantastically amazing time in your life where you no longer have to have birth control, right?

Esther Blum: You don’t have to deal with monthly cycles and getting caught traveling with a flash flood down there. It can be a really liberating time for you to just step into yourself as a mature woman, just free of the shackles of reproductive lives.

Dr. Taz: So true. So true.

Esther Blum: It’s a great time. It’s a great time.

Dr. Taz: I love it. Well, before you leave us, what do you think your super power is?

Esther Blum: Oh, my sense of humor, in a heartbeat.

Dr. Taz: Obviously, with all these titles. I love it. All right, perfect. I know. It’s like my other challenge to my patients and everyone listening is like, find your superpower and then make it work out there in the world for you. But it’s hard to do if you’re walking, right? Getting balanced, getting hormonally balanced, all of these things ultimately matter. Esther, thank you so much for taking time out today to join us. I appreciate it. For everybody else out there watching and listening, thank you for joining us for this episode of Super Woman Wellness.

Dr. Taz: Remember, you can rate and review it and share it with your friends. We’ve got lots of episodes, by the way, on hormones, menopause, detoxing. You name it. Check out all the different episodes, lots of great guests like Esther, and get educated. Advocate for yourself and don’t get gas lit. I’ll see you guys next time.