Optimise Your Hormones & Menopause Transition with Dr Kyle Gillet

10:52AM Oct 4, 2022

Speakers:

Angela Foster

Intro

Kyle Gillett

Keywords:

oestrogen

fasting

hormones

menopause

dhea

individuals

women

health

lean body mass

exercise

adrenal

sleep

benefit

good

progesterone

helps

androgens

bit

age

including

But what we do know is if you go through adrenal pause at the exact same time as menopause, you're going to have particularly some you're more likely to have particularly severe vasomotor symptoms and genitourinary syndromes of menopause.

Welcome to the high performance health podcast with your host, Angela Foster, the show where we talk about everything you need to break through limits and achieve a high performance, mind, body and lifestyle.

Hi, friends, I have your Wow, we're going to be talking all about hormones today, I think you're gonna find this episode. Very, very helpful, in fact, because my guest on today's show, dives into when hormone therapy might be appropriate. So at what age and stage should you be thinking about things like oestrogen therapy and progesterone therapy? What levels should you be looking at in terms of your bloodwork to decide whether it's the right time if in fact, you you are someone who's open to taking hormone replacement therapy? And we also answer questions around DHEA and testosterone, also looking at adrenal function and something you may not have heard of, which is adrenal pores, where the adrenals are not actually working as well. And this happens, inevitably in everyone at some stage of their life. But hopefully, if you're fully optimised, you'll be putting that off until much, much later in life. So we're going to hear all about that today and how to optimise your hormones. And if you'd like more on this and a helpful guide, to help you syncing your nutrition and your fitness and even your creativity with your menstrual cycle, then I have a free guide for you is some delicious tasting smoothie, or the recipes included and a breakdown of the menstrual cycle and what to do in each phase. And you can go and grab that over on my website, Angela Foster performance.com forward slash hormones. That's Angela Foster performance.com forward slash hormones. But let me introduce you now to my guest. So it is Dr. Kyle Guillet. And he is an MD at the University of Kansas School of Medicine. He's dual board certified obesity, medicine and family medicine. He enjoys providing holistic, individualised care to his patients. And he's hugely hugely knowledgeable in the areas of Preventative Medicine, aesthetics, sports medicine, hormone optimization, obstetrics, infertility, integrative medicine, and precision medicine, including genomics. And he really believes that each human is a unique creation that requires attention to their body, mind and soul to achieve optimal health. And as I say, we dive into many areas today around hormones, but also looking at his six pillars of health, which include exercise, diet, sleep, stress, sunlight, and spirit. So without further delay, let me introduce you doubt to Dr. Kyle Guillot. So Kyle, it is so awesome to be sitting down here with you today. I first heard you on Andrew hoomans podcast, one of my favourite podcasts, and I was just completely enthralled. It was it was a long interview as all of his, but just so in depth, I remember listening to it in the gym and thinking, Oh my God, this guy is so knowledgeable, I'm gonna have to find out who he is where he is. And if I can invite him to come on the show. And so just so absolutely thrilled to have you here. Very warm

welcome. Thank you for having me. My pleasure. Yes,

really great to have you here. So we were talking offline a little bit about different topics. And I think there's so many different rabbit holes really that we could go down. But a really good place to start is let's start with women in their 40s Because I think this is the area of real disruption. And I think sometimes it kind of hits you across the face a little bit as a woman right? Particularly if you've maybe had your children and you know, you've had disruption like I did in my 30s You know, when you're having children and you're kind of prenatal, then your pregnancy then your postpartum you may have had things like knee like endometriosis, PCOS, you have all these things going on. And then all of a sudden, there's a bit of a Sideswipe in your 40s when levels change again and commonly. You know from my own experience that I see people in my clinic women really struggle with metabolic issues with anxiety with poor sleep. Can you briefly explain for those listening what's going on during perimenopause

hormone health is a moving target. So throughout your lifespan, whether you're male or female, but particularly if you're female, you're not just finding the perfect formula and then continuing on. Because common problems are common menopause or ovarian failure is extremely common. It's inevitable to happen in everyone, at least with current technology, if you hopefully we live that long. So learning how to manage very common problems is what clinicians should do because that's what helps people the most, and that's one of the reasons why I got it. to it as well. When you're thinking about the connection between metabolic health, body composition, energy, mood, libido, and hormones, hormones are literally the signalling molecules that will send signals back and forth between different organ systems. And within the same organ system. endocrinology is in between organ systems autocrine and paracrine hormones are working on near or the same cells or organ system. And then intra Korean is where you have. That's the intracellular endocrinology as well. So you have endocrine autocrine, paracrine, and interferon. And all those different signalling molecules will start the cascade. And there's an excellent article from the Mayo Clinic proceedings, Dr. Pataky PA, T. A KY wrote this. And you can see their flowchart that they published. And it starts with, it starts kind of in two different areas, you have hormonal changes, for example, menopause, and then you also have insulin resistance metabolic syndrome starting. And then after that, it leads to sarcopenia, which is less lean body mass. And with less lean body mass, you burn fewer calories. So you have body fat deposition, and muscle protein degradation. And this is what people colloquially known as metabolic damage that happens so often carry it around the time of perimenopause.

That's really interesting. And the studies that I've seen, particularly show that that yes, women and I think we're in a census, they say, Why have I got this weight, and it's not necessarily like they're piling on the pounds, but they see those body composition changes. And by that, I mean, they're not just seeing weight gain, which may only be say half a stone, it's that they feel and look different, because muscle mass, as you say, is lowering. They feel all round softer, and then they're getting this belly fat that's going on. And that's something I don't know about you I commonly see where they may have had other symptoms like anxiety, brain fog, hot flashes, they've gone and got some hormone therapy, but that isn't resolving these metabolic issues, which they still feel stuck with. And I think this is where resistance training becomes very, very important.

Absolutely, there is no better fat burner than lean metabolically active muscle tissue. I hear a lot of women say that they feel like they're turning into a guy a lot of times that is because they feel like they have body fat deposition in their abdomen, subcutaneously. And they're depositing body fat more where a male might typically do that. But if you look at their hormonal profile, they actually have less androgens, and relatively more oestrogen more oestrogen dominant, that really makes sense, because that body fat in that area has a high level of aromatization.

And actually, what from what I've seen as well is, I think a strain or a one that the patient has produced more predominantly after menopause is aromatized in the fat cells, right? So actually, the way you enter menopause is key. So it's kind of like a lot of people are talking about this topic with women in their late 40s, early 50s, in common with really strong symptoms. But actually, I feel as though if we can catch this early women in their late 30s, early 40s, and get them really, really metabolically healthy. They're going to have a much easier time and and a better life beyond 50. Would you agree?

I definitely agree. One excellent researcher, the late Dr. Labrie. He recently passed away. Um, he was in his 80s. But he was one of the few scientists and clinicians he was an MD PhD, and he studied endpoints for both hormone replacement and menopause, different interventions that you can do for essentially maintaining your health span. And he also studied cancer. And if you look at the ratio of oestrogen you have two main types of oestrogen central and peripheral peripheral is formed by aromatase and he was one of the main ones that showed that all of your oestrogen after menopause comes from the aromatization of adrenal androgen, so androgens that are produced in the adrenal gland, which is a small gland above the kidney. And then often, those androgens like DHEA convert to oestrogen to help backfill the oestrogen so of course, the better functioning your adrenal gland. So if you don't have adrenal fatigue as that is colloquially known as then you are going to have better oestrogen production after menopause. You're also going to have better testosterone production after menopause. Even before menopause. You have about half and half of your testosterone depending on the female that's produced by your over In the FICO gland it produced in your adrenal, by the Zona reticular OSA.

So as you know, you don't want to be fasting too long and putting your body in a state of stress, particularly if you're exercising alongside on a daily basis as that can really interfere with female Hormonal Health. And so one of the ways that I track that and figure out how long I can be fasting for in the morning, without putting too much stress on my body is by using my lumen device. And lumen basically measures your respiratory exchange ratio to tell you whether you're in fat burn, or carbon or a combination of the two. And if you wake up in fat burning mode, and you continue to extend your fast, and then as you start taking a breath test every sort of hour or so you see yourself moving more into carbon, that is a sign that you've now pushed the envelope a little bit too far. And that's when you want to break your fast is also a fabulous way to find out whether you should be pre fueling before that intense hit workout if you really want to bring it. And so I absolutely love doing this stuff with as you know, I'm big into tracking data. And and using that really for optimal health and optimal performance. And lumen can really help you do that. And they are offering listeners of this podcast $50 or 50 pounds off depending where you are in the world of the lumen device and package, you just need to head over to Angela foster.me, forward slash lumen and enter code Angela at checkout. That's Angela foster don't meet for Sasha lumen and enter code and at checkout. So you're saying that if you if you're if you're less stressed, you're going to be able to produce more DHEA, which then allows some of that to be aromatised. And some to still be about because DHEA itself is important, right in terms of it's an anabolic hormone, It counters the effects of high cortisol. Whereas if you're not producing as much in your aromatizing, then you're going to be low. Is that what you mean by that?

That can be the case, but not necessarily. If you're over producing stress hormones like cortisol, then theoretically, your adrenal factory can be so busy that it might produce less DHEA. However, the one of the really interesting feedback mechanisms is that ACTH which is adrenocorticotrophic stimulating hormone. That hormone ACTH stimulates both cortisol and DHEA. So often, if you produce cortisol better, you produce DHEA better as well. So that shows that things like cortisol burnout can also lead to DHEA burnout. If you look at the reference ranges of DHEA it's kind of similar to andropause. If you're not familiar with Andrew Paz, basically, it's what people call male menopause, decreasing testosterone, but both males and females have adrenal pause, which is where your adrenals tire out. Some people go through adrenal pause at age 30. And some people go through adrenal pause at age 90. It is highly highly variable. But what we do know is if you go through adrenal pause at the exact same time as menopause, you're going to have particularly some you're more likely to have particularly severe vasomotor symptoms and genitourinary syndrome syndromes of menopause. Yeah, that's

interesting. So when I mean, when you're talking about with adrenal pause, you're talking about something that's biologically going to happen at some point anyway, as opposed to burnout, where now actually, we can see that metabolised, cortisol free costs are going down and the body sort of almost starts to protect itself. So adrenal pause is actually an event that will happen to everyone is that what you're saying at some point in their life,

giving it enough time, some individuals are extremely resistant. They have very strong adrenal steroid production. Some of these individuals have a mutation. It's called NC ch nonclassical congenital adrenal hyperplasia to where their adrenal glands just work great. If you have two genes for that, and your female, then it can possibly even you know, have a result of sudo hermaphrodite doesn't. But if you have one gene, then it's just enough to where you're particularly resilient against adrenal pause. And often you have excellent oestrogen and androgen levels, even into very late ages. There's been a lot of studies done with both DHEA testosterone and oestrogen and it looks like if you replace DHEA, the more normal your endogenous production over age, the less it helps, which makes sense. But if you're very, very low, then it tends to help more. And there's it's interesting to look at this DHEA hormone because in different countries, I believe in a Believe in the UK, um, I'm not board certified or licenced in the UK or anything, but I believe for a while it was brand name only I forget the name of the brand name DHEA in the United States is it is over the counter, you can just get it on Amazon because it's considered safe enough. In Canada, I believe it is prescribed only. And also in Canada, there is a lot of different medications. That is essentially just the DHEA combined with a different hormonal modifier. So depending on where you live, DHEA might be seen as a medication or a supplement.

So here it seems to be, it's kind of it's one of those things where you can prescribe it as, for example, a nutritional therapist or functional nutrition practitioner. I can like access that through practitioner accounts. But you wouldn't an individual wouldn't be able to just go is by a matrix, I believe is the one that we have here. An individual wouldn't be able to go and order that themselves except under the guidance of productive practitioner, but it wouldn't need to be a medical doctor. But then my, my concern always with DHEA as well is unless you know which pathways is going down, it can be quite pro androgenic. Right and cause other problems for individuals. So that sort of stuff quite surprised that you could go and get over the

counter. Yeah, and it can also be estrogenic. I've seen develop gynecomastia, which is obviously not just due to oestrogen signalling, but I've seen men develop gynecomastia just from a DHEA. Supplement.

Interesting. Interesting. So with with women, when we look at them, obviously we know that managing stress managing their metabolism is key. How what, how easy do you think it is? Or Should women I guess? And is it always a bit of a controversial question, isn't it? Do you think it's possible? I mean, it must be possible because we had women do this multiple times previously. But in today's current environment, we're seeing such significant hormonal disruption. You probably don't see them in your practice, because people who have problems will be the ones coming to see you. But how common Do you think it is? And how easy is it to make that transition through menopause without symptoms without needing any

PCOS? All the different axes have PCOS. Of course, there's a lot of different axes, which maybe we get into as well. But I would say the prevalence of that is around 30%. In the population of most developed countries, most people that have it don't know and most people tend to have a fairly mild case. Infertility is extremely common. And sub fertility is even more common. I would say at least 50% of couples, whether it's male factor, female factor or third factor where it's combined, at least 50% experience some degree of sub fertility in developed countries for varying reasons. A lot of it is things like metabolic syndrome and sleep apnea. And then even rarer diagnoses, like hypothalamic amenorrhea, or premature ovarian insufficiency, those are becoming much more common as well. Adrenal Fatigue is another one, or just adrenal relative subclinical hyperplasia. And then if you I certainly count, thyroid hormone pathology among that, that is, of course becoming more and more common,

super common. And what about like the transition through to menopause, if you've got a woman who is managing her stress, she's physically very active, she's been looking after her metabolic health maybe shouldn't have any of these problems previously, she's had a regular cycle. Are there many women who can then make that transition without having you know vasomotor complications and all the other things that we have been seeing?

In general, the better you are able to optimise your estrogens and androgens without the ovary, the better your transition to menopause. However, even if you have an optimal profile, it does not necessarily mean you will be symptom free. And even if you are mostly symptom free, it does not mean that you should not consider optimising your hormones naturally, or even somewhat naturally. So, again, to use DHEA as an example, because it's a supplement in the States, or because it's relatively easy to get some people consider that hormone replacement therapy and some people do not. Some people consider synthetic estrogens and progestins. Like contraceptive pills. Some people consider that hormone replacement therapy as I do, and some people do not. So thinking about doing something with your hormones, I would say 100% of females should do and they should do it earlier rather than later. So You're considering it a time to get lab workup and look at your baseline levels and use the accurate precise biomarker would be yesterday rather than today. Another thing to think about with oestrogen signalling is that there's two different oestrogen receptors and various things can affect them. There's also many oestrogen related receptors, for example, there's oestrogen, oestrogen related receptor alpha, and that one cholesterol binds to. So cholesterol is actually a hormone in and of itself. It's a ligand where it binds to that receptor. And there's also one people might be more familiar with oestrogen related receptor gamma. That's what BPA or Bisphenol A binds to. Okay,

I want to get into that Shea to do with sort of environmental efficient disruptors and mimickers. And just a moment, but when we're looking then sticking with what you're seeing there in terms of testing, So how often should women be testing their hormones? Is it like an annual workup? Or more often than that? And at what point should they then be thinking about because there's this theory of this sort of critical window, particularly with things like brain health? What do you advise women at what stage should they be checking their hormones in an ideal world, and when there's should be then be looking at potentially introducing aromatherapy?

A good rule of thumb as a baseline, of course, you can always do more if you want to optimise things, but to get ahead of the ball and use true preventive medicine. Then, once a year, up to about the age of 40. And ideally, twice a year over the age of 40. Of course, you would want to follow how you're doing subjectively. So if you're starting to have menstrual abnormalities, like if they're spacing out, which we call a ligament area, then you want to be a little bit more proactive with that, especially if you haven't had a mid season, say, you know, six months, you would certainly want to get a workup because if you do need to start or tweak something, doing it as early as possible is going to be by far better efficacy.

Okay. And one of the things I see women in the early stages they seem to to struggle with the most is rather than the cycle lengthening, it seems to be shortening, and actually they're getting heavier blades and they seem to have effects where they're producing less progesterone. In that scenario, is that a place where actually they should be thinking about optimising and maybe taking hormones at that point, or using maybe natural things that can support because I know you know many instances a lot of Doc's will say, actually we can or functional medicine doctors will talk about using things like maca and things like that, to try and sort of optimise levels until there's further disruption. And just curious in your view.

Yes. Depending on the patient, each one of those things could work for patients with really severe symptoms, the and that have a congruent hormonal profiles, the chance that you can optimise with something, for example, just maca, is certainly a lot less likely than for someone with mild symptoms, that has mildly suboptimal hormone profiles for that individual. Something like maca might be a lot more reasonable. When you look at hormone productions progestins for example, progesterone pregnenolone, five alpha and three Alpha progesterone. Those drop much more quickly than estrogens. So usually oestrogen is the last hormone to drop during the perimenopausal time. So a lot of women do start progesterone, of course, there's risks and benefits to starting any medication or hormone. But often that is what we see. In general, if your FSH is not suppressed, and the units might be slightly different in the UK, but if your FSH is still below around 35 or 40, you should certainly attempt not to start any oestrogen until it climbs higher and higher. There are exceptions of course, but that's another good rule of thumb.

So I spent a long time trying to find is in fact, a greens powder that I actually liked the taste of and a finally found that basically tastes amazing on its own, or actually mixed into shakes, which is pretty unusual because some of them taste kind of really minty and that overpowers everything else whereas this one just tastes really really nice and it mixes well with banana and protein powder. It also mixes really well with a strawberry protein I've been using and it just works super well just on its own on an empty stomach and That is athletic greens. It has prebiotics and probiotics and naturally occurring enzymes that boost digestion has your daily dose of vitamin C and zinc healing mushrooms, magnesium to help you regulate all day energy and support energy production in our cells and it's packed with superfoods, adaptogens and antioxidants, and I absolutely love it. And the cool thing is, you can get one year supply of vitamin D plus five free travel packs. When you get your order of athletic greens, all you need to do is go to this special link athletic greens.com forward slash Angela foster that's athletic greens.com forward slash Angela foster to buy yourself a year supply that Monday plus five free travel packs. Now let's get back to the show. Okay, that's interesting at what level would you spend start to look with oestrogen therapy?

As far as like a replacement therapy with oestrogen Yeah, if you are no longer having menstrual periods, that's another one. Another good one to see. Because even if you're, let's say your FSH is 70, but you still think you're having very frequent menses, perhaps that's an like endometrial hyperplasia, or even an endometrial carcinoma. Worst case scenario. So you want to make sure that you're no longer having endometrial bleeds or menses and then looking at an FSH above above 50 would be quite safe. When those criteria are met, then, especially if you're at a younger age, you certainly want to consider starting oestrogen sooner rather than later. Because once you are truly in that menopausal time, and your oestrogen is low, and specifically looking at estradiol most of the time, and your FSH is high. The longer you wait, the less benefit that will bring.

Okay, yeah, that's right, that it's interesting. And so what about with progesterone, because obviously, like, as you say, that sort of drops quicker than oestrogen. But it's oestrogen that brings the more obvious symptoms to women, isn't it when they say I've got terrible hot flashes and waking up in the middle of the night or really bad brain fog, I just can't concentrate and things like this. Whereas progesterone and sneaking out the back door, you're getting more anxious, you're not sleeping quite as well, the symptoms going on? What are your thoughts about women just taking progesterone.

Some women are great candidates for progesterone monotherapy, without any estrogens. And just kind of depends on the individual. Some people have bad reactions to progesterone as well. It's not very common. Oral progesterone is not very bioavailable, so not a lot of it is absorbed in the gut. And then also in order to cross the blood brain barrier, it has to be reduced. So five Alpha reduced and or three Alpha reduced. So depending on the individual, they might do that better or worse supplements like creatine can help up regulate the amount of five alpha reductase to help that progesterone cross the blood brain barrier. And this is known as DEHP or th P kind of like testosterone converts to DHT. But depending on the individual, many do very very well on just progesterone.

That's interesting about the creatine, and is that a usual like just standard dose of kind of five grammes daily.

For most people, five grammes daily is a good dose. Some individuals that are non responders or that just exercise a tonne, they use more creatine, I think of it as the backup fuel tank for the mitochondria which is important for maintaining ovarian reserve as well. When I think about the mitochondria that creatine is the extra fuel tank to basically hold that phosphate group for ATP. And then co q 10. Ubiquinol is the active form of CO q 10. That's kind of like the the enzyme or the fuel converter that converts that NAD into ATP. You need Coenzyme Q 10 to do that. And then Intiman NAD plus even in our those are even niacin. Niacin actually cures in a D depletion myology as well, which is just vitamin d3, but those different NAD and ATP precursors, that's the actual fuel that helps go in and then l carnitine. Is the fuel pump. So that helps facilitate the transfer of fatty acids and fuel in general into the mitochondria. So all of those things are important to ensure that you have them optimised in order to maintain the quality of the OVA or ovarian function and fertility into older ages. If you look at mice treated with these various interventions, particularly in a D plus precursors, they can even have reversal of mouse menopause, if you will, and regain fertility.

That's super interesting. There's so I recently have been taking NAD plus precursors, after interviewing a biochemist here in the UK actually has a very good supplement range alongside creatine because I train a lot. And I've really noticed I hadn't realised that research around ovarian function, but noticeable differences in energy noticeable. And also interestingly, in deep sleep, and also just not actually needing quite so much sleep, I almost have to be careful that I'm not under sleeping. It's it's quite, it's quite interesting.

Yeah, that's one of the potential downsides or upsides is that it can improve your sleep. It helps the mitochondria everywhere, not just in the ovaries, of course. But when you think about that, you're essentially optimising your ATP. And you do have to be a little bit careful with doses there. Even though NAD plus precursors are very, very safe, there is theoretical risk behind them. Because they can provide so much energy that if you do have something like a cancer, then theoretically they can provide that energy as well. It is a relatively small risk. But you know, there's a benefit and a detriment to everything. When you're thinking about your rate limiting step. Let's say that there's an individual that is deficient in coenzyme, q 10. And perhaps they need co q 10. In order to unlock that NAD plus, or, or to actually utilise that creatine. Or maybe they have trouble pushing their nutrients into the mitochondria. Insulin resistance can contribute to this as well, because a lot of your fatty acid chains like triglycerides, or glucose are, are outside the cell instead of inside the cell. So those four kind of work together synergistically and for individuals trying to maintain ovarian function that is one vector. We can also talk about sirtuins and hormesis are things like mTOR and rapa myosin, and that kind of like in Tor, aka T, pi 3k. pathway.

Yeah, I'd like to talk about that when you talk in just second when you talk about, like sirtuins, or I'm just curious, in terms of your thoughts around resveratrol, because that seems pretty controversial in terms of its actual bioavailability and absorption. Where do you sort of come out on that?

Yeah, and some people take it with that, which might potentially increase its bioavailability. And some companies have formulated it to where perhaps its bioavailability is better. And it is a plant, it is one plant poly phenol. I don't think there's anything magical about it, I forget. It's either cert one or cert three, I think cert one, that it pretty profoundly changes the activity of increases the activity of cert one I believe, but it's just one plant poly phenyl. It's kind of like I think of it as maybe similar to boron or zinc for hormone health. If you happen to have a really, really hyperactive or really, really hypoactive certain one, then perhaps it's helpful for you. But it's just one of the many plant polyphenols that can be helpful from a hormetic standpoint, and from an antioxidant standpoint. So just like giving everyone zinc is not going to fix all hormone pathologies. If you happen to give zinc to someone who's deficient in zinc, even if they're just deficient intracellularly like it's more common in older ages to be deficient. intracellularly for zinc, but not in the blood. Resveratrol, similarly is not a you know, like a magical antioxidant sirtuin activator.

So do you look at like sirtuin activators then more from like incorporating into your data. So kind of adding cacao into smoothies, drinking, maybe matcha green tea, you know, I mean, from an antioxidant perspective, certainly like Chaga I think, you know, one teaspoon of child has given you the antioxidant support 600 Blueberry, so there's the, as you say, there's the hermetic influence and then there's the antioxidant right, and they're not always the same in each. Yeah, I'm just curious what you what you advise with patients that

some patients have such a wonderful diet with many different plant based antioxidants and hormetic activators that they just simply it's not going to be clinically significant to take a supplement that helps some individuals and I'm I'm trying not to pick on anyone but just as an example. Let's say there's someone Who's on a carnivore diet, they're not taking in any plant molecules. And they do not intermittent fast, their mTOR is always active, and they're in a very anabolic state, then perhaps they would benefit more from something like Chaga Fs, or she legit or resveratrol, or course, a tenner. A lot of these different some people call them adaptogens. Some people call them search activators. That's just one example of a patient that might benefit more from a supplement regimen like that.

If they're not, yeah, as you say, if they're not really getting any of it in their diet. And I think this is the thing isn't it is with women in particular, not including plant compounds, to me just feels very deleterious because of the profound effects on gut health and gut motility, and actually detoxifying accessory excess oestrogen is always sort of concerning to me. And I've seen I've seen some some funny things with the ketogenic diet where women have prematurely gone into menopause, it seems and then actually even post 12 months when they come off that diet, and they go on a more plant based diet with sufficient protein and healthy fats, their menstrual cycle resumes.

Yes, that sums up what the most powerful intervention for almost all females as I am a very strong believer in food is medicine. And it is the main medicine. And as you mentioned, if they're not getting those things in the food, and all the different bandaids of supplements, and medications, are going to only going to bring a fraction of the benefit that those dietary changes can.

Yeah, I think some I think what women are really concerned about that moment, is there's so much on social media around controlling blood glucose, that it's almost become an obsession, that they're very concerned, at any point what happens, what happens, and I see this with women who, you know, I'm gonna have it here on my desk. So I could play with the lumen device, for example. And I do find it really useful to see, you know, am I burning fat? am I burning carbs? But from my perspective, I actually and I'm always quite competitive with things, I understand that burning fats and carbs is a good thing, because that's true metabolic flexibility. I think people get hung up on I need to be in fat burning all the time. And actually, it's those individuals that I find have a harder time of reaching a one or two, whether that's because these devices are not advanced enough, and they're misinterpreting Ketos whether those which I've seen some reports around, but or whether actually these individuals are kind of almost in us in a state of high stress all of the time that their body is now producing it. I'm curious to your thoughts around that. And also the level of hormetic stress that women in their menstruating years should be placing, because fasting again, is a form of stress. I guess first of all, when we're looking at blood glucose, people take their HPA once he levels and we want to get it to an optimal level. It's something for example, I I am monitoring and always want to optimise because I'm someone who has PCOS. So it's a big marker for me and I probably have a harder time controlling blood glucose. But obviously, what we're seeing on the internet is constant graphs put out and books at the moment of look what happens if you have this very natural foods that people are completely staring away. It's like, right, don't have oat milk only have almond milk now, because you're gonna get this huge spike. How much do you think we really need to be worrying about natural foods, providing a momentary spike if actually, we're doing all of the other things like sleeping or exercising? Well, for example,

it's somewhat depends on how high the blood glucose spike is. That's another reason why CGM is are becoming more popular and soon there will be CGM that measure ketones and lactic as well, which will be particularly interesting from a metabolic standpoint. As far as how important you know, your insulin resistance and blood glucose markers, for example, a glucose tolerance test or even just what a CGM puts out, it is certainly important, but it is not the only vector for holistic health. It's not even only a vector for metabolic health. It is good that that has been added as an addition. So many people are a little bit obsessive about it and reductionist in by reductionist I mean that that is all they care about. Some groups, all they care about is calories in calories out, and of course, being obsessed with the physics of that is not going to lead to helpful clinical endpoints for everyone. It's very helpful and you have to address that. And you also have to address the metabolic flexibility, but for optimal health, just like if you're trying to tune your car You're not just looking at how much gasoline you're putting in and burning. And if you're overflowing the fuel tank or not, you're not just looking at the efficiency of how the motor runs, you need to look at the aerodynamics. And you need to look at how the wheels are spinning and how much friction you have on the ground. So when a clinician or a scientist tries to reduce everything to tracking calories, and then tracking the health of an individual's blood glucose and insulin, for example, those are absolute must just like is an absolute must to track the fuel you put into and burn in your car, and also how efficient the engine is running. But there are so many other things to take into account.

And what would those things be because when you look at it, for example, you may find that let's say, you know, I know from interviewing, like the founder of one of the blood glucose companies, all the content of the CGM companies, all the data they've collected, right? We had a chat laughing about it, bananas, make your blood sugar, go bananas, okay. But then the most common food for making your blood glucose spike was sushi. So it's kind of almost a no brainer. While if white rice is going to cause a spike, which gets metabolised into glucose, you know, very quickly, they don't care, it doesn't really seem a lots of vitamins in white rice is sort of a no brainer, or this should be an occasional food. But a banana is something different because and it's interesting, because actually looking at my own measurements, if I take bananas from the grocery store, while they're green, chop them, peel them, chop them up, put them in the freezer, they're great because they contain a lot more resistant starch, which is good for your gut, and then put them into a smoothie. And I say use half an hour very, very minimal spike, if any in blood glucose, and I feel like I'm getting the benefits of that banana. Whereas take a ripe banana off the stand and eat it gonna be a spike. But then, you know, from what you're saying there, you make a very good point there's, there's loads of other things that you're getting from that banana, right? There are vitamins and minerals and things that are having an impact and fibre on your body. What other things should we be looking at them? Do you think and making these decisions?

One of the main ones is just your lifestyle pillars. So your exercise your sleep, your level of stress, you want enough stress, especially in the morning, and not too much stress in the evening in general. And yes, most people have too much stress. But you don't want to have too relaxing of a morning, you want to get into that cycle. Just like you get into the melatonin cycle. You want to get into your stress and cortisol cycle. So you want to address your pillars of lifestyle. But the main other objective marker that you're looking at is your hormone health. You want to have good thyroid hormone health, you want to have good growth hormone and IGF one health and good androgens estrogens and progestogens. And then from that you can look at things like how your androgens profoundly directly impact your VO two max or your ability to carry oxygen to in tissues. That is VO two Max is probably the main healthspan marker. So if you can look at all the other markers and compare them to vo two max. And if you take an 80 year old with very, very good vo two Max, they're probably much healthier across the board than someone with a far suboptimal vo two max. And that's directly impacted by your androgens and many other things as well, but in your mitochondria. So that's one of the main angles that people are missing. And I think more people are talking about it. But there just needs to be a consolidation, if you will, between the traditional academic medicine and the functional medicine for lack of a better term. There's this cultural shift to where people do care about their hormones. But usually the individuals that they seek advice for for their hormones are not the most reputable and accomplished scientists. They're usually not MDs, and DEOs. And PhDs. They're often knowledgeable, but often they're just not those individuals with terminal degrees degrees who are publishing clinical literature on the science. So there's a little bit of a disc congruence between the scientific community and the cultural community. And that is slowly coming together. And those two groups are approaching each other and collaborating with each other as well. Which is very reassuring.

is really interesting, right? Saying I want to dig back deeper than with things like via to max because a very interesting concept that I've been sort of looking at and I first heard from Putra tears, this concept of back casting and looking at what's going to be effective Lay your last decade and then tracking back from there and most people fall very much behind is what his fat so for example, if you really think that your last decade you want it to be somewhere between 90 and 100 Actually most people in their 40s and 50s are falling well below on VT vo two Max and interestingly well below on grip strength right which is a big marker of ageing in terms of their to max, then I'm curious how are people's androgens affecting their vo two Max and can we train our way out of anything that may be adversely impacting

testosterone, specifically the binding of any androgen to the androgen receptor. If you increase the density of androgen receptors in the cytoplasm of a muscle cell, that will think of it as it's grabbing on to that oxygen and helping to hold on to it in addition, and the mechanism behind this second vector is not well understood, but it also increases eco, which is known as erythropoietin. And all androgens do this not just testosterone. But this erythropoietin will cause excess, not excess, increased production of haemoglobin and red blood cells. And that extra haemoglobin in the blood will also carry more oxygen, so you're carrying more oxygen and you're absorbing more oxygen as well. Okay.

And there's also a kind of genetic component from what I've seen from DNA reports as well in terms of your via to max potential, right?

Yeah, there's absolutely a genetic component. So even if, even if you have not ideal genetics for a high VO, two Max, it still is just as beneficial. So you're really competing against yourself when it comes to vo two, Max.

Yeah, and improving it. And that's through a combination of kind of zone two training and then also very high intensity training.

Yes, especially very high intensity training, runners and cyclists. And swimmers might be familiar with VO two Max workouts, which are some of the hardest to do. And usually those are very high intensity. And then Zone Two is essentially training for your mitochondria. And also it helps your sleep profoundly helps your REM sleep specifically.

That's interesting. I hadn't realised that zone two is helping REM sleep. That's interesting. How much is it awake, just briefly describe what zone two is, because people might be wondering what that is.

There's six main zones of cardiovascular exercise, Zone Two is one of the very easy ones. For most people, it's a bit over 100 As far as your pulse your beats per minute. So most of the time, you can talk through it. A stroll that's a little bit difficult, where you're sweating a bit, but you can still talk is a good way to do zone two. And then a lot of fitness trackers will also just tell you if you're in zone two, so that can be that can make it a lot easier.

So walk and this is why I think it's a really difficult boundary, isn't it because walking, for example, with your dogs and you're enjoying you're listening to a podcast, you probably not quite getting into zone two, you're kind of on the very upper limit of zone one right here, which isn't enough, then you've got zone two, where if you start jogging, for many people, they would like my heart rate just goes quickly, too high. Something I've been playing with that I really, really enjoy. And I find it as relaxing, I guess is why people run a say it's like meditation to them is purely nasal breathing, running. And I found that with that, you can come back, it's a very parasympathetic state where you're in and out through the nose, and you can just go on and on and on. And that seems to me a good way of measuring whether you've skipped out of zone two and you've just gone a little bit too high because it comes with quite difficult to maintain nasal breathing once you move out of Zone Two is my understanding, is that correct?

That's a good rule of thumb. Some people are particularly good at breathing through their nose, which is a good thing. That's a pretty good rule of thumb, though. A brisk walk or a power lock for some people would be zone two. That really just depends on the person. So the more fit you are, the more the faster you'll have to walk if you're using walking as your zone to cardio.

So then you kind of need to move into a cycle or swim or a jog or something like that,

possibly, or just, almost everyone can get into zone two with a very brisk power walk.

So from a heart rate perspective, this is sort of for most people in their 40s is going to be around somewhere between 121 30 or 135. Right? Yes, yeah, somewhere in that zone. And this is my understanding Here's that for optimising for that you need to do a round two hours per week.

Yes, a good rule of thumb is at least three to five times a week for 30 minutes each. Like anything else, the law of diminishing returns applies. So if you do two hours a week, for 50 weeks, that is going to be far better than four hours a week for just 25 weeks. So consistency matters. More than that, I guess, the cumulative number over a year,

I'm going over that and doing say five hours a week doesn't necessarily confirm majorly big benefits beyond doing the

two hours. I'm not sure how much the benefit is, but I know that if you do, for example, four hours a week rather than two, it is not double for benefit. Yeah, yeah, maybe, maybe 20%, more, maybe 60%. More, but certainly not 100% more.

But it sounds like it's a good way actually of getting your dog to watch and certainly my ones a lot quicker than than just strolling along. Because you're going to do it in half the time and benefit your VO two Max and your longevity and that that is also going to help to optimise Hormonal Health as what you say.

Yes, it is. It is quite nice. It'll also help raise sh PG. Many people struggle with too low of an sh PG. So they can't hold on to their androgens or estrogens. So there's a lot of fringe benefits of exercise. That's why I put it number two right after diet and your lifestyle pillars. Those two are, you know, they're all important, but those two are the most important.

So talk us through those pillars that you use on a

diet and exercise are the first two. And then the last four, I used alliteration, they all start with S. But stress is one of them. And that includes social stress and collective health, the health of the family and close friends in your household. And then you have sunlight, which is really just being outdoors. And it includes cold exposure, heat exposure, and then you have spirit as well. So that says this is just where you are on Maslow's hierarchy of needs. Fortunately, in developed countries, most people are concentrating on the self actualization. The very top of the pyramid rather than the bottom of the pyramid, which which is their more their physical needs at the bottom of the pyramid. So that's very reassuring. But diet and exercise are really the the main two sleep is the fourth s if I didn't mention it yet. Yeah, so sleep. Sleep is important, looking at your heart rate variability, looking at your sleep as well. And these six interventions are more powerful than any medication or supplements.

Yeah, really, really powerful. I think as much as everyone wants to take the supplement interesting. Industry has become almost like a prescribing platform, I think, just just no different honestly, medication. I think these are all great. But if you haven't got those pillars in place, there's almost Yes, you can take supplements, but I would constant I agree with you, I concentrate on those first, we talked a little bit offline, I really want to dive into this because we talked about the two Macs there. But also the benefits of athletic performance and the interaction with hormones and cognitive health, because I think this is really, really important. What do we need to be thinking about in terms of exercise? You know, I've research I've been account this week is just super interesting around weightlifting, and how that's really, really benefiting cognitive health. But I'd love for you to share more, because I know the scenario, you're very knowledgeable.

There's a lot of theorised mechanisms behind why certain types of exercise help decrease the risk of neurodegenerative disease, so decreasing the risk of dementia, and also improving cognitive performance. In the long run, if you are routinely resistance training, then perhaps that helps increase oxygen delivery to the brain. But it's also possible that that just helps the the signalling of hormone molecules the prevention of sarcopenia which is the decreased amount of lean body mass over time, and that is very closely correlated, and possibly causal Tory with the decline of the health of your brain. So your your brain and your other lean body mass and your muscles are very closely related. Also, the amount of lean body mass you have and the amount of bone mass you have, which is another type of lean body mass. So muscle mass versus bone mass. So sarcopenia and osteopenia or osteoporosis are very closely related as well. If you look at individuals that have the highest risk for dementia, often they will one they did not do any sort of hormone optimization or hormone replacement therapy, after menopause and then to, they're usually obese during the Middle Ages, and then they lose weight as they age, and then they are at their lowest weight and their older ages. If you look at individuals that are the same weight the entire time, whether it's low or high, they're much lower risk of dementia and resistance training can help maintain that good healthy body mass that helps retain the good healthy brain mass.

This is interesting though, because what you're saying there then is if you have somebody who is obese, but they continue to be obese, their brain is better protected than if they lose weight.

Absolutely. And part of part of that reason, is the extra adiposity. The extra body fat helps produce more peripheral oestrogen because individuals have more oestrogen around, which can help with serotonin tone, and also myelination. So it helps maintain the fatty sheath around the nerves. And it might help prevent some of that cerebral atrophy or the shrinking of the brain that is expected with age, many people have seen a CAT scan or an MRI of an octogenarian. And almost always, there is some degree of cerebral atrophy more so in someone who is a heavy nicotine user, or that has certain, you know, more so if you have osteoporosis as well. But the extra oestrogen from maintaining that high body mass and high body fat percentage. And part of that reason is, if you I'm not good at conversion of pounds to stone, but if you're a very high BMI, or you weigh a very high amount, then it is likely you're very strong, very strong legs, and a relatively strong core and a very strong back as well, it takes a lot of strength. It's almost like your resistance training every day.

And yourself around, right.

And that helps you be a much lower risk of dementia. If you look at the average amount of lean body mass that you lose as you lose weight, for every pound that's lost, over a third of that is lean body mass. So if someone loses 100 pounds, then maybe 35, or even 40 pounds of that will be good, healthy, lean body mass that was metabolically active.

Unless you can intelligently do this right, by losing like strength training, eating high protein and trying to minimise any kind of lean body mass reduction. Correct. Yeah. But then I suppose being obese, you're predisposing yourself to other diseases like cancer potentially?

That's true. Very true. For example, breast cancer. Yeah.

Which is difficult. So it's a balance. And so what about for example, do you think that people who are naturally very lean for example, and by that I don't mean necessarily they have a high lean body mass, but are quite petite? And then they just continue along that line? Are they likely to experience? Are they more at risk of things like dementia?

Not that I know of they are certainly more at risk of osteopenia and osteoporosis, which is low bone mass.

Okay, learn bone mass more, which actually, interestingly, I think can you can do DEXA scans annually, right to have a look at this with you with this concept of hormesis. And stressing or is there's another kind of quite controversial around how much do we as women in our cycling years and then in the lead up to menopause? How much do we fast? How often do we like the fasting the length of that period? Because I know, you know, some people are very pro fasting, but it can disrupt female hormone health and also exercise there's growing evidence around restricting really intense activity in that late luteal phase. I'm curious about your thoughts around both those areas.

Part of the controversy regarding fasting is that one it is not done to improve body composition or lose body fat. It's just one tool that can help develop good eating habits. That way you're not dieting you have a a diet or a habit that will last a lifetime of good eating habits kind of developing intuitive eating, if you will, fasting can certainly help that. And it can also help control the hormones like leptin and adiponectin and ghrelin, that crosstalk between fat cells adipose in the brain. When it comes to how much faster an individual should do, it's down the list quite a bit. After other lifestyle interventions. It can be relatively easy to do for some people, but if it's rare really difficult to do for an individual, it's a weak enough intervention to where it might not be worth it. So if you're struggling and you're suffering through fasting, and you know, it's not just the first few days where you're getting used to it, it's a month or two in where most people do acclimate to it. And it's still difficult, and it might not be worth it. And then the other thing to think about is, is there a particular reason why this individual is a great candidate for fasting, for example, a strong family history of brain cancer, as just one example. So that would be for more of a health reason. But intermittent fasting is not going to like make up for, let's say, poor sleep dysregulated stress and a mental state, and just poor collective health in the household as well. On a scale of one to 10, I'd give fasting for, like compared to those things 10% of the benefit,

I think, I think it has been like overestimated, in many respects, sort of inflated, right by different books that have come out and, and social media, because I recently was talking to Dr. Joseph antient, who's the CEO of Prolon. And we were discussing at length how you know it for most people, and in a lean individual, they may after 24 hours begin to stimulate full cellular autophagy. But it's unlikely, most people are going to take about 48 hours. And the reason that they and their studies are created that molecular fast of a five day length was so that people are BSP, for example, will at least get one day of autophagy. And it seems that exercise is a better tool for stimulating autophagy and all of the other benefits that we're talking about. And so if you're exercising regularly, then you know why customers say particularly to women who are in their cycling years is a 12 to 14 hour fast is it seems optimal, right? It's giving your body time to relax, and you're not constantly working right. And it can focus on other things. But it's also not that difficult to stick to. And it's what I find children having had children myself naturally do, they will naturally eat in their younger years, around five 6pm. And they won't think about eating again before seven in the morning. Right? They're naturally doing that it seems that we're primed for that level of fasting on a daily basis.

Yeah, it certainly seems that way. Another thing to remember is, what specific vector are you trying to get out of fasting? Are you trying to look at more of like the mTOR pathway are you looking at, you know, there's a lot of different, you're looking at, like insulin sensitivity autophagy in general. And if you're looking at the mTOR pathway pathway more specifically, and a lot of people discuss rapamycin and other mTOR inhibitors. And then people also discuss BCAAs. But you see some people who are intermittent fasting, but that to make their fast last longer, they take a protein like casein protein, which has a huge amount of BCAAs in it. And also, it's just a very slow digested protein. So they're, they're activating mTOR. And in theory, it looks like they're fasting, but they're not actually getting the benefit of fasting. Because they're having a huge casein protein shake, like before, they're fast.

And this because the BCAAs are kind of spiking insulin potentially. Whereas if you're having a full spectrum of essential amino acids, that seems like specified less of a bump from what I've seen in terms of the impact on fasting.

Also, just because a lot of the amino acids in the casein protein, including the BCAAs, are activating the mTOR, the mammalian target of rapamycin. So they're in towards active, they're in more of anabolic state from that vector. And that's one of the major benefits of fasting. So they, they're negating a lot of benefits from fasting. Ironically, a lot of Toddlers and Babies do this as well. Because if you look at what we give them before, they're fast, in some cases, is milk protein, which has a lot of casein in it. So again, they're activating mTOR, which is a good thing in children because you want them to be able to grow overnight, and you want them to have enough IGF one, which dairy can help with and you don't want them to be too catabolic.

Yeah, that's true. There's some very young children, right. And what about so but if you're if you're having something like that immediately pre workout when I was chatting this over with Dr. Stacey Sims, literally just a few days ago, and we were chatting about how actually, there's some evidence that by having some amino acids pre workout is supportive for women and also protecting against any kind of catabolic effects of breaking down the muscle tissue, and you're getting those benefits of autophagy from the exercise session itself.

Yeah, the the ideal scenario for timing of nutrients around exercise is you as long as you're able to tolerate it is a medium or small pre workout meal with amino acids, and also a post workout meal to the timing your nutrients around the time of exercise, perhaps not as much really vigorous exercise, but for mild to moderate exercise. That nutrient timing certainly will matter. If people want to test this out themselves, they can also do a 24 hour fast and an exercise fasted. And they can do a small pre workout meal and see which one they feel better at as long as you're able to tolerate it. But yeah, I agree amino acids around the time of workout, there's no such thing as like an answer there, no anabolic window. But it can help for health purposes other than building up lean body mass.

And you talking earlier actually about optimising the cortisol rhythm in the morning. So we've got that cortisol awakening response of that sort of first 60 minutes of the day. I if I if I don't exercise first thing, it's probably not going to get done. It definitely won't get done after midday. That's just the way I am. Even though I can see all of the circadian rhythm evidence that are stronger, and I got Greg retic action ties, no one's ever won an Olympic medal. Good job. I'm not going to one of those before midday, and all this stuff, but it's just not going to happen. And I'm a very just naturally early riser. So for me, 5am I'm ready. I'm in the gym at half past five, and I really get a good workout and I love it.

I'm curious if you're gonna Oh, good, thank God for that. I thought you might be saying no, until you're just destroying your hormones and your adrenal how,

but it's just nice. And I feel that I am taking, you know, it's just I was talking to Dave Asprey about it, and he was in my state, and he was saying, you know, we don't want to raise cortisol too much in the morning, and she doesn't raise cause or I don't feel in me, I feel primed, and kind of excited and motivated, but calm for post workout. And I'll either meditate directly before or directly after it anyway. Well, yeah, I mean, it sounds like you agree with me, but I'm just curious what you think around that and how we optimise that cortisol in the morning.

For most individuals, exercising right, when you wake up in the morning, ideally, before any kids would wake up, or before any distractions start coming in or calls. For me, that is the only time that I can exercise and the fringe 5% benefit. I'm not a professional athlete or anything. So it that doesn't matter to me, what matters to me is getting it done. So just like the best diet is one that you can adhere to the best exercise protocol is also one that you can adhere to. I agree most people that's first thing in the

morning, first thing in the morning and the cognitive benefits, I find are profound. And also speaking to sleep scientists about this actually, it helps to make up particularly in your home things like creatine for any deficits in sleep. So kind of having had a poor night's sleep isn't really the excuse for not getting up and exercising, because actually you're doing your body I think so much good by exercising, right?

I agree. We know. And obviously, there's law of diminishing returns applies there, like it does to most things, where if you sleep for two hours, then you probably don't want to get up and have a really vigorous exercise. But most in most cases, that certainly applies.

And then with sleep, you were talking about that as one of your pillars. What are your thoughts there? Because some people I mean, when I've looked at genetic reports, I see indications that actually this seven to nine hours isn't uniform across the population. There are just like we have early morning risers, and we have night owls, there are some people who actually seemed to need less sleep than seven hours. I know when I look at research, if you go sub six hours, it seems to actually be putting your health at risk. And there's a very small just like we're told not to sleep overnight hours, there seems to be a small section of the population who do actually need a sort of nine hours or more sleep. What have you found there and because I am an I seem to function well, very well on six and a half hours, but I carry Apo E for one copy of it. So this is always in the back of my mind. I'm just curious, your thoughts, in terms of you have that pillow to sleep.

Those genetic markers certainly run in my family as well. And some individuals get an extremely low amount of sleep. It is interesting to see how well they function and that they truly just sleep a lot less. But and I'm not asleep scientists and I try to learn as much as possible from scientists like Matt Walker and Andrew Huberman. But what it appears is that if you're getting, let's say five hours, six and a half, I'm not sure that seems pretty pretty close to seven to me. So I wouldn't worry about that too much. But if you're consistently getting four or five, even if you're functioning perfectly well, in the short, medium and even long term on that amount of sleep, you'd be concerned for your health in other ways. In the long run.

You would be concert Oh, as in if you were sleeping, if you're consistently sleeping like four or five hours,

correct. My understanding is if you're sleeping consistently less than six hours, regardless, if it's really good quality asleep, and regardless of your function, that you would certainly be concerned for long term health.

So yeah, that's what I've heard, I interviewed a chrono biologist around this sleep scientist. And it was quite interesting, because one of the things he had observed through his studies PhD was, if you are under sleeping, what generally will happen is as soon as you put that alarm off, your body will naturally try to make up the sleep, so you'll oversleep by quite considerably. Whereas for people who are sleeping less sub seven hours, so six to seven hours, they will then instead what will happen is you'll see your stats, double down on deep sleep double down on REM sleep. So the amount and the quality, you seem to then sacrifice light sleep, but you won't end up over sleeping. And that's certainly what I've observed. So I don't know, maybe you can see what happens with that though. Is there any alarms and see what your body does is quite interesting. Before you go, I just have you've been so generous with your time one question that we hadn't hit. And I know. I've had quite a few questions around this is and I know that this is an area that's growing in terms of research primary ovarian insufficiency. There's lots of women, sometimes this is happening and it is really insufficiency it's kind of in their late 30s, but also women that are just trying to fall pregnant within their 40s More and more now due to the changing lifestyle and environment. What have you found things that can move the needle on this on primary ovarian insufficiency, but also on fertility.

We talked about ovarian insufficiency and the potential reversal of menopause in mice earlier, and how things like NAD plus and ATP optimization from those angles can potentially affect it. So for some women, that mitochondrial angle to have optimal mitochondrial health in the ovary is a good vector to look at. You can also look at the time of menarche. So when when you basically went through adolescence, first period, etc. And if it was particularly early, then perhaps you have access signalling of things like leptin, and gonadotropins sets another angle that you can look for to delay the potential time of menopause. And then you can also look at the angle of one resistance or two ones, which we also looked at. There's some studies, we mentioned the studies on and men and NAD Plus, there's also been studies on medication and as rapa myosin, which of course targets that mTOR that we also looked at. So things like intermittent fasting potentially could help with that hormetic state as well. So there's a lot of different little things, but there's not any one single magical thing. The difficult part of this is up to now, if you have poi, there is no known way to reverse it, which is why a lot of individuals, including myself, are if you're looking to delay fertility, yes, you can consider those vectors and there's natural and medications that you can consider that will slow the ageing of the ovary, but nothing that we know at this point to reverse it. So for that reason, most clinicians if you're looking to have fertility into older and older ages, I'm a fan of freezing eggs. So that being said, the technology in these studies or very frequent and it is the area that we will watch closely.

Interesting. Thank you for that. Very, very helpful. Amazing. Well, thank you so much for for sharing so much. I know that you're very active on Instagram. Your knowledge is just incredible. Where can people can find find you and connect with

you. My main hub is on Instagram, it's Kyle Gillette, MD. And I also have a health optimization clinic that does tele visits and in person visits both, and that is called Gillette health and we're on all platforms. I also do podcasts with one of my partners from time to time and we get far down the rabbit holes of various niches. And his name is James and the podcast we do is called the Gillette health podcast on Spotify and YouTube and such

amazing thank you so much. We We'll link to that in the show notes. And everything else you've been talking about the studies etc. It's been amazing. Thanks so much for sharing your time.

My pleasure. Thank you.

Thank you so much for listening to today's episode. As always, the show notes will be over on my website, Angela Foster performance.com forward slash podcast. And you can download the transcript there together with the show notes and all of the other resources that I have on my website, Angela Foster performance.com. Thank you so much for listening, and I'll see you in the next episode.

Thanks for listening. Remember to review and subscribe, you can grab the show notes, the resources and highlights of everything Angela mentioned over at Angela Foster performance.com. You can also snatch up plenty of other goodies including the highly helpful Angela recommends page which is a list of everything she personally recommends to optimise your mind, body and lifestyle