Perimenopause: Know Your Body, Own Your Health with Dr Mariza Snyder

Explain what perimenopause is.

I would love if you're okay with this. So women go through three big hormone shifts in their lifetime. Well, potentially three. Definitely two. First one is first puberty. You know, you have daughters and we've as women, we've all been through the first puberty. And that is a four to six year transition. As we are navigating into our childbearing years. It is a massive hormone shift where the whole body is recalibrating. The second shift is going to be pregnancy and postpartum. Any mama who has been through that journey knows that who they are. On the other side, your brain is wired to protect your children at all costs and what a superpower that is. And then the third big hormone shift is going to be perimenopause, known as your second puberty. But instead of the ascension into our childbearing years, now we are descending out of those childbearing years. You don't just wake up one day and you're in menopause. It doesn't work like that. We go through a transition. And this transition is anywhere between, I would say, four to ten plus years.

Hey there. Thank you so much for tuning into the show. Today's episode is one I really, really wish more women were talking about because it affects so many of us and yet far. And yet for far too long, it's been misunderstood, dismissed, or just not talked about enough. And I mean, this is not just for the ladies. This is going to help you fellas too. I hope my husband is listening to this episode. I'm sitting down with the incredible Dr. Marisa Snyder. Look, I've got her book right here. She is the author of the Perimenopause Revolution. I can't wait to dig into this, this topic with her because I'm going through it right now. If you've ever felt like your body's changing and you don't recognize it, if your energy, sleep, mood, or weight is shifted and you've thought, what the heck is going on with me? You're not alone. And today you're going to get some answers. I'm so glad she's here. She is here, breaking down what really is what. What's really happening in perimenopause, why so many women feel blindsided by it, and most importantly, why, what you can do about it. This is about more than hormones, y'.

All.

We're going to talk about a lot. This is about reclaiming your energy, your confidence, and your sense of control. So get ready, because this conversation is going to empower you in a whole new way. Welcome to the show. Amazing. Dr. Marisa, look at this.

I am. Oh, thank you so much.

This book is like total legitness. It's not just a book. It's like a bible for people going through perimenopause. It really is. And I heard you speak at the first time. We were both speaking at Brooke Hemingway's align event. And I heard you on stage and I was like, I need to know this lady. Oh my gosh. You were just electrifying like your message, your energy from stage, but not only that, all the wisdom that you shared. I want to know, how did you get so passionate and knowledgeable about this topic?

I love this question. You know, I entered my practice in 2008. My mom had me when she was 19 years old. And so we are 19 years apart. And we've always been really close. My mom is someone I've had the really beautiful benefit, the privilege to get, to take, take care of. And when I was entering my practice as a clinician, and this was, I was 30 years old. And so she was 49. And my mom had been struggling, but she had been struggling in silence. You know, when I was growing up, she was a single mom. And the way that I always thought about my mom was that she was superwoman. She was a freight train. Nothing stopped her. This woman was incredible. And her capacity, her resilience, her energy, she just figured it all out. And I remember, you know, when she was going through this at 49, I got a call from her at 11 o' clock at night. And anytime your mama is calling you at 11pm, you answer the phone. Because your mom, your mom doesn't call you at 11:00 at night. Yeah, my mom was super scared. She was struggling with really, really intense mood changes, really depressive feelings. And she just didn't recognize herself anymore. You know, as we dug into it, you know, realizing that she was in late perimenopause and she had kept kind of shoving back the brain fog, the weight changes, the sleep issues, the low energy, the low mental energy. But it was when her thoughts, her thoughts became very intrusive and very scary for her that she was like, I don't really recognize myself anymore. I feel like a shell of my former self. And every time that she went to the doctor either, sometimes they validated her, but no one had anything for her except for SSRIs. My mom knew that there was something even deeper going on. And I thought, you know, as she was Navigating this. Two things. One, it was mind blowing to me how many times the healthcare system had failed her. And I was embarrassed as. As her. As her daughter not recognizing it myself. My mom just kept blaming herself, or she just kept kind of shoving it back. And two, I also thought as a third thought, I was like, ooh, is this. Is this coming for me? Like, should I be on the. On the lookout? But I ended up taking over my mom's care, and within 60 days, we had such a profound turnaround. And I knew in that moment that there were millions of women like my mother, that we're going through what I call a massive full body recalibration. It's not just your hormones. This is not a reproductive event. This is a neuroendocrine event. This is a metabolic event. Your bones are shifting, your muscle is shifting. Everything is up for review. And if we don't treat that time as a window of opportunity, it can really spiral, and we find ourselves in the second half of our lives struggling with lower quality of life. And so from that point forward, I knew that midlife women were gonna be my focus. I knew that we needed to get in front of it to build resilience before we got to this window of vulnerability. And Now I am 46 years old. I'm just a couple years away from where my mom was. And it has been such a eye opening experience to really be in it versus be a clinician and guide women through it. And I am so deeply grateful. But this was the reason why I wrote this book is I realized that it was such a bigger, profound experience than I could have imagined it was.

Yeah. And you know what? I'm so glad that you brought. And you're. You're. What a blessing you are to your mom to have you help her navigate this. But there are so many doctors. I mean, I've experienced this where I've gone to the doctor and said, something's not right. Can you do blood work? For first of all, I had one doctor say, oh, we don't believe in blood work. We don't do blood work. I'm like, what? How do you tell what's going on with, like, everything that's going on? Like, what? Went to another doctor, they did blood work, and they're like, yeah, everything looks okay. Then I'm like, something is not okay. It's so. I am not myself. Like, something is going on. And even my husband was like, yeah, something's going on with you.

So our family feels it. Our. Our children will feel it, our partner will feel it, the energy will shift our, you know, I always say that we, we as women, we know what our, our capabilities are. Women are so capable. I watch women do things that are just, absolutely, just awe inspiring. And when we step into that perimenopause transition, it's not always menopause, it's usually well before menopause. And you know who you are, you know your capabilities and yet your bandwidth shifts, your mental energy shifts, your capacity shifts. And it, you just, it's this disconnect where you're like, I know who I am, I know what I can do. And something isn't right because this isn't who I've been. And it's, it's so hard to articulate that to clinicians, to a doctor, especially a primary doctor, even ob gyn and, and help them, have them help you navigate the changes. And so for so many of my patients, it's always the brain related changes that really kind of flip them, kind of flip them into a spiral because then they don't understand why. Why is it that I can't remember? Why is it that I have a hard time being more focused? Why can't I multitask anymore? Why don't I have the same stress buffer? Why am I efforting so hard for just the status? This is what I often see.

Why does it bother me to hear somebody chewing or breathing?

Yeah. Yeah. The most common symptom of perimenopause, it's irritability. Again, that stress buffer, it packed its bags along with your progesterone and your cortisol like they just left the party.

Yeah, yeah. But you know what? We should go down, get down to the basics of ex. What is for somebody listening. And I had, I do have some fellows that listen to the show too. And I think it's important for you fellas to hear this because you're going to know what to do and what to say and when not to chew around your partner or breathe. Or breathe.

Or use a fork or use it.

Just get out of the room. No, after listening to this episode. But explain what perimenopause is because I don't know, you know, I don't know if my husband knows what that is. He knows what I think he knows what menopause is. I'm not sure. But explain what perimenopause is.

Yeah. And I would love if you're okay with this, reversing reverse engineering from menopause because I think a lot of us know what menopause Is. So how we define menopause is that you have gone 12 consecutive months without a period. And it's important to note that menopause isn't just a loss of a period. There's a lot of things that have shifted, but they have been shifting well before you get into menopause. So women go through three big hormone shifts in their lifetime. Well, potentially three. Definitely two. First one is first puberty. You know, you have daughters. And we've as women, we've all been through the first puberty. And that is a four to six year transition. As we are navigating into our childbearing years and our brains massively reorganize, but our entire body, our metabolism, our gut, microbiome, everything is shifting and changing. So a lot of extra grace. And to my girls right now who are going through puberty because it is a massive hormone shift where the whole body is recalibrating. The second shift is going to be pregnancy and postpartum. Any mama who has been through that journey knows that who they are on the other side. Exactly. Amberly, you are not the same woman. You are a different woman with different superpowers. Your brain is wired to protect your children at all cost. And. And what a superpower that is. And then the third big hormone shift is going to be perimenopause, known as your second puberty. But instead of the ascension into our childbearing years, now we are descending out of those childbearing years. You don't just wake up one day and you're in menopause. It doesn't work like that. We go through a transition. And this transition is anywhere between, I would say, four to ten plus years. Most my patients, it's six to ten. Like saddle up. That is not a transition, Amberly. That is a freaking career.

Yes, rhyme transition.

We as ovary, as our ovaries are heading into senescence, they're retiring. That's what they're doing. That communication between the brain, the ovaries begins to falter, and as a result, hormones begin to erratically decline. So it's not just that they're fluctuating. They are fluctuating and declining. But that fluctuation where hormones are not consistently rhythmically binding to receptor sites like they have for the last 30 years, give or take, all of a sudden they're showing up when they're not supposed to show up. They're maybe showing up a lot and then they disappear. It's this inconsistency of a signal. Remember, hormones are. They are modulating Inflammation, they are modulating growth, they are modulating our metabolism, they're modulating bone growth, muscle growth. I mean, they are running the show when it comes to communicating with our bodies. And as that communication, it's like, it's like being the CEO of a business. And one day you just don't show up anymore. You stop communicating with your vice president. You don't reach out to your assistant. You don't show up to work until like 6:00pm p.m. one day, and then you show up at 4:00am the next day. It's that inconsistency that the body is having to recalibrate that is literally perimenopause and ultimately the, the end point. And I wouldn't necessarily call it the full destination, but we get to menopause and then we move into, well, into menopause or postmenopause, whatever you would love

to call it, menopause or po. Why is it called menopause or post menopause?

It just depends on the clinical description or the clinical way that someone will describe it. So some clinicians say that menopause is the one day in time you're in menopause for one day. That's the day you haven't had a period for 12 consecutive months. Then the rest of it is postmenopause. You are. I, I just like to call it all menopause. That's how I like to call it. I don't need another word, you know what I'm saying? In menopause, from that point forward, this, that's, that is just where you're at. That's your standing in for the next, what, next 40 plus years, give or take.

Okay, so for somebody who's listening and they might be going, oh, wow, I think, I think maybe I might be in that stage of my life. What is, like, what is the silent driver of perimenopause? Like? What is something that makes it more intense or more, you know, you feel those symptoms more? Is there anything out there that we can do to eliminate that so we don't feel it so intensely?

Yeah, I literally, I think I just recorded a solo podcast on this topic, really. The silent disruptor of perimenopause. It's going to be stress. It's going to be our stress. I believe we come into. I will say what, you know, we were just, we, I just got the opportunity, the beautiful opportunity to interview you. We talked about resilience and how mission critical it is for our dreams and our purpose and our path. But also it's important with our health, resilience is everything. And so building resilience, well, before you get into perimenopause is going to be so important. And that is going to be with lifestyle. You know, lifestyles, habits, they do accumulate. And so if we come into perimenopause with inflammation, if we come into perimenopause with a lot of stress burden, and we come into perimenopause a little metabolically dysfunctional, you know, we already have creeping blood sugar and insulin resistance. We're already starting to see, you know, visceral belly fat develop. We start to see climbing lipids. This can happen before perimenopause. We know that the journey is going to be a lot more bumpy. But I think the thing that is the most surprising to women, because stress can be very insidious. You know, for me, growing up, you know, I was literally just with my mom. She's 65 now. That makes me 46. And she is kicking.

You look like you could be 26, by the way.

Thank you, Amberly.

Thank you.

My mama is a competitive tennis player. She decided that at the end perimenopause, I think perimenopause had kicked her butt so much until I took over that she was like, I am not. This is not the narrative. This is not how. This is not my identity. I don't identify, identify with that messy middle. I'm going to like, catapult into menopause on my terms. And so she decided to become a marathon runner. She decided to become a conventional here. And she decided that she was going to be hot, she was going to be sexy, she was going to be vibrant. And Fast forward to 65 years old. This woman's biomarkers are a chef's kiss. She trains for marathons at 4, 4 o' clock in the morning. She plays competitive tennis multiple times a week. This woman is unstoppable at 65 years old and she's about to retire from her job. And it's been such an interesting journey for her because she's like, I don't feel there's nothing about this that is retirable. You know, I. And I was like, you don't you just retiring from that position, you get to reinvent what it looks like, just like you did in menopause. And so I think it's important for women to note that at any given time, we get to determine what we want that second half of our chapter to look like. And we get to decide that we deserve prioritization, that if you have gotten to your 40s, and you've prioritized everything and everyone else because that's what society has told you to do. And symptoms are becoming a little bit more. They're just kind of yelling at you more than ever before. That is the moment of discernment where you say to yourself, like, what needs to be? What. What do I need to let go of? And how do I need to show up for me in this season? Because most likely a lot of us taking care of everyone else, us prioritizing everyone else as the OB obligations that we're holding onto are kind of silently driving some of those symptoms because we're not. We're not taking care of us in a meaningful way. And right now, your body is calling for a new level of support.

Oh, that's so good. And such a good reminder for me and for you listening that to. Really? They always say put the mask on yourself first before the oxygen mask on yourself first. I think that's sometimes hard for women. I know it's been hard for me that I will do and go and be. And it's like, go, go, go, go, go. Until I drive myself into the ground. And it's like I'm learning. I'm in my 50s, and I feel like I'm still learning and still having to remind myself to take care of myself sometimes. Because I'll put myself. I mean, how many of you put yourself last on the list? But to remember to put ourselves first so we can do all the other.

That's the reframe. That is the reframe. And I have. Because I take care of patients every day, and women tell me, well, would I have this job or I have these responsibilities or I have this everything? And I was like, but how. How do you feel like you're showing up in those moments? You know, how are we getting a worn down version? Are we getting an upgraded version? Are we getting an optimized version? And I was like, probably getting a worn down version based on symptoms. They're coming to me. There's some stuff going on. And so by prioritizing yourself, number one, especially in a time where things are happening silently behind the scenes, perimenopause isn't just a time you hear a lot about. It's hormone chaos. And it is. It is definitely hormone chaos. There's no doubt about that. Hormones are doing a whole lot of things that are not that. That are causing some symptoms. I'm not saying that that's not. And, you know, it's what I hear. So Often from clinicians or what women are told is that it'll all just, it'll all just work itself out, then of chaos, it's all going to be fine. And I was like, yeah, but what, what about the accelerated bone loss? What about the accelerated muscle loss? What about the insulin resistance and the visceral belly fat and, and the brain that is developing a bit more inflammation if we really aren't being more intentional about taking care of ourselves? Yes, maybe these things won't really show up in terms of massive symptomology until you're in your 60s. But I promise you, you're laying the groundwork for that, for future health outcomes. Now, there's a reason why your body is telling you something isn't right. There is a reason why things are. That you feel the symptoms, these symptoms are signals, and that we have to listen to it. So if you've been freight training your life all the way up into this point and you kind of feel like you just hit a wall, it's time to listen to that. And that was my mother. My mom just, she freight trained all the way to 49. I have followed in my mother's footsteps my entire life. You know, I always wore productivity like a badge of honor. I wore. And that was the thing I wanted to share. I was with her, and she's like, you know what we do, Marisa? I was literally with her last weekend. She's like, we pushed through at all costs. I was like, at all costs. I'm like, are you sure there isn't a cost? I'm like, I'm pretty sure there is a cost to that moment. Yeah, you're cracking me up right now. Like, I was, yeah. Felt the cost.

Okay.

Like, I don't know about you, like, maybe you're made from something different, a much more durable material than me. But, like, I have found that I can't push through at all cost anymore.

Like, no, I can't.

Sacrificing I.

You, I used to do that and I, I, I can't anymore. I don't want to take the chance anymore.

And that's okay. That is okay. I think it's important to know, like, we had, there's, we, we get to be strategic, we get to be smart. I don't want women to think that they have to give up on their dreams or I have to step back a little. I think it's about being strategic and it's about, you know, again, there's probably things that you're doing right now that you don't need to do or that are sucking your energy that you don't even love doing. I think this is why I love your book so much. Joy through the journey is that we get to do the things that bring us joy, that help to cultivate more joy. And we also get to let go of the things that are. That are. That is dampening our joy as well. And so that's what this season is all about. It's about discernment, it's about values and it's about taking care of you. What, like you probably haven't taken care of yourself before.

Yeah, that's so good and such a good reminder for. In. In a good reminder for even if you're not going through the perimenopause revolution.

Absolutely.

You know, to like, the sooner we

can learn that lesson, the better.

Yeah, for sure. You talked about inflammation and I would love to talk ask you about that. What are some daily habits to reduce inflammation?

I love this question. I would say, you know, we were talking about this too earlier with you is I always think about food as the foundation. Now food isn't necessarily the force multiplier and I'll, I'll just, I'll, I'll share what that means in just a moment. But food is always gonna set the table in terms of foundation. You're either eating towards more inflammation or you're eating towards greater resilience and capacity. And so the way that I love to think about food is, is this what is. Is what I'm putting in my body right now going to fuel my future brain? It's going to give me resilience, it's going to give me the buffer. It's going to allow me to be sharp and focused and have the energy and capacity to show up the way that I want to for my friends, my family, my patients and the people that. For this conversation. So I always think about how do we fuel ourselves? And we should be thinking about foods that support our blood sugar and our cellular energy. So I think protein, healthy fats, fiber are big ones here. Next it's going to be foods that are focused more around anti inflammatories. So foods that are going to feed the gut microbiome, things like probiotic rich foods and prebiotic rich foods. Lots of the color of the rainbow. So as much as you can eat the color of the rainbow, that's going to fuel your cellular energy. And then we got to think about, we got to talk about things that are going to mess with our cellular energy. Ultra processed foods, refined Foods, added sugar, alcohol. You know, I think there's a lot of narrative around the wind down for women and moms, particularly in this transition. And I will tell you, alcohol is doing you no favors in terms of your brain function, your sleep, your heart rate variability, your resting heart rate, how you feel the next day. And so again, discernment is a big one here and fueling your body is going to be number one next. Sleep, Sleep, Amberly, is a force multiplier. I don't know about you, but sleep will make or break me the next day. Gone are the days, girl, where I can just run into bed and expect to fall asleep. And we know that when we are sleeping, especially to get that quality REM sleep, that deep sleep, that we are going to clean up all the amyloid plaque, we are going to basically do a nice little kind of brain cleaning throughout the night. Like sleep is an act active event of restoration. And if you want to reduce inflammation, sleep is always going to be a part of that pillar. So that's number two. And the reason why it's a force multiplier is so many women, at least women that I get to work with, are struggling with energy, especially in the morning. They're dragging themselves out the door every day to get to work. And it's because their sleep is, they're not just getting the quality of sleep that they need. And so we can go deeper into sleep. But I always tell women, honor your sleep routine like it is a million dollar meeting and go to bed at the same time and wake up at the same time every single day. And I love what you talked about when we, I was interviewing you about brain dumping, getting all of it on paper and getting clear on your non negotiables, your big rocks for the next day so that you don't have to worry about that when you're trying to get to bed. That's going to be a big one as well.

Well, do you have like a nightly ritual that you do that helps you kind of wind down?

Absolutely. I call it the sacred sleep ritual that I recommend to all of my patients. And so I always tell women to what I ask them, what time do you want to get up in the morning? Let's say 7 o', clock, is it 6 o'?

Clock?

Is it 5 o'? Clock? And then I want you to reverse engineer about eight hours from there, give or take. So if it is 6 o', clock, that means 10pm and then an hour before that, that's when we want to set up for sleep. So for me, after I put my son to bed, usually asleep, like full lights out, he's in bed at 8:15. And so I have about an hour, Amberly, to kind of just handle some things, unload the dishwasher, clean up the kitchen, you know, maybe, maybe send an email or two. I try not to do that after I put him to bed, but sometimes things are mission critical. Nine o' clock I go downstairs in the kitchen, I get my supplement stack. It's usually omegas, it's turmeric and curcumin, so reducing inflammation. It's usually my, my electrolyte support water. So I put ice in that magnesium glycinate. So whatever your little stack is, I take my stack, I go upstairs, I do my little beauty routine, which isn't super crazy, but if you've got a sexy beauty routine, by all means. And then I do a brain dump. I get really clear on my non negotiables for the next day. And then I do a, usually a 30 minute kind of relaxing meditation before bed and a little bit of breath work. But note that the house is cool, cooled down. I've got blackout curtains on. I've done all the sleep hygiene that lights are dim. My phone is put away except for the little meditation, but it's still over there. It's in a voice note, so my phone is even in airplane mode at that point. And I am in bed by before 10 o'.

Clock. And what's beautiful, how you are, you're so good.

It's, it's again, it's, we talked about discipline before, but it's just, it's become, it's who I am. When I ask myself, you know, who is my future healthy? The future healthy version of me. It's a woman who wakes up feeling energized. It's a woman who wakes up to do rock her morning routine. It's a woman who shows up with presence and energy and joy for the people that matter most to her. And if sleep is going to be the force multiplier on how I show up and my values are based on the joy and, and being present, then, then there's no negotiating on that front.

That's so good. I think you explain it very well because you gave your. Why, why are you doing it? Well, this is why it's so important that you show up a certain way. So that's why you do it. It's like same for me, working out. Like there are times I don't really want to work out, but I walk into the Gym and work out, because I know it's going to make me feel feel better mentally and physically. It's going to boost my confidence, it's going to release those endorphins. So I think that's important to know your why that really makes sense. And that's going to help me get to better bed, better than I have been in the past.

Well, if you want, I can help mitigate sleep as well. So let's say sleep is an issue and you're even trying all the things. And I've got lots of strategies around sleep as well. But let's just say sleep wasn't that great last night. What we can do to kind of give ourselves a little boost is one honor, that morning routine. So treat that morning routine like you got great sleep or maybe you didn't get. That morning routine is ever more potent for you because you didn't get good sleep the night before. And part of that morning routine is getting outside in sunlight. So if you want to help mitigate feeling like hot garbage the next day because you didn't get the kind of sleep that you want. And. And for women in midlife, it can be so hit and miss. I get it. You could have great sleep for a month, and then all of a sudden it spirals out, even with the best intentions. And so I always tell my patients, like, get outside in sunlight as much as possible during the day to help support your circadian rhythm, but to also energize your mitochondria, energize your cells. That's going to give you a little bit of an advantage towards the fact that you're kind of running on fumes. So there's ways we got to kind of, you know, again, if you're not sleeping well, get that sunlight, make that, get those micro movements in, but get those micro movements in during the day when the sunlight hours are still happening. So that will give you a little boost.

That's so good. And, you know, I. I have my little nightly ritual, but I can. It needs some improvement. But one of them is I love to drink tea at night and herbal tea at night. And I, I travel my tea, my herbal tea that I drink at night. And the first thing I do when I get to a hotel room is like, okay, well, where's the coffee maker if there's not a coffee maker? I'm like, well, I got to go down and find hot water somehow, some way, just because I like having that ritual. Now. Do you do meditation every night and breath work every night?

Yeah. And I love tea. I. You know, I always debate, like, how much I share about my night routine because I don't want women to think as they're listening to this, like, who's got time for that routine? So I always am really strict, you know, kind of. I'm very strategic about sharing the sleep routine. But a sleepy tea or a calming tea, an adaptogenic, you know, herbal tea. Hey, I think all of us deserve a beautiful ritual to kind of anchor us in. Maybe it's essential oils. Maybe you love the smell of lavender in your room, and it really. It sends that little cue to your brain to kind of put on the sleep pressure, right? Oh, the brain's like, oh, it's time for go. It's time to go to bed. So I think tea is a great one as well. And you would ask me. I'm so sorry, you were asking me about.

Well, I. I just. I just have to say really quick. I was talking to a friend of mine the other day. I was like, man, if people only saw what it took to show up. Energize.

So true.

I remember when I was, like, younger, I would just get up and go. Like, when I was in the fitness industry, like, when I first started, I would seriously just get out of bed, brush my teeth, throw my shoes on, and run. Like, put a baseball cap on, no makeup, didn't do my hair, just would go. And was fine with that. Now it's like, okay, the supplements that I take, the sleep that I focus on, the hot tea, the. All the things it's like, a lot. The facial, the creams.

There's a part of us that deserve it. I mean, I. Same thing with you. I could just get up and go. And I still love to. I always say I love to set my future self up for success in the morning. Amberly. So at night, part of my routine as well is I lay out all my workout clothes. I make my protein coffee. It's an iced coffee that's in the fridge. I have water and ice water with electrolytes at the door. My shoes are at the door. The keys are at the door. My hat's at the door. And so I can be ready and out the door, even if it's just a walk before my family wakes up in literally eight minutes, seven minutes, I can do it because it's all ready. And again, I've released the tension. I've released the resistance. It's just who I am. But I find meditating at night. That's what you said. Meditating at night or Listening to a good fiction book now, not something like a thriller or a detective novel or something like that. Something a little bit more calm. But usually I'm listening to something before bed and that just turns my brain off. I'm not ruminating my, you know, I'm not trying to solve the world's problems or the crazy grocery list tomorrow. I'm just listening to something that's either meditative or that is a book, like a fiction book. And usually that knocks me out within about 10, 10 minutes.

Oh, that's good. Yeah, I like listening to, I use the, I'm not affiliated with this, but I like the Calm app. And there's one in particular I'll listen to over and over and I won't even get through the whole meditation and I'll be out. But we have a lot of high achieving like women out here. High achievers, they go, they're running companies, they're running several companies. They're moms, they're just going, going, going, going. What are some supplements that you would recommend for high achievers out there?

Oh, I love this question. Well, I think we're talking about one, optimizing cellular energy. Two, mitigating inflammation. That is the name of the game. Top five. And then I'll get into more cellular energy type supplements are going to be omegas. You want to, you want to significantly reduce brain inflammation so that you are firing all cylinders. Mitigating brain fog, mental fatigue, you know, lack of word recall. Two grams of omegas, making sure that you've got sufficient EPA and DHA in there. There's a lot of great companies that make good omegas out there. I'm not affiliated with any of them. Next is going to be about 4,000 IUs or so of vitamin D with K, vitamin D3 with K. Two, check your levels, see where you're at. But 98% of my patients have sub, suboptimal vitamin D levels. This is going to drive inflammation. It's an inflammation marker. It's going to be a big one. Activated B vitamins. So methylated B vitamins, think B9, B12, but the whole spectrum so that you are making sure detox pathways are open and you are running cellular energy. You're mitigating blood sugar. Magnesium, I love magnesium glycinate, magnesium, threonate, malate glycinate for bedtime, for brain support. Threonate or malate are great. You can get a blend of all of them if you love. Totally up to you, whatever you're needing and then how many Milliliters.

How many milligrams?

Great question. I love this question. Usually 400, give or take, I would say up until like a week before your period. I even will take patients up to a gram. So a thousand milligrams of magnesium. So anywhere between 4 and 600. Again, majority of us are also deficient in that mineral, so usually we need a little bit. And I usually recommend the stack at night before bed because magnesium can be so calming.

Yeah.

So it's a part of my nightly stack every single night. And then gut microbiome changes are going to happen. With declining estrogen and progesterone, it is just the way it is. So obviously we want to do that with food, but also a good probiotic. So find one that you love. I love spore based probiotics. Just Thrive is a company that I've used for myself and my family. So just finding one. And then we get into cellular energy. So big ones for cellular energy are going to be urolithin A. I love urolithin A for mitochondrial support. I love an NAD precursor like nmn. Yeah. So because again, ovarian senescence is happening. Our ovaries age faster than other parts of our body. And as our ovaries are aging until they get to senescence, that does catapult accelerating aging in women. It is what is. So we want to be mindful having good mitochondrial support. So acetyl L carnitine is going to be good. Creatine is a big one, not only for muscle support, but also cognition. I'm usually recommending anywhere between 6 grams and 12 grams of creatine. That's going to be a big one. And then, you know, for mitigating inflammation, this is a big one for me. I've had concussions, I've had brain issues in the past. So glutathione, resveratrol, some combination of those are going to be really important for mitigating system wide inflammation. Especially if you're seeing an inflammation marker go up like highly sensitive CRP or uric acid or even vitamin D levels. That usually is an indicator to me that there's some ongoing low grade or maybe even moderate grade inflammation.

Okay, I love. I need to get some glutathione. What do you, how do you feel about those IV treatments?

I don't know if they're necessary. You know, the way that I think about it depends on what's going on with you. You know, if you've got more of a chronic issue. But most of us, you know, I would say that there's nothing about this modern day life, Amberly, that lends to optimized hormones or that lends to an anti inflammatory diet or a diet, but like a body. And so I really am more of the mindset that we should be supporting our cellular energy. We should be mitigating inflammation every single day. And so I'm usually recommending a liposomal glutathione. There's a lot of companies that make a great liposomal glutathione. Despio, Quicksilver, there's. There's a lot. But make sure that it is liquid and liposomal. I'm usually recommending about 500 milligrams.

Okay, 500. I'm taking notes. Just so you see, over here, you

are struggling with brain ish, like let's say cognitive. You're just noticing the brain fog. You're noticing the fogginess. You're struggling with the energy. It's for my patients, it's the mental energy, Amberly. They're like, I just can't fire the way that I used to. I'm having to try a lot harder to do the things that were effortless, like, I can't multitask. My buffer is gone. And so I'm always like, okay, well, how do we, how can we mitigate the brain changes in inflammation? And so usually a supplement stack, but the big pillars here are going to be an anti inflammatory diet. And I, in the book the Perimenopause Revolution, I lay it all out for you. So you do not have to guess on this at all. It's going to be building muscle. And you know, we talked about exercise snacks when I interviewed you. And it's just movement. You know, you don't, you don't need to be in the gym a long time. It just needs to be quality time. It can be 30 minutes, it can be 20 minutes. I, before I kicked off all of these interviews today, I've been back and forth on podcast interviews all day. I had 20 minutes. I had 20 minutes. And I'm going to be building in exercise snacks throughout the rest of my day. But I knew that it was 20 minutes that was committed, I was focused, it was quality. And then I'm going to fill in the gaps throughout the day. And if that's what you can do, then do it. Okay? You don't. Gone are the days where women in midlife need to be in the gym 55 minutes. You don't, you don't. If it's not working for your schedule, you don't have to subscribe to that. You need to do what works.

I agree. I agree. I mean, I used to be insane. I'd work out for two hours.

Two hours in the gym. Absolutely. First, like, cardio for an hour, strength training for an hour.

Yeah.

And I wish I had that kind of time.

Yeah.

The bandwidth. My body doesn't need that.

Exactly. I am right there with you. I love your book because you also have recipes, but I also love your book because it's so well written and it's easy to read, but it's something that I can flip through and go grab whatever information that I need. So where is the best play? I mean, I could seriously talk to you for hours.

I know. There's so many good things, so many

things that I know you've got to run, and I just. I just adore you. But, you know, and we talked about you getting to Dallas. So when you come to Dallas, we'll have you on the show and we'll get you in the studio when you get. Okay.

Yes. Let's do it. Yes.

Okay.

So where do people buy this? Yeah. DrMarisa.com forward slash book. And here's the thing, Emberly. I believe women deserve the best of things, not the least of things. So I did not gatekeep anything. You've got more recipes, workout plans, exercise plans, videos. It's meal plans. It is my sleep routine, my evening routine, lab guides, optimal lab ranges, guides on how to actually advocate so that you get the care that you deserve, the gold standard of care that you deserve. It is all in the bonuses. It's a part of the book. I mean, I left no stone unturned in that book because I wanted women to have everything that they needed.

Well, you are amazing. I love your book. I love everything about it. And I saw that Dr. Mindy's on. On your book too, and she was on my podcast. She's amazing, too.

She's amazing.

Yeah. Yeah, yeah. Well, you. This. This conversation has just been so important, and I just appreciate you taking the time to be on the show and share your wisdom. I have gotten so much out of your book, but also just our time together. And again, tell people again where they can find you your book and work with you.

Yeah. My website is Dr. Marisa.com. Dr. Marisa forward/ book for the book and energized with Dr. Marisa is the podcast where I'm having conversations with incredible women like Amberly. And that is where, like, you want nuts to bolts about what to do about a specific issue, like going through midlife. That's where you're going to find it.

Yeah. You're amazing. Thank you so much. And thank y' all for tuning into the show. It is seriously, because of you tuning in. You've made this a top 1% podcast. I appreciate you being here, and until next week, I'll see you soon.

Thank you.