Dhru Purohit Show - Why Women Struggle with Insomnia, Weight Gain, and Debilitating Symptoms During Perimenopause and Menopause and What to Do About It with Dr. Sarah Berry

Episode Date: November 6, 2024

This episode is brought to you by Bioptimizers, Bon Charge, and Lumebox.  We know that perimenopause brings a host of symptoms for women entering this stage of life. These symptoms can disrupt sleep, affect mental health, and cause weight gain, often leading to a decreased quality of life. Today’s guest shares insights from her nutritional research to help women reduce these symptoms' impact and feel empowered through this transition. Today on The Dhru Purohit Show, Dhru sits down with Dr. Sarah Berry to discuss a recent study led by her team on the impact of diet in reducing common symptoms for perimenopausal and postmenopausal women. Dr. Berry shares the most commonly reported symptoms and the lifestyle factors contributing to them. She also explains the research behind why muscle mass serves as a protective barrier during this stage of life and discusses the role of blood sugar and a healthy gut microbiome in managing symptoms. Dr. Sarah Berry is a Professor at King’s College London and has run more than 35 human nutrition studies. Notably, she is the Chief Scientist at ZOE, the science and nutrition company. She’s the lead nutritional scientist for the ZOE PREDICT study — the world’s largest in-depth nutritional research program and leads research across menopause, microbiome, and sleep. She's often featured as a guest on ZOE's own podcast, ZOE Science and Nutrition. In this episode, Dhru and Dr. Berry dive into: Weight gain and slow metabolism are the top concerns in perimenopause (1:00)  BMI the correlation between more severe symptoms (6:00)  Dr. Berry’s study (12:26) The worst drivers of symptoms in women (17:09) What is a MenoScale (24:49) Muscle mass as a protective measure (30:07) Why do blood sugar and insulin sensitivity matter (34:12) Breakfast that can cause huge dips in blood sugar (38:37)  How does gut microbiome change as we age (42:00) Doubling down on the basics (56:32) Being cautious about supplementation (01:05:22) Also mentioned in this episode: Zoe Nutrition Study  For more on Dr. Sarah Berry, follow her on Instagram, Twitter, YouTube, or her Website. This episode is brought to you by Bioptimizers, Bon Charge, and Lumebox.  BIOptimizers Black Friday sale on all their products lasts all November long. Just go to bioptimizers.com/dhru and use code DHRU to get your discount and $100 worth of free gifts today! Right now, BON CHARGE is offering my community 15% off; just go to boncharge.com/DHRU and use coupon code DHRU to save 15%. Starting November 8th, Lumebox is having their biggest sale of the year and is offering my community 50% off their FDA-registered portable Red Light device! Just go to thelumebox.com/dhru to get your device today!  Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Sarah Berry, welcome to the podcast. But I want to start off with something that I know is at the top of the minds of so many of our audience members, women, of course, in particular. And it's something that you guys noted inside of your study. So this is jumping ahead a little bit, but we're going to be zooming in and zooming out. In your study, you reported that 66% of perimenopausal women reported experiencing more than 12 symptoms, 12 symptoms. And inside of that, the most bothersome symptom reported

was weight gain and slowed metabolism. 31% of the participants reported having that. I know from my audience that this is one of the top concerns as many of them are going through this stage and period in life. What are the top root drivers that are causing so many women to experience this symptom in particular of a change in metabolism? Estrogen. Estrogen loss, estrogen decline, estrogen fluctuations.

But not estrogen only affecting our body weight and our metabolism, but affecting so many other areas that then interlink with this. You know, our metabolism, our body weight isn't just about how. how we metabolize food or what we're eating. It's so multifactorial and it's so interrelated to the other pillars of health. So our stress, our sleep, our physical activity as well as what we eat. And we know that menopause impacts all of that. So we can deep dive a little bit into why.

One thing just to pick up on, Drew, is actually it was over 80% of our women said that they were experiencing weight gain or slowed metabolism. Wow. That is huge. And when we think about perimenopause, often people think about hot flashes, hot flushes, night sweats. That's the least common symptoms. So as you said, the one of our most common symptom was this weight gain and slowed metabolism. So there's different things going on here. We need to step back and firstly think, well, what is the role of estrogen in our body? The role of estrogen is to impact a whole wide range of different processes, different physiological processes, different neurological processes in our body. actually have estrogen receptors over nearly every single cell in our body nearly. So estrogen impacts so many different processes in our body. And this is why when you go through the menopause transition, which involves the loss of estrogen, then you have such wide-reaching impacts across your body. One of the thing that estrogen does, it has quite an important role in how and where

we deposit fat. So where we deposit adipose tissue. cells, these are fat tissue cells. And really simply put, what happens is when you've got a good amount of estrogen, so your premenopausal, the estrogen kind of directs the fat around your hips. So we typically say premenopausal women have this pear shape look. So they have their fat around their bottom and their hips. Now, as your estrogen declines during the perian postmenopause, you've no longer got that kind of protective effect of estrogen driving the fat to sit there. it's then repositioned around your belly. What we know is that a fat around the belly,

which we call visceral fat, and we call it visceral adiposity, if you have, you know, too much fat around the belly, we know that that's associated with the really unfavorable metabolic effects. It's involved with inflammation. It's involved in insulin resistance, etc. It's metabolically very active, but in a quite harmful way. And we actually know that postmenopausal and perimenopausal women are five times more likely to have that central visceral adipositis that fat around the belly compared to premenopausal women. So it's one thing that's happening.

But what we also know is in addition to that, estrogen's impacting lots of other areas. It's impacting our brain. So it's interacting our perception of hunger and fullness. And there's some evidence now emerging that actually food that would have kept us full, when we were premenopausal, isn't keeping us quite so full now because it's impacting our hunger. This is new area of research. We don't know conclusively yet, but it's quite interesting what's coming out regarding that. And we hear anecdotally people say this.

You know, I'm 47. I'm perimenopausal. Lots of my friends are talking about this. They say, oh, but I'm eating exactly what I used to eat, but I'm still hungry all the time. It's changing our perception. We've then got the fact that most, and again, we see 85% of women have sleep. disturbances if they're perimenopausal. So you've got people not sleeping well. When you don't sleep well, we know that the reward centres in your brain are heightened. So what happens is, is the next day

after you've had a bad night's sleep, your brain needs a quick fix. It needs a dopamine hit. And so it's driving you to go and select foods that we know aren't very healthy, the refined carbohydrates, the pastries, the white bread, etc. And then what we also know is if you've had a bad night's sleep, your blood glucose response following a bad night sleep is more unfavourable compared to if you've had a good night sleep. So that just shows how you've got all of these different things kind of intersecting and then you've got things like anxiety, depression, low mood. Now I don't know about you, Drew, but when I'm feeling fed up, the last thing I want to do is exercise. The last thing I want to do is think about eating a really healthy diet or not having that glass of red wine in the evening. So you've got like this perfect storm of symptoms,

lack of sleep, the estrogen driving, your fat tissues to be in different areas. And all of this culminates in weight gain. And all of this culminates in different ways in how you metabolize food and your metabolism. Incredible. You know, this also highlights the important topic of there's a vicious cycle that can end up happening. You don't feel well. You don't sleep well. You're craving the wrong foods. You gain weight. And one of the important things that you highlighted inside of your study and we'll set it up here in a second and give a little bit of an overview, is that the higher the BMI goes, the worse the symptoms are. Can you talk about that? Yeah, absolutely. So one of the things we looked at, and this is in 70,000 women who we asked them

lots of questions about their menopause symptoms, the impact they were having on their quality of life, and then we also collected lots of health data. So we collected data on their microbiome, their blood glucose responses to food, their BMR, their health history, etc. And then we looked at how do people's symptoms differ according to lots of these other factors. And what we found was that people as their BMI increased, so as their body mass index,

so they would be predicted to therefore have more adipose tissue, more fat tissue. As that increased, their menopause symptoms got worse. And it was kind of in a stepwise progression. So every time their BMI went up by a few points, so did their menopause symptoms. go up. But this is what's really challenging. You know, ask a peri or postmenopause or overweight woman will just go and lose weight and she'll probably throw her coffee at you. So because it's so

challenging. So you're in this kind of vicious cycle where the living with obesity or living with being overweight is making your symptoms worse. Those symptoms for most people are then going to make it harder for people to lose weight. And so I do think there has to be an element of being kind to ourselves as well as pairing postmenopausal women that look it is harder it is tougher it is a perfect storm the odds are stacked against you but having said that there is still hope there are still things we can do about it yeah and we're going to get into some of those things that you had the study participants do and the improvements that they saw in the symptoms that they were facing but let's start off a little bit big picture we kind of talked about it you talked about it a little bit so just

explain high level this study. Who was a part of it? You mentioned it was 70,000 people. What did you have them do? And what were you looking for? So there's two core areas we've been looking at at Zoe. One is we've been looking at the relationship between menopause and health, so disease. So we've been doing some deep dyes into looking at how menopause is related to disease risk factors like blood pressure like post-mill glucose responses, etc. And that's the study we published a couple of years ago. And I'd love if we've got chance at some point to pick up on that because I think it's great that we're talking about menopause more internationally.

It's great that we're talking about symptoms. But what we mustn't forget is the impact that menopause also has on our disease risk related to metabolic diseases like cardiovascular disease type 2 diabetes. But we can pick up on that later. The main research that we've published recently over the last few weeks is some research that we have been collecting data on for about three years, where we've been asking women at a given point in time, what are your menopause symptoms and then taking lots and lots of other measures? This is part of our Zoe predict study and this is a huge cohort of individuals. We have 200,000 individuals in total, some of whom we're following over a period of time. It's the largest in-depth nutrition and health study internationally.

70,000 of these individuals are peri and postmenopausal women. We have about 30,000 that are perimenopausal and 40,000 that are postmenopausal. And this is really important because a lot of research looking at menopause and looking at diet or looking at other health kind of related factors or symptoms, actually just look at postmenopausal. like how does this diet affect postmenopausal women? What we've done is we've got this huge 30,000 individual perimenopausal cohort and these 40,000 postmenopausal cohort. And this is important because we know that the menopause transition period,

i.e. when you're going from pre to postmenopausal, is a really important time, particularly in terms of symptoms. And I'd love to just quickly pick up on that just in case anyone's not so familiar with these different terms. You don't go to bed one night and you're premenopausal and you wake up the next day and it's like, hey, I'm postmenopausal, great, it's all done. There's a transition period and this transition period can last anywhere from two years to eight years for different individuals. On average it probably lasts about three to four years, although it varies across different populations. And during this transition period, this is when your estrogen and other hormones start changing.

But your estrogen doesn't again just slowly decline in this lovely kind of leaf. linear way so that your body sort of gets used to it. It's like a hormonal roller coaster. It's like this chaotic time where your estrogen's going up and down. It's fluctuating day to day. Then what happens is eventually the estrogen kind of settles off at a low level. And that's the stage at which typically your periods will stop. And then we classify women as being postmenopausal when they're one year past their last menstrual cycle. So one year past their last menstrual cycle. So one year they've passed their last period. But that kind of five years before then becoming postmenopausal

is this stage of hormonal chaos when you have these changes, these fluxes, etc. in estrogen. So it's really important we look at symptoms in that perimenopausal phase, but really important we look at symptoms also postmenopausally. Because again, just because your estrogen is no longer bouncing around, you do have very low estrogen. and it takes a while for your body to adjust to that. So symptoms still occur join the postmenopausal phase.

So what we did is we collected data on these 70,000 individuals related to menopause and different exposures. So by exposures, what we mean is different factors that might be related to how people experience these different symptoms. And then we looked at how diet was related to it, how physical activity, how lots of different exposure smoking, obesity, etc. And then in a subgroup of individuals, of around 4,000 individuals, we followed them up over a period of time. And we followed them up after they started to make changes to their diet. They actually went on our Zoe program, which is a personalized nutrition program.

And we looked at how their symptoms changed over time and looked at how that related to the changes that they were making in their diet. Is it possible to extrapolate for our audience here? what were some of the worst drivers of symptoms when it came to the lifestyle and dietary components? What are the worst foods? What are the worst lifestyle habits that made a lot of the women have higher symptoms? Is it possible to extrapolate that from the study? So we haven't done that specific analysis yet. We're sitting on this gold mine of data and we're only just starting to churn out some of the results.

What we're doing is we're looking at each of the different exposures separately, looking at how they impact them, but the next stage is to look at that relative kind of weighting, you know, what's most important, what's least important. What we know is that diet's playing a really big role. So when we look at the association between overall healthy dietary patterns and symptoms, we see that that has a large role. We see that physical activity has some role,

not as big as I thought it would have. We see that living with obesity has a role. We see that smoking has a role as well. But out of those, our current analysis, although we're still kind of crunching some of the numbers who showed that having a healthier diet is the single biggest change outside of taking HRT that you can do to reduce your symptoms.

But we do need to point out that this is data from what we call longitudinal data where we follow people up over a period of time. We don't have a control group. It's not a kind of randomized controlled trial. So we can't say that this is conclusively causal evidence that changing your diet absolutely causes this amount of change. You know, the term healthier diet means different things to different people. Yes.

In fact, if you interview people on the street, you know, a man on the street style, you go up to them and say, do you eat pretty healthy? You know, most people are going to say yes. because they think of their diet as being healthy. So take us a little bit further beyond that. What are some of the themes, at least, of when you say healthier diet? What were some of those themes that were present for individuals who were experiencing less symptoms? So we looked at diet in a number of ways.

We first calculated an overall diet school, and this is what we often do as a nutritional scientist, just to see, is there something going on? And there's different diet scores out there. There's scores like the Mediterranean diet score. There's scores like the PDI, which is the plant dietary index score. And there's a score called the H.E.I, the Healthy Eating Index, which is basically a measure of how well we're adhering to kind of dietary guidelines, for example, in the US.

So we looked at a few different scores. They're all kind of the same in terms of that they are roughly encouraging, you know, very much high fiber, plant-based, whole foods. low in ultra-processed foods, low in refined carbohydrates in general. And what we found was that for every few point increase in these diet scores, you were seeing a reduction in symptoms. Now, some of the symptoms were reduced to a greater extent than other symptoms. So there's some symptoms that diet seem to have a bigger impact.

So particularly the psychological symptoms, diet seem to have the biggest impact. So these symptoms are, for example, the mood swings, the irritability, the anxiety, as well as some of the other cognitive conditions like memory loss. Oh, and now I'm forgetting. Every time I say the word memory loss, my memory loss part of my brain comes in. But that's where we seem to have the biggest impact for improving diet. What we also did is we did a deep dive into looking at individual dietary components. So having seen that on average, if you're following a healthy diet, you experience about a 35% reduction in your symptoms, which is, you know, a huge. This is on average across all of the different symptoms, but some being greater than the other.

We also saw that that reduction was of the same size whether you were taking HRT or not, because this is something people often ask. So we, again, because we had such a big cohort, we could adjust for lots of different variables. We could adjust, you know, does this differ depending on whether you're always. on HRT or not on HRT, those on HRT are obviously coming from a lower starting point in terms of how many symptoms they have and how burdensome the symptoms are. But what we found was that even if you're taking HRT, you still get this big improvement in symptoms when you follow this overall healthier diet. And then when we started to drill down into individual components, and we haven't published this

yet, this is quite new analysis, what we found was that there were some foods that were associated reduction in quite a number of symptoms. So we saw, for example, seeds and nuts, they were associated with a lot lower prevalence of symptoms. We see that fruits and vegetables as well were associated with lower prevalence of symptoms. And we saw that some dairy products, so for example, the fermented dairy products like the whole yoghirts and cheeses were also associated with lower symptoms. And then conversely, we saw that some of the starchy refined foods, so starchy refined foods like white breads, white rice, white pasta are associated with greater symptoms, and that some of the quite heavily processed foods that are high in sugar or high in kind of saturated

fat were associated with more prevalence of symptoms. So nothing kind of surprising in terms of It's kind of just going in the direction of a healthier dietary pattern. The strongest association was the seeds and the nuts, which I think is really interesting. But I wouldn't say there was a silver bullet as such that came out. But we're still crunching some of the numbers. This isn't published yet, this data. That's fantastic. You know, you guys have created something called the Meno scale.

I just want to have you explain it. And what is it that you're trying to find out by having people figure out where they stand? on this scale? Yeah, so having done all of this work, looking at how many symptoms people had and the impact that they had on their quality of life, we started to learn what was really important, what were the most troublesome symptoms. And we started to also reflect and look at what questionnaires are out there. The questionnaires that are out there are developed in the 70s, for example, so they're 30, 50 years old. They're using quite what I think is inaccessible language. I mean, they ask questions like, what is your excitability levels?

Now, as a female, if I was asked that, I would probably want to punch my GP, my doctor, but asking you that, you know, they were developed at a time where things were very different for women. And so what we wanted to do is we wanted to develop a questionnaire that was informed by our science, that covered the most prevalent symptoms, that was usually. user-friendly, that used modern language, but that also assessed the impact that the symptoms were having on their quality of life. And so we developed this questionnaire, and it's got 20 questions. These are what we find are the most common symptoms, so 20 different symptoms that we ask

about. And then for each symptom, people tell us from a scale of zero to five how much it impacts their quality of life. And then out of that, they get a score of 100, because you've got the 20 symptoms and the grading of five. And that grading of five, I think, is really important because rather than just adding up the number of symptoms, because you could kind of have an endless number of symptoms, you know, because the estrogen affects so much, as I said earlier, of our body, it's important to recognise what's the overall burden that menopause is having on you. And that's what that scale

of zero to 100 gives to us. And so, for example, if you're having really problematic sleep issues, because of the menopause, that can affect everything. You know, the next day it can affect what you're eating, how much physical activity, your mood, your anxiety, your interactions with other people, your work, for example. If, however, you're experiencing problems with your hair and skin, which is a very common symptom, it's unlikely probably for most people to have the same level of impact on your quality of life as just not sleeping due to menopause. So that's why we wanted to specifically look at what's the overall impact it has on your quality of life. So the meno scale calculator gives you a score out of 100. It's available online. It's free to access for everyone.

And what's really important is that allows you to track your symptoms. And I think this is key, because there's nothing out there that people can quickly access that returns a number that allows them to track their symptoms. And so again, you know, when I think back to my own experience, A couple of years ago when I started on the perimenopausal transition, I went to see my family doctor and they said, right, before you start taking HRT, track your symptoms, then we'll start you on HRT, then you track your symptoms. There was no way of tracking it. They told me I could go and look at this green scale, which asks me all of these, what I think using these outdated language. On a piece of paper, I was having to write down how I was feeling. The bit paper got lost in my kids' homework or

something or somewhere at some point. And so the purpose of this is to create something that allows women to track, allows women to track in a consistent way by asking the same questions and as frequently as they want to. So what it means is it enables women to be able to work out what works for them. So if they're put on HRT, so hormone replacement therapy, they contract to say, okay, is it helping? If they decide to make a dietary change, what's helping? Is it helping? is it helping? And because they're getting this score out for 100, what we also play back to individuals is how their score compares to an average person of their age, and depending on whether they're on HRT or not. And then we also play back other information about what their most

common symptoms are and how that compares to the general population. So by completing this Meno scale, women can be empowered to understand how menopause is impacting their. and if any changes they're making are helping. There's also a consent box to tick when they do it to say that if they're happy to, they can share the data back with scientists, i.e. me and my team. So there's a kind of double benefit that they also become a community scientist because they share their data back with us, which enables us to learn more so that we can look at how does symptoms differ according to where you live

or according to your ethnicity, you know, areas that just haven't or, you know, being looked at before. You know, zooming out from this study for a second, I want to get your thoughts on a couple of associated and related topics. One of them being that there's a huge focus and emphasis on protecting lean muscle mass as we age. In particular, a lot of the top experts in this space and field of menopause are talking about how important is to preserve lean muscle mass, not just to protect yourself from a fall and avoid a hip fracture in the future if you can, but also because muscle is so good at using that free-floating glucose inside of the body. It has that protective element for our metabolism, our blood sugar, our metabolic health.

I want to get your opinion and your thoughts on this. Is that something that, you talk to your customers about at Zoe or the people that you educate or the podcast that you do. What are your thoughts on the topic of focusing on and preserving lean mass? I'd like to caveat with, I'm not an expert in lean muscle mass area. I'm very quick, Drew, to point out what I'm not an expert in rather than what I am an expert in. From what we have researched and what I know, I would totally agree with you that it's such an important age as you enter perimenopause and postmenopause, it's such an important age to maintain muscle mass. It's such an important age to be doing weight-bearing exercises to maintain bone mineral density because we know that also reduces

during the menopause. And maintaining muscle mass is important, in my opinion, for peri and post-menopause women, for a number of reasons, some of those that you've mentioned, but also to maintain insulin sensitivity. And what we've seen very clearly with a paper that we published back in 2020, that people's insulin sensitivity if your peri or postmenopausal is different if you're premenopausal. And so the more you can maintain your muscle mass, the more insulin sensitive you might be able to, you know, maintain. And we looked at people's post-meal sugar responses. So we looked at what I call the post-pranial glycemic response. So this is the circulating level of glucose after having a meal in that kind of two.

two to three hours after you have a meal. And we looked at this in both pre-perry and post-menopausal women. We gave, there was about 700 individuals. We were given a standardized meal that contained a really high carbohydrate loads. It had about 80 grams of carbohydrate. And then we measured over the next four hours how their blood glucose changed in response to that meal. And what we found is that peri and the postmenopausal women

had a lot higher blood glucose response to that standardized meal compared to the premenopausal women. Now, we do expect insulin sensitivity and muscle mass to change anyway as part of aging. And because we know that menopause is an age-related event, what we wanted to do is think, okay, is there a way that we can see, is this due to age or is it due to estrogen? Is it due to the menopause? So because we had quite a large cohort, we were able to take a subgroup of individuals and we were able to age match them. So what we did is, we took people who were aged the same, but half of who were periol post and half of who were premenopausal. And what we found is even when we age match these individuals, that post-prangial glucose response,

so that increase in circulating glucose from the carbohydrate in the meal, was still significantly higher in the peri and postmenopausal women compared to the premenopausal women, showing that you're having this change in the incident sensitivity in the way that your body is processing. the glucose. So this also ties back to what we talked about right at the beginning to do with metabolism as well, as well as how this might be related to changes also potentially in lean muscle mass. Could you extrapolate on that a little further? I think this is going to be an important topic for our audience. Why is it that blood sugar and insulin sensitivity matters for this stage of life especially? Like how does it make the symptoms worse or better? depending on the quality of insulin sensitivity.

I don't know how it would necessarily relate to the symptoms if we think about things like kind of brain fog, etc. We know that if you have very exaggerated, repeated excessive excursions, so I mean increases and decreases in blood glucose, that's related to all various kind of health outcomes. So we know that if your blood glucose is elevated consistently and also, you know, you have these huge peaks and troughs, we know that that is related over a long period of time

to increase risk of type 2 diabetes, obesity and cardiovascular disease. We also know if you have big dips in your blood glucose, and we've looked at this in Peri and postmenopausal women, and we see that about 25% of them have these dips two to four hours after consuming carbohydrate rich meal. We know that if you have a dip or what we call a dipper, that that drives greater hunger, greater energy intake. So people who are dippers tend to eat about two to 300 more calories over day

than people who aren't dippers. So that just shows how your blood glucose is controlling things like your hunger levels. We see that dippers have less energy, they feel less alert, etc. So it's impacting kind of how they're feeling at a given point in time, but we know it also might increase your long-term disease risk. Whether it's worse postmenopausally versus premenopausal, we don't know yet yet. But what we do know is that these excursions, these peaks and troughs, are more exaggerated in peri and postmenopausal women compared to premenopausal. Yeah, we've called them the roller coasters of the ups and downs of the blood sugar roller coasters.

And you know, this is something we've looked at quite a lot at Zoe is at the dips because people think about it as kind of these hills. don't think about it as the roller coasters. The roller coasters includes not just the peaks, but the dips. And, you know, we've done quite a lot of work looking at who has dips, how big are the dips, how do they relate to, you know, how we're feeling our hunger, our energy, our mood. And also does it vary day to day. And so we've got some really interesting data that we've just recently published showing that if you have a breakfast, for example, it causes you to have a dip that day. So you have your breakfast, it causes a dip about two hours after the breakfast, you will go on to eat about 100 to 200 more calories that day than if the

next day you select a breakfast that doesn't cause the dip. So in simple terms, going back to what you said, if you can prevent the roller coaster, so you can just go on a nice car ride on some undulating hills rather than having this roller coaster, then you can reduce your energy intake potentially as well as hopefully impact other health aspects. The only thing I would say, Drew, is I think that there's a lot of attention at the moment on post-pranidoglycemia, on blood sugar. And I think we need to be really careful when we talk about it. And I always want to emphasise this, that it's a normal physiological response to have

an increase in circulating blood glucose after a meal. We don't want to flatline. We don't need to be hyper-focused on it. It's one piece of a huge, huge puzzle. But I think the data that I've talked about today is just a nice way of demonstrating that we are seeing differences in how we metabolize food in our metabolic health, in our post-pranical responses. But I think we need to be cautious generally as a kind of health community not to overemphasize just glucose as being something that we need to focus on singularly. Yeah, we don't want the extremes. We're not trying to keep our blood sugar completely flat.

And at the same time, as you've mentioned, we also are not trying to have so much variability on the high end because it's going to be driving an excess calorie intake, which is what's going to lead to weight gain, and also the symptoms that come along with it, being lethargic, not having energy levels, et cetera. For those that are not familiar, just give an example of what is the type of breakfast, since you mentioned breakfast? What is the type of breakfast that somebody might be eating that would be causing these big spikes and dips, right? We're not here to demonize any kind of food. We're just more giving an example picking up on what you shared earlier. And then what is a breakfast that is going to have a little bit more of just like a hill, a natural

response that's there to eating a meal and then it naturally kind of coming down in a way that doesn't lead to a massive dip? Yes, so true, I can actually give you an example for myself as someone or I can tell you what I used to have for breakfast before I wore continuous glucose monitor and what I had for breakfast after I wore a continuous glucose monitor as an example. So typically for breakfast I would have white bread. So that's refined carbohydrate and I might have some butter on it and maybe some jam or Nutella, for example. This is despite being a nutrition scientist for 25 years, it's what I enjoyed.

Or I might have a pastry like pan of chocolate or. or a croissant. I would feel by mid-morning absolutely rubbish. I would feel ravenous with hunger. I would feel irritable. I'd feel a little bit shaky because I was getting, which I didn't realize low blood sugar, and I'd feel really grumpy as well.

And I then wore continuous glucose monitor. I wore continuous glucose monitor about, must have been about four years ago. This has having been a nutrition scientist for over 20 years by then, having been measuring people circulating blood glucose, blood fat, for many years because my main focus previously was on post-prangeal metabolism. And it's the first time I wore it and I had this eureka moment that my gosh, whenever I feel grumpy

in the day, whenever I'm ravenous in the day, whenever I'm getting kind of slight shakes, it's because I'm having a low blood sugar dip. Now, I should have thought of that as a nutrition scientist, but I'm too busy doing the science to think of myself. So I changed my breakfast. So I changed from these refined carbohydrates, so the refined cereals, the refined, the white bread, the pastries, for example. And I made sure I was having a combination of nutrients that I know will be good for preventing this big peak, but also more importantly for me, the dips. This is making sure I was getting plenty of protein, plenty of good quality fats, and plenty of fibre. So what I now have for breakfast is I have Greek yogurt. I have full fat Greek yogurt because we know that the saturated fat that's in fermented dairy,

i.e. yogurt and cheese doesn't raise cholesterol like are the saturated fat. I have that mixed with nuts and seeds. So they're rich in fiber. They're rich in polyphenols. They're rich in protein, et cetera. And they're rich in healthy oils as well. And I might drizzle a bit of honey on, for example, on top. There's lots of other options you could go for as well.

You know, you can have whole grain bread. you can have eggs with it, you can have avocado with it, etc. I think the key is to make sure that you're not having just a carbohydrate hit because it starts that rollercoaster off in the morning. So it's making sure you're having healthy fats, healthy oils and plenty of fiber in whatever way you like it personally. I want to switch topics to the gut microbiome, which is an area that you guys are super fascinated by.

Do we know anything, you know, zooming out even bigger than this study? Yeah. What do we know about the gut microbiome? gut microbiome. And it's important to women, especially as they age. Wow. That's a big question. There's lots that we know, but there's a hell of a lot we don't know. And this is the case, I think generally in nutrition research, because it's a relatively young science, nutrition research, despite the fact that we all eat and we've always all eaten. It's only the last 50 years that I think we're really focusing and understanding the importance

of diet on our health. And so we've got a lot of catching up to do. The same with the microbiome. It's actually in its relative infancy in terms of the microbiome, a scenario of scientific discovery. We're evolving our understanding very quickly. What we do know, and again from our own research, but also published research,

there's very, very strong associations between the microbiome and different health outcomes. There's very strong associations between the microbiome and diet. So we published some work a couple of years ago in nature medicine where we looked at how the microcomposition is related to a whole host of different health measures. So these are kind of intermediary risk measures like blood pressure, like inflammation, like blood cholesterol, like insulin sensitivity, for example. And we saw that there was a very close association between the different microbiome,

so different species with these health measures. And we actually developed a microbiome signature where we found that there were some species that were associated with favorable measures of health, i.e. lower blood pressure, lower blood lipids. And then there was another signature of species, so another group of species that were associated with worse levels of health, i.e. higher inflammation, higher blood pressure. And what we found is those species that are associated with favorable measures of health were also associated with favorable measures of diet. And those conversely associated with unfavorable measures of health were associated with a poor diet. Now, this is association data. It's not showing causality. It doesn't show, okay, can you modify the microbiome through diet to change your health outcomes? This is where we're focusing our attention now, and this is where many other researchers are focusing their attention, kind of trying to piece together that chain that you have.

And I think that there's good evidence emerging now that if you can use diet to do, change the microbiome, that that will have knock-on effects and in changing your health. And we certainly know from our own Zoe research as well that by delivering personalized advice to individuals based on their microbiome of what dietary changes they should make to improve their microbiome, we see these changes coming out in their microbiome. So we know that we can deliver targeted dietary advice that will modify their microbiome. Now, whether that is directly impacting their health is the next part of the chain that we need to show. But what we know from a study published this year, again in Nature Medicine, it's from a randomized control trial that

we ran where we randomly allocated people to either follow the ZORI programs, the personalized nutrition program, or follow the US dietary guidelines. We found those following the personalized program that's very much focused around changing the microbiome, that that resulted a change in microbein composition and it did result also in a change in many health outcomes as well. Now, how it relates to menopause and ageing, again, is something that not many people are looking at. There has been some research that's shown that postmenopausal women have a microbiome composition that's quite similar to an average male and that premenopausal women have a microbiome composition that's different to the average male and different to a postman.

We also looked at this in our ZOE predictor research and we found something similar. We found that peri and postmenopausal women have a different microbiome composition to premenopausal women. And what we saw was that there were some specific species that were increased in postmenopausal women. And these species were the ones that we'd identified with our previous research as part of this kind of microbiome signature that we'd developed to be the ones associated with higher inflammation, higher blood pressure, higher cholesterol, et cetera. So they seem to have these species that

I'm very loosely going to call bad bugs. Any microbiologists would probably hate me using that term. But the postmenopausal women seem to have more of these kind of bad bugs and premenopause are more of these good bugs. And then some real exciting research that we've only got the data from on last week. It's not published yet. Is in our huge cohort, so these 70,000 women, we've also tried to look at how the menopause is related to symptoms. Sorry, the microbiome is related to symptoms in the parian postmenopause or women. And so again in this group, we see that there's a difference in the microbiome composition depending on whether you're pre or postmenopause.

But what we also see is that you can partially predict how many and the burden of symptoms that women have based on the microbiome composition. So what that says in simple terms, that there seems to be something interesting going on where the microbiome is associated with these symptoms. Now, what we don't know is, is it actually just a byproduct that we know that diet changes the microbiome? We know that diet is related to symptoms or is there actually a direct effect of the microbiome on reducing our symptoms?

That's what we're going to be analyzing over the next few months. Are there general recommendations that you have for a good, healthy microbiome? I know this is a topic that you guys have covered extensively, but if you would leave the audience with a few principles that they could double down on, pay attention to, when it comes to a microbiome, what would be those things that you'd mention? So I'm going to give you five tips that I cannot claim to be my tips. These are the tips that as a team we've built at Zoe together with my close colleague, Professor Tim Specter and also Dr. Federica Amati.

And these five tips are, firstly, 30 plants per week. So it's the diversity of different plants. Try and have 30 different types of plants per week. And the reason is because we know that nearly every food has about 72,000 different chemicals that all interact with each other or have different roles. We want to get a diversity of these different chemicals. So that's the first thing, 30 plants, diversity. Second thing is fermented food.

So there's good evidence to show that fermented food can modulate our microbiome. Fermented food tends to be high in microbes. So by fermented food, it's most cheeses, keffey yogurt, kimchi, kombucha, sauerkraut, as well. So trying to get some fermented food if you can each day. Great way is, you know, a bit of keffi yogurt if you like that or having some. fermented cheese. Third thing is eat the rainbow. This kind of feeds a little bit into that 30 and diversity. But try and make sure when you're getting a diversity, you're getting lots of different colours. And the reason is, is because the pigmentation in plant-based foods

carries lots of wonderful attributes. So many of the bioactives, as we call them, so the chemicals and foods that we know have wonderful biological properties in improving our health are coloured. And so if you can eat a variety of these, then you're going to get a variety of these bioactives. And these typically are polyphenols, although it's not only polyphenols. So polyphenols have different colors, some are red, some are yellow, etc. But if you're eating a diversity of the rainbow, then you're going to get a diversity of these plant-based bioactives. The other thing is rest your gut. And there's really good evidence now, I think, to support having a, period of time when you're not eating. Now, I don't mean fasting for three days and starving

yourself. What I mean is not constantly eating food for like 16, 17 hours a day. What we know is that from again our own research and also published research, people eating late into the night and not allowing their body and their gut to rest. We know that they're at higher risk of many cardiometabolic diseases like type 2 diabetes, they tend to be overweight, they tend to have higher inflammation, blood pressure, etc. So resting your gut by giving it maybe a 12 or if you're happy to a 14 hour period where you're not eating each day. So if you're giving a 12 hour period, that just means having your last meal at 8 o'clock and your first meal at 8 o'clock the next morning. If you're comfortable going to 14 hours, maybe just have your last meal at 7

and don't have your breakfast till nine. It's got to work for you. And we've done this wonderful study called the Big If Study, the big intermittent fasting study, where we ask people to change to eating in a 14-hour window, so a 10-hour window, so fasting for 14 hours. Most people found it quite easy to do. You don't need to go to extreme.

Then the fifth one is reduced your intake of unhealthy, heavily processed foods. We're eating too much of these kind of foods. You can also call them ultra-processed foods. 50 to 60% of our diet on average in the UK and the US is coming from these unhealthy, unhealthy, heavily processed foods. We are eating an enormous amount. I mean, if I could give you one single thing,

if I had to take a kind of punt on one, it would be reduce your ultra-processed foods and their rest would follow. Those are great. I love those. Even if people have heard them before, the reminder of them, because they're so simple,

they're so accessible for people. They can be challenging to execute, but they're simple in nature. It's just an incredible reminder that there's so much agency that we have to impact our health, including our microbiome. Just one thing I want to pick up on that. It is really hard to change our diet,

and I don't think we should underestimate how hard it is. It's hard because our food landscape is pitted against us. You know, if I'm out and about and I want to get a healthy snack or I want to get, you know, a healthy lunch, it's actually very difficult and it's difficult also to change, you know, the diets that we were brought up with, the kind of foods that we're used to cooking with, it takes a lot of effort, it takes a lot of brain space and I don't think we should underestimate that. I think the important thing is to say, try and just do something simple because it's only

by doing something simple that's easily implementable that you're going to actually have a long-term effect because it's only that that you can sustain. And so something that we've been doing quite a lot of research on in my work at King's College London is looking at snacking. And we know that on average 20 to 25% of our energy comes from snacks. So they are a simple, single strategy that we can implement to improve our health. And we recently conducted a study at King's where we asked people to, it was a randomised control trial, half the people consumed typical UK-US snacks. half the people were randomly allocated instead to consume almond nuts. What we found was those that, and nothing else changed.

We said do absolutely everything else. Eat all your other meals are the same, do the same physical activity, etc. Just by changing the snacks that people were eating reduced their blood lipids, improved their insulin sensitivity, reduced all these other kind of unhealthy aspects related, you know, to their long-term health. And when we equate that to the long-term risk of cardiovascular disease, changing from typical USUK snacks to nuts, reduce the risk, the estimated risk of cardiovascular disease by 30%. And I think that's really powerful.

So yes, I agree with you. It's hard to make dietary change. But you know what? You can find a simple, single strategy that works for you. And that's just an example of one of the kind of things you could do. That's great. I love that recommendation. Yeah, when you think about people switching out a bag of chips, which can easily be thousands of calories,

like so many people don't realize that a serving of chips is not what they're eating. They're eating, you know, five servings of chips when they're going for a bag. And you're replacing that with something like almonds. Were they salted, unsalted? Were they? So they were unsalted. Okay, yeah. So it's hard to overeat.

It's hard to overeat. Unsalted almonds. You know, you're just like, all right, cool. I've had enough. I don't want anymore. But we energy matched. So it was a proper control trial. So both groups had exact 20% of their energy, either from these pre-provided snacks to represent the typical U.S. and UK snack or 20% from almonds.

And they were asked to eat them all. And so if they didn't want, if they were starting to feel full, then they adjusted what they ate at their next meal, i.e. whatever their main meal or, you know, lunch was, for example. But they had to eat all of these snacks. and we still saw that huge difference. All right, I want to bring it back as we're winding down today's topic and today's interview. I want to bring it back and hand it back over to you to this important topic of research, women, menopause. You know, we're going through a period of time where we have a lot of people speaking up who previously weren't finding a platform.

And I think social media has been a big part of that. You guys and podcasting has been a big part of that. this largely underserved community of women that were going through these stages of life, paramenopause, menopause, postmenopause, they're finally feeling like they're being heard and it's being talked about, which is a beautiful thing. That being said, are there still areas that you feel that are low-hanging fruits that women and the men that love them and the researchers that are working on this, are there low-hanging fruits that we're still not tackling in this conversation of how to support women going through these stages of life. Are there things,

trends in health, nutrition, wellness, that we are sort of missing some of the basics that have to be addressed? Do you feel that a lot more women would be better served if more practitioners had appropriate levels of education of how and who should be administered hormone replacement therapy. I think that many practitioners need to get better training in the menopause, in diet. You know, in the UK, our family physicians will have a matter of less than 10 hours of training in diet, in nutrition. They have apparently, as I've heard, it might have changed recently, two to three hours

on the menopause. So I think firstly, they need to be better trained in understanding. the menopause. I think that unless a woman is going through it or is being very conscious in trying to teach themselves about it, then I don't think that it's easy to really understand what an individual experience is. So whether it's your physician or whether it's your husband, your partner, your friends, I think there needs to be a great understanding of just how much it does impact women. In terms of hormone replacement therapy, I'm not a, a, a, medical doctor. I'm a research doctor, so it's a really important eye caveat that I can tell you what I

believe based on the evidence that's out there. And I believe that the evidence for hormone replacement therapy, if delivered transdermally, so using like the gel or patches, if given at least within 10 years or even five years of people becoming menopausal, but preferably starting at the first stages of perimenopause, that there are benefits in terms of symptoms. We know that. That's, I think, irrefutable. Everyone differs in terms of how effective the hormone replacement therapy is. Some people have huge benefits. Some people don't have a huge benefit. But on average people will benefit. What we see from our data, and I think there's a growing body of evidence around this, but it's not conclusive yet. What we see in our data is if individuals are taking HRT,

they do have lower risk of these intermediary risk factors. They have, in our data, lower blood pressure, lower bissel adiposity, lower bad cholesterol, the LDL cholesterol, lower inflammation, better insulin sensitivity. These are all risk factors for chronic disease. We cannot say conclusively yet whether taking HRT will reduce our risk of heart disease, type 2 diabetes, etc., because we haven't been studying it long enough in the way that it should be delivered. So in the past, hormone replacement therapy was given orally as a tablet, which we know is metabolized very differently to how transdermally. So with the patches or the gel, it's metabolised.

We know if it's given orally, for many women, it might not have the same favourable effects of in terms of these intermediary risk factors because of how it's metabolised by the liver. In the UK, I don't know what it's like in the US. HART is given transdermally now. it's not given orally because we know that it can have an unfavourable effect if it's given orally. And so based on what evidence there is for transdermal, so the application to the skin HRT, I would say that there are discussions that every practitioner should have with a perimenopausal or postmenopausal women, as long as it's within 10 years of them becoming postmenopausal about how it's going to improve their symptoms and about how it may impact some of these other

cardiovascular risk factors. It's not licensed in the UK for prevention of cardiovascular disease. So I'm saying this with a note of caution and just telling you based on the results that we have here. I take HRT. That's my personal choice. It's benefited me. There needs to be those conversations. Healthcare practitioners need to be really well educated in how menopause impacts, not just symptoms, but their disease risk. And what can be done, whether it is hormone replacement therapy or whether it's alternative therapies. I think what we haven't touched on, though, Drew, which I think is really important, is the whole area of these other therapies that people try supplements. You know, in the UK, we use this term called menow washing. I don't know if you've heard of it

before. I only heard of it because I watched your presentation where you went through it. The reason I just want to touch on it before we finish is because something that I feel very passionate about is people being misguided. I think everyone should try different things, try what's works for them, but I really worry about the amount of what I call neutra nonsense out there, nonsense related to nutrition. Everyone has an opinion. Everyone thinks they know better, whether they're even in science or they just happen to have read some article that some famous model wrote that made her look as beautiful she does or goodness knows what. Everyone has an opinion. And because of this, there is so much neutral nonsense out there and people are

being misguided. And the menopause, given that it's a huge market now, it's a multi-billion pound dollar market. I worry and I don't want people to be taken advantage of. And I think this is what people need to be mindful of. If you put meno in front of something, can we call it meno washing? You can charge five, ten times as much. You can get a basic multivitamin mineral, stick meno blah, blah, blah in front of it, charge loads more because peri and postmenopause or women who are suffering these symptoms, we're desperate. We want to do anything we can. HART is one possible solution, but in addition to that, there can be some other solutions. But we need to make sure there's sufficient evidence for this. And in my opinion, apart from the evidence around

soyaziflavones, I don't believe there's sufficient evidence for nearly all of the supplements out there to say that they benefit menopause symptoms. What I will say, though, Drew, and I think this is really important. We all respond so differently to everything. And it might be that something is working for your best friend and they feel amazing. Well, great. If they can afford it, go buy it if it's making them feel great. But it might not work for you. And I think it's to be really open-minded that just because it works for one person doesn't necessarily mean it's going to work for you. And to be a little bit careful about some of the claims that are out there, related to some of these supplements. If I was to recommend a supplement, the only supplement

I'd recommend would be soy isoflavones. These are chemicals that are found in soy-based products. They have estrogen-like properties because the structure of these chemicals is similar to estrogen. So they bind to our estrogen receptors. So what we know is populations like China and Japan who have a really high intake of soyazaflovones, they have a lower symptom burden. They have a a lower prevalence of symptoms. What we do know, though, is the type of soy is a flavon and the amount is really important. And my colleague, Professor Wendy Hall, has done some great analysis on this where she's looked to all of the different studies.

And what we know is that there's a particular type of soyazaflavone called genestine and that if your supplement has genestine at or above 15 milligrams per day, that's where we seem to see a consistent beneficial effect. If however it has a lower amount than that, it's unlikely for the majority of people to have a big effect. And then there's one last really interesting element to this. We know that also how you respond to soyazofloin's difference from one person to the other. And this is where the microphone comes in and I think is really exciting. So we have species in our gut in our microbiome that metabolize these soyazoflavones. And they can metabolize them to a really active form that binds really strongly to the receptors. And these bacteria are called equil

producers because from the soyazer flavon, they produce another chemical called equal. And this particular chemical is a really strong estrogen-like compound. It binds to the eastern receptor really strongly. What we know is if you're an equal producer, so if you metabolize the soy isoflavones to equil, and you're supplemented with soyazoflavones, you have a 75% greater reduction in symptoms than if you're not an equal producer. And the reason I want to mention that, Drew, is because that takes me back to my point a few minutes ago that everyone will respond differently. So, for example, if I went and started taking soy isoflovenes, and I'm not an equal producer,

but my best friend started taking soyazaflovones and she had the gut microbiome species that enable her to produce equal. She is going to see a huge benefit. I'm not going to see such a big benefit. But that means that I shouldn't be advising her not to take it just because it doesn't work for me. So it's just giving that kind of,

yes, let's be really cautious about men are washing. Yes, there's good evidence for soyazer flavones, but still there is this. huge variability. What works for one person might not work for another person. Give whatever you want to try, but be careful not to compromise on other areas of your life if you're kind of burning massive holes in your pocket with the money that you're spending on them. That's a great reminder and a great breakdown. So just to make sure that, you know, I understand that correctly, there's a lot of supplements that would have evidence base for being helpful for various sorts of

things. Like let's take, for instance, fish oil supplements. Yeah. And some of the evidence. What you're specifically talking about, though, is when people make claims or companies make claims that this particular supplement is going to be helping symptoms of menopause. That's where people should be extremely skeptical and really ask for the data or you, a top nutrition scientists are saying you're not aware of any other supplements that are out there besides these soy isoflavones so that they should be just super cautious because they might be being. taking advantage of. Is that what I'm hearing? Absolutely. And you know what? There's hundreds of studies, actually. Randomized control trials looking at different supplements. Some show that there is a benefit from this particular supplement. Some show there isn't a benefit. The weight of the evidence, apart from soyazoflovens, I think, shows specifically for

menopause symptoms, there is no strong evidence to show any particular supplement is really beneficial. And whilst you're absolutely right, there will be benefits to many of these supplements for other areas of people's life, like fish oil. You know, there's great benefits in terms of inflammation, in terms of cardiovascular disease, etc. So yes, that would benefit postmenopausal women at a time that they're increased risk of that. But in terms of symptoms, i.e., you know, preventing the weight gain or reducing the sleep problems, etc. I don't think there's strong enough evidence for many of these. But you can try and see how you get on, but just to be careful spending 10 times as much just because it's got meno on the label.

You know what? I was in our local supermarket last week and there's a whole area for menopause skincare and hair care. I mean, it blows my mind that and it's a hell of a lot more expensive than the normal skin care or hair care. Yes, we know skin and hair changes in menopause, but how we can be marketing an entirely different skin product on it. It's, It's just, I might be missing something really obvious here, but it blows my mind that people, I almost feel being tricked into spending twice as much because it's got the meadow in front of it. So save your money, people. Save it for gym membership. It's a great reminder that as things become trendy, because people are becoming more educated,

there's always going to be in every category. It happens in menopause. It's happening in other areas of wellness. or education or technology, whatever the industry might be. And so it's important to be savvy. And that's why I'm such a huge fan of researchers like yourself that go direct to consumer with their education, their content. I think there's a great opportunity to plug what you guys are doing at Zoe. You have a very popular YouTube channel, podcast that does well. Even here in the States, it does really well.

Anything that you want to leave our audience with of how they can continue. to keep in touch with you, your team, and maybe even go deeper down the education rabbit hole that you've taken our audience on today. Yeah, thank you, Drew. So absolutely follow our podcast as well as your own podcast. We have some really great insightful guests on, great scientists talking about all sorts of areas, but we do do quite a lot of focus around menopause and really diving into different areas related to Wim's Health and Menopause. So for anyone that was interested in this episode, go listen to the ZOE Science and Nutrition podcast.

We also have loads of resources on the ZOE web pages. So if you go to ZOWI.com, you'll see loads of resources. And if you go to ZO.com forward slash menoscale, you can access our menoscale. I'd love as many people as possible to start using our Mennow scale. Selfishly, because I want people's data as a scientist, but selflessly, because I believe it's really powerful for women to be able to start to have age. over their own change. I'm also on Instagram on Dr. Sarah Berry. I'm a bit of a typical academic. I don't post as often as I should. But when I have a new paper out, I do post on it.

But on our web pages, you can sign up through the menor scale as well to receive email alerts from us about new research coming out. And also, all of our research is up there on our website. You can actually go into some of the individual papers that we've published if you want to be really geeky and do a deep dive. That's awesome. Dr. Sarah Berry, this has been fantastic. I've really enjoyed this conversation and you've certainly presented a lot of new information to our audience who cares deeply about this topic. We'll have all the links that you mentioned, including to your Instagram, in the show notes below so people can follow you and follow the podcast. Thank you so much for being with us on the podcast today. It really means a lot. Oh, thank you, Drew. It's been lovely

to chat to you and great to share to your audience, our research. So thank you. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend. Share with a friend who would benefit from listening.

Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This

or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.