Question: 
What diet is best for Perimenopause?
Short Answer: 
One of the most common complaints we get from women in perimenopause is unexplained weight gain. Their lifestyles have not changed in years, but all of a sudden, their weight keeps increasing. And if they try to lose the weight, their efforts fall short and often gain more weight in the process. An observation we see quite often is that many women are still tyring to “eat less and exercise more.” This might have worked when they were 25, but for women in their 40’s, this weight loss approach often seemed to backfire. Women in their 40’s typically have a good deal of stress already, so trying to exercise the weight off only adds to their stress. This makes the weight loss process very frustrating, if not seem impossible.
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PYHP 098 Full Transcript: 
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Dr. Maki: Everyone thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So on this one, we are just going to dive right in, and we of course have a lot to talk about. We cannot not talk about perimenopause or menopause without discussing diet and weight loss at least to some extent. Would you agree with that?
Dr. Davidson: Absolutely when women, hit their 40s, they especially perimenopause and menopause. They always say it is like I put on 10, 12 pounds overnight like it, just where did it come from and they will point right to their stomach. I have had women, I love them dearly they will even grab their stomach and say, “I have never had a belly before where did this gut come from?” And things are different, of course, we all know obviously from when we are twenty, to when we are forty, to when we are sixty, we are always changing but it definitely comes from the change in hormones. 
Dr. Maki: Yes, right and believe me that is very complicated and you and I, we have been doing this a long time and we certainly do not have all the answers when it comes to diet and weight loss and especially perimenopausal weight loss or menopausal weight loss for that matter. But the purpose of this episode is to kind of just shed some light on some of the observations that we have noticed and in some ways what does not work for people, we do know some of those things. Everyone is still trying to follow the same advice eat less, exercise more all the time. They are just trying to basically starve themselves and exercise a bunch and that strategy right there and we will kind of dive into that, what that strategy looks like little bit more specifically but that strategy clearly does not work. And in some cases that actually make their situation worse, they actually gain more weight. They are exercising five, six days a week and their weight is going up. 
Dr. Davidson: Yes, you will see that I mean granted I was a child of the 80s. I remember the 80s and the 90s, if you were going to go on a diet, you

Question: 
What supplements are good for Perimenopause?
Short Answer: 
The conventional treatment options for Perimenopause are limited. Most often, women are offered birth control and other habit forming medications. None of those options are very effective in providing women relief of their symptoms.
PYHP 097 Full Transcript: 
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Dr. Maki: Hello everybody. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. 
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So on this episode, we are going to continue our talk about perimenopause. We are going to talk about some of the supplementation that we use in helping people deal with some of the symptoms of perimenopausal. 
Dr. Davidson: Exactly. We have talked about perimenopause many times in other podcasts and blog posts as well. Like we always say, there is really not a lot of answers out there, especially conventionally. The last thing you want to do is take habit-forming or ineffective medications, but at the same time, we also want to have some help so we can kind of transition and feel good during this time of perimenopause. 
Dr. Maki: Yes, right. Now conventionally, like we talked about the past, really, the only options for this window, this demographic, this ten-year span, ten-plus years span for women. 
Dr. Davidson: Possibly.
Dr. Maki: Yes, right. Let us say from forty to fifty, if we just kept it to that, but I think there is an overlap into the late thirties and even the early fifties. So we are looking at a really good solid decade. In some ways, a really highly productive time frame for women where they need to be on their game. They have lots of things, are juggling lots of different parts of their lives and we hear it all the time. Women get to this certain point and all of a sudden, their bodies just stop cooperating. They cannot sleep. They have anxiety. They are irritable. They are gaining weight. They have all these things that are happening that they have never really experienced at that point. They really do not know what is going on. They go to their gynecologist. They go to their primary care doctor and no one really has any answers to be able to help them. 
Dr. Davidson: Yes. Like you were saying, probably the most common medication is birth control pills, which the last thing you want to do is be in your forties taking birth control pills. So, that is kind of frowned upon. I mean antidepressants, a lot of doctors will offer perimenopausal females antidepressants. And they will say, “Well, I am not depressed. Sure, I do not feel well. I am irritable. I am not sleeping. I have a lot of brain fog. My short-term memory is not right.” They have a lot of these symptoms but it is not necessarily a disease. So, a lot of conventional practitioners do feel like their hands are tied. Even like anti-anxiety medications are extremely habit-forming. The last thing you want to do is put somebody on some kind of prescripti

Question: 
Why Is Perimenopause so awful?
Short Answer: 
We work with a good number of women in their 40’s and most of them do complain about how difficult Perimenopause is for them. As female hormones begin to decline, but stress levels are high it can cause a wide variety of symptoms. The most common perimenopausal symptoms are weight gain, irritability, and insomnia.
PYHP 096 Full Transcript: 
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Dr. Davidson: Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Valerie Davidson and I am here joined with my co-host, Dr. Maki.
Dr. Maki: Good morning. How are you today? 
Dr. Davidson: I am doing great. Thanks. 
Dr. Maki: We are experiencing a little bit of almost a torrential downpour this morning. Looking out the window, it is, unfortunately, raining a little bit too hard.
Dr. Davidson: But it is not that cold. So June, June in Washington, Western Washington. What do you expect?
Dr. Maki: Hopefully the sun will come out later this afternoon. So in this episode, I think that we are going to answer a question but it is not an actual specific question. We actually wrote a blog post a while ago. Why is perimenopause so horrible? So we are just kind of playing off that a little bit. That is a blog, this is going to be a podcast, obviously. Why is perimenopause so awful. The same idea, just a little bit of a different title. As of the last few years, I think, the perimenopausal demographic, women in their late thirties to early fifties is probably the majority of the people that we see on a regular basis.
Dr. Davidson: I think you know with perimenopause, it is a little bit of an under-represented, I guess, demographic because it is, you know, it is not menopause but it is not your typical PMS. It is somewhere right in between. So a lot of times women sort of getting blown off and perimenopause is exactly what it sounds like before menopause. It can happen, you know as late as you are in your late thirties and it can last even you know, thirty or early fifties depending on how a female’s ovaries are performing, and when they decide to retire or work part-time or work full time.
Dr. Maki: And their stress level.
Dr. Davidson: And their stress level exactly but I always kind of you know, I do not want to make it so negative. You know, why is perimenopause so awful or so horrible. It is not a negative thing but a lot of women will say that to me like, “This is really awful, what do I do? I cannot stand it. Nobody else can stand to be around me.” But it really has to do with those hormone imbalances. So working on those hormones is completely different in perimenopause than it is with menopause. 
Dr. Maki: Yeah, right. Conventionally, in the medical community, no one is really equipped or prepared to deal with it. Given a woman in her late forties birth control to deal with her menstr

Question: 
What is Oxytocin Used For?
Short Answer: 
The hormone oxytocin is available by prescription from compounding pharmacies. The most common uses for oxytocin is to enhance female libido and mood. Also, research has shown that oxytocin may also be helpful in weight loss. More research is needed to better understand how oxytocin can be used as an effective therapy for obesity.
PYHP 095 Full Transcript: 
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki.
Dr. Davidson:  And I am Dr. Davidson. 
Dr. Maki: So on this episode, again, we are going to introduce something that we have used quite a bit with our patients. We are going to talk about a hormone, actually, a hormone prescription called oxytocin. I know a lot of people have heard of that before, right? It is considered to be kind of the love hormone. But it can be used, it can be turned into a prescription and we use it quite often. 
Dr. Davidson: Yeah. I have actually used it a lot with patients. When it works, it works really well and the great part to it is there is not any necessarily, negative side effects to it. So if it works, awesome. If it does not, then okay, we are back to the drawing board. Those of you that have heard of oxytocin, they think of it as like the love hormone. But it is. You know what, it can help with female libido and that is probably a cup. Probably the two reasons that we use it or I use it is for working on female libido because we know that that can be a tough one. Because school rules are complicated. The other part that I use it for is just a sense of well-being. It does kind of help bring up that mood. We live in a stressful world. We live in a sympathetic, adrenal fight-or-flight world, whether it is watching the news, or driving your car, or getting to work on time, or working with family, things are stressful that I find that oxytocin can really push you over to the other side to help bring that joy back so you do not always feel so rushed and overwhelmed. 
Dr. Maki: Yeah, right. I would agree that those are the two main things that you and I use it for. We are not really big fans of antidepressant medication in general. We never use them. That is fine if people want to take them, but we are not necessarily going to prescribe those things. That is just not what we choose to focus on. Oxytocin is kind of our version of something like that. It has very good, as we are talking about one of our previous episodes, the cost-benefit ratio oxytocin, also has a very good cost-benefit ratio. It works great. You get some benefit from it. There have been a few where they just do not notice anything or the effect of it is not substantial enough for them to notice any subjective improvement. Again, it is very subjective. Libido, maybe not as subjective either, your libido increases or it does not. The mood can also be kind of an up-and-down roller-coaster. There are good days and bad days that it can also be a hard thing to gauge or quantify over time if it is actually helpful or not. But the ones that it does, I had a patient to talk to earlier this week.

Question: 
What is LDN Used For?
Short Answer: 
There are many possible uses for Low Dose Naltrexone (LDN). The common use for LDN is autoimmune diseases but has also been used in many immune system-related conditions, including cancer.
PYHP 094 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: So today, we are going to do not really an actual question like we have been doing on some of the past episodes. But today, we are going to actually something that does come up quite often. So it is kind of a question. It is not coming from one person. But today we are going to talk about low dose Naltrexone or LDN.
Dr. Davidson: Exactly. So LDN, low dose Naltrexone. We have actually used with our patients for a number of years, but we do get a lot of listeners, just people that run across our website, people from thyroid groups looking for low dose Naltrexone, because while it has been around for… Gosh. Naltrexone has been around like…
Dr. Maki: Thirty years. Yeah, late 70s or early 80s.
Dr. Davidson: Yeah, the 80s, you know, doing low dose Naltrexone has not been as, you know, as common wise. Maybe for about the last ten like we have been using it probably for about the last eight to ten years, but it is not very much wide-known. I guess you could say, conventionally, so people will go to their conventional doctor looking into it and then, you know, they then their doctor looks at him like you want to go on Naltrexone.
Dr. Maki: Yeah, right. Yeah. It was originally developed for as the HIV and AIDS epidemic was starting to kind of show up in the early 80s. It was used as a medication to curb alcohol and drug addiction because it has certain effects on the brain. It is supposed to limit your cravings for those types of things, those kind of dangerous behaviors that becomes a little bit too habitual and you have an addiction. But actually, along that path over the early 80s, a doctor in New York – I think his name is Dr. Bukhari – noticed that his, and I am not even really sure how he discovered or how we figured out the low dose part, but notice that some of his patients were actually improved. Their immune system status was improving with HIV. Now, we do not necessarily hear as much about HIV or Aids anymore. It is still around but not nearly as stigmatizing as it was in the early 80s. In some ways, if you think back, even up until the 2000s, you know through the 80s and 90s, you know, HIV and AIDS was kind of, you know, everyone was very fearful of that kind of like they are now at the Coronavirus. A little bit similarities there as how fearful everybody was because we just did not know anything about it.
But low dose Naltrexone, so using it for what it was intended for, FDA approval, that was in doses of let us say 50 to 300 milligrams. What we are talking about low dose Naltrexone if you look it up online and there is some couple of re

Linda’s Question: 
Hello, Dr. Maki. I hope you are well. I eat perfectly. I a small amount of organic food daily. No alcohol. No smoking. I bike forty miles a week. I am a 51-year-old postmenopausal woman at five foot eight.  I am now 25 pounds overweight at 154 pounds. I cannot lose one pound. My TSH was 1.6 free T4, 1.1 free T3, 2.6 reverse T3, eleven had very low sex hormones. Hence, probably the postmenopausal part, recently began one milligram of biest troche daily and 50 mg capsule of progesterone at bedtime. My worst symptoms are water retention, bloating, and weight loss resistance. I also have aching joints and muscles. This hormone protocol does not seem to be working. I was thinking of switching to an Estradiol Patch.
Short Answer: 
Most people trying to lose weight all use the same strategy. They eat less and exercise more. Over time, this approach does not work very well cause the body is forced to adapt to the significant drop in calories and increased exercise. This is especially true for women in perimenopause and menopause. For women to reach their weight loss goals, we encourage them to eat more and exercise less. Bioidentical Hormone Replacement Therapy (BHRT) can be helpful, but it is not as important as how much someone eats, how much they exercise, and how well they sleep.
PYHP 093 Full Transcript: 
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Dr. Davidson: Hi everyone. This is Dr. Valorie Davidson. Thank you for joining us for another episode of the Progress Your Health Podcast. I am sitting here with my co-host and husband and partner in business. I do not know if that is a good thing or not but here we are with Dr. Maki.
Dr. Maki: Good morning everyone. How are you doing today?
Dr. Davidson: It is a very good thing to be married and to work with your husband and have our business together. I did not mean to say that inappropriately. It is a very good thing.
Dr. Maki: Yes well, it was not very nice to say. I like that.
Dr. Davidson: I am very sorry. Not only am I sitting here with Dr. Maki. We are also sitting here with our little Australian shepherd dog who is always our little shadow.
Dr. Maki: Oh, yes. He is always there.
Dr. Davidson: So if you hear a little click-click in the background. That is probably his paws on the wood floor or he is chewing on his little bony.
Dr. Maki: Yes, right. He is always underfoot all the time. So this one we are going to do a question. This one is from Linda. Why don’t you go ahead and read the question?
Dr. Davidson: Sure. Sure. Okay. So we are going to do a reader question. This is from a blog post that we wrote called “What is Biest?” and this is from Linda. “Hello, Dr. Maki. I hope you are well. I eat perfectly. I [inaudible] amount of organic food daily. No alcohol. No smoking. I bike forty miles a week. I am a fifty-one-year-old postmenop

Question: 
A question we get all the time from patients and podcast listeners is if they should take their thyroid medication before a blood test.
Short Answer: 
There is not a simple answer to this question. It depends on the patient and their situation. For new patients, we typically want them to take their medication in the morning 3 to 6 hours before a blood test. This is especially true if we have made a recent medication change. If a patient skips their medication the morning of the blood test, it is harder to determine dosing adjustments. The longer someone has been on thyroid medication, the more likely we are to have them skip taking the medication the morning of a blood test.
PYHP 092 Full Transcript: 
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. 
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: How you doing this morning? 
Dr. Davidson: I am doing very well. How are you doing this morning? 
Dr. Maki: Well, the skies are blue. The birds are out. Looks like it is going to be another beautiful day. 
Dr. Davidson: I look forward to it. It is what, spring in Washington. And even though, it does, it is Washington State it does rain here. But at least the you know; everything is green, and we do get some beautiful days. 
Dr. Maki: Yes. We certainly do. Now, granting the summer, people that are not familiar in summertime, there were hardly rains at all. June, July, August, September, does not rain hardly much. It gets kind of dry. But certainly, the spring, the fall, the winter, it makes up for those months that it does not rain for sure. Okay. So, this one is a situation that comes up all the time, for existing patients, for new patients, for questions we get from listeners and readers, the timing of thyroid medication and blood testing. Some say to take it in the morning, some say to take it the day before, and skip it that morning. There is, like I said, there is, you know, there is a couple of opinions and how that is supposed to be done or what say you? 
Dr. Davidson: I would say both. 
Dr. Maki: Yes. So, you would say that both are right. 
Dr. Davidson: Yes. When somebody asks, should I take my thyroid the morning of the blood test, there are times when I say yes, and there are times when I say no. You know, it really depends on how we are going to monitor it now. We are very specific when we monitor thyroid levels. Specifically, we will do the thyroid stimulating hormone, the TSH, the free T4 in the free T3. You know, we want to, you know, those are kind of like my nitty-gritty. I mean, then you can do a reverse T3 and a few others but really, you know, the free T3 is super important. A lot of conventional doctors do not always test the fre

Question: 
How to cycle bioidentical hormones?
Short Answer: 
When it comes to BHRT dosing, the two main options is static dosing and rhythmic dosing. Static dosing is by far the most common, but depending on the patient’s symptoms and goals, rhythmic dosing might be a better option. We like to use rhythmic dosing with testosterone for men almost exclusively. We are not fans of injectable testosterone or hormone pellet implants.
PYHP 091 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki.
Dr. Davidson: I am Dr. Davidson.
Dr. Maki: How are you doing this morning?
Dr. Davidson: I am doing great. Spring is here in Washington. It is beautiful. The plants are growing, birds are singing.
Dr. Maki: Yeah. We are getting a little bit of rain but a lot of it has been coming at night. In spite of the lockdown, we are still getting some really nice weather. We have been able to spend some time outside. The plants are growing, a lot of weeds. We have a bunch of, what are they, raspberry bushes or blackberry bushes. They are kind of going a little crazy.
Dr. Davidon: They are blackberry bushes. Blackberry bushes grow like weeds here in Washington, which is fun in August because then you get to pick them and eat them, but I definitely have a lot of scratches on my legs from tramps and throw them.
Dr. Maki: Oh my God, yeah. Then, we played with the dog outside. He likes to play with the tennis ball and then chuck it. We live on a kind of a busy road. They are out in front in our yard, and they kind of kind of create a really nice fence because he is very careful going around those bramble bushes or blackberry bushes. He tiptoes in them very carefully. He does not want to hurt his little paws.
Dr. Maki: On today’s episode, we are going to talk about rhythmic dosing. The title of this one is How to Cycle Hormones but we are specifically going to talk about the difference between or the two options, the two main philosophies for hormone replacement: static dosing which is the more common type, and then rhythmic dosing which is in some ways maybe our favorite, or at least my favorite anyways in the right circumstance. It is not right for everybody but there are certain situations where, I think it is the right situation for men pretty much across the board, but we will kind of discuss some of those. Why do not we dive in? First, let us talk about the static dosing, kind of what that involves and entails, not every aspect of it but just an overview and then we will come back around and talk a little bit more about the rhythmic dosing.
Dr. Davidson: Exactly. With bioidentical hormone replacement, static dosing has been kind of like the norm or probably what people think of when doing the hormone replacement but the rhythmic dosing has been around for a long time, and it is a completely d

Jennifer’s Question: 
Hi there! Thank you for this forum! My sister is using the Mirena. I would like to recommend she starts BHRT as she is 49 and has perimenopause symptoms. Is she able to take Prometrium and stay on the Mirena? Thank you in advance
Short Answer: 
The Mirena IUD contains 52 mg of levonorgestrel, which is a synthetic form of progesterone. This is often recommended for women in their mid to late 40’s to control some of the symptoms of perimenopause. The IUD is fine for pregnancy prevention, but we don’t agree with women in perimenopause given birth control to control their symptoms. There are better BHRT options for managing perimenopause symptoms. However, depending on the woman and her symptoms, she could take progesterone with an IUD. We recommend bioidentical sustained-release progesterone, but not Prometrium. There are more dosing options with bioidentical progesterone and the sustained-release form seems to be better tolerated than the instant-release Prometrium.
PYHP 090 Full Transcript: 
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Dr. Maki: Hello everyone, thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson. 
Dr. Maki: So good morning. How are you doing today? 
Dr. Davidson: I’m doing great. I’m doing fantastic. How are you doing? 
Dr. Maki: I’m doing fine. 
Dr. Maki: We have a question. This actually comes up quite often talking about different types of contraception. Although this one isn’t exactly about contraception. But we’re going to talk about the Merina. just a little bit. Anyways, why don’t you go ahead? This is from Jennifer which is pertaining to I believe her sister, which is kind of like an indirect sort of thing, but she wants to encourage her sister and to be HRT, but her sister wants to use the Mirena. 
Dr. Davidson: Which yeah, it sounds like she is using it. It says, so this is from Jennifer she says “thank you for this forum. Hi there.” You’re very welcome. We love it when we get compliments. So Jennifer says, “my sister is using the Merina, I would like to recommend she starts BHRT, bioidentical hormone replacement therapy as she is 49 years old and has perimenopause symptoms. Is she able to take Prometrium and stay on the Merina? Thank you in advance.” So this is actually a question or somewhat a little bit of a roundabout question that we get all the time because since you know the introduction of the IUD, which is from gazillion years ago with Cleopatra, but now they have hormonal IUDs as opposed to the copper IUDs, and they’ve been around for a long time. But a lot of people ask well, you know my hormones are awry, things are off, I’m in my 40s, I don’t want to take birth control pills when you’re in your 40s is an IUD