You are now listening to The Model Health Show with Shawn Stevenson.
For more, visit themodelhealthshow.com.
Thankfully, we're living at a time where there is an abundance of health and wellness information that we have access to.
There's a lot of conversations about longevity, increasing our lifespan, but we also want to increase our health span, so it's the quality of those years.
And with this longevity conversation, there is a huge conversation taking place right now regarding menopause and perimenopause.
And that is an amazing, amazing change that happened just recently.
Again.
This is maybe again a few years, maybe a decade ago that this has become a part of the popular health conversation.
And so today's episode is very, very special because we're gonna be looking at that timeline with women's health, from puberty to perimenopause and beyond and really help to identify some of the obstacles that women are facing today.
And I'm telling you right now, today's expert, to say that she is the GOAT, the G-O-A-T, the greatest of all time would not be an understatement when it comes to communicating issues of health and wellness with the public.
She's been standing up as a bright light in this field for quite some time and distributing information on national television consistently again and again for many, many years.
And to hear her insights and especially her time in this space of not just being a personality in national television, but somebody who's been a practicing physician, a practicing gynecologist all the while.
All right,
She's doing both at the same time.
Her insights are priceless.
And not only are we going to be talking about the changes in our environment that are leading to changes in our physical and mental health, including a dramatic increase in obesity and overweight.
We're also going to be looking at what she refers to as a potential disempowering aspect of this movement with the conversation of menopause.
All right, which was crazy.
Like what?
This should be all empowerment.
But she identifies something that can be disempowering women about these new changes in the conversation around menopause.
And so something to be mindful of.
This episode is important for all of us.
If we're talking about women's health, we're talking about health and wellness that impacts all of us.
We all got here via a woman.
And so to further this conversation, to make sure that this information is a normalized part of our culture is absolutely essential right now more than ever.
And without further ado, let's get to our special guest and topic of the day.
Dr. Jennifer Ashton is a four-time Emmy Award winner for her work in medical reporting.
Dr Ashton graduated from Columbia Medical School with a specialty in gynecology and expanded education in nutrition and obesity medicine.
She's the former ABC News chief medical correspondent, where she was the first woman to hold this position in the history of the network.
Additionally, Dr Ashton served as the co-host of Good Morning America and consistently reported on a full range of medical topics, including the obesity crisis, mental illness and heart disease.
Today Dr Ashton works as the founder and president of Agenda, a multimedia company centered around weight management, women's health and nutrition.
Let's dive into this conversation with the one and only Dr. Jennifer Ashton.
I'm so happy to have you here, Dr. Jennifer Ashton.
Thank you for coming to hang out with us.
It's so great to be here.
I'm glad it worked out.
Well, you know, I'm grateful.
And we talked about this a little bit before we got started that there's a huge movement taking place right now in the.
You know, this is an incredibly important topic.
There's so many different aspects and things for us to cover with this.
But what was particularly interesting and enlightening for me is this concept or this framework of nutritional gynecology.
Can you start off by talking about what that is?
Well, I think I may have coined that term.
I can't say invented it, because I didn't clearly didn't invent the word nutrition and I didn't invent the word gynecology.
But to my knowledge, I'm the first or one of the first people to put the two together.
And I did that 10 years ago now, believe it or not, when in my medical practice it was one of those light bulb moments where I really connected the dots between things that I was seeing repeatedly in my patients which ran the gamut between puberty, polycystic ovarian syndrome, peripregnancy and then perimenopause.
Conveniently and coincidentally, they all start with Ps.
I don't know why.
But in those reproductive, major hormonal kind of milestones in a woman's life, I realized and recognized that almost always they were associated with significant metabolic and weight issues or demands.
And I had initially started by kind of perpetually referring those patients to a nutritionist so that we could have a kind of coordinated approach at helping her manage and thrive through those, you know, kind of events.
And then I realized that there was a massive gap, because nutritionists know a lot about food and nutrition, but don't go through medical school.
So they don't understand.
You know they haven't been formally educated and trained in endocrinology obstetrics gynecology pediatrics, et cetera, et cetera.
And on the flip side, doctors who have had all that formal training, education and training generally know nothing about nutrition and food.
And I thought, wait a minute, this makes no sense.
It's bad for the patient.
It's bad for the nutritionist and the doctors because they're basically only having half a conversation.
And that's when I coined the term and started referring to these issues as nutritional gynecology, the intersection of where the worlds of nutrition and food intersect with endocrinology and gynecology and those major reproductive stages in a woman's life.
And it was really a major light bulb moment.
Yeah, that's so powerful.
Again, this is the thing that I've known about you just even prior to this conversation is like you tend to be ahead of the curve with things and you're sharing it with the world.
Well, ask my kids.
They'd say i'm behind the curve all the time but, thank you, that's what kids do.
Yeah, you know, but you've been this voice where people can tune in and in a, you know, major network television.
But, as you know, it can be like just kind of clouded and just a lot of other stuff going on where maybe people don't get the message right.
And you're just there to shine a light on something, to brighten somebody's day, but there's also a lot of negativity.
There's a lot of other, you know, just a lot of moving parts.
There's a lot of noise.
There's a lot of noise.
There's a lot of noise.
And so, but I see that.
I see that in you.
I'm grateful for that.
And to have you here to talk about these things because, you know, one of the things that I kind of figured out early on was just how our health has been so compartmentalized with modern medicine.
And it wasn't by any kind of nefarious means, but it's just specialty, specialty.
This, you know, when we start to separate ourselves into parts.
And, as you know, it can be very complicated in communicating with people who are working on these other parts.
And all of this is existing in one sovereign human being.
And so being able to meld two of the most important aspects of health understanding gynecology and nutrition, because really, as you know, it's just our diet, and our food is like making up our tissues, let alone the energy it's running on, let alone the things we could be putting in our system to really screw up how everything is working.
Well, it can either help or hurt.
And I think, you know, first of all, I try to give everyone the benefit of the doubt always.
And I kind of am a glasses half full type of person almost all the time.
So, you know, to your point about everything in medicine and health and wellness being so siloed, you know, I could see certain scenarios where that's maybe a good thing, you know, where someone knows more about one thing and they're not a jack of all trades, master of none, that there can be some real advantages to that.
But where I think it's problematic is is that A people become so siloed.
Just it happens so quickly.
After residency training in medicine where there's enough in, let's say, the field of cardiology or dermatology there's new advances and new things being learned every single day.
It's all those specialists can do just to stay current in their specialty, let alone others, right?
So I don't exactly fault people.
It's kind of like a- just it comes with the territory of our medical system.
But from the foundation on, what's not good about our medical system is, as you said, an organ system, like a full organism, like the human being, is not one body part related to another body part related to another body part.
They're all interconnected.
And I would always say to my real patients I am not just the vagina and uterus and ovaries doctor, as a gynecologist.
Like, there's a body attached to that uterus.
So I'm taking care of that entire body.
And part of that is, of course, the nutritional component.
But there's a mental and psychological component.
There's an environmental component.
There's a behavioral.
You know that's really where, when I use the term holistic health or holistic medicine, I don't mean swinging a clove of garlic over your head.
I mean, although my late grandmother probably did that too, and she might have claimed it worked.
I'm talking about holistic in the real sense of the word.
Things are related.
They're interconnected.
One thing has a downstream effect to many other things.
And if you're not accustomed to look at those things or curious to look at those things, I think you can miss a lot.
Whole person, you know, holistic, whole person.
Let's talk about the first P, the earliest P. Let's talk about puberty and what you're seeing.
Because, you know, just some of the things that I think a lot of people are familiar with is that young girls are starting puberty earlier and earlier.
They're starting their cycle earlier and earlier.
And there's more difficulties, more pain associated with it acne issues, skin so many different things are that I just didn't see when I was growing up are happening for young girls.
And so what do you first of all like, just based on your expertise, like what are some things that are going on and what are some things that young women can do, parents can help their daughters with in that phase?
Well, I mean, there's a lot to unpack there and it's so important.
And You and I are both parents.
And even though our children are older, you know, this is something that anyone who's a parent, and maybe a future grandparent, needs to know about.
Anyone who's a parent of young children needs to know about this.
And anyone who will be a parent needs to know about this.
So that's basically everyone.
I think it starts with.
First of all, these are factual statistics, borne out by epidemiologic studies that Yes, girls are getting their first period a year earlier than they were a decade or two ago.
And that is a number that has been progressively going down with time.
Now, someone could say, OK, who cares?
Well, when a nine or 10 year old gets their period.
First of all, there are significant psychosocial issues associated with that, which we could talk about for an hour just in and of itself.
But there are also medical issues that are associated with that.
First age, age of first period, which is called menarche.
The younger that is.
That is a known and uncontroversial risk factor for breast cancer, endometrial cancer and ovarian cancer.
So the longer a girl and woman has exposure to that kind of hormonal stimulation, the higher their risk of those three types of cancers.
That's a big deal.
So if you just look at that and there are, of course, many other tentacles to that you can see how this is a situation that requires and warrants our attention.
A lot of it is environmental, and that is also not a theory anymore.
Environmental exposure to the so-called endocrine disruptors, whether they're phthalates or other toxins in our environment, not in a sense that we're trying to create hysterical panic, but awareness right.
These things are in our environment now more than ever, and exposure to them at young ages, including in utero during pregnancy, affects the downstream life of that fetus.
And right now we're talking about female fetus.
To back up to the utero environment, that means that the environment that that female fetus sees when her mother is pregnant has an effect on the age at her first period, her future fertility, et cetera, et cetera, her risk of obesity, and that's called epigenetics in part.
So we have better idea as to why this is happening.
We know it is happening.
I think that the easiest way to connect the dots on this is between that of childhood overweight or childhood obesity and early puberty which, by the way, occurs for boys as well as girls.
And so, quite literally, a parent of a toddler needs to be aware that what they let that toddler eat will not could, will have an impact on that child's age of puberty.
And unlike many things in our culture, earlier is not better.
So you know there are some things and you know this is well known.
This is quite literally what you preach as well is avoiding added sugar, like your life depends on it, because it does.
Avoiding things that are filled with chemicals and colors not found in nature.
Like your life depends on it, because it does.
And trying to minimize exposure to microplastics, to other environmental toxins, as much as we can.
We can't live our life in a plastic bubble and we shouldn't go down the rabbit hole of panic.
But there are things you know that, with a little bit of effort, can pay off big dividends when it comes to, you know, making childhood puberty not so much childhood and more adolescent.
It's so good.
It's so powerful to be thinking about because it's hard, you know, as parents, to be thinking about when puberty comes, when you got a toddler.
But that's so real.
Like right now and being mindful of these things because in addition to increasing the risk of, you know, variety of cancers, but dementia risk goes up.
You know this is that timeline, when and, if you think about it, you just mentioned the just the psychosocial aspect of this and little girls dealing with that.
It's just, it's such a heavy weight to bear.
To me.
That's what pains me the most as a mom, as an OBGYN, is to imagine.
I mean there are, you know, 16 year olds, 26 year olds, 46 year olds who have a hard time with their periods.
A 10 year old is that is not something a 10 year old should have to deal with.
And, you know, kids today have enough new stressors in their life.
They don't need another one.
And so you know, to me it really comes down to awareness and prevention and just trying to do some common sense things that again are relatively low lift and are very impactful in terms of what they can result in in a positive way.
When you just mentioned the new exposures and things that they're dealing with, it immediately reminded me of one of the biggest changes in their environment, which is technology.
And this was actually published in the Journal of Pediatric Endocrinology and Metabolism.
And they were looking at the number of girls diagnosed with early onset puberty during the pandemic.
When everything shift to being online.
And they found that during this one year study period, the number of young girls with early onset puberty more than doubled that of the previous three years.
And the researchers, and this speaks to again, just one of these new exposures that we're dealing with.
A likely causative agent, and I want to ask you about this, was children's disruption to their circadian timing systems because of lack of natural light and all of this artificial light.
And it's throwing off when certain hormones are getting secreted, neurotransmitters, just how their cells and their body's just like, what time is it?
Am I speeding up time in essence to the onset of puberty because of light exposures?
Well, first of all, please send me that study.
I haven't seen that, but it makes... perfect sense to me in terms of the physiology.
And also, we were talking before about the impact of COVID and the pandemic.
I think it's pretty clear that we're not going to see the full impact.
We may not see certain sequelae of COVID for a generation.
You know, I mean that was a significant line in the sand and on the timeline of science and you know, one of the biggest human experiments ever done in modern times worldwide.
You know we plot those consequences one year down the road, five years down the road 10 20, maybe even 30 years down the road.
And for sure, you mentioned really three things, three factors that are not theories to contribute to the conditions of overweight and obesity, but known ones contributors right, not controversial activity level, disruption of circadian rhythm, exposure to social media okay and dietary influences.
All of them took a hit during the pandemic and so one of them enough could have been powerful in certain scenarios to have an impact, but for together it, in my opinion, has to have been, and I believe will be shown to have been, synergistic and exponentially contributory to a lot of the health outcomes we're seeing.
You know, a great book by Jonathan Haidt.
I don't know if you've read it, The Anxious Generation.
If that doesn't stop you dead in your tracks as an adult and a possible parent or a current parent of young children with respect to exposure to social media, I don't know what would, because that Again, it presents the clear data, not just here in this country, but in other countries around the world.
And the line in the sand, 2008, when smartphones started.
And all of a sudden now kids were spending time on that device, exposed to the world in scenarios that they really should not be exposed to at younger ages.
They stopped moving around.
They started being influenced on all levels in terms of their health wellness, behaviors.
You know, psychosocial development.
And we're seeing clear consequences of that now.
I want to take a moment and give a special shout out to BBLs.
Not the BBL that you might be thinking about.
I'm talking about broadband light therapy.
Light being utilized as therapy in the beauty industry today can be completely transformative for our health.
In fact, a study conducted by scientists at Stanford University and published in the Journal of Investigative Dermatology found that over 1200 genes associated with skin aging were quote rejuvenated after BBL treatment, ie these genes became more similar to their expression level in youthful skin.
The fact is you simply don't see results like this with any other form of treatment.
There are all these special creams and face washes and diet changes and all of those things absolutely matter.
But the power of light to be transformative for our skin is now affirmed to impact thousands of our genes and having a change in our gene expression to reflect a younger version of our skin.
Now, the most studied form of light when it comes to the health of our skin is red light therapy.
In a double-blind, randomized placebo-controlled trial that took 76 patients with notable wrinkles and treated half of their face with red light therapy, near infrared therapy or both, while other patients received a fake light treatment that was used as a placebo.
The researchers found that participants who received two red light therapy treatments each week for four weeks, they had up to a 36 reduction in wrinkles and up to a 20 increase in skin elasticity.
This was just in a matter of four weeks.
Now, absolutely, if we're looking at the aspect of beauty, incredibly powerful.
But when we're talking about changes to our biology, changes to our skin, it should have us thinking about the impact that it has on our mitochondria.
And with the impact on our mitochondria, this is going to have impacts on our metabolic health, on our immune system and so much more.
Now, what part of our bodies can see an intersection between our immune system and our metabolism?
This would be centered at what we consider to be the metabolic center of our health our thyroid gland.
And since the 1970s there's been an increase of over 1000 increased incidence of chronic autoimmune thyroiditis.
Can light therapy, can red light therapy have an impact on this?
Well, a team of scientists took 43 patients with a history of levothyroxine medication use for autoimmune hypothyroidism thyroidism to analyze the impact of red light therapy and their thyroid function.
This was a randomized placebo controlled trial, and this was done over the course of nine months.
At the end of the study, participants in the red light therapy group were able to cut their medication dose by two thirds versus a placebo.
The red light therapy directly to their thyroid gland resulted in a 64 reduction in their need for medication.
Truly, there isn't an aspect of our health that cannot be improved by utilizing red light therapy.
Now.
There are a ton of red light therapy devices out there right now, but I want to urge you to make sure that if you're going to do it, do it right.
Because we should also be concerned about things like EMFs.
And, as these studies indicate, there were actually fake light treatments, like it might show up and look a certain way, but not having the therapeutic benefit for the test subject.
So making sure number one, the red light therapy device that I utilize is portable.
It's always sitting right on the arm of my couch.
It's registered with the FDA and it is third-party tested to provide the luminance that is shown in these studies, to provide both red light and near infrared light right from the comfort of your own home.
My family has been utilizing the LumeBox for years now.
And this is also for accelerating recovery, for speeding up the recovery from injuries, of course, skin health, beauty treatments that will cost hundreds and hundreds of dollars each session going to an esthetician.
And again, not to take away from the wonderful business model that they have, but these are some things that we can utilize right from the comfort of our own home.
And just having that device and having so many applications for it is truly special.
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And now back to the show.
Just to boil this all down for everybody i'm hearing and thank you for affirming this just some of the basic stuff to help our kids with um, hopefully reducing their susceptibility to early onset puberty, but also just that transition period.
Let's be mindful to just like.
Be careful with all the added sugar.
Make sure that our kids are active more than ever, because we're spending more time on screens, whether this is a computer screen, television screen, their iPhones, whatever the case might be.
Get some real time, real exposure to natural light.
Get outside.
You and I, we grew up at a time, you know, we were just outside was the place to be.
Right.
You know, and we'd be out.
That was the...
The only option.
Right.
Unless you want to be bored, quote, bored in the house.
Yeah, you just spend your time outside.
But it's just completely changed within a couple of generations, really.
And now it's just like just being proactive about that stuff to the best of your ability.
And yeah, I mean the recipe isn't that complicated, but the terrain is a little bit more complicated.
The terrain's complicated.
And you know look, anyone who's being honest should be admitting that it takes.
It takes intention and strategy and effort to do this today.
Because, whether it's technology or marketing, things are being put in front of us that are quite literally designed to achieve a certain goal.
And that goal is many times not one that's gonna be aligned with optimal health and wellbeing.
So you know, as a mom, Cause you know to my kids they don't care how many initials I have after my name.
They try to tell me every day how dumb I am.
But you know they.
They know that I'm a doctor, they know I'm a nutritionist and they know what when I say something that comes from a position of formal education and training and credentials, et cetera.
And the way that I raised them, even when they were, you know, in middle school and high school and even before then, is let's make food and nutritional choices as easy as possible.
So when you pick up a food, you should ask yourself, what is this food doing for me?
And I would teach them actually about macronutrients that way.
I would say like, let's talk about an apple.
What is an apple?
Is it a protein?
Not really.
Is it a fat?
No, it's a carb, right?
What do carbohydrates do?
I explained to them what carbohydrates did.
And then I said so.
When you eat that apple, subconsciously train yourself to say what is this apple doing for me?
It's giving me clean energy or good energy, whatever you want to refer to it, right?
That's okay.
Our body runs on glucose.
That's fine.
If I pick up a brownie right, also a carb.
You should ask yourself is this clean fuel for my machine?
Just be honest, right?
You don't have to say it in front of your classroom or a crowded room.
Just ask yourself.
Sit with your answer, right?
It's a little dirty fuel.
It's a little dirty fuel.
And listen, I would love to eat a brownie every single day.
I'm not going to lie.
I would love it.
I wouldn't be as healthy as I am or look how I look and feel how I feel if I did that.
So that's just a fact.
And those are the conversations that I would have with my kids when they were as young as 10.
So, now that they're young adults and they're in their 20s, like we all do as parents, they hear my voice in their head even probably, when they don't want to.
And that doesn't mean they never eat that stuff, but it just means they're making a conscious intentional, deliberate decision with their nutrition.
Yeah, yeah.
I love it.
So you're talking about essentially... shifting the culture, and in particular, the microculture in your own household.
Yeah, it's gotta start there, right?
And also I think and what I talk about in Agenda, my program, my newsletter, is one person can't be an island in their home environment right, or your social environment.
You can't do it alone.
It's so much better if you have buy-in from your friends, your relatives, your family and women are in a really unique and powerful position because we lead the household.
That's not controversial.
Period, full stop.
And so, like it's, in terms of nutrition, there's only one way that matters in my home, and it's my way.
And so it's.
I have a lot of responsibility to my husband, to my family, to lead by example and to do it in a way that's honest informed realistic sustainable, safe.
You know all those things.
And it's a process.
It doesn't, it's not something that, you know, happens like that.
It's baby steps.
But every day you're chipping away towards a goal that really, really matters.
I love this.
So we're going to move along the timeline just a little bit.
And of course this can show up.
You know many places along this timeline from puberty to menopause.
You know better than most about the rise in PCOS.
So let's talk a little bit about for people who might not be familiar with the term what PCOS is and what you're seeing and what's going on.
Why are the rates increasing?
So first of all, Polycystic ovarian syndrome, PCOS.
We love acronyms in medicine, so everything has to be initials.
It's referred to as the most common but least well understood hormonal disorder affecting women.
If you read a gynecology textbook or an endocrinology textbook, you'll see incidents of 5 to 8, maybe 10.
I think it's closer to 15% or maybe even higher.
And That's based on 20 years of clinical experience for me, but also just connecting the dots again for other conditions in our society that I know are connected with PCOS.
Two of them, the conditions of overweight and obesity, have a very complicated but well-documented connection between glucose and insulin, metabolic health, weight management and our hormones.
So it's a flywheel that has a spoke in the middle that shoots out to all these different kind of groups or areas in the human body.
It's a spectrum disorder.
So it's not a disease that continues to get worse and worse and worse.
There are mild cases of it, and then there are severe cases and everything in between.
And you know I would always say to my patients look, it's very easy when someone comes in with every single sign and symptom to say oh, you have PCOS.
You don't need a blood test or an ultrasound.
All you need is eyes and ears.
Listen to the patient and visually look at her.
That's easy.
What's not so easy is the women who have milder form mild to moderate where it's easy to dismiss some of her signs and symptoms.
And that's when it's harder to make a diagnosis.
And that's what I'm always kind of bothered by, because that's a missed opportunity to help manage a condition that is associated with an increased risk of metabolic syndrome, which then, in turn, is a risk factor for cardiovascular disease.
So very, very powerful body weight connection, metabolism connection and, on a cellular and metabolic level, glucose and insulin connection.
So, with a patient who's experiencing maybe, a severe case, what would some of the approaches be, or what would you do from the perspective of nutritional gynecology?
So I always start with the nutrition.
And that's why, you know, I think that term is so relevant, right?
But there's published data that suggests and supports that, with a person who has the conditions of overweight and obesity, that a loss of just 5 of their body weight will improve their hormonal condition with respect to PCOS, that might not be enough for that person in terms of what they want.
But internally, just that little bit of weight loss 5 can make a big difference in a positive sense.
So I start with the food and the nutrition.
Unfortunately for PCOS, there is an insulin resistance and carbohydrate sensitivity that people without PCOS don't have.
So what does that mean?
That means a woman with PCOS and a woman without PCOS, they weigh the same.
The woman with PCOS.
If they eat a slice of pizza, it's going to be much easier for that woman with PCOS to wind up gaining weight with that.
Where a woman without PCOS, same weight, without the insulin resistance, processes those carbs much easier.
And it doesn't, it's less likely to be stored as fat.
You know, that's an oversimplification, but that's basically what's going on.
That's why a lot of women with PCOS are told, go on a low carb diet.
Now, low carb does not mean no carb, right?
And, as you know, and as we just talked about with the apple example, there's carbs and then there's carbs, right?
I would always kind of Try to strike a middle ground, something that's sustainable.
Again, if you're going to eat carbs, make sure that they're really rich, whole grains, the fruit and vegetable variety, and be selective with your fruits.
Like.
I just had this conversation, by the way, with my husband the other day and he said something about grapes.
And I said, listen, grapes are a dessert.
And he goes, what do you mean?
It's a fruit.
I said, it's straight sugar, honey.
It is straight sugar.
There are so many better fruits for your health to eat than grapes. right?
But that's kind of the PCOS eating plan is going to be relatively high lean protein, some healthy fats, good carbs, but relatively lower carbs.
So around and this is not written in stone, by the way, at least in in my philosophy around a hundred grams of carbs a day, or 80, not less than 50.
We're not talking about keto, nothing crazy, you know, um, you have to be careful.
That's just the reality with PCOS.
Yeah.
I love this.
You're just bringing some balance, you know?
And again, it's just so practical, but we tend to go to these extremes, you know?
And so- Because it's clickbaity.
Yeah.
Yeah.
And also, you know again, just being able to have a little bit of carbs.
It just makes everything easier, you know.
And it does so much for us psychologically.
One of the things that jumped out for me early on with this movement, this huge wave with keto diets
And I know the guys, like some of the physicians, who are like the faces of the.
These are my friends and colleagues.
And they advocate for them, many of them, because they've helped people with these frameworks.
But it's very individual.
And also a lot of this stuff tends to work in phases, but sometimes when we get attached to a thing and it helps us, we do or die this thing.
And when it doesn't work anymore, it's just like, I'm just doing it wrong.
I need to do this harder.
Yeah. giving your body some of these healthier versions of carbohydrates, guess what?
You get a little serotonin uptick, you know, a little feel good.
Like I could do this, like I'm good, but you force yourself, you deprive yourself.
And maybe, especially in the case of PCOS, it's more stressful.
And it's just like so, finding that balance for you, finding the carbs that work for you.
You know something, as you just mentioned with with grapes just being very, they're just high in sugar.
You know it's higher glycemic.
Something a little bit more fibrous type of fruit to enjoy.
But you know it's just gonna depend on you.
I think the other thing you know, and as you say, what you're talking about, with any approach, whether it's PCOS, whether it's someone with high cholesterol, whether it's someone you know who's eating for brain health and wellbeing, whatever rigid programs, this is very well known.
Any program can work short term.
Talk to me at the two year mark.
That's the end point.
I want to see, because that's what's reported in the data, that 85 to 90 of diets fail at the two year mark.
So, and we're not You and I are not, I'm not even interested in the two-year mark.
I'm interested in the 20-year mark, the 25-year mark.
I'm interested in something that is no longer a short-term approach, but it's a habit.
It's a philosophy.
It's the way people live.
And in order to do that, from my nutritional philosophy, it has to be four things.
They're all S's.
Even though I said we were talking about all P's in nutritional gynecology.
The four S's are it has to be safe, simple, sustainable diet. and relatively low sugar.
That's it.
So if you wanna do keto-ish short-term, I have no problem with it.
The data supports that it's effective.
There are people who swear by it.
And by the way, if you need to lose 100 pounds, keto is the way to do it.
And that's great.
When you get to your 100 pounds though, then what are you gonna do?
Because, as the daughter of a cardiologist and someone who's on the board of the American Heart Association, you're never going to convince me that eating a stick of butter and a slab of animal protein is good for your coronary arteries or your brain.
Short term, fine.
I'll have a steak.
I'll put butter on my, you know, whatever, on my sweet potato.
But existing on that for your whole life, sorry, I'm not buying it from a medical standpoint.
So Anything that someone does, I'm interested in the sustainability, the safety.
Is it simple?
If you can't do it in college or at work or travel, I'm not impressed by it, because those are the things that make up real life.
And any system has to work in those settings.
Yeah.
Yeah.
Amazing.
So let's move on to perimenopause.
Okay.
And you know, Even five years ago, this was not a big part of the conversation.
10 years ago, forget about it.
But now it's even especially with the way my algorithm is set up.
It's difficult for me to get on to any social media without it.
They probably think you have a uterus.
They're showing you so much of it.
I think it's because obviously the research, but also just being somebody who's kind of lifted up women's voices, to have these conversations early on.
But it's just like the pendulum has swung so quickly.
And so I want to keep everything grounded, because a significant portion of the Model Health Show listeners are in that timeframe of their lives of perimenopause.
And so, first of all, just seeing this onset of all these different random things that might be popping up, related to health issues, weight gain, whatever the case might be,
And what it was initially and still is.
I think, for the most part is women not even knowing that perimenopause is a factor right.
And so just turning on the light bulb, you know, just to know that this is a factor and something to consider at that frame of life.
So, if you could, can you talk about what you're seeing with perimenopause right now and what women need to know, and in particular, through the lens of nutritional gynecology?
I think...
Well, first, can I turn the tables and ask you a question?
Absolutely, you can.
Before the perimenopause blitz, perimenopausa palusa, I don't think I've heard that word, started.
How much did you know about it as a man who was in the fitness and nutrition and wellness sphere?
Yeah, next to nothing.
Wow.
Next to nothing.
Menopause, yes.
Perimenopause, next to nothing.
Right.
I mean-
All right, I think first of all, let's start there again.
I love this topic for so many reasons.
There's so many nuanced areas that I think are interesting to explore.
I think first, again, as I said, I'm a glass is half full kind of person.
So let's start with the positives.
I do have some negative thoughts on this, which I'll get to in a second.
You probably haven't heard them in your algorithm yet.
But on the positive look, women's health across the board has been underfunded under-researched under-discussed underrepresented, you name it.
Any under, it's put it in the category of women's health.
Literally, even till today.
There's no excuse for that, right?
We're 51% of the population, okay?
That could be a whole hour as to why.
Again, I kind of feel like, all right, that's in the rear view mirror.
Let's focus on today and the future.
It's more productive.
But those things are facts, right?
That has trickled down in the field of Western clinical medicine and healthcare, because the trained physicians even including probably today, I think it's probably just starting to change barely from medical school on.
Even in our field of women's health OBGYN we got zero training on menopause.
Zero, right?
Our specialty, OBGYN, is primarily focused on the female human as a vehicle for reproduction.
And you see that literally in the care of the pregnant woman.
It's part of the reason why we have a maternal mortality crisis in this country, because our medical system unplugs from that woman the second.
She's entered the third stage of labor and that baby is out.
We're like, bye, you've done your job.
Thanks for the baby.
Now we're going to focus on the baby.
Pediatric care, neonatal care, infant care, child care, all of that.
That conveyor belt starts immediately.
And- no one pays attention to the woman.
You see that in OB-GYN offices, by the way, where there's a pregnant woman sitting next to a 40 some odd year old woman forget about a woman over 50 all of the attention goes to that pregnant woman.
They're there to see the same doctor.
They don't get the same level of priority.
Okay, so that's.
It is so important to recognize that and understand that that's the landscape that women have to deal with today in the United States.
So it's not really a surprise that something that would start to happen to women in their late thirties, that was not pregnancy related, was totally ignored.
It was heretofore ignored by the medical specialty, by research, by society.
I also believe that, up until pretty much now, our society, our culture also did not place value on a woman once they lost the ability to reproduce.
What changed that?
I think largely popular culture.
And this is where social media and people's ability to see women all over the world, I actually think is a positive right.
Because what are you seeing?
Helen Mirren in.
I don't know how old she is.
You probably do late 70s, maybe even 80, top of her career.
Politicians, worldwide leaders in Europe, in other countries running their governments 60s 70s, in some cases 80 years old.
Women running the biggest corporations in the world in their 50s, 60s, 70s.
That's what changed this.
That's what made everyone say, oh, well, maybe they can't get pregnant but they can win academy awards they can run billion dollar companies they can run governments i guess they're they're okay so i think that's a good thing okay should it have not taken that of course should it have happened years and decades ago of course but we'll take it it's better late than never right i think then when you talk about hormonally It's now very well known that the symptoms of perimenopause, and I'm sure you know this stat, but some of your listeners may not, they can start in a woman's mid-30s.
Sit on that for a second.
Mid-30s.
Brain fog, insomnia, night sweats, irregular periods, weight gain, musculoskeletal problems.
Mid-30s.
There's zero chance that any doctor or healthcare professional seeing a woman in her mid thirties who starts complaining of these things is gonna say oh, you might be in perimenopause because there's a woman sitting next to her in the waiting room who's pregnant at the same age.
So they just, it was not picked up.
The awareness wasn't there.
The diagnostic methods still really aren't there.
And more to the point, the woman's lived experience was not prioritized.
So I think finally, one of the good things about the perimenopause of Palooza.
How many syllables is that?
Perimenopause Palooza.
That's an eight syllable word.
I don't know that I've ever said an eight syllable word before.
That's a lot of syllables, but that is now, it's made it okay, right?
It's made it okay to say like oh, I'm in perimenopause, or I think I might be in perimenopause, or I'm in menopause.
People aren't whispering about that anymore.
And that's really, really good.
Yeah.
It's not just getting brushed under the rug.
Like, you know, you're broken.
By the way, forget about being broken.
I go to the flip side.
Not that it's not a negative.
It's actually a positive.
You know why?
You know what the alternative to going through menopause is?
You're dead.
Yeah.
Menopause is only reserved for for the women who are alive to go through menopause.
And let's not take that for granted.
It was not that long ago that women did not live to age 50.
So I actually think it's a positive.
And humans are unique in menopause going decades beyond reproductive age.
You know, it's very special.
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And this is the right use of technology and innovation is because you know, many people who have places of influence can share their story.
That's right.
And because they, like I, have my voice, whereas before, like major media, it's kind of controlled and it's just this very curated thing.
Now a Holly Berry can jump on her Instagram and say yeah, I'm going through menopause and you know, and just share and I'm here and I matter.
Right.
And so that's a absolutely wonderful thing.
Now, with this being said, I want to go back to In mid-30s, potentially.
You know something else and to tie this together with the first P, early onset puberty, it's likely you're going to see early onset menopause or perimenopause.
You could.
The timeline of that.
Yeah, you could.
There's many reasons for perimenopause to show up earlier, but that's one of them.
You could.
Well, weight is the common thread through that.
Because women, girls who are overweight or have the conditions of overweight and obesity and, by the way, that's the proper way to say it not are because we use person first language, or we should be right.
So someone isn't obese, they have obesity.
Someone isn't overweight, they have overweight.
Girls and young girls who have those conditions are likely to continue to have those conditions as adults.
And women who have overweight and obesity tend to have worse menopausal symptoms.
When they achieve menopause is still variable and there are other factors, including genetics, which is a big factor on the actual age of menopause, but their symptoms are linked with weight.
And so people 100, you're right.
They need to be clear that a problem at age nine is likely to continue to be a problem at 39 and 59 and 69.
Do you wanna hear my negatives about menopause?
Absolutely, I do.
Why would I not?
All right.
I think that you talked about the pendulum, and the pendulum right now is majorly on the like you know, up on the menopause meter right.
In terms of everything people talking about it, people trying to capitalize on it, whatever.
Some bad, some good.
I think there's a potential negative here that no one is really talking about, which is the narrative that women are passive, meek victims of sorts in this whole process.
And that you know we, if things aren't served up to us on a silver platter, figuratively we will be lost at sea and just floundering without that.
And specifically what I mean by that is there are a lot of people often well-credentialed, I hope and think, well-intentioned experts who are because it garners a lot of buzz and it hits the algorithm have literally focused their narrative on the line that no one told us.
Well, no one told us about this.
No one told me I was going to have a hot flash or gain weight around my midsection despite eating all the right things or have vaginal dryness or painful sex or low libido or no one told me.
And unless someone tells me these things, I'm just a meek, like, you know, floundering female.
I push back on that big time, okay?
No one told us how to go through puberty.
Did you have a good sex ed class when you were in fifth grade?
Probably not.
I certainly didn't.
No one does.
I've yet to meet someone who was like yep, I learned so much in my health class when I was in fifth grade.
No one, no one learns that. anything good pretty much, right?
We figured it out.
We went through puberty as women.
We figured it out.
No one, I didn't go to a class on how to insert a tampon.
I figured it out.
Same thing with pregnancy.
I was a medical student when I was pregnant with my son, my first baby.
What did I know about being pregnant?
I didn't know anything till I became pregnant.
And then I
I made it my mission to educate myself and learn as much as I could about pregnancy, for my two pregnancies.
As an OBGYN board certified, I didn't know anything about menopause other than how to prescribe menopause hormone therapy, or HRT, to my patients, to the point where I started having perimenopause symptoms and I didn't even recognize them in myself.
But guess what?
I educated myself.
I figured it out.
I spoke to my doctor, et cetera, et cetera.
And my point is is that I think to have a narrative where women feel that they've been a victim does not help.
And I think it runs a serious risk of actually perpetuating a victim mindset that is really damaging for women.
I think women are, way too strong, way too smart, certainly not passive to fall into that.
That is not to say that the medical community has not dropped the ball on menopause, because they have.
That's simply to say one of my favorite sayings be careful when you point a finger of blame at someone or something, because three are going to be pointing right back at you.
And I don't believe that women deserve that blame.
And that's what a lot of these narratives are about right now.
They're about like we have to.
You know, everything should be just served up to us, you know, or we won't be able to handle it.
No, that's not, that's not how I see women.
That's not how I see women since the beginning of time.
And that's not how I see a woman's arc of her life.
Puberty pregnancy, perimenopause.
We're not really informed about any of those things, and how we get through it is not predicated on how much has been served up to us beforehand.
So I think that's just a potential nuance in this climate.
Right now that hasn't gotten a lot of attention that I think needs to get addressed a little bit better.
Yeah, thank you for sharing that.
Thank you for letting me share.
Yeah, I mean, just...
From a very rational perspective, being that this conversation is new for our society, it can easily fall into this pattern of any kind of diagnosis, right.
Like I have insulin resistance.
I have heart disease.
It runs in my family.
There's nothing I can do about it.
I'm a victim.
I have this label and it is what it is.
That's why.
Because we're searching for what is going on.
If something isn't right, we're searching for that thing, but then- there's a tendency to be disempowered by the thing.
Like this is what it is and there's nothing I can do about it.
And so being able to, yes, have this information, but remember how powerful you are.
And what I've seen and the thing that attracted me to you the most like right now was you are so about that life when it comes to your fitness now.
Oh my God.
Thank you for noticing.
Of course.
So where did that, tenacity come from with you training?
It came from a place of curiosity.
That's exactly where it came from.
And it you know, I was leaving my position as chief medical correspondent for ABC and Good Morning America to start Agenda, my women's health company.
And I didn't really know what it was going to look like.
I didn't know.
You know, I've never started anything like that before you know, other than my former medical practice, but this was different.
And I didn't know, I really didn't know what step one was going to look like.
And so I kind of forced myself to take a moment, which I think anyone can do, and they don't need a crossroads in their life to do this right.
It could be just self-imposed, but say, look, let me just pump the brakes for a second.
Let me start from within.
You know, before I start putting my effort and my attention out to other people whether it's work or family or social life let me take care of what's the saying like?
Get your own house in order, clean up your side of the street before the others right.
That's the saying.
So I was like, let me clean up my side of the street.
And what does that look like?
So I was 55, this was a year ago, I'm 56 now.
And I said with curiosity what would it take and is it possible for me to feel better, more fit, healthier and look better today than I did 20 years ago?
And that was an open-ended question.
Obviously, I didn't have the answer to it.
I didn't even know if there was an answer to it.
But I embarked upon kind of my own wellness journey with that sense of curiosity that was anchored in medical and scientific and nutritional principles, because that's how I see life as a doctor and as a nutritionist.
So I took this assessment, in a scientific manner, of myself, of my life, how I was eating, how I was training, how I was living.
And I kind of evaluated it as objectively as I could, considering it was myself.
I partnered with professional trainer, Corey Rowe.
And I said to him, I want to be more fit now or in six months than I've ever been in my life.
Can you help me?
And he was like, I'm in.
And I knew, and I should say for transparency sake, that I have always been someone who loves fitness.
Exercise to me is my primary means of reducing stress in my life.
And, as a doctor and a woman, it has been the anchoring element in my entire life, in every challenging thing I've gone through physically, emotionally and mentally is my faith in the human body and what it's capable of.
And more than that, my faith in my body and what it's capable of, right?
And so that sense of faith and curiosity medically and scientifically and nutritionally was kind of what drove this.
And in terms of the fitness.
Look, I mean, you're an expert in this.
If you had watched the way I was training a year and a half ago, you would have said, I mean, I guess it's better than nothing, but not by much.
Like it was.
I was that woman who would go to a gym, go to the gym, leave feeling as fresh as I did when I walked in.
Well, that tells you something right there, right?
Never break a sweat.
I would never, I could go out to dinner right from the gym.
No sweating, no thing like, hair intact, the whole thing.
And I was wondering why I wasn't moving the needle, why I wasn't progressing, why I wasn't getting results, more to the point, why I wasn't feeling strong and fit and powerful.
And by the way, can I curse on that?
I can, right?
Shit was hurting.
And I would wake up every morning and be like, oh, my back.
And then I would say, well, I'm 55.
I guess my back hurts.
I guess that's what happens when you're 55.
Wrong, wrong answer.
So I started training with Corey and he took his objective assessment of where I was at baseline.
And by the way, it wasn't good.
And I was someone who was going to the gym five days a week before then.
I couldn't do a single unweighted pistol squat Not one.
I couldn't do one real pushup, triceps pushup.
I could, you know, with a wide stance, sure, I could do 10 or 20 or whatever.
But the real kind that needs significant tricep and back and chest strength, I couldn't do one.
Real one with my knees off the ground.
And forget about my cardio.
It was in the crapper.
And in...
Oh, and by the way, I was skinny fat.
Skinny fat.
So again, not that anyone should need this in this day and age as a reminder, but please do not ever confuse the number on the scale with health, fitness or disease, because it is just one measure right.
My weight was low, fine. but I was not fit.
I was not strong.
And so it was unbelievable, like what I learned on this journey and what I'm still learning.
And I can say now without question, and my kids, who are 25 and 27, if they were sitting in this room, they would attest to my truth with this comment.
I can do things now, not only that I couldn't do 20 years ago, but get ready.
I can do things now that some of their friends at their ages can't do.
Oh, come on.
That's amazing.
Yeah.
It's the miracle of the human body is what it is.
Yeah.
And so it has been unbelievable and it grew so organically.
And you know I was sharing this with you by email that people my followers on Instagram started seeing what I was posting and said please developed this for us.
And so Corey Rowe and I put together a program or he put together the workouts, daily workouts.
I put together the nutritional program and the wellness science for 99 cents a day.
And we had thousands and thousands of women, mostly over 50, but not only at one point.
We had 26 to 86 in this program and it's plug and play.
It gives you everything like what to eat, the portions, the grocery list, the workout, the wellness science.
So I talk about menopause, perimenopause, statins, cholesterol, you name it.
And I've probably positively impacted more lives in this program than I did in 20 years as a doctor in my office.
And it was very, very important for me to make it less than 1 a day so that pretty much everyone could say I know I have a dollar a day for my health.
And it's been amazing.
Yeah, and the results also that came from that are just remarkable.
And so you've mentioned Agenda a few times.
Can you tell people where they can get access and just get more information from you in general?
I would love to.
And also I would love it if you would one time write an article or more than one time for Agenda.
We would love to have you as a guest writer.
So I started Agenda, Before I left Good Morning America, it's a free weekly newsletter.
We have about 200,000 subscribers.
Uh-huh.
Already amazing.
And it comes out once a week.
So people can go to Join Agenda and agendas like Jennifer with a J-E-N.
Joinagenda.com or they can see it on my Instagram at DRJ Ashton.
But what I loved about it is that it was me talking about the nutrition and women's health information and fitness stuff that is in my areas of expertise.
So when I have an article on cardiology, for example, I will interview a cardiologist.
So it's really, I'm big on credentials and I'm really big on staying in someone's lane.
And my lane is obesity, medicine, nutrition, and OBGYN, women's health.
Of course, perimenopause is part of that, but that's what my passion is.
So that's what I wanted to write about.
And it will always be free.
I wanted it to be free.
People feel like they're literally talking to me when they read it.
And it's been a real passion project.
And it's been amazing to hear and see the response to it.
So if you do another wellness experiment, people would be able to get access or stay up to date with that through Agenda.
They can see it through the newsletter.
They can see it on my Instagram and they can see it on our website, which is joinagenda.com.
But you know, I'm a big believer in, you know, as you know yes, not only the field of nutritional gynecology, but where women's health and fitness and nutrition intersect.
And I think if we learned one thing in the last five years in this country, it's that we have to take responsibility for our health and our path in life.
There's a lot of things we can't control.
You can't control who your parents are, so you can't control your genetics.
You can't sometimes control your external environment, but you absolutely can control your behavior.
There's just so much noise in this space right now.
Again, I think it's largely a good thing that people are interested, they're curious, they're talking about things, but getting credentialed information and credible information from trustworthy sources.
It's why you have your following, because people trust you.
It's why I had my position for 16 years in national network news is because I was trusted and I take that trust more seriously than any other responsibility I have in the world other than being a mother.
And so it's really, it's been incredible to work on it.
And there's no shortage of interesting topics to talk about.
That's for sure.
Yeah.
You know, your authenticity obviously shines through.
You know that.
It's certain people, you just, you can't shake it off of you.
And so you've been a bright spot for people tuning in.
And you know again, a medium that is complex.
There's a lot of noise, a lot of stuff going on, but just you know you're so appreciated because it just it really does shine through.
And you've been about that life for a long time and giving us very valuable information about our health.
And now in this phase, being able to like concentrate this stuff to get a lot of people active communicating, it's just super exciting.
So- Thank you.
Yeah.
You know what, it's-
As I said, it's a responsibility that I take very seriously, but I also, you know, as as I said right before we started talking, at the beginning of the day, the end of the day, I'm a doctor, I'm a wife, a mother, I'm a nutritionist.
That's whether I'm talking to you, talking to millions of people, talking to someone on the street, talking to my kids.
The message is the same.
And it's your message too.
And you know, I heard.
I'll end with saying something that I heard 20 years ago when I started in television.
And I think you're a great example of this, but sometimes it's one of two things.
Sometimes the messenger is as important as the message.
I've kind of reframed it to a big message needs a big messenger.
And there is no bigger message than our health.
And so like, we, that's our job is to be good messengers for that message.
Yeah.
Yeah.
Yeah.
I appreciate you so much.
This has been wonderful.
I can't wait to just stay up to date with you, see what you do next, support your work.
Thank you.
And likewise.
Yeah, this has been amazing.
The one and only Dr. Jennifer Ashton, everybody.
Thank you so much for tuning into this episode today.
I hope that you got a lot of value out of this.
If you did, you already know what to do.
Share, subscribe, this information with somebody that you care about.
This conversation is so critical for women's health in particular, but again, this reaches into so many different domains of our community wellness and to have access to somebody like Dr Jennifer Ashton is truly a gift because again, she's been at the forefront of this conversation and her sharing today one of the things that this can be glanced over.
But she is a classically trained from one of the top medical schools in the world in gynecology.
And she learned next to nothing about menopause medicine.
That makes no sense.
It's changed slightly in recent years, but there is so much more work to do.
And that changes by changing the conversation and what we're demanding.
So again, sharing this information is absolutely important.
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