Hormonal Imbalance In Women: Signs, Causes & What To Do

Hormonal Imbalance In Women: Signs, Causes & What To Do

Author Name:Dr Pal

Youtube Channel Url:https://www.youtube.com/@DrPal

Youtube Video URL:https://www.youtube.com/watch?v=QOTMT0m7AGk



Transcript:
(00:00) Stress is one understated determinant of premature menopause. >> What is the first real sign of menopause that a patient can actually see? >> Very hot. >> You're literally sweaty hot because it's a sudden hot flush. Not all women will need hormone replacement therapy. However, women who need it should be given it.
(00:25) They should not be denied telling them [music] facts that breast cancer risk will be increased. >> Dr. Meera Ragavan is a [music] 32-time gold medalist >> and fellow of the Royal College of Obstitricians and Gynecologists >> with over 30 years of [singing] experience across India and the [music] UK. >> She continues to lead in advanced women's healthcare and robotic surgery.
(00:45) >> Tell me about caffeine and PCOS. >> I tell my women with eurogy problems, try to avoid caffeine more than two cups. You think you're hydrated but actually you are. >> Can you list down top five foods that could be useful for permenopausal symptoms? >> First is your iron requirement. [music] So definitely spinach and your dates and taunting texts, inappropriate language, inappropriate [music] messages, inappropriate pictures.
(01:13) Are you facing something quite traumatic? >> Before we dive in, can I be honest with you? It blows my mind that 57.9%age of you who listen regularly still have not subscribed to our channel. If you enjoy the podcast, the stories, the signs, maybe even laugh at our jokes, could you do us a small favor? Hit that subscribe button.
(01:34) It takes only 2 seconds and helps us keep bringing you better guests and episodes every week. I'm truly blessed to have all your support and I'm sure you will support me in the journey. Now, let's get into today's episode. Welcome to another episode of our podcast series Get Feeling with Dr. Pal. In this episode, we have a wonderful, wonderful physician, a lifestyle medicine physician who's also a Eurog gynecologist. Her name is Dr.
(02:00) Mera Ragavan. She's doing a wonderful, wonderful job in Chennai. She works at Apollo Hospitals and also have a separate clinic called Chennai Specialty Clinic in Vessanaga. We talked about menopause, women's health and how women's health is closely related to environmental factors including stress. It was a eyeopening discussion for me.
(02:20) I'm sure you like it as well. Let's dive deep into it. Welcome ma'am. >> Thank you very much Dr. Pal. >> I'm so happy to interview you on women's health today. >> Thank you. It's a great opportunity. Right off the bat, I'm just going to ask you, women in 20s or 30s, should they worry about menopause at this age or they can wait? >> Very good question actually.
(02:45) Uh it's like preparing for the future because we'll have to understand what is menopause. Menopause is complete absence of periods for about a year time. So this is an eventuality which we'll all have to embrace as women at some point in our lives. So the usual average Indian age of the onset of menopause is between 46 and 50 years of age.
(03:10) However, the recent years we are seeing quite a lot of women having early menopause or premature menopause. So below the age of 45 is early menopause and something lesser than 40 years of age attaining menopause is premature menopause. Do not know maybe late to environmental factors their own genetic predispositions or the advent of so many fertility related issues and treatments.
(03:41) Women are now having premature menopause. So I think it's a good time to understand more about this even when in their early 30s or late 20s to be aware of what could be potentially causing this or how potentially they could have long years of hormonal health. >> So it is important for them to understand. >> Ma'am, you are a very popular OB/GYN in Chennai. You see a lot of patients.
(04:11) What in your practice what do you think are the most common reasons for early menopause? >> Um stress is one understated determinant of premature menopause. The reason is I have done health camps in various situations in both urban slums, rural areas and urban city dwellers. What I generally find is more than what is quoted in that literature.
(04:38) the cohort of the urban slums and the rural dwellers have a far higher chance of having early or premature menopause. This made me wonder apart from nutrition it could be the stress of day-to-day needs and demands which could be potentially leading to premature or early menopause. >> How is stress related to menopause? >> Because stress constantly uh reduces the hormonal balance.
(05:05) It keeps your cortisol level high and that could possibly have um disturbance in the homeostasis and could lead on to ovarian depletion and further menopause. This is my thinking process. So cortisol when you say ovarian depletion you know if you think of me as a layman how will you explain that >> the steroidogenesis which happens in the ovaries is the reason for a hormonal balance both estrogen and progesterone that balance if it gets knocked off which we see in patients with steroids as well or an imbalance of hormones or
(05:43) when they have other things like obesity which itself an inflammatory condition potentially they could have sessation of periods and that could be leading on to premature menopause. >> Ma'am, a person listening to this podcast, let's say she's like 30, 35 years old, if listening to this makes me anxious uh in terms of, you know, stress is a very common thing.
(06:07) >> Yes. >> On a daily basis, especially when people are living in the US or NRI community, the amount of work that they do is is next to impossible. >> Very true. Very true. and how serious they should take this. I mean how do we know that they are stressed and it will affect the menopause? >> I think everybody is subjected to stress all of us because I believe in stress having two important aspects.
(06:35) One being a ust stress which is good for your body because it gives you the drive to achieve things. >> It is EU stress. >> EU stress. uh it's in a you are in a good place. >> Whereas there is the opposite which is the distress which the stress is inciting a kind of a response uh more than a response a reaction >> which causes more inflammation uh emotionally physically hormonally and that should be avoided.
(07:10) So the way we manage stress is dependent on multiple factors. the nature we have, our surroundings, the way we have had or faced childhood issues or the childhood security if I may call it or childhood trauma on the contrary all contribute to the way one looks at or perceives stress. For somebody it might be the pushing factor to achieve more.
(07:34) For someone it might be the only pulling factor which kind of derails them and make them underperform or completely lose it. So I don't think I have a clear definition of stress. Each one's perception and reaction in response to stress is what determines our well-being and illness at the same time. >> Same time. Right.
(07:57) You know I think both of us should be very proud of ourselves that we completed this lifestyle medicine curriculum. >> Absolutely. My perspective about illness rather my perspective about being a doctor in the first place has changed from one who treats diseases to one who promotes well-being. >> Mhm. >> So that nobody will come to me as a deceased person.
(08:24) So >> only few percentage of doctor in our community itself >> definitely >> are trying to adapt this method. This has made a complete paradigm shift in the way I look at problems. I do not I now grab every possible opportunity when a woman approaches me for a problem may not be in her complaint list but I would look beyond what is there in the complaint list.
(08:54) Say for example they came with irregular periods. I look beyond. I now ask them religiously are they getting good amount of sleep? >> Are they regularly exercising? >> Are they eating a balanced nutrition in their diet? >> Are they having any kind of stress precipitating factors? Invariably women or girls come to me when they have their board exams, the neat PG exams or when they're relocating.
(09:25) >> What is the symptom that they come to you with? uh periods have not come for 4 months. >> Mhm. >> And you can clearly associate that with a cessic factor. >> Yeah. Or a relocation or a marriage or something which is kind of go giving them that occult stretch which they themselves are not aware of. So this made me wonder whether apart from the nutrition, exercise and everything the two major factors which do have a lot of hormonal interplay particularly in women are going to be stress and sleep in appropriation.
(10:01) >> Uh um ma'am in your experience can you give us an example of how you identify stress as a factor in a patient coming in with your symptoms? uh typically what happens in uh patients or in women who have had a relocation >> say for example they came from the north >> and settled down in Chennai recently for the 6 months or one year and suddenly have a complete change of their period pattern this is not a uncommon issue is right it's very common >> it's quite common uh because this being a IT harbor they come on a bank transfer
(10:37) they are here the food needs to get addressed interested. They probably like you earlier said they might have to manage a lot of things on their own. It's long hours and they do not choose their food in the correct manner. They probably have lot of processed food at that time because they don't have time to do home-cooked meals and all these amount to the stress factor which I'm talking about travel settling down lack of sleep everything put together they suddenly have and they mentioned that I've never had these kind of problems
(11:14) and suddenly they do have >> and uh in your practice when they modify all this they do get better they definitely get better because it's about only giving them that time to settle in and continue the socalled good things which they are doing to keep them healthy or keep up their healthier practices.
(11:36) So their usual complaint will be I'm eating the same type of food or I'm doing the regular workouts which I'm used to do still I'm not shedding weight or in fact I'm gaining weight. That made me think the factor beyond exercise and nutrition there's something beyond which is helping them to put on weight or preventing them losing weight and the answer would come out as lack of sleep or stress which is both inflammatory in nature and that increases the cortisol and acts as a counter regulatory mechanism for whatever weight loss practices they are doing in the first
(12:14) place. Of course, of course. I always say that if a women has tried everything, you know, diet, exercise, but still not losing weight, they're underestimating the perceived stress scale that they are on. >> Absolutely. Absolutely. >> And it's a it's a huge thing. So, I want to come back to menopause and then I'll have to ask you what is the first real sign of menopause that a patient can actually see.
(12:36) >> Yeah. Um menopause can pretty much start with 3 to 5 years before this period irregularity as per menopausal symptoms. The permenopausal symptoms can be uh somatic in the form of hot flushes, night sweats. >> Somatic means >> uh bodily expression of these kind of symptoms suggest >> you think me as a layman ma'am.
(13:02) >> Okay. I'm uh >> you can experience suddenly going very hot >> and suddenly when everybody is in the AC you would want the AC turned down because you're feeling cold and the next moment you're literally sweaty hot because there's a sudden hot flush because of the vasoddilation which can happen the vessels open up suddenly because of the fluctuating levels of hormones okay >> so which is why I commonly tell my women, it's the mothers who suffer from these symptoms because the hormones are yo-yoing.
(13:37) >> Whereas the grandmother is now used to a low level of hormones all through, she's not experiencing that. >> So the typical permenopausal symptoms happen with the somatic changes where the skin becomes really flush. You feel completely red in your face. Our women are of a darker color. They might not feel they you might not perceive that they become red in the face but they can make sure that suddenly some hot feeling is coming on especially behind their ears the whole body is burning that's what they feel it's quite uncomfortable
(14:13) for women who experience and sudden bout of sweating which is quite uncomfortable for them. Um this is not very pleasant. If it happens in a workplace, they find it hard. If it happens in the night, it causes itself sleep deprivation, sleep disturbance. And when they are awakened, they are not able to get back to sleep.
(14:40) And having learned about sleep as part of lifestyle medicine, I have now come to believe it's not the number of hours you are in bed. It's the quality of sleep you have and the type of sleep you have and the cyclicity of it also matters for your betterment of health. If you do not have a deeper sleep in adequate quantity or you do not have them sleep or the dreamy sleep in adequate quantity that itself can put down your health in significant ways.
(15:15) This is something I kind of learned in the process of lifestyle medicine and I also evaluate my own sleep in those ways. Um which is huh because the days when you have felt you've adequately >> rested you still feel groggy or tired in the morning and not energetic that means there has to be something to do with the quality of sleep. >> That is very very important and permenopausal women apart from having these hot flushes night sweats can have sleep disturbances.
(15:49) Usually getting to sleep can be a problem. Early awakening can be a problem or kind of inability to get back to sleep can be a problem. >> Early awakenings, you know, they will be waking up at 6:00 a.m. They might wake up at like 5. >> Yes. And not be able to go back >> go back to sleep. Okay. >> And apart from that, a low mood or an anxious mood can both be present.
(16:12) They suddenly feel generally low and that also could be a factor which is happening in them and of course people do not talk about this is the sexual dysfunction. It's either the lack of interest or the lack of lubrication due to the dryness in the private parts which makes having intimate relationship not so pleasurable and difficult as well.
(16:39) And that is a sign earlier than even the onset of the [snorts] period sessation. >> Period sessation. >> Wow. Is obesity related to premature menopause? >> Can be. >> Can be. Obesity generally is related to delayed menopause because if you imagine obese women, the fat itself behaves like an endocrine organ. >> Estrogen. >> Estrogen excess.
(17:07) They are more prone for disorders with estrogen excess like breast stimulation leading onto a higher risk of breast cancer or a higher risk of endometrial triggering which leads on to a hyperlia or a thickened lining leading onto heavy periods and thereby delayed menopause. So women who do not have menopause beyond the age of 55 generally have obesity or being overweight as a factor.
(17:34) uh as a woman listening to this podcast, let's say they are going through permenopausal symptoms of menopause. The biggest question is should they need hormone replacement therapy? Your take on this? >> Uh not all women will need hormone replacement therapy. >> However, women who need it should be given it.
(17:56) They should not be denied telling them facts that breast cancer will risk will be increased or your dementia risk will be increased or your cardiovascular risk will be increased. If they need it, if they are symptomatic, they are candidates to be given HRT like any other hormone. If I have a thyroid deficiency and if I have constipation, dry skin and weight issues, I will be given thyroid hormones as replacement.
(18:25) The ovary has stopped producing the hormones. You are showing symptoms of those deficiencies. You should have it. There's no question. >> Can you tell the symptoms of deficiency? >> Whatever I mentioned about hot flushes, night sweats and uh sudden feeling cold and hot all the time. that is one particular symptom which needs treatment and that's symptom which will only get better with HRT significantly and the alternatives have to be considered only if there is a strong contraindication to HRT say the woman is having endometrial
(18:59) cancer or an active breast cancer or actively bleeding stroke or active MI >> then I should not be giving it but just because she has a family history I'm not going to deny her that because her quality of life is seriously compromised and this we know that it's going to be staying for 2 years till the body acclimatizes to this decline.
(19:23) M >> so we need to keep her comfortable from that point of view so that she does not have poor quality of life and that itself does not beget stress which can worsen the issue we >> existing problem existing problem >> and to our understanding now after dealing with so many menopausal women is that the vasimo motor symptoms are not something to be taken lightly severe the vasimot symptoms prolong the vasim motor symptoms the chances of that woman having cardiovascular morbid is known to be higher >> in the studies. So it could be a kind of
(19:58) a red flag for futuristic cardiovascular issue. All the more reason this woman needs HRT. >> Wow, wonderful explanation on the HR because it's a debatable. >> It is >> women we do not give HRT are women if I'm going to start asking to start charity on a woman who's 70, there's no point in doing the HR because her risks outweigh the benefits.
(20:23) In women who have already crossed 10 15 years beyond the age of menopause, say the menopaused at 50 and they're now 65, I wouldn't give HRT. So if they are within 10 years of having had menopause or less than 60 years of age, HRT is a must actually. >> Beautiful. Beautiful. Ma'am, we wanted to I want to quickly touch upon the mental health in menopausal women.
(20:48) >> Very nice. [laughter] So really because I think it is being uh not explored that much uh and also I would say even in a regular normal menstruating women as well the premenstrual symptoms where they may be a little bit anxious they may be a little bit depressed how do you differentiate whether there are hormonal changes or like true anxiety or depression.
(21:09) >> Very nice question. Um it's about having them to have a menstrual diary >> and jot down their mood diary in face with the menstrual diary. So they if they exhibit right from 10 days before the onset of the next period and they exper exhibit mood changes and explicitly say that they've been tearful, they've been snappy, they've been irritable, they've been angry or otherwise then that fits into a premenstrual syndrome.
(21:46) They could be having physical symptoms like cramps in the legs, bloated feeling or a an inability to digest whatever they eating. That's what they how they put it as rather than bowel disturbances because normally what they would eat they're not able to take it that much very well and there is craving at that time. Yes. >> And uh breast tenderness and all that.
(22:10) If the mood um >> disturbances cause any concern for self harm or harm to others >> that automatically escalates itself into a an issue which has to be under the perview of a psychiatrist. >> I see. Till then the gynecologist can manage with uh counseling, CBT, adjustments, supplements, so on and so forth.
(22:44) But the moment we do have what is called short course SSRI or SNRIs for women who have that 10day low mood, we just give them that 10day uh period where we give them medications so they get mood better and we have managed quite a lot of women on those kind of medications. I see. So uh that can be possible. >> Example of self harm that you have seen >> um having intrusive thoughts trying to have these thought that I would like to end my life or I would like to jump off a higher place or a top roof or you know hesitant cuts. Yes. On the arms.
(23:26) >> Cuts on the arms. >> Hesitant cuts on the arms. >> Hesitant cuts on the arm. trying to OD on certain medications even their own anti-depressants >> overdosed >> overdosed or um >> all these things you're talking about is not uncommon >> it's not I wouldn't say it's rare >> it's ah so you are seeing patients like that >> yeah yeah yeah they they really cry it's a cry for help basically it's a cry for help and it should not be just brushed aside saying it's PMS >> that is in that's invalidating their cry for help. It should be taken seriously
(24:04) and mental health is never discussed discreetly. So it is the onus of responsibility of practitioners to look beyond the woman and see why is she frequenting the visit. Is there anything which is not quite addressed by the medications we are giving? >> It's not all in the head. Is she trying to tell me something? And most of the time young adults or adolescent I have picked up abuse >> sexual abuse and domestic abuse patients. Yes.
(24:41) >> It's very common in US. to here as well and people feeling very vulnerable at that point. They would come for chronic pelvic pain repeatedly but it is not the somatic symptoms uh the somatic signs are not there at all but they constantly come just look beyond and ask are you facing something quite traumatic? Are you is anybody bullying you at school? >> Are you being bullied by a teacher? Is a teacher inappropriately behaving with you? Is there a misappropriation of touch >> by any of your classmates or your
(25:20) teachers or people known at home? very very straight answers and questions and that really really helps dig deep and get to the bottom of the problem where actually the problem at the surface might be just PMS or >> so when you talk about this you're talking about school >> high school >> high school >> college >> hostel >> hostelates >> uni >> universities >> this is all you're talking from experiences from your patients.
(25:53) >> Yes. >> Sounds uh hopefully I think >> people have been subjected to cyber crime as well like cyber abuse. >> What is cyber >> abuse? and social media abuse, you know, uh taunting texts, inappropriate language, inappropriate messages, inappropriate pictures, and bullying them or tormenting them to send similar pictures or texts.
(26:25) Those kind of cyber issues also have been picked up. And these girls do not know because I don't think uh they would be taken seriously in the first place. That's what they think. Or they might face a lot of criticism from the parents or themselves because they would blame them for encouraging that in the first place without even understanding this is kind of a very erratic behavior on the offender part.
(26:52) >> Isn't that a common thing? >> Yeah. So our children, our young adults and adolescence have also to be educated about these new type of bullying and violences and abuse and be told to report them outright and ask for help and red flag them. The fear of being uh incriminated when actually they are the victims is the commonest reason cited by these gullible vulnerable young adults why they don't come forward.
(27:27) >> And even if they come forward later they again told off because they would say why are you coming and telling now when actually it had happened 3 months before. Why were you keeping quiet? which is very sad when actually it should not be the case. >> I'm really hoping that a person listening to this podcast get educated >> and they would come forward if they are having some problems like this or seek out people who are facing this kind and whistleblow so they can have a remedial pathway.
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(29:05) If I change one person's life, I know I'm changing the whole [music] family. Link is in the pinned comment. Now, let's get back to the podcast. >> Is this what we call as adverse childhood experience? >> 100%. And I now strongly after doing lifestyle medicine have come to believe people's relationship with food is pretty much something to do with what they experience as children.
(29:31) >> Wow. >> Because some people go to food as a comfort which is the reason for their obesogenic practice and environment. And there is always this um kind of abnormal relation with food. The food is comfort. The food is for enjoyment. The food is even for depression. So that uh disharmony with food is pretty much probably related to adverse childhood >> experience.
(30:09) Um in my practice in my uh gastronology practice any female walking into my clinic in between 18 to 24 with obese obesity and gut health issues they have invariably experienced some kind of an adverse childhood experience. >> Definitely definitely I would say the same for people with probably anorexia or bulimia as well though in its own merit it can be a separate entity.
(30:35) these intolerances, the gut related IBS kind of things, we probably do not give much importance to these uh past experiences and adverse childhood experiences as well. >> Ma'am, in your practice, I just really want to focus on this ACC thing a little bit more. Uh irregular periods, PCOS, young people coming to you.
(30:57) Um can you educate them in terms of what they should look for? What has happened in the past in their childhood? what are all the things that they should maybe happen to them might be the reason for what they experiencing right now. patients with chronic pelvic pain or bladder related symptoms or even people who have overt hygiene as a practice >> cleaning themselves all the time or thinking they are having incontinence or UTI all the time or patients with irritable bowel all these girls and young adults should look back and see whether they've had a
(31:33) so-called happy childhood whether they have had um if I'm going to talk Jenza jargon, whether they've had dad or mom issues >> in the first place, whether they have had been subjected to uh grooming or inappropriate touch and abuse in the form of either uh violent encounters or sexual encounters or betrayal in any form or bullying any form.
(32:02) Bedwetting in young adults or children beyond the age of 10 invariably has a psychological element significantly lurking in the background. >> Bedwitting is urinating in the bed. >> Uh yes nocturnal and neurosis for which many of these girls come to me. >> They do? >> Yes. As a eurog gynecologist, they would want to definitely sort it out because if they are heading to a uni or they have to go somewhere, they're not confident enough to go and stay in a hostel and they've left it too long.
(32:34) All these kind of you're toilet trained by the age of two three max. >> You should be continent on the bed by that age. If you leave beyond seven years, that itself becomes a challenge to treat the bed wetting. So if they crossed beyond 12, it's imperative that we look for any psychological issues, worm infestations, gut health issues, and neurological issues like absence, seizures before we give them the pathway of treatment for bedwetting.
(33:02) It's mandatory for us to do it. And without that, you're not going to get to the bottom of the problem, nor you're going to give them a cure. >> Wow. >> So it's important to rule out that psychological aspect. So I had a patient with severe IBS 22 year old we did everything endoscopy colonoscopy CTM you name it of course it's going to be normal because we didn't see anything >> then we really dwell deep into the psychiatric evaluation we she's Indian patient she's in the US in California you know in the India when she was in a
(33:33) school when she was going in the auto and when we're going in the bus you know she was pretty much molested >> uh which she was not able to tell to the parents and uh when she voiced it out exactly what you said that you know why did you go in the first place >> yes >> it took 6 months of cognitive behavioral therapy to treat that patient and even then only 50% of the symptoms were controlled >> yes >> so I think it's a deeper problem than what people actually may think and that may be linked to the persistent obesity
(34:06) as well is what my opinion is >> 100% because they are not able to deal with the trauma and that puts them into distress and therefore the inflammatory hormones comes into play. So whatever healthy practices they're doing it gets negated by these constant higher levels of inflammatory hormones. >> Yeah, thank you so much ma'am.
(34:29) Um you are an expert in endocrine disruptors. >> I if you may I say that I'm actually learning more about that every day. I was floored away by the talk that you gave in the lifestyle medicine conference and I want to educate my audience regarding that. Can you tell me what is an endocrine disruptor? An endocrine disruptor is basically a vehicle through which certain chemicals are present in our body and kind of disrupt the homeostasis or the balance in which the hormones play in our body.
(35:12) So basically they go and attach to the receptors of these hormones like pretending to be the hormone >> but not actually giving the correct effect what the hormone is supposed to do. >> So disrupting the hormonal effect. >> So they mimic to become the hormone get attracted to these receptors in the target tissues.
(35:37) Say for example the uterus or the lining of the womb >> and the vagina where the estrogen is supposed to be coming. >> So they they are basically impostors. >> They impose themselves as the endocrine uh molecule. They come and stick there but they do not have the effect same as what the estrogen do. There are two adverse effects to this one.
(36:02) Because they are imposers they are not going to function the same way. So I can have a imposter as Rajin Gant but he will not flaunt the same style as Rajin Gant. He cannot be superstar. He can only look like one. >> It will not have the same mass effect of superstar. That's what happened to happens to the uterus, the vagina.
(36:23) So there are irregularities in the way the endometrium behaves. They can have irregular periods, can'ty flow, increased flow, abnormal cycle pattern, vagina being dry, so on and so forth. >> I see >> this is major side effect, >> not the desired required effect of the actual hormone. Number one, >> second, apart from that, it puts like the impostor has done a show and it's not having the same mass effect as superstar.
(36:57) superstar gets into disrepute because the mass is thinking it's superstar but did not have the same imperial effect. >> Okay. >> So the poor estrogen which is now free to roam about gets attached to those tissues where are otherwise estrogen dependent as well like the breast the other tissues increasing the effect of it on that tissue predisposing them to higher propensity of breast tenderness.
(37:24) fibroidas or even breast cancer. >> I see. >> So they are not not only disrupting the desired endocrine effect but also allowing the natural hormone to go and display its adverse effect elsewhere. So this way the endocrine disruptors are notorious as far as women health is concerned by predisposing them to lack of the uh desired effect but predisposing them to unwanted adverse effects as well.
(37:56) >> Both it's a combination. >> It's a double whammy. >> A person listening to this what are the common endocrine disruptors that we get exposed to during our day-to-day life? Unfortunately, we idle know that we are swarmed by these inappropriate endocrine disruptors from the time we breathe till the time we go to bed because it's everywhere.
(38:22) If I I myself got so disturbed mentally about it. Uh people who are going to listen to the podcast, I'm worried that they're going to be having nightmares. Your air conditioning can have those chemicals which can be endocrine disruptors. Cosmetics being women who use a lot of cosmetics. Please make sure you see the label like what you eat.
(38:45) See the label for your cosmetics. Please see the label. They should not have any heavy metals. They should not have talates, the BPAs, the additives and uh all those kind of things. >> So heavy metals, phalates and BPA. >> Yes. and also seafood because the seafood unfortunately the bigger fish consume a lot of microplastics and these microplastics when they enter into our body they are permanent members inside our body there's no way to degrade them >> so the fish is swallowing the microplastics >> definitely not the bigger fishes because
(39:21) the plastic load is higher the smaller fishes have better plastic load as endocrine disruptors I see >> and All the um dairy products if they are processed especially can have this. It's been shown that um the so-called roadside paneer which people think in the paneer tikka they're all having a load of microplastics which can potentially act as endocrine disruptors and dy in all its good merit itself is inflammatory in nature which we tend to avoid for gut health.
(39:57) If you are already having sensitivity of the gut. >> Do you believe in that that dairy is an inflammatory thing for patients? >> Dairy in the current state >> because there are definite contaminants in that when I say dairy I mean milk but I do not mean curd yogurt or buttermilk because they're fermented and with it comes the benefit of a fermented food with probiotics.
(40:25) >> I see. So when I say dairy, I just mean the milk. >> Yeah. >> Uh not the other ones. >> In your practice, do you if a patient is you think it's an inflammatory state, you avoid dairy? >> I they themselves tell after I take milk, I'm not able to take it because I have this bloated feeling. I have to do multiple visits to the L.
(40:47) I feel very ill after that. So the two offenders as far as the gut I see in my practice are invariably milk and gluten. >> Gluten. Yeah. So in my practice what I do is that uh when a patient comes with bloating the first thing I do is cut down dairy. Yes. >> Because of the lactose intolerance increase in many uh Indian population mainly.
(41:07) >> Yeah. >> And which was not there before. >> Yes. uh now we are experiencing lactose intolerance a decade earlier because there was a paper which eval evaluated this and we as an Indian community we have evolved in such a way that we're able to handle lactose for a longer period of time but because of maybe this endocrine receptors we are not able to handle the >> yeah it is the composition and we it's not uncommon that we see cows also having a lot of plastic load >> in whatever they eat it's up to us to be
(41:39) protective for our environment so we don't get them back into our system. >> So >> so a person listening to this podcast if they are exposed to this new term endocrine disruptors you think the plastic microplastic plays a major role in that >> very much and the way you store your things the way you cook your things the way you buy your grocery everything matters.
(42:01) Try to avoid anything packaged and tinned and canned. >> Avoid cooking in microwave. Avoid storing things in plastic containers. Use steel or earthen wear or glassear to hold on to your grocery or your pantry items. >> So, uh avoid non-stick teflon cookware because that again contributes to this. Don't grill or barbecue your food all the time because those proteins which are char grilled are more carinogenic and more endocrine disruptors in nature especially if it's on an animal protein >> um sautéing boiling those kind of things fermented foods
(42:43) >> is slightly better >> better so everything matters the water we drink try to avoid acidic water intake alkalinize your water just by dropping a lime slice your water becomes alkalinized. It tends to detox the fluid inside and do have detox practices and I believe fasting itself it's a detox. See we cannot avoid exposure all the time to microplastics.
(43:08) then we should switch off our ACs and probably lie on a bare ground outside because that is not going to be possible in our temperatures and with the global warming that itself was known to be an endocrine disruptor because even slight increases in temperature reduces the health condition in certain places especially in central parts of India when the temperatures can be really high during the peak of summer.
(43:39) So avoiding exposure to microplastics is something very difficult but we can keep the exposure to a minimum by adopting these practices. Beyond that >> I'm sorry. Do you drink water in plastic water? >> I keep it in earn. I don't take plastic. I take a steel bottle. >> Steel bottle >> and I keep it that way. I put some mint or tuli leaves in it.
(43:59) So it kind of creates its flavored and I try to drink at least three liters water a day. We talked about menopause a lot. Do you think supplements help in menopause? >> Definitely. Uh to a certain extent. Say for example calcium and vitamin D. Majority more than 80% of our Indian Asian women are vitamin D deficient because darker the skin overweight women will be vitamin D deficient and not much sunlight exposure is what would be required.
(44:33) At least a half an hour in the morning sun between 8 and 10 would be ideal but I doubt whether everybody's having that. So vitamin D supplementation goes a long way. I forgot to tell this in earlier instant. Not only vasom motor symptoms, muscularkeeletal pain, muscularkeeletal weakness or creaky joints or feeling sore all around the muscle is a predominant symptom particularly in Indian women >> with permenopause and menopause as opposed to vasom motor symptoms.
(45:02) So that's also should be taken seriously. I mean uh we are all guilty of uh neglecting the female medical OPD in the formative years of our medical education um saying no it'll be only Kalachel syndrome the KKK syndrome but actually thinking back those women needed to be seen >> importantly so because they could be having premature menopause or suffering from menopausal symptoms and could have been definitely helped.
(45:36) So, vitamin D supplementation is of prime importance. Calcium supplementation is of importance because calcium keeps your bones stronger and without the vitamin D scaffolding, it will not act in isolation. More so, if they have had been breast cancer survivors of had an early menopause or a surgical menopause when acutely they can be rendered menopausal.
(45:57) M >> we underestimate the number of women who are out there who do not have these supplements because they are not aware in the first place. Yes, calcium can be derived from your nutritional sources like your dairy products. Um your cabbage, your broccoli, your sesame seeds, your ragi, muring drumstick leaves can be very good source of calcium though non-dairy.
(46:21) But how much do women take it? >> Correct. Yeah. So you need at least 800 to,000 milligs of calcium calcium per day especially if you're manopausal >> and osteoporosis being a silent killer. It's important we emphasize the importance of calcium supplementation. >> I really want to touch upon something you are passionate about emotional inflammation.
(46:43) >> Very nice. >> What is that emotional inflammation? >> This is again something I learned from my lifestyle medicine journey. Um this is the constant uh inflammatory response in the body seen by our inflammatory chemicals in the form of interlucan 6 or cytoine rice in response to an emotional reaction which is seen in us in the form of anger rather than despair or sadness because of environmental factors.
(47:20) Say somebody watching the telly and not happy with what is going on in the US with regards to the visa because these are all NI parents sitting here and they're worried about their children or the Gen Z's who watching the Gaza or the Ukraine war and feel it's totally inappropriate and get angry about it or the local people who are watching the telly news and constantly angered by the political scenario the lack of infrastructure so on and so forth.
(47:52) It constantly feeds into this resentment and builds up an emotional heightened state of anger rather than feeling sad. If an uh if a train accident happen or a flight crashes, the initial response is sadness in most of us and we get over it and look at how to improve things. Whereas that if it constantly keeps us angry that is known to trigger off a cascade of inflammatory chemicals in our body which keeps us inflamed for a long time and that is kind of now being studied as a predisposing factor to
(48:37) worsening of already existing chronic illnesses or future chronic illnesses like metabolic syndrome, hypertension, diabetes or even cancer for that matter. So that is what is known as emotional inflammation. >> Wow. >> Uh because if you're not angered all the time, you probably will be finding out or seeking solutions to the problems rather than keeping on at it and being helpless about it.
(49:08) >> And uh on the top of it, any patient who comes to you as a patient has already a hormone imbalance. >> Yes. >> Most of the times. Yes. >> And it kind of emphasizes the point that the psycho neuroimunoendocrinology I always say that that stimulates the sympathy hormones which is your stress hormones. >> Even if you don't think that you're being stressed out on your work, >> all the emotional factors can also contribute.
(49:37) What are you saying? >> Definitely. Definitely. >> See uh it all depends on uh the situation where we are in. This is a common observation I've seen in women. U they would be having normal periods and things like that here. They relocate to a different place. They say example temperate climates. >> They their PCOS becomes more obvious.
(50:04) >> The vitamin D deficiency is profound. >> Those kind of changes do happen. So I strongly believe the environmental factors do play a stronger role in the um harmony of hormones if I may say so. >> There is definite interplay between the environmental factors and social factors on somebody's hormonal well-being.
(50:28) >> No I I have to tell you this experience you know uh in our lifestyle medicine clinic um it's called new me virtually it's a virtual clinic. I'm telling you all the patients with PCOS the first thing that we do is to establish a consistent eating pattern. So we say that you know we will aim for to maintain the circadian rhythm from 7:00 a.m.
(50:50) to 7:00 p.m. because I'm involved in circadian rhythm research. We clearly see that digestive hormones are getting activated unnecessarily because they're going to sleep at sunset. >> Correct. So when we are forcing them to eat after 7:00 p.m. when we are eating we are forcing them to actually work which they don't want to. So as you said we are not giving enough rest.
(51:10) You will not believe this simple task if they can stick to it for like 6 weeks. We are seeing that they are emotionally better. >> Definitely >> emotionally better and they will not see any change in the weight or anything for the first four weeks but they feel so energetic. >> Absolutely. >> Why do you feel good? I think it's the uh rest pattern or the recovery which we give for our visceral organs which matters with the circadian rhythm which is why we see a lot of disturbances in shift workers.
(51:41) >> Ah >> because the the the biological rhythm is not in sync with the circadian rhythm which is not again in sync with the environmental stimulus. >> You see a lot of night shift workers coming to you with problems. Yes, IT workers especially they work in India but they work for the US timing. So they have targets, they have their implementation, they have to work long hours, it's a sitting job, it's a lot of pressure.
(52:10) All these mount to a lot of uh you know stress on them and also the derangement in their eating habits and lack of fitness in terms of lack of physical activity >> contributes to their PCOS in my opinion >> in worsening of the disease worsening of the disease >> and caffeine >> intake at abnormal timings. >> Tell me about caffeine and PCOS.
(52:35) uh the caffeine probably in excess amounts or caffeinated drinks in excess amounts has multiple effects. One, it acts as a brain stability. Definitely the being in Chennai, I should not be speaking against coffee. I should be advocating coffee [snorts] because that is a kickstart beverage for all of us in Chennai.
(53:01) However, um overusage of caffeine or multiple intake of large quantities of caffeine um is a kind of a detrimental factor. I prefer to tell my women and I try to practice that beyond 4 5 p.m. I do not indulge in caffeinated drinks because my sleep can get disturbed. Number one, it acts as a diuretic. So my bladder will keep awake all the time.
(53:28) And I tell my women with eurogy problems, try to avoid caffeine more than two cups, >> not mugs, cups, 150 ml, >> two times, that's it. Because that itself can keep your bladder stimulated all the time. You think you're hydrated, but actually you are dehydrated. More caffeinated drinks can be leading to stone formation.
(53:50) So the multiple effects which can happen and sleep disturbances combined with a state of alertness and inability to wind down itself can be contributing to PCOS related hormonal factors. >> Wow. Wow. We talked about a lot of you know like stress factors, environmental factors, endocrine disruptors. All this to be honest as a medical professional myself it is overwhelming to me.
(54:18) >> It is >> it's overwhelming to me and we try a lot and then we fail and uh they just get exhausted with all the options and they say that you know like I don't want to do any of this let me just enjoy my life. Uh then they get really decompensated even more and then this vicious cycle right and in lifestyle medicine we learned about positive psychology.
(54:38) >> What is positive psychology and how do you practice in your patients? Uh it uh this is a very nice question. I have to mention my mentor Dr. Sheila Nambir who coached me in lifestyle medicine and who I look up to in for personal tips as well. Uh it's a very nice analogy which she says about positive psychology and how different positive psychology is from positive thinking. Uh in case Dr.
(55:04) Sheila's watching, this is credit to you. And uh so if you have a puddle in the middle of the road and you're going cycling or you're going walking, to assume just it's a puddle and I can do it and just landing deep in the puddle is an uh anomalous thinking which people sometime attribute it to positive thinking. All is well kind of situation.
(55:28) Positive psychology is not that. Acknowledging that it is a puddle. Acknowledging the fact that you probably could get in the middle of it and get yourself dirtied or wet. Finding a way to circumvent that puddle and still cross over to the other side. >> An analytic. >> Yes. So first is acknowledging that fact.
(55:53) So the first step towards betterment of anybody's physical, mental health or psychological health as far as lifestyle medicine is concerned is acknowledging and having that insight that there is an issue to be addressed. >> I do not want to call it a problem because it kind of give it a negative connotation to it when we're talking about positive psychology.
(56:16) I have an issue with my weight. >> Rather than saying I'm obese, >> I have an issue with my glucose control than calling myself I'm a diabetic. >> Is one way of constantly implementing positive psychology aspects while we are talking to ourselves or to our patients and that will become a habit and culcated in our patients as well.
(56:44) And no more calling them as patients. Now with um we probably should call them health seekers. >> Health seekers. That's a nice >> I hope so >> connotation huh >> because nowadays patients are not supposed to be called patients. They are supposed to be called medical beneficiaries >> in a political scenario. >> Politically correct. Yeah.
(57:06) >> So I personally should be calling them health seekers. I think health seeker word is a wonderful wonderful thing. Yeah. So you know even for smokers they say don't say smoke alcoholic. >> Yeah. Used to taking tobacco >> or used to using tobacco drinking alcohol. >> All this just a change in the mindset and all these >> it's not a word play.
(57:31) It definitely is not a word play. If you believe and it's all in the name. If you keep calling somebody dull head, dull head, dull head, they will become that way. M >> it's been known even when you nurture plants you you nurture the plants by calling it beautiful green you're bound to bear fruits apparently the plant grows better >> if that is the case for a plant it should be more so for a human being and it's about setting that positive framework at everything we do what is about positive psychology and it's very much important when we deal um
(58:07) personally itself with reversal of diseases. >> So I had been very busy for the last four months with my conference work and other academic commitments and travel. I did not have time to do my strength training or did not or found excuse to do my strength training let me say >> um >> but if I keep on to that and keep giving excuses that I'm busy >> I'm the the loss is for me >> of course >> when I address it and acknowledge this as an issue >> and my muscularkeeletal pain became worse when I acknowledge that the factor
(58:46) is the lack of strength training and start doing the strength training. >> I am it's unbelievable. Miraculously, the muscular skeletal pain disappeared. >> That reinforces my belief that yes, strength training is a must and that's probably curative for me as well in majority of the muscularkeeletal pain issues which women go around at this age.
(59:19) So I strongly advocated to my health seekers as well. >> I'm I'm going to use health seeker as we're moving forward. [gasps] >> A person listening to this podcast. Can you list down top five foods that be useful for permenopausal symptoms? >> Okay. [snorts] Uh first is your iron requirement. So definitely spinach and uh your dates but in adequate quantities not too much.
(59:43) Second is your calcium. your dairy products preferably buttermilk and curd. Third will be your uh goa which is vitamin C helps the iron absorption and good for constipation because it is the uh >> rich in fiber >> for amazingly rich in fiber and an antidote for constipation. >> Fourth is your nuts mainly your badam and your walnut very good for good fats which are needed for our body and a source of protein as well.
(1:00:14) Soak them the previous night. Take them. The fifth one is plain water. >> You can say water as food. >> Yeah. Our if you can imagine this is going a bit spiritual as well. >> Yeah. >> Our [snorts] entire earth is a fragment of the water body which is surrounding it. What is left behind but for water is what the land we live in.
(1:00:38) Our body 70% composition is water. >> Mhm. The first thing which happens when you're dehydrated, there is an intracellular dehydration. So the energy or the balance to the cells in the body is from water. >> So that should be added as a fuel. >> Yes. >> As a supplement, as a treatment. So water is one of the foods which is so underrated, understated, which women completely forget about.
(1:01:10) They go to the comfort of other drinks in the form of tea or coffee thinking they are hydrating which has to be avoided. >> Super. >> So water is a must. >> Beautiful. Beautiful ma'am. Thank you so much for being [laughter] so nice. You brought out that shows the passion. >> Thanks a lot. >> I know I always believe in gender specific healthcare.
(1:01:31) I'm so glad you brought out these aspects. >> That means a lot. I'm going to have you back. I'm going to learn a lot more from you and also I'm going to mutual >> learn your English fluency as well >> and you're coming back for our FEPA and we are looking forward to a hot debate. >> Super. I would be happy to. >> You're you're debating against I think Sheila Krishna Swami.
(1:01:52) >> Yes, of course. Be happy to. Thank you ma'am. Thank you so much. >> She's also coming. Beautiful. Thank you sir. Thank you.