Why Women Are Using HRT Wrong - And paying For It Later | Dr Kelly Casperson
Author Name:TNE with Louisa Nicola
Youtube Channel Url:https://www.youtube.com/@LouisaNicola
Youtube Video URL:https://www.youtube.com/watch?v=MSXMTj9pM6o
Title: Why Women Are Using HRT Wrong - And paying For It Later | Dr Kelly Casperson
Author Name: TNE with Louisa Nicola
Description: I sat down with Dr. Kelly Casperson, urologist, women’s health advocate, and a leading voice fighting for equality in healthcare, to explore what’s really happening to women’s bodies and brains during perimenopause and menopause.
We discuss why UTIs spike after menopause, how vaginal estrogen actually works (and why the FDA finally removed the black box warning), the truth about HRT and dementia prevention, and why estrogen receptors in your brain matter more than you think.
We also unpack why blood work interpretation matters more than ever, how compounding pharmacies work, the shingles vaccine and dementia connection, and why women need to stop waiting for permission to take control of their health.
Reduce your risk of Alzheimer's with my science-backed protocol for women 30+: https://go.neuroathletics.com.au/yout...
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Topics Discussed
00:00 Intro: Why women’s hormone health is misunderstood
02:10 Who Dr. Kelly Casperson is and why women’s sexual health became her focus
05:10 Hormone Replacement Therapy explained (estrogen, progesterone, testosterone)
08:30 Vaginal estrogen, UTIs, and restoring tissue health
12:40 Vaginal estrogen vs systemic estrogen and the FDA warning myth
15:20 Estrogen receptors, skin aging, and visible signs of hormonal decline
18:30 Estrogen, the brain, and Alzheimer’s risk in women
22:10 Why hormone research is conflicting and often fails women
26:00 Sleep, hot flashes, inflammation, and brain health
30:00 Testosterone in women: beyond libido and muscle
33:40 Compounding pharmacies and personalized medicine
38:00 Inflammation, viruses, vaccines, and dementia risk
43:00 The breakdown of modern healthcare and why women feel dismissed
47:30 Blood testing, data ownership, and the future of women’s health
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I’m Louisa Nicola - clinical neurophysiologist - Alzheimer’s prevention specialist - founder of Neuro Athletics.
My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention.
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Transcript:
(00:00) I saw you putting vaginal estrogen on your face. >> Yeah. >> Why? >> Hormones improve tissue quality, not just where you can see it, but everywhere else as well. The skin is an organ. And the cool thing about this is you can actually watch this organ change and improve because of estrogen. >> Meet Dr.
(00:21) Kelly Caspersonson, [music] board certified urologic surgeon, best-selling author, and the voice fighting for equality in women's health. >> Eight years ago, a woman changed my life. She was crying in my office because of a sexual health issue. The universe lightning struck my brain and I was like, "Hold on, who's taking care of the people who are supposed to be sleeping with the people that people like me are giving testosterone and Viagra to?" A man comes in low libido, sexual health issues, low testosterone, and we're not like, "This [music] is
(00:45) just natural aging, buddy." We don't dismiss them on the level that we do that to women. You'll break the internet if you tell people that everybody should be on HRT. With the research that I've done, hormones are profoundly helpful. This would put the beauty industry, [music] you know, bankrupt.
(01:02) I'm Louise Nicola and this is the Euro Experience. >> Hi, Kelly. Welcome back to the podcast. >> Hi, my friend. Thanks for having me. >> So, we've just spent uh about three or four days together. Are you sick of me yet? >> Nope. >> Oh, not yet, cuz we've got a lot to do. >> What's your name again? [laughter] >> Well, you'll learn after this podcast.
(01:19) Um, we're going to go through so much, but I want you to just open up once again and tell us what is a urologist. >> Yeah. So yesterday on stage I think they introduced me as a neurologist and I was like okay we need to clear we need to clear this up. It's better than a meteorologist which I got once in my life.
(01:38) So a urologist is a surgical subsp specialist. So you go to med school and then you go to residency and you spend five or six years in training to operate on the genital urinary organs. So from top down that's adrenal glands, kidneys, urtors. Urers go to bladder. Bladder goes to urethra. Urethra goes to toilet and surrounding the urethra and bladder.
(01:55) We've got the prostate. We've got scrotum. We've got testicles. We've got the penis. So stereotypically male genitalia if the traditional urologist now more and more not every urologist care about the female external genitalia as well. >> Okay. So, I was going to say because now you've you've you've spent most of your career working with men, but you've you've kind of taken an a new focus which is focusing on female health.
(02:20) >> Yep. Yeah. So, traditionally like people don't even know you know you get these crazy things like I didn't know women were urologists and you're like was there a rule banning that like you know but people's like stereotypes right or like why would a woman need to go to a urologist female? It's like OB/GYN men and you're like, "What are you a male OBG?" >> Right. Yeah.
(02:40) The good news is the female urologists are in crazy demand. There's only a thousand of us in America right now. >> So, we're training more, but it's still very rare because it's so predominantly men. When I trained in medical school, there was one female urologist in the entire state of Minnesota, and I'd never met her. >> Oh my goodness.
(02:56) >> Yeah. So, it was much more common now. So as a female in urology, women tend to gravitate towards you because I understand what a urinary tract infection feels like, right? Like I we understand this and they just feel a lot more comfortable. These are massively personal issues. >> So always saw a lot of women did a lot of bladder leakage, pelvic organ prolapse, surgery, things like that.
(03:17) And then about eight years ago, a woman changed my life. She was crying in my office because of a sexual health issue. And this big basically like the universe lightning struck my brain. And I was like, hold on, who's taking care of the people who are supposed to be sleeping with the people >> that people like me are giving testosterone and Viagra to, right? And it really became an equality issue for me.
(03:40) I'm like, as when women are treated the exact same as men are in the clinic, >> my job's done, right? I don't care if you take hormones or not, but I care that you're profoundly educated about it and you get the help you need. and that people treat you like we treat the men where we don't treat we don't tell you know man comes in low libido sexual health issues low testosterone and we're not like this is just natural aging buddy >> like this is just how it is drink a glass of wine >> you know we we don't dismiss them on or natural them on the level that we do
(04:09) that to women >> so you just said UTI and what I've heard from this conference this weekend and you know all around for the last year is that urinary tract infection rise when a in females when a a woman reaches a certain age. So, I'm guessing there's a correlation between that and vaginal estrogen.
(04:31) So, why don't we before we get into that because I'm I'm really interested. Uh why don't we just open the gates and talk about um you're very pro- HRT in if not for everyone or is it for every woman? >> You'll break the internet if you tell people that everybody should be on HRT. >> Yeah. Right. So, and to me I'm like that's your body.
(04:49) I'm not going to tell you how to live it, right? Like your body your choice. >> And I I wrote in my book, I'm like, I don't care at the end of the day what you do with your body. It's not my body. You're not living my life. But with the research that I've done, that the menopause experts have done, hormones are profoundly helpful >> and all in most domains, right, of health.
(05:08) And I care deeply that you're educated and then you can make the right decision for you. So that's how I always answer the like, should everybody be on hormones? Yes. And then sometimes I'll joke and I'll be like, "Well, in the '9s 40% of American women were on hormones." It'd be cool to just get back to the '9s level, right? Like they were doing fine.
(05:23) >> But were they bio identical back in the 90s? >> More likely back then there was oral synthetic. So uh pill. Yeah. Pel. So Prem Pro was conjugated coin estrogen and hydroxy progesterone acetate as a combo pill. So still a very safe medication. Like you know the the short answer is like ah it was so unsafe.
(05:41) It's like it's still a very safe medication. But now that we use trans dder dermal, less blood clot risk, less stroke risk because less blood clot risk, less gallbladder disease with it. So there's a benefit for trans dermal absorption and so but you know we like to make things easy. It's like that was bad, this is good.
(05:58) Like they're just different. >> Yeah. >> Right. >> But go you want to go back to the UTI? >> Well, I just want you know it's interesting because I was just in Australia, right? And you know you and I and and a lot of the other physicians that were there, we go really deep into mechanisms. you know, what does, you know, hormone replacement therapy do at a cellular level? But what I didn't realize is that >> there's still a lot of women, what, 4% of the population is on HRT.
(06:22) There's a lot of women who don't really know what this is. And I know that because when I was in Australia, I had women asking me if they can pick this up from a supplement store. So, when we describe hormones and hormone replacement therapy, we're really describing estrogen, progesterone, and testosterone. Yep. >> Correct. Yep.
(06:42) >> Um, and these are naturally occurring hormones that we have and they start to decline as we get older during what we call this phase which is pmenopause. >> Y >> and if we want a replacement for those, >> it's hormone replacement therapy. >> Yeah. People want people prescription drugs. >> It's a prescription drug in in Australia and in the US.
(07:02) In some countries, it's over the counter, right? Different rules. Mexico. >> Mexico's over the counter. >> Columbia, >> I don't I don't know. I don't know all of them. And then there's again there's some countries that have no access to them, right? So it's like there's all these different levels of how can you get it where it is.
(07:16) So by wherever you live in the world, it might be different than how it is in the US and Australia. I mean even between Australia and the US, you guys have a government approved female dose testosterone. The US doesn't. Yeah. >> Right. So it's like it's different everywhere and access is different everywhere.
(07:31) But by and large, you know, people they have two questions. Number one, where do you get it? Usually have to see a doctor. I do believe a doctor should follow you. Like this is not one-sizefits-all medicine, right? But then people want shortcuts. They're like, "Well, what if I do enough push-ups? I'm being facitious, but what if I eat enough soybeans? What if I drink enough soy milk?" Like, they want to get it with food, but how it works like biochemically is you can't eat enough food to put a hormone into your body. Like, you have to take the hormone
(07:58) and put it in, right? Like our ovaries made it. We were never like eating enough soy in our 20s, right? food is healthy for us, but you can't put a hormone in your body in enough levels via eating a certain food. >> And the reason why we want to obviously replace the circulating hormones that we have that start to decline is because we've got these receptors all over our our body, especially in our brain, which we'll get into that if they're not used, they end up forming certain dysfunctions. Uh before we get into the
(08:29) brain, why don't we talk about UTI? >> Yeah. So for people who need to start at the beginning, UTI is urinary tract infection commonly known as a bladder infection. If it ascends inside, then it's kidney infection, right? And that's where you can get fever and sepsis from. Sepsis means the infections gone into your bloodstream.
(08:44) >> That's dangerous. That's very dangerous. It's deadly, especially as we get older and we get frail and less resilient, right? So we're even more susceptable to being taken out by an infection. So bladder infections common. They they happen. They're like the top eight things that people see a primary care doctor for, but they become more common as we age.
(09:06) And the reason for that is healthy microbiome of the vagina needs estrogen. When estrogen goes away, the lactobacillus die off. Lactobacillus produce something called lactic acid which acidifies the vagina. Why is an acidic vagina healthy? Because it acts as a moat or a barrier between the stool, the poop bugs, the rectum, and the bladder.
(09:28) So a healthy vagina acts as a barrier to the the waste bugs going up to the bladder where you can get sick because they're not supposed to be in the bladder. So that's why in perry menopause, postmenopause, adding back in vaginal estrogen reassidifies the vagina, makes it more inhospitable for the poop bugs to travel up to the bladder.
(09:47) >> Vaginal estrogen, >> vag lo local lowd dose vaginal estrogen, which is very inexpensive. a tube of vaginal estrogen cream in America at Mark Cuban cost plus drugs. It's $13 plus $5 shipping. I have no affiliation. It's just the cheapest vaginal estrogen that I found on the market. And it's lifelong.
(10:05) If you stop taking the vaginal estrogen, >> you'll go back to the microbiome that >> lives without estrogen, right? >> The acidic microbiome, >> the the basic microbiome. So, we want estrogen to make it acidic. >> Acid. Okay. >> And then we lose our acidity. I recently had my labs done through function health and one number that really stood out to me was my Homer IR.
(10:24) It came back as 0.4. I bet you've never heard of Homer IR. Well, it's a more intelligent marker of insulin sensitivity and it's one of the most important indicators we have for long-term brain health and metabolic longevity. Now, this result didn't happen by accident. It's the outcome of years of paying attention to blood sugar, inflammation, sleep, and training.
(10:49) And function is what lets me actually see those trends instead of hoping I'm doing things right. Function gives you access to over 160 different biomarkers from glucose and lipids to liver, thyroid, inflammatory markers, guys. Absolutely everything. I do a huge huge blood panel. I would say every six months, but I'm really doing like the basic blood panels like every three months because I need to know that what I'm doing every day, the protocols, the supplements, the sleep, the training is actually having an effect on my cells.
(11:20) I use Functionhealth. They are the best in this for absolutely all of this. If you want to try Function Health, you can sign up at functionhealth.com/loanicola. You can use code neuro25. you will get $25 off and once you use this and sign up you will be able to look at all of your data in real time. That is functionhealth.
(11:44) com/losa nicola. So how is that the vaginal estrogen different from the patch? Yeah, good question. So patch is transermal meaning it's a dose high enough that if I checked your blood levels I could tell that there was estrogen in your body. Okay. >> Right. Because people are like, "This is estrogen and this is estrogen.
(12:03) Why are you saying they're different?" Dosing, >> dosing, dosing, dosing, which I think a lot of people don't understand. So, if you're on, this is an example. If you're on a year's worth of vaginal estrogen, you take vaginal estrogen for a year >> every day. Do you or once a week? >> Typical is twice a week. >> Okay.
(12:19) >> That is equivalent to one oral estradiol pill. >> Oh, >> so it's like basically micro doing estrogen in your vagina for people who like the micro doing trend. Um, so very different dosing. Now, the next question is, if I'm on a patch and still getting recurrent UTI or pain with sex or overactive bladder, can I then add in vaginal estrogen? Of course, you can >> because it's so low dose, you're not really adding any more estrogen to your body.
(12:44) >> Okay? >> Right? So, it's skin care. I call it skincare for down there, >> which is already trademarked. I've looked, but it just helps people understand like this is skin care. It's not your liver doesn't see it, your bones don't see it. It's just very very minimal, but it's enough to help the bladder function, sexual function, and urinary tract infection decrease.
(13:02) There's no better treatment for urinary tract infections than vaginal estrogen. So then women ask, they'll be like, um, my husband has urinary tract infections. Can he take vaginal estrogen? And I'm like, urinary tract infections in men are a completely different animal. It's usually a prostate or an obstruction or a urinary or a kidney stone, right? Different workup based upon if you have a vagina or not. Wow. Okay.
(13:27) So, that is really interesting and we've got a lot of women who are not currently taking it for god knows what reason. Maybe it's just education. >> Yeah. Well, the so the black box that was on and this is worldwide because what America did, the rest of the world followed. The black box has been on for 25 yearsish.
(13:44) It came on the year after the women's health initiative. So, 2003 is when the box warning came on the products. The FDA said, "Whoa, this looks dangerous. Let's slap this on every dose, every formulation." It says probable dementia, blood clot, heart disease, stroke. It's all untrue. Again, this is skincare. Skincare doesn't cause any of these things.
(14:02) And this has been like 12 years in the making. Multiple petitions to the FDA, but via social media, via via an FDA that actually wants to write some wrongs. The box warning was removed from estrogen products in November. >> We have one p one study done by a female urologist, Dr. Una Lee that said if a woman was lucky enough to get a prescription and then she she gets the package from the pharmacy she takes it home she opens it up it's she reads the boxed warning 30% won't use the product >> 30% >> 30% because of that box incorrect boxed
(14:34) warning so I always told my patients you have to choose between what I'm telling you and what the FDA is telling you that's not a fun task right but now we've taken that boxed warning off so I think we're going to see much more utilization of this >> something interesting I saw on the weekend. Okay.
(14:53) Now, um I am currently spending way too much money on skincare, right, for god knows what reason. I think I'm just I I I fall for marketing. I saw you putting vaginal estrogen on your face. >> Yeah. >> Why? So, let's go back to what a hormone is, right? To answer the question in a scientific way. So, a hormone helps healthy cells stay healthy.
(15:12) >> That's what it does. It's a messenger. It's a communicator, right? So the hormone travels around the body, usually made by the ovaries, sometimes adrenal glands. Travels around the body, goes to all these tissues that have receptors. Skin has receptors for estrogen, right? Sits on the estrogen receptor that then translates into the cell to say affect my mitochondria, affect my DNA, affect my protein synthesis.
(15:34) That's what hormones like a gate. Yeah. >> Okay. Like a key in a lock. It comes in and then opens the gate and then the hormone can go into the cell. >> Yeah. I maybe it's kind of like a phone, right? like it's kind of sitting there and then like a call comes in and you can pick up the call, pick up the call and now your life's different because you picked up the call, right? So it's the receptors are sitting there waiting for the signal and the signal goes decreases as we get older.
(15:57) So in skin in skin cells estrogen helps blood flow, it helps collagen production, it helps elastin production. So elasticity and thickness, right? So why do why does everybody say that pregnant women have the pregnant woman glow? massive levels of estrogen in their body, blood flow, glowing skin, right? And the other fascinating thing about this is people are like, there's no data for estrogen in the skin.
(16:24) I'm like, we have multiple metaanalyses done by dermatologists that show what estrogen does to the skin. Yes, >> the skin is an organ. And the cool thing about this is you can actually watch this organ change and improve because of estrogen. And then you take the step and you say, "Oh, if this organ is changing and improving and I can see that >> that's what it's doing to the bone.
(16:45) " >> Yeah, >> that's what it's doing to other organs inside that we can't see and we kind of have to believe, right? So, I like the face and estrogen and ulva, too, but I don't think everybody's sitting around looking at their vulva is, oh, hormones improve tissue quality, not just where you can see it, but everywhere else as well.
(17:06) So estrogen on the face is incredibly safe. Multiple published studies, enough studies that there's two metaanalyses about it, right? And for some odd reason, people are like, "Oh, it could be dangerous." >> In what way? >> I have no idea. >> Well, then okay, a counterargument then. I mean, this would put the beauty industry, you know, bankrupt because how many girls, you know, who who are buying, you know, copious amounts of cream or injecting salmon sperm into under their eyes for better quality of skin.
(17:39) Um, can like a 25year-old put this on their skin? >> Yeah. I I haven't seen prevented because then you're like, can we prevent the signs of aging? Right. You're like, it makes sense. One might argue a 25-year-old has excellent estrogen. Yes. And at some point there's a threshold where if your receptors are already full is more better >> does become dangerous >> but not that we have data for >> we have data for we have data for >> interesting >> let's stay on this topic of estrogen receptors and and talk about um my field which is brain health because we have
(18:06) estrogen receptors all over our brain in certain parts of the brain hippocampus is one of them which is the memory uh the the location where memory formation and consolidation occurs arguably the first part to go during Alzheimer's disease. You know, I you know, it's funny because I've spent the good part of the la of the last decade researching Alzheimer's disease.
(18:31) And I started off with a wide population of both men and women. And the reason why I veered towards women is because I couldn't understand why 70% of all Alzheimer's disease cases were female. >> We used to think it's just because we live longer. Okay, we now have data four years longer. only four years so there's got to be something else you know and the consensus is because of the hormone transition that we go through.
(18:54) Okay, let's keep digging. >> Why is it in your opinion that we've got one camp of scientists and physicians who are saying no estrogen therapy or hormone replacement therapy does not prevent dementia. And then we've got another scale of people who believe that it is preventative against dementia. >> Yeah, I think there's multiple reasons for this.
(19:21) Number one, we were trained, my generation at least, were trained that the randomized placebo control trial is gold. That's a that's the highest level of scientific proof. And a lot of people say, well, no, not actually because if you aren't studying the people that you are actually interested in, does it apply to you? Right? So, that's one thing.
(19:37) The second thing is cost, right? massive massive the women's health initiative in today's dollars was a billion dollars >> a billion >> billion dollars and with Alzheimer's and this the same thing with prostate cancer right which I like to compare it to it's like it's not just that we don't want to study women it's that some answers take a long time to answer so prostate cancer what's better a prostatctomy or radiation we don't know we've never done a randomized placebo control trial comparing those two treatments why because prostate cancer is slowgoing
(20:05) >> and death after diagnosis is over a decade Right? Same thing with Alzheimer's. That horrible day, and correct me if I'm wrong, but that horrible day you were diagnosed with Alzheimer's disease, it started 20 years ago in the making. >> Right? So, we know you've got to start this when people are asymptomatic and you got to follow them for a long time.
(20:22) That's freaking expensive. >> And then you've also got to consider APOE4 genes. You got to consider genetics. You got to consider lifestyle. >> Yeah. To to be able to pull out just the drug. Like, are you drinking? Are you smoking? Are you exercising? Like, nothing's better for prevention than than exercise.
(20:37) And so to me, I'm like, it's a challenging study to do. And you I can stand on the fact to say we don't have that study, >> but we have multiple observational studies. We've got mechanisms of action. We've got so many signals. And my argument always is number one killer in Australia already. UK is catching up. And I joke it's not fun.
(20:56) >> Number one killer amongst women in the UK though. >> Number one killer amongst women in the UK already. Okay. Yep. And I always joke America America has a good uh good options of killing people for other reasons. So like we probably would be there but we killed people for other reasons. Joking, not joking.
(21:11) But like it's coming America. Like don't think this isn't coming for us as well. >> So number one killer >> devastating financially, emotionally, family wise, independence wise, >> no great cure. >> What we have can slow it down at great expense and great risk. Right? So you check all these boxes. You're like this is the disease where why wouldn't you try everything you can? And when you look at what should a preventative medicine be, it should be cheap.
(21:39) It should be safe. And you should be able to take it for a long time. Hormones check all those boxes, too. So, to me, I'm like, I'm building this thesis of like, what else do you want to say if a woman wants to do everything she can to protect her neurons, why not say you can do this? Yeah. >> Now, people will argue like these are all the arguments.
(22:01) will argue and they'll say, "But hormones aren't recommended for the primary prevention of any disease." That's true. They got a it got a grade D recommendation from the United States Preventive Services Task Force. If you dig into that, their biggest weighted study was the WHI oral synthetics. >> Right? So, we've got a grade D recommendation on hormones for the primary prevention of disease using oral synthetics, which are different than transdermals.
(22:26) Then you can argue, is oral better than transermal? Do we have less data for transdermal? Yes. And this is where we get all nuance for, but I don't think we will ever get back to our nation should, and we're at this conference and you saw a lot of people ask me, should I be on testosterone? Should I be on estrogen? And I just I like rail against that because it's very paternalistic of you should you should do this, right? And and Prem got taken to the taken to the toilet after the WHI.
(22:57) They got sued for like a billion dollars from a flawed misinterpreted study. I don't think anybody's going to stick their neck out and say all people should like the the ship has sailed for many cultural reasons on that. So women sit around and it is going to become the people who pay attention, educate themselves, are listening, are understanding and making the choice for themselves versus the women who don't have that access.
(23:21) And there will be health disparities based upon who's deciding to take hormones and not. And we already have that paper. There's a paper looking at entering Medicare. So these are women who are 65 already on hormones versus not on hormones. And the women on hormones had multiple metrics of decreased risk of disease compared to the women not on hormones.
(23:40) So that health disparity will happen because we will never say all people should. >> Yes. >> But if you're if you going to wait around for a randomized placebo control trial waiting for [clears throat] >> you we're going to be dead. >> It's Yeah. We have to make the decision with what we have. And if you understand academic medicine to see what a double blind placebo control trial actually consists of, like you will be waiting a very long time.
(24:03) Although I do know that it's in the making and it will get done eventually hopefully in our lifetime. But back to um Alzheimer's disease and we do have two well-designed correlation studies and and we spoke about those and the way that I see this and this is literally as a brain scientist which which is everything there is no primary outcome as you mentioned right >> if estrogen is going to help you get stronger bones that is a direct correlation to Alzheimer's disease uh better synaptic plasticity better neuron control um brain metabolism brain
(24:37) metabolism, >> sleep. Yes. And so if that's that's how I see it. I don't see it as okay, we can't just say take estrogen, don't do anything, and have better brain health outcomes. That's not what we're saying. >> Right. Right. >> And I think that when people people argue against it, saying we just don't have the data, >> but we do have the data that it does help. For example, hot flashes.
(24:57) >> Yeah. >> What is a hot flash? You know, it's when the hyperactivity of your hypothalamus just cannot control your core body temperature. you get this immediate rise in your core body temperature and it often happens at night waking you up and then what is happening when you're waking up at night you're not getting into deep sleep you're not getting into the glimpmphatic clearing system airgo building up amaloid and then that's just compounding years to come >> yeah I mean that's why podcasts like this are so important because women once
(25:25) you educate a woman for mechanisms of action and we take away like you and I aren't saying all women should Yeah right if you say all women should it takes away the understanding and the knowing of why >> and it's like we're going to give you all the data, you get to make the decision then >> and there and traditionally in the medical system we treat disease, right? I don't like that people pick on us for sick care because I'm like no, they interpret it as we want you to be sick.
(25:50) No, we just our job was treating disease. But as humans are living longer and knowing on that horrible Tuesday you got diagnosed it started 20 years ago which means prevention should start 20 years ago right I think the culture is changing to be like how about we try not to suffer how about we try not to find the cure once we have the disease but rather prevent the disease >> I think that's changing >> when people ask me what's driving aging I always say mitochondria they're the engines inside your cells and when they
(26:22) slow down everything slows down energy recovery cognition. That's why I use mito pure from timeline. I do so much to optimize my mitochondria from cold water immersion. I do heat therapy through sauners. I obviously exercise, but I also take supplements that specifically target mitochondrial health.
(26:45) And the one from MPure contains uraliththna. Uralithna helps your body recycle damaged mitochondria and produce energy more efficiently. What I feel is just the fact that a I'm recovering better from my workouts and b just steadier energy if that makes sense. But if you care about aging, especially brain aging, this is one of the most evidence-based tools available.
(27:08) And you can get 20% off at timeline.com/neuro. Even if you go on there, guys, and research what it is, you'll be mind blown. 20% off at timeline.com/neuro. I'm very interested in currently uh looking at the nasal microbiome because we have uh you know the alactory bulb plays a massive role in Alzheimer's disease and I've heard um Dr.
(27:33) Mary Cla actually say that she >> hold on seriously. >> Oh, didn't you know it's like one of the first places? >> Oh no. >> Oh no. I I have I have a nausemia. What is that? >> And no lack no sense of smell. >> Since when? >> Since childhood. >> Oh, okay. >> Am I fine? >> Is that a deviated septum? >> Okay. No, no idea.
(27:54) I probably fell off a bed. >> Okay. We have to get you in the lab and scan your brain. But let let me explain the the science. So the alactory nerve um it comes up and it actually uh goes and terminates into something called the alactory bulb. And the alactory bulb literally there are pathways from the alactory bulb straight into the hippocampus.
(28:13) which is why we're getting all of these uh studies now saying that um toxins in the air are a risk factor for Alzheimer's disease. Why? Because pathogens can go through here, go up into the alactory bulb and then parts of it can protrude into the hippocampus and deteriorate it. >> So now we're getting a lot of um science around, you know, get rid of the candles that smell nice, get rid of uh you know, spraying things on you, anything that can >> Sorry, perfume industry.
(28:40) >> Sorry, perfume industry. Yeah. So, I've eliminated all of that. And this is why um uh particle matter in the air is having an effect on your brain health because it's going up. It's actually the almost the same way that uh periodontal disease is a risk factor because you get periodontal disease and it goes up the vagus nerve and into the brain as well.
(28:58) So, it's a really fascinating area and we still don't know why one of the first areas to deteriorate is the alactory bulb. >> Fascinating. So, I wonder, this is my hypothesis, if putting estrogen cream in your nose would help the skin around that and if it's deteriorating because I know that if you put it in your ears that um Dr.
(29:20) Mary Cla said she has some of her patients putting estrogen in her estrogen cream in their ears because they get itchy ears. >> But that's more of I would think that was more of a skin thing. >> Yeah. >> But no, I don't know. Somebody just texted me this week that >> picking your nose is a risk factor for dementia. >> Picking your nose is a risk.
(29:35) Why? because of what I just said because the germs on your finger. Yeah, it was a actually it was a really well done study mice. It was done in >> Did they make the mice pick their nose? >> I think so. Well, >> we've got salmon sperm being able to be injected into the salmon sperm. Are are they pleasing the salmon sperm works? But um I think that this is opening up a whole new gate for Alzheimer's disease and brain health outcomes.
(29:59) >> Somebody was putting somebody messaged me this week that they're putting their vaginal estrogen on their gums. Is that safe? >> I I don't know. It's never I've never seen a study, but looking at it, does it help periodontal disease? >> I I swear in 10 years we're going to be brushing our teeth with like a flavored um a flavored estrogen.
(30:17) >> Yeah. Well, here's here's another interesting thing just kind of going on like the the people who say testosterone is only for libido, which irritates me to no end. opthalmologists. So the eye doctors are using testosterone in drops for dry eyes because we have testosterone receptors in our tear ducts in our eyelids, right? So I'm like hormones affect everything.
(30:39) Do we have estrogen receptors there? Probably. But because dry eyes goes up after menopause, but also that is it testosterone? Is it estrogen? But it's really funny to be like, "Oh, except for the opthalmologists know that this isn't just for libido because they have they're compounding testosterone drops for dry eyes.
(30:55) >> What is compounding?" Because um we got a lot of questions about uh compounding GLP1s. >> What What is compounding? >> So compounding is is it's legal. It's safe in America. Compounding simply means like bespoke. It's made for you. So let's say you come in and you can't swallow or you don't have any teeth, whatever.
(31:17) you you're not able to take what an FDA approved medication is. I can then compound it in a liquid form, in a chewable form, maybe an injectable form. So, I can I can have a pharmacy make something special to your needs. >> Okay? So, sometimes there isn't an FDA approved product, for example, female dose testosterone, right? Or maybe you need a really smaller dose or a much bigger dose of than what's commercially available that's FDA approved.
(31:45) So compoundingies have been around for a very long time. They're actually very highly regulated. So people are like, "Oh, it's dangerous and blah blah blah." Like they have their own regulation system in America. And I mean, I'm not involved in the business of compounding, but I'm a physician and everybody knows, "Oh, you can compound this that that.
(32:02) " So it's bespoke. It's what it's what the pharmacy world was before we had, you know, big business making everything very standardized. And there's safety and standardization, but we aren't all Toyotas. Sometimes we need smaller doses, liquids, chewables, injectables, blah blah blah blah blah.
(32:19) So with GLP1s, uh the compounding is cheaper, right? Because if it's a brand name FDA approved medication, it's very expensive. So sometimes people will compound for cost >> or I need a smaller dose >> or I want to try it orally. There's no orals available, right? So, but the again and I'm not an expert in any of this, but my understanding is the the pharma industry has vested interest in having people buy their product not compounded.
(32:46) So, there's been this big uh kind of I I would say scare about the safety of compounded medications. And we're like, if you got rid of compoundingies, you remove options for many people. Like, there's people who need medicine through a G ttube because they can't swallow or they've had esophageal cancer. They need their medications made a certain way.
(33:04) Don't hate on the compounding pharmacies. >> They're by by and large very very safe and and very useful. >> Yeah, that brings in the N of one studies, right? And you've probably seen, you know, um you've got you've got massive amounts of data for a certain let's just say we'll go to Alzheimer's disease for example, but there's always going to be one person that's not included in that that you will see in your office.
(33:31) And I try and explain that to so many people. And this is the difference between I think when you've got a strong PhD and then you've got a physician that's like but I see patients and I'm I'm both academic and clinician because I'm in neurosurgery and I'm like oh but his case wasn't found in the data. So like what do we do? >> And it's just amazing you know being able to attack something from from both angles.
(33:56) And that's why I love what I do because I can understand both. I'm like, "Yeah, there's no data on it, but I did see a patient with this." >> Yeah. Yeah. Totally. And I think, you know, especially on the internet, you start realizing I a lot of people don't understand like if something's associated or correlated or there's a signal.
(34:14) It does not mean all this causes this. Because people be like, "My grandma drank a pint of whiskey every day and never got dementia. My grandfather spoke until he was 100." >> Yes. Never exercised. And you're like, "Yes." But for every one of those there's a person who died at 48 because they smoked and because they drank alcohol and because Right.
(34:31) So but people will they'll poo poo something because of an N of one. That's not how science works, right? It's like we have to we have to include that. But also people think like they think very black and white like you must be on estrogen. It it makes people feel really bad. If they truly can't be on estrogen, does that mean I'm going to get Alzheimer's? No.
(34:51) There's so many other things you can do, right? You got to exercise. You got to sleep. Don't drink alcohol. Well, >> don't don't play contact sports. >> There's 15 modifiable risk factors in fact. >> So So I think people lose the forest for the trees when they get so and you see this in the supplement world like just just you just need this one thing for your mitochondria and you're like no mitochondria there's a lot of things involved.
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(36:03) So, if you want to try this, new customers get $20 off an order of two bags or more now through the 31st. That's kachava.com code neuro. Right now, I am very clear on the data between certain vaccines and dementia. We've just had two massive studies done both in Australia and in Wales to show that the shingles vaccine can decrease your risk of dementia by up to 50%.
(36:31) And the mechanism is anti-inflammatory. >> Well, the mechanism is this. So, shingles is the chickenpox. Okay. So, you get chickenpox almost. I never had it actually. So, you know, I don't know if that's great. Chickenpox never leaves your body. You have it and then what happens is it lays dormant in the nerves >> in the dorsal root ganglia. Okay.
(36:49) Of the spinal cord. >> Under extreme stress. doesn't have to be extreme, but under stressful or low immunity, >> it can reactivate these dormant little pathogens. And then what happens is they travel up the spinal cords and they go into certain parts of the brain depending where the nerve root is. And you'll see a dermatone pattern of where the nerve root is and that ends up being shingles.
(37:15) And a lot of people think that shingles is just a skin disease and it's itchy and it's crazy, but it's not. It's a spinal nerve disease because it goes up into your brain and that's where it starts to attack certain brain cells. >> Wild. And so this is adults. This is not this is not children with the chickenpox vaccine.
(37:33) This is adults with the shingles. Correct. Yes. And there's also um evidence for HSV1 herpes simplex virus one cold sore that um it does the exact same thing, exact same mechanism. >> Fascinating. >> So we've got you know enormous amounts of data on that. But when people hear the word vaccine, they turn straight to CO. >> They don't think about anything and then they think that you are out there to kill them and then it's pharma and you're sponsored by farmer and vaccines are bad.
(38:00) I don't know where vaccines got their bad rap. I'm I'm I'm thinking it's because of co because hello it became political. Yeah, it became political in the co era. There was always kind of the like fringy anti- for lack of better words people who were not provacine. But I think co made it political and it's so like the physicians it's so upsetting that your medical health became political >> because now you're like on team blue or team red and and it's like more about your alignment than like let's talk about your health.
(38:32) Let's talk about let's actually talk about the risks of not having vaccines. Let's talk about the risks of having vaccines. And again it's that black and white thinking of like if there's risks that means everybody's going to get the risk. No, that's not what risk means, right? It's very small amount. And the benefit of vaccines, I mean, I take care of people who've had polio. They're 78 years old.
(38:52) They are they're walking with the cane because the left leg Yeah. They're postpolio syndrome, right? And that generation had it. >> My, you know, big sadness is like, can you guys speak up, please? >> Yes. >> Can you speak up and let people know what your childhood was like? Because we and people will say this and we've become so successful >> that we don't remember these diseases.
(39:16) We don't remember measles. We don't remember polio. We don't remember these used to kill people, right? Make you make your children infertile, >> right? And again, it's that sadness of it's hard to educate in 90 secondond clips. Like social media is so toxic for this stuff, but podcasts people can actually be like, "Oh, okay.
(39:35) I hadn't thought about it that way. I hadn't thought that one vaccine might be different than another vaccine and you know risks and benefit like medicine is complicated bodies are complicated and what we used to know can change right you know I was talking last night with another surgeon we're like we were taught in med school 50% of what we know will be wrong we just don't know what that is right so for anybody to say they're so certain at this point a great book on that is blind spots by Marty McCary it's like every chapter is where
(40:03) medicine has been wrong. >> And it's very humbling to be like, let's not forget we've been wrong so many times that we might not be 100% right right now. And I think that's, you know, why when people they want absolutes. They want absolute reassurance and we're like can't give it to you, but we've got really strong signals saying this and we've got, you know, studies showing this and it's like we can tell you what we have and therefore why we think but this like >> this overconfidence of we know.
(40:31) >> Yeah. We can't know for sure. Healthcare has become political, but a woman in need is apolitical. >> Love that. >> And I don't like how we are bringing politics into our decision-m when it comes to healthcare. And it's quite scary. And >> of course, people are confused. I'm confused.
(40:53) And my entire life is made up of academic medicine. I I sift through enormous amounts of data. Right now, the uh meta analysis and systematic review we're doing has over 6,000 articles that we need to screen for. 6,000. It's it I know it's it's wild, right? >> But we need to go through the work. You've got to do the work. Okay. And so >> I'm I'm even confused.
(41:14) So I can imagine how you know an average female or male is confused because they get on in 2022 and they see RFK saying vaccines are good. He's vaccinated his children. And then skip forward to 2026 where he's saying, "Do not trust medical professionals. Doctors don't know what they're doing. You need to take your medical history and and your health into your own hands.
(41:35) " That is like getting on a plane and saying, "Do not trust the pilot. You must take the plane into your own hands." >> Yeah. >> Yeah. And I think what it's like everything doesn't happen in a vacuum, right? Like what has happened along with that or maybe to allow that is the fracturing of the doctor patient relationship.
(41:56) So back in the day you tended to have a doctor that lived in your town that was there. They lived in that town. They practiced in that town for 40 years. You were bonded. You trusted them. You went to them with your problems. And if somebody said don't trust your doctor, you'd be like that's ridiculous. Dr.
(42:10) Jones Yeah. Dr. Jones is taking care of my aunt and my mom and delivered my babies. like there was like a fighting for that that precious relationship. Doctors move jobs all the time now. They move towns. They have they have employers now. They're not self-employed. So, their employers change things. And so, it's like that doctor patient relationship has fractured.
(42:31) And I have to think that plays a part in people who aren't doctors abilities to say don't trust these people because you don't have a relationship with them, >> right? that relationship with like that trusted authority who you know has your back and you know has your best interest is gone. It's fractured at least in the American health care system now.
(42:50) People are you know people over and over and over they're like I I have a new primary care doctor again, a new primary care doctor again. It's like >> that relationship's gone. So it's easier to erode that relationship when people can't fight for the understanding of how precious it is. And you look at what's happening with AI and concierge medicine.
(43:09) Why are people going to concierge medicine? Why are people paying a ton of cash that their insurance doesn't cover for a concierge medicine person? Expertise and time and a relationship, >> right? And that will never go away. Like that is precious and it's worth something. And you can't get that in a 10-minute visit. No. >> So, when your visit's only 10 minutes with a brand new person and somebody says, "Don't trust that person.
(43:32) " And maybe you've you've watched you we're more bounded with people on the internet than we are with somebody we saw for 10 minutes. Right. So it's like the relationship because of the culture of medicine has allowed people to say things that >> maybe I don't know this person. >> Yeah. >> Right.
(43:50) But you know economics comes into play and I guess that's where it's political because if you can't afford to see a doctor for cash pay purposes and you have to go through insurance and you might only be able to see your doctor for 10 minutes. can be done in 10 minutes. >> That's true. Yeah, it's very good for like um a paper cut, >> maybe a sprained ankle.
(44:07) Like simple medical problems can be handled in 10 minutes, but complex what do you want to do to prevent future diseases, right? Certainly mental health issues, >> it's much easier and I get it like I I am on the doctor's side. I am one of them. I trained with them. >> But giving a medication is more simple than saying, "Let's get to know each other. Tell me about your past.
(44:29) What are your goals for the future? Like this stuff takes time. And the insurance companies are the reimbursers of the value of healthcare. The doctor doesn't decide what that's 10 minutes is worth. >> They don't decide what that's worth. The insurance companies decide what that's worth. >> And so you can't do that work in a 10minute period.
(44:49) And where doctors have been fooled is in us thinking we can. What better way to cut in right now than to tell you how important it is to start your year off right. And the start of a new year makes me want my home to feel calmer and more intentional. Not perfect, just supportive of how I actually live. So, I've been using Wayfair to do a bit of a reset.
(45:14) Simple things like upgrading my bedding, [clears throat] my storage, and refreshing a few spaces where clutter quietly builds up. What I love is that Wayfair really is a one-stop shop. From mattresses and towels to desks, shelves, kitchen essentials. And by the way, if you live in New York, Wayfair is a godscent.
(45:33) I was honestly surprised by how easy it was to find things that fit in my style and my budget. You can search by room, by vibe, by price, and suddenly getting organized or refreshing a space doesn't feel overwhelming. Your environment matters and especially if you're a bookworm like me, you want the best lighting and the best atmosphere to take all of it in.
(45:56) So, if you want to get organized, refreshed, and back on track this year for way less, then head to wayfair.com right now and shop all things home. That is wayfair.com. Wayfair every style for every home. When we have a case in neurosurgery, generally glyobblasto, which you know is incurable, and you have to have the conversation with the patient, the neurosurgeon has to have that awful conversation saying like, uh, it's inoperable or maybe we can, but we can only probably get 40 or 50% of the tumor and that's most likely going to grow
(46:31) back and you've got x amount of years and like how do you sit in 10 minutes and tell somebody, I get your affairs in order and we'll do what we can. And so it's a it's a lengthy process that is only really offered to unfortunately e economy e economics does play a role here and that's sad and scary and I don't like that.
(46:49) No >> but this is why I do the podcast to try and give this free education but albeit >> just watching something is very hard because you still don't know about yourself. >> Yeah. And you always say individual results may vary right because people will be like well I see this a lot for social media.
(47:06) What's the best lab value for X, Y, and Z? What's the right do what's the right dose of X, Y, and Z? And it's like, dude, we didn't come out of a Toyota factory. And people are like, what do you mean by that? And I'm like, you're not the same as that person. Like, we're all human beings. >> That's actually the last part that I want to talk about.
(47:21) So, we're seeing this >> rise of people getting blood work cuz now before 20 years ago, you'd have to go to your doctor and you'd get, you know, your metabolic panel and that's it. >> And maybe Yeah. And maybe you'd only get what your insurance covers. >> Yeah. Right. Cholesterol. to just give you total LDL HDL. That's it.
(47:35) Now we've got everything. We've got LP little A, we've got APOB, LDLC. And so we're becoming more educated on blood work. And now anyone can order their blood work. You can just go on and click and you sign up and maybe it's $500. >> Well, and and now it's getting where they'll just ship it to your house. They're doing these amazing like needleless arm.
(47:54) >> I don't like that. You and I did it together. >> Yeah. Yeah. I'll tell you why. Because I got mine. When we did it together, it came back. My LDL said 180. Never in my life. And I'm I'm, you know, I'm very proactive. I've never seen my LDL at 180 and my APOB at like 150. I said, "Oh my god, I'm dying.
(48:17) " So I went and did my blood work two weeks later. What can change in two weeks? Okay. My LDL was actually 90. Apo B was actually 80. >> Yeah. >> Why is that? So, >> yeah, we're in our infancy with the with the not having to go to Quest Labs to get your blood drawn. But, yeah, I agree. I uh I had a shocking cholesterol reading on that as well.
(48:39) And I do need to repeat that in a traditional lab. >> But, um the reason why I bring this up is because a lot of people are getting their own labs and they're trying to interpret it themselves. And I always say with blood work, I've been saying this for years, anyone can take your blood. A phabotamist, it takes two days to train as a phabotamist.
(48:53) They just take your blood. It's who is interpreting your blood work. And a lot of a lot of physicians don't even know really how to go deep into the weeds of blood work. Like if one thing is high, if your Billy Rubin is high, what does that mean? If you know, I've I've heard so many people respond to creatine. Oh, my doctor said I can't take creatine because my creatinine is high.
(49:13) It's like that's not the measure of your kidney function. And it's not the only measure of your kidney function. And there's so many things to take into play. And I think that that's going to be the next rise. Like who is going to interpret your blood work? And I think it's gonna be a combo of expert physicians and AI.
(49:30) >> Yeah, >> AI is coming. AIology is not even deep into the new, you know, Yeah. >> Yeah. >> AI as in like you put in your entire background like age. >> People are doing it right now. They they type it all into CHAGTP. I know. Well, no, we're we're in our infancy, right? But it's accumulating data.
(49:50) I you know somebody told me 80% of CHAGTP entries are health related questions like it's massive. Well, that's scary because >> because it's because it makes I mean CHGP can hallucinate, >> right? Like it can tell you incorrect things, >> but it's a place to start, >> I guess, >> for a lot of people. And and it does amazing things if you're like, "Hey, I need a get a meal plan for me that doesn't include onions and is 120 grams of protein a day.
(50:18) " Like, it'll start creating ideas for you to so you have a place to start from. So, it's it can be very useful for health things. >> What's your mission? What are you doing? >> Education. Education and empowerment in the fight for equality and healthcare for women. >> I love that. And how are you doing that? >> Talking. Being fancy on stage.
(50:37) >> Yeah. >> Having a crazy hair so people look at me. >> What did >> using humor to educate adults? >> Tell everyone what Jane Fonda said. >> Oh, so that where we were this weekend, we we did I did a panel with Lzanne Falsetto who is very high up and very amazing in YPO. um Vonda Wright and Jane Fonda and we had this amazing four-person panel.
(50:57) It was an hourong panel and if you don't keep people entertained like you're going to lose them in an hourong panel, right? So, we understood the assignment and uh like we were I was taking off my shoes. Jane was we were talking about brands. We like it was so fabulous. And in the middle of it, I don't remember how it came up.
(51:12) I think I was talking about sex. Jane Fonda is like, "Your hair looks like it had an orgasm." >> [gasps and laughter] >> And then I was I was immediately like please tell me this is being recorded like I need this for social media. >> She is um a wonderful example of why exercise is medicine.
(51:31) She's 88 years old for those people who don't know and we just you know spent the weekend listening to her on stage and her all I was thinking about was her brain the whole time. Everyone was probably like marveling at how I was like her brain is switched on. Albeit halfway through giving her analogies and scenarios, she did ask what the question was and I was like, she's 88.
(51:47) >> I do that, too. >> Yeah. I mean, she's phenomenal. Her cognitive performance was on fire. And she's funny. >> Yeah. I was just like, first of all, this woman is living forever, >> right? Like it's incredible. Like >> the 70s, the 80s. She she talks about eras because she's lived through all of them, right? and her analysis of how women's rights and health are being taken away by the rules of other people who don't get pregnant, right? Like her analysis on that of like watch what's happening. Pay attention. This is worth
(52:19) fighting for, right? and like her analysis of all these movements that have happened. It's like the wisdom and the knowledge and the like understanding of how America is changing over time is like it's the whole respect your elders, right? Because people, you know, the 45 year olds and the 50-y olds like ah getting old's awful.
(52:40) What's the point of menopause? Blah blah blah blah. And it's like you get to become the wise old elder who has seen and who knows and who's had experience. And the other really awesome thing that I I took away from Jane Fonda this weekend is like there's a level of what you've lived through enough stuff, you don't take everything as seriously anymore. Yeah.
(52:59) >> Like there's a level of like you don't give a f. Yeah. Right. And it's it it looks so freeing on a person. It's got to feel so freeing. I know I'm experiencing that as I'm getting older. You know, you and I famously broke the internet in the middle of 2025. And like I think even three years ago, I would have been like, "Oh my gosh, I upset some people by saying something and blah blah blah.
(53:22) " And now I'm like, "Whatever, it'll blow. It'll blow over." I did it for a reason. I wanted to make people pay attention and listen to what their brain health is doing. It's like you give less f. >> And that was interesting because you were like my therapist during those two weeks and you're like, "Hey, who cares?" I was like, "Oh no, look what happened.
(53:36) Oh no, I'm hoping I'll get to your stage very soon." >> It happens time and repetition. And like and I think the other thing is like if you do it right as you get older, your core knowing of who you are and why you're here and what you're meant to do, it becomes a solid metal rod >> and it's not this weak elastic thing that like somebody's opinion is going to change. Yeah.
(53:58) >> Right. And the more you get solid on that core, the more you're like, >> I know what my mission is. I know that this was not a big deal and will not disrupt the mission. Right? like don't don't do something so disruptive that it will disrupt the mission, but like saying something on an on an Instagram post to make people think and to get some people pissed off is like they're paying attention. They we good.
(54:18) We should be talking about brain health. Yeah, we should understand how our brain changes with age, right? Like I understand the mission, but it's like and you get to a point where you know so much that you know the people hating on you know less than you. >> Yes. and and you know the people who know more than you and they would never do that to you.
(54:36) >> Isn't that interesting? I feel like you only get um you only get hate by people who are either there to attack you because they feel inferior to you and they feel like they need to prove something to bring you down. And it's actually it's really upsetting to see that it's women against women and I can't understand that.
(54:54) >> Yeah. Yeah. It's wild, right? Well, I think culturally for so long there was one seat at the table for a woman. >> And so culturally we were trained there's one seat. You you got to fight for it, right? And I think our generation knows no no we will we will bring the whole table. We will do our thing. We will create our business.
(55:12) We will do our podcast. We will do our our events, right? Like there isn't one seat anymore. So when so in thinking about it that way, I have compassion. >> Like oh you were trained to hate. You were trained to think that this was scarcity mindset land. This is actually abundance mindset land, right? And I'm not going to play with that.
(55:32) >> Well, I have to say it's such an honor to have you here again. Um, you and Vonda are like uh your mentors to me and I'm just I'm so grateful for you. I mentioned uh to you in the car ride home last night. I said I feel like I'm getting just another PhD just by being around you two. So, I'm I hope it um continues to grow our relationship and I'm I'm with you every step of the way.
(55:54) >> I'm with you, too. >> Thank you, my friend. >> Thank you.
Author Name:TNE with Louisa Nicola
Youtube Channel Url:https://www.youtube.com/@LouisaNicola
Youtube Video URL:https://www.youtube.com/watch?v=MSXMTj9pM6o
Title: Why Women Are Using HRT Wrong - And paying For It Later | Dr Kelly Casperson
Author Name: TNE with Louisa Nicola
Description: I sat down with Dr. Kelly Casperson, urologist, women’s health advocate, and a leading voice fighting for equality in healthcare, to explore what’s really happening to women’s bodies and brains during perimenopause and menopause.
We discuss why UTIs spike after menopause, how vaginal estrogen actually works (and why the FDA finally removed the black box warning), the truth about HRT and dementia prevention, and why estrogen receptors in your brain matter more than you think.
We also unpack why blood work interpretation matters more than ever, how compounding pharmacies work, the shingles vaccine and dementia connection, and why women need to stop waiting for permission to take control of their health.
Reduce your risk of Alzheimer's with my science-backed protocol for women 30+: https://go.neuroathletics.com.au/yout...
Subscribe to The Neuro Experience for evidence-based conversations at the intersection of brain science, longevity, and performance.
Topics Discussed
00:00 Intro: Why women’s hormone health is misunderstood
02:10 Who Dr. Kelly Casperson is and why women’s sexual health became her focus
05:10 Hormone Replacement Therapy explained (estrogen, progesterone, testosterone)
08:30 Vaginal estrogen, UTIs, and restoring tissue health
12:40 Vaginal estrogen vs systemic estrogen and the FDA warning myth
15:20 Estrogen receptors, skin aging, and visible signs of hormonal decline
18:30 Estrogen, the brain, and Alzheimer’s risk in women
22:10 Why hormone research is conflicting and often fails women
26:00 Sleep, hot flashes, inflammation, and brain health
30:00 Testosterone in women: beyond libido and muscle
33:40 Compounding pharmacies and personalized medicine
38:00 Inflammation, viruses, vaccines, and dementia risk
43:00 The breakdown of modern healthcare and why women feel dismissed
47:30 Blood testing, data ownership, and the future of women’s health
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Transcript:
(00:00) I saw you putting vaginal estrogen on your face. >> Yeah. >> Why? >> Hormones improve tissue quality, not just where you can see it, but everywhere else as well. The skin is an organ. And the cool thing about this is you can actually watch this organ change and improve because of estrogen. >> Meet Dr.
(00:21) Kelly Caspersonson, [music] board certified urologic surgeon, best-selling author, and the voice fighting for equality in women's health. >> Eight years ago, a woman changed my life. She was crying in my office because of a sexual health issue. The universe lightning struck my brain and I was like, "Hold on, who's taking care of the people who are supposed to be sleeping with the people that people like me are giving testosterone and Viagra to?" A man comes in low libido, sexual health issues, low testosterone, and we're not like, "This [music] is
(00:45) just natural aging, buddy." We don't dismiss them on the level that we do that to women. You'll break the internet if you tell people that everybody should be on HRT. With the research that I've done, hormones are profoundly helpful. This would put the beauty industry, [music] you know, bankrupt.
(01:02) I'm Louise Nicola and this is the Euro Experience. >> Hi, Kelly. Welcome back to the podcast. >> Hi, my friend. Thanks for having me. >> So, we've just spent uh about three or four days together. Are you sick of me yet? >> Nope. >> Oh, not yet, cuz we've got a lot to do. >> What's your name again? [laughter] >> Well, you'll learn after this podcast.
(01:19) Um, we're going to go through so much, but I want you to just open up once again and tell us what is a urologist. >> Yeah. So yesterday on stage I think they introduced me as a neurologist and I was like okay we need to clear we need to clear this up. It's better than a meteorologist which I got once in my life.
(01:38) So a urologist is a surgical subsp specialist. So you go to med school and then you go to residency and you spend five or six years in training to operate on the genital urinary organs. So from top down that's adrenal glands, kidneys, urtors. Urers go to bladder. Bladder goes to urethra. Urethra goes to toilet and surrounding the urethra and bladder.
(01:55) We've got the prostate. We've got scrotum. We've got testicles. We've got the penis. So stereotypically male genitalia if the traditional urologist now more and more not every urologist care about the female external genitalia as well. >> Okay. So, I was going to say because now you've you've you've spent most of your career working with men, but you've you've kind of taken an a new focus which is focusing on female health.
(02:20) >> Yep. Yeah. So, traditionally like people don't even know you know you get these crazy things like I didn't know women were urologists and you're like was there a rule banning that like you know but people's like stereotypes right or like why would a woman need to go to a urologist female? It's like OB/GYN men and you're like, "What are you a male OBG?" >> Right. Yeah.
(02:40) The good news is the female urologists are in crazy demand. There's only a thousand of us in America right now. >> So, we're training more, but it's still very rare because it's so predominantly men. When I trained in medical school, there was one female urologist in the entire state of Minnesota, and I'd never met her. >> Oh my goodness.
(02:56) >> Yeah. So, it was much more common now. So as a female in urology, women tend to gravitate towards you because I understand what a urinary tract infection feels like, right? Like I we understand this and they just feel a lot more comfortable. These are massively personal issues. >> So always saw a lot of women did a lot of bladder leakage, pelvic organ prolapse, surgery, things like that.
(03:17) And then about eight years ago, a woman changed my life. She was crying in my office because of a sexual health issue. And this big basically like the universe lightning struck my brain. And I was like, hold on, who's taking care of the people who are supposed to be sleeping with the people >> that people like me are giving testosterone and Viagra to, right? And it really became an equality issue for me.
(03:40) I'm like, as when women are treated the exact same as men are in the clinic, >> my job's done, right? I don't care if you take hormones or not, but I care that you're profoundly educated about it and you get the help you need. and that people treat you like we treat the men where we don't treat we don't tell you know man comes in low libido sexual health issues low testosterone and we're not like this is just natural aging buddy >> like this is just how it is drink a glass of wine >> you know we we don't dismiss them on or natural them on the level that we do
(04:09) that to women >> so you just said UTI and what I've heard from this conference this weekend and you know all around for the last year is that urinary tract infection rise when a in females when a a woman reaches a certain age. So, I'm guessing there's a correlation between that and vaginal estrogen.
(04:31) So, why don't we before we get into that because I'm I'm really interested. Uh why don't we just open the gates and talk about um you're very pro- HRT in if not for everyone or is it for every woman? >> You'll break the internet if you tell people that everybody should be on HRT. >> Yeah. Right. So, and to me I'm like that's your body.
(04:49) I'm not going to tell you how to live it, right? Like your body your choice. >> And I I wrote in my book, I'm like, I don't care at the end of the day what you do with your body. It's not my body. You're not living my life. But with the research that I've done, that the menopause experts have done, hormones are profoundly helpful >> and all in most domains, right, of health.
(05:08) And I care deeply that you're educated and then you can make the right decision for you. So that's how I always answer the like, should everybody be on hormones? Yes. And then sometimes I'll joke and I'll be like, "Well, in the '9s 40% of American women were on hormones." It'd be cool to just get back to the '9s level, right? Like they were doing fine.
(05:23) >> But were they bio identical back in the 90s? >> More likely back then there was oral synthetic. So uh pill. Yeah. Pel. So Prem Pro was conjugated coin estrogen and hydroxy progesterone acetate as a combo pill. So still a very safe medication. Like you know the the short answer is like ah it was so unsafe.
(05:41) It's like it's still a very safe medication. But now that we use trans dder dermal, less blood clot risk, less stroke risk because less blood clot risk, less gallbladder disease with it. So there's a benefit for trans dermal absorption and so but you know we like to make things easy. It's like that was bad, this is good.
(05:58) Like they're just different. >> Yeah. >> Right. >> But go you want to go back to the UTI? >> Well, I just want you know it's interesting because I was just in Australia, right? And you know you and I and and a lot of the other physicians that were there, we go really deep into mechanisms. you know, what does, you know, hormone replacement therapy do at a cellular level? But what I didn't realize is that >> there's still a lot of women, what, 4% of the population is on HRT.
(06:22) There's a lot of women who don't really know what this is. And I know that because when I was in Australia, I had women asking me if they can pick this up from a supplement store. So, when we describe hormones and hormone replacement therapy, we're really describing estrogen, progesterone, and testosterone. Yep. >> Correct. Yep.
(06:42) >> Um, and these are naturally occurring hormones that we have and they start to decline as we get older during what we call this phase which is pmenopause. >> Y >> and if we want a replacement for those, >> it's hormone replacement therapy. >> Yeah. People want people prescription drugs. >> It's a prescription drug in in Australia and in the US.
(07:02) In some countries, it's over the counter, right? Different rules. Mexico. >> Mexico's over the counter. >> Columbia, >> I don't I don't know. I don't know all of them. And then there's again there's some countries that have no access to them, right? So it's like there's all these different levels of how can you get it where it is.
(07:16) So by wherever you live in the world, it might be different than how it is in the US and Australia. I mean even between Australia and the US, you guys have a government approved female dose testosterone. The US doesn't. Yeah. >> Right. So it's like it's different everywhere and access is different everywhere.
(07:31) But by and large, you know, people they have two questions. Number one, where do you get it? Usually have to see a doctor. I do believe a doctor should follow you. Like this is not one-sizefits-all medicine, right? But then people want shortcuts. They're like, "Well, what if I do enough push-ups? I'm being facitious, but what if I eat enough soybeans? What if I drink enough soy milk?" Like, they want to get it with food, but how it works like biochemically is you can't eat enough food to put a hormone into your body. Like, you have to take the hormone
(07:58) and put it in, right? Like our ovaries made it. We were never like eating enough soy in our 20s, right? food is healthy for us, but you can't put a hormone in your body in enough levels via eating a certain food. >> And the reason why we want to obviously replace the circulating hormones that we have that start to decline is because we've got these receptors all over our our body, especially in our brain, which we'll get into that if they're not used, they end up forming certain dysfunctions. Uh before we get into the
(08:29) brain, why don't we talk about UTI? >> Yeah. So for people who need to start at the beginning, UTI is urinary tract infection commonly known as a bladder infection. If it ascends inside, then it's kidney infection, right? And that's where you can get fever and sepsis from. Sepsis means the infections gone into your bloodstream.
(08:44) >> That's dangerous. That's very dangerous. It's deadly, especially as we get older and we get frail and less resilient, right? So we're even more susceptable to being taken out by an infection. So bladder infections common. They they happen. They're like the top eight things that people see a primary care doctor for, but they become more common as we age.
(09:06) And the reason for that is healthy microbiome of the vagina needs estrogen. When estrogen goes away, the lactobacillus die off. Lactobacillus produce something called lactic acid which acidifies the vagina. Why is an acidic vagina healthy? Because it acts as a moat or a barrier between the stool, the poop bugs, the rectum, and the bladder.
(09:28) So a healthy vagina acts as a barrier to the the waste bugs going up to the bladder where you can get sick because they're not supposed to be in the bladder. So that's why in perry menopause, postmenopause, adding back in vaginal estrogen reassidifies the vagina, makes it more inhospitable for the poop bugs to travel up to the bladder.
(09:47) >> Vaginal estrogen, >> vag lo local lowd dose vaginal estrogen, which is very inexpensive. a tube of vaginal estrogen cream in America at Mark Cuban cost plus drugs. It's $13 plus $5 shipping. I have no affiliation. It's just the cheapest vaginal estrogen that I found on the market. And it's lifelong.
(10:05) If you stop taking the vaginal estrogen, >> you'll go back to the microbiome that >> lives without estrogen, right? >> The acidic microbiome, >> the the basic microbiome. So, we want estrogen to make it acidic. >> Acid. Okay. >> And then we lose our acidity. I recently had my labs done through function health and one number that really stood out to me was my Homer IR.
(10:24) It came back as 0.4. I bet you've never heard of Homer IR. Well, it's a more intelligent marker of insulin sensitivity and it's one of the most important indicators we have for long-term brain health and metabolic longevity. Now, this result didn't happen by accident. It's the outcome of years of paying attention to blood sugar, inflammation, sleep, and training.
(10:49) And function is what lets me actually see those trends instead of hoping I'm doing things right. Function gives you access to over 160 different biomarkers from glucose and lipids to liver, thyroid, inflammatory markers, guys. Absolutely everything. I do a huge huge blood panel. I would say every six months, but I'm really doing like the basic blood panels like every three months because I need to know that what I'm doing every day, the protocols, the supplements, the sleep, the training is actually having an effect on my cells.
(11:20) I use Functionhealth. They are the best in this for absolutely all of this. If you want to try Function Health, you can sign up at functionhealth.com/loanicola. You can use code neuro25. you will get $25 off and once you use this and sign up you will be able to look at all of your data in real time. That is functionhealth.
(11:44) com/losa nicola. So how is that the vaginal estrogen different from the patch? Yeah, good question. So patch is transermal meaning it's a dose high enough that if I checked your blood levels I could tell that there was estrogen in your body. Okay. >> Right. Because people are like, "This is estrogen and this is estrogen.
(12:03) Why are you saying they're different?" Dosing, >> dosing, dosing, dosing, which I think a lot of people don't understand. So, if you're on, this is an example. If you're on a year's worth of vaginal estrogen, you take vaginal estrogen for a year >> every day. Do you or once a week? >> Typical is twice a week. >> Okay.
(12:19) >> That is equivalent to one oral estradiol pill. >> Oh, >> so it's like basically micro doing estrogen in your vagina for people who like the micro doing trend. Um, so very different dosing. Now, the next question is, if I'm on a patch and still getting recurrent UTI or pain with sex or overactive bladder, can I then add in vaginal estrogen? Of course, you can >> because it's so low dose, you're not really adding any more estrogen to your body.
(12:44) >> Okay? >> Right? So, it's skin care. I call it skincare for down there, >> which is already trademarked. I've looked, but it just helps people understand like this is skin care. It's not your liver doesn't see it, your bones don't see it. It's just very very minimal, but it's enough to help the bladder function, sexual function, and urinary tract infection decrease.
(13:02) There's no better treatment for urinary tract infections than vaginal estrogen. So then women ask, they'll be like, um, my husband has urinary tract infections. Can he take vaginal estrogen? And I'm like, urinary tract infections in men are a completely different animal. It's usually a prostate or an obstruction or a urinary or a kidney stone, right? Different workup based upon if you have a vagina or not. Wow. Okay.
(13:27) So, that is really interesting and we've got a lot of women who are not currently taking it for god knows what reason. Maybe it's just education. >> Yeah. Well, the so the black box that was on and this is worldwide because what America did, the rest of the world followed. The black box has been on for 25 yearsish.
(13:44) It came on the year after the women's health initiative. So, 2003 is when the box warning came on the products. The FDA said, "Whoa, this looks dangerous. Let's slap this on every dose, every formulation." It says probable dementia, blood clot, heart disease, stroke. It's all untrue. Again, this is skincare. Skincare doesn't cause any of these things.
(14:02) And this has been like 12 years in the making. Multiple petitions to the FDA, but via social media, via via an FDA that actually wants to write some wrongs. The box warning was removed from estrogen products in November. >> We have one p one study done by a female urologist, Dr. Una Lee that said if a woman was lucky enough to get a prescription and then she she gets the package from the pharmacy she takes it home she opens it up it's she reads the boxed warning 30% won't use the product >> 30% >> 30% because of that box incorrect boxed
(14:34) warning so I always told my patients you have to choose between what I'm telling you and what the FDA is telling you that's not a fun task right but now we've taken that boxed warning off so I think we're going to see much more utilization of this >> something interesting I saw on the weekend. Okay.
(14:53) Now, um I am currently spending way too much money on skincare, right, for god knows what reason. I think I'm just I I I fall for marketing. I saw you putting vaginal estrogen on your face. >> Yeah. >> Why? So, let's go back to what a hormone is, right? To answer the question in a scientific way. So, a hormone helps healthy cells stay healthy.
(15:12) >> That's what it does. It's a messenger. It's a communicator, right? So the hormone travels around the body, usually made by the ovaries, sometimes adrenal glands. Travels around the body, goes to all these tissues that have receptors. Skin has receptors for estrogen, right? Sits on the estrogen receptor that then translates into the cell to say affect my mitochondria, affect my DNA, affect my protein synthesis.
(15:34) That's what hormones like a gate. Yeah. >> Okay. Like a key in a lock. It comes in and then opens the gate and then the hormone can go into the cell. >> Yeah. I maybe it's kind of like a phone, right? like it's kind of sitting there and then like a call comes in and you can pick up the call, pick up the call and now your life's different because you picked up the call, right? So it's the receptors are sitting there waiting for the signal and the signal goes decreases as we get older.
(15:57) So in skin in skin cells estrogen helps blood flow, it helps collagen production, it helps elastin production. So elasticity and thickness, right? So why do why does everybody say that pregnant women have the pregnant woman glow? massive levels of estrogen in their body, blood flow, glowing skin, right? And the other fascinating thing about this is people are like, there's no data for estrogen in the skin.
(16:24) I'm like, we have multiple metaanalyses done by dermatologists that show what estrogen does to the skin. Yes, >> the skin is an organ. And the cool thing about this is you can actually watch this organ change and improve because of estrogen. And then you take the step and you say, "Oh, if this organ is changing and improving and I can see that >> that's what it's doing to the bone.
(16:45) " >> Yeah, >> that's what it's doing to other organs inside that we can't see and we kind of have to believe, right? So, I like the face and estrogen and ulva, too, but I don't think everybody's sitting around looking at their vulva is, oh, hormones improve tissue quality, not just where you can see it, but everywhere else as well.
(17:06) So estrogen on the face is incredibly safe. Multiple published studies, enough studies that there's two metaanalyses about it, right? And for some odd reason, people are like, "Oh, it could be dangerous." >> In what way? >> I have no idea. >> Well, then okay, a counterargument then. I mean, this would put the beauty industry, you know, bankrupt because how many girls, you know, who who are buying, you know, copious amounts of cream or injecting salmon sperm into under their eyes for better quality of skin.
(17:39) Um, can like a 25year-old put this on their skin? >> Yeah. I I haven't seen prevented because then you're like, can we prevent the signs of aging? Right. You're like, it makes sense. One might argue a 25-year-old has excellent estrogen. Yes. And at some point there's a threshold where if your receptors are already full is more better >> does become dangerous >> but not that we have data for >> we have data for we have data for >> interesting >> let's stay on this topic of estrogen receptors and and talk about um my field which is brain health because we have
(18:06) estrogen receptors all over our brain in certain parts of the brain hippocampus is one of them which is the memory uh the the location where memory formation and consolidation occurs arguably the first part to go during Alzheimer's disease. You know, I you know, it's funny because I've spent the good part of the la of the last decade researching Alzheimer's disease.
(18:31) And I started off with a wide population of both men and women. And the reason why I veered towards women is because I couldn't understand why 70% of all Alzheimer's disease cases were female. >> We used to think it's just because we live longer. Okay, we now have data four years longer. only four years so there's got to be something else you know and the consensus is because of the hormone transition that we go through.
(18:54) Okay, let's keep digging. >> Why is it in your opinion that we've got one camp of scientists and physicians who are saying no estrogen therapy or hormone replacement therapy does not prevent dementia. And then we've got another scale of people who believe that it is preventative against dementia. >> Yeah, I think there's multiple reasons for this.
(19:21) Number one, we were trained, my generation at least, were trained that the randomized placebo control trial is gold. That's a that's the highest level of scientific proof. And a lot of people say, well, no, not actually because if you aren't studying the people that you are actually interested in, does it apply to you? Right? So, that's one thing.
(19:37) The second thing is cost, right? massive massive the women's health initiative in today's dollars was a billion dollars >> a billion >> billion dollars and with Alzheimer's and this the same thing with prostate cancer right which I like to compare it to it's like it's not just that we don't want to study women it's that some answers take a long time to answer so prostate cancer what's better a prostatctomy or radiation we don't know we've never done a randomized placebo control trial comparing those two treatments why because prostate cancer is slowgoing
(20:05) >> and death after diagnosis is over a decade Right? Same thing with Alzheimer's. That horrible day, and correct me if I'm wrong, but that horrible day you were diagnosed with Alzheimer's disease, it started 20 years ago in the making. >> Right? So, we know you've got to start this when people are asymptomatic and you got to follow them for a long time.
(20:22) That's freaking expensive. >> And then you've also got to consider APOE4 genes. You got to consider genetics. You got to consider lifestyle. >> Yeah. To to be able to pull out just the drug. Like, are you drinking? Are you smoking? Are you exercising? Like, nothing's better for prevention than than exercise.
(20:37) And so to me, I'm like, it's a challenging study to do. And you I can stand on the fact to say we don't have that study, >> but we have multiple observational studies. We've got mechanisms of action. We've got so many signals. And my argument always is number one killer in Australia already. UK is catching up. And I joke it's not fun.
(20:56) >> Number one killer amongst women in the UK though. >> Number one killer amongst women in the UK already. Okay. Yep. And I always joke America America has a good uh good options of killing people for other reasons. So like we probably would be there but we killed people for other reasons. Joking, not joking.
(21:11) But like it's coming America. Like don't think this isn't coming for us as well. >> So number one killer >> devastating financially, emotionally, family wise, independence wise, >> no great cure. >> What we have can slow it down at great expense and great risk. Right? So you check all these boxes. You're like this is the disease where why wouldn't you try everything you can? And when you look at what should a preventative medicine be, it should be cheap.
(21:39) It should be safe. And you should be able to take it for a long time. Hormones check all those boxes, too. So, to me, I'm like, I'm building this thesis of like, what else do you want to say if a woman wants to do everything she can to protect her neurons, why not say you can do this? Yeah. >> Now, people will argue like these are all the arguments.
(22:01) will argue and they'll say, "But hormones aren't recommended for the primary prevention of any disease." That's true. They got a it got a grade D recommendation from the United States Preventive Services Task Force. If you dig into that, their biggest weighted study was the WHI oral synthetics. >> Right? So, we've got a grade D recommendation on hormones for the primary prevention of disease using oral synthetics, which are different than transdermals.
(22:26) Then you can argue, is oral better than transermal? Do we have less data for transdermal? Yes. And this is where we get all nuance for, but I don't think we will ever get back to our nation should, and we're at this conference and you saw a lot of people ask me, should I be on testosterone? Should I be on estrogen? And I just I like rail against that because it's very paternalistic of you should you should do this, right? And and Prem got taken to the taken to the toilet after the WHI.
(22:57) They got sued for like a billion dollars from a flawed misinterpreted study. I don't think anybody's going to stick their neck out and say all people should like the the ship has sailed for many cultural reasons on that. So women sit around and it is going to become the people who pay attention, educate themselves, are listening, are understanding and making the choice for themselves versus the women who don't have that access.
(23:21) And there will be health disparities based upon who's deciding to take hormones and not. And we already have that paper. There's a paper looking at entering Medicare. So these are women who are 65 already on hormones versus not on hormones. And the women on hormones had multiple metrics of decreased risk of disease compared to the women not on hormones.
(23:40) So that health disparity will happen because we will never say all people should. >> Yes. >> But if you're if you going to wait around for a randomized placebo control trial waiting for [clears throat] >> you we're going to be dead. >> It's Yeah. We have to make the decision with what we have. And if you understand academic medicine to see what a double blind placebo control trial actually consists of, like you will be waiting a very long time.
(24:03) Although I do know that it's in the making and it will get done eventually hopefully in our lifetime. But back to um Alzheimer's disease and we do have two well-designed correlation studies and and we spoke about those and the way that I see this and this is literally as a brain scientist which which is everything there is no primary outcome as you mentioned right >> if estrogen is going to help you get stronger bones that is a direct correlation to Alzheimer's disease uh better synaptic plasticity better neuron control um brain metabolism brain
(24:37) metabolism, >> sleep. Yes. And so if that's that's how I see it. I don't see it as okay, we can't just say take estrogen, don't do anything, and have better brain health outcomes. That's not what we're saying. >> Right. Right. >> And I think that when people people argue against it, saying we just don't have the data, >> but we do have the data that it does help. For example, hot flashes.
(24:57) >> Yeah. >> What is a hot flash? You know, it's when the hyperactivity of your hypothalamus just cannot control your core body temperature. you get this immediate rise in your core body temperature and it often happens at night waking you up and then what is happening when you're waking up at night you're not getting into deep sleep you're not getting into the glimpmphatic clearing system airgo building up amaloid and then that's just compounding years to come >> yeah I mean that's why podcasts like this are so important because women once
(25:25) you educate a woman for mechanisms of action and we take away like you and I aren't saying all women should Yeah right if you say all women should it takes away the understanding and the knowing of why >> and it's like we're going to give you all the data, you get to make the decision then >> and there and traditionally in the medical system we treat disease, right? I don't like that people pick on us for sick care because I'm like no, they interpret it as we want you to be sick.
(25:50) No, we just our job was treating disease. But as humans are living longer and knowing on that horrible Tuesday you got diagnosed it started 20 years ago which means prevention should start 20 years ago right I think the culture is changing to be like how about we try not to suffer how about we try not to find the cure once we have the disease but rather prevent the disease >> I think that's changing >> when people ask me what's driving aging I always say mitochondria they're the engines inside your cells and when they
(26:22) slow down everything slows down energy recovery cognition. That's why I use mito pure from timeline. I do so much to optimize my mitochondria from cold water immersion. I do heat therapy through sauners. I obviously exercise, but I also take supplements that specifically target mitochondrial health.
(26:45) And the one from MPure contains uraliththna. Uralithna helps your body recycle damaged mitochondria and produce energy more efficiently. What I feel is just the fact that a I'm recovering better from my workouts and b just steadier energy if that makes sense. But if you care about aging, especially brain aging, this is one of the most evidence-based tools available.
(27:08) And you can get 20% off at timeline.com/neuro. Even if you go on there, guys, and research what it is, you'll be mind blown. 20% off at timeline.com/neuro. I'm very interested in currently uh looking at the nasal microbiome because we have uh you know the alactory bulb plays a massive role in Alzheimer's disease and I've heard um Dr.
(27:33) Mary Cla actually say that she >> hold on seriously. >> Oh, didn't you know it's like one of the first places? >> Oh no. >> Oh no. I I have I have a nausemia. What is that? >> And no lack no sense of smell. >> Since when? >> Since childhood. >> Oh, okay. >> Am I fine? >> Is that a deviated septum? >> Okay. No, no idea.
(27:54) I probably fell off a bed. >> Okay. We have to get you in the lab and scan your brain. But let let me explain the the science. So the alactory nerve um it comes up and it actually uh goes and terminates into something called the alactory bulb. And the alactory bulb literally there are pathways from the alactory bulb straight into the hippocampus.
(28:13) which is why we're getting all of these uh studies now saying that um toxins in the air are a risk factor for Alzheimer's disease. Why? Because pathogens can go through here, go up into the alactory bulb and then parts of it can protrude into the hippocampus and deteriorate it. >> So now we're getting a lot of um science around, you know, get rid of the candles that smell nice, get rid of uh you know, spraying things on you, anything that can >> Sorry, perfume industry.
(28:40) >> Sorry, perfume industry. Yeah. So, I've eliminated all of that. And this is why um uh particle matter in the air is having an effect on your brain health because it's going up. It's actually the almost the same way that uh periodontal disease is a risk factor because you get periodontal disease and it goes up the vagus nerve and into the brain as well.
(28:58) So, it's a really fascinating area and we still don't know why one of the first areas to deteriorate is the alactory bulb. >> Fascinating. So, I wonder, this is my hypothesis, if putting estrogen cream in your nose would help the skin around that and if it's deteriorating because I know that if you put it in your ears that um Dr.
(29:20) Mary Cla said she has some of her patients putting estrogen in her estrogen cream in their ears because they get itchy ears. >> But that's more of I would think that was more of a skin thing. >> Yeah. >> But no, I don't know. Somebody just texted me this week that >> picking your nose is a risk factor for dementia. >> Picking your nose is a risk.
(29:35) Why? because of what I just said because the germs on your finger. Yeah, it was a actually it was a really well done study mice. It was done in >> Did they make the mice pick their nose? >> I think so. Well, >> we've got salmon sperm being able to be injected into the salmon sperm. Are are they pleasing the salmon sperm works? But um I think that this is opening up a whole new gate for Alzheimer's disease and brain health outcomes.
(29:59) >> Somebody was putting somebody messaged me this week that they're putting their vaginal estrogen on their gums. Is that safe? >> I I don't know. It's never I've never seen a study, but looking at it, does it help periodontal disease? >> I I swear in 10 years we're going to be brushing our teeth with like a flavored um a flavored estrogen.
(30:17) >> Yeah. Well, here's here's another interesting thing just kind of going on like the the people who say testosterone is only for libido, which irritates me to no end. opthalmologists. So the eye doctors are using testosterone in drops for dry eyes because we have testosterone receptors in our tear ducts in our eyelids, right? So I'm like hormones affect everything.
(30:39) Do we have estrogen receptors there? Probably. But because dry eyes goes up after menopause, but also that is it testosterone? Is it estrogen? But it's really funny to be like, "Oh, except for the opthalmologists know that this isn't just for libido because they have they're compounding testosterone drops for dry eyes.
(30:55) >> What is compounding?" Because um we got a lot of questions about uh compounding GLP1s. >> What What is compounding? >> So compounding is is it's legal. It's safe in America. Compounding simply means like bespoke. It's made for you. So let's say you come in and you can't swallow or you don't have any teeth, whatever.
(31:17) you you're not able to take what an FDA approved medication is. I can then compound it in a liquid form, in a chewable form, maybe an injectable form. So, I can I can have a pharmacy make something special to your needs. >> Okay? So, sometimes there isn't an FDA approved product, for example, female dose testosterone, right? Or maybe you need a really smaller dose or a much bigger dose of than what's commercially available that's FDA approved.
(31:45) So compoundingies have been around for a very long time. They're actually very highly regulated. So people are like, "Oh, it's dangerous and blah blah blah." Like they have their own regulation system in America. And I mean, I'm not involved in the business of compounding, but I'm a physician and everybody knows, "Oh, you can compound this that that.
(32:02) " So it's bespoke. It's what it's what the pharmacy world was before we had, you know, big business making everything very standardized. And there's safety and standardization, but we aren't all Toyotas. Sometimes we need smaller doses, liquids, chewables, injectables, blah blah blah blah blah.
(32:19) So with GLP1s, uh the compounding is cheaper, right? Because if it's a brand name FDA approved medication, it's very expensive. So sometimes people will compound for cost >> or I need a smaller dose >> or I want to try it orally. There's no orals available, right? So, but the again and I'm not an expert in any of this, but my understanding is the the pharma industry has vested interest in having people buy their product not compounded.
(32:46) So, there's been this big uh kind of I I would say scare about the safety of compounded medications. And we're like, if you got rid of compoundingies, you remove options for many people. Like, there's people who need medicine through a G ttube because they can't swallow or they've had esophageal cancer. They need their medications made a certain way.
(33:04) Don't hate on the compounding pharmacies. >> They're by by and large very very safe and and very useful. >> Yeah, that brings in the N of one studies, right? And you've probably seen, you know, um you've got you've got massive amounts of data for a certain let's just say we'll go to Alzheimer's disease for example, but there's always going to be one person that's not included in that that you will see in your office.
(33:31) And I try and explain that to so many people. And this is the difference between I think when you've got a strong PhD and then you've got a physician that's like but I see patients and I'm I'm both academic and clinician because I'm in neurosurgery and I'm like oh but his case wasn't found in the data. So like what do we do? >> And it's just amazing you know being able to attack something from from both angles.
(33:56) And that's why I love what I do because I can understand both. I'm like, "Yeah, there's no data on it, but I did see a patient with this." >> Yeah. Yeah. Totally. And I think, you know, especially on the internet, you start realizing I a lot of people don't understand like if something's associated or correlated or there's a signal.
(34:14) It does not mean all this causes this. Because people be like, "My grandma drank a pint of whiskey every day and never got dementia. My grandfather spoke until he was 100." >> Yes. Never exercised. And you're like, "Yes." But for every one of those there's a person who died at 48 because they smoked and because they drank alcohol and because Right.
(34:31) So but people will they'll poo poo something because of an N of one. That's not how science works, right? It's like we have to we have to include that. But also people think like they think very black and white like you must be on estrogen. It it makes people feel really bad. If they truly can't be on estrogen, does that mean I'm going to get Alzheimer's? No.
(34:51) There's so many other things you can do, right? You got to exercise. You got to sleep. Don't drink alcohol. Well, >> don't don't play contact sports. >> There's 15 modifiable risk factors in fact. >> So So I think people lose the forest for the trees when they get so and you see this in the supplement world like just just you just need this one thing for your mitochondria and you're like no mitochondria there's a lot of things involved.
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(36:03) So, if you want to try this, new customers get $20 off an order of two bags or more now through the 31st. That's kachava.com code neuro. Right now, I am very clear on the data between certain vaccines and dementia. We've just had two massive studies done both in Australia and in Wales to show that the shingles vaccine can decrease your risk of dementia by up to 50%.
(36:31) And the mechanism is anti-inflammatory. >> Well, the mechanism is this. So, shingles is the chickenpox. Okay. So, you get chickenpox almost. I never had it actually. So, you know, I don't know if that's great. Chickenpox never leaves your body. You have it and then what happens is it lays dormant in the nerves >> in the dorsal root ganglia. Okay.
(36:49) Of the spinal cord. >> Under extreme stress. doesn't have to be extreme, but under stressful or low immunity, >> it can reactivate these dormant little pathogens. And then what happens is they travel up the spinal cords and they go into certain parts of the brain depending where the nerve root is. And you'll see a dermatone pattern of where the nerve root is and that ends up being shingles.
(37:15) And a lot of people think that shingles is just a skin disease and it's itchy and it's crazy, but it's not. It's a spinal nerve disease because it goes up into your brain and that's where it starts to attack certain brain cells. >> Wild. And so this is adults. This is not this is not children with the chickenpox vaccine.
(37:33) This is adults with the shingles. Correct. Yes. And there's also um evidence for HSV1 herpes simplex virus one cold sore that um it does the exact same thing, exact same mechanism. >> Fascinating. >> So we've got you know enormous amounts of data on that. But when people hear the word vaccine, they turn straight to CO. >> They don't think about anything and then they think that you are out there to kill them and then it's pharma and you're sponsored by farmer and vaccines are bad.
(38:00) I don't know where vaccines got their bad rap. I'm I'm I'm thinking it's because of co because hello it became political. Yeah, it became political in the co era. There was always kind of the like fringy anti- for lack of better words people who were not provacine. But I think co made it political and it's so like the physicians it's so upsetting that your medical health became political >> because now you're like on team blue or team red and and it's like more about your alignment than like let's talk about your health.
(38:32) Let's talk about let's actually talk about the risks of not having vaccines. Let's talk about the risks of having vaccines. And again it's that black and white thinking of like if there's risks that means everybody's going to get the risk. No, that's not what risk means, right? It's very small amount. And the benefit of vaccines, I mean, I take care of people who've had polio. They're 78 years old.
(38:52) They are they're walking with the cane because the left leg Yeah. They're postpolio syndrome, right? And that generation had it. >> My, you know, big sadness is like, can you guys speak up, please? >> Yes. >> Can you speak up and let people know what your childhood was like? Because we and people will say this and we've become so successful >> that we don't remember these diseases.
(39:16) We don't remember measles. We don't remember polio. We don't remember these used to kill people, right? Make you make your children infertile, >> right? And again, it's that sadness of it's hard to educate in 90 secondond clips. Like social media is so toxic for this stuff, but podcasts people can actually be like, "Oh, okay.
(39:35) I hadn't thought about it that way. I hadn't thought that one vaccine might be different than another vaccine and you know risks and benefit like medicine is complicated bodies are complicated and what we used to know can change right you know I was talking last night with another surgeon we're like we were taught in med school 50% of what we know will be wrong we just don't know what that is right so for anybody to say they're so certain at this point a great book on that is blind spots by Marty McCary it's like every chapter is where
(40:03) medicine has been wrong. >> And it's very humbling to be like, let's not forget we've been wrong so many times that we might not be 100% right right now. And I think that's, you know, why when people they want absolutes. They want absolute reassurance and we're like can't give it to you, but we've got really strong signals saying this and we've got, you know, studies showing this and it's like we can tell you what we have and therefore why we think but this like >> this overconfidence of we know.
(40:31) >> Yeah. We can't know for sure. Healthcare has become political, but a woman in need is apolitical. >> Love that. >> And I don't like how we are bringing politics into our decision-m when it comes to healthcare. And it's quite scary. And >> of course, people are confused. I'm confused.
(40:53) And my entire life is made up of academic medicine. I I sift through enormous amounts of data. Right now, the uh meta analysis and systematic review we're doing has over 6,000 articles that we need to screen for. 6,000. It's it I know it's it's wild, right? >> But we need to go through the work. You've got to do the work. Okay. And so >> I'm I'm even confused.
(41:14) So I can imagine how you know an average female or male is confused because they get on in 2022 and they see RFK saying vaccines are good. He's vaccinated his children. And then skip forward to 2026 where he's saying, "Do not trust medical professionals. Doctors don't know what they're doing. You need to take your medical history and and your health into your own hands.
(41:35) " That is like getting on a plane and saying, "Do not trust the pilot. You must take the plane into your own hands." >> Yeah. >> Yeah. And I think what it's like everything doesn't happen in a vacuum, right? Like what has happened along with that or maybe to allow that is the fracturing of the doctor patient relationship.
(41:56) So back in the day you tended to have a doctor that lived in your town that was there. They lived in that town. They practiced in that town for 40 years. You were bonded. You trusted them. You went to them with your problems. And if somebody said don't trust your doctor, you'd be like that's ridiculous. Dr.
(42:10) Jones Yeah. Dr. Jones is taking care of my aunt and my mom and delivered my babies. like there was like a fighting for that that precious relationship. Doctors move jobs all the time now. They move towns. They have they have employers now. They're not self-employed. So, their employers change things. And so, it's like that doctor patient relationship has fractured.
(42:31) And I have to think that plays a part in people who aren't doctors abilities to say don't trust these people because you don't have a relationship with them, >> right? that relationship with like that trusted authority who you know has your back and you know has your best interest is gone. It's fractured at least in the American health care system now.
(42:50) People are you know people over and over and over they're like I I have a new primary care doctor again, a new primary care doctor again. It's like >> that relationship's gone. So it's easier to erode that relationship when people can't fight for the understanding of how precious it is. And you look at what's happening with AI and concierge medicine.
(43:09) Why are people going to concierge medicine? Why are people paying a ton of cash that their insurance doesn't cover for a concierge medicine person? Expertise and time and a relationship, >> right? And that will never go away. Like that is precious and it's worth something. And you can't get that in a 10-minute visit. No. >> So, when your visit's only 10 minutes with a brand new person and somebody says, "Don't trust that person.
(43:32) " And maybe you've you've watched you we're more bounded with people on the internet than we are with somebody we saw for 10 minutes. Right. So it's like the relationship because of the culture of medicine has allowed people to say things that >> maybe I don't know this person. >> Yeah. >> Right.
(43:50) But you know economics comes into play and I guess that's where it's political because if you can't afford to see a doctor for cash pay purposes and you have to go through insurance and you might only be able to see your doctor for 10 minutes. can be done in 10 minutes. >> That's true. Yeah, it's very good for like um a paper cut, >> maybe a sprained ankle.
(44:07) Like simple medical problems can be handled in 10 minutes, but complex what do you want to do to prevent future diseases, right? Certainly mental health issues, >> it's much easier and I get it like I I am on the doctor's side. I am one of them. I trained with them. >> But giving a medication is more simple than saying, "Let's get to know each other. Tell me about your past.
(44:29) What are your goals for the future? Like this stuff takes time. And the insurance companies are the reimbursers of the value of healthcare. The doctor doesn't decide what that's 10 minutes is worth. >> They don't decide what that's worth. The insurance companies decide what that's worth. >> And so you can't do that work in a 10minute period.
(44:49) And where doctors have been fooled is in us thinking we can. What better way to cut in right now than to tell you how important it is to start your year off right. And the start of a new year makes me want my home to feel calmer and more intentional. Not perfect, just supportive of how I actually live. So, I've been using Wayfair to do a bit of a reset.
(45:14) Simple things like upgrading my bedding, [clears throat] my storage, and refreshing a few spaces where clutter quietly builds up. What I love is that Wayfair really is a one-stop shop. From mattresses and towels to desks, shelves, kitchen essentials. And by the way, if you live in New York, Wayfair is a godscent.
(45:33) I was honestly surprised by how easy it was to find things that fit in my style and my budget. You can search by room, by vibe, by price, and suddenly getting organized or refreshing a space doesn't feel overwhelming. Your environment matters and especially if you're a bookworm like me, you want the best lighting and the best atmosphere to take all of it in.
(45:56) So, if you want to get organized, refreshed, and back on track this year for way less, then head to wayfair.com right now and shop all things home. That is wayfair.com. Wayfair every style for every home. When we have a case in neurosurgery, generally glyobblasto, which you know is incurable, and you have to have the conversation with the patient, the neurosurgeon has to have that awful conversation saying like, uh, it's inoperable or maybe we can, but we can only probably get 40 or 50% of the tumor and that's most likely going to grow
(46:31) back and you've got x amount of years and like how do you sit in 10 minutes and tell somebody, I get your affairs in order and we'll do what we can. And so it's a it's a lengthy process that is only really offered to unfortunately e economy e economics does play a role here and that's sad and scary and I don't like that.
(46:49) No >> but this is why I do the podcast to try and give this free education but albeit >> just watching something is very hard because you still don't know about yourself. >> Yeah. And you always say individual results may vary right because people will be like well I see this a lot for social media.
(47:06) What's the best lab value for X, Y, and Z? What's the right do what's the right dose of X, Y, and Z? And it's like, dude, we didn't come out of a Toyota factory. And people are like, what do you mean by that? And I'm like, you're not the same as that person. Like, we're all human beings. >> That's actually the last part that I want to talk about.
(47:21) So, we're seeing this >> rise of people getting blood work cuz now before 20 years ago, you'd have to go to your doctor and you'd get, you know, your metabolic panel and that's it. >> And maybe Yeah. And maybe you'd only get what your insurance covers. >> Yeah. Right. Cholesterol. to just give you total LDL HDL. That's it.
(47:35) Now we've got everything. We've got LP little A, we've got APOB, LDLC. And so we're becoming more educated on blood work. And now anyone can order their blood work. You can just go on and click and you sign up and maybe it's $500. >> Well, and and now it's getting where they'll just ship it to your house. They're doing these amazing like needleless arm.
(47:54) >> I don't like that. You and I did it together. >> Yeah. Yeah. I'll tell you why. Because I got mine. When we did it together, it came back. My LDL said 180. Never in my life. And I'm I'm, you know, I'm very proactive. I've never seen my LDL at 180 and my APOB at like 150. I said, "Oh my god, I'm dying.
(48:17) " So I went and did my blood work two weeks later. What can change in two weeks? Okay. My LDL was actually 90. Apo B was actually 80. >> Yeah. >> Why is that? So, >> yeah, we're in our infancy with the with the not having to go to Quest Labs to get your blood drawn. But, yeah, I agree. I uh I had a shocking cholesterol reading on that as well.
(48:39) And I do need to repeat that in a traditional lab. >> But, um the reason why I bring this up is because a lot of people are getting their own labs and they're trying to interpret it themselves. And I always say with blood work, I've been saying this for years, anyone can take your blood. A phabotamist, it takes two days to train as a phabotamist.
(48:53) They just take your blood. It's who is interpreting your blood work. And a lot of a lot of physicians don't even know really how to go deep into the weeds of blood work. Like if one thing is high, if your Billy Rubin is high, what does that mean? If you know, I've I've heard so many people respond to creatine. Oh, my doctor said I can't take creatine because my creatinine is high.
(49:13) It's like that's not the measure of your kidney function. And it's not the only measure of your kidney function. And there's so many things to take into play. And I think that that's going to be the next rise. Like who is going to interpret your blood work? And I think it's gonna be a combo of expert physicians and AI.
(49:30) >> Yeah, >> AI is coming. AIology is not even deep into the new, you know, Yeah. >> Yeah. >> AI as in like you put in your entire background like age. >> People are doing it right now. They they type it all into CHAGTP. I know. Well, no, we're we're in our infancy, right? But it's accumulating data.
(49:50) I you know somebody told me 80% of CHAGTP entries are health related questions like it's massive. Well, that's scary because >> because it's because it makes I mean CHGP can hallucinate, >> right? Like it can tell you incorrect things, >> but it's a place to start, >> I guess, >> for a lot of people. And and it does amazing things if you're like, "Hey, I need a get a meal plan for me that doesn't include onions and is 120 grams of protein a day.
(50:18) " Like, it'll start creating ideas for you to so you have a place to start from. So, it's it can be very useful for health things. >> What's your mission? What are you doing? >> Education. Education and empowerment in the fight for equality and healthcare for women. >> I love that. And how are you doing that? >> Talking. Being fancy on stage.
(50:37) >> Yeah. >> Having a crazy hair so people look at me. >> What did >> using humor to educate adults? >> Tell everyone what Jane Fonda said. >> Oh, so that where we were this weekend, we we did I did a panel with Lzanne Falsetto who is very high up and very amazing in YPO. um Vonda Wright and Jane Fonda and we had this amazing four-person panel.
(50:57) It was an hourong panel and if you don't keep people entertained like you're going to lose them in an hourong panel, right? So, we understood the assignment and uh like we were I was taking off my shoes. Jane was we were talking about brands. We like it was so fabulous. And in the middle of it, I don't remember how it came up.
(51:12) I think I was talking about sex. Jane Fonda is like, "Your hair looks like it had an orgasm." >> [gasps and laughter] >> And then I was I was immediately like please tell me this is being recorded like I need this for social media. >> She is um a wonderful example of why exercise is medicine.
(51:31) She's 88 years old for those people who don't know and we just you know spent the weekend listening to her on stage and her all I was thinking about was her brain the whole time. Everyone was probably like marveling at how I was like her brain is switched on. Albeit halfway through giving her analogies and scenarios, she did ask what the question was and I was like, she's 88.
(51:47) >> I do that, too. >> Yeah. I mean, she's phenomenal. Her cognitive performance was on fire. And she's funny. >> Yeah. I was just like, first of all, this woman is living forever, >> right? Like it's incredible. Like >> the 70s, the 80s. She she talks about eras because she's lived through all of them, right? and her analysis of how women's rights and health are being taken away by the rules of other people who don't get pregnant, right? Like her analysis on that of like watch what's happening. Pay attention. This is worth
(52:19) fighting for, right? and like her analysis of all these movements that have happened. It's like the wisdom and the knowledge and the like understanding of how America is changing over time is like it's the whole respect your elders, right? Because people, you know, the 45 year olds and the 50-y olds like ah getting old's awful.
(52:40) What's the point of menopause? Blah blah blah blah. And it's like you get to become the wise old elder who has seen and who knows and who's had experience. And the other really awesome thing that I I took away from Jane Fonda this weekend is like there's a level of what you've lived through enough stuff, you don't take everything as seriously anymore. Yeah.
(52:59) >> Like there's a level of like you don't give a f. Yeah. Right. And it's it it looks so freeing on a person. It's got to feel so freeing. I know I'm experiencing that as I'm getting older. You know, you and I famously broke the internet in the middle of 2025. And like I think even three years ago, I would have been like, "Oh my gosh, I upset some people by saying something and blah blah blah.
(53:22) " And now I'm like, "Whatever, it'll blow. It'll blow over." I did it for a reason. I wanted to make people pay attention and listen to what their brain health is doing. It's like you give less f. >> And that was interesting because you were like my therapist during those two weeks and you're like, "Hey, who cares?" I was like, "Oh no, look what happened.
(53:36) Oh no, I'm hoping I'll get to your stage very soon." >> It happens time and repetition. And like and I think the other thing is like if you do it right as you get older, your core knowing of who you are and why you're here and what you're meant to do, it becomes a solid metal rod >> and it's not this weak elastic thing that like somebody's opinion is going to change. Yeah.
(53:58) >> Right. And the more you get solid on that core, the more you're like, >> I know what my mission is. I know that this was not a big deal and will not disrupt the mission. Right? like don't don't do something so disruptive that it will disrupt the mission, but like saying something on an on an Instagram post to make people think and to get some people pissed off is like they're paying attention. They we good.
(54:18) We should be talking about brain health. Yeah, we should understand how our brain changes with age, right? Like I understand the mission, but it's like and you get to a point where you know so much that you know the people hating on you know less than you. >> Yes. and and you know the people who know more than you and they would never do that to you.
(54:36) >> Isn't that interesting? I feel like you only get um you only get hate by people who are either there to attack you because they feel inferior to you and they feel like they need to prove something to bring you down. And it's actually it's really upsetting to see that it's women against women and I can't understand that.
(54:54) >> Yeah. Yeah. It's wild, right? Well, I think culturally for so long there was one seat at the table for a woman. >> And so culturally we were trained there's one seat. You you got to fight for it, right? And I think our generation knows no no we will we will bring the whole table. We will do our thing. We will create our business.
(55:12) We will do our podcast. We will do our our events, right? Like there isn't one seat anymore. So when so in thinking about it that way, I have compassion. >> Like oh you were trained to hate. You were trained to think that this was scarcity mindset land. This is actually abundance mindset land, right? And I'm not going to play with that.
(55:32) >> Well, I have to say it's such an honor to have you here again. Um, you and Vonda are like uh your mentors to me and I'm just I'm so grateful for you. I mentioned uh to you in the car ride home last night. I said I feel like I'm getting just another PhD just by being around you two. So, I'm I hope it um continues to grow our relationship and I'm I'm with you every step of the way.
(55:54) >> I'm with you, too. >> Thank you, my friend. >> Thank you.
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