Shownotes Transcript
Welcome back to the Health Longevity Secrets show with your host, Dr. Robert Lufkin. His book titled Lies I Taught in Medical School is a New York Times bestseller. See the show notes for a link to download a free chapter. And now please enjoy this week's episode as we look at all things menopause while going menopausal with Amy Alkin.
Amy Alcon's eight-year scientific deep dive into menopause began with a hot flash that felt like being locked in a trunk in the Everglades. What followed was a shocking discovery of the vast gap between medical practice and scientific evidence in women's health care.
As a self-described "science mole rat" without medical training but with rigorous research skills, Amy uncovered critical distinctions between perimenopause and menopause that most doctors overlook. Through compelling personal anecdotes and accessible explanations of complex hormonal processes, Amy reveals how medical institutions are failing women during this transition.
Her frustrating battle to obtain proper medication, that is oral micronized progesterone rather than synthetic alternatives with potentially powerful side effects, highlights how women must often become their own health advocates. The book is called Going Menopausal, what you and your doctor need to know about the real science of menopause and perimenopause. And the book is being published as of today.
It equips readers with the scientific understanding and practical tools to navigate a medical system that often gaslights women. You can download a free chapter at amyalcon.com and discover how evidence-based approaches can transform your experience of menopause from a medical mystery into an empowered new chapter of life.
Before we start the episode, I'm also excited to share the incredible news that Dr. Casey Means has been nominated to be the next U.S. Surgeon General. She is a brilliant physician, a compassionate leader, and a dear friend. I think her vision for a healthier future makes her uniquely suited for this role. Congratulations, Casey. Our nation will be in your capable hands.
This episode is brought to you by El Nutra, maker of the ProLong Fasting Mimicking Diet. If you'd like to try it, use the link in the show notes for 20% off. What's the best imaging test to assess health and longevity? I used to think it was the CT coronary artery calcium score. Well, I don't anymore because now with the same x-ray exposure and time as a calcium score, I can get a complete metabolic heart scan.
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This scan is available anywhere in the U.S. without a doctor's prescription. See the attached link and use the code LufkinCT for $100 off. Join the health longevity medical imaging revolution today. And now, please enjoy this week's episode.
recording in progress great hey amy welcome to the program thanks for having me i'm so excited to have you here fresh off the joe rogan podcast and other programs as well um
But today, your book with a brilliant title, Going Menopostal, what you and your doctor need to know about the real science of menopause and perimenopause goes on sale today.
at Amazon, all independent bookstores, Barnes & Noble, everywhere. So go out and get it. It's a great book. And that's what we're going to talk about. I'm so, so excited. So before we dive in, well, just start off, tell us a little bit about your background and maybe, you know, what inspired you to write this book?
Well, I have an accidental career. I thought I would write movies and TV. And then I'm from Michigan. And I asked my parents to send me to grad school for film, which they thought was hilarious. Wait, we're going to pay for you to listen to and watch movies. And so I worked in advertising at a big ad agency and I, these two friends, we were mad cap and we did all these pranks and things. And so we had this idea like Lucy from peanuts, the advice, five cents stand, um,
that we would do that on the street corner in New York in our fancy black clothes and hats and everything, basically to be a visual joke. And then, you know, for us, it was free advice because we thought, you know, no one's even going to give us a nickel. So free advice from the advice ladies. And we set up on West Broadway in Broome in Soho just to do this for one day and have people walk by and laugh, make people laugh good.
Well, New York, the sign said free people lined up around the block. And then we kept doing this because it was really satisfying. And I realized this is sort of awful because people would sometimes ask us not the silly stuff on our sign, like wigs and beards and proper spelling, things like that. But ask us about a relationship breakup or something like that. So
Feeling irresponsible, I read through all of psychology and I was just shocked. Freud just made stuff up. And I discovered Albert Ellis, who is the founder of one branch of cognitive behavioral therapy. He was very rationally focused with his therapy. I think it's better than the general CBT therapy.
And so anyway, the three of us are on the corner doing this just for fun. And there's a New York Times story about us. And I run with this. I get us a TV deal with De Niro and a book deal and a column in the New York Daily News. And then one of my partners tragically had a drug problem. We broke up. I was doing the column. I syndicated the column to papers.
around the country. And during this time, I just worked increasingly to become more versed in scientific research and also how to assess, critically assess scientific research because it's easy to be fooled by papers or you see these big medical statistics in the news from pharmaceutical companies like 50% of the people had their lost leg reattached because they took this drug.
And those are usually overblown. They're called relative risk statistics, where it's comparing one group to another. You don't actually get that kind of, you know, the 50% is not true. So...
I did this and I met this guy in 2007 who is one of the top biostatisticians and epidemiologists in the world. He's very generous. And so since that time, he has informally coached me on how to read and assess medical research to be a real skeptic, but not just skeptic for skeptic's sake where you find everything wrong.
You know, everything's wrong. You need to be truthful about all of it. And so he also clued me into the horrible abuse and errors and fraud in medicine. And so for years and years sent me these articles. So.
Flash forward to 2016, I think it was. I'm sitting here. I'm in Venice, California. This is the most temperate place in the world. It's like 55 year round. You know, it was a summer breezy and all of a sudden locked in a trunk in the Everglades. That's how my body feels. And I thought, I think that was a hot flash. And so what you want to do in that situation is go to your doctor and say, I'm really uncomfortable. What should I do?
But I know that medicine is really not evidence-based. In the U.S. Academy of Medicine, the National Academy of Medicine in 2011, they estimated that more than half of our medical care is not based in solid evidence.
And I think it's much more now because of the growing complexity in medicine. So I did what I do, which is I dove in like the science mole rat I am into just an enormous amount of research. And I was really horrified to find this huge gap between the medical practice standards for menopause and perimenopause and what the science said.
And this is the science when you're looking at, as I do, I'm an outsider. I didn't go to medical school. I've driven past medical schools, but that's about it. And so I don't have any foundational beliefs. I check everything. I look at the physiology. I had endocrinology textbooks pasted all over my walls while I was writing this book to make sure I'm understanding everything in a transdisciplinary and deep manner, which is the way this is how modern science should be done. And it's not.
And so I look at all of this and I see what I need. I'm then in perimenopause. This is the transition phase to menopause, like three to 10 year transition phase before you're in menopause. And now doctors see this as menopause, like perimenopause, but it is not.
It is a unique stage with unique hormone profile. And I had discovered the work of this amazing endocrinologist, Gerilyn Pryor, this fierce fighter for science. And this comes from her work where she is looking to have perimenopause understood as a unique hormone.
hormonal, you know, hormonally different time it is for all the differences between that and menopause. And then also to have oral micronized progesterone, to have progesterone B, that's the drug form, FDA approved drug form, but to have progesterone, the second hormone of the menstrual cycle, you know, working with as a partner with estrogen to have that recognized and also used because it's a very effective treatment for perimenopause, unbeknownst to doctors.
And so this is what I realized I needed, not estrogen, because what happens in perimenopause, while doctors think it's just menopause light with your estrogen declining, but
It is on decline, but what happens is it spikes and dives horribly in some women. I was one of them where you have horrible side effects from you're in, you have these inexplicable rages. I like people I'm really friendly. And, you know, I would go places like be in line at the hardware store and literally want to murder the man behind me. Some nice old man. He's humming. My dad hummed.
I mean, normally I'd think, oh, he's nice. He's humming. I wonder what he's singing. I wanted to kill him. And this was not me. But you don't recognize there's so many things that go wrong with you. All these mysterious symptoms, the hot flashes, the mental health issues. I got very nauseated. I got carsick again, terribly so in my 40s. I mean, all of this is so crazy. And so realizing I need oral micronized progesterone to fill in for the progesterone I'm not getting.
in perimenopause, to feel good again, to sleep again. Sleep is one of the major side effects, not sleeping rather, where before this time, I would go to bed. It was like someone hit me with a large frying pan. I would go to bed. I'd wake up at six in the morning. And you could have dropped nuclear warheads in my front yard. I wouldn't know. Just placid, peaceful sleep.
And I started to wake up five or six times a night. And this has horrible effects, brain fog. And then also there's the glymphatic system. This is like the janitor of the brain. You have your brain is too big during the day to swollen in your head to have cleaning go on. But at night, if you get adequate sleep, healthy sleep,
It shrinks. And so cerebral spinal fluid can wash through and clear out all the Taco Bell wrappers and other things you have in the backseat of your head. And but that wasn't happening. So you have this neural trash accumulated. You're not sleeping. I couldn't do my work. I would write one sentence and rewrite it 43 times. And then I go back to the original. This is so terrible.
So, flash forward to asking my doctor. I have a gynecologist. He's wonderful. He's really terrific. And at first I was angry at him. I asked him for the progesterone prescription and he sent me something saying, read this HealthWise newsletter on menopause. And I thought,
you just saw me. I'm not in menopause. Menopause is 12 months without a period. And I just had a period when I saw him. So that would have been like two months before. So I thought, why are you saying this? And I was angry because I was already seeing how medicine was not serving women according to science. Um,
Um, but anyway, he is, he's terrific. And he actually prescribed me what I needed. I asked him for Prometrium, which is the brand drug for oral micronized progesterone. This is the same as the progesterone in your body. However,
Kaiser Permanente, I don't know if they still do, had on their formulary medroxyprogesterone acetate, not the healthy FDA approved progesterone. The progesterone, this is a knockoff, a synthetic knockoff of progesterone that has terrible effects
It has adverse effects on your cardiovascular system, your brain and your breasts. It can increase your risk of breast cancer. Hi. No, thank you. You know, progesterone was a little, it was more than it's come to the prices come down. It's not much more now. And there's no reason why, you know, I shouldn't have been given the progesterone, but I get to Kaiser and, um, I, it ends up not being covered, you know, and I
I'm also not getting the amount I need. And so I have to fight these battles with Kaiser. And it was with my gynecologist and his boss. And they actually listened to me. I threw all the science at them. I'm very irritating. And they eventually, after I had three battles with one with a panel of experts who had no expertise in menopause whatsoever and just denied everything, even though they'd heard the science, they covered the progesterone in the amount I need
and gave me the amount I need. And so that was very important because they don't give you enough progesterone in this country. They give you 100 or 200 milligrams and you need 300 milligrams a night to be protected.
to have your, this is to protect the uterine lining, the endometrium from estrogen induced overgrowth. And also progesterone is very important because in your breasts, it keeps the cells from going delinquent. So you have these immature cells, there are generic cells and what progesterone does, it differentiates the cells and forces them to mature into breast cells. So they're not just these delinquents with no job that can double and become breast cancer.
So all of this, you know, this is what every woman should get in perimenopause. Women tend not to need estrogen. Some women can take it. But because your estrogen is spiking, going to extraordinarily high heights in some of us, if you just take more estrogen, which doctors prescribe you because they don't know the hormonal profile of menopause, as identified by this endocrinologist, Gerilyn Pryor,
They don't know that they're spiking and diving estrogen and that you tend to be deficient in progesterone. So they overdose you on the thing that's already making you sick. Or they also, the other thing that happens is doctors really don't know anything about perimenopause.
So they don't diagnose you at all. And women go, you know, uncertainty is so disturbing to us. Women go trying to figure out what disease they might have and maybe take medicine for fibromyalgia or get some diagnosis that has nothing to do with what they're going through. And they cause themselves medical harm. It's really caused by the medical system not treating perimenopause and menopause in an evidence-based way.
So, so yeah, what, that's great. I mean, what, what you're doing really is, is coming at this with, with, with not a medical degree. And it's actually an advantage in some cases that it's part of the long tradition of the citizen scientist where you approach your problem without preconceived notions, perhaps. And then out of personal interest, whether it's, you
you know menopause or chronic disease that you know many of us develop it suddenly becomes really important for us to learn about it and and now with the internet and ai and you know there's ways to get information uh that is really accessible to motivated individuals who want to do this and you know it's it's really hard for doctors to keep up with a a motivated individual who who
knows more about that disease in their own personal experience than any doctor will know. And there are different strengths, but it's, it's, it's,
It's great that you're doing it, and I think it's so powerful to have these fresh approaches to disease. I also love, not only your previous books that you've written, which are delightful and fun, in this book, too, you really blend neuroscience and behavioral science with humor, as we've seen. And so why is that so important in this particular topic? Oh, yeah.
This is terrifying. All this was terrifying for me because I needed to not get anything wrong. And so I really checked this and sent it out and sent it to researchers and said, hand me my ass. But this subject, you cannot read this without having some kind of vacation. And also, I'm talking really in this book, I have this expertise from reading all this research and also being transdisciplinary, which is really vital for
The body is a system, it's interconnected. And so my knowing cognitive neuroscience and the brain is really, really important for understanding some of the science on perimenopause and menopause. You know, from the hypothalamus, which is the basically looks around the body and says, okay, you're hot, you're cold, you're hungry, sends a message to the pituitary. The pituitary sends out a message. These are in the forms of hormones, right?
And so, and then it sends out a message, Hey, get going on this, you know, and, and so this helps you stay in healthy and functional form and understanding that you can understand when things malfunction. And without that kind of knowledge, um, which is hard in medicine, cause it's so complex now, you know, where if you have an eye surgeon, I had, I had an eye surgery, my eye surgeon needs to be, um, an
expert in that. And really, she's sticking an X-Acto in her eye, basically. You really want her studying how the X-Acto goes in your eye and all this stuff around that. But to expect those doctors to be experts in the steroids they prescribe, they can't be. They aren't.
But these medical institutions, they don't have an expert telling them, all these doctors, look, here's how steroids work and this is how you prescribe them and you don't. The idea that my eye surgeon had, and it really harmed me. I'm still recovering from this. It's called adrenal insufficiency syndrome.
because she gave me so much in the way of steroids as a metabolically healthy person, totally suppressed my immune system and my ability to heal. But so she thinks that the field standard of giving you four corticosteroid eye drops to keep your transplant in your eye, this one cell layer, the endothelium,
transplanted from somebody else. And it's like the plumber of your eye. So you need to retain that. And, but for, if four drops is a clinical habit based on, not based on science, but just based on this is what we do. Nobody compares. How about this drop this level? There's very little of that. What if you give two and this kind of drop,
you know, it's just not really research, which is disturbing, but she thinks, okay, four is good, eight is better. Well, steroids don't work that way. And you need to look at patients as individuals, right?
For a metabolically healthy patient like me with low inflammation, you suppress any kind of healthy inflammation I have that I need to heal to power my little mitochondria, to little energy furnaces, to simplistically put it, to get my ATPase, sodium, potassium pumps working in my eyes so the transplant begins to do its job.
And she just doesn't know that and really can't be expected to. So I see the institutions and the medical institutions as being at fault here. I don't bash doctors because I understand the problems of medicine. And I detail three myths that we believe. This is the problem. We don't want to believe this. It's so horrible to understand why.
The level of evidence behind the medicine we do get, which is often...
There isn't good evidence. And it's just hearsay and myth. And, you know, we do this because we do this. And so the three myths are that doctors use, they know how to read medical research, and they use that to determine your care, and they're able to critically assess it. Doctors are not trained in medical school to read research.
They don't know how to critically evaluate it. And this is just not part of medical education. And this is a moral failing on the part of medical schools. This risk scientist, Gerd
Gagarinzer says, and I agree with him. And then the other problems are doctors are not trained in diagnostic reasoning. That's the doctor house thing, figuring out what you have. And so doctors will often make what I call from Randy, this is actually Randy Nessie, the psychiatrist and founder of Evolutionary Medicine,
he calls it the viewing symptoms as disorders error. So doctor, you'll come in with a symptom and the doctor will treat the symptom. Well, you need to look and see what is the underlying cause because, okay, if you've headaches, maybe you're distressed, but maybe you have a brain tumor and that headache is an important signal and you don't want to just quash it. Then you're not bothered anymore. You're not bothered into the grave. That's not good.
And then the final one is that doctors do not know how to properly assess risk. What is my risk that if I take this drug, how likely am I to get breast cancer or other problems? And they are unable to correctly tell you.
And this is not a hard thing to teach. Gagarin's are teachers that it's called natural frequencies. You don't have to be a math genius, but we don't deal well as humans. We didn't evolve with percentages, but what we can do is on a sheet of paper, draw a hundred people, color in two. Those two are going to die. Then let's see, what's your individual, what are your health metrics? Okay. Maybe if it's you, like they're going to be like four people colored in.
So, and you can show that to a patient and they completely understand what the risk is. And where doctors, the percentages, they are, I think it's like 12% in one area were able to calculate risk properly. This is really bad. I would think oncologists would be the best. So if you need to know what your breast cancer risk is, see if you can get assigned to an oncologist to ask because they need to do this for the patient. So there's a better chance that they'll be actually accomplished at it and okay at it.
Yeah, that's a great point. And as a participant in the medical establishment, as a professor at medical schools, and still am the last time I checked, at least, I would agree with those shortcomings of the medical profession, although a cynic might look at it and say that
Given that, you know, the medical profession increasingly is medical education is funded by the pharmaceutical industry and the big food industry, largely through various ways that maybe, you
Doctors not being able to critically read literature or understand risk can be better manipulated by forces there. I mean, that's a cynical view. And it's not what we should accept, of course. But those are really important points. I mean, yeah.
So you've been in your social media and in this book, you've been outspoken about medical gaslighting of women. How does that play out with menopausal care and perimenopausal care?
Well, I would say that, you know, basically that women are, they are, they go to their doctor with symptoms and the doctor will often not have any idea because the doctors, I should backtrack a little bit. The big secret, the scandal that I expose about gynecology departments in the U.S. and probably other places too, is that there are almost no doctors who have ever
any experience or training in treating menopause. Now, maybe you get, you tell me how many days do you get like a page in your medical textbook or maybe two pages on menopause and perimenopause, but they're not getting, you know, like a residency with some mean taskmaster, you know, um, a doctor, you know, to, to apprentice with, um, they're not getting, uh, you know, any kind of, um,
They're not reading the science. They can't. So there are all these doctors who basically go by what are called practice standards. And these are guidelines for treatments. You can look up how much this drug do I give this woman? But they aren't able to identify the actual symptoms of perimenopause.
You know, so many doctors just dismiss women. The women come in, they feel terrible. And they're the it's what's going on with them is not identified. And this is terrifying. You've all these things. You're mysteriously unwell in the middle of your 40s. You feel like, is this it? I'd like, you know, 43 good years. And now it's just I'm in the dumpster. You know, everything is wrong. You know, I feel sick. I'm starving. Oh, that was the other thing.
Starving, unquenchable hunger. I was insatiably hungry. This is part of one of the symptoms of perimenopause. And progesterone really helped me. Now, some women need to take it cyclically. I took it every day because I was so sick.
And the reason that you need progesterone is this. So in your normal menstrual cycle, you ovulate in the middle. There are two parts, the estrogen part at the top and the bottom part is the progesterone part. I just identified them that way because it's easier. I write to be understood and I speak to be understood. You don't need all the medical terminology. So you see like, aren't I smart? I read a book.
um anyway so what happens is um ovulation the egg rupturing the sac rupturing that the the follicle that the egg is in rupturing in the ovary and being the egg being released and then the fallopian tubes they look like little hands come grab the egg and send it off to the uterus to see if it meets any sperm um anyway in um perimenopause
you're often weakly ovulatory or the egg sac doesn't rupture at all.
So this is a problem because when that egg sac ruptures, there's litter left behind. It's called the corpus luteum. It's this yellow waxy stuff. And that is what progesterone is made out of. And you need enough of that for enough days that you aren't sick and at risk because progesterone protects your bones, your heart. It is an estrogen partner in all of this.
But too much estrogen and no progesterone is a recipe for hell, especially if you're like me and your estrogen really just skyrockets. I was so sick.
And so there are ways to determine whether you're ovulating. And I have this in the book, it's called quantitative basal temperature taking. And this, you take your first morning temperature. This is not for figuring out fertility. That's a whole other ball of problematic wax that I cover in the book. But you do this and what you do is to look for, you know, whether what your temperature is to tell you whether or not you're ovulating.
You can see that. I don't want to go into all the complexities here. And this also comes from Gerilyn Pryor. She developed this based on the Swiss scientist work. And this is so important because you can go to your doctor. The book is designed so you as a woman understand the science. I explain it all in clear, everyday language.
So you can bring the science to your doctor because you can't expect medicine to reform. You need care now. Like, oh, I'll wait for medical schools to fix themselves. Yeah, that's not going to happen in enough time. So you can bring the science to your doctor. But, you know, hey, can I have this drug? No.
But what you need are fail safes. And that's why this quantitative basal temperature taking is so important. It's medically valid. It's data you collect from your body. You need the nine 99 temperature taking the digital temperature, digital thermometer from the drug store. And you just take your temperature every day and you write it down. And ideally you take it for more than one month. And the thing is normal periods, normal growth, smelly. I know I'm not supposed to say that, but, um, normal periods, um,
they seem no different from periods where you don't ovulate. So you wouldn't know otherwise. And so if you say to your doctor, look, here are my data. I'm not ovulating and this is very unhealthy. And here are all the things that causes. And the secret fail safe is that
you know, insomnia. So we need sleep. You can die without sleep, you know? And so basically that's what I said to get the amount of the drug of progesterone I needed to say, look, you know, I know you only let me have 200 and not the 300 they take in France that protects the endometrium, the uterine lining.
you know, sufficiently because we don't know how much, what our metabolism is. So you want to take a little more. It's not a, it's not a dangerous drug. So I need my sleep. You're not going to take my sleep away from me, are you? And so that's really persuasive. A doctor denying you sleep, you've got a pretty good case there because you can show with the stuff from the
QBT, the temperature taking look, here's what I have. This is scientifically valid. It's all there, you know, in simple terms. And so that's a way to be able to get your doctor to not just, you know, stand their ground and,
which some will do. And to also to not be antagonistic, because if you go to your doctor, and you're angry at them, which is understandable in many cases, for not giving you care, you know, that that angry position is going to get them to be reactive and angry and feel disrespected. And they're just going to shut you down no matter how righteous your your claim is.
Yeah, it's such a great point. And there's a whole bunch in the book, advice for women to advocate for themselves in the healthcare system that really often ignores them or sidelines them. So it's great information there. And you talk about reclaiming agency. So how can menopause become a turning point for strength rather than decline in a woman's life?
Oh, first of all, it's so it's so exciting, because now since we can be healthier, you know, you cover a lot of this in your work about how to eat. So if you just take these lifestyle, you know, maneuvers that that medical that medical institutions should be advising us. But like you said, I mean, there's so much money and feeding people and it's disgusting, the diabetics pudding. I
I just saw a friend's mother in the hospital. She had more sugar in her breakfast than I eat in a year. This terribly diabetic woman, you know, it's so terrible. But if you take these steps, they're actually two. One is to, to eat a low inflammatory, um, low carbohydrate diet. I eat carnivore now. Um, I have never been healthier. I feel so good. Um, I'm 61 years old and I tell everyone my age all the time because I don't buy into the stigma. This is part of the stuff I say at the end of the book. Um,
because all this fabulous, you know, okay, my eyes don't work like they used to, you know, and there are other things, your health is not as robust, your immune system isn't, but I'm a much wiser, much better person. Women become more confident, I find in general at around 50, where you were timid, and you know, maybe not everybody's like that, but where you were a little afraid to speak your mind or stand up,
At 50, something happens for a lot of women. I love seeing this. And so now being 60, you know, you really lose that and you begin mentoring younger women just in the course of your life. I find that I see other women doing that. And then the thing is, if you are living vitally, if you're healthy,
you can have a whole other career. So women who have kids, they go on and do something, you know, they're doing stuff, what they really wanted to do. Maybe, you know, while they were having kids, like my friend Debbie Levin, she sold Kellan cartoons to the Alt Weeklys and represented animators. And now she's this incredible, incredible ceramic artist. All these designers want her work.
You know, she sells her work all over the place. It's very sought after. And, and she just started doing this. This was, this was like the third act of,
You can have a third act and a fourth act and do charitable work, move to Lisbon or whatever it is. And this is important to see. It's important to identify this time as a wonderful time that the world is your oyster. You know, we need money and these, you know, the fundamentals of life to get by. But, you know, there are ways to manage these things and to, you
see what you're going to do that you've limited time. This is how I saw it. This book, because this is a big sacrifice to write. It took me eight years going menopausal. It took me eight years to write. It was horrible because you have such a responsibility to get it right and to really understand things. And then another big responsibility was to not do what I call amazeball science. When people, everything's just this most amazing claim
Those are things you need to suspect. Maybe they're not, maybe they're valid, but often they're not. And so, you know, in my chapter on breast cancer, believe me, I was desperate to say, okay, here's the conclusion. But what I did was I said, I'm really sorry. I don't have a conclusion for you in terms of, you know, risk and what's safe and what's not safe because there's, there's so much it's called heterogeneity in the research world.
They tested this group of women on this and this group on that and wrong amounts of time and, you know, like not long enough. And it's just a mess. And so what I did at the end of that chapter is say, you know, I can't.
give you this, but here's my assessment for myself, which doesn't mean you should do what I do because you're not me. You don't have my individual health metrics, but there's a risk of breast cancer in my family. But what I wrote about in the book, this really stark thing is that right now, one in five women die of heart disease.
And soon it will be one in three. So if you get breast cancer, thankfully they're curing a great deal of it now. You know, 90% of the women diagnosed with breast cancer today will, will survive it. Now you don't want breast cancer. It's horrible. But you know, so, but if you get breast cancer, you're likely to die of heart disease.
And so heart disease just ruins you in every way. And, you know, you can get mammograms and there are problems, false positives, there are all sorts of problems, you know, but, but that was where I put my own assessment as far as what I'll do.
you know, not having, I list some of the things I don't have a propensity for gallbladder disease or other things. And that's why I made this calculation. So, so one of the things I do throughout the book is to show women, you know, the, how these calculations are made, you know, there are trade-offs and things. What's the trade-off? How do you make that a reason decision that's safe and
you know, and best for your health because you need to make these women need to make these decisions for themselves, you know, because when a doctor doesn't know the science at all and can't assess risk, I mean, it's really terrible that we're left with this, but we are right now. And these things can be understood, you know,
You know, if they're just explained and not explained in some kind of medical high church of medical language, if they're just explained in common terms. And that's what I do. It's very important to do that. Yeah, you're great at explaining things and the humor makes it enjoyable as well.
I love what you said about the, um, the second and third and fourth act. It sort of resonates within, in longevity space. People talk about their first 60 years and, and then their second 60 years they get with, you know, uh, lifestyle and, you know, uh,
a lot of luck. And then the third 60 years is with partial epigenetic reprogramming and, you know, aspirationally, at least we'll, we'll see what happens. So, so what, what would you say to younger women who think that, you know, many that menopause is kind of, it's, it's decades away for them or irrelevant, you know, we'll deal with that later. Well,
they don't need to worry about menopause now. What they need to do is to eat and exercise in what I found were the most powerfully powerful and efficient ways. Efficient is important because what I mean by that is doable, you know, palatable food and everything. And if you just do two things, one is to eat a, a,
I, what is it? I'm quoting Jeff Follick and Steven Finney, who are two dietary researchers at Virta that I respect, a well-formulated ketogenic diet. So that's a low carb diet, but, but you know, it isn't just like go eat steak. There are ways to do this. And for example, you probably need more salt, salted chicken broth. I actually, cause I eat carnivore, I salt my water. I have to put Morton light salt in my water and salt,
to keep my electrolytes balanced. And there are things like that. And you need to eat sufficient fat and sufficient protein. Protein is one of the biggest problems. If you don't eat sufficient protein, this idea, oh, I'll take calcium. And for my bones, first of all, calcium is unhealthy to take.
Um, you don't need as much as they say you need. Big calcium is like big pharma. I mean, big, big supplement. There's a whole scam level on that too. Um, you maybe need 500 to, um, oh no, this is, um, this is magnesium. I'm forgetting. So I shouldn't say, but, um, basically if you don't eat enough protein, you couldn't eat an entire dairy's worth of calcium and it will not manifest in your bones.
And so the government tells you need to eat 0.8 grams of protein per kilogram of body weight. And actually you need at least 1.2. And this notion, there's this notion Smith that, oh, you'll ruin your kidneys. Okay. If you're a person with healthy kidneys, you can eat protein. That's only for people who are, have kidney disease, that it's a problem.
And then vitamin K2, magnesium, and D. You have to get your D level tested. Many people are really low. So these are synergistic supplements, D, magnesium, and K2, MK4, and MK7. They're reasoned to take both.
And then the exercise is to do slow speed weight training, which is very slow weightlifting for not a lot of reps to muscle failure, which means that you can't do another one with good form. And you do, it's really slow, like five seconds up.
like this. I'm lifting my arms. You can't even see it, but partly because they're out of frame, but, um, and five seconds down and you need to do it with very good form. Um, because otherwise you can get hurt. You always do bilateral weightlifting, both arms, not pumping iron in the fast thing is not good. And what you're doing with this,
is that you should do, oh, you should do it with weights heavy enough for you that you can only do like eight or 10 reps. So I do one set of these a day. I don't know if you can see my arms. I like, you know, I like muscles and everything. It's sort of incredible. You know, and I lift like
I live like Barbie's weights. My weights are silly. Like they're over there. I have a weight graveyard in my living room. But so what you do is by going to muscle failure, you stress out your muscles and what you do for muscles, you do for bone. And so the next day,
There are these teeny tears in your muscles and they're being repaired. That's how you build muscle quality, bone quality. And this is the vitally important thing to have the sort of strength. And also your bones and muscles are metabolically active.
So they're working to bring down insulin resistance and blood sugar. They really working out like this is vital for your overall health. And I guess the way you put that about what should they worry about with menopause? The real problem is that we don't go by a fire extinguisher until the house is on fire, basically. So we think I'm fine. I'm fine.
you know, and I, I'm not going to worry about diet. I'm going to eat what I want and I'm going to drink a lot and everything. And the problem with that is that the more, the more you go on like that, the, the less, the less basically you're, you're, you're setting up a lifetime of ill health because as cardiovascular issues start to take place in you, like atherosclerosis of the plaque in your arteries, you know, you don't reverse that.
So you want to avoid that and avoid inflammation because then you can be this like bouncy, like slightly wrinkled version of you, you know, in your seventies and going out and living your life and not, you know, as these, as these people I see, I go get eye treatment in a place where there are a lot of diabetic patients. They're really overweight. They have walkers. It's so sad. You see, I know how much these people are suffering, right?
And it's this, you know, standard American diet. You look at those pictures, you've shared some of these from the fifties, you know, you don't see a fat person on the beach. And maybe there's one like the three stooges guy, who's the big one. Maybe there's one person like that, you know? Oh no, I'm thinking of Laurel and Hardy. See, I'm 9,000 years old. Yeah. But so, you know, this is the thing, like to just live, you know, to eat in a healthy way, starting now to exercise starting now because your bones decline, right?
and you only have till you hit menopause it's very hard to build bone after that so women in perimenopause you better lift those weights ladies and I send threatening messages which is funny because I'm about as threatening as a tooth fairy but with um barbells to my friends to tell them they need to exercise and I'm just irritating enough that some of them start to do it
but I do one set a day and two on Sunday and I'm in the best shape of my life, really low inflammation. My triglycerides, they're 50. HDL is 102. Now these are just indicators of health. We know that the lipid hypothesis has not been proven and probably blood sugar and insulin resistance and the diet we eat is what causes heart disease. But eating this way,
eating this, this low carb diet and it's delicious, you know, and eat and doing this weight work where by the way, the, the, the doable part of this is that I don't go to a gym. I mean, this is like the idea of going to a gym, wait, I'm going to do manual labor for an hour with iron bars. That's so boring. Um,
it's so and you feel like dress up and oh let me find some lululemon like to stick myself in no I do the weight work here you know on my floor I don't go anywhere it takes you know a couple minutes and it hurts at the end but you know you get used to it and and this and I'm
healthy this way. And then with the eating thing, I like to joke, I don't cook, I heat because I write. And if I write, look, there's like a book here. You know, if I eat, if I make a hamburger, it's gone. Like, so it seems a bad idea to spend my time in the kitchen. And so what I do is I have food that takes two steps, like hamburger, flop, flop.
salmon, flop, flop, sear the salmon. You know, these things are very fast to make they're greasy and good. And now one thing to take care of is to not eat inflammatory foods. And so high omega six, people have probably heard of this. I eat fish, I eat fish, salmon and herring throughout the day, and and also hamburger and eggs. But I cut out my my beloved pork rinds. I'm a Jew from Michigan, from the suburbs of Michigan, I eat like I'm from Appalachia.
So the pork brines, I smoked two big jars, which was sad. And then bacon, because while I was dealing with the eye transplant,
I needed to really be SWAT team on my immune system and healing and have no inflammation, no unnecessary inflammation. And so I just very sadly one morning I cut out the bacon and I ate people think this sounds gross, but it's great smoked herring. I put butter on it and then I microwave it a little bit. It's really delicious. So I ate that the first morning I was looking at it like it's not bacon, but you know what habits are built on.
you know, one uncomfortable thing you do at a time. So I did that and then, okay. And I did the next day and then it just became normal.
And so you, you get used to things and that's how, if you just make yourself repeat things, you know, eat this way, be disciplined for two weeks. This is an idea I got from my friend, Mary Dan Eads, who's one of the doctors who wrote protein power. She would have, she and Mike, her husband, also a doctor, they helped like 10,000 people who are very quite obese in Arkansas get thinner. And on what she would ask her patients, you don't say, Oh,
Will you change your whole dietary life? She'd say, okay, for two weeks, will you do this? You know, eat this discipline way for two weeks and then see how you feel and how you like it. And so what happened with me, I started eating low carb in March of 2009 because we were shooting a book cover for
And I had my snout in a vat of ice cream all month in March. And knowing Gary Tobbs, who's a friend of yours too, who wrote Good Calories, Bad Calories, and has really led the low carb movement to a great degree in America. So I knew about that from him. And I thought, okay, I'll just eat that way because I know I can lose weight quickly to eat just like hamburgers and eggs and black coffee. And I did drop weight, but
I felt so good from eating this way. And same with carnivore. I did carnivore last February just to, you know, for a couple of weeks. And I thought like, I feel too good to go back. And,
And so all of this, you know, to make this stuff doable, the food's delicious. You know, you have to plan a little. If I'm going to a party and they're serving pasta I eat beforehand or I bring, I have herring in my purse. I used to bring bacon. You know, so, because I don't want to be that pain in the ass guest. I'll eat the salad or whatever. You know, you know, so, yeah.
But to have things be doable. And this is what I used to ask myself as an advice columnist. You come up with a column. And I didn't actually give people advice because if you tell people what to do, it's called it's instigates psychological reactance, which is rebellion when you feel like you're being controlled. So I'd say, but OK, and this is sort of absurd. I'd show something in a funny way and then say, you know, you might consider doing this.
And when I would write that, then I'd take a step back and look at it and say, okay, is this doable? Like, will people actually do this? And will they keep doing it? And if the answer to either of those questions was like, really? No. Then it's back to the drawing board. And so this is what was very important about this. And also to instill, you know, a sense of self-compassion about our failures and
And how to look at it when we don't follow through. And to not just throw out our diet. There are ways to deal with this, like having systems instead of goals. System is...
you know I'm going to change my life I'm going to be healthy I'm going to work to being a healthy person so I have a wonderful old age I'm not suffering I can be an old lady like having sex with the cabana boy in south of France or whatever you know and that you that's your that's your system and so if one day you eat something you shouldn't well you have a whole system that's big but
But if you just have a goal that I'm never going to eat a cookie and then you eat a cookie while you suck and then you feel bad about yourself. So that's an important thing to set that up. And then also when you do fail, understand before you fail, we fail. We suck. We're like the chimps. We're all chimps.
And we're grabby and, you know, don't have good impulse control. And so when that happens, I mean, don't just allow that and say, okay, I'm going to just, you know, throw everything to the wind. But have self-compassion and say, okay, you know, I did this, but I've been working so hard. You know, look at all the great success I've had, you know, sticking to this. We're going to do that some more. Tomorrow's a new day.
And, and I just about the cookies. I want to say this. So for me, because I am a hedonistic pig, I can't have ice cream in my house. I will. I mean, I will like eat the carton to get any chocolate out of it. But,
But, you know, when I go to a party, which is not that often, if there are chocolate chip cookies there, okay, I'm like the scientist of chocolate chip cookies. I have to analyze them. Were they made by a vegan? And do they have all this horrible stuff in them that's going to be tasteless like particle board? Or were they made with the good stuff? And then I have to analyze, wait, the dark chocolate or whatever is
And then I'm going to eat one and I eat three. I swear to God, every time I eat three. But so that makes my life not feel like I'm deprived of things. It's delicious. But then I'm back to eating the way I eat because I need to not do things that are going to make me suffer and be in a bad place in old age. So the take home message, if you're having a party and inviting Amy, be careful of the chocolate chip cookies that you have. Yeah.
But so much wisdom, so many pearls in this book. We don't have time to go in all of them, but you really need to get it. And if people go to your website, they can download something, yes? A free chapter? Yes, something.
So amyelcon.net, you can buy the book there at Amazon, at indie bookstores, and you can also get in Barnes & Noble. And you can also get the audio book, which is recorded by Carrington McDuffie, who does all my books. She's a singer. She's so excellent. So she's really worth hearing if you're not a reader. She's terrific. And so here's my book. I hope it's not backwards.
It's perfect. And it's coming out today, as we said in the beginning. It's releasing today, May 20th.
I forgot to say two things. You asked me a question. I didn't finish it as usual. That on my, on my website, amyalkon.net, you can get a free book chapter and you can also download Dr. Robert Lufkin's forward for my book, which is really wonderful. Thank you. And you'll find all sorts of other information about me and the book. And I'm going to have a sub stack, a newsletter as of the end of May. So you can sign up for that there. And then you can also, it's easy. You can opt out if you decide, Oh, she's a,
I didn't want to hear this person, which I hope you will. Well, thank you so much, Amy, for being here today. It's really been a blast. Thank you so much. So it's Amy Alcon. The book is Going Menopostal. What you and your doctor need to know about the real science of menopause and perimenopause. It's out today. Get it. Thank you.
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