Menopause Self-Care – Before, During, and After

Robert Rountree:

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them, and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Hi, everyone, and welcome to The Thorne Podcast. This week, we're speaking to returning guest and my good friend, Dr. Joel Evans, a board-certified OB-GYN, international lecturer, the founder and director of The Center for Functional Medicine in Ridgefield, Connecticut, and also, the chief of medical affairs and lead educator at the Hormone Advanced Practice Module for IFM. Welcome back, Joel.

Joel Evans:

Great to be here, Bob.

Robert Rountree:

So I understand that you did a little volunteer work in India. Tell me what that was like.

Joel Evans:

Yeah. Well, thank you for asking. So I like to go to India for two reasons. One is that for whatever reason that's unique to me, that is one of the places in the world where I can really get into this meditative state a lot easier than when I'm here in my regular routine. And so I go there to have really profound and wonderful meditative type experiences. And then I also do a lot of charity work on helping the poorest of the poor, primarily with a hospice and aged care home and a hospital. So I get to be a little bit selfish and get to enjoy the meditative experience and then I give back by being of service.

Robert Rountree:

Wonderful. It's amazing that you can make the time to do that, and I'm really impressed. I know one of the last times you were on the show, we talked about stress management, adrenals, etc. And so this sounds like one of the ways that you address those issues.

Joel Evans:

Absolutely.

Robert Rountree:

Absolutely. All right. So let's get in the main topic this week. It's going to be menopause. You know something about this, I assume. 

Joel Evans:

I do.

Robert Rountree:

It’s a natural part of life that every woman will experience, but it's often surrounded by confusion and misinformation. So, Joel, let's start by discussing the basics. So exactly, what is menopause and why is it such a pivotal, important time in a woman's life? And really, let's talk about what the issues are around it. So it happens, but obviously, it's dealt with in different ways by different practitioners, etc.

Joel Evans:

So what happens is that menopause happens to coincide with the time in a woman's life where two very important things happen. No. 1 is, it's the age where chronic disease starts to really set in. And the second thing is it's the age of societal and familial stressors. That's the age when marriages start to fail. That's the age when the health of parents start to fail. That's the age when kids are going to college or having the stresses of parenting a child in high school. And so when you're in that situation where those biological changes are happening, then that's just coincidentally when your ovaries start to, I hate to use the word fail, but I would say your ovaries start to produce less hormone. And the reason your ovaries produce less hormone is because a woman doesn't produce more follicles or eggs. She's born with the amount that you'll always have.

And it just somehow works on average that the number of eggs that can be active and produce hormone stop producing those hormones anywhere between age 40 and 55, on average. So you have this incredible change in what's going on with sex hormones, the incidence of chronic disease, and the stresses of life, all happening at the same time.

Robert Rountree:

They're all intersecting.

Joel Evans:

All intersecting. And then patients come to me, "Honestly, I don't feel right. I'm stressed. My hair's falling out. I'm gaining weight," and they don't know why, right? And it's because it's this confluence of all these different things, and that confluence of things is different for every woman, right? So some of them feel the change in hormones more significantly than others, right? We've all heard of some women that sail through menopause without a hot flash, and others that are just miserable and others who are getting chronic disease and others that are gaining weight or losing hair. 

So it's unique for everyone and that's why the functional approach is an analysis of what's going on or an evaluation of what's going on that has to look at all of these variables so that we can personalize the underlying imbalances that every woman has, overlay that with her unique stressors and then what her health goals are. And that's how we come up with a personalized plan, that's different for everybody.

Robert Rountree:

So this would be in contrast to say what a very conventional gynecologist might do when a woman comes in with all these complaints. They might say, "It's your hormones. Your estrogens dropped. Here's a hormone prescription. See you later."

Joel Evans:

Right.

Robert Rountree:

And you're saying, "That doesn't cut the mustard."

Joel Evans:

It doesn't. That's a Band-Aid. And why do they do that? Because most women will feel better, right? So because the underlying issue here is a decrease in the amount of hormone. So if you re-establish some hormone in the body, people will feel better. But that doesn't mean you're doing the right thing for them because the right thing for them is addressing underlying issues that may be making them feel problematic. So, for example, one of the very common menopausal issues is a change in mood or depressed mood. And we know that giving HRT can help mood.

Robert Rountree:

Hormone replacement therapy.

Joel Evans:

Right. Giving hormone replacement therapy can help mood, and it will. But it's not right for a particular woman if the reason for her depressed mood is low B vitamins or too much inflammation. So there are reasons to be on hormones, but you have to look at the hormone replacement decision as one that looks at what's going on with that patient in front of you so we can address those functional imbalances, then see what percentage of hormone deficiency symptoms remain, and then make a decision if we want hormones for symptomatic relief or just overall health benefit. And it can do both.

Robert Rountree:

So this process, this thing that we call menopause, it's not overnight, right? It's generally taking place over a prolonged period of time and that makes it complicated.

Joel Evans:

Yeah, it can take up to 15 years.

Robert Rountree:

15 years, really?

Joel Evans:

Yes.

Robert Rountree:

I didn't realize that. I would be thinking a couple of years. And in the official definition of menopause, one year without periods. Is that what the mainstream says?

Joel Evans:

Right. And the reason it says that is because a label of being in menopause really means you're not going to be able to get pregnant or you can stop using birth control. So you're hesitant to give women permission not to use birth control until we know that they're not going to become pregnant again. So a year of no menses in a woman approximately 50 years of age, you can say that safely. Up until a year, you can always have these spontaneous ovulations, if you will. And that's where this whole concept of midlife pregnancies comes from. So that's where that definition comes from. And it gets confusing for women because they say, "My doctor said I'm not in menopause. It's been 10 months. I'm miserable." I'm like, "Well, you know what? You are symptomatically in menopause. Your body thinks you're in menopause."

Robert Rountree:

Yeah.

Joel Evans:

"I just can't tell you you're not going to have a spontaneous ovulation. So we can still treat you as though you are in menopause." So that's why the languaging is so confusing.

Robert Rountree:

So except for the birth control issue, the rest of it's more of a semantic issue.

Joel Evans:

Correct.

Robert Rountree:

Whether you call it menopause or perimenopause, etc.

Joel Evans:

Right. Correct.

Robert Rountree:

I'm curious, we know that puberty, when girls go through the change, is happening at a younger and younger age. What's happening with the age at which menopause occurs? Is that changing or is that pretty much the same?

Joel Evans:

It's pretty much the same. It's inching a little bit later in some groups and a little bit earlier in others. So it's hard to say there's a definite change or a definite trend. It's still around 51 or 52.

Robert Rountree:

OK. And are there things that can influence whether it happens at an earlier or later age? Lifestyle factors, and I'm not talking about a woman, say, getting chemotherapy for cancer, which obviously can knock out the ovary. So there's things like that, or there's surgery, the obvious things. But are there other lifestyle factors that can bring it on, induce it earlier or later?

Joel Evans:

What I would say is that overall, if you start later, you're more likely to end later. And also, if you start earlier, you're more likely to end earlier only because you have that finite number of eggs. The other thing that's interesting is that there is such a thing as finding out when your mother or female relatives had their change of life experience because there is a genetic propensity or a family history propensity. So if the women in your family all go into menopause early or go into menopause late, that's significant. And I remember early in my training, I never was taught that. And patients would always start off telling me when their mother went into menopause. And I would inwardly roll my eyes like, "This is useless information." But in fact, many of the things I learned in practice, those sorts of things actually do matter.

Robert Rountree:

Yeah, they do.

Joel Evans:

Yeah. And women that are clearly stressed or inflamed or having other issues, can go into menopause earlier. One of the things we know is, and I don't know how much you want me to explain, or your audience is familiar with the term “leaky gut.” But when you have leaky gut and things get through the gut lining that shouldn't, one of the things that go through that gut lining are things called lipopolysaccharides or the–

Robert Rountree:

Endotoxins.

Joel Evans:

–endotoxins. And when that happens, it can actually stop the ovaries from making progesterone. So when we're teaching at the IFM Hormone Module, that's one of the wonderful things – “wonderful” may not be the right word – I would say one of the illustrative things that I like to point out about the link between gut health and hormonal health, and gut health and fertility. So women can have earlier menopause if they're inflamed, gut issues, etc. So that's another way. It's all linked.

Robert Rountree:

Again, some of women comes into you with typical menopausal symptoms, she's 51, 52, you're not just going to measure her hormone level.

Joel Evans:

Correct.

Robert Rountree:

I mean, maybe you're not. But you're not just going to go, "This is strictly a hormonal issue, and that's how we're going to deal with it." So she may say, "I'm having hot flashes, mood swings, etc." And you say, "Let's look at your gut."

Joel Evans:

Right. Exactly.

Robert Rountree:

I mean, when you say that, do women go, "Why do you want to look at my gut?"? Do you get surprise when that happens?

Joel Evans:

Yeah, I get surprise. And because now as the practice has evolved, I mean, now the practice is called The Center for Functional Medicine, sometimes it's the flip. It's like, "I hope you're going to look at my gut."

Robert Rountree:

Yeah. So they might ask for that.

Joel Evans:

Exactly.

Robert Rountree:

Yeah. Now, something I'm curious about. We started this understanding of menopause by looking at two hormones, estrogen and progesterone. But obviously, there's other hormones involved. There's testosterone, etc. And it seems like it's an evolving story. So how much is that story evolving that we're going beyond these two basic hormones of estrogen and progesterone? Is this turning out to be a much more complicated scenario than we imagine?

Joel Evans:

It really is. And this is where I sort of am feeling very empathetic towards women that are going through menopause now because the science lags a little bit. Before menopause, women in general feel better than after menopause. But what we also know is that your breast and your brain and uterus was designed to not be exposed to estrogen for your entire life. Everything was pre-programmed that estrogen would be around until your earlier mid 50s. So those are the two main competing philosophies about how do you manage this. So whether you want to say, "I'm worried about giving too much estrogen for the breast …"

Robert Rountree:

Maybe cancer risk, etc.

Joel Evans:

"... because of the cancer risk," yeah, I understand that. That makes total sense. And then you say, "Well, the brain expects estrogen." But then when you lose estrogen, that's when you lose cognition or heart disease. And women don't really get heart disease until they stop begging estrogen. So you become sort of standing there with all these different things being thrown at you because you don't know which lens to look at, overall what's best or what's best for your brain, what's best for your heart, what's best for your breast. And sometimes there are differences. What's best for the brain might not be what's best for the rest. So everything has to be personalized.

Robert Rountree:

It seems like we've just gone through all kinds of changes in terms of the official recommendations, from, "Every woman should take massive amounts of hormones and be feminine forever," to that Women's Health Initiative study that implied that hormones will give you cancer. And then suddenly there was a mass exodus from prescribing hormones to now a huge range of doctors' opinions, from doctors that say, "Well, I don't ever prescribe hormones," to doctors that say, "It's the best thing ever for you." So how do you navigate that with patients?

Joel Evans:

So as we sort of alluded to in the beginning of this conversation, there's really two reasons to be on hormones. No. 1 is for symptom relief, and there's a long list of symptoms that come with menopause. And two, is what's best for my overall health in terms of longevity, maintaining heart function or optimal heart function and optimum cognition and bone health, and then, of course, skin and cosmetics. So we have to decide what's most important because there are women that have no symptoms and have risk of heart disease or cognition that even though they've got no symptoms would be better off on hormones. And then you have women that have symptoms, but are in incredible cardiovascular health and have no issues with cognitive decline or mild cognitive impairment. So again, that's why we're personalizing. 

And if I were to answer your question, which I know I'm sort of expected to do, which is why I'm here, which is, what's the best way to proceed? What I would say is that hormones overall are beneficial. So they'll make you feel better, number one.

Robert Rountree:

Beneficial for women in menopause with symptoms.

Joel Evans:

Yes.

Robert Rountree:

OK.

Joel Evans:

And even without symptoms.

Robert Rountree:

Even without symptoms.

Joel Evans:

Hormones are beneficial. And hormones have that symptom relief component, which is very important because what most doctors don't know and what most women don't know is that hot flashes are actually bad for your health. They reduce your heart rate variability and are associated with cardiovascular disease.

Robert Rountree:

So they're not just an unpleasant symptom.

Joel Evans:

Exactly. So that's where this old way of thinking, and I used to have patients that would come in and say, "In my family, we just grin and bear it." I understand the motivation for that, but it's not true anymore, because those symptoms, those flashes are not good for women. So symptomatic relief is important, but no symptoms, also, it's important because there really is a cardiovascular benefit, there really is a heart disease benefit, there really is a bone benefit. So it's heart, brain, and bone.

Now, the next question is, how do I know if it's safe for me? And that's another conversation we can get into in a little bit. But the important thing that's come up now is “If I'm going to be getting hormones, which hormones do I get and how long do I stay on them?”

Robert Rountree:

Yeah.

Joel Evans:

Because we used to say, "You don't want to be on it more than 10 years after menopause," because there used to be something called the timing hypothesis in regard to heart disease, and critical timing hypothesis when it came to cognitive issues where after 10 years, you would see less of a benefit. So we would say…

Robert Rountree:

There'll be a drop-off.

Joel Evans:

Right. So we would say, "Stay on it for 10 years and then go off." And then we just have a recent study that came out that says, "You know what? It's safe to continue past 10 years."

Robert Rountree:

I'm going to say “yay” to that.

Joel Evans:

You can say “yay” to that. But what I would say is it's not all good news specifically when it comes to heart disease protection. Because when you look at the basic underlying effects of estrogen on the heart, and this is something we dig deep into in the module, there's like a switch that gets flipped in terms of the benefits of estrogen on the heart, where within the first 10 years after menopause, it's anti-inflammatory in the heart, causes the small vessels to relax. It's like there's all these wonderful things. And then physiologically, after 10 years, that changes. So then it becomes pro-inflammatory in the heart. And we know how inflammation is so bad.

So if I'm now, as I am, working with patients that want to stay on it for more than 10 years, I am being super careful to monitor the heart, thinking about sophisticated lipoprotein profiles. I'm thinking about doing calcium scores. I'm really staying on top of what's going on with my patients in terms of their cardiovascular system. As far as cognitive decline, I think it's OK to stay on it more than 10 years. It's less concerning than the heart and certainly bones. So that's my big picture.

Robert Rountree:

Great. I'm so glad that you touched on that because I can't tell you how many women in my practice have been on hormones for 15 years, and they get a letter from their insurance company saying, "You need to stop." And the women go, "It's helping my bones. It helps my hot flashes. I feel good. My energy's good. So you're telling me I need to stop for a theoretical reason." And what you're saying is, "Well, it's more than theoretical. There are things that can be problematic like cardiovascular risk, and we can address that especially with functional medicine." Am I summarizing that-

Joel Evans:

Perfectly.

Robert Rountree:

OK. Great. So that's been an amazing discussion. We're going to take a break now and then when we come back, we're going to answer some questions from our listeners.

Joel Evans:

Beautiful.

Robert Rountree:

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And we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asks, “What age does premenopause begin?” What is premenopause exactly and when can it start?

Joel Evans:

That's the process where the ovaries start making less hormones. And don't get mad at me for this answer, but it could be as early as 35.

Robert Rountree:

So it could start, I assume, with irregular periods or a change in the type of periods?

Joel Evans:

Exactly.

Robert Rountree:

Yeah. So it can start pretty early?

Joel Evans:

It can. It doesn't always do that. That's the extreme early side. Most women start noticing these symptoms around age 45.

Robert Rountree:

So, “What causes hot flashes? Can I do anything to stop them?” And I assume this person is not asking for a drug or, I mean, maybe you should include your discussion on hormones, but there was a new drug that got approved for hot flashes, and I just read that it can cause liver toxicity. So I think we probably won't recommend that.

Joel Evans:

Yeah. So hot flashes, there's an area in the brain called the hypothalamus. There's something called the thermoregulatory zone, which is where the body tries to keep its temperature within a certain zone, and that zone changes during menopause. And so when you're trying to stay in that zone, but you can't, your body wants to sweat to get you into that zone. And that's really sort of what's happening with hot flashes. It's also caused by stress and the catecholamine response. So that's the biology of it in the overall setting of estrogen deficiency. So what can you do to stop them? Well, what I would say is – this is true, I'm sure, for everybody that Bob interviews, no matter what the subject, no matter what he says – be as healthy as you can.

So when we're in functional medicine, we talk about the different areas of the matrix, which is areas of clinical of excesses and deficiencies, and we want to achieve balance. So it's achieving balance in the body, achieving optimal function of the body. So that's gut health. It's reducing inflammation, reducing stress. There's this incredible connection between stress and hot flashes so much so that there have been studies, one even published in the New England Journal of Medicine, that stress reduction techniques reduce hot flashes to the same extent as estrogen therapy.

So how do you stop them? You stay healthy. You don't do things that you know can trigger them. Sometimes it's spicy food for people. And we say have cooling foods, whatever that looks like to people, mint and so on. If you go to an acupuncturist or traditional Chinese medicine practitioner, they have lists of these cooling foods. There are techniques that they use to induce cooling and get rid of heat, for example, which, in a lot of things, they can notice that by looking at your tongue and doing tongue diagnosis. And then there's simple herbs. Black cohosh is an herb that works really well. It's very effective.

Robert Rountree:

Great research on it.

Joel Evans:

Great research on it.

Robert Rountree:

And very safe to the liver.

Joel Evans:

And very, very safe. And there's been controversy about its safety, but it really is safe. In fact, I was an author on a paper at Columbia University that actually studied black cohosh for hot flashes in women with breast cancer. And that was a poster presentation at ASCO, American Society of Clinical Oncology, and that got published in Journal of Clinical Oncology. It's safe and it's effective. So I love black cohosh. And soy, believe it or not, is good. I never recommend soy as taking it in a supplement form, but I like eating it part of a healthy diet.

Robert Rountree:

Tofu, tempeh, miso.

Joel Evans:

Right. Exactly.

Robert Rountree:

And flax. What do you think about flax?

Joel Evans:

I think flax is great too. So that, I think, are some good ways to address hot flashes.

Robert Rountree:

Great. So, “What can a woman do to live happily, lose weight, and grow back hair during menopause?” And I think in the center of that question, lose weight, that brings up this issue: Women tend to gain weight with menopause. Do we understand why that happens so commonly? And what can they do?

Joel Evans:

I'd say those three things are 60 percent of my practice, right? And the live happily, I'm glad it was listed first, because I'll tell you it's the most important, and it's different for everybody, right? So it's easy to say, I'm recently back from India, "Find a sense of purpose in your life." Now, having said that, and this is what I call cosmic humor, I don't even know if you saw this, Bob, but within the last two weeks, there was a paper about having direction and purpose actually decreases cognitive decline.

Robert Rountree:

That's great.

Joel Evans:

Yeah.

Robert Rountree:

So knowing what you want is a powerful thing.

Joel Evans:

Right. So it's direction and purpose, which is big picture stuff. But then there's little picture stuff, which is, find out what the pebbles are in your shoe. And we have a saying in functional medicine that Bob knows, which is if you're sitting on 10 thumbtacks, getting rid of three isn't going to make you really feel better. But the importance there is if you've got 10 things that really annoy you, start addressing it, right? You are now in menopause. I'm not going to say you're in your last lap, but let's say the final third of your life. So now's the time. Give yourself permission to address these things that aren't working in your life. Does it mean you need a therapist to just discuss things? Is it a marriage issue? Do you not like your coworkers or your boss? Or whatever it is.

Because you want to have not only direction and purpose, but I would say contentment. You want to be at peace with where you are in your life. So that's really a priority. And that will then, to go back to our last talk about adrenals, decrease your cortisol and decrease your stress. And that's one of the main causes of weight gain around the middle.

Robert Rountree:

The high cortisol.

Joel Evans:

The high cortisol. So get your adrenals tested, work on your stress. And if you can normalize your cortisol, your weight will start to fall off. 

The other thing is that many women will either choose to have food sensitivity testing or, if they don't, will do better with getting off of gluten and dairy. And I'm not a zealot when I say no one can eat gluten. What I say is, if you want optimal health, you owe it to yourself to do an experiment and see if you feel different on gluten versus off of it.

Robert Rountree:

So try a few weeks or a month or…

Joel Evans:

Right. Yeah, I would say two weeks is enough not to know, for sure. But if you don't notice anything after two weeks, you're unlikely to notice anything after four. If you notice a little bit after two, then continue because then you may notice more if you're able to do it. So two weeks off gluten and dairy, and that also makes a difference with weight. Now, when I say off of gluten, don't substitute gluten-free muffins for regular muffins.

Robert Rountree:

Yeah, junk food.

Joel Evans:

That's not going to help your weight. And unfortunately, gluten-free bread has a lot of junk in it, including sugar. So when I say go off gluten, doing it that way is if you're concerned about, let's say, a gut symptom or whatever. But if we're talking about the weight loss aspect, go off of gluten, but you don't substitute it with other sources of sugar or carbs. So then I always encourage my patients that have these three things is, again, let's try to change both what you eat, how you eat, and when you eat.

So what you eat is essentially protein and veggies, no-to-minimal sugar, no-to-minimal carbs. And by carbs, I'm not talking about the fact that some vegetables are carbohydrates. I'm talking about not a lot of potatoes and rice and bread, primarily. So that's the what you eat. 

The how you eat is mindful. Chew your food as close to liquid as possible. That will increase satiety. Ideally, say some sort of blessing over your food. It doesn't have to be religious. You just be gratitude, "I'm thankful to the plant kingdom and the animals that are sacrificed for this food." I think that that makes a difference.

And then the other thing I would do is talk about the when you eat. And there's something called time restricted eating. So if you can eat all of your food in 12-hour window, that's nice. If you can do it in a 10-hour window, that's better. And if you can eat everything in an 8-hour window, that's best.

Robert Rountree:

Optimal.

Joel Evans:

So it's what you eat, when you eat, and how you eat. And the other thing that I forgot to mention in what you eat is a lot of protein. And we're now having a seismic change in recommendations for protein requirements.

Robert Rountree:

Absolutely.

Joel Evans:

And it's important that you're eating more protein, three quarters of a gram per pound, something like that, ballpark. But you need to be exercising and lifting weights as well, and that will help with the weight loss. So you're doing more exercise with weight and you're eating more protein. It's hard to get a ton of protein in with your diet without supplementing. So I personally take a scoop of whey protein a day now. That's 25 grams of protein. I add a scoop of collagen that's 15 grams. That gives me 40 grams of protein right then and there. And then the specific exercises, you definitely want to do some cardio. It's not like you need 60 minutes of cardio anymore, but 15 to 20 is good. We now know that sauna counts as cardio. So sauna is very important, at least.

Robert Rountree:

It's not cheating. It's the real deal.

Joel Evans:

Right, 175 degrees, 20 minutes. So if you can do that for 20 and do 10 to 15 of cardio, that's great. Walking at a 10 percent incline for 10 minutes, two to four miles an hour, most people can do that. And that's also good as an exercise to prevent osteoporosis. So that's how I would sum up.

Robert Rountree:

Your overall. So that's a lot, and yet it's all very practical and doable. So “For someone who's been biohacking their health, how can I best prepare for the hormonal changes that come with menopause?” So I guess the person is asking, “Is there anything I can do in advance that is a good setup for what is inevitable?”

Joel Evans:

Yeah. And so it's what we said before. It's optimal health from a functional perspective. So gut health, what's the health of your microbiome? Making sure you're not eating foods that are triggers for you and causing inflammation. Making sure you're not constipated. Constipated women have more estrogen and more prone to menopause. Making sure your thyroid is functioning optimally. Making sure you're both not taking in a lot of environmental toxins through makeup or food and so on. Making sure you're eliminating things properly. Making sure your mitochondria are working well. And there are tests that functional medicine practitioners can do for this. 

Robert Rountree:

So clean living is way up there is what you're saying.

Joel Evans:

Clean living. Healthy eating. Stress reduction, including mission and purpose. Relationships. Sleep is critical. And then when you're in optimal health, you will be better positioned to absorb the hiccups that come from changing hormone levels.

Robert Rountree:

That's great. Now, one thing I might add is that I do see women who show up in the office in their 50s and say, "Hey, I've heard I should get a bone scan." And we quite often will diagnose osteoporosis at that age. I'm guessing you would say, "You should be thinking about preventing osteoporosis a long time before that."

Joel Evans:

Correct.

Robert Rountree:

You can't wait until your calcium's gone from your bones and then say, "Well, maybe if I take some calcium and vitamin D, it's going to magically restore it."

Joel Evans:

Right. So anyone that comes into my office, no matter what the problem, will get the vitamin D level check, right? So that's important. I like that between 60 and 70 or between 70 and 80 if I'm really worried about cancer. So vitamin D levels are important. Then I'll measure, a test called Pyrilinks, that’ll test the rate of bone loss. So that way we can assess if people are losing too much bone. If they're losing too much bone, then I'm concerned and may order a bone density just to see where I'm at. But this urine test by Quest is covered by insurance. And women need to have calcium. Now, ideally, calcium from a diet's better than a supplement, but women need calcium.

Robert Rountree:

So you're going to have that conversation about bone thinning sooner rather than later.

Joel Evans:

I am. And interestingly enough, bone density in adolescent girls is what correlates best to the onset of menopause.

Robert Rountree:

All right. Folks, that's all the time we have this week. Dr. Joel Evans, thank you so much for coming on the podcast. If listeners want to follow more of your work, where can they go to find out what you're up to?

Joel Evans:

Look at Center for Functional Medicine website, which is TheCFFM.com – Charlie, Frank, Frank, Mary – TheCFFM.com. We have updates. Can't say I'm a big social media person, but that's where updates are. And just doing Google searches. I'm out there giving talks and podcasts and stuff a fair amount.

Robert Rountree:

You're all over the world.

Joel Evans:

Yes.

Robert Rountree:

All right. Excellent. As always, thank you, everyone, for listening. Until next time.

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