Earlier this season, I spoke with several experts about cosmetic dermatology and the science of skincare. The response was terrific and thank you very much. Today we're going to continue to explore medical topics, discussing the latest research, innovations and health recommendations. Today I am at Newsstand Studios right in Rockefeller Center speaking with doctor Elizabeth Poynter, a gynecologic oncologist, an advanced pelvic surgeon, and an expert in midlife women's health.
I've known doctor Poynter for several years and I am so impressed by her depth of knowledge about women's health. And just to clarify the situation, she has also been my gynecologist for several years and I have been extremely happy with her treatment and with her consultations. So many are very hesitant to talk about menopause. Many doctors, many women are hesitanted to talk about a very natural occurrence
in every woman's life. But I firmly believe it's important to learn as much as possible and to understand how the changes associated with menopause can affect physical, emotional, mental, and social well being. Doctor Pointer, welcome to our podcast.
Thank you so much for having me today and allowing me to talk about to speak with you about.
One of my favorite subjects, women's health.
Well, it's so much more than about women's ability to reproduce. Elizabeth, I've heard you say that we need to go beyond bikini medicine. Can you tell me what you mean by that?
So women have distinct physiologies from men, largely dictated by fluctuating hormone levels throughout the month and throughout our lifespans. So we know, and we've known for quite some time
that women are not small men. However, there hasn't been a lot of work devoted to this or a lot of research relating to this, And now we're just at a pivotal moment where we're beginning to realize the importance of specific female physiology and it needs to be studied and entreated and looked at very differently through a different lens, a hormonal lens.
And you, as an expert, know a lot more than most of us, because for the record, I've been on hormone replacement since I was like forty years old. That's great, and you want to know something, I think it is great. I think it has kept me more vital, more healthy, more my bones stronger. If that's true, I'm not sure if that's just genetics or if it really has been helped by my hormone replacement.
Definitely for women, when hormone replacement, usually consisting of estrogen or estrogen plus progesterone, started within a few years of menopause or in that perimenopausal transition or before the age of sixty, you're really going to get great benefits from it. You're going to get cardiac benefits, cardiac protection, bone health protection, of course, maybe even brain protection.
That data I certainly hope. Yes.
So it's great that you started early and had physicians who were engaged and who actually did that foil years.
It was because I had a lower abdominal hysterectomy after the birth of my daughter, I developed fibroids or something like that. I don't know, I can't you know. That was a long time ago, and the doctor said, oh, it'd be best if you just had this procedure and then but he started me immediately on hormone replacement. It was primarily progesterone and a little bit of justeosterone. I think, so.
Before the Women's Health Initiative study that was very standard. Kind of the advantage of being an older physician is you get to see the history of medicine and the history of trajectories and how we treat people. And when I first started in surgical oncology, when we would remove ovary's or do a hysterectomy with ovaries, we would always
recommend hormone support to protect the heart. The Women's Health Initiative Study was published and came out in two thousand and two and really took that off the table for a lot of people, and a lot of doctors then became very scared to provide hormone support for their patients before well the study was the interpretations of the study were prematurely released, right.
We looked at the Women's.
Health Initiative Study included one hundred and fifty thousand women who were as young as in their forties and as old as seventy nine, and they were randomized to either be on hormone support or no hormone support. And what we found is the risk of cardiac disease and breast cancer was higher. But remember we were starting women far after the transition of menopause. These were women who were in their sixties and seventies, who were more than twenty
years for some of them probably after menopause. But when we did a subset analysis, meaning we took and we looked at specific populations or groups of women within that study, we found that if hormones were started early in that perimenopausal or menopausal transition, that you actually did gain significant cardiac benefit from paramant support and decreased our death from all causes actually other than breast cancer, which was slightly elevated in this study.
And not all surveys are the surveys that we need.
We need to interpret studies the appropriate way just because something is published and we need to look at how to interpret it, and we have to be intelligent about how we interpret it.
Now I'm looking I had a very beautiful, slender, chic, short skirted, long leggage, high heel wearing Guya colleges.
Kay, I'm coming back here more often.
When I first met doctor Porter, I thought she was maybe the office assistant on a summer break from college or but here here I am sitting next to a very beautiful female doctor with long black hair. How do you keep in shape like this with your horobably difficult schedule.
Well, I practiced what I counsel my patients. I started on hormones when I was forty three. I had some new mood issues actually around the age of forty three, and I was doing very large surgical oncology cases and kind of hand ringing a little bit and developed some anxiety.
Was your son born then?
Note he was born. He was about a year or two after he was born. And it was my mom who said, oh, I think it might be your estrogen. And so I actually started on hormone support due to some anxiety, which was I'm now in retrospect, was definitely the perimenopausal transition. And this is before anybody really reconnized that anxiety or depression was actually linked to perimenopause or menopausal transitions. So I started early on hormone support, and
I think it's kept my metabolism good. And I practice what I speak about in terms of nutrition, exercise, lifestyle, healthy sleep, good outlook, all those things that helped to keep us young. So I try my hardest.
There are men who will say, oh, she's in a bad mood today, she's in menopause. Probably men are telling me this and I mean, what do they know about menopause?
Well, we need to educate them more. And I think you're aware. My husband is a breast surgeon, and so when I was starting on hormones, my husband is very knowledgeable obviously about breast cancers. Like, no wife of mine is going to start on hormones because of the breast cancer risk.
And we can talk more about that, and I hope we do.
But he went to all the best medical schools, had all the best training, knew nothing about menopause, knew nothing about hormonal transitions, and was like, this.
Is no joke.
And I'm like, yeah, no, it's not a joke in terms of the changes that we go through. But I think there's more conversation now. There's more out on social media about menopause. There's certainly more in the popular press about menopause, and so now individuals are men and women are realizing that anxiety or depression or mood issues are tightly linked to hormonal fluctuations.
Now once on hormones, now I've been on hormones for a long time. I started like right in my early forties too. Does your treatment have to change? How do you test for hormonal balance and everything.
So this is the tricky part about hormonal management. Naturally, we will need to change hormone dosing over an individual's lifetime. If you still have your ovaries and you're transitioning through perimenopause or into menopause, the ovaries don't just decide one
day they're going to turn off. They naturally decline, and so we may start on lower doses of estrogen, we may start on doses of progesterone with odd estrogen or and then naturally anticipate that they will need to be escalated over a woman's lifetime and then maybe drop down
a little bit when we get a little bit older. Actually, so that this is a conversation and dialogue that every woman should have with her physician or the person who's helping her manage her hormones, because it's really a communication because what works for one person doesn't work for everybody. So it's very highly personalized medicine.
I don't usually talk to people about their treatments or medical treatments, but a couple of my very close friends have spoken to me like, oh, why do you have such a nice skin? And I say, I think it's because of the hormones I taken, and of course genes, but and I said, do you take hormones? And most of them, most of my friends, have never been on hormone replacement.
So about that period of the Women's Health Initiative Study when it came out, and I remember this, I mean, we sent letters to our patients. At the time, I was at Slung Cattering as a surgeon, and we sent letters to our patients, you know, stop your hormones immediately. We were very couscormed about it. Stop them immediately. Well, about fifty percent of people went back on hormone support. Actually, so fifty percent has significant symptoms off of hormone support.
So everything with the Women's Health Initiative Study came from a screeching halt because it was just a knee jerk reaction because there was an elevated relative risk of breast cancer with this type of hormone support that was prescribed in this study, everybody to stop their hormones. And instead of throwing out the drugs and saying, okay, these drugs might not be the safest that we could use, we
actually throughout the issue. We threw out menopause and said, well, there's nothing we can do for you because this Women's Health Initiative study came out. You can't take hormones, they're
not safe. But we have newer preparations now that the French have had for a number of years, longer than us, that are actually safer than our older preparations, and this is now being brought to the forefront, so we have instead of saying we can't do anything, we now have safer preparations to treat with well.
Most discussions around hormone therapy is about relieving symptoms of menopause, but they must affect so many other parts of our health. I mean, they must help so much more in bone strength and good hair.
Is that true? Absolutely?
There's estrogen receptors all throughout the body. I mean we could talk from the tip of your head down to your toes, to the muscle, bones and joints basically. So there's estrogen receptors in the brain that are increasingly being identified as being important actually and maintaining cognitive function for women.
In terms of estrogen support.
It was recently published that around the time of perimenopause, estrogen receptors are those hearts of our cells that hold on to estrogen actually increase at the time of perimenopause, and there's some data out that really suggests that women who are on early hormone support within three years of menopause actually have improved cognitive function and may have a decreased risk of dementia. Overall, that's the brain, cardiac health.
We know that there's a thirty percent reduction in all cause of mortality other than breast cancer with hormone support, and that's thought to be largely through cardiac risk. Skin definitely increases, collagen production, decreases fine lines and wrinkles. There's data in the literature that few people review and discuss that even with topical estrogen we can improve skin muscles. Well, of course we are muscle mass changes when our estrogen drops.
It can also drop and decline as estra levels decline. Bone health has been recognized for many years that as estrogen declines, bone health deteriorates, and we can help bone health by adding back estrogen. So really and metabolism also, right, So when estrogen levels start to decline, we begin to develop metabolic disruptions. So you can look at every organ system in the body basically and have some link to hormone fluctuations in terms of the health of that organ system.
So what happens to the woman who has a brisk cancer history in the family, what do you tell her about taking hormones.
So a family history of breast cancer without a personal history of breast cancer is not an absolute contra indication to hormones. Even with our highest risk individuals in terms of genetic mutations, we will many times speak with them about hormone support after ovaries are removed and recommended. Actually, so I think every individual in every situation is to be personalized, but a family history of breast cancer is not a contraindication to hormone support.
Are you writing about this too?
Oh yeah, oh yes, yes, So we're working in a book. Definitely, we're writing about this.
When is that book available, Probably.
Within the next eight or nine months. We want to offer you solutions and how you can age beautifully and be vibrant just as you're doing.
I have so many friends who need this book, so good luck with it. I can't wait. I can't wait. Thank you. You'll have to come back on the podcast to talk about the book. So what innovations are you seeing about when it comes to the science of managing and treating the symptoms of MENOPAUSEA when do you know that you're in menopause? When? How do you know?
So menopause is really defined as being postmenopausal as you don't have I haven't had a period for a year. But that's an antiquated kind of definition, right, because that definition was before we had laboratory testing. Everybody kind of forgets you know, one hundred years ago we weren't able to check for these levels of bollicle stimulating hormones and asterrodial level. So menopausemeaus you haven't had a period. And when your post menoposamis you haven't had a peer in
one year. Perimenopause is that time leading up to menopause. And then perimenopause really can start anywhere between eight and ten years prior to your final menstrual period.
So women, that's an elongated right in a bad mood? Well, I mean that's what you hear. Everybody is in a bad mood.
Think everybody reacts differently, right, I mean, I think everybody has their own different types of issues as their hormone levels fluctuate. And that's actually an interesting question is in itself. Why are some individual symptomatic and others not right?
And could that be also because if they were taking hormones maybe that would prolong good health or of course, and that's when I phone the actual menopause.
Right, that is one of the big questions that I have actually just as a practitioner. If we start hormones earlier, can we stave off some of these cognitive changes that we see because right at the time of perimenopause and menopause, we see real changes in the brain. The brain size changes, the blood flow changes, the metabolism change them. You can
see it on scans. So if we start hormones earlier, especially at women who maybe elevated risk of cognitive issues and that type of thing, if we start earlier before fluctuations really set in, can we actually stave off these issues even better? And those are big questions right now that are not just now being asked and beginning to be answered based at a basic science level and at a clinical level also.
So are you giving brain scans to women now on a regular basis?
There are research protocols where people are beginning to do that, looking at MRIs of the brains, looking at brain size, brain processing, this type of thing, and that's very kind of elevated testing.
What about physical tests physical.
Test Well, certainly in terms of cognitive testing, there are definitely physical testing. But by the time you have manifested any of these physical symptoms, and I'm just talking about brain health as an example, we could talk about every organ system. But the time you've manifested, you are transitioned into a disease state. So we want to keep you from transitioning into a disease state. We want to cut we want to prevent anything.
Early detection, early examination is best.
Yeah, and early prevention.
So like what age would you say a woman and should start really considering this?
So I think you know, women between the ages of thirty five and forty can begin to see significant hormonal fluctuations and really need to pay attention to their symptoms. Right now, we don't have great laboratory testing. Again, this is an area that I'm super interested in, is can we really begin to define when estrogen levels start to fluctuate or progesterone levels start to decline with our current
testing that's really well accepted. We're not really there yet, and we have to listen to narratives, And this is why doctors need and physicians and healthcare providers really need to listen to the patients that they're caring for about. You know, may have a little more anxiety, like some of the earliest symptoms of actually hormone changes, a little bit of anxiety, maybe a little shape shifting. You don't even have to gain weight, you just get a little
thicker in the waste. That may represent an accumulation of what we call visceral fat, which happens as estrogen levels start to decline. May have a little new anxiety, libido issues actually or early worn early symptoms of estrogen fluctuations, vaginal dryness at certain time points of the month, actually a cycle maybe, So we need to listen to our narratives of our patients to really kind of determine where
they are in this transition. And then it'd be great to have some laboratory testing too.
And women should be a little bit more open with their doctors. I would say, are women are still a little shy? I think sometimes I think so physical being.
I think some that's changing.
I think thanks to social media and the internet and more conversations. You know, I realized during COVID actually that when we were having these kind of anonymized zoom meetings and things like this with patients and speaking groups, that women talked a little bit more freely. And now they can get information a little bit more easily, so they might become a little bit more open. And this generation of women now who are transitioning through menopause are very
open about it. And that's great because that's bringing all of this conversation to the forefront and helping women to open up about it. But still you still have to elicit and ask questions, do you have pain with intercourse? Do you have vaginal dryness? People don't always volunteer that information. We have specific questions that we ask our patients.
So it's up to the doctors as well as the patient's Absolutely we have overt and uh open about all this. There's so many other questions to ask a guidecologist of your stature. What is the current guidance on frequency of mamograms?
For example, most professional societies actually recommend a yearly mammogram. Still AI is going to help that, I hope actually in terms of in terms of looking for pattern recognition, I mean, AI is like so great looking at pattern recognition, Like, we're at a point now where we can look at an EKG and this was just brought to my attention, and that AI group can look and that the machine learning can look and say it's a male or female EKG. There's no physician who can do that. So now we
have all this great pattern recognition. So this is really going to contribute to our screening. But most people still recommend a yearly mammogram and of course a breast ultrasound if you have dense breast and if you're at elevated risk, consider a breast MRI.
And what about pap smears.
Pap smear is a little bit less on the guidance in terms of the frequency is recommended now every two to three years if you haven't had an abnormal pap smere or HPV negative testing every five years if you're over the age of thirty and HPV negatives.
So I used to be every visit right.
But there's guidelines are for population health, right, and so it's always like I always, I think it's a conversation between the individual and the person who's taking care of them.
Of course, copies seems like everybody is prepping for a kolonoscopy.
Well, so colonoscopy.
We've decreased the age of recommendation of kolonoscopy down to forty five. That's because we're seeing aggressive colon cancers and younger people. We're not quite sure why, but definitely colonoscopy has remained the gold standard. But there's also there's liquid tumor biopsies looking for fragments of tumor DNA in stool samples and such, and also in the blood. And so these screening modalities are also poised to contribute.
To mail order stool samplings. That right, I mean you could just you can just put some poop in a in a tube and send it off in the mail.
Right.
Are those accurate?
They are very accurate.
They are not well accepted for an individual who is known to be at elevated risk, such as.
A family history or a pre do that, you know, they're extremely accurate.
They're a little scary to me.
The easier that we can make a screening test for somebody and the less invasive that it will be, the more acceptable that it will be. Overall, and so, and I think again we're moving as we get as we have more molecular diagnostics.
And I always worry about the temperature, and if it's one hundred degrees outside, well, any symptoms disappear, you know, That's what I think about if it's in the mail. For us, ever, are sitting in a hot truck for four days, right.
We're looking at fragments of DNA and such, and so that's pretty stable.
Actually that's stable. Yay? Stable? So can you break down by decade? This is a this is a kind of a hard question. How should women adjust their medical routines and health habits. Let's just say in their late thirties forties. What do you do then?
So, for for many women in their late thirties, they're completing child bearing if they've chosen to have children, and are focused less on reproduction and more on now focusing attention a little bit to their own health. And some of us need attention, need to do that, and because we all have busy lives or we're taking care of children, or we're taking care of our families, or we're working. But this is a time after child bearing, right to
really begin to focus and focus on health. And that is healthy exercise, making sure that you move every day, healthy nutrition, staying socially engaged, stress management, paying attention to sleep for a lot of people, which is also very difficult. But you know, late thirties early forties time to just establish your patterns and patterns of good health and also listen to your body. What's your body telling you? You know, we don't talk as physicians about this enough. Like your
body will speak with to you a little bit. Sometimes it whispers, but it'll tell you when things are a little bit of wry or not wrong. So I always try to tell women, you know, if you feel like something's not right, bring it to the attention of your physician. So thirties and forties are where you're started to listen to your body and establish good health habits and get into the to the routine of making sure that you
get a yearly exam. See you see your physician once a year, have your lipids checked, have your hemoglobin A one seed checked, find out what your baseline is and where you're starting from, and then grab onto some good health habits to age with strong and what you do.
So fifties are a time where really estrogen levels are really declining, and so thirty five to forty to to the late forties, right, we're starting to we see estrogen fluctuations, but we really see estrogen levels start to decline in the early to mid fifties. And so again that's paying really close attention to your symptoms. Knowing your family history, know your family history of cardiac disease, know your family history of dementia, speak to your health care provider's hormone
support right for you. Paying attention to maybe not feeling yourself. I always as my patients, you know, do you have you lost your JOI de v You know, you might say I'm not, I don't have anxietyor depression.
But you might say, you know, I don't feel like myself. I don't.
I don't have the same confidence when you while I walk into the boardroom, Am I having any word finding difficulty? It's really about how am I enjoying my life?
You know?
These are all just very subtle things that we as physicians don't always ask, but these are important things to ask yourself. And then if you have any of these issues and they're new for you, something that's new or different from you needs to be addressed. Actually, sixties sixties that's a time to really double down. I think on nutrition, exercise, mindset, stained socially engaged, making sure you have a great sense of purpose.
Of course, having all of your testing that.
You would normally have with blood test, I failed to mention a coordinary calcium score. But know your family history of cardiac disease super important. But consider advanced testing in terms of more advanced cardiac testing in the fifties and early sixties, pay attention to that, of course. Also the sixties are where we have to, I think, make a real concerted effort, Like I am going to exercise every day. I'm going to do one hundred and fifty minutes of
zone two cardiac. I'm going to do strength training three days a week. I'm going to make sure that I'm eating enough protein because we tend to lose muscle masses we age, so we want to make sure we ramp up the protein, decrease the carbohydrates. Maybe a little bit in nutrition a little controversial with that, yeah, but definitely ramp up the proteins. And how you adjust that with your carbohydrates, that's your choice, but.
Definitely ramp up on protein.
And then I think it's really like I said, sleep is really important, becomes a little bit more difficult to sleep as we age, and so what.
Should one do about that? I mean, this is so many people are talking about, Oh I can't really sleep. I can't.
One thing that's really important is realize that sleep is an active process. Realize that it's something that's really important. It's not like you just go to sleep and your body's not doing stuff. It's doing really important stuff, right, So scheduling sleep, making sure and we all know sleep hygiene, you know, turning screens off, giving yourself an hour of wind down, you know these things. But also I think it's really important just to get in that mindset of
training your body to realize that sleep is important. And also I just recently got an aura ring. You're supposed to wearing a four PingER. I get data on my ring finger. But what that showed me which was really interesting.
I mean I have a million degrees from all these Ivy League educations, and I didn't realize that being in bed does not mean that you are asleep, that you are sleeping exactly, or a ring gives you or any of these wearables whoop or any of these give you insight into if your sleep is disrupted.
Or by the way is, Oh, you are a and I just got one. It was too small for me. So I'm waiting for my new one to come because i want to wear it on my forefinger. It is, and I want to I'm dying to see what my horrible sleep habits.
It will give you a lot of insight and then you can see, like, you know, does a little bit of wine the night before does it disrupt my sleep? And you'll be amazed that like two ounces of wine will actually lead to some sleep disruption or you know, I'm always amazed at the heart rate variability actually correlates with my stress.
Actually, it's really so. It gives you good insight into when you sleep better? What did I do the day before?
What to do correct exactly? That's what I'm looking forward to to really determining with mine. So what should we do in our seventies.
I think similar to the sixties. I mean, you just you really want to make sure that you are really focusing non nutrition, exercise, sleep. I think even more so sense of purpose and social engagement becomes really important in the seventies. I think that we need to you know, we live in I always say it's a great time to get being getting older in our society right now, because I love all the older Instagram accounts, I love the older the magazines that are for individuals post fifty.
I think it's really great. In the past, we wouldn't have seen these.
Public AA and what else.
Yeah, oh, there's there's a few others actually that don't have retired in the.
Title because AARP is like that retired shouldn't be there, because yeah, I encourage people never to retire.
I'm not retiring. No, yeah, don't Yeah, I'm not retired never.
But I think that's why that sense of engagement and purpose becomes really important, because a lot of us will exit the working fields, and I think that we have to really focus on community, sense of engagement, sense of purpose. These are all if you look at the common denominators of individuals are centurions, and they are people who have a great sense of purpose, a great sense of optimism. They remain socially engaged. So got to do all the
other good stuff with nutrition exercise. Protein exercise becomes even more important because you want to really maintain muscle mass and don't want to become frail, and because that has its own set of issues. But that maintaining of that social structure is so important and sense of purpose is so important, and then eighties, same thing, really the same thing, and I think, you know, just really maintaining that all those great health abb is that you established.
It's harder and harder to find doctors to take care of you as you get older. Being involved with the Center for Living at Mount Sinai, I learned that geriatric medicine is a medicine that for a while fill out of favor because doctors didn't want to deal with elderly people. But now with the aging population, it's starting to become
a more interesting field of endeavor for doctors. So I hope more and more go into geriatric medicine because we need to really deal with all of those as we get older and not feel bad about getting older.
It's great to get older. You want to age strong. You want to be you want to age with strength. That's the title age strong. You want to be strong as we because you're getting older. The opposite is no good, right. You want to get older. You want to be chronologically older and biologically fit and a little bit younger. And I think that this is a great time. I'll always
say it. I think we're aging with more optimism now, and I think we're on the cusp of really changing that whole approach to medicine for older individuals.
When it comes to longevity medicine. Are there specific considerations for women that would be different from men.
Totally in terms of longevity. You know, we're just now realizing the importance of estrogen to basic issues such as dementia, cardiac disease, and cancer. Right, these are the three things, the three issues they associated with aging. Mitochondrial support and inflammation are issues as we age, right, or mitochondria aren't as strong. Those are the little powerhouses that make energy in ourselves, and we have more inflam so we really need to pay attention to ways to mitigate that.
Well, how do you because inflammation, I think is a big problem. I feel it.
Yeah, that is a strong foundation in nutrition, exercise, good mindset, keeping your cortisol levels lower, so managing stress super important.
And then I'm going to say.
It estrogen, right, because estrogen is an anti inflammatory, it's an antioxidant, so that will definitely help. There's some evidence that actually estrogen directly impacts on the mitochondria. So what's new in longevity medicine is that we're we.
Are remembering that word everyone medachondria.
Yeah, that's really important.
They're what we're realizing is that women and men are different and and that will translate over at the cellular level also in terms of how we respond.
Tot Oh, of course, that's what I want to know.
I think, you know, women, so women live tend to live longer than men, but we live currently we still live in more years of being unhealthy. We have fewer years of active health than men.
Do.
We really have to get to the bottom of that and why that occurs. And that's you know, because we didn't have women in research until nineteen ninety three and I AGE did it and mandate at female animals until twenty sixteen. So we live more years in poorer health than men, but we tend to live longer. But the idea is to get us to get to better health. Actually for those all of those years.
Let's get real about midlife metabolism and women. What happens to our metabolism as we age?
So as estrogen levels go down, we do this shape shifting, right, so we begin to deposit fat in the visceral areas or the abdominal areas, so around your liver, around your heart, and your stomach. Basically, so the fat are adipocites that live in the hip region and buttock region actually begin to not migrate, but shifts into to the visceral area. That becomes an flammatory and then that leads to what we call insulin resistance, so we have metabolic disruption, so
and that also leads to more inflammation. So it becomes a vicious cycle of low estrogen levels, visceral fat deposition, inflammation, more visceral fat deposition.
Meno pot.
I wouldn't use that term because I am a professional, but there is that term that is definitely circulating. Yeah, I wouldn't use that, but that is definitely circulating around and that does refer to our waste to hip circumference ratio increases, and that's actually a better measure of what's going on in our body because one term that we do use is called skinny fat.
You can be abnormal weight.
Or of normal BMI, but all of that fat can be in your abdominal area and that's unhealthy and that leads to this what's called insulin resistance and weight gain.
And eat of watermelon a day. I just read that's a new hack. Just eat a watermelon a day and you will not ever get fat in your stomach. Well, that just came over the you know, that was on the Instagram the other day.
But that reminds me of the old pineapple diet for the nineteen seventies, of which I ate so much pineapple that my mouth was about to fall off. So yeah, I don't think eating a watermelon a day.
I don't either. But sleep habits are of ultimate importance.
Sleep is really important. Sleep is really important to cognitive function. Less sleep equals worse cognitive function, it equals higher when people who don't sleep have a higher risk of dementia. It is, like I said, it is an active process. We're clearing our brain waste products. There's a whole system where the way lymphatic fluid circulates around the body at night.
So you think that when you're sleeping, all that is going away.
There is, there's active So it's an active process. It's like it's an active process.
It's not bunk, as my grandfather would say.
No, And it's really really, really important. And I actually did a course for a malpractice carrier recently, and it was all about sleep and cognition and cognitive function. And there's been a lot of studies and physicians that we make poor diagnostic when we have less sleep, and it's really so there is an activity that is going on in our brain as we sleep.
Is there a connection to cardiovascular health? How lipids and cholesterols start to change at this age and beyond.
Certainly in terms of there's a link to sleep in cardiovascular health because when we don't sleep, where we live in an inflame state, and that's actually bad for cardiac health. And in terms of cardiac health and lipid metabolism are extremely linked. And at midlife our lipids change in our cardiac health changes.
So what are some no nos in terms of diet for anti inflammatory?
Get rid of processed food.
So anything that has more than three ingredients on it is probably a processed food. Shop the periphery of the supermarkets. Eat freshole food and don't use added sugars. Sugars are super super inflammatory. The sugars that you get in fruits and berries actually are fine because they come with fiber, but the sugar that's just added into something is not good at super inflammatory.
So you don't eat any sugar.
I really minimize it, really pay attention to that chocolate, dark chocolate. Dark chocolate's great for your brain, good antioxidants. So no, no sugar.
Coffee.
So there's one hundred studies trying to prove that coffee is bad for you, but no studies have shown that it's really bad for you. They tried to link it to pancreatic cancer at one point that was not successful. So I can't find anything bad about coffee, and coffee has antioxidant's good for your brain.
Especially teas are okay. Also same thing.
You just have to watch out for your caffeine content, especially with teas. Also, you just want to drink a tea that's caffeinated too close to sleep because that can really be a disruptor for your sleep.
Diet coke, oh.
So yeah, that would be a processed food.
More than three ingredients. Those are the things that people forget. They think that that's just water.
Yeah, and you have to look at artificial sweeteners and the impact that they have. A lot of physicians, especially surgeons, have big diet coke habits. And I stopped diet coke a while ago, and when I was actually stopping drinking it. I actually had like some mood issues and I was like, this is so weird. I'm like, everything's great. I shouldn't have any mood issues. And then I start reading about I was like, oh, I'm withdrawing from all the aspartame.
When I read about artificial sweeteners or actually, my daughter pointed it out to me. She had listened to an interview with the man who invented an artificial sweeteners, the most popular one, and he said that if he could do it all over again, he would never invent it. It's interesting because it's so dangerous for the human health. But I don't use a lot of sugar, but I do like dessert.
So there's a ninety percent rule, right that we have got to enjoy life, right, you know, just don't need a lot of chocolate cake or eat a lot of cake all the time.
You know, but what do you use? It's nice to enjoy.
Every now and then. So how do we deal with mental health and mood and women's health.
I think that we need to be really attuned to it. And this is where as health providers and specialists in women's health, we really need to key in on that that so just can be a simple question about how are you feeling? Are you feeling any different? How are
you feeling? That goes back to those JOI de v questions, And I do think that we need more mental health providers that are keyed into midlife women's health and really understand these changes that occur because estrogen and progesterone really do affect the neurotransmitters. I mean, there are real issues that are medically happening in the brain as estrogen levels
are fluctuating. We see that also in women before midlife with PMS and PMDD and postpartum depression, and the treatments of these issues and recognition of these issues definitely warrant further study and for their higher numbers of individuals involved in these specialties.
Is it true that women are at higher risk for dementia?
Yes? Two thirds of Yes, totally.
And this is one area that I'm super interested in actually and is gaining in popularity in terms of interest, And because why is that? Is it hormone fluctuations? Is our lifestyle what makes us more susceptible intimasions? A lot of individuals are looking at the role of hormones on the female brain, and we are moving in that direction. Lifestyle factors are also being looked at, but that research
is really accelerating and it's super exciting. And this leads us back to, you know, can we identify women who are at high risk and then get hormone support or lifestyle support initiated earlier?
Are there lifestylent interventions that one a woman can take?
Absolutely anti inflammatory nutrition, making sure that you have your homoicystine levels checked, which is inflammatory for the brain and the heart.
Good stress who does that? Who?
Generalists can do that? Check? You can add what is it's a blood test?
There?
These are blood tests and is what do you ask for?
I would ask for just a general metabolic panel. I would ask for homoicysteine levels and that's not all generalists will do a homicistine level but super important, super and I think that we are at elevated risk for dementia and cognitive issues, so we need to be a little bit more aggressive in our female population. But definitely early identification of individuals who may be at elevated risk and warrant more intensive interventions. And then for individuals who are
not deemed to be at risk. We are all at risks because we're all women, you know, so, but just paying attention close attention to lifestyle factors and those subtle hormonal issues that you know. And one of the first signs of perimenopause is like word finding difficulty. Sometimes I'll ask people, you know, is your memory off, and they'll say, no, it's not really often. So are you having any word finding difficulty?
Oh?
Yeah, I can't remember names the same way. So what we what we call associative memory or coordinating like like things or faces and names and such starts to go off a little bit and word finding goes off a little bit, and that can be correlated actually with real changes in the brain structure. So these are active areas of research and are just.
What can one do about that?
Again, review it with your position. Maybe are your healthcare providers. Speak to your provider about maybe starting on hormone support earlier if you're considering it. And I think this is one one thing that I'd recommend to people. Also kind of get your opinion on hormon support. Are you going to go in that direction?
Yes or no? Right? And then you know, educate.
Yourself early, be reactive to it, be proactive actually and then, of course, lifestyle interventions. We know that lifestyle interventions in terms of stress management, nutrition support, supplement, targeted supplement support, and exercise can help with brain health. Interestingly, when we move skeleton muscle, we release a hormone called a risin.
Actually, so when we just move.
Skeletal muscles, I don't even know, so.
It's a myokine. Of course, it's a myokine.
So it's a substance that's produced by the muscle that when you just move muscle, it's a substance, a chemical substance. It travels throughout the body into the brain and increases your brain function and structure.
Actually, I did my pilates today. Why did I move some.
Yeah, that's piloates.
Great, Just moving skeleton muscle will help your brain. And we're getting the scientific so to provide context to it. We can always tell people like what to do, but why to do it? Actually will help people.
I like that. I like that. I mean, we're reasoning. My trainer did not tell me about that, but I'm going to tell her about it because there is a a reason for doing the six thirty am pilates. As an oncologist, do you have any insight into why we're seeing a rise in cancer in younger people.
Why, you know, I don't think we understand that now. I mean obvious targets are nutrition, social stressures, social structure leading to increased stress, nutrition, environmental exposures. A lot of people will point to nutrition right now, but I have a lot of patients in my practice who practice excellent nutrition who have had early young colon cancers and are not a lot.
But a few. Why is it something else in our food, in our environment, in our water.
Well, we also have to look to our microbiome. Is our microbiome putting us at risk? Which is intimately linked? So that's all The bugs that live in the gut are really important, you know, is our microbiome at risk from our modern lifestyle. I don't think we have those answers yet, but those are kind of the targets of where people are looking right now.
Good research going on.
Definitely lots of good research going on.
So now this is a new project for doctor Poynter. She has recently left her beautiful gynecological practice in a private office with lovely help. By the way, your your ultrasound woman was so amazing, you would go to doctor Poynter's office and you would lie down on the table and you would have your all your organs ultrasounded right, and it was I really liked that because it was such a nice way to start an examination, knowing that there was nothing to look for.
Empowering, right, It's very empowering.
And doctor Poynter has left to join Atria. It's a it's an organization started here in New York City. So describe Atria.
So Atria is super unique and poise to I think make some really big contributions. Leaving my practice was like literally ripping my heart out of my chest voluntarily.
It was such a personal practice and your offices were so personal. It was a unique place.
Thank you for the compliments of the office. So Atria is a multi specialty group. So I work next to the smartest brain health people, the smartest endocrinologist, the smartest cardiologist. We have nutrition experts, we have exercise experts. We even have a naturopathic physician who has involved in integrative care.
We all work together and it's a real cross fertilization of ideas and how to approach clinical issues, further research, and also we are involved in patient care, and it is the way that the world of what we call primary prevention is going to move forward.
It is a private organization, so.
It's not bound by many of the constraints that will happen in an academic setting. However, every physician who is there has a very strong academic and research background. We have strategy specialists all working together to help formulate and develop a new model for how to deliver care and how to deliver primary prevention because we want to be proactive, we want to be predictive. We want to get things before disease happens and before disease transitions, or pick it up at its earliest point.
How does one find out about ATRIA?
So we're online of course, and a R I A. We have two locations currently New York and Florida. I have to pinch myself a little bit that I'm there because I work with the smart, very smart people, the smartest people I've worked with, and it was a lot of the work that I was trying to do on my own in my private practice, and I realize that I can't do it all by myself, and I need help to further the cause. Right, And so we're all working together to further the cause of primary prevention medicine.
I think you'll see more in the future. Atre is just getting started. It is just in its infancy, and we are still in it two or.
Three years old. It sounds like such a good way to learn about oneself and know about oneself for the future. I mean, you know, at my age, I really need to know a lot.
Right, and I think we're we're collecting the information on how to get that to everybody in the future. And how what do we need to know, how do we need to know?
How do we intervene?
And this can only happen with a multi specialty group that is nimble and can ask questions quickly and adjust and readjust as needed.
I got very interested in blood in the last five years, so I will have a blood tist of complete you call it what do you call it? Big?
You say chemistry profile?
And I get a choice a year and I look at it and it's so funny how some things go up and some things go down. Accounts go down. Is that because the testing is different or is it because the laboratory is different?
OK?
I'm not an expert in any way, but I just like to see that I'm pretty stable and within the parameters of good.
Health, there's variability. There's variability in the human body. We react to our environment, right. Our body is constantly reacting, readjusting, right, So if you.
Take an iron supplement, it's going to change your iron and your blood.
Correct and it's the human body is dynamic, so you know, and you have to look at trends over time. We look at trends over time. We look at not just individual components of the blood, but how they're interacting together.
And this our AI is really going to help us in exciting.
Wages to see that. Yeah, yeah, well, this is so fascinating. Your practice has expanded exponentially with this new adventure that you've joined. Very interesting to learn more about the challenges facing women in each of their decades. We have to pay be very aware of women listening about this, and so to men. It's a very interesting time in medicine, and I applaud your efforts. It's really great and I look forward to your book.
Thank you so much for having me and allowing me to speak today. I think we're at a great time in medicine. We're about to crack through some issues.
Well, that is excellent to know. Thank you, doctor Pointer.