Amy Alkon Reclaiming Your Vitality in Menopause

Nigel Rawlins: my guest today is Amy Alkon, an award-winning investigative science writer who specializes in science help. She does a deep dive into the research, critically evaluating it, and then translating it into everyday language, allowing us to make scientifically informed decisions for the best of our health and wellbeing.

Alkon's new book, her fifth, came out on May the 20th is called Going Menopostal, what you and your doctor need to know about the real science of menopause and perimenopause. The book not only exposes the shocking gap between the scientific evidence and the medical practice standards in women's health, but in all of medicine, as well as how to overcome it and get the evidence-based medical care that we all expect and deserve.

Amy, welcome to the Wisepreneurs podcast, can you tell us where you're from?

Amy Alkon: I am from Detroit, Michigan, where the cars come from, and I live in Venice, California. I lived in New York City before, and Venice is fabulous. That's where I'm coming from right now.

Nigel Rawlins: fantastic. And you've got a dog there, I think. Have you?

Amy Alkon: Yeah, she's a Chinese Crested, so basically the wolf from Jack London crossed with my little pony. She's six pounds and very mirthful and adorable. Very loving.

Nigel Rawlins: Now I'm really intrigued about some of the information I've read about you or some of the blurbs that you got started on all of this health advice and advice, as one of the advice ladies, can you tell us more about that part of your life?

Amy Alkon: I, I'm a crackpot. What can I say? I'm live this madcap life in New York. I always have fun. You can make really a lot of things fun, even standing in line at the drugstore. And so with two friends, we had this idea that we would make New Yorkers laugh. We would sit on the street corner, um, in Soho. We had a magazine rack as a table.

I made a sign that said Free advice, presented by the advice ladies and all these topics. And there were things like, you know, the, like directions, proper spelling, you know, I, I didn't have any kind of expertise in anything. Um, and then we thought people would walk past us and laugh. And New York, the sign says free.

They'd line up around the block. So, uh, you know, this, we, we started giving us advice every weekend. It was wonderful. And then, people started asking us questions that were meaningful, you know, that where you need to know something. So I read through all of psychology. I've always been this, this intense reader.

And so when I saw Freud just made stuff up crazy. And I discovered Albert Ellis, who's one of the co-founders of Cognitive Behavioral Therapy, he is, his branch is actually better. It's called Rational Emotive Behavior Therapy. That basically you're disturbed because you're thinking irrationally. And um, it comes off the ideas of, um, he was influenced by the Stoics,

Epictetus in particular, who paraphrasing said, it is not events that disturb us, but the view we take of them. So a rational view would be, this thing that happened, I prefer it didn't happen, but what am I going to do about it? And not to say things like, it's awful and terrible and horrible and catastrophic because you know, you're like a chicken with your head cut off going hysterical, and that's not gonna help anything.

It's gonna make things worse. And so from this, I started to, um, read science because I also felt a responsibility. You cannot just give people advice, pull it out of your butt, basically, because it's not right. Our intuitions are often wrong. So, I read and I read Richard Dawkins, uh, the Selfish Gene, and realized that evolutionary theory, evolutionary science, was foundational to all science, and that science is empty without it.

And so, you know, these conclusions well, okay, you came up with this conclusion. Why would this have evolved to be, you know, a feature in our psychology? And so, um, we're basically working now in modern times with an antique psychological operating system. So we're adapted for ancestral era, uh, times, and it's sometimes a mismatch with the times we live in.

And now people say this thing that makes my head fly off and explode. Um, oh, evolutionary psychology is just-so stories. No, it's not because nobody likes us in psych world that the rest of psychology, this is the most rigorous, uh, social science research there is. And, um, EVs psych pioneered, uh, what's called, um, non weird research.

Where is Western elite? Oh, I'm not gonna remember all the things, but, but basically testing college students in America is not giving you the substantial truth you need. And so you have to test people across cultures. And David Buss, who does mating research first did this in 1986, or 1984, with his massive mating study across cultures, where he found that what people prefer. So men preferentially look for women to be attractive, and women preferentially look for men to provide, to be providers. Not, that's not all the top wants for both men and women are intelligence and kindness.

But the evolved preferences have to do with how, um, women have a very high cost, from any sex act potentially of getting pregnant and then what the guys run off, you know? So you're not, you're not able to raise your kid, feed your kid, especially in ancestral times. Um, and then for men, if you have sex with grandma, well, you're not gonna leave any descendants.

So men prefer throughout their lifespan, by the way, men prefer women in their twenties. Doesn't mean they can get them where they wanna talk to them, you know? Uh, but that's, that's the, that's the preference of, of men. And so this, you know, was where I started. I was giving advice, relationship, love, dating, sex advice in newspapers, science-based.

And then, um, I wanted to be as good as possible at, at, at making sure the research was valid and reliable. And so in 2007, I met an epidemiologist and biostatistician, who's one of the top in the world, co-authored the seminal textbook in the field. He's very generous, and he began coaching me informally in how to vet science. And he also would send me all these articles about the medical fraud and abuse that, you know, devices implanted in people that didn't work and were harmful and that the research had been buried on that. Um, one of the things I bring out in my book Going Menopostal is pointless knee surgeries.

So they discovered they did fake knee surgery and real knee surgery of the laparoscopic chimey incision. And then for some of the patients, they just, they made the incision and poured some saline on so it seemed like they'd gotten the surgery and there was no difference in the pain level between the people who had gotten the fake one and the real one.

So this is 2002. 2016 I think it was, my knee was hurting and I went to my provider, Kaiser Permanente in America, and the, orthopedic surgeon or you know, bone doctor. Um, I, I can't believe I'm not remembering that right now.

But anyway, he, um, said to me, oh, well, you know, if it keeps hurting we can do lapa laparoscopic surgery. And I thought, well, no, we can't, not on me because I've read the research. So this is, this is 14 years after that, that study. If it was 2002, I think it was either 2000 or 2002, and this guy's offering the pointless knee surgery.

So I, I have medical care that has coverage, but if you don't, so you're paying for that. You're laid up, you need, you need physical therapy, you're damaged. Surgery always has risks, you know, and so this is terrible and this is, you know, what I would see from the articles he sent me. So I ended up, um, you know, having a different approach to any kind of medical issue.

And, and that's how I approach this. And that's why this book exists. It started with a hot flash, basically.

Nigel Rawlins: We've got a very different system of medical care in Australia. It's, uh, it's, you can have private medical care. It gives you extras, but we have free medical care, so we can go to a, a local, doctor. We may have to pay a gap fee. Um, but if we have an accident, we are straight into hospital and cost nothing.

We're very, very lucky. But we could have the same issue in terms of medical knowledge.

Amy Alkon: Oh, you definitely do because this is, this is medicine around the world. It's med schools, medical education, and medical institutions. They're at fault here. When I started the book, uh, I was angry at doctors and, you know, and I still, I still am. I'm getting some really, I mean, just absurdly unscientific care through Kaiser Permanente right now.

I have to fight and fight. It's ridiculous, 'cause I know the science and these doctors don't. The big, the big secret of gynecology departments around the world is that these doctors, they're mostly baby doctors. They have no training or expertise in menopause and perimenopause. And so it is against medical ethics for them to treat you.

It's really terrible. And, um, they, this is gynecology as usual, so they just have them treat you. They should refer you to someone who's an expert, but there really are no experts. And then here in America, the ones who say they're experts like this, there's a doctor um, who's just doesn't even show up for appointments with me. It's so amazing. You get ghosted by your doctor, like twice. You sit there telemed, I'm sitting on my computer hour, I leave it on all day on Zoom. She never shows. Then the next time. How do I, how do I get care? if

It's crazy. But she's supposedly their menopause expert. I understand why she doesn't wanna show up to appointments with me, because when doctors say something about menopause or perimenopause science, I have spent eight years sitting in this chair where I'm right now doing this deep dive into the research and the physiology and i, I had to learn endocrinology, I had a British med school textbook pinned all over my walls in my bedroom. Then I take the pages down, put up more pages, you know, learn them. And so doctors don't learn this steeply. So I know more than they do. They'll say these things to me, uh, that are just unscientific and wrong.

Um. And so, you know, the, the, this is the, this is the betrayal. And patients don't know because they don't know when doctors are wrong, for example, um, I had a doctor say to me, I, I have what's called high sex hormone binding globulin. This inactivates much of the estrogen that I take. So I get between that and I have some other, I have a liver enzyme called the, we, we, we have a liver enzyme, the CYP P three A four liver enzyme.

Um, in me, I'm a rapid metabolizer. I had pharmacogenetics done, which is genetic testing to see how your body and drugs react, your genetic makeup, how that influences how you metabolize drugs. And so I get less than half the estrogen I take. And then I have ADHD, I'm diagnosed with that. And, uh, you know, whether it's the, the bright lines in psych in psychiatry are another thing I take issue with.

Like, oh, you have this single disorder, you have to be called disordered. I'm not disordered. I just, you know. You know, untidy. But, um, my brain is really something I, I love and appreciate because I put together these connections that other people wouldn't. But, so you need to be diagnosis disordered in order to get drugs.

And so, wait, where was I going with all of this? Oh, so that I take Modafinil, which is this drug that they came up with for airline pilots to stay awake. For me, you know, I, I take amphetamines and modafinil. I can take a nap. It just, it, it slows me down so I can focus. And so modafinil though, it decreases active estradiol by 11 to 18%.

So I, um, basically I take this estrogen, my body basically takes it and throws it out the window. And so these doctors, she and the other ones, they say, oh, we, we don't wanna give you a super physiologic dose. Okay? So I take one milligram of Climara, it's a transdermal estradiol, have a patch, a sticker on my butt.

Super physiologic means you take way too much. You know, I'm not looking to replicate myself as a fertile young woman. I'm 61, but when I take that, that dose, I get half of what other women take and, and you see it, the pharmaceutical minimum for putting it on your butt is 71. My estrogen test out the 45, and that's not even free estradiol.

It's just total. Free estradiol, mine's like in the tank. So what I want is to take a double dose. So I can get a normal dose and not super, and, but they call this super physiologic and then they also say, oh, you know, we're afraid you have heart disease risk. Well, no, I don't. If you look at my metabolic health in total, you, you would know that.

But you know, I have high LDL because I eat a carnivore diet. And so this, this doesn't mean you have unhealthy LDL, your body, you're taking a lot of saturated fat. So you're clearing a lot. I have actually these sort of superhero metabolic stats of like so good for heart disease, a good ratio of triglycerides to HDL, which is the most determinant factor.

You know, you can look at that and, and know if you're, you know, if you have heart disease, pretty much. Um, my triglycerides are 30. My HDL is 79, and so a good ratio is four. Mine's oh 0.4, you know, uh, c-reactive protein, you know, one is good. Mine's oh 0.3, that's, that measures inflammation in your body. So all of my stats, they're stellar.

They're, they're like extraordinary off the charts. And these people who don't know anything about heart disease, medicine's very unscientific, um, they're, they're making all these, you know, basically coming up with fiction about my medical situation. So I'm having to fight and fight and fight it. It's truly terrible.

I, and I just wanna get into just because I, I realize I didn't mention this. There are three big myths about our medical care that we believe, and one is that doctors, um, make decisions according to scientific evidence and that they can read and evaluate it. The other is that they're trained in diagnostic reasoning, and the third is that they can properly assess risk.

And none of those are the case. Doctors don't learn to read research in, in med school. They're not trained to do it. They don't know how to do it, and they don't have time to do it at a medical provider like mine, Kaiser Permanente, where, um, they're seeing patients every 20 minutes and have electronic medical record keeping requirements.

So basically, I put out my book Going Menopostal because other women need to have this information that I have that I can use to drive my care. And they don't. And really we need this for every area. My friends Gary Taubs and Nina Teicholz have done this for low carb and there are others too. But every area of medicine needs some kind of nerd like me, crazy scientific mole rat,, dig through the research for eight years and put out a book saying, here's what it is.

Because there is no area of medicine that is evidence-based. And that sounds crazy, but it's true.

Nigel Rawlins: What I'm hearing is you have an amazing knowledge of how your body works, and I think we're, we're probably not advanced like that. I think you're able to get a lot more, um, testing done in America with your blood work and stuff like that than we do here. Um, for us to get that amount of testing, we'd have to go to our local GP and then find general practitioner and then find a place that will test that blood.

I think you've got a lot more services in America, but you have an amazing knowledge of, of your physiology and how your body works, and also the intellectual power to understand what that all means.

Amy Alkon: Thank you. But I also, I, I wanna say, I also understand, you know, medicine across the disciplines, and this makes me different from doctors. So with friends, I do this all the time. I look at people's labs, um, the, the lab tests here, and I will evaluate them and tell them what things really mean because the doctors don't know, it's really terrible.

Uh, you know, and I'll have to correct, uh, you know, the, the errors in, in the, in the labs and then the things they wanna prescribe, it's truly terrible. And so, you know, but you need to be able to read the research. I had a corneal endothelium transplant for my eye, and the medication they give in that field, throughout the field, they give people medication with preservatives. They're, they're probably gonna ban them soon in Europe. They begin destroying the corneal endothelium and goblet cells in a matter of days. Sorry, epithelium, not endothelium. And, I mean, and you can get drugs that don't have the preservatives. So instead of a, a floxacin, you can take moxifloxacin, which these names they kill me, um, which is a generic, about the same price and just doesn't have the thing that destroys your eyes.

This is an antibacterial, so you know, this is every area. It's very disturbing.

Nigel Rawlins: And, and yet the average person would have no knowledge or even think about it 'cause they trust the doctor. Okay, your book Going Menopostal, obviously you've had that experience and you've done the research, but what would you say is the single most important truth that women need to understand, to begin reclaiming their health?

Amy Alkon: The same, I'm, I'm always bad at these ranked things like, what's your favorite movie? I immediately have no idea.

Nigel Rawlins: Oh, where do women start? The book Menopostal, you know, it's come from your deep experience

Amy Alkon: Oh, no, this isn't, I have to correct you, it's not my experience. I mean, I experienced this, but no, it's from science. What I did is look at the science things that don't affect me. In fact, in first, my first pass of the book, I didn't have any chapters on cardiology because I don't have problems in that area.

And I was like, hello? I said a bad word. Insert bad word. Here, here person. Um, you, yeah, this is not okay. You know, go dive into that. And that was a big deal, you know, to learn cardiology for a book. Uh, but I do know it, I can give med school lectures now. Um, you know, so this is a thing where it's across the board science and, and this is why there isn't some kind of single thing to do.

There. There are two things. We talked about this before, where, um, there I figure out the most powerful and efficient ways to eat and exercise. But, um, dealing with the symptoms of perimenopause especially, and, and menopause, they're very important because they're not just disturbing, they're indications of harm going on in your body that you need to be protected from.

Um, so I can take, if you want me to talk about the diet and exercise thing, I can, but I wanna make sure we deal with the, the symptoms and how to treat them.

Nigel Rawlins: Yes. Well, let's, let's deal with the symptoms and how to treat them. I mean, at what age does for women does, um, Perry, oh God, I've forgotten the word.

Amy Alkon: perimenopause.

Nigel Rawlins: Well, at what age does Peri, you know, the indications and the symptoms of perimenopause and menopause? So let's talk some of those so that women, you, because one of the things you, you say is that when you get these things, you go, oh, well, what's going on?

And go to a doctor, and then you're in the hands of the doctor. So what are the first indications that they need to know? At what age does this start? Because, you know, I've, I've got a 41-year-old daughter. My wife's got three daughters in their forties. At what age does this start to appear? And then what do they do?

How do they take control and, and have some sort of agency in their healthcare? And then I'd love to talk to you about the exercise and diet and stuff like that.

Amy Alkon: So, um, women can get, they can start in their, in their late thirties or even at 35. Some women do, but what's more normal is in the forties. And so perimenopause is the transition stage to menopause. It lasts three to 10 years and it, it lasts longer than, um, people know. And then the, the international organizations recognize, you know, it's not just the doctors getting it wrong.

Researchers too. It's so disturbing. So there's a thing called S.T.R.A.W. It's the strategic, oh, I'm gonna get it wrong, anyway, what they came up with is that you are in perimenopause when your periods start to become irregular, variable by seven or more days.

And so, you know, this is in length I'm talking about, and so well, yeah, that's true. But what happens is it excludes all these symptoms that happened be happened before that this is really terrible. And the first part of my book, this incredible researcher, Jerilynn Prior, she's a doctor, she's retired from that now treating patients, but also a researcher, an endocrinologist, um, a doctor.

They, they study hormones. She really worked very fiercely to, um, have perimenopause recognized for the unique hormonal state it is properly with the hormones, what really goes on, properly recognized. And to have, um, progesterone recognized, that's a second hormone estrogens and estrogens partner in the menstrual cycle.

The second phase hormone, have that recognized for the healthy and protective hormone it is, and for how it goes missing for a lot of women in perimenopause causing the symptoms. So what she has come up with, she and her colleagues is a list of nine changes that women go through. And if you have three out of nine of these, I can tell you what they are.

These are things where it's new onset, so you have, um, heavier or longer, longer menstrual flow, you know, and then you have shorter menstrual cycle links, maybe 25 or fewer days. Breasts that are more swollen or sore or lumpy. I mean, the worst thing is like, it's called premenstrual syndrome. You start to feel like, it's like always menstrual syndrome.

It's terrible. Um, waking up mid sleep when that wasn't an issue previously, new onset of night sweats. Um, more frequent or new migraine headaches. Um, more or more frequent mood swings, um, newer, more frequent mood swings, and then notable weight gain where you haven't changed your diet or exercise or anything.

And so these can bother you for several years before you get any kind of, you know, these variable periods that, that this organization talks about. And this is terrible because it leaves women with the most disturbing emotion, uncertainty. This is very disturbing for us. And, um, you have no idea what are all these symptoms?

Why is everything in you going wrong? I felt like I was falling apart like this is it? Okay? You had, you know, 40 some good years and now you know it's over. You're an old woman, you're in pain, you know, you're dizzy. I I got car sickness in my forties. Um, I had terrible, terrible symptoms. I, I was sleepless after being an expert champion sleeper from way back. Not anymore, but, um, you could, you know, I would go to bed at 11, like someone hit me with a cast iron frying pan and wake up at six. And if you didn't launch a nuclear warhead into my yard, and then my dog didn't start barking, you know, bloody murder. I, I would be asleep that whole time and, and then I started waking up five or six times a night.

You get brain fog, your brain becomes filled with neural trash because you're not having the cerebral spinal fluid wash through which you need to have deep sleep for. It was really terrible. And so, and when you don't know what that is, you search for diagnoses, you know, it might take a drug or get a diagnosis that's not really real.

It's really terrible.

Nigel Rawlins: So what do they do about it?

Amy Alkon: So, okay, so in perimenopause, what women need to do, and this is in my book, it's called Quantitative Basal Temperature Testing. It comes from a researcher Rudy Voldman, in the in the seventies, and then Jerilynn Prior the endocrinologist from UBC, and her colleagues turned this into this validated form of testing is different than the basal thermometer testing on your phone, which by the way is wrong.

It's based on a 28 day menstrual cycle, which actually isn't the case. It's so horrible. They tell women, oh, you wanna have a baby? Like use our app. Oh, no, it's wrong. I mean, it's hideous. So what you do is you measure your first morning temperature. Every day, you know, for a month. Ideally, you do it for a few months because you wanna see, and this is in the book, if your temperature is rising and rising for the correct amount of days to indicate that you're making progesterone.

And what happens in perimenopause is that your estrogen level is going to be fine. You know, you, you, unless you have some kind of disease where you don't make enough estrogen. Um, but if you don't ovulate the, this is where the egg sac ruptures and the egg is released. If that doesn't happen, the litter leftover from when it does rupture is not there.

This is called the corpus luteum, it's this yellow waxy stuff and progesterone is made from that. And so you must be ovulating. And if you're not, you're not making progesterone, which is really important because not only does a lack of progesterone cause symptoms, including the horrible mental health symptoms I had where you're just like rims on the highway in a freeway chase.

We have these here in California a lot. Um, that's how you feel mental health wise. You're, you're a hate filled, rage filled, horrible person. And then you feel ashamed because why are you this horrible person all of a sudden it's 'cause you're wired all the time. It's horrible. And so, you know, if you don't ovulate, you're not making that progesterone to keep you calm, to help you sleep.

Um, it, it's, and it's also very unhealthy because progesterone does important jobs in the breast and the endometrium, the uterine lining. In the breast, it's basically like a school principal, it wrangles the delinquent. So you have generic cells in the breast. And these cells, progesterone makes them differentiate, which is specialized.

You do their job as breast cells, it makes them, you know, become breast cells basically. So then they're doing breast cell work and they're not just dividing wildly and becoming cancer. And then in the endometrium, um, progesterone stops what's called hyperplasia, which is estrogen driven cell overgrowth.

See their partners. If you don't have the partner to estrogen, you're in trouble. Estrogen does some wonderful things. Both are necessary, but doctors give estrogen in perimenopause thinking this is a solution because it is very powerful for hot flashes, but so is progesterone. You don't wanna take estrogen if you're having, what happens in perimenopause, which doctors don't realize. Doctors think of perimenopause as menopause light. Like it just like sand in an hourglass. Oh, it's just petering out my estrogen's petering out. It's not what happens. Estrogen spikes and dives sometimes to three times a level in a fertile woman.

And the problem is the diving. This causes withdrawal like symptoms. Like you're a junkie, you know, and it's horrible. So if you're withdrawing from drugs, um, you're, you end up you know, having hot flashes and all these symptoms people do in menopause. Oh, and I have to say about the word junkie. Amy Dresner edited much of the book.

She wrote My Fair Junkie, so I'm allowed to use that word. You know, it's considered Un-PC, but her book, My Fair Junkie is fantastic. So I recommend that too. Um, anyway, it just, uh, I was like, oh no, I'll be canceled now.

That's our world. Yeah, I'm very Un-PC. Um, I just try to catch myself. So, um, you know, this is very important that you have this, and progesterone's really important for bones, your cardiovascular system and the time to take estrogen, which is also protective.

It's a big lie from the Women's Health Initiative study that estrogen causes cancer. It'll tell you why that is, but. If you take estrogen as a healthy woman who does not have plaque progression, and I tell you how to check for that in my book, um, there are tests you can have and you know, so in in America you can, I order tests like, you know, like you, you can get them from a lab independently.

They're not necessarily always, you know, cheap. Um, but they're cheaper labs and you know, so I need to sometimes do that when a doctor won't test me for something or when I need to know without letting them know what the level is. 'Cause, I practice defensive patienting, which different defensive medicine is when a doctor is ignorant and under treats you or overtreat you because of it, 'cause their priority is seeing that they don't get sued or lose their license. So for me, what I do is I know the way doctors will interpret things and I just need what I need. Um, and I, I know how to interpret things and I don't want to, you know, like fall prey to their misconceptions. So I just look at things myself to see where things are.

Uh, so anyway, I got a little off track there. But, um, estrogen right after menopause is healthy and protective and you can take it throughout your lifespan. You should be monitored. But this is an important change that they made. Now I had the head of Kaiser Gynecology, this is my big provider in Los Angeles, she tells me I'm on the phone with her 'cause my guy unfortunately has left. I really love my gynecologist. He's a man. 'cause I'm not like those people who are like, if my cancer doctor hasn't had a glioma, I'm not going to him. Like, I don't require someone to have a vagina to treat me, just to be good and listen.

Anyway, I have all these substitute gynecologists who are all uninformed about menopause and perimenopause, everyone of them including the expert one, quote unquote, who's choosing the formulary, the drug formulary for menopause and perimenopause tells me that estrogen causes cancer and all these things for this is 2002 research that was discredited in 2004.

This is 2025, tells me, oh, cancer, Alzheimer's, all these things. Well, no. And then she said, you should taper at 60. I'm 61. Okay, no, this is also discredited. And so she, she tells me, she reads the science and I, you know, I know doctors don't and can't read it. And I made the mistake 'cause I'm so upset about them all denying me the level of estrogen I need.

Um, which I've since gotten, had to fight huge battles to do it. She was telling me this stuff, if she had read the signs at all, she would know because it's been out there. There have been 2013, there was a very definitive paper. Anyway, that she just read the Menopause Society bulletins.

Which just sort of digest all the signs and say, here's what you do. These are practice, these are practice bulletins. 2017, 2022, it was, it was NAMS, North American Menopause Society in 2017 and 2022. It's now Menopause Society. They both say, look, we revise this. There's no stopping rule.

Monitor your patients, make decisions based on individual health and risk. I'm so metabolically healthy. I'm as likely to die of a heart attack as I am to be kicked in the knee by a unicorn. You know, anybody who says I have heart disease, I mean, it's, it's like there, there like it's idiotic, you know? And that's because the lipid hypothesis, this idea that you know, you eat a steak and you're gonna keel over, no, this is wrong.

I eat a carnivore diet. I eat only fish and meat and eggs and I eat butter all day. And you know, I have stellar metabolic health, very low inflammation, no insulin resistance. You know, we can talk about that with the diet stuff. But, so this doctor, if I did what she said, you need estrogen at age 79, when you break bones to be protecting your bones, it's the strongest protector of bones.

And these bone drugs for osteoporosis, they give, they are horrible. They benefit the drug company, not patients. They make your bones more brittle and micro cracked within three years. And what they do, they don't make your bone healthy. They say, oh, bone density, this is a BS measure. Um, bone density is, how much bone stuff do you have?

Well, they do that by keeping the old bone that the, the out of like beyond its prime bone you should get rid of. They hang onto that. Well how fantastic. So I, you know, I have a house and it's wood, except all the wood is eaten by termites, and so the house is gonna fall down. It doesn't matter that the, it's still, oh great, we got wood walls.

Yes, they're, they're compromised. And this is, this is a horrible state medicine's in, doctors have no idea. And what you need is bone quality and strength. And it needs to be resilient and not, not brittle. And these are the things that are fostered by the right kind of exercise. So the, this is a kind of betrayal, you know, all of medicine is, most of our medical care is not scientific as the US National Academy of Medicine said that most of our medical care, this is in the US, but I'm sure it's, you know, globally with some exceptions, um, that most of our medical care is not based or supported by adequate evidence.

They're not saying excellent evidence or rigorous evidence or fantastic evidence, just adequate. And this, this, the state of things. It's. Really terrible, and patients are harmed by this. And so the reason I wrote this book, I, I'm a, since I was an advice columnist for many years, what I do that other people don't do is that I make sure the advice is realistic.

So all these doctors, all these doctors with menopause books out some better and some really not very good. And, um, they tell you, here's the science, well, fantastic. Go to your doctor. I want this care. No, like, they're the gatekeepers. So what you need are fail safes that I provide in this book. Look, here are legitimate medical data you can collect from your own body.

Like, you know, doing the first morning temperature, taking the quantitative basal temperature taking to go to your doctor and say, um, look, I'm not making progesterone. This is very unhealthy. And you can screenshot some stuff from my book. So you have it there with you. Oh, breast not protected and endometrium not protected.

Very bad. I can't, oh, so the big thing, I can't sleep is the best. Not that I tell people to lie, but, um, you probably are not sleeping if you're having this problem, um, that, you know, I can't, sleep is a really important complaint because what are they gonna say? Tough, tough. You got don't sleep then, you know you need sleep to you, you die without sleep and you can't function without sleep.

And so many women, these vital, important, powerful, accomplished professional women, they, they lose their, their power at work, you know, to, to function even, you know, and, and they don't know it's perimenopause and other people don't. They think they're lazy or drunk or, you know, something's wrong with them in some kind of pernicious way.

And, you know, they should be treated like we treat people with diabetes. Like someone tells you of diabetes, you might offer to drive them dialysis. You're not gonna talk behind their back and try to get them fired. You know, this is, this is the stuff that goes on because of the ignorance.

Nigel Rawlins: It is my biggest worry, you know, we have intelligent women and this is occurring to them and, they're not getting the advice or the help that they need. So let's go a little bit back with the perimenopause, did you say you need to have progesterone in addition to

Amy Alkon: You shouldn't take estrogen, this is from  Jerilynn Prior the U BBC endocrinologist, and I agree with her. Some women can take it at the end, you know, but at the end of perimenopause and perimenopause officially ends it's 12 months without a period means you're in menopause. But like at 11 months and 16 days, if you get another, sorry, clock resets another year.

And this is important. You need to know when you're in menopause, because if you're bleeding in menopause, this is, this is a thing that requires immediate medical attention and it can be nothing. It's not always something. It's often not anything. I had this problem, and sorry, you're a guy, but I'm gonna tell the story.

So I'm bleeding and I think, okay, I'm a progesterone factory. Now in America, they give a hundred or 200 milligrams for no scientific reason. By the way, this, it kills me. Um, so in France they give 300 milligrams of oral micronized progesterone. This is an FDA approved drug here in America. You need to not get it off the internet or use a cream 'cause it's not gonna protect your endometrium and your breasts.

It's not gonna give you an adequate amount to, to make your symptoms go away. You need to get the actual drug. Um, and we have telemed here and you can do it if you have a recalcitrant doctor, you can use telemedicine to get it. And I, you know, wholly recommend that but oral micronized progesterone don't get a drug made in India.

They're not safe. And so the estrogen you have, you, you have estrogen, and so you know, and your estrogen's probably spiking. And, and, and if you're symptomatic, that's probably making you very sick, that estrogen spiking, plus a lack of progesterone. Um, and so taking more of the thing you're already being overdosed on by your body, I mean, you're gonna make yourself sicker.

If I had taken estrogen, I think it might've killed me. I was so sick in perimenopause that there are about 15% of us who have just the worst symptoms where I started getting carsick in my forties and I couldn't go. I'm in Venice, Santa Monica's like right next door. I couldn't go from Ven Venice to Santa Monica.

I actually threw up in my shoes. Like, you know, everyone said, oh, you should drive and that'll help. The worst take, Dramamine. Wow. Really? I hadn't figured that out. And also, should I kill a family of five because I'm gonna fall asleep up behind the wheel, you know? Thanks. These are great solutions.

And progesterone actually really helped. Now this is an anecdote, it's a story from Amy Alkon alone. It's not valid scientific testing. But this was a thing I accidentally discovered, and I speculate in the book why this is related to histamines, which caused swelling.

And so the progesterone was, was enormously helpful for this. Um, and for the other symptoms, my symptoms, just the, the sleep alone. So I didn't sleep perfectly anymore, but I wake up maybe once or twice a night, and then I would go right, right back to sleep. It wasn't like before where I'd wake up, thrash around. I mean, you try every form of voodoo. Like, if I just sleep on this side, or if I eat this, or if I drink this, or if my feet are hot, my feet are cold, you know, you'll try anything. And I tried every supplement that had any kind of scientific validation behind it for sleep. And none of them work.

Oh, and the best is when they say there's, there's research on, it's called uh, CBTI, Cognitive Behavioral Therapy for Insomnia. Okay. You know, I'm not sleeping, I'm not having problems sleeping 'cause I'm irrational, and sleep hygiene, my bedroom is like, it's like dark, like a tank. The windows have black stuff over them.

I use a blindfold. And then, so I have, I have what I call a Jew fro. I have, um, red hair, but it's like, you know, basically I have like black hair, so white Jew. And so my black friends, my black girlfriends, they like direct my haircare. I wear a satin bonnet like black women do to sleep. So my hair doesn't get all like frizzed up on the pillow and I pull that over my eyes.

And I have these, the, the headphones on, like for noise canceling. Nothing worked. Nothing worked. It's horrible, you know? And so the progesterone was the thing that gave me my sleep back. And then the thing that was important from that was not having the brain fog 'cause I would wake up and I was useless.

My sharp brain was gone. And this is an incredible thing. It's so painful. And these women who are in work environments, I could at least, you couldn't see what I was going through. But you're on display in a workplace. Oh, in fact, I was on display. I forgot about this. I, um, volunteer as a mediator.

I'm certified under California Law Dispute Resolution Act. I'm a senior, very expert mediator, I give talks on how to improve mediations for behavioral science. It was the most uncomfortable, horrible thing. I ended up having a fan in our office, a tower fan that was a shared fan for the whole whole floor of city hall.

Guess whose fan that was? You can tear that fan outta my cold dead, outta my actually very hot dead hands. And that was my fan, my baby, like my boyfriend at my desk, you know, my cubicle. And then, you know, you have this is another thing and I'll just, even though you're a guy, you're cool and you're from Australia.

So, um, heavy flow. When it, when  Jerilynn Prior talks about heavy flow and there are ways to manage this that doctors don't know and they are not, they do not include surgery because that doesn't make physiological sense. I can get into why that is. Oh my God. I would have to like go to the bathroom like every 20 minutes or even less.

And the bathroom for women was on another floor. You'd take an elevator, you know, and you could take the stairs, but then you're like crossing your legs and hopping. Horrible. Horrible. And so women go through this stuff. How do you have a meeting? You're in a meeting and you're sweating from hot flashes.

You know, you're, you're like, uhoh, there's a shining in my pants. You know, the elevator scene, you know, all this stuff impedes you at work and you become this, your, the woman with superpowers becomes this woman, just besieged by perimenopause and, you know, understanding, taking, using the drugs. And then also using methods like, um, ibuprofen decreases the bleeding.

We don't know this and getting tested for, you know, getting your iron level tested, um, getting thyroid tested. These are recommendations for  Jerilynn Prior that I put in the book. She's really great on all of this. And these things like women need to know them and doctors, your doctors should tell you this stuff.

You shouldn't need Amy Alkon. I should like, you know, writing something else or off in an opium den or something like that. Not spending eight years nervously digging through science 'cause I have to get it right. You know, I had the book fact checked by researchers and I tell them, hand me my ass be mean to me.

Tell me I'm an idiot. Because the most important thing was not putting anything in the book that wasn't, you know, based in solid evidence. And there were things I took out Scott Alexander, who's a psychiatrist. He um, questioned some of the stuff I wrote on antidepressants and I thought, yeah, he's right.

I wanna know, if you're writing this kind of stuff, you better be really humble and just, you know, accept it, admit it when someone tells you you're full of, you know, whatever. I dunno if I can say that,

Nigel Rawlins: You can.

Amy Alkon: okay. Yeah. Right. Where men are, men are, and sheep are nervous. That's our quote from when I worked at Ogilvy, New York.

Yeah. That was my favorite thing about Australians.

Nigel Rawlins: What we're saying is that they need progesterone, and you also mentioned that there's different types of progesterone when they're, uh, perimenopause. But when they are in menopause after the 12 months period-free, they do need estrogen.

Amy Alkon: Okay, when you said different kinds, you do not wanna take anything but like the, you guys probably have a drug agency there, the approved real medical drug that providers give, you must get that if you're to go through telemedicine, you have to get that validated drug. The creams on the internet, these things that these, they're, they're these gynecologists who are influencers, so gross, they sell these drugs and I see them and they're not safe to take and they're just scams, you know, you can get drugs and supplements.

You know, I use a site called Consumer Lab. It's a membership site you could join from somewhere else, I think it's maybe 50 bucks. So worthwhile because what I do is I find the cheapest good supplement, 'cause that's a wild west area, but using any kind of cream, no, please don't you put yourself at risk of cancer.

Go through the pain in the ass thing of like, you know, telemed or whatever. And so what Amy Dresner I mentioned before did, her doctor, and this is so crazy. Her doctor would only give her a hundred milligrams of oral micronized progesterone, not enough for her symptoms. The hot flashes, you know, and then 200 was the highest, she would go and she tells Amy, get some kind of cream from the homeopathic pharmacy. Oh my God. First of all, homeopathy is just bullshit. Now I can say bad words here. Um, it's based on this idea of like, let's put less than a molecule of the stuff in the, in the thing and sell it to you.

And it's like, why does you just burn your money? 'Cause then you don't have to go to the drug store. It's a little faster. Um, it's worthless. And people end up doing that instead of getting meaningful care they need. And so with Amy, I put this story in the book because she had this very funny joke about this where she said I that , right now I could get any illegal drug I wanted meth, oxy, molly, meet some dealer or jack in the box who'd hand it through the window in his 87 Honda, but progesterone, this drug made of yams, forget you lady can't score you that. That was the irony. This legal FDA approved drug she couldn't get. And so she then goes through telemedicine and then, um, she texts me the photo of the drug. I see it, it's like from this Indian pharmacy, generic version from India.

And so I had just finished reading a colleague's book, Bottle of Lies, it's science journalist Catherine Eban. She does great expose on how corrupt the Indian, um, pharmaceutical industry is. Uh, you know, basically killing patients around the globe with tainted versions of generics. And I said, you cannot take this.

So she had to get another one and, you know, get one from America and like, just, you just need to call and make sure where is your drug coming from before you get it? And, and just don't get it from India or China. The others may not be great either, but they're gonna be better because, um, what what happens here with the, our FDA is they inspect the production facilities in America and they just show up in India.

They're like, we'll be there in a couple of weeks. So can you like hide all this stuff that contaminated crap? I mean, it's incredible. And still they were able to find this out. So this is, you know, this some of the stuff that doctors don't know, you know, and they also don't know about, you know, when generics don't work, sometimes they don't work.

I have a chapter on that too. Very important, how to swap your drug out if you get a generic that's not working. Um, because they can be sub potent or super potent. And, it's pernicious with drugs like Wellbutrin where the extended release generic, it released the, the drug so fast that people committed suicide. When you get a generic, they, they have the same substance as the active ingredient.

But what they can't find out this proprietary, is how are the inactive ingredient ingredients formulated? You know, and like, is our drug going to react the same way? And it often doesn't and to, to terrible effects.

Nigel Rawlins: Now one of the big concerns, you know, you've mentioned it, that it's this fear of getting cancer if you're taking estrogen. So when you're in menopause, you are suggesting they do take estrogen.

Amy Alkon: Oh yes. Okay. So, um, this, this cancer fear, this is based on the fraudulent women's health initiative study from 2002. And now, and I can talk about breast cancer risks 'cause I have a whole chapter on that. Um, and, but I wanna say estrogen. So there are different types of estrogen and the Women's Health Initiative Study, they give conjugated equine estrogen.

So it's from horse pee. And so that has some substances in it that are not native to the human body. And so what I take and what appears to be the safest is to take bioidentical estradiol, that's the name of the, the that's, estrogen is sort of the class. And then estradiol is the drug that you're taking, that's the the menstrual cycle hormone.

So the bioidentical FDA approved, um, it's the same molecule as the estrogen in your body. And then you take that transdermal estrogen and what that means, it's this, it's a, a sticker. There are also creams, but I think that the, the patch, the sticker is the most effective way to get a stable dose, and you're also not getting on things you maybe wiping on your kid, you know, on your son to grow boobs.

Same with testosterone creams and things like that. Um, and so transdermal estrogen patch taken as a healthy woman right after going into menopause at 12 months without a period that is safe and protective throughout your lifespan. You have to get tested. I give you this, the test in the book, which test to get.

To see that you don't have heart disease risk, and these are not the ones your doctor gives. So they'll give a test for something called A POB to see if you're unhealthy. And this test, independent of anything else is not, it doesn't tell you what you need to know. You need to get a APOA one also tested and look at the ratio to see whether you have risk.

I mean, it is really all of this, this is medicine, terrible and black and other women of color, they have some different physiological, you know, metrics and these are not attended to. And one of the things my book does that I'm very proud of, I have 23 pages on the unique, you know, physiology of black women and other women of color where it makes a difference.

Women, black women have very high, , like they have a lot of metabolic unhealth problems. You there's certain substances like LPA, lipoprotein A that can be very elevated and it's, it's really vital to have these tests and to have black women looked at metabolically, for example, they have, um, much lower triglycerides, like 20% lower triglycerides, and I think 17% higher HDL, if I'm remembering correctly.

It's, it's about those ranges. And so in this patient, in a patient population with metabolic health issues, very severe metabolic health issues in general, you can miss heart disease in a black woman if you go by white people's standards. You know, this is, and when we test, like in Jews, we test Jews for Tay-Sachs disease, a birth defect, and we test blacks for sickle cell.

We don't test blacks for Tay-Sachs disease 'cause they're not from Poland. You know, some of them, some of us are ancestry, um, of course originally from, you know, one of the 12 tribes in Israel, but we, you know, got chased out. This is really important and, and, and Hispanic women, this invasive form of breast cancer.

If your name is Lopez or Rodriguez, or you might be Hispanic, you know, we should test you and look at you in a special way to make sure, this isn't an issue for you and look at you more than we would another woman who doesn't have that risk level. So these are some of the things that happen. So the transdermal you, you take this, I use a patch that's a once a week patch.

There's some that are twice a week and you know, would start out, try a lower dose and see what works. But, um, I started out at 0.035, um, it's milligrams. Um, of the point is important 0.035. And then I went up. Now I'm at one and I'm going to need two. I have two on right now. I fought this battle with Kaiser, all these doctors who don't know anything, um, to get the two.

And I really feel the difference and that's not valid science, but, um, memory is affected. So I have ADHD and so people with ADHD has have low dopamine and norepinephrine. Um, normally, you know, and I take Adderall Modafinil, and, I started to feel like they weren't working in, in menopause.

And also I'm in this extreme nerd meetup group with all these, they're all mostly software engineers, quantum physicists. They work at SpaceX, they're amazing. And so we debate homework. We have homework every week, and we count off to go into groups. And I, I was like, and it's not like, count to 300, be 1, 2, 3 sometimes.

And I would have to ask Eric sitting next to me, what, what's your number? Because I would say my number and I would forget. I mean, this is horrible. Oh, one funny story from that. So Vishal, who runs our group, I say to Vishal, we have a party. And I say, um, Vishal, um, I, I would just wanna let you know that I probably have better memory after Tuesday because I'm gonna start estrogen.

And he said, that's the fifth time you told me tonight. I love that. Uh, you know, and so this is what women are being denied by these doctors going by the 2002 discredited research. I mean, it's horrible. And I have to say, I I, when I, this came out, I wasn't your menopause, so it wasn't really something I was worried about or anything, but I, I sort of got the thing like, oh, estrogen sounds horrible.

Estrogen is Satan. I'm never taking it. Okay, this isn't scientific. So I start doing this book with this belief and I start reading this studies, and like you ass, no, you're completely wrong. I admit that in the book because I want people to know science is not about being right. It's about looking for, you know, the most evidence-based facts you can find.

And then when you see that you've been wrong to revise your views and publicly state them. And it is, it should be a point of pride to say I was wrong. You know, and to say, look, this is, this is, you know, this is better. And this is, you know, the evidence says is there's something I just saw that, oh, I know testosterone.

I've changed my mind on that. Um, I have to ask the doctor who ghosted me, she's ghosted me for two appointments. I have the screenshots here. I have to send to some grievance person at Kaiser, you know, and so she's the one who told me, she told me to take testosterone 'cause I have low free testosterone because of my carnivore diet, raising sex hormone binding globulin, which basically grabs the testosterone and goes like, whoosh out the window. Bye. You don't get it. So. Um, I had been using, um, a supplement called DHEA that I validated through Consumer Lab, um, because I had seen that there wasn't longitudinal research, so long-term studies validating the safety of, of testosterone for breast cancer risk and cardiovascular risk.

And since, since I first looked at that, 'cause I did this whole big book, um, you know, in the book I say, you know, we don't really know, but I look this up and I see that the 2022, there are some studies. So the breast cancer risk seems to be answered to the satisfaction of like, yes, you can take this. And I think cardiovascular also will be like that.

So there may be some risk, but it's less, the less risk that I'm putting myself in by using a very high amount of DHEA. So I'm harming myself that way and it's not correcting the testosterone, um, level. And so I'm, I have an email to go to her saying, look, um, you know, you're right about this and I wanna take this, but, here's the problem. Medicine is so terrible. We, we, patients are so betrayed. So I call because I have to tell doctors what to prescribe. 'cause I know the science and a level they don't. So men have skin that is 20 to 25% thicker than women, and you have more sebum, more oil. So a gel, a drug that you put on skin for men, you can't just, you know, throw that on a woman because it's not going to be reacting correctly. She might get an overdose. And so, and also for men, the dose you take as a man is huge. Compared we take a minuscule dose. So I need to take oh point, oh point 1875, um, milligrams a day, twice a day, not a teeny amount.

So, you know, I call Kaiser and they say, oh, we're just gonna give you AndroGel for men. And you have to just like, you know, you like divide it from the package. Okay, this is like a package of lotion. How do I oh 0.187. How, how do I do that? And, you know, and the answer is you can't. And so they're having patients, Kaiser Permanente, big medical care, I mean, it's multi-state, nonprofit, huge.

They're having patients take this unvalidated amount, like it can vary day to day. This is horrible and damaging. You don't wanna get too much testosterone, you know, you need what you need, you know, you can, so as a woman, you would take between five and 10 milligrams. So I'm conservative. I know I need, I know I'm low, so I think I need more than five, but I wouldn't start at 10.

I would start at 7.5. That's where this one oh point 1875 gets me. And so what they need to do is to compound it, you go to a compounding pharmacy, you need to go to an accredited one. They mix this up for you. You get individual, they're called oral syringes. They're not oral, but they're the, the dose you need and, and you squeeze that out into your skin.

So you're getting exactly what you need in the kind that is, it's cream made for a woman, not for a man. And Kaiser, every patient, this is like medroxyprogesterone acetate. When the reason I did this book, so I read the science, I don't go to the doctor, you know, without knowing exactly what's wrong and what to do, 'cause I can't trust really. I, I have a psychiatrist who's evidence-based. He's the only one. He's, he is fantastic doctor. I'm so grateful for him. But, so I read the research and I see this huge gap between the evidence and the practice standards. And that they give  medroxyprogesterone acetate , the synthetic knockoff of progesterone instead of progesterone.

And in fact, researchers confuse the two and they say progesterone causes cancer. It does not, you know, it's, it's protective. Um, and I'll get into the breast cancer risk about both estrogen and progesterone because there's real wonderful receptor research that, you know, gave me an answer of sorts at the end of the breast cancer chapter.

But, um.  medroxyprogesterone acetate binds with the wrong receptor in the breast, increasing her breast cancer risk. The glucocorticoid stress receptor risk instead of preferentially binding with the progesterone receptor, the correct receptor. And, um, it is harmful to your cardiovascular system and your brain.

So wait, I'm gonna kill my brain, and not kill them, but I'm gonna harm them and, and like increase my breast cancer risk. No, I want progesterone. I had to fight three battles armed with science. Denied. Denied. And then finally I got it. Um, uh, to get the progesterone I need to get it covered and get the amount I need, which is the amount given in France.

And you take 300 milligrams at night 'cause it makes you drowsy. Drowsy is good at night. Um, and then, you know, and the reason for this is you don't know how you metabolize drugs. And so you need this amount to be safe for your endometrium and breast to make sure you're protected. You know that estrogen is properly counterbalanced.

Kaiser doesn't do this. All their patients are all at risk. You know, they're not given this, I don't know if it's that they're allowed to prescribe progesterone now. If for women have to pay extra, I couldn't afford it. When you do books, you know, people think, oh, you're gonna Rich. Yeah, I'm not Stephen King.

Guess what? You write a book for eight years, like doing nothing else. Guess what? You're, you're like not like living in a castle, you know, in the French Riviera. So, once I did this, 'cause I'm a, the Midwest, we're, we're like the saps of America. We're, we're nice, like people are decent and raised to be considerate and everything.

And you know, so after I do this, I'm community oriented, so I say, well, okay, you're going to, now I've shown you all this science. You're gonna give all women this healthy, safe drug, right? Put it on your formulary. And I'm like, no, you know, and so for me, what I realized it would be like sitting across the street, sitting at cafe, watching a woman about to walk into an open manhole and saying nothing.

And so I saw all these women, this progression of women in my head, you know, just going, being un unknowingly harmed by doctors. They're, they're trusting to provide them with medical care. So I had to write this book because women deserve to know. And, you know, it's, it's, this is egregious.

My gynecologist who's gone from Kaiser, he, he was so wonderful, you know, so he, initially I was mad at him because he, he didn't know the science on this. I didn't realize that they hadn't been trained. But what he would do, he would listen to me. This is very important when a doctor really listens to the patient.

Because this is called shared decision making, where, you know, they listen to you and take, take into account your values and who you are.

So when I would go in my gynecologist, he said you're getting an ultrasound vaginal, it's transvaginal ultrasound, you know, see if you've got anything, you know, the cancer, whatever, fibroids growing up there. And he said, I know you wanna see this. And so he turns the ultrasound toward me and I see my bowel.

It's like moving like the four or five freeway. I like amazing, like holy crap. You know? So that's the kind of thing when doctor pays attention to who you are, that they do. And, and I saw that and thought like another, another bit of evidence of that. And so he would, when I presented him with the science, that I'm sure he had never read. Um, he looked at it and considered it and then would treat me according to the science. He wasn't like these, all these women, you know, it's so funny. I had a male gynecologist who's so respectful and great and science-based. All these women are horrible, you know, denying me care.

Oh, and the worst was this thing where women have been treated in medical care, like it's all in your head, this really egregious thing, I'm still so angry about it. So I go back, she revises the treatment, the patient visit notes, and so I'm sure they all hate me in gynecology.

'Cause I didn't do what I advised in my book of like how to partner with your doctor and approach them and everything. I was angry and afraid and um, you know, I basically came off like the, like unlikeable know-it-all in, in these appointments. Um, 'cause I was so upset because, um, 'cause I was threatened that she wouldn't give me my, my doctor who left, he, it was his idea to do the two patches.

You know, and I just, I didn't get it in there before he left. So I, the problem of all these, like medical muppets who are ignorant, deny their ignorance, you know, and, and like deny me drugs. So she says in the patient notes, patient has labored speech. Of course I do. I have a ADHD lady. I'm really smart. I can't clap on the beat, but I'm really smart.

I have a lot of thoughts that come all at once and you're making me afraid. You're not gonna give me a drug I need, you're calling it super physiologic. That is, you know, incoherent and physiologically wrong. I'm not getting, I get half the estrogen I take or less, I wanna take a double dose so I get a single dose.

This is like, we all understand this. You don't need to be a statistician or mathematician. Okay, I get half give me whole, you know, and takes, it takes two for me. We don't treat based on like the mythical average patient. So she puts that in the beginning and then she said patients should continue with psychiatric care at the end.

Okay? I'm not crazy. You are ignorant and I'm angry, and that's legitimate. You don't know the science and you claim to, I mean, it's really horrible, you know? And so this is, you know, this is an old trope. I, I wanna write an op-ed about this and name names, because how dare you. I'm writing a piece now I'm gonna have a substack if anyone wants to subscribe.

Subscribers at subscribers with an s@amyalcon.net. And the first piece is going to be on how women, um, don't have what, what I call the Hollywood heart attack that you see on TV where a man clutches his arm and drops. There are these symptoms where you feel digestive disorders, you know, like really tired.

All these things that are, that don't say heart attack to people. And so women go to the emergency room and trained medical personnel, dismiss them. It's all in your head, you know, you're stressed. And this happened to my beautiful friend, Dr. Helen, Helen Smith, forensic psychologist, where they said it was a psychological symptom and all this stuff.

And then, she had her doctor test her and they said, get to the hospital right away. And, you know, she had, she had a heart attack. Meanwhile, what's so funny about this is that Albert Ellis, who founded cognitive therapy, Ellis, I met him because he was a fan of my column, 'cause he thought I was highly rational and mirrored what he taught, it influenced me, but I'd always been a person who valued reasoning and critical thinking and it was incorporated into who I am always.

And so, it was just natural for me. And see, see how I corrected that, you know, this is a, the benefit of being a 65-year-old, not 65, sorry, 61. Oh my God, I'm aging myself. That's all I need right now. 'cause as you age, aging is, uh, it's associated with physical problems increasing. Hopefully my diet and exercise make that not so much a factor, but, all of this is just really egregious that, that we all have to go through this.

Nigel Rawlins: So your postmenopausal,

Amy Alkon: No, I'm not. That word, is, um, a ridiculous misnaming. American researchers caused this stupid problem. So I'm in menopause. What happened was Americans and Europeans, they were doing this thing that's, that's important, which is they were trying to standardize terminology.

And so people in America, and probably the rest of the world, they knew it, knew what this situation is. This phase as menopause, it comes from meno and pausis from the Greek. And then it went to the French. And so basically it means, um, the stop of the monthly bleeding. And so, what happened was the Americans, sorry, people we sometimes really fuck up, basically they named it as one day, so the day, like the, when you've had 12 months on a period, just a single day. So then what's the rest? So they had to tack on this thing, the post post menopause, and that means officially, wait, I have it here somewhere because I never remember what it is.

Oh, here it is. Okay, so that means actually after the monthly bleeding stops, I mean like really a single day in a woman's life. And so what I did is I used the term the public understands, which is menopause rather than post menopause because, oh  Jerilynn Prior's friend the, she's the UPC endocrinologist, she pointed out that, um, wait, where is it here?

That, after menopause is an actual stage and it's death, so really incoherent.

So yeah, menopause.

Nigel Rawlins: Menopause, so that's forever for women. See, being a bloke, obviously, I don't understand. So what are you doing? You are in menopause, so you are taking estrogen. You are continuing to take estrogen,

Amy Alkon: Mm-hmm.

Nigel Rawlins: but you're also doing some,

Amy Alkon: too. I take progesterone and so if you have a uterus, you need to take it. That's what people say, but I don't agree with that. I think every woman needs to take it, even if you have had your uterus removed, hysterectomy, which is very bad to have if you don't need it, and doctors do needless hysterectomies that cover this in the book, really terrible, leads to all this increased risk of cancer and all these other diseases, bones, you know, dementia. It's, it's beyond horrible, but so progesterone isn't just protective for the endometrium, it protects your breasts, you know it, and it is healthy and helpful for your cardiovascular system.

It works with estrogen there. So you know, you wanna take progesterone in menopause as well as in perimenopause. And I take the estrogen also. Um, and then I also take steps because your body is just not as robust as you age. You, your immune system isn't. So I basically went SWAT team on my diet on inflammation also because I had to get this, um, corneal endothelium transplant.

So I mentioned the endothelium. There's this one cell layer in your arteries and then in your eye also. It's basically the plumber of the eye. And, um, thanks mom. I have a genetic disease, it's called flukes dystrophy and I call it, fuck you, fuck, fuck, fuck you dystrophy. Um, and basically the, the, this endothelium, um, the cells die.

They look like hammered copper called guttata, which sounds too much like frittata, which is good if you don't overcook it, which annoys me to no end. And you go progressively blind unless you have a transplant. And I got donor tissue. Isn't this amazing? This is why I'm an organ donor. Um, somebody donated their corneas and I have donor tissue aftermarket parts in one eye, and I'm getting the other eye done at the end of the month. So you need to be as healthy as possible when you're going through something like this so you can heal. And so what I did, this is so tragic. As a Jew who was denied bacon, my mother was the worst cook in the world. The food all tasted like particle board, early adopter of health food.

So when I, in my adult life discovered bacon and began eating three greasy strips a day, the thing that got me out of bed, um, I had to stop because it is high in omega six fatty acids. And you wanna have, you wanna have a balance. I try to eat an ancestral level of Omega-3, which is the healthier one to omega six.

And omega six is in everything. And so, you know, if you can eat a one-to-one ratio, that would've been an ancestral ratio. That's good. And so I cut out bacon and then, so tragic pork rinds. I'm a Jew from Appalachia. What can I say? That's, uh, in case anybody doesn't know the mountains, where people like are like missing teeth and they eat squirrels.

So it's, and now people from  Appalachia are gonna hate me 'cause they're also, I'm sure nice whatever house in suburbs or whatever there. But anyway, um, I stopped that and then I exercise and I'm very disciplined about it. And, um, the carnivore diet, I eat, um, herring, mackerel, um, hamburgers, um, 'cause I'm poor, beef chuck, which is very fatty and eggs, and I literally eat butter and I use ghee, this is clarified butter from India, very healthy. And these are the lowest inflammatory substances. Olive oil is usually fake. It's usually adulterated. And people think that that's healthy oil, and so I don't use seed oils. And the, the reason seed oils are problematic is not what people say, Nina Teicholz, my friend who wrote Big Fat Surprise, she was the first one to expose this in her book, so you can read it there.

Um, but anyway, so I do this and then I do slow speed weight training and I like to show people 'cause I have these muscles that you wouldn't expect on me. 'Cause I'm kind of like, feel like these muscle and like I do 16 minutes a week, that's 16. You know, I like to ask people, how many hours do you think I work out a day?

I'm like three. Okay, I'm not gonna do manual labor with iron bars. First of all, I'm not going to a gym in LA to wear Lululemon and like they stare at me 'cause I'm like physically uncoordinated. It comes with ADHD, I took a yoga class once and they say you have to do something or doctor says, raise your right hand. And I have to think about it. So anyway, those two things, these are the two things. There's a fork in the road basically at menopause where you can protect your cardiovascular health and your overall health. And, um, inflammation and insulin resistance and high blood pressure.

And high blood sugar. These are the things you need to need to stop and these are the causes of heart disease and diabetes and what's called inflammaging, which is a broken immune response. Your, your pancreas when you eat, uh, starch or sugar in your diet, a carbohydrate, and it doesn't matter if it's whole wheat bread.

This is a big misconception. Oh, I eat not healthy whole grains. No whole grains are not healthy. Nor are starchy vegetables, nor is apple juice. So you eat these and they raise your blood sugar and so your pancreas has to pump out insulin to, to bring down your blood sugar. And so this keeps going on and on and on, and eventually it gets tired and you have a broken insulin response. You have insulin resistance, you have high blood sugar. And so if you eat a carnivore diet like this, you keep your insulin low. You know, I have very low insulin, normal blood sugar, and you know, I'm not having these spikes. And so because of this I have low inflammation.

This is, this is how you be healthy throughout your lifespan, and the exercise is part of it. Doing this weight training where you lift five seconds up. And five seconds down very slowly with weight that's heavy for you to the point you can only do about 10 reps. And then when you can no longer do another with good form.

And I lay out how to do this in the book, you know this is, that's muscle failure. And this is, you've created this tension that helps build muscle, healthy, strong quality muscle. Not this whole bone density thing. Oh, and I should say what you do for muscle, you do for bone. So you, you do something to your muscles and it transmits to your bones.

And bones and muscle are, are metabolically active. If you're working them, you are you helping yourself not have insulin resistance, not have high blood sugar. You're helping your mitochondria, which power us. Very important to keep healthy mitochondria. And so that was the thing that happened where I went SWAT team on my diet.

You know, I had this transplant and I thought. Okay. Okay. Young lady, you know, cut the crap here. And I had, I just decided one morning, no more bacon. And this might gross people up, but it's very good. I eat smoked herring. So I put smoked herring in a bowl. I put butter on it, put it in the microwave with some, there's stuff called Old Bay we have in America. I'm really a culinary heathen. I just, but I eat a lot of fat and everything's delicious. And, and then, so that was my first day of no bacon and I still have two big jars of pork rinds. I hid them. Um, so I can't see them and eat them 'cause I'm a pig. Um, so last night they had chocolate chip cookies in my meetup.

I'm like, yeah. Oh, you know, and I'll, I'll eat like once every three months or so. If I go to a party, um, I do this like analysis, the deep analysis, look at the, like the chocolate chip cookies. Wait, were these made by a vegan with that disgusting crap? Like where it's not butter and eggs and things. Um, or were these like classic chocolate chip cookies with sugar and chocolate chips and everything.

And then I'll analyze which one is the great one to eat, like the white chocolate, the dark chocolate, and then I'll eat three. 'cause I'm a pig, so I don't have any ice cream at home. You have to foster good habits in whatever way you need to do that. You know, because I'll have my snout in that vat of ice cream and it'll be gone like very quickly.

Nigel Rawlins: Yep. I'm the same, worst thing I'm sort of at the end of a long road from the town and round the corner, I happen to have a beautiful gelati shop. You know, he makes it out of beautiful milk, very little sugar, but he's around the corner.

Amy Alkon: That's

hard.

Nigel Rawlins: I'm at the end of a long road from the shopping center, which is up there, and we've got a little cafe and him and a hairdresser and a dog groomer at the, and it's, it's like in the middle of nowhere.

But you're right, I'll go around there and I'll eat the whole tub. So, yeah, that's the problem. And I, I think it's the man thing, but so what you've been saying is for women, you know, when this starts, you need to take, well, what we call agency of your health. Read this book. 'cause it's obviously very important because women make up, well 50% of the population and if they're not, and if they're not getting, um, the help or they don't understand, they need to, don't they?

But not every woman's going to read this book.

Amy Alkon: Oh yeah.

Nigel Rawlins: book.

Amy Alkon: Well, okay. Tell your friends, because I just want this information to get, actually, I say this horrible thing as an author who like. I mean like I'm really poor from writing this. Oh, review my book too, please, everybody. I really need reviews and spread the word. But like, I actually told people, okay, if you can't afford it, you can steal it.

But I said, I prefer you get outta the library because like, I also need to earn back my advance. So it'd be better if you bought it. It's like 9 99 is an ebook, please. Like, but spread the word. And I want people to do that because I mean, this is egregious and I'm like this, I'm really a weirdo. So being, having been used to this all my life, I will, you know, I'll talk to somebody, you know, I basically don't go out that much.

I go to my meetup group and then I go to Kaiser and there are many people there who are black. And so the, I'll tell them, you know about the stats, the difference in heart disease stats, because these need to be spread around, you know, and if you look on sites, there's a Scripps Health, this is a medical provider in the US.

They have a Scripps health site for black women. Like, hey, black women take charge of your cardiology. Do you think they tell them the specific standards for black women? Like, look, you could have heart disease. No, absolutely not. I mean, it's so egregious. And then another thing that I do in this book and that because I'm now, I'm losing my voice for some reason, um, as an advice columnist for 25 years, I'm syndicated or I was syndicated to many papers and they all went out of business.

I had to stop. But, um, you know, I would do look at the advice from my weekly column and say, okay, asshole, is anybody gonna do this? Is anybody gonna keep doing this? And if the answer wasn't yes, well how disrespectful, you don't deserve to be read. Go back to the drawing board. And so I'd always make sure that I put out something doable. You know, and this book also, you know, this is doable stuff by mere mortals. Like, I'm not gonna go to a gym, but what I have, I have a little weight graveyard in my living room. And you don't have to do a ton of this weight work. Now, if you have bone issues, then it's different. You need to do more.

I have a friend who has 23% loss in her, in her spine, which is really bad. Um, but the whole bone density thing, that's another lie that I get into in the book. Like this is what matters. I, I got into this a little bit how it's, the tissue is, it's like old tissue that's being hung onto.

It's not, the density is not good density. Here's some old crap that we've, you know, hung on to thanks to these drugs. Um, not bone quality, you know? And so those are things that you need to take charge of, um, and to, and like to go to your doctor and be able to ask for this care, like realistically.

And that's why I give you the fail safes in the book. Sorry, I rambled a little bit. Um, but this is the thing of where this is doable advice, it's the, the eating and the exercise is doable. I describe myself as a lazy hedonistic pig. And so I don't cook. I write, you know, if I write something, people read it and they might read it again.

If I eat, you know, it's like gone. So I do like, everything I make is like two steps, like flip, flip, you know, meat, flip, flip. Or I make this, um, now, 'cause salmon's really expensive, there's some kind of salmon disease, so I need to not spend a lot of money. The hamburger I eat is like the next best thing to dog food comes in a big roll, but that's still better than eating carbs to eat that crappy meat.

You know, it's like crappy compared to like, it's not like grass fed and the monks like sung to them while they were grazing, um, or whatever, you know? And so doing this, you like being frugal? I make this like soup out of broth. I put in the herring and tins and the mackerels in a can.

It's so in elegant. It's like 15 ounces of like chicken of the sea chub mackerel, dump in two cans. The broth I put in butter and um, what else? Uh, heavy whip and cream, and then all these like the base spices and pepper and salt, and then some curry and gingers. 'cause I had those there. And like, that might be good.

And it's delicious. I mix it with an immersion blender really fast, so that takes me like five minutes to all throw together. And then I put it in jars and I just pour it in a soup thing and then like heat it in microwave, like, like a little like mug. So that's like lunch and the, the mackerel's, $2.50 a can.

So it's not like salmon, which is now like $10 the for the discounted kind at um, Amazon Fresh. That's where I get my groceries from because they deliver them and so you have to be creative like this. The most important thing though is to protect your health throughout your lifespan by doing this and being disciplined about exercise and then getting, for example, another thing is getting first morning light in your retinas.

This helps circadian rhythm. It helps prevent depression or make it ease depression. And then eating this kind of diet where you're eating, it's called ketogenic, meaning you're in ketosis where you're, um, burning fat for fuel instead of sugar. Um, this is very helpful for mental health. And Georgia Ede, who's a friend and colleague, she has a book on that now.

Um, that's, that's wonderful. She's a psychiatrist and so I, you know, support all these people basically saving lives through their books. And work, it's vitally important, you know, Maryanne Demasi, by the way, is down there, I think. Um, she's one who is rallying against statins and all the, she, she's a source of truth.

Zoe Harcombe, also the two of them, I forget which one is which sometimes. But they're both, you know, really good. And, you know, we need to have people who are like me, you know, like doing these books in every area of medicine. Hematology, I'm not that swift on hematology, that's blood. Um, you know, I can look things up and understand 'em.

I know what white blood cells are and everything, what all the names are on the CBC, A complete blood count. But, um, I don't read the science in that area. And then cardiology, if you're having like a, you know, an infarction, you need a stent or something, like, don't ask me, you know, not gonna do it on my kitchen floor. Kitchen floor appendectomy is my joke.

Nigel Rawlins: Now people can't see you because this is an audio, but looking at you, you are lean, you look strong. And for a 61-year-old, you look young.

Amy Alkon: Oh, sorry, I forgot when I said look at my muscles. I wanna say, but women don't, since we don't have high testosterone, when he says muscular, we get toned. I don't have like, you know, Hercules

muscles.

I look, they

look nice.

Nigel Rawlins: it's lean. You don't have what we call the bingo arms with it. It,

Amy Alkon: The high Helen, we call 'em here where you can like go, you know, like you wave your arm and there's this flopping flesh.

Nigel Rawlins: No, you don't have that at 61. So there you go. So this, this is an indication. So Amy, we're probably coming to the end there. Is there anything else you'd like to add or should we say where to find the book and where to find you?

Amy Alkon: Oh, I'll tell you those things. Okay. So if you want to get, I'm gonna have a substack where I answer questions and you can ask me questions, but, and I'm gonna put it up probably, it might be by the end of this month. Um, it's subscribers@amyealkon.net um, to, to be on the list for that. It's free. And then on my book, Amazon, here in America, I'm probably there too.

And I have a wonderful audiobook. Um, if you don't, if you're not a reader, you know, there're very, this is a misconception. People like, oh, if you don't read, you're not smart. No, that's not true actually. People just don't like long form reading. Um, that's okay. Um, Carrington McDuffy the singer. She's stellar.

She does a voiceover from my book. She's great. So ebook paperback, I recommend getting the paperback 'cause it's like beautifully done. Um, and then, um, what else? It's really important, you know, start eating it and exercising this way, you know, do one at a time. You don't wanna make two changes at once because you tend to be overwhelmed.

So start with your diet. And if you're going to eat low carb, I'm sure I include this in book, eat salted chicken broth at first because you need that. Keep your electrolytes normal and then commit to, here's what my friend Mary Dan  Eades who's one of the doctors actually referenced.

I I respect her and Mike Eades very much. There are two doctors who practiced evidence-based medicine. They're retired now, but, um, the low carb stuff they're good on that. But she said she would tell her patients when they're in Arkansas, look, will you do this for two weeks?

Try this low-carb thing, be disciplined for two weeks. Can you do that? And so if you give yourself some kind of span like that, that's helpful. 'Cause you can do that for two weeks, and then you start to feel so good, you know, and it's so good for your health. And then once you begin a habit like that and you're doing it diligently, it makes it easier to continue.

Nigel Rawlins: That's fantastic, you're incredibly knowledgeable, you are sharing that knowledge and I'm hoping that people will listen to this, buy the book, which I think is gonna be important to get,

Amy Alkon: Well, I should say the name of the book, I think I forgot, Going Menopostal, What You and Your Doctor Need to Know about the Real Science of Menopause and Perimenopause. I'm Amy Alcon, A-L-K-O-N, so you can find that and please buy it and review it and please spread the word about all this stuff in the book because it's really important women have this.

We deserve to have evidence-based medical care, however, however we can

get it.

Nigel Rawlins: and you're making that happen. Thank you, Amy, for joining me.

Amy Alkon: Thank you.