[00:00:00] Hello, my beautiful and epic friend today on the podcast, I had the pleasure of bringing on Dr. Manna Semby. And we talk about things related to women’s health, particularly around perimenopause and menopause. Dr. Manna Semby is a naturopathic and functional medicine doctor. She is also the founder of Aruna Precision Medicine, where she uses genetic epigenetic Genomic testing, in addition to conventional and functional labs, as well as additional assessments to help her patients revitalize whole body and brain health.

Dr. Semby is especially passionate about helping women navigate perimenopause and menopause and preventing dementia. Today on the podcast, we talk about being proactive about your health versus being reactive with disease management. We also talk about signs and symptoms of perimenopause and menopause and things to look out for during this [00:01:00] time.

We also discuss the holistic approach to hormonal health, gut health, brain health, and so much more. I hope you will enjoy this discussion with Dr. Manna Semby.

Well, hello, Dr. Manna Semby. Welcome to the podcast. I’m excited to have you here. And as we dive in, I know we are both, uh, very passionate practitioners when it comes to midlife, perimenopause, menopause, and that big transition time. And when I met you, I was very excited as we were talking about our similar focuses when it comes to managing women in this phase of life.

And you said something that I thought was quite brilliant about helping them be proactive about their health rather than being reactive. with disease management. So I’d like to open our discussion there. And what is your approach to that and how you empower women in your patients [00:02:00] to be more proactive about health rather than reactive with disease management?

Yes. Let’s start with the bank. So thanks, Sherry. Thanks for having me here. Um, I think that’s the only way to be, you know, to being proactive. That means you are in control instead of letting events control you around, letting your health going down control you, then you kind of trying to play catch up and then you don’t know what else might be going on.

How else you can catch up to where you want to be. So it’s always so much better to be In the know of where you are age wise in your health and what, , our common concerns, challenges that women generally face during that time. What happens is a lot of women going into perimenopause and menopause are not educated about what are all the potential symptoms they could have.

A lot of women do not know that their cholesterol will go high. And if their doctor is not educated well enough about hormones, they will put you on a statin. But what you [00:03:00] need at that point is not a statin, you need your estrogen, right? So knowing what to look out for is super critical in being proactive.

So first, just educating yourself, getting the information, speaking to the right people, , knowing what are all the symptoms to look out for, and then tabulating your experience against that. Right. What symptoms are you having already? What is the severity of those symptoms? Tabulating that. And then kind of noticing, okay, there are these other symptoms that you’re not having at the moment.

Great. , but if you talk to a friend or somebody else, they might be experiencing those things. So you could educate yourself and others. So I feel that is one way to be proactive as you’re going into your perimenopause transition. And of course there are so many others, right? There are things like what you eat.

if you’re moving appropriately and enough every day, how are you managing your stress? All the other things that go into foundations of health, are you doing those things? That’s being [00:04:00] proactive. That’s being responsible about your health. So as long as you’re doing those things, then I think you’re in good shape.

I mean, things can still come up and take you by surprise, but you’d be better off if you are prepared and proactive in that manner. Yeah. And I like your example about cholesterol, because I think, you know, when you talk about menopause, the things that get highlighted so much are, you know, the hot flashes, the night sweats, uh, vaginal dryness, uh, loss of libido.

, and we don’t really talk about holistically. There’s so many more symptoms that women experience, you know, the cholesterol, the increase in blood pressure, the, you know, just the, sometimes the lack of drive, right. They get more tired, more fatigued, and they don’t know what’s going on as they’re Hormones are lessening throughout this time.

And I really believe that we need a lot more education in this area. I know, you know, my mom never talked to me about menopause and what to expect and what she went through. I’m not even sure it was, [00:05:00] You know, more stigmatized back then, and you just didn’t talk about it. It’s something you just suffered silently through.

So I really love having experts like yourself come on and talk about exactly what’s going on for women , when do you, , encourage your patients to start looking for these signs and symptoms around what age, and then what are like some of the early things that you have them, um, think about with their health as they’re transitioning through this very important time.

Yes, so, um, just going back to the critical importance of heart health for women, that is definitely one of the challenges a lot of women will see around midlife is that up to the time that they started perimenopause, their cholesterol was fine, and now they go to the office and suddenly they’re, they’re Low density.

LDL is high. The HDL is low. The triglycerides are high and other markers can also be dysregulated. So just know that heart health, , is the biggest concern for women. Actually, more women die from heart [00:06:00] related problems than of the seven top. cancers combined for women, right? So it’s super important for us to know how important heart health is.

And the second thing you mentioned is your mother never spoke to you about menopause, neither did mine. And I think most women don’t get personal experience from older women because, , forget about society as a whole. Even we, as women do not talk about menopause, have not talked about menopause enough.

Now there’s people like you and me that have talked Chosen to make this our work and our passion. So we talk about it, but I know that even today when women get together, this is not something that really talking about in different circles, they’re not talking about in their friendships. So they’re not sharing their personal experience as much as is needed.

Right. And then I don’t know how much are we talking to the younger women that are coming after us to educate them. This is what my experience is, and this is what you need to be prepared for. So all of these are super important things to keep in mind. [00:07:00] And then coming to your question of when do I tell women to prepare?

When do I tell them to be on the lookout? , so as you know, and as I’m sure your listeners and your viewers know that the average age of menopause in the United States, in North America is 51, which means, , , the average and the median is kind of the same in this place. So basically, half the women are going through menopause at 50, and the other half are going through menopause at 51, 52, or those ages.

And perimenopause can start 10 years before, right? So half the women are starting their perimenopause journey At 40 right and there is a small subset of those that are starting actually even earlier. I have a young woman right now. She’s 25 years old and we are running some tests for her right now, but I think she is in premature ovarian, , failure, which is going to technically put her in menopause at 25.

Right. So, uh, I [00:08:00] mean, of course, there’s a lot we can do about it and we will do about it, but this is what I’m thinking that, that, that it’s important for people to know that just because we say the average age is 51, it doesn’t mean that you wait until 40 or 41 for perimenopause to begin. It very often begins in your late 30s, most often in your early 40s.

But it’s not uncommon for women to have given birth just a couple years ago and then be in perimenopause right away. And this is not on their radar because they have just given birth, their babies are so young. Um, how could they be in perimenopause? But it can happen. So it’s important to pay attention to the symptoms more than, , the age that you’re at.

So then, which means it’s super important to know what symptoms to look out for. And just have it on your radar. If you begin to see, experience some of those symptoms, then you know the transition has begun for you. Mm hmm. And what would you say the big, uh, symptoms are? I know for me, uh, anxiety increased [00:09:00] a little bit of feeling blue or less motivated.

Um, I usually have a lot of passion jumping out of bed and, you know, just the wonky sleep I was starting to get. , Those were some of my main highlights as I transition, uh, not at menopause yet, but, um, as I’ve started realizing my hormones were fluctuating, what are some other symptoms you would have women beyond the lookout for?

So the symptoms that get talked about the most often are of course, as you mentioned, the night sweats and the hot flashes, but they’re actually not the most common. The most common ones are, um, brain fog. Difficulty thinking clearly, , forgetting, memory loss, joint pains, migraines, itchy ears, , ringing in the ears, , body composition changes, weight gain, , of course, anxiety and depression, these are mood changes.

So for different women, this whole, um, spectrum manifests differently. [00:10:00] And of course there are some lucky women, a very small percentage, that don’t have any symptoms. , but more than 80 percent of us will have these symptoms and it ranges. Um, of course the most uncomfortable and the ones that you cannot hide and have almost kind of become a joke are the hot flashes.

Right. Because you’re in a meeting, you know, you’re delivering a presentation and your anxiety is high. And I noticed for sure that whenever I had a hot flash, I could trace it back to what thought crossed my mind a couple of seconds ago. Was it an anxiety provoking thought? And right there was a hot flash.

Hmm. I don’t know if you have noticed this or have somebody else reported to you. But for me, it was like I, anytime I had a hot flash, I could trace it back to, there was an uncomfortable thought that went through my head. Interesting. Interesting. That brain body connection. Oh, for sure. Yeah. Very powerful.

Very powerful. Now, when people are in this transition, , how do you talk to them? Are [00:11:00] you a proponent of hormone replacement therapy? Um, what are some risks and benefits? Can you discuss some of that? So when people come to me, I ask them first, what is their approach? What is their, um, attitude towards hormones?

Because there are women that are not comfortable, that have heard all the, uh, propaganda out there against the hormones, you know, that it’s cancer causing, cross blood clots and all those things. So I don’t want to start countering people right away. I don’t want to do that. I just want to understand. What is the information they have and what that is based on.

And then I can try and give a little bit more information and really see where they’re at. Like there are women who are going through menopause who have troubling menopause symptoms, but are so uncomfortable with hormones that they will choose to either experience the discomfort. Or use one of [00:12:00] the other therapies out there, which are like anti depressants or anti pain medications, which can also, to some extent, turn off the signals of hot flashes for sure.

, it’s not as effective, but it’ll certainly give you some relief. So I really want to meet a person where they’re at. And if they’re open to learning more, then I want to provide them the information. Um, and then of course I do a lot of these engagements, a lot of interviews, a lot of webinars and in person talks where I am talking about how much the hormone replacement can help.

I also try to educate women about the fact that no matter what we say about hormone replacement, about menopause, um, psychologically, sociologically, um, Whatever kind of name we might give to this transition that this is a drag, it’s a pain, it’s like we’re losing fertility and youth and beauty and all that stuff.

What it is in our bodies is simply a [00:13:00] deficiency of hormones. It’s just a hormone deficient state, um, and we can choose to give it any label. Right. And instead of menopause, um, which has kind of gathered a negative connotation over the last several years or decades, um, we could choose to redefine, rename, call it whatever we want, but what it is, is really just a hormone deficiency.

, and often I will also recommend to women that are hesitant is like, just do a trial. Okay. Do a three month trial, see how you feel, do your labs before and after, see the results for yourself, your symptoms will tell you, and you don’t have to take my word for it. So I think that goes a long way in getting somebody kind of like, giving them the information so they can decide for themselves.

Yes. And I, I believe they become very convinced after starting some of the medications and how they feel right. And how it really eliminates a lot of these, uh, [00:14:00] signs and symptoms that they’re experiencing that are uncomfortable. And, uh, I imagine they feel much better. With the hormones. Yes, certainly with the hormones with if they started any other medications, they may have partial relief.

, but we have to remember that those also come with other side effects. So you have to keep kind of all of that in mind. Yeah. Yeah. Yeah. And are you a big proponent of bioidentical hormones when you’re using a hormone? Yes, we only do bioidentical. We only do bioidentical. I would be surprised if anybody was still doing Premarin or Prempro or any of the other, um, conjugated equine estrogens or any, I mean, you know, um, insurance companies often will still not pay for the bioidentical progesterone because they want to pay for the midroxy progesterone, which is the, , synthetic version of progesterone.

So many times my patient will have to pay out of pocket for that. Um, or they’ll have to push back and say, I do not want medroxib. [00:15:00] I want the other progesterone. And sometimes the insurance companies will then cover. , but yes, so I only do bioidenticals. Yeah. And that’s probably because of the great research they have on them and they better data, of course.

Yeah. Yeah. Yes. So the, the study that you’re referring to is the women’s health initiative where they, there were a lot of missteps, but also one of them was the fact that they did not use bioidentical hormones. They use the synthetic hormones and, um, even those showed benefit in some places, but on the whole, we do not recommend using them because there are some downsides to those.

Okay. Yeah. And I love when you pointed out, cause I talk about it as well, but it’s always nice to hear from other professionals in the space of that. Those were done by synthetic hormones. Those were not bioidentical in that there’s a whole plethora of data showing how bioidentical hormones have been helpful for women, not to say every woman should be on them.

Of course, it’s individualized, [00:16:00] um, based on other conditions. And so can you talk to maybe who would not be a good candidate for. a bioidentical hormone replacement therapy. So, um, again, it requires an, you know, individual case by case evaluation. , it depends on if you have a personal history of breast or ovarian cancer, not so much family history.

In that case, um, somebody might begin with low dose bioidentical hormones and they might decide in conjunction with their oncologist to screen more frequently. But even so, there really isn’t any data which shows that hormones are going to lead to any kind of cancer. In fact, um, in the book, Estrogen Matters, I’m sure you’re familiar with it.

Dr. Avram Blooming has said that if you are on hormones, you are 23 percent less likely to develop, , breast cancer. And if 40 percent better than the person who’s not taking hormones. So [00:17:00] that’s one thing. So after doing it in a case by case evaluation, the two things that kind of remain to be considered,, are one is a risk of a venous blood clot.

This is not an arterial blood clot, you know, this is not the kind of blood clot that will cause a stroke. or, um, a heart attack. This is a kind of blood clot that travels in your veins and can end up in your lungs and it will be painful at the time. , The odds of that venous clot are very low. So for a normal woman with no health conditions, her risks of developing a venous clot are 2 in 10, 000.

 For a woman who is on hormones, the risk is 4 in 10, 000. So you could say , there’s a 100 percent increase. Right. , but that is very misleading. You want to look at absolute number, you know, the relative risk, like, you know, and then it’s also important to know that anytime you’re [00:18:00] pregnant, your risk is six in 10, 000.

So it’s higher, it’s higher than normal and higher than what it is in hormones, but nobody tells us not to be pregnant and have babies. So, so that’s one risk. But it’s a very, very, very small, so small, in fact, that I would just say it’s not even a risk, right? But it’s important to know that that’s out there.

 And the other thing is, , if a woman has gallbladder disease, then, , potentially it can cause some complications. Right. So the importance of that is the fact that how estrogen is metabolized and how the metabolites are eliminated from the body. The gallbladder plays a very big function in that. So if your, , digestion isn’t optimal, If you are constipated, if you have any gut related symptoms, nausea, cramping, , diarrhea, constipation, , any kind of digestive symptom or you have leaky gut, , then it’s really important to fix those problems [00:19:00] before you start on hormones.

Right. So, and if you already have, uh, gallbladder disease and you are on hormones, it’s important to address those as soon as you can, because, , what can happen with the gallbladder disease is eventually you may end up getting an infection and needing to have your gallbladder removed, , which is very common in a lot of women.

, because what is the gallbladder doing? Basically, it’s a storage house for the bile. Um, The pancreas produces the bile and the gallbladder stores it. Anytime you eat, the gallbladder releases a little bit of bile so that your digestion can proceed completely. Now, if you don’t have a container for the bile, then the pancreas is producing the bile and it’s continuously Flowing out, dripping through your system and there’s no container for it.

And then that can create other complications and then you have to manage that and that kind of becomes a lifelong condition. So it’s really important to know if you have the [00:20:00] propensity for global bladder disease, if you have the risk factors for that, and then fix it. It’s very fixable, so fix it and then you can, um, proceed with the hormones.

Yeah. And when you’re looking at, uh, how estrogen is metabolized, do you run the Dutch test on women? Is that something you commonly do? Or do you look at other laboratory, , measures? So generally what ends up happening is, , I don’t run the Dutch test as a matter of, I run it only when it’s needed because their patient symptoms tell me a lot.

, their bowel movement history, how frequently they go, do they have to take, , laxatives, , what is the general routine? What are the symptoms? And I do a stool test, which tells me a lot about their gut health. And it’s also tells me a little bit about their beta, beta glucuronidase, which tells me.

how they’re metabolizing things. So I try to use a test that give me a lot of information and not just, , I mean, I think the Dutch test can be useful in some places, but I don’t always use it. Um, because I just [00:21:00] try to steer, uh, people towards like, if you’re not having at least one bowel movement every day, then I need you to do so and so so that you can do that.

Right. So , I’m trying to help at the source, , and fixing those problems and using the information from the stool test and other tests and patient symptoms to kind of put together a picture to see what’s happening in the body. That’s yeah, so important to do because if We’re not eliminating, like you said, we’re just going to keep recycling that estrogen rather than eliminating it.

Right? And so we need to make sure that they’re detoxing their estrogen and they’re actually metabolizing it, leaving their body. So, , it’s not storing up and causing other problems. So very important that we’re looking at that. And so I really want women as we’re talking. You know, to be proactive about their health, really looking at their, , bowel movements.

Um, and also, you know, there’s a lot more information we can get from the bowel movements to the consistency, how often they’re having them and just making sure that digestion [00:22:00] is optimized. And I love this holistic approach, right? Is really not just about. One symptom and here’s a drug for that symptom, right?

That’s kind of like band aid medicine. That’s what a lot of conventional medicine is still today, unfortunately. So I love that you’re like a holistic integrative practitioner because you’re really understanding their body as a whole. How is their digestion working? How is that impacting their hormones?

And if we do place them on hormones and their candidate for it, right, how are they going to handle those hormones and making sure that the body is optimized and not just treating a symptom here, a symptom there. Yes. And it’s also important to know that, um, when I’m evaluating somebody, whether they’re a good candidate for hormones or not, I’m also looking at their total toxic burden that they’re carrying.

I am looking to see what is your load of mold toxins or chemical toxins or heavy metals? Because if you have these toxins in your body and everybody does to some extent or the other, some have more than others, right? And, , [00:23:00] what happens is our body is a giant detox machine. Right? But it can get clogged up and then not be detoxing appropriately.

If you’re not detoxing properly, then what could potentially happen is, , if you have been exposed to a lot of endocrine disruptors, as we all are, that is going to make a difference. If you have fibroids, it’s going to create a problem there. If you take hormones, you may not absorb as well or maybe absorb too much.

, it may create problems with again, metabolizing. So it’s really important to understand your toxic burden. Also, before we put you on hormones, , the world is just changing every day and, and we need to keep pace with what we need to do to make sure your health is optimized and not just give you a band aid solution, even if from a holistic perspective.

Yeah, absolutely. And we know more and more chemicals are getting approved and into our foods and, and, you know, our body’s not meant to detoxify all these products that we take in, even through our personal care products or [00:24:00] makeup, you know, just the amount of exposure that we have to these endocrine disrupting chemicals, as you mentioned, our body will just hang on to that unless we have our detox pathways open and also monitoring and measuring this just to see, you know, for that individual and that personalized medicine approach that you bring, , so that they know exactly.

How much they are retaining, and then also ways to minimize that toxic burden. Now, I want to switch to, because I know you have such a passion, and this was kind of how you got into the space around dementia, right? And brain health. And really, I would love for you to describe, , You know, the brain fog you talked about, not finding the words, these things that start to happen during perimenopause and into that transition, , what are some key principles that you can educate us on when it comes to maintaining our cognition?

So, genetics is part of the problem. Right, we begin with the genetics because we know that some genes predispose us to dementia and Alzheimer’s and there are [00:25:00] others that are much more determinative. So if we have some of the early onset dementia genes, , we will begin to see manifestation and a significant manifestation pretty early on in life.

Is this the ApoE or? The ApoE is a predisposition. It doesn’t like determine, it’s not determinative. There are other, the PSYN1, PSYN2, the APP genes, , which normally, right now, it isn’t a practice to check for them because it can actually send patients into a tailspin because, like with the ApoE, even if you are a homozygous, which means if you have two copies of the ApoE4 gene, there is still a lot that we can do and keep dementia at bay.

There’s a whole lot. With some of the other genes, it is less so. We have less in our hands. So, , It’s important to know family history. It is also important to know your own history, but you really have to evaluate it with like, are you going to be able to take it in your [00:26:00] stride, work with a practitioner to stay proactive and not give in to, , An unnecessary hopelessness, right?

, so once we know that, then the second important thing to know is that women are diagnosed twice as much with dementia and Alzheimer’s as men. So it’s twice as, critical for us to be on top of this thing, right? The other thing we need to know is that for women, often dementia begins at menopause.

Because we are losing our estrogen and estrogen is the master regulator for women’s brains. So it is super important to discuss with your practitioner. If you are a candidate for estrogen therapy and also progesterone and started at the right time, it doesn’t always have to be that you have to have not had your period for a whole year before you begin your hormones.

, once you work with your practitioner, you may come up with a solution that is, , Much [00:27:00] before that, actually, because sometimes women can go through perimenopause for long periods of time where they have one period every three or four months. And once you go three months without a period, the rate of bone loss is highest at that time.

So you want to really be on top of this game. So once women know what the genetics are, once women know that their risk for dementia is twice as much as that of men, And then, um, that it begins at menopause, then it’s super critical to kind of see, okay, in addition to hormones, what are the other things we need to keep in mind?

The, uh, two biggest things here are your metabolic flexibility, which means how insulin sensitive you are, , What is the response of insulin once you eat a meal? And this is a test that everybody should be getting with their doctor. You can check your fasting insulin at the next labs, and this number should be a low number.

If you look at the range on Quest Labs or Lab, or LabCorp, you will notice that the range is [00:28:00] anywhere from 3 to 25 units. That doesn’t serve us. That’s a very wide range and it’s not, you know, if you’re a 24, you’re healthy. That means you’re very insulin resistant. So you want that number to be closer to 3, 4, 5, 6, even if when you’re at like 10, 11, 12, even though you’re squarely in the middle of the range, you’re insulin resistant.

So you want to work to get that reversed. And then the 

 Other thing is, , exercise is super critical, super important. Exercise releases brain derived neurotrophic factor, BDNF, which helps the brain to grow and nourishes your neurons. So in addition to knowing your genetics, , being metabolically flexible, , and exercising regularly, and then all the other things come in in terms of what you eat, , looking at your toxin load.

Looking at if you have any chronic, low grade, latent infections that could be causing a problem. So all these things are part of [00:29:00] preventing and reversing early stages of dementia. Yeah. It’s so good with exercise too cause it increases that cerebral blood flow, right? It’s just oxygenating the brain, helping the brain, um, mentate better and then also sleep, right?

Sleep being a critical factor for, um, the glymphatic system overnight just clearing out, I hear sleep is super important to sleep is super important. Sleep is super important. Not only just the quality and quantity of sleep, but also you want to rule out.

You want to screen for sleep apnea. It’s more common than you would think. , we used to think that you have to be overweight. And be snoring a lot to, and usually you used to think it affects more men. It does affect more men, but a lot of women also have sleep apnea and they don’t know. sleep apnea can create a lot of problems.

Of course, your brain is not getting the oxygen and nutrients at night for sure. And, It can also, , worsen heart disease. , of course, when your, , brain is not getting the oxygen, of course, your [00:30:00] parts of the brain, , they are, um, not thriving. But also , you will not be able to be metabolically flexible.

You won’t be able to lose weight if you have sleep apnea. You won’t really be able to reverse heart disease if you have sleep apnea. So super important to do that as well. Yeah. And you just, um, speak with your physician and get a, a sleep study for this or a sleep apnea study for this. So, um, you have to go to a physician, I think the most important thing that I want to say in any interview is the, what we can do is like, just educate yourself on what to look out for.

And when you speak to a physician, what to tell them so that they understand where you’re coming from, right? Like, if you are an informed consumer, you can bring the right information to your physician so that they can order the right tests for you. Right. So how will a person screen, agree to screen you for sleep apnea?

, there are a few factors. , generally, of course, snoring is one, but there, there are others like [00:31:00] if somebody has witnessed you kind of gasping for air at night, or if you wake up gasping for air, that’s a big red flag. If you have a very dry mouth, which gets worse at night. That’s a concern and then there are these sleep studies, some that you go to a sleep center for and there are others that are home studies and these are like a little clip that you wear on your finger, like a pulse oximeter and there’s a little electrode that gets put on your chest and you download , an app on the phone.

 Home sleep studies, even though they are not as robust as, um, a sleep study that you would do at a center. It’s a pretty good screening tool. So I had done a sleep study for myself at home and that showed mild, like, you know, zero to five apneic events, , per night is almost like you’re fine, but five is where mild sleep apnea begins and mine was five.

So it was a big enough concern for me that I spoke to my doctor and I told them that, okay, I also tend to get a very dry [00:32:00] mouth at night. So do I have sleep apnea? So I actually went to a sleep study center. And of course, they put all these electrodes and wires everywhere in your body can be a little hard to sleep.

But, if the home sleep study shows you some concern, then you can make a case for an at center sleep, you know, study. It’s really important to do that. Mm hmm. So we touched on sleep. We touched on nutrition a little bit. Um, how about a little bit more detail around that? Like really supporting the gut microbiome, really supporting those deep talks pathways.

Do you put people on a certain diet or do you subscribe to a certain diet or, , it’s just more of a whole foods, organic, plant based? , diet that you would recommend. Yeah, I don’t believe in one diet for everybody. , we have different taste buds, we have different, uh, preferences. Um, for me, the thing is anything that’s helping you being metabolically flexible and, , satisfying your taste buds is good enough for me, [00:33:00] right?

If you are insulin sensitive, And you are eating to remain insulin sensitive, you can eat whatever you want, right? , of course, if, , and when I say metabolic flexibility, I’m including your lipid panel in that, that your cholesterol is under check, you don’t have high triglycerides. Um, but I don’t, like, the only time I’ve had, I’ve paused a little bit is when, is when somebody is at an only meat diet.

And I wonder about that because yes, , I have heard about all the benefits that people talk about for the only meat diet, but I, I have seen gut health of those people and it is not optimal. And so for me, it’s like, as long as your gut is in balance, you’re insulin sensitive, your lipid panel is good, you can eat whatever you want.

But what I find is that, um, there is a, Common grounds where everybody can meet where they’re like, vegetables are great in any diet that you’re on, um, [00:34:00] the low glycemic vegetables, the cruciferous vegetables, the green, um, vegetables, the, All your vegetables, most vegetables are like low glycemic, um, as long as you’re doing plenty of vegetables a day and you’re getting your hydration and you’re getting a lot of movement and you’re getting enough protein, don’t have to overdo the protein, but if you’re getting enough protein, I’m okay with whatever cuisine, Um, I’m also a big proponent of people trying a continuous glucose monitor and seeing for themselves what is their metabolic flexibility status?

How much sugar, how much glucose are they spiking each time they eat? The important thing is not to just know your glucose numbers fasting, but how it’s responding to food. And what is the response to different foods? Because then you know for yourself and then you can self regulate. Some people do great with quinoa.

Some people spike blood sugar a lot with quinoa. [00:35:00] Some people do great with steel cut oats. Some don’t. So, you know, you may think you’re eating really well. And yet you may be insulin resistant and so the best thing to do in that case would be get a continuous glucose monitor for a month at least and try it, see it for yourself and then tabulate what are the things that, , cause your body to produce a lot of blood glucose.

And then, uh, what are other foods that don’t spike it so much? And then you can build your, uh, meal plans around that. Hmm. Such excellent advice. I wore a glucose meter for a month, a month and a half, maybe, maybe it was even two months. And I found out so much information, you know, just how regular coffee with milk would change it versus, you know, just straight coffee, black, and just, um, learn so much about the choices I was making and just having that real time data that you’re able to scan right there and learn.

It was such a. Yeah. You know, like positive feedback for me [00:36:00] from, for my brain, it’s like, Oh, this is really how I’m responding to this. And is there a healthier option? Cause this, this is really spiking me. And I didn’t think I was, and here I am insulin sensitive, just wanting to, you know, um, make better choices.

And I think that kind of device really gives you that real time data and the data doesn’t lie. The other thing that the continuous glucose monitor does, which people don’t normally talk about is it tells you how you respond to stress. Right. So you may not have eaten anything for a while and your fasting glucose is like 70, 80, 85.

And then if you are in a stressful situation, you will actually see your glucose begin to rise. Because your body is, your liver is preparing for you for a fight or flight response. And it’s pouring glucose from the liver into your bloodstream. So you learn to see how your body responds to stress, and you know that stress and your [00:37:00] response to stress can also cause insulin resistance, right?

Because if it’s consistently elevated, then your body has to put out the insulin to put it back into the cells. That’s right. So super important to also know what are the things that stress you out and how to bring that stress down a little bit. Very good point that you bring up about the stress and the cortisol.

Is cortisol something you monitor a lot for your patients? I have done the four point cortisol test for people. I put that test also along with the Dutch test. I don’t do it that often, um, because, , I think it’s a given that we live in stressful times. People’s stress is super high. When people come to me, I often find there are other tests that are going to give me actionable information and I’m just going to presume the stress is high.

I’m just going to presume that. And so I, that is also something that I will do only infrequently. Well, thank you so much, [00:38:00] Dr. Sembi, for coming on the podcast. As we’re wrapping up, is there anything else that you want to mention to my audience about how to empower them as they talk with their physician about this perimenopause menopause transition?

Yes. I would just say that, , educate yourself on what to look out for. Educate yourself on what are the symptoms of perimenopause and menopause. And, , I have a resource on my website if you think it would be helpful for your listeners. It’s basically arunamed. com slash quiz. So my website slash quiz and there is a list of 33 symptoms.

And those symptoms are taken from the National Menopause Society Menopause Questionnaire. The list of 33 questions is from there. So you can go to that list and kind of see what are the symptoms. that you have and what are the other symptoms that perhaps you don’t have that a friend might have so you could talk to them about it.

You should just be [00:39:00] educated on what to look out for and that questionnaire also has ways to score yourself like you have the symptom not at all a little bit or a lot and then it gives you a score and tells you like whereabouts you are and what kind of help you might potentially need. Wonderful. So this is really helpful so that when you go talk to your practitioner, you are really informed and you’re speaking in a very knowledgeable way about what are the symptoms of menopause that you’re having so that they will listen and offer you a solution that is right for you.

Wonderful. We’ll definitely link that, uh, website in the show notes. And then also, can you let my listeners know how to find you in case they want to learn more about you and all your handles and where you’re at and in case they want to make an appointment with you. Yes, of course. So my website is aruna.

med. A-R-U-N-A-M-E-D. It’s short for Aruna Personalized Medicine. That would’ve been too long. Aruna med.com and and my [00:40:00] email. You can reach out at hello@arunamed.com and I’d be happy to connect with anybody. Great. And you’re on Instagram as well, and Facebook? I am on Instagram. It’s Dr. Manna. Uh, so just Dr.

Manna Semby on Instagram and on Facebook also as Arunamed. And also I share a lot on my personal page as well. So all those are options and all these social media links are on the website so you can see them. Fantastic. We’ll make sure we put all those links in the show notes as well. Well thank you so much Dr.

Semby for coming on the podcast today. Thank you Sherry. It was wonderful.