S9 Ep11: Midlife Transitions: An Integrative Approach to Navigating Menopause Naturally with Dr. Anjali Dsouza
“We need to know what we're doing so that we can support women to feel their best and live long lives.” —Dr. Anjali Dsouza
Cha Cha Cha Changes Mini Series
Welcome to the Cha Cha Cha Changes Mini Series, a special limited exploration of menopause and the essential ingredients for navigating this transformative life stage!
Menopause and perimenopause are significant life transitions that impact women's health in profound ways. From changes in mood and cognition to increased risks of chronic conditions, this natural hormonal shift can bring a host of challenges. Yet, with the right knowledge and support, women can navigate this transformative period with greater ease and vitality.
District Center for Integrative Medicine (DCIM) Founder, Dr. Anjali Dsouza, is a leading expert in integrative medicine and a certified specialist in menopause care. Drawing on her extensive training and passion for holistic wellness, she provides comprehensive guidance to help women optimize their health during this pivotal stage of life.
In this insightful conversation, Justine and Anjali delve into the physiological changes of menopause, the importance of food as medicine in navigating the challenges of menopause and perimenopause, practical tips for symptom management, and a wealth of resources to support women on their journey.
Connect with Anjali:
Dr. Anjali Dsouza is the Founder of District Center for Integrative Medicine (DCIM). She is a board-certified physician specializing in Integrative Medicine, Palliative Care, and Psychiatry. Her areas of particular interest are women’s health optimization, autoimmunity, digestive dysfunction, lifestyle medicine, nutritional medicine, preventative care, and metabolic health.
Episode Highlights:
00:17 The Cha Cha Cha Changes Mini-Series
03:10 Meet Anjali
08:33 Understanding Menopause and Perimenopause
12:28 Menopause: Common Symptoms and Health Risks
16:51 Food as Medicine for Menopause
20:03 Tips for Managing Menopause Symptoms
26:44 Resources and Support for Menopause
Tweets:
Hot flashes, brain fog, and a rollercoaster of emotions— welcome to the wild world of menopause! In the first episode of our Cha Cha Cha Changes Mini Series, @jreichman and District Center for Integrative Medicine Founder, Dr. Anjali Dsouza is spilling the tea on navigating this transformative life stage. Tune in! #podcast #entrepreneurship #socialgood #inspiration #impactmatters #NextGenChef #EssentialIngredients #Season9 #ChaChaChaChanges #menopause #womenhealth #integrativemedicine #hormonereplacement
Inspirational Quotes:
04:38 “We need to know what we're doing so that we can support women to feel their best and live long lives.” —Dr. Anjali Dsouza
15:43 “We lose estrogen when we're in menopause. We no longer have the protective effect of estrogen, which supports bones and gives bones that extra oomph. —Dr. Anjali Dsouza
17:14 “Everything is individualized; people will respond differently to things.” —Justine Reichman
17:33 “Food is at the center of everything. It is the first message that your body gets. It is a biochemical message that your body will respond to.” —Dr. Anjali Dsouza
19:04 “There's no limit to vegetables ever, so always plant forward.” —Dr. Anjali Dsouza
26:22 “We have to detoxify our hormones too. All of these hormones are moving through our liver and so putting any stress on that system with alcohol is going to have ripple effects on the rest of our bodies.” —Dr. Anjali Dsouza
Transcriptions:
Justine Reichman: Hello, and welcome to Essential Ingredients in our special limited series on Cha Cha Cha Changes, it's a very special series that gives us an opportunity to speak with experts and navigate us through menopause. So many women go through menopause and have challenges, and this is an opportunity to hear from a doctor that's dealing with this in an integrative way, as well as other founders that have innovated in the space to create other foods that can help us better deal with these symptoms. Make us live that happy fulfilled life feeling good. So I invite you to join us and listen to our series as we move forward.
Welcome to Essential Ingredients. I'm your host, Justine Reichman. With me today is Anjali Dsouza. She is a leading expert in Integrative Medicine. Thank you so much for joining us today.
Anjali Dsouza: I'm so excited to be here, Justine. This is going to be a great conversation.
Justine Reichman: I'm super excited too. I would say that today's conversation is part of a limited series that we're doing on menopause. And so as I've reached the middle age and I hit 52, I often hear people say that that's like the time, the average time when people go through menopause. Now for me, I personally don't know that. Because as I started to tell you, I've been on the pill for hundred years because I was useless for the (inaudible). The week before, I was nauseous, tired and cranky. The week above, oh, my god, I'm so tired. I don't know it well, and it's icky. And then the week after, I'm still tired. So three weeks out of the month, like non functioning. That's not useful. I went on birth control years ago, and I went on and off throughout my life, but it really made such a huge difference. But the reason I share that is because today, whereas we talk about menopause, I'm going to be coming off of the pill as we decide that we're going to do this around 52 so we could figure it out, and then do some hormone replacement and all sorts of things.
Anjali Dsouza: Yes.
Justine Reichman: One of the inspirations is because I'm not alone in this journey, and we've had a variety of other folks come on to talk about products that they've made with different ingredients that have helped minimize some of the symptoms. I'm excited to have you on to really talk about it from a medical perspective as well, and hear what you're thinking at this time. What some of the resources are that we can all tap into. So as a leading expert in Integrative Medicine as it relates to menopause, we'd love to get started talking and just hear what inspired you to go down this path
“We need to know what we're doing so that we can support women to feel their best and live long lives.” —Dr. Anjali Dsouza
Anjali Dsouza: I will start by saying that I have always loved the underdog in medicine. That married with my kind of interest in more holistic care that started as a young kid. I have just sought out additional training to be able to really provide people with care, especially when they can't get what they need from the conventional medical model. And that could be menopause, and generally women, right? That could also be people with lots of chronic conditions who maybe are not getting what they need out of conventional medical care and a whole host of other things. But menopause, I think, specifically has been an area in women's health that even OB GYN will share that they never really received proper menopause training, and so I went kind of out of my way to study this and become certified in menopause care to be able to support women. Because in fact, it's not just a time where maybe you feel bad, it's a time where there is a significant change in your physiology that has a lot of connection to pretty serious medical things, whether it's cardiovascular disease, or diabetes, or Alzheimer's disease or osteoporosis. These are things that actually put a lot of weight on the quality of life and even the morbidity and mortality for women. And so we need to know what we're doing so that we can support women to feel their best and live long lives.
Justine Reichman: I couldn't agree more. I couldn't agree more. And one of the things that comes to mind as you're talking about this, and you're saying you did some extra training and wondering, okay, so what is this extra training? I'm always curious, and I always want to dig deeper. When there's certain things that are more interesting, you want to see where you can find the resources to be able to get it and understand that it's vetted. I'm curious, can you share with us a little bit about that extra training and where you went to find it? How did you decide that was the right training to get to make you the expert that you are today?
Anjali Dsouza: Hopefully, I made the right choices. Since I have more of an integrative medicine practice, I sought out an integrative medicine fellowship and received a board certification in integrative medicine, which is board certified doctors are the standard that we have in America at least of being able to understand, there is some rigor in the training. There are some standards of what kind of education these doctors need to stay with? And so I first did that to give me tools more holistic, which for your audience, there's a lot in the nutrition and food as medicine category that women can really be thinking about to support their health. And then I went on to seek out the menopause society, which was previous call the North American Menopause Society, which is really one of the main kind of governing bodies, or bodies in America that provide menopause education for clinicians and resources for non clinicians that are looking to find, oh, is there a clinician that has studied menopause that could help me with this specifically where people that are listening to this podcast or otherwise could go and find. I would say I chose them based on the rigor and the notoriety that they have, and then sought out to study and complete their certifications to be able to feel confident that I was providing good care for people.
Justine Reichman: Thank you for sharing that. For me, it really does round it out and says, because so many times you go to a doctor, or you go to go find that resource and that expert, and you're wondering, okay, how did you become an expert in this? Especially when we talk about food as medicine. Because so often, I hear from doctors that they get four hours worth of nutritional training and they're like, you really need to go see a dietitian or something. So here we are talking about food as medicine. I think it's really important to acknowledge that you specifically went to go learn more about these things to be able to help people. And it's not just life experience with patients, but it's coupled with that additional training. So yeah, that's really, I think for me, when I'm looking to talk to somebody, whether a doctor or a resource. One of the things I really like to do is figure out and vet their experience the best way I can because we get so much information. And as lay people, how do we know? How do we make that? Let's talk about menopause a little and what you've been seeing. Are there any trends that you can share with us around age? What to expect? How to tap into resources so we can do things to make ourselves feel well?
Anjali Dsouza: And if I may answer your question, but maybe take us on a tiny detour to just explain, yeah. Okay. When we are born as females, we have about 1 to 2 million eggs that we have that one day could be fertilized and turned into babies. And there's a ramp up process to get that whole system working. The brain starts talking to the ovaries somewhere around 8 years old, but it takes years to crank that system up until it's working. And I just want to name to normalize this that as it cranks up, it also cranks down. That whole journey of cranking down perimenopause into menopause is the other side of the same spectrum. It's this beautiful blossoming and changing into a different kind of flower. And I think it's useful to name that. Because sometimes, it can help people understand that you're not just feeling like crap when this happens. It's because there's a different physiology that's changing and shifting into a different gear for the next whatever 20 to 50 years of your life, whatever that may be. I would say that what I most commonly see is people early in perimenopause that come in saying, what got you to go on birth control? I don't know, but I'm super irritable. I have brain fog. My actual menstruation is a gong show. It's super heavy or super painful. There's just stuff happening. And it's not to say that our periods are without any discomfort, but the degree of discomfort is just so great, right? And then that can kind of just continue as you get to, the definition is, once you've had one year without a period, you're in menopause.
Justine Reichman: That's why I don't know.
Anjali Dsouza: I was thinking about that when we were planning, well, I'm on birth control. I'm like, for all we know, you may actually be in menopause.
Justine Reichman: It's not a bad thing.
Anjali Dsouza: It depends. I think I would never say it's a bad thing. My philosophy in medicine is that everything is individualized, and everything is a risk benefit for that person in front of you. It sounds like you had a great deal of suffering, and you chose the birth control pill to help manage that discomfort, those symptoms that you were dealing with. If I had the chance to have met you 7, 10, years ago, I might have explored if you wanted to look at a different avenue. But it also made me protected against pregnancy which was something that could have been important to you, or anybody who's looking at options out there. So it's not good or bad. It's more like what is going to work for your body. I think the curious thing is that when you're on birth control in your early 50's, given the average age of menopause, like you said, around 51, 52, then it's kind of like, I have no idea. Are you in menopause? Are there things that we would have known that we're starting to shift if that birth control wasn't on there? That may be something that you'll be able to explore once you get off of it.
Justine Reichman: Sharing that, I can imagine for me, for so many others, is really pivotal because I'm thinking about all these different experiences that I had. My lower hip and glutes have been hurting me for 10 years. I don't know if the phone is listening to us, but I keep getting ads for hip pain and how it connects to menopause. I'm not sure. I keep remembering what the name is. Somebody listening to me here about complaints about my hip and my lower back, and then my neck. I'm curious, as we dive into this a little bit more to understand some of the things that people can see during that time. Because I was on the pill, and as you said, I might have missed things that might have been connected. So this glute and hip pain, could that have been related? Could it still be related?
Anjali Dsouza: It's possible. When you've got birth control on board, you kind of have a steady state of hormones that are present. It's hard to know what's what. But yes, absolutely. We're still, overall, probably dealing with declining estrogen levels. And to just kind of frame this, we've got more than 400 receptors for estrogen all over our body, whether that's musculoskeletal, skin, heart or brain. Think of hot flashes as a very menopausal symptom. That's like the tip of the iceberg, Justine. Sleep changes, mood changes, cognitive changes, depression. Interestingly, you're 14 times at higher risk to have a mood episode in the two years prior to menopause than the entirety of your life before then, and that's even if you've never had depression before. So it's pretty significant. Obviously, hair can change. People will notice a thinning, a drying, a dropping of hair. Skin changes, which can be acne, but also dry skin. Body composition changes. So we change from more of this subcutaneous fat, to a more inflammatory kind of fat called visceral fat as we move towards menopause. And then our cardiovascular risk goes up.
Justine Reichman: I kind of like that, like you're having a party.
Anjali Dsouza: I gave a thumbs up, and suddenly there were fireworks everywhere.
Justine Reichman: For those that are listening to the podcast and not watching the videocast.
Anjali Dsouza: Yeah, the explosion of fireworks. I think I said cardiovascular and metabolic, so things like diabetes can greatly increase your risk, and so does just weight gain generally. And then there's a whole spectrum of musculoskeletal things. Si joint discomfort actually increases in arthritis and an actual kind of rheumatoid disease related to musculoskeletal health, and then a very specific kind of vaginal vulvar changes. So vaginal dryness, pain with intercourse. It's a whole host of things that can change. And I don't want to be doom and gloom. It's more like just being aware of those things that may change. And most importantly, go and talk to someone. This is hopefully an invitation for advocacy.
Justine Reichman: You mentioned also, I think osteoporosis.
Anjali Dsouza: Something on my list, but that's a big one.
Justine Reichman: I think you did say it before, though you didn't say it now, but you said it is good. So I'm wondering, is that something that comes up as it relates to perimenopause to be an indicator? Is that an indicator that something is changing?
“We lose estrogen when we're in menopause. We no longer have the protective effect of estrogen, which supports bones and gives bones that extra oomph. —Dr. Anjali Dsouza
Anjali Dsouza: There's an interacting sensitivity there. So just as a function of us losing estrogen, we are kind of naturally losing the ability to stimulate bone and muscle. And so this is related to some of those changes you see in the body that happens as you get there. As we literally lose estrogen when we're in menopause, we no longer have the protective effect of estrogen, which tends to really support bones, and give bones that extra oomph. Is menopause causing osteoporosis? Not necessarily. There are certain people that are more at risk, but it's certainly that the loss of estrogen is going to put you at higher risk. So you'll see a higher incidence of osteopenia or osteoporosis as you move past menopause.
“Everything is individualized; people will respond differently to things.” —Justine Reichman
Justine Reichman: I'm so glad that you brought this up. I've heard so often that it's the hot flashes, or it's being temperature sensitive, or something like that. And there's all these other things that could just be indicators or red flags, or just something to give you a moment to pause. Be like, let me look into this further. So if we did that today, for anybody listening to me, this is a great win. So since you said we were getting a little doom and gloom, I want to recognize that we do have some exciting things here to talk about too as you started to bring up the idea of food as medicine and the impact that can have. So I'd love for you, if you could, to just talk a little bit about that. What does that look like? What that means for people as they are either in perimenopause or menopause, and the impact that they can expect to see. And of course, everything is individualized, and people will respond differently to things. But even just to start the conversation to say, here's a couple things to try, and the impact they could expect.
Anjali Dsouza: As someone who practices more integrative and functional medicine, food is at the center of everything. It's literally the first message that your body gets. It is a biochemical message that your body will respond to eating a bunch of french fries. That's an inflammatory message that's going to have a certain impact on your body. So when we just narrow this down into perimenopause and menopause, some of the recommendations are going to be standard that I would give anybody that's trying to live a wholesome long life. But there are some nuanced things. So like I mentioned before, there is this change metabolically that's happening where we are less able to handle sugar, caffeine, alcohol. And this is going to have impacts that will increase the symptomatology that we experienced during perimenopause and menopause.
Justine Reichman: Before you go, I'll ask you a quick question as it relates to sugar. When you're talking about the impact of sugar and how people respond to it, are you talking about refined sugar or even sugar in fruits, and those kinds of foods that might have it already in it?
“Food is at the center of everything. It is the first message that your body gets. It is a biochemical message that your body will respond to.” —Dr. Anjali Dsouza
Anjali Dsouza: Yeah, great question. Thank you for the great question. Thank you for the distinction. I would say, primarily refined sugar. Although there are a subset of women that become glucose intolerant, and it really affects how they feel in perimenopause and menopause, actually lowering their overall even complex carbohydrate load helps them feel better. Interestingly enough, now there's no limit to vegetables ever. So always plant forward, always, always, always. If you could have a croissant every morning for breakfast, and in perimenopause and menopause, that is more a fun thing that you do every once in a while versus your morning routine. Obviously, that's more refined. But even thinking like a whole brain pasta or a brown rice, it may just not work as well for you as it used to. So there are just things that you may have to pivot around. Nutritionally, I find that carbohydrates tend to be one area. And then the other area is interesting, if you're trying to really help yourself maintain body composition, keep your bones as strong as possible, and support brain fog. These are all things that can come up that really a protein forward approach is very important. You might have been able to get away with less protein in your earlier years. But as you move into this time, somewhere in your 40's for most women, getting around 30 grams of protein three times a day to hit around 90 to 100 grams a day is actually really beneficial, and that's hard.
Justine Reichman: I was curious, I eat a lot of protein and I'm wondering, I love protein like it is. I woke up and ate leftover steak for breakfast, or leftover fish, whatever it is because I'm so intolerant to so many things like eggs, gluten and etcetera. So to me, that's how I feel my best. But I'm curious, that's a function of how I feel. I'm very attuned to what I eat. How might you recommend for other people to figure that out for themselves since no two people are the same, and not everybody is quite in tune with, okay, I ate four strawberries. I shouldn't eat anymore, because I really do get a stomach ache from that. Do you know what I'm saying?
Anjali Dsouza: I do know.
Justine Reichman: Just to follow up by eating the 90 to 100 grams of protein, what kind of impact can somebody see or expect to have?
Anjali Dsouza: Great questions. So let me start with the first one. I think some people are naturally more in tune with their bodies than others. They just naturally have a very visceral sense of this. Makes me feel one degree more tired than this template. And that's awesome if you have that, and people that don't can train it. But we are also busy and that's not always high on the training list for people. So I think those individuals feeling bad enough is what motivates them. As a clinician, I can say that I often will recommend, well, just at baseline, I think this would be best to do, and they'll be like, I don't think that makes a difference. Okay, great. But once they feel bad enough, they like, come back and be like, what was that thing you said to do again? I'm willing to try it. And most of the time, I would say 90% of the time, Justine, they notice it. Once they feel bad enough, they start paying attention. They're like, oh, no, you know what? That was remarkable.
Justine Reichman: What's the window that people need to stick to something at minimum to be able to see the impact? When are people giving up too quickly?
Anjali Dsouza: So for food sensitivity stuff, the minimum is 21 days if you look in the medical literature. I typically round that up to, if you can at least stick with something for one month. After one month, if you really don't notice a difference, then fair maybe, it's not going to make a big difference. I have seen, though, if I'm being honest, that people with significant chronicity to their symptoms do need to wait longer. Sometimes, it's more like three or six months. But if we're going for average shots here, what's going to hit the bell curve for most people, probably 30 days.
Justine Reichman: If we wanted to give people a couple tips to start with, to kick this off to say, okay, I think I'm in perimenopause, or I'm going into menopause. I'm getting really bad hot flashes or joint pain, or whatever their symptoms are. What are maybe three things that you could recommend that they could try to deal with these things from a food perspective?
Anjali Dsouza: Definitely the protein forward would be one. So just getting as much protein as you can, but around that 30 grams three times a day would be really important. I think the other thing would be, depending on how nerdy you want to get about it, figure out how to balance your blood sugar. Some people will actually put on a continuous glucose monitor and figure out, in that very individualized way, what food works for my body best, which is awesome. But if you're not going to do that, then just do an experiment of saying, I'm definitely going to remove the refined carbohydrates for now. I find that some people do like you did, but maybe for different reasons. Better without gluten, and better without grains, generally speaking. But if we're starting again with simple take out the refined carbs, take out any cola, take out any juices, anything that has a quick glucose rise, just say goodbye, or make the choice like, I'm gonna do this.
Justine Reichman: When you say juices, are we talking grain and fruit?
Anjali Dsouza: Even grain juices can have a little bit of a glucose spike for people, but I would certainly say definitely fruit juices and cola. If there are some grain juices that are totally fine, and we can do a whole deep dive on which one is good and which one maybe is not, and which person does it depend on. It's probably too nuanced for this home. But I think in general, grain juices are probably fine. So yeah, the glucose angle, the protein angle. And then the last thing would be, figure out how much you really want alcohol, because this is the time of life where you're going to have to make a choice on, are you going to feel okay? Or are you not going to feel okay? Are you going to sleep? Are you not going to sleep? Are you going to be grumpy, irritable and feel depressed? Even though alcohol has that kind of more immediate positive impact as we get older, as our hormones change and as our liver toxic detoxification systems are not as robust, we just pay for it when we drink alcohol as we get older.
Justine Reichman: I do have a question for you as it relates to alcohol, because my understanding, and I don't know if this is true, that men and women metabolize it differently, and so it affects how we feel more than it does them. Can you talk to me a little bit about that, and how it specifically relates to menopause?
“We have to detoxify our hormones too. All of these hormones are moving through our liver and so putting any stress on that system with alcohol is going to have ripple effects on the rest of our bodies.” —Dr. Anjali Dsouza
Anjali Dsouza: I think there's two things happening there, just like the capacity of filtration. So there's a different filtration capacity that a female has versus a male, and so there's going to be a lower capacity, generally speaking. But I think what's also happening here is, as our hormones are fluctuating, we are kind of dealing with these changes, and we have to detoxify our hormones too. All of these hormones are moving through our liver as well. Cortisol, stress hormones, everything is moving. And so putting any stress on that system with alcohol is also going to have ripple effects on the rest of our bodies, our hormones and other things that are much more vital to a woman than to a male just because ours are always fluctuating versus a man that for the most part has more of a steady state.
Justine Reichman: Okay. Thank you so much for all this information, for the conversation, for the inspiration to dig deeper, for so many of our guests that experience menopause. So if anybody wants to learn more about your integrative practice, where might they be able to find that information?
Anjali Dsouza: Our practice is called District Center for Integrative Medicine. It's a little bit of a mouthful, but we are here in Washington, DC, the very heart of the city, to provide more comprehensive care, both for women, men and all humans that are looking for a more comprehensive approach to their care. I also have an Instagram handle where I do more specific kinds of gear towards women's health topics, and that's just my name. So A-N-J-A-L-I-D-S-O-U-Z-A-M-D is the handle, and those are probably the best ways to find me. And my last little offering is an online network for women, again, specifically to come together and support each other. Maybe you're not someone looking for a full medical experience, but you want to meet with a clinician who can give you guidance about, what should I be eating or not? Hey, I saw this trend on Tiktok that said I should be washing my ears with iodine. I don't know, making this up. Should I do that? It's just a place to have community and support. And I do educational series there as well. So for example, I'm going to do one in my reproductive years. Your period is actually a vital sign that you should be thinking about coming up soon. I did one on menopause recently. It's a really lovely community.
Justine Reichman: Awesome. Thank you so much. For those that are joining in today and listening to the podcast, don't forget, we also have the videocast on YouTube. And for those watching us on YouTube, don't forget, we have the podcast wherever you listen to your podcast, iTunes, iHeartRadio, etcetera. And if you're not following us, make sure to follow us at essential.ingredients. Thank you again, Anjali, for joining us.
Anjali Dsouza: The wisdom trip is so fun to chat with you, Justine. Have a lovely day.
Justine Reichman: Thank you.
