How functional medicine can help ease the experience of menopause

We talked with Esther Blum, an integrative dietitian and high performance coach, about the important role of nutrition, exercise, stress management, and sleep for women experiencing perimenopause and menopause. In addition to working with patients, she is the author of four bestselling books. Her fifth book, on menopause, is currently in the works and will be released on October 6th.

Ms. Blum received a Bachelor of Science in Clinical Nutrition from Simmons College in Boston and a Master of Science in Clinical Nutrition from New York University. She is credentialed as a registered dietitian, a certified dietitian-nutritionist, and a Certified Nutrition Specialist (CNS).

PinnacleCare (PC): Why did you become a dietitian?

Esther Blum (EB): I grew up in a family of doctors, watching them work from a place of service. I spent the first five years of my career in hospitals in cardiology units and felt like I wasn’t making a difference giving someone who had a heart attack 10 minutes of diet instruction and never seeing them again.

So, I got certified in functional medicine so I could understand the impact of nutrients, supplements, diet, and herbs on health. As I increased my education, I began working with more complex cases.

PC: What is functional medicine?

EB: It’s holistic care that takes the whole body and person into account. I work to find the root cause of health issues. I look at lifestyle, diet, gut function, stress hormones, and blood sugar. All of these can impact how you’re feeling. Western medicine will typically look at one system, but no one is putting the pieces together.

PC: What are some of the issues women in perimenopause and menopause face and what questions should they be asking their doctors?

EB: A lot of women experience changes physically and emotionally. They gain weight more easily. They may have sleep issues. Their periods get irregular and can be longer, more frequent, and heavier. They may experience breast tenderness, irritability, brain fog, acid reflux and more gut inflammation, hot flashes, and night sweats. All of those symptoms are very uncomfortable and disruptive because it’s very hard to get a good night’s sleep when you’re waking up drenched in sweat. Another big symptom people don’t talk about is a loss of or change in libido and vaginal dryness.

PC: If a woman goes to her OB/GYN or primary care physician with symptoms of menopause, what types of care is she usually offered?

EB: Unfortunately, I have many patients who were prescribed antidepressants and menopause was not acknowledged at all as a root cause of their symptoms. Many GYNs offer the Pill or an IUD as a bridge through menopause. For some women, these options do work. But it doesn’t work for a lot of the women I see.

PC: What does your approach include?

EB: I do comprehensive blood testing, including a full thyroid panel, insulin and glucose levels, inflammatory markers, and a full lipid panel. I also do two at-home test kits. One is a stool test to check the microbiome, and the other is a urine test for a detailed look at hormones, neurotransmitters, and cortisol. The microbiome informs your immune system, digestive wellness, inflammatory markers, and influences hormone production and detoxification. The urine test looks at your production of hormones and detoxification pathways. This information helps uncover whether your problem is a thyroid, liver, or gut issue, or if you’re missing nutrients. I also look at your cortisol levels. Cortisol is a stress hormone that can help you store food as fat, especially around your midsection, and impact your sleep.

Sleep is the first thing I work on. When you’re sleeping well, you can think clearly and make decisions from a better place, your cravings are under control, and your appetite is regulated.

PC: What strategies help people sleep better?

EB: Not sleeping with a phone next to your head. The blue light tells your brain to shut off your production of melatonin. Stop using screens at least an hour or two before bed. Sleep in a cool, dark room in 100% cotton pajamas. Lower the temperature of the room by sleeping with a fan on you or cranking up the AC. Limit or cut out caffeine.

Exercise is also key. Walking lowers cortisol. Switch to more to weight-based and strength exercises and yoga versus high intensity cardio, which can raise and sustain higher cortisol levels. When you go through menopause you need longer recovery time after exercise. If you’re doing strength training one day, do walking the next.

PC: What about diet and nutrition?

EB: Many people are afraid of carbs during menopause, but having carbs, in the form of whole foods like sweet potatoes, white potatoes, winter squash, plantains, and beans, in the evening makes a huge difference in your sleep. Getting enough protein during the day is also important because that stabilizes blood sugar.

In terms of supplements, magnesium glycinate works on reducing anxiety. As progesterone falls during menopause, we tend to have a lot more anxiety. Ashwagandha and rhodiola can help regulate cortisol levels. Melatonin may also be needed.

PC: What strategies can help women advocate for themselves so they get the care they need?

EB: If your doctor isn’t listening to you and you aren’t getting answers to your questions, find a new doctor. You’re the expert on your body. Menopause can be challenging, but it’s absolutely treatable and you will get through it. It’s also a great time to reevaluate your stress and take things off your plate that aren’t serving you so you can live your best life.