Navigating Perimenopause: Women’s Health & Wellness Tips with Dr. Aleksandra Gajer

Natalie Tysdal (01:31)

Welcome Dr. Kyer to the podcast today.

Aleksandra Gajer (01:34)

Thank you so much. Thanks for having me.

Natalie Tysdal (01:36)

So ⁓ you just said before we started recording, this is a topic near and dear to my heart. What is that topic and why is it so near and dear to you?

Aleksandra Gajer (01:45)

Yes, that topic is helping women navigate health at every age. ⁓ Mostly talking about the transitions that we go through in perimenopause, which can be the transitions in our health anywhere from age 35 to for some women closer to their 40s. And those changes can continue to have lingering effects into our 50s, 60s, 70s beyond. So ⁓ my passion is really working with women and helping them.

feel their best and feel like themselves at every stage of life. think we are in a generation where we're actually starting to talk about this and I think it's so beautiful that we have access to more tools than our prior generations did.

Natalie Tysdal (02:31)

It's so true. mean, I don't think my mom or my grandmother, they even knew what paramenopause was. It was just this menopause that we didn't talk about that because that was old people. But now it's so normal. What are some of the first things that might indicate your impairment of pause? I know from, because I've done so many topics on this, that it can range from a short period to a very long period of time for women.

Aleksandra Gajer (02:55)

Absolutely, it really does differ. But the biggest thing I would say is that women say, no longer feel like myself and my body in some way. And that may be that your energy levels aren't what they used to be. It may be that you're not sleeping like you used to, that you used to get to sleep easily and get a restful seven, eight hours of sleep. And now it's hard to fall asleep. It's hard to stay asleep. And for a lot of women, it's weight.

where you kind of hide your ball of tricks and your bag of tricks and you knew what was going to work to keep you at your healthy weight, at your happy weight, at your confident weight, and suddenly all those things are just not working anymore and it feels like someone changed the game on you. Some women do experience temperature irregularity where all of a sudden you get really hot and then you're really cold.

I also see a lot of inflammatory issues pop up around this time. So that might mean joint pain. For some women, they just have this sense of I'm inflamed. My joints are swollen, my hands are swollen, my skin might be breaking out. So there's a number of things that can be really changing at this phase of life.

Natalie Tysdal (04:08)

There's not a list that applies to every woman. It is very different for everyone. Are lifestyle factors, genes, food intake, do all of those things affect perimenopause or is it just going to be different for everyone?

Aleksandra Gajer (04:24)

Absolutely. I we now have a great number of studies that show that the women who are prioritizing movement, healthy movement, ⁓ as well as nutrition, do much better. And I think we have to define what that is. Many years ago, not that many years ago, but for a long time, women were sort of taught to eat less, move more.

And I think nothing has harmed women more than this diet culture of restriction. And we had a generation of cardio queens because that's what we were taught to do. know, more cardio, burn more calories, burn more calories, eat less. And it got us into a very undernourished state. So I think the women who really experience less of those symptoms or less of the impact on their health from the transition are women who are strength training.

and building healthy lean muscle. And that can be a number of things, but lifting weights is really healthy for women, which is somewhat new. We weren't taught that ⁓ some years ago. And also focusing on getting nutrients into our bodies. I think diet culture for women for a long time was very focused on...

you know, little we can eat, how many calories we can get rid of, know, drink this if you're hungry, how to curb your appetite. But I encourage the women I work with to go on a nutrient hunt. rather than trying to eat as little as you can, try to find the protein, try to eat multicolored vegetables, try to get nutrients into your body that will feed you and support you so that you can really thrive in this phase of your life.

Natalie Tysdal (06:02)

Yeah, all of these things ⁓ apply so much to me. And I'll tell you, because I'm sure you see people like this. And I know it is different for everyone, but I did some gene testing. So I was able to see where my strengths were and where some of those weaknesses were in my genes. And my doctor recently said, Natalie, if you just start lifting a little more than you're doing cardio, you're going to see a massive difference in how you feel and how your body. ⁓

Aleksandra Gajer (06:11)

you

Mm-hmm.

Mm-hmm.

Natalie Tysdal (06:30)

holds onto and lets go of weight. Basically, just going on my walk or run every day, my body was saying, I'm gonna hold on to all this because you're starving me or you're just doing too much cardio. And so that light bulb really went off for me that the cardio's hurting me more than it's helping me.

Aleksandra Gajer (06:41)

Right.

Yes, I think that's so important. I think weightlifting was always seen as something that the men do. And again, exactly, we don't want to get bulky, but it's very hard for us to actually get bulky. And I think there's been some messages in our culture, too, that women just, we need to make ourselves smaller. We need to eat less, be thinner, smaller, smaller, smaller. And I think we can be strong and still feel really good about our bodies and have that body composition that's that.

Natalie Tysdal (06:54)

You want to get bulky, right?

Aleksandra Gajer (07:17)

makes us feel confident and really great. And cardio is important. I think we're kind of turning that page where we're understanding how important strength training is because healthy muscle is the currency of health. There's been a lot of research in the last 10 years that has really equated muscle with health outcomes. there have been longevity studies that show that one of the biggest predictors of how long you'll live is how much muscle you have.

But also one that I always find really interesting is there was a huge study looking at what factors might predict if someone will survive a cancer diagnosis. And the most potent predictor was how much muscle mass they had going into the diagnosis. So aside from everything else, their other health problems, their age, how much muscle mass you have going into a serious health diagnosis will determine how you come to the other side.

Natalie Tysdal (08:05)

Wow.

Wow.

Aleksandra Gajer (08:17)

And just to

circle back quickly to the cardio, know, there's another, some people may be familiar with something called VO2 max, which is ⁓ how your body extracts oxygen from your blood. And that's also a very important metric and it determines what our cardiovascular capacity will be later in life. And I don't want women to ignore cardio entirely because we need to be training for the future decades of our lives and to be able to be active.

and walk up that hill and pick up our grandkids. But muscle is really a critical unit of health.

Natalie Tysdal (08:53)

It's really just flipping the two though, that we're reused to feel like we have to do the cardio and do some weightlifting, but it's do the weightlifting and then of course go on that walk. Of course, stay active, but not let that be the primary. Yeah. Okay. Let's talk about some other things, some other common misconceptions, ⁓ ideas or things we can be doing to just feel better during this time.

Aleksandra Gajer (09:00)

Right. Yeah. Absolutely.

Yeah, so I think the foundation really is in the foundation. our metabolic health, which is about what happens to food once you put it in your mouth. Again, ⁓ I think trying to focus less on the calories and more on eating whole foods, real foods, foods that come from the earth is really powerful for women. ⁓ There are so many of the chemicals that are in processed foods are endocrine disruptors, which means that they disrupt

our hormone function, but also they disrupt our gut microbiome, which is such an important part of our health and how our hormones work. So there may be a low calorie food that's highly processed and ⁓ we think will kind of get us there, but the disruption that that causes to both the bugs that are living in your colon that are sending signals throughout your body about your overall wellbeing as well to your hormone balance.

is often not worth it and trying to really choose whole foods, I think, goes a long way. It's also much harder to overeat whole foods than it is for those highly processed foods. So I don't see too many people sit down and eat 10 apples in a row, whereas if you were about, if you were going to get that same amount of carbs from chips, it might be very easy.

Natalie Tysdal (10:28)

Yeah.

Yeah.

It's so true. Okay, two things in what you just said I wanna ask you about. There are so many low calorie things and I know because I like my ⁓ sugar-free ⁓ coffee and coffee creamer. And I look at that and I start looking at the ingredients and I go, uh-uh. So I've cut a lot of those things out. Do we have to be careful about all the ingredients in things that are low calorie or no sugar?

Aleksandra Gajer (11:09)

Yes, definitely. I think, unfortunately, we are living in a landscape where things can be labeled as healthy. And unfortunately, on a closer look, they are not. looking at the ingredient list, if the ingredient list is short and you can recognize most of the things on there, then you're probably good to go. If it's very long and you've never heard of most of these chemicals, then ⁓

Natalie Tysdal (11:15)

Mm-hmm.

Aleksandra Gajer (11:35)

this may not be the best choice. And there are some convenience foods, some foods that are somewhat processed that can be a part of a healthy diet. We're all living busy lives, and I think that there are times we need convenience foods, we need foods that we can eat quickly and ⁓ get energy and strength from. But I think those foods with a simple ingredient list, real foods in there, not a bunch of names that you can't pronounce are the better choices. ⁓

Natalie Tysdal (12:03)

Well, it's not the predominant part of your diet that, know, for me, the 80-20 rule, you might not like that one. But if I'm eating well 80 % of the time, my body can handle the 20%. Yeah. Okay, let's talk about proteins. So we know we need to focus on protein. Get the protein first. What are good proteins and where do you lead people first?

Aleksandra Gajer (12:08)

Mm-hmm. No, no, it's great. Yes.

Yes, I think that's fantastic.

Yes, so I think meat is a good source of protein, and especially lean meat. I think it's important that it's high quality meat that we're eating, meat that is not raised with antibiotics or hormones. ⁓ There's actually a of studies also that are pointing now to more of the negative effects that we've seen from meat coming from the chemicals that those animals were treated with rather than the actual meat itself.

There was a study that I was looking at recently that looked at people who were eating steak on a weekly basis, two to three servings, but it was organic steak, grass-fed, no hormones, no antibiotics, and their heart tests were actually better than people who were avoiding that meat. So I think there was some fear of meat. I think the way that your meat is prepared, where you're getting it is important. Some people don't like meat.

which is okay too and or they choose not to eat meat and I think that it makes sense.

Natalie Tysdal (13:28)

makes it a little bit harder, but what do you do

if you're getting your protein in other places? What do you recommend?

Aleksandra Gajer (13:34)

Yes, so I think it makes it a lot harder. And I actually spent a good number of years of my life being vegetarian, and eventually I found I had to ⁓ go back to meat. I feel better when I eat it. Yeah, so if someone is not eating meat, of course, seafood, you're willing to eat seafood. But if not, then if you can tolerate dairy, think Greek yogurt is a great source of protein.

Natalie Tysdal (13:47)

the protein.

Aleksandra Gajer (14:01)

eggs, ⁓ cottage cheese is a really great source of protein and you can mix it into unexpected places. So many things, yeah. Yes.

Natalie Tysdal (14:08)

So many things. You can blend it so it doesn't have the texture that a lot of people don't like. I've found that to

be great. My favorite, ⁓ cottage cheese blended really well with some ranch seasoning. Use it as a dip and you're getting so much protein. Yeah.

Aleksandra Gajer (14:22)

Yes, my

goodness, yes, exactly. You can make your own dressing and it's super simple and you're getting the protein out of it too. So yeah, I think those are all good sources of protein. And then of course there are beans which also have fiber that can be a good source of protein as well.

Natalie Tysdal (14:42)

What about proteins from powders? So whey protein, soy protein, pea protein, all of these mixes and smoothies, or we're blending our protein powder into our yogurt to get a little extra. Are there better sources or just depend on what your body tolerates?

Aleksandra Gajer (14:55)

Mm-hmm.

I think it does depend on what your body tolerates. And again, I think some of the protein powders just have so many extra ingredients that ⁓ I found it easier to find pea protein and beef isolate protein that is just cleaner, that's not mixed with a hundred other things. I think it's mostly, I think that most of the protein sources do pretty well. I don't think that you should be over-reliant on powders. ⁓

sources of whole protein do more for your body than the protein powders. But ⁓ I think it's perfectly fine to supplement and trying to stick with ⁓ protein powder that's clean, that doesn't have too much extra stuff in it that will, again, disrupt your hormones or those ⁓ bugs living in your colon that are sending a lot of messages to your body.

Natalie Tysdal (15:56)

What's the right amount of protein a day? What should the goal be?

Aleksandra Gajer (16:01)

Yes, so I think it depends on your weight and your level of activity, but somewhere around...

I would say 0.75 to one gram per pound of weight if we're looking at pounds. But higher if you're very active, lower if you have kidney issues. So for most women, I would say try to get at least 80. And for very active women who may be tall and athletic, would say 120 is probably the maximum.

I know that people push it further. I think that risks outweigh the benefits when you go over 120 and it becomes a little unreasonable.

Natalie Tysdal (16:45)

Yeah.

Is there an amount of, I've heard this before and I've never really known the truth. If you're doing say a protein shake and it's 30 grams and you're having some Greek yogurt and you have an egg, at some point is it diminishing returns? Are you not getting the benefit?

Aleksandra Gajer (17:03)

Yes, mean, is ⁓ your gut, your stomach can only absorb so much protein. So ⁓ at some point, it will be hard to absorb ⁓ all the protein that you're getting. But I think trying to aim for at least 30 grams per meal, 30 to 40 grams per meal, and spread that out over the...

course of the day is really ideal and having that protein with every meal also signals your GLP-1 system, which we all know that word and we did it. We all know it now and we can naturally improve our GLP-1 production by trying to include 30 grams of protein in every meal. Okay.

Natalie Tysdal (17:38)

We didn't know it a couple of years ago, but we all know it now.

Well, let's go a little bit more on that because GLP-1

⁓ medications or even vitamins I'm seeing now, like tell me more about that as it's so popular and so many people are having success with it. How do you recommend people get more GLP-1 stimulators or even the medications if you think that's helpful?

Aleksandra Gajer (18:05)

Yes.

Yeah, absolutely. think this is, we cannot ignore the GLP ones. They've made a big splash and I think they're an important tool. And if they're used appropriately, they can be very helpful. I think that for many of us, our metabolism has been quite disrupted for many reasons. One is just we're all under a lot of stress and...

Natalie Tysdal (18:19)

No, we can't.

Yeah.

Aleksandra Gajer (18:38)

We are exposed to, again, non-food chemicals that pass as food throughout our lives, and that's what's available, that's what we eat, and that has really disrupted a lot of our metabolism. Plus, we're always being marketed these highly palatable foods, these foods where you have the Doritos commercial, you can't eat just one. That's not a good thing. ⁓ They're telling us their tricks. ⁓

And unfortunately, it's caused an epidemic of people who also feel like it's their fault. Women who feel like, can't control how much I eat, there's something wrong with me. Where really this is happening to a lot of us. This is what the food environment looks like right now. This ⁓ is the landscape that we live in. for women whose metabolism is disrupted, and that might look like...

You're not, the things that you're doing are not working for weight loss anymore, or you've gained a lot of weight over a short period of time. I think the GLP ones can be very helpful. I personally prescribe them at the lowest effective dose, sometimes at a micro dose, and when someone starts them with me, we do some pretty intensive health coaching as well. I work with a few health coaches, and I want the person to commit to.

eating differently, eating enough protein, eating enough vegetables, because if we're going to make a push for weight loss, I don't want the drug to do all the heavy lifting. sometimes you do need the drug because your metabolism is stuck and you're already, I work with so many women who really, we talk about what they eat, what their life looks like, and it's pretty tuned in. They're doing a fantastic job, but their body's not listening the way you do.

Natalie Tysdal (20:12)

Yeah, right. Yeah.

Aleksandra Gajer (20:30)

So I think the GLP-1 agonists can tune your body up so it starts listening better to the signals that you're putting in and your exercise and your food choices do more for you. But I prefer to work with the lower doses and then some people choose to stay on it long term, but a lot of my patients choose to stop it after a period of time. then ⁓ we know that more of your lifestyle changes made these

made this change happen and although we use the drug it may not have done so much heavy lifting.

Natalie Tysdal (21:05)

And then have they been successful getting off of it in maintaining weight and staying with those healthy decisions?

Aleksandra Gajer (21:12)

Yes, and of course life happens and of course ⁓ it's always worked. No matter how you lose weight, keeping it off will be ⁓ work and a challenge. I actually, I also like the GLP-1 probiotics. There's a company named Pendulum that makes them. The probiotic strain is called acrimancia and you can take it and basically help your gut naturally make more

Natalie Tysdal (21:21)

work. Yeah.

Aleksandra Gajer (21:42)

GLP-1. So when I transition people off the GLP-1 agonists, first off, I do it slowly, where we just lengthen the time between doses. So rather than just stopping, we may go to every 10 days, and every two weeks, and maybe every three weeks. And in that time period, I usually have people take the GLP-1 probiotics so we can naturally repopulate the gut with the bugs that are making more of that GLP-1.

and stopping it very gradually. Some people do, especially women in the perimenopause transition, often benefit from staying on a microdose. It decreases inflammation. Plus, most of our weight issues happens because of the hormonal transition, not necessarily because we lose hormones or because hormones are low. Eventually, it stabilizes. So once our body gets used to the new normal, it becomes much easier.

to maintain weight, but there is that very wild period, know, in perimenopause and menopause where your body's like, what is going on? Our bodies don't love it when our hormones are going crazy. Our bodies like stability.

Natalie Tysdal (22:50)

Yeah.

Yeah, and then

everything else in your life feels out of control when that happens. you might not even, it reminds me of like, you know, teenage girls who's, they're going through hormonal changes before their period and they have PMS that's crazy. It reminds me of that because you're like, I don't feel good, but I don't know why I don't feel good. So once we can identify it and say, your hormones are all over the place or they're diminishing, it's okay that you have anxiety, some forms of depression and fears and all of these things.

Aleksandra Gajer (22:57)

Yes.

Mm-hmm.

Yeah.

Right.

Natalie Tysdal (23:22)

are pretty normal at that part of life.

Aleksandra Gajer (23:24)

Absolutely. Yes, it

is so true and it is so similar to puberty. It's another, it's a transition and ⁓ I often think of it as another initiation. We are getting initiated into this next phase of our lives and a lot of women find...

this phase of their lives are really fulfilling, where you let go of a lot of the societal expectations or of all these things you felt like you had to do to impress other people maybe earlier in life. I think it can be really beautiful and a great revolution in a woman's life and really stepping into ourselves in a new way, but ⁓ it takes some navigation.

Natalie Tysdal (24:03)

I love the framework of that.

That's a really, really great way to put it. like that. Yeah. Any other last tips that you would give and I'll be sure and put your information in the show notes, but last things that, that you find helpful or tips that you would have.

Aleksandra Gajer (24:09)

Yeah. Yeah.

Yeah. ⁓

Sure. So I think, you know, we talked a lot about diet and exercise. I think sleep is a crucial part of how you'll experience any symptoms related to perimenopause and menopause. ⁓ we often think about working on our diet, but we can also work on our sleep. And sleep hygiene is something that we can continually get better at. And sleep is extremely supportive when it comes to.

hormone health. I think that there's, could speak for a whole hour about sleep and ⁓ for those women who are having trouble with, yes, 100%. Yes, it's very, very challenging. I think ⁓ I would just encourage women not to just accept it as a given. I think there are tools and there's different things that we can do to sort of help optimize our sleep.

Natalie Tysdal (24:53)

We'll need to do another episode on it because it's much easier said than done when you're going through these changes.

Aleksandra Gajer (25:15)

And I think it's similar with stress, where I think sleep and stress often feel like, well, this is just the way it is. And although maybe we cannot control the external stressors that are coming into our lives, I think we have a lot of tools to deal with the physiologic impact of stress. And again.

Natalie Tysdal (25:32)

Yeah. And all of

those things, when they start to balance, add up. You'll sleep better when you're lifting weights more, when you're eating more protein, like all of those things, when you can just get a system, right?

Aleksandra Gajer (25:42)

Yes. Yes,

yes. And it may feel overwhelming. And I would just say start slow. You don't have to change your life overnight. But the little things do add up. And I would just encourage women to keep trying to work with someone who understands this life transition and help you have this be your revolution. This is your up level.

Natalie Tysdal (25:51)

Yeah.

Yeah.

I love it. Yeah. I'm going to put your

link, but any other places people can find you that you want to mention before we say goodbye.

Aleksandra Gajer (26:12)

Yeah,

sure. So we're on Instagram as at the Gair practice G-A-J-E-R and our website is thegairpractice.com and there's a link to a free intro call that anyone can book at any time just to understand a little better of how we work with our clients and yeah, we hope to see you.

Natalie Tysdal (26:33)

Wonderful. Thank you so much, Dr. Geir. It's nice to meet you.

Aleksandra Gajer (26:35)

Thank you.

You too.