Medication as Support, Not Failure: Breaking Free from Treatment Shame

Keywords
menopause, medication, cholesterol, statins, diabetes, GLP-1, thyroid health, Hashimoto's, women's health, empowerment

Summary
In this episode of the Hot Flash Diaries podcast, Jessica Caceres and Dr. Diana Castleman discuss the importance of medication in managing health during menopause. They explore the misconceptions surrounding medications, particularly statins and their role in cholesterol management, diabetes, and thyroid health. The conversation emphasizes the need for individualized approaches to treatment, the significance of lifestyle changes, and the empowerment that comes from education and understanding one's health.

Takeaways

• Medication is a tool, not a failure.
• Statins are crucial for managing cholesterol and preventing cardiovascular disease.
• Lifestyle changes can complement medication but may not be sufficient alone.
• LDL cholesterol is now recognized as a risk factor for dementia.
• Women should not feel shame for using medications.
• Thyroid health is critical, especially in women during midlife.
• Education is key to empowering women in their health decisions.
• Muscle mass plays a significant role in glucose metabolism.
• Regular screening for cholesterol and diabetes is essential.
• A holistic approach to health includes both lifestyle and medication.

Chapters
00:00
Introduction to Menopause and Medication

02:42
Understanding Cholesterol and Statins

05:38
The Role of LDL Cholesterol in Women's Health

08:28
Cognitive Health and Dementia Risks

11:27
Lifestyle Changes vs. Medication for Cholesterol

14:08
Diabetes and Its Impact on Women's Health

17:56
The Role of Muscle in Glucose Management

20:08
Understanding GLP-1 Medications

23:23
Thyroid Health and Hashimoto's Disease

28:17
Medications for Thyroid Conditions

29:50
The Importance of Medication in Health Management

35:01
Empowering Patients in Their Health Journey

Interested in working with Dr. Castleman:

https://www.daianacastleman.com/

Interested in working with Jessica Caceres, NP:

https://www.bonitamedicalaesthetics.com/hormone-therapy

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Website: https://www.bonitamedicalaesthetics.com/podcast
Instagram: @thehotflash.diaries & @youare.bonita
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Youtube: @thehotflashdiariespodcast

Transcript

SPEAKER_01 0:09

Welcome to the Hot Flash Diaries, the podcast where no topic in women's health is off limits. I'm your host, Jessica Casaris, a board-certified nurse practitioner with expertise in hormone and sexual health. This is your safe space for candid conversations about perimenopause, menopause, intimacy, and so much more. If you're tired of being dismissed or want to feel like yourself again, you have found your community. Let's break the silence, tackle tough topics, and help you reclaim your wellness. It's time to feel empowered in your own skin. Welcome back to the Hot Flash Diaries Podcast. This is now episode number six, and we have again Dr. Castleman here, Dr. Diana Castleman. She is from Oakville, a naturopathic doctor who specializes in evidence-based care for women navigating the often confusing and overwhelming transition through perimenopause and menopause. If you missed our last episode, episode five, you'll need to go back and listen to that first because we had the opportunity to chat all about cancer screening prevention and overall prevention when it comes to blood work, focusing in on cholesterol management and diabetes screening for women. So really encourage you to have a listen to that episode first and then come back to this episode because today we're going to chat about treatment as a support and not a failure. And this is something that I absolutely loved in your messaging when I first met you and then started following you on social media. I thought this woman is the queen of amazing messaging and really educating patients and just the world around feeling validated if you were somebody who needs to be on medication for your own health and well-being, as opposed to feeling almost shameful or shamed for being on medications. Cause I think in our circle, you know, when it comes to health and wellness and menopause and perimenopause, there's a lot of conversation around almost that medication is the villain, right? And really, if we just focus on hormone replacement therapy only, that we can solve all the problems. And while that hormone replacement therapy is a huge piece of the puzzle, it's not everything. And there are certain areas and certain conditions that do require medication at times for people, depending on where they're at.

SPEAKER_00 2:31

I completely agree with this. Again, it's a tool in our toolbox. And I think it is a really important tool when we're specifically talking about medication. But I started getting actually really passionate about having this conversation online when almost every single woman that I was talking to, when I was talking to things about like statins and cholesterol, every single one of them said to me, I just feel like I failed. I feel like I failed that I now need, quote unquote, need to take this because I've been doing all the things and you know it's not, it's not working. And it really just opened up this conversation about, okay, like let's educate on stans. There's so much misinformation on stans online. Like I don't actually think I've seen more misinformation about a drug than I have with Stans. And I think that that's why I get so passionate about talking about it. Because again, when we're talking about cardiovascular disease in women, this is something that can be incredibly life-saving. And I will use the word life-saving because again, if we're leaving things untreated for a very long time, it can cause a lot of harm. So we know fear-based messaging around medications in general will fuel non-adherence for patients taking them for discontinuation, or let's say they were on something and then they, you know, are online reading some other messages and then they come off it without even informing their doctors, right? Like that's, I think, the the scary part is that actually a lot of practitioners don't even know. And this is where I'm so excited to have this conversation today because there is a lot to unpack here. And really, I just want every woman who is listening to this to really understand that there is no shame around this or guilt around this if we are using medications as part of our, as a part of our toolkit.

SPEAKER_01 4:18

Absolutely. And again, such an individualized approach, right? Some people will be able to get away with doing some lifestyle changes with great changes in their lab work and they're reducing their risk. But there are some cases where medication is necessary, especially in the high risk situation. I think, you know, if we could look back, oh, we should have started a medication or could have started a medication 10 years ago and we would have felt a lot better and been in a better state of health. Maybe I would have had I have known A, B, C, and D. So I think it's such an important conversation to have early on, because if we can reduce the risk in our 40s and in our 50s, again, it's all about what we're doing now that's going to impact how we feel when we're in 60, 70, and 80, right? And that's really what it's about. So we don't want to start, we don't want to turn this into what's called secondary prevention, right? We want it to be primary, which for those of you listening out there who are not in the medical world, what that means is secondary prevention is when we're trying to prevent something from happening again. So for example, a heart attack or stroke that has happened and we're trying to prevent it from happening again, whereas primary prevention is preventing it from happening at all, ever. So, really important distinction and important conversations to be had. But let's chat about cholesterol right out of the gate, if that's okay, because we left off the last conversation chatting about what LDL is, you know, as it's labeled as the bad cholesterol, you know, and why it's it's problematic in certain situations. But tell us about what statins are and when that would be applicable for somebody who has a higher cholesterol level.

SPEAKER_00 5:56

So, statins have actually been one of the most powerful and widely studied tools in cardiovascular medicine. They are really the cornerstone of cholesterol-lowering therapy, and for good reason. They have really great research outcomes. They don't just lower numbers on lab report, although that is important, they significantly reduce your risk of heart attack, stroke, death from cardiovascular disease. And it has also been studied in women. I get this question a lot. Yes, in a lot of the trials that have been done, women historically have been more underrepresented and haven't had as high of a number, right, as men, but they have been studied in women and they have been shown to be as effective. So that is really important to know. Um, so statins actually how they work is they work by blocking an enzyme in the liver called HMG CoA reductase, which is a key enzyme that your body uses to produce cholesterol. And so by inhibiting this enzyme, basically statins reduce the amount of cholesterol that your liver makes. So that's essentially how they work. And so, one out of all the studies that have been done, we have one consistent finding is that when we lower the LDL cholesterol with statins, they do reduce cardiovascular events. And I think the other part that I really hear about statins, so again, like I mentioned there's a lot of misinformation around them, but one that I definitely hear a lot is that I don't want to lower this cholesterol because it's gonna harm my brain. So uh that is definitely one that I hear. So a fun fact actually is that our brains are entirely responsible for making what it needs. So it does not actually rely on cholesterol from the bloodstream. So this means that even if blood cholesterol levels are lowered, it does not affect the brain's cholesterol supply. And I think that's really, really important to know. The brain will continue to function normally, produce, and use its own cholesterol. So studies that have actually been done that have looked at things like dementia have actually shown that if we are working on reducing our LDL cholesterol, if it is elevated, we're actually reducing our risk of dementia and Alzheimer's, which is really, really important. So the Lancet Commission on Dementia Prevention last year, they released new guidelines in 2024. And LDL cholesterol is now a risk factor for dementia, and it is listed as one of the 14 modifiable risk factors, meaning that you can do something about it, right? You can lower it and reduce your risk of later dementia, like dementia later in life. So I think that's incredibly important. So I'm just gonna bust that myth that no, it's not gonna fry your brain. Because I do hear that one a lot.

SPEAKER_01 8:29

Yes. Oh, thank you for saying that. And I absolutely loved when the guidelines were modified in terms of taking a look at LDL or cholesterol in general when it comes to your brain health, because I don't think that that correlation had been made or was official anyway, as far as the guidelines were concerned, for some time. So I think it really does provide a new perspective and one more reason why it's important to check your cholesterol regularly. And especially, you know, that's another sort of tool that you or not a tool, sorry, one of the things, things that you can use to advocate for yourself with your family doctor or a nurse practitioner if they're not wanting to really order a cholesterol panel, let's say yearly or every two years. I'm just saying, you know, my a parent of mine or somebody that I've known has had, you know, dementia if that's the case. And I really would like to know where things are at. So one more, one more thing that you can use to advocate for yourself. But really important, that one hits home for me because unfortunately my mom has dementia. Yeah, I'm sorry to hear that. Yeah, thank you. Yeah. So it's been a it's been a long uh journey, but you know, in looking at her now, I just feel like that's probably something that although she was on a statin for a while, I don't think she was overly compliant. And I just think, oh, if if this was something that we could have, there were other factors too, but I just think, oh gosh, you know, this could have been something that we could have been on top of a little more. But anyhow, that's just, you know, another, another tidbit. Yeah, for sure.

SPEAKER_00 9:51

And I would say I think a lot of people, even if maybe they have a family member with dementia, but I think a lot of women in general, when I speak to women, it's something they're really scared of, right? Like when we talk about the three, the sort of the big three of post-menopause, cardiovascular disease, osteoporosis, and cognitive health, right? Like whenever you talk about that cognitive health component, I understand, right? The being having that fear around it because it does affect more women than men, right? And so yeah, it it is one of those things that I think actually is top of mind for a lot of women. Yeah.

SPEAKER_01 10:24

Oh, for sure. And I think because in that perimenopausal phase, in that state of chaos with our hormones sort of being all over, memory is a challenge sometimes. Like I describe it as that filing cabinet's not opening either fast enough or we can't get through the files fast enough, you know, in our minds. And so immediately you start thinking, is this my mind that's going? Right? It's it's kind of scary. And at times when you're looking at somebody and you're like, what's your name again? I know I know you, but I can't think of your name right now. And it's awful. And it's always in the most awkward moment that that happens. But I think that's one of the reasons why women are so sensitive to it and worried about it because it it really just does comes out of nowhere and it's it's um life-changing in a way. So yeah.

SPEAKER_00 11:05

And so when we're talking also about the statin piece and cholesterol piece, here's one thing I do want to note. Are there, you know, dietary lifestyle things we can do? Absolutely. Of course, we know that. And I think a lot of women in my practice, you know, will want to take that approach first. And oftentimes they'll come to see me as an atrophic doctor, and they're like, I'm gonna do everything I can to avoid medication. Uh, how can you help me? So here's what I really want to say about the dietary and lifestyle changes. We're gonna be recommending them whether you go on a statin or not, or let's say a cholesterol-reducing medication, right? They go hand in hand. They are, of course, very important. But at best, if you are following dietary and lifestyle changes, this is what we see in research, is that it's going to lead to about a 30% at best reduction in your levels. Okay. Meaning that we can't necessarily, we don't see further decreases than that. So if someone's following all of it like to a T, that is like sort of the best outcomes that we have. And actually, a lot of that data from a dietary perspective comes from the portfolio diet, which has been researched for cholesterol. So if you're someone who feels like you're doing everything right, like I said, you're eating well and you're exercising and you've been doing it for a while and your cholesterol is still elevated. Again, this doesn't mean that you failed. It also depends like what was your baseline to start off with, right? Like I actually find, um, and in my practice I see this, but even in research, we see this genetics plays a huge role with cholesterol, a huge role. And so again, I always use this saying like we can't outlifestyle genetics, right? Like we can eat all the fiber, decrease our saturated fat, you know, and those are great things to do. We're still gonna encourage those things, but it doesn't mean that it might, you know, normalize everyone's cholesterol level. So I really want to emphasize that that medications are really not failure. It's actually a very, very, very proactive, evidence-based decision to really protect your heart, your brain, your future, right? Like it there really are great medications in that way.

SPEAKER_01 13:04

Oh, exactly. And again, looking at the risk, so where the one blood test that you discussed, the lipoprotein A testing that's done, you know, once in a lifetime, that is so important because if that's elevated, then the approach is going to be different as far as what you're going to prescribe for somebody who perhaps doesn't have an elevated one versus elevated if they were identical in every other way. You know, you might be a little bit more inclined to prescribe a um statin sooner for somebody who has an elevated marker versus somebody who doesn't. So again, it really is such an individualized approach, but it's all about knowing where you're at and what your numbers look like. And what does that trend really look like? So really, really important.

SPEAKER_00 13:47

And here's another thing I will say to my patients, and this comes from so much love. You don't get a gold medal for not going on medication or coming off your medication. You don't get a gold medal, you don't get a gold star, right? I'm not gonna say, oh, Jessica, like you're doing so amazing. You didn't have to go on medication, right? Like we don't do that. This is all about preventing atherosclerosis. That is our goal, preventing that plaque buildup when we do have elevated cholesterol. And so if medication is part of that solution, that's amazing. We're gonna take that stand medication every single night and say, thank you for helping me prevent cardiovascular disease.

SPEAKER_01 14:24

Exactly. You're absolutely right. And again, at the same time, we're not looking at just throwing medications at somebody if we're able to make some changes, right? So it doesn't mean that that's the end all and be all, but in some cases, it is strongly suggested. And it's okay to do that. There's a reason, and the studies support that it really does have an impactful reduction that can quite literally be life-saving. Yeah, no, I love that so much. Now, about diabetes, diabetes is a big can of worms because there's first of all two types of diabetes, but oftentimes in midlife and later on, we see when there's a development of diabetes, it's quite often type 2 diabetes, which is very different. And so that is where that hemoglobin A1C test that we talked about in our previous episode is really important because it gives us that sort of marker, doesn't it, as far as where you're at?

SPEAKER_00 15:16

Yeah, and exactly we want to be looking at those trends over time. Again, we actually see that an HBA1C um already at around 5.7 can start to have some concerns, uh, some like significant issues for people. So again, looking at what is that trend over time, if you're doing blood work more often, you're gonna be able to catch it before it's that officially at 6.5. Once it reaches that 6.5, it's uh diagnosed as that diabetes. But again, you're pre-diabetic when it's between six to six point four, right? So again, we can do so many things. And I'm sure you talk to your patients about this a lot as well, in terms of how we can help support you during that time, again, when you're catching it early. It's just gonna be a lot easier if we catch it early versus waiting a little bit longer. When we actually talk about longevity, maintaining euglycemia, like normal blood sugar, is actually one of the best things that we can do to maintain longevity. A lot of things that actually help with longevity, a lot of them focus on the glucose insulin pathway. And so again, blood sugar is incredibly important to your health overall. And if we are able to maintain that over a long period of time, that is essentially what our goal is.

SPEAKER_01 16:25

Absolutely. And with um diabetic or diabetic screen, I oftentimes, in fact, all the time, will order a fasting insulin level as well. So I find that that is so helpful. I'm so happy to hear that. I know it's one that that is not ordered often, but should be great for for younger women with PCOS as well, or to help with that diagnosis as well. So it's not only, you know, elevated sugar levels, it's also is your body detecting what how much insulin your pancreas is actually making and how is it utilizing it, right? So that is so, so important. And for those of you that don't know what insulin is, do you actually have a uh I'd love to hear your description analogy?

SPEAKER_00 17:06

Yeah, I have an analogy that I use, but I love to hear yours.

SPEAKER_01 17:08

Sure. I I generally tell my patients that it's it's the key. It's the key that opens the door.

SPEAKER_00 17:14

Yes. That's what I use as well.

SPEAKER_01 17:16

Yeah. Yeah, that allows for that that glucose, that sugar to be utilized into energy, right? Into the tissues and actually utilized. And what's really interesting, I could talk about insulin all day long because I'm fascinated by metabolic conditions, to be honest. But it's what's what's interesting is that it's really a negative feedback loop, you know, because the more insulin you have in your body and your body's not detecting it, the more sort of sugar you're craving because your body's wanting you to make more insulin. And so it's really quite, quite fascinating. And that's really the crux of the matter in many conditions like PCOS, diabetes, and so forth, right? So a really important thing to look at. But what's really amazing about catching diabetes or pre-diabetes early, as well as a high insulin level, is that so much can be done before medication is even on the table. And then medicate, there's so many great novel medications like GLP1s now, everyone knows it as Ozempic, that you can really utilize in a safe way when monitored, you know, by somebody who understands these medications and what you need to look for in labs. But there are so many things out there that we can implement lifestyle, diet, and medication that can have such a quick and impactful change. Yeah.

SPEAKER_00 18:32

Right. One of actually the biggest things I focus on with my patients when it comes to those lifestyle pieces is muscle. So I actually would love to explain this pathway. If that's okay, I'll just please explain it. I always like nerd out to this too, because I love this stuff. So when we think to your point about like how typically glucose is uptaken into cells, is we eat something, insulin gets released from the pancreas, right? It opens that door in our cells, and then glucose is able to come in. But what's really fascinating is that when we actually stimulate our muscles, so during muscle contraction, we can actually still stimulate this pathway because contracting our muscles is going to take this transporter called GLUT4 within our cells and bring it to the cell surface. And that's a GLUT4 is basically like a glucose transporter protein that's like that door that opens for glucose to come in. And so you can do that independently of activating insulin. So I always call it this insulin-independent pathway to being able to support your blood sugar. Dr. Eve Henry, who's um, I really look up to her, I think she's amazing. She always says, the more muscle you have, the more glucose disposal you have. And I think it's such a great way of putting it because it really does sum it up so nicely. The more muscle you have, the greater your capacity to actually store and utilize glucose, which is fascinating, right? Like we have this pathway that we can literally utilize. Uh, to your point, whether it's with medication or not, where we can literally be able to effectively bring that glucose from the bloodstream into the cells. And it really comes from activating our muscle. It's fascinating.

SPEAKER_01 20:13

It is fascinating. And then secondary to that, all of a sudden we're not our pancreas isn't being whipped, you know, by our brain to say, make more insulin. We need more insulin, right? Because eventually it gets tired and says, I'm done. I've made high levels of insulin for so many years. Leave me alone. And then that's when we run into trouble. So it is so fascinating. It makes me want to, well, definitely have to get a workout in later today, but I'll be doing some extra weightlifting as a result, contracting all those muscles.

SPEAKER_00 20:39

Exactly. Just think about insulin every time and glucose every time you contract the muscles. Yeah.

SPEAKER_01 20:44

Yeah, exactly. Can you give us a little bit of information around GLP ones? Just I know that we initially didn't really, we weren't gonna really dive into this, but it is a hot topic, right? As you know, everyone is sort of chatting about this. It's on social media everywhere about Ozempic and Munjaro and so forth. Do you typically see a lot of patients in your practice that you recommend GLP ones to?

SPEAKER_00 21:08

Yeah, I do think they can be a fantastic tool for sure. I think in the right person. I mean, we have, as you know, so much more research now beyond that we're using, you know, we're looking at GLP1s beyond the weight loss components, like really so much more than that. I think that's actually a very small component of it when it comes to decreasing inflammation, right? Improving insulin sensitivity. Like I think it definitely can have a role in the right person. And I think the biggest thing though, I do tell my patients to your point, I do refer to specific people because I I cannot prescribe these medications. So I do refer them to specific people that I know know them really well because you do want to be using them in the correct way and having the correct follow up and the correct testing. So again, I think it can be a powerful tool 100% in conjunction with all the other right diet lifestyle things that that. Person is doing. But yeah, I'm actually quite fascinated where the research is going with GLP ones. It's really fascinating.

SPEAKER_01 22:07

I agree, especially combination medications like Munjaro, which is a two in one and how that affects brain health too. There's just so much information coming. I I know that in the next five years our practice will change as far as how often we're, yeah, we're recommending GLP. So it's it's it's fascinating. But I think there's a lot of stigma and there's a lot of shame out there around people who are utilizing these tools for the purpose of weight loss. And it's, I find that really hard. I don't have patience for it, to be honest. Um either. Right. It's the same with anything anything else. If somebody, you know, needs to be on a medication for prevention or for for treatment, you know, why on earth would we shame that? That's that's really, you know, crazy. But um, I'm hoping that that's gonna change as time goes on and we understand more and more.

SPEAKER_00 22:54

Yeah. And I think I've already seen that conversation changing for a lot of people, which is exciting, right? Because we know that even something when it comes to weight loss, it is again complex, right? There's so many variables at play here. And I think again, medication, there really shouldn't be any shame or guilt around that because I think, again, we are really improving overall health in so many different capacities than I think we even realize, right? Like with something like that. And um, I I've seen it, I've seen it in my practice, it can be life-changing for so many people.

SPEAKER_01 23:28

Yeah. Well, and again, to your point, it's not strictly just about the medication, it's it's a whole approach, looking at it from all angles in terms of stress management, sleep, you know, the the pillars really of health is really important, you know, dietary and exercise, like all of those things are important, but the utilization of medications to get you to your goal and get you into a safe zone is just amazing. And why, why wouldn't we? So another thing I wanted to chat about was thyroid treatments. Now, you know, I see a lot of women, again, the majority of my practice is women in midlife. And so we see a lot of Hashimoto's and a lot of underactive thyroid. I tend to do a full thyroid panel, including the the um thyroid antibodies, because I I again think that those are things that are oftentimes not checked. And it's quite fascinating how many Hashimoto's I've diagnosed in my practice. It just blows my mind. But is it explains so much more about why a person is feeling the way that they're feeling? It's so validating. So, is that your experience as well? Do you see a lot of that?

SPEAKER_00 24:32

Definitely for sure. To your point, if you look at the guidelines, they don't include uh thyroid antibody testing there. And I think that's probably one of the reasons it's not often tested. It is recommended to do the TSH, the thyroid stimulating hormone, right? And then in some situations, the T4. And then you're right, beyond that, we we're not doing the antibodies. And if we're not doing the antibodies, then we cannot be diagnosing Hashimoto's because that is part of the picture, right? So for those of you, uh those listening who don't know Hashimoto's, it's an autoimmune thyroid disease where essentially the immune system attacks the thyroid over time. And so this is actually the most common cause of hypothyroidism in Canada and the US, right? And a lot of people are surprised to hear that. And so when we're talking about something like Hashimoto's being diagnosed, this is more of a lifelong uh sort of situation. And actually, again, this is where medication can be so powerful. If let's say TSH is really elevated, right, in uh hyperthyroidism, you have those elevated antibiotics to your point, it's explaining how a lot of women feel, they're symptomatic. It really, I see it definitely a lot for sure. I actually don't know if I haven't looked recently, the numbers off the top of my head. I don't know if you've looked recently at the statistics, but I'm sure it's probably really quite high in Canada as well, like the diagnosis of it. But yeah, it is something to definitely address. It's something to run and to your point, if maybe you've only had the TSH run, uh, then to advocate for further screening.

SPEAKER_01 26:03

Yeah, and just to give our listeners some understanding around what the these different tests really mean, aside from the antibodies, as you've explained so beautifully, is really to screen for Hashimoto's. But when you're looking at a TSH level, that's really the little pituitary gland in our brain is is sort of sending out this hormone to, I describe it as whipping the thyroid to say, hey, make more thyroid hormone. Come on, this person needs more thyroid hormone. And that's because the thyroid is not producing enough hormone. So our brain senses, hey, we need to get this engine, you know, fired up again. And that's what we see is is elevated in hypothyroidism. But there are times when, again, trending, looking at numbers, where perhaps our stores are not at an adequate level. Maybe they're low end normal or high end normal. And that gives us a lot of information. Whereas when you're looking at what the stores, it's the T3 and T4, you know, that's our usable thyroid versus, you know, the stored thyroid. So these are important markers. And again, to your point, because they're not in the guidelines, it's something that's not often tested. But I I love testing the thyroid. I think it's such an important part of it of the whole picture. But again, something that, you know, is is treatable and easily treatable, you know, and we have great, great medications that have been tested for a bazillion years, it feels like. And we know they're safe, right? So why on earth would we not treat your thyroid, which is really the metabolism center of your body?

SPEAKER_00 27:28

I was just gonna say that. Yeah, it's in, I mean, we know thyroid is important for regulating so many things. Metabolism is definitely at the top there. Heart rate, body temperature, like so many other functions. And in fact, it's always, to your point when working with women in live midlife, so important to screen for this because if you look at the symptoms of perimenopause and symptoms of hypothardism, they're pretty much identical, right? So important that we're ruling that out as a potential cause of symptoms for someone.

SPEAKER_01 27:55

Exactly. And even things like hair loss, brittle nails, um, you know, that that fatigue. But again, there's the trouble is that a lot of the symptoms overlap so much that you don't really know what's what. And so that's why a lab panel is great because then we can really tease out what's working well and what needs some support. So that's great. Do you have a preference in terms of medications for a thyroid condition or for treating an underactive thyroid?

SPEAKER_00 28:21

Well, I think the most studied is synthroid for sure. Uh levathyroxine, we have the best data for this. We know women uh during pregnancy can use it. So I think it is really well studied. Actually, a lot of people respond really well to it. And if it is something that, again, we have it proved, um, can be covered by someone's benefits, I think all of those things are really important. So, you know, it is something that I will often recommend for my patients first.

SPEAKER_01 28:44

Amazing. Yeah, I tend to use some desiccated thyroid as well. I find that that, especially in the context of Hashimoto's, I find that generally people feel a little bit better. But if they're a lot of times women will come to me already on levothyroxine or synthroid and they're feeling great and their numbers are perfect. So why touch it? Just leave it alone. It's working for them, right? So again, very, very dependent. But I do really think that that's an important conversation to have. That, and again, if you're having some of these symptoms and you know that a TSH has been checked and it's normal, but you know, you're not feeling great, it's worthwhile advocating to have a couple of extra thyroid tests done. And that that one I think is probably the hardest to convince a general practitioner to order. But it's great if you go and see a naturopathic doctor or a clinician who's uh specializes in women's health because we're pretty well versed in it. So yeah, that's a great option. But yeah, so you know, again, the message is medications are okay. We don't need to feel badly about being on medications. They oftentimes have such a good place in our plan when it comes to to prevention and treatment.

SPEAKER_00 29:51

Yeah, and I think like one thing I'd add to that if you've come to the conversation and you feel that you are very anti-medication, I think there's just a few things like reflective questions that I would just like to give listeners to kind of think about. So I think one, it's really important to reflect on where do I get my views from, right? So for example, was I taught that natural is always better growing up, right? And does that belief still hold true in all situations? You know, did I have family members that were very against medications or did not have a great experience, right? And that kind of influenced my decision. Have I associated needing medication with weakness or failure or not trying hard enough? And then the other thing too is like, have I internalized someone else's negative experience and made it part of my own belief system? I think that that's a big one because sometimes we hear other people's experiences and then we just sort of internalize that and it becomes almost our own belief system. And then other times maybe we've had past experiences with healthcare providers that made us feel like our concerns or preferences didn't matter. So maybe sometimes this is less about the medication itself and maybe more about how the care was delivered. I think that that's a really important reflection point. And then, as we touched on as well, like what sort of information am I consuming online? Am I only seeing one side of the story? Right. I think social media, we all know is the algorithm is very good at feeding us things we want to hear. So am I only hearing stories of, let's say, harm or concerns and never actually hearing the stories of where it saved lives, you know, and really helped other people? So that's just some reflection questions I think that I would uh throw in there and just again think about like, am I open to the idea, right, that medications and lifestyle can work together rather than being in opposition? Because again, if our goal is to reduce long-term disease, preserve our quality of life, you know, feel like ourselves again, then again, does say no to the medication align with that, right? And so this is where again, you know, having a circle of care, a team around you that can uh that you really trust, that you can open, you know, bring your hesitations, right? Bring your concerns with and discuss them is really, really important.

SPEAKER_01 32:02

Absolutely. And and I would urge everyone to consider when we're when we're hearing a negative or even a positive experience around medication or treatment, to really think about how there are thousands of people who are thousands, millions of people who are on medication. I'm referring to specifically or thinking of a statin, for example, who have been on medication on this medication or a one of the statins for many, many, many years and doing exceptionally well. However, we hear all the negative stuff too online, right? Um, and the same is true for even some hormone replacement therapy. There's there's all kinds of things. Generally, when people are feeling well, they don't feel compelled to go online and share their story. It's really when people are not feeling well about stuff. So there tends to be a higher number of um negative information, if you will, um, online. So just really careful around the resources. And I always like to, of course, refer to the Canadian Menipo Society website, uh, tons of great information. And we'll include that link as well in the show notes. But and you've provided a ton of great resources today as well, and in our our previous uh episode. So I will make sure to include all of that. But really, education is what can empower us to make the best decision for ourselves and to feel really good about the decision that we make, you know?

SPEAKER_00 33:18

Exactly, exactly. And again, we're in this a lot of what we talked about today and like looking at chronic disease prevention. We're in this, it's it's a long game, right? Like we're it's it's a long game. And so I think it's important to remember, you know, if I give a situation like I have someone come in and, you know, it's the first time they've seen elevated cholesterol and they're concerned about it, it doesn't mean we're going to again go to medication right away, right? It means like, okay, we're here to play the long game. Okay, it's slightly elevated. Let's look at making these lifestyle changes or doing these dietary changes. But the key here, and this is really the key message, is that we are rechecking. Number one, we have a timeline of when we're rechecking and we're making sure that that plan is already in the calendar to your point. Maybe you're putting reminders to do your blood work, let's say six months from now. Because what I see often happen, and you might see this too, Jessica, is we have a plan, but then five years goes by. You know what I mean? Like we forget about it, and then, you know, life gets busy and things happen. And we're like, oh, we didn't check on that cholesterol, you know, that I was supposed to check on five years ago. And that's what we're just essentially talking about today, is it's not necessarily meaning that again, from a cholesterol perspective, you need to go on that statin right away. But, you know, let's say you have been doing the dietary lifestyle changes and you know, they're not necessarily improving it the way that we would like it to, it might just be part of the conversation that you have, right? It's not again all happening in one visit, right? This is a continuous conversation.

SPEAKER_01 34:47

Exactly. And and if we're trending in the correct direction, maybe not at goal, we continue to make those changes and check again. You know, that's very, very reasonable, but again, taking risk into consideration with every step. So I agree a hundred percent. And it's really about meeting the patient where they're at and also your your clinician working together. And really, that's our job is to give you all the information and make recommendations. But really, what happens long term is really, you know, the patient is in the driver's seat as you as you uh describe. So yeah, it's really we're in such an exciting time, I think, for women's health. So many more conversations happening than ever before. And the accessibility to good information too is so, so available, you know, which is amazing.

SPEAKER_00 35:30

Yeah, and resources like this, like your podcast, it's amazing what you're doing and keep doing the amazing work.

SPEAKER_01 35:36

Oh, well, thank you so much. I just appreciate you so much taking time out of your busy schedule to be on the Hot Flash Diaries podcast. And if any of you listening are interested in working with Dr. Castleman or learning more about her integrative approach, I will put her website in the show notes. Um, she works you're with Loom, correct? Correct, yes. And then do you also have a another practice or only with Loom? Yes, I have my private practice in Oakville as well. Yeah. Okay, amazing. So I'll link her website so you're able to get a hold of her. With her practice in Loom, it's an integrative approach clinic. Is that right? Where you that's correct.

SPEAKER_00 36:10

Yeah. Work with medical doctors, yeah, gynecologists, pelvic floor physio, dietitian. We have so many um psychologists, we have so many wonderful practitioners. It's a full, full team.

SPEAKER_01 36:20

Yeah. Amazing. That is so, so good. That is what any woman would really ever want, especially when it comes to getting a gynecology referral or even pelvic floor physio. I know it's been, we actually have Kristen Parisi. She she comes to my clinic in uh St. Jacob's a couple of times a month. Um her associate pre is there now too. So it's just made a world of difference because it it adds an extra layer of support in-house, which is amazing. So we're really, really thrilled to have that. But like your your clinic loom is uh that's just amazing. So I will post um Dr. Castleman's website with all of her information if you're interested in working with her. You do offer virtual consultations as well. That's correct. In Ontario, yes. Yeah, amazing. Okay. So I'll put all that information there. So thank you so much again for taking the time to chat with us. And I hope our listener, and I don't hope, I know that they uh will feel more empowered to advocate for themselves and to ensure that they're getting all of the different screening done that they should to keep themselves healthy and to prevent disease from happening. So we're really excited. Thank you again. Amazing. Thank you, Jessica. Thank you for tuning in to the Hot Flash Diaries podcast. I hope that today's episode left you feeling more informed and empowered. This is your safe space for honest conversation. So be sure to subscribe, share, and join again for more insights on reclaiming your health and wellness. Take good care of yourself and we'll see you next time.