Episode Transcript
Speaker 0
Mick, I have to ask, when is the last time you actually spoke with your pharmacist? Like, really talked to them.
Speaker 1
Honestly, mine's on speed dial. I call her all the time. She may have even blocked me at this point. I call all the time Stop. Dosing questions, side effects, whether something is worth bringing to my doctor. This this woman has saved me from so many unnecessary doctor's appointments.
Speaker 0
Okay. That's amazing. And you're obviously we all know this, but way smarter than me. Shut up. I treat my my pharmacist for me is the person I smile at as I pick up the prescription.
Speaker 1
That's a missed opportunity, babe, which is one of one of the reasons I wanted to get a pharmacist on the podcast. It takes a village to get through perimenopause. And I think that pharmacists are probably one of the most underutilized tools for most people's healthcare team or their their toolkit, especially right now when getting a doctor's appointment can be near impossible.
Speaker 0
Yeah. Well, it certainly feels that way.
Speaker 1
Yeah. So in this episode, pharmacist Jennifer Bruce is sharing what a pharmacist with prescribing authority can do. Things like health screenings, vaccines, they can prescribe for minor infections, even UTIs, so
Speaker 2
you don't
Speaker 1
need to see your doctor. Amazing. And they can even help navigate menopausal hormone therapy.
Speaker 0
Well, yes, which is awesome. And we also learned a little bit about Jennifer's new venture, SugarTrack Consulting, which is helping women manage their metabolic health. And that's how I recently reconnected with Jennifer. So
Speaker 1
Well, if you've ever struggled to get a doctor's appointment, wondered who to call with a quick health question, or you just wanna boost your health care team, this one's for you.
Speaker 0
After all, this is perimenopause, and some days, we need all the help we can get. Let's get into it. And now, a word from our partners.
Speaker 3
Hi there. Volva speaking. We need to talk. For years now, you've been calling me the wrong name. I'm the vulva, not the vagina. I'm all the external bits you can see. My neighbor, the vagina, she's the internal tunnel connecting me to your uterus. You know, the baby highway. Different parts, different names. It's pretty hard to address dry, uncomfortable situations when you don't even know which one of us needs the attention. Now that we're properly introduced, can you please hook me up with some Iris? Their water based moisturizer and lube are exactly what I need. No irritating fragrances, just clean ingredients to keep me happy and well hydrated, not dry and disgruntled. Eternally grateful for the hydration and finally getting my name right. Signing off,
Speaker 0
x o x o, your vulva. And now that you've been properly introduced, do your girls a favor and use code t I p twenty for twenty percent off at love my iris dot com. That's t I p two zero at l o v e m y I r I s dot com. Jennifer, welcome to This is Perimenopause. We're so excited to have you here today.
Speaker 2
Well, thank you for having me. I'm excited to tell you all the great things about pharmacists. Yay.
Speaker 0
Yay. You know what? Because it's really interesting. Michell, years ago, when we started This Is perimenopause, wrote an article about use having a pharmacist as part of your perimenopause toolkit. And I think that it's always been top of mind that we wanted to have a pharmacist on the podcast. And lucky you're in the hot seat today, so lucky you. We chose you.
Speaker 2
I will try to represent my profession
Speaker 1
Oh, sure.
Speaker 0
In the best light. Possible. McAlg has more experience with their pharmacist than I do, but Correct. It's a huge tool and a huge asset that I I I don't think many women understand. Unless you really need support with your medication and you're on a lot of medications, you probably don't really know that this little gem is out there. So let's Absolutely. Let's dive in and
Speaker 2
Very underutilized because until you get sick and you don't go into the pharmacy all the time, you don't realize everything, how your pharmacist can help you. Really, people don't usually present till they're older when they all of a sudden, there's a lot of medical conditions are coming up. And so when they have to come see their pharmacist, like, oh, I didn't know this happened. But it's trying to get people like your age who, you know, things are starting to happen, but maybe you don't have, like, a real underlying like, a real medical condition that needs active treatment. You just don't know what we do.
Speaker 0
No. And and it's funny because it's so difficult to get into the doctor. Not for everyone, but often, it's very difficult to get into the doctors. And my understanding is that there is a lot of things other than just filling prescriptions that your pharmacist can do. And so I'd be really interested. Can you tell us about some of the health checks or screenings or quick tests, some of the health things that people can come to the pharmacist for?
Speaker 2
Sure. I think, first, though, I wanna start with, like, the umbrella of what a pharmacist could do. Please. So, like, your your pharmacist is like, the best thing about a pharmacist, a community pharmacist, which is what I am, we work in, you know, stores and retail settings, is that we're accessible almost, like, I mean, really in this day and age, twenty four hours a day. You can get a pharmacist twenty four hours a day, but we're very accessible. You can just come and see you. And I think that one of the best things someone can do for their health health to start with is to realize a pharmacist is part of the health care team and to actually find a pharmacist you like, find a pharmacist who you respect, find a pharmacist that you can build a relationship with, just like you do your doctor. You see your doctor, you build a relationship, the doctor knows who you are, they learn other things about you than just maybe your health conditions, like what your family situation is or what your stressors are in life or what trip you just went on. And all of that is part of a whole person's life. It's not just your medical condition or just your drugs that the pharmacist is interested in. So once you develop that relationship with a pharmacist, they become a member of your health care team that has some real information to provide you and know something about you also. So what what are some of the health checks things that we do? Well, one, big one, pharmacists should be screening for your vaccines, flu season now or if you are interested in COVID. You know, we can make sure you can get your med your immunizations. The big thing in middle age is shingles vaccine.
Speaker 1
I was just gonna say,
Speaker 0
I just heard about this. I need to get this. Right.
Speaker 1
You haven't had this, Michelle? No. Yeah.
Speaker 2
Shingles vaccine is like a like, you know, if we're talking about people in perimenopause in forty forties, fifties, you need your shingles vaccine starting at fifty. It's recommended to get your shingles vaccine.
Speaker 0
And how is it one dose? Is it two doses?
Speaker 2
Two doses. It costs some money for sure unless you have private insurance. If you don't have private insurance, it costs probably about I think they're about two hundred dollars a shot. You need two of them. I have this funny thing that if you ever get shingles, you'll give me four hundred dollars so fast to take it away. It should seem like a deal.
Speaker 0
And even if I've had the chickenpox as a kid, I still need to get my shingles vaccine?
Speaker 2
Yes. Chickenpox goes dormant, and it comes back as we're older when you it comes back as shingles. And, you have to have had chickenpox to get shingles.
Speaker 0
Okay.
Speaker 2
So our kids who we vaccinated against chickenpox probably will never get shingles because they've never had chickenpox. But you can only get shingles if you've had chickenpox. So we need to vaccinate those of us who all had chickenpox so that we do not get shingles.
Speaker 0
Oh, okay. Okay. Okay. Now I got it. Okay. But I need to come. I'll see you next week.
Speaker 1
And just, hot tip if I may. It's not universal, but it can knock you on your butt. Oh. And, I have never had body aches like I did after both doses. It wasn't it wasn't dire or anything. Just, you know, you might not wanna do it right before you have a big weekend planned or something.
Speaker 0
That's right. Not during ski season. Yeah.
Speaker 2
Yeah. It's very individual. Like, my husband
Speaker 1
Very individual. Yeah.
Speaker 2
Same day, and I was fine, and he was knocked out the next day. You just Yeah. Just depends how you do it. You always get a really sore arm with a shingles vaccine. Okay. Let's say you get a shot. I don't know. It just seems to hurt your arm where the where the needle goes in.
Speaker 1
Another quick tidbit, when I got my first dose, my husband got shingles.
Speaker 2
That's the universe.
Speaker 1
Not it's the universe and not fun.
Speaker 2
Like No. Fun.
Speaker 0
Within, like, moment? Like, not Or day? Like like, I
Speaker 1
didn't cause him the vaccine. Let's be clear. No. No. No. Just our you know, coincidence, funny. My point just being that what I went through from the side effects of the vaccine for twenty four hours were absolutely nothing compared to what he
Speaker 0
experienced getting shingles. And if I've had shingles, can I get the vaccine, or is there any point to
Speaker 2
getting the vaccine? Wait a year. Yeah.
Speaker 0
Okay. Okay. Okay. Yeah. Sorry. We totally digressed there, but
Speaker 1
but this is really important because but, yeah, this is really important. Right? It's Yeah. Ladies Yeah. For your toolkit, you get shingles. And and the shingles, the problem
Speaker 2
is maybe we should just to round out the conversation. Why you don't want shingles is because it's really terrible at the time is that you get this rash and it and it can feel like burning and electricity and it can be really itchy and very, very, very painful. That's fine. The the problem is sometimes you get damage to your nerve from the shingles, and that the rash will resolve, and you will have the pain for the rest of your life. That's what we want to prevent. It's not that we you know, too bad you have two weeks of having terrible shingles. It's that there is can be long term consequences of this, and we can never get the pain to go away. And that nerve is damaged forever. Oh
Speaker 0
my god. And if you get it on your head, is there something like
Speaker 2
about your Or your eye. If you get it on your nerve that comes across your eye, it's can be really dangerous because you could lose your sight from that. Okay. Mhmm.
Speaker 0
Shingle vaccines, ladies. Okay. Yeah. Talk about it. Ski season ski season of Sodom coming in next week. I don't care. Yes. Thank you. Like, what are the kind of for instance, my my husband was having had a a really significant stye. Yeah. And he went to the eye doctor and they were like, no. No. Just keep putting this warm compress and whatever. And then two weeks later, it was still swollen and went he's like, I'm not going back to the eye doctor. Forget that. So I happened to call a pharmacist, and I was like, hey. Can I and he prescribed an antibiotic? So what what are the kind of things like that can people come in for?
Speaker 2
I mean, we live in Ontario, and so every pharmacy every pharmacist has different laws in each province. So pharmacists in Alberta can do different things than pharmacists in Ontario can do. In Ontario, we have this minor ailment, and I think there's, like, thirteen minor ailments that we can prescribe for. Eye infections would be one of them. Lyme disease prevention's another. Thrush in your mouth. The most common one I do is urinary tract infections for sure. That is the most common thing. And cold sores. K. Getting cold sores. Those are kind of the there's a whole
Speaker 0
can prescribe an antibiotic for a UTI?
Speaker 2
Yes. We can.
Speaker 0
Okay. Interesting. Yep. Save a lot of women a lot of
Speaker 2
It does. Because we're very accessible, and you don't have to wait for your doctor. And you, you know, you can call a pharmacist twenty four twenty four hours a day. On Ontario, you can do that. I'm sure in Alberta, you can do that. Alberta pharmacists have a lot more prescribing rights than any other pharmacist in the country. They can start medicine and change medicine. They have a lot more.
Speaker 1
Which is really handy, and maybe this this is a good segue into the next sort of question about menopausal hormone therapy and what, you know, you can and can't do. So I've been trying to figure out if I need to increase my dose of estradot, which is the one of the patches, for example. Right? And and in Alberta, I can do that with my pharmacist. Right? We can we can titrate back and forth and, you know, at some point, I do need to check-in with my nurse practitioner again, but my pharmacist. So it's really helpful in that context in terms of saving time, but also, I don't know that I would be doing this if I had to go in to see my nurse practitioner every time. Right. That'd be yeah. Yeah. Anyway, maybe you could tell us a little bit a little bit about that and what maybe what you can do as a pharmacist in Ontario in terms of, you know, hormone related things.
Speaker 2
So pharmacists in Ontario cannot prescribe hormone therapy, and I can't change your dose either without your doctor's permission.
Speaker 1
Right.
Speaker 2
What can a pharmacist do in Ontario to to help with your hormone therapy? Well, I think that the pharmacist's job is to take complex information and explain it in a way to the patient in front of me that they can understand this information. So that information may be what type of estrogen is available. There's a gel form, and there's a patch, and there's tablets, and there's ones that come combined with progesterone, and there's separate progesterone. So pharmacist could be your resource of this is what's available. And maybe if you're already on the patch and you're having side effects or something, we go over, okay, maybe this isn't working for you. Okay. Very common thing would be the patch is working great. You're you're getting all the benefits of of the hormone therapy, but every time you put that patch on, you have an itchy, itchy, terrible spot because you are having a reaction to the adhesive. And this is not drug thing, but this is something that really does affect people's lives because then you don't want to use this patch because it's very itchy and uncomfortable, and you're wearing it for the next ten years. That would be an example of something that a pharmacist could help you solve, either by moving you to a, like, a gel that goes on or maybe you wanna take the tablets. Or, you know, we have a way of preventing the allergic reaction. Like doing, like like, the the the trick is to put a, quote, unquote steroid inhaler you use for asthma. You spray it on your skin, and then you put the patch on, and that will stop the allergic reaction.
Speaker 0
Serious?
Speaker 2
That is something your pharmacist can help you with, and I will tell you not many doctors know this, but all pharmacists know that. Very nice.
Speaker 0
That's interesting. And is it the blue puffer or the purple puffer? Like, does it matter? It
Speaker 2
has to be here.
Speaker 0
I've got all kinds of puffers in my house. Orange puffer. Orange puffer. Oh, okay. Okay. We've got some of those.
Speaker 2
To be a steroid puffer. Interesting.
Speaker 1
I think that's sort of the strength of
Speaker 2
the Ontario pharmacist is to be that resource that can help you understand maybe what you need to know or what you want to know so that when you go back to your doctor and say, well, this is what is happening. You have the words and you have the knowledge that you can have a good conversation with the doctor to say this is what's going on. Your pharmacist can provide you with that knowledge or suggestions. It could be as specific as you're coming in and I say to you, Michal, I think you need to go up, and I would go up to a seventy five microgram patch. That's what I would do. Or I'm gonna say, you know what? I think maybe you actually need more progesterone, so why don't you talk to your doctor about that? And go in with a list of suggestions to talk to your doctor about.
Speaker 1
Or maybe this is your third UTI in however long. Maybe you need some vaginal estrogen.
Speaker 2
That's right. That's my passion. Vaginal estrogen treatment.
Speaker 0
Right? That's my passion.
Speaker 2
See, last week at work, I gave four people in their seventies antibiotics for a UTI in under eight hours and called every single doctor and wrote a note saying they should be put on vaginal estrogen. Good grief. Those women are on vaginal estrogen. This is my little pet project is to get everyone who is in menopause on vaginal estrogen in order to prevent UTI so I stopped seeing these seventy year old women who are on their fourth UTI of the year, and they're miserable We have vaginal estrogen to prevent that from happening. And I think it is a huge missed opportunity.
Speaker 0
It's interesting. We had that's about We had a nurse practitioner on in the fall, and we were talking about this. And my mother was one of those people that had recurring UTI, like, always, always, always. And, I mean, it was twenty years ago. No one no one knew, but or maybe they did know. They I don't know. Anyway, yes. So so someone comes in, they keep presenting with these UTIs. So you then reach out to the doctor and you you give a recommendation or
Speaker 2
I either reach out to the doctor if that's what they want me to do. Some people don't like that, so I write a little note to give them that they can take it to their doctor so that they know the name and why I just write a little note saying, ask your doctor about this. This is really important. And are
Speaker 0
any of these women aware of the black box warning, and is that
Speaker 2
No. No. No. No. I'm gonna tell you these people are between seventy and seventy five, and they're just desperate to not have bladder infection.
Speaker 1
Okay.
Speaker 2
Like, they're so sick of it. That's they just and so when I say I think this could help, they're just, okay. Let I wanna do this because it can help. You had a bladder infection. We gotta fix it. So let's let's get some cultures and sensitivities. Let's get you on the right antibiotic. Let's follow-up in a week. Is it gone? Perfect. Then it happens again. And no one that would be the role of the pharmacist to look, oh my goodness. We're missing something here. We can get them on vaginal estrogen and prevent this. It's just sort of a bigger picture look and trying to look at everyone's whole medication history and what's going on.
Speaker 1
And do you go beyond the whole medication? Do you ever counsel on, you know, maybe lifestyle changes or I guess you would also counsel on over the counter options Yeah. Or as you mentioned, dealing with side effects, like, that's a great tip, the reaction to
Speaker 2
the issue. Easy side effect.
Speaker 1
Yeah. Yeah. Are there other things like that?
Speaker 2
With in like, talking about, like, menopause hormone therapies, there's a lot of things that go with that. If someone's in menopause and they're on hormone therapy, then we wanna know, are they sleeping? We wanna know what their iron levels are. We wanna know what supplements they're interested in taking and what we think they should be taking. And so I think that's all something that you can go to your pharmacist about. Even just the iron thing, again, goes back to a simple thing. People have low iron in menopause. Lots of times, they're being told to take iron supplements. Your pharmacist is a great resource of of making sure you're on one that works for you, or maybe you are taking the one the doctor told you to take and you can't take it because you have constipation and upset stomach and you just can't face looking at that bottle because it's already making you sick. You can come to your pharmacist and say, okay. What can we do about this? And we can say, let's lower the dose of iron and start real slow, like, just slow things down. And you just have this person, especially if it's your pharmacist who you have a relationship with, who is sort of coaching and guiding you and making sure you're on the right step and making a plan for you that's going to work. Right? And you're not just floundering, like, I can't take the iron. I just get sick. End of story.
Speaker 0
End of story. Stop.
Speaker 2
Yeah. Right? And that if we don't fix your iron, it doesn't matter how much hormone replacement therapy we give you, you're still gonna feel terrible.
Speaker 1
Right. I think that's important to you know, because I know a lot of people since Michelle and I have been doing this will say to me, when what what am I taking this for, and when should I be taking it in terms of hormone therapy? And I think there's also something that gets missed, which is, like, the timing of when you take certain medications becomes really important, especially for things like progesterone that you wanna get the benefit of being sleepy if it's gonna make you sleepy. So take it at night. And, like, there's all of these things that I think when you know, you take for granted and not everybody does. And so pharmacist is a really good tool, person to help guide you, and you can call up and easily ask questions of.
Speaker 2
Yeah. And I guess we haven't really focused in all the drug things the pharmacist can do. They can do lots of drug things, but your question was sort of what else can we do. Mhmm. There's There's the other things. But then there's other things like menopause and sleep. This is, you know I mean, sleep's a problem and anything, but menopause and sleep is terrible. It's just that your pharmacist can say, listen. Have you gone to this program out of Dalhousie called My SleepWise? I do handouts on sleep just to help people with sleep hygiene, like going through their sleep hygiene. Tell me about your sleep. Tell and sometimes there's just a little thing they're doing wrong, like, you know, being on their screen for the hour before bed. It seems like common sense, but sometimes people just need to be told by someone who, one, isn't their husband, isn't their wife, isn't their mother. Yep.
Speaker 1
I think too we, one of our favorite doctors will be on the podcast again very shortly. And, what we talked about is the fact that in perimenopause in particular, you know, sleep is often there's a recognition of it. Sleep is often the first thing
Speaker 2
to Mhmm.
Speaker 1
Be affected or impacted, and it's very challenging to figure out what's going on. But, also, there are a lot of things that can be going on, and there are different types of medications or solutions. Right? So you would also have a great insight into that that I think a lot of medical providers don't necessarily. Right? Because if you're waking up at two AM wired versus you can't fall asleep, like, that's those are two different different things that you address differently. Yeah.
Speaker 0
Well, and and I've you're not my pharmacist, but I started on davigo. So I was prescribed it for sleep. Yes. I happened to be talking to you and I said, like, it's actually not working. I go to bed fine, but I'm waking up in the middle of the night still. And you were like, oh, well, why don't you try taking half a pill if it's before midnight or one or two? Try taking a half a pill and go back to bed. And it's been a game changer.
Speaker 2
It worked.
Speaker 0
Yeah. It totally works. So even last night, I was couldn't get warm. It's cold here in Ontario right now. And and so eleven thirty, I was like, I I know I've slept a bit, but I still feel like I've been awake. And so I just popped a half of one and slept like a babe the rest of
Speaker 2
the night.
Speaker 0
It was amazing. I just loved it. Yeah. Thank you for that.
Speaker 1
Are there any non prescription recommendations that, you know, recommend to people in our stage and phase?
Speaker 2
A lot of people come in the pharmacy wanting to talk about supplements and what they're taking and what vitamins they should take or even what natural products they're interested in taking or someone has recommended. And really, from the research, there is not a lot of supplements that are shown to do very much. So I always everything in my viewpoint is a risk benefit. What's the risk of the medication? What's the benefit of the medication? And it's a balance or a scale, and that risk benefit scale changes for everybody. So the risk of taking vitamin d, very little risk, and there's actually lots of evidence to show we need vitamin d, especially because we live in Canada where we don't get a lot of sunlight. And in the summer, we're all covered in sunscreen, so we don't get a lot of sunlight. So we need vitamin d. There's good evidence for that. B twelve, as you get older, you your body just does not absorb b twelve from your food as well as it did when you were younger. So that is another vitamin that there's some proof you need some b twelve. B twelve is good for your blood. It's good for your brain. You just need a a set amount of b twelve, so it's easy to take b. After that, there is not a lot of supplements that show that they actually do anything.
Speaker 0
Okay. Fair.
Speaker 2
And natural health products are not examined by anyone. Anyone can sell a natural health product. There is no one monitoring this. There is no one regulating it. There is no one testing what is in this. So to me, the benefit is very small of these things, and the risk is big. I I can't even think of a supplement I would recommend that's a natural health product for anyone and
Speaker 0
especially even, like, not even calcium or omega?
Speaker 2
No. Calcium is for bone health.
Speaker 0
Oh, sorry. Magnesium sorry.
Speaker 2
Magnesium is not a supplement. Magnesium is a is a mineral that we need. Right? So I don't see it as, like, turmeric or Saint John's wort or sort of these sort of natural products like that. Magnesium is used for very specific things. If it can help with some anxiety, it can help you go to sleep, it can also help if you have some constipation.
Speaker 1
I was gonna say go to
Speaker 0
the bathroom in the morning.
Speaker 2
That's right. And it can help with muscle cramps. So if you have those specific things, again, the risk of taking magnesium is very low, and the benefit might be great.
Speaker 0
Okay.
Speaker 2
You have to try it and see. I also am a big believer that you try these, like, magnesium so you have muscle cramps. You try the magnesium, you do it for eight weeks. If you notice no difference, you stop taking it. It's not something you add on and just keep taking. You actually have to decide, is this doing what it's supposed to be doing?
Speaker 1
Yeah. So good to determine there should be a need. And That's right. Would you even go so far as to say for vitamin d and and b twelve, you should should you check your blood levels, or is that necessary?
Speaker 2
You can check your vitamin d blood levels in Ontario, but it there's a cost to it. I think it's about sixty dollars. So most people won't do it. And most people have vitamin d levels that aren't mentally too low. Right? Right. They're they're gonna come back within the normal range. But there's no harm in taking extra vitamin d, making sure you get enough.
Speaker 1
Maybe it's not the crazy high. Like, some vitamin d supplements Mhmm. I've seen are, like, crazy amounts.
Speaker 2
Those are for people who've had their vitamin d tested, and they are deficient in vitamin d, and we need to get their vitamin d up. Right. If you're just an average person, you probably don't have low vitamin d. You just need to take, you know, two thousand units a day. It gives you enough vitamin d. Make sure there's enough there for your body.
Speaker 1
Yeah. Good. Thank you.
Speaker 2
And vitamin b twelve does get measured, but mostly when you're older, and you can have that measured. Again, people usually fall within a normal range, but if you wanna make sure you have enough, you just take a a a supplement. And, again, the risk is so there is no risk, and there is a benefit of both those vitamins. And the calcium and the magnesium and the iron, iron's a really big one. That, you should not be taking iron unless you've had blood work done. That's a different one. You need to have your iron levels measured before you take iron. Iron has a lot of side effects. You shouldn't just be taking it because you think you need you need iron.
Speaker 0
Fair.
Speaker 2
It needs to be monitored.
Speaker 0
That's really, really helpful. Thank you for that.
Speaker 2
Yeah.
Speaker 0
So you and I met each other years ago when our kids were little, but we we reconnected at a menopause event in town. And it's because you had started a new company called Sugar Tracking Consulting. And so you are still a pharmacist and you're still working in the community. But additionally, you've you've got this company where you're specializing in metabolic health. And I thought that might be interesting to talk a little bit about metabolic health and why is it important for women in midlife and and all of those great things. So, yeah, tell us a little bit about metabolic health.
Speaker 2
I guess metabolic health is is the process of how your body uses its energy that it takes and fuels its body. And what happens is it's responsible for your blood sugar levels, it's responsible for your cholesterol levels, it's responsible for your blood pressure, and it's usually responsible for your waist circumference, which is all, you know, the middle the middle bellies we get at
Speaker 1
Everyone's ears just parked up. Exactly. Listening.
Speaker 2
My business is mostly focusing on your blood sugar. But again, if we focus on your blood sugar, we actually focus on your waist circumference, your cholesterol, and your blood pressure. So at middle age, you lose your estrogen when you go into menopause, and it makes you a little bit more insulin resistant. So what's insulin resistance? Insulin's insulin is the hormone that our body uses to move sugar from our bloodstream into our body cells, and this is a natural process. This is what's supposed to happen. As we age and due to lifestyle and diet factors, your body stops listening to the insulin as well as it used to. So it means that you need more insulin to be able to move that sugar, and that sugar has to be moved from your bloodstream into your cells because your body only likes to have its blood sugar at a certain level.
Speaker 0
Okay.
Speaker 2
And so you need more and more insulin. Problem with insulin is even though it does its job of giving energy to our cells, it is a growth factor, and it will push sugar into your cells. And if there's extra sugar, your cells can only take up so much sugar. So it can only use so much sugar to burn as fuel. It needs to do something with this extra sugar that insulin's putting in there, and it converts it to fat. And it gets stored as fat for future use. The issue is if you always have insulin present, which you will if you have insulin resistance because your body's pushing out more and more insulin, your body will never go to that fat. And you use that fat that is stored up for later use. It's only going to use sugar as fuel, and it'll never burn off that fat. And in fact, more fat gets laid down, and it becomes a cycle.
Speaker 0
Why in the stomach?
Speaker 2
So when you have estrogen present, your body, when it's when it's laying down fat, will put it in places like your hips and your thighs. When you lose your estrogen, it starts to move it to your tummy and gets laid down in your abdomen and around your organs. And this is the the next level of sort of explaining what happens is that fat gets laid down around your liver and your pancreas, which are responsible for your blood sugar and maintaining it at a certain level. It's called visceral fat, and that's where we get that little lovely postmenopausal belly that we cannot get rid of.
Speaker 0
Yeah. Fair. Yes. And and I under and I believe that that the circumference, like, the has something to do with prediabetic. Like, what's the connection there?
Speaker 2
Those are markers. Like, so the bigger your waist circumference, and that's a marker that maybe your blood sugar you're not metabolizing your blood sugar as effectively as you should, which will then lead to prediabetes. So prediabetes diabetes is when your body can no longer keep your sugar your blood sugar at a certain level. So we have to give medication in order to get that level down.
Speaker 0
Okay.
Speaker 2
That's sort of the definition of diabetes. All of a sudden, it just can't return it to what we'd consider normal blood sugar. So there's a few steps before that. One being insulin resistance and one being prediabetes, which a lot of people will prediabetes before, and then you move on to diabetes. So it's sort of like a range. You you start here at insulin resistance, and insulin resistance takes decades to develop. Like, it's choices we've made through our whole life. So it is that the menopause is happening, the estrogen affects it, but it's also just the time frame. Insulin resistance takes twenty years, and all of a sudden, now you're fifty. You're you're You've been drinking wine. At the same time. Right?
Speaker 0
Yeah. Fair. So
Speaker 1
is sorry. Can I just clarify prediabetes? What it how do what does that mean exactly?
Speaker 2
Prediabetes means so so we would measure, like, a blood test. So Yeah. So what is your your hemoglobin a one c, which is sort of the blood test we use to diagnose diabetes and prediabetes. And if you hit a certain number, that's considered prediabetes. That means that you are no longer having optimal or effective blood glucose metabolism. Your body's got too much sugar floating around.
Speaker 1
And the markers that you talked about, is that used in conjunction with your blood work to make the diagnosis, or are they things that show up?
Speaker 2
We make the diagnosis. We make the diagnosis on a on a blood on a blood test. And, you know, you can always have the person who doesn't have a big waist circumference and has prediabetes or doesn't have blood pressure, but they are correlated. They usually do have this. They are correlated.
Speaker 1
Okay. That makes sense.
Speaker 2
Yeah. And so fifty percent of people who have prediabetes will move on to have diabetes. Diabetes is a huge health issue. There's a lot of morbidity and mortality associated with diabetes, But, you know, we could talk about diabetes. That's a whole other
Speaker 0
Yeah. Perfect. That's a whole other conversation. It really scary.
Speaker 2
It is it is scary, and you should be scared if you have diabetes. You should be really, like, nervous because bad things can happen if you don't take care of it. And it could be that you have very slow progressing diabetes. We used to say, like, when I first was a pharmacist that, you know, diabetes is a progressive disease. The only thing you can control is how the speed at which it progresses. Your lifestyle choices and taking your medicine and your exercise and your diet will all slow that down. There's sort of been a shift, and I'm a big believer that this diabetes can actually be reversed or pre or put into remission with some targeted changes. This is possible. It is no longer considered progressive disease. If you make changes
Speaker 0
And what are some of those changes?
Speaker 2
So that's where we come into the, you know, business I've started.
Speaker 1
One question. Is there a differentiation when we're talking about turning things around between type one and type two?
Speaker 2
Yes. Okay. Type one diabetes is is not applicable to type one diabetes. Type one diabetes is an autoimmune disease where your pancreas has no longer works and no longer produces insulin. You have to provide it with insulin. Type two diabetes, people do not start on insulin when they get first diagnosed with type two diabetes. Again, it's a progressive thing. We have about four or five different medicines you were put on before you were put on insulin. Insulin may be your fifth drug. Even when you're put on insulin as a type two diabetic, we don't stop the other drugs. It's just another drug to add to try to keep it in control. So there there's one thing of diabetes. If your son doesn't like take medicine, you don't wanna get diabetes because you're going to be on a lot of medication. And, yes, six million people have prediabetes in Canada, and fifty percent of them are gonna go on to develop diabetes. This is a big health thing in our in our specialized medicine that we pay for for people. Right?
Speaker 0
That's a heavy burden. To
Speaker 2
help people. It's a heavy burden.
Speaker 0
So so what are some of the things we can be doing?
Speaker 2
So what we wanna do is we need to improve your insulin sensitivity. That's what we need to do. If you improve your insulin sensitivity, then your insulin works better. The sugar all moves in the purse in the way it's supposed to work. You sometimes can burn off some of that extra fat that you have there because you don't have insulin around all the time.
Speaker 0
Mhmm.
Speaker 2
So some of the things you do is mostly your food choices is the big one. There's, like, four caveats of everything of feeling better, which is food, exercise, sleep, and stress. You have to work on those things all affect your insulin sensitivity. Most of it is food, and it's trying to teach people who already have a predisposition for like, if they have insulin resistance or prediabetes or that or they have some of these markers, like a large waist circumference and increased blood pressure and high cholesterol, that they now are people who maybe should not be eating as many carbohydrates as they are used to eating. So this is not for everyone. This is for people who will fall into those categories of going down the the road of of approaching prediabetes or diabetes. And if you have any of those conditions, then you're there. Like, if someone's told you you have prediabetes, you're already there. Your body doesn't need so many carbohydrates. That would be the big one. Really limiting rice and potatoes and bread, all those white carbohydrates. But there's lots of other things. I mean, we believe in our business that one of the things is to learn how to stabilize your blood sugar so that you don't have these really, you know, high blood sugars and then come back down and then go back up and then go back down. Because that, again, causes every time your blood sugar goes up, lot a big bowls of insulin gets released by your body. That's what it's supposed to do, and you just have more exposure to insulin. Get a good night's sleep. That helps the sleep helps makes you more insulin sensitive, sensitive to that insulin working. Exercise, building muscles. Muscles are sugar sinks, I like to say. So the more actual cell cells you have, you can pull in more sugar, and that makes you more insulin sensitive because your body doesn't have so much sugar to have to deal with. It has somewhere to put it.
Speaker 0
Yep. It's interesting because, as part of the sugar track consulting Yeah. You wear a CGM, a continuous glucose monitor.
Speaker 2
Mhmm.
Speaker 0
And so I won a package at this event, and I got to wear one of those for two weeks and and consult with you, which is really, really fascinating for me because, as you know but maybe our listeners don't. In twenty twenty, around COVID, I was addicted to, like, learning all about this stuff. So I was wearing one and that and I was spiking and plateauing up at the high, and it would take me forever to drop, and it was all over the map. And then, I started doing Gina Levy and and but which is which is all those things you just talked about. Eating healthy, nutritious whole foods, sleeping, prioritizing your sleep, prioritizing movement. Like, it's it's all of those aspects. It's very, like, lifestyle. And when we did the CGM again five years later, I guess, I I did spike, like, you know, depending on what I was eating, but I had really stabilized. And I and I I will also tell you, I went from belly, like and I still have a bit of a belly, but because I don't work out, enough. But You
Speaker 2
don't do the muscle part. I know.
Speaker 0
I need to do that. Like, I really wanna wanna do it. And, anyway, Mikaela is like an ace at this right now. And I need I need but it did it did really change my insulin sensitivity, I guess, I would say. Is that correct?
Speaker 2
Yes. Yes. It did. Yeah. So that you you have very stable blood sugar. Like, you had if I could share this, like
Speaker 0
Yeah.
Speaker 2
When you ate something, your blood sugar went up. Your blood sugar is supposed to go up when you eat, but it never, like, like, skyrocketed. It went crazy high. Your insulin gets released, and it came back down very quickly. And you just didn't have a lot of variability in your day of how of your of your blood sugars going up and down.
Speaker 0
Except for at night when I woke up.
Speaker 2
So at night, what we found in our program is a number of women, We're watching them with we put a CGM on, which is a a monitor we put in your arm that measures your blood glucose in real time so you can see it. And we can see that during the night, their sugars were dropping
Speaker 1
Mhmm.
Speaker 2
To what we consider low, and they're waking up.
Speaker 0
Yes.
Speaker 2
And so we've I've had a number of women. We've said, why don't you have a a little bit of carbohydrate with some protein snacks, some crackers and cheese, or peanut butter and apple or something right before bed, and their blood sugar is not dropping too low, and they're
Speaker 0
sleeping sleeping better. Yeah. That was Fascinating. No.
Speaker 2
And we I had a lady, like, this is really common too. Like, she wakes up and she thinks, oh, it's because I have to go to the bathroom. Right? We all get it. She gets up, goes to the bathroom, lies back down, can't get back to sleep. Then maybe she does get back to sleep and it happens again. Gotta go to the bathroom again because we're all drinking, like, three liters of water, whatever people are drinking because you know? But what happened with her, the minute we added the snack, she wasn't waking up to go to the bathroom. It was actually that her blood sugar may have been waking her up. Then you're awake. You're like,
Speaker 0
oh, I'm not When your blood sugar drops, your cortisol spikes so you don't die. Right? Is that is that Yeah. Was that right?
Speaker 2
I guess. Yeah. Something like that?
Speaker 0
But no. This because you sent this to me, and so I was like, wait. So I would start tapping. Like, I would wake up then, and I could see, but this way I could know that, okay. Yeah. I tapped at that time I was awake. And sure enough, I would drop, and then I would be awake. And Yes.
Speaker 2
So I thought it was just fascinating. You think it's because you have to go to the bathroom while you're waking up. But actually, for this woman, it was that she was waking up and then having to go to the bathroom because you're awake.
Speaker 0
Yeah.
Speaker 2
Yeah. That was really
Speaker 1
So who are your sorry. I cut you off, Jenna. No. No. That's okay. Go ahead. Ask you. Who so who are who are the target clients for SugarTrack consulting?
Speaker 2
What we what I think that our sugar track consulting is is that there is so much information out there. Like, you hear me say, oh, you may have prediabetes. This is what you should do. Don't eat bread. I mean, that is actually not useful. Or you can go on social media or go on websites or go try to educate yourself, and it is just, like, where where do you even start? If you're someone like me, you read all that and you just, oh, I'm gonna go lie down. I'm gonna go turn on Netflix. I can't even I don't even know where to start.
Speaker 0
Start. Right? I can't.
Speaker 2
Yeah. Like, where do you start with this? So what I see our program being, it's just a fourteen day program. We put a CGM, which is a continuous glucose monitor, on you that tracks your sugar in real time, and it's a gateway, I like to say, or a starting point, or it's it's somewhere to start that is not overwhelming. You're going to have a pharmacist lead you through this program. It's it's self directed, but we we give some suggestions. So it's not like this isn't hard. It's really simple. It's a virtual appointment. It's for anyone. We walk you through putting on a CGM. We talk to you about insulin and sugar. And at the end of the fourteen days, we go over some of the things we saw. You track your food. We can see what you're eating. We can see what you're sleeping. We'll say, look it. You really, really start your morning with a breakfast that maybe is not doing you any favors. You you your sugar goes really high. I know you love your oatmeal covered in maple syrup with any I know you're putting some nuts on it because that's healthy, but really look at this. Your blood sugar is going to nine or ten, and then it comes back down. But all day long, it just creeps up. After fourteen days, we're not going to solve all your problems. But what we're going to do is be able to give you personalized directed suggestions that can help for you because everyone's different. Mhmm. We may have someone who, again, like the sleeping thing. Well, their sugars ended up being just fine. They don't have prediabetes, but now we've helped them sleep. I have people who have prediabetes that do this, and they take the suggestion I give them. And because they're so specific to them, because we've watched them for fourteen days, they make those changes that really this is the caveat. None of these changes are huge changes. Some of them are just because they're much more directed towards you. Yep. Like, stop having a muffin as a snack in the middle of the day. Your Tim Hortons and your muffin is what's killing you here. Your meals look great. It's these snacks you're choosing to have. And people have tweaks. Yeah. That's right. We've had a number of people who've gone from having would be diagnosed with prediabetes and on their next blood work, just doing the things and keeping it up, like, do taking the suggestions, following it through for twelve weeks, they do not qualify as having prediabetes anymore. I've had a patient lose thirty pounds with that one fourteen day, gave him some tweaks of what you need to do, and, he's lost thirty pounds.
Speaker 0
Because he's a man and it drops right away.
Speaker 2
I know. So, like, even if we translate into a woman, they might lose fifteen pounds. Right. Fair.
Speaker 1
Fair. Some things, maybe.
Speaker 2
So that's sort of where I see
Speaker 1
my business. There's lots of
Speaker 2
people out there, like Gina Lively and I mean, I can give you a million businesses like doctor Joey Shulman who's, you know, this Canadian nutritionist who does lots of programming who can do the whole programs for you. The problem is so you're on the Internet. Where do you start? Yeah. Where do you start, and how do you get something? This at least gives you real time data so you can actually see what's happening to your blood sugar, and that will affect your metabolic health almost as much as anything else. Because when you can see it, you're like, oh my goodness. I don't want to eat that anymore, or I'm gonna eat a smaller portion, or it just gives you information so that you can make better decisions. I think the real strength is getting someone to start. No one knows where to start. You gotta make the first step. This is somewhat thing to do.
Speaker 1
I think, also, it's guided by people with expertise. You are then making recommendations that are specific to them to help them manage a health condition that could be Yeah. Very, very serious.
Speaker 2
Yeah. Yeah. And, like, as a pharmacist, I have because I have this passion in sort of in diabetes remission or reverse or whatever you wanna call it, I really believe that if everyone thought they could make a difference, they actually would make a difference. But they don't actually know. They just think, I just gotta stay in the medicine and try to not eat too much and exercise better, and it'll all be okay. But it's it's just too vague. It's it's not personalized enough.
Speaker 1
That sounds simple, but what you just described is not easy to do.
Speaker 2
That's right. It's not. And there isn't a lot of good feedback. Like so you do it, and then in three months or six months, you go for your blood work, and it's no better or it's just the same. Like, there's no immediate feedback. Using a CGM is a tool that gives people immediate feedback, and our brains are wired. We get immediate feedback, we make better decisions.
Speaker 0
Fair. Yeah. Yeah. Sometimes. Yeah.
Speaker 2
No. Okay. Kathy, it's No. We try to make better decisions.
Speaker 0
To make. When we know better, we do better. We try. Jen, what is the one thing you wish every woman knew about using a pharmacist as part of their perimenopause toolkit?
Speaker 2
I think that really is that you just have to realize that your pharmacist is this untapped resource. They know a lot of stuff, and maybe they're not the specialized pharmacist. If you go to the, like, a a special menopause clinic, there might be a pharmacist there who knows the ins and outs of every single study and every single drug, but your community pharmacist who you build a relationship with knows you. They know maybe your partner. They know your kids, and maybe they even know your parents. They know where you live. They know your community. They know your background. They know how you kind of eat. And so if everyone could go to their pharmacist and just ask some questions or just say, tell me what you know about menopause or tell me what you know about estrogen. Tell me what you know about my bone health. Tell me how I can feel better and maybe even what are the questions I should ask my doctor. I feel terrible. Am I in menopause? Am I not in menopause? We're just that resource you can go and see. And we know lots and lots of stuff, and people just need to build a relationship with their pharmacist so that they can have those conversations with them.
Speaker 0
Thank you. Amazing. Great answer.
Speaker 2
I hope I've done my my job of convincing people why pharmacists are important.
Speaker 1
That was amazing. Yeah.
Speaker 0
No. I'm in.
Speaker 2
You should go and find a pharmacist that you can have a relationship with.
Speaker 0
Well and yeah. I'm I'm I'm coming your way, Jen.
Speaker 1
Thanks so much for listening to the show. If you like what you hear, please subscribe and write a review.
Speaker 0
So more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 1
This information is not intended as medical advice. The intent of this information is to provide the listener with knowledge to support more efficient and effective communication with their medical.
