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Pull up a seat at our table, where badass women from all walks of life—fashion, beauty, design, music, philanthropy, art, and more—come together to share honest stories, serve truths, and dig into the realities of modern womanhood.
Johanna Almstead:
Hi everyone. As you know, the impetus for this podcast is the fact that I get to sit at dinner tables with some of the most extraordinary women in the world. And every episode is an invitation to you to sit down with us, learn from us, ask us hard questions too, and be inspired. So as every guest comes on, I like to think about if they're sitting at my table, what I would be serving them. I'm feeling inspired. I think I'm going to just have a couple nibbles out, maybe just some nuts and some wasabi peas and a couple little... What are the beans called? The little Italian beans that are marinated? Lupini beans. I'm going to have a couple of those out because I'm going to go a little bit hard on the first course.
I just had this delicious dinner out the other night for my mother-in-law and my husband's birthday, and we went out to dinner. And so I'm basically just going to copy the menu that we had. To start, I'm going to do some baked clams with a little bit of bread, garlic, and parsley. I'm going to do some crispy artichokes, which were so good, drizzled with a little olive oil and salt and a little bit of lemon. And then for our main course, I'm going to do a lovely branzino with lemon and caper and white wine sauce, and a little tiny side of mashed potatoes, because just a little bit. And some French-cut green beans. I might just serve Vermentino the whole night. I hope she likes it. It's just like a crisp Italian white wine. It goes really nicely with all the fish. And I think it'll be just easy, kind of going old school Italian.
For music, I think I'm going to have a mashup because I don't really know what kind music she likes. She is really fun and energetic, so I think I might start out with a little Bebel Gilberto, a little mellow, and then move into some Feist and maybe some Coldplay. But I can't wait for you guys to meet her. She is brilliant. She is wise. I hope she shares information today that can help your life, your body, your health, because it most certainly has helped mine, and I cannot wait for us to dig in. So let's go.
Hello everyone, and welcome to Eat My Words. I am super fired up today because we're going to talk about something that I'm really, really recently very passionate about, and I'm so very fortunate to have as my guest today a brilliant badass who has genuinely helped change my life for the better and has done the same for tons of other women. So ladies, listen up. She is a board certified nurse practitioner with over two decades of clinical experience specializing in, here it is, guys, hormonal health, menopause, and women's sexual wellness. That's what we're getting into today. She believes that midlife isn't a crisis, it's a power shift. And she is here to help women not just survive it, but own it, redefine it, and rise through it with confidence, clarity, and this part I love, agency.
She is kind, she's brilliant, and she is a straight shooter who cares deeply about women. She has created a new kind of care model, one rooted in clinical expertise and real-life experience. She's one of us, guys. She translates complex medicine into actionable strategies for high-functioning women, hello out there high-functioning women, body women, who want more. More energy, more pleasure, more purpose, and are done settling for generic advice. I've been there too. She's a mother, a speaker, a consultant, a clinician, and a podcast host. She has become a trusted resource and supportive voice for me over the last year and has genuinely changed my life for the better. She's passionate about rewriting the story around midlife for women, and I'm so, so very happy that she's joining me today to share her story. Jackie Giannelli, welcome to Eat My Words.
Jackie Giannelli:
Wow. Hi, Johanna. That was easily my favorite intro of all time that I've ever heard anyone do for me.
Johanna Almstead:
Oh my gosh.
Jackie Giannelli:
So I am honored to be here, and thank you for introducing me in such a beautiful way. And I'm thrilled to be on this podcast with you.
Johanna Almstead:
Oh, well, thank you so much for being here. I know you live a very busy and colorful life, so I appreciate you taking the time because we're going to get into some really important stuff. But first, I like to tell people how we know each other. We met when I became a patient at the practice of Dr. Anna Barbieri, everybody write it down, she's a genius, where you are part of the team of amazing practitioners who basically helped me get out of my own personal hormone situation, to get that sorted out. Which has been truly life-changing. And we're going to really dig into the nuts and bolts of that in a little bit. But first, I want to learn a little bit about your own life and your career trajectory and how you got to be where you are today. My first question that I ask everyone is, where did your journey begin? Because I love to hear where people say their journey begins. So where did your journey begin?
Jackie Giannelli:
My journey in women's health, I think began long before I ever took care of women. I just think I was a natural problem solver. I loved puzzles, I loved logic, and I loved learning new things. And always somehow, I'm not sure as the eldest daughter how this happened to me, but took the path less traveled a bit. Did travel nursing, worked as a pediatric cardiac ICU nurse for a really long time.
Johanna Almstead:
Ooh, goodness.
Jackie Giannelli:
Doing kids' heart transplants and flying all over the world with babies on planes with single ventricles, and just doing all this really wild and crazy stuff. In clinical medicine, I went on mission trips to El Salvador and Nepal and just really wanted to just solve problems, big problems for people, and do it in a really, I don't know, a way that felt just really impactful to the person sitting across the room from me. I spent a decade doing that kind of work, and then eventually had my own kids and that type of work became really hard for me to continue to do. And I was at this inflection point where I was living on the West Coast, I'm from the East Coast. I was ready to move back, and just all this confluence of factors, I've had two kids, hit me in the face and I was like, "It's time to uproot."
So moved back to the East Coast and sort of fell into women's health by accident. I just, again, kept an open mind and thought to myself, "All right, if I can take care of kids, I can take care of adults." And worked with a urogynecologist. I worked with a gyn onc surgeon, and really just learned by doing, which is my favorite way to learn, how both men and women were being cared for. And I really got a front row seat to the differences when we are dealing with a men's health issue and a women's health issue. For example, my prostate cancer patients were being given quite explicit instructions about how exactly their prostatectomies, the removal of their prostate, was going to impact their sexual functioning. That was taught to them. They were provided with resources. The questions were asked. They didn't wait, there was no shame, there was no taboo.
And then I'd go over to the other side of the clinic and see women suffering with recurrent UTIs and really not being offered any meaningful solutions that were changing their health trajectory in any meaningful way, especially for my women who were in their post-reproductive years, the 40-plus crowd. I kind of was scratching my head at that, and I was still a little bit naive to the whole concept of menopause and women's health. And just, again, kept this curious mind, really started looking into institutions like the Menopause Society, the International Society for the Study of Women's Sexual Health. I started going to conferences. And just asking myself, especially having just been in Silicon Valley, who's innovating in this space? Who's doing things a little differently? Who's got new ideas about how to approach this problem?
Luckily, I was down the street from a practice doing just that. I really learned how to think outside the box about women's sexual health and menopause, and became certified in menopause in the middle of the pandemic. In a massive rainstorm in Times Square is where I took my test in the height of 2020, as I was like, "I'm not going to miss this test." And luckily I passed. I really just, again, got into innovation. I was working at that time with Dr. Barbieri at a wonderful startup that she and I were on the founding team of together, called Electra Health, which was one of the first digital health companies to really innovate and to offer care to midlife women online at the time, in 2019 and 2020. This was all new. The conversation was early. I felt like kind of a strange person sometimes getting on... We were all online, because everyone was in the middle of the pandemic and nobody could go anywhere. So I would just get on an IG Live and start talking about libido. And I kind of just didn't care.
Johanna Almstead:
You're like, "My comfort zone is just stretched."
Jackie Giannelli:
It's like we're all at home, why not? Why not? That's just kind of how I did it. And so my care model has been revamped a few times since then. I'm continuing to learn, continuing to challenge myself, continuing to think differently now that the cultural conversation around menopause has shifted so much about what women really need, when they need it, how they like to receive information, and how to meet women where they are. And certainly our practice, I hope does that well.
Johanna Almstead:
Yes, it does.
Jackie Giannelli:
I know you and I were working together on that exact thing, and I'm thinking continually to think about different ways we can reach women to serve them best.
Johanna Almstead:
I want to just touch on something that you said, because this is crazy and this is something that I've recently learned is you said that, so you've been a clinician for a couple decades. You've been doing all this stuff around the world. You had done all the certifications to get to where you are today, and you weren't certified in menopause until five years ago.
Jackie Giannelli:
That's right.
Johanna Almstead:
That's fucking crazy. This is news to me, I just learned about this, but even OBGYNs who've gone to medical school for however long you have to go to medical school to be doing that, they get a very, very small amount of training in menopause, right?
Jackie Giannelli:
If at all.
Johanna Almstead:
It's like a day, or seven hours or something crazy.
Jackie Giannelli:
And really, it's not even just the OBGYNs. Your internists, your general practitioners, your nurse practitioners, your midwives. Literally no one. No one was taught this and it was intentionally removed from school because of the Women's Health Initiative study in 2001, 2002 when that study came out. We stopped prescribing estrogen. And because our healthcare system is very much predicated on a prescription for a problem, when we no longer needed to prescribe, the pharma companies walked away from it. There was not a reason in many people's mind to teach about this.
Johanna Almstead:
Okay, wait, let's pause. Let's explain what that study is to the people who don't know what it was.
Jackie Giannelli:
Yeah, it's since been very much debunked and reevaluated in the context.
Johanna Almstead:
And that's very important for everyone to hear. It has been debunked. This is not fact any longer.
Jackie Giannelli:
It's not. Exactly. And I continue to say this because there are still people who, the stigma lingers. But at the time, it was profound. It was a massive study, massive randomized control trial, gold standard of studies. The problem was not the study design, it was more that the group of people that they were looking at, the problem that they were aiming to solve, was not actually the problem that was being reported on publicly. So it was this misconstrued, really, it was like a public health communications issue. And like all things that we see, it was the early days of clickbait. Like, what can I say that will sensationalize this topic? It was basically reported that hormone therapy was going to give women cancer, specifically breast cancer, that women were having strokes and dying of heart disease, and it was extremely dangerous to continue to take your hormone therapy.
At the time, many, many women were on hormone therapy. It was actually possibly even being overprescribed at the time. It was sort of looked at as the fountain of youth and it was pushed in many ways. And then that pendulum swung completely the other way. Women threw their hormones in the toilet and flushed it down the drain. We walked away from the conversation. OBGYNs became terrified. It's a specialty in medicine that is highly litigated because it's a high risk to have a baby. And so OBGYNs are risk-averse as a profession. They have to be. And so the fact that we have a gynecologic and OBGYN clustered together specialty is quite unfair in many ways. But also, we became very afraid of hormones and it really impacted the lives of women for two decades, especially the women who were probably in their late 40s, early 50s, like my mother right at that time [inaudible 00:12:57] hitting 50.
And that group of people really now were looking back and they have osteoporosis and heart disease and things that possibly could have been prevented, or at least looked at a little differently had we had a more nuanced conversation about the results of the study. Which when we reevaluated it, we came to see truly that when hormone therapy is started within 10 years of the final menstrual period, and generally speaking in someone who's less than 60... These are guidelines, not hard rules. I want to say that as well. I get this a lot. "Oh my gosh, the clock is ticking. My last period was seven years ago. I need the hormones now or I'll never be able to get them." No, it's not like that. But we do just generally on a trajectory, understand that the closer you are to menopause when you start hormone therapy, the more benefit you will derive with fewer risks.
The risks truly just being... There aren't many, I'll say. And sometimes I have a hard time thinking of them because I honestly don't have this conversation as much anymore, because people have gotten this in their head now that the WHI was kind of a sham. But yes, there's a tiny increased risk of breast cancer, especially if you're using a progestin as part of your hormone therapy. We can explain more about that later, but that's not what we tend to prescribe anymore anyway. If you're taking an oral estradiol, just like a birth control pill or any oral estradiol, there's a tiny, tiny increased risk of a blood clot. The breast cancer conversation is really minimalized at this point. We really know that estradiol alone especially is breast protective, so we've stopped really even counseling in the same way we were before. So the guidelines are clear, and I think that that's what women hopefully can anchor on going forward.
Johanna Almstead:
Yeah, okay. I think that's so important for people to know, because like you said, there were probably two decades of women who suffer. I can only imagine also the mental health stuff, because knowing what I went through, and mine was pretty early and pretty young, of not being able to get the care that I needed was rough. And so I can only imagine that there's basically two decades of our mothers who really suffered during this time. That brings me to how I came to you guys. I basically spent the better part of five years meeting with doctors. I had terrible, terrible symptoms. I had brain fog, I had crazy inflammation, crazy weight gain. It didn't matter if I ate water or air or donuts, it didn't matter. Awful irritability, really bad mood swings, lethargy. I couldn't even write an email. It was so bad. Really bad periods. General just sort of malaise and feeling awful. And I kept going to doctors. I went to a new general practitioner. I went to an OBGYN. I went to another OBGYN. I went to another general practitioner.
And I would go in saying, "I know that my hormones are screwed up. Because I have been pregnant twice, I have delivered two babies, I know what it feels like when my hormones are out of whack, and they are out of whack." And no one, including women, two of the OBGYNs that I went to were middle-aged women, which is the other part that kills me, looked at me like I had seven heads, would take my blood test, they would tell me I had to get off the birth control that I was on in order to do anything. And I was like, "No, the birth control is actually the only thing that's keeping me slightly kind of leveled," because I also knew what happened when I would go off birth control. Most of them were just like, "You're normal. There's nothing to do." And I was like, "I'm not normal." So then someone told me I needed to go on an antidepressant. I was like, "I'm not depressed. I am hormonally out of whack."
Another person told me I just needed to lose weight and that was going to change everything. I was like, "Great, cool. I'm drinking air and nothing else, and nothing's working." I was at my wit's end and I was super, at that point, depressed. I was depressed because I couldn't get the help, I wasn't depressed clinically. Finally, a dear friend of mine and an angel in my life, recommended Dr. Barbieri's practice and all of you. It included me meeting with Dr. Barbieri to begin with, then meeting with you, then also meeting with a nutritionist who's amazing, on your team.
We spent basically the next six months making me into a science experiment. I don't think it's wise for me to say exactly what we're doing for me because I don't want people to think that it's like a one-size-fits-all answer. I will say that we basically spent several months tweaking hormones. We tweaked estrogen, we tweaked progesterone, and we tweaked testosterone. We added some, took some out, changed them, changed levels, did all the things, with a combination of a few different ways of delivering those things. Patches, gels, pills, all the things, with a bunch of other things as well. I want to talk to you about that too, because we had a huge conversation around metabolic health and hormonal health, and that's one I want to really get into.
Basically, we spent six months together really tweaking all this stuff. And when I say now I'm a different person, I am a different person. I am happier, I am healthier, I feel alive again. I feel like my brain works again. I feel like my body works again, and has been truly life-changing. Because when I came into your guys' office, I had this laundry list of things, and first of all, the first most amazing moment was when Dr. Barbieri looked at me and she's like, "Of course you feel awful, right? You're a disaster." In the kindest way possible. She's like, "Of course this is a terrible way to feel and a terrible way to live." I just burst into tears, I think actually, because I had spent five years meeting with all these clinicians, all these doctors, all these people who supposedly knew all this stuff, and everybody was telling me that I was wrong.
So for someone to say that I was right was a huge moment, and then to actually then spend the next six months tweaking it and making it better is proof. The proof is in the pudding. Oh, I guess the other important thing for me to say is I was still getting my period. So I was like, "I'm not in menopause because that would mean that my meno would've paused. It has not paused." And I didn't really know that perimenopause was a thing. I think that's a really important differentiation or fact to talk about. Can you just tell our listeners what perimenopause is, what could possibly be happening, some of the symptoms that people might be having that they might think are something else? So can you just give a little overview?
Jackie Giannelli:
Sure, yeah, I'd be happy to. And it's important that we understand these definitions and understand what our hormones are, who the players are, what they do in the body. We don't teach women what their hormones are about. In fact, we sometimes have negative conversations about our hormones. "Oh, I must be hormonal," is how we teach young girls when they're going through puberty about how horrible their hormones are in their body. That really does no one a favor later in life. What happens? We give girls who have pain with periods or we just don't want to deal with their periods or more of the root cause of why their periods are painful, we gaslight them. We tell them, "Sorry, here's a birth control pill." I am not against a birth control pill. It has its role, and I actually think it can be very helpful in the short term. The problem is that we're then masking hormonal health for decades. That's what a birth control pill does.
It really suppresses one's own endogenous hormones, meaning the hormones that your body makes and the cycle that your body would normally be having, and give somebody a nice consistent level of hormones and also prevents ovulation. That is a wonderful thing. We want birth control. Sometimes a consistent level of hormone is exactly what our body needs. The trouble I find is that it really masks our ability to understand our own bodies, and that comes to a head in our 40s when we eventually want to try to come off the pill and be in perimenopause. We have no idea. Our body is foreign to us. One of the most important skills that women in their 40s who are going into perimenopause can have, is symptom tracking.
Because really, to this day, we're in 2025 right now recording this, the only way that we actually can diagnose perimenopause is by understanding the symptoms you're experiencing, the trajectory of those symptoms, and your cycles and how you feel in and around those things. And when women aren't in tune with that and can't be good historians for that, it does make it harder for your provider to help figure out where you are in the menopause or perimenopause trajectory and for us to give you treatments that can really work through the perimenopause. So to back up-
Johanna Almstead:
Hold on. I want to just say something really quick there. I feel like that's a super important point for people who are listening, and everyone is so busy and life is so fast right now, but start paying attention and writing down when you are feeling crazy things. And start paying attention. I feel like I gaslit myself. I was gaslit by many doctors, but also I gaslit myself because I was like, "You're just tired. You're unwell, whatever, you're working too much." Pay attention to the symptoms which you're going to tell us about in a minute, but pay attention and write it down, people. Okay, sorry, go ahead.
Jackie Giannelli:
Sure. To define it, menopause is actually a single day. It is the day in time when you have been 12 consecutive calendar months without a menstrual period due to just the natural decline of your hormones. I'm not talking about somebody who has a hormonal IUD and doesn't get a period. I'm not talking about somebody who's had a hysterectomy, the removal of her... And doesn't get a period for that reason, or somebody who has an abrupt menopause due to chemotherapy or other ways that one can go into menopause. But the idea that menopause is when you've been the full year without cycling or bleeding, what that tells us is now your ovaries have officially retired, not making hormones, but making enough hormones to ovulate. At that point, we're actually in our post-reproductive era, so you don't get all Taylor Swift on us here.
Johanna Almstead:
I can't wait until she gets into that era.
Jackie Giannelli:
Yeah, she's going to be [inaudible 00:23:10]
Johanna Almstead:
See what the songs are going to be like.
Jackie Giannelli:
Exactly. But it doesn't mean that you're no longer making hormones. That is, I think a myth. It just means you've not met the threshold now to ovulate every month. The window of time actually leading up to that final menstrual period and that year without one, is the era of perimenopause. And peri, the Latin word, which means around the time of. And perimenopause for women, that gradual cessation of estradiol, progesterone, and ovulation is, in many women, sometimes five to seven to even up to 10 years. So an entire decade is spent getting through this. And if the average age of menopause in this country is 50, 51, then we are starting these changes often in our early 40s, sometimes in our late 30s, and that's not unusual.
As you could imagine, it gets missed, especially in our younger women who are on the earlier side either due to genetics or autoimmune conditions, or other lifestyle behavioral factors that can contribute to when you'll go through menopause. But oftentimes it crosses over as well with infertility. It's not like you're fertile one minute and then you're in perimenopause the next. They're actually overlapping windows of time. You can get pregnant in perimenopause because you're still ovulating. This is confusing.
Johanna Almstead:
Sorry, one sec. That's also interesting because I also feel like women are having babies later, so that window in between of just sort of normal, is smaller. I had my second baby at 40, so I was postpartum and then I was perimenopausal basically all at the same time.
Jackie Giannelli:
You got a double whammy. I have lots of friends who are feeling that, and the gynecologists are trained to understand it as being postpartum. A lot of them don't even think it could have anything to do with perimenopause. "Oh, you just must be postpartum. You'll get through this." When in reality, sometimes that postpartum feeling really just stays right on-
Johanna Almstead:
Never went away. Never went away from it.
Jackie Giannelli:
Like, it's been two years, am I really still experiencing postpartum depression, or could this be something else? And how might we think about our treatment for this a little bit differently than what we would normally do for somebody who had a baby two weeks ago? There's a lot of gaps in education around this time. Millennials as a generation are handling perimenopause very different than the Gen X counterparts did, partly due to just the conversation that has emerged over the last three to four to five years, thankfully. We're seeing shifts in being reactive to the symptoms of perimenopause and menopause to people really wanting to be proactive and not wait to feel miserable. I'm loving that aspect of the cultural zeitgeist we are living within. But the perimenopause symptoms that start earliest are often undiagnosed as perimenopause, and women do spend, unfortunately, sometimes years gaslighting themselves, seeking care, being prescribed an SSRI when really they needed progesterone.
Johanna Almstead:
I have so many friends who are like, "Oh, I just started going on Wellbutrin" or Lexapro. And I look at them and I can tell that they're hormonally out of whack. I look at pictures now of myself a year ago and I was like, "Oh, God." You can just tell. And I'm like, I don't want to get too in their business, but I'm always like, "Did you get your hormones checked, and by somebody who's real?" Because before you do that, again, if people need that stuff, it's fine, it's not a judgment, it's just a, you might be barking up the wrong tree.
Jackie Giannelli:
Yeah. Or maybe you need both. That's possible too. So much of this is neither just hormones or just mental health. So much of it is about our nervous system and about our lifestyle and our relationships and our stress resilience and our gut health. There's so much more to it than just your reproductive hormones, that can change how you feel through the transition of perimenopause, by the way, we're all going through. Every one of us who lives long enough-
Johanna Almstead:
No one is [inaudible 00:27:09]
Jackie Giannelli:
... is going to have to do this, go through this portal. So we all need to learn it.
Johanna Almstead:
You said the early symptoms get missed in younger women. What are some of those symptoms? What are those usually the ones that are getting missed?
Jackie Giannelli:
What's happening in the earliest parts of perimenopause is that you are still ovulating every month. However, as we age chronologically, just the quality of our ovarian follicles, our eggs, they're just not as good. We don't know yet still how to preserve "ovarian longevity," quote, unquote, in order to continue to make robust amounts of reproductive hormones after the age of 40. There is a decline and the quality of the eggs aren't as good. And when you don't ovulate, quote, unquote, "as well," you don't make enough of the hormone progesterone. So what women sometimes will notice as a first clue that perimenopause is upon them is they feel really good in their follicular phase. Those two weeks, the first half of your cycle, you feel where estrogen is dominant, a lot of women will still feel pretty good. They got their mojo back, their words are coming to them easily. You can kind of tell when somebody is in their follicular phase in their 40s.
And then a lot of women will be very sensitive to either ovulation or to the post-ovulatory period known as the luteal phase, which is after ovulation. When progesterone is really supposed to be dominant and we don't make enough of it, our brain is very receptive to that, and it manifests symptomatically as loss of sleep or often difficulty staying asleep. These women are tired, so they fall asleep quite well, but they're waking up at 2:00 or 3:00 AM with their heart pounding or feeling anxious about nothing, and can't fall back to sleep. These are women who may feel a little more anxious again for no particular reason. They just can't put their finger on why. It's not often disruptive enough for them to maybe seek psychiatric help. I mean, it can be, but for many women it's just this under the radar, general feeling of I'm not feeling like myself. I call that NFLM syndrome, because it's not actually diagnosable yet. You're just intuitively aware that something's shifting.
Periods often at that point, because progesterone keeps our uterine lining, keeps it intact and keeps it from being too thick. So these women without enough progesterone often will have heavier periods where they're bleeding, soaking through tampons or pads more than one an hour. These are women whose cycles might've always been 28 days, and boom, all of a sudden their cycles are 25 or 24 or 21 days. They're coming more often. And again, this feels like a nuisance. The usual solution for these things when they go talk to their gynecologist is, "Well, we can put you on the pill." And sometimes that's fine and sometimes that actually works quite nicely, because it does, it evens out all this stuff. But many women are like, "Well, I don't really need birth control," or "I didn't really feel so great when I was on a birth control pill in the past. That's not really my favorite option. What else you got for me, Doc?" And they don't have anything else.
So we kind of just say, "I'll figure it out. I'll shop some supplements or I'll clean up my diet." And the reality is that women in our 40s, there's a lot on our plate and so we don't do those things. And then we're right back six months later asking ourselves, "Okay, what do I do next?" There's a lot of pausing and steps that it takes to really end up in the right seat with the right clinician and saying yes to the care that you really need.
Johanna Almstead:
So major. You just hit on something and you talked about it on one of your podcasts, about the whole supplement thing. Because I spent those five years when I was meeting with all these people and getting gaslit and not getting any clear help, buying every fucking supplement on the planet. Thousands of dollars that I spent on supplements. And some worked, some helped, definitely. And some, maybe placebo effect helped. And it just felt like I was doing something. I was trying and I was doing something. But you made such a good point in your podcast the other day when you said something like, "If you actually stopped buying all the supplements and put all that money that you spent on supplements to finding a really good clinician," like you guys, "you could get that care and that help a lot sooner in your life."
And so that is something I want everyone who is listening to hear me say now. If you are not getting the answers from your doctor, find a new doctor, find somebody else. Google women's health, midlife women's health clinics. Find information, find people, get referrals, ask friends. Because literally I still have, I actually have some on my counter now that I don't need anymore because I feel better because of everything we've done. And I'm like, "Oh my God, that was like $500 worth of supplements right there that I... You know?
Jackie Giannelli:
That's [inaudible 00:31:56]. They just keep coming.
Johanna Almstead:
They keep coming. I'm like, "Oh shit, I forgot." And you have to cancel it. Again, not to say that no supplements work. I'm not saying that. There are some that did help and they certainly got me through a little bit further. And some actually helped identify or sort of clarify that I was right. The ones that were made for hormone health, some of those helped, and I was like, "Okay, so this is real. It is the hormones."
Jackie Giannelli:
That's a good way to think it.
Johanna Almstead:
So that did help clarify and give me more gumption to keep fighting and to keep finding the right person or the right team. I call you guys my hormone team when I'm referring to you. So I think that's a really important point to make for the listeners is like, it's probably not going to come from a supplement. You end all, be all, I don't want to say cure, but treatment, is not going to come from herbs and supplements probably.
Jackie Giannelli:
Yeah, and a couple things about that, Dr. Barbieri is a double board certified integrative gynecologist. We are not integrative medicine. In fact, we love acupuncture and supplements and breath work and yoga and meditation and all of these things. It's like, there's the wellness side and then there's the medical side, and the way that these things are explained to us is that you have to choose between the two, that you can't be on a statin and also do acupuncture. And that's ridiculous. It's like making a chili in the winter. You keep adding things and tweaking your recipe and figuring out what goes in. I think the problem, you mentioned this, but I've been calling it lately wellness creep. Because what's happening is we're at home, it's 3:00 AM, you've woken up. You're like, why do I keep waking up?
You pick up your phone and you go into your algorithm and your algorithm knows exactly why you're up at 3:00 AM, they diagnosed you quite well, and you get all of the supplements. With one click they have that in your cart. We then are fed more supplements. We end up on this, "This is the solution to my problems. If I just keep going down this route, we'll get there eventually." And it leads us so far astray and delays care. That's the problem that I have with the wellness industrial complex in the context of menopause, is that it's impeding the time to care for women who truly would've, like you said, be best spending that money. The ROI is going to be so much better on a GLP, in the end of the day, than it's going to be on berberine. And not everyone needs a GLP, but if you're taking berberine for nine months and your weight is still the same, how much time was lost and money that could have been spent differently?
Those are just questions I encourage people to continue asking themselves. Should be always reevaluating, in perimenopause at least, the state of where you are with your care every three months, and just asking myself, what am I taking? Why am I taking it? Is it helping? What's still messing?
Johanna Almstead:
Yeah. I think that's the hard part too, is you don't know what you don't know. I didn't know how much better I could feel until I felt that much better. That's the other part that I want to really reiterate to people, is this was six months of making chili. This was not a one-shot deal. This is literally me and you meeting every several weeks, or I can't even remember now how often, and you being like, "Okay, how do you feel?" And me being like, "Okay, this is working, but this is still happening," or "I'm still having this." And you'd be like, "Okay, so we're going to add a little bit of this into the chili." And then I would call you or email you and say like, "No, that didn't make me feel good." I think it's so important, again, that's why I don't want to say all the things that I'm doing because I think it's not helpful, because I don't want people to just go out and try to get a prescription for those things.
I think it's so important that you find a partner who can bob and weave with you through the process and that you don't get discouraged when it doesn't happen right away. Because I have had friends who are like, "Well, I went to a doctor and I got estrogen." I'm like, "Okay, cool. Great. Good start. You're probably not done." And they're like, "This has helped. I'm sleeping," or whatever. I have a one friend who's like, "Oh, the progesterone, that made me sleep through the night," or whatever. So it's just not a one-shot deal, and I think what happens is, people... I have friends who have had to fight with their provider to give them something.
So they're just going in and they're like, "Please just give me estrogen," which is like, okay, again, good start maybe. But then they're like, "Well, it didn't really work. I feel a little better, but then I still have this, this, and this." And so that's what I want to just keep underlining for people is it is not a one-stop fix. It is not a one thing. It's many, many, many things. And again, supplements, holistic, other stuff, acupuncture, yoga, all those other things can be part of that chili, but it's just that you have to be willing to go through that little bit of the cooking in the kitchen part and being a little bit of a science experiment.
Jackie Giannelli:
And being a flexible thinker, I think as well, and open-minded, because that's what perimenopause is, I think here to teach us is, how are we changing and growing? We get to choose who the person is that we're going to become on the other side of perimenopause. But that's an investment that you're making in your future self by spending the time, by thinking about what's your mindset around aging. I've been thinking a lot lately about how our thoughts, I think shape our emotions, but also shape our actions, and so imagining yourself as, who is the person that I want to be when I'm through menopause and I'm 60? What does that woman look like? And then doing the things today that are going to, in your mind, bring you to that place. Starting from that vision, I think is really helpful as a way to back into this process, rather than us keep sweeping it under the rug as something to avoid or not to face.
Johanna Almstead:
I think that's amazing. I can say to you during those five years, that would've been even hard for me to get there. I was in such a sludge, I call it, that I could kind of see her where I wanted to be and who I wanted to be. I knew I didn't want to be where I was, but because everything was so out of whack, it was very hard for me to get there. I do think that I want to acknowledge that for people. If you are in the sludge, I get it, and it may be hard to daydream about this glorious, fabulous 50-something that you're going to be, but it's possible. It's possible to get there with help and support
Jackie Giannelli:
100%. That's the clinical framework that I operate from, that's actually step four. I think it's really unfair for us to ask anyone to do any kind of therapy or self-help type of work without gas in their gas tank. We talk about this when we talk about sexual health a lot, it's the biopsychosocial model. Nobody is going to be successful if they are in a depleted state, if they are circling the drain. They first need to be stabilized. There's a process. For me, it's restore, optimize, maximize, and then rewire. And the mindset work for me is part of the rewire aspect of my framework, because now you've got the prescription for estrogen, let's say, or testosterone, or you've got your supplements, you've cleaned up your diet, and now you're in a place where you're like, okay, I feel better. I feel more like myself. Now how can I use this as energy, as motivation, in order to continue to evolve into the second half of my life in the way that I envision?
Johanna Almstead:
Totally, totally. I think that's huge, because again, I couldn't get there until I got there. I couldn't get there until we went through this whole process. I do also want to just say there were times where we were changing the first round of hormone stuff and I felt awful. I would email Dr. Barbieri and she would be like, "Okay, we're going to give it till Friday." And it would be Wednesday. She's like, "We're giving it until Friday, and then we're moving on. We're changing it." I think that's also really important. And you should give the clinical information on this, but the changes happen pretty fast, and if they're not happening, then you have to be open to changing again and have a clinician who's willing to change. Because I changed mine three times within two months, I think. It was pretty quickly we could see one way or another what was happening and what was working.
Jackie Giannelli:
Yeah, and that's the beauty of this, is that people think that they don't have options. We have so many options now for women to receive treatment. We have different routes, through the skin, we have orals. We have different kinds of combined medications, we have injections. There are lots of different ways that you can make a hormone therapy cocktail that works for you, and everybody's going to find their secret sauce. You may not nail it the first time. That doesn't mean that you're done and there's nothing that can be done. I love that aspect of the fact that we are now starting to see non-hormonal treatments for hot flashes for our patients who choose to or don't want to take hormone therapy. Women have choices and they should know what they are.
Johanna Almstead:
I think it would be nice if you could shed a little light on some of those options, because a lot of that was very new to me. It was interesting because you would say, "Okay, well, if this is the issue we're talking about, these are three different things we could do." And I would be like, "Okay, I don't think I want to do that one. That one sounds okay," whatever. And you don't have to list every single medication you guys are talking about, but the general categories of things. Because I know at one point you did talk about, I don't know if it was an SSRI, but it was like an antidepressant or anti-anxiety thing. Anyway, I can't remember what it was that you recommended. And I was like, "I don't think that one's for me, but we're going to try something else." And you were like, "Hey, I think we should address the sleep issue with this because of this." Can you give everybody an overview of the types of things that you're using that could possibly go into that cocktail? Because it's not just estrogen, progesterone, and testosterone.
Jackie Giannelli:
No, those are the three hormones that just categorically we box and walk you through. I never start all three at the same time. People are sometimes like, "Give me all the things, I'm so miserable." And you're like, "No, I promise you don't want that." And also, it's not smart. Because we want to do something and then we want to act, and then we want to react, and we want to change course. And we won't know what's helpful and what's not if we're starting seven things at the same time. So that's always the rule of thumb.
Johanna Almstead:
I think that's a really good point, because again, it's not a one-stop shop. It's not like we're going to do all this and then you're going to be better.
Jackie Giannelli:
Right. If you're in a panic and you're not thinking clearly, that sounds great. Please give me all the things. That's an important point. But it depends again, where you are, that's why I always start with staging somebody, and I do that based on the cycles and the symptoms for the most part, and sometimes just their story. We sit and we talk for a long time. I hear your story and the history of your symptoms and when they appeared and the severity. I ask a lot of questions because I'm doing mental gymnastics in my mind about what that means for what your... I'm doing a deep dive into what your ovaries are doing and how they're behaving. When I am surfacing that information, the output is what stage of perimenopause are you in? Are you in the earliest part where you're ovulating still every month, but the hormonal output isn't that great, and so we're just starting to be deficient on progesterone? So maybe we need to give that back first.
The later part of perimenopause, which is when now you're really close to that final period, but you haven't quite hit it yet. Often this is the period where women feel the worst because their hormones are really fluctuating and declining now, estrogen in particular, which is our master hormonal MC, basically of the party. He's the one doing all the things. And when that is not only declining but fluctuating, sometimes wildly, really does a number on our body, particularly our brain, and our mood and our emotions. We just don't feel great at all. Lacking of energy, sleep, all the things. That's sometimes the hardest part of the transition for women.
And so if that's where you are, I'm going to need to think about giving you estradiol. And progesterone if you have an intact uterus. I have to protect your uterus with a hormone that opposes estrogen in the uterus, progesterone, so you'd likely need both. And then if you're post-reproductive as well, it's really you still need both, meaning if you're post-menopausal. But now it's a little easier sometimes to give you hormone therapy because your hormones are low, but they're consistent.
Johanna Almstead:
Right. They're not doing the roller coaster thing anymore.
Jackie Giannelli:
They're not doing the roller coaster. It does make it easier to treat a post-menopausal woman with one dose of hormone therapy that she can be on for quite a while. The challenge, as you could imagine in peri, is that hormones are fluctuating. So one month you might feel completely great, like, "Oh, wait a minute. Oh, what happened last month? That wasn't me. I must've had too much wine when I was out to dinner or I must have been just having a bad month in my marriage," or whatever excuses we're telling ourselves. And then you go and you have a good month, and then the next month you're right back at it again, and it really does a... This is where the personal gaslighting really comes in.
Johanna Almstead:
Yes, I'm familiar.
Jackie Giannelli:
We all are. The hormones you're going to need one month that might feel perfect for you, are then not great the next month. It is a challenging time not only for you, but for your clinician to find the right thing that's going to-
Johanna Almstead:
Because it's like a moving target, right?
Jackie Giannelli:
It's a moving target. Testosterone comes into the mix as well, and I don't want to refer to it as a hormone of perimenopause because it actually is a hormone that starts to decline slowly and gradually, but before perimenopause. It's the hormone of vitality, energy, confidence, sexual functioning, all the good things, the quality of life stuff, that oftentimes is supporting us in the background. And we don't even realize it was a missing link in our hormone therapy until we add it in, often after we've restored and course-corrected all the craziness. If we're like, I feel good, but something's still missing, often that's when testosterone gets layered in and it's like, oh, okay, I feel really balanced now. I feel like I have energy. I'm killing it at work and my libido is back and orgasm is better, and I just feel like I'm ready to attack my day.
That's not always a feeling that estrogen can give you alone, and so sometimes I'm a big fan of testosterone for women. It's one of our major hormones. We have more testosterone than we actually have, by volume in our blood than estradiol, and women don't often know that. If you're still not right on your hormone therapy, often I ask that question and sometimes it gets the job done.
Johanna Almstead:
All right, so that is a lot. I think that's a lot for people. I think that the main takeaway for me here, and for everyone, is keep pushing. This conversation is what I have over dinner all the time with my girlfriends. And those of us who've gotten help are like, "No, you need to push. You need to push." We have a group text of, she's like, "I'm going in and I'm asking for estrogen and I'm asking for testosterone." But again, find your clinician who can help. What would be your recommendation for people who are not near you or can't come to you guys? Is there any sort of resource where people can find specialists and people like you who are doing this work? Is there a place that they can go to find that out?
Jackie Giannelli:
Yeah, there's not one great... The reason that there's not one great place to go is that it's a good thing actually that we are getting more and more menopause certified clinicians every single day. People are really excited about this as a new learning opportunity. Especially women clinicians are really like, "I'm not serving my patients. I need to up my game." And so I'm constantly hearing about clinicians going back, and every day I'm hearing about new resources and educational outposts for people. But the Menopause Society is the major society that certifies practitioners of all kinds. So you could certainly start there and look and see who in your zip code is menopause literate.
Oftentimes though, it's word of mouth. It's the group chat. It's asking your girlfriends, just striking up the conversation and not being afraid to say, "Wow, you seem really good. What are you doing?" And just being open about your challenges. This is nothing to be ashamed about, we're all going through it. So some of the best recommendations, I think come from your best friends.
Johanna Almstead:
Yeah, I've become a crazy evangelical about it. I meet someone for the first time at a dinner party, I'm like, "Have you had your hormones checked? I really think we should talk about this."
Jackie Giannelli:
Yes.
Johanna Almstead:
It's a little bit weird icebreaker.
Jackie Giannelli:
Unfortunately, a lot of the clinicians that are on the Menopause Society website and in that directory, some of them who take insurance are sometimes capped, their practices are capped because there's such demand to be met. There's so many women who need this type of care that there's not enough. The supply-demand is just all mismatched. Don't stop there if you haven't found your person yet through that channel. Go on social media and really start to look for, not just health coaches, but who are the real clinicians? And there are a lot of us who are online who are starting these conversations, who have free resources, and sometimes that's a great place too, to look. And even if that clinician isn't accepting patients, they may have a website where they list who they love. They may be connected to other clinicians. So really just, again, being diligent and persistent, and if you meet with somebody, don't jive with them, don't stop there.
Johanna Almstead:
Yeah, move on. You did bring up the point about insurance and costs, so I think that's an important thing to touch on. Sadly, our health system is broken, and I certainly didn't find a lot of help in the people who took insurance. I want people to understand that going the private route is expensive, but worth it. And back to the conversation about the supplements, if I had canceled two supplement subscriptions, I could pay for it. I do just want people to know that, yes, I acknowledge that it can be costly and it can feel like a lot. I feel like there's always the good conversations of, "Hey, can we do a payment plan or is there a sliding scale? Or do you take credit cards?" Or whatever. And again, I don't want people flushing their money down the toilet. I want to make sure if you find a clinician that feels right and is listening to you and is acknowledging you and validating your experience, for the most part, in my experience, that is going to be money well spent.
Save up. Don't go out to dinner. Do the things you have to do to try to invest in your own healthcare, because it is no joke and it will change your life. Okay, so what's the best part about your work? What's your favorite part of the work that you do? Because it's such important work, but what do you get out of it?
Jackie Giannelli:
I think I just love the partnership, but I also love the stories. I have just met the most incredible women who are just so high achieving, who just want to do so much good in this world. There's just so many women who are passionate about their families, their communities, their employment, and serving and giving back. It breaks my heart to see so many women who can move the needle so much in our society, be suffering in a way that holds them back from doing that. And I truly believe that we have all this wisdom, we've come so far, we've learned so much, and then we get stuck in this place. And that's not acceptable to me. I think women, as much as they deserve to feel not sick, they deserve to feel really well. It's okay to ask yourself, "If I feel fine, how could I feel amazing?" We don't allow ourselves that type of conversation because we're just supposed to be grateful and just be happy to be well enough. And you're really just here to serve the other people in your life.
That, to me, is so unfair. The same way that your teenager deserves braces and you wouldn't think twice about investing in braces for your teenager or paying for your kid's college, why don't we show that same generosity to ourselves? Knowing that, yes, it might be six months of an investment, but the place you find yourself on the other end of that empowers you for truly a third to a half of your life that you are now facing. How do we want to show up to that? Do we want to show up feeling broken and dejected? Is that the kind of grandparent that we want to be? No, we have a choice. My favorite thing is to just help women not just feel okay, but just feel fantastic. And get their sex life back, become at the top of the C-suite if that's what they want, be a leader in their community if that's what they want, but just they want, but just to see how it really impacts their personal goals beyond just not having hot flashes.
Johanna Almstead:
Yeah, I think that's huge, and I think that has been... For me personally even, I remember feeling guilty about taking the day and having a sitter and going to the city and meeting with Dr. Barbieri, and spending all the money and then choosing to sign up for the six-month plan, and I had all this weird shit around it. I was like, "What the fuck am I doing?" No one in my family was saying, it's not like anybody was saying I shouldn't do it. It was me. I think that that, just societally, we have to change that narrative. Like, ladies, you deserve to feel great and you can feel great. It's not something that is out of your reach. It is not something that someone is serving to you on a silver platter, I'll tell you that. You have to search for it, you have to find it.
But it is so important to me that this dialogue changes because I had it myself, and it was my own stupid internal dialogue of like, "Oh God, that's a lot of money." But like you said, I spent, whatever, thousands of dollars on my kid's braces. I didn't think twice about that. So what can we do to help each other, remind each other to put the investment back into ourselves? And also, by the way, it's going to make you better at whatever you're trying to do, whether you're a stay-at-home mom, whether you're a C-suite executive, whether you're an inventor, whether you're a teacher, whether you are a nurse. It's going to make you better at whatever you are trying to do and achieve. I can now say with 9 million percent clarity, that is real. And so, I think that that's the other part that I want people to know, is there is a bright side. There is light at the end of the tunnel if you can find the right people. Okay, what's the worst part about your work?
Jackie Giannelli:
I think prior authorizations, just to completely go the opposite direction in terms of how we're talking about this. There are still so many barriers to care. Even when you are in a cash pay practice where things should feel easy, healthcare is really, really hard for everyone. I just want to say that out loud. It's a highly regulated space. We have licenses to protect. We have insurance that we still have to deal with when we're prescribing medications, when we're dealing with lab work. And there are a lot of people out there who are trying to extract value from the healthcare system at the expense of clinicians and patients. We're on a team together.
And I struggle when my patients who have been on a Zepbound, for example, a GLP that some of your listeners might be aware of, it's tirzepatide and it's one of the best medications we have today for weight loss, and recently one of the insurance companies just decided that they weren't going to cover it anymore. And all of their patients who are on Zepbound, which has superior efficacy and outcomes, especially in certain populations... This is all science and research. I didn't make that up. This isn't my experience, this is what all the research shows. "We're only going to cover Wegovy," which is a different drug. And for many women they've already tried Wegovy and were not successful on that drug. We're struggling. We get these prior authorization letters and then we have to answer these questions as clinicians. And Dr. Barbieri and I were commiserating over it, this questionnaire was over 100 questions that I had to stop and answer.
Really you know at the end that they don't care what you write because it doesn't change the outcome. They have algorithms now that are fighting back against our clinical judgment in order to save insurance companies money and really lace the pockets of the executives there. And so it's very frustrating, especially when it involves a tool or a treatment modality that is so important for so many people. We have a cardiometabolic crisis in this country and there are patients who need these medications, and all of us are up against quite the challenge with the healthcare system we're in.
Johanna Almstead:
That just brings me to the point because you and I talked about this a lot on our sessions, the correlation between metabolic health and hormonal health. People, it's very real. If your metabolic system is out of whack, it's going to put your hormones out of whack. If your hormones are out of whack, it's going to put your metabolic system out of whack. That is just something that I learned through this process and didn't understand. And so when you're talking about using GLP-1s or other things to treat weight loss, it's all part of your hormonal package, right?
Jackie Giannelli:
Yeah, your ovaries don't work in a vacuum. They're connected to your gut health, they're connected to your genomics. Really, it's a confluence of a lot of different things. And we metabolize our hormones. Our hormones circulate and need to be excreted, and they do that by passing through the liver. Our gut health, our gut microbiome really is also a big determinant of our hormonal health. Our body's always looking for equilibrium, so when one thing is off, it's going to often throw off other aspects of our endocrine system and our hormonal health. And so sometimes we have to go one layer deeper and really work on our insulin sensitivity and our cortisol and our melatonin, and then many times things above that, like your progesterone production often will improve if we're not in a cortisol crisis all the time. That takes, again, a systems thinker, someone who can really look at the body as a whole and go down deep and discover what the thing is that's really in control, fix it, and then continue to iterate above that.
Johanna Almstead:
Yeah, that goes back into the chili that we're making. The chili is not just the hormones. Okay, so what is an achievement that you are most proud of?
Jackie Giannelli:
Such a good question. This is going to sound silly, but I am most proud of the A that I got in organic chemistry many, many years ago.
Johanna Almstead:
Yeah, girl.
Jackie Giannelli:
And this is when I thought I wanted to be a doctor, and so I was like, "I'm applying to medical school." I really wanted it. And I'm an Enneagram 3, so I am an achiever, and I love goals and getting there, and I often won't stop until if I decided it for... Not if someone else decides for me. Then I rebel. But if I decided for myself, I'm going to not stop until it happens. And that was just, I think again, I love problem solving, but I do it on my terms. It was the hardest class I ever took, and I did it. I took an entire summer, I went to NYU, and I did nothing but write out those equations and do that hard work.
The first semester I think I got a B+, and the second semester I got an A. What it did at such a young age, I think I was like 21 or something like that when I could have been partying and doing all these other things was like, it just taught me the value of just grit and hard work and not stopping when something feels really hard, and that eventually you get there. You're probably going to stumble seven times and you're probably going to fail a couple of times. And as an eldest daughter, straight A student, that was a hard lesson for me to learn, but I needed to learn it. So I'm proud of the intuition I had to do that.
Johanna Almstead:
I love that it still resonates with you this many years later. I also feel like I've heard that organic chemistry is the one class that people end up deciding not to become a doctor because they can't get the A, because they can't do well in it because it's so hard. I love that for you. That's amazing. What is something that you once believed about yourself that you've since outgrown?
Jackie Giannelli:
I think about this all the time, but just that I can control everything around me. That if I work hard enough, I can control other people. I grew up in a house where it was always about controlling things. If we just say it a different way, I can change the people. No, you can't change other people. You can only be in control of you and your own choices. I think it was Mel Robbins was that whole let it go theory-
Johanna Almstead:
Let them. Yep.
Jackie Giannelli:
First I was like, "Okay, that's really silly. Is that really a thing? Come on, that's so..." But really, you know what? It's the only way I think to get through your midlife when you're trying to do a lot of things, be a mother, work, be involved in your kids' schools. We're going to do all of it. We're not going to do all of it at the same time. And everything else, we have to let it go, and so I'm trying really hard to get better at that.
Johanna Almstead:
That's good. Is there anything that you've said no to that you wish that you had said yes to?
Jackie Giannelli:
That's a good question. I think I wish that I had studied abroad more when I was in college. I did study abroad for a very short period of a couple weeks. But again, I wish I used my 20s more as a time to fail more and to take more risks.
Johanna Almstead:
I love that.
Jackie Giannelli:
Yeah, I think when you are in healthcare, at least this has been my experience, we go into healthcare because we love a linear path. We're told, if you do this, you will get this. And then if you do this, you will get this. What happens is that you just get indoctrinated into this way of thinking that's very like, there's always an external reward that someone is going to give to me, that if I just do the thing I'm supposed to do will become-
Johanna Almstead:
Like you're literally going to get a new certification or you're going to get a new... Yeah, exactly.
Jackie Giannelli:
That's so not how the world really works. And then you go into healthcare and you don't learn anything about the business of healthcare, and you end up turning around at one point and just saying, why am I unhappy here? And so, I think I would've loved also to have taken more business courses. I think it's really important for clinicians to understand, and for consumers to understand, the business of healthcare, how healthcare works. Business was not anything I was interested in, but I do wish that it's something I had gotten better at younger, because I do think it would've helped me, I think navigate through the mazes of healthcare in a stronger way. I don't regret it, but looking back, I think that would be advice I would give my younger self.
Johanna Almstead:
Okay. All right, now we're at the very, very fun part of this interview. This is the lightning round of silly questions. I know you're a very good student. You do not have to study for this. There's no wrong answer. Just tell me what comes to your mind, the first thing. Favorite comfort food?
Jackie Giannelli:
Pizza.
Johanna Almstead:
Ooh, I love that. What is something you're really good at?
Jackie Giannelli:
Math.
Johanna Almstead:
Oh my God. You're the first. Okay. This is funny. I'm a fashion person. Most of the people on here are design, fashion, entertainment kind of people. And the next question is, what is something you're really bad at? We've had five or six people say math is that something they're bad at. You're the first to say that math is something you're good at. I love this.
Jackie Giannelli:
I mean, I was really good at math when I had to do it all the time. I'm very proud of my almost perfect math score on my SATs that now it serves no purpose whatsoever.
Johanna Almstead:
Except that you can say that you're good at math.
Jackie Giannelli:
I feel like [inaudible 01:02:56]
Johanna Almstead:
Okay, what is something you're really bad at?
Jackie Giannelli:
Oh, gosh. I think I am really bad at sports.
Johanna Almstead:
Okay. Favorite word?
Jackie Giannelli:
Trust.
Johanna Almstead:
That's nice. Least favorite word?
Jackie Giannelli:
I don't know. What's my least favorite word? Oh my gosh.
Johanna Almstead:
The pressure's on. It doesn't have to be your life least favorite word-
Jackie Giannelli:
[Inaudible 01:03:20]
Johanna Almstead:
I'd just be one you don't like today.
Jackie Giannelli:
Ugly.
Johanna Almstead:
Ugly. Okay, good. Least favorite food? Like, you're not even ever tasting it again.
Jackie Giannelli:
I think caviar or anything that texture.
Johanna Almstead:
No, really? Okay. Best piece of advice you've ever received?
Jackie Giannelli:
I think the best piece of advice I ever received was that life is hard and that it's very long, and that we're always in a rush, I think to achieve something, to get that next star on our report card. And all that's going to turn into is, what is the next star you want? And so it's like, enjoy the process and enjoy the learning and enjoy the growth, and really orient yourself around that rather than the outcome.
Johanna Almstead:
Great. What's your idea of a perfect day off? I'm sure you don't really have any.
Jackie Giannelli:
I don't.
Johanna Almstead:
Because you're busy. But what would you do on a perfect day off?
Jackie Giannelli:
Eating in a really amazing restaurant in New York City, shopping, and then maybe doing a little cold plunge, sauna, spa situation all in one day.
Johanna Almstead:
Oh, I like it. I like it. I'll join you on that day. If your personality were a flavor, what would it be?
Jackie Giannelli:
Ooh, I think miso, because it's a little bit like of this and a little bit of that, and the blend is just like... It's on its own level.
Johanna Almstead:
Its own thing. I love that one.
Jackie Giannelli:
Thanks.
Johanna Almstead:
Okay, last supper, what are you eating tonight?
Jackie Giannelli:
Ooh, I've been into hand rolls lately. And after work last night I went to an Omakase restaurant, and it hits all the right notes.
Johanna Almstead:
All the right notes. And are you drinking anything with your hand rolls?
Jackie Giannelli:
Maybe a little sake because that's what I do when I'm there, but I love a good dry white wine. That always gets it for me.
Johanna Almstead:
Okay. And are you a hot sake or a cold sake person?
Jackie Giannelli:
A cold sake person.
Johanna Almstead:
Have you ever had a moment in your life where you've had to eat your words, where you've had to just be like, "Ooh, I shouldn't have said that?"
Jackie Giannelli:
Of course. I talk a lot for my profession. I always try to think about the person in front of me and not to make judgments about who they are or where they're coming from. And inevitably, you're going to screw up. I think when you're in a service-based industry, you're always going to offend somebody with your words, whether you mean to or not and whether they tell you or not. I can't think of a specific time that I said something egregious to somebody, I know I have, but maybe I've tucked it away in a place in my brain where it lives.
Johanna Almstead:
It lives and festers.
Jackie Giannelli:
Probably.
Johanna Almstead:
Wakes you up every once in a while at 3:00 in the morning.
Jackie Giannelli:
Right.
Johanna Almstead:
Oh God, I can't believe I said that.
Jackie Giannelli:
Yeah, or apply all that I didn't mean to do, something like that.
Johanna Almstead:
That one. Okay, if you could eat one food for the rest of your life, it's going to sustain you nutritionally. I know you care a lot about nutrition, so I don't want you to worry. It's going to sustain you. What would you eat every day if you had to?
Jackie Giannelli:
If I had to eat something every day, probably would be an apple with peanut butter.
Johanna Almstead:
I love that.
Jackie Giannelli:
Yeah. It's sweet, it's salty, it's crunchy, it's juicy, and it gives me energy.
Johanna Almstead:
[inaudible 01:06:21] There you go. Where is your happy place?
Jackie Giannelli:
Oh, by the water, easily. I feel like a different person when I'm close to water. I cling to the Coast. I won't ever leave it.
Johanna Almstead:
And ocean water? Or it's lakes or rivers?
Jackie Giannelli:
Ocean or salt water, I would say.
Johanna Almstead:
Yeah, me too. Okay, what do you wear when you feel like you need to take on the world? You're going to do a big presentation or you're speaking on a panel or you've got a hot date or something.
Jackie Giannelli:
I'm not very tall. You've met me. I love a really nice tailored jacket, but it's got to be a monochromatic situation because I think that that lengthens me and that definitely helps me feel more confident. I love jewel tones, so probably something in that family. I also just love a really good midi dress, like a one and done. I would wear dresses every single day. I'm a huge fan of dresses and not thinking too hard about what you're wearing. Women spend a lot of time thinking about what they're going to put themselves in to get out the door. And I think it was President Obama who said he just has the same suit jacket he wears every single day because he is all about efficiency and he's got a job to do. And I think I'd love for women to think that too. Own five things that you can just keep pulling out of your closet that you know fits you impeccably and make you feel amazing, and wear them to death.
Johanna Almstead:
Right. I'm a big believer in that. I wear things over and over and over again. Are you wearing a heel with your dress or are you wearing flats?
Jackie Giannelli:
Always. Yes, but I like a block heel, not a stiletto. Unless I am really needing to do that, it's going to be time limited.
Johanna Almstead:
And I'm going to be sitting down for most of it.
Jackie Giannelli:
Yes. But I've got a couple pairs of shoes that I keep going back to that are high quality, and again, they just make me feel really good.
Johanna Almstead:
Good. Okay, go-to coping mechanism on a bad day?
Jackie Giannelli:
If it's the end of the day, I call it quits and I go to sleep because-
Johanna Almstead:
Shut it down. That's what I call it.
Jackie Giannelli:
I've been doing more of that lately. Not even if it's a bad day, but if I'm just feeling uninspired or I feel like I need a reset, for me, sleep just is everything. I love sleep so much. I feel so good when I'm well rested. But if it's the morning or the day got off on the wrong foot, a walk outside is my go-to. Even for 15 minutes.
Johanna Almstead:
You'll get up from your desk and actually go in the middle of the workday?
Jackie Giannelli:
Yes. If it requires that, yes, I will do it. I've learned that my output is better when I do take that pause, than if I just keep pushing through, and I'm just not as happy with my productivity.
Johanna Almstead:
Yeah. Okay, dream dinner party guest list. You can have as many people as you want, dead or alive. Who's coming to your party? And they're all going to say yes, by the way. You don't have to worry. We'll pull strings. We'll make sure they come.
Jackie Giannelli:
Okay, RBG of course.
Johanna Almstead:
Of course.
Jackie Giannelli:
Audrey Hepburn. Probably Michelle Obama would be my three.
Johanna Almstead:
She's popular here on this podcast.
Jackie Giannelli:
Yes.
Johanna Almstead:
She's getting invited to a lot of dinner parties here.
Jackie Giannelli:
I'm sure she gets a lot of invitations.
Johanna Almstead:
And lastly, what is one thing for sure right now, today, here in this moment?
Jackie Giannelli:
I think one thing I know for sure is that if I lost everything in this world, I would still have my family. At the end of the day, I come home to them. They are the most important thing to me. My work is important to me too, and that I can have both at the same time. I may not be perfect at all of it at the same time, but those two things are rocks and they're what keep me steady, and they're definitely my why.
Johanna Almstead:
Love it. Please tell people where they can find you and ask you questions and do all the things.
Jackie Giannelli:
Yeah. I am on Instagram, which is where I do a lot of just free education and talking publicly. And so that's @Jackie.giannellinptalks. I'm sure you can put it in the show notes because there's a lot of letters in my name-
Johanna Almstead:
There's a lot of letters. We will put it in the show notes.
Jackie Giannelli:
And my website as well, Jackiegiannellinp.com. I write a newsletter called In the Saddle that is all about power, pleasure, and confidence in midlife, and just a little bit of longevity, and a little bit of my hot takes are in there. I have a podcast called The Well Kept Podcast that I co-host with my friend Carmen. And that is where we have a lot of fun and a lot of good conversations about stuff in the wellness industry. And for those who like it, I'm on LinkedIn too.
Johanna Almstead:
There you go. I feel there's very much a LinkedIn type.
Jackie Giannelli:
There is.
Johanna Almstead:
Everyone, if you are struggling and you don't know where to start, I would say start there. Go on her social media, go on her website, listen to her podcast, just to start informing yourself, educating yourself about the options that you have, because it'll change your life. So, Jackie Giannelli, thank you so much for taking the time to be here with me. Thank you for sharing all of your incredible wisdom and your incredible experience, and I'm so, so grateful that you've spent this time with me today. So, thank you.
Jackie Giannelli:
Thank you, Johanna. It's been fun.
Johanna Almstead:
Wow, that was amazing. I hope everyone learned something, felt understood, felt taken care of or supported. Please, please, please reach out to her, reach out to me on social media if you have questions, if you want more help with resources. I think it's such an important conversation that we are having. And if we play this little game of telephone and spread it to our friends and our colleagues and our mothers and sisters and cousins and sorority sisters, and all those things, that maybe, maybe, maybe women can take better control of their health and their bodies and their happiness.
As always, I'm so very, very grateful to all of you for tuning in. I'm so grateful for the fact that you guys are spreading the word and tuning in every weekend, then sending it off to your friends and relations. If you haven't done so already, please follow us on social media. We're @eatmywordsthepodcast on Instagram and TikTok, and please subscribe to the podcast. These numbers matter, it makes us grow. And again, thank you, thank you, thank you.
The Eat My Words podcast has been created and directed by me, Johanna Almstead. Our producer is Sophy Drouin, our audio editor is Isabel Robertson, and our brand manager is Mila Bushka.