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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff, MD (00:27)
Welcome back to the Modern Midlife Collective. If you listen to part one, we talked about something that I think hit home for a lot of women. We know it hit home for a lot of women. That feeling of being exhausted and really not understanding why. Like I know we're stressed. I know we certainly could sleep better. We could eat better. But why are we so tired? Because it's definitely, we've always been busy, right? But it's like different than it was before.
Ade Akindipe, DNP, APRN (00:52)
Yeah, it's really important for us to understand that it's not just about stress or being told that you are getting older, but it's really empowering to know that you have some actual drivers behind that and that can be physiological to really explain how you're feeling.
Jillian Woodruff, MD (01:08)
So this is part two. Part one, we talked about hormones and how they impact sleep, the thyroid, stress. And today we're gonna go even deeper into three more root causes. And these are things I think we both see every single day in clinical practice, blood sugar, nutrient deficiencies, and chronic inflammation.
Ade Akindipe, DNP, APRN (01:29)
Yeah, and these are the ones that I feel like most women are not told about, or maybe if they were, it wasn't very clear, or maybe their labs look normal, or they've tried everything, they are eating the best that they can, they're exercising. Again, labs are looking normal, but they still feel really tired, exhausted. So if you're listening, this episode is definitely for you to listen to.
Okay. So we have to start with blood sugar because we need to start normalizing that you don't have to get high blood sugars on your blood levels, your blood, your lab tests, really for you to really realize that something is going on. And I think that's the conversation that we need to start now that we're seeing more women develop metabolic dysfunction because insulin resistance and blood sugar volatility are some of the forces that really drive that bone deep fatigue that women are feeling.
who've been told that they have metabolic issue because their fasting blood sugar looks normal, but they have underlying disease that's growing. So that fasting blood sugar is within the normal range, but that's not the full picture.
Jillian Woodruff, MD (02:34)
Exactly, that's exactly right. Because by the time that fasting blood sugar goes up, insulin resistance has often been like been present brewing for many years. And your body's really just been compensating like our bodies are really incredible with the amount of crap that it puts up with right like there's external environmental toxins, there's emotional stresses, there's physical stresses, there's like so many things.
Ade Akindipe, DNP, APRN (02:53)
Yeah.
Jillian Woodruff, MD (03:01)
but our bodies really are resilient. And the younger we are, the more resilient we are. And then the healthier we are, the more nutrition we put into our bodies, the better we can keep up with things, right? But when we show signs, that is oftentimes things have been going down for a while and their body's been compensating behind the scenes the whole time. So.
Getting blood tests like fasting glucose level and something called fasting insulin level, I think that's even bigger, and then something called a HOMA IR, which is calculated glucose insulin ratio, where they calculate those both together. these things can be really important, and they're really not something that's typically drawn in traditional medicine. I see that quite a bit with people who have really normal...
normal glucose levels, right? They're just not absurdly abnormal, but we see an insulin level that is super high with their borderline glucose level. And you would have never known that they had insulin resistance if you didn't check the insulin level, or even if it's a high normal level, that's still not optimal, right? So
Ade Akindipe, DNP, APRN (03:55)
Yeah.
Yeah, absolutely.
Jillian Woodruff, MD (04:11)
You want to catch these problems earlier before blood sugar officially looks abnormal and there's like an official diagnosis of diabetes because our energy crash and that fatigue happens way before a diabetes diagnosis and your cells can already be struggling to use fuel efficiently. You you need insulin to carry glucose into the cells to be used for energy. So if insulin is present in high amounts,
especially if you see a normal borderline or semi-high glucose and you have high insulin level, that insulin's out there and it's not being recognized by the cells. It's knocking at the door like, I've got glucose with me, let me in. And your cells are like, no thanks, I've seen too much of you. I don't recognize you anymore. And at that point, you can fix these things, but you're much more kind of in this valley, trying to climb out.
Ade Akindipe, DNP, APRN (05:03)
Yeah, and even when this doesn't look like that on labs yet, I actually had a patient that came in today and for years she'd been told that her labs are normal, but in real life, it wasn't normal. So what does that look like? This is a woman who eats something, her blood sugar spikes, and then by 2 p.m., or maybe a few minutes later, her blood sugar starts to crash.
feel like this person where you're like, why do I feel like I need to get my coffee at 2 p.m. You know, that second time where you really need to start to get your energy up. That's a sign that you might have some metabolic dysfunction or high blood sugar. But like Dr. Jill says, your body's still in the compensatory phase and you are able to cope or you feel like your brain just shut off. There is not lack of discipline. You feel like you need to eat because your blood sugars are low.
So often when we put on a continuous glucose monitor, one of those CGMs that you see sometimes diabetics will wear, that's where you really see the tracks. You can see the patterns rather, where there's really big glucose spikes and sometimes the blood sugar stays up for hours and hours at a time. And this is how your body's developing insulin resistance. You're storing the extra energy, long-term energy as visceral fat.
So in my practice, this is something that I will slap on them right in the clinic and say, here, put it on. Let's upload the app and let's see how your blood triggers are doing. So watching that, watching visceral fat going up, watching percent body fat going up, those are clues, even though you're doing all the right things or you think you're doing the right things, is already sending that signal. So it's one of the most powerful tools you can use in the setting of, OK, my labs look fine, but what are some things that I can check?
in the meantime to make sure that I'm not developing insulin resistance and you don't wait until your blood sugars are higher. So fatigue is one of those signs and then tracking your blood sugars along with that.
Jillian Woodruff, MD (07:01)
Yeah, absolutely. You know, and I talked about insulin being the carrier to bring glucose into the cell, but then what happens, you have your mitochondria. They're like the tiny power plants inside every cell of your body, and they're responsible for turning that food into real usable energy. So let's say they, you know, the glucose gets in there, but we have issues with that mitochondria working efficiently, right? So mitochondria work well when you have a balance of
Ade Akindipe, DNP, APRN (07:25)
All right.
Jillian Woodruff, MD (07:29)
glucose and you have a balance of insulin. So when you start having that insulin resistance, which happens to many women in midlife, many people in midlife really, your cells can't even use the fuel as efficiently anymore, like as it did before. So you may have that, you have everything you need, you have the energy there, but you cannot access it, you can't use it. So even if you're eating well, you're sleeping better, you're trying harder, or you're just like,
Powering through your body may still feel like it's running on this low battery state, know What your phones doers just like let me conserve energy But your cells are literally producing less energy. They're producing less ATP so they cannot function as they used to so people say, know, I haven't I don't feel like myself anymore So the lights are there. It's just they're dimming, you know, maybe they're flickering
Ade Akindipe, DNP, APRN (08:04)
⁓
Yeah.
They just need a reset. And that's why sometimes when you put women on intermittent fasting, sometimes they feel like, my goodness, I feel less bloated. The brain fog is lifted and they have more energy. It's that energy blood sugar connection. And when you're in perimenopause, that connection is even more critical. So estrogen protects mitochondrial function. So you lose estrogen.
that energy, the powerhouse that you have has less function. So estrogen goes down, less energy. At the same time, insulin resistance also increases, that risk increases. So you're getting hit from both sides, hormonal and then the whole metabolic dysfunction. So that's why when we tell women, less, move more, it's kind of frustrating. And it's like they hit that wall where they're trying everything and it's not working. Energy production system, it really itself needs to be repaired.
Jillian Woodruff, MD (09:14)
I think when people hear that, you know, eat less or move more. And remember, it's not like just eat less, it's eat properly, eat appropriately, right? But, you know, they think it's not this isn't some fancy medication or a whole plan, but it is. It can be pretty simple, but very, very difficult to bring these habit changes and things into our daily lives. So, right. So what can we do about it? Start simple.
Ade Akindipe, DNP, APRN (09:23)
Right.
It is.
Jillian Woodruff, MD (09:42)
But with these changes that we're asking to be made, they're very, very powerful changes. So protein before at the time at every meal and really eating that protein before you eat other things on your plate. So prioritize your protein, add fiber to your meals because it slows down how fast your sugar hits your bloodstream. So how fast you get that blood sugar spikes, you're not going to get as much of a blood sugar spike.
Ade Akindipe, DNP, APRN (10:04)
you
Jillian Woodruff, MD (10:09)
leading to that crash afterwards if you have that protein and that fiber first. And I mean, this is a really underrated tool, but move after your meals. Move. Just walking for 10 minutes. Really, I think it's like 30 minutes. You're supposed to walk like 30 minutes a day. Yeah. So and. Oh.
Ade Akindipe, DNP, APRN (10:19)
It sure is. ⁓
It makes a huge difference. Yeah, you can actually see that real time on the CGMs when they start to move more,
you see those blood sugar starts to go back down.
Jillian Woodruff, MD (10:37)
I think that monitor probably is really helpful in so many ways. So not just looking at how the response, what your body's response is to the foods you eat, but just like you said, okay, what is the response? If I exercise, what is the response right after a meal? What is the response later? Can I eat different things if I were to move more or test it out? Eat the protein first, right?
Ade Akindipe, DNP, APRN (10:53)
Yeah.
Absolutely. Even the opposite too, right? Even
opposite when your blood sugars are lower, because actually that's what was happening with me. I was dropping my blood sugars overnight, so I started adding more protein into my meals at nighttime so that I can work out in the morning, which is when I like to work out. So the CGM is something I highly recommend. If you are having that fatigue, you can't lift more. You're trying to lift more. You're trying to build more muscle, but you can't.
Jillian Woodruff, MD (11:05)
⁓
Ade Akindipe, DNP, APRN (11:22)
It could be a metabolic thing. could be you're low or you're high. So it's either one of them. So very good.
Jillian Woodruff, MD (11:27)
So when your
blood sugar was dropping overnight in the morning, were you feeling different? Like were you feeling tired, more tired in the morning or, ⁓
Ade Akindipe, DNP, APRN (11:34)
Yeah, I just realized I
just could not lift heavier. I wanted to lift heavier and I couldn't. I would just wake up very exhausted. So I was dropping to the 50s overnight. And of course you have that rebound, your blood sugar kind of goes up, but then it's back down again. So it was just my, didn't really eat as much as I should be at nighttime, usually proteins, of course, fiber. That'll stabilize your blood sugar more.
Jillian Woodruff, MD (11:59)
Well, also timing of your eating is important too, right? I've just eaten a late meal and that is not ideal, right? So then if you're going to be eating these, you know, high protein meal and such, your body has to work to digest that food. So you're going to eat a little less if you eat later. So it's a whole shift that you have to really think about. Which sometimes doesn't always happen like it didn't.
Ade Akindipe, DNP, APRN (12:01)
Mm-hmm. Yeah.
It needs time. Yeah.
Absolutely.
Jillian Woodruff, MD (12:27)
happened today eating earlier, there was a saying about food. was something about, there was like the saying, I forget what it is, I'll have to come back to you, but it was something about like not eating after seven, like what it does, you pack on the pounds or something after a certain time. ⁓ I'll get back to you. It was, I'll get back to you with that. Maybe if I remembered it, I wouldn't be eating after seven.
Ade Akindipe, DNP, APRN (12:29)
That's all right. You have another day. What's that?
Yeah. Yeah, let me know.
Jillian Woodruff, MD (12:50)
All right, I think we can go on to root cause number five, nutrient deficiencies, quiet energy drains. We talk about these quiet energy drains because they may not even be deficient to the point of causing many other symptoms or needing, you know, IV replacement or things like that. But still, a quiet energy drain is just like just
taking away little by little, right? So this is not about, okay, I just need a multivitamin and then I will be fine. This, no, the multivitamin isn't going to do this. It's about specific, measurable, correctable deficiencies that directly impair your energy production. Energy production, without that, we have fatigue, we have exhaustion. So iron and specifically ferritin, your storage form of iron, that's what I think is...
Ade Akindipe, DNP, APRN (13:17)
Yeah. Yep.
Jillian Woodruff, MD (13:43)
I just see this a lot in practice and I know you do too that people have these normal and I have quotations right now, air quotes, normal, typical, you know, they're not normal. They may be within an average range, but they're on this low end. They may be 15, they may be 20. 20 is like at the very low end of the average range. And they're saying, oh, I was told everything is normal. And
Ade Akindipe, DNP, APRN (13:51)
Yeah.
Yeah, absolutely.
Jillian Woodruff, MD (14:11)
ferritin declines first, so your storage form starts declining and then your iron levels will start declining. So to me, why are we waiting to be in this state where we're, you know, now we're so exhausted we can't even do something to advocate for ourselves, you know? There's no reason to get to this pathologic state, so.
Ade Akindipe, DNP, APRN (14:31)
No
reason at all. you add another layer of peri-mental pause where you're not done with having periods. So of course you start having these yo-yo cycles where you're having heavy prolonged periods. That's extremely common during the transition. And you're right, ferritin, it starts to drain quietly over time. And the gap between in range and actually functioning, of course, depends on the woman.
So standard labs will check it if you're normal, but maybe you need to be functioning at a higher rate, at a higher level of ferritin. So a woman that comes in and says, I'm really fatigued, yes, ferritin, the storage is of iron, definitely needs to be checked. And optimal range is important. There is a research here that we kind of pulled up, a March 2025 study in menopause analyzed daily menstrual data from over 2,300 midlife women, and they found
Jillian Woodruff, MD (15:05)
Right.
Ade Akindipe, DNP, APRN (15:26)
that heavy and prolonged menstrual bleeding during perimenopause significantly increased fatigue risk. Obviously, that makes sense. So even after controlling all other variables, iron depletion was identified as the primary mechanism with downstream effects on sleep quality, restless legs, how many people can identify with that, brain fog, cognitive function. So all of that just from having low iron, that can cause brain fog. So
not just the hormonal shifts, but also a low iron.
Jillian Woodruff, MD (15:56)
Yes. Okay. So aside from that, because you mentioned the restless leg. that brings to mind magnesium. That's another, it's not always checked. So that's not a big one that's checked. And actually it really doesn't need to be
Ade Akindipe, DNP, APRN (16:00)
Mm-hmm.
Jillian Woodruff, MD (16:09)
unless you're looking for some overt issue where people have this low magnesium, right? But it's one, it's a very common nutrient deficiency or low level that leads to a restless leg or
Ade Akindipe, DNP, APRN (16:12)
Mm-hmm.
Jillian Woodruff, MD (16:23)
cramps, people tend to have more leg cramps and muscle strain, muscle fatigue and perimenopause and in menopause. Magnesium is really important for ATP synthesis so that energy, that cellular energy production needs magnesium for that process to occur. It's also very much needed for deep sleep. So we want to get, and that's a specific segment of sleep.
You you have your, you have light sleep, you have rim sleep, you have deep sleep, and it's important to get to deep sleep. Some people sleep and they don't have appropriate amounts of deep sleep, and that's our restorative phase where, you know, our body repairs itself. It regulates the nervous system. It supports over 300 enzymatic processes in the body. I mean, there's tons of processes that occur, but that's a lot for one, you know, for magnesium. You know, people don't talk about magnesium a lot.
Ade Akindipe, DNP, APRN (17:13)
Yeah,
absolutely.
Jillian Woodruff, MD (17:15)
⁓ Chronic
stress burns through your magnesium. You have reserves of magnesium. So people are typically, like I said, not going around like these low levels. You have these reserves, but chronic stress, which a lot of people have a lot of chronic stress issues that they may not even notice. Like they don't even clock it. You know, they're just constantly living under this.
Ade Akindipe, DNP, APRN (17:34)
Yep.
Yeah,
You mentioned the sleep issues too. And it just brought me back to the whole blood sugar issue that'll also wake you up in the middle of the night. If you're dropping your blood sugar, your body kind of stimulates that whole cortisol goes up and then you're wide awake so you can't sleep. So it's your body trying to protect you. So that's just another thing. But yeah, absolutely magnesium doesn't always reflect what's happening inside the cell very well.
Only 1 % of your body's magnesium is in the blood. So you need an RBC magnesium for a meaningful picture. Also, the form matters. So if you're looking to improve sleep, things like restless leg syndrome, there are some, there's different brands out there. There's magnesium oxide from the drugstore, but that tends to be more poorly absorbed. So magnesium glycinate and magnesium malate forms.
are the ones that typically work well. there's one brand that we have in the clinic, it's called Complete Mag, and it's got Malia, it's got Glycinate in there. And I think Torinate, I can't remember the last one, but it works really well for women who find it hard to shut their brain down, relax, relax the muscles, and just kind of wind down. So some women will take it with their progesterone and just clock out for the night. So magnesium has a lot of great benefits for...
women's sleep and of course, cell function too. Nervous system.
Jillian Woodruff, MD (18:59)
I love the magnesium, the triple power or those three different forms, that's great. I love magnesium, specifically the glycinate one because it's less likely to cause soft poops or a lot of poops. The other one's good, but if you need help with the poop, then the other ones would be great for that.
Ade Akindipe, DNP, APRN (19:03)
Yes, wonderful. Yeah.
too.
There's your answer.
Jillian Woodruff, MD (19:23)
Let's see, another one, B12, another deficiency that we both see a lot is the B12. B12 is really essential for your neurological energy. I call it an energy vitamin and probably I should be talking about these other ones as energy vitamins too. But B12 also neurological energy, so it's really great for memory and a lot of times people are having the brain fog and the short-term memory loss in perimenopause and menopause.
This is so easy to check and it's also pretty easy to replace, it's water soluble so you pee it out pretty quickly too. So you need to have a good form of B12. And I like something like, if it's not an injection, I like a lozenge, it's something that dissolves in the mouth, something sublingual more than a capsule.
Ade Akindipe, DNP, APRN (19:53)
Thank
Jillian Woodruff, MD (20:13)
But B12 also because it is really affected by other things that we take. if you're taking, which a lot of people are taking, proton pump inhibitors for reflux, gastric reflux, or they're taking metformin because they have blood sugar, insulin issues, pre-diabetes, type 1, type 2 diabetes, excuse me. So they're on metformin for that.
Birth control pills affects your B12 levels. with those things comes exhaustion, comes brain fog. Your brain's just, things are running slowly or you're seeing through like a cloud or what did I come into the room for? What was I doing? You're asking these questions. So B12 is important for that. Vitamin D also, especially with us living here in Alaska.
Ade Akindipe, DNP, APRN (20:53)
Yep.
Jillian Woodruff, MD (21:00)
People have low vitamin D levels. That's also pretty easy to replace. And then I usually like that with a vitamin K2. Really important because you don't want to pull calcium from your bones. So that helps to prevent that from happening. But vitamin D is also a hormone. And you know, if you haven't, if you couldn't tell, you know, we love our hormones. So.
Ade Akindipe, DNP, APRN (21:10)
Yep.
Mm-hmm.
Jillian Woodruff, MD (21:24)
Vitamin D is pretty important and low levels correlate with fatigue as well, muscle weakness and mood. Mood is an interesting one because I don't think people really associate it with mood changes, low vitamin D levels, but low mood impaired immune function too. So I always check vitamin D levels.
Ade Akindipe, DNP, APRN (21:43)
Absolutely that vitamin D, you know, Living Alaska B12 vitamin D absolutely for women. D is like a hormone you need it. Lots of it if you live here. And another one is CoQ10. So if you're a woman over 40 or you are anyone on a statin, which is a medicine commonly prescribed for high cholesterol, CoQ10 is that
it really helps in terms of like energy. They call it the electron carrier in the mitochondria energy train. So without it, it's like your, it's really hard for you to produce or process energy efficiently. So statins block that code Q10 synthesis. So for women on statins, especially if you have symptoms of muscle aches, you're tired a lot.
Sometimes it might even resemble like fibromyalgia. I know had one lady that was complaining of like fibromyalgia symptoms, but she had been on statins for a while. So CoQ10 is absolutely worth it. Again, easily replaceable. So basically it's important for you to get your ferritin checked like we talked about, making sure that the target is between 70 and 100. And again, not just looking at those ranges, making sure that you actually are functioning at the optimal level for you.
⁓ Vitamin D, what we call 25 vitamin D. That's what it looks like on the labs when you're looking at it. B12, RBC magnesium. These are the most common nutrient deficiencies that drive women just feeling exhausted all the time. So not just looking at, whether it's your hormones, these are the things, nutrient deficiencies that could happen. Of course, food can also be medicine. Doesn't have to be something supplements because some of these capsules are
pretty large, like the magnesium that we have is really, so if you have trouble taking pills, there's also injectables. There's injectables. I love that idea that you said sublingual B12. I've actually never tried that. So that might be an option for if you have trouble swallowing pills.
Jillian Woodruff, MD (23:40)
I do not like big pills, not the large ones. Vitamins, especially big vitamins like multivitamins that claim to have everything in the world. my goodness. just meant there's a mental break for me and that mental issue where it makes me sick before I've even taken it.
Ade Akindipe, DNP, APRN (23:42)
Mm-hmm.
Mm-hmm. Yeah.
Yeah, it's like
I have to have food right there, something I can just shove it in there and with lots of water, it's there. Forget about it. Otherwise not happen anyway.
Jillian Woodruff, MD (24:05)
Yes.
But supplements are just that. They're supplements. So, right? They're meant to supplement what we're doing, what we're getting from our food. We know our food isn't as nutrient dense as it was 20, 30 years ago or more. However, our food does have nutrients. That's where we should be getting the vast amount of these things. And then we supplement when it's needed, right?
Ade Akindipe, DNP, APRN (24:10)
Supplements.
Jillian Woodruff, MD (24:33)
I know we already talked about this in root cause number five, but one of the biggest nutrient gaps I see probably isn't the vitamin, it's the protein. We just talked about it. But many women are profoundly under eating their protein, especially during stressful years, during stressful times, when they're dieting, when they're just prioritizing everything else. Protein isn't always the easiest thing. People don't always gravitate towards snacks with the proteins in them.
But we need proteins. The amino acids are required for neurotransmitters, muscle maintenance, signaling hormones, blood sugar stability, and right?
Ade Akindipe, DNP, APRN (25:11)
My example, blood sugar stability,
dropping blood sugars at night because I wasn't having enough protein. So yeah, absolutely.
Jillian Woodruff, MD (25:16)
Exactly.
So, I mean, I'm talking to myself here that coffee in the morning with some toast is not adequate. And then you go and have your salad for lunch with maybe a few pieces of chicken. It's not adequate. Your body literally, at least there's some chicken, but your body literally doesn't have raw materials needed to make energy.
Ade Akindipe, DNP, APRN (25:31)
You got some chicken in there.
Yeah, we're basically not helping ourselves in that department where we're not eating right. We're taking care of everybody else but not taking care of ourselves. So it's important protein, protein, protein. yeah.
Jillian Woodruff, MD (25:43)
No.
Yes. Yes.
Well, another supplement too that we've been hearing probably more about is creatine. I think people are hearing more and more about it, and especially in women and specifically about their cognitive function. So I think in the past, people were thinking about creatine with weight, bodybuilding, know, building muscle, which yes, it's important for that, but it's also important for rapid cellular energy production. So...
Ade Akindipe, DNP, APRN (25:56)
Mm-hmm.
Jillian Woodruff, MD (26:14)
I think we're going to hear more about it. There are a lot of forms of creatine. Usually, think a popular type is like powders that you can put in your drink, just like protein. So you can put it in your same smoothie that you put your protein in. There's gummies, but I've tasted several and they're not the best. So may just be what I've tried.
Ade Akindipe, DNP, APRN (26:21)
Yeah.
Yeah, I'm actually, I'm
actually just starting and I'm probably like three weeks into the creatine thing. I don't know yet. I will, you know, I'm just trying it out to see if it's something that I can continue to recommend for patients. But I don't know, I will, I will keep seeing if I notice any difference with strength and muscle and all of that recovery. So
Jillian Woodruff, MD (26:49)
back. Yes, but
I think also they maybe take the people when you're when you're doing it for bodybuilding and muscle, they're taking higher than the amounts. I believe it's like five milligrams for women that has been helpful for cognitive function. They're taking much more than that. yeah. Yeah, yeah.
Ade Akindipe, DNP, APRN (27:00)
Of course.
Of course, yeah. Yeah, I got my little scoop in my coffee and that's it for the day. So I don't know. And of course, sometimes
exhaustion isn't just calories or hormones, it's hydration and electrolytes. most women, they'll say they're drinking water, but if you find out how much water we're really drinking, it's not enough to really sustain us. So sometimes I might show up on labs a little bit.
But women who are, if you're more active, if you're in the gym a lot, if you're sweating a lot, another one is if you're on the GLP medication for weight loss or for diabetes, that tends to slow down your metabolism, but also the brain gut thing, you may actually forget to drink water. So, important to make sure that you are hydrating, you're nourishing. If you are fasting, make sure you're hydrating.
fasting but drinking water, you're still fasting, you're not spiking your insulin, so feel free to drink as much water as you can. or if you're eating very low carb can become chronically under-mineralized without realizing it.
Jillian Woodruff, MD (28:05)
Before we end this section, because you specialize in the gut, maybe you can talk a little bit about, we're talking about increasing intake, right? We should take these vitamins as supplements, more protein, but can you speak to people who are having a hard time with absorption? Because intake's important, but absorption is just as important. You can't have intake if you're not absorbing what you're putting in your mouth.
Ade Akindipe, DNP, APRN (28:15)
Mm-hmm.
Yeah.
Jillian Woodruff, MD (28:31)
What do you see with absorption and all of these gut issues that people may start to have or may have exacerbated at midlife?
Ade Akindipe, DNP, APRN (28:38)
Yeah, it's a really great point. ⁓ Absorption definitely matters. see sometimes women will say, keep taking all these supplements, but I'm still not noticing anything. Even vitamin D, you'll check their vitamin D and their vitamin D hasn't climbed up at all. find sometimes it's just we need to work on just cleaning out your gut, cleaning out any foods that may be causing more issues, causing leaky gut. And sometimes they, you women have been eating
the wrong foods for so long and then compounded by hormone imbalance. They're not making enough stomach acids. They're not able to digest the foods that they were able to eat. They're like, why I was able to eat this before, but now I can't. When I eat meat, I feel bloated. I feel awful. So sometimes even just replacing some of the digestive enzymes can really go a long way. Chronic inflammation from stress, even just
Stress alone chronic stress can really wreak havoc on the gut. So calming down a nervous system can improve the gut lining I know we've both worked with Ashley Ashley who's a nutritionist who has done amazing with a lot of women who struggle with gut dysfunction If you have celiac disease you where you have a gluten sensitivity That can also wreak havoc on the gut if you've had surgery
bariatric surgery, IBS, even aging itself can impair absorption of nutrients like we talked about like iron, B12. If you've had a gastric shrinking of the stomach, that can also decrease the absorption area of the stomach. So all of that can impact it. And I think if you work with someone that has that in mind, especially when they're not able to lose weight and they're doing all of the things.
It usually, the gut is a really good place to start cleaning it up, removing some things, even if you're not necessarily testing for sensitivities, but removing the common triggers, know, gluten, dairy, reducing stress, and then start to add back, you know, the good foods, the whole foods and remove all the processed stuff.
Into the gut and that it and it takes time. This is not something that happens overnight. It can take months Before you start to feel better and then maybe you can start to eat those things you really love again But sometimes you did it for me. It was tomatoes. I had to Completely not do that. She was like you can't have tomatoes. I'm like, I am Nigerian my family lives on tomato It's in everything we eat, but I'm able to eat it now thanks to her for a little while. So yeah
Jillian Woodruff, MD (31:01)
Yes, don't you have that in everything? Yes. Wow.
Ade Akindipe, DNP, APRN (31:10)
That's one of the common ones that impacts women.
Jillian Woodruff, MD (31:13)
So you probably cleaned up the inflammation that it had been causing and that other things were causing because maybe it was okay alone but if you have this little thing that causes a problem and another all these things just compound on each other. Right.
Ade Akindipe, DNP, APRN (31:15)
Yeah.
Mm-hmm.
Perimenopause, all of the things going on at
that time. Speaking of inflammation, now we're going to the root cause number six. And this is one I think challenges us a lot. There's inflammation, a lot of inflammation. We become exhausted because of that as well in midlife. Chronic low-grade inflammation, which we've talked about before. This is not when you get a cut or you have an infection. That's inflammation, but this is something where
Jillian Woodruff, MD (31:30)
Yeah.
Ade Akindipe, DNP, APRN (31:52)
There's fire going on in the background all the time, low grade. The ambulances are there and they're trying to put it out, low grade, but your body's trying to respond to that. And over time that can cause problems. So Dr. Jill, take us into a little bit of research. You find out about this.
Jillian Woodruff, MD (32:07)
Well, more and more emerging research is increasingly showing that this isn't just about lifestyle choices or even getting older. The hormonal changes of perimenopause, yes, it's estrogen. It contributes to everything. And in this situation, it contributes to
Ade Akindipe, DNP, APRN (32:21)
D'oh.
Jillian Woodruff, MD (32:28)
Increased inflammatory signaling in our body when we have lower
estrogen levels. So estrogen declines, the immune system becomes more inflammatory, and it's less buffered against stress. And maybe this is a little bit about, you know, why people are having more like irritability and such too, or things are affecting them more than they used to. They're reacting to things so much more, right? So we're releasing these cytokines like interleukin-6 and TNF-alpha. These are just names of some common inflammatory cytokines.
Ade Akindipe, DNP, APRN (32:49)
Yes. Yes.
Jillian Woodruff, MD (33:01)
You know, these are important things. So all of these things are happening in our bodies. Having inflammatory cytokines and things are important for specific things. So for battling something, we just don't want to be battling a world war every single day. And so this increase in these cytokines are increasing, are causing this low-grade inflammatory state that you just spoke of. And this is explaining symptoms like fatigue,
The body aches, muscle aches, sleep disruption, the mood changes, and the brain fog. So, right, you have a little bit of B12 deficiency, a little bit of vitamin D, you're chronically stressed, you're not sleeping, you're not getting your deep sleep, so you don't have any repair for your body. Like, you see where I'm going?
Ade Akindipe, DNP, APRN (33:47)
Yes, absolutely. It's the story of every woman that we see that says, I've tried everything, but there's always that something in the background going on. you see that too with the abdominal visceral fat gain. It's like, estrogen goes down like you talked about. will say, I don't know what happened. I haven't changed anything. My diet hasn't changed. But now I feel like all the weight is in my belly. And that's what happens with estrogen loss. It shifts from the hips to the belly.
and then it starts to, know, visceral fat goes up, inflammation goes up, blood sugar starts to go up. So it's not just aesthetics, but you know, because if it's that deep biologically active fat, and that's what makes it so dangerous, it produces inflammatory cytokines like you talked about. So estrogen declines really impacts women in perimenopause, and that's why they find that so frustrating. So yes, we can measure this.
We have high sensitivity CRP that can be measured to see, that should be in any kind of workup. Your HSCRP is another thing that you would see. It gives you that number that represents an overall inflammatory burden. It also tells us how hard to work on all the pillars to help reduce inflammation. Another one I think to check is your ferritin levels. If they're really high too, that can also signal
Not that you have iron overload, but that could be some inflammatory process going on too. ⁓ High ferritin, yeah. So color.
Jillian Woodruff, MD (35:10)
you said they're really high? Yeah. Or that
you had iron infusions.
Ade Akindipe, DNP, APRN (35:18)
That too. So yeah, if it doesn't
make sense, if it just is out of proportion elevated, that could mean something's going on there as well. Colorful vegetables are great ways to, I always think colorful vegetables, Mediterranean diet, because it's just shown to help with reducing inflammation, omega-3s, which again, you don't have to take a pill for it. This is great. You can find that in, you
Jillian Woodruff, MD (35:23)
Yes, yes.
Ade Akindipe, DNP, APRN (35:44)
fatty fish like we have salmon, which are great sources of omega-3s, fiber for the gut microbiome, absolutely really good source of fiber, movement, stress management. These are evidence-based, we know it works. We see it, once people start to do this, they start to see their blood sugars start to stabilize, they have more energy, right? So it's definitely...
Chronic ligar inflammation in general is just, it's a bad root cause. So if this is what's going on, needs to be uncovered right away.
Jillian Woodruff, MD (36:15)
Absolutely. It's all interconnected.
Ade Akindipe, DNP, APRN (36:17)
Yeah.
All right, let's stop here because I can feel the protocol conversation trying to start and let's not rush it. So Dr. Jill.
Jillian Woodruff, MD (36:22)
Yeah.
Yeah, same. think we should stop the conversation about what do we do exactly. Like we shared two bits of things that we need to check and supplements that you can take, but there's more than that. And so we did put that together into a protocol of sorts so you can start here and work your way through to figure out how we can fix things. Just knowing it's step by step, right? There's not a magic. I don't know. We don't have a magic pill, right?
Ade Akindipe, DNP, APRN (36:32)
Mm-hmm.
Yeah.
No.
Jillian Woodruff, MD (36:53)
I
mean, it's work. It's going to take work on your part, but there will be improvements from each of these small changes that you make. And so the next episode, we're going to get into it. this week, we finished up the six root causes. I don't think that we missed any big causes. We laid the foundation.
Ade Akindipe, DNP, APRN (37:12)
We sure did and the foundation matters because it's important to have clarity. It's why I would like to start with the first step, understand what's happening and then you feel more empowered, I believe.
Jillian Woodruff, MD (37:22)
Yes. So next time we're going to do the what, what to test, what to take, what to actually say when you walk into your provider's office and you want help for the symptoms that you're having. But, you know, let's be honest, knowing all of this, all of these things we shared today that we couldn't even share in 15 minutes, right? And then sitting in a 15 minute appointment, having time for you to share and them to share.
Ade Akindipe, DNP, APRN (37:42)
way.
Mm-mm.
Jillian Woodruff, MD (37:47)
So we're gonna talk about how do we advocate for ourselves. That's its own problem. We'll tackle that too.
Ade Akindipe, DNP, APRN (37:53)
Yeah, that's exactly why we did part three. We're building the full protocol for you, the complete lab panel, supplement stack with the rationale for why do you take them, and the exact language to use with your provider so you walk out with the workup you actually need.
Jillian Woodruff, MD (38:07)
Yes. So if you're sitting with all this information right now thinking what do I do that's your homework, sit with today's episode, go back and listen to episode 31 and get ready for part three. I'm excited.
Ade Akindipe, DNP, APRN (38:22)
All right, so that's it right there. So share it with a woman who needs to hear this today. The woman in your life who keeps saying she's tired all the time and laughs it off like she's okay, send her this episode. It might change her life.
Jillian Woodruff, MD (38:33)
Yeah, hopefully she could laugh, right? Right? I mean, that's a good sign. When she can no longer laugh, I'm more worried. But yes, thank you so much for listening. Part three is coming soon. We will see you there.
Ade Akindipe, DNP, APRN (38:35)
Yeah.
Right.
Bye.
Jillian Woodruff, MD (38:47)
Bye.