What’s Missing From The Conversation on Longevity with Andrea Nakayama

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here. As we dive into today’s episode, as always innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed healthcare team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi there. Welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond. Today I have a very special treat for you. This is one of my favorite episodes yet. I know I say that a lot because I love so many of my guests, but if you’re interested in longevity, this is for you. And if you’re struggling with the kind of social media conversation around hormones and protein, like, everybody better have 900g of protein and be powerlifting every single day.

Dr. Jessica Drummond 00:01:35 I’m a physical therapist. I love building muscle, helping people build muscle. But we’re going to talk about why sticking to the kind of strict social media protocols out there are probably doing many of your clients more harm than good. And why personalized medicine and personalized coaching and nutrition and all the work that we do here at the Integrative Women’s Health Institute is so important. And I’m going to introduce you to my dear friend Andrea Nakayama. She is a functional medicine nutritionist. She’s been an educator through her program Full Body Systems for as long or longer as I have, almost two decades now. She’s led thousands of clients and now teaches even more coaches and clinicians around the world revolution, reclaiming ownership of both their own and their clients health. And we talk a lot about that. Like what is longevity? What are people really trying to achieve? What does it mean to them? Andrea is also the host of the 15 Minute Matrix podcast. She’s the former CEO of the Functional Nutrition Alliance. She draws on systems biology, mental models, root cause methodology and the therapeutic partnership to offer long awaited solutions for the rapidly growing chronic illness epidemic.

Dr. Jessica Drummond 00:03:03 And we are delighted to be having her as a guest lecturer in our membership. Coming up very soon this fall. So if you’re not yet in membership, click the link in our show notes and learn more about the Integrative Women’s Health membership, where she’s going to do a deep dive with our students on narrative medicine. And we talk a lot about her Longevity book club. We talk a lot about how we listen to our clients stories and help integrate them, how we take this trauma informed lens. You’re going to get at least 1 or 2 golden nuggets from this conversation with Andrea. Lots of clinical pearls, lots of personal insights from both of us. We get a little personal because we’ve been friends for so long about the experience of moving towards the empty nest and what that means. What? Identity is in our 50s and beyond. Listen. Enjoy. And I’ll see you on the other side. Hi, Andrea. Welcome to the Integrative Women’s Health Podcast. I’m thrilled to have you. So introducing everyone.

Dr. Jessica Drummond 00:04:16 This is my dear friend and brilliant colleague Andrea Nakayama. Welcome.

Andrea Nakayama 00:04:22 Thank you Jessica. I am thrilled, as always, to spend time with you.

Dr. Jessica Drummond 00:04:27 So I think we can have a lot of fun today. And our audience is primarily women’s health and wellness professionals. And so this gives us an opportunity to get a little naughtier. And I want to talk about what’s top of mind for you when it comes to the conversation around perimenopause, menopause and hormones. And I think particularly for women over 50, because I think we’ve talked a lot on this podcast about younger women who are just starting perimenopause. But there’s even more questions over 50. What’s safe for me? What do I need to keep doing forever? You know, that kind of thing. So what are your thoughts on some of that?

Andrea Nakayama 00:05:11 So interesting, because I’ve been really diving in as a functional medicine nutritionist to the realm of longevity, and I’m seeing longevity being spoken about by a lot of younger women, women under 50 who are kind of the trailblazers in the longevity space.

Andrea Nakayama 00:05:29 I just turned 59. It is a different story as we hit post-menopausal periods or seasons in our life, and the entire conversation around longevity is really different. There are different factors that we’re confronting as we are women who are aging. So what I see a lot of our protocols pills, whether it’s bioidentical hormone therapy or high protein diets or all the things that are being touted as the longevity solves that are missing the mark in a lot of ways. And it really does come back to my approach in functional nutrition, which is grounded in epigenetics, omics and precision practices, where we are embracing the need for the bio individuality of the person in a trauma informed lens, which is missing from a lot of the conversations. So that’s the big picture. But I know we can dive into elements of that.

Dr. Jessica Drummond 00:06:34 Yeah. So both of us are trained and licensed functional nutritionists. And I think when we talk about nutrition, let’s start there. Because you’re right that some of the loudest voices in menopause medicine, if you will, are saying every single woman over 45, if you will, needs to be on a certain hormone stock and 100.

Dr. Jessica Drummond 00:06:56 And I won’t over exaggerate, but really they’re saying like 120g of protein a day and need to be powerlifting as absolutely much as possible. And yet I’m 51. I just spent five weeks in Europe doing nothing but playing with my family, taking a lot of walks, eating and drinking literally everything I wanted. Certainly not tracking my protein intake, although I did eat plenty of protein and did not lift a weight and yet came back biochemically, if you will, personalized healthier. So let’s start with the conversation about protein.

Andrea Nakayama 00:07:43 So from a functional nutrition perspective and I’ve been a functional medicine nutritionist, training other providers for two decades now. My conversation has really shifted away from the rules into broader principles, because I’ve seen those rules really do people harm and more harm than good if they’re not the appropriate rules for them, or if they can adhere to the rules? It’s also a very privileged opportunity to be able to eat some of these ways that we’re being told and not do it in harmful ways. Just say for protein, quality really matters a lot.

Andrea Nakayama 00:08:23 We could be bringing in a lot of inflammatory fats when we’re eating a high protein diet that doesn’t honor quality. So my conversation around nutrition has shifted pretty significantly since the time I started my practice, where I might be talking more in terms of rules. So the principles that I like to adhere to in nutrition. And this will bring me to your question about protein. Our number one fat, fiber, protein at every meal. And we can look at quality for that. But that’s going to help with our blood sugar balance which is going to be part of the conversation. Why protein can be detrimental. Eating the rainbow. So making sure we’re getting not just lots of fiber, but lots of the micronutrients and phytonutrients that actually support our body’s ability to utilize the proteins that we are consuming. And knowing our yes no maybe list. And this may be the place that most clients or patients need to start. Because if you’re working with a client or patient who doesn’t even know that there’s foods that make them not feel good, but they never feel good.

Andrea Nakayama 00:09:31 We got to start with uncovering that kind of intersection, that understanding of what makes me feel better, what makes me feel worse. You came back from Europe saying, I feel better, and that’s because you’re tuned into your body. A lot of the people were seeing aren’t tuned in to what they’re experiencing. And so there’s those people who don’t know and never feel good. And then there’s the people who have gotten so tight in their rules that they’re down to eating three foods. They haven’t done the internal healing. So we’ve got to start in a more broad fashion and get away from these dogmatic rules that really promote a diet focused culture and how we’re addressing things when it comes to protein. And again, I said fat, fiber, protein at every meal or snack when it comes to protein, protein can be turned to sugar in the body. As many of us know, through gluconeogenesis. And we have to understand that if blood sugar isn’t balanced, if insulin isn’t operating like it needs to for our blood sugar balance, that we can be utilizing the proteins that we’re consuming.

Andrea Nakayama 00:10:49 And they could be doing more harm than good. Also, muscle, like you said, is really important. And as we age, our muscle loss increases pretty exponentially. And so we might not be feeding the muscle that we were at 35 at 40 at 45. And estrogen is a real player in that equation. So estrogen is going to help with that muscle build. And as our endogenous estrogen decreases we’re going to be at more risk. So all this to say that what I think often gets missed in a lot of this media promotion of dietary principles or rules is the individual and the physiological terrain that is helping us understand what’s true for this person and what we’re seeing or what I know I’m seeing with previous clients, students, friends, family members is they’ve been following these rules to eat more protein and even to lift weights, but they are seeing negative results in their labs and in their body and in how they feel. And it’s because they followed the rules without understanding the needs of the body. The other thing I just want to add, and I know I’m kind of on a roll here, Jessica, but want to hear your thoughts is a lot of people are adding dairy that I’m seeing.

Andrea Nakayama 00:12:19 I’m not saying dairy is good or bad, but what I’m hearing from a lot of people is that they weren’t eating dairy because they determined it to be a no, or on occasion, food. And as they went into a high protein diet and all the cottage cheese frenzy started adding dairy and mass, which made them more constipated, which impacts the hormone metabolism often and causes more problems. All this to say, we can’t talk about food without talking about physiology.

Dr. Jessica Drummond 00:12:50 Yes, that final piece you just said, I think is so important because when we’re thinking about as practitioners, a lot of my students and I’m sure your students come to you with this desire as well. They’re like, I’ve joined our perimenopause and menopause training program. I want the protocol, but I think how we have to shift our thinking is, how has your client arrived? In what state has she arrived? And then what are her goals? And so everything you said is so important because most of our clients, if I can kind of generalize.

Dr. Jessica Drummond 00:13:28 So the most common 50 year old, let’s say they’re really tired, they’re burnt out, they’re overwhelmed, they’re spending too many plates. They don’t have very stable blood sugar. They are not necessarily on adequate, appropriate dosing of estrogen support. So they are struggling with insulin resistance. They may be menopausal or perimenopausal or surgically menopausal. And very few of them have had much support in that transition. So that is a sort of a metabolic fire. And so you’re circling back to where we need to start is actually anti-inflammatory phytonutrients, which is carbs usually.

Andrea Nakayama 00:14:20 Yes, absolutely.

Dr. Jessica Drummond 00:14:21 And that sort of panics people initially because there’s this idea that carbs are bad. And so I think as professionals, that’s the first reframe. And I think your point about the privilege, the environment in which we live, in diet culture. You know, we certainly don’t want people eating 120g of Big Macs a day, correct? Because then you’re going to add inflammatory fats to the protein that’s going to be converted to sugar pretty directly in their liver, stressing the liver.

Dr. Jessica Drummond 00:14:55 But what we do want is protein and amino acids enough to maintain and build muscle. And so if we start with the fact that most of our 50 year old clients are a mess metabolically and are very stressed and then have been told all these foods are dangerous, our step one is always nervous system regulation. And I think foods can be really powerful as nervous system regulation. And I think in particular how you teach nutrition is interesting from that regard because there’s a lot of Beauty to how you teach nutrition from like a seasonality lens. So talk about that. Like how we could actually start just almost like throw out the rules of macronutrient proportion and start with using food to calm and stabilize the nervous system. And thus the metabolism is like a step one.

Andrea Nakayama 00:15:56 There’s so much I have to say to follow up on that, and I know you and I can go off on these topics. I do want to say something about bioidentical that I’ll come back to, but when I’m looking at nutrition, I shared those principles.

Andrea Nakayama 00:16:10 We are also thinking through the lens of the functional nutrition matrix, which really mimics the functional medicine matrix. It’s just a little simpler, and I’m always thinking through a model that I call three roots, many branches. Any sign, symptom, or diagnosis that your client or patient is experiencing Thing is a branch, and there are medical individuals who are addressing the branch in a targeted fashion. I see our role in functional nutrition as coming down to the roots and to the soil that nourishes those roots. So for me, with any chronic health situation, any chronic sine symptom or diagnosis, the roots to any of those branches are the genes digestion and inflammation. And part of inflammation is exactly what you’re talking about. To address inflammation, we need to clear, calm, enhance and modulate. That’s the soil around inflammation. We’re often thinking I have to clear an infection and calm the immune system. But like you said, I really try to get people to think about that more broadly. If the nervous system is not in a calm state, a parasympathetic dominant state.

Andrea Nakayama 00:17:33 The body can not heal. And so that might be how we’re using food, how we’re supporting digestion. Because nutrition without understanding digestion and digestive physiology is not functional. But understanding that need to calm. And part of that calm is being able to not walk such a tight line like you’re talking about where we have so many things we can and can’t do, that we’re constantly in an alarm state and a worry state. And I had one of those conversations this week where I literally had to convince somebody that they could put blueberries in their fat fiber, protein boosted quinoa for breakfast because they didn’t know what to eat for breakfast after having lab results. And that puts Put somebody in a panic state and the body can not heal. So when I’m thinking about dressing hormones at all. Blood sugar is the basis of that. And then insulin and then cortisol. To your point, that nervous system regulation as well. Digestive piece there, then thyroid then sex hormones. We’re often taking a top down approach and we’re missing the opportunity to provide that physiological calm.

Dr. Jessica Drummond 00:19:02 Yeah. And so in our practice I collaborate with a nurse practitioner. So sometimes we work with hormones or you know, our clients are working with a local gynecologist or PCP who will provide their hormones. And often we sort of slow down the process rather than sort of like the protocol of everyone needs X amount of estrogen and everyone needs X amount of progesterone and X amount of testosterone. We’re trying to, like you said, top down. Just fill up the gaps. Instead, we very commonly start with calming the nervous system with lots of different practices, including adding a lot of phytonutrients and kind of re enjoying eating. But also we often start with progesterone instead of estrogen so that people sleep better. What are your thoughts on kind of the integration between hormone replacement therapy and nutrition?

Andrea Nakayama 00:19:59 I love that, and similarly I am absolutely pro bioidentical therapies. I like to start low and go slow. A lot of what I’m seeing is that medical providers who are administering hormone therapy are going multiple hormones at once and higher dose, and I’d rather just build our way there.

Andrea Nakayama 00:20:24 I do find that starting earlier than later helps. I personally do not feel good. Bioidentical if anybody out there feels the same. I’d love to hear from folks who don’t. They don’t feel good to my body, and I am tuned in to that sensitivity, which I think is another piece of the equation. So I think what you’re doing and what you’re talking about, that tandem and partnered work, starting low and going slow and having somebody really tune in to what makes a difference. Always incorporating progesterone when estrogen is part of the therapy or not. But can we do enough with progesterone alone? But sleep, poop, and blood sugar balance are my non-negotiables, and I do think that progesterone can and does help with sleep. I think there are other things that can help with sleep as well. And so progesterone for me isn’t the first route that I’m going to go for supporting sleep, because we may be looking to address something physiological with what we think is the fix that it is because of low progesterone.

Andrea Nakayama 00:21:37 It might not be low progesterone. So what I will say is from a functional nutrition perspective, my job is to focus on not hormone levels but hormone metabolism. So what I’m looking at specifically and training providers to look at is okay, we have to create it. We have to transport it, we have to utilize it and we have to excrete it. So that’s our hormone metabolism action. And then within there there’s more research really illuminating hormone sensitivity. So what looks good or bad high or low on a lab may not be what that woman is experiencing within her own body. When small doses or small shifts are happening.

Dr. Jessica Drummond 00:22:30 Yeah, I think I’d like to talk about that for just a second. We absolutely see in our practice people who don’t tolerate let’s just start with progesterone. But I would like to talk about estrogen as well. Supplemental progesterone. You know, oral microRNAs, bioidentical progesterone. It’s very easy to access about 10%. And even this is just in the data of women have a bad response to that.

Dr. Jessica Drummond 00:22:54 They feel more anxious. They can’t sleep. And I think what often happens is the practitioner is just like, well, I don’t know, that just didn’t work or try it longer. You know, you just have to adapt. There’s not this idea that for some women either it’s the wrong time, it’s the wrong dose, or the hormone is not being well metabolized or the body doesn’t have the capacity to use it. So what we’ve seen is when we slow it way down. And again, one hormone at a time. First of all, for some women it’s absolutely not the right tool. Any tool could be absolutely not the right tool.

Andrea Nakayama 00:23:31 Correct.

Dr. Jessica Drummond 00:23:32 I get asked this all the time. I’m sure you do too. The question would be something like blah blah blah blah. Good, right? You know our estrogen patch is good. Our GLP one is good. That is not the question. Correct. Is this tool the right thing to support this woman’s biochemistry, physiology, symptoms, etc.. Now?

Andrea Nakayama 00:23:58 Exactly.

Dr. Jessica Drummond 00:23:59 And so one of the things we would do with progesterone, if people do have that sort of you know, I call it the like anti Benadryl effect. Right. You get those those.

Andrea Nakayama 00:24:06 Like a paradoxical response to yeah.

Dr. Jessica Drummond 00:24:09 Those kids who take Benadryl and then bounce all over the plane. Right. So so the same thing can happen with progesterone. You should be having this nice deep sleep. No, you’re wide awake. Anxious. One, we often just dramatically decrease the dose. But also what you said was start with all the supportive tools. Has this woman been getting adequate fat long enough to build her own progesterone? Maybe ever. And maybe not. If she’s had disordered eating or been on a low fat diet for a really long time, or has a gallbladder issue, like there’s lots of reasons all the way through to is she pooping, how’s her liver, etc. so I think that and then estrogen I think is even more interesting. I keep telling people my perimenopause book is going to be perimenopause in the age of the zombie apocalypse.

Dr. Jessica Drummond 00:25:03 So. There’s a lot going on right now, but one of the things we are absolutely seeing in this age of the zombie apocalypse, otherwise known as the continuing Covid pandemic, 40 to 55 year old women are 45% more likely to get long Covid. And one of the key factors of long Covid is mast cell activation syndrome. And so estrogen destabilizes mast cells in many cases. So if you have a client who starts on, she has all the symptoms, right. She’s hot flashing. It seems like estrogen would be the holy grail. Like is estrogen good? Like the answer would be yes. And then they take it and they start having more burning pain, more hot flashes, more bladder pain. Back up and do exactly what you just said, you know, how’s her immune system? Stabilizing her mast cells. How’s her digestion? So anything else you’ve seen? Because I’ve actually seen people. Once we get their mast cells stabilized, they do really, really well on estrogen. Any other things you’ve done for people who maybe can’t tolerate estrogen initially or, you know, other things we do.

Dr. Jessica Drummond 00:26:18 Maybe we just don’t use estrogen. What are some of the other tools?

Andrea Nakayama 00:26:22 Yeah, I think it does come back to the matrix. So let me just talk through the matrix. And that when we look at the matrix as a whole, it has three sections to it. And these are all things that you also use and think through in your own ways. Jessica. So like just adding to the ways our work kind of pairs so well with each other. I call it the story, the soup and the skill. Right? So the story in functional medicine, our antecedents, our triggers and our mediators. And I’m going to come back to that because I think it’s grossly overlooked in functional medicine practices. And it’s what really took me down the path of more trauma informed narrative medicine. And your practice is so trauma informed from the get go because you’re really hands on with an individual, but that’s not the case for a lot of what we get in media. The soup in the center of the matrix is the full body systems.

Andrea Nakayama 00:27:21 It’s the systems biology. And those hormones are just a piece of the puzzle. When I’m teaching people and they’re asking me, what should I do for this hormone issue or that hormone issue, I will pull up the matrix and show that we are looking at a tiny piece of the whole map. And if we are looking at that tiny piece, what are we missing? And the answer is obvious. Everything else we are missing everything else. So like you mentioned, we have to be thinking about the gut. We have to be thinking about the liver and detoxification. The metabolism of hormones is very, very important to be thinking about. And metabolism might be something that we can address with the immune and inflammatory balance, with gut function, with detoxification optimization, but it may just be the season of life and how that body has not had that hormone in that way to be able to utilize in an appropriate way. So like when I said, I think it’s better to start earlier, you’re going from the endogenous production of hormones to supporting low and slow the exogenous introduction.

Andrea Nakayama 00:28:41 If the body is adaptable, I’m going to say this is true for me. I’m going to knock on wood and say, if the body is adaptable and has gotten accustomed to not having that hormone production, then bringing it in may cause more harm than good, more problems than not, because it’s adapted to not having that. And how many generations of women before us have done that, adapting through lifestyle practices without having the significance of the hormonal symptoms that we’ve experienced. So again, I am all for bioidentical hormone therapy. I just think it’s a very individualized and addressing our hormone function, maybe about full body systems or systems biologically managing and adapting to changes in the body. And it may be when we start, there are so many factors that have to be looked at in that very individual way. So I said this story, the soup, which is that physiological function, the skill is where people are asking us, is this good or bad? Should I use a CGM, a continuous glucose monitor? Like is it good or bad? And it’s like, why are we using it and what are we looking to gain from it before we’re just introducing something.

Andrea Nakayama 00:30:13 So the skill has to match the person and the physiological terrain. And when we think like that and see the whole instead of the part, that’s where I believe we have increased clinical results.

Dr. Jessica Drummond 00:30:30 I think that’s really important because when you talk about The matrix, having these different sections, to just explain that to people a bit more, you know, we’ve got the endocrine system, we’ve got the immune system, we’ve got the nervous system, digestive system, musculoskeletal, etc. those are the other systems. And so going back to that estrogen example, someone is prescribed an estrogen patch. They don’t do well. Their bladder pain increases. They feel bad, their sleep is off whatever. So we look at immune system. We look at mast cells. We also could look at nervous system because Us. What if someone has a really deep family history of breast cancer, let’s say. And for generations have been told, never use estrogen. It’s going to be dangerous. That can be deep in their subconscious. And so the nervous system could drive a response or it could be circulatory system.

Dr. Jessica Drummond 00:31:25 One of the things in the original women’s health study that helped us give information, they didn’t interpret their data very well. But one of the things that we do know from that study is that it is possible that if there’s been too long of a time, certainly the vascular system may not like a new addition of estrogen, and then each system left and right. And so the good news is, though, is if we know that maybe estrogen is not the tool in this example, now we have the opportunity to go system by system.

Andrea Nakayama 00:32:01 And we may get to a place where we don’t need that intervention. Like our goal is to help a person feel better, not take hormones. Right? And I know you agree with that, but I just like saying that to the so many of the providers that think, you know, sometimes that’s the answer, that if we can give somebody more of the tools to have more of the mediators in their own toolkit, you went away. You felt great. If you didn’t.

Andrea Nakayama 00:32:35 You know, your toolbox to right size what’s happening for you. And that to me is the definition of health, where it’s not so narrow and so dependent, and it has a little bit of wiggle room for us to live, which is a part of the longevity equation. When we are so restricted and so tied to all the things we have to do. We’re not actually supporting longevity. Even though we are doing the things that promise us longer, healthier spans.

Dr. Jessica Drummond 00:33:14 I love that point you just made, and this is the next question I wanted to ask you, because I think we really do need another perspective on this idea of longevity. The reality is that a lot of the men in this field, not all of them, because some of them, I think are just deep thinking clinicians. But I saw a post from Brian Johnson as an example, just a couple like within the last couple of days. And he basically said, look, my desire and mission was like he was looking for sort of a purpose.

Dr. Jessica Drummond 00:33:43 And he had almost like a scientific curiosity, which I fully support. His true goal is to just scientifically figure out if we can not die.

Andrea Nakayama 00:33:54 Right.

Dr. Jessica Drummond 00:33:55 And I mean, hey, more power to him. But for the vast majority of people. And I think the whole longevity conversation has been built around that, that we’re going to live to be 100, 120. Like, that’s almost like a given. If you just follow these six steps, but you have to be all in and you’ve got to be, you know, testing your VO2 max and wearing your data tracker and wearing all the time.

Andrea Nakayama 00:34:22 Correct.

Dr. Jessica Drummond 00:34:23 Two problems with that. You can do absolutely everything right and still get cancer. Still get hit by a bus. Still get heart disease. Still get a chronic autoimmune condition. You can do absolutely everything right and still get sick or die. Yes. And no one says that. That said, you know, I’m not walking around telling people like start smoking and like, eat 40 Big Macs a day.

Dr. Jessica Drummond 00:34:49 But the second piece that’s not addressed in Longevity Conversation, which you touched on, which I think is even more important. Well, I think that first points a little bit important because right now I do think we have a lot of people feeling shame for being sick. It’s not your fault.

Andrea Nakayama 00:35:06 No. And if I can just jump in on that point. I’ve been leading a longevity book club called The Long View this past year, and we’re reading a lot of the books and a lot of the bro literature, you know, that really is about the science and technology of aging. And I think that it is about the science and technology that’s something different than the way we live our lives. Like the pursuits of the technology are like what Brian Johnson is talking, what’s possible. The truth is, not a lot of people have lived past 120. There are more people getting to 120, but not necessarily past it. And the truth is, everybody’s talking about health span versus lifespan. And Doctor Peter Attia probably says it best with like avoiding the Four Horsemen, the things that we are more susceptible to as we age? And what influence do we have and what influence do we not have to contract metabolic disorder, cancer, neurodegenerative disease, or more immune issues that we might be subject to? It’s happening because our bodies are aging.

Andrea Nakayama 00:36:18 It is entropy, and we are more susceptible. We do have some influence, but that influence is not control. And in the book club, we are really also reading about death and dying, because I don’t think we can talk about longevity without talking about aging and the physiological realities of aging. And we can’t talk about longevity or aging without talking about dying and death. And as somebody who lived through the death of my husband at a young age, 23 years ago now when he was just 34. It’s not his fault that he got cancer. It’s not my father’s fault at 79 that he got cancer, right? And like you said, there’s a lot of shame around this idea that we have control over those outcomes when there’s so many other factors. So I think it’s a broader conversation that we’ve made really, really narrow. Once again, it’s what we do in health. We make it really narrow. And then we sell a lot of stuff that’s meant to support what we’re measuring. Tracking, eating, taking, to support this idea of what’s possible as opposed to being where we are, and then also embracing the other aspects that do support longevity, belonging, passion, purpose.

Andrea Nakayama 00:37:51 These things that I call the pharmacy within that also activate and turn off inflammatory mechanisms as well. Like they have physiological power.

Dr. Jessica Drummond 00:38:03 Absolutely. So to me, there’s this conversation around longevity that’s very aligned, especially for women with diet culture. Right. Like you have to do everything right. If you don’t, you got older and it’s your fault. You know, eat less, lift heavy weights or eat more protein.

Andrea Nakayama 00:38:24 Protein, interact fast, measure this.

Dr. Jessica Drummond 00:38:27 You know, track everything. And I think the challenge with the conversation around this, at least from my perspective, is there’s always a grain of truth. Of course, if we learn to nourish ourselves, we eat healthier. We enjoy the phytonutrients of a wide variety of colorful fruits and vegetables. We do sleep, and sometimes that involves tracking so we can get back in touch with our own. We sometimes, like you said earlier, like there’s this loss of being in touch with our own. How do I feel? Like, barely even know.

Dr. Jessica Drummond 00:39:01 So all these tools are so helpful, but nobody talks about the other stuff that you were talking about. So for me, it’s equally as important, if not slightly more important, to talk about what is longevity mean to you? What is a well-lived life? So if you had two years, what would you do with that time? Because when we have this longevity conversation, I think it also encourages people to put off. I have 30 more years, so they’re not going to live. They’re going to try to live longer like live now.

Andrea Nakayama 00:39:37 Correct. And I think what you’re talking about is really what I’ve identified throughout all the reading and the discussions that we’re having in the book club as a tension that exists Between what’s the doing part of it and what’s the being part of it, and how do we each make kind of a risk reward decision for ourselves? That’s about tuning in, being present and inviting more of the things that really make us feel alive. I think that one of the most interesting things for me to experience, and you may be on the brink of this, given where your kids are in their ages, is that there’s a really significant role shift that occurs.

Andrea Nakayama 00:40:26 And I think it’s a bigger role shift for women that I think men have been going through it for a long time, and I think women are kind of experiencing it in a new way, and I’ll talk into that. But there’s a role shift that happens with who we are as a parent. I’m very close to my son, and it was just the two of us. Given that his father passed when he was just an infant. But he’s a young man, and my role as a parent really struck me as he was like having to push me away and do his own thing and find his own way. That really hit me hard to recognize that. It’s not that he doesn’t need me, he is choosing me. I’m not being pushed away. But I did a certain part of my job, and that role as parent needs to go through a transition. That kind of woke me up in a way that I wasn’t anticipating. And then I think about my role in my business and my practice and all of these ways in which my role or roles have really defined me.

Andrea Nakayama 00:41:44 And that as you age, especially out of your 50s. We’re not done. But that role and that importance and what we put into those things is really shifting. And with that, I think comes a lot of nervous system dysregulation, not understanding who I am anymore, because I’ve been very tied to being a mother and being a business owner and being a this and a that and a leader and a and all of that for me is what led me down the longevity path, because I realized, oh, wait a minute, I have to be present for these shifts because they are really dysregulated, really dysregulated, because I am attached to that definition of self.

Dr. Jessica Drummond 00:42:36 Absolutely. I think many of us are. And I think the other thing, I was talking to one of our students earlier this week, she works with women primarily in their 60s and older. And this is a very new experience for women like. This is the only generation ever where women in their 60s and 70s, and to some extent 80s, were single or married by choice and had their own money.

Andrea Nakayama 00:43:08 Correct.

Dr. Jessica Drummond 00:43:08 This has never happened before in history, and it might not happen for that much longer. We don’t know. At least in this country. So I think that is really powerful because women have never, ever before had this level of choice. And so, like you said, it’s kind of destabilizing. Like, I literally can do whatever I want, but also everything I thought I was and, you know, my role as a mom, which is a very, very strong role now as it was ever my role as a person who works my role as a high achiever, because to get to these levels, women had to be a high achiever in elementary school and high school and their whole life. It is very destabilizing. And yet I think such an opportunity that we’re not slowing down and really considering enough. Yes.

Andrea Nakayama 00:44:05 Thousand percent.

Dr. Jessica Drummond 00:44:06 And I think we risk because we know from the literature on men that when men retire from their jobs, if they’ve kind of been in the workforce most of their lives, and that was their primarily defining role, if they retire with no plan, they actually are at a very high risk of dying within the next two years.

Dr. Jessica Drummond 00:44:27 So I think it’s a really important conversation for women to be having, because women, it was sort of like, well, if you’re still alive, you just step into being a grandma. Right. That was what you did. That’s it. Right. But now we could do that. but we also might not. And I think that’s a piece of this longevity conversation I’ve barely heard of.

Andrea Nakayama 00:44:48 I know I feel like it’s really, really important. And there are stories like Julia Louis-Dreyfus podcast Wiser Than Me, and that’s talking to like, the trailblazers, the people who are in their late 70s and 80s who kind of paved this way for us. We are the everyday trailblazers. There aren’t a few of us. There’s more of us than not. And I think one of the things that was also remarkable to me, that really made me turn my attention towards women and longevity, and this more broad conversation was watching my friends from college and high school who are so talented, not being hierarchal Anymore and recognizing, yes, we know men have been through that like you’re talking about, but I’m watching people who I know are brilliant, and I’ve watched them form their brilliance in these beautiful careers, not have opportunities anymore.

Andrea Nakayama 00:45:57 So again, that led me back to that idea of role. And I think it only starts to happen in our 50s. And there is purpose in really taking time to slow down and recognize, wait, what am I holding on to as part of my identity and what is just innately part of my identity? Even going back to the things that make us smile, that give us purpose, that really light us up, and making time for those things, whether it’s dancing or listening to music or playing music or being creative or painting. What are those things that we can reintegrate that give us life? Because I don’t feel I know I’m like nowhere near done. If I get opportunity to keep creating. But that’s not what the world is going to tell me. If I went out and looked for a job, so to speak.

Dr. Jessica Drummond 00:47:03 Absolutely. And what’s so ironic about that is that a woman in her 50s has so much more time than a woman in her 30s. Depending on how old your kids are to some extent.

Dr. Jessica Drummond 00:47:16 And then, as we were talking about earlier, we now have all these tools from functional nutrition, lifestyle medicine, nutrient supplementation, hormones, peptides. We actually have exercise, you know, which is one of the most impactful. We have tools to have a very similar level of energy that we’ve had our entire adult lives. For most of us. And yet, we’d have to be very, very precise about maintaining work and passions. Because, like you said, pretty much the world looks at a 55 year old woman as old and retired. Yes.

Andrea Nakayama 00:47:57 Yeah, exactly. And I think this goes back, Jessica, to what you were talking about with understanding the patient narrative around any intervention, hormone or otherwise, like you really identified. If a woman’s been told her whole life comes from a family of breast cancer survivors and is given estrogen and has a lot of fear inside that this part of the story and the women that were helping and understanding where they are in their life, what loss means, what Cleaving parts of our life, parts of our roles like that.

Andrea Nakayama 00:48:38 Terrain is also part of the equation, not just the marker on a piece of paper.

Dr. Jessica Drummond 00:48:45 Yeah. And I also think without examining those underlying thoughts, those underlying traumas, just the things that are deep in our nervous system without taking a moment to examine them. The other thing that I think really happens is women, you know, the reality is your looks changes. Your physicality changes. And that can be terrifying if you have no context. And that’s part of what you know was really important to you or your family or your mother or, you know, the messages of your community. It’s interesting. My daughters are 21 and 14, so the older one is 90% like foot out the door. She barely calls me unless she needs money.

Andrea Nakayama 00:49:32 Still a daughter, though. Mother. Daughter?

Dr. Jessica Drummond 00:49:34 Absolutely. I mean, she’s lovely. We’re very close, but she’s very vigorously living her own life now. We’ll see what happens when she graduated from college and has to really live her own life. But she’s enjoying it now and then.

Dr. Jessica Drummond 00:49:47 I still have a 14 year old, and I think we’re going to have also more and more women in their 50s and even 60s with teenagers, because more women are having their first or last child in their 40s. You know, you still have teenagers when you’re in your late 50s. And so it’s a very different in terms of mothering. Also, one of the things I see kind of being immersed in mom and, you know, my daughters like to watch all kinds of like, reality shows, and one of them’s in a sorority, and we watch all these shows, and there’s a show coming out right now. We’re in rush season almost for colleges, you know, like getting into a sorority and in the South in particular, the mothers are very tied into this identity of what their daughters are doing and wearing. And and I think that that could be a culture of anything, like if you were the VIP at Goldman Sachs and you want your daughter to be at the VIP at Goldman Sachs, like when women don’t slow down for a second and examine what it is they want.

Dr. Jessica Drummond 00:50:54 And the same way that men have been doing this to their sons forever, we could have that same problem. It’s like, well, my looks are fading or my prestige at this job is fading, so my daughter better take it. She might not want to do that at all, you know.

Andrea Nakayama 00:51:11 Exactly. And that’s where that kind of divide happens and the role shifts, because we don’t necessarily get to shape it in the same way anymore, but people are holding onto it. You know, there’s so much in what you just said in terms of our connection to our looks or our bodies And, you know, culture is upholding some version of ourselves that we’re supposed to be. But this is another place of tension. It’s not about like, oh, I’m just going to let it all go now because my body is changing. It is that desire to still be vibrant and be able to do the things that we do. And for my birthday, just a couple of weeks ago, I was on a really intense hiking trip with my boyfriend, who’s a climber I can’t climb, but I do want to be able to hike, and it’s not easy for me.

Andrea Nakayama 00:52:03 It’s not something I’ve done my whole life, and I can feel the differences and be working towards the goal of being able to do it with the exercises that I’m putting in when I’m not doing it right. Like that tension between it’s not all about how I look, or the reality that this might not be something I can do at some point. And that’s kind of cultural shift that I think we go through.

Dr. Jessica Drummond 00:52:31 Yeah. And I think that comes back to what we were talking about before that it isn’t all or nothing. It’s not that tracking your data or training for a big hike when you’re 65, 75, 85, I don’t care how old you are, is not valuable. But I think the point that we’re both making here is that it’s so rare to slow down. This is why coaches and functional nutritionists, having someone on your team that will allow you to stop every once in a while and be like, is this what I actually want to do? Or was this passed down? Or was this what wellness culture is telling me? Or is this what I’m supposed to be doing? Anything from 120g of protein to injecting stuff in your face.

Dr. Jessica Drummond 00:53:18 Like, it’s all kind of the same in that none of it is good or bad. It’s about choosing it.

Andrea Nakayama 00:53:28 Yes. And for us as providers. The simplest thing I always like to remind people is that those of us who are seeking our support are not broken. And we need to stop treating them like they need to be fixed. And they may be coming to us feeling like they are broken. And part of our job is holding that reality, creating space. I want to say, one of the really simple practices that I’ve learned to do around that is when I am tracking someone Serum Labs, I am color coding them so that the first thing I can say to them is, can we just take a moment to look at how much green there is on your lab tracker? Like, let’s look at all the ways in which your body is functioning for you. It’s doing what it’s supposed to be doing. And so I think my biggest call to action for providers Writers who want to be helping people to feel better is to anchor on that parasympathetic, dominant trust in self and helping people find that inner voice that helps them to calm and know this is what works for me.

Andrea Nakayama 00:54:42 This is what doesn’t. Oh, I have another tool. It’s mine. Now, as a patient, I don’t need to rely on you to tell me everything to do.

Dr. Jessica Drummond 00:54:51 Yeah, I think that’s the most important thing, is anchoring people in their own resilience. And then even if they have to apply to 100 more jobs than they had to apply to ten years ago. But if they want to do it, they do it. Or if they have to grieve that their mother role is changing, they give themselves a space to do it.

Andrea Nakayama 00:55:15 Oh man, that one’s hard.

Dr. Jessica Drummond 00:55:17 Yeah, I bet I’m not there yet. So I can say that More. Yeah. I’m not. My kids are still pretty. I still have a pretty active role as a mom. I’m not able to grieve that over.

Andrea Nakayama 00:55:31 But it’s shifted, and I didn’t see it coming. So that I think was like, you know, it was a rude awakening. But I can only imagine that it happens for all of us in some ways, and sometimes not soon enough and sometimes too soon.

Dr. Jessica Drummond 00:55:47 Yeah, I bet there’s some that are like lunch. That is one interesting thing about having them so far apart is that, like, I sort of experience it once I get to take a breath because like, my oldest one is a year and a half out of graduating from college and the younger one hasn’t started high school, so I almost get enough time to forget certain things before we do it again.

Andrea Nakayama 00:56:10 Yeah, and it’ll be different the second time with a different person. But I think the things that you and I are illuminating for others, hopefully in this conversation, is that this part of our story. Is a part of our health. And so these things we’re sharing are equally a part of how our hormones are behaving or metabolizing and what signs and symptoms we have.

Dr. Jessica Drummond 00:56:34 Yeah. Well, thank you so much for being here today, Andrea, and I hope you’ve inspired some really exciting ideas for some of our practitioners to think about doing things like book clubs and doing longevity programs that do take some of this into account, because I think leading programs like this, where women are in community within their communities, is even more powerful.

Dr. Jessica Drummond 00:56:59 And everyone listening to this has the opportunity to create that. So thank you for sharing. Thank you for being here. I’ll see everybody next week.

Andrea Nakayama 00:57:09 Thanks, Jessica.

Dr. Jessica Drummond 00:57:14 I hope you enjoyed that conversation as much as I did. Andrea Nakayama is such a brilliant thinker, and I love how she really puts things structurally into alignment to help with our clinical decision making, to help with our holding space, coaching for giving structure to challenging conversations. That’s why I invited her to teach you in the Integrative Women’s Health membership coming this fall, all about narrative medicine. There’s many, many clinical pearls to pick from in this episode. One of the ones I really want you to really think about, I really, really want you to think about, is how you frame with your clients the conversation on longevity, on health and wellness, and that tension that Andrea and I discussed. Like, we know there are all these things we can do to help people optimize their health, and yet we don’t want that to become their full time identity.

Dr. Jessica Drummond 00:58:14 We want them to really choose, living their lives in a way that feels healthy, that feels nourished, that feels connected to things that are meaningful to them, but not necessarily that their quote unquote wellness is their job. And unless they actively want it to be. You know, I talked about that story of Brian Johnson, and he has this mission of scientifically what it might look like if we could live forever. I mean, look, if that’s something he wants to play with in this life. More power to him. If that’s something one of your clients wants to play with in this life. More power to them. But just like diet culture, we could get really wrapped up in all of these things we should be doing to the detriment of actually living the life that we’re here for right now. So I just wanted to open that conversation because I really think it’s missing in the interesting and important conversation on longevity. But I want to be careful that we don’t fall down another diet culture shame inducing rabbit hole for and with our clients.

Dr. Jessica Drummond 00:59:31 Think about that. Let me know what you think and I’ll see you next week on the Integrative Women’s Health podcast. Have a great week. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.