Scenic Route, Social Change and Mental Health Conversations for Perfectionists

Perimenopause Club: Break Free from Supplement Scams & Reclaim Your Health with Nutritionist Sandra Mikhail

Jennifer Walter Season 6 Episode 86

Ready to cut through the noise around perimenopause? In this episode, nutritionist Sandra Mikhail helps us navigate the complex world of women's health without falling prey to expensive supplement marketing.

Key Episode Highlights

  • Common perimenopause symptoms and when they typically start
  • Why supplement companies target perimenopausal women
  • How to identify quality supplements vs marketing scams
  • The truth about collagen supplements and the bone broth trend
  • Understanding hormonal changes and their impact on metabolism
  • Practical nutrition strategies for managing symptoms


Tired of wasting money on pricey supplements that promise hormonal harmony? In this episode, nutritionist Sandra Mikhail reveals what your body needs during perimenopause – and it's not another expensive miracle pill.

Sandra shares practical nutrition strategies that won't break the bank, from protein targets that support muscle health to the intriguing "Power of 30" rule (hint: it's about plant diversity, not your age!).

Plus, learn to spot the red flags in women's health marketing and understand why those trendy at-home hormone tests might be leading you down the wrong path. Tune in to discover this game-changing approach to perimenopause nutrition.

Join us on the Scenic Route.

Connect with Sandra Mikhail
Website
Instagram
LinkedIn

Listen to her podcast "The Gastroenterologist And His Daughter"

Buy her book "The Gut Chronicles"

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Jennifer Walter:

I'm your host, jen, and today we're diving into something that's probably flooding your social feeds right now Perimenopause. You know that mysterious transition that apparently requires a small fortune in supplements and a PhD in hormone science to navigate. But look, here's the thing Between the targeted ads, the scarcity tactics and the endless miracle solutions pushing, we're all feeling a bit lost in the perimenopause propaganda machine. And if you've ever found yourself doom-scrolling through hormone-balancing supplements at 3am, this episode is your permission to pause and breathe. Today we're cutting through the noise with Sandra McHale, a nutritionist, who's about to give us the real talk we've been craving no expensive supplements, no fear-mongering, just honest conversations about what actually is happening in our bodies and what we can work with. So grab your beverage of choice and let's take the scenic route through perimenopause together.

Jennifer Walter:

Hi and welcome to the Scenic Route Podcast, where we believe in embracing life's journey with purpose, curiosity and a bit of potty humor. I'm Zo Mom and I'm always looking out for that perfect slice of gluten-free rhubarb pie. Every week, I get the joy of sitting down with dreamers and doers who dare to take the road less traveled in pursuit of their own magic. Together, we dive into the inspiring stories of soulful entrepreneurs and visionary leaders who boldly share their beliefs, lessons and fuck-ups. Excited so am I. You're exactly where you're meant to be, and now let's take this conversation off the beaten track, thank you.

Jennifer Walter:

A Master of Advanced Studies in Nutrition and Health and is a member of Dietitians Australia. Further, she also holds a sports nutrition diploma by the International Olympic Committee. With experience spanning well over a decade, sandra's main areas of specialty are digestive disease, sports nutrition, eating disorders and corporate health. Working with local and multinational brands alike, sandra's passion for gut health created a movement of normalizing food talk, shedding light on topics that you might find yourself secretly googling about. As a mental health advocate, her workshops and articles on stress and nutrition have gained popularity internationally. Sandra, welcome back Sc the podcast.

Sandra Mikhail:

Thank you for having me back and I'm going to try not to. As I said, I think I asked you if I can swear and cuss on the podcast, but you know I'll try to keep it PG.

Jennifer Walter:

Yeah, like, maybe disclaimer if you're around little ones, just grab your headphones. Now we're not open to complaints, we're not. We're just going to talk as we talk, and this might include the occasional swear word, and that's not news if you're a regular here, so okay. So, oh, I, I jotted down so many questions, um, for you, but basically, right now I don't know if, if your social media feed looks anything like mine, I don't know. You think every woman over 35 has like some sort of hormonal crisis going on that can only be solved by like a very expensive supplement subscription, of course, and this new buzzword of the wellness industry that is perimenopause is really going around town and I'm always I feel like I'm always like one button click, like one Apple Pay face ID, away from buying like a really expensive miracle supplement. So what is going on with perimenopause, sandra? Like enlighten us please.

Sandra Mikhail:

Look, perimenopause is an absolutely legit term. The issue is, we are starting to see a lot of these terms pop on on the wellness trends bandwagon. So I mean menopause is something that we're hearing left, right and center, which is fantastic. I mean we, we need to have these conversations. I think that's the beauty about having more and more funding when it comes to female health. So I'm all for having these conversations, but and as with everything, it turns trendy and hip to talk about it because there's money to be made. I mean every wellness unicorn right now, every. I mean you've got hormone coaches popping up left, right and center. I didn't even know this was a thing because, again, if you're a hormone specialist, you are either an endocrinologist or a gynecologist. Now the issue is and we can talk about that too is that? Yes, there's a ton of issues within the medical field, absolutely, especially when it comes to female health. We have been dismissed, disregarded. You know, it's all in your head. We're not taken seriously, have you tried yoga gaslighting, absolutely, I mean everything you know.

Sandra Mikhail:

Have you meditated? So I understand when you don't feel heard you, you are going to go on the lookout for other alternatives and someone I'm sure someone out there is going to give you the solution yeah, it's capitalizing on this exactly, exactly.

Sandra Mikhail:

so the issue with it? I mean people, people always, you know, dub pharma, big pharma or the medical field as like some sort of um, you know, people just wanting to prescribe medications left, right and center. But actually, if you look at the wellness industry and like to call it big wellness, look at how much money is being made out of people who are vulnerable, desperate and don't have any answers. Now going back to this whole area of perimenopause Now, by definition, it is the transitional period before menopause, when our hormones you know primary hormones, estrogen and progesterone naturally start to decline, leading to hormonal fluctuations 30s typically, it's, it's your 40s, but it can really start quite early, I would say mid 30s, and it can last anywhere between two, you know, from a few months to over a decade, exactly until we arrive to the menopause.

Jennifer Walter:

um, tell me, yeah, yeah no, yeah, like it's a part of a big and I've loved that you mentioned a big part of why it's confusing and all is because it's like all everything concerning women's health is critically underfunded. But at the same time, it's this big period we can be in perimenopause and there are a whole myriad of symptoms that are different for each and every one of us. So could we highlight a few symptoms that are more common? Is it possible to cluster symptoms of this? This is like what a lot of women experience, so we are starting to see the most common complaints right.

Jennifer Walter:

So, starting off with night sweats and hot flushes and sleep disturbances, yeah, I feel like I need to have like a card, like yes this is one I mean these are very, very common complaints that start off in your late 30s, early 40s.

Sandra Mikhail:

I'm starting to experience that too. The second thing is irregular periods, now one thing that you do notice. Again, I've tracked different elements of my health throughout a three-year period. It was really interesting to see, when I did track my cycle, that my average cycle is actually getting shorter and shorter. So, like my average cycle, again, everyone's different and also it makes a difference if you're on any birth control, but in, let's say, using myself as an example, so my average cycle was around 29 to 30 days. Now it's about 25, and this is over a three-year period. I just turned 39. So I'm not far off from, you know, starting to experience all these changes. So that's when it comes to your menstrual cycle, mood changes.

Sandra Mikhail:

Things that we actually start to see is like low libido and vaginal dryness. This is also a very common complaint, but not a lot of women talk about. I see a lot of bloating and gut issues start around that period too. It's around, let's say, early to mid forties. Again, this is anecdotal, but you can start to group or cluster these symptoms around. You know, let's say, within this age group. Look, brain fog is another thing.

Jennifer Walter:

I mean, I've been blaming brain fog on yeah at first it was like the new mom brain fog and now it's smoothly transitioned into perimenal brain fog and I feel it's just gonna stick with me for the rest of my life that you know what?

Sandra Mikhail:

and and I think it's not um, how do you say I? I don't it's, I don't want to make it pathological. Do you know what I mean? I feel like we are pathologizing I don't know if that's even a word a lot of these symptoms where it's a matter of being more confident and understanding. Okay, what do I need to do to cope? What do I need to do to manage, for example, if I am experiencing any gut disturbances throughout this time?

Sandra Mikhail:

So this is where I would say look it's, rather than pathologizing, let's start to understand our bodies a little bit better, because we don't. I haven't learned about perimenopause or the menopause in high school or, you know not until my, in my twenties, basically, or like, obviously briefly, when I was at university studying dietetics, nutrition and dietetics. But we are starting to see more and more and more research come out and also more I'm not going to say concrete, because hormones are extremely complex. Right, we are complex creatures. We're, you know, an ever evolving mystery to everyone. But I think but do you know what? I think this is where it's really about empowering yourself to start understanding your body a little bit better and just knowing.

Sandra Mikhail:

Okay, when is this a concern? When should I start worrying Now? The reason why we can't really diagnose perimenopause is because our hormone levels do fluctuate day to day and doctors can't really pinpoint exact changes. So sometimes lab tests or testing your hormones aren't always conclusive, unless it's medically justified or required by your gynecologist or endocrinologist. So a lot of the times during this period, I would say it's more of a symptom-based diagnosis, so it's really guided by your symptoms, obviously within the scope of ruling out other things as well. This is kind of the most common changes and the most common difficulties, what everyone encounters, because when you start experiencing all these things, you just want someone to give you an answer. Tell me what's wrong with me.

Sandra Mikhail:

Yeah, so I can go fix Exactly, and I feel like this is where big wellness comes in and really starts taking advantage of women who are extremely insecure, just unsure about what's going on yeah, I I feel we've like, from the targeted ads that I get, I feel we have left out one, one kind of like bucket of those um symptoms clusters is metabolic changes.

Jennifer Walter:

Right like, I see, dear lord, my like, my tiktok feed is full of like slowing metabolism. Do this like change in fat distribution? Do this more belly fat? Do that like? Is there like a base for this or is it just fear-mong?

Sandra Mikhail:

I would say, look, it's definitely a mix of both, because generally, as we age, there are slight changes to our metabolism, but not drastic enough to kind of complete, to cause complete, absolute havoc within the system. I mean, yes, with certain changes. I mean you have to look at yourself as a whole. It's not just the metabolic changes, but also when it comes to a change in hormones. You know, especially with declining estrogen levels, you are more likely to become at risk of osteoporosis. So your bone health is at risk here. So I mean again, maybe I'm probably going off track a little bit, but to gather my thoughts, when you look at what really does impact metabolism that's completely out of our control is sex. So we do know that females generally have a slower metabolism than men. Age and genetics. We have no control over that.

Sandra Mikhail:

What we do have control over are a lot of the other lifestyle implications. One of them is training, movement, exercise. The other thing is, as we get older as well, what we do notice is that our appetite changes. So you do notice that you know females and you know, and men as well, as they get older, especially if you're like in your late seventies, early eighties, they don't have much of an appetite anyway. So there are appetite changes that happen that, can you know, again, impact your metabolism too, so you're not eating as much, things kind of slow down, your body goes into conservation mode. So I would say, like again, to kind of give you a simple answer, yes and no, I don't. I definitely think there's a lot of fear mongering there because they're potentially trying to sell you a dietary plan. You know, lose belly fat within six weeks, or whatever it is.

Jennifer Walter:

As if you could target specific point of fat loss anyway, which you cannot but Exactly so in terms of like.

Sandra Mikhail:

Yes, we do notice that as we get older, as as females sometimes you know, where do we generally deposit fat? I mean around the belly area. That's one of the common ones within, you know, your mid forties, early fifties. A lot of women will come complaining about why am I, you know, can I lose my belly fat? I was like I can't target these areas. I think, at the end of the day, it's really looking about. What do we know has an impact in terms of lifestyle changes and tweaks that you need to do within this age group, and we can talk about that too when we talk about nutrients, but also about exercise and different types of exercise that we need to be doing as well.

Jennifer Walter:

Okay, yes, so let's go into that. But first I really think, yeah, you highlighted some super, really important points and one is and maybe I really encourage you listening in due to this too like you have to know yourself, like track yourself whatever you feel comfortable tracking right, so you know the changes that are happening and you're less I don't know, know less likely to fall prey to charlatans selling you whatever. And also, because most of us I know I have not been taught any of this in school. I know most of my friends have not been taught like the role of a progesterone in female bodies or estrogen in female body, like basic stuff so just really be curious, read a book and be like, hey, what does it actually do?

Jennifer Walter:

so I can piece together if whatever this person is telling me does it actually make sense or not.

Sandra Mikhail:

And it's so hard, but also learning how to be critical, right? I think the issue is like where are we starting to get our information from? Yeah, I would say, about 80% of the time it's social media or TikTok or I don't know. X, y, z on the internet, or my friends tried this, or my friend's naturopath has told her that. So I think this is how, currently, within our society, people are getting their sources of information, especially when it comes to nutrition and lifestyle, when it comes to hormonal health, and maybe we can add that in the show notes. I can actually give you some excellent resources that you can share with your listeners as well, because there's some fantastic again medical doctors who are still ethical, that are doing some fantastic work out there in terms of breaking down all this jargon that we're not familiar with.

Sandra Mikhail:

Yes, we will go to link this in the show notes for sure I'm happy, as I said, I'm definitely happy to share a lot of these links and resources, because they're also an excellent resource for me, just whether it's learning from my clients or even just, you know, educating myself. But yeah, I think one of the most important things as a dietitian is understanding. Okay, so let's talk, you know, within this age group of 40 to 50.

Jennifer Walter:

let's say this is our age group well, it is mine since june this year.

Sandra Mikhail:

So I'm one year away from 40 and I am also starting to notice all these changes too, so it really is about being mindful, okay, during this time or during you know, within this, this transitional period, let's call it, what are the most important nutrients that I need to be mindful really is about being mindful, okay, during this time or during you know, within this, this transitional period, let's call it, what are the most important nutrients that I need to be mindful of.

Sandra Mikhail:

Number one is, um, if I had to break your macros like the ones that you need to be mindful of, protein generally, I would say we do not meet our protein needs in general, and this is why we end up having an imbalance in our plate. So, like looking at the ratio of carbohydrates, protein to vegetables, ie fiber to fats, a lot of times we're actually not meeting our protein requirements. So, for that age group, for that specific age group, I would say I even go a little bit higher in our protein requirements than the average. So I don't know if you've heard this before you know when people tell you, okay, how much protein should?

Jennifer Walter:

I need. What's the formula Exactly?

Sandra Mikhail:

Look, I mean, I would encourage you to work with a dietitian to help translate that into practical terms. Like, what does you know? 100 grams of protein per day look like for me, but I would say the average. You know, if we had to look at, right, if you want to multiply your body weight in kilograms per day, your body weight in kilograms per day, initially for the general population, we'd say, okay, multiply your weight in kilograms by 0.8 grams per kilograms per day to get your baseline protein requirements. Now, if I had to look at our age group, I would say multiply that your body weight in kilograms anywhere between 1.2 to 1.5 grams per kilogram per day. So it is a higher range. Why? Because I do want to encourage a muscle preservation, but also even muscle building, because that has an indirect effect on your metabolism too. So when people say, like, how do I increase your metabolism? I was like well, build more muscle. So make sure you are prioritizing protein.

Sandra Mikhail:

And again, I always talk about protein diversity. We do know and that's the other thing, and you notice that with your grandparents or great grandparents that as they age they do lose muscle. They've got really, really skinny legs a lot of the times, or really really skinny arms. So this is I mean, with the estrogen loss that is happening, it can accelerate muscle loss. So this is why I would say definitely prioritize protein and keep it diverse. So, if you do consume animal foods and lean protein choices I always go poultry, fish, seafood and then look at your plant sources, such as your legumes, beans, lentils and chickpeas, lots of nuts and seeds. Keep it diverse when it comes to your sources of protein. The next macro is healthy fats. Fats are extremely crucial for hormone production and again, not to you know I don't know if you remember back in the day and this is, you know, going back years ago was that there was this huge fear around fats.

Jennifer Walter:

There still is. You know, there was light everything like yogurt light special case.

Sandra Mikhail:

So, at the end of the day, it's really taking the fear out of fats and really emphasizing that we do need a lot of anti-inflammatory fats, specifically those that are high in omega-3 fats, for example. So think of your fatty fish like salmon, trout, mackerel and sardines. Think flax, seeds, walnuts.

Jennifer Walter:

We have a good excuse for avocado toast, right, an avocado.

Sandra Mikhail:

So I think fats are also because they're anti-inflammatory we're looking at again you know inflammation is a big word, but you know it's really looking at how to counteract all these things that are going in our bodies. Inflammation is a part of it. The other nutrient that, again, I know we can talk about for a whole episode separately are carbohydrates, because you know there is evident carbophobia within our society, especially when it comes to weight management. I think, again, at the end of the day, when it comes to carbohydrates, you need to look at your choice of carbs and you need to match your carbs to your activity levels. And this is it's about being strategic with how much carbs should I be consuming per day, based on how active I am?

Sandra Mikhail:

So a lot of times they look on the days where you're sedentary, not doing much. You should be eating differently than you know the days where you are maybe training, strength training or potentially need that extra boost because you want to go for a run. Go for a run, you're on your bike for a longer period of time. So I think this is one thing that I noticed, especially when women complain of fatigue and brain fog, a lot of them are either under fueling if they do exercise, so they are not consuming enough carbohydrates, or they've been extremely restrictive with their diets Very keto-like, I would say and that contributes to these symptoms. So a lot of the times you fix the carb issue, you fix the energy and the fatigue and the brain fog issue as I'm going back, to really educate yourself on the roles of each of these macros, especially the carbohydrates in your body.

Jennifer Walter:

Right like what? What purpose are they fulfilling? Quick energy boost carbohydrates, more focus, I was gonna say, like when you know.

Sandra Mikhail:

One question I do ask my clients whenever they they hear carbohydrates, like, what keywords pop into your mind? First comes weight automatically, weight weight loss, uh, fat, belly fat these are all the keywords that a lot of my clients have. Literally it's just like a top of mind response. I was like, look, I want you to change that, because when you think of carbohydrates, I want you to think about performance, I want you to think about energy, focus and fiber. This is how you should start thinking about your carbohydrates.

Sandra Mikhail:

So again, it's changing the narrative and taking the fear out of these nutrients. So these, I would say, would be, let's say, the macros, if you want to call them. But then we need to look at the vitamins and minerals that we need to be again mindful of during this transitional period calcium and vitamin D, two very important nutrients that we need to be mindful of. Yes, our calcium requirements might be a little bit higher, but again, it doesn't mean you need to jump on the supplement bandwagon. Absolutely not, because too much calcium is not good, especially when it comes to the heart.

Jennifer Walter:

So this is where I would say first policy.

Sandra Mikhail:

um, when it comes to if you do consume dairy, I mean, that is a source of calcium, but we do know there's a lot of dairy alternatives that are fortified with the extra calcium that you need, but also there's a ton like your green leafy veg, almonds, sesame paste or tahini. So having a nice varied diet can help you meet your requirements. And then, when it comes to vitamin D levels, again, test and not guess. See where your vitamin D levels stand. That's your sunshine vitamin, basically, and if you are not exposed to the sun, I would definitely recommend going on a low dose, again based on what your levels are doing, because vitamin D can be stored in the liver. Everything goes through your liver. Think of your liver as a factory. So if you don't need a specific nutrient, you don't have to overload the system in it with it. Basically. So vitamin D, I would say in terms of I mean, now, what are we? It's almost November, we're in Zurich barely seeing the sun.

Sandra Mikhail:

I have not seen the sun except for like as it sets, basically, which is quite depressing. But we do know that we need to up our vitamin D intake during the darker months. So I would say a baseline of 800 to a thousand international units per day could be kind of again, a very, very rough estimate of how much you need up until, let's say, march. Basically, again, vitamin D is extremely important for brain health, for muscle function, but also for our immune system too. So these would be two nutrients to be mindful of.

Sandra Mikhail:

The other thing are your B vitamins. Your B vitamins are your energy vitamins, so they help extract energy from food, but also they're your mental health vitamins, which a lot of people don't even realize. So I always say a lot of your B vitamins are linked to mood and energy. So if you are dealing with low energy levels, again unexplained, if your doctor can tell you why, I would say look, you can actually test all your vitamin D levels. You can get a panel done just to see where they all stand.

Sandra Mikhail:

And again, keeping in mind, food works in synergy too. So you know, be 12, if you are vegan or vegetarian, be mindful of where your sources are coming from, so you might need to supplement there. The other thing that you need to be wary of is that you can over supplement. So something that we're seeing, especially with people who rely on a lot of supplements, is B6 toxicity. B6 is one of your B vitamins, so it's a neurological vitamin, but a lot of these perimenopause and menopausal so, let's say, supplements have added B6 into them way over the daily recommended value. So I have had to take my clients off certain supplements because they're just completely overloading the system with B6.

Jennifer Walter:

And what does like B6 toxicity look like?

Sandra Mikhail:

I was going to say, in a very, very extreme cases you can definitely will get nerve and neurological functions um misfunction. So basically, one of the symptoms is again it can indicate a deficiency of certain things, so, for example, b12 deficiency. Sometimes people always complain of extreme fatigue, low energy levels, brain fog, but they will notice the tingling in their hands and their feet. I mean, I think a client of mine once described it as having a vibrator in her shoe.

Jennifer Walter:

So this is what it always felt like Obesity.

Sandra Mikhail:

toxicity has very similar symptoms as well, so you will notice that extreme tingling numbness. So again, I would say, before jumping on a supplement, look at your foods. If I have to pick four foods that contain different types of b vitamins, I would say include mushrooms, spinach, sunflower seeds, beans, lentils and chickpeas. So your legumes at least five days a week, and that will cover your b vitamins. Now Now, except for B12, because B12 is only from animal sources that's where you can get B12. So if you do consume a little bit of fish, eggs, dairy, you should be getting enough B12 from that perspective in poultry. So this is where I would say again, we've got calcium and vitamin D, we've got B vitamins and then magnesium, magnesium.

Sandra Mikhail:

Again, you'll notice a lot of these perimenopause and menopause supplements will have magnesium added into them, and the rationale behind is that, okay, magnesium helps with relaxation, especially relaxing your muscles, any muscle tension, but also can help regulate mood and bone health too. So this is where I would say again, before jumping on the supplement bandwagon, are you having a nice variety of nuts and seeds and legumes, because these are your sources of magnesium as well, and if not, you need to work with your health professional to actually understand what is the right dosage for me. Is it 150 milligrams or is it 350? Because magnesium can also, because it's a relaxant. It can act as a laxative depending on what magnesium you're taking. So again, I mean one of the different types of magnesium serve different purposes, and a type of magnesium is used for constipation.

Jennifer Walter:

Oh I remember when I, after pregnancy, when I had to take iron supplements, I had to take magnesium, because the iron supplements, there you go Well exactly.

Sandra Mikhail:

So and this is where I say, look, everything goes hand in hand. And also your vitamin d levels are influenced by magnesium levels too. So again, everything works in synergy. But the reason why I'm mentioning this always prioritize a food first policy and then be strategic with supplementation, and supplement as needed, based on your individual levels too yeah, is there a supplement that you would almost universally recommend?

Jennifer Walter:

yes, and no, I mean right now.

Sandra Mikhail:

I would say yes to vitamin d. Yeah, during the winter months. Um, again, there's a supplement served different, like nutrients serve different purposes. I mean like, again, if we're looking at immunity, especially during the wintertime again, depending on which time zone you live in I would say okay, it could be worthwhile, if you do not consume, let's say, fruits high in vitamin C, to go on a vitamin C supplement during this time. Check your zinc levels. Zinc is extremely important for immune health. So if your zinc levels are low, potentially supplement during the winter months as well to help support your immune system. So this is why I would say yes and no. I'm not a fan of just jumping on the supplement bandwagon because it's sexy and trendy and it looks cool. You know, having a nice selection of supplements in your pantry, a lot of people rave about it as well, yeah, so this is why you know what I mean it's, it's yeah yeah, no I feel confusing I, I feel you, I totally feel you.

Jennifer Walter:

I, when I I asked, I pulled um, I, just I, I invited you back because a lot of this mirrors a lot of conversation I had in my DMs when I once asked okay, what should I, what topic should I cover? On um, the city grad podcast next, and they're like oh, perimenopause, like what's going on, female health, blah, blah, blah. And one question that came up was, too, it was all this kind of like the changes in, like skin elasticity, if you want right, like the other big buzzword. I feel that's right now it's very going strong is collagen? Collagen? Well, like, what can we do to like not need bodocks, or like, I mean, what is the buzz behind collagen? Like, is there? Do we need to supplement this? Like what's going on?

Sandra Mikhail:

look in a. In a nutshell, I would say again yes and no. We do produce less and less collagen. I'm trying to be very Swiss about this. We do produce less and less collagen as we age Doesn't make sense to have a collagen supplement daily. I would say again, yes and no, depending on your finances. If you do have some spare cash that you don't, you're happy to kind of you don't know what else to do with it Exactly Then, yes, you can definitely jump on a collagen supplement, but you also be you need to be very wary about the quality.

Sandra Mikhail:

So there is again I don't want to mention any specific brands, but, yes, I am very picky when it comes to collagen supplements and there's potentially only one brand that I work with because it's been tested high quality collagen supplement and again, this is anecdotal but I have seen it work with my clients. Now, why do I use collagen? The only time, to be honest with you, that I have used collagen within my practice is for anyone that is going through recovery after an orthopedic injury, so potentially after shoulder surgery or they've had some sort of sport injury. I do notice that. I'm not going to say it speeds up recovery, but potentially it does. So we do notice whether it's athletes or just the recreational you know, average Joe or Jane um get back quicker to their regular, let's say, training routine.

Sandra Mikhail:

Um, again it goes back to are you getting enough protein from food? Right, so you need to. You know if, at any point, before jumping on the collagen bandwagon, just make sure you are to. You know if, at any point, before jumping on the collagen bandwagon, just make sure you are prioritizing where your protein comes from. And then, if you have the extra spare cash, by all means go for a collagen supplement.

Sandra Mikhail:

One of the side effects of taking, you know, a good quality collagen supplement, you do notice better skin, you do notice stronger hair and nails and for anyone, let's say again within that age group group, if we're looking at bone health or joint health, there is some good quality research. They're looking at joint health and improving it. So, again, collagen is what you know. I don't want to bad mouth it because there is some decent science out there, but again, it really comes down to the actual brand because you know it can be extremely high in heavy metals. Um, you know, there is no potentially such thing as vegan collagen at this point. I know there's going to be lab, you know, lab manufactured vegan collagen. Because when you look at where your collagen comes from, it either comes from especially from a supplement perspective bovine, so your cattle or marine sources. So this is, you know, this is where the source of collagen comes from so this is.

Jennifer Walter:

You know, this is where the source of collagen comes from. And this, yeah it. This brings us into I don't know it's, it's a detour, but this brings us into the whole. Let me give me the eye roll, I know, and the whole, like bone broth cult, I'm scared, no, but I mean you know, look, bone broth is more of a cultural thing.

Sandra Mikhail:

It's quite comforting, there's nothing wrong with it. But yes, there are certain circumstances where you need to be very, very mindful, because using bones and and marrow, etc. You can you know if, if you do consume them very, very frequently, it can backfire purely because of the heavy metal content in them, especially looking at lead, for example. So this is what I would say, all within reason. You know, too much of a good thing can actually be be bad. So I'm not again, I don't want to, I don't want to nitpick and bad mouth, all these things. But you need to know that food works in synergy. You can't just say, like bone broth is a miracle of miracle food. Um, it is absolutely not. It is very big in certain cultures. I mean, who wouldn't like a broth?

Jennifer Walter:

if you're not feeling, well, oh yeah, I mean, I know my grandma used to make one with bone marrow Same and it was like very comforting, very comforting, and there's absolutely nothing wrong with that.

Sandra Mikhail:

But I just think, you know, don't over sensationalize certain foods. Yeah, because I don't think, and I'm not don't think, I know that the science really doesn't back it up.

Jennifer Walter:

Okay, that was just kind of see to it. I want to go back to what you said before, like the whole test, not guess um theme, and it really brings us back to we've covered a lot of things, a lot of symptoms, a lot of things you can generally do like watch your macros and things like that.

Sandra Mikhail:

The other thing hold on before cutting you off. Actually talk about macros. I just hit. I was like, hey, I talk about poo for a living. I mean, gut health is at the center of what I do.

Sandra Mikhail:

Fiber you need to find the right amount of fiber for you that works for you and works for your gut health. But also you will notice that you will works for your gut health, but also you will notice that you will need to change and adapt depending on what you're experiencing. I mean, look, we all experience gut turbulences throughout our cycle and this is where you need to adjust. A very, very simple example let's say, during PMS or that end of that luteal phase right before your period, a lot of women complain I'm constipated. So this has to do with progesterone's role, basically as it declines and causing a sluggish gut. So potentially, during that period, you need to up your fiber intake a little bit. Maybe add some ground flaxseed, maybe have your kiwi fruit every day, and then for some women, as soon as their period arrives, they just switch diarrhea and lose stool. So this is where, again, you might need to be mindful of the different types of fiber that you're consuming.

Sandra Mikhail:

The reason why I'm highlighting fiber so much because fiber nourishes your inner ecosystem. So you've got microbiome and we are starting to see this gut hormone connection. So there's this whole collection of microbes called the estrobilone that we're starting to learn more about and we're starting to look at. Hold on, do you actually play a role in metabolizing estrogen or breaking it down or recycling, et cetera? So what we know is we want to nourish that inner ecosystem. So this is where fiber comes to play, or the power of 30. So making sure you're including 30 plant ingredients per week. This is where I come in as a gut health specialist. Dietitian is I do help people again translate how do I get this 30 in? Because it can be very, very overwhelming for people, especially those who really want to eat seasonal.

Sandra Mikhail:

It sounds like a lot like 40. Exactly, but it's not. I mean, if you use a nut and seed mix, you can easily get five to six points right there in one tablespoon. So there's a lot of things that you can do. You know, a rule of thumb just at least one meal a day, make sure you've got three different types of vegetables, make sure that you've got one to do handfuls of veg at mealtime. So there's a lot of different ways that you can implement these, these tactics, or this, these hacks, if you want to call them, not to overwhelm the system, and just you know. And then obviously, there's a lot of guilt associated if I don't meet this, or it's really hard to meet that.

Jennifer Walter:

Again, you need to find ways to make these recommendations work for your reality yeah and don't, and how to not go on the guilt bandwagon like we don't want a guilt, we don't want shame.

Sandra Mikhail:

It's not helping us absolutely, it's just gonna backfire.

Jennifer Walter:

I always say it's wasted energy, absolute waste of energy, big time thank you for that cutting in no worries, please proceed I thought like we, we went like what, 30 minutes without center talking about poo, like what's going on?

Sandra Mikhail:

I know, I know this is just like quite shocking. It's just like and it's how do you say? It's like just this, this built-in thing that I need to break.

Jennifer Walter:

I see it had to go out, it had to like just it was bubbling up the whole test not guess. I think this brings us to another thing, important part that we briefly covered at the beginning Like, there's a lot of like women's health is under research. It's also really hard to advocate for your, your, your health, because a lot of doctors I don't know when they went to school that was not part of the curriculum and we're at this age where we should get regular blood work.

Sandra Mikhail:

Yeah well, again, it depends how regular so I do. Yeah, like I was gonna say, the rule of thumb is once a year. Okay, rule of thumb once a year. Just there's a whole panel that I advise my clients to get, either through their gps and there's some great gps out there, you just need to find the good doctors out there and build your team um or through labs that pretend you know, for example, I directly work with. So there's like this panel that you should be getting with the basics once a year. Then we kind of take it one step further. If you have had a, you know, a history of certain deficiencies, it's always good to maybe get them checked once every six months just to make sure that your levels are within range. So this is kind of the general rule of thumb, but then there's a whole other.

Sandra Mikhail:

You know, this whole world of testing can also be quite overwhelming, especially when it comes to hormones. Now, I am not the one, I'm not the expert at all when it comes to hormonal tests etc. Again, that's your gynecologist and endocrinologist. But there's a ton of these tests that you can do at home and these are the ones that I would advise against, because they are confusing. They are going to drag you down a rabbit hole of absolute misinformation and anyone selling these at-home tests guaranteed are going to sell you a supplement to balance your hormones. This is an absolute guarantee.

Sandra Mikhail:

So one of the most common confusing tests out there, and maybe I'm actually going to link up a really good review about it I don't want to talk too much about it, but it's about this Dutch test. So the Dutch test is an acronym for I think it's dried urine test for comprehensive hormones. So this whole hormonal panel you get to, you know it's a urine test over a two day period and it tests the metabolites of these specific hormones and actually in clinical practice there is no such thing as looking at the metabolites, which is like the broken down elements of the specific hormonal panels. Now there is a lot of controversy and a lot of rebuttal, especially when it comes to the companies that have created these tests as well. But I would say say maybe this is just a quick shout out to dr jen gunter, who, um, I think is an absolute fantastic. You know she's brilliant. No fucks given really exactly.

Jennifer Walter:

She's like she's.

Sandra Mikhail:

She's on the right side of history she, she is, um, she's someone that will bust all this, all the amount of misinformation out there, especially when it it comes to female health and hormonal health. So I would, as I said, when it comes to these hormone tests, be very, very wary, because they're to date. You know from a clinical and in clinical practice we don't. I mean that's the same thing in nutrition. You'll get a lot of these at home food intolerance tests, etc. So anyone promoting these tests are a red flag. So this is, I was gonna say, if someone is promoting the dutch test, and actually you'll be surprised, some dieticians do, um, even some doctors do. Anyone with a dog. You know that that's the thing people are, so confused they were like but I thought you people are accredited, you guys have some sort of ethical standards. Some people, you know, fuck the ethics, I can make money out of it. So this is the issue that we're falling into.

Sandra Mikhail:

My role is to really educate and empower people, to help them navigate this world of misinformation. And I always say be critical and even question me, question my advice. You're entitled to question someone. So don't don't. Just, you know, always take things with a grain of salt, but if something sounds too good to be true. It is too good to be true. So this is another thing you know. Maybe that takes us to the topic of how can I spot a quack online?

Jennifer Walter:

yeah, what are the red flags? Red?

Sandra Mikhail:

flags, so we I said selling you some you know at home test to do whether it's a food intolerance test or a hormone test. Um, if they're overusing the word cleanse and detox, so that is definitely another oh yeah, that's, that's a no for me.

Jennifer Walter:

That's, I'm like, yep, I'm out fear I was gonna say.

Sandra Mikhail:

The other thing is fear-based marketing. You know a lot of these fear-mong messages, because they're going to offer you a safe alternative afterwards, they're going to offer you the natural way to do it. You know, and we do see that within the realm of hormone health too.

Jennifer Walter:

Or the one thing to, there's always also like a red flag, the one thing to lose? Belly fat or something. There's never one thing.

Sandra Mikhail:

And I might get a lot of hate for this, but if anyone starts to okay, a few things, maybe I was going to say a few keywords. Holistic is one, because I don't need to mention that, I don't have to rave about. We are holistic in nature as health practitioners as well. I mean doctors should be.

Sandra Mikhail:

This should be our basic procedure, our standard operation within the medical field, because I do come from that medical field. As we are holistic in nature, I'm not going to sit there and rave about it. Functional is another word or keyword. Oh, functional medicine.

Sandra Mikhail:

Yes, that's a big, that's a big buzzy thing I was gonna say functional medicine, but again it ties into this whole the root cause. If anyone puts somewhere, please run away or just swipe next. So these tend to be certain keywords to kind of just be a little bit mindful of Anyone that's got any celebrity endorsements using a lot of testimonials. Actually, because I am still regulated by a board so, like I'm accredited in Australia by Diet, by dietitians australia, we're actually not allowed to use testimonials, so within our code of conduct we cannot use testimonials. So this is where you'll notice a lot of these supplements will use testimonials instead of clinical evidence. But even when you look at the evidence, it's either you know on test tubes or I think we're talking about you know done on exactly lab rats or animal studies, or even if it's done on humans, again you need to look at the quality of the research. Now the general public do not know epidemiology. They don't know how to decipher which is okay.

Jennifer Walter:

Right, it's, which is okay, but I want to I want to tie in here because you use you like, set it too fast. And I want people to understand because it's not just medical, it goes for online coaching, it goes for life coaching, goes for all the shit. Yeah, the use of testimonials, the quantity of testimonials and its purpose is to suggest a legitimate like to be legit in quantity. Right they're. They're taking what they experienced on their body, in their life, on their money, mindset, blah, blah, blah, and try to make it from one body to everybody by the use of like a gazillion of testimonials, but lack any scientific relevance, so rant over.

Sandra Mikhail:

So that's why, yeah, but that's exactly, absolutely, and I back you up 100. This is why you will not see testimonials on our website. I'm not allowed to use them, but I don't I'm not gonna say I don't see the value in them. Obviously it's like I do want people to rate and review us, so they publicly do that and I don't clearly have control over what they say. So this is where I would say just be mindful of of the placement of these testimonials and you'll notice oh, they've got like 4 000 reviews, but what? What does that mean?

Jennifer Walter:

yeah, yeah, 100 like. I love. I love a good story and I love when someone had success with what they're doing, when they heard something on a podcast or they were working with me or whatever, and this is cool. But I'm never using it as from a like oh, she achieved this, well, just because of me, anyway, right, and to know, like doing on her own, and then she did it, so you can too, and it's just like nah, no, no, but do we have more red flags? I feel one of my biggest red flags when it comes to like do I need to like watch this tiktok or just scroll by. Is anyone who calls themselves king or queen of something that I'm like God, dear Lord, like just or goddess, yes, goddess.

Sandra Mikhail:

We're looking at you glucose goddess, Exactly Again, I don't, you know. Sometimes I know we laugh about it, but trust your gut. If you have any sort of little tingling in your gut going not quite sure about that, Trust it. That first instinct, it's right's right yes, it always is so.

Jennifer Walter:

Whenever, yeah, and maybe just sometimes you need to really pause a moment. So before you like, try to apple car, apple pay your way to the next like supplement, just pause or delete apple pay from your phone so you actually have to go get your credit card and then when you're back, you're like no wait, brief, I don't actually need this shit absolutely look, I'm 100 with you.

Sandra Mikhail:

You need to know that social media is curated, especially I mean nowadays, not just social, but every like. This whole world of marketing is curated to take advantage of your searches, your vulnerabilities, what you know, your uncertainty and, again, being female with all the hormonal fluctuations that we are meant to go through again this whole again another maybe red flag and we can potentially wrap the red flags up is hormone balance. Yes, you will notice, or balance your hormones. I mean, again, what are we trying to balance here and why? I think it comes down to that level of fluctuation that we're looking into, if there are any certain hormonal imbalances that you know, if we're looking at thyroid issues, if we're looking at PCOS and demetriosis yes, these are examples of which there are you know that level of fluctuation is way over and we need to look into it more.

Sandra Mikhail:

But, generally speaking, our hormones are meant to fluctuate. They're designed to fluctuate Exactly. They're dancing. You know it's an intricate dance and I always say it's just that level of how off that dance is. We need to investigate and look into it a little bit more. So just be mindful of all these trending words and trending keywords because, at the end of the day, you know when you scroll down they are going to sell you something yeah, always follow the money.

Jennifer Walter:

Yeah, right it's. It always comes down to this, like think about how who is profiting of you feeling bad and sorry for your body? And if it's something that like, if you feel concerned about your lack of sleep or your let it know loss of skin elasticity or whatever, that's legit if you feel concerned about it, but always ask yourself if the concern is truly yours or if it has kind of, like, been instilled in you exactly, couldn't get any more. Yeah, so, sandra, thank you so much for renting. I kept it relatively clean.

Jennifer Walter:

I was gonna say, I think I kept it relatively clean no ptr maybe thank you so much for bringing me on though where can people find you when they want to hear more of you?

Sandra Mikhail:

tell us the easiest would be the website, so that's nutrition-azcom. I am on instagram, although, again, I have a love-hate relationship with social media, so that's nutrition a to z by sandra mctale. I also have a podcast which I co-host with my dad, so that's the Gastroenterologist and His Daughter, which we launched last year, and LinkedIn. I would say these. This is probably oh, and the book. I'm so bad so I did launch a book last year. So if you are going to link it in the show notes I show, I was gonna say if you are confused about gut health and want to learn about, you know the seven most common gut conditions people struggle with and you know breaking the taboo around poo, then grab a copy.

Jennifer Walter:

but it has the best intro into a book ever thank you for that.

Sandra Mikhail:

I was gonna say spoiler spoiler.

Jennifer Walter:

No, we're not gonna tell you gotta buy the book. Uh, we're gonna link it in the show notes. And speaking of books, I always have one last question before I let anyone off the hook. What book are you currently reading or what audiobook you're listening to?

Sandra Mikhail:

I just finished matt haig's the life impossible oh I loved it. Very, very different from his usual books. I mean, he's the author of the midnight library, which is one of my favorite books out there yeah, so the life impossible. I mean, I finished it within a couple of weeks and that's okay I know I'm on the well. One of my goals for this year is to have, you know, finish one book a month and I'm, I'm, I'm on a roll.

Jennifer Walter:

Yay, go you. Yeah, maybe I'm like a book every two months. That's kind of like currently my speed, but it's not about speed.

Sandra Mikhail:

Exactly, I was just about to say that.

Jennifer Walter:

So, sandra, thank you so much for being on the Cine Group. Thank you again, and just like that, we've reached the end of another journey together on the scenic route podcast. Thank you for spending time with us, curious for more stories or in search of the resources mentioned in today's episode, visit us at scenicrootpodcastcom for everything you need. And if you're ready to embrace your scenic route, I've got something special for you. Step off the beaten path with my scenic route affirmation card deck. It's crafted for those moments when you're seeking courage, yearning to trust your inner voice and eager to carve out a path authentically, unmistakably yours. Pick your scenic route affirmation today and let it support you. Excited about where your journey might lead? I certainly am. Remember, the scenic route is not just about the destination, but the experiences, learnings and joy we discover along the way. Thank you for being here and I look forward to seeing you on the scenic route again.

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