Ep. 649 Hormone Therapy After Hysterectomy |Menopause, Perimenopause, Hormone Health

Welcome to this week’s Midlife Minute! Today, I examine partial and full hysterectomies and what we know about their potential long-term effects, clarifying what the research tells us about bone, brain, and cardiovascular health, and what women should discuss with their healthcare providers before and after surgery. IN THIS EPISODE, YOU WILL LEARN: How a partial hysterectomy differs from a full hysterectomy, and the abrupt estrogen changes ovarian removal can produce  Why having a hysterectomy before ages 40-45 can have a greater impact than having surgery closer to natural menopausal age. How a hysterectomy can impact women’s bone health What the research reveals about the connection between surgical menopause at a younger age, cognitive decline, and Alzheimer’s pathology How a hysterectomy can affect women’s cardiovascular health Why starting HRT early after an early-age hysterectomy could be important for your long-term health Why younger women who experience surgical menopause may require higher estradiol doses than the standard menopausal regimens The importance of advocating for yourself, understanding your personal risk, and talking with your clinician about estrogen and other hormone therapy before undergoing surgery Quotes: “Start those conversations early- before you ever have surgery.” “If you are having these surgeries done before 45, before 40, you need HRT!” “We have to manage our stress.” “We have to get enough sleep.” “We should be strength training.” “We should be physically active.” “We should be eating an anti-inflammatory diet.” Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Research: Increased Risk of Osteoporosis With Hysterectomy: A Longitudinal Follow-Up Study Using a National Sample Cohort. American Journal of Obstetrics and Gynecology. 2019. Choi HG, Jung YJ, Lee SW.  Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al. Cardiovascular Disease After Hysterectomy in the Nurses' Health Study and Nurses' Health Study II. Obstetrics and Gynecology. 2025. Thao V, Borah B, Stewart EA, et al. Treatment of Women After Bilateral Salpingo-oophorectomy Performed Prior to Natural Menopause. The Journal of the American Medical Association. 2021. Kaunitz AM, Kapoor E, Faubion S. Hysterectomy, Oophorectomy, and Bone Health: A Systematic Review and Meta-Analysis. European Journal of Endocrinology. 2025. Shariful Islam M, Tuesley KM, Wilson LF, et al. Risk of Osteoporosis and Fracture After Hysterectomies Without Oophorectomies: A Systematic Review and Pooled Analysis. Osteoporosis International. 2022. Xu W, Wu W, Yang S, et al. Hysterectomies Are Associated With an Increased Risk of Osteoporosis and Bone Fracture: A Population-Based Cohort Study. PloS One. 2020. Yeh YT, Li PC, Wu KC, et al. Age at Surgical Menopause Influences Cognitive Decline and Alzheimer Pathology in Older Women. Neurology. 2014. Bove R, Secor E, Chibnik LB, et al. Reproductive Period and Risk of Dementia in a Diverse Cohort of Health Care Members. Neurology. 2019. Gilsanz P, Lee C, Corrada MM, et al.  Examining the Association of Hysterectomy With and Without Oophorectomy on Cardiovascular Disease and All-Cause, Cardiovascular or Cancer Mortality: A Systematic Review and Meta-Analysis. BJOG: An International Journal of Obstetrics and Gynecology. 2024. Chen Y, Li F, Liang L, et al. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. The Journal of the American Medical Association. 2019. Honigberg MC, Zekavat SM, Aragam K, et al Optimizing Health After Early Menopause. Lancet. 2024. Mishra GD, Davies MC, Hillman S, et al. Hormone Replacement Therapy for Women Previously Treated for Endometrial Cancer. The Cochrane Database of Systematic Reviews. 2018. Edey KA, Rundle S, Hickey M.

Today, I’m delighted to connect with Dr. Erin Kinney. She’s a naturopathic medicine doctor and the founder of the Kinney Clinic, which focuses on hormone replacement therapy, nutrition, adrenal health, thyroid, and lymphatic system issues. Dr. Kinney is also the stress reset expert and author of The Cortisol Cure. In our conversation, we explore cortisol debt, how to recognize it through self-assessment, and why Dr. Kinney believes we need to change the narrative around stress. We discuss ways to modulate the autonomic nervous system, specifically the parasympathetic, the true drivers of low cortisol, including sleep and circadian rhythm disruption, overtraining without adequate recovery, nutrient depletion, chronic or stealth infections, and unresolved trauma. Dr. Kinney explains how Lyme disease, Epstein-Barr virus, and mold and mycotoxin exposure can contribute to more pronounced stress responses, and we examine the influence of caffeine, alcohol, and stimulants; calming supplements for stress and sleep; the gut-brain axis and gut immune dysfunction. Dr. Kinney also shares her preferred strategies to regulate cortisol easily and effectively. Stay tuned for a truly enjoyable conversation with the delightful Dr. Kinney. Her book, The Cortisol Cure, is a great resource for anyone suffering from multiple stress-related issues. IN THIS EPISODE, YOU WILL LEARN: What “cortisol debt” means The value of short, intentional periods of rest for training the “relaxed muscle” How low cortisol can involve both external and internal stressors How early trauma can train the nervous system to stay activated  Why alcohol may lead to disrupted sleep and anxiety  How caffeine and stimulants can increase your energy debt Why supplements cannot replace foundational practices that support stress-response regulation Dr. Kinney’s preferred supplements for calming the autonomic nervous system How a poorly functioning gut can impact immune cells, thyroid-hormone conversion, and the body’s immune response Dr. Kinney shares three repeatable practices to begin regulating cortisol Bio: Dr. Erin Kinney is a naturopathic doctor, author, and speaker specializing in hormonal health and the effects of chronic stress. She is the creator of the “Cortisol Bank Account” framework, the foundation of her book The Cortisol Cure, which breaks down complex stress and hormone science into a simple, accessible approach that helps readers understand what’s happening in their bodies and how to start feeling better. She founded The Kinney Clinic in Annapolis, Maryland, where she helps high-functioning men and women get to the root of fatigue, hormone imbalance, and chronic health issues so they can reset their stress response, boost their energy, and feel better than ever. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Erin Kinney The Kinney Clinic  On Instagram The Dr. Kinney Show

This episode is sponsored by Life Extension. I am delighted to have Dr. Crystal Gossard, the Manager of Education at Life Extension, joining me today. Dr. Gossard is a Doctor of Clinical Nutrition with over 15 years of experience in nutrition, fitness, dietary supplements, and integrative functional medicine. In our conversation today, Dr. Gossard and I discuss uncommon heart health testing, including gaps in care for women in perimenopause and menopause, and clarify the critical importance of a bioindividual personalized approach. We dive into specifics on labs, including ApoB as a direct measurement, the influence of glycation, insulin resistance and insulin sensitivity, LP(a), and high-sensitivity CRP as both a marker of systemic inflammation and a targeted inflammatory profile marker. We also cover oxidized LDL, inflammation and oxidative stress, the importance of CoQ10, and screening modalities like coronary artery calcium scoring, CCTA, CT angio, and Cleerly, and minerals, including magnesium and its role in over 600 enzymatic reactions in the body. ***Try Life Extension https://www.lifeextension.com/Cynthia10labs @LifeExtensionWelleness and save $10 on orders of $50 or more, plus free shipping, with code: Cynthia10 IN THIS EPISODE, YOU WILL LEARN: The importance of advanced lab testing for cardiovascular and metabolic health in women, particularly during perimenopause and menopause What ApoB reveals about cardiovascular risk Why Dr. Gossard considers LP(a) a one-and-done test How elevated high-sensitivity CRP can indicate inflammation “simmering” in the background How to manage inflammation through nutrition How Dr. Gossard explains oxidized LDL The value of CoQ10 for oxidized LDL When should someone move beyond lab work to cardiovascular screening? What magnesium testing can reveal How magnesium supports the body  Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Crystal Gossard Life Extension Instagram  LinkedIn Live Foreverish Podcast Try Life Extension and save $10 on orders of $50 or more, plus free shipping, with code: CYNTHIA10.

I’m thrilled to reconnect with microbiome expert Kiran Krishnan today. Kiran co-founded Just Thrive and previously served as Chief Scientific Officer at Microbiome Labs. He has more than 16 years of experience in the dietary supplement and nutrition industry, with postgraduate research experience in molecular biology and virology. In today’s conversation, we take a deep dive into the science of spore-based probiotics, their ecological impact, how they interact with the existing gut microbiome, their potential to address dysbiosis, and why standard probiotics fail to survive stomach acid in meaningful numbers. We explore research on osteoarthritis, catabolism, and the gut-hormone connection, discussing how declining bacterial diversity may influence the metabolic and hormonal changes associated with perimenopause and menopause. Kiran explains the role of the pathobiome and endotoxemia, how the gut-brain axis can influence inflammation, and the importance of gut-barrier integrity, neurotransmitter production, and vagal nerve signaling in regulating the immune system. We also discuss the differences between fiber, resistant starch, polyphenols, fermented foods, prebiotics, and postbiotics, and Kiran shares his perspective on the carnivore diet, its potential impact on the microbiome, and key insights into SIBO. Stay tuned for today’s fascinating and informative conversation with Kiran Krishnan. IN THIS EPISODE, YOU WILL LEARN: Kiran explains the science behind spore-based probiotics Why spore-based probiotics can survive stomach acid better than many standard probiotics  How inflammation can inhibit the growth of beneficial gut bacteria How bacterial diversity in the gut decreases during perimenopause and menopause Why awareness of endotoxemia remains limited within the broader medical community Kiran explains how the gut-brain axis helps the body respond to its environment What prebiotics and postbiotics actually do Why an inability to tolerate fiber may point to a problem with the underlying biology rather than the food itself How SIBO and SIFO can be symptoms of a more complex underlying problem Bio: Kiran Krishman, Ph.D. Kiran is a research microbiologist and a health and wellness expert who aims to make complex information understandable to all. He has founded several successful health and supplement companies over the last 15 years, including co-founding and leading Microbiome Labs, a preeminent microbiome therapeutics-focused brand among healthcare professionals. He is currently a co-founder and partner in 3 other companies that aim to revolutionize wellness care. He has conducted and published several research studies in scientific journals, published chapters in scientific textbooks/references books, holds global patents, and is a sought-after speaker on human health and the microbiome. Connect with Cynthia Thurlow   Check out Cynthia’s website. Check out the Everyday Wellness Podcast on Instagram! www.instagram.com/everydaywellnesspodcast Follow on X, Instagram & LinkedIn Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Kiran Krishnan The Biome Learning Center: Join Kiran’s circle community to download his free leaky gut guide and 5 pillars for building a resilient gut.

Welcome to the latest Midlife Minute. Today, I answer some listener questions about bone health, osteoporosis, HRT, and the menopause transition. Stay tuned to learn more about bone loss, bone health, and proactive ways to protect your bone mass. IN THIS EPISODE, YOU WILL LEARN: Bone density loss during perimenopause Value of HRT for protecting bone mass during the menopause transition  If you’re using an estrogen patch and your estrogen levels are still low, what should you consider? How women with osteoporosis can continue strength training with guidance from a licensed medical provider What highly-active women who consistently under-fuel their bodies may experience Conditions and medications that could contribute to low bone density The value of DEXA scans and bone health markers Bone loss may accelerate during menopause  How HRT for osteoporosis prevention differs from HRT for established osteoporosis The benefit of AMH and FSH labs for identifying women who may benefit from earlier intervention Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line

I’m thrilled to reconnect with Roseann Capanna-Hodge, Ed.D., today. She's a licensed clinical psychologist, board-certified in neurofeedback, and mom of two neurodivergent children. She's also the author of the upcoming book, The Dysregulated Kid. Today, we discuss how midlife women become stressed and how stress is an event and dysregulation is a physiological state. We also explore emotional regulation, hypervigilance, midlife’s invisible load, strategies to stimulate the vagus nerve, and ways to address both over- and under-stimulated behavior. Stay tuned for today’s insightful and informative conversation with Roseann Capanna-Hodge. You’ll walk away with tangible strategies for yourself and your family members, too! IN THIS EPISODE, YOU WILL LEARN: How stress “creeps in” through everyday pressures and affects the nervous system Why some coping strategies that worked earlier in life may become less effective or maladaptive amid midlife hormonal and neurological changes  The value of practicing belly breathing and other regulation strategies in “micro little bits” throughout the day How emotional regulation can help change dysregulated patterns passed down through families. How explaining regulation through science can reduce shame and help children become more receptive to these strategies. Why caring for a dysregulated child can be especially triggering for parents with difficult childhoods or histories of dysregulated parenting How women carrying an “invisible load” can find small openings to practice regulation strategies throughout the day How nutrition can support emotional regulation and affect focus, motivation, irritability, anger, and hyperactivity How using brief regulation practices, movement, breathing, touch, and daily routines can help manage chronic stress.  Why regulating the nervous system should come before, or support, other interventions Bio: Roseann Capanna-Hodge. Ed.D. is a leading expert in emotional and behavioral dysregulation with more than 30 years of experience helping families transform chaos into calm. As the creator of Regulation First Parenting® and the CALMS Dysregulation Protocol®, she bridges clinical science with everyday parenting so families can finally understand what’s really driving their child’s struggles. Specializing in nervous system dysregulation, the root cause of challenges like ADHD, anxiety, OCD, mood disorders, and PANS/PANDAS, Roseann gives parents and professionals brain-based tools that create lasting change without blame, shame, or guesswork. Through her bestselling books, upcoming book The Dysregulated Kid, and top 1% podcast, Dysregulated Kids, she has helped thousands of families support their child’s brain, behavior, and emotional well-being in practical, hopeful ways. Featured in The New York Times, Forbes, and Parents Magazine, Roseann is on a mission to bring Regulation First Parenting™ to every home so that children can thrive and families can finally feel calm again. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Roseann Capanna-Hodge, Ed.D Website Social media: @Dr Roseann Order Roseann’s NEW book, The Dysregulated Kid.

I’m honored to reconnect with Dr. Felice Gersh today! She is a multi-award-winning physician with dual board certification in OB-GYN and Integrative Medicine. We connected once before in Episode 221, where we spoke about PCOS and metabolic health. Today, Dr. Gersh joins me to dive into perimenopause and menopause. We discuss various issues surrounding the Women’s Health Initiative and talk about estrogen as a family of hormones, estrogen-mimicking chemicals, synthetic hormones, and oral contraceptives. We cover the importance of thyroid function, the pro-inflammatory state associated with estrogen loss in perimenopause and menopause, and the role of nutrition and exercise in metabolism. We also discuss lesser-known changes that occur in menopause, including changes in body odor, constipation, sarcopenia, osteoporosis, and vocal changes.  I plan to invite Dr. Gersh back to discuss women and mitochondrial health, and then again to talk about her latest book, Menopause: The Fifty Things You Need to Know.  Stay tuned to find out what menopause really is, and what it does to a woman’s metabolic system. IN THIS EPISODE YOU WILL LEARN: Dr. Gersh discusses the Women’s Health Initiative study and its devastating effects. The difference between synthetic and bioidentical hormones. How chronic diseases of aging can be delayed when hormones are incorporated along with other lifestyle refinements. What do hormones do? Why every immune cell in the body has receptors for vital hormones. Menopause may not be defined by a specific moment in time. Physiological changes that occur during the perimenopause years How hormones can change the perimenopause paradigm entirely. Perimenopause and sleep issues Phytoestrogens - nature’s gift to women Connect with Cynthia Thurlow Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Felice Gersh Website:⁠ Integrative Medical Group of Irvine⁠ Instagram⁠ Dr. Gersh’s books are available on ⁠Amazon⁠ Previous Episode Mentioned ⁠Episode 221 on PCOS with Dr. Felice Gersh⁠

Today, I’m honored to reconnect with fan favorite, Dr. Tom Dayspring. Dr. Dayspring is a fellow of both the American College of Physicians and the National Lipid Association, and is certified in internal medicine and clinical lipidology with extensive experience in perimenopause and menopause management. He has been a frequent contributor and educator at Everyday Wellness. In this episode, we discuss labs that help to monitor changes in insulin resistance (specifically the LPIR score), the clinical practice limitations Dr. Dayspring believes stem from a lack of humility, and aspects of women’s medical histories that may indicate greater heart disease risk. We examine statin therapy and other treatment modalities, premature menopause and cardiovascular disease risks, Lp(a) as the primary inherited risk factor for heart disease, and current guidelines, treatment goals, and recommendations. Dr. Dayspring also shares his thoughts on estrogen patch shortages and oral estradiol therapy challenges with elevated triglycerides. As always, this is an invaluable conversation with Dr. Tom Dayspring. Stay tuned for an upcoming podcast with Dr. Dayspring, where we'll focus on lipids and brain health. IN THIS EPISODE, YOU WILL LEARN: Lipoprotein changes and how they can reveal insulin resistance before fasting insulin or glucose begin to rise Why someone can be insulin resistant while showing normal triglyceride levels The importance of looking at a woman’s broader medical history to find potential cardiovascular risk signals Why premature menopause and premature ovarian failure should be taken seriously as cardiovascular and long-term health risk factors How Lp(a) is the most inherited risk factor for atherosclerotic heart disease across the population Why women may benefit from repeat Lp(a) testing around the menopausal transition What clinicians may address when Lp(a) is elevated, including other modifiable cardiovascular risk factors Oral estrogen may have a beneficial effect on Lp(a). How epidemiological evidence has linked endometriosis with heart disease Why Dr. Dayspring recommends checking ApoB when triglycerides are elevated Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Tom Dayspring On X (@DrLipid) LinkedIn

Welcome to the latest Midlife Minute. This episode unpacks ongoing research on Lp(a), explores how women’s lipids change during the perimenopause-to-menopause transition, and clarifies what we can do about it. Stay tuned for more! IN THIS EPISODE, YOU WILL LEARN: How total cholesterol, LDL, and ApoB tend to rise most steeply around the final menstrual period, rather than increasing gradually with chronological aging Why women should have their Lp(a) checked both before and after menopause How oral and transdermal estradiol can affect LDL, HDL, triglycerides, and Lp(a) differently Why I recommend including ApoB when checking your lipids during the perimenopause window How your lifestyle can reduce your cardiovascular risk, even when your Lp(a) is elevated Why omega-3 fatty acids and commonly used lipid medications do not lower Lp(a) Why supplements are not replacements for statins in genuinely high-risk patients  I review the various PCSK9 inhibitors currently available, how they are administered, and their effects  How a CAC, a CT angiogram, and an AI-assisted CT angiogram can help women and their providers determine how aggressive their approach should be when Lp(a) is elevated Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line References: 1. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al.Guideline 2. Menopause: A Cardiometabolic Transition. The Lancet. Diabetes & Endocrinology. 2022. Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T.Review 3. Dyslipidemia Across the Menopause Transition: Mechanisms, Trajectories, and Opportunities for Cardiovascular Prevention. Maturitas. 2026. Castaneda R, Tatit CP, Hurtado Andrade MD, Faubion SS, Shufelt CL.RecentReview 4. Lipoprotein(a) and Women's Cardiovascular Health: A Review. JACC. Advances. 2026. Michos ED, Saucier S, Mehran R, Koschinsky ML. 5. Lipid Metabolism in Women: A Review. Atherosclerosis. 2025. van Oortmerssen JAE, Mulder JWCM, Kavousi M, Roeters van Lennep JE.Review 6. Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?. Journal of the American College of Cardiology. 2009. Matthews KA, Crawford SL, Chae CU, et al.Observational 7. Trajectories of Lipids Around the Menopause Transition in Chinese Women: Results of the Kailuan Cohort Study. Fertility and Sterility. 2023. Dai Q, Wu S, Cao Z, et al. 8. Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2020. Newman CB, Blaha MJ, Boord JB, et al.Guideline 9. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2022. Nie G, Yang X, Wang Y, et al.SR 10. Perspectives on Dyslipidemia and Coronary Heart Disease in Women. Journal of the American College of Cardiology. 2005. Bittner V.Review 11. Dyslipidemia in Midlife Women: Approach and Considerations During the Menopausal Transition. Maturitas. 2022. Torosyan N, Visrodia P, Torbati T, Minissian MB, Shufelt CL.Review 12. Effects of gender, age and menopausal status on serum apolipoprotein concentrations.13.Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg     14. Why, how and in whom should we measure levels of lipoprotein(a): A review of the latest evidence and clinical implications. Diabetes, Obesity & Metabolism. 2025. Razavi AC, Bhatia HS, Blumenthal RS, Shapiro MD, Mehta A.RecentReview 15. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. Journal of the American College of Cardiology. 2021. Cicero AFG, Fogacci F, Zambon A.Review 16. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs. 2023. Blais JE, Huang X, Zhao JV.SR 17. Non-Genetic Influences on Lipoprotein(a) Concentrations. Atherosclerosis. 2022. Enkhmaa B, Berglund L.Review 18. NHLBI Working Group Recommendations to Reduce Lipoprotein(a)-Mediated Risk of Cardiovascular Disease and Aortic Stenosis. Journal of the American College of Cardiology. 2018. Tsimikas S, Fazio S, Ferdinand KC, et al.Review 19. Consumption of a defined, plant‐based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clinical Cardiology. 2018. Najjar RS, Moore CE, Montgomery BD. 20. Lipoprotein(a): Current Evidence for a Physiologic Role and the Effects of Nutraceutical Strategies. Clinical Therapeutics. 2019. Santos HO, Kones R, Rumana U, et al.Review 21. Effect of Lipid-Lowering Therapies on Lipoprotein(a) Levels: A Comprehensive Meta-Analysis of Randomized Controlled Trials. Atherosclerosis. 2025. Xie S, Galimberti F, Olmastroni E, et al.Recent 22. Effect of Omega-3 Fatty Acid Supplementation on the Postprandial Metabolism of Apolipoprotein(a) in Familial Hypercholesterolemia. Journal of Atherosclerosis and Thrombosis. 2023. Ying Q, Croyal M, Chan DC, et al.RCT 23.Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024. Nordestgaard BG, Langsted A.Review 24. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2022. Reyes-Soffer G, Ginsberg HN, Berglund L, et al.Guideline 25.Clinical Trial Design for Lipoprotein(a)-Lowering Therapies: JACC Focus Seminar 2/3.Journal of the American College of Cardiology. 2023. Malick WA, Goonewardena SN, Koenig W, Rosenson RS.Review 26.2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American Collegeof Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026. Writing Committee Members, Blumenthal RS, Morris PB, et al.Guideline 27. Noninvasive Coronary Atherosclerotic Plaque Imaging. JACC. Cardiovascular Imaging. 2023. Kwiecinski J, Tzolos E, Williams MC, et al.Review 28. Computed Tomography Angiography Versus Agatston Score for Diagnosis of Coronary Artery Disease in Patients With Stable Chest Pain: Individual Patient Data Meta-Analysis of the International COME-CCT Consortium. European Radiology. 2022. Wieske V, Walther M, Dubourg B, et al.SR 29. Association of Coronary Artery Calcium Score With Qualitatively and Quantitatively Assessed Adverse Plaque on Coronary CT Angiography in the SCOT-HEART Trial. European Heart Journal. Cardiovascular Imaging. 2022. Osborne-Grinter M, Kwiecinski J, Doris M, et al.Clinical Trial 30. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. JACC. Cardiovascular Imaging. 2024. Nurmohamed NS, Bom MJ, Jukema RA, et al.Observational 31. The Lancet Commission on Rethinking Coronary Artery Disease: Moving From Ischemia to Atheroma. Lancet. 2025. Zaman S, Wasfy JH, Kapil V, et al.Review 32. Efficacy and safety of novel lipoprotein(a)‐targeted therapies: A systematic review and meta‐analysis of randomized controlled trials. Diabetes, Obesity & Metabolism. 2026. Santana AUL, Yusufzai MO, Freitas APS, et al. Recent Opinion

Today, I am honored to connect with Dr. Zaldy Tan, a geriatric medicine and memory disorder specialist whose research career has centered on the Framingham Heart Studies Offspring Cohort. Dr. Tan currently directs Cedar Sinai’s memory and healthy aging programs, after previously leading the memory clinic at Beth Israel and Harvard Medical School. His book, Age Proof Your Mind, translates his clinical and research background into a practical framework for people trying to assess and protect their own cognitive trajectory. In our conversation, Dr. Tan explains why middle age is the old age of youth and the youth of old age. We discuss common symptoms of memory issues and those that are reversible. We explore the Framingham Offspring Study and its impact on brain health over time,  looking at the effects of sleep, depression, vitamin deficiencies, alcohol, loneliness, and nutrition, and Dr. Tan shares the three Ds, dementia, delirium, and depression- the red flags he sees in his clinical practice, explains how he helps prepare caregivers for caring for loved ones with neurocognitive memory loss, and discusses late-stage issues, medications, blood-based biomarkers, and the role of genetics in brain health. Stay tuned for a truly fascinating discussion with Dr. Zaldy Tan. IN THIS EPISODE, YOU WILL LEARN: The importance of being sensitive to how your memory changes over time Various factors that could contribute to memory problems The profound effect alcohol has on the brain and neurologic function How social isolation can increase the risk of dementia in future years Dr. Tan discusses the Framingham Offspring Study and the links between metabolic dysregulation and brain MRI markers of brain aging. How the 3 Ds, delirium, dementia, and depression, can overlap The red flags in a patient’s history that lead Dr. Tan to believe there may be a more serious issue What care partners should be aware of when a family member is experiencing dementia  The importance of protecting sleep and maintaining consistent sleep patterns for those with memory problems How genetic testing is incorporated into Dr. Tan’s care model Bio:  Dr. Zaldy Tan is the Director of the Memory & Healthy Aging Program at Cedars-Sinai Medical Center, which U.S. News & World Report ranked in 2024 as the best hospital on the U.S. West Coast and among the top hospitals in the country. He holds the Carmen & Louis Warschaw Endowed Chair in Neurology and is a professor at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Tan was the founding director of the Memory Disorders Clinic at Harvard Medical School/Beth Israel Deaconess Medical Center. Dr. Tan performs aging and dementia research covered by The New York Times, Time, CNN, The Wall Street Journal, NPR, The Washington Post, The Chicago Tribune, Reuters, ABC News, and NBC News. He regularly speaks at major national and international conferences and is the author of Age-Proof Your Mind and What to Remember When You Are Forgetting. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia’s website. Submit your questions to [email protected]  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia’s book, The Menopause Gut. Cynthia’s Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Zaldy Tan Dr. Tan at Cedars Sinai (Los Angeles)   On Instagram Dr. Tan’s book, What to Remember When You Are Forgetting, is coming out on September 15th, 2026. Pre-order HERE.