Episode 11: A Discussion With Dr. Wolloch M.D., Hormones, Great Sex And Longevity
Transcript:
Welcome to my podcast asking the question, "If Not Now…When? Thank you for joining me today. For more information, visit me at www.ifnotnowwhen.best
I am so excited about today's episode with my special guest, Dr. Emmanuela Wolloch M.D.. I had met her quite a few years ago. She was the keynote speaker at an event I attended. Not only is she a board certified OB/GYN but she's also focused on integrative medicine including disease prevention, women's health, bio-identical hormones, holistic living and I was so impressed with her approach to medicine and women's health that I became a patient of hers. And it's no wonder she won the prestigious Helen Lansman award for the physician with the greatest compassion towards patience.
It's a completely different experience when you sit down with Dr. Wolloch. She doesn't meet you first in an examination room. You sit down with her in her office and she gets to know you and she treats you holistically. What I mean by holistically is looking at our overall health through the lens of diet, lifestyle, including quality of sleep, physical activity, stress levels and understanding how it all impacts our health and longevity. And I can't tell you how honored I am to have her on our show today. It's not often that we have the opportunity to ask candid questions and learn from a doctor with her credentials.
During our conversation we talk about menopause both female and male menopause. We talk about some of the health and life extending benefits of hormone replacement therapy with so many stigmas regarding this topic based on outdated science. And we talk about the difference between bio-identical hormones and synthetic hormones. We talk about great sex in the second half of our lives and some cutting edge therapies and treatments that doctor Wolloch offers helping us look and feel great extending our life and health spans. So without further delay please enjoy my conversation with Dr. Wolloch.
Cindie: So Dr. Wolloch thank you so much for joining us today. I can't tell you how excited I am to have you here. As you know, the heart and soul of my podcast is to help our listeners have an amazing second half of their life and I can't think of a better person to help share some of your wisdom and knowledge that for me has been so personally helpful. So with that Dr. Wolloch tell us a little bit about your story. What made you interested in medicine, gynecology, obstetrics and then more interesting is your interest in integrative medicine and longevity which is such a blessing to find somebody that has combined all of those talents in practices.
Dr. Wolloch: Hello. Thank you so much for inviting me. I'm really excited to be here and share my knowledge with your audience. I was born and raised in Paris and I went to medical school in Paris where at that time, few years ago it was all about learning about the whole body. We did have classes in nutrition. We did have classes in exercise. We did understand that the body was a whole and medical students in Paris in many cities in Europe are trained to be first internist for seven years and then they become specialists if they want to and they take an additional training for two or three years and it becomes specialist. And the reason why I wanted to go to medical school is growing up I always felt a calling to be what we would call nowadays a healer. That word did not exist back then. I was always fascinated by Chinese people who would do acupuncture. And I grew up in a family where my grandmother who was from Eastern Europe would do cupping on me at home. And understand that's being done now by acupuncturist. It's very popular. So for me it was natural. If I had a cold or not feeling well she would put the cups on my back which would bring the blood flow to the area and I would feel better. And I grew up with acupuncture. As soon as I got my first period at age 13 and I have menstrual cramps, my mother took me to an acupuncturist and she was able to help me. So it all came together when I decided to go to medical school. So I then moved to Miami when I was 28 years old and I did my residency, my specialty in obstetrics and gynecology in Miami at the University of Miami. And I decided to choose this field because it's a happy field. I knew I didn't have to deal with chronic illnesses. I knew I could help young women have their children and then follow them through life. I stopped doing obstetrics, which is the art of delivering babies about 20 years ago. And now I do specialty gynecology, longevity or age management. And I love it because I take care of the women I met many many years ago and I help them to go through the transition. Their aging with me together and I even love it more the fact that now they bring me their daughters that I delivered more than 15 years ago
Cindie: Oh my goodness! How fantastic! Aww….
Dr. Wolloch: Yes I'm having goosebumps when I think about it. So I think more about myself as a specialized and proactive internists because I take care of the whole person.
Cindie: Right and I'm telling you it is hard to find somebody or doctors that do holistic or take care of the whole body because it's all interconnected and I have found it to be challenging at times going to specific doctors and they prescribe a pharmaceutical pill and say see you later. But to have somebody that takes the time to really understand your physical health your mental health what your lifestyle is like and work with you and partner with you is so helpful. Before we go any further let's just talk a little bit about OB/GYN, obstetrics and gynecology. What is the difference and then there are some other fields also that I'd like you to talk about urogynecology. I do have a friend who was treated by the wrong doctor or could have been treated by a better specialist in it can be sometimes confusing to understand what each specialty is if you can help us understand that.
Dr. Wolloch: So during the four years of general obstetrics and gynecology residency a doctor is being trained as being a general obstetrician gynecologist. Obstetrics means following a patient, a pregnant patient during the nine months of pregnancy doing the delivery either vaginal delivery or caesarean section and then doing the postpartum care for the next six weeks. That's what obstetrics means.
Cindie: The OB part of the OB/GYN.
Dr. Wolloch: Gynecology is taking care of the non-pregnant women starting at puberty starting with the need to be on birth control pill to prevent pregnancy, taking care of sexually transmitted infections, taking care of polycystic ovaries, hormonal imbalance and menopause surgery. So that's what the general gynecology would do.
Cindie: Great! The GYN part. Tell us about urogynecologist. Help us understand that.
Dr. Wolloch: Urogynecologist are gynecologist who finished the four years of residency as general OB/GYN and then they decide to do a fellowship an additional three years in urology learning all about connection between the bladder, the urethra, the vagina it's all interconnected. Taking care of overactive bladder, urinary incontinence, prolapses meaning when the either the bladder the rectum or the uterus falls down. And it will require surgery. But they also use techniques that are called bio-feedbacks where they learn the patient to do pelvic floor rehabilitation. So it's a combination of medical and surgical but that's all they do. They do not do pap smear they do not do menopause or contraception.
Cindie: Super that is so helpful 'cause it can be confusing sometimes out there. So let's talk a little bit about menopause. I've got a couple questions that I've experienced and I'm sure some of my listeners are or will or have experienced some of these things as well. But first, there's perimenopause and menopause so the difference between the two are what?
Dr. Wolloch: So perimenopause are the five to ten years before menopause. Officially menopause is absence of periods for twelve months. But that's a very old definition. Patience my experience menopausal symptoms even before they start missing periods. That would be called perimenopause. And it's due to a drop in levels of progesterone which is one of the two female hormones. There are two female hormones and two male hormones. The two female hormones are estradiol or estrogens and progesterone. And the first one whose levels go down is progesterone and that's what triggers the night sweats, the irregular periods, or the opposite two periods in a month or heavy bleeding's mood swings, PMS type syndromes. Menopause, it's better usually or it could be worse. In addition to that, it effects hot flashes, short-term memory issues, insomnia. Actually most of my patients come with the symptoms of fatigue, low energy and insomnia as opposed to hot flashes and night sweats.
Cindie: Do you think the insomnia is part of the reason is the hot flashes meaning there hot and they wake up?
Dr. Wolloch: Yes
Cindie: Or is it, yeah, because I think that was my experience. I was just always hot at night and I kept waking up. And I know that I did an episode on good sleep and I know that 62 to 65 degrees is ideal to get that deep sleep. And man I would just I would always be really hot and then that would affect the quality of my sleep.
Dr. Wolloch: Definitely. But sleep is such a complex issue because you can add also stress. Whatever happened during the day.
Cindie: Yes
Dr. Wollach: Has an impact and maybe in your talk you spoke about the sympathetic system versus the parasympathetic system and we need to…
Cindie: I didn't go into that.
Dr. Wolloch: That's very interesting. I talk a lot about it in my practice. I am very interested what's going on in the brain. I also wanted to be a psychiatrist but I couldn't do two residencies. Because I think everything goes back to the brain at the end of the day.
Cindie: Absolutely.
Dr. Wolloch: It's the connection between the mind the body and specially the gut, the gastrointestinal system. And the parasympathetic system is the calming system. Unfortunately we live in the world where it's very difficult to slow down and take deep breath. We are multitasking like never before epically with news on TV on Internet. Or we are always solicited. People expect an answer from us right away. And that activates the bad system, the sympathetic system which releases the adrenals and that conveys into bad sleep because it it continues throughout the day and the night. And people wake up also because they cannot quiet their minds.
Cindie: Yes
Dr. Wolloch: It's still active. I am sure so you spoke about some supplements to take and things like not going on your iPad or computer an hour before sleep.
Cindie: Right, that blue light, right. I wanted to ask you about all of these; the hot flashes, the night sweats, vaginal dryness, thinning in the vaginal wall, brain fog, mood swings, weight gain. All of these things if I'm hearing you right, the cause of all of this and the changes in our body is because of the reduction of progesterone and estrogen. Is that's what's causing this?
Dr. Wolloch: Yes. First progesterone and then when a woman hits menopause her blood levels of estrogen reaches 0. Exactly.
Cindie: OK, for listeners that have not gone through menopause yet, kind of the "ready set go". Is there anything from a lifestyle, diet/lifestyle perspective that isn't 100% genetic where we'd say I could influence prior to even perimenopause or in perimenopause my symptoms to reduce those symptoms?
Dr. Wolloch: That's an interesting question because perimenopause and menopause is actually genetically determined. It's more important to ask your mother how old she was when she went through menopause. Because usually the patient will go through menopause at the same age and menopause is when there are no more eggs in the ovaries, basically. A woman runs out of eggs does not ovulate anymore and does not release those two female hormones. But some symptoms, even menopausal symptoms could appear a few years before. It has to do with stress. Stress reduction. Symptoms are definitely worse if cortisol is elevated because hot flashes may also be due to cortisol stress and it's called adrenal stress. The adrenals are the little plans on top of the kidneys that release epinephrine, norepinephrine. So sometimes the level the blood levels of hormones at normal and a patient is still experiencing hot flashes and night sweats. So we do a saliva test to measure the amount of cortisol during the day and if it's very high there are some supplements to take it's called adaptogen. We're talking about Ayurvedic Medicine with supplements like Ashwagandha or Rhodiola that will lower the cortisol and that's going to lower the hot flashes as well.
Cindie: See I had no idea that you could do that. I didn't know that at least from a sleep cycle perspective. If you're able to get, this is what I have heard. Exercise in the morning, sun in the morning increases cortisol levels which then when cortisol levels are increased melatonin is decreased so then it at night if you've increased your cortisol levels in the morning then at night your melatonin levels are high in cortisol is low.
Dr. Wolloch: And this is true.
Cindie: Yeah. That was something fascinating but I had no idea that there were herbs that could help us as well. What roll does food play in menopause? And I'd heard that higher dairy and meat versus lower dairy and meat has some effect on menopause or does fiber impact estrogen levels? These are a couple things regarding diet that I had heard.
Dr. Wolloch: Yes and I'm really passionate about nutrition. Being raised in France it was a shock for me when I moved here in Miami at age 28. The food was so bad back then. It's a little bit better now and now we have changed since we could choose organic food. So for women it's always advisable to buy non-GMO food otherwise there is an excess of the bad estrogen. It's called Xenoestrogen that could increase the risk for breast cancer and thyroid cancer as well. The two of them are related. And also be careful not to eat too many dairy product specially the way it's made now. There's so much hormones in the milk and in red meat.
Cindie: Aww, so it's the added hormones, when we talk about dairy and meat it's the industrial raised meat that has the impact on estrogen levels because of the added hormones to the food.
Dr. Wolloch: Yes. That's why eating fiber everyday is a must because the bad estrogen will bind to the fiber and will be eliminated in the stools. So you're absolutely right.
Cindie: Interesting.
Dr. Wolloch: Eat a lot of vegetables, of course organic vegetables or a scoop of fiber in a smoothie or a capsule of fiber every day.
Cindie: Such good information. So my podcast is all about making the second half of life amazing and definitely great sex is a good part of that. So let's talk about sex after menopause.
Dr. Wolloch: OK
Cindie: So some experience not being in the mood, it takes longer to reach orgasm, it's painful rather than pleasurable. What are your recommendations to make sure that we have great sex after menopause?
Dr. Wolloch: So as I said previously, everything starts because of lower level of hormones, everywhere including in the genital area around the clitoris and in the vaginal walls, the vulva, everything becoming dry except if I put the patient on hormones. And we can talk about the advantages of going on bio-identical hormones. And the decrease in DHEA and testosterone which are the two male hormones would be responsible for decreased sex drive, decrease libido and difficulty to reach an orgasm. So it's all linked.
Cindie: Interesting.
Dr. Wolloch: My recommendation besides going on bio-identical hormones transdermally or vaginally would be also to talk about nitric oxide supplements. It's called NO and to talk about vaginal laser surgery which is done in the office. So let's talk about bio-identical hormones.
Cindie: Yes
Dr. Wolloch: And the difference between bio-identical versus synthetic.
Cindie: I appreciate that. I think that's a point of trying to understand what the difference is.
Dr. Wolloch: Yes, women are very confused because of the famous study that came back in 2002 telling women that going on hormone replacement therapy did increase the risk for breast cancer. But that study was made with synthetic hormones, Premarin and Prempro which are not used anymore. Nowadays we use only bio-identical hormones and the word means that the chemical formula resembles exactly the chemical formula of the hormones we use to make before menopause. There are no added no additive no changes in the chemical formula. And there are two ways of giving those hormones. They could be FDA approved and you can find them at any drugstore in the form of a Patch or capsules. Or non FDA approved and this can be compounded to the patient needs in a compounding pharmacy.
Cindie: And when you talk about to the patients needs, so I know, how do you know where those levels are? What would be the optimal level? Is it the hormone level that 30 or 20 or is how do you determine the dosage I guess is the best way to ask?
Dr. Wolloch: Right. So I'm being very careful because I want to help my patience but I don't want to increase the risk for any cancer. So I will personally I would never bring a levels back to when she was age 25. I don't think it makes any sense because that will be increasing the risk for cancer. In my personal practice I do increase the level but not so high just enough to be comfortable and to be able to stay on hormone replacement therapy for the rest of their life because there's no reason to stop if they're feeling fine.
Cindie: Got it. I'd also heard estrogen reduces the risk of heart disease as being another benefit of hormone replacement therapy is this correct?
Dr. Wolloch: This is correct. If it's given transdermally it does protect the heart. It does protect the bones, the brain and memory because our body has receptors for estrogen and progesterone everywhere. So correct. Again it has an effect on the endothelium which is the lining of the arteries.
To go back to the previous question, how to increase the sex drive and libido we need to talk about the male hormones a little bit.
Cindie: Yes.
Dr. Wolloch: So in age management practice, we doctors, we do prescribe DHEA and testosterone but again very safe levels. And my practice, I like to talk about the possibility of doing testosterone pellets which is inserting a little pellets which is the size of a grain of rice underneath the skin in the upper part of the buttock and it's bio-identical testosterone and it's being released every day for three to four months. So patient would come to my office to do a 5 minute procedure every three to four months. The other option is to apply cream daily transdermal cream.
Cindie: The pellet, you don't have to think about it.
Dr. Wolloch: That's the advantage and they love it. It's good especially for women who do exercise a lot who at the gym or exercise at home every day, they do much better.
Cindie: Why would the pellet if your exercising do much better? Just because of the release is consistent?
Dr. Wolloch: Exactly. That's the word, there's a consistent release. There's no up and down transdermal approach.
Cindie: Now that's the testosterone but what if you're in a you have a mixture of estrogen, progesterone and testosterone one would be a pallet but then the other you still would put on transdermally. Correct?
Dr. Wolloch: Correct. Estrogen, we do a mix of estradiol and estriol and we call it biased cream. The estriol is called the weak estrogen and it's the one that protects the breast and you do apply the cream twice a day. The progesterone is a must. Has to be given to counterbalance the effect of estrogen and I give it even in women who have a uterus as opposed to traditional gynecologist to tell their patients should do not needed after hysterectomy. And the reasons are we have progesterone receptors in the brain, in the bones I'm thinking about keeping strong bones. Very important to prevent osteoporosis as we are living longer and longer. So it would be one pellet. Sometimes we able to put a second pellet together. Estradiol, some women are willing to try. It doesn't always work. Sometimes it triggers bleeding. So we try and if it doesn't work I just continue with the testosterone pellet alone.
Cindie: Got it. And I was going to ask you about bone density but you certainly did answer that. But it does bone density as I understand you can't go backwards meaning growing bone again but you can slow down or stop. Is that correct?
Dr. Wolloch: That is correct. Naturally everybody loses 2% of bones every year and we do recommend to do a bone density at the onset of menopause to get a baseline and then to repeat it every two to three years. And certainly, hormone replacement therapy does help to slow down together with exercise, vitamin D3, vitamin K2 and magnesium. It all works together.
Cindie: Interesting. You'd mentioned, do men through menopause is well? Do they benefit at all from hormone replacement therapy?
Dr. Wolloch: They do. It's called andropause and the best way to check is to do a blood test to check their testosterone level. It should be more than 350 and if it's less they benefit from getting either pallets injections or a transdermal cream.
Cindie: Got it. Now, my favorite topic of longevity. So, as I had said I had done an episode on longevity and my goal is to live to 120. So within this wonderful field there's so many more people becoming more interested of some of the really promising health extending science that's out there. Tell us some things you have seen that have really brought light to opportunities to extend our health span.
Dr. Wolloch: So yes, I would like to talk about telomeres. First of all. Telomeres are the equivalent of the end cap of shoelace and it's inside each DNA, inside each cell and it appears to be the single best marker of longevity. And you can ask your doctor to check your telomeres to see where you're at. Some studies said that taking vitamin D which by the way is considered more like a hormone than a supplement nowadays. Having a vitamin D level around 80 nanograms per ML will prevent shrinkage of telomere. So something to keep watching, telomeres. And I know there are many companies were trying to market products to maintain telomeres length. I do not believe there's a single one I could recommend yet. But I just wanted to mention it to our audience.
Cindie: Thank you.
Dr. Wolloch: And then I will move on to other products that I've tried in my practice in particular, peptides. Peptides are groups of amino acids which are precursors of human growth hormones. So I know some anti-aging doctors do prescribe human growth hormone but I decided not to because there are some side effects such as increasing the risk for cancer in general or diabetes. I decided to look into something a little bit different, the precursors. And there's a whole list a whole catalog of peptides we can use depending on the action that we want to achieve. The most popular one is the CJC 1295 together with the ipamorelin. It would be a subcutaneous injection done by the patient herself or himself at home before bedtime five days a week for three months at a time. And then take a break of a month and then repeat. And that promotes better sleep, helps to lose the weight. So basically it works a little bit like human growth hormone but doesn't have the side effects. It's a precursor. It's very safe. It's just a group of amino acids, a precursor of human growth hormone. Another emerging component is NAD which stands for nicotinamide adenine dinucleotide. It's a cofactor essential to metabolism and is found in all living cells. It does support the cellular energy and it does help to maintain healthy DNA.
Cindie: Is it related to the mitochondria?
Dr. Wolloch: A little bit but not really.
Cindie: OK
Dr. Wolloch: What is related to the mitochondria is the ATP. So it's the body premier cellular energy and longevity molecules. It's also an emerging field and there are so many companies right now promoting either capsules or a liposomal formula. A liposomal form of NAD plus. That's how it's sold. It's sold under the name NAD Plus. I'm not going to mention brands because I'm not endorsing any brands.
Cindie: Right but it requires a prescription, correct?
Dr. Wolloch: No, actually the one I use does require a prescription through my compounding pharmacies. But I did so search and you can find it online some companies are selling it. Either captures or liposomal formula. I don't know how it works but that's something to watch as well the NAD and the peptides. Those two are very promising.
Cindie: It sounds exciting. I've heard of NAD a couple times so I think it's and with some very positive results. I know there's an elder elderly gentleman who's in his 80s and is supplementing with NAD and is just mentally sharp, physically sharp, true signs of the slowing of the aging process. It's certainly, you're right, something to watch.
Dr. Wolloch: I really don't think it has any side effects. I looked into it, there's no side effects. It's worth trying for a couple of years because longevity is all about aging gracefully keeping our memory sharp, our eyesight and our mobility. I'm always looking at those three factors.
Cindie: I know that you do some cosmetic procedures as well in your office. Platelet rich plasma something I've heard and I know you've do some other types of cosmetic procedures.
Dr. Wolloch: We do mainly the Platelet Rich Plasma (PRP) because it's very safe. We do not do stem cell injection. That would be another topic. PRP is when we spin the blood. We take one tube of blood and we spin it in a centrifuge and then we inject the top that is rich in platelets in different parts of the body so it could be, of course you think in the face so we inject in the face. Or for thinning hair, it does help to bring more blood flow to the scalp and it does prevent thinning hair. I do not do it personally. I have a nurse practitioner who does it. And is very successful with men. I've seen great results in men who are losing hair who have thinning hair. Husband of our patients. What I do is the O-shot to increase the orgasm the vaginal orgasm and the clitoral orgasm. After I apply a layer of a topical anesthetic for half an hour and I am using a very small and very thin needle. I inject the platelet rich plasma where the G spot is supposed to be and on the hood of the clitoris. I know it sounds painful but it's not.
Cindie: It does sound painful.
Dr. Wolloch: No, no, no. So, I do that part. It is considered PRP. It lasts about 18 months.
Cindie: Interesting. I had no idea that even existed.
Dr. Wolloch: And that together combined with the Co2 vaginal laser that prevents vaginal dryness is great to prevent painful intercourse and to keep sex going after menopause.
Cindie: That’s a good thing. So Dr. Wolloch there was another therapy. It's called IV nutrition therapy. What is that? Can you tell us about that?
Dr. Wolloch: Yes. This is one of the modalities we offer in our office which is basically IV nutrition therapy. We start an IV and give you a bag of very high doses of supplements, vitamin C, B complex, glutathione which is a major antioxidant. And we do recommend this to be done for patients who suffer from chronic fatigue syndrome due to a reactivation of the Epstein-Barr Virus or for patients who are getting chemotherapy for cancer. It has been shown to improve the results to chemotherapy if they come in between the sessions and if they do receive very high doses of vitamin C only and we're talking about enormous amounts of vitamin C. We take out time. The patient is sitting in a reclining chair and it takes about an hour and a half. The drip goes very slowly and I've had very good success with those patients.
Cindie: And is it also have any longevity effects that help us feel and look better?
Dr. Wolloch: Yes. There is actually a cocktail that I put together to help with the skin to improve the skin, collagen in the skin. Yes. It's called the ageless IV therapy.
Cindie: Wonderful! We always want to look younger and healthy.
Dr. Wolloch: Our best.
Cindie: Exactly! Dr. Wolloch thank you! This has been just absolutely wonderful to be able to sit and talk to you for a bit and learn so much about menopause, things we can do to possibly alleviate some of the symptoms, have great sex after menopause and then some things we can do to increase our health span so your information is invaluable and I'm certainly grateful for your time. Tell us where we can learn more about you and your practice and what you're doing and where we can contact you.
Dr. Wolloch: So my practice is located in North Miami Florida and my website has a lot of information. It is www.emmanuelawollochmd.com I did post some of the videos explaining some of the procedures that we do in the office including vaginal laser procedure, including the IV therapy and the PRP. And the address is there. I also offer telemedicine. I have patience who are contacting me from Europe, from the Caribbean, from South America. I can help anyone through telemedicine at the moment.
Cindie: That's fantastic especially at the time of Covid. That's extremely helpful. And I'll also make sure that I have your contact information in the show notes for all of our listeners to reference as well.
Dr. Wolloch: Thank you very much.
Cindie: Thank you Dr. Wolloch. Have a good day.
Dr. Wolloch: You too.
Cindie: bye now.
I hope you found this episode informative and helpful. Before I leave you I did want to tell you about the ChiliPAD today. I had mentioned it in a previous episode that I had bought it and was going to try it and was going to let you know how it went. And I am here to report it's amazing! I've increased my deep sleep about five to six points averaging about 30 to 35% of my sleep is in the deep sleep state which is so helpful for our brain health. And for those that aren't familiar with the ChiliPAD, it's basically a pad that goes on top of your mattress and you can set it at any temperature from 55 degrees up to I think it's up to 115. And for me it's worked great because I find my body heat heats up the mattress and I wake up warm at night so I highly recommend the ChiliPAD Pad to help with the quality of your sleep. I'll include a link in the show notes for your reference. And the show notes can be found on my web page at www.ifnotnowwhen.best
I'm so grateful for you joining me today and I continued to work hard to bring you valuable and relevant content.
Wishing you peace, love, joy and good health. Bye for now.
References:
Dr. Emmanuela Wolloch M.D.
Board Certified in Obstetrics & Gynecology
Perimenopause, Menopause, Adolescent Medicine
The Causeway Square Building
1801 NE 123 Street, Suite 415
North Miami, FL 33181
Phone: 305-935-8775
dremwolloch@gmail.com
Resources:
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