727. The Health Truth Every Woman Over 40 Deserves to Know

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Ladies, if you have ever been told your labs look normal while your body says otherwise, this one is for you. Dr. Amy Loden is a physician who nearly died from preeclampsia and now builds her practice around what medicine misses in women. She breaks down why pregnancy complications are a warning sign, what perimenopause is really doing to you, and why heart disease deserves your attention more than you think. You will walk away knowing what to ask for and why it matters.


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In this episode you will learn about:

  • How pregnancy complications reveal health risks that were already there.
  • Why perimenopause symptoms get dismissed as normal aging.
  • The heart disease signs that look nothing like the classic ones.
  • Why good quality sleep matters more than hours in bed.
  • How to eat and move to protect your metabolic health.


Episode References/Links:


Guest Bio:

Dr. Amy Loden Tiffany is a St. Louis-based physician entrepreneur, author, and TEDx speaker dedicated to women’s metabolic, hormonal, and cardiovascular health. After surviving severe preeclampsia and experiencing burnout in traditional, high-volume medicine, she pivoted her career toward a personalized, root-cause approach to patient care. As the founder of Vitality, she guides women through major life transitions—from postpartum to perimenopause—to help them recognize subtle warning signs and prevent long-term illness. Through her clinical work and her book, The Postpartum Pivot, Dr. Loden empowers high-achieving women to listen to their bodies, optimize performance, and take control of their long-term health. 

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Episode Transcript:

Amy Loden Tiffany, MD, MBA 0:00  

If we're going to call pregnancy a stress test, which is becoming an increasingly common term, is pregnancy a stress test of a woman's metabolism and her cardiovascular system? Then we have to ask, what are we stressing it for? And the way I'm looking at this is a little bit different than how I was trained, which again was if you got the problem, the solution is in the pregnancy. So what if we started looking at pregnancy from the perspective of this is an unveiling, an unveiling of what was already there, and that nothing's actually gone wrong. 


Lesley Logan 0:29  

Welcome to the Be It Till You See It podcast where we talk about taking messy action, knowing that perfect is boring. I'm Lesley Logan, Pilates instructor and fitness business coach. I've trained thousands of people around the world and the number one thing I see stopping people from achieving anything is self-doubt. My friends, action brings clarity and it's the antidote to fear. Each week, my guest will bring bold, executable, intrinsic and targeted steps that you can use to put yourself first and Be It Till You See It. It's a practice, not a perfect. Let's get started. 


Lesley Logan 1:11  

Oh my God, Be It babe. Get ready. Get your notepad out. Get ready. If you're driving, listen. You're gonna re-listen. You're gonna share this episode with everybody. I am so freaking stoked about the guest that we have. I fell in love with her with every single answer, and we need women like this in the medical world. So Dr. Amy Loden is our guest today. We're going to talk everything from postpartum to perimenopause and heart health, because ladies, you can't be it till you see it if you get sick, cannot. And I know it's confusing. There's so much information out there in the world, and it's like, who do we trust? What do we do? And I'm just so grateful I found her, and you're gonna love it. So make sure you get ready to hit share on this episode for women in your life and the men who need to know about what women are going through. My mind is blown on the episode. Here's Dr. Amy Loden.


Lesley Logan 1:54  

All right, Be It babe, I'm excited. I'm super stoked. We're gonna talk about all things women, health-related, with an amazing professional person who actually studies this stuff, not what I've read, and then I'm asserting to you because I don't want to be that influencer. I think those people need to take a little step back and let the professionals do it. We have Dr. Amy Loden here on the show, who's going to tell us everything we need to know. But Dr. Amy, we tell everyone who you are and what you rock at, kind of how you got here.


Amy Loden Tiffany, MD, MBA 2:20  

Sure, thanks for inviting me. I'm happy to be here, Dr. Amy Loden. I am in St. Louis, Missouri. I help primarily women over 40, but certainly anyone who's like, "How are my hormones working for my life or not? How is my weight in the mirror matching the weight in my head or not?" And all the things that come with life transitions from postpartum to perimenopause, beyond, my goal is that women who've interacted with our team will have a better care experience because it's the care experience we want each of us to have had ourselves, and because each of us are not only professionals within the medical nursing communities, we're patients too, or daughters and sisters and mothers and neighbors and all the things. We know how much it sucks to be patient, right? And so we've tried to redesign what is the best thing for our ladies. Now, in full transparency, we do have a few dudes, but most of them have had their arms twisted by our rock-star ladies, and they are the ones that are coming because they're forced to. And eventually, they decide they like us, but we're pretty cool too. So that's who we serve, and that's what we do. And happy to go into any detail or rabbit hole you want to chase?


Lesley Logan 3:21  

Oh my God, Amy! I love that. When people ask about the people who listen to this podcast, we have mostly women and a few good men because there are some men out there, including my husband. They want to be interested. They want to. They want their partners, the women, their lives. They want to get what's going on. They don't want them to feel like an alien or like they're alone in this journey. So I think that's really, really cool. I also just want to highlight. I love that you brought up your patients too, because as someone who I feel very lucky to go through my perimenopause journey in today's time when people actually are talking about it, versus even 10 years ago, generations were not talking about this stuff, and I just feel it's really nice because then there's information I would never have known about HRT unless my girlfriend had told me about it. Oh, that could be going on, and then I could talk to someone. Can we go back though? Yeah, I feel like to be a doctor like yourself, who has empathy and understands, like you must have gone through a journey as well. You don't just want to do this 


Amy Loden Tiffany, MD, MBA 4:13  

Because you wanted to do this. That's true. 


Lesley Logan 4:16  

Maybe there are a few. There might be a few, but typically, like there there has there's a story there that got you to be like I want to care about this. So can you tell us a little bit more about that?


Amy Loden Tiffany, MD, MBA 4:24  

Absolutely, yeah. So definitely with the traditional college to medical school road, really didn't understand that there's a and I say this with all the love in my heart, but there is a bit of brainwashing to be a good doctor, right? And what is a good doctor was who you've been told it is. It's not necessarily an external criteria. It's who does academic medical center say, and that was very different. I learned through transferring all of my non-medical student fears into the actual application of those fears, and then being a patient and living those fears. That I realized there's a whole lot we're not talking about. There's a whole lot that we're not being told, both as doctors and as women, as patients, and it's hard to realize you don't know what you don't know if you've been told you're the expert and you know everything, right? And most doctors don't go around saying they know everything, but there's enough patients who feel like that's what's communicated, that that's the language I'm using.


Lesley Logan 5:18  

Yeah.


Amy Loden Tiffany, MD, MBA 5:19  

And that's really frustrating as a patient, so I didn't realize how frustrating though it was until I was a patient, and I'm a mom of five kids, my third and fourth are twins, and really I am so grateful to live in the United States in a time in history where complicated pregnancies does not mean that mom dies, because I developed severe preeclampsia with heart failure, and my twins came 31 weeks instead of at least 37, and I nearly died the night they were born. They nearly died the night they were born, and I just am grateful that God let me be in this situation that I had the help I needed. Historically, these are not good situations. We see this on TV and in movies frequently. And something like 70,000 women a year across the globe die of the same disease I had, preeclampsia. So it's not nothing, even in our day and age, in certain countries, and even in countries where you have advanced medical care and they do everything right. It can still happen. So, that for me was the pinnacle of this isn't working. What we're telling people to do isn't working because I had done all the things.


Lesley Logan 6:30  

Right, you were a doctor. You did all the things. I did all the things. You enjoyed all the appointments. You were probably doing, and this is your third and fourth. So you knew what it should feel like. You knew what you should be eating. You knew all the vitamins to take.


Amy Loden Tiffany, MD, MBA 6:41  

Correct, and it didn't work, right? It didn't work, and so I think that is the fundamental kind of if you place a pivot on why did I change how I think about healthcare as a doctor, it was because of my experience as a patient for myself. My husband had cancer twice, so being the advocate for him in those types of things, guiding my children and now my parents through healthcare, you start to carry a lot of stories, and you start to see, wow, they're not doing what I think is just the bare minimum. And if they're not doing that for me or for my family, I know they're not doing it for everybody else.


Lesley Logan 7:11  

Yeah.


Amy Loden Tiffany, MD, MBA 7:12  

And then at the same time, holding a ton of grace in my heart because that's—they're doing what they were taught.


Lesley Logan 7:17  

Right?


Amy Loden Tiffany, MD, MBA 7:17  

Right. And they can't do differently if they don't know differently. You can't be better if you don't know to be better.


Lesley Logan 7:23  

Yeah.


Amy Loden Tiffany, MD, MBA 7:23  

So that is a really tight tension. But I thought I would just keep plodding through and just be a better doctor in that context of me being a patient until a little—I guess it was two years later. My daughter at that time, my oldest, was seven, and I had about 3000 patients. I was working somewhere between 65 and 80 hours a week, and had four kids at that time. And my daughter came up to me one night, and I'm opening the computer. I'm doing work like I do every night, and she says, "You're gonna make my birthday gifts. Like, can I help?" Right, totally innocent seven-year-old looking forward to her birthday knows that her mom shops online, right? And so she's like, "I want to pick my birthday presents," and I kind of stared at her. I was like, "No, no, I'm going to work. We'll do that later," and go watch whatever show. It's probably Paw Patrol for all I know, right? That's in the background. Go watch it. It's gonna be bedtime soon. And she just stands there, and I haven't even looked at her at this point. My eyes are on my computer. I'm just telling her this as I'm going. I'm totally not in the moment, right?


Lesley Logan 8:19  

Of course, because like you have so many, you have 3000 patients and four kids.


Amy Loden Tiffany, MD, MBA 8:23  

 I can't keep up. I can't keep up. Right? I'm barely getting enough sleep. I'm not exercising, and I'm just trying to survive. And she doesn't move. And so I remember not totally slow motion, but I remember turning to her and feeling like I was going to be like, "What?" Right? What do you need? And she's just got out of the shower, so her hair's wet. She's got her pink pajamas on, bright big blue eyes, and they're full of tears. And there are just silent tears tracking down her face, and I'm horrified. Oh my gosh, what's wrong? Right now, I'm in fix-it mode.


Lesley Logan 8:55  

Yeah.


Amy Loden Tiffany, MD, MBA 8:55  

And she still doesn't really budge, and she just says in a very sad voice, "Mommy. Why do you love your job more than me?"


Lesley Logan 9:05  

Oh.


Amy Loden Tiffany, MD, MBA 9:07  

Yes. So the twins tried to kill me. She did kill me, right? Like, that was a knife in my heart because nothing ever had I wanted to be better than a so-called good doctor than to be a good mom.


Lesley Logan 9:17  

Yeah.


Amy Loden Tiffany, MD, MBA 9:18  

And that was for me the moment that I realized I'm not doing either of these well, and I'm not showing up how I want to be personally or professionally. I'm certainly not taking care of my health. I'm not doing the things I'm telling my patients to do. Like, it was a moment where I really felt the failures. I felt all the feelings, and I told my husband that night, "This is not working anymore." And he actually thought I thought was talking about our marriage, and so he was like, "Oh my gosh, what's wrong with our marriage?" Right? No, but I need to, like, redo. We have to redo this. I either have to retire, or I have to do something different.


Lesley Logan 9:51  

Yeah.


Amy Loden Tiffany, MD, MBA 9:51  

And he was like, "You're not retiring. You will drive me crazy. Go find something different to do, and I will make sure our family is okay." And so I did. And this June will be five years of having Vitality here in St. Louis and serving women and trying to lean into all the pain and the things and the feelings they're dealing with from all the things and the feelings I dealt with having walked that path.


Lesley Logan 10:13  

Yeah. Oh, Dr. Amy, I love that you shared that whole story because I think there's so many women who are listening here and, like, they don't have, they may have one kid or they have no kids, but, like, I think we can all relate to, like, having just too much on the plate because.


Amy Loden Tiffany, MD, MBA 10:27  

Right.


Lesley Logan 10:28  

Hello, my high-achieving woman. I see you, everyone here listening. We call recovering perfectionists and overachievers. There's nothing wrong with being a high achiever, but what happens is we tend to just keep saying yes to things, and we're like, yeah, we can fit that one more thing in, that one more thing. All of a sudden, it just comes to, like, a volcano breaking point. Yes, and because we don't, we don't see the signs early that we are at the breaking point. We don't, you know, we, it's almost, it's actually proven to be not true. But everyone uses the frog in the boiling water, right? Like, we just kind of, like, you don't realize how hot it's getting until it's until your daughter is crying in front of you. Oh, exactly.


Amy Loden Tiffany, MD, MBA 11:05  

Yes, it was awful. I never want to relive that moment.


Lesley Logan 11:08  

Yeah, but also, like, thank goodness for her because that she felt brave enough to say that. Like, what a badass she is. I mean, she's just going to be, like, she's just going to be a girl who speaks her mind. She does.


Amy Loden Tiffany, MD, MBA 11:18  

She's 13 now, and she heard me tell that story once, and now she's like, "Well, you have to credit me for opening your business because I hadn't said what I did." I was like, "Won't you just tone it down a notch, please?"


Lesley Logan 11:27  

It's called balance, babe. It's called balance. Yes. Okay. So, can we, like, let's get to some of the health stuff that I think our listeners want to—I want to definitely get into perimenopause, but I do want to, because we started with a pregnancy, and I have had family members who, you know, have had preeclampsia in their, and it's scary. So, how are pregnancy complications connected to long-term heart risk? I don't think anyone's thought about that. I just thought, like, if it's because I don't have kids, like it's going to screw up your pelvic floor, and you might have to rebuild your abs and these other things. But I didn't know it can affect your heart long term.


Amy Loden Tiffany, MD, MBA 12:01  

I had no idea. I'm so glad you brought that up. So I actually did a TEDx talk on this very topic, where the idea is pregnancy is so much more than just the birth of a kid. That's how we think about pregnancy in our culture. That's even how we think of it medically, right? Like if you have preeclampsia, you have gestational diabetes, you have high blood pressure, whatever in pregnancy, the answer is end the pregnancy, deliver the kid if they're old enough, right? Like, get, move it along and it's gone. But that I strongly believe is not true. We can't test this in a lab, so you have to do a little bit of extrapolation here. But if we're going to call pregnancy a stress test, which is becoming an increasingly common term, is pregnancy a stress test of a woman's metabolism and her cardiovascular system? Then we have to ask, what are we stressing it for? And the way I'm looking at this is a little bit different than how I was trained, which again was, if you got the problem, the solution is in the pregnancy. So, what if we started looking at pregnancy from the perspective of this is an unveiling, an unveiling of what was already there, and that nothing's actually gone wrong. It's scary. It's horrifying. And yes, absolutely, people die. So how can I say nothing's gone wrong? What I mean is nothing has gone wrong in the context of the situation we put your body in. It's exactly responding the way it should for the context it's in. So if I have underlying insulin resistance, and then I put a pregnancy on top of that or perimenopause, and I'm starting to have more insulin resistance. Well, of course I'm going to develop gestational diabetes. If I'm having a lot more fluid retention and I'm putting up a low weight, of course my blood pressure is going to go up, right? If I've got underlying inflammation, of course preeclampsia is going to develop. So I think we need to stop and think about it as it's not done; it is unmasked.


Lesley Logan 13:42  

Got it. 


Amy Loden Tiffany, MD, MBA 13:42  

And then once you know it's unmasked, you treat it.


Lesley Logan 13:45  

I see. I see. Because again, we think of pregnancy as just the baby, so you have the baby, but it's well, but there's a problem, an underlying problem that the pregnancy revealed is what you're saying. And so great if having the baby is the safest thing for both people, we do that. But also, you still have this underlying issue.


Amy Loden Tiffany, MD, MBA 14:01  

Yes, it's still there. Correct.


Lesley Logan 14:03  

Yes, and I don't think anyone does that. I think they're just, "Okay. Now you don't have gestational diabetes anymore." But I have had clients who had it, and then afterwards, so what do we got? Oh, I'm fine. Are you correct? I don't think so. I'm not a doctor, but they're not fine. Don't just be diabetes. Yeah, for a moment. Yes.


Amy Loden Tiffany, MD, MBA 14:19  

So I actually experienced this as a patient too. I went in after my first pregnancy with gestational diabetes. At the time, I was living in New York City. I walked everywhere. I was a normal weight. I ate pretty clean, and despite being in residency, I'd got decent sleep. I didn't have any other kids. It's my first kid, so I got decent sleep. Right, but I had the baby after having had gestational diabetes. I go see my OB, and she's, "Oh, just follow up with your primary doctor." I go see my primary doctor, and he's, "Your weight's normal, your labs are normal. We're done," and that is how I was trained too. So again, lots of love in my heart. They're not; they're just not told. But for more than 10 years, we've known that women who have these high-risk pregnancies are at high risk not just for diabetes, but heart disease, stroke, kidney failure, dementia. Listen, I can't treat dementia well in the clinic, right? So why wouldn't I want all hands on deck trying to prevent it?


Lesley Logan 15:07  

Yeah.


Amy Loden Tiffany, MD, MBA 15:07  

But that's not how our medical professionals are trained—nurses, advanced practice providers, any of them. And so we're asking people and expecting people to fill in a gap they don't know exists, and so all these reproductive-age women are falling into it. And then where it gets really interesting is some of the same things you have immediately postpartum in all your different types of hormone fluctuations are matched intermittently for 10 to 15 years before menopause when you're in the perimenopausal years.


Lesley Logan 15:32  

What?


Amy Loden Tiffany, MD, MBA 15:33  

Correct, but that's why these women are feeling, "I'm going to my doctor, I'm putting on weight, I'm doing all the things, it's not working," and they're being gaslit, partly because their doctors don't know what they don't know, and partly because we're not acknowledging this is the same physiologic status of hormones that are different than baseline. So we're not in a country, and we don't have the testing that would promote or facilitate checking what is your normal hormone level at 18, so that we know what 18 should look like, and then by 45, you know, we're not. So we're trying to patchwork together a whole bunch of tests, and different labs have different testing, and different people say different things about testing. It's very confusing.


Lesley Logan 16:10  

Yeah.


Amy Loden Tiffany, MD, MBA 16:11  

And you end up with women suffering. And at the end of the day, that's the problem I'm trying to solve: is how do we stop these women from suffering? Because they are called to live big lives, to be ambitious for a purpose, for a calling. They have a lot to do, and their health is one of their biggest assets. It should not be a liability.


Lesley Logan 16:27  

Yeah.


Amy Loden Tiffany, MD, MBA 16:27  

And that's what's happening, especially for women who are trying to not work just in the home but outside the home. Right? There's a lot they're carrying. Yeah. So that's, I don't remember. Sorry, I'm having a total perimenopause moment. I don't remember where we started with that question here. I'll stop there. 


Lesley Logan 16:42  

Don't worry, babe. I got my focus meds on the ADHD today, so I'm tracking. So we're good. But we were talking about the postpartum, and then we got into those hormones that switch as, and they can repeat into perimenopause. And I think this is fascinating. I love that you brought up. It doesn't matter if you're in the home or out of the home. We have big lives. Correct. We can't have our health be a liability, and I think for a lot of us, it feels like, like my girlfriend's a weight-loss coach for women over 40 who feel like their body gave a middle finger. That's what her coaching is, and it's all about not going to yo-yo diet. That's not going to work. We have to figure out what is the underlying issues, and it can only go so far because you said we don't test our hormones at 18. We don't do that, so we don't know what is normal for us, and I remember I was having a lot of health issues, digestive issues in my 30s, and no doctor could help me. In fact, one doctor sending me to, I was in this weird part where they study HIV and Ebola in the hospital, and she's like, "Do you know why you're here?" I don't know why I'm here. I don't. This scares the hell out of me. This feels like a department I should not be in. I'm not in any pain. I feel like I'm taking someone's spot, and so because he could, he just couldn't figure out what's going on my stomach. So I found someone who did an actual test of everything. He's so range normal. We don't know what normal is for you. We just know what the average person of this population of people that who knows who they were that were tested. So what is normal for you might not be the average. And I was, "Oh well, that's the first time anyone said anything that makes sense. That's the first time." So you can be in range, but for your hormones, but it wasn't in range for you because maybe you were used to higher testosterone, you're used to higher things. And so I love that people like you exist. I'm sorry for the frustration of your own journey, but also without people like you, women like me wouldn't have someone going, "Hey, actually, maybe you should be on testosterone right now," even though the, this is what it is. Mine was actually zero, but people, you know, we can actually get you help because I feel so much better because someone finally was listening to me and thought, "Yes, we're not going to compare you to a random person. We got to compare you to how you're used to feeling."


Amy Loden Tiffany, MD, MBA 18:42  

Correct. And for most people, that can't happen in the traditional system.


Lesley Logan 18:47  

Yeah.


Amy Loden Tiffany, MD, MBA 18:47  

You can't do that in a 10-minute visit.


Lesley Logan 18:49  

Right.


Amy Loden Tiffany, MD, MBA 18:50  

You can't do it when your doctor has 3000 patients, 10-minute visits, and they really don't actually know who you are.


Lesley Logan 18:55  

Yeah.


Amy Loden Tiffany, MD, MBA 18:56  

You just can't. So we've got a little bit of unrealistic expectations as a society, and then you know any women's magazine or journal article you read says, "Talk to your doctor about this." So then you go in, I'm all prepared. I have my list. I've done it too, folks. Right? This is not a criticism, but they, they can't. They don't have the ability to process it, and the way they're paid is based on the questions they ask you for insurance. So every incentive is misaligned, and at the end of the day, women, people are being screwed.


Lesley Logan 19:22  

Yeah, yeah. No, it's so true. So I'm glad we talked about the postpartum. I want to get into now. We're in the perimenopause, and yep, this is hard because you mentioned the hormone shift of people after postpartum is its own crazy world. I keep checking on my sister-in-law every day. How are you feeling? Are you feeling okay? Right. You feel okay? She's, "I'm fine." Are you fine? Let me just, I just want you to know. It's okay if you feel different, right? I think I'm crazy, but I know that that people don't realize how they're feeling, and it's hard to get to the doctor until it's too late. So I'm just, I'm on her. But for people like me, we didn't have children, so we have never experienced a crazy shift. We just start to experience, "I don't feel like my, anymore," and all the symptoms are so different for every single person. I'm not having hot flashes, but I'm, I got to keep my hair still here. But my inflammation was insane. I was putting on weight and working out and eating the same. And I don't understand what's going on. You know, so can we talk a little bit about what, I don't know where you want to start with that. So you tell me where you want to start with my post, my perimenopausal people who are not necessarily attributing these changes to that.


Amy Loden Tiffany, MD, MBA 20:27  

So I think the biggest confusion I see in the exam room conversations is that there's just question of, am I in perimenopause or not? And it's more of a less of a yes-no and more of, are you on the spectrum, and where on the spectrum are you? And so if you think of it as a sliding scale, because some months those ovaries are working really great, and you feel all the feels, and you're 18 again, but a lot of months maybe you're more like 20 or 25, right? And then maybe out of the blue, I feel like I got run over by shock. Nothing's working for two or three months, and then we're back to 25, right? And so it's ups and downs. You're like, what is happening? It is a roller coaster, and it runs anywhere from 10 to 15 years before you actually go through menopause. So I think of it as reverse adolescence, and I think it's completely ironic that God lets us have teenage girls when moms are going through perimenopause because that is just double-adolescence whammy, right?


Lesley Logan 21:19  

And no wonder, no wonder marriages don't survive certain things. Right, you have a daughter going through puberty and a wife with a pair of menopause. Good luck to the husband. Correct, because


Amy Loden Tiffany, MD, MBA 21:28  

I want to have sex. I don't want to have sex. I have pimples all over my face. I don't want to go to the house. I do. My belly's bloated. It's not like my mood's up. All the things, and it's all in reverse. So it's a it's a period of a woman's life that I think needs to be acknowledged, and then within the healthcare system, there's more noise about it over the last five years. You're seeing more and more people talk about this, but there's not a lot of standardization, and so you're getting chiropractic, functional medicine, traditional medicine. You're getting all sorts of different recommendations. So my hope is that over the next decade, we start to see some standardization, and we start to say this is what is normal for this population. You still have to apply it to the person. You cannot take population data and apply it to individuals and say that you're going to have good luck, bye. We'll see you in a year. That doesn't work. What I do think is that women need to know what's normal for that time, and then they need to decide, do they want to do something about it beyond what their body is experiencing? And here's some really interesting data that I hope your listeners suddenly stop and listen. If they don't hear anything I've said yet, this will be really important for women who have hot flashes and night sweats. Either one, they're actually the same thing. We call them vasomotor symptoms. When you have those at a certain degree, so that they're happening most days of the week, more than 10 times a day would be an easy target to kind of pay attention to. You have that, and you choose not to take hormones. You actually have an increased risk for cardiovascular disease and stroke. That does not mean every woman in that category can or should take it. There may be reasons they can't, but the hormones we use today are different than what in the Women's Health Initiative that came out in the early 2000s. So you're getting a lot of confusion because women are reading about data from that, not realizing that it has changed, and that study is not going to be redone. It was a huge study. We're not going to see data like that, so we have to make really informed decisions. But cardiovascular disease, hear me, ladies. Cardiovascular disease, which includes stroke and heart failure, kills more women every year than all your cancers combined. Yeah, I get the women and they come in religiously for their mammograms or their Pap tests, right? But they don't know that the bigger risk is that they're going to die of heart disease, cardiovascular stroke, and we know that one in eight women, roughly, have breast cancer risk, and those women get it. One in two women are getting heart disease. So there's one in


Lesley Logan 23:50  

Two.


Amy Loden Tiffany, MD, MBA 23:51  

One in two. So that means there's two of us on this call, right? We already know I'm going to get it because I had preeclampsia. So I'm the one. 


Lesley Logan 23:56  

I was going to say. I hope it's not maybe. I hope it's not you. But, like, thank God you know that because I think it's one and two, especially if you don't know. Because if you know that you're at risk, you do. Then you can you do something. I am. I'm double the risk for breast cancer, so I have to do an MRI and a mammogram every six months, and I have some decisions I might have to make in my life. But because I know.


Amy Loden Tiffany, MD, MBA 24:18  

Right, I can take.


Lesley Logan 24:20  

I can take action. Yeah, correct.


Amy Loden Tiffany, MD, MBA 24:22  

And you know, using that same kind of history, if someone comes in my office and says that I don't want to take hormones because I was a breast cancer, I'm like, that's fine. But let's look at all the facts. Let's lay it out like your financial advisor does, and then you can make an informed decision. Because just acting out of fear or reacting is not wise either.


Lesley Logan 24:38  

I actually really appreciate you mentioning that because it's true. If I'm, I'm very lucky in that I still get to do the HRT that I'm on, even with my risk. But also they're checking me every six months, and I'm checking me. So if anything's going to happen, we're going to catch it so much more quicker. Whereas the hard stuff, there's only so much you can do with that. And so if you're, especially if you're not aware. Say there's all conversations, but I liked the way you laid it out with the wealth manager. I just met with mine. He laid out here's where we're being aggressive. Here's where we're doing this. Here's what's going on here. We're going to move this over here because we're going to risk-manage these risks. And I think that's that's a better way to look at it because we're not going to, every single one of us is unfortunately going to experience something because it's a body. We're not a machine. 


Amy Loden Tiffany, MD, MBA 25:21  

It wears out.


Lesley Logan 25:22  

I did not know it was one in two, girl.


Amy Loden Tiffany, MD, MBA 25:26  

Yeah, and what's even more disturbing, you may have heard a lot of women have by now that women's heart disease presents differently than men.


Lesley Logan 25:32  

Yeah, can you tell us just in case my people haven't heard because I didn't know it was one in two? So let's go over the signs.


Amy Loden Tiffany, MD, MBA 25:38  

A lot of times people think of what's the so-called traditional? It's the jaw pain, the radiation of pain from your chest up to your jaw, to your back, down your left arm. Very classic symptoms. Classic because it was studied in men, and then we have these so-called atypical for women because they're not typical compared to men, but they're classic for women. And so, got a little bit of lingo here that it doesn't make total sense. But for women, sometimes it's they just feel a lot more anxious than they've been for unclear reasons. They have this sense that something bad is on the horizon. They can't really place why their sleep is different. Maybe they're having some shortness of breath they didn't used to have. Maybe they go up the stairs in their house, with a laundry basket, and they're huffing and puffing when six months ago they weren't. So it can be very subtle differences. It could be a new fatigue. Check labs are normal, but the fatigue's still there. That worries me when I hear women say this. Unfortunately, the number one sign that you have heart disease is sudden death.


Lesley Logan 26:33  

Oh.


Amy Loden Tiffany, MD, MBA 26:34  

So let that sink in for a second. So we can't always wait on what the signs are.


Lesley Logan 26:39  

Yeah, we can't fix that. Right. Correct. Okay, so that's hard because our signs are also. I feel like high-achieving women would so easily brush away that anxiety.


Amy Loden Tiffany, MD, MBA 26:51  

All the stuff. Correct. Because I have a lot of tabs open.


Lesley Logan 26:54  

Yeah, I got this going on, or I haven't been working out, so of course I'm out of breath going up the stairs. They would just so easily.


Amy Loden Tiffany, MD, MBA 26:58  

It's May, it's graduation season. It's wedding season, right? This is just aging, and that's not the story at all. The problem is 10-minute visit with your doctor who has 3000 patients. They don't know who you are. They're not going to notice that this is different for you.


Lesley Logan 27:13  

Yeah.


Amy Loden Tiffany, MD, MBA 27:13  

Decreased exercise tolerance is a big one. And so, if you could walk three miles every day in your neighborhood, now you're like, "Wow, I'm really struggling to get through one." I'm worried about that. I want to know what's going on and why.


Lesley Logan 27:25  

Yeah. So I guess since one getting a 10-minute visit is hard. I, where I live in, I live in Las Vegas. Last I heard, we are short general practitioners by 1400. I don't have one. I go to a women's clinic, and I'm really grateful. It's a, it's also a student-teacher thing. So I actually, they've caught things because the students are asking the questions because they're


Amy Loden Tiffany, MD, MBA 27:44  

Yes, yes.


Lesley Logan 27:46  

I love them. I'm so grateful for them, but are there things that women can do to check their heart, or is it just being, is it just noticing the one mile versus a three mile? What can we, what are the signs we need to be checking on?


Amy Loden Tiffany, MD, MBA 27:57  

Certainly be aware of what your body is telling you. Again, if you have to remember nothing else, this is another one: is that your body is smart; it will talk to you, but you have to listen.


Lesley Logan 28:05  

Yeah.


Amy Loden Tiffany, MD, MBA 28:06  

So that's really essential. If something's different, say something. You're right. There's a big collapse, if you will, of how much support we have in healthcare, whether it's nurse practitioners or chiropractor or whatever. And the issue is not all of them are trained the same way. So when I worked in the OB/GYN clinic, it became apparent to both of us, on both sides of it, that OBs know stuff about women's health. I don't know, but I know stuff about metabolic and heart health that the OBs aren't taught, and most women use their OBs as their primary care, at least to a certain age.


Lesley Logan 28:32  

Right.


Amy Loden Tiffany, MD, MBA 28:33  

And again, you don't know what you don't know, so you don't realize what you're not looking for that you should be. And our system's not set up for good collaboration. So if I could tell women, here's a checklist of things I want to make sure you get, your doctor is going to give you some resistance, most likely because they don't realize that lipoprotein with a little a, it's like in parentheses at the end of it, not the big A. Lipoprotein little a. If you have that mutation, and 10 to 20% of our population does, you have a different rate of plaque development, at least risk for that than the average risk will miss. If you have high insulin levels, you have a higher risk that you're going to be on a pathway toward diabetes. Those are not things that are standard checks. So knowing that there's other tests you can ask for, and even if your insurance doesn't cover it, they're not expensive tests. Just get it once, right? Have an idea of what's going on in your body once gives you a ton of information. I offer a lot of our patients to wear different glucose monitors, even if they're not on diabetes. And all my physicians who are listening to this are probably like, "You do what?" But the reason is, if you can figure out that your glucose and insulin are high before you develop diabetes or pre-diabetes, if you figured out that insulin-resistant stage, that's a lot easier to fix, and our doctors aren't even taught about what is insulin resistance, what is the criteria for it, and how do we reverse it?


Lesley Logan 29:47  

Right, because there's some prevention we can do if we have information.


Amy Loden Tiffany, MD, MBA 29:50  

There's a ton, and it's things women can do in their homes or their businesses. It's not stuff I'm doing in the exam room.


Lesley Logan 29:56  

Yeah, and that's also, you know, you're listening to this podcast, you're kind of a go. Anyway, so you're gonna, you'll take the action. Our health insurance is very bizarre. I thought it was crap because, but it has a lot of preventative stuff that goes on with it. Hey, we want to put this thing in your house and check your heart and some other levels every, I don't know, two or three times a week. They keep calling them. I have two adults. We have two ADHD adults in this household. The box is here. One of us will open it when it becomes the pressure. I just have to hang tight. We'll get there. But I'm really impressed by that because we don't have access to a regular doctor. So what information can we gather so we could be watching it and monitoring it? So we can advocate for ourselves if something comes up. So having that prevention is really amazing. Okay, so we talked a little bit about the perimenopause and the different things. What are some simple shifts that women can make now to protect their future? I mean, obviously we have a wide range of women, so the now is different. But what are some things that they could be doing? Because I do think that they are getting information from the magazines and the Instagrams, and we should get it from the person who's experienced it and has seen it. You know, so you.


Amy Loden Tiffany, MD, MBA 31:00  

Some easy things, and I say easy relative because they're easy to do, which means they're easy not to do. So acknowledging that, right? It's real. Number one, understanding that just because you get eight hours of sleep, if they're not high-quality hours, you've got a metabolic risk from your sleep not being normal. That's important to understand because you spend a third of your life asleep, right?


Lesley Logan 31:19  

What's a metabolic risk? Just in case my people. So.


Amy Loden Tiffany, MD, MBA 31:22  

If you don't get good-quality sleep, your cortisol goes up. It's one of your stress hormones, and when cortisol goes up, glucose goes up. When glucose goes up, insulin goes up. Insulin's your fat-storing hormone. So even without your sex hormones being involved, or the ghrelin and leptin you're hearing about with weight and GLPs and all that, just those, you're not getting good sleep. It's going to be a problem. Insulin resistance is going to go up. Insulin resistance means your cells are not listening to the insulin your body is giving it, so your body works harder to get more insulin, and the cells work harder to ignore it, and it just keeps going in a vicious cycle. So if we consider that that's the root cause of a lot of these problems we've been talking about, we fix that. Number one is get good sleep, get good-quality sleep, and it's not, not just enough time in bed.


Lesley Logan 32:02  

Yeah, so.


Amy Loden Tiffany, MD, MBA 32:03  

That's important. Number two is most people don't realize that they're doing it backwards. They're, if they're, if they're even able to get exercise in their life right now, right? So we're going to make the assumption that you figured out some exercise regimen you like. We're, we're at that level, but they're doing it at the wrong time, and they're doing it in a way that they're sabotaging their end result. So rather than going to the gym and then going and eating dinner, or going to the gym first thing in the morning and skipping breakfast and all these things, you need to eat protein and fat, and then you need to move your thighs. I don't care if that's jumping jacks, going for a walk, running up the stairs, something where your thighs are moving regularly for 10 minutes. So make it whatever you like doing. This can be the mom at home who's doing all sorts of fun class activity with her kid, right? Like moving the baby around or the teenager can be equally fun to move around for what it's worth. And then it could be the CEO who's getting ready for a meeting and has 10 minutes after eating whatever lunch she had in the five-minute break she did, right? So looking at what makes sense in your life, but 10 minutes of physical activity, ideally after every meal, that's not realistic, but that's ideal. And then you start with the one meal a day you can do, and you do it most days of the week to start with, because most of us have to figure out how to make it a habit.


Lesley Logan 33:15  

Yeah.


Amy Loden Tiffany, MD, MBA 33:15  

But movement for 10 minutes after eating, it's, it's crucial. I cannot stress that enough.


Lesley Logan 33:20  

I didn't realize it was. It makes total sense moving your body after eating because I like to go for a walk after I have lunch. Otherwise, I'm tired. Correct. I can't go back to work now. 


Amy Loden Tiffany, MD, MBA 33:30  

The reason you're tired though is because your glucose goes up and your insulin went up to match it. When you walk right after you eat, glucose still goes up, but it's less, and so you have less insulin spike. Insulin is the bright driver here, and so you've got to do the movement after. And if it helps to understand why, think back to what our ancestors did 1000 years ago. Right? We weren't checking hormones. We weren't checking insulin. We weren't talking about hacks. We were trying to survive most of the time. Yeah. But the things they did is they, if they, what, after they ate, they moved around. Right? Like they were building their shelters. They were taking care of the kids. They were moving in the community, helping build, create, relocate, whatever. They were always moving, and they did not get the whole three square meals a day. That's bogus. You don't need three meals a day, okay? And most of my ladies don't realize that they're eating their nutrients potentially in the wrong order for their body. That they're eating them in the wrong time for the cycle of the month they're in, they're not getting enough protein, not getting enough fat for their hormones and their brain, and it doesn't happen quickly, right? It's months, years, maybe even a couple decades before they're, I don't know what happened, but my body in the mirror is not the body in my head. This is not who I am. There's a disconnect, and they finally are at that place where they have to do something, where the body is forcing them to stop because they've pushed it as hot as you know.


Lesley Logan 34:44  

Oh my God, that's a whole episode. We're having you back. I'm just telling you right now because I want to have a whole episode on the whole. Because what I do know is if you eat certain things, if you work out too late, if you get your cortisol up, sleep that. I have been trying to figure out sleep for over a decade, and I, I get good-quality sleep most of the time. But I'm obsessed with it because I'm like, I don't want Alzheimer's. I do not want heart problems. It doesn't really matter what I'm doing at the gym if I'm not sleeping. None of that matters. Doesn't matter what you're, If you don't get good sleep, all the rest is gonna just fall apart anyways. So it's interesting. It makes sense about the food because I remember when I was having problems with my cycle and I had my one of my doctor friends, she said you should try seed cycling because I just, the worst cramps and, like, the worst everything was just the worst in the world, and so I tried seed cycling and my goodness, you know, I'm not a woo-woo girl, but the seed cycling makes, I got, I had no more zits, my boobs didn't hurt as bad, everything leveled out, and I didn't need any extra hormones for it. I was, whoa, so now there must be more. We need to know about it. So we'll have to have you back for that. I can talk to you forever. So we'll just, this is part one of many. I'm just going to take a brief break and then find out if people can find you, follow you, and work with you. All right, Dr. Amy Loden, where do you hang out? You mentioned St. Louis. Can people work with you if they're not in St. Louis? How does this work?


Amy Loden Tiffany, MD, MBA 36:03  

Yes, absolutely. Best way to get into contact with our office is just going to our website, www.vitalitymwc.org. They can sign up for a consultation, and we can go through what their options are. There is also lots of opportunity if you don't want to work with us directly, but you want to continue the conversation and hear what we're seeing. I do all the social media I can so that people can hear what's being said in their exam rooms and have it in their real lives too. So you can do that on follow me at Dr. Amy Tiffany, whether it's on Instagram or TikTok or Facebook. You find it where they're also on LinkedIn at Dr. Amy Loden. So lots of places depends on what their needs are. One special offer I do have for your audience: we talked about pregnancy and perimenopausal bit through this conversation, they can contact my office for a free physical copy of my book, The Postpartum Pivot. And before you stop listening, ladies, and you think, "Well, I'm not postpartum." If you've had a baby, you're postpartum even it's 20 years ago. Your body's different than it was before that baby, and so you can understand what does this look like for perimenopause and other types of areas that we go through as we grow less young, but grow more wise.


Lesley Logan 37:03  

Oh my God! Every one of my female females, that's where your Christmas present is. Sorry, just gonna get a doctor because they don't. It's, if their doctor doesn't tell them, they don't know, right? And then they are just going through it. And I feel so bad because every woman in my life is such a badass, and then they get their body doesn't keep up with what they're wanting to do in life, and then it just becomes not just like a liability, but like this hangup. So you are amazing. Okay, you've given us some great stuff already. I mean, we're gonna have to rewind, and I'll listen to this. I've got, you know, getting my notepad out, but our bold, executable, intrinsic, or targeted steps people can take to be it till they see it. What do you have for us?


Amy Loden Tiffany, MD, MBA 37:37  

I want each one. When you be it as you see it, I want you to be true to what your body's telling you, and recognize nothing's gone wrong. Listen when things are happening and they seem like it's a crisis. Nothing's gone wrong. Your body's talking to you. Listen, and when you listen, you become more wise. You become a better version of yourself.


Lesley Logan 37:55  

Okay, I really love that. We talked about that earlier, but it's true. Some of us think our body is against us, and it's doing something to us. But really, it's like, hello. The alarm bells. 


Amy Loden Tiffany, MD, MBA 38:05  

It's doing exactly what it should do for the situation we've put it in. That doesn't mean we like it. You get diabetes. No one's like, oh yeah, my body did exactly what it's supposed to do. But if we understand that, then it becomes a neutral thought. It's not bad or wrong. It's I didn't listen, so now I'm going to stop, and the best place to reverse is as soon as you realize you're going in the direction. Right? It's not to keep going in the wrong direction. So nothing has gone wrong. We just need to listen. We need to turn around, create a better story.


Lesley Logan 38:33  

Love it. Love it. This is and then so enlightening. This is so fun. Thank you so much for being you and your and and the journey that you've been on is something we can all benefit from. So thank you for that, you guys. We all need to share this episode with all the women in our lives, and I would love for you to make sure that Dr. Amy knows your favorite takeaways. Send them to the Be It Pod as well. And since I'm going to have her back, not that I even like asked her beforehand, but I'm just going to tell her she's doing that. You can send your questions, and we'll make sure we get that. So, beitpod.com/questions. Until next time, my loves, Be It Till You See It. 


Lesley Logan 39:03  

That's all I got for this episode of the Be It Till You See It Podcast. One thing that would help both myself and future listeners is for you to rate the show and leave a review and follow or subscribe for free wherever you listen to your podcast. Also, make sure to introduce yourself over at the Be It Pod on Instagram. I would love to know more about you. Share this episode with whoever you think needs to hear it. Help us and others Be It Till You See It. Have an awesome day. Be It Till You See It is a production of The Bloom Podcast Network. If you want to leave us a message or a question that we might read on another episode, you can text us at +1-310-905-5534 or send a DM on Instagram @BeItPod.


Brad Crowell 39:45  

It's written, filmed, and recorded by your host, Lesley Logan, and me, Brad Crowell.


Lesley Logan 39:50  

It is transcribed, produced and edited by the epic team at Disenyo.co.


Brad Crowell 39:54  

Our theme music is by Ali at Apex Production Music and our branding by designer and artist, Gianfranco Cioffi.


Lesley Logan 40:02  

Special thanks to Melissa Solomon for creating our visuals.


Brad Crowell 40:05  

Also to Angelina Herico for adding all of our content to our website. And finally to Meridith Root for keeping us all on point and on time.



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