Exploring Women's Health and Longevity: Insights into Menopause Care and Hormone Replacement Therapy with Kristin Mallon

Parker Condit: 0:00

Hi everyone and welcome to Exploring Health Macro to Micro. I'm your host, parker Condit. In the show I interview health and wellness experts and by the end of each episode you'll have concrete, tangible advice that you can start implementing today to start living a healthier life, either for yourself or for your loved ones. That's the micro side of the show. The macro side of the show is discussing larger systemic issues that are contributing to health outcomes here in the US. An example of that is understanding how and why there are care gaps for women in healthcare. That's something we discuss in detail during today's show. My guest today is Kristin Mallon. Kristin is the CEO and co-founder of Femgevity. She's a board-certified nurse, midwife. She's a menopause feminine longevity expert, published author and a mother of four. She graduated from Cal Berkeley with a degree in psychology and then completed her bachelor's degree in nursing from Johns Hopkins in Baltimore. This episode bounces back and forth on the spectrum of micro to macro. Kristin gives great advice on specifics like how to improve sleep, exercise and heart rate training. That's sort of the micro side of things. But then we also spend a lot of time discussing larger issues like why we need new sub-specialties in the healthcare system, why there's such a lack of coordination around menopause care and basically what the long-term effects were from the women's health initiative study, which basically halted hormone replacement therapy in the early 2000s. So for anyone who's interested in women's health, menopause, hormone replacement therapy or longevity, this episode will be extremely helpful to you. So I hope you enjoy my conversation with Kristin Mallon. I'd love to understand sort of the history of what care gaps exist within the healthcare system for women and maybe after that getting into why those gaps exist as well.

Kristin Mallon: 1:50

Yeah, that's a really great question to start off with. So I think there's so many gaps in healthcare. I mean you could probably write books and books about the gaps. So I think, to kind of start from the top down, the major gap in healthcare is that wellness and prevention and optimal health is really being solved by allied health professionals and it's not solved by physicians or people that have medical degrees. So in my instance, I'm a nurse practitioner, I have a nursing degree, but it's very similar to the counterparts in medicine, my counterparts in medicine. I pretty much do everything my counterparts in medicine do, except I don't do surgery. And wellness is handled by acupuncturists and chiropractors and nutritionists and personal trainers and they offer a very wonderful, fantastic perspective in health. But to get a physician's perspective or a medical perspective in health and optimal wellness, I think is just lacking right off the bat, right there. So now let's go down to women's health and we have one specialty that's really supposed to be the end all be, all, do all for women. So we've basically just thrown everything onto OBGYNs and OBGYNs are supposed to be experts in childbirth, pregnancy, breast health, cancer, gynecology, screening, internal medicine and menopause. So I think within all of those things that an OBGYN is supposed to be an absolute expert in, they really become experts, usually in one. You know that you find that gynecologists kind of specialize in urogynecology or they go into a fellowship in breast health and they become a breast specialist, or they become a gynecologist that does endometriosis specifically, or robotic surgery, and then similarly, similarly in pregnancy, you have high risk specialists and you have a lot of OBGYNs who focus primarily on childbirth and they do very little gynecology, because I think that's just the natural evolution of where medicine's going. So forget the fact that menopause is this huge, huge gap in women's healthcare. That's completely ignored and women really get the run around because they. A lot of times we hear from women that they don't really know where to go. They don't know should I go to my OBGYN, should I go to my internist, should I go to my endocrinologist? And the problem is is that none of them are really experts in menopause management or in really midlife for women. So women in midlife they're not having babies anymore, they're not having reproductive concerns, but they're not sick yet. So it's left like this huge hole in healthcare, and that's really what we were trying to fill and solve at Femjavidi.

Parker Condit: 4:39

Yeah. So I'm going off track already just because I knew you'd say something interesting and that would just trigger a good question. So clearly from the consumer side, because obviously it's going to be confusing, right? Do you go to your primary, Do you go to your OBGYN and, like you said, endocrinologist? So there's confusion on that side. But maybe on the provider side, like is there a specialty? Or like who should be quarterbacking it on the provider side- yeah, totally so.

Kristin Mallon: 5:06

right now there's no quarterback, so we're playing this game with no quarterback and everybody's.

Parker Condit: 5:11

So the patients figured out.

Kristin Mallon: 5:13

Exactly exactly, which is why we made this company in the first place. So what's happened is that women are lost when it comes to menopause care. They're not really sick and it is something that they can like, quote unquote, just get through and, quote unquote, endure even though I hate to kind of use that terminology in that word. So there's not this urgency that there is, like when you're delivering a baby, you need someone to help you. When you have an ovarian mass, you need someone to help you, and then when you trickle down from there, there haven't been any CPT codes that have been created or reimbursement codes. So when a physician or anyone in the medical field is looking at okay, like what am I going to specialize in? They want to specialize in the money makers. They want to specialize in the things that are going to bring the most money for the time they're spending. And a lot of times, menopause is complicated. It's multifactorial, there's a lot of different facets to it and it's not just something that's straightforward. There's no surgery involved, there's no procedures involved. So it's been dropped by OBGYNs, understandably. It's been dropped by internists, because internists are kind of. I always call internists are internal medicine people or primary care physicians to be the renaissance people of medicine. They kind of dabble a little bit in everything and they're not really experts in anything, which is great. That's their, that's what they're supposed to be. They're supposed to be able to, you know, like a renaissance person, people to sculpt a little bit and to be able to do watercolor and be able to paint and use oils and acrylics, but are they the masters and the best in acrylics? No, and so menopause really requires a lot of education, a lot of specialty, and then, similarly with endocrinologists, it's just. It's just not a moneymaker. There's just not a lot of reimbursement when you can be seeing someone for diabetes care or you can be doing anisins or Cushing's disease or some other form of endocrinology pediatric endocrinology that's just going to be so much more fruitful and have surgeries and procedures that are associated with it. I think there's something else that happened to with our healthcare, very specifically in the United States, and that was really the, the study that came out in 2002, the women's health initiative study. It's kind of a famous study in anyone who's in the menopause space about how HRT and hormone replacement therapy was just like halted across the United States really, with the results of just one study that was like incorrectly cited and the JAMA the JAMA article that was a result is wrong. I mean, they have a lot of things that say that estrogen causes breast cancer. It doesn't, and I think that that happened in 2002. And so then anyone who graduated around the time so I graduated in 2006. So I was, in that time, the sequelae or the fallout of this women's health initiative study and it was like, well, menopause is a thing that happens. It's a day you've had a period for 12 months and there's nothing we can do because we all know that HRT causes breast cancer. Now, so tell women to just suck it up, okay, next, moving on, and it was, you know, probably not even a whole lecture devoted to menopause. And I went to Johns Hopkins. I mean, I went to a really good medical institution for my education and my physician counterparts you know the OBGYNs that were graduating the same time as I was. They weren't learning about it and they really, we didn't really start learning about it until a few years back. Now they're starting to learn more about it. They're starting to learn more about the options, and so if you wanted to be a practitioner in any of those fields in internal medicine and OBGYN or an endocrinology you really probably less endocrinology. They probably learned more than the rest of us. But you really had to seek out the information on your own. You had to self educate about how to treat and how to treat properly and appropriately.

Parker Condit: 9:00

Right On top of all their other continuing education that they're required to do.

Kristin Mallon: 9:04

Right, right. And then you know and it's not something that's making money for your practice the way that reimbursement and insurance is set up.

Parker Condit: 9:11

Yeah, all right. So we touched on a few things there that I want to. I want to pull in a few threads. One of them is, like you mentioned, very specific cases, and I think this is this is probably ubiquitous across the healthcare spectrum where when something gets to a very diagnosable state, then the answer is a little bit obvious about who should be dealing with it. Like you said, pregnancy. So, like we know, we know what needs to happen with pregnancy. That's the quarterback. There is pretty obvious Diabetes once it's diagnosed. That's pretty obvious. It's like what's happening leading up to these instances. I think that's, you know, across the healthcare industry. You know your primary should be doing a lot of that, but I think when there's not, like, a clear diagnosis, it's going to be less obvious as to who should be stepping in from the provider side of things. Is that a fair assessment?

Kristin Mallon: 9:58

Yeah, absolutely. And and I think that you know, I think a lot of times in my career I've liked to say that I've been ahead of the trend or ahead of the curve and, you know, not waited for the institution of medicine to catch up. And I think that Femgivity is really no exception, that eventually we will create a subspecialty within some you know, whether it's internal medicine or whether it's OBGYN or both where you can now get a fellowship in hormone, reproductive hormone balancing, feminine hormone management, basically, and I think that that's going to come once the insurance companies get on board. That will actually, if we start treating these women when they're in perimenopause and before they're having really severe symptoms, we can save money on the amount of visits that a woman is seeking, the amount of hysterectomies that we're doing, the amount of unnecessary surgeries that we're doing. So I think we're, I think we will get there. But you know, my co-founder and I we were like we're not going to wait around for the decade or more that it's going to take for that to happen.

Parker Condit: 11:02

Sure, that was actually one of the questions I had later on. I was like do you see a shift on the provider side into there being like a new specialty? So you think there is and then my follow up, or the other side of that question is going to be or do you think it's going to happen in the private sector, where it's going to be companies like yours that are just solving the problem in the meantime, but it'll probably be like a push from these companies like yours to drive that new specialty?

Kristin Mallon: 11:29

Yeah. So I think it's going to be really interesting how it all plays out. I think that that's one option or possibility that we could go in that direction. It's, I think, that our healthcare system is so fragile. Anyway, I see a lot of different ways that I think our healthcare system could be going. I think we could be moving more towards the UK system, where you have, you know, basic healthcare for all, but then you have private healthcare for people who want to pay. Canada has a very similar structure, although a lot of Canadians end up coming to the US to pay. So there's like less for fee for service in Canada, although they do exist. So I think that it's possible that we're going to go that route at the same time, where we're moving more towards socialized medicine as a country as a whole. And I'm not trying to be political pro or against, I think that's just the general trend and the general movement I see kind of happening. And then and then there'll still be fee for service or, you know, out-of-pocket options that you know will cover the gaps and also cover people who want maybe a little bit more out of their healthcare and kind of want to get out of the sick care cycle.

Parker Condit: 12:43

Yeah, I mean, there's so many things I want to kind of dig in here, but we're kind of on reimbursements right now and yeah it's. It's so weird that, like, talking about socialized medicine is like a political thing, but I think it's important to understand that there are many different models. I think, people just have this idea of socialized medicine and they might look at one external model, like the UK model, for example. But there are other options like we and plus in the US we already we have a lot of socialized medicine, like the VA is, you know, government funded and government owned hospitals and employees. And then Medicare, for example, is government funded but it's private practices that are administering the care. So there's a lot of different ways to cut this.

Kristin Mallon: 13:23

Yeah, I mean I'd like to see you know this is I'm not trying to get political, but I'd love to see the government get their own lab because I think that's one of the biggest ways that we get taken advantage of in a lot of different ways. I mean, my co-founder comes from the lab background in the lab industry and you know lab laboratory testing is like a big differentiator that our company does. A lot of companies in the menopause space don't do any laboratory testing. They treat without labs, which I think is kind of crazy. It's like looking at only 50% of a puzzle.

Parker Condit: 13:49

Right.

Kristin Mallon: 13:49

But you know, I'd like to see, I'd like to see the US get a lab. I mean I think that would cut down on a lot of like unnecessary repetitive testing right there. You know, you do you do a CBC when you just had one done a week before. You could go into a national database and look that up. I think that would save a lot of money.

Parker Condit: 14:06

Yeah, the idea of interoperability, which is like ubiquitous sharing of patient data, that's that would solve so many problems, but there's a lot of financial incentives that Are pushing against that. But can you explain what CPT codes are, because you mentioned that a while back. You know those are, I know those are, but Everyday people might not understand why. Why would a doctor not be incentivized to do something if there's not a CPT code?

Kristin Mallon: 14:33

Yeah, so I think when it comes to medical billing, there's really like two codes the ICD-10 code, which is like the diagnosis title. So in order, so in order for insurance to even recognize that this is the thing, there has to be an ICD-10 code. So there's so many things and obstetrics actually, that there's no ICD-10 code for, like, delivery of the second twin, when the first twin was a vaginal delivery. Now you're doing a C-section, so like that specific instance which happens, right, like, let's say, you're delivering twins and you're having someone, and someone delivers the first twin vaginally, but then something happens in the second twin that delivered via C-section. So now this is like a C-section done subsequently after a vaginal delivery. Right, it's just no ICD-10 code that exists. There's a ICD-10 code for a vaginal delivery, there's an ICD-10 code for a C-section, there's an ICD-10 code for a V-back or vaginal birth after C-section, but there's no ICD-10 code for that specific procedure. So in order for us to kind of then have procedure codes or the CPT codes, we have to first have the diagnosis. So the diagnosis has to first get recognized and then we can start saying like, okay, well, now we're gonna, we're gonna perform this specific procedure, we're gonna perform a venopuncture, for example, which is a blood draw, well, that CPT code has this specific number that goes with it. And then everybody knows, the insurance companies know, and the doctors know, that this procedure or this actual action that we're doing, this actual time that the doctor spent or a provider spent on this one specific thing, has this code and that code carries a cost like a charge. Basically that goes along with it. So that's kind of like how they all kind of work together, like the ICD-10 code. So we need both really. And there's the menopause. Just even the menopause diagnosis codes Don't really exist. I mean, menopause exists as a diagnosis, but perimenopause is like really kind of gray and and I think that that's even just right there or you know Menopausal anxiety, or you know we have postpartum anxiety now we got a diagnosis code for that, or we have a ICD-10 code for that and we have postpartum depression. But menopause has the same type of mental health disorders that go along with it or the same type of System changes that go along with it. So there's there's a lot of work that needs to be done in terms of just like explaining to companies, these insurance companies and and to be the Basically Medicare and Medicaid, which kind of make these codes and kind of make the standards for these codes, that these are real things that really happen and and they're different. Then, like menopausal anxiety is different than regular anxiety that a woman's facing in her regular life.

Parker Condit: 17:19

Yeah, and thus the treatment should probably be different.

Kristin Mallon: 17:20

Totally different, absolutely like menopausal anxiety can be treated with hormones or can be treated with like progesterone, for example, and regular anxiety maybe might be treated with an SSRI or an SNRI or something like that.

Parker Condit: 17:31

Yeah. So the point I was trying to highlight because the health care industry is so complicated and the financial model is very complicated as well. A lot of people say why can't we just do preventative care? Largely because the financial incentives aren't there. Like people, at the end of the day, doctors still need to make money, practitioners still need to make money and the the comparison I usually have to give people is like how much of your job do you want to do for free and not get paid for it? And it's unfortunate that that is the case. But there does have to be these ICD-10 codes and the CPT codes to get reimbursed, otherwise you're working for free, which you know a lot of practitioners. They do want to work in the best interest of their patients, but they have to operate a business at the same time. So it's this really weird balance that a lot of people probably don't appreciate. That is Extremely challenging for providers on the on the side of the health care.

Kristin Mallon: 18:21

Yeah, absolutely, and even though it's just like this weird catch 22, because you think that insurance companies would have this incentive to push Preventative care because it's eventually gonna save them money down the line long term, but, like, for whatever reason, like that hook hasn't caught yet, so it's not happening.

Parker Condit: 18:39

Yeah, there's probably something with like the portability of risk in the US and that you can. You know You've got united today. You can have blue cross a year from now. So, united, investing in your health today might make it cheaper for the next payer. It's. It's so complicated, it's. That's definitely another conversation. But Can you, can you dig into the women's health initiative a little bit more? Because that was on my list as well and all I knew about it was that once it came out, like you said, hrt was pretty much put on hold and it was because of this correlation, there's association with breast cancer. Was that just a poor interpretation of the data or like what exactly was it? I just knew yeah. I knew the results came out and I knew this happened and then everything I've heard since then it was like it was a really it was. What was reported was not correct.

Kristin Mallon: 19:25

Yeah, so I'm like really grateful that you've given me an opportunity to kind of like set the record straight on the WHI initiative. So, so, actually there was a study, and so I wish I had my facts like right in front of me so I could like be like really exact. But there was a study that was done, a nurses study that was done, with actually even more, with even more test subjects 30,000 women were enrolled in this study and I believe the study came out in 1998, around the late 90s, okay, and it basically proved that HRT has no risk, no risk of breast cancer and and kind of like Told us a little bit about how it could potentially be. What we know, what we now know today, is that, like hormone replacement therapy could, back then in the 90s, that we found out that it could potentially be helpful for cardiovascular risk reduction, bone loss prevention and Alzheimer's and dementia prevention. We now know that, but that's true now that HRT is incredibly helpful for those three areas of health. And Then now fast forward to 2002, a study that was run, I think the study only went for a couple of years, four years or so, and this study had 27,000 enrollees, so 3000 less, and they found that estrogen, when taken alone, actually increases your risk of endometrial cancer. Okay, we know that now and when we give HRT, pretty much no one gives Estrogen alone except to women that don't have a uterus. It's given in conjunction with progesterone to make sure that you don't develop an increased risk of endometrial cancer. And they found that there were two arms of this study. So there was the Prem pro arm, which is the progesterone and the endometrium I'm sorry, the progestin, the progestin and the estrogen arm of the study. And then there was the prem RIN arm of the study. So that was the arm of the study that was just estrogen alone, so that was given to women that didn't have a uterus. Okay, and what they found, actually what the actual results say, so relative risk, you know. So that's really what we're talking about here, like relative risk versus actual risk. So the relative risk I think was actually reduced and I think it was something like 0.77 in the estrogen arm which would indicate so. Actually those results aren't even statistically significant, but that would indicate that estrogen has a decrease Effect on breast cancer. And where they found the increase was actually in the progestin Estrogen arm and that's where they found that the relative risk went to 1.26. So you're talking about three thousand three. Three women in a thousand getting breast cancer, going up to four women in a thousand getting breast cancer in the progestin Estrogen arm, the combined arm. And then all of a sudden the study comes out estrogen causes breast cancer. So I mean there's so much to extrapolate from that of like where that's wrong. So, first of all, estrogen actually decrease breast cancer. Number one in the study. Number two estrogen doesn't cause breast cancer. Someone would argue that maybe progestin causes breast cancer in that, or a progestin estrogen combination. So if you're looking at like what are we really trying to say here? What is the? What is the data really showing us? That's what it's really showing. So, long story short, I mean they, and also I think just based on one study alone, like just to halt Across an entire nation, I mean women were literally like called in their homes and said like don't take your HRT tonight when the study came out because you're it's so dangerous for you, and Like I think that's just one of the greatest faux pas, or like the greatest debacles of Medicine that we've had, probably in the last like 50 years. And I think I think it was Peter Atea who said he talked to one of the primary principal investigators of the study and he kind of like asked her. He was like you know, how many women do you think have suffered now because we've had 20 years of not giving HRT? Like how many women have suffered and actually had increased morbidity and mortality from bone loss and from Alzheimer's and dementia and from cardiovascular disease because they were not given the option of HRT for 20 years? Because we all thought that it was it was wrong and it was bad and and you know, she kind of was like oh, I don't think that that's what really what happened. And he was like well, I estimate it to be a 4.5 million women.

Parker Condit: 23:44

So I think that that's a non-zero number, for sure, exactly.

Kristin Mallon: 23:49

So so does that kind of clear up the yeah totally?

Parker Condit: 23:53

Like I didn't even have that on the initial lesson. Glad you're like such a subject matter expert I, because it's one of those things I've had questions about for a long time and one of my questions was was it the results or was it the interpretation of the results? And it sounds largely like the interpretation, because you said relative risk. So like, are you gonna know off the top of your head what was the absolute change from risk? Do you know?

Kristin Mallon: 24:16

No, that I don't remember off the top of my head. That's fine, so like, but I know that it was not considered to be Statistically significant by the people in the study. Like by the people who were conducting the study, they didn't even consider it to be statistically significant.

Parker Condit: 24:30

Right. And then you got people who are writing about it, who are not first in statistics or research, and they they provided poor interpretation.

Kristin Mallon: 24:40

Right, exactly.

Parker Condit: 24:42

Yeah. So I think it's worth kind of going into absolute and relative risk especially because the subject here is breast cancer, of the women's health initiative and you were saying that hormone replacement therapy is very beneficial for cardiovascular disease, dementia or the other ones, and and bone loss.

Kristin Mallon: 25:00

Bone loss prevention bonus.

Parker Condit: 25:02

So of like the, I think that the three top causes of Mortality for women is gonna be cardiovascular disease number one, I think, by a factor of seven or eight over breast cancer.

Kristin Mallon: 25:13

Yeah, so breast cancer, your relative risk of breast cancer is actually striated based on your decade of life. Yeah, so like, and your relative risk. So, with one in four women will die of cardiovascular disease and I think it's like of, I think it's more like one in eight. I think we'll dive breast cancer, although don't quote me on that, I'm not entirely sure. But then when you striate that based on the decade, it can go all the way down to like one in 26, right, and the relative and the risk of cardiovascular disease does not change like, it's just stable.

Parker Condit: 25:49

The point being is that even if you I, I think for people to be better advocates for themselves understanding the idea of absolute and relative risk, you need to understand what the absolute risk is first. So if you read a headline is gonna say oh, this thing Increases your risk of heart disease by 10 percent right. You need to know what the starting point is. If my starting risk is 2%, a 10% increase is only going to 2.2%. So if, unless you understand the the idea of absolute relative risk, you're never going to be able to get a good interpretation of what that new research is actually saying in regards to your current health. So I think, with the the fact that cardiovascular disease is a Significantly higher risk factor for not just women but everyone, I think it's important to understand that distinction.

Kristin Mallon: 26:42

Yeah, and that's why I like to give the actual numbers of like what the study in the prem, in the prem pro arm, found, which was that it was three in a thousand women were getting breast cancer, versus four in a thousand women in the prem pro arm. So like just baseline, your baseline risk of getting breast cancer is three in a thousand, but then if you go in this prem pro arm it's four in a thousand, which that's not Statistically significant enough, like we're not sure that that wasn't just like a normal variation in data, given that sample size. Right, but given those numbers, if you look at the relative risk, exactly what a 33% increase exactly that's gonna scare the shit out of people, exactly exactly.

Parker Condit: 27:20

Okay. So yeah, I'm glad you did have those absolute, those numbers. So hopefully that gives people an idea of why understand absolute risk is so important when, anytime, you're reading some sort of scientific study.

Kristin Mallon: 27:32

Yeah, and I think that that's like why we all we also have to be like as consumers. I mean, as clinicians it's different, but as consumers we have to be very careful of like sound bites, because you can really make numbers, say whatever you want you know, you can. You can manipulate numbers and data to say pretty much anything. So, knowing like exactly yeah.

Parker Condit: 27:51

That's why I think these conversations are so important, because, at the end of the day, patients do need to be their own best advocate. Even if it is, it's so much to learn, but hopefully these little nuggets help someone somewhere. That's, that's the goal.

Kristin Mallon: 28:02

Yeah, well, I think, like that's what's so great about like all of this access to media that we have, is that, like people are, in general, becoming their own doctors, like in some ways, like we're becoming co-pilots, like we're becoming navigators, like, okay, this is safe, that's not safe, you can go here, you can do, you can go there versus, like the dictators that I think that the medical community used to be like 50 years ago.

Parker Condit: 28:26

Sure, all right. So you've brought up your company a few times. Can we actually just dig into, like, what exactly you do, sort of like what your business principles are in like, do you take insurance, are you concierge, are you remote, only are you in person, anything like that? I'd love to just learn more about what exactly you're doing there.

Kristin Mallon: 28:45

Yeah. So Femgevity is really a company that was based around longevity for women, and we found that menopause and midlife, perimenopause, menopause so really like the post reproductive time in a woman's life is really the time, one of the best times in her life, to start thinking about longevity, and also it matches up really nicely to when she's actually thinking about longevity herself. And so what Femgevity does is it really does bring, it aims to bring concierge medicine down to an affordable level. So, similarly to what Uber did, to bringing chauffeurs to kind of like the everyday person we're looking and we're aiming to bring concierge medicine down to an affordable level where it's not costing you thousands of dollars but you're getting the same exact thing for hundreds of dollars. So, yes, you can use your insurance to access our services some insurances so you would need to have a PPO insurance plan or a plan that lets you go out of network, and then we can provide a superbill that you could then get reimbursed from your own insurance company, because all of our practitioners are board certified, we all have NPI numbers, and so we're able to provide that to patients that have that specific type of insurance. And if you don't have insurance, then you can use an FSA or an HSA health spending account or you can pay it a pocket, and obviously we can put people on payment plans as well. But so what we're doing is we're doing concierge medicine through telehealth visits. So every visit is usually like the first visit is usually about an hour and follow up visits can be anywhere between five minutes, however much a patient needs, up to about 30 minutes. They usually don't go much longer than that. Every once in a while someone has like and it really complicated in depth question, and then they do go on longer than 30 minutes, but that's roughly like about how often they are. So the initial visit is an hour and then you're meeting with your healthcare provider, usually every month, until you're getting into a maintenance plan, and then a maintenance plan is you're meeting with your provider every three months to just check in, run labs, make sure everything's kind of up to wherever your health goals are, and so everybody has different health goals when it comes to longevity. Sometimes it's about risk reduction, sometimes it's about menopause management, sometimes they all kind of go together. But we're taking this opportunity to educate women about longevity and a lot of it is focused around perimenopause and menopause.

Parker Condit: 31:11

Yeah, that's a good explanation. I was wondering what the typical cadence of like frequency for visits and I guess it starts off monthly, ends up sort of every third month. Yeah, do more people come to you with specific cases, or more people come into you on the prevention side, sort of like prophylactic, like I know, when we going through this I wanna do everything I can now, or is it more like I'm already having these symptoms?

Kristin Mallon: 31:38

Yeah. So I would say it's about 70, 30, like, just kind of based off my own anecdotal experience, that about 70% of women that are finding us because we are really seen as a menopause company are coming to us with menopausal and perimenopausal symptoms and they're like I really need help. I know that this is something that you're really good at and that you can do and you can take the time to figure it out with me and you're not just gonna throw HRT at me like that's not the only solution. Not everybody's looking for that. Not everybody needs that. Not everybody needs the same type of HRT if they get to HRT also, which is why I think concierge medicine fits this niche so well. It's very personalized and very customized to each person. But then about 30% of the people that come to us are all ages. Actually, I mean, we have patients who are 25 years old and all the way up to patients in their 70s, so and we're happy to take people younger than that and older than that too, like that just happens to be the age range that we're treating right now. And then the younger women that we're treating, and also the older women that we're treating too, they're much more focused on prevention, gut microbiome balancing, micronutrient testing and optimizing sometimes their performance when it comes to some type of sporting activity or exercise activity, like they're doing an Ironman or they're running a marathon or they wanna get better performance out of their body. So that's a little bit more about the preventative or the longevity clientele that we have.

Parker Condit: 33:01

Are you familiar with Stacey Simms' work?

Kristin Mallon: 33:04

No, I've never looked at Stacey Simms or maybe I have, but does she have a company?

Parker Condit: 33:12

I'm sure she does. I think anything like women's health related was introduced to me through her. So she is. I'm not sure if she's a practitioner, but she wrote a book. I think it was very specific, to like strength training or like endurance training for women.

Kristin Mallon: 33:27

Oh, she wrote the book Roar. Okay, yes, I've heard of that book, that's kind of the name. Yes, yeah, yeah, yeah.

Parker Condit: 33:32

Okay, yeah, a lot of what you were mentioning, especially the triathlon that triggered it. I'm like, oh, that sounds like right in Stacey Simms' realm and wheelhouse.

Kristin Mallon: 33:38

Yeah, definitely. So we have a lot of the women who seek us out for the longevity portion are pretty heavily active women themselves that are looking for the type of functional medicine testing that we offer and they wanna get their hands on that testing. They wanna like understand how to interpret it Because, again, it's usually like above, unless you have some sort of medical degree to interpret, the functional medicine testing is a lot, which is why I think sometimes over the counter functional medicine testing is like dumb down and they test like really basic, basic, simple things, because it's kind of too complicated if they open it up to everything that functional medicine testing is really capable of looking at. And that's really where we come into play. Like we have these board certified medical people versus like someone who maybe is super into health and fitness but they're in finance or they're a lawyer or they're a teacher and they didn't spend their life kind of understanding physiology and anatomy and the body.

Parker Condit: 34:40

Yeah, I think it's great that it's a lot of people are coming much more proactive about their health, but at the same time, I do think access to some of these tools are gonna end up confusing people just because, like you said, they're not particularly trained to interpret the results properly, right? So how does your company fit in with, I guess, like an existing primary care doctor or an OBGYN, like how do you like do you coordinate with?

Kristin Mallon: 35:07

Yeah. So we really like to coordinate with all of the. Any doctor that we can coordinate with, the better. So we've worked a lot with OBGYNs. We'll write up care plans for OBGYNs or we'll do endocrinologists. We'll kind of coordinate with them and actually believe it or not, a lot of cardiologists are kind of looking to. They know that they want. A lot of cardiologists are very into estrogen I think rightfully so because they see, like what it can do for lipids and what it can do for cardiovascular health and so they'll partner with us to get their patient on some sort of HRT to kind of help them with their lipid management.

Parker Condit: 35:47

Interesting. Yeah, so it's. Yeah, I feel like everything moving forward is gonna be like big success in the healthcare industry is gonna be making this coordination easier. Like, how do you do it right now? Is it just calling them, Is it just emailing?

Kristin Mallon: 36:01

with them. Yeah, so it's funny because we have a. We have like an EMR that's, you know, was a startup itself and it's supposed to be like the super tech kind of savvy company and they still haven't solved for this issue about how physicians can kind of communicate really well with each other and talk to each other. So a lot of times it's so we still fax. I know it's weird. I mean a lot of it's digital faxing, but we still do fax in the medical world because of HIPAA and because the faxing is HIPAA compliant and because of data protection. So that's usually what we're doing most of the time is we're writing up a consult note. It's pretty detailed and, you know, really explanatory and we have templates. So some of it is drag and drop because a lot of it is very customized. But it's also kind of like putting all the right pieces together that go for each patient and then we'll send that to via fax a lot of times to whatever doctor we're coordinating with and we're really not looking to replace at all primary care or OBGYNs at all. We're looking more to be an adjunct and a navigator and a co-pilot to the patient themselves.

Parker Condit: 37:11

Yeah, no, that's what it sounds like. It sounds like a very like necessary, like you said, adjunct or just yeah, just filling a gap that is clearly missing in the healthcare system as it is today. And to speak to your EHR. So we deal with interoperability and data management, so I can speak to that. It's incredibly complicated, Like there's so many companies that are trying to solve that, but it's, you know, every time a new standard of a data, like data transfer standard like right now we're on HL7 with something called a FHIR protocol, so like everyone has to change to that but you know, every three years a new standard comes out. So now there's like 14 accepted standards of how data is supposed to be transferred. Again, it's not this conversation, but it seems like it should be so simple, but the more you look into it, you're like this is such a mess.

Kristin Mallon: 38:00

Yeah, no, definitely. It's funny because, like, all of our finance information is like so readily available, like if I and I feel like that I'd so much rather have my health information stolen than my finance information. But that could just be me. I understand the privacy around health information, but if I go across the street and I buy you know a water, that's gonna show up everywhere, in every single bank that I own, and they're gonna know my credit card. Everybody's gonna know that I did that.

Parker Condit: 38:27

Yeah, they're probably selling that data to, so water companies can market towards you and stuff like that, Right exactly. Yeah, it's a mess. It's so complicated, I guess. One last thing I'd like to ask on sort of like the healthcare infrastructure side of things. It's like what do you think needs to be done like systemically in the healthcare system to create like more quality and equity around women's health?

Kristin Mallon: 38:51

So you know, because I've been in women's health for 20 years and I've just I've seen kind of how things start with companies like mine and then filter down throughout the whole healthcare system. I think that other companies like mine that are doing more fee for service is eventually gonna make other is eventually gonna wake up the rest of the system to be like, okay, let's solve for this, let's figure this out. I think there's also like I like to look at like the good in things too, like I'm like okay, where's the optimism here? Like where is this, like where could this potentially be going? And I think that there are some large companies that have internal health like they call them products, or like human resource products or point care solutions or patient solutions that are really looking to bring down their overall costs. And they're doing it right now with like really big ticket items, like for. So, in women's health, like a really big ticket item is hysterectomy because that's a very expensive surgery that is gonna drive premiums up for these big companies. So the large companies that are employing 50,000 people or 20,000 people have an incentive to figure out how to bring those costs down. So I think there's a way for us to partner with them and once we kind of work with more of these larger companies as opposed to the health insurers, we'll be able to start finding solutions to bring other costs down too that are smaller ticket items, like more items, like this, and I think that like that can translate into solving for women's health issues. At least, that's hopefully how I see it, and I think that Every patient that does pay for something out of pocket and gets a result, that's still data and even though, like you know the way that we're using data, but it's still like it's still information about okay, well, these are things that are actually working and these are things that are actually Making women's lives better. So let's invest time and energy into these things so that we can, like you know, when the water raises, like in the, all the boats go up, like when the water in the harbor goes up, like all the boats go up. So I think that there's hopefully like from the system as a whole. I think that women, as consumers, are gonna demand better experiences and, yes, initially it is gonna be fee-for-service companies like mine, but I really do believe that that's gonna have a trickle-down effect into the rest, the rest of every part of health care.

Parker Condit: 41:26

Yeah, I mean it nice to. It'd be nice to say like, oh, it's just gonna be integrated into the system in five years time. Yeah, I do think. Yeah, there just needs to be sort of Like private solutions like yours, and then that raises awareness. Awareness can sort of drive results. And then also, like you said, if you're working with these big employers a lot of people probably don't know that big employers they actually they're paying, like they're carrying the risk for all their employees health insurance, like your card might say etna, but if you go to the doctor like your employer is paying, so they're, they're highly incentivized to save money. And then you know I hate to always bring it back to money, but that's kind of what makes the gears of our economy in our world turn. You know, if it saves a company money and improves productivity and increases employee retention, all those things are gonna incentivize these companies to make make those types of decisions. So I'd love to kind of move on now to like the specifics of like lifestyle factors, understanding exactly what longevity is, so kind of moving away from the health care Infrastructure of everything and just getting down to like what can people do, right? So I think it'd be good to just start with understanding. How do you think of longevity, like? How would you define that?

Kristin Mallon: 42:36

Yeah. So longevity is really Expanding health span and lifespan. So Medicine is really good at having people live longer, but medicine is not good at improving the quality of life, especially in that marginal decade. So that last ten years of someone's life and that's what longevity medicine or the people who call themselves longevity medicine practitioners are really aiming to do, really aiming to Not only have you live longer or have someone live longer or have ourselves live longer, but have you live better too. So health span and lifespan so that's really what longevity is, and a lot of it does focus on this marginal decade, or the last 15 years of someone's life. Because what's the point of living longer If you can't go on an airplane and put your bag in an overhead bin, or you can't go on a hike, you can't play tennis, you can't get on the floor with your grandchildren or your great-great grandchildren. So that's kind of what we're focusing on when we when we talk about longevity medicine. And then More specifically, like when you break it down, there's there's like the four horsemen of disease. So there it's really kind of basic, like there's four main pillars of longevity that we look at when we're looking at someone's health, so we're looking at their cardiovascular risk Like I said, number one killer of women. We're looking at their cancer risk, so genetic history, maybe genetic cancer screening. We're looking at their neurodegenerative risk, so do they have a risk of Alzheimer's or cognitive decline or dementia? And then we're looking at their metabolic risk, so are they at risk for something like diabetes, liver disease, kidney disease? So those four areas is where we focus on when we focus on longevity. A lot of times women will have two out of four. That really Kind of stand out as the ones we need to focus on the most. Sometimes women have all four, sometimes women just have one, and we work on reducing those key Pillars on a series of data points.

Parker Condit: 44:30

So it's probably based on that. You probably specific metrics for each of those pillars that you're talking about, but are there any things that you broadly look at for for everyone to just get a general understanding of, like what they're, what their likelihood for increased longevity is?

Kristin Mallon: 44:45

So when you say like are you talking about like laboratory tests?

Parker Condit: 44:50

Are you talking about like lifestyle habits, like smoking reduction, or yeah, I'd say both right, because it's it's a combination of things right.

Kristin Mallon: 44:58

Yeah, so I mean the number one. I mean other than smoking cessation. The number one thing after quitting smoking and quitting probably exposure to heavy metals and other hard hard drugs is Exercise. So it's more effective than, like the most effective statin that we have in terms of reducing overall morbidity and mortality pretty much about across every single disease platform. There is even cancer. So we really work on a lot with exercise and lifestyle modifications, the psychology about behind exercise, why you're exercising, why you're not exercising. We try to pull up as much data as we can to kind of educate people about how much exercise can really improve someone's life. We do look at diet as well, so diet can be different for every single person. We do a lot of, we do offer a lot of genomic insight and genomic testing and nutritionomic testing, because there's so much now. So everybody kind of in the pregnancy community knows about mth fr, which I think is like the first like genetic test that's really kind of made it to the mainstream, like to the internet and the reddit, the reddits in the blog.

Parker Condit: 46:13

Cuz got a fun name.

Kristin Mallon: 46:15

Yeah, and it's um, you know. So there's there's hundreds of other genes that are also related to diet and what types of diets are best based on your genetic makeup and and and DNA. And then also, like, your laboratory data can give us a lot of information like do you have, do you have, insulin resistance? Do you have, you know? Do you have LDLP that's elevated? You know certain lipids that can sometimes indicate that you know a plant-based diet is better for you, etc. So there's the diet, there's exercise component, there's the diet component, and then we kind of get into a lot of the functional medicine testing. So gut microbiome testing is huge because every time I balance someone's gut microbiome, like the, the wonderful Side effects that come out of it, like the health benefits that they got that they weren't even thinking that they were gonna get, are just like. I'm always shocked every time, like they'll be like, oh my gosh, my vision is better. Or they'll say something like my psoriasis cleared up when they were doing gut microbiome balancing for something else. And and then we do a lot of Using, like the regular data, lab points like hemoglobin a1c and apob and LDL, little p and cholesterol levels, glucose levels, to track how someone's doing in terms of Just overall health, wellness and prevention basically.

Parker Condit: 47:40

Okay, so a lot of those things are like we're gonna dig into some of the lifestyle stuff in a little bit, but for the, the labs and the metrics that you're looking at a1c pretty common glucose looking at insulin lipids and that's your cholesterol and triglyceride stuff like that. But you mentioned a few of like the advanced lipid test, could you talk about those a little bit? I think LDLP that's not super common, lp, little a also not the most common thing. Like if you're just a regular 34 year old person going to your doctor getting annual labs, you're probably not getting those. Yeah and LDLP. Can you talk about those a little bit? Yeah, lp, little a yeah.

Kristin Mallon: 48:19

so basically I mean this. This is, these tests are looking at like how much particle deposit or athelosclerotic like, so plaque Build up you have in your body, or like the potential to lay down plaque you have, like how many plaque particles and and how many, how many building blocks do you have to block arteries? Basically, and and it's something that is just kind of used as a metric Over time as an indication of where you are certain Certain values can mean, you know, higher risk for stroke and heart attack and certain values can mean lower risk. Although it's not, it's not a foolproof way, you can certainly have someone that ends up having heart attack that has amazing lipids and and vice versa, you can have someone I mean we have, we have triathlon triathletes who have elevations and their LDL, their LDLP and, and you know they literally do everything perfectly and they still whether it's just how their body is structurally made or how they Process cholesterol in general, which might not necessarily end up being bad. So I always want to kind of caution, like whenever looking at these kind of like more extraneous lipid tests that like we don't have a full handle on how, how they are gonna play out long term, especially in like uber healthy people, but they're kind of just used as like benchmarks and ways to kind of track process progress, because Data on ourselves is one of the best ways to kind of motivate ourselves. It's a very good way and it works really well to motivate ourselves to kind of keep going and also to To get better. So the the thing too about like LDL little P or LDL P and LDL little a and APO B, is that like when you, when we have arthroscopic particles, or when we have plaque particles like floating around in our bloodstream like we, you can have someone that's young, like even even in their late teen years or twenties that once plaque is laid down in the arteries it's not coming back up, and so I think that's a big key distinction that people don't understand about cardiovascular disease as compared to metabolic disease. Like a lot of times metabolic disease can be completely reversible, whereas arthroscopic disease and plaque buildup disease and cardiovascular disease, like, once the plaque is down, it's down, and so tracking that, even when you're younger, can just give you an idea or an incentive of like, okay, well, I am more prone, either genetically or just from the way that my body's built, to have higher lipid levels and to have higher particle levels, higher arthroscopic plaque particle levels, which is what those labs are testing. So that means that I wanna be more careful about the decisions I make, I wanna be more committed to my exercise, I wanna be more committed to my diet. Maybe I would even consider a statin at an earlier age, like a lot of times, there's this like push against statins, which is drugs that help to prevent the laying down of arthroscopic plaque in our arteries, and so I think that that's kind of how we use those labs and that data to kind of give us information about longevity.

Parker Condit: 51:36

Yeah, so that was probably more than most people know about cholesterol. Yeah, that was also super helpful because, yeah, so I've been tracking my cholesterol and like do an advanced lipid profile since I think I was like 23. And it's for that case because a lot of people think, like you said, be like, oh, I can just adjust it with lifestyle factors. But unfortunately, for cardiovascular disease, or specifically atherosclerosis, which is always a mouthful, it's described as like a bell that you can't unring.

Kristin Mallon: 52:10

That's right, yeah, and I think that, like to your point, like women especially get confused because there's so many things that can get better, but this isn't one of them.

Parker Condit: 52:21

Right, and you know, like I think, a lot of risk profiles. They don't. Even if you try to figure out what your risk for heart disease is before you're 40, most of the calculators say it's zero, yep, which is crazy, because heart disease starts, like you were saying, potentially in your teens, if you happen to be somebody who is accumulating this plaque. Yeah, so again, I'm really glad you brought that up, because it's these conversations that at least make people aware of, I guess, like what is happening physiologically in people. So it's, yeah, it's definitely one of those things that people should be aware of. And I think, even if you're not completely aware of what ApoB is, or particle number, or LP little A, I think it's helpful to have a history of blood work. So if something does come up in your late 30s or 40s or 50s, you have this beautiful history that somebody who knows what they're doing can look back on and be like, oh, this is a great picture. I can really see what's happened up until this point, other than just going to get like getting your labs and then seeing. Well, I understand what's happening right now and I know that you got here somehow, but I don't know how you got here.

Kristin Mallon: 53:34

Yeah, and I think that one of the other things that even just this awareness about cardiovascular disease because I think that it's so not talked about because it's really like a silent, slow killer and also it also comes like a thief in the night. And so that's also when you get the 38 year old that had a heart attack, that didn't really know but like, oh, when you think about it, like he did have a family history of cardiovascular disease on both sides and he had someone dying, his family really young, from a car accident and it kind of like doesn't have. You have all the pieces of someone's family history, and so sometimes people don't know their father or they're adopted, and these tests can be really great ways to kind of just have a little bit more of a broader picture of yourself from a cardiovascular perspective, especially because it is like it's so, so common and there's a lot that can be done from a prevention and a longevity medicine management perspective. And then I think also, too, like we wanna really get away from looking at just total cholesterol. So I'm like always shocked when I see my other physician counterparts being like oh well, the cholesterol was 213, so it's fine. And it's like well, okay, wait, I'm gonna like back up like what is the HDL, what is the cholesterol HDL ratio? Like, because someone could have a low cholesterol but have a really high cholesterol to HDL ratio and that could mean something entirely different than what just being like, oh, 220 on cholesterol, this is fine. So I think it's also just kind of like a good rule of thumb that if you're working with someone who's just kind of like looking at cholesterol, like oh, yeah, yeah, yeah, that's the only thing that's important, like there are broader perspectives that could be taken, rather than like just looking at one metric like total cholesterol.

Parker Condit: 55:23

I think that's gonna improve. Like, speaking of like relatively new specialties like lipidologists, people like specialized in lipids and cholesterol and understanding those things, that's 20 years old, I think, less than 20 years old, I think. There's only 500 lipidologists in the country. So again, that's a relatively young specialty. So again, I think, as that grows, broader awareness is gonna happen. But yeah, I'm glad you brought it up because it's I'm always happy to talk about cholesterol. Can we move on to some of the lifestyle stuff? Like I'd love to just dig into how you think about exercise. Do you have any tricks to get people to start exercising who have never exercised before?

Kristin Mallon: 56:02

Yeah. So I think one of the one of the like most important things I could say about exercise is it has to be done with a heart rate monitor. So without a heart rate monitor, it's just kind of like throwing paint on a canvas, like without any like guidance of like okay, we're gonna make a landscape or we're gonna we're making a fruit bowl here or what we're trying to do, and it's. I mean, there's so much to say about heart rate and about how to use heart rate and heart rate exercise appropriately, but there I think there are some companies that are starting to get it right, like even the fact that, like orange theory, which uses the different zones, the different heart rate zones, and they have five different heart rate zones that I think Peloton has also kind of adopted and they're using five different heart rate zones, is a really good, just kind of like basic generic path to follow. So the heart rate zone of like just walking around or doing Pilates or yoga, which like heart rate zone number one versus heart rate zone number two, which for most people, if you get it right and you get heart rate zone number two, should be about 70% of your max heart rate, which is where you're gonna be in an aerobic capacity, so you're building your brain maximum amount of fat still in aerobic capacity, still able to utilize oxygen in the right way, versus a zone three, four and five, which are used in different ways for different types of things. When it comes to whatever the goal is, so like, is the goal to reduce cardiovascular risk? That's a specific type of exercise, that's a specific type of heart rate goal and monitor that you wanna do. Is your goal to do weight loss? Well, that's a different type of heart rate zone that you wanna target for a different amount of time. So I think, like working with people is really important to figure out what their goals are and then have their heart rate targets match. So I'm always like so amazed when I'm like someone's like well, my goal is heart rate reduction and they're not using any heart rate monitor. I mean, their goal is weight loss reduction and they're not using any heart rate monitor.

Parker Condit: 58:14

Yeah, and just having that data is incredibly helpful for one, a provider practitioner like yourself, but then also just to learning more about their own body People who have never. So I come from a personal training background, so people who have never really exercised, they're very out of touch with their body. So giving them some data points to reference be like hey, when we can still have a conversation like this and you're on the stationary bike recognizing, oh, I'm approximately in zone two or whatever might be for that person, it's a good reference for them to understand, without always being super reliant on the technology, to just become more introspective and getting more familiar with their body.

Kristin Mallon: 58:58

Yeah, absolutely so. I think that. So that's one of the things that we kind of like get them started on right away and there's so many they don't have to go out and buy like a $200 Apple Watch, like there's a Fitbit that's like $20 on Amazon and that will connect to your phone, and that data helps me to guide them and counsel them about whatever their goals are when it comes to longevity.

Parker Condit: 59:24

So I'm a 34 year old guy let's just say I'm a 34 year old woman and I come to you and I've never exercised before. What would you put me on a strength training and aerobic split, like one day strength training, one day aerobic, or how would you sort of ease me into that?

Kristin Mallon: 59:42

Yeah. So I think for us it really depends on, like, what her goals would be like coming at 34. So she's starting. So we really break down what's like advisable based on decades for women, so what women need to do in their 20s versus their 30s, versus their 40s, 50s, 60s, 70s. Even so she's 30s, mid 30s. Then, like, her weights probably have to start going up in terms of what she was lifting in her 20s or, if she was lifting nothing in her 20s, definitely need to start getting her going on the weights. And then, what is her goal? So, like we go back to those four pillars, like is she at risk for cardiovascular disease, cancer, is she at risk for metabolic disease or is she at risk for neurodegenerative disease? And then we kind of tailor the exercise based on whatever pillars we want to reduce. And then most of the time, women want weight loss reduction. So we try to keep them out of that zone. This is like just really really general and basic too, because every woman has something different. We try to keep them out of that zone three. That zone three. I call that the junk zone because they're working really hard, but not hard enough to be building stamina and endurance and too hard for aerobic exercise. So we kind of build them around what they're able to kind of handle and also incorporate into their lives. From a timing perspective, so it's really like multifactorial, like that's what again, like why I think the concierge medicine is really the way to go in these instances, because there's really like no one size fits all when it comes to exercise. And that's where the monthly visits really come into play and are so useful, because we can check in with women and be like okay, this is what we put as our goals for last time, like what's working, what's not working, what can we tweak. And yeah, it would be great if we could have, you know, like three to four hours of zone two every single week and we could have 60 minutes of zone four and five and we could have three days of resistance training and strength training plus flexibility and stability. If we could get all of that in in a week. But if most of the time we can't because of time constraints. So then it's like how can we really get the best bang for a buck? And a lot of times women are resistant to one type of exercise. I found that I don't know if you found that with the counseling and coaching people. But they're really good with zone two, but they hate zone four and five, or they love HIIT and they hate zone two, or they won't do weights. So sometimes it's, like you know, working with the psychology around that as to like, how can we find a way to incorporate these things that they're not as excited about doing? But how can we gamify it or how can we make it fun for them to where it's something that they'll actually start doing?

Parker Condit: 1:02:24

Yeah, totally so. Much of it was always just like seeing where they are, seeing what they're willing to do. I'm like I'm gonna build the exercise habit first and then I'm gonna start tweaking and like which levers I really need to pull. You know, if you hate lifting heavy, guess what we're not lifting heavy right away Like maybe get you addicted to exercising first, and then I'm gonna sneak in the vegetables. How does sleep play into all this? Because I know sleep is a big factor for, like neurodegenerative disease. Sure, it has an effect on everything it's. You know, I think if we could have evolved out of needing eight hours of sleep per night, we would have, because it's like, from an evolutionary standpoint, like the most dangerous thing to just be unconscious for eight hours a day. So I think it's clearly necessary from a survival standpoint. But like, so how does that fit into some of those like the pillars that you were talking about?

Kristin Mallon: 1:03:12

Yeah. So I think sleep and hydration is often so overlooked when it comes to any type of medicine at all, and it's definitely obviously one of the factors that we really like hone in on. And most women, especially paramedic, causal women, are not sleeping and that's something that we wanna fix right away and we work on fixing almost, we try to work on fixing almost immediately. And there's a lot of different way to collect data. So we like to collect data. So we like to collect data for a lot of reasons, like one it really helps the patient themselves to like track their own progress and see like, okay, I've made these changes on myself, like they're almost like their own experiment on themselves, like I made these changes and now I can see that like my data's improving here and my sleep is improving here. So that's gonna motivate me to continue to do these interventions and that's gonna motivate me to continue to take whatever the remedies are. The treatments are continue with the plan of care. So sleep is like no different. We love to kind of get sleep trackers involved, obviously like I don't have any affiliation with them at all, but like the ORA ring, I think, is like the number one sleep tracker. It's one of the number one wearables in general, and so, if they're willing to spend the money, ora ring isn't cheap it's like $300. Plus, I think they make you do a monthly subscription. Now Apple Watch has a lot of apps that will help track sleep, and Fitbit and Garmin too, and I think Woop also. They have apps that will track sleep and so just starting to collect data and then figuring out how to make adjustments within sleep hygiene so that somebody can really maximize their sleep. A lot of times, so often, hormone imbalance affects sleep and that's something that we can fix really, really simply with just Adjusting hormone imbalances, and there's a lot of different ways we can adjust hormone imbalances, but that's one of like the number one, I would say benefits that people report to us is they're sleeping better, and then sleep just has this cascade of like well, all these other things are now better because I'm sleeping better.

Parker Condit: 1:05:18

Yeah, sure you have the energy. Yeah, it's Just sleep three or four hours a night for a few weeks and you'll just see the quality of life just drop down so significantly. Can you talk about sleep hygiene a little bit like what are some common things that people are maybe unaware of that are going to be affecting the quality of their sleep?

Kristin Mallon: 1:05:38

right. So there was this really funny Amy Schumer like video about how this doctor like goes in front of like he's like giving this talk to His patients and he's like, okay, guys, like I'm gonna give you guys the best sleep of your life and all you have to do is just stop using your phone, like one hour before bed. And they're like, oh man, doctor, we can't do that. Like we'll do anything, we'll take any pill, we'll take any, we'll take any surgery. Just we need sleep. We need sleep. And he's like okay, how, about 30 minutes before bed, and I like dude, we can't do that doctor. And then he gets down to five minutes and they're like we can't, you want to lose us, live like the Amish, we can't do that. So so I think like, just right off the bat, obviously screen time, and you know there's a lot of different options. I mean Kindle makes a kind of a Kindle white and there's a blue light blocker glasses. There's a lot of different options to still like have your time with devices, but kind of like minimize your exposure, definitely minimizing exposure in in the room. So I tell women to use red lights a lot of times, like especially for night lights If they're getting up in the middle of the night and going to the bathroom. Not eating, not eating late at night, it's really helpful for sleep hygiene. Not exercising too close to bedtime, watching the amount of alcohol intake that someone consumes, and, and this is stuff that when, once you start tracking on data, you start to see how all of these things make a difference. Okay, well, if I eat through two hours before bed, it's fine, but if I eat an hour before bed or an hour and a half before bed, it's affecting my sleep, it's affecting my deep sleep, it's affecting the different sleep cycles that I'm having. Certainly, meditation is really helpful for sleep exercise is absolutely almost key for anyone who's struggling with sleep and To use Any sort of like white noise or to make sure that the room itself has the right ambiance for sleep and I think that there's a lot of different ways that that can be done. So it's like making sure to block out natural light when possible, making sure to block out external noises whenever possible, making sure that the temperature in the room is correct. So these are kind of the things that just like off the top of my head, that I think about when I think about good sleep hygiene.

Parker Condit: 1:07:48

Yeah, I think all that's great. It's all things that you can implement or try to implement immediately, you know. And then there's obviously the pharmacological interventions as well. There's the longer term Lifestyle factors, like continually exercising, but, yeah, at the sleep hygiene, cold, dark room, trying to avoid screen time leading up to bed. Another thing to keep an eye out for is Caffeine intake, because caffeine is a half life, so a lot of people be like, oh it's well, it's eight hours before I went to bed. Some people metabolize caffeine at different rates, so it's one of those things that it's. If you're drinking caffeine into the afternoon, it's, it's one of those things. Maybe maybe cut it off at 11 or cut it off at noon. It's just one of those things to look at it additionally.

Kristin Mallon: 1:08:30

Yeah, and I think that like, so, like I said, like for FM Jeviti, this is like one of the number one things, especially for perimenopausal women. So I want to say, like women that are like 40 to 50, they're really struggling with sleep and this is something that like is really really really easy to fix With, sometimes just like really small, subtle hormone support so not like full-blown HRT and not, you know, not talking about estrogen patches and all that kind of stuff, but sometimes just like a little tiny whimper of a bio identical can like Do a world of difference with sleep and help women to adjust to the loss of hormones that they have in their 40s, to kind of like make the calm down of the hormones like just a little bit gentler so that they're not having these like really significant shifts in in sleep and then that, like you, like you said, will affect Cognition and actually can increase your risk of dementia later down the line hmm.

Parker Condit: 1:09:30

So I mean not to bring back the the HRT WHI study, but Is there any downside to HRT like I feel like there's no such thing as a free lunch right. So there's, there's got to be some yeah, yeah. So what do you? What are your considerations? When you're like I know this is a good solution for a lot of people, but you, there has to be a downside right.

Kristin Mallon: 1:09:53

Yeah, there's not really a lot of downside, because Women are getting their bio I. They're getting, basically, they're getting a Bio identical hormone, especially in the form of astrodial and micronized progesterone, which is what the what makes up the bulk of HRT these days. I mean, we do have some other Formulations which you know. This is why you need a specialist who understands all the different formulations you know, not someone who's just prescribing based on like the drug rep that walked into their office that day but the. They are identical hormones to what the body already makes. So, similarly to like how, when someone has hypothyroidism and they take Synthroid or they take level thyroxin, or when someone has diabetes and they take insulin, these are also hormones, but the body already makes them. So the problem can come into play when you take too much Right. So like the same thing, like too much of any hormone too much testosterone, too much growth hormone, too much Estrogen, too much progesterone it's the same thing. So we. That's why you really need to work with someone monthly and someone who's gonna titrate you and also follow your laboratory data to make sure that You're getting the right amount so that you don't have Too much, but when you do have too much. So I did mention that If you're taking estrogen, if you have a uterus and you're taking estrogen and you're not taking progesterone, there is the risk of endometrial cancer. So the risk of uterine cancer. But as long as you're taking progesterone, that's gonna mitigate that risk. And that's what's really funny is like no one ever talks about that. No one ever talks about uterine cancer, which is really like that's the real risk of HRT versus breast cancer. The other risks are, you know, there can be some bleeding, like just like with taking any estrogen. There can be some irregular bleeding and then, very similarly to how a woman's body reacts to pregnancy or a woman's body reacts to birth control pills, to those hormones, there can be the same side effects. So pregnancy has a whole slew of side effects like nausea and breast tenderness and, you know, irritability and things like that. So when you're having too much of a hormone Again, like we at FM Jevity, we really try to avoid that at all costs, although it can happen but when you're having too much of a hormone, then you can start to have the effects of, of an overabundance of a certain amount of a hormone, and so those are the main side effects. Is is is basically anything about taking too much, too much estrogen in general. There, you know, we do use testosterone and we do use progesterone. Progesterone has very, very few side effects. Progesterone can have some spotting. I can have some bloating. Sometimes it can have some water retention. Progesterone is a somalesson, so it can make people sleepy, but a lot of times that's a desired side effect. Especially if you tell women to take it at night. It helps with sleep, but if someone's taking it during the day it can make them feel drowsy or kind of like, you know, just a little bit tired. The the thing about testosterone, you know. So we're using like very, very, very, very low doses of testosterone. But again, if you're taking too much testosterone or you're it, you know, in pellet therapy or you're you're in an unmod, you're in an unregulated dose then you could have, you know, side effects associated with testosterone. So that would be like growth in areas that you don't want, especially like hair growth, muscle growth. It could be Also mood changes that come along with testosterone Too much testosterone for women.

Parker Condit: 1:13:23

All right, one of the things that meant to bring up earlier are ask you about earlier when you're talking about from Jevity is like your average panel size, because I think again Just getting people to understand the difference between, like what a traditional doctor what that relationship is like, versus that with the concierge practice. Concierge practices generally have significantly smaller patient panel sizes. Thus you can spend the hour at the initial visit, you can meet with them monthly and then quarterly beyond that. But yeah, can you speak to that a? little bit about Average panel size and like maybe what you want to cap it ass, so you can maintain those relationships and maintain that frequency of touch points.

Kristin Mallon: 1:14:06

Yeah, so we, you know our Nurse practice, so we use a nurse practitioner model and so each of our nurse practitioners they there's no real cap on the amount of patients that they're taking, because Women do come and go in with within the practice. So sometimes they'll do six months and then sometimes they'll go. They'll just go in on a six month check-in and so there's there's not really like a set limit, but in general they're usually spending about six hours a day consulting and you know the initial visit is about An hour and then the subsequent visits are like they're booked for 30 minute time slots but, like I said, they can take anywhere between five to 30 minutes. So that's kind of like how their day goes. So in any given day they could be talking to 10 people in any given day. Yeah, so just for reference.

Parker Condit: 1:14:58

Traditional primary- care practice panel is going to be around 2,500 patients for a single physician, so I'm guessing it's not that many. No, no, no, like right now our nurse practitioners are in the hundreds, so they're nowhere.

Kristin Mallon: 1:15:10

They're not even close to a thousand. So yeah, and that's the difference they're not even close to a thousand.

Parker Condit: 1:15:14

So yeah, and that's typical. I just want to give people like some numbers to kind of work out and be like that's, that's why they can spend this much more time. And then again the empathy for your family physician, like they want to spend more time with you, but to stay in business they need about 2,500 patients.

Kristin Mallon: 1:15:29

Yeah, yeah, and I think too, like at least a lot of the primary care physicians, I know like they're frustrated by the system, like they want to be able to sit down and have these conversations, but they they just the structure doesn't support them to be able to do that.

Parker Condit: 1:15:46

Yeah, that's why, like every one of these conversations I have, I always try to bring that up because, like, I think humanity is sort of missing from healthcare. It's become sort of like this big monster of an industry and I think, from the patient side, for the providers, it's important to understand like pit providers, they want to do better, they want to do what's best for you. It's just the infrastructure of the industry that they're working in and those, those financial incentives that just don't allow currently spending more time with patients. Where do you see, I'm gonna be respectful of your time. So I got to start wrapping up. Like, what, what are your goals for from Jeviti? Like, where do you want to take this as a company?

Kristin Mallon: 1:16:22

So what I really? I really want there to be two outcomes that come of this one. I really want women to have access to menopause trained Practitioners and longevity medicine trained practitioners. So if they want to work with someone while they're going through perimenopause, menopause and inter longevity, there is someone there for them and they have access to someone that is at a rate that's reasonable, right that they can. You know we can't do it for free. That would be awesome we could find someone, you know, who was willing to support us, but that's really like my number one goal, and the number two goal I have is like More awareness in general as a whole for our society and our cultural, about what women are experiencing and what women are going through, what solutions are available. The HRT isn't the only option out there that this time in a woman's life really needs to be managed in a very like customized concierge, handheld way to meet her where she's at and to give her the support that she Needs to make the right decisions for her, and I think that the those two things are then gonna ultimately Lead to what I'd like to see in medicine in general is I'd like to see there become a fellowship, like how you said with lipidemologists and how what happened with breast specialists. Like I'd like there to become a fellowship where we're focusing, I think, on two both things separate, obviously but where there's a longevity medicine fellowship where, okay, you become an internist or you become an OBGYN and then you do your long longevity medicine fellowship, and then, similarly with menopause, like you become an OBGYN or become an internist and now you do your menopause Fellowship, where you are seen as a special specialist.

Parker Condit: 1:18:04

Yeah, that sounds like a. I think that's where things are gonna head. It's just, it's always a matter of one right.

Kristin Mallon: 1:18:10

Yeah.

Parker Condit: 1:18:12

Do you have any other clothing slot, any other clothing thoughts for before? We kind of let you go?

Kristin Mallon: 1:18:18

Yeah, I'm just really very grateful to be given the opportunity to kind of share that there are options like this out there for women and, and really I want to encourage women that are in their late 30s to 40s to really think about their health and like their symptoms that they're experiencing and it really could be perimenopause and there could be help and solutions. And a lot of times we have Patients in our practice who are just like totally shocked that they feel better at 47 or 52. Then they did at 37 and that's always really fun.

Parker Condit: 1:18:52

I can imagine it because, yeah, that's, that's very counterintuitive to what Society would. Society would say what the normal expectation would be. So that's got to be. It's got to be really gratifying to provide hope for so many women. Yeah, so much fun it's so fun. One other thing I want to ask before I let you go. Like you alluded to it once, the age where people should really start paying attention, those, or women, should really start like being proactive about, you know, thinking about like menopausal symptoms, like when, when can that really start?

Kristin Mallon: 1:19:23

Yeah. So I think it would be great if every woman kind of got a baseline panel down at 25. You know, certainly earlier is better, but at least that would be like a minimum that I would want to see, because that's when hormones start to get out of the hormones start to change and go down. So there's this shift in between 35 and 45 where reproductive longevity goes down and then the parametapause Parametapausal time kind of ramps up and they're overlapping for this period of time, and so to have that information, like kind of before everything starts, before testosterone goes down, before progesterone goes down, would be really helpful. Another thing that I think is like really totally not talked about at all, and and I would be surprised if anyone's really talking about this at all is that Women who have babies after 35 could actually be experiencing postpartum symptoms and parametapausal symptoms at the same time, and I think they can get confused, and so that's another reason to kind of Also be consulting with or thinking about like hey, wait a minute, like I had just had a baby, I'm 41, like I could be experiencing postmenopausal, postpartum symptoms and parametapausal symptoms together.

Parker Condit: 1:20:41

That's a really good point to bring up. And then for people who are already postmenopausal, it's never too late to start implementing these lifestyle factors right, like exercises never kind of be not beneficial, right.

Kristin Mallon: 1:20:52

Yeah, absolutely.

Parker Condit: 1:20:54

Yeah, so that's one of those things I always have to bring up. It's never too late to start working on your sleep, working on your nutrition, your stress management, your exercise, your daily movement, and the other thing I was lump into there is like connections, right, the maintenance of healthy relationships. So I will, I will let you go. This has been a great conversation for me. I've learned a ton. You brought up a bunch of things I didn't even have down on our sort of initial topic list, but clearly we were in sync on some of those topics and where the conversation should go anyway. So I really appreciate you having you on and we're gonna link to you in the show notes and Make sure everyone can get in touch with you if they need great.

Kristin Mallon: 1:21:31

Thank you so much. Thanks for having me on the show.

Parker Condit: 1:21:33

Thanks, chris. No, it was a platter. Well to those of you still listening. That is all for today's show. I want to thank you so much for listening. I really hope you enjoyed today's conversation. If you want to learn more about today's guests, please visit the website www. Exploring health podcast calm. They can find show notes for today's episode, links to the guests and our full episode Archives. If you enjoyed today's show and you want to hear more, make sure you subscribe on your favorite podcast platform. I really appreciate each and every one of you listening. Until next time.