Nutrition & Medicine

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  • Perimenopause: Understanding the Transition Before Menopause

    Perimenopause: Understanding the Transition Before Menopause

    Perimenopause is more than an irregular period.

    For many women, the years leading up to menopause can feel like their bodies have suddenly become unfamiliar. Periods change. Sleep becomes harder. Hot flashes appear out of nowhere. Mood, energy, libido, body composition, and even the way the body responds to food and exercise can change.

    But perimenopause is not a disease.

    It is a normal physiologic transition, one that deserves to be understood rather than simply endured.

    The goal isn’t necessarily to “stop” menopause. The goal is to help the body move through the transition as comfortably and healthfully as possible while identifying when medical treatment may be appropriate.

    Disclaimer: This article is for educational purposes and is not a substitute for individualized medical care. Hormone therapy, supplements, and botanical products should be discussed with a qualified healthcare professional, particularly if you have a history of cancer, blood clots, cardiovascular disease, liver disease, abnormal bleeding, or other significant medical conditions.

    What is perimenopause?

    Perimenopause is the transition toward menopause.

    Menopause itself is diagnosed retrospectively after a woman has gone 12 consecutive months without a menstrual period, assuming there is no other explanation for the absence of menstruation.

    Perimenopause can begin years before that point.

    One of the most important things to understand is that ovarian hormones don’t simply fall in a straight line.

    Instead, they become increasingly unpredictable.

    As the ovarian follicle pool declines, inhibin B also decreases. This reduces negative feedback to the pituitary, contributing to a rise in follicle-stimulating hormone (FSH). Ovulation becomes less consistent, progesterone production becomes less predictable, and estradiol can fluctuate substantially (sometimes rising, sometimes falling) before eventually declining more consistently after menopause. (PubMed)

    In other words:

    Fewer functioning follicles → less inhibin B → rising FSH → less predictable ovulation → fluctuating estrogen and progesterone → eventual estrogen decline

    This hormonal variability is one reason perimenopause can feel so unpredictable.

    Why are periods suddenly so strange?

    Changes in menstrual bleeding are often among the earliest signs of the menopause transition.

    Cycles may become:

    • shorter or longer
    • more frequent or less frequent
    • lighter or heavier
    • more prolonged
    • increasingly unpredictable

    One reason is that ovulation becomes less consistent.

    When ovulation doesn’t occur, the normal progesterone rise that follows ovulation may be absent. The endometrium can therefore experience estrogen exposure without the usual cyclic progesterone influence, contributing to irregular or heavy bleeding.

    However, not every episode of heavy or abnormal bleeding should be blamed on perimenopause.

    New, very heavy, prolonged, or otherwise unusual bleeding deserves medical evaluation. Causes such as fibroids, polyps, pregnancy-related conditions, thyroid disorders, endometrial hyperplasia, and malignancy can also produce abnormal bleeding.

    The symptoms of perimenopause

    Perimenopause can affect much more than menstruation.

    Vasomotor symptoms

    These are the classics:

    • hot flashes
    • night sweats
    • flushing
    • sudden sensations of heat

    They can also contribute to sleep disruption and fatigue.

    Sleep and mood

    Some women experience:

    • insomnia
    • difficulty staying asleep
    • irritability
    • anxiety
    • low mood
    • changes in concentration
    • “brain fog”
    • fatigue

    These symptoms can overlap with many other conditions, so persistent or severe symptoms shouldn’t automatically be attributed to menopause.

    Genitourinary symptoms

    Changes in estrogen can affect the vulvovaginal and urinary tissues.

    Symptoms may include:

    • vaginal dryness
    • burning or irritation
    • decreased lubrication
    • pain with intercourse
    • urinary urgency or frequency
    • recurrent urinary tract infections

    This group of symptoms is often referred to as genitourinary syndrome of menopause (GSM).

    Importantly, systemic hormone therapy isn’t the only option. For women whose symptoms are primarily genitourinary, low-dose vaginal estrogen can be highly effective, with very little systemic absorption. (The Menopause Society)

    Other changes

    Women may also notice:

    • headaches
    • joint or muscle discomfort
    • changes in sexual desire
    • changes in body composition
    • changes in skin and hair
    • breast tenderness
    • palpitations

    Not every symptom is caused by menopause, however. New or concerning symptoms should be evaluated rather than automatically attributed to hormones.

    Why does menopause affect bones and cardiovascular health?

    Estrogen doesn’t only participate in reproduction.

    It interacts with tissues throughout the body, including bone, blood vessels, the brain, and metabolic tissues.

    As estrogen declines, bone remodeling changes. Bone resorption can accelerate, contributing to a faster decline in bone mineral density and increasing the risk of osteoporosis and fracture. (The Menopause Society)

    Cardiovascular risk also changes during midlife. Menopause occurs alongside aging and other metabolic changes, so it is important to think about the transition as an opportunity to pay closer attention to blood pressure, cholesterol, glucose regulation, physical activity, body composition, sleep, and diet.

    This is one reason I prefer to think about menopause as a whole-body transition, rather than simply a reproductive event.

    Start with the foundation: lifestyle

    Before reaching for a supplement or prescription, there are several fundamentals worth getting right.

    That doesn’t mean lifestyle changes can replace medical treatment for everyone.

    It means they give the body a strong foundation regardless of whether additional treatment is eventually needed.

    1. Eat for metabolic and cardiovascular health

    There isn’t one magical “menopause diet.”

    Instead, build meals around:

    • vegetables and fruits
    • whole grains and other high-fiber carbohydrates
    • beans and legumes
    • adequate protein
    • nuts and seeds
    • fish and other nutrient-dense protein sources
    • unsaturated fats such as olive oil and avocado

    Limit excessive added sugars, highly processed foods, and excessive saturated fat.

    Rather than obsessing over whether every food is “clean,” think about the overall pattern.

    Your goal is nourishment, not restriction.

    Adequate protein and resistance exercise become particularly important as women age because preserving muscle mass and strength is part of maintaining metabolic health and independence.

    2. Move your body

    The current general recommendation for adults is at least 150 minutes of moderate-intensity aerobic activity per week, along with muscle-strengthening activity on at least two days per week. (ACOG)

    For the menopausal transition, I would especially emphasize:

    • strength + weight-bearing movement + cardiovascular exercise.
    • Strength training helps preserve muscle.
    • Weight-bearing activity supports bone health.
    • Aerobic exercise supports cardiovascular fitness.
    • And movement can be an important part of maintaining mood, sleep, and metabolic health.

    You don’t have to do everything at once.

    Thirty minutes of movement five days a week is already a meaningful starting point.

    3. Don’t underestimate sleep

    Sleep disruption is extremely common during the menopause transition.

    Night sweats can wake you up, but hormonal changes aren’t always the only cause. Stress, sleep apnea, medications, alcohol, caffeine, anxiety, and other medical conditions can also interfere with sleep.

    If you’re consistently exhausted despite getting enough time in bed, that’s worth discussing with a healthcare professional.

    Some supplements are marketed for menopausal sleep problems, including melatonin, magnesium, L-theanine, and phosphatidylserine, but evidence varies considerably depending on the supplement and the specific problem being treated.

    “Natural” does not automatically mean effective or risk-free.

    4. Stress management matters

    This is the part of integrative medicine that I think is sometimes underestimated.

    Your nervous system doesn’t exist separately from the rest of your body.

    Meditation, prayer, yoga, breathing practices, time in nature, meaningful relationships, therapy, and other forms of stress regulation can all become part of a person’s approach to the menopause transition.

    For some women, spirituality is an important part of that process.

    Whether that looks like prayer, meditation, church, journaling, yoga, or simply creating quiet time each day, the goal is the same:

    create space for the nervous system to recover.

    Hormone therapy: when is it appropriate?

    Hormone therapy remains the most effective treatment for bothersome vasomotor symptoms such as hot flashes and night sweats. For healthy women younger than 60 or within 10 years of menopause onset who have no contraindications, the benefits often outweigh the risks. (The Menopause Society)

    Hormone therapy can also help prevent bone loss and treat genitourinary symptoms.

    But hormone therapy is not one-size-fits-all.

    Before starting treatment, a clinician should consider the woman’s:

    • age
    • timing of menopause
    • symptoms
    • cardiovascular risk
    • breast cancer history and risk
    • history of blood clots
    • liver health
    • uterine status
    • bleeding history
    • personal preferences
    • other medical conditions and medications

    Situations requiring particular caution or generally making systemic hormone therapy inappropriate

    These include conditions such as:

    • unexplained vaginal bleeding
    • current or certain histories of breast cancer
    • active or previous thromboembolic disease
    • stroke or significant cardiovascular disease
    • active liver disease

    The exact risk profile depends on the individual and the formulation being considered. (The Menopause Society)

    Having obesity, dense breasts, or a family history of breast cancer does not automatically mean a woman can never use hormone therapy. These factors should instead be incorporated into an individualized risk assessment.

    Route matters

    Hormone therapy can be administered in different ways, including:

    • oral tablets
    • transdermal patches
    • gels
    • sprays
    • vaginal preparations

    For systemic estrogen, transdermal therapy can have a different risk profile than oral estrogen, particularly regarding venous thromboembolism, because it bypasses first-pass hepatic metabolism. (The Menopause Society)

    But there isn’t one universally “best” route.

    The right choice depends on the individual.

    And one thing I would strongly caution against is assuming that compounded hormone pellets are automatically safer or more “natural.” ACOG does not recommend routine use of custom-compounded menopausal hormones when FDA-approved formulations are available, and specifically raises concerns about pellet therapy. (ACOG)

    Don’t forget progesterone

    For women who have a uterus, systemic estrogen is generally paired with a progestogen to protect the endometrium.

    This is an important distinction:

    Estrogen treats many menopausal symptoms. Progesterone/progestogen helps protect the uterine lining when systemic estrogen is used in someone with a uterus.

    The exact regimen should be individualized by a clinician. (The Menopause Society)

    What about botanicals?

    This is where integrative medicine becomes particularly interesting and where we also need to be honest about the evidence.

    Some women prefer to explore botanical therapies for menopausal symptoms.

    That doesn’t mean every botanical is effective.

    And it doesn’t mean every botanical is safe.

    Black cohosh

    Black cohosh is one of the most studied botanicals for menopause.

    A 2023 review of 22 studies found that black cohosh products may improve overall menopausal symptoms and hot flashes, although evidence for other symptoms, such as anxiety and depression, is less convincing. (NCCIH)

    Its exact mechanism is not completely understood, and I would not describe it simply as a natural form of estrogen or a proven selective estrogen receptor modulator.

    There is also an important safety consideration: rare cases of liver injury have been reported in people taking products labeled as black cohosh. Product quality can also vary. (NCCIH)

    If you have liver disease, take multiple medications, or have a history of hormone-sensitive disease, talk with a healthcare professional before using it.

    Rhapontic rhubarb extract

    Another botanical that has attracted attention is ERr 731, a standardized extract from Rheum rhaponticum (rhapontic rhubarb).

    Clinical trials have reported reductions in menopausal symptom scores, and a 2024 meta-analysis of four higher-quality studies found an overall benefit compared with control therapy. (PubMed)

    A newer randomized trial published in 2026 also studied 4 mg daily in perimenopausal women and reported improvement in climacteric symptoms. (PubMed)

    Laboratory research suggests that compounds in the extract interact with estrogen receptors, particularly ER-β. (PubMed)

    That mechanism is interesting, but receptor activity in a laboratory is not the same thing as proving that a supplement is safe for every woman.

    Anyone with a history of breast cancer or another hormone-sensitive condition should discuss botanical estrogen-receptor-active products with their clinician before using them.

    What about acupuncture, yoga, and other integrative therapies?

    This is an area where the evidence is evolving.

    A recent systematic review conducted to inform International Menopause Society recommendations found promising evidence for several complementary approaches, including acupuncture, Chinese herbal medicine, herbs, nutrients, and mind-body/touch therapies, but also emphasized that the certainty of evidence for many interventions remains low or very low. (PubMed)

    So I think the fairest way to describe these therapies is:

    They may be useful tools for some women, but they shouldn’t automatically be presented as replacements for treatments with stronger evidence. It may work really well for some women, but not others.

    Acupuncture may help some women with menopausal symptoms, but studies have produced mixed results. (PubMed)

    Yoga and mindfulness may be valuable for overall well-being, stress, and physical function, even though evidence is less consistent when looking specifically at hot-flash reduction. (PubMed)

    And as someone interested in osteopathic medicine, I find OMT particularly intriguing. However, high-quality evidence specifically supporting OMT as a treatment for menopausal symptoms remains limited. That doesn’t mean it cannot be useful for an individual woman; it means we should be careful about claiming that it has been proven to treat menopause.

    That distinction is important.

    Menopause is an opportunity, not a failure

    There is a tendency to talk about menopause as if a woman’s body has suddenly stopped working.

    I don’t see it that way.

    The ovaries are changing. The reproductive years are ending. Hormonal signaling is changing. And because estrogen receptors exist throughout the body, those changes can be felt far beyond the reproductive system.

    But menopause is also an opportunity to become more intentional about health.

    An opportunity to:

    • lift weights.
    • Eat nourishing food.
    • Protect your bones.
    • Pay attention to your cardiovascular health.
    • Prioritize sleep.
    • Manage stress.
    • Nurture your relationships and spiritual life.
    • Address symptoms instead of suffering silently.

    And, when appropriate, use evidence-based medical therapies.

    There is no prize for suffering through menopause without treatment.

    And there is also no requirement to treat every change with a prescription.

    The best approach is individualized.

    The integrative approach

    If I had to simplify the approach, I would think about it in layers:

    1. Foundation

    Food + movement + sleep + stress management

    2. Evaluate

    Understand your symptoms and your individual health risks.

    3. Target the symptoms

    Consider appropriate medical and non-medical treatments based on what is actually bothering you.

    4. Botanical or complementary support

    If desired, explore evidence-informed options with attention to product quality, interactions, contraindications, and the strength of the evidence.

    5. Hormone therapy when appropriate

    For women with significant symptoms and an appropriate risk profile, hormone therapy remains one of the most effective tools available.

    The goal isn’t to choose between “natural” and “medical.”

    The goal is to choose what is safe, appropriate, evidence-informed, and actually helpful for the individual woman.

    Menopause is a transition.

    It doesn’t have to be something you fear.

    It can be something you understand.

    And understanding your body is one of the first steps toward caring for it well.

    Sources & further reading

    • Rakel DP, Minichiello V, eds. Integrative Medicine. 5th ed. Elsevier; 2022. The book includes a dedicated chapter on Perimenopause to Menopause and sections addressing nutrition, exercise, botanicals, mind-body medicine, spirituality, and other integrative approaches. 
    • The Menopause Society. Hormone Therapy. Current patient education and clinical resources. 
    • American College of Obstetricians and Gynecologists. Hormone therapy and physical activity guidance.
    • National Center for Complementary and Integrative Health. Black Cohosh.
    • Relevant peer-reviewed studies and systematic reviews cited throughout the article.
    A Note Before You Go

    This article is intended for educational and informational purposes only and is not intended to diagnose, treat, or prevent any medical condition or to replace individualized medical advice.

    Every woman’s experience with perimenopause and menopause is different. Before starting hormone therapy, changing medications, or beginning any supplement or botanical product discussed in this article, please speak with your physician or another qualified healthcare professional who can review your medical history, medications, symptoms, and individual risks and benefits.

    This is especially important if you have a history of breast or uterine cancer, unexplained vaginal bleeding, blood clots, stroke, cardiovascular disease, liver disease, or another significant medical condition.

    The information in this article reflects a combination of current evidence and integrative medicine perspectives. Research and clinical recommendations can change over time, so readers should consult current clinical guidance and their healthcare professional when making decisions about their health.

    If you have any questions, please leave them below. What worked for you? What didn’t work for you?

    Leave a comment

  • Understanding PCOS, Insulin Sensitivity, and Inositol: A Functional Medicine Deep Dive

    Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine conditions in women, yet one of the most misunderstood. As both a dietitian and medical student, I see firsthand how confusing the symptoms, hormones, and treatment options can feel. Many people are told to “lose weight” or “come back when you want to get pregnant,” but PCOS is far more than a fertility disorder. It’s a metabolic, hormonal, and/or inflammatory condition that deserves real attention and individualized care.

    In this post, I’m breaking down PCOS, insulin sensitivity, how inositol works, when it helps, when it doesn’t, and what current research really says.

    What Is PCOS?

    PCOS, or Polycystic Ovary Syndrome, is a hormonal and metabolic condition that affects how the ovaries function. You don’t need ovarian cysts to have PCOS. In fact, many people with PCOS don’t have cysts at all.

    Common Symptoms

    • Irregular or absent periods
    • Ovarian “cysts” on ultrasound (really immature follicles)
    • Acne, especially jawline or cystic
    • Excess hair growth (chin, chest, abdomen)
    • Hair thinning on scalp
    • Weight gain or difficulty losing weight
    • Infertility or anovulation
    • Fatigue
    • Mood changes
    • Sugar cravings

    Why It Happens

    PCOS isn’t caused by just one thing. It’s a mix of:

    • Genetic predisposition
    • Insulin resistance
    • Hormonal imbalance (androgens ↑, progesterone ↓)
    • Chronic low-grade inflammation
    • Environmental factors

    PCOS and Insulin Resistance: What’s the Connection?

    Up to 70–80% of people with PCOS have some level of insulin resistance, even those who aren’t overweight.

    How Insulin Resistance Contributes to PCOS

    When your cells don’t respond well to insulin, the pancreas produces more of it. Elevated insulin:

    1. Stimulates the ovaries to produce more androgens (testosterone, DHEAS).
    2. Suppresses ovulation → leading to irregular cycles.
    3. Increases inflammation → worsening acne, fatigue, cravings.
    4. Promotes fat storage → especially abdominal.

    High insulin is actually one of the key drivers of PCOS symptoms.

    What Is Inositol?

    Inositol is a naturally occurring nutrient that acts like a B-vitamin and plays a huge role in:

    • insulin signaling
    • ovarian function
    • egg quality
    • mood and neurotransmitters

    There are nine forms, but the two used for PCOS are: Myo-Inositol (MI) & D-Chiro-Inositol (DCI)

    They work together but have different roles.

    Where It Comes From

    Inositol comes from:

    • fruits (citrus, cantaloupe)
    • beans
    • whole grains
    • nuts
    • your own body (your liver + kidneys also produce it)

    People with PCOS often have trouble using inositol properly at the ovarian level, which affects insulin signaling and ovulation.

    How Inositol Helps in PCOS

    1. Improves insulin sensitivity

    Inositol acts as a secondary messenger for insulin.
    This means it helps the cell “hear” insulin more clearly, so the body doesn’t need to produce as much.

    → Lower insulin → lower androgens → more regular ovulation.

    2. Supports ovulation and menstrual regularity

    Myo-inositol especially improves:

    • follicular development
    • ovulation rates
    • menstrual cycle predictability

    Some studies show it can be as effective as metformin for many patients, but with fewer GI side effects.

    3. Reduces androgen symptoms

    With insulin stabilized, many people see improvement in:

    • acne
    • unwanted hair growth
    • hair thinning

    4. Improves fertility

    Inositol may improve:

    • egg quality
    • embryo quality
    • IVF outcomes
    • ovulation frequency

    Research-Supported Benefits

    Clinical studies have shown:

    • Myo-inositol + DCI in a 40:1 ratio is the most physiologic and effective formulation.
    • It improves ovulation in up to 70% of patients.
    • It significantly improves metabolic markers (glucose, insulin, lipid profile).
    • It may reduce the need for fertility medications in some women.

    But not everyone responds, especially those with severe insulin resistance or rare receptor differences.

    How to Take Inositol: Evidence-Based Dosing

    The most studied formula is the 40:1 MI:DCI ratio, which mimics the body’s natural ratio.

    Typical dosing:

    • 2,000 mg Myo-Inositol + 50 mg D-Chiro-Inositol
    • Taken twice daily
    • Total daily: 4 g MI + 100 mg DCI

    Effects usually appear at:

    • 4–8 weeks → cycle improvements
    • 3–6 months → metabolic/hair changes
    • 6–12 months → fertility changes

    A Note on Inositol Supplements

    A friend of mine who has PCOS with insulin sensitivity has personally found inositol helpful for regulating her cycle. She uses an over-the-counter myo-inositol + D-chiro-inositol supplement and has experienced consistent periods for over five months.

    Her personal routine is 2,000 mg twice daily. She usually takes it either 2 hours before eating or 1 hour after eating because many people prefer to take inositol away from meals to support steadier absorption and reduce the chance of mild stomach upset. However, there is no universal rule on timing, and individuals should follow the instructions on their specific product or the guidance of their healthcare provider.

    This is the supplement she uses: Inositol Capsules

    Important:
    Everyone’s physiology is different. What works for one person may not work for another, especially because not all PCOS involves insulin resistance. If you’re considering inositol for PCOS, fertility support, or metabolic health, it’s best to talk with your primary care provider or OB/GYN to find the right dose and formula for your situation.

    Inositol vs Medication

    When Medications Are Used

    Your clinician may use:

    • Metformin → for insulin resistance, prediabetes, A1C elevation
    • Oral contraceptives → for cycle control & androgen symptoms
    • Spironolactone → for acne/hair symptoms
    • Fertility meds (letrozole, clomid) → if actively trying to conceive
    • Do NOT replacement insotiol for your medication, always take your medication; follow your doctor’s instructions

    Inositol Compared to Medications

    TopicInositolMedications
    Insulin sensitivity✔ Effective✔ Effective (metformin stronger)
    Ovulation✔ Effective✔ Fertility meds strongest
    Androgen symptoms✔ Improved✔ OCP + spironolactone strongest
    Weight lossMildMild–moderate (metformin)
    Side effectsVery lowMetformin GI upset, OCP risks

    Many clinicians use both inositol and medication, depending on severity.

    Who Should Not Use Inositol?

    • Bipolar disorder (may destabilize mood in rare cases)
    • Those with very low blood sugar
    • People on strong diabetes meds without supervision

    Symptoms & Labs to Watch

    Symptoms Suggesting PCOS

    • Irregular cycles
    • Acne
    • Hirsutism
    • Weight gain
    • Fertility struggles

    Key Labs

    • Total & free testosterone
    • DHEAS
    • LH & FSH
    • 17-OH progesterone
    • A1C
    • Fasting insulin
    • Lipid panel

    When Inositol May Not Work

    Some people need more intensive metabolic support:

    • class II–III insulin resistance
    • A1C > 5.9%
    • significant obesity
    • genetic androgen excess
    • adrenal-driven PCOS

    In these cases, medication + lifestyle changes may outperform supplements.

    Final Thoughts

    PCOS is complex, but it’s manageable, especially when you understand what’s happening beneath the surface. Inositol is a powerful, research-supported tool that can help improve insulin sensitivity, ovulation, cycles, fertility, and metabolic health. But it’s not a magic fix, and it’s not the right approach for everyone.

    If you think you may have PCOS or you’re considering inositol, it’s always best to talk with your healthcare provider or endocrinologist, especially if you’re on medication or trying to conceive.

  • My Honest Guide to Taking Care of 4C Hair + My Braid-Out Routine

    If you have 4C hair, you already know: it’s beautiful, versatile, coily, and full of personality. But it also takes intention. Over the years, I’ve tried every DIY mask, every trend, every “magic hair growth” routine and honestly the real secret is keeping it simple, moisturizing consistently, and protecting your hair.

    This is my real routine, exactly what I use, how I maintain moisture, and how I keep my hair healthy through both summer heat and winter dryness. And most importantly how I bounced back from serious heat damage and still grew my hair back.

    Understanding 4C Hair

    4C hair shrinks the most, dries the fastest, and needs the most moisture love. Our coils are tight, delicate, and prone to breakage if we’re not gentle. But when you treat 4C hair with intention, it grows thick, beautiful, and strong.

    My Moisturizing Routine

    I keep it simple and consistent.

    Products I swear by:
    • TGIN Daily Moisturizer: my absolute staple. I use it every time after washing and before putting my hair into box braids or natural braids for a braid-out.
    • Big Poppa Doux: softens my hair and gives my braid-outs definition.
    • Camille Rose Ayurveda Hair Oil: this has strengthened my hair so much. I use it to seal moisture and keep my scalp nourished.
    • Ketoconazole dandruff shampoo: once a month when my scalp needs a deep cleanse or I get flakes.

    How often I wash my hair

    • When my hair is out: twice a month
    • With box braids in: every 2–4 weeks
    • During winter: honestly… sometimes every 6–8 weeks because the cold dries my hair out so badly

    Summer vs. Winter 4C Hair Care

    Summer

    The heat + humidity actually help my hair stay soft. My summer focus:

    • More frequent washing
    • Light oils
    • Heavy hydration
    • Air drying whenever possible
    Winter

    Winter is where 4C hair needs extra love:

    • Thicker creams and butters
    • Protective styles for weeks at a time
    • Less frequent washing
    • Double nighttime protection (silk scarf + bonnet)

    Box Braids: My Protective Style That Helps Me Grow

    My hair stays in box braids most of the time and this is honestly what helps my hair grow the most.

    Box braids keep my ends protected, reduce manipulation, and make moisturizing easy. I spray my braids, apply TGIN moisturizer, and seal with my Ayurvedic oil. Simple.

    When they get dirty or stiff, I wash them gently with diluted shampoo.

    The DIY Hair Masks I Tried

    I’ve tried:

    • Rice water
    • Eggs
    • Avocado masks

    They work temporarily, but honestly? They’re not a magical growth solution. The real key has been leaving my hair alone, protecting it, moisturizing consistently, and eating well.

    My Heat Damage Story + How I Grew My Hair Back

    Let me be honest for a minute…

    I flat-iron blow-dried my hair in February 2022, and my hair was at the spine of my scapula, a bit past shoulder length. And it was fried. I didn’t have the courage to cut it at first, so I tried to “recover” it…but 4C hair does NOT bounce back from heat damage.

    I finally cut it in April 2024 all the way to ear length.

    I literally started over.

    Now it’s November 2025, and my hair is right back to its previous length about 8 inches of growth. And that’s with me trimming consistently every 2 months (only about ½ cm each time).

    My growth came from:

    • Low manipulation
    • Moisture
    • Box braids
    • Eating well
    • Gentle trims
    • Leaving my hair alone

    I didn’t do anything dramatic. Just consistency.

    My Braid-Out Routine

    When I’m not in braids, I love a braid-out. Here’s how I do it:

    1. Wash or co-wash
    2. Apply TGIN Daily Moisturizer
    3. Add Big Poppa Doux for hold
    4. Braid in medium sections
    5. Let it dry overnight
    6. Take down gently and fluff

    Soft, moisturized, defined curls every time.

    Final Thoughts

    4C hair grows but it grows best when it’s protected, moisturized, and left alone. There’s no magic product. What actually works is having a routine that matches your lifestyle and sticking to it.

    My routine is simple, honest, and realistic:

    • Box braids
    • TGIN moisturizer
    • Ayurvedic oil
    • Controlled wash schedule
    • Minimal manipulation
    • Healthy eating
    • And patience

  • Cardiovascular Health & Nutrition: What You Need to Know

    As a dietitian and medical student, I’ve learned that cardiovascular health is one of the most important and most overlooked aspects of overall wellness. Heart disease and related conditions are the number one cause of death in America and also one of the highest areas of healthcare spending each year.

    Whether it’s influenced by genetics, lifestyle, or a mix of both, cardiovascular health affects everyone in some way. The heart and blood vessels don’t just keep us alive; they reflect how well our body’s systems communicate and function together. Understanding how nutrition, movement, and daily habits impact heart health can make a real difference, no matter where you’re starting from.

    What Is Cardiovascular Health?

    Cardiovascular health refers to the health of your heart and blood vessels. It affects everything: your energy, mood, and even brain function. When your arteries are clear, your blood pressure is stable, and your heart muscle is strong, your body functions more efficiently and you simply feel better.

    When things go wrong, though, it can lead to serious conditions like:

    • Hypertension (high blood pressure)
    • Atherosclerosis (hardening or narrowing of the arteries)
    • Heart attack and stroke

    These aren’t just “older adult” issues, cardiovascular disease is the #1 cause of death worldwide, and many of the risk factors begin silently years earlier. That’s why medical providers take it so seriously because prevention truly saves lives.

    Why It’s So Serious

    Uncontrolled high blood pressure or cholesterol doesn’t just affect your heart; it affects your entire body. It can damage blood vessels in your kidneys, eyes, and brain, leading to organ dysfunction or stroke. The scary part? Most people don’t even know they have it.

    The good news: 80–90% of cardiovascular disease is preventable with lifestyle and nutrition. That’s huge.

    The Power of Diet, Especially DASH

    The DASH diet (Dietary Approaches to Stop Hypertension) was originally created to lower blood pressure, but its benefits go far beyond that. It’s not a “fad diet.” It’s a flexible eating style rich in nutrients that protect your blood vessels and reduce inflammation.

    The basics:

    • Plenty of fruits and vegetables
    • Whole grains like oats, brown rice, and quinoa
    • Lean proteins like fish, chicken, beans, and lentils
    • Healthy fats from nuts, seeds, olive oil, and avocado
    • Limited sodium, processed foods, and sugary drinks

    DASH helps lower blood pressure naturally, supports healthy cholesterol, and even boosts energy.

    Lifestyle Habits That Matter

    Food is powerful, but it’s not the only factor. Your lifestyle choices are just as important.

    • Drinking: keep it moderate. Excessive alcohol raises blood pressure and triglycerides.
    • Smoking: damages arteries and increases blood pressure. Quitting is one of the most powerful things you can do for your heart.
    • Fast food: loaded with sodium, unhealthy fats, and added sugars. Best treated as an occasional indulgence, not a routine.
    • Movement: Aim for 150 minutes of aerobic exercise weekly. Walking, biking, swimming, or even dancing. Exercise keeps blood vessels flexible and strengthens the heart muscle.
    • Stress & mental health: Chronic stress raises cortisol, which can elevate blood pressure and trigger inflammation. Mindfulness, prayer, journaling, or simply taking breaks matter more than you think.
    • Community & family: Having supportive relationships reduces stress hormones and improves long-term heart outcomes. Connection is medicine, too.

    Functional Medicine Perspective

    In functional medicine, we go beyond symptoms to find root causes.
    Instead of just prescribing a blood pressure pill, we ask:

    • Why is blood pressure high?
    • Is inflammation present?
    • Is there insulin resistance or chronic stress driving it?
    • Is the person stressed?
    • Does their occupation bring mental and/or physical stress?
    • Is it genetic?
    • Is this a result of their environment or lifestyle?

    Through lab testing, nutrition, and lifestyle interventions, functional medicine aims to restore balance and prevent disease before it progresses.

    Understanding Your Heart Labs

    Knowing your lab numbers helps you understand what’s happening inside your body long before symptoms appear. These markers give you and your healthcare provider valuable insight into your heart and metabolic health.

    Total Cholesterol
    • What it does: Cholesterol is a fatty substance needed to build hormones, vitamin D, and cell membranes. It’s not inherently “bad”, your body actually makes most of it naturally.
    • When it’s high: Levels over 200 mg/dL can signal an imbalance between LDL (the “bad”) and HDL (the “good”) cholesterol, potentially raising heart disease risk.
    • Functional support: Focus on a balanced diet rich in fiber, omega-3 fats, and antioxidants. Address stress, blood sugar, and thyroid health, all of which affect cholesterol balance.
    HDL (High-Density Lipoprotein)
    • What it does: HDL is the “good” cholesterol. It helps clear excess cholesterol from arteries and transport it to the liver for removal.
    • When it’s low: HDL below 40 mg/dL (men) or 50 mg/dL (women) is linked to higher cardiovascular risk. Low HDL is often seen in people with insulin resistance, inflammation, or high refined-carb intake.
    • Functional support: Increase physical activity, eat omega-3–rich foods (salmon, walnuts, flaxseed), and consider antioxidant-rich foods like berries and olive oil. Avoid smoking and manage blood sugar to naturally raise HDL.
    LDL (Low-Density Lipoprotein)
    • What it does: LDL carries cholesterol through the blood. The concern isn’t just how much LDL you have, but how many small, dense LDL particles are present. These are more likely to stick to artery walls.
    • When it’s high: LDL above 130 mg/dL may increase the risk for plaque buildup, especially if accompanied by high inflammation (CRP).
    • Functional support: Emphasize soluble fiber (oats, beans, flax), plant sterols (avocados, nuts, olive oil), and anti-inflammatory foods (fatty fish, turmeric, leafy greens). Reduce trans fats, processed foods, and chronic stress.
    Triglycerides
    • What they are: A form of stored fat in the bloodstream. Elevated levels often reflect excess sugar, refined carbs, or alcohol, not necessarily dietary fat.
    • When they’re high: Levels above 150 mg/dL suggest insulin resistance or poor carbohydrate metabolism. Chronically high levels (>500 mg/dL) increase pancreatitis risk.
    • When they’re low: Low triglycerides (<40 mg/dL) can occur in undernutrition or hyperthyroidism.
    • Functional support: Reduce refined carbs and added sugars, limit alcohol, and prioritize omega-3 fats from fish or chia seeds. Regular movement and blood sugar regulation (balanced meals, adequate protein) are key.
    hs-CRP (High-Sensitivity C-Reactive Protein)
    • What it does: A marker of systemic inflammation, not specific to the heart, but when elevated, it can signal higher cardiovascular risk.
    • When it’s high: hs-CRP above 3.0 mg/L suggests inflammation that may come from infection, obesity, autoimmune issues, or metabolic stress.
    • Functional support: Prioritize an anti-inflammatory diet (rich in fruits, veggies, herbs, and healthy fats), manage stress, get quality sleep, and ensure gut health is balanced since gut inflammation can raise CRP.
    Optional & Functional Labs
    • ApoB: Measures the total number of atherogenic (plaque-forming) particles, considered more accurate than LDL alone.
    • Lp(a): A genetic lipoprotein that can increase heart disease risk even when other labs are normal.
    • Fasting Insulin or HOMA-IR: Detects early insulin resistance.
    • Homocysteine: High levels may damage blood vessels; often improved with adequate B12, B6, and folate.

    Functional support: If these are out of range, interventions often include anti-inflammatory nutrition (like the Mediterranean or DASH diets), stress management, blood sugar balance, and targeted nutrient support under professional guidance.

    Takeaway

    Your lab results aren’t a diagnosis, they’re a roadmap. When interpreted together, they help uncover why your heart may be under stress and how you can support it through food, lifestyle, and, when needed, medical care.

    Suggested Heart-Healthy Grocery List

    Here are some staples I always recommend to support heart health naturally:

    Proteins

    • Salmon, tuna, sardines (rich in omega-3s)
    • Skinless chicken, turkey, eggs
    • Lentils, beans, tofu

    Grains & starches

    • Oats, quinoa, brown rice, barley
    • Sweet potatoes, whole-grain bread, or pasta

    Fats

    Produce

    • Leafy greens (spinach, kale, arugula)
    • Berries, citrus fruits, apples
    • Tomatoes, bell peppers, broccoli

    Extras

    • Dark chocolate (70%+ cocoa) → rich in antioxidants
    • Green tea → supports healthy cholesterol
    • Herbs and spices → like turmeric, garlic, and cinnamon for natural anti-inflammatory effects
    • Artichoke extract → supports healthy cholesterol metabolism
    • Omega-3 (EPA/DHA) → reduces inflammation and lowers triglycerides

    Final Thoughts

    Your heart is more than just a muscle; it’s a reflection of your daily habits and self-care. You don’t need to overhaul your life overnight. Start small: one walk, one healthy meal, one less soda, one more hour of sleep.

    Over time, those small steps build a stronger, healthier heart.

    If you found this post helpful, leave a comment below or share your favorite heart-healthy tip!

  • Supplements I take

    Supplements I take

    As a medical student and dietitian, I’m a big believer in a food-first approach, but I also know that even with a balanced diet, some nutrients can be hard to get in optimal amounts. Below are the supplements I personally take, why I take them, and a few recommendations if you’re considering adding them to your own routine.

    • Calcium: bone health
    • Multivitamin
    • CoQ10 w/ PQQ
    • NAC
    • probiotics
    • Vitamin D3
    • Alma

    Why I take these supplements

    • Calcium: I take calcium primarily for bone health. As a 26-year-old woman, I’m aware that bone density gradually begins to decline after our early 20s. Research suggests that maintaining adequate calcium intake early on helps strengthen bones and prevent issues like osteoporosis later in life. Adults generally need around 1,000–1,200 mg of calcium daily. I know I don’t consistently meet that through diet alone, so I supplement with 600 mg about 4 times a week (I admit, I forget sometimes 😅). Exercise, especially resistance training, is also key for bone strength.
    • Multivitamins: I personally don’t think everyone needs a multivitamin if their diet is balanced, whole foods should always be the foundation. However, I take one because the formula I use is rich in antioxidants and potent micronutrients, which can be helpful during periods of stress or long study nights. The multivitamin I take is quite strong, probably better suited for older adults or those with absorption issues, so I only take it 2–3 times per week instead of daily. These are the multivitamins I take –> Multivitamins (you can click on the underlined for the link)
    • CoQ10 with PQQ: This is one of my favorites! CoQ10 supports cellular energy production and antioxidant protection, while PQQ (Pyrroloquinoline Quinone) helps your body create new mitochondria, the “powerhouses” of your cells. I take this combo to support energy and recovery, especially during medical school when sleep can be inconsistent. It helps my cells function more efficiently even when I’m running on minimal rest. CoQ10 + PQQ is also great for older adults, post-op recovery, and anyone experiencing fatigue or oxidative stress. This is the CoQ10 that I take –> coq10 with pqq
    • NAC: NAC is a powerful antioxidant and a precursor to glutathione, one of the body’s main detoxifiers. It supports liver health, immune function, and respiratory health, and can even help reduce inflammation. It’s one of those “all-around good” supplements that supports overall wellness, especially helpful during stressful or sick seasons.
    • Probiotics: Gut health is everything. Probiotics help feed and balance the beneficial bacteria in your gut, supporting digestion, immunity, and even mood. Since stress, poor diet, and antibiotics can all disrupt gut flora, I take probiotics regularly to maintain a healthy microbiome.
    • Vitamin D3: Vitamin D is essential for bone health, immunity, and hormone balance. Most doctors recommend levels of at least 30 ng/mL, though many studies suggest that optimal levels fall between 50–80 ng/mL. If your vitamin D is low (<30), you might benefit from 5,000 IU daily for 2–3 weeks, then retest you D3 levels. If your levels are within range, 1,000–2,000 IU daily is usually fine for maintenance. During the winter months or if you’re not in a sunny area, I recommend 2,000 IU daily. I use NatureWise D3 + K2 Vegan –> NatureWise D3 + K2 Vegan, since K2 helps move calcium from your blood into your bones, a perfect partner to D3.
    • Amla (Indian Gooseberry): I have slightly low HDL (the “good” cholesterol), which seems to run in my family. I take an Amla-based supplement called Advanced Lipid Control, and it’s helped increase my HDL by about 4–5 points in just one month. Amla is rich in vitamin C and antioxidants, and has been shown to support healthy lipid levels and cardiovascular function.

    Supplements I would suggest

    • Calcium + Vit D3 + Vit K2 – Great for bone support. (Vitamin D helps move calcium from the gut to the bloodstream, and vitamin K helps move it into the bones.)
    • Mary Ruth’s Multivitamins – Excellent for men, women, or kids. Multivitamins aren’t mandatory if you’re eating well, but they can help fill small nutrient gaps, especially for B vitamins.
    • CoQ10 with PQQ – Great for energy, recovery, and cellular support.
    • NAC – Supports detoxification, immune, and respiratory health.
    • Probiotics – Helps maintain healthy gut flora, digestion, and mood.
    • Naturewise D3 NatureWise D3 + K2 Vegan – the vegan option has K2 in it which helps with bone health. vitamin D3 is needed to move calcium from the gut to the blood and K2 moves calcium from the blood into your bones.

    Bonus Section: Important Note on Calcium, Vitamin D3, and Vitamin K2

    Many people take calcium supplements or get plenty of calcium through their diet, which is great for bone health, but calcium alone isn’t enough. Without the right supporting vitamins, that calcium can end up in the wrong places.

    Here’s how these nutrients work together:

    • Vitamin D3 (cholecalciferol)
      Helps your body absorb calcium from the gut into the bloodstream. Without enough D3, you can’t properly take in the calcium you eat or supplement, no matter how much you consume.
      You get Vitamin D3 from sunlight exposure, fortified foods, and supplements.
    • Vitamin K2 (menaquinone)
      Directs calcium to the right places, mainly your bones and teeth, and prevents it from being deposited in soft tissues and arteries.
      Think of Vitamin K2 as the “traffic controller” that tells calcium, “Don’t stay in the bloodstream, go to the bones.”
      It’s found in foods like natto (fermented soy), hard cheeses, and egg yolks, or as a supplement (often labeled MK-7 or MK-4).
    • Calcium
      The main mineral that gives bones and teeth their strength. But when calcium isn’t properly guided by K2, it can accumulate in the arteries, contributing to stiffness or calcification over time.

    Together, these three nutrients form a synergistic trio:

    Vitamin D3 helps you absorb calcium, and Vitamin K2 ensures it ends up in your bones, not your arteries.

    If you’re taking Vitamin D or calcium supplements, it’s smart to pair them with Vitamin K2 for balanced and safe calcium metabolism. And as always, it’s best to consult your healthcare provider before starting new supplements, especially if you have cardiovascular or bone health concerns.

    Final Thoughts

    Supplements aren’t a replacement for good nutrition, they’re a tool to fill in the gaps. Always check your labs, talk to your healthcare provider, and choose high-quality, third-party tested brands when possible.

    Consistency is key, but so is balance, nourish your body with whole foods, movement, rest, and mindfulness first. The supplements just help support the rest of the work you’re already doing for your health.

    If you have any questions about supplements, leave them below ❤

    Leave a comment

  • About Nutrition & Medicine

    Hi. I’m Angie Esthers. I’m a medical student and a dietitian on a mission to make evidence-based health information accessible, practical, and empowering. I combine clinical training with nutrition expertise to help people understand why their bodies respond the way they do and how to make sustainable changes that improve symptoms, energy, and overall health.

    My background

    Before medical school I worked in prenatal care, addiction medicine, and at a supplement company. Those roles taught me how deeply nutrition, lifestyle, and environment influence health, and how powerful practical education can be. Today I’m training to become a family medicine physician and plan to practice functional medicine alongside conventional care so I can treat the whole person, not just symptoms.

    Who I serve

    I’m especially passionate about helping people in underserved communities who often face barriers to reliable health education and quality care. Whether you’re struggling with chronic gut symptoms, trying to improve heart health, or overwhelmed by conflicting advice about supplements and diet, I want to meet you where you are and make health information approachable and useful.

    What I do here

    This blog is a hub for evidence-based, compassionate health education. On this site you’ll find:

    • Biweekly blog posts covering a wide range of topics: IBS & gut health, heart health, practical diet advice, supplements, lifestyle medicine, medical school life, and more.
    • Free eBook guides and downloadable worksheets (like IBS food journals) to help you take action.
    • IBS-friendly recipes and simple meal ideas that support symptom management without sacrificing flavor.
    • Occasional affiliate recommendations for products I genuinely use and trust, I always disclose affiliate links and only recommend items I believe in.
    • Future offerings: one-on-one consultations, group workshops, and clinically informed courses (launching as my training and schedule allow).
    My approach

    I believe health care should be educational, collaborative, and rooted in compassion. I use an evidence-based, patient-centered approach that blends conventional medicine with functional principles: find the root causes, use the least invasive interventions first, and empower patients through knowledge. Education is central to everything I do, when people understand their bodies and the “why” behind recommendations, they make better choices and see better outcomes.

    Why I write

    I create content because I’ve seen how life-changing clear, practical guidance can be. I’m here to simplify confusing medical and nutrition information, debunk myths, and give you tools you can use right away. My goal is to help you feel more confident making decisions about your health, whether that means managing IBS, improving heart health, choosing supplements wisely, or navigating medical care.

    Support & community

    Much of my content is free because I believe good information should be accessible. If you find this site helpful and want to support the work, you can donate to help me keep producing free guides and posts while I complete medical school. I also offer paid eBooks and resources for deeper, step-by-step guidance, each designed to be practical, actionable, and based on the best available evidence.

    Let’s connect

    I love hearing from readers, questions, topic suggestions, or collaboration ideas are always welcome. You can contact me via the contact page, follow my latest posts, or join my email list for exclusive guides and updates.

    Thanks for being here. Let’s learn, heal, and grow together.

    – Angie Esthers 🩷🌿

  • Hello, welcome to my blog!

    Hi, I’m Angie Esthers, a dietitian and medical student passionate about the intersection of nutrition, lifestyle, and medicine. This page is a space where I share what I’m learning, what inspires me, and how knowledge can empower us to take better care of our bodies and minds.

    I believe caring for the body starts with understanding it. Food, movement, community, and mindset all play a role in how we heal, and education is the foundation that makes real change possible.

    My goal is to become a family medicine physician who practices the kind of medicine that treats the whole person, just like it used to be a hundred years ago, with compassion, curiosity, and heart.

    Whether you’re here to learn about nutrition, integrative medicine, or simply how to live a little healthier every day, I’m glad you’re here. Let’s learn, grow, and care for ourselves – together 🩵