Protein: how much you need, how to choose it, and why it is key to maintaining muscle   Hello, I'm Dr. Isabel Viña Bas, physician and Scientific Director at IVB Wellness Lab. We talk about protein more and more every day. We find it in shakes, bars, yogurts, breads, and all kinds of enriched foods. And it is completely normal for questions to arise: Do we really need that much protein? What happens when we eat it? Does all the protein we consume go to muscle? Are all proteins equal? How much do we need depending on our age or activity level? To answer these questions, I am joined in this episode by Dr. Juan Viña, a physician, professor of Biochemistry and Molecular Biology, and an expert in protein metabolism. And there is an idea that will be present throughout the entire conversation: protein is much more than muscle. Our body needs proteins to maintain tissues, produce enzymes, build hormones, participate in metabolic pathways, and carry out many other essential functions for life. That's why, when we talk about protein, we need to stop thinking solely about gaining muscle mass and start understanding it from a much broader perspective. What does our body do with the protein we eat? When we consume a food that contains protein, our body does not directly use that protein as we have eaten it. First you need to digest it. Proteins are made up of chains of amino acids, and during digestion, these structures are broken down into smaller units. Amino acids are absorbed in the intestine, enter the bloodstream, and from there can reach the body's various tissues. Y aquí encontramos una de las primeras ideas importantes: the protein you eat doesn't go directly to the muscle. Amino acids are distributed throughout the body and are used to build different types of proteins. For example, they can be used to produce: Structural proteins. Enzymes. Defense-related proteins. Hormones. Proteins required for different metabolic pathways. Muscle is one of those tissues, but it is not the only one. Why do muscles need protein? Muscle needs amino acids to manufacture the proteins that make up its structures. But it also needs protein so the muscle itself can function properly. Within muscle tissue, there are different metabolic pathways and enzymes that allow processes such as energy generation and utilization, glycogen storage, or muscle contraction to occur. Therefore, when we talk about protein and muscle, we have to think about two different concepts: Protein is used to build muscle, but also so that muscle can function. And this is especially important as we get older. Because the goal of maintaining good muscle mass isn't just about having more muscle. It is about ensuring the muscle remains functional. That allows us to walk, get up from a chair, climb stairs, carry bags, maintain our independence, and fight against frailty. Por eso, cuidar el músculo es importante durante toda la vida. Protein isn't just in muscle When we think of protein, the first thing that probably comes to mind is muscle. But protein is practically everywhere. For example, many hormones are proteins. Among them we find the insulin, prolactin, growth hormone, and various hormones related to the functioning of the reproductive axis, such as FSH and LH. Enzymes are also proteins, and they are essential for the various chemical reactions that keep our body functioning. Therefore, when we consume protein, we are not simply providing "muscle-building material." We are providing the amino acids that our body needs to produce its own proteins. Muscle is of special importance because it is a highly active tissue and because its maintenance is directly linked to our mobility and independence, but metabolically speaking, it is not the only tissue that needs protein. Where does the protein we eat go? Once proteins are digested and amino acids are absorbed, they reach via portal circulation the liver. And here we find a key piece. The liver is the first major organ to receive these amino acids from the gut, using a significant portion of them for its own functions. Among other things, the liver uses amino acids to make structural proteins and proteins that it subsequently releases into the blood, such as albumin. But not all amino acids remain in the liver. A portion continues into the general circulation and can reach other tissues such as the brain, kidneys, heart, or muscle. Therefore, when we ingest protein, there is an amino acid distribution among different tissues. And this also helps us understand why liver health is so important when we talk about protein metabolism. Why is the liver so important for protein metabolism? Amino acids have a structure containing carbon and nitrogen. When we consume more amino acids than we need to synthesize proteins, our body has to metabolize them. El amino group is converted into urea, a process that occurs in the liver, and the urea is subsequently eliminated through urine. Furthermore, the carbon skeleton of amino acids can be oxidized or transformed into other metabolic products. Under certain circumstances, it can even contribute to lipid formation. Therefore, the liver plays a fundamental role in amino acid metabolism. And this is especially interesting when we talk about people who present metabolic disorders or hepatic fat accumulation. Does exercise increase protein delivery to the muscle? Here is one of the most interesting concepts from the episode. Amino acids are distributed throughout the body, but exercise can help ensure that a greater amount reaches the muscle. And why? Through several mechanisms. On one hand, insulin promotes the muscular uptake of certain amino acids, especially branched-chain amino acids. Additionally, exercise itself promotes the transport of these amino acids to the muscle. But there is another very simple mechanism that we often forget: exercise increases blood flow to the muscle. If a certain concentration of an amino acid is present in the blood and blood flow to the muscle tissue increases, a greater amount of that amino acid will reach the muscle. Por eso, si queremos favorecer que los aminoácidos que ingerimos se utilicen para mantener y desarrollar nuestra masa muscular, la combinación tiene mucho sentido: enough protein + strength training. It is not just about eating more protein. You also need to provide the muscle with the stimulus it needs. How Much Protein Do We Need a Day? This is probably one of the most frequently asked questions. For a long time, the figure of 0.8 grams of protein per kilogram of body weight per day. Pero aquí es importante hacer una distinción: 0.8 g/kg does not necessarily mean it is the optimal amount for everyone. It is a minimum reference established within a specific context and under certain conditions. And one person's needs are not the same as another's. Does not need the same: A young person than an older person. A sedentary person than a person who trains. A healthy person than a sick person. A person who is maintaining their weight than someone who is losing weight. A 30-year-old person than an 80-year-old person. Human beings are heterogeneous. Therefore, we cannot take a single figure and apply it identically across the entire population. Where did the 0.8 g/kg recommendation come from? This figure also has an interesting historical context. The first recommendations were established decades ago, at a time when social and health circumstances were very different. During World War II, for example, there was a clear concern with determining what the amount was minimum of protein that could be guaranteed under certain circumstances. Over the years, research has evolved, and so have the methods used to study protein requirements. Today, we have a greater understanding of individual differences, aging, physical exercise, disease, and protein composition. Therefore, the figure of 0.8 g/kg may fall short for many people. As a general reference, the episode suggests an approximate intake of 1.1–1.2 g of protein per kilogram of body weight per day, siempre teniendo en cuenta la calidad de la proteína y las características individuales. For certain individuals, especially those who are physically active, requirements may be higher. Do older adults need more protein? Age is one of the factors we need to consider most. Over the years, what we know as anabolic resistance. This means that the muscle may respond less effectively to a given amount of amino acids and to the stimulus of exercise. A 70-year-old person can consume the exact same amount of protein as a 25-year-old and yet get a different muscle response. This happens because the body changes with age. There may be lower efficiency in the absorption of certain nutrients, diseases may coexist, medication consumption may increase, and, above all, physical activity may decrease. That's why maintaining an adequate protein intake and pairing it with strength training becomes even more important as we age. The goal is not simply to live more years. It's reaching those years maintaining our autonomy and our functional capacity. What is anabolic resistance? Anabolic resistance can be understood as a lower muscle sensitivity to amino acids and to the stimulus needed to build and maintain muscle protein. It can appear with age, but it is not exclusive to aging. It can also be related to: Immobility. Disease. Inflammation. Lack of exercise. Metabolic disorders. And here we find a fundamental principle of biology: for a response to occur, there must be an adequate stimulus. Eating protein provides the necessary amino acids, but without sufficient muscle stimulation, the response won't be the same. For this reason, a person who remains immobilized for an extended period can lose muscle mass even if they continue to take in protein. ¿Qué relación existe entre resistencia a la insulina y músculo? Insulin resistance can also influence the muscle's response to protein. Among the amino acids especially important for muscle are branched-chain amino acids, such as: Leucine. Isoleucine. Valina. In order for these amino acids to enter the muscle, there is a relationship with insulin signaling. If a person has peripheral insulin resistance, muscles may respond worse and absorb certain amino acids less efficiently. This adds another piece to the concept of anabolic resistance. And here an interesting relationship emerges between metabolism, body composition, and muscle mass. How can we improve insulin sensitivity? One of the main tools is once again the exercise. Ganar masa muscular puede ayudar a mejorar la sensibilidad a la insulina y, al mismo tiempo, favorecer una mejor utilización de los nutrientes. Diet also plays an important role. Among the strategies mentioned in the episode, we find the increase in the consumption of fiber, which can help improve certain metabolic parameters and reduce inflammation. It also mentions some supplements that can be used as support in certain contexts, including: Berberine. Coenzima Q10. Lycopene. Silymarin. Gymnema sylvestre. Myo-inositol. But once again, supplements are no substitute for the two main foundations: movement and proper nutrition. How much protein can we absorb in one meal? There is a widespread idea that our body can only absorb a certain amount of protein in one meal. However, from the standpoint of digestion and absorption, there is no simple limit beyond which the body stops absorbing ingested protein. Our gut features numerous amino acid transporters and different absorption mechanisms. Therefore, we should not think that if we consume more than a certain amount in a meal, the rest simply "goes to waste." What happens after absorption is different. Once our body has more amino acids than it needs to produce proteins, these can be metabolized. The amino group is converted into urea in the liver and excreted through urine, while the carbon skeleton can follow various metabolic pathways. absorbing protein does not necessarily mean using all of that protein to build muscle. They are different processes. Are all proteins the same? No. And here we need to introduce another fundamental concept: protein quality. To assess the quality of a protein, it is not enough to simply know how many grams it contains. We also need to know: How much essential amino acids it provides. What part of that protein we can digest. How much of those amino acids we can absorb and utilize. Currently, one of the systems used to assess these aspects is the DIAAS, which takes into account the essential amino acid composition, as well as the digestibility and bioavailability of the amino acids. This allows for a more comprehensive assessment than simply looking at how many grams of protein appear on a label. Which foods have the highest quality protein? We can find high-quality protein in both animal- and plant-based foods. Among the examples discussed in the episode, we find: Milk. Egg. Meat. Fish. Soy. Quinoa. Trigo sarraceno. Tofu. Lupin. Pea. We also find isolated proteins with high protein quality, such as whey, milk, or soy isolates. And this is important because it dispels another common idea: It is not necessary to consume animal-based foods to get high-quality protein. There are plant sources with a good amino acid profile, and we can also combine different foods to improve the overall amino acid profile of our diet. What is protein complementarity? Different plant proteins may contain varying amounts of certain amino acids. However, this does not mean that a plant-based diet cannot provide all essential amino acids. complementarity. If a protein contains a lower amount of a specific amino acid, we can combine it with another protein that provides a higher amount. For example, throughout the day we can combine different foods such as: Cereals. Legumes. Eggs. Soy. Peas. Nuts and seeds. Not every meal needs to be mathematically perfect. What matters is the food intake as a whole. That is why, when assessing protein quality, we must also look at the overall range of foods a person consumes throughout the day. What role does leucine play in the muscle? Among the essential amino acids, leucine plays an especially relevant role in muscle. Along with isoleucine and valine, it is one of the branched-chain amino acids. Leucine is especially important because it plays a role in signaling related to muscle protein synthesis. But this does not mean that we can reduce muscle nutrition to leucine alone. To make a protein, we need all essential amino acids. Leucine can act as an important signal, but the body needs to have the remaining essential amino acids available to complete protein synthesis. That's why a complete, high-quality protein makes sense as part of a strategy aimed at maintaining muscle mass. What happens when we are sick or immobilized? During an illness, a period of immobility, or a major inflammatory process, maintaining muscle mass can be particularly difficult. The body can increase the breakdown of muscle proteins and reduce the ability to build new proteins. In these situations, in addition to trying to maintain a sufficient protein intake and exercising whenever possible, it can make sense to turn to certain supplements. One of the ones that particularly stands out in the episode is the HMB. What is HMB and what can it be used for? HMB is a metabolite derived from leucine. It is produced naturally in our body, although in very small amounts. Its main interest in this context is that it can help to reduce muscle protein breakdown, a process known as proteolysis. This can be especially relevant in situations where muscle is at a higher risk of loss, such as: Fragility. Immobility. Disease Major inflammatory processes. This does not mean that HMB replaces protein or exercise. In fact, the order of priorities should remain: sufficient protein + strength training + avoiding immobility. HMB can be used as support when these tools are not enough or when there are specific situations where maintaining muscle mass is particularly difficult. Can collagen replace a complete protein? Collagen is a very important protein. In fact, it is the most abundant protein in the body It is essential for tissues such as skin, tendons, and ligaments. But here we need to differentiate between two concepts. It is one thing for collagen to be an important protein for our body, and a completely different thing for it to be a good source of complete dietary protein. Collagen has a different amino acid composition and features very low amounts or an absence of certain essential amino acids, such as tryptophan. In addition, it contains low levels of leucine and methionine. That is why, collagen should not be used as a substitute for a complete protein. We can use collagen peptides for other reasons, as there is evidence regarding certain parameters related to the skin, tendons, or ligaments. However, this does not mean that it can replace foods like eggs, fish, meat, soy, or an isolated protein when our goal is to meet overall protein requirements. They are different objectives. Protein and muscle: what should we keep in mind? After discussing digestion, absorption, protein quality, age, exercise, anabolic resistance, and metabolism, we can draw several key takeaways. Primero: Protein isn't just for building muscle. The amino acids we obtain through diet are used to make structural proteins, enzymes, hormones, and many other molecules necessary for the body to function. Second: quantity matters, but quality does too. We shouldn't just look at how many grams of protein a food contains. We also need to evaluate its essential amino acids, digestibility, and bioavailability. Third: Age, exercise, health status, mobility, and metabolic context can alter our needs. Bedroom: Strength training is essential. Eating protein alone is not enough if we want to maintain our muscle mass. Muscle needs an adequate stimulus to respond. Quinto: anabolic resistance may develop with age. That is why maintaining a good protein intake and performing strength training becomes even more important as we age. And, finally, collagen does not replace a complete protein. It may be of interest for specific fabrics and targeted objectives, but we should not confuse its specific properties with its ability to meet general protein needs. Because, in the end, when we talk about nutrition and muscle health, there is no single variable that explains everything. Protein quantity matters. Quality matters. Exercise matters. Age matters. Metabolic state matters. Rest and lifestyle matter too. Health, once again, does not work in isolated pieces. Transforming your health is a matter of applying science consistently, day by day.   Hope you like it :)For more information, you know you can find me on my Instagram @isabelvina, where I share daily content with youMy TikTok @isabelvinabasEn mi canal de YouTube And the supplements formulated by my https://ivbwellness.com  

Menopause and Perimenopause: What Happens, Symptoms, and When Hormone Therapy Is Indicated Hello, I am Dr. Isabel Viña Bas, physician and Scientific Director at IVB Wellness Lab. Perimenopause and menopause are two of the stages that raise the most questions. When does menopause actually start? Why do hot flashes, brain fog, mood swings, or insomnia appear? What can we do to navigate these changes? When does hormone therapy make sense, and when can other tools help us? The first thing I want to make clear is that menopause is not a disease. It is a physiological process in which the ovaries progressively deplete their function and the body has to adapt to a new hormonal environment. However, just because it is a physiological process does not mean that every woman experiences it the same way. Some women experience hardly any symptoms, while others go through changes that significantly impact their quality of life. That is why understanding what is happening inside our bodies is the first step toward deciding how to support them. What is menopause and how does it differ from perimenopause? The menopause is defined as the moment when a full year without a period. The perimenopause, en cambio, es la etapa de transición que rodea a la menopausia. Puede comenzar varios años antes de la última menstruación y prolongarse durante un tiempo después. During this stage, significant hormonal changes occur. The ovaries progressively deplete their activity, and estrogen levels begin to decrease. That's why I like to explain it as a sort of late adolescence: our body is adapting to a new hormonal state. And, just as no two adolescences are alike, no two transitions to menopause are alike either. Some women experience hot flashes, irritability, brain fog, sleep disturbances, vaginal dryness, or changes in body composition. Others go through this stage with very few symptoms. Both situations are normal. At what age does menopause occur? Physiological menopause usually occurs between the ages of 45 and 55 years old 51 years old. When it appears among the 40 and 44 years old, hablamos de menopausia precoz. Under 40 years of age, it is referred to as primary ovarian insufficiency. These situations require a different approach than physiological menopause. Si una mujer tiene menos de 45 años y deja de menstruar durante varios meses, no debemos asumir automáticamente que se encuentra en menopausia. Existen otras causas que pueden alterar el ciclo menstrual y que son potencialmente reversibles. Por eso, en estos casos puede ser necesario valorar parámetros como: Prolactin, ya que una elevación puede suprimir la menstruación. TSH, because changes in thyroid function can also affect your cycle. FSH and estradiol, to evaluate the hormonal axis. Hormona antimülleriana, to assess ovarian reserve. If premature menopause or primary ovarian insufficiency is ultimately confirmed, a hormone replacement therapy until reaching the average age of menopause, siempre que no existan contraindicaciones. In these cases, we are not just talking about treating symptoms: we are replacing hormones that should be naturally present at this stage of life. ¿Por qué aparecen tantos síntomas durante la perimenopausia? Menopause doesn't happen overnight. During perimenopause, the ovaries gradually decline in activity, and estrogen levels can fluctuate wildly. I like to explain it with a very simple example: imagine you have a bottle of ketchup that is almost empty. You shake it, and nothing comes out. You shake it again, and suddenly, a large amount comes out. Something similar can happen with the ovaries. There are cycles where there is still significant estrogen production, and symptoms such as the following may appear: Fluid retention. Very heavy or prolonged periods. Síntomas premenstruales más intensos. Irritabilidad. Mood swings. And as menopause approaches and the decline in estrogen predominates, other more characteristic symptoms appear: Hot flashes. Night sweats. Sleep disturbances. Niebla mental. Cambios en el estado de ánimo. Sequedad de la piel. Itching Vaginal dryness. Recurrent urinary tract infections. This explains why perimenopause can feel so confusing: one month you might feel one way, and the next you might experience completely different symptoms. Estrogens are not only involved in fertility One of the fundamental ideas for understanding menopause is that estrogens are systemic hormones. They do not act solely on the reproductive system. They have receptors in different tissues and are involved in functions related to the brain, metabolism, blood vessels, skin, mucous membranes, and bones. Therefore, when estrogen levels drop, changes can appear in different parts of the body. And this explains why menopause can manifest in so many different ways.  Why do brain fog and mood swings occur? Estrogens play an important role in the brain. They promote the synthesis and action of the serotonin, related to well-being, and they are also involved in the dopamine, related to motivation and the feeling of reward. In addition, estrogens are involved in neural connections and promote the production of brain-derived neurotrophic factor, related to the maintenance and development of neural connections. When estrogen levels drop, especially during the first few years, the brain has to adapt to this new hormonal environment. That is why the following may appear: Brain fog. Dificultad para concentrarse. Memory impairments. Mood swings. Sadness. Lack of motivation. This situation does not have to last indefinitely. The brain is capable of adapting to the new hormonal environment, which is why these symptoms can be especially pronounced during the first few years.  Why is exercise so important during menopause? Here you'll find one of the most important tools to support this stage: physical exercise and, especially, the muscle. Exercise can independently promote the production of serotonin, dopamine, and brain-derived neurotrophic factor. In addition, muscle is capable of producing molecules that have effects on the brain. That is why maintaining good muscle mass is not just an aesthetic matter. During menopause, strength training can become a tool to support: Cognitive function. The mood. Metabolism. Body composition. Maintenance of muscle mass. And the sooner we start taking care of our muscles, the better. We shouldn't wait until menopause to start working on it. Why do hot flashes occur? Hot flashes are one of the most well-known symptoms of menopause, and they also have a hormonal explanation. Estrogens are involved in the brain mechanisms that regulate body temperature. Cuando disminuyen, especialmente durante los primeros años, se altera este sistema de termorregulación. The result is that a temperature that might be completely normal for someone else can trigger a sudden hot flash in us. Then hot flashes appear, which may be accompanied by sweating and can be especially bothersome at night. Alcohol can also act as a trigger or exacerbate hot flashes, so reducing its consumption may be considered as part of lifestyle adjustments.  Which supplements can help during menopause? Depending on the symptoms, there are different supplements that can be used for support. The soy isoflavones are one of the supplements with the strongest evidence in the nutraceutical management of menopause. Depending on the objective, the following can also be used: Sage, especially in relation to hot flashes. Valerian, especialmente cuando existen alteraciones del sueño. Saffron extract, for certain symptoms related to mood and appetite. Bacopa monnieri, in the context of memory and cognitive function. Omega-3 rich in DHA, por su interés en la función cerebral. Zinc. L-theanine. The choice should depend on the symptoms each woman experiences. It is not about taking every available supplement, but about identifying what needs exist and choosing the tools that make sense. Are soy isoflavones safe during menopause? This is a point that causes a lot of confusion. Soy isoflavones are phytoestrogens, but they are not human estrogens. Their action depends on the estrogen receptors to which they bind, and therefore, they do not replicate the exact behavior of our estrogens in all tissues. The episode highlights specifically its interest in the nutraceutical approach to menopause and its safety profile. Additionally, it is noted that soy can act on various tissues associated with menopause symptoms, such as blood vessels, the brain, or mucous membranes. For this reason, soy isoflavones can be one of the options to consider when a woman wants to manage certain symptoms through supplementation.  Why does body composition change during menopause? Otro de los cambios que más preocupan durante esta etapa es la modificación de la composición corporal, especialmente la tendencia a acumular grasa en la zona abdominal. Estrogens play a role in regulating metabolism and insulin sensitivity. Cuando disminuyen, cambia el entorno hormonal y metabólico. Additionally, changes in appetite and sleep disturbances may also appear during this stage. Todo ello puede contribuir a que resulte más fácil acumular grasa y más difícil mantener la composición corporal que teníamos anteriormente. Therefore, the approach should not focus solely on eating less. We need to take special care of: Strength training. Adequate protein intake. Physical activity. The quality of the food. Rest. How can we protect muscle mass during menopause? Muscle is one of the main highlights of this stage. Maintaining good muscle mass helps improve insulin sensitivity and promotes a healthy body composition. The essential tool is the entrenamiento de fuerza. But muscle also needs the necessary nutrients to maintain itself. That is why we must ensure an adequate intake of protein Creatine. HMB. Vitamin D. Taurine. It's not about replacing training with supplements. The primary stimulus remains strength training. Supplementation can be used as support when it makes sense within an individualized strategy. Why does vaginal dryness occur during menopause? Los estrógenos también tienen un papel fundamental en el tejido vaginal y urinario. They help maintain the mucous membrane and promote a suitable environment for the microorganisms that make up the vaginal flora. Cuando disminuyen, pueden aparecer: Sequedad vaginal. Itching Irritation. Pain during intercourse. Infecciones urinarias recurrentes. Urinary disorders. It is what we know as genitourinary syndrome of menopause. For these symptoms, there are various options available, ranging from non-hormonal vaginal moisturizers to local estrogen treatments. If a woman has a medical history that requires extra caution with hormonal treatments, non-hormonal options can be particularly appealing.  When is menopause hormone therapy indicated? Hormone therapy can be a very effective tool, but it is not suitable for all women nor should it be used as a preventive treatment in women who do not present symptoms. The episode identifies four main situations in which it may be indicated: 1. Vasomotor symptoms hot flashes that affect quality of life. 2. Fracture prevention Can be used for the osteoporosis prevention It is important to differentiate between prevention and treatment: hormone therapy is not the treatment for established osteoporosis. 3. Genitourinary syndrome In women with symptoms such as itching, pain during intercourse, or recurrent urinary tract infections who have not adequately improved with local estrogen treatment, hormone therapy may be considered. Urinary incontinence is an important exception, as hormone therapy can worsen it. 4. Menopausia precoz o insuficiencia ovárica primaria In these cases, hormone therapy has a different goal: replace the hormones that should be present until reaching the average age of menopause. Do you have to take hormone therapy for life? No necesariamente. Some women use it for a few years and then gradually reduce the dose. Others need to stay on it longer, and others decide to stop earlier. The important thing is to understand that there is no single duration that is identical for all women. It often starts during the first few years, when symptoms are most severe, and the situation is reviewed later on. If symptoms have improved, a gradual reduction can be considered. And if a woman decides to change her strategy, use supplements, or discontinue therapy, it does not mean she has failed. The strategy may change as needs evolve.  Can hormone therapy be used during perimenopause? perimenopause-associated depression. Durante los primeros años de esta transición se produce un cambio hormonal importante y los estrógenos influyen sobre la serotonina, la dopamina y el factor neurotrófico cerebral. Some women may experience depressive symptoms specifically related to this transition. But it is important to make a distinction: we are not talking about just any depression. This is a specific situation related to hormonal transition and must be evaluated on an individual basis.  And what about loss of libido? A decrease in sexual desire can also occur during menopause. Estrogen has receptors in different areas of the brain related to motivation and arousal, so its decline can contribute to a decrease in desire. testosterone can be used for hypoactive sexual desire disorder associated with menopause. But there is something we must not forget. If a woman is experiencing hot flashes, not sleeping well, vaginal dryness, painful intercourse, and mood swings, it is logical that her sexual desire would also decrease. That is why treating libido alone is not always enough. Need to address the combination of factors affecting that woman's well-being.  When is hormone therapy contraindicated? Before starting hormone therapy, it is essential to evaluate your personal medical history. Situations that contraindicate hormone therapy include: Unexplained vaginal bleeding. Active breast cancer. Certain hormone-dependent gynecological cancers. Intermediate- or high-risk endometrial cancer. Personal history of pulmonary thromboembolism. History of stroke. History of acute myocardial infarction. Furthermore, there are situations where the problem lies specifically in the use of oral estrogens, such as certain blood clotting disorders, Factor V Leiden, a history of migraines, or gallstones. En estos casos puede ser preferible, cuando la terapia está indicada, utilizar una vía transdérmica. Therefore, before deciding which treatment to use, the first question should always be: Am I a candidate for hormone therapy?  What should be evaluated before starting hormone therapy? When a woman is a candidate, there are still several aspects to consider. In the episode, the following points are brought up for review: cardiovascular risk Carotid artery status. Individual breast cancer risk. Up-to-date mammogram. Bone mineral density. And there is a fundamental question: Do you have a uterus? Porque esto condiciona el tratamiento. If a woman has a uterus, estrogens must be accompanied by progesterone, ya que los estrógenos estimulan el crecimiento del endometrio. Progesterone acts as protection against that growth. If there is no uterus, it is not necessary to use progesterone solely for this purpose.  What options exist within hormone therapy? Estrogens can be administered through different routes: Transdermal patches. For oral use. Transdermal spray. In general, the transdermal route avoids the first-pass hepatic metabolism of oral estrogens and can be particularly beneficial when certain risk factors are present. Progesterone can be administered orally or vaginally. There are also other therapeutic options, such as tibolone, which has estrogenic, progestational, and androgenic activity, and may have effects on hot flashes, sleep, mood, libido, and bones. Another alternative is the combination of conjugated estrogens with bazedoxifene, which allows the endometrium to be protected without using progesterone. The choice always depends on the individual characteristics, history, symptoms, and preferences of each woman. Can we combine hormone therapy and supplements? Yes. Supplements and hormone therapy do not have to be mutually exclusive. A woman can use hormone therapy and certain supplements if it makes sense for her needs. Another may not want to use hormone therapy and choose instead to opt for nutritional and lifestyle strategies. Another option is to use supplements during one stage and later consider hormone therapy. And another may reduce or suspend hormone therapy when their symptoms have improved. there is no single correct strategy for everyone. The important thing is to achieve the maximum possible benefit with the lowest risk, using the tools that every woman actually needs. Menopause: Understanding the Change to Better Support It Menopause is not simply the moment when menstruation disappears. hormonal transition that can affect different body systems Hot flashes, mood swings, brain fog, sleep disturbances, changes in body composition, or vaginal dryness all have an explanation related to your new hormonal environment. And precisely for that reason, the approach does not always have to be the same. La terapia hormonal puede ser una herramienta muy eficaz cuando está indicada. Los complementos pueden ayudar en determinados síntomas. Y el ejercicio de fuerza, la proteína, el descanso y una alimentación adecuada deberían formar parte de la estrategia de salud independientemente de que utilicemos o no terapia hormonal. Because it's not about fighting menopause. It is about understand what is happening and thoughtfully choose the tools that best suit each stage and each woman. Transforming your health is a matter of applying science consistently, day by day.   Hope you like it :)For more information, you can find me on my Instagram @isabelvina, where I share daily content with youMy TikTok @isabelvinabasOn my YouTube channel And the supplements formulated by my https://ivbwellness.com  

High Cholesterol: How to Interpret Your Blood Test and Protect Your Cardiovascular Health Hello, I am Dr. Isabel Viña Bas, a physician and Scientific Director of IVB Wellness Lab.Cholesterol often appears in a blood test accompanied by a label that is far too simple: good or bad. If HDL is high, it seems like everything is fine; if LDL rises, it seems the only explanation lies in what we have eaten. But cardiovascular health does not fit into two adjectives. Cholesterol is an essential molecule. It is part of your cell membranes and allows for the production of steroid hormones, vitamin D, and bile acids. The problem is not that it exists, but how it circulates in the blood, in what quantity it does so, and what other risk factors accompany it. That is why, to interpret a blood test, it is not enough to look at total cholesterol. We need to understand the whole picture: LDL, HDL, non-HDL cholesterol, triglycerides, and, at least once in your life, lipoprotein(a). You also have to place those data points alongside blood pressure, glucose, smoking, body composition, family history, and medical history. The same LDL level does not mean the same thing for two people with different risks. What is cholesterol and why does your body need it? Since cholesterol does not dissolve in water, it cannot travel alone through the blood. To move, it needs particles to transport it: lipoproteins. Among them are LDL, HDL, and VLDL. When we talk about LDL or HDL cholesterol, we are actually talking about the cholesterol that travels inside those particles. LDL carries cholesterol from the liver to the tissues. When there are too many atherogenic particles circulating, they can cross the artery wall and promote plaque formation. HDL participates in reverse transport: it collects part of the cholesterol from the tissues and returns it to the liver so it can be reused or eliminated. This explanation helps to understand why we call LDL "bad" cholesterol and HDL "good" cholesterol, but those labels have limits. A high HDL does not automatically neutralize an elevated LDL or erase other risk factors. A blood test is interpreted as a system, not as a competition between two numbers. What cholesterol values to request in your blood test A basic blood test should include total cholesterol, HDL, and triglycerides. Based on that data, the laboratory can report or calculate LDL and non-HDL cholesterol. Each marker answers a different question. Total cholesterol. It is the sum of the cholesterol transported by different lipoproteins. It serves as a starting point, but on its own, it provides little information about real risk. LDL cholesterol. It is one of the main targets of treatment because it reflects the cholesterol transported by particles capable of contributing to atherosclerosis. The higher a person's cardiovascular risk, the lower the LDL target should be. HDL cholesterol. It tells us about the cholesterol transported by HDL. A low value is usually associated with a less favorable metabolic environment, but trying to raise it in isolation is not the main goal. The important thing is to improve overall risk. Triglycerides. They are another way of transporting and storing energy. They can increase with insulin resistance, excess alcohol, certain thyroid disorders, some medications, or sustained energy excess. When they reach very high levels, the risk of pancreatitis also increases. Non-HDL cholesterol. It is calculated by subtracting HDL from total cholesterol. It gathers the cholesterol from all potentially atherogenic particles and is especially useful when triglycerides are elevated. Lipoprotein(a). It is genetically determined to a large extent, and can raise cardiovascular risk even if the rest of the blood test seems correct. That is why it is recommended to measure it at least once in adulthood; if it is elevated, the professional can adjust the assessment and follow-up. High LDL cholesterol: why there is no single optimal level I can give you several indicative ranges, but there is one idea that must remain above any figure: LDL targets depend on individual cardiovascular risk. A young person with no other risk factors does not need the same target as someone who has already suffered a heart attack, has diabetes, kidney disease, or documented atherosclerosis. In people with low or moderate risk, the professional may propose less demanding targets. In those who present high or very high risk, guidelines recommend more intense reductions and much lower targets. Therefore, it is not advisable to interpret a result in isolation, nor to modify a treatment just because a number moves away from a generic range. The same happens with triglycerides: they are usually considered desirable below 150 mg/dL, but context matters. A high figure requires assessing diet, alcohol, glucose, thyroid, medication, and history. A blood test does not provide a closed diagnosis; it opens a clinical conversation. Low HDL: why it can happen even if you eat well Diet influences a person's lipid profile, but it does not control HDL on its own. A low value can appear associated, for example, with smoking, diabetes, insulin resistance, excess body fat, a sedentary lifestyle, or certain medications. It may also happen that the person in question has a genetic predisposition. There is a frequent error here: confusing normal weight with good metabolic health. A person can have a body mass index within the usual range and yet present low muscle mass and a high proportion of fat. The scale does not distinguish between muscle and adipose tissue, but your metabolism does. If HDL is low, the goal should not be to look for a food or supplement that raises it artificially. It makes more sense to act on what truly reduces cardiovascular risk: stop smoking, improve insulin sensitivity, increase daily movement, and do strength training to preserve or gain muscle. Muscle captures glucose, responds to insulin, and helps manage energy better. It is not just a tissue related to performance or aesthetics. Building muscle is also a metabolic and cardiovascular health strategy. Does high cholesterol come from genetics or diet? Most of the cholesterol the body uses is produced within the body itself, especially in the liver. That does not mean that high cholesterol is always genetic or that diet does not matter. It means that the relationship between what you eat and what appears in the blood test is more complex than adding up the milligrams of cholesterol in each food. There are hereditary disorders, such as familial hypercholesterolemia, which can cause very high LDL levels from an early age. If there is a history of premature heart attack or stroke in the family, or an especially high LDL, it is important to consult a doctor to rule out a genetic cause. In these cases, eating well is necessary, but it may not be enough. In many other people, the liver increases the production of triglyceride-rich particles and cholesterol in a context of insulin resistance, excess visceral fat, a sedentary lifestyle, or a sustained energy balance above needs. Diet participates in that environment, although it is not the only factor. That is why saying "my cholesterol is genetic" or "it's all because of eggs" could close the investigation too soon. So it is advisable to review the complete pattern: history, body composition, physical activity, dietary fats, fiber, alcohol, glucose, thyroid function, and medication. Eggs, saturated fats, and high cholesterol: what really influences it Dietary cholesterol does not affect everyone the same way and, in many people, has less impact on LDL than the overall quality of the diet. Eggs, for example, provide cholesterol, but also protein, choline, and other micronutrients. They do not need to become either a forbidden food or an unlimited food. The answer depends on the person, their cardiovascular risk, and the rest of what they eat. An egg within a pattern rich in vegetables, legumes, nuts, olive oil, and fiber does not have the same context as a diet based on ultra-processed foods, fatty meats, and low plant variety. Saturated fats can indeed raise LDL, especially when they replace unsaturated fats. They are found in different proportions in fatty meats, sausages, butter, some pastries, and oils such as palm or coconut. It is not about eliminating all fat: it is about replacing part of the saturated fats with olive oil, avocado, nuts, seeds, and other sources of unsaturated fats. Also important is the soluble fiber present in oats, legumes, fruits, vegetables, and seeds. This helps reduce the intestinal reabsorption of bile acids and can contribute to improving the lipid profile. The effect is not in a miracle food, but in the daily repetition of a pattern. How to lower high cholesterol and triglycerides When a blood test is altered, we look for a quick fix. But before talking about supplements, it is advisable to rebuild the foundation. The most effective strategy is one that acts simultaneously on atherogenic particles, insulin sensitivity, blood pressure, and body composition. Substitute, don't just remove. If you reduce saturated fats, I recommend replacing them with unsaturated fats. Removing foods without deciding what will take their place usually makes the change short-lived. Increase fiber progressively. Vegetables, legumes, fruit, oats, nuts, and seeds help improve the overall quality of the diet. If you currently eat little fiber, increase the amount little by little and accompany it with water. Train strength and move every day. Exercise improves insulin sensitivity, helps reduce triglycerides, and protects muscle mass. Walking is valuable, but combining daily activity with strength training offers a more complete metabolic stimulus. Check alcohol. It can raise triglycerides, especially in sensitive people or when consumption is frequent. You don't need to drink alcohol to protect your heart. Take care of rest and energy balance. Sleeping little and maintaining an energy excess favors a less healthy metabolic environment. The goal is not to live on a diet, but to recover signals, schedules, and habits that can be maintained. After a period agreed upon with the professional, the blood test is repeated. If the risk is high or the numbers are very high, you should not delay an effective treatment to "try natural remedies first." The time to intervene also depends on the risk. Statins for high cholesterol and coenzyme Q10: what is the relationship? Statins reduce the synthesis of cholesterol by inhibiting the enzyme HMG-CoA reductase. That same metabolic pathway also participates in the production of coenzyme Q10, a molecule involved in obtaining energy within the mitochondria. For that reason, it has been studied whether the reduction of CoQ10 can contribute to the muscle symptoms that some people experience with statins. The biological relationship exists, but supplementation with coenzyme Q10 is not automatically recommended for everyone taking statins. Studies on its ability to prevent or relieve muscle pain have offered variable results. If muscle discomfort, unusual tiredness, or weakness appears after starting or changing the dose, do not abandon the medication on your own. The professional can review the cause, check for interactions, assess other diseases, adjust the dose, or change the statin. In certain cases, they may also propose a trial with CoQ10, individualizing the dose and follow-up. A well-indicated statin reduces the risk of heart attack and stroke. The goal is not to choose between medication or self-care, but to use each tool when it provides more benefit than risk. Red yeast rice, berberine, and other supplements: natural does not mean harmless In initial phases and always within a professional assessment, some supplements can be studied as support. But they should not be presented as universal substitutes for statins or combined without reviewing interactions. Red yeast rice can contain monacolin K, a substance with a pharmacological action similar to lovastatin. Precisely for that reason, it can produce similar adverse effects and interactions. It should not be combined with statins and requires special caution in pregnancy, breastfeeding, liver disease, or when taking other medications. The amount of monacolins can vary between products, so quality and control are essential. The berberine has been studied for its possible effect on glucose and certain lipid parameters. Even so, it can interact with drugs, it may not be suitable for everyone, and it does not replace the treatment indicated for a high-risk person. The same goes for turmeric, resveratrol, probiotics, or omega-3 supplements: each option responds to a different goal and needs context. Omega-3s, for example, can help reduce triglycerides at therapeutic doses, but they are not a tool to lower LDL in a general way. Some preparations can even raise it slightly. Before choosing a supplement, you have to define which marker to modify, why it is altered, and what evidence supports that decision. High cholesterol in pregnancy and breastfeeding: when is it physiological and when to consult During pregnancy, cholesterol and triglycerides increase naturally. The body needs lipids to form hormones, cell membranes, and the baby's structures, and in the third trimester, a physiological insulin resistance occurs that facilitates the availability of nutrients for fetal growth. Therefore, a lipid blood test during pregnancy is not interpreted with the same criteria as outside of it. That values increase can be normal, but it does not mean that any figure should be ignored. Extremely high triglycerides may require specialized follow-up due to the risk of pancreatitis, and women with familial hypercholesterolemia or cardiovascular disease need an individual plan. It is also not advisable to group pregnancy and breastfeeding as if they were exactly the same stage. After childbirth, the lipid profile usually evolves and decisions depend on maternal risk, the type of breastfeeding, and the treatment considered. Many drugs and supplements are not suitable during these phases. If you are pregnant, trying to conceive, or breastfeeding, do not start statins, red yeast rice, berberine, or other cholesterol supplements without medical assessment. In these stages, protecting the health of the mother and the baby requires individualizing more, not acting less. How to interpret your next blood test without getting stuck on a single number When you receive the results, start by gathering the pieces. Look at LDL, HDL, triglycerides, and non-HDL cholesterol. Check if you have ever had your lipoprotein(a) measured. Add blood pressure, glucose or glycated hemoglobin, smoking, physical activity, body composition, and family history. Then, ask what your risk level is and what target applies to your case. Do not limit yourself to knowing if the laboratory has marked the LDL with an asterisk. The reference range describes a population; the therapeutic goal is decided for a person. If the result is altered, look for the cause before accumulating solutions. Review your dietary pattern, alcohol, movement, strength, rest, thyroid, and the medications you take. And if the figures are very high or there is a cardiovascular history, act quickly together with a professional. Cholesterol is not an enemy that we must eliminate. It is an essential molecule that needs to circulate in balance. The key is to reduce exposure to atherogenic particles, take care of the metabolic environment, and make decisions proportional to your risk. Transforming your health is a matter of applying science with consistency, day by day. You have in your hands the knowledge to better understand your blood test, ask more precise questions, and turn each result into an informed decision. I hope you like it :)For more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel And the supplements formulated by me https://ivbwellness.com

In medical practice, prescribing a drug is always based on the risk-benefit balance principle: medications provide us with an essential benefit for treating pathologies or preventing complications, but they are not exempt from metabolic tolls. In this episode, we address drug-induced depletion in a clear and informative way, a silent phenomenon by which certain very common treatments can hinder the absorption, increase the elimination, or alter the activation of essential vitamins and minerals. Understanding this connection allows us to comprehend why symptoms such as fatigue, myalgia, insomnia, brain fog, or hair loss may appear after starting a treatment, remembering that knowing the cause is the first step to alleviating discomfort and improving quality of life without the need to abandon prescribed medication. Throughout the talk, we meticulously analyze the most common pharmacological groups and the nutrients that are especially affected. We delve into proton pump inhibitors, such as omeprazole or pantoprazole, explaining that they are not mere "stomach protectors," but potent suppressors of the gastric acid necessary to digest proteins and correctly assimilate magnesium, vitamin D, calcium, iron, and, very critically, vitamin B12, whose progressive deficiency affects memory and constitutes one of the main reversible causes of dementia. Likewise, we explain the mechanism of statins for cholesterol, which block the hepatic synthesis of Coenzyme Q10, an antioxidant and mitochondrial nutrient essential for cellular respiration and muscle contraction, which justifies the frequent appearance of muscle pain or chronic fatigue. We also address metformin and its impact on vitamin B12 absorption, warning how this deficit can raise homocysteine (a pro-inflammatory molecule with an impact on cardiovascular health and fertility) if it is not adequately replenished. In addition, we delve into the effects of oral contraceptives, which increase catabolism and reduce the hepatic activation of vitamin B6, favoring the appearance of seborrheic dermatitis or cracks at the corners of the mouth, and deplete reserves of magnesium, folate, and hepatic antioxidants. We also analyze the urinary loss of magnesium, thiamine (vitamin B1), and zinc caused by diuretics, the muscular and bone impact of corticosteroids, and the need to protect the gastric mucosa with vitamin C when taking acetylsalicylic acid (aspirin) continuously. Finally, we highlight the importance of always choosing the active and bioavailable chemical forms of each nutrient, such as methylcobalamin for B12 or pyridoxal-5-phosphate for B6, and we review some key food-drug interactions, such as the need to avoid grapefruit if taking statins or certain antihypertensives. In short, the episode invites us to abandon extremes to understand that drugs and targeted nutritional supplementation can coexist synergistically to protect our overall health. For more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My website

Insulin is an absolutely essential hormone for life and fundamental for muscle mass synthesis, but when its levels remain constantly elevated, it becomes the main culprit for body fat accumulation, especially at the visceral and abdominal levels. In this episode, we take a deep dive into what happens when our cells become "impermeable" to the action of insulin  as if they were putting on a raincoat that prevents them from hearing its signal, and the pancreas responds by secreting more and more, entering a vicious cycle of hyperinsulinemia and insulin resistance. This metabolic alteration not only makes it difficult to lose weight or gain muscle, but it also has a direct impact on the entire hormonal balance. Throughout the talk, we explain how excess visceral fat first affects the liver, leading to fatty liver and compromising key hepatic functions such as the detoxification of toxins and the proper activation of essential vitamins like vitamin D and B6. As a consequence, problems with mood, sleep disturbances, unexpected spikes in cholesterol, triglycerides, and uric acid may appear, as well as manifestations in hormonal health such as polycystic ovary syndrome (PCOS), acne, or hair loss. To find out if you are going through this process, we address how to identify it simply, whether through a blood test by calculating the HOMA-IR index (multiplying fasting glucose by fasting insulin and dividing by 405, where values equal to or greater than 2.5 suggest resistance) or simply by measuring your waist circumference with a tape measure. Finally, we share the fundamental pillars to recover metabolic sensitivity and remove that waterproofing layer from the cells: the combination of strength and cardiovascular exercise, a daily intake of at least 25 to 30 grams of prebiotic fiber to promote the natural secretion of satiety hormones like GLP-1, the reduction of alcohol and sweeteners such as sorbitol and maltitol, and the targeted supplementation strategy with active ingredients like phytosomal berberine, silymarin, Gymnema sylvestre, or myo-inositol.  I hope you like it :)For more information, you know you can find me on my Instagram @isabelvina where I share daily content, my TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me https://ivbwellness.com

GLP-1 agonist treatments have marked a turning point in the management of obesity. But, as with any therapeutic tool, it is not just about losing weight; although these drugs offer very good results, they also carry a great responsibility: avoiding the loss of metabolic health along the way. Because, what happens to muscle? Why is it so important to ensure adequate protein intake? What role does fiber play when we eat less? And which micronutrients should be monitored, such as iron, vitamin B12, vitamin B1, vitamin D, or choline? In this episode, we talk about the part of the treatment that is discussed the least: how to ensure that weight loss is also fat loss... and not a loss of health. Because losing weight should not mean losing strength, functionality, or increasing the risk of nutritional deficiencies. If you or someone close to you is following a treatment with a GLP-1 agonist, I believe this episode can help you understand how to support it through physiology and scientific evidence to obtain the best results. And if you also want to delve deeper into other aspects related to these treatments, I recommend you also listen to episodes 77 and 111, where you will find complementary information that will help you better understand how they work, their benefits, and how to use them in the safest and most effective way possible. As I always say: know more to fear less and choose better.

Celiac disease is an autoimmune and systemic condition that goes far beyond simply eliminating gluten from your diet. In this episode, joined by Dr. Laura Crespo, we take a deep dive into what actually happens when a person with celiac disease consumes gluten, how the disease is correctly diagnosed, and why it is essential not to remove gluten before undergoing testing. Furthermore, we address common and lesser-known symptoms, the differences between celiac disease, wheat allergy, and non-celiac gluten sensitivity, and we answer questions about cross-contamination and everyday foods and products that may inadvertently contain gluten. An essential episode for understanding celiac disease through scientific evidence and debunking common myths.

*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:f5ab3494-dec0-4957-94da-f1b4fdb59e4e-0" data-turn-id-container="request-WEB:f5ab3494-dec0-4957-94da-f1b4fdb59e4e-0" data-testid="conversation-turn-2" data-scroll-anchor="false" data-turn="assistant"> Did you know that a food can look perfect and still cause food poisoning? In this episode, we talk with Mario Sánchez, a food technologist and food safety expert, about the most common mistakes we make at home when handling, cooking, and storing food. From salmonella or listeria to bagged salads, cooked rice, refrigerator organization, or reusing oil, we debunk myths and review practical tips to reduce risks in daily life. An essential episode to understand that eating safely depends not only on what we eat, but also on how we handle it.

In this episode, we speak with Sandra Gómez, a physiotherapist specializing in pelvic floor and sexology, about the importance of caring for a part of the body that is rarely discussed. We talk about urine leakage, pain during intimacy, physical exercise, hormonal contraceptives, menstrual pain, and other symptoms that are often normalized when they shouldn't be. Additionally, we debunk common myths and explain why the pelvic floor is also important for men's health. A practical episode to understand that living with discomfort is not normal and that there are solutions.

*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh]" dir="auto" data-turn-id="request-WEB:0901dc6c-0d76-4094-8e00-a286e2ee79cb-3" data-testid="conversation-turn-6" data-scroll-anchor="false" data-turn="assistant"> Constant tiredness and fatigue are not always isolated problems: they can reflect a deeper imbalance between the immune system, sleep, muscles, and inflammation. In this episode, Dr. Enrique Esteve explains the role of the Epstein-Barr virus in fatigue, viral reactivations, and its relationship with certain autoimmune diseases. We also discuss the importance of sleep, the impact of sleep medications, and the role of muscles in immunity, as well as topics like thyroiditis, histamine, and obstetric antiphospholipid syndrome. A reminder that the body functions as a whole, where immunity, rest, and fertility are deeply connected.

Eyes don't work in isolation: they can reveal a lot about overall health. In this episode, ophthalmologist Sara Mora explains how diseases like diabetes or hypertension can be detected through vision and what signs should alert us. We also cover topics such as dry eye, eye strain, contact lens use, and factors like pregnancy or menopause. A reminder that taking care of eye health is key and that seeing well doesn't always mean being well.