Hot Flashes: Part 1 Talkin’ ‘bout Triggers

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Tina: Leah. The reason we're going to have this talk today, or the reason we're going to talk about hot flashes or hot flushes—depending what you call them—and cancer care, is you made a comment to me. And I thought it was funny. 

Leah: And I don't remember what that comment was. 

Tina: But you said, when we started a phone call, you came on, you were like, "Ugh, I had ice cream last night. I couldn't sleep." 

Leah: Oh, that's right. 

Tina: And I laughed because I was like, what do ice cream and sleep have to do with one another?

Leah: Because you do not experience hot flashes. 

Tina: Right. Yes, exactly. So everything I know about hot flashes is okay, I will admit, it's mostly academic because I'm fortunate that I don't have them yet, anyways. So it opened up a whole conversation about half flashes, what causes them and how to control them and the do's and don'ts and what's going on physiologically...

Leah: And I'd seen a post about someone recommending a medication for hot flashes that was like in a phase three trial. And we both were like, "oh my God, weight gain." So yeah, that kind of like spurred that whole conversation. So hot flashes in the cancer patient, I guess. Yes. That's why we're here today. 

Tina: Yeah. We're going to stick mostly to breast cancer, right. 

Leah: Mostly to breast cancer. Some of it can apply to prostate cancer is...because that is, you know, that's the big one (side effect), for patients and I always found that more challenging. Some of this can apply for patients with prostate cancer, but yeah, we're mostly sticking with breast cancer. 

Tina: And just for the record, breast cancer and prostate cancer are the second, most common cancers behind lung cancer. So this applies to a whole lot of people. 

Leah: Right. And when patients have like temperature fluctuations with lung cancer and other cancers, it's not always related to the same things as with these cancers. 

Tina: Okay. So fair to say, we'll stick to hormonal causes. 

Leah: Yes. We will stick to hormonal causes. 

Tina: That's fair. That's fair. Cause yeah. Cause there's other immunological reasons and lymphomas and leukemias and what are called B symptoms in the case of lymphomas. And so we'll just, we're not going there today. We're just going to stick to the hormonal type. 

Leah: Exactly. 

Tina: Okay.

Leah: And these can also be used with, you know, I mean, not that we're prescribing anything, but like I have used these same things for patients when an oncologist said, we need to take them off of their hormone replacement and what can you do you know, naturopathically, integratively, you know, what can you do. So I have used these with patients outside of, breast cancer or prostate cancer setting, but, that's what we're sticking to. So...nice. 

Tina: So, I'm Tina Kaczor, I'm a naturopathic physician and I've been doing cancer care for just about 20-something years. So my whole thing is just helping patients and hopefully through our discussions, we will reach enough people to, move a few needles and get the help people through their symptoms, whether they're in treatment or after treatment. Today's discussion is on hot flashes. 

Leah: I'm Leah Sherman and I'm a naturopathic physician. I have worked not quite as long, in cancer care. I also am certified in Yoga 4 Cancer, focusing on supporting patients as they go through treatment, beyond treatment, wherever they're at in their cancer continuum. I work with cancer patients on that and...oh, I'm a cancer survivor. Duh. I had breast cancer. Hello. So I am the, I don't know, I'm not the guinea pig. What am I, you know, it didn't work with me and worked with me. Who knows, like I'm the, I don't know what to call it...yeah...

Tina: You're keeping it real.

Leah: I'm keeping it real!

Tina: If I fly into some academic or theoretical thought. You can bring me back down and say, yeah, but it doesn't work that way.

Leah: Yeah. One Of those things that they have on like DJ shows where you like hit the button and it goes like, screeeeeech, put the brakes on it...makes a noise...

Tina: Sound board.

Leah: Sound board. There you go. I always pictured them to be like cartridges. Like, you know, like beta max...

Tina: You're showing your age, man. Most people don't know what a beta max is. I'm

Leah: Sorry. Sorry if I have noise in the background.

Tina: Quite all. Right. 

Leah: My phone ringing whatnot. Okay. So, okay. So we have introduced ourselves, we have introduced our subject and we will add that we may be doctors, but we're not your doctor. And so we're talking about things that we have used in our practice. We're not prescribing anything. We don't know anything about you. If this is something that's interesting, write down a little note and take it to your doctor because that's our disclaimer. We are not treating you. 

Tina: Yeah. Don't mistake our conversation for medical advice because we're not doling that out today. 

Leah: No, we're just having a talk.

Tina: And you're listening in on it. And this is The Cancer Pod. Did we even met that?

Leah: No! This is The Cancer Pod!

Tina: We should mention that, The Cancer Pod. That is where you are at right now. So you're at The Cancer Pod. So let's talk more about hot flashes. So where should we start? You wanna start with anatomy of a hot flash? You want to start with, your ice cream story I think let's, let's start with your ice cream story.

Leah: My ice cream story? Okay. So, I had ice cream the other night. It was really hot and we went out and got these really good gluten-free, waffle cones. And then I had some, okay, I'm going to mention brands and I'm not really promoting them, but I might be. No, I'm not! We had, some oat ice cream, maybe Oatley, because it's really delicious. So it was a non-dairy ice cream. And I had it late. I try to eat before a certain hour. I wanted ice cream. We had some ice cream. And I had a miserable nights sleep. I just woke up hot and sweaty and uncomfortable. And so, I mean, there are multiple things going on because there is sugar in that ice cream. and that shouldn't cause a lot of different issues. And one of them is hot flashes. So that's kinda my ice cream story. And we'll get more into triggers and stuff, but that is definitely one of my triggers is sugar. So, yeah.

Tina: So, no ice cream the next night. 

Leah: No, no, no ice cream the next night. I mean, I...every once in a while I want some ice cream and I have it and I kind of pay the price I kind of know what's going to happen. 

Tina: You know, I feel like adults have that right. You know, you know, when I, when I know that foods make me worse or, or I have a patient and they, we find out some foods make them worse, cause inflammation or some other reason and they decide to eat it, I figure, you know, there's action and consequence. And if they're willing to deal with the consequences, then they can take that action. 

Leah: Right, like you go into it knowing that there's something that's going to happen. And so what I tend to do, on the rare occasion I do indulge in ice cream, is I try to have it early in the day, and so that way I can go for a walk, I can do something and just make sure that it's mostly out of my system, my blood sugar is more regulated at night. So, my husband and I were joking about ice cream for breakfast is probably the best thing. But I'm not that big of an ice cream person. But I'm not that big of a, I'm not that big of an ice cream person. I do, as you know, we have gone out for frozen yogurt, you know that I do like to indulge, but I don't have that same reaction when you and I meet in the afternoon, because we're walking, I'm active. Yeah. So ice cream before bed...

Tina: In ice cream, because sugar is a trigger because you, you find it because it's probably inflammatory? 

Leah: Or it's a fluctuation in my blood sugar.

Tina: Aha. Alright. 

Leah: The drop in the blood sugar and all of that. So, so, so Tina, what do you know that causes a hot flash, because I don't know if anyone truly, do we truly know what causes a hot flash? 

Tina: Party line is no. 

Leah: Right? 

Tina: You look it up. I looked at anatomy of a hot flash. I mean we know roughly what does it. We know the hypothalamus, which controls... 

Leah: It's in your brain...

Tina: ...it's in the middle of the brain and it controls body temperature. Thermoregulation, if you want the technical term thermoregulation. So if you get too hot or too cold, your hypothalamus kicks in. To put it in the simplest terms, a hot flash is a knee jerk reaction. The hypothalamus gets the wrong signal. It thinks for a moment that your body is overheating. So the signals that go to the hypothalamus, signal it to say, oh, you got to break out in a sweat because your body, your core body temperature is getting too high. When in fact of course, every woman who has hot flashes knows that's not happening prior to the hot flash, the hot flash makes you feel like you got hot. 

Tina: Right? But what you're really feeling when you break out into a sweat is a reaction to what your brain thinks is an overheating. And so it breaks out, your body breaks out into a sweat to get rid of what it thinks is the excess heat. And then doing, you know, vasodilation, which means that opens up the blood vessels which causes you to turn red because your blood vessels are wide open at your skin level. So, that makes you look reddened. And it usually starts in the head and neck area and works its way down. Heart rate goes up, so there there's like a sympathetic nervous system, like a that's the that's like adrenaline kind of thing that happens or feels like that. It's actually a different hormone called neuroepinephrine. But in any case, yeah, it's, it all starts with hypothalamus. At least there's consensus on that. 

Tina: Right. There's consensus that that little thermoregulation is what's off. What's fascinating, I actually looked up a little information about how many women on Tamoxifen or aromatase inhibitors have hot flashes? How many women normally would have hot flashes, percentage-wise? Well, it's pretty darn close. 75% of women have hot flashes, no Tamoxifen in sight, just menopausal hot flashes, which, you know, perimenopausal post-menopausal, they last for whatever it could be. Six months could be six years could be till they, you know, to the day they die. It could be anything. In any case, 75% of women, regular, no breast cancer history, have hot flashes, 80% of women on Tamoxifen. 

Leah: Is that because of the, oh no, because I guess Tamoxifen is typically premenopausal. Yeah. Huh. Interesting. 

Tina: So what you do is you're now you have hot flashes in premenopausal women. The severity is worse on Tamoxifen. 

Leah: Interesting. 

Tina: So when I looked at that, I was like, well, this is kind of an interesting thing. So Tamoxifen, just so we're clear to anyone who might not know this already, generally speaking Tamoxifen is the preferred anti-estrogen agent post breast cancer in women who have not gone through menopause yet. So they have functioning ovaries, they still are cycling. Tamoxifen is the drug of choice. Generally speaking postmenopausally is an aromatase inhibitor, which blocks the production of estrogen in fatty tissues for the most part. So, 

Leah: And, and women who have been on Tamoxifen when they transitioned to an aromatase inhibitor, if their hot flashes were controlled or they didn't really have them with Tamoxifen, they may get them with the aromatase inhibitor. 

Tina: Yes. 

Leah: Yeah, because of the action of the medication. 

Speaker 1: There's a little bit on the aromatase inhibitor being a little bit less, persistent than Tamoxifen, like Tamoxifen hot flashes, if they set in, generally you can control them. You can manage them with some things that you and I are going to talk about, but they don't change over time. Like if you're on Tamoxifen for five years, when they looked at studies 80% of women on Tamoxifen have hot flashes in year one, year two, year three, year four, and year five, there was no huge drop-off in the data and aromatase inhibitors, it's different. And aromatase inhibitors, it's like they have hot flashes in the first six weeks, few months, three months maybe. And then they drop off. And I think that has to do with the difference between still having a fluctuation up and down with Tamoxifen and the aromatase inhibitor, once they have been on it a while, there's essentially almost no estrogen in circulation. So there's no fluctuation of the estrogen hormone in those people. 

Leah: And that's what's happening is that this reaction, this hot flash reaction is coming from a fluctuation. 

Tina: Yes. 

Leah: So if someone was, if they were to go off of Tamoxifen after five years, 10 years, and then cause that's not going to completely block their hormones, they may have hot flashes coming off of it. So it's not necessarily a dip in estrogen. It's a change in the hormones. 

Tina: Yeah. And that reminds me of the, I think some people think Tamoxifen blocks estrogen, the actual term for what a Tamoxifen is a, selective estrogen receptor modulator, a SERM, S-E-R-M. And I know we're not discussing that today, but it's an important concept that it's not just, it's not like a, every tissue gets its estrogen blocked. So this is, makes it a little more confusing to understand Tamoxifen Tamoxifen is role in the body because it could be anti-estrogenic on breast tissue in breast cancer cells. And it is, but it's pro-estrogenic on other tissues and that kind of throws a whole layer of, of complexity to understanding what it's doing in someone's body, because it's, it depends on the tissue, not on the molecule Tamoxifen. So I'm just saying that as an aside, because it becomes confusing sometimes. And just keep that in mind and we'll talk about SERMs and maybe another time. 

Leah: Right. So, thinking about myself being, you know, having been a cancer patient, I remember when I first got my hot flashes, I was given a drug called Goserelin to block, to basically shut down my ovaries, could be temporary, could not be, I mean, who knew I was 46 years old, so they didn't know which way it was going to go. I remember because I'm getting chemo, so I remember, waking up sweating and hot and thinking like, "I have a fever, it's like what they warned me about!" And so I'd get my thermometer. I take my temperature and I was like, I don't have a fever. And so, yeah, that was, that was a fun little surprise. And I also another little thing, which I think is kind of amusing, but I've had patients tell me the same thing is I would sweat, like in strange places. So it was like my elbow pits, between my breasts, and I think my neck where like the main places, like it, wasn't like I was completely drenched, unless I had a glass of red wine and then I would just completely get blanketed in sweat. But yeah, we'll hit on trigger. So that was just an interesting thing, is that it wasn't like what I thought night sweats or hot flashes would be cause night sweats and hot flashes. We kind of use interchangeably, but yeah, my elbow pits with sweat and I don't recall ever that happening in any other situation.

Leah: So, but I've had patients say the same thing, like, oh, it's my, like between my breasts and my elbow pits. And I'm like, I know that. 

Leah: So, well let's, let's kind of go into triggers cause I kind of mentioned, we mentioned sugar at the beginning and then I touched, I touched on red wine. So... 

Tina: Well can I say one thing about chemotherapy before we jump into triggers? 

Leah: Oh yeah. 

Tina: Women who have had chemotherapy are twice as likely to have super hot flashes, then those who did not have chemo as part of their treatment. 

Leah: Well, there you go. 

Tina: Just a little factoid. 

Leah: That's fascinating. 

Tina: That's it. That's all I have to say. Go ahead. 

Leah: No, that's really interesting. 

Leah: Yeah. Or special.

Tina: In so many ways, Leah.

Leah: So many ways. I know. Okay. So triggers. Triggers for hot flashes. Sugar, sugar is a big one. So we'll put that as a category, we'll say like, I guess diet could be a trigger, right? So, sugar...

Tina: Well, when you say that, do you mean ingestion of sugar or blood sugar?

Leah: Both.

Leah: Because ingestion of sugar. So you're okay. So blood sugar, right? Blood sugar could be ingestion of sugar, skipping a meal, you know, or being on like a specialized diet where they're not getting enough foods to help to stabilize their blood sugar throughout the day.

Tina: Makes sense. Yep. 

Leah: So that is, and these are like triggers other than like the medication that you're taking or that the chemo that you've been through. so, so that is a big, a big trig. 

Tina: What else? What I suspect is happening when sugar does do this, there's a couple things that could be happening, but one of them, I think because a lot of times, especially white sugar can be worse than natural sugars for some people or sugar all by itself. Sugar, especially white sugar and you know, kind of the straight up sugars, can cause inflammation in the body. And that background inflammation may contribute to the sensitivity of the, of what have triggering a hot flash. So one thing that another is, there's also consensus around the idea of women prone to hot flashes--and this is generic, this was whether you're on Tamoxifen or just post-menopausal hot flashes and never had breast cancer--women who are more prone to hot flashes have a smaller zone, their body, their hypothalamus ultimately has a smaller zone before it jumps to a conclusion about your body temperature. 

Tina: So in other words, you know, I might be able to, I don't have hot flashes. Okay. So maybe my body doesn't have shivers until like I don't get cold shivers until it gets, I don't know, 40 degrees, 45 degrees out. And I don't really sweat until I get to, you know, an environment that's oh, I don't know my core temperature goes up enough and I'm in an environment that's a hundred degrees or 110 degrees in someone with hot flashes, their body responds differently to those environments. As their core temperature goes down, they might get shivers at 55 degrees, 50 degrees and they might start sweating at 90 degrees, literally the zone in which they begin to shiver and sweat is smaller. The temperatures don't as small. 

Leah: That's just, that's just any, anyone?

Tina: This is true on or off the drug...

Leah: So people who have like, they're like, okay, "My comfort zone is from 70 to 80 degrees" is somebody who might be more prone to hot flashes.

Tina: Yes. 

Leah: So someone who has like a tighter comfort zone or more narrow, more narrow comfort zone. Interesting. Oh, interesting. 

Speaker 1: It's very interesting, because they they've done enough studies on this. And again, it's all from coming from the hypothalamic processes, the signals that are going to it. I, I think of it like a knee jerk reaction or so it's overreacting, it's 90 degrees in the room. You're, it's not really objectively time to sweat, but the hypothalamus goes, AH! and that whole, triggers the entire, you know, events that unfold after that, that caused hot flash. So anyways, I thought that was, it's an interesting thing because there's a little bit of a, you've probably heard this before, if, for people who aren't on, any drugs like Tamoxifen or aromatase inhibitors or, or the anti-prostate, the anti-androgen agents, if we're talking to men with prostate cancer, it's it for women, if your mother had hot flashes, you're more likely to have them. It's always been kind of the way of thinking about it, and it may have to do with a little bit of this hard wiring about thermal regulation. 

Leah: Oh, wow.

Tina: So anyways, I thought that was a very interesting thing to think about and why we can't completely a hundred percent always control it. 

Leah: Right. 

Tina: We can unbolt diet, let's go into more triggers. 

Leah: Yeah. So what you're saying about inflammation, and how we're talking about diet. I mean, that could also be, like food sensitivities. 

Tina: Yes. See?

Leah: Yeah, because I have had patients say, when I eat a certain food, it gives me a hot flash and it might be something that they have a food sensitivity to... meat... I mean, people get meat sweats. That's right. There's something called meat sweats

Tina: There is?

Leah: Yes! You've never heard of the meat sweats? If you eat too much meat? I don't know. It's a thing...

Tina: Sounds disgusting! 

Leah: It's a thing... know I'm talking to the vegetarian. 

Leah: So, so red meat, especially... 

Tina: ...and that can be inflammatory depending on its source. 

Leah: Exactly, exactly. Or it could be, would that be histaminic?

Tina: Only if it's been sitting around a while. 

Leah: Okay. So an ...

Tina: Or if it's an aged meat. There are aged meats. 

Leah: Yeah. So histamine is another potential trigger. Oh, smoking. That was always, you know...

Tina: The classic...

Leah: The classic, you know, the patient who's like, "I don't know. I only seem to get hot flashes when I smoke."

Tina: So did you say now you have several more reasons to quit?

Leah: One more reason, one more reason to quit smoking. 

Tina: Can we put that in the con column when the pros and cons... 

Leah: Yeah. So, and then temperature changes, you know, like walking into a room and it's a really hot room. It's a real cold room. That can definitely because like what you were saying, with the hypothalamus. So we have those.... Stress...

Tina: Before we get off foods. Can I encourage people to do a food diary?

Leah: Oh, that's perfect. 

Tina: 'Cause you know, in clinic we test people's food sensitivity, we do all this stuff, but to be perfectly honest, the only real great way of doing this and doing it without spending a bazillion dollars is write down everything you eat, then track your sleep. Don't look at day in and day out because it's hard to see things in real time. You do it for two weeks straight or so. And you see if there's any correlations.

Leah: No, that's perfect. I actually prefer that to getting food, testing, food sensitivity testing in this situation because it, that can open up a can of worms.

Tina: Yes. 

Leah: So, yeah, definitely a food diary, a diet diary is a great way. And then that way you can be like, oh, it's when I eat corn or whatever it may be. It's when I eat tomatoes, you know. Yeah. 

Tina: Yes. It's much more reliable and, you know, take out whatever (food) you think is it. And if you take it out and you sleep better, you don't have night sweats, then that's confirmation 

Leah: New. If you eat it, go into it. Knowing that when I have chocolate ice cream, whatever, cake that's, what's going to happen. Yeah. You're just prepared. no, that's excellent. Stress, which actually, if you think about it, stress includes food, sensitivities, inflammation, all of that is stress on your body. But the, you know, there's like that mental, emotional aspect of stress that also, you know...not only being in a stressful situation where you break out in a sweat, but even recalling a stressful situation can also trigger a hot flash. Speaking of stories. I did tell you the story the other day about my, my hot flash, stressful trigger driving when I used to drive to the cancer center and I would, go from one highway to another and I would take the on ramp to a major highway, interstate. And it was really stressful because people are coming in from behind you and they're trying to go to the right. And then you're trying to merge onto the highway to go left. And every single time I would come to that ramp, I would just break out in the sweat, on my way to work. Like freshly showered, everything...la, la la, la la...air-conditioning on, windows down, didn't matter. And then I would get to that. And I...and if I went to work and I recalled something that happened, traffic wise, like on my way to work, which often happened when you're driving on the interstate in Arizona, I would start to sweat. So yeah. So stress and recollection of a stressful event definitely is a trigger. And it's not just me. I mean, you talk to, you talk to anyone. 

Tina: Yeah. Yes. And when you say stress, you're saying like a stressful event, not like a constant stressor, but more like events that trigger a flash right then and there. 

Leah: Yeah. I mean, I guess it could be somebody who's constantly under a stressful situation, but yeah, I'm thinking more, that change, that, that stress, that, you know, the sudden change, I have two more things that I think of off hand and those are kind of the ones that make people go, awww... caffeine. 

Tina: Awww...

Leah: Right? So caffeine definitely is a trigger. and then alcohol. 

Tina: Awww...

Leah: Right...

Tina: Was I on cue. 

Leah: That was perfect. Yeah. 

Tina: Well, they were both sincere to be honest. I mean, I do like my coffee and, I would think I would be super bummed if I couldn't have my coffee and just enjoy it without consequence that would bum me out. 

Leah: Yeah. And sometimes switching to a decaf helps. But... 

Tina: How about cold brew? Does the acidity have anything to do with it, if you did a cold brew coffee, you think that might help?

Leah: I don't know. I didn't. I never experimented. I just, I mean, I give up caffeine for other reasons, but, and I drink cold brew anyways. So I being in Portland, cold brew is a thing. 

Tina: Yeah. We should explain what cold brew is. How do you make your cold brew?

Leah: I grind my beans and then pour them into a giant Mason jar and then let them sit in the appropriate amount of water for however many beans I put in there and let it soak overnight. And then I take a pour-over, Chemex, whatever they're called and then I put my filter in there and then I filter out the grinds in the morning.

Tina: One could do that. And just use a regular coffee filter, paper coffee filter. 

Leah: Yeah. Coffee filter, any sort of like Melita, pour-over type of a thing. You just use a coffee filter into another container or another receptacle and you filter out the grinds and it's a much smoother coffee. 

Tina: It's less acidic without the heat.

Leah: Without the heat. And then I filter it. I don't just like put it, some people put her in a bag like, you're making cheese or, oh, like you're or any other like, like a giant tea bag type thing, you know, and they kind of squeeze it out or whatever. I don't do that. I filter it again through a paper filter. 

Tina: Okay. 

Leah: And so that makes a smoother coffee. Recipe tips.

Speaker 1: So yeah, if I was someone having hot flashes and someone said my caffeine could be doing it, I would try that. And I would cross my fingers. 

Leah: Yeah. And then, I mean, you know, people can always switch down to, I mean, we're kind of getting into our integrative approaches, but I guess it's appropriate. People can switch, try doing half caff, you know, kind of reducing your caffeine intake and, you know, reduce, you know, doing that. I mean, if you're putting sugar and like milk and you know, you're having like a, you know, frappuccino-type thing every morning, then that's another, that's a whole another issue. But if you're drinking black coffee, if you're like, okay, I'm not going to do the sugar because it obviously makes me have hot flashes, but I'm still having them, it could be the caffeine. And I mean, who knows that could be, yeah, creating stress. I mean, right. 

Tina: Like anyone, I'm in a deep state of how do I, how do I make this reality a different one. I don't like this reality. I'd like to change this reality. So I'm just, that's why I'm like, you know, grasping at whatever, 

Leah: You know, when we get there. We will approach it, speaking in the Royal We.

Tina: Oh, okay. I like that. 

Leah: Yeah. We will, we will approach it. So yeah. So alcohol is the last one. Alcohol is another thing that affects your blood sugar, correct? Correct. 

Tina: Yes. 

Leah: I, from my experience you know, your experience with patients, it tends to be, red wine that does the most damage. And I mean, I literally remember sitting outside in Arizona at a restaurant, it was beautiful weather, with a girlfriend. We both ordered a glass of wine 

Leah: And she's like, are you hot? I'm like, I guess, maybe I have a fever and my face was flushed and I just had, it was like, it was like a fountain. It was like someone had a hose on my head and I was just like, sipping the wine, like, oh, let me cool off...

Tina: Someone just flipped your hot flash switch. 

Leah: Yes. So, so those are triggers and we have, you know, our integrative approach and we have our pharmaceutical approach. 

Tina: One, one last trigger that we didn't mention

Leah: Oh, what didn't we mention? Sorry. 

Tina: So, and, and this is more of a trend than a trigger: excess fat on the body, you're more likely to have hot flashes. So people with higher BMI, have more hot flashes or 

Leah: If they are a thin person, but don't have as high of a muscle mass. 

Tina: Yeah. 

Speaker 1: So that was me, that I mean, that, that that's always been, except for the period of time when I actually did lift weights, but yeah. I mean, yeah, that was often me where I was a thin person, but I didn't really have muscle.

Tina: Yeah. I have a friend who called herself skinny fat because of that. 

Leah: And that's, that's kinda, that's kind of, yeah. I would call myself that too, when I realized what was going on. I called myself that too. So yes. So...definitely...

Tina: Just for the record, excess fat tissue, also is an inflammatory background. So again, you go back to inflammation cause there's something definitely about, a higher background of inflammation in the body, whether it's your foods or it's because you're holding excess fat that excess inflammatory background, systemic inflammation makes one more likely to have hot flashes, particularly in the night, but during the day as well. So the one thing, and I don't know if it's a trigger for you, but the one thing we haven't mentioned for some people spicy foods can also trigger. 

Leah: Oh, absolutely. Yeah. No spicy foods for sure. can be a trigger. 

Tina: All right. With that, let's move on to, what can be done about it, right?

Leah: Yes. So in our next episode, we'll review both conventional and integrative approaches to hot flash management.