Dynamic Dialogue with Danny Matranga - 158 - Training Around Your Cycle & Female Physiology Considerations with Jessica Raymond NP.

Episode Date: January 28, 2022

Today we are joined by Jessica Raymond, NP of Marek Health. We discuss some of the finer and more nuanced details of female physiology and how those things can impact training, nutrition, and recovery.-FOLLOW JESSICA HERE!-Thanks For Listening!SUPPORT THE SHOW:There is NOTHING more valuable to a podcast than leaving a written review and 5-Star Rating. Please consider taking 1-2 minutes to do that HERE.You can also leave a review on SPOTIFY!OUR PARTNERS:Legion Supplements (protein, creatine, + more!), Shop HERE!Get Your FREE LMNT Electrolytes HERE! Care for YOUR Gut, Heart and Skin with SEED Symbiotic HERE!RESOURCES/COACHING:I am all about education and that is not limited to this podcast! Feel free to grab a FREE guide (Nutrition, Training, Macros, Etc!) HERE! Interested in Working With Coach Danny and His One-On-One Coaching Team? Click HERE!Want Coach Danny to Fix Your S*** (training, nutrition, lifestyle, etc) fill the form HERE for a chance to have your current approach reviewed live on the show. Want To Have YOUR Question Answered On an Upcoming Episode of DYNAMIC DIALOGUE? You Can Submit It HERE!Want to Support The Podcast AND Get in Better Shape? Grab a Program HERE!----SOCIAL LINKS:Sign up for the trainer mentorship HEREFollow Coach Danny on INSTAGRAMFollow Coach Danny on TwitterFollow Coach Danny on FacebookGet More In-Depth Articles Written By Yours’ Truly HERE!Support the Show.

Hey everybody, welcome into another episode of the Dynamic Dialogue podcast. As always, I'm your host Danny Matranga, and today I'm joined by Jessica Raymond. She's a nurse practitioner. She works with Merrick Health, the company that I use to run some of my preventative health labs. Get a look at my thyroid hormone, sex hormone binding globulin, testosterone, estradiol, estrogen, luteinizing hormone, vitamin D, my inflammatory markers, my cholesterol, stuff I do for the maintenance of my health. And we're going to talk a lot about female physiology, the variances between the different

phases of the menstrual cycle from the early follicular to late follicular to ovulation to early luteal, late luteal. We'll talk a little bit about birth control, PCOS, menopause, lifestyle interventions, and what you might be able to do to run your own labs, as this is something that you guys have been asking me quite a bit about in the last couple months. So I wanted to get you some information on how you can go about doing that, as well as have a discussion with somebody who I think can bring you a lot of value. So sit back and enjoy. Hey, Jessica, how's it going? Great. How are you today? Very, very good.

Thank you for coming on. Everybody who's listening, I'm joined today by Jessica Raymond. She's a nurse practitioner. She's an expert on female physiology, and we're going to be talking about a variety of different things in today's discussion, from exercise, fitness, body composition, to various hormones and the ways that female physiology is different from men's, the ways that it may be the same or similar, what we can borrow from kind of the world of chemistry and physiology to optimize how we perform, our health and our longevity. So just so

everybody kind of gets a gist of where you're coming from, Jessica, why don't you tell the audience a little bit about what got you inspired and interested in all of this stuff? Yeah, so I'm a nurse practitioner. I work as a hospitalist currently in one of our local hospitals here, and I also work with Merrick Health. And I have always loved health and fitness. And what really kind of started me on this journey was after having my first child, my one and only child. I have a six year old son now. I really knew I needed to fix my health and wellness. I was overweight, I had a few miscarriages,

I just, you know, wasn't living the healthiest life. And I knew in order to be the best mom, provider, partner as I could be, I needed to fix my health and wellness. And it fit perfectly along with me being a nurse practitioner. And I just kind of went from there. And when you went through this journey of kind of transitioning to really being focused on your health, on your wellness, what were your primary areas of focus? Were you doing resistance training? Were you doing a lot of aerobic training? What did you do with your diet? Did you maybe make some mistakes along the way? Of course. When I first started out, we had a local gym in our small town.

And I just went and just started, of course, started on the treadmill because that's the first thing you know to do. You go on the treadmill, you start there. And then I just wanted to be as strong as I possibly could be. And so I started powerlifting. And I just loved being strong. And I just started with that and did, you know, the squat bench deadlifts and ended up doing two competitions here in Michigan. And I did well, my second one, I got all my lights. So I was happy. But of course, I didn't like, you know, place anywhere, but it was just a personal win for me.

I'm coming from, you know, not, um, knowing much about the gym and then finally, um, putting myself out there and, and lifting the weights and not just being on the treadmill and moved in that direction. And then after doing powerlifting for a little while, I just wanted to, I wanted to look like I lifted and lifted like I look is what I started with. And so I transitioned to kind of like a power building. So I loved squat bench and deadlift, but I also wanted to look like I went to the gym, right? Of course, that comes along with like diet and everything else too. And it was easier just to go to the gym. And when you really dial in your nutrition and really focus on different types of accessories

instead of just the big three lifts, I enjoyed that transition. And so I like doing bodybuilding currently. That's awesome. And I think that it's a nice little jumping off point to talking about how your experience as a lifter, an athlete in the gym, and your knowledge and experience as a practitioner probably work together to help you create a physique, a routine, a nutritional protocol that's good for you in the long term. What are some of the things that you think a lot of people miss who maybe don't have such an understanding about

the physiology, particularly women, when it comes to making considerations about how they exercise? Are there myths? Are there misconceptions? Is there misinformation targeting women when they get started on this journey? Because it sounds like you handled it really well and really used the knowledge you had from your job and your career to do this well. Yeah. Yeah, absolutely. I mean, I think the biggest myth we always hear a lot of females here is like, I don't want to look like a man. Okay, we're not going to look like a man, we don't have as much testosterone as they do. I mean, we could take some performance enhancing drugs and potentially get to that point with significant amounts of food and lifting and

taking those performance enhancing drugs, but we're not going to get there, we are going to increase our muscle mass. And that muscle mass is going to utilize all the extra glucose we have in our body. And we're going to be, um, fat burning machines off that treadmill. We don't need to be on there. We can be able to increase our muscle size and be able to, um, burn calories even outside the gym. So that was really something I really wanted to focus on my nutrition, learn more about that. And it's the continuous learning through social media. I think that's been a great avenue to learn and understand ways that we can utilize our physiology and inside the gym, outside the gym. And it really makes you have more energy for your family and for your job and

makes you feel better all around. Yeah, I agree. One thing I think with women's health that is still misunderstood, I think we're moving in the right direction with this. We talked a little bit about how social media has become a place where you can more reliably find some good information. There's some bad stuff out there, but there's also a lot of people making good content. But one area that I think many women are still not quite aware of, or they're interested in learning more about is the way that their menstrual cycle affects their training and their body composition. And can we unpack that a little bit and talk perhaps how the female physiology, particularly during that menstrual cycle, what we might experience during

our training, the differences between the phases, if you know, and go from there. Yeah. So I think it's interesting how females go through the menstrual cycle and don't really understand it. And we can really, um, utilize it to our benefit and not think of it as just an hindrance. You know, it's something that happens every month. It's what are we going to do? We have, um, you know, less energy one day versus the other. We have more cravings one day versus the other. We can really use this to our benefit. Um, I mean, men, they come in the gym and some days they are not as motivated others. It goes up and down, but women, we have this cycle that happens that can be predictable and we can use that predictability to our benefit. I love that. So looking at our cycle in general,

we'll just kind of take, take it basic. I think it's really good to understand like the basics of it. I love it. The basics is what I'm all about. Right. Let's start with the basics. So generally a 28 day cycle, right? A couple more days, one side or the other, generally about 14 day is the day of ovulation. Um, and usually generally the first day of your cycle is the day that you start bleeding in the morning. Usually that last one to seven days, a few days of heavy bleeding, and then it tapers off. And then about day 14, you ovulate and then day 28. Um, if we're not pregnant, we start the cycle all over again. So there's three main players in our menstrual cycle. So we have our brain that has the, um, has the hypothalamus and the anterior pituitary. So the hypothalamus produces what's

called the gonadotropin releasing hormone. And it sends a signal down to the anterior pituitary that releases the luteinizing hormone and the, and the follicular stimulating hormone. Um, also men have this as well. Um, the follicle stimulating hormone in men men have this as well. The follicle stimulating hormone in men stimulates the Sertoli cells in the testes to produce androgen binding protein. And then the luteinizing hormone stimulates the Leydig cells to produce testosterone. And those two together help with spermatogenesis. But in the back to the female side of things, what happens is day one of our period, we, um, our body says, okay, there's no pregnancy.

We need another egg. So what happens is the egg starts the, um, anterior pituitary sends the, um, uh, follicle stimulating hormone. This is called the follicular phase of our period, by the way. Yeah. Yeah. So the follicle starts to form, Um, and then the FSH still continues to grow the egg. And once the egg matures, it starts to put off estrogen. So then

estrogen starts to increase. Once there's estrogen at a steady stable or steady state for about 48 hours, it sends off that signal to the brain and then luteinizing hormone is secreted. So that luteinizing hormone is kind of like the end of the maturation of that egg. And then once that luteinizing hormone is secreted, the follicle that the egg is in gets secreted. So in the ovaries, we have all the follicles and eggs that we're ever going to have, we can think of the ovary as like a vault. And when we were born, um, there, we only have so many, um, eggs in our ovary. And when those, when those eggs are over, that's when, um, that's when, uh, menopause happens. Gotcha. Okay. Yeah. So once this egg, um, is ovulated, um, the corpus luteum, which is actually the follicle that it came from, stays there and that's producing the progesterone. That would be the luteal phase. So then once we go across ovulation, we hit the luteal phase and that's when that corpus luteum

is there and the corpus luteum produces the progesterone. And the progesterone keeps feeding the egg and then the progesterone increases, estrogen progesterone keeps feeding the egg. And then the progesterone increases, estrogen kind of dips a little bit after ovulation, goes up a little bit. If there's no pregnancy, both estrogen and progesterone drop off and then our period starts. So it's kind of, it's a whole process. It is, it does, but it makes a little bit of intuitive sense. So let me make sure that I'm tracking here. At the beginning of the cycle in the follicular phase, the follicle is secreting or exposing an egg, which is releasing estrogen. Estrogen stays pretty elevated during this first part of the phase. Well, so in between the day, like one and seven estrogen and progesterone are on the lower side. Okay.

So when the ovary, so the ovary has one egg, the follicle stimulating hormone connects with that egg in the fall, the egg inside the follicle and continues to tell it to grow. As the egg starts to mature, it starts to secrete more estrogen. So as you go from like day one to day 14 or day of ovulation, the estrogen starts to increase. And once the estrogen is at that stable level for about 48 hours or so, that's when the luteinizing hormone comes out and tells it to ovulate to come out. Gotcha. Oh, fascinating. So it's, it's, so those would probably be the days where your training might be the best is like around ovulation. Cause you have high estrogen. And I've also heard that your testosterone peaks a little bit around ovulation for,

I've heard different explanations of this. Do we, do you have an explanation as to why? Well, from my understanding with the testosterone, it just, we have ovulation because we need to make babies, right? We need to reproduce. That's why we ovulate. That's what we're supposed to do as humans. So our body is so smart. And when it does, it gives us a little extra testosterone during that time to like make us want to have sexual activity so we can make a baby. But that's why we can see a little spike in testosterone too. And that's just a great window for training then, because I think estrogen oftentimes gets communicated as a bad hormone, but it's not really a bad hormone.

It's androgenic in itself. Yeah, exactly. So this is that window where, like you said, it's predictable. You might be able to go, okay, these are the days that I want to position some of my more challenging sessions. Or if I'm working with a coach, I want to make sure that me and my coach are on the same page about when I'm here, so we can really dial it in. And when I'm maybe at the opposite end of that hormone spectrum, where things start to kind of taper off in the back end of that luteal phase going into PMS, because it sounds like... We'll get back to it because I love hashing it out like this. It's great. But it ramps up slowly, estrogen. Then you get a little bump of testosterone. And in those first 14 days, you can probably train pretty good.

But then things start to shift and these hormones kind of bottom out in the luteal phase, correct? Right, right. So when you're on your period to the day one to, we'll just say like one to five, one to seven or so, um, those days are estrogen, progesterone are on the lower side. And so this is before we're going to reach the late we can. So there's a follicular phase and there's the luteal phase. Each phase can be divided up into early and late. So early, we can look at it that way as well. So the earlier follicular phase, um, when we're having our period, that's when we may want to like optimize our sleep, nutrition, our rest day, stretching, yoga.

But also if you're training at that time, like if we were training for something, we can't just like just rest and go to yoga. We need to train, right? So during that time, we can continue to train during that fatigue state. Um, if you're feeling with a perceived fatigue at that time, it totally varies. I'd say we're having worked with a lot of women. Some women can train totally fine on their period. They're unaffected. And for other women, it's really a challenge because they get rather lethargic or just the way their unique physiology is going. So, yeah. Gotcha. And when we think of that fatigue, we don't have to think of that.

We can put a positive spin on that too, by thinking if we're going to train through this fatigue, let's focus maybe on other than like lifting really heavy and trying to hit a PR at that point. Let's try to do more. Getting a pump. Yeah, getting pumped, doing more reps, looking at technique.

And when we train in that fatigue state, we know we should be training in general, even men training in general, not for the optimal environment, right? When we go to an event and we go to run a marathon, when we go to lift weights, it's not going to be the perfect environment. So we can utilize this time during our cycle when we are a little more fatigued and say, hey, okay, I'm a little more fatigued. I'm training for different environments that may happen when this, when my event occurs. So you can utilize it and just try to change your thinking about it.

Build some resilience, develop a little bit. Building that stamina during those phases is something you can focus on. Not that you're just wasting time and you're really doing something during that. I like that. Yeah. So then when you move forward, you got the estrogen jumping up. You got the androgenic effects from that. So this is late follicular.

We left early and now we're in late follicular. Cool. Yeah. So the late follicular phase, we're feeling good. We're energized. We have a little decreased appetite. Our blood sugars are more stable during that avenue. Strength training, time to hit a PR. Let's see where we're at. Let's push it. little decreased appetite. Our blood sugars are more stable during that, that, um, avenue, um,

strength training, time to hit a PR. Let's see where we're at. Let's push it. Um, we ovulate. Some people may have some abdominal pain, some back pain, some discomfort. We actually increase our basal temp during that, that time, about a 0.3 degrees. We increase our heart rate and our resting rate because of that progesterone increasing or resting rate. Um, and our cravings for our cravings for blood sugars are or for carbs and sugar a little bit increased at that time because our blood sugars are a little less stable not completely off yet but recovery at that time maybe take a little bit longer but we still shouldn't see too much different from that early luteal phase the luteal phase happening after ovulation versus late follicular phase right before ovulation gotcha so there shouldn't be too much of a difference through there.

So that might be the best training window is late follicular into early luteal. Yeah, I believe right through there. Okay, cool. Yeah, I think that would be the best time. And then as you go through the luteal phase, you get to the late luteal phase. And that's when you get like the PMS symptoms. So around then there's like that inflammatory response. You have the typical PMS symptoms, um, cravings, and that's again, where you can reimplement less weights, more reps. I think having that, um, variety of training anyways is best for you overall. I agree. And what we do with my company is we try to, you know, manipulate training in such a way that one it's productive and two that you don't go completely insane. try to manipulate training in such a way that one, it's productive and two,

that you don't go completely insane. And I think training in a variety of rep ranges allows you to do both of those things, especially if you position it intelligently like this, where you're not trying to go as heavy as possible when your progesterone and estrogen are at zero. And maybe you position that closer to where your estrogen and testosterone are higher because you might get better returns. But in the meantime, you don't let your training become unproductive. Right. Right. No, you're trying to utilize the best. Can you have to deal with what, you know, you have to deal with the best situation you're handed. So women are handed a menstrual period that we deal with. So let's optimize what we have to deal with, you know, not look at it negatively, but spin it around to benefit us. I love that. And then one more thing here in this late luteal phase with regards to

inflammation. You know, one thing I find that's difficult, and I'm sure a lot of this has to do with things like estrogen and progesterone fluctuations, but that can be a really difficult time for women with regards to self-talk and body composition. What's going on hormonally in that late luteal phase that leads to this inflammation? What are some things that women should maybe know about their body so they can practice a little grace during that time period? Because I tend to find that's when the self-talk can really be the most intense. For me, I have a great relationship with a lot of the clients that we work with. And it's interesting to watch the way they communicate about themselves

during that particular phase, because I would imagine it's challenging. Men, we get the luxury of kind of just having a pretty stable hormonal environment, but if ours is adjusted even acutely, we become completely unreasonable. So I'd love to unpack that a little bit before we talk about some of this other stuff. Yeah. I think as we get later in our cycles, like in that luteal phase, we just are with our progesterone estrogen at its lowest. So we're just more apt to getting more anxiety. We feel bloated. It just doesn't feel good. We we're a lot of us that confidence, like I'm not doing as well as I did like last week in the gym. Now I have confidence

because it's so close. It is. And so it's really understanding that, okay, it's nothing's wrong with me. My body has lower estrogen, lower progesterone at this time. This is part of my cycle. This is what's going on. What can I do to help support that? Um, we're changing reps. We're doing maybe a little less weight. We are still optimizing our training by doing variability. We're working in a fatigued state. We're going to be okay. Um, this is going to improve and understand that this is not a continuous, um, uh, negative side. That's going to continue on. Um, the weight that we might see is just water weight. I mean, I've done it to myself before I get on the scale every morning and

I gained five pounds. Like how did this happen? I didn't change anything. It's just the water that's retaining that we're having. And to help with that, with the bloating too, um, you should increase your fiber intake and increase your water intake that will help with our gut health and decrease that bloating. Um, zinc also helps regulate our hormones and then also the thyroid cofactors like selenium and vitamin a, those type of things can be added to our diet at that time to just help us feel a bit better, especially like B6 that increases our neurotransmitters like dopamine and serotonin. So those things are maybe more essential at that point. These things should be taken all the time, but maybe more essential during that phase, just so we can help with that anxiety and the PMS that we experience through the low progesterone, low estrogen. I love that. That's very, very

insightful. And I think that that's something that for pretty much anybody listening, whether you're a male, a male coach, a female, a female coach, an athlete, a hobbyist, whatever you are, these are good things to know for yourself, for your clients, for your partners. And I think having a little bit of power and control and taking agency and ownership over this is predictable. I don't want to let this become a cycle of training really hard and then getting really down on myself. I want to plan for it. i want to take things i know and apply them this is a really good place to start uh something that i've seen a lot transitioning to a new topic here but staying in the umbrella of female physiology um is an increased prevalence of women coming to me who are trying to manage their body composition

or improve their health, dealing with something called PCOS. And PCOS first popped onto my radar like eight, seven, eight years ago. I wasn't really sure what it was. Not many people were talking about it. I think a few people in the health and fitness space had inadvertently run into it, run with some clients that were really struggling with weight loss. And then it became something that was much more prevalent, much more commonly diagnosed, much more commonly talked about. And it's something that I think is worth unpacking a little bit because there's a lot of women out there with PCOS who are trying to improve their health, their body composition. What is PCOS? What are some of the markers of PCOS? And then what are some of the lifestyle things we can do to improve the longevity, health, wellness performance of women with PCOS?

Right, right. So yes, PCOS, polycystic ovarian syndrome, affects five to 10% of US women, which is about 5 million women. And of those women, if they're trying to conceive about 80% of the inovulatory women who are infertile is a cause from PCOS. So when we look at PCOS, it's diagnosed from what they call the Rotterdam criteria. You have to have two of the three to qualify versus irregular cycles. So if you can't predict when your period is going to start, or if you have some spotting before your period, um, or have a very low or a short cycle, um, that can qualify as a regular cycles, um, androgenic symptoms like acne or hair growth, or on your labs, like high testosterone, DHEA, those on your labs, and then also

polycystic ovaries on your ultrasound. Okay. Well, those are our criteria. Yeah. And I have found that it's somewhat more common to find metabolic issues and elevated testosterone than it maybe even is to actually find polycystic ovaries. Not that I'm the one doing the scans or anything, but having talked to women who have had this diagnosis, it's very common to see it flagged with those metabolic panels. So for people who are maybe curious if they do or do not have PCOS or if they want to better manage it, what is the first, let's talk about perhaps medical intervention or a thing that they could do with a practitioner? What's the best place to start if you want to make sure that this is not something you're dealing with? Right. I think if you are having irregular cycles,

whether you're trying to conceive, whether you're having any problems at all, I think starting, what we all need to do is just really start with tracking our cycle for three months, right? For three months, start there, figure out where you're at. Are your cycles really irregular? If they're irregular, then we need some some help maybe some more guidance with either your family doctor or your ob-gyn um just the androgenic symptoms of acne hair growth if you have any of those um that those two will qualify you already for pcos yeah and so i think um initially a lot we can go through the process of what PCOS is. I think it'll help everyone understand it a little bit more too. Definitely.

A lot of it has to do with insulin resistance. Yeah. So that's a big part of it. With PCOS, a lot of times you hear people that are overweight. Now, if you look at their criteria, there's no criteria that says you have to be overweight. So there's two phenotypes to people that have PCOS. So phenotypes is how we look. So there's a thin, like you can have PCOS and be thin, um, or you can have, you can be obese. Um, well let's run through maybe how this works. And then I think it'll help everyone understand it. Yeah. I think that's great. Cause I do think that

the archetypical PCOS woman is often portrayed as being larger, heavier, struggles with body fat reduction. But it sounds like there's a little bit of a continuum here. Oh, yeah. We need to paint with some color. So in remembering that PCOS is a hormone imbalance, it's endocrine, an ovarian endocrine disorder. So not just obesity, but it has to do with our endocrine, um, an ovarian endocrine disorder. So not just not obesity, but it has to do with our endocrine system. There's an issue going on there where we're not ovulating. So again, when we can refer back to the regular menstrual cycle, the pituitary gland, again, gets the surge

from the hypothalamus, from the gonadotropin releasing hormone, telling the anterior pituitary to release follicle stimulating hormone. That follicle stimulating hormone is to get one egg to choose one egg out of the ovary to mature. When someone has PCOS, that vault in our ovaries is jam packed with eggs. So when the FSH comes out to tell the ovary to produce or to stimulate this egg to grow and to mature in the follicle, several eggs come out at once. So the follicle simulating hormone comes down, it sees that there's all these eggs, and all the little eggs produce a little bit of estrogen. And remember, in that cycle,

when we said the estrogen, once it reached a certain steady state over about 48 hours, then it would stimulate the luteinizing hormone, We have all these little eggs and all the little eggs are saying, Hey, we have all this estrogen and it's kind of equivalent to just having one good mature egg, one egg ready to go. Um, so the feedback to the pituitary from the estrogen is saying, Hey, we're good. We don't need any more follicle stimulating hormone, but really we have all these little eggs there that are just not mature, not the one that are not the chosen one yet. And so there's not one that's going to continue to get that FSH to get to mature level. Gotcha. And so since that's happened and they kind of get stuck in this cycle. And so the LH or the luteinizing hormone, and now it's telling the ovary to produce

testosterone. There's no mature egg. It's detecting all these little eggs. It's, it's, it's, it thinks it's a time that it's not basically. Yeah. So it's saying that, um, there's no ovulation. I have these little eggs. So what do we need to do?

So the luteinizing hormone tells the ovary to produce testosterone. So the testosterone, um, that's where we're getting our acne from our hair growth, our insulin resistance, and all those metabolic changes. Gotcha. So, yep. So it's just kind of this cycle that keeps going on. And what's interesting is that when, um, uh, with, to make it more complicated, our fat cells, our adipose tissue also creates estrogen. So the estrogen from the fat cells coupled with this whole process of the FSH not stimulating just one egg and the luminizing hormone telling the ovaries to produce testosterone, all gets complicated. Hey guys, just wanted to take a quick second to say thanks

so much for listening to the podcast. And if you're finding value, it would mean the world to me if you would share it on your social media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. Yeah. And so being heavier would make it that much, probably more challenging because you have more estrogen, more testosterone, more symptomatic. Yep. Gotcha. So that's where like the weight loss comes into play there too. But for the thin phenotype, the females that are thin, losing weight isn't going to help them.

They need to go to the family doctor and help. Sometimes they get put on birth control pills to help regulate that. I've heard that. Yep. birth control pills to help regulate that. Yep. So we don't have to continuously increase the, it's the endometrial hypoplasia that'll continue on to when they don't bleed because they're not having the ovulation. So they're not bleeding. So the lining in the uterus will keep getting thicker and that can lead to the endometrial cancer. So they should be seen and evaluated. And so they may have to be put on a birth control to manage

all these hormones. Metformin has been used for insulin resistance. And really a lot of it is lifestyle. So just like anything else, any other disease, we really need to focus on our lifestyle changes. Really, it's dialing that in low glycemicmic carbs to help with our diet so we can just start with diet first. Lots of the fruits and vegetables, whole foods, portion control. We can even go to time-restricted eating to help with those insulin levels. So when we sleep at night, our insulin levels drop down. And so we want to prolong those low insulin levels as long as we can in the morning by eating just like fats and proteins in the morning and avoiding those carbs first thing. Less insulinemic food and pushing it off even if

you can. So that window of low insulin kind of stays into the early morning, mid-morning hours. You're almost stealing a few extra hours by pushing off breakfast or pushing off something insulinemic that's going to raise your blood sugar. Yes, absolutely. And really there's been like, if you search PCOS online, you'll find lots of diets, lots of things that'll help, but really it's going to be, what is the individual going to be able to stick to? Could they stick to a ketogenic diet? Maybe they could do that for a little bit of time, maybe lose some weight, but after that what could they stick to for long-term? Because it's not just goals for just their PCOS, it's for their overall health in general that we need to stick to a good diet or nutrition that will be sustainable. Supplements that they can utilize are inositol, which is found in whole

grains, citrus fruits, shown to improve the metabolic profile, omega threes to, um, in or improve our insulin resistance, um, vitamin D probiotics to help to decrease the inflammation that's associated with it as well. Um, maca and, um, cinnamon and anti-oxidants and inflammatory. So those types of things too. So it's really like all these little things that add up, um, sleep reducing stress, both those help reduce our inflammation and definitely want to know smoking. I mean, smoking in general, we should not be doing that anyways. Because a lot of times cardiovascular risks are increased with patients with PCOS. In regards to exercise, the minimum number of minutes per week should be about 150. Now I think about 150 minutes. I think that's like very,

that's like two workouts, you know, right. But at least 150 minutes. Um, and because of the cardiovascular risk with PCOS as well, um, we know exercise in general improves our cardiovascular risk factors.

So that's part of that insulin sensitivity, um, and decreasing our hyperinsulin estates, um, movement and also PCOS. A lot of times it's mental health issues too. Like a lot of these people don't realize this until they're trying to get pregnant. And, and I remember when I was trying to get pregnant and had three early miscarriages, I it's, it's mentally taxing. It's very difficult. And the gym is our mental relief, right? We go to the gym and we get mental health through going to the gym. So that's another part of it. It's another component

to PCOS that I think the exercise helps with a lot too. I love that. And I do think that those lifestyle interventions tend to work best and having things that you can turn to, whether it's inositol or some of these different supplemental forms of things. You got metformin that you can turn to, but starting with those lifestyle factors. We did touch a little bit about birth control being used as a potential intervention here, but I think that that's a topic worth discussing on its own, which is hormonal birth controls, different forms of contraceptions you have. You have pellet form, I think, which are injectable. I can never remember what that one's called. You have the dual progesterone ones. You have the IUDs. You have

the non-hormonal IUDs. You have all these different kinds of birth control. And I feel like more now than ever, I'm hearing women talking about changing birth control, getting off of birth control. And I feel like more now than ever, I'm hearing women talking about changing birth control, getting off of birth control and, you know, for various different reasons. But what are some common things or basics that we should understand or women should understand about how different forms of birth control might affect their body composition, might affect their training if they even do? And is it something that they should be concerned with? Yeah. I think when you start talking about contraception, I think you have to look at the goals of the female. So what are their goals? Are we not looking to get pregnant for a while?

Are we thinking we'll get pregnant in a couple of years? Do we have very heavy periods? Do we have very painful periods? And that's a time where birth control may be a benefit to them with in the aspect of training. So your period shouldn't cause you to have any interruption in your daily life. So if it causes you not to go to work, if you're not going out to social events, because you're having so much pain, we need to evaluate that more with OBGYN visitor, your primary care doctor to look into that issue. So sometimes contraception is just so it controls your hormone balance and gets you more able to feel more functioning in life. Now, there's a lot of controversy with contraception, and it does change your hormones

quite a bit. So you have to look at the risk and benefits, but for some women, if they're not able to go to work, they're unable to work out, the risk may outweigh the benefit. And that may outweigh the risk too. I think it's a great point because there's been like an exodus away from birth control because some women don't want to use it, which is fine. It's reasonable, but it doesn't actually eliminate the fact that it's an incredibly valuable intervention and can be really helpful and something that a lot of women really rely on. you don't want to demonize one thing over the other because some women have to have it and you want that you don't want them to feel guilty because they're on a birth control pill if they need it for their symptoms they need it for their symptoms and they will work on you know any side effects they'll know them and recognize them and be able to work on them and continue to deal with them even after they're off birth control. There is several forms. I mean,

there is the combined methods where you get the estrogen and the progesterone. You have the progestin only, which is also the mini pill. You have the Depo shot and the Depo shot is the one that can increase your weight gain. And really the studies had showed about five pounds. What happens when, when women start to take these birth pills too, it's either, you know, they're they're later teenagers going to college or starting the birth control pill. And so there's a lot of different avenues or a lot of different aspects that can cause their weight to increase, not just specifically their birth control. Some women, yeah, they start it and they gain weight. You know, that this is never a hundred percent, but you have to look at the whole picture too. And when they start taking that birth control, did they also go off to college and gain that freshman 15? Or is there something along those lines that went along with it too? Or is their diet not optimized? Are they not working out? So it's hard to just blame one thing. Yeah. It's a great point because we oftentimes will completely neglect our lifestyle adjustments when we begin taking

different therapeutics, different pharmaceuticals, different supplements. And just because you might see like a common communication that, hey, birth control makes you gain weight. It's not always just the birth control and it's not all birth controls and that does not make them bad. Right, right. Exactly. And with the IUD, I mean, those are more, they have, they're just local instead of systemic. They don't give the systemic effects of the hormones. There's more progesterone. So there's a non-hormone one, a copper IUD called Paragard. Yeah. And then also a hormonal one called Mirena. And there's several other hormonal ones as well. Um, and they may affect your periods differently. Um, the hormonal ones like the Mirena, um, a lot of women I know don't get periods with them. Um, and then with

the copper one, they get heavier periods. It just depends on how you respond to them. Um, and in the background of having these, um, the IUDs in some of the pills, you still go through that cycle. Like you can still, like I've had both the copper and the Mirena and you can still feel your cycle in the background. Like I can still feel like I have the Mirena right now. So I can still feel in the background that I'm having more energy during this week. So I can still track my cycle, even though my cycle is not happening, it's still happening in the background. You can think of it that way.

Yeah. So you can still, I know some days that I'm stronger in the gym, other days that I'm a little bit less, more fatigued, I should say. Um, so you can still track that, but still get the benefits of either not getting a period, um, if you're training hard. Um, but yeah, I think yeah, I think it all is specific to the female, what their goals are and what they want to achieve. I love that. And we've talked a couple times now, it's come up about tracking your cycle. Do you have a favorite way or a preferred way for doing this? I know there's apps, I know there's journals. What is an efficient way for somebody to start tracking their cycle if they want to begin to leverage it to their advantage? Yeah. So I like to use the app called Flow, just F-L-O. I mean,

you just think of it as tracking like your calories and everything on there. It's a little bit cumbersome, but the data that you'll achieve from that is very beneficial. Yeah, it's helpful. Yeah, it's super helpful and just helps you be in tune with your body and how it's helpful. Yeah, it's super helpful. And just helps you be in tune with your body and how it's functioning. It's kind of like that mind muscle connection that we all need in the gym is just that mind body connection that females need a little bit more than men. And so by tracking it on something like an app like flow or, or something similar to that, we're able to understand how best to utilize the gym or nutrition during, during our stages. Um, I think that that's just super important to do and it'll benefit us in the long run.

I love that. And then one more thing to talk about that's kind of unique to female physiology before we transition to talking more about maybe labs and what people might want to look into if they want to take a more in-depth view or take a more in-depth examination of their physiology. One of the things that I think really doesn't get talked about often is menopause and what happens to the female physiology during menopause. And we've discussed mostly some of the nuances and differences that happen when we go through the different phases of our cycle. We've talked when we go through the different phases of our cycle. We've talked a little bit about how different forms of birth control might influence

us differently. And then of course, there's the last kind of usually less touched on hormonal modulation or adjustment period in the female lifespan, which is menopause. And what is happening during menopause? What is the change? I think I've heard a lot of women refer to it as the change. What is the hormonal change that occurs during menopause? Because I think if women can start to take a zoomed out, lifelong look at how their physiology works, they'll feel more empowered because I think a lot of women feel like totally powerless and that the minute they hit a certain age, they're just toast. Yeah. Yeah. And I think empowered is the best word there. Cause I think females feel, don't feel empowered in themselves. And by understanding all

this, that's where they, the empowerment comes from knowledge. And I, I think that'll be very helpful for them. So like how we talked about with the ovary, the ovary has so many eggs. So as we go through our lifespan, we get to perimenopause and we get to menopause. And by the time we get to menopause, there's no eggs left. So what happens is our LH and FSH are going and they're going and going and there's no eggs. So then we get all these symptoms and there's no egg to produce and that's menopause. So our perimenopausal timeframe too is also really important. Now our average age of menopause is 51, but that perimenopause can happen in our 30s. Now I'm 34 and I honestly like didn't think how menopause is so far away.

I don't have to really worry about it for a while, but really the habits I'm forming now are really going to help me once I get to menopause and through the perimenopausal timeframe. So what perimenopause is that fluctuation in our hormones, um, that, um, leads to the regular menstrual cycles, the mesomotor responses, you know, with our hot flashes, um, brain fog, sexual dysfunction. So we're kind of getting to that point. And then finally, we have no more estrogen or no more estrogen. Our progesterones are low. We have this LH and FSH telling us we need to produce everything and there's nothing there. So it kind of we're dropped off, dropped off the map. And so at that point, when you get to menopause, that's when you can start that hormone replacement therapy at that time. Really leading up to that and that perimenopause, that's when you can start that hormone replacement therapy at that time.

Really leading up to that and that perimenopause. So initially what women should do in their 20s, 30s, develop those habits, those good habits, exercise, good dieting, relaxation techniques, sleep, getting that sunlight exposure, direct sunlight exposure in the morning to increase low dopamine levels, finding ways and avenues to decreasing our stress. So when we get to this perimenopausal phase, when we're feeling those hot flashes and everything, we can utilize things like, you know, they say black coal hush for hot flashes, increasing our calcium vitamin D, vitamin D and K2 omega-3s. If we're already doing those things, it's going to make it easier theoretically to go through these phases. It's a great point because I do find having worked with a lot of general population clients who don't even begin exercising until during or after menopause, it's very challenging to integrate habits.

Not impossible, but it is more difficult later in life to form these habits. So I think perhaps the best way to approach it, if you know what's coming, which is a physiological inevitability, is to get some of these lifestyle things in check that can ease some of the symptoms and fluctuations. That's kind of what I'm gaining. Absolutely. And make it not as, it's like, oh my gosh, menopause is going to happen. It as like doomsday is coming. But no, we're preparing for it. We're laying the brick every day by we're working out. We are eating healthy. We're taking our vitamins. We are going to be able to overcome that and we're going to expect it. And then we're going to check our labs. We're going to watch our FSH. We're going to watch the LH. Once the LH hits above 30, once the FSH is above 30 or above 50, and we're not having periods for at least six months, we're going to be able to start on that hormone replacement therapy early on. So we can decrease our cardiovascular risk, our risk of heart attacks and strokes. So we're going to be right on top of it. And what we need to go ahead. I was just going to say hormone

replacement therapy for menopause is oftentimes something people don't even know is an option, but it apparently can make quite a big difference for some women. Oh, a huge, I mean, it's night, it'd be night and day. I mean, it'd be night and day for them and it'll decrease the risk of cardiovascular events. And you have to get it within a certain timeframe within a few years of when you start the menopause. So a lot of times I'm going through this. I don't know, am I in menopause. So a lot of times I'm going through this. I don't know. Am I in menopause?

There's still kind of like a gray area there. So if you're checking your labs, you're watching your thyroid function, your TSH, your free T3, your free T4, watching that LH, watching that FSH, you're going to be better able to predict when that's going to happen. And then so when that does happen, you can get on stuff or get on hormone replacement therapy to help ease you through that and deal with everything else and prevent those cardiovascular risks. And moving forward, if you didn't get somebody who's super inclined to use a pharmacological intervention, it becomes that much more important to get the lifestyle stuff really, really dialed as early as you can. And I have heard from many women that once you hit this certain age,

your metabolism just tanks. And there's actually some recent literature that I've seen that shows metabolic adaptations only occur at about a rate of negative 6% per decade. So basically, you're going to lose 6% metabolic output every 10 years. But if you really think about it, that's like 18% decrease over a 30-year period. That's not un-overcomeable. So even though there might be some metabolic adjustments, it's nothing you can't plan for. It's nothing you can't prepare for. Just touching up on labs before we finish, because I think this is super beneficial. And Merrick is actually the company that I have used to do my labs. I just was going over my lab review

yesterday. And this kind of stuff is interesting, guys, because it gives you some insights. And I figured I'd kind of share what I got from mine. And then we could talk a little bit about what women in particular might want to look at if they're going to get a panel drawn up for performance. But I looked through a standard male health panel, guys, and I got a look at my hemoglobin, my red blood cells, my white blood cells, my platelets, all the different stratifications of white blood cells that might reveal something like an infection or might reveal something like a parasite or something that would clearly be like, okay, you have something here that's causing an immune response. I got insights about my liver enzymes, my kidney function, my A1C, fasting glucose, things that

are really important when you're looking at your metabolism and things like insulin resistance or being insulin sensitive. I got a peek at my cholesterol, a detailed panel where I got to see that I have a good number of the good cholesterol and an in range number of the bad stuff. I got to look at my testosterone, free testosterone, estrogen, sex hormone binding globulin, my luteinizing hormone, which we talked about today, my FSH, which we talked about today. These things are cool. And I even got a peek at where my vitamin D was at and some of these unique markers like C-reactive protein, for example, that are good for understanding what your cardiovascular risk is. And I've talked to you guys before on the podcast about why I like to get labs, what this stuff kind of does for me with regards to

the direction I take my habits and behaviors. And many of you said, well, what labs do I get? What labs should I look at? And I really don't know the answer to that. This is just the panel that I have gotten and I got a lot out of this. So if you are a woman in this instance, since we've talked about female physiology, let's start with a woman. If you're a woman, what labs might you want to look at and what's the best way to get those labs looked at? Because I'll tell you this, I have attempted to get labs done through my primary insurance. Like I have Kaiser, for example. I'll try to get labs done at Kaiser. It's pointless. It's basically a nightmare. It takes forever. If you're going in

for anything preventative, it can be quite sticky and slow. So is there a best way to get labs? And then what labs would you recommend getting for somebody who wants to really take a deep look at their health? Yeah, I think definitely the lab panels that we get for females um definitely we're going to look at your shbg the sex hormone binding globulin the estradiol your progesterone your cortisol levels we're going to look at them and we like to look at them at day 21 through your cycle too so kind of like and if it can't be done on day 21 we just like to know like what day it was taken on so because our range is so wide of the estrogen progesterone through the lab panels that we need to be able to know when we have those labs done

to help us better look at the estrogen progesterone, LH, FSH, all those. And a lot of them are similar to what the men's panel would be too. So we are going to look at your white count. We're going to look at your hemoglobin numbers. That's the amount of blood we have. We're going to look at your platelets. We're going to look at your liver enzymes, make sure your liver is functioning well, and your kidneys are doing well. Their electrolytes are doing good. Your potassium and your magnesium, um, those, and your sodium levels, make sure those are all good.

Um, we're going to look at, um, your insulin growth factor, um, IGF one, we're going to look at that too. Um, you know, with our birth control pills, we're going to look at that too. Um, you know, with our birth control pills, we're going to look that can inhibit our, um, free testosterone, our testosterone increase the SHBG. So knowing if you're on those pills too, is helpful. And so we can see how they're actually helping or hindering some of your lab panels and see if we can improve anything from that route, but it's really looking at your whole, um, panels in general, just to see how we can optimize your health and be able to identify if there's any illness,

if you're at increased risk of cardiovascular events, um, like if your LDL is elevated, if you have a high, um, lipoprotein, little a, um, apple protein B, um, those markers help us look at your cardiovascular risk. So we're able to tell you if, okay, you have a little protein B, those markers help us look at your cardiovascular risk. So we're able to tell you if, okay, you have a little bit higher risk of cardiovascular events. When I say that, I mean, an MI or a heart attack or a stroke, we can start really implementing in more serious efforts toward implementation of lifestyle modification factors to help prevent them from the future. I love that. And also I'm sure that that panel includes the thyroid panel. Oh yeah. The thyroid, absolutely thyroid, thyroid a hundred percent. Um, that has so much

to do with our metabolism, our thyroid. If we can, um, optimize our thyroid level, we can optimize our metabolism. Lots of cofactors to like selenium, vitamin A, um, vitamin D plays a role. All those factors play a role in optimizing our thyroid's function and that plays along with everything else. So yeah, all of that would be included. And so these are panels guys through the company Jessica works with that I've used for labs, Merrick Health. If they're interested in working with you or following you or getting a lab panel done, where can they do that? Thanks again so much, by the way, for having this discussion. This has

been really insightful, really enjoyable. Where can they find you? Where can they work with you? Where can they take themselves if they want to get these labs done? How's that all work? Yeah, we have a website at merichealth.com. You can go through there and start the process through there and get your lab panels. You talk with a patient care coordinator and they talk to you specifically about your goals and help you determine what lab panel would work best for you based on what your goals are. And they get you set up with your lab panels. And then once the results come back, then you talk to someone like myself and we go over them with you and give you recommendations regarding either supplementation, medications, lifestyle modification factors you might need and go from there. Great. And if they want to follow you, Jessica, if they want to keep up with you, where's the best place for them to do that?

I'm on Instagram under JessNP, that one body, one life. All right, Jessica, thank you so much for coming on. We enjoyed the discussion today and we'll have you back on soon. All right. Thank you so much.