Good Life Project - Aviva Romm, MD | Women's Health Revolution

Episode Date: June 10, 2021

The world of medicine is in a place of profound disruption, and that’s a really good thing. Because things have needed to change for a long time. That’s why I’m so glad to be able to sit down with an old friend today, Dr. Aviva Romm, who is my go-to doc for a better understanding fact from fiction, and where the world of medicine is headed, in no small part, through her efforts. Referred to as “the face of natural medicine in the 21st century” by Prevention Magazine and named one of the 100 Women to Watch in Wellness by Mind Body Green, Aviva Romm, MD has bridged the best of traditional medicine with good science for over three decades. A midwife, herbalist, and Yale-trained MD, Board Certified in Family Medicine with Obstetrics, as well as a graduate of Dr. Weil's Integrative Medicine Residency, she is an avid environmental health advocate, researching and publishing on the impact of toxins on fertility, pregnancy, women’s hormones, and chronic illness in women and children. Aviva is one of the nation’s leaders in botanical medicine and is the author of seven books on natural medicine, including the textbook Botanical Medicine for Women’s Health, The Adrenal Thyroid Revolution, and her latest book, Hormone Intelligence (https://amzn.to/3wboGt8). She is the author of the integrative medicine curriculum for the Yale Internal Medicine and Pediatric Residencies, and is on numerous scientific advisory and editorial boards, including Prevention Magazine. And, today, we’re diving into the evolving issues around medicine, equality, agency, and the role that hormones play in nearly every aspect of wellbeing, and how nearly everything we do affects this system.You can find Aviva at:Website : https://avivaromm.com/book/Instagram : https://www.instagram.com/dr.avivaromm/If you LOVED this episode: you’ll also love the conversations we had with Dr. Frank Lipman about a fully integrated approach to healing and wellness : https://tinyurl.com/GLP-LipmanCheck out our offerings & partners: Join My New Writing Project: Awake at the WheelVisit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.

So the world of medicine is in a place of profound disruption, and that's actually a really good thing because things have needed to change for a long time. That is why I am so glad to be able to sit down with an old friend today, Dr. Aviva Ram, who is my go-to doc for really better understanding fact from fiction and where the world of medicine is headed in no small part through her efforts. Referred to as the face of natural medicine in the 21st century by Prevention Magazine and named one of the 100 women to watch in wellness by MindBodyGreen, Aviva has brought the best of traditional medicine with good science for over three decades.

A midwife herbalist and Yale-trained MD, board certified in family medicine with obstetrics, as well as a graduate of Dr. Weil's Integrative Medicine Residency. She's an avid environmental health advocate, researching and publishing on the impact of toxins on fertility, pregnancy, women's hormones, and chronic illness in women and children. And Aviva is one of the nation's leaders in botanical medicine and is the author of seven books on natural medicine, including the textbook Botanical Medicine for Women's Health, The Adrenal Thyroid Revolution, and her new book, Hormone Intelligence. She's the author of the Integrative Medicine Curriculum for

the Yale Internal Medicine and Pediatric Residencies and is on numerous scientific advisory and editorial boards, including Prevention Magazine. And today we're diving into the evolving issues around medicine, equality, agency, and the role of hormones in nearly every aspect of well-being and how nearly everything we do affects the system and how that system affects nearly everything we do, who we are, how we feel, and our state of overall well-being. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. The Apple Watch Series 10 is here. It has the biggest display ever.

It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest charging Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series 10, available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. I am so excited to be hanging out with you. We first connected years ago. You were back when we were filming, actually,

the very, very early days of Good Life Project. Immediately realized that we had known each other in a past life and we're a family and have been kind of jamming ever since then. And it's been really fun for me to sort of like watch your evolution also. You've got this fascinating history long before, you know, like we were in each other's orbits. You started out, I guess, in the world of like fiercely devoted to women and women's healthcare and women's wellbeing in the early days, really focusing on mid-wivery and herbalism. And then eventually end up at Yale doing your MD. And then launching into this world of, you know, it's interesting, actually, I'm curious what you call it. Because

in the early days, it was sort of like, well, if you weren't doing the traditional thing, but you were traditionally trained, you know, there was this functional medicine term, which came out into the universe and feels so heavy and clunky compared to the way that I know you have really developed a lens on wellbeing. I am calling it the new medicine for women because it's not just the wellness space. It's not all the entrapments of functional medicine that we could talk about, but it is clunky. And it's not just conventional medicine. And nobody just really goes to their doctor anymore, but not many people just go to their acupuncturist either. Most people are doing this

new thing, right? They have a fever and a cold and they go to their doctor to make sure there's nothing big going on and maybe get something there. Then they go to their massage therapist for that. Then they go to their naturopath for the nutrients and supplements. And then maybe they get a little acupuncture tune up and hit up the sauna. And so to me, it's this new medicine that is evolving, that is an amalgamation of all of it. The other thing is I'm playing with a term and I don't like to make up medical terms because I feel like they don't, that doesn't really, there's not a lot of validity in that to me, but there is this concept called exposome science. And so I am, and it's all about how our external and internal ecosystems influence our wellbeing. So I am playing with this term

and concept more internally with my team and my writing and my audience of ecosystems medicine, which is looking at these different internal ecosystems, whether it's our microbiome or our stress or our diet or the external ecosystems that we live in. And I think of a Venn diagram. I'm very visual, but these Venn diagrams, when you have a circle and then another circle and they cross over and then there's like that area in the middle, it's usually like me or where you are or something like that. And I feel like that represents it so well. Yeah. I mean, it's interesting also, because I think, you know, on the one hand you could hear this conversation and think, well, it doesn't really matter what

you call it. But on the other hand, I feel like language really matters because it creates a perception and it also creates sort of like an openness to engaging in certain practices with certain practitioners or just a knee-jerk reaction against it based on a lot of the way that things are communicated. It's interesting. We see zooming the lens out, like we're having this conversation in 2021, the last five years or so have seen this groundswell of change in society on so many different level. And especially in women, women identifying people, changes in politics, changes in culture, changes in representation, changes in work and business. And you've written about this. And you've also written about this really interesting phenomenon where you see all this stuff happening, but you're not necessarily seeing the same thing in medicine. No. In fact, I was thinking about it this morning that we really need a Me Too medicine movement, really, not just in the fact of women going to the doctors and feeling not seen and not heard,

but there are actual levels of documented abuses that happen to women physically, emotionally, and actually sexual abuse too, in an environment where you should be able to go and get care and be able to trust that provider. There are changes happening a little bit. I think particularly the Black Lives Matter shift in the movement, because I don't want to say the Black Lives Matter movement, it's been going on for a long time, but the real sea change that we started seeing last year in 2020 with Breonna Taylor and other just very egregious abuses of the system that we saw leading to deaths and all kinds of situations, I think has led to a new recognition of the need to identify bias in medicine, if only to be politically correct and not end up getting sued and having a backlash against you. It's not always

the best intentions that lead to these changes, but sometimes the changes happen necessarily, and then it leads to that seed change you're talking about. So there's an opening right now to look at biases in a lot of systems, but it still hasn't really been focused on women and women's health. Yeah. And I mean, it's interesting that you said the intention behind it isn't necessarily what you'd like to see the intention, but because almost like for financial and legal reasons and PR reasons, you're seeing some energy put behind it. But it doesn't seem like you'll ever really get the level of intentionality and funding and devotion and groundswell and mass change until there's something else that's really motivating it. Yeah. You know, Buckminster Fuller, you know, Bucky Fuller, right? His work, of course. And he has a quote, which I can't cite exactly, but basically says, we kind of have to wait for the old guard to die out and then actually just create a new system. And what's tricky with medicine is it's a really old system with a lot of entrenched biases against women, racial biases, other biases. Like system with a lot of entrenched biases against women,

racial biases, other biases. There's a lot of fat shaming in medicine, particularly against women. And what's happening now, half of all physicians in primary care are women, but we're still training in the same philosophical system. So we're still internalizing these same biases because they're so, so implicit and so tacit. Sometimes they're overt, but we're so used to ignoring them. Like one study came out this past year showing a video of women being spoken with by physicians and physicians saying just completely inappropriate things, like things that you should just not say to another human being or a woman in the context of an appointment, whether being dismissive or just

inappropriate. And most of the men who watched that video who were physicians didn't even identify that there was a problem. More of the women did. But the problem is, is that way of speaking and communicating is what is typical in medicine. So we may recognize it, but we may still be doing it also. Right. So it's like, even if you're taught that this is the appropriate way to be, because that's the way it's been for generations, you may not even realize that there's something inappropriate about the way that you're behaving. Not that that condones it or dismisses it in any way, shape, or form, but it sounds

like the problem that you're identifying really, it's much more upstream. It goes all the way back to the fundamental education from day one when you step into med school. Yeah. We bring to anything that we teach what we believe or what our culture teaches us. And that's part of the problem. Yeah. I mean, you mentioned that something like 50% of practitioners are female identifying, women identifying. Is it a similar distribution in med school itself? I'm curious. It is probably close in med school. I think that it depends on what med school you're at. So yes, increasingly, it's like in the 40% to 50% range. But increasingly, part of why it's interesting, part of why more women

go into primary care is because it is a little bit more amenable to being a mom. It's competitive, of course, to be in med school, but it's a little less cutthroat than going into a surgical career. And those surgical careers are a little bit less tolerant of motherhood, for example. By the time women identify people end up out of medical school, they're very much ready to have children if they're going to because they're already in their late 20s, early 30s, mid 30s, depending on when they finish residency. So there is even the fact that more women are in primary care than other professions is part of the bias. And the number of women who are leaders in medical education is still significant. It's in the 20s percent, not near the 50s percent. So there's a huge disparity in deans of medical schools,

presidents of medical schools, et cetera, being women. Yeah, it's so interesting. We had Michelle Harper on the show last year, and she was sharing some of the information on sort of like representation for black and brown people in the profession also. And it was horrifying. I mean, these are things that I didn't know. And when she was sharing the actual numbers, I was like, that is, you know, and like you said, it's a lot of these problems, they show up in everyday life and the treatment of patients and the interactions and the most fundamental point of service.

But it sounds like the real bigger solutions, they need to happen multiple steps upstream from that. They do. And also bringing in more people who represent more diverse populations in and of itself could bring significant change. So for example, we know that black babies, newborns taken care of by black medical providers are far more likely to survive against what are already uphill statistics for black babies in this country than if they're taken care of by a white provider. And that can only be a matter of attention to detail, prioritization, super complex systemic racism factors that are influencing how providers treat

people. We know that women who are treated by other women, but people who are treated by women are much more likely to have successful hospitalizations, successful discharges, and live longer than treated by men. So just the diversification itself may, diversification, but also listening to the voices and paying attention to what are those people doing differently than people with different outcomes. Yeah. So I know a lot of your focus has really become focusing on women on, you know, both within the profession, but also in patients, inpatient experiences and patient outcomes. And, you know, you were describing how bias shows up in the system. How does that actually show up in the experience of women in medicine when they're seeking help?

Oh my gosh. It's, let me just give you one example. That's really astonishing. So a study was done looking at women who experience pain. That pain could be due to chronic pain. It could be due to endometriosis, something like that. And this study found that women who go, well, we know across the board that women's pain is treated differently than men's pain. So if a woman is reporting that she has shortness of breath and chest pain and goes to the hospital, she's more likely to get an anti-anxiety medication than a workup for a heart attack than a man going and reporting the same symptoms. And she's just as likely, if not more likely, to be having a heart attack. So that is one example. We know that women wait far longer in the emergency room when they have pain upwards of over an hour longer, which is actually serious

if you have something significant going on. But this one particular study was fascinating to me. So women who go to the primary care doctor for pain, if they look too put together, right, if they're dressed nicely, they've done their hair, and they look too put together, right? If they're dressed nicely, they've done their hair, and they've done their makeup, they can't possibly be experiencing pain because if they did, they wouldn't have time to put themselves together like that. So dismiss, nope, you don't get your pain treated. Conversely, women who show up appearing quote unquote more disheveled per this article, meaning you show up in your sweatpants pre-COVID, but you show up and maybe now it's okay, but you show up in your sweatpants,

your hair is not done, you haven't put on makeup, and you're asking for pain treatment. Now you're perceived as drug seeking. So there are these biases. If you look too good, you couldn't possibly be uncomfortable. And if you don't take care of yourself, you must be a drug addict. So we can't take care of your pain either way. Women are, women, let's just use endometriosis as an example. It's a gynecologic and immunologic problem. Takes nine years on average and many doctors to actually get a proper diagnosis. Women with autoimmune conditions, five years and four doctors on average to get a diagnosis. I've had women had things, you know, I've had one patient, she had Hashimoto's. She had gained a lot of weight in a short period of time, like 30 pounds. She went to her doctor who basically said,

you know, what are you eating? And she said, I haven't changed my diet. This is what's happening. I haven't changed my exercise. This is what's happening. And he told her, if you would control your fork to mouth problem, you'd probably lose the weight. And so she came and found her way to me. And she had florid Hashimoto's thyroiditis, which makes you gain weight and have difficulty losing it. So these situations are on and on. Then at a deeper level, when we look at the top surgeries that are done in the United States, two of the top ones that are most frequently done are hysterectomy and cesarean section. We know that at least half of all cesarean sections done in the United States are medically

unnecessary, are overdone. There are economic and time incentives on the part of the physicians, but we know that a cesarean section increases a woman's mortality 28 times over a vaginal birth. We know that most women who are offered a hysterectomy do not need them. And a large number of women over 50 in the United States will have a hysterectomy. Probably 35% or more are completely unnecessary. But interestingly, this multi-center study done in Michigan some years back found that it wasn't just women in their 50s and 60s who were being told they needed a hysterectomy and not given any, not just like alternative medicine alternatives, but like conventional alternatives. Like you could take this medication for six months and have that

uterine fibroid shrink and you won't need the surgery. And so women were being funneled into these surgeries, but even in their 30s. So women who hadn't had children yet might want to have their uterus in, not given alternatives. Then as women, we're so programmed from our earliest ages to not question authority, not make waves, not push back, not be difficult. And at the same time, physicians who have women who come in and question, those women are often labeled as difficult patients. I mean, doctors talk to each other with an eye roll and say, oh, it's that kind of patient. You know, she read about that on Dr. Google. So there's a complexity of women keeping ourselves quiet and not pushing back. But when we do push back,

we get labeled as difficult. And so let's say that woman who does have chronic pelvic pain, and she goes from one doctor to another, and it takes her years to get a diagnosis of endometriosis, and maybe she ultimately does get it. Half of all women who were told, at least half, up to 70% of all women that were told all along the lines that everything was fine did actually have endometriosis. But for every subsequent doctor she goes to, it's statistically well documented now that each subsequent doctor is going to think that she's an increasingly more difficult patient because she didn't believe what the first doctor said.

She didn't believe what the next. So now she gets labeled as having a psychiatric problem. Which just compounds everything. And then you take that, right? And at a certain point, I have to imagine that then as a patient, you start questioning yourself. So many women do. So many women have come to me and said, I don't even know anymore if I'm actually feeling this symptom or if I'm making it up. I'm so confused. And even more so if they do look really well or they are really highly functional in their lives. They're like, maybe I am just crazy. I've had women say that. Maybe I am just depressed.

Maybe I am just anxious. Maybe I do just need to, you know, work less or whatever the things are, rather than somebody going deeper and saying, yeah, there's something going on here. And when they find out there is, you just watch their shoulders drop. It's like, or the tears start rolling. The thank goodness someone is finally listening to me. Because that's the other thing. We know that the average physician has about 14 minutes to see a patient and the average physician interrupts their patient within 90 seconds to three minutes of asking questions. So you barely even get your words out. Yeah.

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You know what the difference between me and you is? You're going to die. Don't shoot him, we need him. Y'all need a pilot. Flight risk. I mean, so there's an even bigger paradigmatic issue just in the system, the way that healthcare works, at least in the United States, in that the financial structures and the operating structures kind of force you to move at an unfathomably fast pace to be able to keep up. And that just compounds the issue. It really does. There's so much paperwork. There's so much medical legal

stuff going on. Some doctors are seeing upwards of 40 patients a day just to make ends meet. And the average primary care doctor makes, what, $180,000 a year, you're paying back $200,000 in medical loans. It sounds like a lot of money, but you're paying back half of your income while you're working, seeing 40 people a day. There's a huge amount of pressure. There's a huge amount of burnout in medicine. The rate of physician suicide, for example, which is the extreme point of burnout, is really high. And for women physicians, it's especially high. So the other thing too is that the reason there's more burnout amongst women physicians is that we know that the rate of burnout amongst women is highest

amongst those who have a higher level of compassion, a higher level of interaction and relatability with their patients, which means that we're putting more time into each patient, but the day is only so long. So we're still taking our paperwork and charts home at the end of the day. We're more involved in the emotionality of what's going on in our patients and tend to feel very responsible for it. And we're more likely to cross our T's and dot our I's to make sure that our patients

are safe. The dosing of their medications is right. their schedule of their follow-ups is right. And so it's exhausting and the system is not set up to express that level of compassion. To give you an example, when I was in my medical training, there was a woman in the hospital, I was on my OB-GYN rotation, and she was having her fourth baby. She had had three previous cesarean sections, which due to some of the changes that happen in the uterus can make you more at risk for your placenta being, let's just say, overly sticky in your uterus. And she was having that complication, which means that she was going to need major abdominal surgery to have this baby, but also put her at higher risk for more bleeding in the pregnancy. So she had to be hospitalized her entire third trimester and her husband's home

taking care of the three kids. So in medical training, you rotate through different services, but on every service in the morning, you round on your patients. And typically you're seeing 10 patients by about seven in the morning. So you get there, whatever, 5, you round on your patients, and then you go to morning report or morning rounds and you talk about your patients. So I was on this service for a couple of months and she was in there for three months. And so I would save her for last every morning and then go sit on the foot of her bed and chat with her. How are you doing?

She had a lot of worries. Every morning we had to check and see if she was bleeding. Was she going in for emergency surgery? It's a high stress situation. And she felt terrible not being there for her kids. So I'm walking out of her room one day and one of the attending physicians saw me come out of the room and said, Dr. Ram, if you are ever going to be a good doctor, you need to spend less time talking to your patients. And I just remember in that moment having a conversation with myself saying, okay, checkbox, that one, if that's good doctor, I'm taking that out of the list. And okay, I guess I'm not checking off being a good doctor, you know, but that was very symptomatic of the

system, you know, just like very exemplary of how it actually is. So that's what people are experiencing on both ends of it. And then, you know, if you're a woman and you go in and you're fatigued, if you're any patient and you go in and you're fatigued and you have these symptoms that you don't know what they are, and now you talk to your doctor and your doctor's trained to think we know everything,

but we don't know what's going on with you and we're burnt out and we're exhausted and we have 14 minutes for you. It's not a recipe for the best relationship for people hearing and understanding each other. Yeah. And I mean, you add to that a sort of a reductive approach to medicine, which is sort of trying to like narrow it down to like, let me identify the symptom. Let me sort of like focus just on the symptom and and the narrowest possible thing and the narrowest possible treatment to try and check those boxes. And all of a sudden, I think it's just a recipe for struggle, not just in patients, but in providers and physicians. Nobody is happy.

And also, the outcomes on both sides, you know, just aren't what they, they could be. Yeah. You know, there's another layer of problems too. A couple of things with women specifically. One is that a lot of what women experience, whether it's menstrual pain or heavy bleeding or these kinds of things that are woman part things, a lot of that historically has been just chalked up to normal. So, oh, well, it's normal to have period pain, so just take some ibuprofen. It's normal to have heavy bleeding, just take some ibuprofen for that too, because it helps lighten your bleeding and wear a maxi pad. So there's a lot of misinformation about what actually is and isn't

normal. And then historically, and this continues to be a problem, there has been significant lack of study of most phenomena in women's bodies. So most medical research on pharmaceuticals and interventions has actually been done on men. And, you know, in my book, I say women are not just small men. We have different physiology. We are different size. We have different amounts of fat on our bodies. We have boobs and hips and butts. And those things, those parts of our bodies actually accumulate and store medication. We break down things and eliminate them differently. And we do that not just differently at one time in our life. We do it differently when we're in our puberty years to our menopausal years. We do it differently in pregnancy. So there's just been this real dearth of study that there are people who are taking

action about that. I mean, there are people who are being activists for more medical research to happen in really important women's health areas and in pharmaceuticals. So that there have been a lot of layers of challenge to peel back. Yeah. And I mean, it's, it's interesting because part of what you're saying is even if you come in and report symptoms that are acknowledged and saying like, yes, that's real. Yes, you're feeling it. Hey, thanks for acknowledging that. Like even if it's not viewed as something that is capable of being changed and then something that can and maybe should be changed because it may add to your health, it may add to your comfort, it may add to your ease and your state of mind. If it's just viewed as,

but that's just the way things are. There's nothing that you do about it. You just endure it. Then you're still going to walk away without living a life that you don't have to live with a certain amount of weight, a certain amount of pain, a certain amount of discomfort and risk that you just don't have to live. It's been interesting because we've had conversations for years and I've seen a lot of your energy has really shifted on, okay, so what's really going on here underneath the hood? What is happening on a physiological, biological and endocrinological, is that even a word that I said? Yes, it is a word. I know it sounds funny when you say it, right? Right. On the level of chemistry in the body that may be underlying all these things. And are all these things that we're seeing on the surface just signals?

And if they are, what is the deeper, what's the root cause? And I know you've focused a lot in recent years on chemistry. Yeah. So one, as you know, I'm a bit of a geek. I like to understand the why and the causes and really peel back and unpack what's really going on, what's underlying this phenomenon. So we do know that women's health concerns have escalated in recent decades. And one might say, well, why is it that that's happening? Well, if we look back at the last, let's say 70 years, the entire food system has completely changed in the last 70 years.

We did not have herbicides and pesticides that were in our food, most of our food. But also there have been quite a lot of studies done from substantial universities and institutions documenting and demonstrating just basic things like the nutrients in our food now don't compare well to the nutrients in our grandmother's food. So, you know, we think about the CDC with infectious disease now, but they actually do a lot more than that. They do a study called the NHANES study, and they look at a lot of different parameters on big surveys around the United

States. And they found in one study in recent years that in every state in the United States, people were only getting 16% of their daily recommended fruits and 14% of their daily recommended vegetables. And it sounds so, oh, we need to eat more fruit and vegetables, but actually we really do because the nutrients in them are doing biological things in our bodies that help us maintain hormones, that reduce inflammation, that keep our gut healthy, that help us break down and eliminate the estrogen and progesterone and testosterone that we're naturally producing in our bodies. We also know from the world of toxicology that there are over 80,000 what are called new to nature chemicals in our environment that

very few of which have ever been approved. They're just grandfathered in by the FDA, and almost none of which have been reviewed in any way on their impact on women's reproductive health. And if you think about hormones, they're just tiny little nanoparticles. They're parts per million in our bloodstream. So people will say, oh, well, drinking out of plastic water bottles couldn't do anything because, I mean, how much could you get from that? But you don't actually need that much. You just need parts per million to mimic what's happening in your hormones or imbalance what's happening in your hormones. And this has been just beautifully studied. Here's a funny story. When I was applying to residency, I applied in OB-GYN at my alma mater

for med school. And the interviewing gentleman who happened to be an endocrinologist and an internationally known researcher, looked at my application and he said, I see that you're interested in doing specialization studies in endocrine disruptors. And he looked at me and he said across this big formal desk, you don't believe in that BPA crap, do you? Literally, just like these things that stick, because you will never forget exactly what someone said. And I was like, well, actually, I do. And the irony is about seven, eight years ago, there was a huge blow up of information at Yale from Dr. Hugh Taylor in the reproductive endocrinology department, identifying BPA as such a significant endocrine disruptor that two states immediately banned its use in cashier receipts and in airline tickets because that thermo-covered paper actually was covered in BPA,

and most of the people handling it at cash registers or at airline counters were women, and it was significant enough to be affecting reproduction. So infertility, miscarriages, et cetera. So these are some of the things that are under the hood that I look at, that we have really strong documentation from siloed areas of science. The microbiome is another huge one. If you just get into the piles of research on microbiome, let's just go to the good literature in the good journals, you can find powerful connections between microbiome and polycystic ovary syndrome, microbiome and endometriosis, microbiome and fertility, microbiome and preterm labor, and on and on and on. But this information is not making its way into conventional medicine

in any more than maybe lip service, if anything, but certainly not in any clinical applicability. Where it's happening is in really more environmental science and toxicology. So there's an entire field of medicine or science now called exposome science. And it sounds just like what you talk about, what you're exposed to and om meaning the realm of. So the microbiome is the realm of your microbes in whatever part of your body. The exposome is the sum total of everything we're exposed to. And they're documenting stress as a toxin, lack of sleep and circadian rhythm disruption, microbiome disruption, endocrine disruptors, and what we eat as core areas that really do

contribute. So can I say that changing your microbiome is definitely going to heal this, this, or that? I can't say that. I mean, some studies do show really well what we can really do by changing our diet, changing these different factors. But what I do know is that why not try if it just means shifting your diet a little bit and doing things that are gentle rather than spending 15 years on a birth control pill. And I'm not saying those things aren't incredibly valuable and that I don't prescribe them sometimes, but let's go as upstream as possible. Yeah. I mean, it makes so much sense. And it's good to know also that there is a part of medicine now that is really focusing more rigorously on what the environment around us does to and for us and trying to actually

measure. I think oftentimes, you know, we try and rush to what do I do? And I think the, you know, the step that we sometimes miss is, well, how do we actually really figure out how to identify, like, what are the things we're interacting with and how do we measure them in a way so that we can then really understand what's going into us, what's coming out of us, and what's the effect that it's having in a meaningful way. And you talk about food, you talk about BPA chemicals that are in the environment around us. You talk about the microbiome. Most people will call that the gut these days. Although microbiome isn't just the

gut. I guess that's one big fallacy too. It involves- Yeah, and the gut's not just the microbiome. Right, right. So really- There's intestinal lining and- Yeah, so I remember the very first time I had exposure to the notion of the critters in the gut.

It was like this term leaky gut that was in the early days of functional medicine. And now it is expanded and gotten so much more nuanced and granular to really understand what's going on. Yes. And it sounds like a lot of this is like all these different things influence the body in ways that also either inflame or don't inflame, which it sounds like a lot of what we're talking about here is, and tell me if I'm totally getting this wrong because I'm a neophyte. You're my brilliant guide, which is why I'm always asking you questions. Inflammation,

it seems like it's just popping up everywhere you look in research, in popular articles and conversations. So I'm curious because it seems to underlie so many conditions and I'm curious what the relationship is between inflammation and things you were talking inflammation and hormones, inflammation and your microbiome. Is it even, or is that like a whole nother conversation that'll take us hours? Yes and no. Yes and yes. But so inflammation, I have a dear friend, she's a physician

and an herbalist as well. There are actually two of us, believe it or not. And she says that inflammation is like a fire in the fireplace or a fire out of the fireplace. If it's in the fireplace, it's keeping you warm and it's cozy and it makes you feel good, right? To see it. If it's out of the fireplace, it'll burn your house down. So we all need some inflammation, right? If you get a splinter, you want your body to be able to recognize that as a foreign object and get rid of it.

If you get a cold and your body mounts a response, all those things that make you feel achy and kind of crappy, that's all inflammation. Those are inflammatory chemicals that are circulating that are doing their job. And the collateral of them is they make us feel achy and tired. And so we rest and then our body can really do its job, hopefully. But when it gets out of the fireplace, when it starts to be consuming, it can overwhelm the body's capacity to maintain it or contain it. And so rather than just getting that splinter out because it's recognized that splinter as a foreign object, it might be recognizing your thyroid as a foreign object. It might be inflammation in your gut. You mentioned leaky gut. It's a real phenomenon

called intestinal hyperpermeability. And when there's inflammation in your gut, you mentioned leaky gut, it's a real phenomenon called intestinal hyperpermeability. And when there's inflammation in the gut, it gets almost a little spongy, if you will. And it allows particles that are in your intestine that should stay there or be eliminated to get across the intestinal lining into this very rich tissue called the gut-associated lymphoid tissue or the GALT. And it sounds like a Yiddish term, I think, doesn't it? The GALT. But that tissue then mounts a reaction. And when that happens, it can become systemic. So a lot of the chronic illness that we see in our culture, diabetes, heart disease, dementia, there's a strong inflammatory component that we know can lead up to those, perpetuate those, and also can then in a vicious cycle,

particularly with heart disease and diabetes, happen as a result of those. But even things like premenstrual pain, if it's normal to have a little bit of discomfort, your uterus is full, it wants to empty itself out, you might have a little aching, a little heaviness in your pelvis, that's normal. But if it's causing you to be doubled over in pain or have to take ibuprofen every month, something else is going on. I say being a woman is not a diagnosis just because you're a woman doesn't mean it's okay to say, yes, you're supposed to live with this. And that's often a reflection of increased inflammatory chemicals that are actually causing irritation in the uterus, for example. You know, I could go on with,

that's where we would have ours. But yes, inflammation, I call inflammation the mother of root causes, although it sounds bad because I like mothers. But it is the root of all root causes. And the result of all root causes. Right. And the result of most disruptions. So inflammation doesn't come out of nowhere. So we know, for example, that exposure to endocrine disruptors causes chronic inflammation. We know that when the gut microbiome starts to get populated with certain organisms that might not be our best friends, that can cause inflammation. We know that diets that are high in sugar and processed flour products in and of themselves cause inflammation, but then they can cause something called insulin resistance

that causes inflammation. So it's kind of always tied in there. Yeah. The Apple Watch Series X is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes.

The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required. Charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were gonna be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're gonna die. Don't don't shoot if we need them y'all need a pilot flight risk it seems like part of the sort of like the the master regulatory piece of this also is you use the word endocrine disruption endocrine system a number of different times i think i

phrase is like your chemistry, but the notion that, you know, like we've got all these symptoms that show up on the surface. We have all these potential contributors, but underneath it, there's this sort of like, there's a constant, there's a dynamically changing soup of chemistry that's happening in our body that is sort of like provides this regulatory role for everything. And if we're sort of like always looking at the stuff that's happening outside and always looking at just the symptoms and we're never actually looking at this constantly changing chemistry system within our body, we never really get to what's going on. And it seems like that's where so much of your focus is right now is what's actually happening on that level. You know, it's really interesting, about around 2007 and then again in 2013, two major medical

organizations, first the American Academy of Pediatrics, then the American College of Obstetricians and Gynecologists identified the menstrual cycle as women's sixth vital sign. So we have blood pressure, heart rate, respiratory rate, temperature, then pain is actually considered the fifth vital sign and menstrual cycles as the sixth vital sign. So when our menstrual cycles are awry, you know, too much pain, irregular periods, heavy periods, light periods, whatever it is that's going on, and not just menstrual cycles, but what we're going through gynecologically, which is a reflection of what's going on hormonally. But what they

identified is that what's going on hormonally is a reflection of yet underlying causes that if we can pay attention to early on, we may offset some of the downstream problems. So if you know that you're having heavy periods every month and they're really painful. We know that there's a very good chance you have excess estrogen. Well, where is that coming from? Often from these endocrine disruptors or the body's lack of nutrition or microbiome to break those down and eliminate them well. So you're overwhelmed by them. But we know that too much estrogen is a long-term risk factor for developing uterine fibroids, breast cancer, endometrial cancer. So we actually have an opportunity to identify things early that

may actually help us prevent some of those bigger chronic problems. And it's interesting, men don't actually have that. Like we have a monthly opportunity to kind of have almost like a scorecard that we can look at and go, check, check, check, that's going pretty well. Or, huh, this actually seems to be a little off or a lot off. Let me realign what I can do to bring myself back into some harmony here. And then you see it. You see the improvements or you see the changes. I just want to be careful to say that because of endocrine disruptors and a lot of other factors, sometimes these things are set in motion before a woman is even born, before she's even hits puberty.

And then puberty is like the switch that sets everything off. But we now know that things like polycystic ovary syndrome and endometriosis may actually be happening a couple of generations back. So it may be that our mother was chronically exposed to something or our mother had a medical problem that caused a lot of intrauterine inflammation that nobody identified. And now you're in your mother being gestated you have all your ovaries that are forming while you're still in your mom hers formed while she was in her mother so we literally have situations that can be intergenerationally like the tracks are laid down but then when you hit puberty it's like the train could go this way or the train can go this way and now you've i'm doing

hand gestures for those of you guys who can't see me because i talk with my or the train can go this way. And now I'm doing hand gestures for those of you guys who can't see me because I talk with my hands. So you can go left or you can go right. And it's like your nature wants you to go right, but all the tracks got laid down to the left. And then you add to it standard American diet, the number of antibiotic doses kids get by the time they're in their teens that alter their microbiome. The fact that teens are using a gazillion cosmetics that contain these endocrine disruptors, and it's almost like somebody pulls the switch and it goes down that track. So as we're talking about healing or transforming and, you know, taking back our health, I also feel, and this is something that

I feel so strongly about, because I think the wellness movement and even maybe a little of the functional medicine movement gives you this sense if you just do everything right. You do the diet right. You do the yoga right. You sleep the right amount. You do your meditation app. You get out in nature. You're somehow going to have guaranteed perfect glowing health. And it can lead to people feeling like, what am I doing wrong? What am I not doing enough of? Or am I just broken? And it's so important for us to take a step back and say a healthy dose of self-compassion and self-love, but also perspective that this is not anyone's fault. And yes, doing all these things is really healthful, but it doesn't mean 100% or 80%. We have no measure of like, that doesn't mean you're going to need the medication or the

surgery either. And I really want there to be like a no fault, no blame approach to healing. I think that's so, so important. And whether that's fat shaming in medicine or fat shaming in the wellness space, that's got to stop for us to live more comfortably in our bodies and minds. As you were sharing that, I had this brief flashback. And a number of years ago, I was at a conference, a really big event, and I was just sitting in the audience next to someone. And the person from the stage said, okay, we're going to take five minutes now and turn to the person next to you and share a bit about yourself.

And I turned to the person next to me and shared a typical you know, a typical three minute completely non-vulnerable, you know, like line of stuff. And it was her turn and her eyes start to well. And I don't know her at all, but there's like, for some reason that she felt safe enough so that in that moment, you know, I start to well. And she just says to me, she's like, I just learned today that I have cancer. She's like, I have done everything right. She's like, I am the person who has done everything right. I never smoked.

I never did this. I do yoga. I eat all organic. I take myself, like everything. And as you're saying that, that conversation flashed back to me. And I wonder how many people are like, have that storyline in their head. They may not be verbalizing it, especially to total strangers, but you know, which just you take a situation and then if you start spinning that storyline, then you add shame

and stress to your current psychological and physiological state, which just adds to the spiral and decreases the likelihood of good outcomes. I can't even imagine the layers that go on top of the fundamental happenings within your body. I hear that story so often. I had one patient who came in, she had a diagnosis of very early breast changes that could become breast cancer. And she was having a mastectomy and medications recommended to her. And she just wanted to know what to do. And she was in her early 40s, three children, very, very vulnerable on so many levels for her. And same thing. She said, I have been a vegetarian since I was 18. I am a yoga instructor. I live a clean life. I meditate. Yeah, I'm type A, but I mean,

it's not like I'm stressed out all the time. We've got resources, everything. And she said, I just don't know what I'm doing wrong. And I said, this could be, and we were in New York City at the time, and I knew that she lived out on the island, Long Island. And I said, you know, it could have been that your grandmother was a little girl and chased those DDT foggers that they used to use on Jones Beach to clear the beach of weeds. This was a really big thing that was done in the fifties. And then your mother was through pregnancy exposed. And then you got exposed and her jaw dropped. She said, I don't know how you knew that, but my grandmother used to tell us these stories

about how they would chase this fogger on Jones Beach when they were kids. And it was just one of those lights going on. I still get chills when I say it. It was just random. I just randomly pulled on that, but maybe it's not. Maybe these things aren't random, but yes, there is so much going.

And it can also feel so doom and gloom, like, oh my God, there's 80,000 chemicals and our microbiomes are screwed and like, what do we do? It's so overwhelming. And I do think that asking the why is really interesting, especially if that's something that you love. Like you and I, we're information seekers, so we like the why. But when you unpack the things to actually do, they are pretty simple. We know that you can restore a healthy microbiome in just a couple of weeks of eating a healthy diet. Studies show this. We know that you can reduce your exposure to certain things that

you're using for body products and drinking out of plastic water bottles, and just that can reduce your blood phthalate levels. So the answers to me seem simplistic in a way when I say them, but getting better sleep, stressing less, eating healthier diets, learning what that really means. And that's where I think for me, when you asked how I think about medicine, sometimes I think conventional medicine is like a pill for every ill and so much over-testing. But sometimes I think functional medicine, I jokingly say, is a supplement for every symptom and also a lot of testing. And the answers, when you get down to it, are still the same.

Change your diet, do this, do this, do this. And what I really love about this new medicine, if you will, is it's not new at all. If we go to every indigenous traditional culture around the world, they already know it's all connected, right? It's just all connected. So we can't tease out what we put in our bodies from how we feel, but we also can't tease out how we're treating the environment from how we feel. And I feel like as women, our bodies are, not to sound biologically reductive or romantic, I really do believe that our bodies are such a powerful mirror of what is happening to the planet. And in a sense, we're a little bit like the canaries in the coal mine.

All of these symptoms that are showing up now in women's bodies are just telling us that there is a life out of balance. And how can we restore hormonal balance, if you will, without restoring a life imbalance? And that's really more, I find, what I'm working with women around. Even if they are going to use a pharmaceutical to feel better or have the surgery, it's still about how do we reclaim this knowing that everything is connected, that our relationships affect how our hormones show up. Our beliefs about our bodies affect how our hormones show up. They also affect how we advocate for ourselves when the doctor isn't listening, for example. So I love that part of this new way of thinking.

Yeah. It's so interesting to hear you describe it that way and just share that. I've spent time with your most recent book, Hormone Intelligence, and I'm going through it. It's 400 pages of just chock full of... I stopped taking notes because it's just like there's so much detail and so much information and so much nuance and a lot of detail and it's highly prescriptive. And you can look up very specific things. You can understand all the different systems in the body and lay it out in a way that's powerful and compelling. And yet at the same time, it was interesting because there's this broader sense that everything that you're talking about is woven together into this bigger context, this bigger system, which feels organic and intrinsic and natural. And it's a really interesting experience of being able to dive into something. And like you said, we're both geeks, we're both scientists. We like to kind of deconstruct.

But then also have this sense of, but there's an elegance and a naturalness to everything that you're talking about. And sure, you can get lost in the weeds or you can get very specific wisdom if you want. But at the same time, it's always tethered to this understanding that there's a bigger thing, there's a bigger intelligence, and there's a certain simplicity which grounds

all of this. And it's always going to be that way. Yeah, I've been reflecting. Well, first of all, thank you. That means the world coming from you. I have so much respect for you as a reader and a thinker and adore you and love you so much. So thank you for that. That really moves me. This thread that you talk about, you know, one of the things I've been thinking about is like when women are called hormonal

or when we call ourselves hormonal, there's almost like this, not almost, we're kind of being told that we're irrational and unpredictable and unstable. But one of the things that really came through for me as I was crafting this book is that it's actually exactly the opposite. There's this biological blueprint that has existed hormonally in women since the time immemorial. It hasn't changed. So why is it that suddenly, it's entirely predictable. Certain things happen when you get into puberty. Certain things happen when you've been in puberty for about three or five years. Certain things happen when you get pregnant. Certain things happen when you go into menopause. It's the same. It shows up a little differently for each of us, depending on our history, our medical stuff and all of that.

But it's the most predictable human biological thread. So the idea that we're unpredictable is really fascinating to me. It's, I think I'm trying to reframe that for ourselves as women. It's like, oh, actually, no, I'm pretty predictable here. Yeah. I know what's happening. There's a certain sense making element to here. Yeah. I know what's happening. There's a certain sense-making element to it. We could go a lot of different rabbit holes here,

but I think this is actually a really nice place for us to come full circle. I have asked you this question in the past, but it was a number of years ago now. So I'm gonna ask you again because we are evolving human beings. So sitting here in this container of Good Life Project, if I offer up the phrase to live a good life, what comes up?

You know, I remember when you asked me this the first time, and I remember saying presence, that being present was really so powerful and so important. And in some ways, Jonathan, I don't, I know, I mean, I've evolved and changed so much, but I really feel like if I would add to that presence, meaning that I am so here right now in this moment, giving that time and experiencing that time and connection from you, I would say that if I would shift anything, I might just say authentic connection. Because I think when I was talking about presence many years ago, it was really about making time for that authentic connection. I think time and space for authentic connection in life to me is living a good life. Thank you. Thank you. Hey, before you leave, if you loved this episode, safe bet you

will also love the conversation that we had with Dr. Frank Lipman about a fully integrated approach to healing and wellness. You'll find a link to Frank's episode in the show notes. And even if you don't listen now, be sure to click and download it so it's ready to play when you're on the go. And of course, if you haven't already done so, be sure to follow Good Life Project in your favorite listening app so you'll never miss an episode. And then share the Good Life Project love with friends, because when ideas become conversations that lead to action, that's when real change takes hold. See you next time. a strength program. They've got everything you need to keep knocking down your goals. No pressure to be who you're not. Just workouts and classes to strengthen who you are. So no matter your era, make it your best with Peloton. Find your push. Find your power.

Peloton. Visit Peloton at onepeloton.ca. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum.

Compared to previous generations, iPhone XS are later required. Charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were gonna be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're gonna die. Don't shoot him, we need him!

Y'all need a pilot? Flight Risk.