Realfoodology - Getting Pregnant After 25, What You Need To Know

Episode Date: February 3, 2026

286. In this episode, I’m joined by Dr. Natalie Crawford, a board-certified fertility doctor with a nutrition background, to talk about what women aren’t being taught about fertility and hormonal health. She breaks down how to understand your menstrual cycle, and explains the benefits of learning this even before you’re ready to have kids. We also talk about how mindset, lifestyle, exercise and sleep can contribute toward fertility, especially if you’re in your late 30s and 40s. This conversation shifts the narrative away from fear and age and back to the health of the woman.  Topics Discussed: → How does hormonal birth control impact fertility and the menstrual cycle? → Why should you track your cycle naturally? → When does health matter more than age when trying to get pregnant? → What is AMH and when should you check your levels?   → What is the biggest factor impacting fertility? Sponsored By: → Cowboy Colostrum | Get 25% Off Cowboy Colostrum with code REALFOODOLOGY at https://www.cowboycolostrum.com/realfoodology. → Just Thrive | Get your health in check and save 20% on your first order at https://www.justthrivehealth.com/realfoodology. → Yayas EVOO | YAYA’S is offering 15% off your order, and it even stacks on subscriptions. Go to https://www.yayasevoo.com/realfoodology. → Manukora | Head to https://www.manukora.com/realfoodology to save up to 31% plus $25 worth of free gifts with the Starter Kit, which comes with an MGO 850+ Manuka Honey jar, 5 honey travel sticks, a wooden spoon, and a guidebook! → Timeline | Support your cells and how you age with Mitopure® Gummies from Timeline. Visit https://www.timeline.com/realfoodology and save up to 39% off your Mitopure® Gummies.  → MASA | Ready to give MASA a try? Go to https://www.masachips.com/realfoodology and use code REALFOODOLOGY for 25% off your first order. You can also find MASA Chips at your local Sprouts supermarket! Timestamps:  → 00:00:00 - Introduction → 00:04:43 - Understanding Fertility Earlier → 00:19:44 - Fertility: Health, Diet & Lifestyle  → 00:32:47 - Health Tips to Improve Fertility       → 00:46:02 - Preparing to Conceive    → 00:54:10 - Diets for Fertility  → 00:01:33 - Fight For Your Health   Show Links: → The Fertility Formula | Book  → As a Woman | Podcast  → Dr. Natalie Crawford | Website Check Out: → Instagram  Check Out Courtney:  →  LEAVE US A VOICE MESSAGE →  Check Out My new FREE Grocery Guide! →  @realfoodology →  www.realfoodology.com →  My Immune Supplement by 2x4 →  Air Dr Air Purifier →  AquaTru Water Filter →  EWG Tap Water Database Produced By: Drake Peterson

How do you prevent kids? What birth control do you want? Don't have kids, don't have kids. It's really a backwards approach to something that is such a big part of so many people's lives. Time will make a decision for you eventually. That doesn't mean age is the end-all be-all. But it does mean that we deserve knowledge and data about our bodies earlier so that we can be the one in control of our reproductive future. All you hear are these doom and gloom stats.

Like the older you get, the less likely that you're going to get pregnant. It does get harder as we get older. But by no means is it impossible? Let's focus on being healthy. Let's look at your cellular health. Let's check markers for insulin resistance or chronic inflammation. And let's make sure that you're in the best position possible so that you can have an easier journey no matter what your fertility journey looks like.

Welcome back to the Real Foodology podcast. On this week's episode, I sit down with Dr. Natalie Crawford, a double board certified OB-Gen and fertility doctor known for her work empowering women to understand reproductive health. In this conversation, we dig into why your metabolic and inflammatory health matter more for fertility than just your age. and the doom and gloom narrative around getting pregnant in your 30s and beyond. Dr. Crawford breaks down how cycle tracking, hormone testing, and lifestyle foundations like sleep, strength training, and gut health can transform fertility outcomes for both women and also men.

Whether you're trying to conceive now or simply want to protect your fertility for the future, this episode is all about giving women the data, tools, and confidence to make informed decisions about their bodies. I loved this episode. There's also a really fun announcement, so you're going to want to stay tuned. If you are loving the podcast, take a moment to rate and review. It means so much. I know I ask every week, but seriously, you guys, it helps the show more than you will ever know. So please take a moment to rate and review. If you're loving this particular episode, please tag me. Please also tag Dr. Natalie Crawford. We will try to share them and get it out to people. Thank you so much for listening. We really appreciate the support. And I hope you love the episode.

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with Just Thrive. Natalie, I'm so excited to have you on the podcast. Thank you so much for coming on. Thank you for having me. I'm so excited for this discussion. Yeah. We actually got connected through a friend and I was blown away that you lived in Austin. I love being in Austin. There's so many amazing people here. It's such a great town and I'm not from here originally my husband is, but it was one of those things in our marriage. He's like, if we get a chance to move back to Austin, I want to go. And it's just such a unique and special city, and we're happy to have you now. Thank you. And there's so much health and wellness here. It's so cool. So please tell my audience who you are and what your mission is. Yes. So I am a fertility doctor, which means that I did training

in OBGYN and then reproductive endocrinology. So that's seven years of training after medical school. I have been practicing now for over a decade. I have a practice here in town called Fora Fertility. but a large part of my mission is to try to educate women before they come in, meaning when do we learn about our bodies? When do we learn about our fertility? When do we learn how to track our cycles or how the world around us can impact our ability to get pregnant? We don't until it's too late. And so my biggest mission would be right now the field of infertility is very reactive,

meaning you have to fail first before you go see a fertility doctor, before you get fertility testing, and I'm sick of it. I think that this should be a more proactive approach where we start talking about our bodies, talking about our health, talking about testing or what we should do to have a higher odds of getting pregnant when we're ready to start. And so that's my big mission is to help women advocate so that we can change the trajectory of their journey. I love that.

Well, one gripe I've always had just as a woman that's gone through this personally, I hate that we're not having these conversations with women in their 20s. And honestly, we're not really having it even that seriously with women in their early 30s either. Like, I wish doctors in my 20s were like, do you plan on having kids later? I know you're not now, but do you plan on having them later? Absolutely. The first chapter in my book, The Fertility Formula, I'm talking about even in training, every question is about how do you prevent kids?

What birth control do you want? You don't have kids, don't have kids. And there's never a discussion of, hey, would you like kids one day? And when would we approach any life goal, right? You and I both have said, hey, we want to be moms one day. But when we were younger, when did anybody ever approach that? as, okay, here's what you're going to do to achieve that goal. For our other goals, right, to become a doctor and you had to take the MCAT, take these

classes, do an internship, right? I had this plan laid out for me. Yet for parenthood, one of the biggest goals I had, it was just, well, don't get pregnant now, and then suddenly stop birth control and have no idea what I should do, what was helpful, what was harmful. It's really a backwards approach to something that is such a big part of so many people's lives. I totally agree. And again, like, I wish someone had asked me in my 20 so I could start thinking about it to prep for it later because I've always known I wanted to be a mom. And what I

hate so much is what I, then what I found, I started hearing all these conversations about people saying, okay, you want to start prepping for your body for pregnancy. Ideally, at least for a couple of years, you don't have to, but that's kind of what I've been hearing is like detox, maybe get your gut order, your gut in order, do certain things just to start making your body prepared. So then I find myself, because I didn't find my partner until later in life, at like 38. And then I'm like, oh my gosh, I'm rushing. I'm like, shit, like I should have already been doing this years ago. And now I'm rushing to make sure that my gut is good, that my health is good.

Maybe they don't have high glyphosate, like just all these things that I'd never thought about. And I wish somebody had talked to me about that when I was younger. We just don't even have the discussions. You're not even in a position of power to make educated choices or decisions. And the reality is for women, our eggs are inside our body, our whole lives. That doesn't mean they're destined to be terrible as we get older, but it certainly means that genetics are one component we can't change. With the metabolic health of our eggs, we can influence by the choices we make every single day. And the sum of these decisions add up.

And so the earlier we start having these discussions in the open, women can start making more informed decisions for their overall health, but also their fertility and hormonal health earlier. Yes, exactly. So what would you do, maybe take a step by step? let's say you had a woman that was maybe 25 that was just coming to see you, maybe she's getting her birth control or whatever it is. And you ask her, do you plan on having kids later in life? What would you kind of advocate for her to do throughout her life to prepare herself for it when she finally wanted to get pregnant?

Absolutely. So number one, the most important thing that our body is trying to give us is these hormonal clues is going to be your menstrual cycle, your period. Yet so often we are on hormonal contraceptive and we lose this vital sign. Your period actually shifts. When you ovulate in reference to the follicular and luteal phase of your cycle gives you a lot of data that we're not learning to leverage. And in fact, we're not even starting to pay attention to it

until we're having trouble conceiving on the back end. So learning your normal can be highly important for later on because shifts from normal always weren't an evaluation. If you're like me and I was on hormonal birth control for well over 10 years, and trust me, I loved it. It was perfect for me at a moment in my life. But there were moments I wish I would have stopped it earlier. I would have said, what is my cycle doing?

I would have learned to track my cycle, leveraging my body's tools. And I'll say to this, so many people say, oh, I'll track my cycle, I'll get this app, and I'll just put in cycle day one. And they're just looking at when their period is coming. And that's helpful over nothing, but truly we want to know when you're ovulating. Because the first stage of ovulatory dysfunction can be a shift in the ludial phase, which is the second half of the cycle. So if you just say my periods are every 26 days, that's great that they're regular,

but that's not telling us the full picture. And so in order to understand when you're actually ovulating, we want to be tracking our cycle either with our basal body temperature, with cervical mucus, or with urinary hormone monitoring. It doesn't have to be all of them. But something to start to understand what your normal pattern looks like so you can evaluate for some of those shifts that can occur later in life. So first, cycle track at some point when you're younger. I've had a lot of young women who missed opportunities because they didn't know what their normal was

and their body was giving them these warning signs and I didn't see them until much later. The second is to know that to put it really simply, inflammation hijacks your fertility. Inflammation is going to harm the metabolic health of your eggs. It's going to harm your body in so many different layers. And the way to combat inflammation is really by taking a more holistic approach to your health. That means looking at your gut health, your gut microbiome, the foods that you eat. but also other things that cause inflammation. Chemicals you're exposed to, your stress levels, how you sleep, how you move your body.

And it's not that there's one thing that will cause or cure infertility, but really looking back and saying the sum of these decisions and the length of time that I'm exposed to certain levels of inflammation can be either helpful for me or harmful. And letting the person make the individualized choice for them at an earlier stage. Yeah, absolutely. Well, you know, I have a lot of girlfriends. I, by the grace of God, I got saved by the birth control.

Because for some reason, when I was in high school, my mom didn't want me to go on it. By the time I hit college, I had tried to take it one time. And I think, yeah, I think because I didn't go on it on such a young age, I think a lot of my friends went on it when they were like 13, 14, and they just didn't have the wherewithal to know that their body was maybe not doing what it was supposed to, or maybe they were having a great experience too. And that's also a lot of people's stories. But for me, by the time I was like 21 or 22, when I first tried it, I was like, whoa.

Like, I don't feel like myself. I feel like I'm a monster. And so I just never took birth control. And so I learned at a really young age how to track my cycle, do all of that. So in that regard, and that was just by accident. I'm really grateful. But I have a lot of girlfriends. What happened was they were on birth control from like 14, sometimes 10, 15 years.

And then they're coming off of it. And they're going, oh, my God, I have all these issues that were masked. I never knew that I had all these issues. and many of them were coming off and then hoping that they could easily get pregnant and then realizing, oh my God, I'm not ovulating or oh my God, I... They're behind the game, right?

Because they didn't get that opportunity to know what was happening in their body. I'll say this. We have a generation of women, like myself, who were put on the birth control pill and maybe for a valid reason, but it wasn't explained to them. I bet you there are doctors

who thought, oh, this person probably has PCOS or endometriosis, but the birth control will fix the complaint they have at the moment. They didn't have formal testing done. or at a minimum, they weren't even explained. Hey, I think you might have this. We're going to do the pill for now.

But when you want to get pregnant, you should consider coming off this earlier or getting more testing done or just some knowledge. That really speaks to the paternalistic view we have in medicine or we've had for so long that people don't need to fully understand what's happening in their bodies.

They just need to be told what to do. And luckily, we're seeing, you know, a huge change. We're seeing women advocate for their own health. And I think that goes along with that, you know, to the earlier question, I think all women should have what's called their ovarian reserve checked at an earlier age. And to be clear, this goes against medical advice. The American College of OBGYN, A-C, says, don't check this if you're not trying to get pregnant or you don't have infertility. But there's a hormone called AMH, which is made from the cells that surround all of the eggs that you have available in a given month.

What's really interesting is I always use the analogy of imagining all the eggs in your body are stored inside of vault in your ovaries. So when there's more eggs remaining, you actually have more eggs available every month because eggs come out of the vault. One of them is chosen to ovulate and the rest of them died. But as you start to have fewer eggs remaining, fewer eggs come out every month. Long story short is that AMH is made from these eggs, so the more you have, the higher it is, the fewer you have, the lower. And the reasoning they say, well, if you are not going through infertility, don't check AMH, is they say it'll cause undue stress and that it's not associated with infertility, meaning having a low AMH doesn't mean you can't get pregnant.

And that makes sense if we think about it, right? If somebody has five eggs or 20 eggs, if you're ovulating one egg, both people, you should have the same age-related chance of getting pregnant. My argument there is twofold. One, what cause AMH to be low? There's certainly, you know, chronic inflammatory disease, autoimmune disease, things like endometriosis

or toxic exposures like smoking cigarettes, that can cause a low AMH and can cause infertility. and the sooner you know about some of these, the sooner you can help your body. But also, that takes that personal choice away from the woman. Because if you found out your AMH was low at an earlier age, you might be put in a position where you will do something different.

And I've had women freeze eggs. I've had women who have found their life partner earlier. And they've said, well, we were waiting to get pregnant because I was chasing XYZ dream. But if I have a limited time to grow my family because I will run out of eggs early, maybe I'll start sooner. And I've had people say, well, if I don't have as many, quality matters. So I'm going to really start to focus on decreasing inflammation.

Or sometimes you say, I'm not going to do anything about this. But I was the one who made that choice. Because for every single woman, time will make a decision for you eventually. That doesn't mean age is the end-all be-all. But it does mean that we deserve knowledge and data about our bodies earlier so that we can be the one in control of our reproductive future instead of just letting the passage of time make that decision. I used to think that all extra virgin olive oil was basically the same.

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because I think we keep saying this, but it's like so many people or so many women are going through this blindly, but to no fault of their own, we're not having these conversations with them. I didn't even know to ask these questions until I started listening to all these podcasts and going, oh my gosh, wait, one, I've never thought about this. I've never had a doctor talk to me about this.

I've never checked any of this stuff before. Like, why didn't anybody raise a flag to me about this? And you're, you know, a science educator and, you know, you're healthy. You are the perfect person who should know about this information at a minimum, and even you were not armed with this knowledge. I tell all my friends who are OBGYNs out practicing, hey, in the same breath where you say, what birth control do you want? Say, do you want kids one day?

At least give somebody the opportunity to say, yes, but what should I do about it? And it doesn't mean we can prevent everything or control everything, but we've got to have these discussions so that we can play a more central role in what's happening in our own lives. Exactly. So in the instance of the AMH that you were talking about and maybe some other markers, I don't think this has talked enough about in the fertility world. Are there things that women can do? We're not blaming women specifically, but are there things that women can do that can either help that number or harm it even further? It's important to understand that AMH is going to fluctuate some, right? So it's not a perfect marker.

It is a reference of how many eggs are outside the vault in a given moment, and we know that number can change by 20 to 30 percent month to month. month. Yeah. We also know that number can be artificially lower if you are on hormonal contraception or if you're not ovulating for a prolonged period of time. And that could even be in pregnancy or postpartum or breastfeeding. So there's some nuance to getting it checked. But importantly, yes, there are definitely things that cause you to run out of eggs earlier. Some part of it is genetic. We're all born with a set number of eggs. We actually lose the most in our egg count from the time we're a five-month-old baby inside our mom until when we're born. At five-month-old, months of gestation, inside our mom, we have six to seven million eggs, but by the time we're

born, we only have one to two million. That's wild. So you're constantly losing eggs, and we think this is a large reason why maternal exposures can have a big influence on what younger women may see due to some of the epigenetic changes, meaning what you choose to do when you're pregnant can turn genes on or off, can influence the egg health or the fertility of your unborn daughter, which is wild in a way, but speaks to the importance of taking care of your self. and the choices you make, both for you and for future generations.

Yeah. But yeah, we can influence our AMH. We know autoimmune disease, especially the higher you've had levels of chronic inflammation is going to be associated with a decrease of AMH. And so anything that's contributing to that inflammatory burden is going to be detrimental in the long term to what your egg count is. Similarly, toxic behaviors that cause high levels of inflammation. So, you know, smoking when you're younger, marijuana use,

heavy consumption of alcohol, but also endocrine disrupting chemicals and things that we talk about a lot that often I find patients can sometimes be dismissive of because it seems really overwhelming. Oh, all these toxins or, oh, the foods that I eat doesn't seem to the average person like it could be that harmful. But if we look at your fertility as a health marker, which we know women who have infertility have a higher rate of cancer, cardiac issues, stroke, metabolic syndrome, earlier death. And it's not the infertility that causes any of those things, right? There's an underlying common cause that is contributing to both the infertility and to this latter risk of disease.

This is telling us our body's all connected and the cellular health matters so much. And so starting to look at how do we really decrease inflammation, how can we start to improve our long-term health outcome is so important, especially when it comes to your fertility. Yeah, I totally agree. Well, one thing that I've been personally struggling with in the narrative of fertility, is we hear all these doom and gloom stats, right? So my audience is very well versed to the fact that I've been on this fertility journey for a little while.

I just got married in June. And I've been telling my audience, I'm like, I hope I don't regret this. Like, I'm kind of giving you as a timeline. And like, I'm holding myself accountable to, like, I hope I can get pregnant around this window. And I've been listening to a lot of podcasts about fertility and all this stuff. And all you hear are these doom and gloom stats. Like, you know, the older you get, the less likely that you're going to get pregnant, the more likely you're going to have miscarriages.

After 35, we get called geriatric pregnancy. And I'm kind of on this mission to push back a little bit. I'm not saying that the stats are not saying that right now. But what I'm curious about is it's all about age. Why are we not having conversations about the actual health of the person and the health of the cells? Because I'm also here to share that I'm 41 years old and I got pregnant on the first try. Yay! We're so excited.

And I cannot believe it. And the only reason I share that, I just want to be very clear. The only reason I share that is not to boast, but to give other women hope. Because what I really found, what I needed the most was not all these doom and gloom stats. I get it. I know it's hard. I know it gets harder as you age because of your egg reserves and there's so many other factors involved. But I don't think there's enough of a conversation about the actual health of your body and the health of your cells.

And I would love to hear the conversation more about how that affects your body and your fertility. You have hit the nail on the head here because even as a field, we have simplified the ability to get pregnant when it comes to, you know, how old you are. And we've simplified the age discussion to simply be genetics. Yeah. Right. And genetics are a huge piece. We're not going to say that they're not important. Yeah.

And I'm not going to sit here and say that age is not an important variable. But it doesn't mean that it's impossible to get pregnant as you get older. And it doesn't mean that we should have this while I'm old, so there's nothing I can. can do or this really doom and gloom mentality. The way I like to think about it is, well, also, thank you for sharing and for opening up and being vulnerable with your audience because we do need more real stories. When women do get older, they get scared. They hear these narratives that are very 3% chance.

If you're 40 and older, and that's fecundability, so that's chance per month. And that does sound really scary. But on population-based levels, because these are population studies, that is a lot of people. Right. And we have to compare that to you, you know, when you're 30, it's 20% per month. It's not compared to 100 because we see 3%, we think 100, and we feel like that's zero. The reality is it does get harder as we get older, but by no means is it impossible. And to me, the empowering part of the narrative is that if it's not all genetics and metabolic health can be important to you,

exactly what you're saying, why are we not talking about our cellular health? Why are we not talking about what we can do to improve the odds of getting pregnant? Because I think the older you are, that just gives you more ownership of saying, well, I can't rewind the clock. I can't have found a partner earlier or have been at a place where I could have gotten pregnant. So this is my moment. So instead of perseverating over doom and gloom statistics, we should say, okay, the empowering

factor is that half the discussion is my health, decreasing inflammation, understanding my body and tracking my cycle, maybe earlier fertility testing for some patients. because if time is not maybe on your side, we want to take better ownership. I also have to say that when it comes to metabolic health, population-based levels. Women who are 38 and older tend to have poor metabolic health, right? That's exactly it. Right? We do see that, you know, they have more abnormally shaped mitochondria in their eggs.

There's an increased rate of having insulin resistance and chronic inflammatory and autoimmune disease. So there's a lot of overlap and nuance by what we might deem to be just genetic and also metabolic cellular health. But I will say this. In IVF, we take eggs out of people, we are fertilizing them in the lab, we're getting the genetic component of your embryos before we implant them very often. And there's a couple truths to be had. One is that I can only work with the eggs and sperm somebody gives me. So the narrative that IVF can overcome everything is also false and harmful because I'll see some people say, my lifestyle doesn't matter,

or I'll just do IVF and I'll get pregnant. Right? And that's upsetting too, because I will see somebody sometimes have really poor egg or sperm quality. We'll talk about inflammation and how to decrease their inflammatory burden, improve their cellular health.

They'll have a very different outcome in the next cycle. And I think that's also an empowering narrative. But to me, if I'm going to spend the money, time, effort to go through IVF, I want to have the highest odds of success possible. So it's even more important to look at all the factors outside the lab that you can control. We definitely do see a higher rate of genetic abnormalities as you get older. The eggs

have been inside your body, your whole life. I like to think about the chromosomes. So the chromosomes inside your eggs are held in perfect cell division. They're held apart by myotic spindles, which are proteins, and proteins break down over time, even in the healthiest of us, right? We know that that's to be the truth. And I say it's like a line of kindergartners. The longer I ask them to stand in alphabetical order, like higher likelihood somebody's going to get out of line. So they don't split until you ovulate. So if you're 25 and you're ovulating, most your eggs will be genetically normal because they haven't been held there very long. If you're 43, most your eggs are going to be genetically abnormal because they've been there for a longer time.

They've absorbed more of the wear and tear just of life and tincture of time. But that's just one piece of the puzzle. From there, you know, the egg mitochondria passes onto the embryo. That egg, allows fertilization, it has to grow and divide and have the competency to turn into an embryo that can function. So that's the piece of the puzzle that is too dismissed based on how early can you start to focus on this cellular health, especially as you get older. There's this, there's nothing I can do. It's hopeless. Instead of saying, hey, it's even more important. Like, let's focus on being healthy. Let's look at your cellular health. Let's check markers for insulin resistance or chronic inflammation. And let's make sure that you're in the best position

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I was just thinking, you know, hearing you talk about all that and I was thinking, you know, it's so crazy. I think I'm healthier now being pregnant now at 41 than I would have been if I got pregnant at like 24. I believe it. Because I was binge drinking. I was basically eating Slim Fast bars and like Pinkberry frozen yogurt. You know, like we're not doing the right. It wasn't a great era at all. Just not taking care of my body, not sleeping well, doing overnights all the time, you know, to study and just not.

I mean, I just, I was unwell. It probably had some sort of undiagnosed like insulin dysregulation happening. I mean, just, you know, the list goes on. And so I think about now versus all the things that I prepped my body for in the last year, which I actually really think made a big difference. And I've just been on this health journey for the last, you know, 15 plus years, making sure that I'm avoiding ultra-processed foods. I check my CRP levels twice a year and make sure that those are at normal healthy ranges.

I check my A1C and make sure that I'm not headed towards diabetes or insulin resistance. There's all these things that can and will affect your body and ultimately your fertility if you don't have them in line. Absolutely. I think sometimes people will say inflammation is a buzzword. You and I both know it can be on a disease process, but actually inflammation is not supposed to be constantly present. Your body is not meant to constantly heal from inflammation. The inflammatory system is actually really important in getting pregnant, right? And we think about acute inflammation, I get a cut, my body's going to go heal it.

Well, acute inflammation is also really important in ovulation and implantation. So those are important steps in getting pregnant. So I'll have patients say, can I just take some anti-inflammatory? medications or, you know, can we just treat the inflammation? And it's not as simple as that. We even know women who are taking anti-inflammatory medications around ovulation won't have the follicle rupture. They'll go through all the hormonal changes of ovulation, but an egg won't be released. So we can't just treat it on the back end. We really got to take a preventive approach. And things that cause inflammation can interfere with hormone secretion, kind of interferes

with the hypothalamus in the brain, which is the command center for hormone, has to interpret hormones and send out hormone signals. So if you have high inflammatory levels, you have a higher likelihood of having ovulatory dysfunction. So your brain's not going to appropriately respond. That's obviously going to be problematic. And then it's going to directly impact ovarian function. So then can the ovary respond? Can the ovary protect the eggs? Can the eggs mature appropriately? And then, of course, egg quality and some of the metabolic health that we're talking about. Dietary change, gut health are probably the biggest area for improvement for most people. Yet it can feel really overwhelming and daunting.

It does. I've been there. Yeah, same. I used to, you and I were similar. In my early 20s, I, you know, glamorized hustle culture. I don't need sleep. I can live on caffeine, eat all this junk food, drink alcohol, I can work hard, play hard. And I was the epitome of that was fine, right?

As long as I could, you know, get good grades or do well, in other areas. If I looked like I was doing well, then... If I looked like I was healthy, I was healthy. Yeah. Right? But that really wasn't true at all on a cellular level. And eventually that will catch up with you one way or another.

For many women, infertility or difficulty getting pregnant is that first medical problem they ever have because we're relatively healthy or ignore our health. And then suddenly when we're struggling to get pregnant, it is that gut check moment of what's really happening inside my body. When you then go and you get dismissed by your doctor, it's even worse, right? And I have patients who've seen other people. They've asked for labs that won't be done. They've brought up problems and gotten dismissed.

And that was me too. I had multiple pregnancy losses. When I saw my, thank you. When I saw my own doctor, though, I was told, oh, just relax or it's just bad luck. Very dismissive and really eye-opening for what it's like to be the patient on that side of the journey. But I think what's really important here is, you know, dietary change in gut. health can make the biggest difference. But also, I always tell people, let's not start there, because that can feel overwhelming. Let's number one start with the foundation of your day. And that's

going to be sleep more. So when your body heals from inflammation, work on lowering your stress levels because stress contributes to chronic inflammation and insulin resistance and work on building skeletal muscle. Because skeletal muscle can help your body clear insulin resistance and then clear inflammation without having to kind of need the normal process, right? So if I spend a minute because I use inflammation, I use insulin resistance, and I know your audience is really well educated, but my analogy for insulin resistance

is to think about the fact that glucose, so breaking down from the foods that we eat, glucose is the fuel for cells. When you eat, a glucose is going to be released into your bloodstream and the pancreas is going to send out insulin. And insulin is the hormone that lets glucose into cells. And I like to think about insulin like a salesman knocking on the door trying to let glucose in. And so if we eat foods that have a lower glycemic index,

they don't cause as high of a glucose load or we're eating at meals instead of constantly snacking, we're going to have this really beautiful response where we eat, glucose goes up, insulin goes up, glucose goes in cells, glucose goes down, insulin goes down, process repeats itself. However, if you're eating high glycemic index foods, lots of artificial, you know, sweeteners, ultra-processed foods, you're constantly snacking, you're going to have this constant glucose in your bloodstream. Insulin is then going to be released. And then what's happening is it's like a salesman who comes to your door every day. What are you going to do? You're like, go away. I don't want to open the door for you. I am not going to open the door. And that's exactly what happens in your cells.

Your cells like, I know who this is. No thank you. This causes this terrible cycle because cellularly, your energy low. So then your body is going to actually start breaking down glucose from your liver. putting more glucose in your bloodstream. The cell is so sick of seeing insulin still, so the same process is happening. And it results in a process where you need really high insulin levels to even let glucose in.

I think about like the salesman's got a pound at the door so that glucose can even get him. Well, we've got to stop that process, right? And so part of it is changing how we eat when we eat what we eat, which we can talk about in a second because I know you and I are very, like, have a love language over here.

Yes. But also part of this can be, number one, sleep is a great time for your body to kind of lower that glucose burden, to allow some of it into the cells, and to become what we call more insulin sensitive. I always say clearing inflammation, but you've got to sleep at least seven and a half hours to give your body time to do this process appropriately. So sleep more, sleep better. Two, stress activates this process. And the way I like to think about it is if we think about stress, let's imagine we live in the olden days, and there's a bear, and you need to run away from the bear.

Your body suddenly needs extra glucose so that you can run away from the bear. It's got to fuel your body. So if we get a really bad email or we have a bad meeting or we get bad news of the doctor or we have a bad conversation, all the things that cause stress now, what's going to happen is your body thinks it's a bear. And suddenly glucose is going to be freed up. It's ready for you to go run and use it, but we don't do that. We're sedentary or worse.

We stress eat or we. We stress drink, we add to the glucose burden, and we start to worsen this process from having chronic stress. And this is especially hard when it comes to social stressors, right? Like PTSD or social environments that never alleviate. So learning to manage stress, it does work on preventing stress, right? So building in protective mechanisms, because the idea that we can avoid all stress is ridiculous.

Instead saying, hey, the world is stressful. So I need some moments to have that cortisol drop, but I'm going to build those in in a way that works for me. And maybe that's journaling, meditation, mindfulness, a walk, feet in the grass, sitting outside, acupuncture, yoga, therapy, talking to friends. Less time on social media. Less time on social media. That always spikes my stress.

But there's no one-size-fits-all. Yeah, right, there's a lot of different things we can do there. But the other thing I say when it comes to stress is, well, know your body. So if your body thinks there's a bear, like get up and walk. Use some of the goals. glucose that's been released. Like, let your skeletal muscle use it. And the reason why is that your skeletal muscle has a transporter called glute four. And to put it simply, it allows glucose into the cell without needing insulin. So if we can say this insulin resistance problem is happening,

but I can bypass this over here by building and using skeletal muscle, that's going to be a huge tool to try to help you get better hormonal health and fight back on this insulin resistance. But what tends to happen for most people because high insulin levels cause you to distribute visceral fat. You start gaining weight because insulin's a growth hormone. And instead you're like, oh, no, I need to go do some high intensity workout. I'm going to go try to lose this extra five pounds I put on. So instead of building, using skeletal muscle, we're using it, but we're kind of doing it in a more cardio-focused way only instead of picking up weights or doing some resistance or strength training. that often helps people get started

that feels a lot more attainable at first, right? You start saying, okay, those changes I can start to work on. But the biggest room for improvement is, of course, going to be improving your gut health, changing the foods that are going into your body, and working on avoiding things that are extra toxic, whether that's in our food or the environmental chemicals that are in our kitchen, our food itself,

the processing, everything that's happening, because that is a huge source for inflammation directly and when you damage your gut, you change the microbiome of your gut. The microbiome is important in hormone metabolism, but also in your entire hormonal health communication system. So we really have to start saying these choices that feel very passive or health neutral, a lot of people think the food they eat is very health neutral. I know.

Right? It's wild to me, actually. It's one of the best things you can do to control your health right now. Yes. In a month from now, in 10 years from, now is to pay attention to the choices you are making when it comes to the foods that you are eating, it directly correlates with your overall body health and your cellular health. Yes, exactly. And this is what I like to remind people a lot is, yes, of course, there's always

things we won't be able to control. I can't control my age, but there are so many things about your health that you can control. And I really like to focus on the controllables because that makes me feel empowered. I can't do anything about the fact that I couldn't find my partner until later, and then I'm 41 and having a baby. But what I can control is how much sleep I get, what exercise I'm doing, am I working on building muscle, what foods am I eating,

am I making sure that I'm drinking filtered water? So I'm getting, you know, least amount of exposure to, you know, chlorine and all the other stuff that's in the tap water, right? There's a lot of decisions that we can make that I find incredibly empowering. And I want women and people in general just to know how much of a difference this can actually really make in your health.

Sometimes this can be, the difference between really struggling to get pregnant and not. Oh, absolutely. I mean, to put it simply, again, like people who are paying and going through IVF will have extremely different outcomes when they are just living, quote, unquote, their normal life. And many people think that they're being healthy, right? So we're not judging or blaming. Yeah. But we're really saying, evaluate your life and let's start, look at how these little decisions are to add up, because the sum of of these choices really do matter. You know, my big why, like, why you get on social media, why do you start talking about this?

I really got sick of sitting across from women who are smart, educated, goal-oriented, and they kept saying, if I'd known this information, I would have made different decisions, right? Yeah. We can't always control the outcome. You couldn't necessarily control if you were going to get pregnant.

Yeah. But you knew you were going to be in a position of power by saying, I'm doing everything I can to have the highest chance of success. Yeah. I'm taking other variables off the table. I know I'm decreasing my inflammation, having healthy foods.

I have like a good, for this to be able to happen in addition to knowing your body and tracking your cycle. So coming to it from a place of knowledge and power and not just relying on luck or the luck narrative, I think is so empowering and really important. I totally agree. And the way I was just picturing this is just get all the obstacles out of the way that you can. You know, like you're climbing a mountain, you're going on a hike and it's going to be tough already.

But like, let's get all the debris and stuff that's in your path out of the way to at least to make it a little bit easier and give you a better chance of getting to the top of the mountain. Oh, absolutely. It's like running a marathon. You're going to just show up one day and run it, or are you going to train, prepare, know the course, know what you're doing, right? Exactly. We want to come into this from a place of knowledge. We are goal-oriented. We are smart enough to know that it doesn't make sense that the choices we make every day don't impact our fertility. Exactly. And I think this is what I've really, really been trying to get out in my message is that for so long we've been hearing in the medical system, oh, there's absolutely nothing you can do.

It's just all genetics and it's all your age. This is just what happens. There's nothing you can do. There's a lot we can do. The data supports that too. It's important to say this isn't just you and I sitting here saying this is the way that we like to live and the way we think other people should. Data actually supports that inflammation is harmful to your fertility.

There's a lot of population-based studies showing greater adherence to anti-inflammatory lifestyle practices. improves the odds of getting pregnant naturally and with fertility treatments. So why do we not talk about this on a greater scale? I mean, you and I are both sitting here talking about it to help educate women, but that knowledge should help you feel empowered and say, okay, great. Hopefully that can be the night as to change for a lot of people who do want to get pregnant or even outside of pregnancy, right?

In your 40s, you know, menopause is going to be coming for everybody. And so the longer your ovaries function, the better your hormones can communicate, the better hormonal health you have, the lower inflammation, you're going to do better throughout paramedopause and the menopausal transition than you are if you are already going into that change in a state of poorer health. Yeah, exactly. So something I want to talk about because I want to hear what you,

what advice you give your patients, but I also want to share what I did leading up to this. So about a year and a half ago is when I really, like I've been paying attention for the last couple years, but I really started to go, okay, I just want to make sure that I have all my ducks in a row. I want to make sure that I'm not dealing with any sort of underlying thing that, like, if I need to address it, I need to address it now. And so I found just some little stuff like that I needed to like clean out my gut a little bit.

My gut was kind of like all over the place. I had some like dysbiosis and stuff. So I was doing, you know, cleanse and like getting my gut in order. I was testing for environmental toxins. I actually at one point found my, I've been testing my glyphosate last couple years. My glyphosate randomly shot up. And so I was detoxing glyphosate. I'm trying to think of what else we did.

I also got myself and my husband on a prenatal a year ago. Love it. There's this brain called wee natal where they make one for the men too. And this is the other thing is I sat down my husband and I was like, We are not trying, but my husband takes that. Yes. It's just good for them in general, right? It's good for their longevity and vitality.

And so I sat him down and I was like, okay, there's some things that we need to like make sure that we're really cognizant of. Like, please don't drink as much as you have been. And I love this. Like this is before you're even married. or you're, you know, right approaching that, but you're being so proactive in your approach here. Exactly.

We got my husband's gut tested. We got all of his markers tested. We just wanted to make sure that everything was in line because if there was anything really serious. Like, let's say that I had, I was dealing with endometriosis and I didn't know it. I wanted to know now so that I had time to deal with it. Absolutely.

So what are some other things that you suggest that women, if they know that they are eventually going to want to get pregnant, what are some areas that they should just start exploring now? Okay. So first, you already said it, right? So being on a prenatal vitamin is going to be really important. So I'm going to say, number one, prenatal vitamin. I always say a man should be on a men's multivitamin as well.

We know that many partners are not going to do what you're not going to tell them to do. So you need to be like, hey, honey, like let's do this together. It's true. I have to literally give it to remember when I'm like, please take this. Same. I'm like, here's a little jar. This is for you. Fertility is a team sport.

50% of infertility is due to male factors, 50% to female factors. So this idea that the burden is all in the woman. That's all we've talked about so far is really also not. not true. In addition to that, sperm change every three months. The life cycle of a sperm is so different. They are generated in the testes. They are packaged and developed. That's so different than you and I who have our eggs inside our body our whole life. That means that the lifestyle of a man can make even a bigger impact. Yet day to day, I see the opposite. I see women jumping through every hoop, doing every test, being as healthy as they can, and their partners making no change.

Maybe they're smoking cannabis. They're not sleeping. They're doing. whatever they want. And so number one, I love what you said is the we. We wanted to do this. This was a goal for us. We sat down and said, what do we need to do to have a higher chance of this happening? And so hopefully everybody listening is in a relationship where they can have that conversation too. So instead of just you do your thing, he does his thing, this is a team sport. What are we going to do? How are we going to change? And even in my own journey, when I started to do research in fellowship, I was having my pregnancy losses, was told there was nothing I could do. And I started learning about environmental chemicals undercurrent

disrupting factors. I studied PFC, so perfluorinated chemicals and their impact on ovarian reserve and fertility. And I was like, oh my gosh, like we have teflon pans and we have plastics in our kitchen. And of course, this was 12 years ago. So it wasn't quite as common knowledge as now. But I remember coming home and getting rid of all of it. And my husband being, what are you doing? I was like, we're making changes, right? Like this stuff is not. good. So take this team-based approach, right? So we need to say, number one, prenatal vitamin for both. Number two, if you have known health issues, do not pass go, right? So go get those explored. If your partner has difficulty achieving or maintaining an erection, has low libido, gaining weight,

has diabetes, prediabetes, those things all need to be, you know, worked out now. There can be a sign of something else. If you're a woman, your cycles are telling you a lot about your body. So as we said earlier, tracking them. Your ludial phase should be at least 11 days in length. Your period should come regularly predictably. You should be able to take your finger, put on a calendar, and with one to two days of accuracy, know when your period's coming. Many women have what I call irregularly regular. It's coming this month, but I don't really know when. Or it can hop around week to week. That is too much variability. Or they have a short ludial phase or spotting in the ludial phase, which is a sign of an ovulation problem. It could be thyroid, prolactin, hypotivate,

thalamic, that warrants an evaluation earlier. Similarly, if you're bleeding through your clothes, it's not normal. And if your pain is so bad from your period that you're not going to dinner, you're working from home, you're canceling plans with friends, that is not normal. The problem with period symptoms and pains is that many women, like you talked about earlier, well, they were on contraception for a long time. They never learned what was normal. But also, we don't do a good job of sharing. So we assume that, okay, well, my periods are really painful, but nobody else is complaining about theirs, I must have a low pain tolerance and just not deal with it well. And that's the narrative that we even convince ourselves instead of saying, oh, I shouldn't

throw up for my period pain or, oh, I shouldn't have to call in sick to work. That's abnormal. That's concerning for endometriosis or anomyosis or uterine fibroids. And I should get that evaluated. So really thinking about your period and working up any of those period problems should happen from the get-go. So we have, are you ovulating? Can you detect it? Do you have any kind of period abnormalities? And there's preconception testing, which a lot of people don't talk about. This is evaluation of things before you get pregnant that can make a difference in your story. I'm a big fan of preconception genetic carrier screening. So this is seen if you and your partner carry the same genetic disease. According, I'll tell you some of the saddest stories I've seen are people who did not have

infertility, but got pregnant with the baby with a genetic disease that died. and they had no idea they carried this. And so we've all heard of some of the more common ones that can be survivable, like cystic fibrosis or spinal muscular atrophy. And those can be serious and devastating. But some of the worst ones, things like Pearson syndrome or Bardette Bidel, you don't even, these people have babies that die. They don't even know about it sometimes until postpartum.

It's devastating. And they can do IVF with genetic testing if they want to take this really terrible disease out of their family line. But just knowing you have that ahead of time can be helpful. And it doesn't mean you have to do IVF. But another good story is I have a couple sometimes that come back with congenital deafness. And I've seen this a lot. I've seen this more commonly.

And people will make different decisions. So if you and your partner both carried a gene and you had a 25% chance your child could end up deaf, I've had some patients say, you know, that would be really hard for us. We want to do IVF and, you know, have a higher chance of having a hearing child. I've also had patients say, you know, we're going to start to learn sign language. We're going to make sure that we get in with the community and that we know about earlier, you know, neonatal hearing screens and that we have the right resources so that if they did have a non-hearing child, they were in a position of power instead of learning about this.

Could you imagine postpartum, really emotional? No. Right? So they said, okay, we're making this active choice. So again, it goes back to being the one to make the decisions. And we can't make decisions on data we don't know. So genetic carrier screenings is a simple tube of blood, checking to see if you're a silent carrier for a lot of different conditions.

It's not really clinically relevant unless you and your partner carry the same one, which odds are you're probably not, but again, we don't know unless we check. Right? Yeah. And then there's some vitamin and hormone levels. So things like we talked about AMH already, you know, thyroid hormone, vitamin D. These are things that can be really helpful to check ahead of time because we know that deficiencies or problems can make it harder to get pregnant.

Yeah, exactly. I'm curious to know in your experience, have you ever seen differences in fertility outcomes with patients that have really bad diets and then patients that have really good diets? You know, bad and good, I don't love bad and good for diet, right? You'd probably do either, right? Well, let me rephrase that then. Maybe patients that are eating more ultra-processed foods and fast foods versus just eating whole real foods. Absolutely. I think it's, you know, again, there's always in a one.

So when we talk about this, somebody's going to come in the comments and they're going to say, but my sister-in-law ate McDonald's every day and she got pregnant with five kids and it was no big deal. It's an anomaly or it still happens. Yeah. So of course there are going to be people whose bodies are different. Here's the thing that I say. All of our bodies are different. Our gut microbiomes are different. But if you're in a place when you want to say, I want to get pregnant as fast as possible,

I want to have an easier journey, I want to decrease the risk of having a complication, then paying attention to these things is going to matter. on the whole, people who are healthier tend to have better outcomes than people who make poor choices. That, of course, is not all or nothing. Some people make really great healthy choices and they still have a difficult journey. Of course. And some people do nothing that we recommend and they get pregnant just fine. But when we look at the odds of it or saying, hey, I want to optimize my odds.

I want to try to run the marathon knowing what's coming. We are going to see improved outcomes when we are eating less, ultimately. processed foods, when we're actively decreasing our insulin resistance, so avoiding artificial and added sugar, when we're increasing, you know, fruits, vegetables, fiber, feeding our gut microbiome, and ultimately eating a healthier, more anti-inflammatory dietary pattern is going to be extremely important in your long-term journey to health, but especially for hormone health and fertility. Exactly. I want to know what's one health trend that you wish would die? Oh, the carnivore diet.

Right? So it's not that all animal meat is terrible, but, you know, in general, right, animal meat doesn't have fiber. And if we're going to roll back to the gut microbiome, fiber is the food for it. Fiber is really important to have a healthy gut microbiome. And ideally, getting that fiber from a diverse array of fruits and vegetables that have different micronutrients is going to be really important. Yeah. Well, what we see is that people who are on the carnivore diet and they're not eating fruits and vegetables, they have a really limited dietary pattern, they are not feeding their gut microbiome with what they want. And ultimately, that's a very inflammatory dietary pattern. Yeah. I know. I will tell you, I'm on the fence with carnivore. And here's why. I completely

agree with you. I think long term, I think it's terrible. I'm, I always say for me, I don't believe in diets. I just believe in eating real food. And that to me means you eat a whole array of everything that was once alive. So plants, animals, you know, fruits, vegetables, produce, fiber. Things are not processed. Exactly. Exactly. However, I have seen short-term for very specific situations where somebody has like, I mean, my husband is actually a perfect example of this. We went down this whole journey for two years trying to figure out his psoriasis,

and nothing, nothing, I mean, it's driving us nuts. Like, nothing has helped. And he went on carnivore for like four months, and we basically got rid of, like, all of the psoriasis on his elbow, except for on his scalp. But again, I see it as a very short-term clinical thing or maybe for a couple months, but I think it's more of the fact that it's an elimination.

diet. I was going to say it's so limited that it's almost hard to say which thing we're not consuming was the problem. And we're always when we look at dietary studies, one of the hard thing about it is, well, what were we doing ahead of time? Are we going from standard American to carnivore, which is still probably going to be an improvement? It's going to be way better for you. Or are we going from Mediterranean to carnivore, which is probably going to be harmful for you. 100%. I personally, like, I hear about people just this is their whole lifestyle and they're like, I'm never going to eat anything else. I'm horrified by it because I'm just like, you need a variety of food. You need phytonutrients.

You need the antioxidants. There's so many other things you're missing out on. So I agree with you on that. You know, I always tell patients it's not really sexy, right? Like, carnivore diet sounds sexy. Like what we're recommending isn't as sexy because you've heard about it a really long time, right? Avoid the easy processed foods. Avoid added in artificial sugars.

You need to have number one, fruits, vegetables, fiber. Number two, healthy protein sources, right? If you're going to have, you know, dairy products, we want them not to be processed. We want, like, that whole fat, that real dairy. And then when it comes to your carbohydrates, they're not all created equal. So really lean towards those whole grain, those complex carbohydrates. That doesn't sound very sexy to the average person, right? And it's, let's be real.

It's not clickbaity. It's not controversial. It's not, oh, my God, all you're eating is meat. And we should say fats too, right? Yes. But healthy fats are so important to your diet, especially when it comes to hormone health. Cholesterol is literally the backbone of your steroid hormones.

Meaning if you are not eating fat, you are not giving your body what it needs to make progesterone and other hormones. So we've got to really look at especially, you know, those unsaturated fat options, the olive oils, the nuts, the avocados, that can be so advantageous for your body and making sure that we're not in this low-fat craze, which we've seen kind of a tend away from that. But I will say, right, as we see skinny culture coming back, I am seeing more patients who previously felt comfortable, you know, eating fat.

And I say full fat dairy and having good, you know, fats in their diet, but now getting really nervous about what they're intaking again, as we're seeing kind of public perception of body size, you know, switching back. It's the ozempic effect. It is the ozropic effect. And, you know, I think JLP ones can be really incredible for a lot of patients, especially those with PCOS, chronic inflammatory disease. We can see a lot of benefits.

But I think societal, we are seeing a shift towards smaller body sizes. And that can do some detriment towards eating patterns. Yeah. Especially to those of us who did grow up in the low-fat craze. it all rate, it almost seems like patients maybe are not even aware that some of the bias they're having towards the foods that they're eating. For sure. I will tell you, you actually reminded me, this is another thing that I started doing. So I had Sally Fallon on the podcast last year, who wrote nourishing traditions. And one of the things she told me, because I told her I was on a

fertility journey and I said, what do you recommend I eat? And she goes, eat full fat dairy and have it every day. And I was always one of those people that I had avoided it. I was diagnosed with lactose intolerance when I was younger, and so I just, I never really ate it. But I've been doing A2 dairy and I've been doing full fat. And I swear to God, obviously, I have no like stats or science or anything to back it up. It's just intuitively. But I feel like that might have made a difference because I just feel like my hormones came more online. I felt a little bit more vital. There's just something about having those full fat, the full fat that helps your body. What we know about dairy is for a lot of fertility markers, it seems quite neutral. However, full fat does better. Low.

low-fat skim options actually can be harmful. And then there's certain nuance to it, right? And so what I say is that do you need to just purely eat cheese and yogurt and dairy? No. Not what I'm saying. Can you incorporate it into your diet? Yes, and you should feel comfortable that it is a good, you know, fat protein source, that it can have good nutrients in it, but you should choose the full-fat version. Yet we still see people getting skin milk or low-fat yogurt. And I always say, hey, there's processing involved in that. You're taking out some of the nutrients that are in there. in this processing. And you and I are both trying to walk people back towards a simpler way of

eating, where we're eating foods more in the forms that they're coming. Exactly. And let me be clear, I wasn't like, you know, I'm not gorging myself on dairy all that. Exactly. It's like, okay, I've been adding a little bit of cottage cheese. I've been adding a little bit Greek yogurt, you know, and balancing all of that out with other things. But I just... A lot of people do get diagnosed with lactose intolerance or sensitivity to dairy. I think often this is happening because of other factors in our diet at that same time. And when you start to eat, cleaner in other areas and you're having less processed foods, many people can incorporate full-fat dairy back in and they actually are not sensitive to it they previously thought they were.

Yeah, well, and I really think there's a lot to it. I mean, not even I think there is data to back it up that if you get it from A2 dairy cows, your body processes it in a different way because it's a different type of protein. So a lot of people that say that they have issues with dairy, I want to be very clear, not everyone, but there are a lot of people that say that when they have A1 dairy, which is the majority of what you see on the shelves. If they get A2, they don't have any sort of reaction to it. I mean, we could have an entire podcast about factory farming and the food industry and what that has done to the food that we're eating, how that impacts, you know,

our hormones and our cellular health, right? So I think what we have to do is start empowering people to make those educated choices. And there's times where you don't get to choose which type of day, right? Maybe you are at a friend's house, you're at a restaurant. So we make the best decisions we can in the moments that we have to make the decision. but that to me speaks to the importance of the moments that we are in control, things in our house, the food that we purchase, making sure that we're making those really informed choices

so that we can experience the world around us and not worry that this one-time exposure is going to set us off on some terrible inflammatory cascade because we are all exposed to inflammation. Our diets and everybody, we're going to have moments where we eat something and your body's meant to process that inflammatory burden and then heal from it. But if you have a higher baseline inflammatory level, you're not going to be able to heal from these one-time exposure.

So that's what we're trying to change. Is there anything else, just based on everything that we talked about today, that you really feel like women need to hear? I think the biggest thing I'm going to say is that when it comes to your body, we've got to educate, right? So we're trying to increase, you know, the baseline fund of knowledge. Two, we have to advocate for our own health. We have to be the steward of our own journey.

Unfortunately, the current medical system isn't made to be really friendly to patients right now. And there's many great physicians stuck in bad practices or bad systems. But that means that it's up to you to fight for your health in a certain way. Part of that means scheduling appointments that are made to evaluate your problems. So one good example to leave with is to say, I love so many patients who will say, oh, yeah, my period's abnormal, but I'm going to bring that up to my OB at my annual. Well, that's not the point of an annual exam. An annual exam, your doctor has 15 minutes to get through a slew of preventive health questions.

Instead, schedule a problem-specific visit, say irregular cycles, go in, but also as a physician, I can only work with the data that you're giving me. So take the time to think through your story. How long has this problem been happening? How did things used to be? When did it change? What's associated with that? Because the first question you'll often hear is, tell me what's going on.

So be prepared for that question. Know your story and come to the table in a way that you can help your doctor out as well. but also you're not married to any physician. And if you're getting dismissed, gaslit, you're not getting what you want. There are a lot of good physicians out there in different health structures. Go see somebody new. Your physician care team or your nurses or your PAs, whoever you're going to see, they have to be advocates for your health as well.

And this is a personal relationship. So do not hesitate, and especially asterisk star star star if you're trying to get pregnant or have infertility. You need to trust that the person who you're trying to get to help you, also understands your goals and is aligned because you don't want to second guess everything. You don't want to be searching the internet. You want to trust that y'all are in a partnership. So if that means sending your records, getting another opinion, please, please, please do that.

And then number three, life is hard enough. There's inflammatory exposures everywhere. Control the factors you can. Everything that we're talking about to say, hey, I want to make sure that I have the highest odds of success, that I'm my healthiest self. Those things do in fact matter. and I hope that information is empowering to people and that we kind of refuse the luck narrative

and instead say, I have more control over this than I've previously been told, and I'm going to leverage that to my benefit. Yes, I'm so, so glad that you brought all of that up. It's so incredibly important. I don't feel like many people, I think the conversation is being had more, but I think so many people go into their doctor

just thinking like, okay, I just have to take whatever they say, and if they don't respect me, and I don't really feel respected by them. I just have to keep going back to them because they're my doctor and no one's ever told you, well, you can change doctors. You don't have to go to who's close to you

or who your friends saw. Yeah. Send your records, go see somebody else, the end. Yes, it should be a symbiotic relationship. And I like to remind people of this because I'll get messages from people all the time and I'll say, well, my doctor's not listening to me. They won't even running these labs.

And I go, sounds like a new time for a new doctor. Absolutely. Get a new doctor. And that's totally fine. I mean, I'll see it on a fertility in two or people are doing IVF cycle or transfer after transfer, they're not getting questions asked. They're doing the same protocol, no changes.

Nobody's really personalizing anything. And that's not normal. But again, to one of our earlier points, if that's all you've ever experienced, you're going to think that's what everybody else goes through. Instead of saying that's not what the normal relationship should be, you deserve to have a health care patient relationship that you feel really good in, that you feel seen and heard,

and somebody who, even if they can't get you all the answers, they're trying and they're giving you the data that you need to make the best choices you can in that moment. So if that means a new doctor, send out records, travel for care, I know that not everybody's privileged enough to be able to do that. But if you can, you deserve that. Yes. I love, I'm so glad that we ended on this. I feel like that's such a good reminder for everybody. Please let everybody know where they can find you. Oh, absolutely. So I am on Instagram at Natalie Crawford, MD, and I host the As a Woman podcast. My debut book, The Fertility Formula, is in pre-order right now. It'll be available in April. I'm so excited. It goes through everything we talked

about, but in so much more, right? So the first section is all educating. What I want you to know about your fertility. Two is advocating when things are off. What should you do or what should you do when you want to get pregnant? And the third section is optimizing. How are we going to leverage decreasing inflammation and the data between that and our fertility? And I practice it for fertility here in Austin. So thank you so much. I'm so excited about your book. I can't wait to get my hands on it. I'm going to get to you as soon as I can. Thank you so much for coming on, Natalie. This was awesome. Thank you. Thank you so much for listening to The Real Foodology podcast. This is a Wellness Loud production produced by Drake Peterson.

The theme song is by Georgie. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can leave us a voicemail by clicking the link in our bio. And if you like this episode, please rate and review on your podcast app. For more shows by my team, go to WellnessLoud.com. See you next time. The content of this show is for educational and informational purposes only. It is not a substitute for individual, medical, and mental health advice and doesn't constitute a provider-patient relationship. I am a nutritionist, but I am not your nutritionist. As always, talk to your doctor or your health team first. If you struggle with bloating gas, constipation, digestive issues, yeast overgrowth, well, you may already know about digest this. It's the podcast hosted by me, Bethany Cameron, also known as Little Sipper on Instagram. I dive into gut health, nutrition, the food industry, and drawing from my own experience.

I break down what's good, what's bad, and what's the best for your gut, your skin, and so much more. I even offer gut-friendly recipes. New episodes every Monday and Wednesday, produced by Wellness Loud.