The Dr. Hyman Show - Acne, Weight Gain, Facial Hair, Hair Loss, Infertility: Is PCOS The Cause? with Dr. Elizabeth Boham

Episode Date: January 25, 2021

Acne, Weight Gain, Facial Hair, Hair Loss, Infertility: Is PCOS The Cause? | This episode is sponsored by Kettle & Fire and Dr. Hyman’s Sleep Master Class PCOS, or polycystic ovarian syndrome, affects between 5 to 10 percent of all women. PCOS symptoms include irregular or heavy periods, acne, facial hair, scalp hair loss, increased belly fat, and increased levels of testosterone. It is also strongly correlated with infertility. While conventional medicine typically views PCOS as a gynecological issue, it is actually commonly driven by things such as diet, environmental toxins, genetics, and more. In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss the Functional Medicine approach to treating patients with PCOS. They delve into topics including the relationship between PCOS and insulin resistance, gut health, and much more. Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well. This episode is sponsored by Kettle & Fire and Dr. Hyman’s Sleep Master Class. Right now, you can get 25% off Kettle & Fire bone broth plus free shipping. Just head over to kettleandfire.com/hyman and use the code HYMAN. In this modern world we place too much value on staying busy and deprioritizing sleep, which is why Dr. Hyman created his first ever Master Class. It guides you through the most important steps to getting better sleep, starting today. Get free access to Dr. Hyman’s Sleep Master Class at drhyman.com/sleep.  In this conversation, Dr. Hyman and Dr. Boham discuss: The continuum of symptoms that can occur with PCOS The role that insulin and insulin resistance plays in PCOS How conventional medicine treats PCOS Common drivers of PCOS, including diet, environmental toxins, genetics, and more The hormone/gut microbiome connection The Functional Medicine approach to treating and testing for PCOS How dairy affects hormones and can cause acne and digestion problems PCOS and infertility Additional Resources The Fertility Diet: Groundbreaking Research Reveals Natural Ways to Boost Ovulation and Improve Your Chances of Getting Pregnant https://www.amazon.com/Fertility-Diet-Groundbreaking-Research-Ovulation/dp/0071627103 A Simple Diet Experiment That May Solve Most Of Your Health Issues with Lisa Dreher https://drhyman.com/blog/2020/08/22/podcast-hc24/ Clara’s Case Study: Overcoming Infertility https://www.ultrawellnesscenter.com/2018/09/05/claras-case-study-overcoming-infertility/ Why Most Everything We Were Told About Dairy Is Wrong https://drhyman.com/blog/2020/08/19/podcast-ep131/

Coming up on this episode of The Doctor's Pharmacy. When somebody's eating too many of the refined and processed carbs, too much sugar, too many of those coffee drinks with sugar in it, you know, juices, sodas, refined and processed oatmeal, you know, cereals, and, you know, pastas and breads and muffins and, you know, those foods that we've been grabbing too much of for some people with some genetics that can really throw off this whole system in their body. Hey, everybody, it's Dr. Mark. With winter in full swing, I find myself searching for warm and nourishing meals that can fit

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go to drhyman.com forward slash sleep and sign up today free. That's drhyman.com forward slash sleep. Welcome to the doctor's pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And today's conversation is going to matter a lot because it's a special house call episode with Dr. Elizabeth O'Han talking about something called PCOS or polycystic ovarian syndrome, which is a super common affliction that affects women that causes all sorts of misery from infertility to acne to facial hair to loss of hair on their head and weird periods. And it's just a miserable problem that affects millions and millions of women. And traditional medicine just doesn't do a great job

at this. So we're going to get into it today and talk about this problem. So welcome. Welcome, Liz. Thank you, Mark. It's great to be with you. All right. Well, let's get into it because this is such a common problem. How many people does it affect? It's amazing. Five to 10% of women are impacted by PCOS. Five to 10% of women. That's a lot of women. I mean, listen, if half the population of America is 330 million, if that's the population, half of that's like 165 million. And 10% of that's like 16 million people. That's a lot of people. And PCOS or polycystic ovarian syndrome is a syndrome that involves irregular periods or not having any periods and androgen

excess or changes in your hormone balance. But it is a syndrome. So that means that there's a continuum where some people have all aspects of PCOS and some people just have some aspects of PCOS. And we can talk more about that. But so there may even be more than this, you know, that we're not even picking up. It's quite common. And it's definitely something we're thinking about all the time when somebody's coming in and complaining about irregular periods or not having had their period for a bunch of months. You know, a young woman that should be having regular, you know, periods. And then you're really heavy periods, they can miss periods, they get life periods. What are the other symptoms that are pretty common?

Yeah. So we see hertutism, which is the growth of hair. It sounds terrible. The growth of hair where women don't want to have it. So on their lip, on their chin, on their abdomen, like in their belly area. So the hair is growing where they don't want to have it. And then they may have hair loss where they want to have hair. So they may have some male pattern hair loss. They get acne. And typically- Wait, wait. So basically they're losing hair where they don't want to lose it,

and they're getting hair where they don't want it and it's because of these high levels of male hormones yes like dhea and testosterone that end up causing basically this male appearance almost yeah their their their hair their hair growth shifts because their hormones shift and so you see the bearded women in the circus that's what this is right yes well they might they some of them may have had some other things going on too, to an extreme, right? But yes, in general, yeah, this is, you know, you're starting to grow hair where you don't want it and not having good hair on the top of your head where you want it. And all because there's been a real shift in your hormone balance in your body. And so when you check, when we actually check, we see high levels, like you mentioned, of that DHE balance in your body. And so when you check, when we actually check,

we see high levels, like you mentioned of that DHEA in the blood, we may see high testosterone levels or high free testosterone levels. And so those are some of the biomarkers that will show up when you look. Yeah. And you also get acne, bad acne. Bad acne. Yeah. And a lot of times like in the lower jaw area acne and sometimes cystic acne. So, and then they'll often gain weight. Now, not everybody with PCOS is overweight. We have, there's a lot of women and we can even talk more about that today. There was a lot of women, and we can even talk more about that today, there was a lot of women who don't have the obesity part of it, and they're just dealing with irregular periods. But for a good portion of women with PCOS, they gain weight because of the high levels of insulin that are going on. So if they have high levels of insulin floating around. So with PCOS, typically there is high levels of insulin.

And we've talked about insulin so many times on this podcast, and you've talked about it many times, you know, but that insulin is that hormone that helps us balance our blood sugar. So you eat a meal, the body makes insulin, that insulin tells your body to take your food and get it into your muscles so it can be used for energy. And what happens when somebody has insulin resistance is their body's not listening to that insulin as well. And they've got high levels of insulin.

And that high level of insulin will cause people to gain weight around the belly. And so we often see with PCOS that weight gain around the belly, that belly weight. Yeah. So this sounds like a miserable condition. You get pimples, you lose hair on your head, you grow a beard, you are infertile, your periods are all over the place. This just sounds terrible.

And traditional medicine has very kind of weird approach to it, because the way I think about it is that it's called polycystic ovarian syndrome, which makes people think it's a gynecological problem, but it's actually a dietary problem. Right. Right. It's often a dietary problem. And, you know, it's not, it's not always dietary, which is so interesting, right? Because we're, you know, we're learning about how toxins from the environment, like BPA and plastics, and we were learning about the microbiome and how that can be a trigger. So toxins and dysbiosis or imbalance in the microbiome are common things that we see.

But toxins can cause insulin resistance. Absolutely. And the microbiome imbalances can cause insulin resistance and prediabetes. So it's all connected. It's all connected. And you're right. And a huge portion of people,

it's dietary as well. You know, where they're, but I think it's important to remember it's not always that, right? But there's a huge portion of people where they're just eating too many carbohydrates, too many refined and processed carbohydrates for their body or for anybody's body. But those high levels of refined and processed carbohydrates really can be a trigger for this insulin resistance and weight gain. And then that

insulin resistance shifts the hormone balance. And then you get this imbalance in hormones and you get the high androgens or testosterone and DHEA, and then the periods get irregular. But interestingly, as a syndrome, it's important that we pay attention to that individual person because it's very different. You may have 10 women in a room with PCOS and you may have 10 really different reasons for why they have PCOS. They're really not all the same.

Yes, it's really an interesting aspect for functional medicine doctors to work on. Right, I mean that just speaks to the whole approach of functional medicine, which is because you know the name of your disease, it doesn't mean what's wrong with you, right? Absolutely. It's just a description of the symptoms, but not the cause.

And so functional medicine is about the cause, it's about why, not what. Not what disease you have PCOS, but why do you have that? Right? And traditional medicine, the symptoms are treated symptomatically. So what are the traditional treatments that you see regular doctors giving for PCOS?

Yeah, so often women will be placed on birth control pills because if they're having irregular periods or they're skipping their period, many times the physician will put them on birth control pills because it will regulate their cycle. They'll put them maybe on metformin because metformin improves insulin sensitivity. It's a diabetes drug. Yeah. And then that can many times help with the weight gain. It sometimes helps with the acne and the hair growth or hair loss. And they'll often put them on spironolactone, which is another medication that helps with balancing the hormones

and can help with some of the symptoms. It's a diuretic and it just blocks the conversion of testosterone to the kind that really causes the hair loss called DHT. But it's really fascinating, but it really doesn't speak to addressing the root causes. So from a functional medicine perspective, what are the root causes for PCOS

and how do we start to deal with these? Yeah, so as you mentioned already, diet is huge. Diet has a huge impact when somebody's eating too many of the refined and processed carbs, too much sugar, too many of those coffee drinks with sugar in it, juices, sodas, refined and processed oatmeal, cereals, and pastas and breads and muffins and those foods that we've been grabbing too much of for some people with some genetics that can really throw off this whole system in their body. Another big common area are toxins. I see this a lot. I see a lot of what I think is toxin related. We know genetics plays a huge role here. We also know that when,

what women are exposed to, um, as a fetus, when they're, when, what has happening to their mom is really when their mom's pregnant with the, with them, um, that really impacts their hormone balance and their metabolism later in life. So what the mom's eating. Yes. She's at Dunkin' Donuts all day. What's fascinating with- Eating the frappa mocha latte all day long with more sugar than three cans of Coke. I mean, yeah, people don't realize that. Yeah. So when they're pregnant with their baby, it's really important that they're paying

attention to what they're eating because if they're gaining too much weight or eating too many refined carbs or not gaining enough weight it's kind of interesting so if they're if they're if they're not gaining enough weight or they're gaining way too much weight or they're eating too many refined and processed carbs and sugars that really throws off the the fetus that baby's metabolism and so you know sometimes you know you know, we tell our patients, you can just blame it on your mom. They call it epigenetics, which in the genes get tagged and messages of, you know, Jeff Bland's called the book of life and where the bookmarks are in the book of life, you've got this whole genetic code, but not all of it gets read, but you can

bookmark different aspects of it depending on what exposures you've had. And we know this from lots of research on epigenetics, that what the mother does, what she eats, what she's exposed to, her thoughts, feelings, all those tag the baby's genes for what happens to them in the future and whether they get diabetes or heart disease or cancer or obesity. I mean, it's all programmed, but that doesn't mean it's not fixable. You can actually modify your gene expression. And that's what functional medicine is all about is changing the environment. Then the big picture of the environment, meaning your diet, lifestyle, toxins, et cetera, et cetera, how all of those inputs affect your gene expression is what functional medicine is about. It's about modifying your lifestyle and your environment to influence

your genes, to change your health in every aspect. Yeah, so for some people, it's harder for them than others. Like some people come in and they're like, it's just not fair. I have to be so much more careful than my friend Susie, right? And it's true, you know, because there are some people. Yes, there are some people that have to be so much more careful with their diet. I mean, we all should be eating a healthy diet, but some people have to be more careful with the carbohydrates than others.

Yeah, I would say, you know, there are a few people who are better adapted to higher carbohydrate diets and there are a few. I know a few of them and those are the ones who stay skinny eating anything. But when you look at the fact that 88% of Americans are metabolic and healthy, almost 9 out of 10 of us have some degree of insulin resistance. Yeah. You know, that should get our attention. It's probably the majority of us who don't do well with a lot of starch and sugar.

Yeah. And there's a continuum, right? Some can do more. Some can do less. Some look at a bagel and they gain weight, literally, because they think about it and their insulin goes up and they put all the fat on their bodies. I want to jump back to something you quickly talked about, which is toxins. And I want you to explain how environmental toxins and what toxins influence hormones

and influence insulin resistance. Because both of those things are going on with PCOS and I think it's something people don't understand yeah um you know this was impacting men more than women but we realized in Agent Orange right so when men were exposed there may have been a few women I don't really know how many women went to Vietnam probably not very many right not too many not too many so when um they were exposed to Agent Orange in Vietnam, they had a much higher rate. They have a much higher rate of getting diabetes with less weight gain, right? So that's when we started to say, oh, this is interesting. There's a real interesting connection between toxins in the environment and our

metabolism and our weight. And then we get diabetes. And they get diabetes. Agent Orange exposure had lots more diabetes. Lots more diabetes at less weight gain. So, you know, I'm just going to make this up here, make up some numbers, but just so people understand, they may have only had to gain 10 pounds or 20 pounds to get type 2 diabetes, where a typical American maybe was gaining 50 pounds before they got type 2 diabetes, you know, just for an example. So they were getting type 2

diabetes with less weight gain, meaning that there was more to it than just the weight gain, right? And that's when we realized that these toxins were damaging probably the mitochondria, right? So that powerhouse of your cells. We also know BPA, that plastic, that's been really well- Bisphenol A. Yeah, really well studied to show there's a connection with insulin resistance. Yes. You know, we've known for a long time about the connection with breast cancer and BPA, but there's also this connection with

insulin resistance and weight gain so that hard plastic um they it's they use bpa in the lining of cans or on receipts bottles baby i know right yeah when you get your credit card receipt your gas station receipt the people say join your system like no thanks okay because i i don't want to constantly expose myself gets absorbed through the skin yeah yeah so you know we realized that this toxin caused weight gain insulin resistance and and i'm sure there's a lot of other toxins that we haven't even you know figured out yet yeah that are really influencing, pretty much all the petrochemical toxins, all the plastics and all the fossil fuel derived toxins are endocrine disruptors. And I read way back when we were at Canyon Ranch, I read a book called Our Stolen Future by Theo Colburn, which was about

the ways in which these environmental toxins were disrupting reproductive health of animals and humans. And I was like, oh my God. and so what's going on is that these are not just one exposure so you're not just exposed to bpa you're exposed to literally hundreds of these in our daily life through our modern living and there are ways to reduce it and i think the environmental working group is a great resource for finding out what household products skincare products cleaning products you know are food products that you can eat that are not going to be full of these chemicals. And you just go to ewg.org. So that's important. So let's talk now about the gut because most people don't really think that your hormones

are connected to your gut microbiome, but it's incredibly connected. Fascinating. It's so fascinating, but they've been, they've shown that there's certain types of molecules from the gram negative bacteria in our gut. So if the microbiome, if all of those trillions of bacteria are out of balance and there's an overgrowth of some unhealthy bacteria in our, in our gut, that the, they have these gram negative bacteria have something on them called lps or lipopolysaccharides that these things can then these components can get into the body and they've shown that this can trigger this insulin resistance in our um in our body so that people when they have higher levels of these abnormal bacteria, will have more insulin resistance. That's absolutely right.

So there's a name for this, we call it metabolic endotoxemia, which is a fancy way of saying that the poison crap in your gut leaks into your bloodstream and your immune system goes, ah, and starts creating an inflammatory response, which then affects your insulin sensitivity. So anything that causes inflammation, right?

Anything, stress, bad food, toxins, infections, microbiome nastiness, all that can drive inflammation that can cause insulin resistance. So you don't even be eating sugar, right? But if your gut's a mess for various reasons, then you have to fix the gut. And also there's a lot of effect on insulin resistance, but there's also other effects in the gut around the kind of bacteria that are there and how they affect your metabolic processing of estrogens and other hormones. So it's really important to eat the

right kinds of fiber and the right kinds of foods and to feed your microbiome and your inner garden. So we've talked about a lot of things. We've talked about diet. We've talked about stress. We've talked about environmental toxins. We've talked about the gut microbiome. All these things play a role. And so the job of a functional medicine doctor is to dig down and figure these things out.

So how do we begin to assess these? And I want you to share a little bit about some cases. But how do we begin to assess these? And I want you to share a little bit about some cases, but how do we assess? Because it seems like a lot of stuff that you go to the endocrinologist or the gynecologist, they're not like looking at your poop. They're not measuring your toxin levels. They're not looking necessarily at insulin resistance very well. What do we look at that's so different here at the Altria Wellness Center and through the lens of functional medicine? I mean, I think that's what's critical about functional medicine. And what we do is we get a really good detailed history. And that gives us a lot of information. So when we take the time to get to know our patient and get all of the

history of their life, their timeline of their life, what things have happened to them, what illnesses they've had, what disruptions they've had, what exposures they've had, what other things are going on in their body, that really impacts where we go and what we choose to look for. So you get a really good history first and foremost, and then that informs you what you want to test. You could test everything, but this ends up being a lot of tests. So what's important is to get a really good history so you know where to ends up being a lot of tests. So what's important is to get a really good history. So, you know, where to really focus. So for one person, it may be, I really got to look at their gut microbiome. I've got to figure they they've got this sort

of history. I think that might be an area that we really have to focus on. I want to look at what those, the balance of the good and bad bacteria are. I want to see if they have maybe some of these lipopolysaccharide components that may be triggering inflammation and insulin resistance. Or maybe somebody else, you know, you've got a sense based on their history and some of their other symptoms that it's more toxin related. Or somebody else, it may be, you know, more lifestyle related. And you've got to just really focus more on breaking that cycle of craving those carbohydrates. Because what happens for a lot of people is it becomes a vicious cycle, right?

They eat the carbohydrates, the real refined processed carbohydrates, their insulin goes up. But then they end up, they gain some weight, then they crave more and more of them. And it becomes this vicious cycle that gets out of hand. And I think that's important. Yeah, it's so important. And we really don't just look at the hormone levels, which a typical endocrinologist or GYN, we look at those too, because they're very helpful and informative to look at the testosterone levels, DHT, and look at DHEAS, and all kinds of things that we look at.

But we also do looking at toxin load, looking at the microbiome or looking at nutrient levels or looking at insulin resistance in ways that may not be looked at. So tell us about the first patient you had who was 20 and she had these really irregular periods and acne and bad digestive issues. How did that all get started for her? Right. So she was 20 when she came to see me and she was frustrated with her, she was frustrated with her acne. She was frustrated with her digestion and her,

she, her periods were kind of all over the place. She had a lot of ear infections as a child. So she was, she was put on antibiotics and then ended up getting a lot of recurrent ear infections, more antibiotics and more antibiotics. And so I think that really just set the stage for her microbiome to be out of balance. And then when she started having her period when she was 14, it never was regular. So from day one, she had an irregular cycle. So always one month, it'd be six weeks, and then two or three weeks, and then she'd skip a month. And then, you know, she'd be eight weeks between periods. So always irregular. And, um, and then as a, you know, I'm not really that surprised just having done this for so long, but she also then in puberty developed a lot of acne. So, you know, probably because of some of the shifts in the

microbiome in her young, young years, and then, you know, just all of these things going on. And you see that a lot. You see kids, you know, kids with a lot of ear infections, maybe she's eating dairy, which commonly can cause a lot of congestion. They throw the antibiotics at the kids and then they get a little older, then they start getting gut issues and they start getting acne and other things. So it's all connected. Yeah. So what we did is, you know, because of her digestive issues and her acne and her irregular periods, I said, you know, I'm really curious about her digestive system. I really wonder what's going on in there. And, you know, could this be the driver of her insulin resistance?

And so we did a test that looks at antibodies against different components in the digestive system. And one of the things it looks at are these lipopolysaccharides, which are on these gram negative bacteria, which as we talked about, has been shown to trigger- These are bacterial toxins, essentially. The insulin resistance. And when we did that test on her, she had really high levels, which means that her levels were high enough to get into the body to trigger this, this,

these antibody levels to occur. So we also did a stool test in the stool test. We showed, it showed that she had an imbalance. She didn't have enough of the good bacteria. She had an overgrowth of some unwanted bacteria. So she had this dysbiosis. And so I said, you know what, this is where we've got to start. This is where we got to focus to help both your skin, well, actually all your skin, your digestive system, and your cycles, your periods. We did see when we did hormone testing that she had signs of PCOS. She had some high level of DHEA and her testosterone was a little bit high. And her LH-FSH ratio was off. So we did see some signs on hormone testing that she had some PCOS going on.

So Liz, when you treated her, you also took her off dairy. Yes. And I want you to talk a little bit about why dairy is bad, both for hormones and insulin resistance and acne, because she had all these problems. Yeah. So, you know, as you can imagine dairy is dairy products both milk and cheese and dairy products coming from a cow are full of hormones you know the the that that cow to make cow's milk is um has a lot of hormones floating around those hormones get into the milk even if it's organic yeah yeah and so and there's more than ones that aren't organic. Yes. There's like 60 different hormones in milk.

Yeah. And so, and some people are very sensitive to those hormones and they will cause acne production. They will cause more acne, more, and then of course people are, a lot of people are sensitive to dairy. Yeah. So it can cause a lot of people are sensitive to dairy. So it can cause a lot of digestive unrest and digestive issues. And what's also interesting to me is that when you look at people consume dairy, dairy will spike insulin pretty high. Yes. A 300% increase

in insulin consuming dairy, which I was sort of surprised at when I looked at the literature. Especially the lower fat dairy, right? Because that, you know, and so for so long, we were going to the lower fat and then we were going maybe to the lower fat chocolate milk in school, right? Because that, you know, and so for so long we were going to the lower fat and then we were going maybe to the lower fat chocolate milk in school, right? You know, all those things that were spiking insulin. And I would say for women with hormonal issues, I think dairy has got to go for most of them to start at least to see how it affects them because whether it's irregular cycles or whether it's PCOS or whether it's acne, whatever is going on, I think it's an incredibly hormonally disruptive food for so many people. And a lot of people can tolerate it fine,

but if you've got problems, you've got to start thinking about what you've got to cut out. And I think what is really helpful a lot of times at the beginning when you're dealing with, when you have a lot of things going on and you're not sure how food's impacting you, sometimes to do a full elimination of a food or a group of foods is really helpful because it gives you a lot of feedback. So sometimes if you just sort of cut down, you don't really go, I'm not really eating much dairy. And I get that all the time. I don't really. After dinner. No, I agree. It's like, it's hard for people to understand that, you know, a little bit can do a lot of damage. And

the way I explain it to people is think about like a peanut allergy. Sometimes if you're just exposed to peanut dust, you can get an anaphylactic reaction. That's how powerful your immune system, it responds to microscopic doses. So I think that's important to remember. So what happened with this young woman? You treated her? Yeah. So because we found this dysbiosis or imbalance in good and bad bacteria, we needed to get rid of the dysbiosis. So we used an herbal combination to treat that. We also gave her a lot of good probiotics and prebiotics, the things that feed the good probiotics. And we took her off of dairy. We also did more of a comprehensive elimination diet at the beginning. So we took her off of dairy, but we also removed gluten and a lot of other inflammatory foods and really focused on

a phytonutrient rich diet. And I think sometimes we don't think about how powerful that can be, right? Those phytonutrients, those components from our plant foods that have amazing qualities in our health, from lowering inflammation to helping detoxification to helping the process of elimination of our hormones that we want to eliminate, you know, so they really are powerful. And so when you help people get those eight to 12 servings of phytonutrients, which come from your vegetables, some fruits, some- Nuts and seeds.

Yes. Spices, teas. Really, that can be really powerful for the body. Yeah. So it's not just about what you eliminate. It's what you add. That's very true. Yeah.

I like to change the name called the very true. Yeah. I like to change the name called the addition diet. Yeah. I like that. So that was very powerful for her. We also added in some inositol, a combination product that has some myoinositol and d-chiroinositol, which actually helps improve insulin sensitivity. So we did this for a while as well. You know, it can help improve the cell signaling in the body and improve how the insulin works. We also really repleted some deficiencies she had. She was low in D, vitamin D,

which we know is important for insulin sensitivity. And she was low in vitamin A, which is important for skin. She was low in omega-3 fats, which is really anti-inflammatory. So we replaced a lot of the deficiencies that we found as well. That's amazing. And then what happened? You know, what was great because her digestion improved. That was the first thing that got better. And then her skin, it got better. And then after a few months, her periods just started to really get regular for her. Yeah. I mean, it's just so, I get, honestly, Liz, I get so angry because

in doing functional medicine for so many years, people suffer so needlessly from problems that do have solutions. And it's not rocket science. It's not like we need to know some great new discovery in medicine. We understand biology enough now using the lens of functional medicine and systems biology, which is now gaining more traction and people are becoming more aware of it. But it's just so disheartening to me that it takes so long for people to get access. And I think I want to just sort of end with a case, a short case study that you had of a woman who had infertility. Because this is a problem that affects one in seven women.

We've covered it before on the podcast. But I think I want to dig into this particular cause because it is one of the most common causes and also easily remedied. And I can't tell you how many women that I've treated personally. I know, sure, you have who have this problem and you fix it and then they get pregnant. Yes, we see it all the time. It's phenomenal. So this woman was 34 and she came to see me because she was trying to get pregnant and she had been trying

for three, four, four plus years, I think, and had not gotten pregnant yet. And her periods were really irregular. And she was 34, so she was getting closer to that age where she was getting really concerned about the fact that she hadn't gotten pregnant yet. And, um, she also noted that over the last few years, she had been, she had gained some weight. She was about 20 pounds overweight. Most of that weight gain was around her belly, which was making her frustrated, you know, and, and she didn't really feel like she was doing much different anymore. She also had to get some laser therapy done. So to remove the hair on her chin and on her belly. So she had had some laser therapy done.

And she was also struggling with acne. She was on birth control pills from the age of 17 to 29 to really regulate her period. But when- I hate that. I hate that. When I hear that sentence, oh, my doctor put me on the pill to regulate my period. I'm like, well, why is it irregular? And let's figure that out instead of just slapping you on the birth control pill, which

is not side effect free. Right. No, it's not. No. And so, but when she went off of the birth control pills, her periods were irregular since then, and she developed a bunch of acne. So you know, she really came in to really for us to help her with her fertility. And so we did testing and we found that her testosterone level was high, her DHEA was high, her LHFSH ratio was

off. And her insulin, her fasting insulin was really high. So her fasting insulin was 13. And, you know, we really want that to be like five. Yeah. So it was really, it was high. And to me that signaled, okay, that this was an area that, you know, she's got insulin resistance, she's got PCOS, and that's really what's driving all of these things that she's dealing with. And so when I got her diet history, which she filled out when she came to see me, she

said she was trying to eat healthy. She was having oatmeal for breakfast. She was having that refined oatmeal that so many people are eating thinking it's healthy, right? Sandwich for lunch. And at dinner, she'd have some pasta with some chicken or vegetables on it. And so that's really where we focused. We really worked to lower that carbohydrate intake for her. We pulled away those extra refined and processed carbs.

Oatmeal, you think is healthy, she's having her breakfast, but it was not so healthy for someone like that. No. And especially a lot of the oatmeal's out there, you know, and the way that we eat them. Like if we're eating a bowl of oatmeal with not a lot of other stuff in it, there's none of the, you know, good, healthy fats and, and protein to balance that blood sugar. Right. So, you know, you can have some, you can have some steel, a small amount of steel cut oats with a lot of, you know, nuts and maybe some coconut milk. And, and, and, and that can you, you know, for some people that can be a healthy breakfast, but for her, that's not how she was eating her oatmeal. And it was, it was spiking her blood sugar and it wasn't helping with her, with her

weight. It wasn't making her feel satiated and satisfied. And it was, yeah. So what did you do? So we really, you know, food first with her, we, we put her on the pegan diet, right? You know, we pulled away the, um, the extra refined carbs. We said, we, when you're getting your carbohydrates, we want them to come from vegetables. You know, that's where you're going to be getting most of your carbohydrates from, from the greens and the broccoli is a carbohydrate. Yeah, exactly. It's a wonderful, healthy carbohydrate, you know, and, um, and,, and really rich in all those phytonutrients. We work to balance her blood sugar.

So she had a good protein source and fat source at every meal. And, and we got her exercising, you know, she had really kind of just, she was really focusing more on the fertility and working and had kind of like, let that go. So we got her on a good exercise program, both that included some high intensity interval training and some good cardiovascular exercise and strength training. She was a healthy woman. So we just had to get her moving again more intensely. And within a few months, three months or so, she lost that extra 20 pounds, Her periods regulated and she got pregnant.

That's unbelievable. So basically, these are people who go to fertility doctors, spend tens of thousands of dollars. And what you're saying is all you do is take a good history and get all the starch and crap out of her diet and sugar, got her moving a little bit. She lost 20 pounds. Her cycle's regulated and she got pregnant. I wish it was this easy for most people. Some people, it's a little more complicated, but you'd be surprised at how many people just following this simple approach can make a

huge difference. There was a book by one of the top Harvard scientists of all time, Dr. Walter Willett, called The Fertility Diet that really focuses in on this whole idea of why we have so much infertility and why it's such a problem. So this is an area where I get nuts because from a functional medicine perspective, it's relatively straightforward to sort through this using a very detailed history, the right kinds of diagnostic tests that you wouldn't get at your regular doctor, using a food first lifestyle approach fixing the basic things you need to get fixed whether it's diet toxins you know allergens low-grade gut issues that all can drive problems uh and we just see amazing results and it's so satisfying and you know i think your work is just so incredible liz and i'm just so happy we're all here at the ultra wellness center

because we get to see miracles every day. And they're really not miracles. They're just application of good science. But they seem like miracles. And I'm just so happy to be able to do this and provide this in the world. And I just want to thank you for your amazing work teaching functional medicine all around the world, virtually now, of course. But you really have been a leader in the field. And we have probably over 60 years of collective experience here at the Ultra Wellness Center

in Functional Medicine. So if you're suffering from any of these issues, we'd love to see you here at the Ultra Wellness Center in Lenox. We can do all virtual visits now. People can't make it here in person. And we'd love to see you. So if you love this podcast, please share with your friends and family. Share on social media.

Leave a comment. And maybe you've struggled with fertility or PCOS, and how have you solved your problems? And what have you found? And subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Pharmacy. Thank you, Mark. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from.

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This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.