The Dr. Hyman Show - How To Balance Women's Hormones With Lifestyle And Diet

Episode Date: November 27, 2023

This episode is brought to you by Rupa Health, Bioptimizers, and Paleovalley.  Contrary to popular belief, women cannot follow the same health and fitness protocols as men and expect the same results. Unlike men, women in their reproductive years have specific hormonal considerations, and their rise and fall throughout the month impact everything from energy to focus, mood, metabolism, and the ability to adapt to good-for-you stressors like exercise or fasting. Meanwhile, perimenopause and menopause pose a whole other list of considerations to keep women feeling well. In today’s episode, I talk with Dr. Mindy Pelz and Dr. Sara Gottfried about why we need to prioritize teaching women about their hormones. Dr. Mindy Pelz is a renowned holistic health expert and one of the leading voices in educating women about their hormonal health. She has empowered hundreds of thousands of people around the world to tap into their bodies' innate healing abilities through her “5-Step Approach,” which uses fasting, personalized nutrition, stress management, chemical detoxification, and lifestyle changes to optimize health and slow the aging process. Dr. Sara Gottfried is a board-certified physician who graduated from Harvard and MIT. She practices evidence-based integrative, precision, and Functional Medicine. She is a Clinical Assistant Professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her three New York Times bestselling books include: The Hormone Cure, The Hormone Reset Diet, and Younger. Her latest book is called Women, Food, and Hormones. This episode is brought to you by Rupa Health, Bioptimizers, and Paleovalley. Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free live demo with a Q&A or create an account at RupaHealth.com today. During the entire month of November, Bioptimizers is offering their biggest discount AND giving away amazing gifts with purchases. Just go to bioptimizers.com/hyman using code hyman10. Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal. Full-length episodes of these interviews can be found here: Dr. Mindy Pelz Dr. Mark Hyman Dr. Sara Gottfried

Coming up on this episode of The Doctor's Pharmacy. We have more physical stressors, emotional stressors, chemical stressors. The world is packed, as you know, with endocrine disruptors. The hormonal problems are getting bigger and bigger and bigger. Hey everyone, it's Dr. Mark. They say knowledge is power, and that's definitely the case for those of us who are functional medicine doctors or practitioners. We need the right data to determine and eliminate the root cause of our patient's health issues. But that often means

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hymen. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. 75% of women experience symptoms of PMS, such as mood swings, irritability, depression, anxiety, fluid retention, bloating, breast tenderness, sugar cravings, headaches, and sleep disturbances. But just because you're a woman doesn't mean you have to live with these symptoms. There's no one-size-fits-all approach to hormonal health, and in collaboration with your practitioner, the right hormonal plan for you will consider your stage of life and overall lifestyle factors. In today's episode, we feature three conversations from the doctor's pharmacy about why it's vital for women to learn more about their hormones so they can remain comfortable and

vibrant at all stages of life. Dr. Hyman speaks with Dr. Mindy Pelz about testing hormone levels and how fasting impacts hormones. Dr. Hyman discusses why women's hormones are more sensitive and how to deal with difficult symptoms. And he speaks with Dr. Sarah Godfrey about what foods to eat to balance your hormones. Let's jump in. The biggest challenge we have right now with hormones is that we are hormone illiterate. So this is women, this is doctors, this is men. We just don't understand our hormones, both men and women. But for women, this is a massive problem because our hormones run and regulate everything from our menstrual cycle, obviously, but also our appetite, our moods, our sleep, everything is driven through hormones. In fact, when you actually look at the word

hormone, it comes from the Greek word meaning to excite. It actually is what will initiate chemical reactions within the cells. So you have to have your hormones in balance in order for your cells to do the job they were meant to do. But when we look at the collective societal way that we approach female health, nobody's being taught how to live a life that works with these hormones. So my passion started when I started seeing my own patients suffering with perimenopause and menopause. I started having my own experiences. And to your point, when you opened up this conversation, there was really only one solution. Well, there was two, and that was don't do hormone replacement. It's very scary and take the birth control pill. But there was no education about what our hormones were and what lifestyle we

should be using to match to the hormonal fluctuations that happened to us, not only monthly, but also throughout our lifetime. So it's really the lack of fluctuations that happen to us, not only monthly, but also throughout our lifetime. So it's really the lack of knowledge that has us in the place that we are at as far as women's health goes. Yeah, I like that concept of hormone illiteracy because I really think it's true. I just am shocked at how even endocrine experts, you know, they know what they know about what they know, but in terms of how do we impact hormones without using drugs, it's kind of like, what? You know, and I think it's really one of the most gratifying parts of my practice and functional medicine is seeing the power to transform women's lives from painful periods,

from heavy periods, from irregular periods, from PMS, from fibroids, from infertility, from perimenopause, from menopausal symptoms, all of it, sexual dysfunction, libido issues, weight, metabolism changes. All these things are not inevitable parts of being a woman. And I think about it, you know, I joke, you know, 75% of women have some form of PMS. Like, was that just a design flaw? Or is something actually going on here that we can address and get rid of it? Yeah. So on that note, you bring up such a good point. There are two major issues that are going on for women. One is this illiteracy problem. I can't tell you how many women that I've talked to that don't even understand when estrogen comes in during their cycle, when progesterone. Most women don't

know that they get testosterone in a big way only at one point of their whole cycle. So we have this lack of knowledge, not only with women, but doctors, like you said as well. But then we are in an evolutionary mismatch with our hormones. So we have more physical stressors, emotional stressors, chemical stressors. The world is packed, as you know, with endocrine disruptors. And so the hormonal problems are getting bigger and bigger and bigger because the world is getting more and more toxic, not just from a chemical level, but from an emotional level. And then we don't we don't understand ourselves. So we have this mismatch that's happening and it's creating this hot mess for women.

So talk about this. Talk about why are women's hormones so screwed up? And by the way, men's are, too. I see like 20 and 30-year-olds with testosterone levels of like 80-year-olds. And I'm like, what is going on here? But a lot of it's due to poor metabolic health. So let's talk about women because it's a little more complicated with women. It's not just about bad diet. It's about a lot of things that are influencing their hormone function. Well, I mean, each hormone is going to have a different thing that's messing it up is

the way that I look at it. So I think the best place to start this conversation is to realize that men are really driven by one hormone, which is testosterone. And testosterone is made in the outer layer of the testes, goes up to the brain and converts to estrogen. Women, we've got testosterone, progesterone, and estrogen made in not just the ovaries, but the adrenals and some of the peripheral tissues. So we have to really address different lifestyles when we're looking at these different hormones. So when we look at why women are struggling right now, a large part of that is there's a one-size-fits-all approach to healthcare.

I walk into my doctor's office. I have high cholesterol. now, a large part of that is there's a one size fits all approach to healthcare. I walk into my doctor's office, I have high cholesterol, I have high glucose or high insulin, and we're never asked what part of our cycle we're at. So we have a real challenge just being able to get medical care that can bring in this hormonal picture. So more women are suffering. I don't know if you saw the New York Times article on menopause recently, but one of the things that really stood out to me is that there was this line where they said that we have a societal acceptance of women suffering with their health. Yes, a hundred percent. A hundred percent. I'm like, you don't need to suffer. Absolutely.

So a woman, when she's suffering, goes into the doctor's office and they're given a one-size-fits-all approach. So we have that issue. The second issue we have, and this is a big part of what I'm trying to teach women, is that when you look at your menstrual cycle, estrogen has vastly different qualities and lifestyle habits she wants us to live by. And whereas progesterone completely wants us to do something different. So let's just use cortisol as an example. Estrogen is pretty forgiving of cortisol. If you decide to run a marathon or do a really long fast when estrogen is coming in, it's not going to really affect estrogen too much. But progesterone that

comes in the week before your period, it does not like when cortisol shows up. When cortisol goes high, progesterone goes shy, like she's out. She's not going to make her appearance. So then we start to see women losing their periods and then, or having really difficult periods once they start because of the lack of progesterone. And that's just, that's just with cortisol alone. We can do the same thing with glucose, insulin. I mean, you can take, you can take exercise. We should be exercising according to our cycle, but we have to look at these three hormones through the lens of our lifestyle to get them back in balance. Yeah, it's so important. And I think there's a lot of other things that affect women's

hormones too. Obviously the stress, sugar in our diet, alcohol, environmental toxins, sedentary lifestyles, all these things affect our hormonal balance. And there are things that we can usually do something about. Toxins in the environment, we can reduce our exposure. It's a little harder, but pretty much everything else, whether it's smoking or caffeine or alcohol or sugar or how we manage stress or sleep, all these are things that are within our control. And I've seen so many patients just recover from years and years of misery

and thought they just had to live with PMS or thought they had to live with PMS or thought they had to live with all these menopausal symptoms. And, you know, it's important to realize that you actually can fix it. How do we decide, you know, when you need to use hormone therapy? What ways that we can use lifestyle that actually work better than hormone therapy, whether it's the pill pre-menopausal or hormone replacement after, you know, what, what are the things you're finding as you're, as you're helping women through this process of regulating their hormonal dysfunction with, with food and lifestyle?

So my philosophy is always lifestyle first, do lifestyle, clean up your lifestyle, and then see if you need the medication or you need the hormone therapy. So that's my approach. Now, what is a big challenge that we have right now is that I strongly feel as our hormones start to decline around the age of 40, that our lifestyle has to dramatically change. And this is another piece of education that's not getting out to the world.

And so there are five things that I recommend women over 40 start to do. Fasting is one and cycling their fasts, going in and out of high carb, low carb and making sure that, yeah. So going into low carb so we can balance estrogen and then going into higher carb so we can keep the thyroid happy and we can keep progesterone happy. And then making sure you're eating enough protein for sure. And then the third one is you got to, most women, when they get into their forties, they've got to repair their microbiome. They've been on birth control for decades. They've been on multiple rounds of antibiotics and steroid use. Their microbiome is

in bad shape. And you need that as you move into those perimenopause and menopausal years. And then you mentioned it, detox is another one. We got to start teaching women how to look at all their beauty products and what are they doing for detox in general. And then the last one is what was actually a phrase coined by Dr. Libby Weaver, and it's called Rushing Woman Syndrome. We got to bring in more mindfulness tools. We've got to learn how to chill out a little bit more. And so we got to start with those five steps first. And then if that's not course correcting, now you can go in with more success, whether you choose bioidenticals or hormone replacement, it's up to you. But we've got to stop looking at those tools as being this, I'm going to absolutely do it or

I'm not going to do it. Because as we go along the journey, there may be a time you want to pull it in, but you're still going to have to fix your lifestyle. Yeah, there's no way around that, for sure. I think a lot of people just don't realize how powerful it is. And it works better than most medications. And I can't tell you how many women I've helped with all sorts of hormonal disorders from menstrual issues, PMS, heavy bleeding, painful periods, cramping, to really more serious issues like fibroids and infertility and PCOS. And it's just amazing when you start to apply these principles that a lot of women out there who struggle with these issues can get better and not using hormonal therapy. Right, right. And I know this is like a hot debate right now, especially amongst women's health groups is really this idea of should I do hormone replacement? Should I not? I know we're looking at it a little different. But what we have to realize about hormones

is that there is the production of a hormone, then there is the breakdown of a hormone, and then there's the hormone being able to get into the cell. So if all you're doing is focusing on the production of a hormone through a medication or through a hormone therapy, you're still got to have a good microbiome to be able to break that down. You still got to have a great functioning liver to break it down. And you got to still detox so that hormone can get into the cell. So this is why it doesn't matter if you're going to do it or not do it.

It's a personal choice, but those five steps have to be considered. Otherwise, you're going to end up in one of those situations where you're like, I took it. It's not working. And women, as women, unfortunately, what we do is we start thinking it's our problem. Yeah, it's our fault, right? It's our fault. We did something wrong. And that has to stop as well.

Totally. Amazing. So, you know, where do women start? How do they sort of start thinking about working on this for themselves? How do they begin to begin a strategy? What are the steps they should take? You know, you have this five-step program. Kind of walk us through what it would look like.

Yeah. So the first place, it depends on your age. So this is the other complicated thing about talking about women's hormones is that we've got women that are in their fertile years, you know, the twenties, thirties, teens, twenties, thirties, we've got the perimenopausal years, the forties, and then we have the postmenopausal. So the first is you got to know where you are and what your hormones are doing. If you have a cycle, make sure that you're tracking your cycle. I'm also a huge fan of a urinary hormone test so that you know where your hormones

are at. Highly recommend that because then you know what you need to work on and you can get to know these. This is why I call them the personalities. Like we got to get to know the personalities of these hormones and when they're showing up, like progesterone is going to make you really hungry and crave carbs and, and estrogen, estrogen is going to make you very verbal and want to go out and, and, you know, and, and put your party hat on and be out, you know, socializing all night long. And, and testosterone is going to spike your libido and increase your motivation and drive. So get to know these personalities because they're coming in and out every single day. Once you know that, now how do you pair your lifestyle? And this is the five steps that I wrote. I actually wrote that in a book called The Menopause Reset.

And so that was my book before Fast Like a Girl. It's all written out there. But start to take these five steps and ask yourself, am I fasting? Am I varying my foods? Am I working on my microbiome? Am I detoxing? And am I slowing down? Start there. I mean, that could be a decade. That could be a long time working on that. And then from there, you can start to figure out, do I need to supplement? Do I need to med use, you know, go into more hormone therapies from that point you can navigate. And, and it's not, you know, it's not a linear absolute approach. And, and this is perhaps why we have been giving women one size fits all because, because it's much easier for the doctor to say your cholesterol is high, your blood pressure is high, take this medication, then hey, you're going to need to eat different. You're going to need to vary your fast. You need to stop stressing, repair your microbiome and detox. Most women are like,

what? I have to do that? Right. Right. It's a lot, right? It's a lot, but it's where health exists. I mean, it's, it's, it's putting the responsibility back on us. And, and, and, and then the other part of that is all of us. I love this idea of women doing health as a community, because when, when we are in community, we're raising oxytocin. And when you bring oxytocin up, you bring cortisol down. And when you bring cortisol down, you regulate insulin, and now you can regulate your, your sex hormones. So women are so good at connecting in community. Let's do it all in a community and learn from each other and share our stories with each other. I love that. I love that. I think it's really important because I think when people feel isolated, they feel on their own. They feel like they just have to figure everything out,

you know, and that they're not getting the answers they want from their doctor. And I'm curious, like, why do you think it is that the medical system is just so blind to hormonal regulation? Hey everyone, it's Dr. Mark. Inflammation is at the root of virtually every disease, whether you're talking about brain health, digestive health, joint pain or arthritis or metabolic disease, it all comes back to chronic inflammation. So if you're looking to improve your overall health, it starts with reducing unhealthy levels of inflammation in the body. And that's why I'm excited to introduce to you Paleo Valley's Turmeric Complex. Turmeric is one of the most potent natural ways to encourage a healthy inflammation response in the body. Their supplement is packed with turmeric plus a whole

host of other beneficial compounds that support joint, brain, cardiovascular, and immune health. I love Turmeric Complex because it contains turmeric in a whole food form, which has been found to be more powerful than isolated curcumin, while also containing nearly 300 other beneficial components. Plus, it includes coconut oil and black pepper, which have been shown to increase absorption of turmeric by 2,000%. Right now, my listeners can get 15% off the entire Paleo Valley store, including Turmeric Complex. So just head over to paleovalley.com forward slash Hyman to take advantage of this deal today. And now let's get back to this week's episode of The Doctor's Pharmacy. Well, I think the first part is that we look for absolutes in our healthcare system. You have this symptom,

I'm going to give you this diagnosis and I'll give you this pill or surgery. So it's very linear like that. I call that more of a patriarchal or masculine approach to health. When we look at a more feminine approach, and I love this, I actually heard Sarah Blakely speak last year and she was saying that one of her desires was to bring a feminine approach to business and be able to integrate the masculine and the feminine together in business. And she believes that that was one of the reasons why Spanx was such a huge success. I would say the same thing needs to happen with healthcare. We need to bring the feminine back

into healthcare. And what that looks like is us understanding our own natural cycles and then not giving our power away to the doctor and just saying, hey, here's my symptoms, tell me what to do, but actually to start to collaborate with our doctors and say, tell me why this is showing up at this part of my cycle. Tell me what I can do that affects the different aspects of my cycle and become educated and have an educated conversation with your doctor. So I really see an integration of the feminine, the masculine together that's going to change this conversation within the doctor's room. But what's happening is within the doctor's room, it's absolutes, it's guilt, it's shame, it's one size fits all. That has to stop. And it's not their fault, honestly, because I never learned about any of this in medical school.

And I think one of the things I'd love you to talk about a little bit is hormonal testing, because I think we don't know how to manage hormones through testing, whether it's saliva testing, you mentioned urine testing, blood testing. What's the best way to get a handle on hormones? There's the Dutch test, there's urinary estrogen metabolites, there's blood work that you can do to look at hormone levels. Talk us through some of that. Yeah. So if you're a cycling woman, a blood test is not that helpful for you. I think that your door in is more a Dutch test. I'm a huge fan of the Dutch test. In fact, I don't know what your feelings are on the Dutch test, but I feel like if we could get a Dutch test into every

woman's hands, somewhere around in her thirties and her 40s, she could really start to see if her lifestyle was working for her or against her. And one of the reasons I love a urinary Dutch test over a blood test is that it can tell me the estrogen metabolites. And the estrogen metabolites are how is your estrogen breaking down? So you can go and get a blood test and your doctor might say, oh my God, your estrogen is so high. You, it's probably coming from toxic estrogen, maybe an estrican, an endocrine disruptor. But when we look and compare that to a Dutch test, which we've done a ton in my clinic, we start to see, well, maybe, maybe it's high because you've been eating really well and you actually have a lot of the good protective estrogen and not as much of the bad estrogens.

So the Dutch just gives us so much more than a blood test. And that's a saliva test or is that urine? It's a urine test. Yeah. It can be both. You can, saliva is really for adrenals. A lot tells us a lot more about adrenal function, which is also important for hormonal health. Yeah. I mean, it does attest so much to all the cortisol hormones. It attests the sex hormones. It gives you a really pretty good picture of where things are.

And it depends on where you do it in your cycle if you're premenopausal, right? Yeah. So that's the other thing is Dutch will have you do it somewhere between day 17 and day 21 so that we can see what progesterone is doing which is really really important you also get like dhea levels you get you get a organic acids test with it now so you can see dopamine and norepinephrine these are things you just don't get on a blood test. You're just getting a big, broad picture, whereas Dutch is giving you the details. And so what exactly does the Dutch test look for that's different than you'd get on a regular panel of hormones that

your doctor would check like FSH, LA, estrogen, estradiol, progesterone, testosterone? How is it different and why is it better? The way that I look at it is I think the Dutch is more functional. So remember, if we go back to this idea that hormones need your gut, they need your liver, they need the support of the other hormones. So we can't, when we just look at LH, FSH, and we just give it a big, broad picture, we're not really looking at the supporting actors. Let's put it this way. If estrogen, progesterone, and testosterone were the stars, we need to know what the adrenals are doing. We need to know what the liver is doing. We need to know what the thyroid is doing to affect that. And that is what the Dutch gives you as opposed

to a blood test. And it measures different things too, right? It measures different kinds of sex hormones, not just the ones we typically look at, right? Yeah, so it looks at major ones are estrogen, progesterone, and testosterone. It looks at cortisol. It also will tell you your cortisol pattern, which is super cool because you can see if your pattern of when cortisol comes in

is actually in regulation with what is the circadian rhythm of the day, what is actually supposed to happen. We've read thousands of Dutch tests in my clinic. And one of the biggest things we see is that women will have high cortisol at eight o'clock at night and very low cortisol at when she wakes up in the morning. And no wonder she can't sleep and she needs coffee to wake up in the morning. So it's really helpful for showing you that pattern. And then it also will show you methylation pathways. So we can see like, are you able to detox efficiently? Or is your body working really hard to detox? Or maybe it's been exhausted because it's been detoxing too much.

So, I mean, I could go on and on. There's so many nuances in the Dutch test that you just don't find anywhere else. It's unfortunate, but women have to suffer a lot more hormonal chaos than men for a lot of reasons. Their hormones are changing all the time with menstrual cycles, with menopause, with puberty. They're much more sensitive to environmental toxins and how those impact hormonal function.

They're much more affected by stress. They're much more affected by alcohol, by dietary changes, by lack of exercise, by smoking. All these things mess up hormones. So it's important for me to understand what their hormones are doing, how they're affecting them, why they feel what they feel. And we see, you know, incredible array of hormonal disorders in women that cause so much suffering that really isn't necessary. You know, women should not have screwed up hormones that cause all sorts of symptoms like PMS or fibroids or PCOS, which is polycystic ovarian syndrome or infertility or menopausal symptoms, or menstrual cramps. I mean, these are things that are not a design flaw in humans. It's because of how we're living

and what we're doing, and then we have agency over. So I've written a lot about this. I used to be a doctor at Kenya Ranch, and basically that was my whole population was women between like 30 and 60. So I got a really good sense of what's going on and was measuring a lot of hormonal tests and could see changes over time. Think about it. 75% of women have some PMS symptoms, which is nuts. Why is that something women have to suffer from? It's not. And I had a patient recently who had severe menstrual cramps and things were really out of balance for her. And she didn't really realize what was going on and there's ways to fix that. So we were able to fix it for her, change her diet, adjust a few things, and she has no more menstrual cramps.

So the body has an incredible capacity to repair and heal. We just have to know how to activate it. So what are the tests we look at for women? A few of the same ones, but also different ones. We look at estrogen. We look at progesterone. We look at also testosterone. We look at DHA sulfate. We also look at pituitary hormones like FSH, LH, sex hormone binding globulin, and a few others I'll talk about in a minute. So that gives us a really complete picture and know what's going on. So we can tell, for example, if women are having something called estrogen dominance. This is a really common condition in the world because a lot of things we do cause us to produce too much estrogen in relation to our

progesterone, particularly in menstruating women. And even postmenopausal, by the way, postmenopausal women can have high estrogen levels. And what causes high estrogen levels? Well, sugar and starch. Okay, they're the problem. We know that. If you listen to me, you know that's kind of basically a good problem for everything. too much sugar and starch raise um insulin which causes more fat deposition more fat leads to more estrogen production because you're there's something in your fat cells cause called aromatase which actually uh causes your sex hormones to turn into estrogen that's what happens to men too their estrogen gets converted i mean their testosterone gets converted. I mean, their testosterone gets converted to estrogen. So when you have too much fat tissue, particularly belly fat, you get higher levels of estrogen. If you drink alcohol, it poisons your liver and you get higher levels of estrogen.

If you don't exercise, you may have higher levels. If your gut is not healthy and you don't have enough of the healthy bacteria in your gut and fiber, you might increase your estrogen levels by recirculating estrogen that you excrete from your liver into your body and raising your estrogen levels. It can be because of stress. Cortisol will increase estrogen levels. Certain environmental toxins will do that as well. There's a lot of things called xenoestrogens, which are environmental toxins, like all the plastics and pesticides and petrochemical toxins, all can screw up your estrogen levels. So we really need to understand that our hormones as women, I'm not a woman, obviously, but women's hormones are highly variable, change over their life cycle, and are highly influenced by our lifestyle and what we do.

So we have tremendous agency over changing those things and figuring out what to do about them. So knowing your numbers is really important when it comes to this. And we see, for example, if I want to know if a woman is having like estrogen imbalance and they may be having heavy bleeding, they may be having clots, they may be having menstrual cramps, they might be having fibroids or maybe all these issues. And I know that might be high estrogen. So I want to check their estrogen and progesterone ratio. If they have high estrogen and low progesterone relatively, that's a problem. I also can look at the other numbers like LH and FSH. This is common if you have a woman with PCOS, which is really common. It's a cause of infertility. But we'll see with those women, a high level of LH and FSH being low. So the ratio of LH to FSH goes up, and that's a clue

that there's this problem of PCOS. So we can tell a lot from these numbers, from the patterns in the numbers. We also look at something called prolactin, both in men and women, and this is a pituitary tumor that has a broad impact on our health and is influenced by many factors. And we've actually found people with tumors in their pituitary that are benign tumors, but they actually produce prolactin, and that can cause all sorts of health and metabolic effects. So it's important to kind of get a picture of these numbers. We also look for women also at the IGF-1 for the same reasons.

And we also look at another test that's unique to women called antimalarian hormone. Antimalarian hormone is a great indicator of your fertility. The higher the number, the more fertile you are. The lower the number, the less fertile you are. So a lot of women wanting to know their fertility status can actually get this test. Also, we also check testosterone because just as we check estrogen in men, we also check testosterone in women. And a lot of women tend to have low libido or low sexual function or decreased arousal, lower orgasms. And that all can be because of hormonal effects. And I'll often treat people directly with hormonal therapy with this

or with other things that boost testosterone. But it's fixable. And sometimes, you know, lifestyle can be very effective, as we mentioned. And sometimes you need bioidentical hormones, both for men and women. So I will prescribe hormones for men, testosterone. I will prescribe a combination of hormones for women, estrogen, progesterone, testosterone, depending on what they need. But it's very personalized and it's very individualized. So in the guide that you get with your function

report, you actually get to know, you know, what are the things you can do about these numbers, but it's really about finding the nuances. And then there's a lot of supplements that can help both with men and women. There's a lot of supplements that can help, both with men and women. There's a lot of great supplements that help with libido and sexual function. Also for women, same thing. A lot of women can take herbs to help with regulating estrogen and progesterone imbalances, with various kinds of hormonal disorders. For example, Chaseberry is great for PMS.

There's other therapies we use. But it's a combination of things. In a perfect world, look, I'd be seeing millions of patients, billions of patients, ideally. I've had so much experience, but the truth is I'm just one doctor. And the conventional healthcare system is already buckling under the weight of so many sick people who aren't able to access good access to healthcare. In fact, there's, I think, over 100,000 physicians shortage, nursing shortages, and we have so many sick people in America, six out of 10 are of chronic illness, 93% are metabolic and healthy, 75% overweight, one in two have diabetes. I know it's depressing, right?

But here's the deal. Most of those things are entirely preventable or even reversible using a comprehensive approach that deals with the root causes, addresses the lifestyle factors, and are things that you can do on your own and don't need a doctor. What are the hormone balancing foods that we should be eating? Well, they're the things that help you with your hormones. So that includes making sure that you're getting healthy fat. So my recommendation for four weeks is to increase your healthy fat so that it's about 16 to 70% of your calories. 60 to 70? 60 to 70% of your calories per day.

And this is for a few reasons. We know that fat is the backbone of hormones, the sex hormones, as we described. It also helps with decreasing gastric emptying. So it makes you feel fuller. It helps you with decreasing gastric emptying. So it makes you feel fuller. It helps you with satiety. It's part of this process of nutritional ketosis where you make ketones, you feel more satisfied. But when you combine that with dialing in your carbohydrates. So what I really like for patients to do, for people who read this book to do, is to get your carbs so that it's less than 25 net carbs per day.

That's low. It's low, but if you're really eating carbs that are from vegetables and you've got that fiber that comes with the vegetables, especially the cruciferous vegetables, broccoli, cauliflower, radishes, and you've also got those methylating vegetables that help you to inactivate the Homer Simpson type of estrogens. That's what really allows you to get into nutritional ketosis. And that's the protocol that's in the book. And then the remainder is protein, a moderate protein diet, about 20% of calories from protein. Yeah. That's really quite different than the American diet,

which is kind of the opposite, right? It's about 60 to 70% carbohydrates that are mostly starch refined processed foods and about 20% protein or maybe 20% fat. So that's a big shift. And I think it creates a lot of changes for people, not only will they lose weight, but they have mental clarity, more energy, they'll build muscle, they'll lose body fat, they'll build bone density, they'll reduce inflammation. Everything gets better, right? And it's- Yeah. I mean, the SAD diet gave me prediabetes. It doesn't work in terms of metabolic health. And so the work I do is precision medicine. I think it's important for us to be thinking in terms of how to personalize diet. So nutritional ketosis is not for everyone, but for people to try it for four weeks to

see how sated they feel when they're producing ketones, where they've got that mental acuity from this particular set of macronutrients. And then to see the metabolic flexibility that it creates so that you can flip back and forth based on the type of fuel available between burning glucose or carbs and burning fat, depending on what you're eating, what's available. That's what really works for people. Can you talk about this idea of metabolic flexibility? Because I think it's fascinating. And I think it's something we really don't talk much about. Yeah. Metabolic flexibility. I think of like a hybrid car. So, you know, one of my first hybrids was a Prius and you could flip back and forth between burning gas or burning electricity. And the body is very similar. You

can either burn carbs, which I think of like gas, or you can use the electricity pathway, which is burning fat. And so of course, the fat is more renewable. We've got more of it. And so what's important for folks to realize is that you want to toggle the switch back and forth depending on the type of fuel that you have. So for me, this morning, as an example, I haven't had any food yet and I'm burning fat. So I've got ketones. I feel satisfied. I don't feel hungry.

I've got mental acuity. I'm able to focus. And that's hardwired into our DNA. Now, when I was eating more carbs, what I found was that I was hungry when I first woke up in the morning. I had more sugar cravings. My insulin was out of whack. It was too high. I was stuck in fat storage mode.

It just didn't work very well in terms of trying to live the deep life that I want to live. Yeah, sure. Yeah, so you got all out of balance. And, and, you know, what's interesting is that, you know, the, this sort of talked about a little bit, but the cocktail of hormones that go awry in women's forties and early fifties is, it's really not well recognized. And that is the sort of the, this,

this soup of hormones that get out of balance, including stress hormones, cortisol, the sex hormones, like estrogen, progesterone, and all the other hormones related to sex hormones, thyroid, and insulin. And so those are very subtle things to play with in a body, and yet they respond really well to lifestyle, to the right supplements, to fixing your microbiome, to just tweaking everything, reducing toxins, detoxifying. I think one of the things you talked about earlier was really important, which is there are certain foods which we know help with hormonal regulation and balance. One of them is the brassica family of cruciferous vegetables.

You mentioned that, but I don't want to sort of gloss over it. It's really important. I think women should probably have a cup or two a day of broccoli, collards, kale, cabbage, Brussels sprouts, that whole cocktail of vegetables because of the compounds, the phytochemicals they contain that help regulate estrogen metabolism and sort of de-risk your estrogen from being a carcinogenic type of estrogen to a more healing, beneficial type of estrogen. And I think also the same thing is true around insulin and blood sugar. When you start to sort of get into the trouble with that, you've got to really do what you're saying is shift your diet towards more good fats and less starchy carbs.

So we kind of know that if we kind of work on all these things that actually women can really, really get rid of these symptoms. You can. And, you know, I think there's a few interesting areas related to this topic. One is that I was taught when I went through my training that the symptoms women start to experience after 40, you know, the difficulties sleeping, the night sweats, the hot flashes. Those are these inconveniences that could be medicated with hormone therapy in the right candidates. learning is that many of those symptoms are biomarkers of something much more serious, which is dysfunction of blood vessels, endothelial dysfunction. It's a biomarker associated with bone loss. And so it becomes much more important, I believe, to get these hormones back into balance, starting first with diet and lifestyle. Another piece that's really

essential is that having large blood sugar excursions, which was my story until I figured this out in the book, that can trigger hot flashes, night sweats, mood swings, many panic attacks, many of the things that women are starting to experience in their 40s. So the more we can dial in that metabolic health piece, along with balancing these sex hormones, the better off women are. Yeah, it's so huge. And I think we really just come to understand that these are not normal things. They shouldn't be normalized, that women aren't just sort of relegated to being, quote, hysterical, which is the, I hate that word. It's like, it basically comes from hysteria, which is the uterus, right?

Hysterectomy and hysteria are not unrelated. I hate it too. I mean, I love how you do it. Oh my God, it's terrible. Why don't we normalize it? It'd be okay for women to have all these hormonal dysfunction and not actually get to the root causes of it. So it's really not normal. Like 75% of women have some type of PMS and 85% of women have some type of hormonal issues in their life. Why is this happening? Why has it been so normalized? And

what are the root causes of all this hormonal dysfunction? And what is it? Well, I would say the days of normalizing this need to be over because women are suffering unnecessarily, as you just described. There's a lot of different hormone issues at play here. One is cortisol related to toxic stress. It can be high, low, a combination of the two. A another hormone that gets out of whack is thyroid. So, thyropause especially affects women about sevenfold more than it affects men. And that is a common cause of weight gain and hair loss and many of the things that women face. And then as you described, estrogen and progesterone often get out of whack. That can be related to just the cycling years, the reproductive years. It can also be related to being postpartum.

And then perimenopause is when a lot of this becomes a perfect storm of many of these hormones out of whack. Insulin is another important one because so many women notice, especially after 35 or 40, that insulin is just not on their side the way that it once was. They become insulin resistant, which I think of as insulin- It's not on their side, but it goes to their tummy. That's right. It goes right to their body. Not to the side, but it's in the middle. Exactly. Exactly. And I think there's a few issues at play. One is the way that our world is changing. It's related to stress. It's related to unrealistic expectations. It's related to over-functioning and trauma, which we know affects women more than men. Men are still affected,

but women more so. It's related to the food that we're eating, the way that our food has changed, which you talked to so brilliantly. And it's also related to the fact that physicians are not taught about this, right? Like I wasn't taught at Harvard Medical School about this. I imagine you weren't either. No. We were taught to hand over a prescription for a birth control pill or maybe hormone replacement therapy once women was feeling impossible. And that is no solution because it addresses symptoms.

It does not address the root cause. That's right. And functional medicine and the perspective around functional medicine hormones is so rich and developed and allows us to understand one root causes, but also all the variables in our life that impact our hormones and how to regulate and change those to create balance, whether it's adrenal and stress hormones, thyroid hormones, sex hormones, or insulin. And in your book, Women, Food, and Hormones, really helps us to map all that out in a way that gives women a toolkit for how to fix all these problems. That's right. I mean, this was born of me struggling myself

with almost every hormone imbalance that you can imagine, and also struggling with my weight. So unlike you, Mark, when I was sitting down and writing that first book, I gained about 25 pounds. I've never seen your weight fluctuate very much. I don't know. Is that true? I go up and down. If I go off the reservation, like I was in Italy this summer and I was just eating bread and pasta and drinking lots of wine, I gained about five pounds in a week. So I can put it on if I go off the tracks.

And I actually lost weight from being sick.. So I can put it on if I go off the tracks. And I actually lost weight from being sick. But no, my weight can go up and down. But mostly, it's pretty stable. Well, it sure seems stable. And we know that women have this asymmetric response to stressors, to food. So many of us will gain weight and there's, you know, there's an evolutionary bias for women to gain weight rather than to lose weight because it helps us with fertility. It helps us with pregnancy. So, you know, for those of us who are trying to fit into the clothes in our closet, that can present some problems.

So my own struggle with weight, my own struggle with hormones became really the basis of the books that I've written. So I'm a case study as well as someone who's really curious about how do we get these hormones into balance, especially with targeted lifestyle changes, starting first with food. And then how do we, you know, how do we get out of that place of misery around hormone balance? Because the truth is, it's so much easier to get your hormones back into balance than to live with the discomfort, the misery of them being out of whack. Yeah, it's true. And I think the beautiful thing about it is that the solutions are relatively straightforward, and yet you're not hearing about them.

And I think that the suffering around hormones is quite extreme. I mean, it's irregular periods. It's heavy periods. It's PMS, which is a whole range of symptoms from breast tenderness and fluid retention to diarrhea, migraines, fatigue, mood changes, sleep issues. That can be quite debilitating. And they treat it now. They call it PMDD, which is

premenstrual dysphoric disorder. They treat it with a version of Prozac. Essentially, they change the name of Prozac to some other name, and then they use it for PMS. That's not the solution. And even with postmenopausal symptoms and perimenopausal symptoms, those are often exacerbated by the things that are driving hormonal imbalance. So I'd love for you to talk about what are the things we know that drive hormonal imbalance, and then we'll get to what we do to fix those hormone imbalances. Because I think we know a lot about whether it's food or lifestyle or environmental toxins, talk about the things that really drive women's hormones out of whack. Well, you got it. I mean, I would say food is one of the primary drivers. And that includes

not just getting sufficient fat, which is the backbone of the sex hormones that you make. It's also getting the right dose of carbohydrates for you, which is so important when it comes to insulin and leptin and some of these other hormones that are involved in fat storage, as well as satiety. So getting the carb dose right, also getting the protein dose right. So dialing in these macronutrients becomes incredibly important. And a big part of what was behind this book was that I was struggling not just with weight gain, but with a loss of metabolic health. And that's something that we know affects about 88% of Americans right now. So 88% of us are metabolically unhealthy. Many of us don't know it. So it's not just about the bathroom scale. It's not about diet culture. It's about becoming metabolically healthy. And the hormones are such an essential part of that. So as you described, food, stressors, especially toxic stress, I think a lot of us

going through the pandemic had an experience of toxic stress. Some people had weight gain associated with that. There's the changes, there's environmental toxins that we get exposed to that are endocrine disruptors. The root causes are something that many of us encounter. The solutions are not what mainstream medicine is really taught to manage. You talk about how we don't want to normalize this. And what it reminds me of is that analogy of the frogs in the pot on the stove, where you very slowly turn up the heat and the frog doesn't jump out because it's so slow and imperceptible. And so I don't want women to just sit back and say, oh, my doctor checked my labs and said, I'm just getting older. Like don't settle for that.

Don't be dismissed. There's so much misunderstanding about this. And so it takes us taking our health into our own hands and saying, okay, this is not how I want to live my life after 40. I want to change things. Definitely not. And the things that we also talk about in terms of how to change things in terms of diet. So there's questions people have about soy foods and I think about flaxseed. And a lot of people say, oh, soy is bad for you. It's going to cause hormonal dysfunction and it's an estrogen. What's your take on that? Because I think there's a lot of controversy about that.

There is a lot of controversy. I think the problem is with GMO soy. So I think that, you know, you can go overboard with even whole foods. My general feeling is that some of the benefits associated with soy, with phytoestrogens like flax, outweigh the potential risks of them. I mean, you have to be cautious about getting the dose right. But for the most part, I think having whole soy in your diet once or twice a week, having whole flax in your diet a couple times a week is very healthy for you.

It's not really the whole foods that we're having a problem with in the US. It's those processed foods, the ultra processed foods, the foods that are genetically modified. Those are the ones that are causing problems with hormones, not really the whole foods. Same thing with goitrogens. I always get asked about, well, what about the Brassica family? Is that going to slow down my thyroid? So you lightly cook them. That reduces the goitrogenic effect. I've looked at the data. I've been underwhelmed by the data really showing a significant impact on thyroid function. You get so many benefits from eating these foods that I think, once again, the benefits outweigh the risks. It's so true. I think people can, like, and it cracks me up, there's a lot of doctors who treat cancer patients, breast cancer patients will say essentially that they shouldn't eat soy food because they're worried about cancer. And yet they say that

it's okay to drink alcohol and to eat sugar. And to have insurance sugar if you're losing weight having sure oh my god yeah it's crazy it's really crazy so i think i think what you're saying is important i want to come back to the glucose thing because you mentioned the changes in blood sugar and glucose they also affect hormones and we know for example in men who eat a lot of sugar and starch they tend to get more estrogens they're going to get breast enlargement or you know man boobs they get lose the hair on their body they get big bellies they get soft skin and it's boobs. They lose the hair on their body. They get big bellies. They get soft skin. And it's because the fat produces estrogen. And the fat is laid down because of high insulin. And so you discovered a lot by using the continuous glucose monitor,

which is really kind of a new advance in actually personalizing medicine, what you call precision medicine. And you are an advisor level, so am I, in terms of this company that is really driving the space around looking at our own blood sugars in real time and how different foods affect it and how we can modify our diet to actually keep our sugars in balance. So what did you learn from doing it yourself and why is it so important for estrogen and hormone balance in general? I'm a huge fan of continuous glucose monitoring. The great thing is that you don't have to have a continuous glucose monitor to benefit from monitoring your glucose. You could also use just a $25 glucose meter to get some of the same data. It's not quite as dense or comprehensive. But I had a lot of surprises. I started wearing a continuous glucose monitor about four years ago.

And at the time, I had prediabetes. My fasting glucose was about 105 years ago. And at the time I had prediabetes, my fasting glucose was about 105 to 110. And what I discovered was that many of the foods that I thought were healthy were giving me these massive excursions with glucose, things like beans, chickpeas, legumes, sweet potatoes, apples, a lot of fruits were just making me spike so high, grapes, peaches. What I had to do to reclaim metabolic health was to really dial in my food plan and to avoid some of those foods that were spiking me to the diabetic range. And I found that that really helped. So a big part of what

I learned as I dove into the literature for this book was that you've got a few choices for metabolic health. One is to go 100% plant-based. And there's a lot of evidence behind that. And what I discovered myself was that being 100% plant-based was not the best fit for me. I started to lose muscle mass. I'm Jewish. I'm hungry all the time. And so 100% plant-based just didn't work very well for me. I don't know what to say. Wait a minute. Wait a minute. When you're eating the way you're now, you're still Jewish and you're not hungry all the time. So I'm not sure that logic flows, Dr. Gottfried. Well, I have to say keto saved me. So going on a ketogenic diet made my blood sugar go from severely spiky, which you don't want, to a lovely flat line where my mood is more stable.

I don't have anxiety anymore. I've got this feeling of like, oh, like the angels are singing because I can focus. I don't have this jacked up glucose every day. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy.

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forward slash PICS, P-I-C-K-S, and sign up for the newsletter. And I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or 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 you have someone in your corner who's

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