The Dr. Hyman Show - Reclaim Your Hormones: How to Treat PMS and PCOS Naturally

Episode Date: December 9, 2024

Struggling with PMS or PCOS? It’s time to get to the root of the problem. In this episode of “The Dr. Hyman Show,” I revisit powerful conversations with Dr. Elizabeth Boham and Dr. Heather Huddleston to uncover the hidden triggers of hormonal imbalance. From the risks of hormonal birth control to the critical role of diet, we explore how stress, toxins, and inflammation wreak havoc on your hormones—and what you can do to fix it. Tune in for a personalized approach to achieving hormonal balance and reclaiming your health. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: The Hidden Cause of Your PMS and How to Fix It Fast The Underlying Causes and Solutions for Women’s Hormonal Balances with Dr. Elizabeth Boham The Root Causes And Treatment For PCOS This episode is brought to you by Rupa Health, Mitopure, and AG1. Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. Support essential mitochondrial health and save 10% on Mitopure. Visit TimelineNutrition.com/Drhyman and use code DRHYMAN10. AG1 is offering new subscribers a FREE $76 gift when you sign up. You’ll get a Welcome Kit, a bottle of D3K2, AND 5 free travel packs in your first box. Just go to DrinkAG1.com/hyman

Coming up on this episode, many young women are becoming increasingly aware of the potential harms of birth control, not because their conventional gynecologist is explaining it to them, but through their own personal experience. They're on a journey to educate themselves, and they want a more nuanced, personalized approach to hormonal health. Hey everyone, it's Dr. Mark. We all know that as functional medicine practitioners, our time is precious. So imagine having more time to focus on what truly matters,

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so you can get the data you need without the hassle. So sign up for free today. I love it, and I know you will too. You can find out more information by going to rupahealth.com. That's R-U-P-A health.com. For me, being healthy means being able to get up every morning and do exactly what I want to do, no matter my age. In fact, I recently hiked 15 miles in the snow in the mountains of Patagonia. I was sore and tired after, but so was my 28-year-old guide who was half my age. And that's why I'm excited to share a supplement that's been a game changer in my fitness journey. Timelines MitoPure.

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Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to the doctor's pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. PMS is not a normal consequence of being female. If you're one of the many women who do suffer from PMS, you don't have

to suffer from PMS every month, enduring mood swings, breast tenderness, fluid retention, migraines, bloating, or heavy painful periods. While medications may sometimes be helpful, they can have pretty significant side effects. And the good news is you can balance your hormones without them and without their potential side effects. Many young women are becoming increasingly aware of the potential harms of birth control, not because their conventional gynecologist is explaining it to them, but through their own personal experience. They're on a journey to educate themselves and they want a more nuanced, personalized approach to hormonal health. So today we're going to discuss what you can do to support your menstrual cycle through your diet

and a comprehensive functional medicine approach to get rid of PMS for good and feel great all month long. The key to solving this type of problem is getting to the root cause of the symptoms. Now I hear this story all too often, but the good news is that there are simple solutions that don't involve taking medication. We know what causes hormonal imbalances. Sugar, caffeine, alcohol, stress, a lack of exercise, and environmental toxins all contribute to hormonal imbalance and worsening of PMS. Even changes to your gut microbiome

can affect your hormonal health. So what would conventional medicine docs do for PMS? Well, they give you NSAIDs or things like ibuprofen, birth control. They might give you Serafem or Prozac, in other words. But they don't get to the root cause of symptoms, and they inhibit your natural cycle, your infradian rhythm. And the birth control pill often has significant side effects with long-term use, including mood and gut issues, dysbiosis, taking the pill depletes folate, vitamin B2, B6, B12, vitamin C and E, magnesium, zinc, selenium, all important, by the way, for fertility. There's also an association between hormonal birth control and depression. In fact,

a nationwide prospective cohort study of over a million young women in Denmark reported an increased risk for antidepressant use in women prescribed hormonal contraceptives. And the results were published in JAMA Psychiatry. And their risk was highest in the adolescents who were aged 15 to 19 years old. So we don't want to be giving these teenagers antidepressants and the pill and just medicating the side effects of medication. It's crazy. So you have to look for what are the real underlying causes of PMS. Well, it's hormonal imbalance, and there are a lot of causes for hormonal imbalance. So it's important to understand what they are and how to deal with them. The main problem is something called estrogen dominance, which means that your estrogen levels

are too high and your progesterone levels are too low. Now, this may be an absolute increase, in other words, a very high estrogen and low progesterone, or it may be a relative dominance of estrogen over progesterone. And unfortunately, this is not something well recognized by traditional medicine. And you can measure this, right? The fluctuations in estrogen in relation to progesterone can cause all sorts of problems, including neurotransmitter signaling and lots more, because estrogen in part regulates serotonin levels in the brain, and that can contribute to PMS symptoms, things like mood swings, depression, irritability.

And an absolute or relative excess of estrogen in relation to progesterone drives most of the symptoms of PMS, and menstrual problems like fluid retention, breast tenderness, migraines, mood swings, heavy bleeding, cramps, all that is really related to this excess estrogen and inadequate progesterone as women get through their later cycles in life. Poor diet is certainly a big factor. And when you clean up the diet, a lot of hormonal stuff just gets sorted out. And then there's a lot, unfortunately, of hormones in conventional meat and dairy products. So I encourage you to eat regenerative, organic products. And particularly dairy might not be your best friend if you're having a lot of female

hormone issues. I'd encourage people to just quit dairy as an experiment to see what happens. There are also environmental toxins that play a big role in hormonal health. And unfortunately, a lot of these petrochemical toxins are also endocrine disruptors. They act as hormonally active compounds in the body, even at low doses. And in fact, there's a word for them called xenoestrogens. Xeno means foreign and obviously estrogen means estrogen. So foreign estrogens, and they come from pesticides, plastics, many personal care products, skincare products. I mean, these petrochemical products act as a toxic foreign estrogen-like molecule that drives hormonal imbalances in most female cancers like breast, uterine, ovarian cancer.

So toxins are a big factor, and you have to reduce your exposures. A lot of nutritional deficiencies also affect hormone function, particularly magnesium, vitamin D, and also iron. What else should we be doing for PMS or premenstrual syndrome? How do we get you back in balance and so you don't have to suffer and be really struggling your whole life? Because I just don't think that

is something that women should accept. It makes me actually quite angry that the conventional medicine system doesn't really take this seriously or just tries to medicate it instead of dealing with it from the root cause. So the first thing is food. Food is medicine. It's information. It controls every function of your body and mind, including your hormones. And it connects us to almost everything that

matters in our lives. So you have to know that what you put in your fork is the most important thing you do every day for your health. So the first step to do with your diet is to cut down inflammation because inflammation will mess up your hormones. So first get rid of the junk, right? Then get rid of the junk and then add in the good stuff. So take out the bad stuff, add in the good stuff. What's the bad stuff? Well, our current diet is really high in sugar and starch and that drives insulin resistance and that leads to belly or visceral fat. And here's something most people don't know. It's not just your ovaries that produce estrogen. Your belly fat is also an estrogen producing factory, right? So all those

belly fat cells in there aren't just holding up your pants. They're actually spewing out hormones. And there's something called aromatase also that increases estrogen production that's found in fat tissue. So, you know, having more estrogen is not necessarily a good thing, especially when it comes from your visceral fat. So what are the things you should eat and not eat to eliminate PMS symptoms, right? Eat real food, right? Real food. You know what that is, right?

My joke is if God made it, eat it. If man made it, leave it. Did God make an avocado? Yeah. Did God make Doritos or a Twinkie? No, right? Just don't eat that. So also you want to reduce fast-absorbing carbohydrates, right? Any flour products, sugar, quickly absorbed sugars like flour, instant oats, white rice, potatoes, or not all potatoes, like the small fingerling potatoes may be okay, but the big starchy potatoes we all eat are a problem. And they can spike insulin, and that leads to insulin resistance and inflammation, and that can cause PMS, can

cause PCOS. It can increase the risk for all chronic diseases. Also, you want to really limit caffeine or get rid of it entirely for a while to see how it affects your hormones. And for sure, alcohol. Alcohol, it will screw up your estrogen and make you estrogen toxic ultimately. These really make hormone imbalances worse. Also, I would encourage you to do a full dairy elimination for eight weeks. It's often a huge factor in PMS and many menstrual and hormonal issues.

Next, I want you to avoid ultra processed foods, right? Starch, empty carbs, grains, sugar, sugar sweetened beverages, energy drinks, teas, coffee, you know, I mean, think about any coffee or frozen blended drink from Starbucks, sunken donuts with flavor. It means tons of added sugar or glucose syrup. And lots of women drink these and they start their day with these drinks, not realizing it's a sugar bomb, like a vanilla latte, mocha frappuccino, even a matcha have tons of added sugar. I mean, a grande mocha frappuccino has almost 13 teaspoons of sugar.

I mean, you never put 13 teaspoons of sugar in your coffee in the morning, but if you're going to Starbucks for your morning fix, you're literally killing yourself. Also avoid some of these quote healthy nut milks or oat milks. They're often blended starch, sugar and water. So be careful, oat milk really spikes your blood sugar.

Sometimes there's also additional sugar from the flavoring too, like vanilla or chocolate, whatever, hazelnut. Just stay away from all that stuff. Drink black coffee. Put a little almond milk in it. Ask for the unsweetened almond or coconut milk, although usually you don't have that. Also, I want you to avoid processed food packaged food um all kinds of food with quote health claims

on the label you know plant-based vegan keto gluten-free whatever it doesn't mean it's healthy and my rule is that if it has a health claim on the label i guarantee you it's bad for you so just don't don't it's a way of of getting food marketers to kind of get you engaged, but it's, it's often hiding something bad underneath. You want foods that really balance your blood sugar. You want to focus on fiber rich, low glycemic, non-starchy veggies, low glycemic fruits. And fiber is really important because it helps balance out your hormones. It helps build a healthy microbiome. It helps prevent the reabsorption of estrogen that can cause estrogen toxicity. So you want to eat the rainbow. Aim for about eight to 10 servings of colorful veggies daily for all their health benefits. Make sure you sort of eat every day something from the cruciferous vegetable family, like that's the broccoli family. Broccoli, cauliflower, kale,

collard, cabbage, Brussels sprouts, arugula, bok choy, they're all important because they actually support estrogen detoxification. And they help balance the estrogen and progesterone because they contain amazing phytochemicals such as glucosinolates or indole-3-carbinol, diindylmethane, all of these are big medical words, but they're essentially molecules that are in the broccoli family that help induce the expression of certain enzymes called CYP450 enzymes that enhance the metabolism of estrogen in the right way to produce beneficial estrogen metabolites, including, for example, they're called 2-hydroxyestrone, and they reduce the formation of a toxic estrogen metabolite called 16-hydroxyestrone. And they reduce the formation of a toxic estrogen metabolite called 16-hydroxyestrone.

This is associated with heavy periods, with breast tenderness, breast cancer, and DNA damage. So there's different ways your estrogen can be metabolized in your body to the good or bad metabolites. And the bottom line is if you eat more broccoli, you'll be shifting towards the good metabolites. So that's the take home. But the science is there. It's quite fascinating. And I do measure in my practice the estrogen metabolites. And I can see what's happening with women's metabolites and whether they need more B vitamins

or more support for glutathione or more of these chemicals from food, these phytochemicals like indole-3-carbinol or diethylmethane. You also want to focus on slow absorbing and burning carbs. Sweet potatoes, yams, lentils, some whole grains are fine like quinoa, non-starchy veggies. Protein to avoid the blood sugar spikes. Those are really important. Then you eat protein first as opposed to starch first. Eat about four to six ounces of protein per meal, roughly the size of your palm. Make sure you use high quality sources, grass-fed meats, pasture-raised eggs, poultry.

I recommend Force of Nature. I love it. I don't have any financial relationship, but they have great regenerative sources of chicken and meat and bison and venison, elk, so forth. You actually need protein, by the way, to make hormones. So they're part of the building blocks. You need good fats to make hormones as well. Make sure your diet is really nutrient dense. You want a lot of bioavailable micronutrients like iron, magnesium, B vitamins, and so forth.

Nuts and seeds are great for hormones. I know a bunch of science on how they regulate hormonal health, but things like flax seeds are my favorite. Almonds, chia seeds, hemp seeds, pumpkin seeds, sesame seeds, pumpkin seeds, sesame seeds, sunflower seeds, all these are rich in fiber. They're full of good fats. They have micronutrients like calcium, magnesium, zinc, iron, B6, phosphorus, which are all important for a healthy menstrual cycle and hormone balance, right? Your body is just a big biochemical machine, and you have to put in all the right ingredients to make the right things work. And what the problem is, is most of our diet is depleted. Most of us are nutritionally deficient at some level or other. Most of us have unhealthy microbiomes. Most of us are exposed to toxins. Most of us eat too much

sugar. Most of us drink too much coffee. Most of us drink too much alcohol. Most of us don't exercise enough. No wonder we're having all these problems, right? So we really need to get our act together if we want to reset. And it doesn't take that long. One or two cycles of doing this for women really helps reset the whole system. One of the cool things you can do is use flax seeds, ground flax seeds, about two to four tablespoons. It's great for your hormones. It's great for beneficial compounds that are helpful in regulating your hormones like lignans. And also it's great for bowel movements, right? So they really balance the hormones and they block the negative effects of some of the excess xenoestrogens. So if you're exposed to environmental toxic estrogens, you can actually reduce your exposure to them by having

these flax seeds. Also, you want to increase the anti-inflammatory fats in your diet, the omega-3s, EPA, DHA. And my favorite sources obviously are sardines, herring, mackerel, anchovies. You can use small wild-caught salmon. Sometimes there's omega-3 enriched eggs. There's plant-based sources like walnuts, chia, and hemp, but they're not really moving the body into the EPA and DHA. Only about 10% is converted. So you want to get also the preformed EPA and DHA from fish or from supplements. Now, if you're a vegetarian or vegan, it's a really important supplement with omega-3 fats. It really will help your hormonal health. Also, increase monounsaturated fats. These are avocados, olive oils, extra virgin olive oil, macadamia nuts, seeds, really important. Saturated fat may

not be bad for most people. You just have to watch your cholesterol and see what happens, but grass-fed butter, ghee, coconut oil. Actually, saturated fat may not be bad for most people. You just have to watch your cholesterol and see what happens. But grass-fed butter, ghee, coconut oil, actually saturated fat is the building block for your hormones. Your hormones are made out of fat. Also, you want to decrease the inflammatory fats, right? Trans fat, hydrogenated fat, margarine, even a lot of the vegan butters. They're actually not recognized as safe to eat anymore by the FDA, but they're still lurking on the grocery store shelves. So be religious about never eating them. Also, you want to reduce your intake of vegetable oils, these refined, highly processed oils. You

know, if they're cold-pressed, if they're organic, if they have high oleic levels, they may be okay. We need some, but the amount we're eating is just a pharmacologic dose. Sunflower, corn oil, canola oil, safflower oil, not so great. Also, stay away from processed meats. Stay away from like hot dogs. Stay away from weird processed cheeses. I mean, you shouldn't be eating there anyway, but Kraft singles. I can't call it cheese because it's not more than 51% cheese. That's just a bunch of chemicals.

Obviously, reduce your exposure to pesticides and hormones and antibiotics that are stored in some of these foods. And you can use the Clean 15 and Dirty Dozen Guide from the Environmental Working Group to guide you on which are the least contaminated or the most contaminated foods, fruits and vegetables. So it's not always possible, but try to eat grass-fed and organic when possible. Fill it to your water. Also, support your gut. Really important to support your gut. Probiotic rich foods are key. Things like sauerkraut, kimchi, miso, natto, which may taste weird, but it's actually really good for you.

And prebiotic foods also like asparagus, artichokes, jicama, and juice from artichokes, all great for your gut health. Don't eat within three hours of bedtime. Don't fast for too long. Actually can be problematic for women. And start your day with a nutrient-dense food, right? Protein, fat, and fiber. Think protein, fat, and fiber. Not the typical breakfast.

We have cereal, muffins, bagels, you know, sugared coffees. I mean, French toast, pancakes. I mean, the American breakfast is the worst. And you do not want to start your day with that. You want protein and fat and fiber for breakfast. So you can have eggs, spinach, peppers, olives, maybe some feta cheese from sheep, an omelet with avocado, protein shake. And you also need potentially some supplements. A number of supplements have been shown to really help ease PMS symptoms because they improve metabolic health, hormonal metabolism. And here's the superstars.

Magnesium glycinate, about 400 to 600 a day. Calcium is sometimes helpful. It's calcium citrate, about 600 a day. Vitamin B6, really important for estrogen metabolism, 50 to 100 milligrams a day. And folate, especially a preformed form called methylfolate, about 800 micrograms a day. Vitamin B12 in the form of methylcobalamin, about 1,000 micrograms a day. And evening primrose oil, that works really well. Take 500 milligram capsules, one or two twice a day. Take fish oil, omega-3s, EPA, DHA, about 1,000 milligrams, one or two a day. Taurine, also really important for hormone metabolism. It's an amino

acid, about 500 milligrams a day. Helps liver detox, and a good multivitamin. All these things work together. And the good news is there's also a lot of herbs and phytochemicals that can really help, including chaseberry. Also, vitex is known as vitex, but chaseberry fruit extract is very good for regulating menstrual cycles and helping with PMS. Milk thistle, dandelion root also is great. Certain isoflavones from soy, red clover, kudzu root help improve estrogen detoxification because they boost some of the metabolism enzymes that you need to properly regulate estrogen. And they can be taken as supplements or in the diet. Starting the day with AG1 feels like a boost of pure energy, but without the caffeine crash.

Just one scoop and I'm getting a powerful blend of vitamins, minerals, prebiotics, probiotics, and adaptogens. I love that AG1 combines prebiotics and probiotics to support a healthy gut. And studies actually show that 97% of people notice better digestion after 90 days. Plus, AG1 is made with bioavailable ingredients, which means my body can actually absorb the nutrients, no fillers, no added sugar, just pure, effective ingredients that help me feel my best each day. So this new year, make AG1 part of your daily routine

and see the difference it can make. Right now, AG1 is offering new subscribers a free $76 gift when you sign up. You'll get a welcome kit, a bottle of D3K2, and five free travel packs in your first box. Just go to drinkag1.com slash hymen to get started. That's drinkag1.com slash hymen to kick off your new year on a healthier note. When I see a woman, so often we're dealing with hormone imbalances. They're so prevalent. You know, everything from, as you mentioned, PMS to issues with menopause and perimenopause,

to issues with estrogen dominance, right, or overlevels of estrogen, high levels of estrogen in the body, which can lead to breast tenderness, or more PMS or cancers like uterine cancer and breast cancer fluid retention and heavy bleeding that too the nasty symptoms yeah so so we're really thinking about hormones and hormone balance when anybody comes into the office so I mean that's something I think that that's an area.

And it's so common, right? 75% of women suffer from PMS. How is that normal? That's not a normal state of biology. It's an abnormal state. Just because it's so common doesn't mean it's actually optimal, right? Absolutely. So then we need to ask that question, why?

Why are the hormones out of balance? And we look at everything from how is the body metabolizing the hormones? How is the microbiome and how is that influencing it? How is the person dealing with stress and is that influencing the hormone balance? So you want to look at the whole body when you're trying to figure out what may be out of balance with somebody's hormones. Even fertility issues. I mean... Oh, it's getting so common, right?

It's so common. You know, it affects one out of seven couples. And it's big. And so when you go to a regular doctor and you have these symptoms of PMS or heavy bleeding or, you know, menopause, like, what do they do? So often they'll say, okay, I'm going to put you on birth control pills. Oh, yeah. Right. Right. Like if with with PMS and or regular cycles or perimenopause,

that is the common response, you know, is let's just start some birth control pills and that's going to even everything out. Is that safe? I don't know. I mean, it's a good question, right? I mean, there's there are side effects to birth control pills. You know, we see we see We see stroke and blood clots with some women with birth control pills. Needs infections, affects the microbiome.

Absolutely. There's some women where we know that the longer you've been on birth control pills, or if you're on them more than 10 years, or if your risk for breast cancer goes up. So there is an association with long-term use of birth control pills. Or just breast cancer. Just breast cancer. Yeah. Yeah. So that is interesting.

So you take the pill for a long time and your risk of breast cancer goes up. Yeah. For women, when they're on the birth control pill or if they've been on it a long time, they have a slightly higher risk. And, you know, so that's something we got to pay attention to. Not everybody handles the hormones in the birth control pills the same. So not everybody is being prescribed birth control for birth control. They're using it as a medical therapy for hormone imbalances when there's a very different

way of treating it that works better, where the women feel better, and their hormones get imbalanced without nasty side effects of stroke and cancer. Right, right. I mean, you really want to ask... And migraines, and who knows what else. Right, migraines too, absolutely. So you want to ask, well, why is there that imbalance in the hormones? And what may be out of balance for that woman?

You know, I think perimenopause is such an interesting time where we get a lot of women who come in to the office at that time because they're just feeling so crummy, right? Perimenopause is the time frame between when your cycles are normal and you can easily get pregnant and menopause. So perimenopause are those years, you know, it can be like 10, 13 years of perimenopause and it can occur anytime. You can go into menopause anytime between 45 and 55 that's typical and that perimenopause can be 10 6 to 10 to 13 years beforehand before you actually go into menopause is considered

perimenopause what is that and it just means yeah i mean there's there's just the this the hormones are not as regular and consistent right so what happens a lot in perimenopause is during those years, women will have what are called anovulatory cycles. So they don't ovulate every time they have a monthly cycle, right? And so those anovulatory cycles, meaning no ovulation that month, results in less progesterone being produced in the body. Because when you ovulate, that's when you make progesterone. And if you're sort of weaning down your years of reproductive life, you don't necessarily make progesterone. You don't ovulate every time.

You don't ovulate every cycle. And then you get these high levels of estrogen. And that causes a lot of these symptoms of clots and heavy bleeding and bad PMS and mood issues and sleep, and migraines, and all the stuff that women suffer from that is so unnecessary. Right, you think of it as, you know, when you're having regular cycles with ovulation,

you have estrogen and progesterone, and they sort of balance each other out. And then when you're in those perimenopausal years, you're gonna have, many women will have cycles where they don't have that progesterone spike so it feels like their body feels like it's higher in estrogen because they don't have that progesterone to balance it off and so you feel like you have high estrogen and and like you mentioned you get more breast tenderness or more clotting or heavier bleeding. And the low progesterone makes us often feel crummy.

So you can be more irritable. You can just, you know, cranky, harder time sleeping because progesterone really is a calming hormone and it helps us, helps women, helps people sleep better. So when it's low, many times you don't sleep as well. You'll have irregular sleep patterns where you've never had that before. And you just feel more irritable and cranky and it's no fun. Out of balance. Yeah. Yeah. Out of balance. And it's important to understand that we know a lot about what causes these imbalances. And we know a lot about how to fix them, except your traditional doctor is just not doing it. So what are the things that we know create hormone imbalance that make things worse for women? And by the way, you know, just to sort of a little aside, you know, it's not just sex hormones that get out

of balance. And when you see this sort of period of life around perimenopause there's like four different hormones that are all interacting that all kind of gets screwed up one is insulin and blood sugar yeah because you're you know you're all in the sandwich generation you're you have kids and your parents are getting older and you're trying to have a career and it's like it's a lot going on at that time for women often yeah and then they have uh estrogen imbalances and progesterone. They have adrenal imbalances because their adrenal glands are their stress response, and they're highly stressed in that time of life. So their adrenals interact with the sex hormones and screw that up.

And then, of course, you've got thyroid thrown in there in a lot of cases. So you've got thyroid, adrenal, sex hormones, insulin. And so it's like a big mishmash of hormone chaos. And actually you can fix it. Absolutely. And I'm so glad. These are like so easy to fix with functional medicine. Yeah. Yeah. And I'm so glad you brought that up because all of our hormones are interrelated. They're all playing off each other. They're all influencing each other. And so that's important to really understand because that's how we

can really help women feel better yeah so when you really focus on the adrenal glands for example so you have you have two adrenal glands typically they sit up on top of your kidneys and those glands produce cortisol and they produce DHEA and they a bunch of other things. So cortisol is one of your stress hormones. So when you're under a lot of stress, if you're under chronic stress, for example, I mean, you know, your body's going to be producing a lot of cortisol all the time. And so what can happen, what can happen is then the body is spending all this time making cortisol to handle that, that chronic stress you're under

you're dealing with your your kids and then your parents as you talked about you know you're working all the time your job you're not giving your body enough time to rest you're not getting enough sleep you might not be eating right you know you might be just running from one thing to the other and maybe not be taking the time to do your meditation or your exercise right you're just not doing that self-care which is so important for your adrenal glands and when that's when that's happening then then your body's spending all this time producing cortisol that it can't do as good a job at producing progesterone yeah right right and so then you have it's like a chicken wire thing it's all connected it's not like they're all separate. And so then you have more of those signs of low progesterone, which we talked about before,

which is irregular sleep, irritability, more crankiness, more PMS, right? So it's really important that we step back and say, okay, how can we support your adrenal glands? And that's really a lot of self-care by you know, by saying, okay, I need to give myself time to rest. I need to give myself enough time to sleep. Meditate maybe. Exactly. I got to get my meditation in, right? And I think that makes a big difference. It can really help with balancing the hormones. We know, right, that even simple meditation, 15 minutes twice a day can cut back on,

can significantly cut in half the amount of hot flashes a woman has. During those perimenopause, we haven't even talked about hot flashes yet, right? Well, I mean, let's talk about the things that screw up your hormones, right? Yeah. So sugar.

Yes. That causes insulin resistance, that causes more estrogen to be made and all the imbalances, right? Right. We were talking about how when you get more insulin resistance, you gain more weight around the belly, right? And we know that when we gain more weight around the belly, that we have more of that aromatase enzyme, which makes more estrogen, and again, throws us out of balance. And what about alcohol? Yeah, alcohol really is a concern because the way alcohol, and there's multiple ways that alcohol can impact risk of breast cancer,

for example, but it also seems to result in a higher level of free estrogen in the body. And so we know it disrupts sleep. It's a liver toxin. Yeah. And it literally impedes the body's ability to metabolize estrogen. Yep. And I've seen studies, it was shocking to me, where people were on hormone replacement and drinking and their liver just can't handle it. And the estrogen level spike and their risk goes up. So we have, enormous link there. I remember a study I read years ago, which was if a woman had a glass of wine a day, it increases her risk of breast cancer by 40%. Yeah. Unfortunately, there's a linear relationship between alcohol and breast cancer risk. So for every drink a woman drinks per day, like every time she increases the amount that she

drinks per day, her risk of breast cancer goes up even further. So, you know, what's considered moderation for women is five or less drinks a week with a drink being, you know, five ounces of wine or, you know, an ounce of hard liquor. Yeah. It's not very much. No, it's not very much. And that's all for a whole week. But what's interesting is you're right. There has been even studies showing that even one drink a day is linked with an increased risk of breast cancer. And maybe because it is impairing, well, partly because it's impairing our liver and our ability to detoxify. And it's shifting estrogen levels.

And it also depletes the body of B vitamins. So there's so many impacts that alcohol has there. Yeah. And even the microbiome plays a role in your hormone balance, right? Right. Absolutely. Right. That's something we're always measuring, right? We're looking at how the body is metabolizing hormones and we're looking at the microbiome. And I think that that's important when we're dealing with a woman in perimenopause. Like sometimes they just don't even understand why am I feeling this way?

You know, why am I all of a sudden more irritable? Why am I having a harder time with my periods? You know, why are they heavier? Why can't I sleep? Why am I getting hot flashes now, right? And so sometimes just educating them is a great first place to start. And a lot of times women just feel better when they start to understand, okay, this is, this is gonna, you know, my hormones are shifting and then what can I do to support them? And we were talking about how great meditation is, right? Because it's, oh yeah. Yeah. And the things, you know, we see typically the women who have the worst problems have the worst diet, the most stress, they drink too much, they don't exercise, they don't, they have lots of stress, they don't

meditate. It's not rocket science why hormones get screwed up. Right. And we know how to intervene using very specific diagnostic tests that we do at the Ultrawana Center to actually help map out what's happening with the hormones. We can look at estrogen metabolism. We can see how to really be sophisticated in manipulating those hormones so that actually they're better.

We can fix the gut and the microbiome. We can look for environmental toxins, which act like estrogens in the body and get rid of those or heavy metals. And we can actually have an impact through using various foods to help, whether it's flax seeds or other broccoli family, help estrogen metabolism, certain soy products that are whole foods, soy products are good. And then we can kind of get people's hormones to kind of work better. We may want to products are good. And then we can kind of get people's hormones to kind of work better. We may want to even use nutrients. And you were talking about sulforaphane,

which is a powerful broccoli chemical that you can take. And there's a whole cocktail of things we use to help estrogen metabolism. Well, we should probably talk about soy a little bit because honestly, this is probably the most common question I get because people are so confused about soy. And like, oh my goodness, should we eat soy or not eat soy?

So soy, right? Soy foods are in, they have these things called phytoestrogens in them. And this is what got everybody nervous, right? So they have these components, these phytonutrients, these components in them that can actually impact the estrogen receptor. And so for, you know, a bunch of years ago, oncologists used to say, oh no, it can impact the estrogen receptor. I don't want you to eat soy. But what we know actually is that they bind to the estrogen receptor, preventing your own estrogen from binding to the estrogen receptor. And as a result, you have a lower estrogen-like impact in the body.

And so multiple studies have shown that soy is actually associated with a lower rate of breast cancer. But if it's traditional soy. That's a good point. Like tofu, tempeh, natto, miso, soy sauce. Edamame, right? Right. Those are whole soy products that are not industrial food.

And most soy we're eating today is industrial soy. Yes. It's turned in all kinds of weird ingredients like soy burgers and soy hot dogs and texturized vegetable protein that gets inserted in all kinds of protein bars and isolated soy protein which very different than regular whole soy and maybe linked to cancer in animal studies so i think it's important people realize that you know it's it's um you know food is a modulator and it usually helps the body do what it does rather than interfere with it and so sometimes it's true with like you eat too much broccoli or whatever, raw broccoli, you're going to get vector thyroid,

but the phytoestrogens in soy actually help to act more like a thermos. They keep things balanced, right? And I think recommending those whole soy foods is great. And I think that's a really easy thing to do. Flax seeds also really help. Yeah. Flax seeds in the gut. Yep. The broccoli family vegetables, simple dietary things and getting more fiber to help the prebiotics in the gut, getting rid of all the starch, the sugar, the processed food, all those ingredients, alcohol. There's really simple things you can do.

Yeah. Like balancing your blood sugar, balancing your blood sugar by making sure that every meal has a good source of healthy fat, has a good source of fiber, and has a good source of protein, right? So that prevents the spikes in blood sugar and the spikes in insulin, right? So you make sure your meals are balanced like that, then you won't get those ups and downs in your energy. And so you just feel better.

And that helps with preventing that high insulin, which then- And then you're gonna be binging on carbs and sugar to get your energy up and all that. Right, right, right. So then that helps with the balance of all the hormones, as you were mentioning earlier. And so when a woman is going through perimenopause, the first place we look at is, OK, what are these personalized lifestyle factors? What can we really focus on with them? I mean, there might be times where we

at the Ultra Wellness Center may use some hormones to help with their sleep if necessary. But many times just a woman understanding what's going on and then making some shifts in their lifestyle can make a huge impact and make them feel better. What are the causes of PCOS? Well, I mean, I think it's a little bit of a million dollar question. There's a lot of research trying to answer that question. It's also a very heterogeneous disorder. So I don't know if there's one thing that causes it for

everybody. But I think we do know that a major underlying factor is the hyperandrogenism that is, you know, that there's elevated androgens starting at puberty, and that that may then sort of underlie a lot of the phenomena that comes across with women. So one of the things we know is that there's an increase in visceral adiposity, or sort of belly fat, belly fat, that happens that we know is more common in general with men. But this is what happened when you have elevated androgens in a woman, especially starting at puberty, they lay down fat in that area. And that in women causes a lot of inflammation, that then can really be a setup

for insulin resistance. So there may be sort of a pathway where you see hyper androgenism, then in many people also leading to the insulin resistance. Then you start to get into a little bit of a vicious cycle because the insulin resistance in and of itself causes some weight gain, but it also can drive androgen production from the ovaries. So starting at puberty, a lot of these people get into a little bit of a vicious cycle. It's very hard, if not impossible. What starts the high levels of androgens or the male hormones, testosterone and others? So it's a debated issue. I think that there's one component maybe that there's just, if you look at some of the enzymes in the ovary and

in the adrenal gland, there's just sort of an overactivity of those enzymes in the ovary and in the adrenal gland. So there's some thought that it's just an intrinsic overproduction of androgens. There's also, at least in some patients, we think just from the get-go, they have an increased LH secretion from their pituitary. This is a hormone that drives androgen production from the ovary. And so they may be set up by that even sort of in utero to have increased LH secretion. So we don't really know, but we know that at puberty, immediately, these girls will often start to have much higher indrogen levels than their peers. And then that sort of lays the groundwork for a sequence of events to happen. Yeah. You know, one of the things that's sort of read a lot about is the role of

endocrine disruptors in our health. And endocrine disruptors are environmental chemicals. Years ago, I read a book called Our Stolen Future by Theo Colburn. It was kind of like the silent spring of its time, where she mapped out the ways in which environmental chemicals affect all kinds of reproductive functions. And whether it's determining sex or determining risk of cancers or infertility in animals and human models. How do you think environmental toxins play a role in the uptick of what seems like this increasing phenomena of endocrine disorders in women? I think it's hard to know how much they are causative in terms of PCOS. I think it's hard to know how much they are causative in terms of PCOS. I think it's possible.

I certainly think it's definitely possible that they may exacerbate certain elements of it by interfering with hormonal function. But PCOS has been around for a long time, as far as we can tell. It seems to be present at a pretty standard or set prevalence across many different countries and parts of the world, which somewhat argues against it being truly environmental. Now, I do think that certain environmental endocrine disruptors or just societal patterns, especially diet, can definitely exacerbate the way PCOS gets manifest. So if you look at PCOS patients in Europe, especially 10 or 20 years ago, or in China, they tended to be much more lean than patients in the United States and have much less sort of inflammation

and insulin resistance. And so there's certainly, if you have a PCOS phenotype and you put it in an environment where there is calorie excess or limited physical activity, you are going to see potentially, at least in some patients, an exacerbation of the symptoms. But I don't know that you, I don't know that in my view and from what I understand about this syndrome, I don't think it's necessarily caused by our lifestyle. And the nutritional part, what role does that play? Because I've had many patients with infertility who, when we address the starch and sugar in their diet and treat the insulin resistance, they get better. And I mean, I had a very close relative who had obesity and pretty severe PCOS and

herestatism and acne. And we radically changed her diet and she was able to get pregnant and have a baby. So can you talk about the nutritional aspects of PCOS and how that plays a role and where it doesn't play a role? Yeah. I mean, I think for sure there's evidence that in some people with PCOS, especially if there's evidence of insulin resistance or if there's evidence of glucose intolerance, you know, that they're clearly have entered a phase where they're not processing glucose well, that if you act to correct that through diet and through exercise, and you reduce the degree of insulin resistance, you reduce the degree of adiposity, that in some of those patients, they will ovulate more regularly, they will have more successful,

more healthy pregnancies. So that is certainly something that I think I always talk to my patients about when I see them if I think that there's a window for that. There are patients, however, you know, especially when you look at some of the lean PCOS patients or patients from the point of adolescence have never had regular cycles. You know, I think it's a lot to say, oh, just change your diet and you're going to start ovulating. I don't think that's always the case. So I think every patient's a little different and you need to really look at it. Um,

the, what I usually look at though, is I want to say, how are we going to get you as healthy as possible for pregnancy? And maybe that will help you get pregnant. Maybe it won't, but I want to get you as healthy as you can for pregnancy and get, you know, your insulin resistance as much as possible under control. Yeah. How about the microbiome? Because this is sort of the era of the microbiome. And before, nobody ever thought that the gut played a role in hormones or endocrine health or infertility. But now it's clear that it's sort of got its finger in everywhere.

And we see studies, for example, on breast cancer. Women who take antibiotics have high risk of breast cancer. We know that the microbiome plays a big role in hormone metabolism. So can you talk about what you're learning about that and how that plays a role and how you approach that? Well, I think that there's definitely some really interesting research going on around microbiome in PCOS. And there's this idea that there may be a more sort of inflammatory microbiome that

leads to more inflammation in the body. And we know that many patients with PCOS just have high rates of inflammation that is detectable. And if you look at sort of blood markers or just even at the insulin resistance. So this is in many ways an inflammatory disorder. And so there is research going into like how much of that might be driven by the microbiome. And that's a little outside my scope and maybe more your scope, exactly how that may be the case. But I think it's definitely a really interesting area for us to try to understand more, how much that may be sort of setting people up to have PCOS sort of evolve at adolescence and really to exacerbate the metabolic phenotype. Yeah, well, you said something super interesting about the

inflammation because inflammation, independent of its source, seems to be a trigger for all kinds of things, obviously chronic disease in many ways, but for these hormonal disorders. So can you talk and maybe unpack a little bit more about the link between inflammation and endocrine disorders and in particular PCOS? Well, I think for sure we know the inflammation may have some direct effect on ovarian dysfunction. So there are some studies showing that if you treat inflammation, you can improve sort of ovulation to some degree in the ovary. So there may be a direct effect of inflammation on the ovary. There's also a path where inflammation does

drive up insulin resistance. And that's through sort of TNF-alpha and other cytokines that are thought to interfere with insulin action. And we know that insulin resistance really drives androgen production from the ovary, at least in patients with PCOS. So there's definitely a metabolic sort of driver of the hyperandrogenism and hormonal dysfunction and anovulatory sort of status that we do see. And then we also know that that inflammation in and of itself has really important downstream consequences, not only in terms of cardiovascular disease, but there's more and more of a thought around

depression and cognition that may be impacted by inflammation. So I do think it's really an important piece of this disorder that we want to try to get a handle on and try to treat. It's so important. And it's so many causes of inflammation. It can be environmental toxins. It can be the microbiome. It can be inflammatory foods. I mean, there's so many factors that we know that are driving inflammation in our society that are just getting worse and worse. And so it might be not one thing. It may be so many different things. So can you talk about the difference between the patients you see with PCOS who would be the typical ones we learned about in medical school are overweight, they have acne, hair loss on their head, facial hair, irregular periods, infertility, versus the ones who are thin and exercise and don't seem to have any weight issues.

Is there a different subtype? Are these the same kind of condition? How are they different? I mean, I think that they're probably subtypes. I mean, I think that this is a PCOS is I think a very heterogeneous disorder. It's really just a syndrome, right? It's a collection of things that kind of go together and sort of have somewhat of a shared pathophysiology. But it's not like, you know, if you think about something like hypothyroidism, which is very much, you know, it's like, your thyroid gland isn't functioning, you're going to have this, you fix this, you know, translates. PCOS is messier. And so, yeah, so the patient, there is a lean phenotype, we call it lean PCOS, and it's often quite

different than the obese PCOS. Some of the things that may be similar is the lack of ovulation, the need for help with fertility care. So that may be a constant. The other thing that may be a constant is trouble with elevated androgen. So hair growth on the face, acne, that can still manifest in lean PCOS. But, you know, lean PCOS patients are lucky in that they are often not quite as much struggling with some of the metabolic features. Although in studies where they measure insulin resistance very closely and very carefully in research settings in even lean PCOS, they are more insulin resistant than lean non-PCOS. So there is still an insulin resistance piece there, but it's sort of either genetically not as sort of exacerbated, or maybe that that person has just a very healthy lifestyle and they're able to keep a lot of it at bay. And what, you know, what are the consequences

for people if they have PCOS? What should they be aware of? What should they know about in terms of their own health and long-term risks? I mean, it's, I think, a very multifaceted disorder. There's generally sort of five or six things that I go through with patients with PCOS. So the first is menstrual cycle control. So it's important for people to have somewhat regular menstrual cycles or to have at least some sort of progesterone in their system to prevent overgrowth of the lining. There's the management of their skin or cutaneous findings with PCOS. So how can they manage their hair growth? There's fertility concerns.

There's metabolic concerns, especially things like future diabetes, future cardiovascular disease. And then there's a lot of mental health disorders that we see in PCOS. So there's a high rate of depression. Yep. And- Do you think it's a cause or a consequence of it? I mean, it's something I've been really interested in researching. One of the things we've shown in some of our work has been a very strong correlation between insulin resistance, actually, and depression. And even when you control for body weight, and even when you control for androgens, even when you control for hirsutism. So, you know, I do think at least in

some of these patients that insulin resistance in and of itself may be contributing to depression. That's something we see in the diabetes literature as well. That's a frightening idea because when you look at the metabolic health of America, I think a new data came out from Tufts that 93.2% of Americans are metabolically unhealthy, meaning they have some degree of insulin resistance. And we also see this sort of epidemic of mental health disorders and depression. And I don't think people realize that, you know, sugar and starch and processed foods is driving not only weight issues, but also mental health issues. Yeah, I think it's, to me, one of the more profound connections and profound concerns.

And I think it's unfortunate because in some ways that depression can often make it harder to address the diet and the exercise. You know, if you're feeling depressed, you're not in the most ideal state to sort of make those important lifestyle changes. So I think it's important that we take into consideration what's happening in terms of a mental health milieu for patients with PCOS and take that into account when we kind of talk to them about treatment, because that's an important component, I think, that needs to be addressed if we want them to make those important lifestyle

changes. Yeah, for sure. So when you see someone with this problem, what's your general therapeutic approach? How do you treat these patients? What are the ways that we sort of can help them have regular cycles to where their acne, their hair growth, their hair loss. And I think you mentioned something really important, which is that you want them to have progesterone, which is sort of the antidote to this overbuilt up of estrogens that happens in these patients. And they don't ovulate every cycle, so they don't make progesterone, which is what you do when you ovulate. So can you talk about what are the kind of therapeutic approaches and how do we potentially use progesterone or other therapies like that? I mean, so I think in terms of therapeutic approaches with PCOS, it's always hard because

I think it to some degree depends on what is their goal. Like, what are they trying to achieve? You know, are they trying to get pregnant at this moment or not? But in terms of the menstrual, let's say it's someone who's like 22 and she's coming me because she's only having three periods a year. And when she does, it's very heavy bleeding. I want to address that because we know that when people go many, many, many cycles without ovulating, it means they don't get progesterone. And that means that estrogen is going to cause over time buildup of the uterine lining, which can lead to very

heavy menstrual cycles, but it also is a risk factor for endometrial cancer over time. So it is important that patients with PCOS get some sort of progesterone exposure. And that can be in the form of oral contraceptives. It can be in the form of bioidentical progesterone being taken cyclically. It can be in the form of an IUD that releases progesterone. I mean, so there's a lot of ways to do it. But if I have a patient who's having three cycles a year or something like that, that's an important conversation that I'm going to have is like, look, we need to figure out some way for you to have progesterone because it's not healthy for your uterus to not have that progesterone over time. So that's helpful. And what else do you do to help with their,

so besides bioidentical progesterone, what other kind of therapies support these patients? In terms of their other symptoms? Yeah. How do you deal with the hair loss or how do you deal with the acne or how do you deal with the irregular cycles? What hormonal therapies are used besides progesterone? Yeah. So I think the irregular cycles, what hormonal therapies are used besides progesterone? Yeah. So I think the irregular cycles would be addressed through some form of progesterone. But the hair loss or hair growth or acne, those skin findings are best addressed, quite honestly, by being on something like a birth control pill.

Because you're going to suppress the sort of stimulation of the ovary that's driving up the androgens and you're also going to increase sex hormone binding globulin which is a protein from the liver that really soaks up that extra androgen so that's honestly the best way to get benefit in terms of the especially hirsutism and acne. And then sometimes we'll even use medications that will block estrogen, block androgen action like spironolactone. Now I do have patients who don't want to go on those medications and, you know, feel like that's not fixing the underlying problem and it's just patching it, or they don't want to be on the pill

for any reason. So that tool is not always, you know, the ideal tool for our patients, but it is certainly one that I would discuss. And what role do you see as diet? Is it a strong lever for changing these patients' reproductive health and their cycles and their symptoms? I mean, if you basically put people on a low-starved sugar sort of diet that treats the insulin resistance, do you see big changes in their clinical picture? I think in some, for sure. And I think, you know, there haven't been great studies on this. There's been a few. I do think that if patients are able to maintain a very low-carb diet, sort of a ketogenic diet, they will be able to really

manage their insulin resistance. And that really takes away one of the sort of drivers or triggers or things that's really exacerbating their sort of phenotype or their symptoms. So if you are able to get the patient to sort of embrace that approach, I do think that you will see that often patients will see benefits. I think it's something that has to be monitored. I don't think all patients will suddenly start having regular cycles and their hair growth isn't going to suddenly go away. But some patients may have more cycles. Some patients may be able to conceive that way on their own without fertility treatment, but others will not. So I think it's something that I try to discuss as an option, but I think I shy away from saying like, here's a way to fix this because I think in all honesty,

it doesn't fix it for some patients. And that's really frustrating if they feel like they're sort of somehow failing. Well, that sort of speaks to how little we know, right? Because in some patients it works, in some patients it doesn't. You don't really know which one's which, right? And it's really about personalizing care. Yeah. So I think it's a challenge. And I do think it's one.

I mean, PCOS is definitely a disorder that just takes a lot of personalization because it's such a diverse heterogeneous disorder. The concerns and the goals are often very diverse. So I think no patient and no treatment plan, quite honestly, is exactly the same. Thanks for listening today. If you love this podcast, please share it with your friends and family.

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