The Liz Moody Podcast - Ask The Doctor: Hormone Edition—Everything You Need To Know About Balancing Hormones Naturally with Aviva Romm, MD

Starting point is 00:00:01 Hello, friends, and welcome back to the Healthy Together podcast. I am your host, Liz Moody, and I'm a longtime journalist and cookbook author, and I am so excited about today's episode, which is my fourth edition of Ask the Doctor. If you are new to the pod, a bit of background. In my years writing pieces for magazines, I have been lucky enough to have access to all of these amazing functional doctors as resources. They are best in class people on the cutting edge of natural practices and Western medicine. It can be hard to find doctors that look at these things in these types of ways and simply have the breadth of knowledge to pull together so much information, though, and it can be really expensive to visit functional practitioners.

Starting point is 00:00:42 So, once every few months, I have my absolute favorite doctors on the podcast and I ask them a ton of questions and pack as much information as possible into the episode so you can reap all of the benefits of their brilliance. The first episode covered more general health questions with Dr. Will Cole. It was about inflammation and gut health and hormones. And then the second covered all things anxiety with my friend, holistic psychiatrist Ellen Vora. And then the third answered literally every single gut health question that you have ever had with Dr. Will B, the gut health MD. So if you're interested in gut health or anxiety or general health, definitely check out those earlier episodes.

Starting point is 00:01:23 But today we are talking all about hormones. I am so excited about today's guest, whom I think is one. of the most brilliant women's health experts in the country, Dr. Aviva Rahm. Aviva is a Yale-trained, board-certified family physician with a specialty in women's health. She's a certified professional midwife, and she's an herbalist. She has been called the face of natural medicine in the 21st century by Prevention Magazine. She's a member of the Yale Integrative Medicine Program's advisory board, and she currently serves as an adjunct assistant clinical professor in the Department of Family Medicine at Tufts University School,

Starting point is 00:01:59 medicine. She's also written some brilliant books, including the adrenal thyroid revolution, which we're going to do a little giveaway for over on Instagram if you want to go and check it out. I asked her basically every hormone-related question that I could think of and all of the ones that you shared with me on Instagram. This episode is truly so comprehensive. We cover what hormones are and why they matter for women. Common signs that you can look for at home that would tell you if your hormones are out of whack, exactly what tests. to ask your doctor for to measure thyroid issues, adrenal fatigue, and other hormonal issues, her thoughts on home hormone testing kits, the relationship between hormones and energy

Starting point is 00:02:40 and how you can take care of your hormones to boost your energy, easy lifestyle changes that you can make to support your thyroid and her thoughts on thyroid medication, the relationship between hormones and anxiety, and ways to support your hormones to lessen your anxiety. I was obviously very interested in that part. How hormones impact weight gain. I'm always saying that I think hormones are a big part of the weight equation. Everybody's always like calories, calories, calories. Let's talk about calories.

Starting point is 00:03:05 But hormones are a really big part of that. So we talk about that. And I was really interested in what Aviva had to say. What having a shorter or longer menstrual cycle means and then how to optimize your cycle in general, whether it's making it shorter, making it longer, just kind of getting your hormones in balance around your cycle generally. Her natural remedies for PMS, including the one food that she thinks you should before your period to help get rid of PMS, which was really interesting. Her thoughts on seed

Starting point is 00:03:33 cycling, which so many of you asked about. So I was glad to answer that. I literally got that question like 50 times. Steps that you can take now to optimize your fertility in the future and her thoughts on egg freezing, her thoughts on hormonal contraception, and steps you can take to balance your hormones while on birth control and then how to detox from the pill if you choose to go off of it. The types of diets that are best and worse for hormones and the individual foods that make the biggest difference in hormone health, the relationship between hormones and low libido and her tips to boost sex drive at different phases in your life, and so much more. I really cannot say enough about how brilliant and kind and compassionate Aviva is. If you haven't already fallen in love with her,

Starting point is 00:04:19 you will when you hear the way that she approaches medicine and women and their brains and their bodies. You can find more from Aviva at her website, which is Aviva rom, rom with twoms.com. It's an amazing resource in general. I highly recommend just so much information there. And then you can also find her on Instagram at Aviva Rom, again, with two M's. I am, of course, at Liz Moody on Instagram, and we would both love to hear any thoughts or reactions or even questions that come up as you're listening. So definitely screenshot and tag us both on Insta. And maybe we can do like an IG live and answer even more. questions if you would be interested in that. Okay, there is a lot to cover here. So without further ado,

Starting point is 00:05:00 let's get right into it. I hope that you enjoy the Ask the Doctor hormone edition with Dr. Aviva Rom. All right, Aviva, thank you so much for taking the time to join me on the podcast. I know you get a lot of interview requests and I'm so honored that you chose to join us on Healthier Together. Yeah, Liz, thank you so much for having me and I am selective. So let's just say this was a deliberate choice. It's wonderful to be here with you. Well, I've long loved you and I'm so excited to share your infinite wisdom with the world. So let's get right into it. I would love like a crash course 101. What are hormones and why do they matter for women in a nutshell? Hormones are chemical messengers and what they do is they take a bit of information from one part

Starting point is 00:05:50 of your brain or body and deliver it to a part that's waiting to get that information. And information, kind of like a relay. So let's say your brain creates one hormone and it needs your ovaries to release another hormone. That hormone is like doing the relay between one part of the body and the next. And they're produced by glands, which are just organs in the body that produce and secrete hormones and other things as well. And women, human beings in general, but particularly women, I mean, hormones are the entire musical accompaniment of our lives. Nothing happens once we hit puberty, basically. And even before, like even before the puberty hormones, even before the estrogen and progesterone

Starting point is 00:06:34 and testosterone, we still have hormones like thyroid hormone that's dictating our growth. And then once those, I call them the lady hormones kick in, you know, we get those monthly cycles, we get different life cycles, we get changes in our body. We get changes in our mind, mood, emotions, all of it. All right. That was actually like a really nice, it was the most succinct explanation of hormones that I have heard. That's amazing because I'm not always succinct.

Starting point is 00:07:03 What are a few signs that people can look for? We'll talk about test kits and stuff like that and doctor testing, but what are a few signs that people can look for at home that would show them that their hormones are unbalanced or out of whack? Well, it also depends on what hormones we're talking about. talking about. So if your thyroid hormones are out of whack, then you're going to get one of two sets of symptoms. You're either going to get under functioning thyroid hormone activity or overfunctioning thyroid hormone activity. So underfunctioning would be hypothyroidism,

Starting point is 00:07:35 which may or may not be an autoimmune type, which would be called Hashimoto's. And that's things like constipation, fatigue, depression, sleep problems, dry hair, dry skin, thinning hair. brain fog. There's a whole host of symptoms that go with slow functioning thyroid. And then over functioning thyroid, you get almost the opposite of that. Instead of the depression, you tend to get more anxiety. You can't sleep. You have loose stools. You're instead of gaining weight, you're losing weight, or you just cannot, you feel like you can't eat enough. So those are the thyroid symptoms. If you're having imbalances in your adrenal stress response and your producing too much cortisol, that creates one set of symptoms. That can be things like anxiety,

Starting point is 00:08:26 depression, sleep problems, weight gain around the middle. Some of them are mimic kind of symptoms of slow functioning thyroid. And then if you start producing too little cortisol because your body says, all right, we can't keep overproducing this. We've got to slow it down. Then you might start getting sick more often than usual. You might notice that you're wounds if you know you have a small cut it's not healing as quickly or as well and in some serious cases you can even end up with burnout or autoimmune diseases so that's you know those are the common hormones that we don't think about when we talk about the sort of more female hormones the female hormones show up in every aspect of our reproductive cycles so our menstrual cycles may be irregular they

Starting point is 00:09:17 They may go AWOL, that you may just start skipping periods or not having periods. You may have heavy periods, really, really light periods, which might sound like fun. You know, oh, I don't have to think about my period that much because it's so light and it only lasts one day and I barely need to wear a pad or a tampon. But it could mean that you're not ovulating and that can lead to fertility challenges, low progesterone, which can lead to mood, kind of like moody feelings because progesterone helps keep us calm it helps us sleep. So anything where your cycle is really irregular, lasting too long, really heavy, really light,

Starting point is 00:09:55 those would all be signs of hormone imbalance. But also things like depression, you know, about probably as much as 30% of people who have depression, it's really not something going on psycho-emotionally per se. It's not necessarily a mental health problem. it's a mental health symptom that can be happening because of cortisol or thyroid or imbalances in estrogen and progesterome. So really pretty much any of the sort of day-to-day functioning that we expect to or hope to have flowing and humming through our lives, whether it's being able to sleep or, you know, having regular bowel movements that are easy, not too loose,

Starting point is 00:10:40 not too constipated to that monthly cycle. Also things like fertility challenges suggest there's a hormone imbalance. And then as we get into our 40s, 50s, menopausal symptoms can start to happen. And there's a whole range of kind of complicating or complicated imbalances like PCOS or endometriosis, which involve the hormones, but also involve the metabolic system or involve the immune system. It's pretty far-reaching, actually. Okay, so if you have, you just list off so many things, and I feel like I have some of those symptoms. If I'm like, oh, yeah, that's me. Some of those things, would I get an at-home test kit?

Starting point is 00:11:28 Do you think that those are a valid option? Would I go to the doctor and ask for a panel of some sort? Yeah, so great question. if you suspect a thyroid problem, you can get at-home thyroid testing or have your doctor do it, or your doctor can send someone to your house to draw the lab work for you. The nice thing about having your doctor do it is that you then get your doctor, or it can be another healthcare provider, it can be a nurse practitioner, a naturopass, someone licensed to order and interpret tests. Then they can help you with the interpretation, and then they can help you with what you might

Starting point is 00:12:01 need to do next. So for thyroid, you would get a complete thyroid panel. That would include tests like a T-S-H, free T-3, free T-4, and then the thyroid antibodies. For cortisol, there are two different types of basic tests. There's either a test that you can get and you do it at home and you spit into one little vial, like four different times a day. You get a different vial, and it's measuring your cortisol levels at four different points in the day. or you can do a 24-hour cortisol. There's a nighttime cortisol.

Starting point is 00:12:39 And again, a functional medicine practitioner, a naturopath can provide those for you. There are some home test companies. I think the quality can be variable. So you definitely need to do your homework looking at the different companies. And also some of the companies, it gets to be a slippery slope

Starting point is 00:12:59 because a lot of them also sell supplements. And so they may have an ulterior motive in how the labs are interpreted and what they funnel you into doing. So I'm always a little bit cautious there. Are there any that you would feel comfortable saying like this is a good company, I trust them? Because I personally prefer my patients to go ahead and get them done either at a lab core or a quest. So I would generally not recommend specific companies. Okay. Well, then in that case, I do like to give the, I think a lot of people have doctors that they don't feel.

Starting point is 00:13:32 like are as functional or they'll say if you don't have huge problems, you probably don't have a hormonal issue. So then I like to give them like the specific information that they can go to with their doctors so they can get to the bottom of things. Absolutely. So the thyroid is TSA free T3, free T4 and the thyroid antibodies. Most doctors will have no problem ordering a TSA for someone if they seem like they have thyroid symptoms. Sometimes it's a little bit more work to get them to order the other tests, but you can start with the TSA and see how that looks. For adrenal, the main thing is that doctors don't believe in the concept of adrenal fatigue. It's not considered a real thing.

Starting point is 00:14:18 So what you want to do is go into your doctor and explain the symptoms you're having and share an article from a website like mine that explains that it's not adrenal fatigue, but here's what it is. And you can call it HPA axis dysregulation. They may be a little more responsive to that. Most aren't going to know what it is because we don't get that training in med school, even though it's a real thing. But in that case, you want to ask for either a 24-hour salivary cortisol or a nighttime cortisol,

Starting point is 00:14:51 and they'll know what that is. And then for hormones, it gets a little bit trickier with women's hormones. hormones because, for example, there's not one set of tests that proves that you have PCOS. There's not one set of tests that shows you what your hormone levels should be once you're in menopause. Should your estrogen be like you were 26 or 28 or 36 or is it appropriate for it to be low? So you can get a hormone panel and that would include your estrogen panel, a progesterone panel, usually free testosterone and total testosterone. And then I also order something called sex hormone binding globulin or SHBG. And it's ideal to get it on day three of your cycle or day

Starting point is 00:15:47 21 of your cycle. If your cycles irregular or you don't get regular periods, then kind of guesstimate where you would be. And ideally day 21, and technically it's between days 18 and 21 is going to be the most revealing about your estrogen and your progesterone. The other thing is it's optimal if you can get the test done by about 9 a.m. for the hormone panel. So those are the things that you want to talk with your physician about. And then if it's a physician who's doing telemedicine, which so many are right now, they can

Starting point is 00:16:24 write you a prescription to go get the labs done somewhere like lab. core request. Okay. And then if we get the results, are there articles on your website that would tell you how to, like, this is high, you might have adrenal fatigue. This is how your cortisol might be out of whack. Yep. So on my website, you'll find all the symptoms of these different things that we're talking about, these different conditions, and then what testing you can do and exactly what to ask for and then what it means. Okay, perfect. I love, I think your website, I think doctor websites are such a underused resource for people versus, you know, media, which might be more clickbaity. And I say that as a person who works in media, I think that going directly to the source,

Starting point is 00:17:09 I always send people to your website and I think it's so, so helpful. Thank you. Yeah, my website, my kind of dream for my website would be, you know, yes, someone goes to mind-body green and they go to well and good and they go to go to goop. And then at the end of the day, they put that all together and go, okay, but what does Dr. Aviva say? And that helps them make their own best decision about the different options that they've learned about. Yeah, I love that. Okay, so we know what we have. We've been diagnosed. Let's start talking about various symptoms and how we can treat them. So first, I would love to talk about the relationship between hormones and energy and ways that we can support our hormones for more energy, whether

Starting point is 00:17:46 that's via supporting them for better sleep or just supporting them for more energy throughout the day. Yeah. So the hormones that are most likely to impact your. energy directly are your thyroid hormones. So if you're feeling fatigued, I mean, there can be a lot of reasons that people are tired, everything from not getting enough sleep to having an autoimmune condition to depression. And right now, I feel like a lot of people are just kind of fatigued and overwhelmed from what's going on in the times that we're living in. But it's, you know, so if you can put your finger on it and say, okay, I know I haven't been getting enough sleep, I've been like staying up, binge watching Netflix every night till two in the morning and then I'm getting up at

Starting point is 00:18:27 six, boom, you pretty much have your answer, mic drop, you know, get more sleep, right? But if you're staying up till two in the morning because you're having anxiety, then it's a good idea to look at, well, what's causing my anxiety? If it's because you're drinking too much coffee, then you want to back down on the coffee. So, you know, common things being common, if you can put a finger on it and adjust the behavior, often it's just making that shift in what you're doing and how you're living your lifestyle. Like you're not getting enough exercise and then you're exhausted, get some more exercise. But if you can't put a finger on it, if it's been something that either like came on really suddenly and you're just like, wow, I am just dog tired. I can't do anything.

Starting point is 00:19:09 Or if it's been creeping up over a bunch of months and you're really noticing a change in your pattern, that's when it's good to get lab tested, right? Because with things like your thyroid, you have to, I always say test, don't guess. You can't just treat. You. You can't just treat. your thyroid based on guesswork. So get it tested out. If it's completely normal, then kind of go back and look at, well, is there something else medical? Am I an anemic? Do I have an autoimmune condition? Is there testing that I need to do to make sure none of the other like big or scary things are going on or none of like the nutritional things are going on or other things that are easy to fix with, you know, a supplement or your diet or lifestyle? If you find out that it is your thyroid,

Starting point is 00:19:52 Sometimes it does take thyroid medication, but often if it's very mild, you can work with adjusting your stress levels. There are certain herbs and supplements like Oshuaganda and vitamin D that have been found to be helpful for supporting thyroid health. So, you know, if it's pretty vague, you can't figure out why get tested and then take the appropriate next steps, either looking at a website like mine or another one that you trust that can give you the answers on, okay, I have this, I've been diagnosed with this, what do I do next? You mentioned the thyroid medication and a lot of people wanted to know if you were okay

Starting point is 00:20:32 with synthetic thyroid or bioidentical thyroid medication or what your thoughts are on that. Yeah, so my experience with thyroid is if somebody has a pretty entrenched thyroid problem, they've had hypothyroidism for a long time, they've been on, let's say they've been on synthroid, which is a synthetic thyroid hormone. My grandma always said, if it ain't broke, don't fix it. And so I'm kind of like, if it's working for you, you're managing well on that medication, unless you have a philosophical reason to not be on the synthetic, just go ahead and stay on it. But if someone's coming to me and I'm newly diagnosing a thyroid problem and I'm starting them on a medication, most people that are coming to me, come to me philosophically because they know I practice more naturally. And so they're going to want a more bioidentical natural thyroid hormone replacement. And so I'll start them. on that. But if they're not getting results, I don't have a problem using syntheroid. I mean, it works. It's not my ideal, but it works great for some people. So sometimes it's just finding the right one for you. If you have a mild thyroid problem, you know, or you're just

Starting point is 00:21:38 recently diagnosed and there are root causes that you can maybe get to the bottom of. It doesn't mean you necessarily need a thyroid medication, though. So you kind of want to figure out how severe your symptoms are, how much they're impacting your life, how far off from normal your labs are. Like if they're off the chain abnormal, you may want to do a thyroid medication for a while to kind of bring them more into range. So you feel better and then, you know, add in the herbs and supplements and support as you go along. And I talk about that on my website, like what things are safe with what pharmaceuticals, but mostly the herbs and supplements for thyroid support our safe with thyroid hormone medication. Could you just briefly talk about a few

Starting point is 00:22:23 lifestyle practices that would support thyroid if you're on those more mild ends of the spectrum? Yeah. So one really big one is stress. And I know it's so easy to just throw out the word stress, but let's get really granular here with it. I talked about the thire, the, um, adrenals and cortisol before. When we're under chronic stress, so, you know, a little bit or a lot of stress over a prolonged period of time or when we're under a short-term but significant amount of stress, you know, like a job loss, a move, the kinds of things that are happening right now with COVID-19, for example, we know that that can cause your body to increase cortisol production. Cortisol has three different ways that it actually blocks the thyroid from working.

Starting point is 00:23:10 It actually stops the thyroid from getting stimulated by TSA so that you're not making as much thyroid hormone. It prevents the body from converting the inactive thyroid hormone T4 to the active form T3. And it blocks the receptors on the cells. So even if you do make the thyroid hormone, the cells won't accept it. It would be like putting a key into a lock, but somebody changed the lock and the lock won't work. So the key won't get in and turn the door. So stress in and of itself is a really big trigger of thyroid problems. So working with stress is really important. For some people, certain dietary triggers may be causing problems with their thyroid. So if you have celiac disease, and for some people, even non-celiac gluten intolerance, gluten may actually be a factor. It's probably a

Starting point is 00:24:04 factor for a small percentage of people, but it can definitely be a factor. Imbalances in the gut microbiome and also something called leaky gut, which can lead to systemic inflammation, can also affect the thyroid. So anything you can do to support and heal your gut can be really beneficial for the thyroid. And that can be some surprising things. So for example, we know that certain herbicides and pesticides can actually affect the gut and also affect the thyroid. We also know that artificial sweeteners can affect the gut and affect the thyroid. there are a lot of little kind of subtle things that we can change that when you add them all together may actually have a big impact. The other thing is sleep because anytime we're not getting

Starting point is 00:24:54 enough sleep, that actually acts as a stressor to our body and that can activate your thyroid, your cortisol. So anything you can do to just improve your quality of life. I mean, playing more, laughing more, getting out into green space. more, getting to just beautiful natural places, unplugging. I mean, we're all on the computer so much right now. And not only is that stressful, as we all know, being on Zoom all day or whatever it is that we're all doing, but if you're on the computer into the evening, that can keep your cortisol elevated, but also prevent your melatonin from going up. And so then you have trouble sleeping and melatonin acts as an anti-inflammatory. So I would say, you know, reducing stress,

Starting point is 00:25:44 having more fun, stepping away from the computer, eating a really balanced diet, and, you know, anything you can do to heal your gut, great, great stuff for your thyroid. But I also want to say that if it turns out that you do, for example, need help with your thyroid, especially for hypothyroidism or Hashimoto's with thyroid medication, it's not a failure on your part. And I think a lot of times in the integrative and functional and wellness space, we can give people the idea that if you just eat the right diet, if you just have the right yoga and meditation practice, if you just live the perfect lifestyle, you won't have these health problems or that if you develop one that somehow you have failed. And it's way more complex than that. I mean,

Starting point is 00:26:29 nobody is failing to not respond to stress well right now. Nobody fails to not get enough exercise. Nobody fails to eat the perfect diet. It's just life happens. And sometimes these problems got kicked in to action before we ever even became conscious of doing those things. Some of these things started when we were little children and we were given too many antibiotics. So we have to be really gentle to ourselves whenever we're looking at any hormone imbalances or any health problems. Yeah, I just went on a whole Instagram rant about this because I do think it's a slippery slope in the wellness world. I think we want to be encouraging people to make actionable choices and take care of their health. But I also think that there can be this attitude that

Starting point is 00:27:17 if you, it's all within your control. And I think there's both genetic factors, but I also think there's a lot of systemic factors from things like access to healthy food and affordability of healthy food, but also things like the load that women tend to carry in their households that makes it harder for them to not have stress that's just sort of been built in over years and years and years and years. And we're seeing that so much in the pandemic. So yeah, emotional labor is huge. Yes, emotional labor that women do is a real burden. And then all of the insidious environmental exposures that we get, you know, and then add to that, I mean, how could anyone not be stressed in the world right now. It's such a vulnerable, volatile time. And so I think as we are able to

Starting point is 00:28:09 acknowledge to ourselves, you know, it's not my fault. And yes, there are things I can do. But I think as we take away the blame and especially for women, that self-blame and the idea that we should, could do it all, fix it all, be perfect is part of that emotional labor. So stepping out from emotional labor and giving ourselves a little bit more time to enjoy life and be forgiving and appreciative of our bodies, even if things do come up and when things do come up, can be part of the, that acceptance and gentleness and compassion for ourselves can be part of the healing process. So beautifully said. I want to talk about the relationship between stress and anxiety and hormones because I personally feel like I'm in this vicious cycle of I know that having elevated stress and anxiety

Starting point is 00:28:58 is bad for my hormones, but perhaps my hormones are also causing elevated stress and anxiety. And it feels just like I'm trapped. And I don't know. I'm curious what are actual things I could maybe do day to day to help with my stress with my anxiety. And then also if there's things I could be doing on the back end hormonally that would just make me feel less stressed and anxious in the first place. Yeah. Do you feel comfortable going a little deeper with some of what's going on so we can kind of dive into it? Yeah, sure. Like, what am I feeling? Yeah, yeah. Can you identify, are they specific stress triggers, specific things that activate your anxiety? How is your anxiety

Starting point is 00:29:43 showing up? And like how are you personally, like in your own experience of your body, your mind, your life, how are you connecting that to your hormones? I feel like I'm just in this hyper, I identify as a sort of highly sensitive person already, and I feel like I'm in this hypersensitive, hyper-aware state all the time, both in like being aware of not being exposed or exposing somebody else to a virus that is going through the world. But then also, I just feel like all of my senses are being absolutely stimulated. and on high alert with the news and what's happening in the world.

Starting point is 00:30:25 And then I don't sleep as well because I'm both up on my phone trying to distract myself from everything going on, but also kind of addicted to reading about everything going on. And then it starts all over the next day. So I feel like my chest is always like a little tight and a little constricted. And I do the base level stuff. Like I meditate and I eat pretty well. and I take probiotics and things like that. But I guess I don't know how to not have stress and anxiety in the world that we live in currently.

Starting point is 00:30:58 Yeah, yeah, I really feel you on that. So, I mean, in some ways, I had a teacher who many years ago, she's passed now, but she used to say the wound reveals the cure. And, you know, in some ways, like the answer is embedded in your own insight, which is that when you're reading the news and staying on that cycle of following what's going on, you get really activated. And then, I mean, who wouldn't be? We're living in this dystopia, right?

Starting point is 00:31:32 We're living in, short of zombie attack, we are sort of living in a zombie movie, right? We're living. Don't count it out. We have more of 2020 left. Yeah, but it's true. I know. I was actually watching a zombie show recently thinking, could that happen? What virus could rabies mutate and do that?

Starting point is 00:31:53 So I can say for me what's been helpful and what I would recommend trying. You know, when the pandemic started, naturally one, as a physician, it's my responsibility to know the data and really keep up with it. And as I found myself like, I remember when the Johns Hopkins site went up live and there were, you know, tens of thousands of cases. And I remember thinking, huh, I wonder what they would do if it ever got to seven figures. And I remember my husband's saying, because the space that they had the numbers in wouldn't have fit seven figures. And my husband's like, it's going to get to seven figures. I don't know. I mean, I'm just curious what they're going to do digitally with this. And, you know, then it went up another hundreds of thousands and then it went up another millions. And every time it went up, I would struggle with the, this sense of balancing the responsibility and importance of knowing so that we can be prepared and safe and so that I could also inform others in a meaningful way and how it was affecting me on a personal level. And I found that the anxiety, like, if I checked before bed and I

Starting point is 00:33:07 saw the numbers before bed, forget it. It was just impossible not to spin out, right? So I found that for me, I would check once a day, check early in the day. And then I personally, I'm also super sensitive. And if I read the news, I get very, like it's very upsetting. How could it not be? It should be. We wouldn't be living, breathing, sentient, compassionate human beings if it wasn't upsetting. Yeah. My husband loves to read the news. And so. So does mine. Jack likes to read it so much. And he's, he can like move through it and not be. and I'll be sitting there crying and he's just like, oh, yeah, that's interesting information. And I think men, you know, from what we know about cortisol and oxytocin, they do respond to

Starting point is 00:33:50 stress differently, both emotionally and psychologically, but also physically. We internalize, it's been well studied. Women internalize stress in a different way that tends to show up in physical symptoms, whether those are migraines or headaches or sleep problems or digestive symptoms, even IBS or hormone problems. And anxiety and depression, of course, we're much more prone to those. But at the same time, like you, Liz, I mean, I manage a social media platform.

Starting point is 00:34:19 I'm communicating with people. I mean, the last thing I would want to do is post my beautiful new dessert on a day when, oh my gosh, like something more cataclysmic happened in the world and it just would be completely insensitive and inappropriate. So I have it where my husband, in the morning before anything goes live, he lets me know, like, there's been something that happened last night, so this is what you need to know for today. And that is still upsetting. And I don't mean to

Starting point is 00:34:49 sound like an ostrich with my head in the sand, but my work depends on me being able to be present and focus and give to others. And if I'm distracted by a million bits of bad news, it's really hard to do that. So I found and recommend to my patients who are struggling with this, now in my online community, find that person in your community who's going to let you know what you need to know so that you are prepared, you are safe, you can respond appropriately, whether that's talking to your children about something that happened that they might hear of somewhere else, or whether it is managing your, you know, social media or whatever it is you need to do appropriately and considerately that day and whether what you need to be

Starting point is 00:35:30 involved in reacting to and, you know, helping within the world. And then have the discipline to just hear about it that one time and learn what you need to know about it. And then if you need to hear something more at the end of the day, like do it around four in the afternoon, not in the evening, not before bad. So that you're actually containing and compartmentalizing it. And once you start to do that, you know, we know that going on the internet, we know that engaging in social media, especially if you're getting likes on things. We know that all of this activates the dopamine centers of our brain, that it is actually physiologically addictive. It's not like it just feels addictive or you think you're addicted. It actually is addictive. And so breaking that pattern by

Starting point is 00:36:20 setting a boundary for it. It's like if you didn't want to eat cookies, you wouldn't buy the cookies hopefully and not have them in your house. Kind of the same thing, just setting some parameters. And then if you're also asking someone to kind of be your guardian of the news or whatever it is, then you're setting a time limit and somebody else is kind of being your support and sponsor around it. So be more mindful of what you're letting in and recognize that it doesn't mean that you're a less caring person. It doesn't mean you're a less thoughtful or intelligent person. but it doesn't mean you have to know every new horrible thing that happens in the world. And that's been part of the 24-hour media cycle, intentional development of media addiction in the media industry.

Starting point is 00:37:10 I mean, this has been well studied. We didn't used to have 24-hour media cycles. This is a relatively modern phenomenon. And as we track the rise of these media cycles and as we track the rise of device use, we've also seen the rise of anxiety. and depression. Are there any other practices that you as a human or you as a doctor sort of incorporate into your life to help keep stress, lower anxiety at a minimum? Yeah. So I'm really diligent about not being on electronics before bed. So I read a hard copy like real book that I can hold in my hands, not on a device before bed. And when I start to get sleepy, I put the book down,

Starting point is 00:37:54 shut the light, and then I do just a little breathing exercise. I'm very diligent about keeping my blood sugar steady throughout the day, so not skipping meals, not having sugary breakfast, but really very mindful about the making sure I'm getting like plenty of good quality fats, which are good for our brain and nervous system too, good quality protein, lots of veggies. I'm not, I don't eat a lot of sugar. I mean, I'll have like a little honey in my chai sometimes or something like that, but refined sugar is not a big part of my diet. And then keeping caffeine to a minimum if you're sensitive to it, especially after like 10 o'clock in the morning. I would say probably one of the practices that my patients have found the most valuable is something that I accidentally made up,

Starting point is 00:38:42 and it's called the worry journal, actually the worry watchers journal. I had a patient who had been very, very overweight at one point in her life and had amazing success with weight watchers. And with weight watchers, I don't necessarily agree with the principle, but you can kind of eat anything as long as you stay within your basic calories. That's simplifying it. But you have a certain amount of calorie points essentially and you can use those up how you want to. And then you're done with it. And she came to me for really severe anxiety. And I said, okay, it just kind of popped into my head. I was like, well, what if we did, instead of wait watchers, we did worry watchers? And so you can worry for 30 minutes a day, not whenever you want to

Starting point is 00:39:27 and whenever you need to, but you've got to like sit down and do your worrying or you can break your worrying into two 15-minute segments. So you can worry for 15 minutes in the morning and 15 minutes in the evening. And then we're going to wing you down to 15 minutes of worrying a day. And then what for her, the anxiety was especially bad at night. You know, she'd either not be able to fall asleep or she'd wake up in the night and like those worrisome thoughts about everything. Like what if her husband died? What if like their house burned? It was like every human worry you could have she'd worry about, you know. So I started having her do a journaling practice before bed where she'd go to either her dining table or a chair in her living room, but not in her bedroom

Starting point is 00:40:09 and sit down, just get out a journal or even a cheap notebook and write down just stream of consciousness is everything that she's worried about. Just like write it out. Don't judge it. Just write it out. And then put the notebook down, go take a shower, put some essential oils, like some essential oil of lavender in the shower, and then just let that wash away and then get in bed and read a book and go to sleep.

Starting point is 00:40:33 And it was transformative for her. So then I started doing it with patient after patient after patient. And it's really powerful when you say, okay, I'm recognizing that I'm worrying right now. and I'm going to let it go. I'm just going to let it run wild, like, you know, a dog out in the front yard. It's just going to go crazy. It's been pent up in there. I'm going to let it go.

Starting point is 00:40:53 But recognize that it's just worry. And then, okay, I'm done with that. Like, worries you've had your, like actually talk to them, worries you've had your time, boom. And then later in the day, if the worry starts to creep in or the anxiety feelings, because they might not be thought worries, they might be physical sensation worries, start to creep in. then remind yourself, okay, I've done my worrying for today. I can worry again later before bed, but right now I don't have to worry about that. Another thing is that for some people,

Starting point is 00:41:23 their anxiety takes the form more of physical symptoms. So, for example, I had a patient who had experienced a very severe trauma and she had developed true PTSD. And she would suddenly find herself throughout the day, just realizing she wasn't breathing. Like, I mean, she was breathing enough to stay alive, but she could feel like her shoulders were up, her chest was tight, and she was just in that moment of almost like frozen panic. And she was kind of living that way. So I encouraged her to create a practice where she would use her smartphone. So she would just set her iPhone for four alarms throughout the day. So like one at 10 o'clock in the morning, one at like two o'clock in the afternoon, one at seven, and then one before bed. And during those times, just

Starting point is 00:42:12 stop what she was doing and check in with her body and do a couple of minutes of breathing. So proactive, preemptive, am I paying attention to my body? How am I feeling right now? Am I hydrated? Have I eaten? You know, are my shoulders up to my ears? If they are, like, I'm going to just do a few minutes of deep breathing to re-center myself. And doing that and making that a habit, eventually she was able to stop using the phone. And we used other things. I mean, she used some herbs before bed. She used some CBD, which helped her with her anxiety and her sleep. And she increased her magnesium. She added more healthy, good quality fats to her diet. Really, we worked with balancing her blood sugar. And now, a year and a half later, she's writing a book about healing her trauma. And it's

Starting point is 00:43:11 a really powerful story. Yeah. Wow. So those were some of the things. And then for me, I mean, for me, getting out in nature, it always clears my head. So I think for me, you know, worry is like when you're imploded in on your own thoughts and your own sensations and your own concerns. And so life starts to feel really small. You know, it feels like you're narrowing into this really tiny, narrow field of focus, and that's all you can think about. For me, when I even just step outside, I remember that I'm just part of something bigger. That's really beautiful and really amazing. And that, for me, that automatically eases my worry, all the more so if you live near the ocean or a forest or somewhere where you can really get into something bigger. And then the last thing I would

Starting point is 00:44:02 say, which probably seems obvious, but I mentioned earlier when we were first talking that oxytocin is one of the hormones that connects with the stress response. Or I think I said that to you. I've done two interviews today, so I may have said that earlier. So if I didn't say that oxytocin is a hormone that acts as an antidote to the stress response, so it acts as an antidote to cortisol and adrenaline, it calms the stress response down. and how do we increase our oxytocin by connecting with others? So reaching out to someone who you really feel like you can dish with,

Starting point is 00:44:40 you know, not just someone who you have to be polite and BS around how you're actually feeling, but someone who you really, you know, I call it the 2 o'clock in the morning friend or the drunk by the side of the road friend who would actually come pick you up if you were drunk and naked and like just broken up with your partner. And they still wouldn't judge you. They'd be like, what did you do? but they still wouldn't judge you and they'd get you home, you know, that friend. And here's the thing.

Starting point is 00:45:04 Sometimes, and especially as women, we don't want to burden other people with our stuff. Or maybe we don't even want to admit how anxious or stressed out we are. But the studies that have been done on oxytocin and stress reduction and healing have shown that not only does the person who is reaching out get the benefit, but the person who is receiving and supporting on the other end also gets an equal benefit of an oxytocin boost. So, I mean, obviously you want to give your friend a heads up and make sure it's a good time to, you know, engage with what you've got going on. But the more we open up and the more we get real about what's going on and how we're truly doing, and the more we can connect with others.

Starting point is 00:45:52 And all the more, like, if you could take a walk in nature and have the conversation, like that, you know, it's so thorough. Double dose. Yeah. A pets are really good for oxytocin too, aren't they? Like, I always feel like smelling my pet is the most anti, the best anti-anxiety drug on the planet. Yes, I was just talking with someone and thinking that as I was saying that about connecting, that there's really cool evolutionary biology that I learned about a few months ago about how dogs evolved from wolves to become pets and how when human beings make eye contact with their pet, and it's especially been found with dogs, that their oxytocin goes up so it's relaxing for them and our oxytocin goes up. And I don't know what happens with dolphins also. The only mammal I know

Starting point is 00:46:42 that it actually happens with is humans. Like the only cross species is humans and dogs. But definitely, like, we absolutely know that pets. Now, my dog is probably going to be the death of me because he loves me so much that he's always under my feet. So I, like, I can be cooking in the kitchen with a knife in my hand. And I step back and there's scout under my feet. But in general, yes, there are so long. Well, and I can attest, There's not hard science maybe, but I can attest to the same experience with my cat. So if there's cat owners out there, I do think there's a lot of oxytocin to be had from them as well. Yeah, just petting them and snuggling. And I think that getting a pet in this time, especially like, please don't blame me later if you get a pet and it eats your shoes. But especially if you live alone right now, it's such a great time. My daughter, my youngest daughter, she got a dog. And it's just been amazing for her. having that amazing companion. And she got a very active puppy, so she's been training him too. But yeah, I really watched it with my own eyes, how impactful it's been for her to have this little guy around. So you mentioned earlier that if your cycle is short and light, it's a problem. And also,

Starting point is 00:47:53 if your cycle is longer or heavier, that's a problem. Can we talk about optimizing your cycle length if you're experiencing either of those extremes? Like, what could we do if we have that? Yeah, totally. So let's talk about what normal is first. So you'll read a lot of different things on the internet, especially from folks who have period products or are, you know, wellness influencers around menstrual cycles that sometimes define a healthy period as being between, like almost you get to feeling like you have to have a 28 day period that always happens at the full moon to be normal or something like that. And there's way, way, way more variety than that. So technically, a normal menstrual cycle can be as short as every 24 days and as long as every 36 days and still be completely normal.

Starting point is 00:48:45 Also, you can have a period that's as short as two days long and relatively light where you only change your pad a few times and as long as seven days and be on the heavier flow side and that can be really normal. So the way I look at it is kind of understanding what the normal parameter is and then also how you're feeling. So if you're having a period every 24 days and it's a gusher, you could get anemic and you may be really exhausted and that may be a sign of really being imbalanced. So if your period is causing you discomfort, if it's draining you, if you're trying to get pregnant and you're having trouble getting pregnant and you have irregular periods, like that is kind of what to look for. Also, if your period doesn't come consistently within about a four-day span each month. So let's say you always have periods that are 26 to 30 days apart and they always last about three to

Starting point is 00:49:44 five days. That's normal. So if you have it for 30 days one month and 28 days another month and 26 days another month and then 29 days the next month, if it's within a four-day range, it's really not an issue. So, you know, it's how uncomfortable are you if you're having heavy cramping, if your periods are so all over the place that you don't even know when your next period's going to come. If you typically skip periods, like you go typically more than 36 days on the regular that's happening for you or if there's 36 days, someone's 50 days, someone's 28 days, like that is too far a range because it's more than that four-day variability. A normal amount of pads or tampons to change a day, you kind of want to think about four to six. Like if you're

Starting point is 00:50:33 wearing one pad or tampon all day, not that you would wear one all day, but if you didn't have to change it because there's not enough blood, like you're just basically spotting, then you're probably not ovulating and producing enough hormones to build up the uterine lining. And not ovulating can be a problem because you're not producing progesterone, which is really important for your nervous system. But also it can mean that you're not. your bone health and some other things that are really important to protect because it would be low estrogen. And so not ovulating not only means that you would have trouble getting pregnant, but there can be other things going on. Also, you want to think about, well, why wouldn't somebody

Starting point is 00:51:12 be ovulating? And one of the really common reasons is not eating enough calories or over-exercising. And you might be listening and thinking, well, who would do that? But Liz, I mean, you and I are in the wellness world. And we know that even some of the most well-meaning, die-hard diet and yoga people are struggling with subtle eating disorders that kind of like our work can give us an excuse to hide. So if you're overly restricting, if you're overly exercising, that could put a kibosh on your cycle. So, you know, these are just some different things to look at. On the other hand, if you are having a really long time between your period or you're skipping a lot of periods, then what can often happen is that your uterine lining is continuing to build up. And that's what sheds when you have a period.

Starting point is 00:52:05 But if it's building up over like six weeks, eight weeks, 12 weeks, when you get your period, it may be really heavy. And a heavier period is usually going to also be a more crampy, painful period. Even if you're not skipping cycles and you're having your period pretty regularly, if it's really, really heavy, where you're having to change your pad every couple of hours, it's pretty soaked, you're having to double up pads during the day, that's not considered optimal either. And that can be a sign that you have either too much estrogen or that you have low progesterone and the low progesterone is not balancing the estrogen. It's not supporting the uterine lining being stable so that a lot of blood comes out. A lot of that buildup comes out

Starting point is 00:52:56 at your cycle. And the reason that the heavier periods are often more painful is that the way that the uterus gets that uterine lining out is by contracting and squeezing. So the more it has to do that to clear itself out each cycle, the more crampy it's going to be. Now, there are other nuances about this, which is why I've got a book coming out in March of 2021 on women's hormones, in that there can be dietary reasons. For example, chronic low-lying inflammation that can happen when you're producing too much of a chemical called inflammatory prostaglandins can also cause a lot of heavy periods. They can cause a lot of women might notice they get like really loose poops before their period.

Starting point is 00:53:44 And they can also cause really painful periods. So there's lots of different nuances, Liz. How do you want to unpack this so that it can be really actionable? Okay. So I would love one. Is there an easy at-home way to know if you are ovulating? Yes. So there are a few easy at-home ways.

Starting point is 00:54:04 One is you can get an app. You know, there are lots and lots of apps on the market now. So anything from flow to Daisy. I mean, there are so many that you can pick from. Those were just two that came to the top of my mind, not even necessarily the only ones I would think of. So you can use an app, although they're not always fully accurate. In fact, my daughter was trying one of them. I can't remember which one.

Starting point is 00:54:29 And she said she was really feeling pre-menstrual one day. And her app showed that she was ovulating and she was just like F you to the app. Like clearly you don't. She actually said she said it out loud to the app. Bing that she was ovulating. She's like, F of you, but she said it, you know. And so that's one way. I like the more organic old-fashioned way, which is learning how to chart your cycle and learning how to pay attention to what your body's doing. So when we ovulate, a number of different body changes happen. One, we tend to be more horny. We actually tend to want to have sex more because our body is

Starting point is 00:55:06 biologically, reproductively fertile right, that moment. And the way our body gets us to reproduce is to make us want to have sex when we're ovulating. So start to like pay attention to, are you feeling more attracted to someone? You know, maybe not even your partner or like you're just really wanting to have sex right now. Our bodies give us clues. So pay attention to that. Look at where you are in your cycle. If you have a pretty regular cycle, then we typically ovulate about 14 days before our period. And depending, it doesn't really matter what length your cycle is, you're still going to ovulate about 14 days before your period. So whether your cycle's 30 days or whether your cycle's 24 days, you can basically kind of, if it's regular enough, backtrack.

Starting point is 00:55:52 And then another thing to look at is your cervical mucus. Now, you do not have to stick your fingers up on in there to get your cervical mucus. You can notice it when you wipe. A lot of us notice that we have a different traction down there at different parts of your cycle. So right before your period or right after your period, you might just feel like normal dryness when you wipe. But then when you get to your middle of your cycle where you're ovulating, you notice a lot more slippery mucus even on your toilet tissue. And if you, you know, if you're a gully and you want to check it out with your fingers,

Starting point is 00:56:27 you can stick your fingers right to the vaginal opening and you'll get this stretchy, almost like egg white consistency mucus, but it actually stretches between your fingers. And then another thing is to learn to track your basal body temperature. So my book is coming out in March. It'll explain how to do all of this. There's a book called The Fifth Vital Sign, which is a wonderfully done book on learning your cycle. And the classic book is by Margaret Knopfziger. and I cannot believe I'm blanking on the name of this book because I have had this book

Starting point is 00:57:05 since I was 16 years old and it's been in incarnations ever since. And is it the natural fertility book? I'm totally blanking, Liz, I forgot. But it's by Margaret Knopfsiger. It's one of the classics. And learning to know your body signs and use what's called natural family planning or natural fertility awareness is very effective. whether or not you're trying to get pregnant or avoid pregnancy for knowing your ovulation.

Starting point is 00:57:35 Another way to know whether you're ovulating if you're really not sure or if you're concerned that you are having a hormone problem is to get your hormones checked between day 18 and 21. Because in the second half of your cycle, which is called the luteal phase, you will produce progesterone and it should peak around that time. If you're not producing adequate progesterone during that time or much of any, then that's a sign that you're not ovulating. Okay, so you'd want to get your progesterone checked between those days. Right. Isn't there also like a pee strip if you suspect you're ovulating, you can confirm it by peeing on something?

Starting point is 00:58:13 Well, there's, there are a number of different home fertility and ovulation checkers that you can absolutely use. I mean, they're usually more geared toward people who are trying to get pregnant, but you can definitely use. ovulation tracking home devices. Okay. And then second, if you don't feel like you're ovulating, you feel like you're having some sort of progesterone issue, I would love like one or two lifestyle changes you could make just to see if they help before you would seek further help.

Starting point is 00:58:42 And then also one or two on the other end, if you suspect the longer, heavier period problem. Yeah. So if you think that you're not ovulating, probably the biggest lifestyle thing to do, particularly if you're under weight, if you have low body fat, is to actually improve your diet and put on enough weight so that your body mass index is over 19.4. So under 18.4, that's actually like too low body weight and you're probably not going to ovulate. So that's one really simple thing that you can do. Just increase your calories through good healthy nutrition whole grains,

Starting point is 00:59:21 fats, et cetera. You can also use supplements that support your ovulation. The two or three, I'll mention three that I think would be really the most beneficial. One is an herb called Vitex or chased berry. And the typical dosage is either about 180 to 220 milligrams a day of capsules or five milliliters, which is about one teaspoon of the tincture. Vitamin C has been helped to improve the ludial phase and progesterone levels. And you want to get about 2,000 milligrams of vitamin C a day. And then adding more flax and sesame seeds to your diet, not seed cycling, but actually adding like a couple of tablespoons of tiffany or a couple of tablespoons of flax seed around the month every day. And you don't have to use both. You can use one or the other. I love

Starting point is 01:00:17 tahini. So I put it in so many things. It's a great way. I love tahini too. It's so delicious. Have you ever had it? Have you ever steamed a sweet potato and drizzled some tahini and some lime juice and some sea salt and some red chili flakes on it? Girl, there is, yes, actually. I haven't done it with lime juice, but I've done it with tamari, tahini. I love red chili flakes. I use them almost every day. I do too. I use them on everything. I know. And sweet potatoes, we eat them several times a week. I have been eating tahini since I was 15. I don't think there's a way I haven't eaten to me. But my new obsession is, now my food photography is not anywhere near yours, but I love sharing what I make. And so recently I made, I did an article on seed cycling and then I did another piece on eating dates for going into labor. And I was like, I'm going to put dates and sesame seeds into a recipe.

Starting point is 01:01:13 What can I make? And I'm like scooching around online, trying to look for ideas. And I saw a halve recipe. And I was like, okay, this is it. And I made this amazing tahini date dark chocolate fudge. It is so good. And it's got so much tahini. You could use that.

Starting point is 01:01:31 But I love the sweet potato idea because sweet potatoes are so good for our digestion, our immunity. Yeah, I think they're like a miracle food. You're listening to the Healthier Together podcast. When I asked you on Instagram recently how you were feeling in life generally, so many of you replied that you were stressed, which I definitely get there is a lot going on right now. I wanted to take the time to share a few of my favorite stress relieving supplements with you. I love Garden of Life's Whole Food magnesium chelate, which is non-GMO, vegan, gluten-free, organic, all the good stuff.

Starting point is 01:02:07 It's great for keeping your gut healthy, which is an important part of managing stress. But magnesium also just melts away tension in the body. Seriously, try sipping a glass and you will notice a huge difference. The Garden of Life one comes in raspberry lemon and orange, and the orange tastes like a creamsicle, which is crazy and so delicious. Garden of Life also makes my favorite, favorite, favorite probiotic, the mood plus one, which is the one that comes in a purple bottle. It's a great general probiotic. It's great for supporting your gut health, which again is so important for stress management, and it's also great for supporting your immune system. But it has specific strains selected to help with anxiety.

Starting point is 01:02:44 in addition to Ashwaganda, which has a ton of studies to back up its stress-relieving properties. I used to take it in the morning, but after interviewing the gut health MD for my Ask the Doctor Gut Health Edition episode, I actually take it right before bed now, which he says really helps all the bacteria do their best work. You can find Garden of Life products on Amazon or at your local Whole Foods, but the best way to support this podcast is to use my affiliate links, which can be found at lizmoody.com or in the description for this episode. I super appreciate it.

Starting point is 01:03:13 It doesn't cost you anything extra. It just tells Garden of Life that you found them through my podcast. I know you are going to love the probiotic. I know you're going to love the magnesium, and I cannot wait to hear what you think. Now, let's get back to the episode. Can you speak to a few lifestyle factors if you're on the other end with the heavy periods and the longer cycles? Yeah. So it can be a thyroid problem.

Starting point is 01:03:38 So, you know, get your thyroid checked. one of the most important things to check in your lifestyle and your diet is are you getting a lot of estrogen disruptors in your body? Because those can contribute to having too much of an estrogen load. Obesity can also, but I don't want to get too much down that road because if I did, I'd want to also talk about fat shaming and what that really means. But if you're very overweight, you're going to produce more estrogen. So that's, you know, just like being significantly underweight at the one end being significantly overweight at the other end can cause some hormone imbalances. But things like drinking out of plastic water bottles, storing food and especially heating food up in plastic

Starting point is 01:04:23 containers, body products that have phthalates in them. So anything that has a lot of fragrance in it. You kind of want to go as clean and green as possible if you are having those really, really heavy cycles because that can be a shockingly large contributor. The other thing is one of the most common reasons for heavy cycles is a condition called polycystic ovary syndrome. And the symptoms may be subtle or more obvious. I talk at length about that over on my website, but that is often accompanied by skipping periods, in which case, then you want to do lifestyle things like balancing your blood sugar, but also using specific herbs and supplements that can help your body to bring your hormones back in balance.

Starting point is 01:05:15 So I have a speed round for you at the end, and I was going to put seed cycling in there, but you brought it up and everybody, like, I put out and ask for questions for you on my Instagram, and I swear I got 50 about your thoughts on seed cycling. So can you just go ahead and share that? I think people are like, is this a woo-woo wellness bullshit thing? Is this actually effective? Is this worth doing? And what is it actually just for the layman who is like, what the hell is seed cycling?

Starting point is 01:05:42 Right. Okay. So seed cycling was made up by someone in the wellness space and it caught on almost like a wellness meme. And then pretty much everyone and their uncle was taught or their aunt, I should say, was writing about seed cycling, like all the women in the wellness space in hormone space we're writing about it. The idea behind seed cycling is that if you eat certain seeds at certain times of the month, they will affect your hormones during that or the next

Starting point is 01:06:09 cycle. And like so many wellness things like this, there's a little bit of truth that then gets blown way out of proportion. So when you look at all the research on the health benefits of seeds for your hormones, eating large amounts of seeds, well, let me back up and say, all the research has been done with minimal amounts other in flax in humans. All the research has been done on cows, feeding cows large amounts of like sunflower seeds or flax seeds or pumpkins or whatever the different seeds are. And even there, you'd have to use enormous amounts to even marginally affect hormones. So the idea that you could eat like one tablespoon of sesame seeds for three days, like on the first three days of your period, then eat like five days of a

Starting point is 01:06:59 tablespoon of pumpkin seeds, and then eat seven days of sunflower seeds. That's the bullshit part. But the real part is that seeds are really beneficial for women's hormonal health. And so on my website, in my blog on seed cycling, I break all this down. I'm like, here's what we do know and here is how they actually can help. Like pumpkin seeds are really rich in zinc and we really do need zinc to produce thyroid hormone and produce other hormones. Flax seeds really can help with estrogen level balance, for example. But you have to eat way more than like a teaspoon or two here or a tablespoon or two here or there to get benefit. You want to just incorporate seeds abundantly regularly in your diet. And also, eating seeds at a certain time of your cycle, for the most

Starting point is 01:07:48 part, doesn't affect one hormone or the other. So you can eat any of them at any. At any time. So the bottom line is if eating seeds according to a seed cycling chart helps you to remember to eat seeds and you want to post a cute chart on your refrigerator or in your pantry and do that, there's absolutely no harm, no foul, except you have to eat more seeds than are usually. So you want to think about like a quarter cup of sunflower seeds, a quarter cup of pumpkin seeds, flax seeds for sure. You can use like two tablespoons. That's plenty. Sesame seeds. We're talking more like two tablespoons of tahini, not two tablespoons of sesame seeds. So if you want to do it, go for it. And it's great. It's a great way to be in touch with the different phases of your cycle.

Starting point is 01:08:34 But from a medical scientific perspective, you can just eat seeds and enjoy them, which I highly encourage you to do. And is there ever a time where you wouldn't want to because they are affecting your hormones? Like if you have high estrogen, would you want to avoid blacks or anything like that? or is it always going to have a net positive balancing effect? I would consider it to always have a net positive balancing effect. So even though flex may have an impact on estrogen, it does it in a way that's supporting healthier forms of estrogen while blocking some of those estrogen environmental chemicals that I was mentioning.

Starting point is 01:09:11 So the net is still positive. I would say the only time you'd want to be careful with something like flax seeds or the Vitex, the Chaseberry, I mentioned earlier, is if you have a head. history of estrogen receptor positive cancer. So either estrogen-related endometrial or estrogen-related breast cancer, in which case, eating seeds is a helpful part of your diet is still fine. I just wouldn't go crazy on them. Okay. And that's the BRCA gene. Or any estrogen receptor positive. Okay. Is PMS ever a part of a healthy cycle, or is it always a sign that something's awry? Well, it depends on how we define PMS. So if you're talking about being a little bit moody,

Starting point is 01:09:51 Ah, that's a perfect one for you, right? If you're talking about being a little moody, noticing a little bit of changes in your breasts, a little bit of like, oh, my rings are a little bit tighter. But nothing that is doing anything more than like, oh, my period's coming in the next day or two, that's normal. Our bodies are going to retain a little more water. Our mood is going to become more introspective. So you might not feel like going out to that party or that club or whatever. Like you may feel like, you may feel like, little more irritable and that's all okay. If it's causing you discomfort in your life, if it's causing someone else discomfort in your life because you're just really like unbearable to be around because you're just so like losing it or you can't function or you're so physically uncomfortable that you have to take supplements or medication to not feel that way, that's when I would say no, it's not normal anymore. You know, our cycles change and we live in a world that doesn't honor the abs and flows of what we go through as women daily or monthly or at various points in our life. Like maternity leave is the perfect example.

Starting point is 01:10:59 Like as a culture, we don't honor and understand what women are going through after they've had babies and give space and time for that. And we don't do it for our periods either. So, you know, it's finally, it's like balancing what the cultural impact is on our bodies and what's actually going on physically. But if you're uncomfortable, you're, you're cyclical. should never make you feel miserable or even borderline miserable. So if it does, if you have bad cramps, bad headaches, bad mood swings, if you're taking a day off work, do you recommend addressing those

Starting point is 01:11:34 symptoms or is bad PMS a sign of something specific and underlying that should be addressed? Bad PMS, I would say, is a sign of something specific and underlying. And interestingly, bad PMS isn't necessarily a hormonal imbalance per se. It's more. an imbalance in the neurotransmitters that affect our brain. So it's interesting, like, studies have looked at women with PMS. Many, many studies have looked at this and don't find that women with PMS across the board have high estrogen or low estrogen or high progester or low progesterone. It seems that women with PMS, right before we get our periods, our serotonin, which is a neurotransmitter that helps us to feel happy drops. And that's just a normal problem.

Starting point is 01:12:20 part of the cyclic changes. But if you're someone who's drops a lot or you're more sensitive to that drop, and it seems like some women with PMS, the interaction between estrogen and serotonin is more significant, then you may be more likely to have PMS or even severe PMS, which is why actually one of the few things that antidepressants do seem to work well for is PMS, whereas hormone treatments don't work for PMS. So if you have PMS symptoms, that aren't necessarily straight up like depression, but headaches or things that feel unrelated to that, would you want to go back to the serotonin boosting activities we discussed earlier? Well, if you have headaches, that's usually a big drop in estrogen. And so then you want to look at

Starting point is 01:13:05 estrogen balance. But if you have pretty severe PMS, you know, whether it's fluid retention or anxiety or depression or sleep problems, that's when I would look at the neurotransmitters. And one the really cool things is that whole grains actually boost your serotonin. So a lot of women cut out carbs and they, you know, we've been on such a kick in the wellness world to avoid grain for such a long time and lectins, et cetera, that a lot of women are not getting enough whole grain in their diet. And so actually just getting whole grains in like the five days or so before your period can make a huge difference in how you feel. Another thing is a lot of women aren't getting enough B6 and enough calcium. And we know that supplementing B6 and calcium

Starting point is 01:13:59 in that like five days before your period can also make a huge difference in PMS. I was going to ask, well, first of all, what do you think about the lectin issue? Do you prepare your whole grains in any specific way or do you just think all whole grains are net positive? So this is going to be a little, bit critical, but, you know, I can say this as someone who's been in the wellness world for a really long time. And I can say this also as someone who has worked in the epicenter of the medical and functional wellness world for a while now, like years now, that again, we're at that little, when it comes to lectins, we're at that little bit of truth being spun into a whole crazy story. and many different grains and legumes do have lectins, but for the most part, human beings can tolerate them

Starting point is 01:14:53 when those have been broken down by sprouting or by boiling, by cooking. So what happened was one person took this lectin idea. He who shall not be named. Yeah, who created a whole scare tactic around it, bought a mega marketing platform and did mega marketing and made it a thing. But from a science perspective, yes, if we were to eat enormous amounts of unbroken down lectins, they would not be great for us. Or if you are the rare person, rare, I'm talking like infinitesimal rare person who for some reason can't digest lectins, maybe you would have a problem with them. But for everyone else, if you soak your legumes or beans ahead of time, cook them well with traditional spices that can be things like human, ginger, even the seaweed kombu, a little bit of kombu

Starting point is 01:15:53 when you cook your beans. And when you soak them, strain the liquid and then add fresh liquid. If you want to sprout your grains before cooking, sure, do it or eat sprouted grains, but I don't. I soak my beans and legumes before I cook them and I cook my grains straight up. And you know, knock what, I mean, honestly, I'm 54 and I mean, I feel really healthy. And I can honestly say I don't have any chronic medical problems. And my hormones have been great too. I mean, I'm just a test case of one, but I don't have problems that adult women and my family do, which is interesting too. And just in case people out there like me and they're not always going to soak their beans, if you buy beans that have been pressure cooked, it also is a really great way of getting rid of

Starting point is 01:16:42 lectin. So like the brand, eat in organic, always pressure cooks their beans and they cook them with combo, which also makes you not as farty when you eat beans. Exactly. And I pressure cook my beans too. But I sometimes I just buy them pre-made like, you know, like you're talking about too, because I only want a couple of cups of them to make something. Can we talk about food for a second? Are there diets that you think are particularly beneficial for hormones? Are there diets that you think are particularly negative for hormones? Well, any overly restricting diet is probably negative for hormones. And that overly restricting could be anything from being so strict paleo that you're really not getting any whole grains. I mean, if you're getting sweet potatoes and squashes, it may compensate,

Starting point is 01:17:26 but anything super restrictive. Now, you have to balance, you know, do you need one of those diets? for another reason, and then you want to heal that reason, and then be able to segue more foods back into your diet. For me, hands down, the healthiest style of eating is a Mediterranean-style diet. So getting plenty of fresh fruits and vegetables, if you eat it some fish, if you don't eat fish, then getting a fish oil or an algae-based essential fatty acid is really important. nuts and seeds, legumes, if you eat dairy, small amounts, only organic. I do think that a lot of women's hormone problems could be solved by taking dairy out of the diet at least for a while.

Starting point is 01:18:15 And even organic, healthy, full fat dairy, it does have some hormones from the animal that it's coming from. So I often do recommend taking dairy out, although I consider dairy if you tolerate it for some people like fermented dairy can be really healthful. And then speaking of fermented, having some lactofermented foods in your diet every day and healthful fats in your diet every day. So avocado and olive oil are my two really big go-to for healthy fats. And I actually like butter and ghee. Also, I think they're delicious and helpful and great to cook with. I would say the biggest triggers that have been shown over and over for things like PCOS and

Starting point is 01:18:58 endometriosis and period pain, all of which share a common root cause of inflammation, are red meat. And so even eating red meat a couple of times a week for some women may be enough to be a trigger for inflammation significant enough to cause period pain, for example. And then not getting enough fish in the diet and not getting enough fruits and vegetables in the diet have also been shown to be triggers of endometriosis and bacteria. period pain. So ideally, really good quality salmon or other low mercury high omega three fish two or three times a week would be great. Again, if you don't, then getting some fish oil.

Starting point is 01:19:41 And ideally six or eight servings of veggies a day with an emphasis on getting some leafy greens like kale, collards, broccoli, or anything in the Brassica family at least once a day because those help clear estrogen. And, you know, coffee. Coffee can be fine as long as it's not keeping you up at night. So a cup of coffee a day, if you just love your coffee and it brings you pleasure, should be fine for most women's hormones. I find that for women who have significant breast tenderness with each cycle, coming off the coffee, you can make a huge difference.

Starting point is 01:20:16 And this one is probably going to make me incredibly unpopular, especially right now. But alcohol is probably the worst thing women can do for our hormones. And even good organic red wine can imbalance your estrogen. And especially if you have PMS irritability, you know, it's so tempting like, right before my period, I'm going to just have a couple of few glasses of red wine. But it can actually make you feel worse later that day or the next day. And for perimenopausal women, it can just wreak havoc on your sleep. If you wanted to drink, is there, you know, what's the best way to do the worst thing?

Starting point is 01:21:00 Okay, I actually have a whole best way to do the worst thing thing. And that to me is vodka. Because it's clean. It's gluten-free. You can get an organic vodka. And you can have a small amount and get a nice, relaxing little disinhibiting buzz, but not too much. and not get as much of that estrogen kick. The other thing that I recommend is if you're out socializing or you're sheltering and having people over and you're having drinks, you can dilute. Like if you're going to have two ounces of vodka, dilute it over two drinks.

Starting point is 01:21:41 You know, have one ounce first, like, you know, a little finger or whatever that is. Add some sparkling water. Add some lime. Add, you know, some muddled mint if you want to. whatever you love in it, and then sip it slowly and keep it to not more than once a week. So pick a night that you're going to do it and just stick with that and see how you feel with that.

Starting point is 01:22:03 And if we wanted extra credit, if we were doing the general healthy diet, but we wanted to be like the superstar student, is there an amazing food for hormone health? I would say probably I would be in a toss up between fish and leafy greens. Again, if you don't eat fish, that's okay. You can do legumes and some good quality fish oil. But I would say if you're really, really trying to balance your hormones and you just wanted to kind of go full throttle with it, if you could eat like a dinner every day of, say, some salmon and half a sweet potato with whatever you want on it. I mean, not like loaded with cream cheese or, I mean, like sour cream, but like whatever you want to help you.

Starting point is 01:22:47 the tahini sounds really good, and then some steamed or sauteed or oven-roasted kale. I mean, that's such a great meal. Very, like, working your way through a variety of butto-bowls for lunch and dinner is really phenomenal. Yeah, I'm all about keeping a ton of delicious sauces in your fridge because if you have a good sauce, you can make like any vegetable or bootable type situation taste amazing. You're good to go. Yeah, we're all about this organic Vermont fire. roasted maple saracha right now. Oh my god. Oh my God. It's so good. And then we make a tahini sauce

Starting point is 01:23:23 several times a week. And sometimes we do just like tahini. I'll vary up which miso I use or if I'm doing it more macro, like I'll do ginger and scalyons or more Asian ginger and scalyons. Sometimes I'll do if you eat peanuts, you can do a peanut sauce. There's so many wonderful ways to use sauces. A huge question we got are people who are pretty similar to me probably. They're in their 30s. They're generally healthy. Some are single. Some are partnered. But they know that they want the option of having children available to them later. So what are some easy steps that they could be taking now to make it easier to conceive later or protect their fertility? Well, it's a really great question. I thought you were going to ask me should they freeze their

Starting point is 01:24:11 eggs, actually. You can say your thoughts on that too. So the way I think about it is what things damage your eggs. And probably the biggest thing that you can do if you smoke is to quit smoking, which I know is so much easier said than done. But that is just such a huge fertility preserver. And then eating a really healthful diet and avoiding as many environmental triggers as possible. And not just the woman, but if there's a male part, partner who, you know, obviously if it's a sperm donation and anonymous, then you can't do this. But if you

Starting point is 01:24:52 have a male partner who can be doing this healthful preconception nutrition and kind of eat like that. Like I have an article on my blog on my website on preconception nutrition and you want to think about eating that way all the time. I mean, it doesn't mean you can't, you know, I call it the 95-5 rule where if you eat 95% of the time healthy, five. You can eat whatever you want. You know, you can have that mojito. You can have that chocolate cake. It doesn't really matter.

Starting point is 01:25:22 80-20 is not enough, in my opinion. But following that Mediterranean kind of core diet as your lifestyle is the most important thing you can do. And then kind of back to what we were talking about earlier, if you're underweight, particularly and not ovulating, you want to make sure that you do get to where you're ovulating because that's critical for fertility. But anything that's going to support your hormones now is going to support your fertility later. So it's really a lot of the same thing.

Starting point is 01:25:50 As to egg freezing, you know, the technology has gotten better for egg freezing and egg defrosting, if you will, and for insemination. The outcomes are still in the early stages and it's really, really expensive. So I typically recommend if you are ill, very ill, like you might lose your fertility because of chemotherapy or something like that. You may end up needing a hysterectomy with your eggs removed and you would want to do a surrogate with artificial insemination. Then absolutely, you know, if you just have money and you want to plunk down $10,000 and get it done.

Starting point is 01:26:36 But then I do recommend doing as much. as possible a natural egg retrieval because I've had a lot of patients over the years who had ovarian stimulation for fertility and their hormones really went offline after that. And for egg retrieval for freezing your eggs, if there's hormonal stimulation, that can really set your hormones off. So you want to weigh that balance. And if otherwise you feel like you're healthy, you've always ovulated well. I mean, I've midwifed babies well into women's 40s, even their first babies into their early mid-40s who had zero fertility problems. So, you know, it's so easy to get sucked into worrying about and anticipating having a fertility problem when most women actually

Starting point is 01:27:27 won't. That's really, yeah, I think there's a huge, like, even with the fact that after 35, you're considered advanced maternal age by, you know, common medical practices. And I do think there's a lot of pressure on women to have children young and to think that their fertility is just going to take a nose dive after their 35 particularly. Yeah. And it doesn't necessarily. And, you know, the other thing is that we have to keep in mind that chronological age and biological age aren't always the same thing. And so just really doing your best to stay well nourished, avoid the things. that we know our triggers, try to have that healthful lifestyle and Mediterranean-style diet. And to some extent, you know, to the extent that you can sort of support and trust your body, I think that's really important. Because worrying about it now, I mean, supporting yourself now is important, but worrying about it now feels unnecessary and like just too much pressure.

Starting point is 01:28:27 You know, advanced maternal age, I'm 54. And when I had my first kid, who's now 35, advanced maternal age was considered 40 years old. And you know, you look at these changing parameters and how, I mean, 35 is so young and yet it makes women feel really old and really worried. And then what happens is we don't give fertility enough time. And we know statistically that within one year, 90% of people won't get pregnant. And within two years, those who didn't, most of them will. And yet I had a friend in mind who's like really well known in the wellness space who is 30. And her fertility doctor told her that she better get started having kids before her eggs were like fried eggs.

Starting point is 01:29:14 I'm like, oh my gosh. But the thing is it psyched her out so much. It made her so anxious. Well, and to that point, if you try for six months and you're not getting pregnant and then you internalize that something's wrong with you and then you get stressed, that can affect your ability. to conceive anyway. It's such a vicious cycle. It also makes sex really stressful. I just see people who are starting to have sex for the sake of getting pregnant and the whole experience of their relationship becomes really fraught. Getting every period is such a huge disappointment. And I don't want to diminish how incredibly painful a fertility problem is. But I think we're diagnosing too fast and too

Starting point is 01:29:58 early. And look, it's the one of in 20, before COVID, the 2020 prediction was that the fertility industry, which is what is called, was going to be one of the biggest growing industries right now. And it's not just because women are having so many problems. It's because people are able to capitalize on the anxiety around the problems. Yeah, that makes sense. Okay. On the complete flip side, what are your thoughts on hormonal contraception? So I, kind of take a broad perspective on hormonal contraception in that I really honor and respect the fact that, you know, just less than 100 years ago, it was illegal to talk about or even distribute information on hormonal contraception. And when women started having access to

Starting point is 01:30:48 hormonal, safe legal hormonal contraception, it sort of like increase our presence in the workforce and in our careers and professions by something like 70%. It's had an enormous impact on women's ability to choose when and whether to have children. And the tenets of reproductive justice, the definition of reproductive justice, is the ability for a woman to choose if she wants to have children, if she doesn't want to have children, and if she does want to have children to be able to have them and raise them in, healthy and safe way, and if she doesn't want to be able to do that in a healthy and safe way.

Starting point is 01:31:31 So to me, it's a really important part of reproductive justice to have access, to have that access be over-the-counter, non-prescription, easily affordable, et cetera, et cetera. That said, we also want to be cognizant of and informed about the very real potential adverse offense, the side effects and the risks of hormonal birth control ranging from just not feeling great when we're on it to the fact that it is a major contributor to depression, particularly hormonal forms of birth control that contain estrogen like the pill. There was a major study done in, I think it was Denmark or Sweden, looking at teenagers using hormonal contraception all the way through women in their 30s and the risk of developing depression,

Starting point is 01:32:29 even in women who had never had depression before. And depression severe enough to go and get medical help and a diagnosis and take medication was really high. The problem is that most physicians, when we're trained in medical school, get almost no training in hormonal birth control, like literally almost no training. And we're taught superficially about the risks. So, for example, a woman who has migraines with aura shouldn't take estrogen containing birth control because it can increase her risk of a clot and a stroke. Or women who are XYZ age and smoke XYZ packs of cigarettes a day, they have that risk also.

Starting point is 01:33:13 But I can say quite honestly that most women go to the doctor and do not get any of their risks looked at or communicated to them and the risks and side effects of birth control pills and other forms, the nor plant, the ring, et cetera, are really minimized. So we're not given informed consent. So I think it's a very personal choice. I think that if you're 60% of women don't use hormonal contraception for birth control anyway, they use it for other things like heavy periods or other symptoms. So I think rather than using birth control as a panacea for all those things, we should be looking at the root causes and treating the symptoms and causes of those things and then only use the birth control if needed. And for contraception, I think we need way more

Starting point is 01:34:04 research and way better options than the ones that have been on the market for basically like 60 years now with very little improvement. Yeah, I agree with that. I got my Mirena taken out, like two years ago and we switched to condoms and cycle tracking. We kind of do a mix of the two. And it's so interesting how much I built it up in my mind is like, this is going to be impossible. This is going to ruin our relationship. And it's been almost a non-issue.

Starting point is 01:34:33 And in some ways, it's been a really positive thing because instead of me feeling mildly resentful that I'm taking all of this on for myself, it's become something that we are doing together. And also it's been positive just because my sex drive is so much higher. being off of hormonal birth control. But I do think it's interesting. Bute is this hugely hard thing to use condoms. And I don't think it's that hard or bad. Yeah, my husband ultimately, he had a vasectomy about 10 years ago. But we've been together for 36 years and he's 64. He's 10 years older than I am. So at some point, it was just like, all right, let's just have fun and ditch all this other

Starting point is 01:35:13 stuff. But that's what I always use. In fact, I was really fortunate to start tracking my cycle when I was 15. So I've never been on a hormonal contraceptive. Oh my God. That's amazing. When I was 15, I was like given it by my doctor. I don't even think there was any reason other than I was, I wasn't sexually active. She was just like, oh, you're like up age. Here's your hormonal birth control. Yeah. I had the same thing. I was just given a pack of pills and kind of sent on my way. And I never took them and just decided to start tracking my cycle. And I, we've done the same thing. We've done fertility tracking and obviously not using condoms when we want to have babies and then using them until he had the vasectomy, which was really great too, but obviously not something everyone's ready to do. But I agree.

Starting point is 01:36:02 It really does share the responsibility. It makes you much more aware of your body, your creative, sexually and intimate around your cycle. There's a lot to be said. for it. And I know that it's not for everyone. And, you know, I think that unfortunately, again, you know, people have built their platforms of fame around how bad the pill is. And I think we can get too extreme. Like someone was saying that one of the people who does that said that if you're, if you've taken hormonal contraception oral birth control pills at any point in your life, your child has a risk of developing cancer later in life. And it's like, that is so not true or that if you get pregnant ever, you could have birth effects. And like, that's not true. And also, if it were true,

Starting point is 01:36:53 that would affect such a huge swath of society that we would have heard about that at this point. Exactly. Why didn't we heard about it? Now, one thing that is really important for women who are taking the pill, particularly, is that the pill does deplete a lot of nutrients. So it depletes vitamin B6, it depletes B12, it depletes magnesium, and a number of others. So on my website, I actually have a blog about what to do if you're on the pill. And it is important to, in that case, take a multivitamin, make sure you're getting some extra vitamin D just to support and buffer yourself against what the pill is depleting. And it's not just the pill. Lots of medications deplete a lot of different nutrients. It's just that one is one, of course, that women in my wheel

Starting point is 01:37:39 house are commonly on. Yeah, I actually interviewed perhaps the same person that you're talking about about if there was steps you could take to mitigate the negative effects of the pill or to balance your hormones on the pill. And she was like, no, there's no way. You're just screwed if you have any sort of hormonal birth control. So it's nice to hear that's not true. Yeah, it's not. And look, you know, I have a patient right now who is a wonderful young woman, very, very oriented toward wellness. And during COVID, she had a really, she became my patient during that time. She had had a really bad flare of her PCOS. And she had just a horrible cystic acne breakout. She was losing hair. And one of her family members had gotten very, very sick. And my patient was living in a house with four

Starting point is 01:38:30 other people because they were sheltering in place together. And she said, it's just way too hard for me right now to do all the diet stuff and to make all these changes. She's like, I want to do it and I know, but I just, I can't right now. And this acne is really embarrassing me and really stressing me out. And look, I mean, one of the best most effective treatments for the PCOS with acne is low dose progesterone birth control. It can really, really help alter that testosterone. I feel like sometimes, you know, kind of back to what we were talking about earlier, Liz, about blaming ourselves in the wellness space for things. Sometimes we, and I will tell you, and I will say this, and I have had one antibiotic

Starting point is 01:39:21 since I was 14 years old. I got a very severe urinary tract infection in my medical residency that turned into a kidney infection. So I took an antibiotic. And I've taken an ibuprofen in 44 years since I was 14. I've taken an ibuprofen a few times ever. Like I had a wisdom tooth coming in. So I'm not a physician that uses a lot of pharmaceuticals or pushes a lot of pharmaceuticals.

Starting point is 01:39:46 And I really walk my talk about my lifestyle. I mean, I've raised four kids who all through their growing up had never had a single antibiotic. And it's not that I wouldn't have used it if they needed it. But point being, I'm not a drug-pushing doctor and I tend to spend more time getting people off of pharmaceuticals. But I also see people being so polarized about like food is medicine, natural supplements, that's all like the good stuff. And the pharmaceuticals are a failure or people even embarrassed to say that they're using them. And the thing is there are people, there are wellness influencers who are using pharmaceuticals for things.

Starting point is 01:40:28 You know, I mean, it's really important, I think, to be comfortable. doing what we need to do to take care of ourselves and not suffer. So if you're trying the natural thing for a while and it's just not working for you and you need to use a pharmaceutical, like it's actually, it's okay. Just know the risks, know the things you can do to balance them. And I guess it's also just really important to as wellness space consumers, to always look and see not just what the message is, but does the person who's giving the message have a horse in the race? So if the person giving the message is selling you a whole bunch of things

Starting point is 01:41:15 that have to do with that message, it doesn't mean it's a bad message. It's like if IKEA was talking about good Swedish furniture, but they weren't selling you the furniture, that would be weird, right? it's okay that they're talking about the furniture and selling the furniture because you need the parts to build the, you know, build the furniture. But it is important to step back and say, okay, if this person is giving me a really extreme all or nothing message, what is their get from it? Because sometimes that can confound things a little bit. I agree completely. If somebody does want to be on hormonal birth control for whatever reason, do you have?

Starting point is 01:41:55 have a preference, the pill or the Morena or a copper IUD, which isn't hormonal, obviously, but is a form of birth control? Yeah, I'm a big fan of the IUD, actually. And as a physician, I've put a lot of them in. They definitely have their own set of discomforts and risks. But I think that the copper IUD, the advantage is that you can keep it in for 10 or 12 years. And if it's not bothering you, causing you cramping, you know, irregular spotting. If you tolerate it well, then you can kind of place it and forget about it and just take it out whenever you're ready to get pregnant and your fertility resumes. The disadvantage of the copper IUD is that there is a small but real number of women who are reporting that after getting the copper IUD inserted,

Starting point is 01:42:46 they developed autoimmune conditions. And the medical community is largely denying that this is a related phenomenon. I tend to trust women and we've seen time and time and time and time and time and time again that the medical community assures us that something is safe. And that's sort of like a pun in that the e-shore device was one of those that turn out to be like, oops, not so much. Actually, we've caused irreversible, like, life-threatening damage. I would say with the copper IUD, it's been around a long time. Overall, it has good safety. But if you do notice that you're experiencing something, I just had a woman tell me the other day that she never had, she actually got the hormonal IUD, not the copper, but she's had her third baby, has never used hormonal

Starting point is 01:43:36 birth control before and got the hormonal IUD. And she said that she's had severe depression ever since. And she said, her doctor said it couldn't be related. And I'm like, well, to quote Bob Marley, who feels it knows it. If you never had this before, you've got this thing in your body, you're not depressed about anything else in your life and your otherwise life is good. It probably is, you know? So I think listening to your body if you start something, but I think the IUD can be a really great option. If you're not, and a lot of the fear that women have about the IUD comes from sort of the ghost of the Dalcon Shield. The problem with the Dalcon Shield were very specific to the Dalcon Shield. It was a massive cover-up and just

Starting point is 01:44:22 disaster for women. But the IUDs that are on the market now are much, much better. The hormonal IUD lasts five to seven years. Again, you're ready to get pregnant. You get it taken out. It's just a little bit more than a procedure than pulling a tampon out, but pretty similar, actually. More uncomfortable to get IUDs put in. More uncomfortable. It's the word. pain. I feel like I've had my entire life. Put it in. Yeah. Like if you're, you know, if your doctor is like, or your nurse practitioner or nurse midwife is going to put it in, that is a time that you definitely want to take some ibuprofen, like an hour before and have a heating pad on your belly. I felt like I wanted to take like hair. It was honestly, like, it was so awful. And they were they, it just felt like such an example to me of, of downplaying women's

Starting point is 01:45:14 pain that I was expected to go in and have that as a casual outpatient procedure. They didn't tell me to have anybody come with me to take me home. Oh my gosh. And it was just like, it just felt like if a guy had to do that, it would be a full anesthetic thing, you know? Totally. Totally. Yeah, it's uncomfortable for sure. And getting it pulled out though is not. No, it didn't hurt at all. It literally is something like it. So they get it taken out. And then, you know, that is the issue. It can cause some cramping and spotting. And if you can get through like the first four months of it and tolerate it, then most women will settle into it and feel it's great.

Starting point is 01:45:51 As far as the pill, whenever possible, either go on a no estrogen or as low dose an estrogen progesterone combination as you can. And then there are so many nuances. You know, I'm not a huge fan of the pills that do like long. term hormone suppression for like six months or a year. I think I'm just too much of a hippie midwife, nature girl at heart, that there's something that always just sits wrong with me about it. Every study that's been done on them doesn't show that they're more medically problematic, but we get concerned when women don't have their periods for six or eight months for medical

Starting point is 01:46:33 reasons. So this feels counterintuitive to me. It's not my favorite. And then anytime I have a woman who's willing to do cycle awareness with condoms. That's always my favorite first choice. But, you know, high school women or college women, they don't necessarily want to be bothered with that, right? I would be a liar when it came to that kind of thing. Like, I would have just been pregnant if I'd been tracking my cycle in college. So I think that being aware of people's life is important. If somebody just went off the pill and they want to support their body getting back to a happy hormonal state? Is there things they can do to sort of detox from it? Yeah, totally. And I just want to like add to what you said before in terms of some women for religious reasons and cultural reasons

Starting point is 01:47:19 aren't able to choose when they do and don't have sex and whether they do and don't use a birth, you know, what they are or aren't using. So sometimes having a pill that you take that nobody else knows about when you can't control whether you're having sex according to natural family planning and your partner won't use a condom is another thing that happens, right? So sometimes our lives don't always give us as much choice as we would hope for. 100%. Yeah. Yeah.

Starting point is 01:47:48 So coming off the pill, within three months, at least 80% of women, even if they did nothing else, would be cycling regularly again. So if you went on the pill just for birth control, not because you had PCOS or another problem. So just purely for birth control and you go off the pill and you haven't been bumping up your nutrients. Definitely you want to start bumping up your nutrients. And then I don't honestly recommend doing anything other than eating well, making sure you're getting your greens, you know, your healthy diet. I know it sounds so simplistic, but it really is the best medicine. I don't take supplements every day. I rarely take some. Now that I've turned, you know,

Starting point is 01:48:29 into my 50s, I try to take a multivitamin a few times a week. And during COVID, I try to take vitamin D a few times a week. But I'm not a big supplement pusher either because I really have a lot of faith in lifestyle and diet for most people. So, you know, just making sure that you're doing all the healthy things. And the vitamin D is important because when you go off the pill for some reason, our body's vitamin D levels drop. So especially right now in COVID when vitamin D may actually be protective, if you're not already taking 2,000 to 4,000 units a day, which is safe for most people, including pregnant and breastfeeding, it's a great option. And then definitely when you come off the pill. If you've been on the pill for a hormone imbalance, then when you come off the pill,

Starting point is 01:49:14 you may have just been suppressing that imbalance all along and so the imbalance may come back. In which case, then you would want to be on a protocol to support rebalancing your hormones. So if that's PCOS or endometriosis, et cetera, then on my website I have, you know, different pathways that you can go down for that. If after three months your cycle hasn't come back or you're somebody who is just really concerned about post-pil, then you can use, if you were on an estrogen pill, you can use things like calcium deglucorate, you can use n-acetylcysteine, you can use herbs that support the liver, like a nice bitters combination, or you can use something. like Vitex or Chaseberry is another name for it to support estrogen and progesterone balance.

Starting point is 01:50:09 And I have a whole article on my website about what to do after the pill. Perfect. Okay, I have two more things I want to cover. I'm trying to be cognizant of your time. All good. What causes low libido? I know that the pill can, but I also know that some people wish their libido were higher if they're not on the pill.

Starting point is 01:50:29 And is there anything that we can do that will help us boost our sex drive? Yes. So the first thing I would recommend is get a copy of Emily Nagoski's book, Come As You Are. It is the best explanation for how and why low libido happens and about how your sex drive hormones work and how your brain works. Interestingly, most low libido for most women actually has less to do with hormone imbalances and more to do with lifestyle and relationship factors. So the single biggest reason that's been attributed that Gen X or millennials aren't having as much sex as the previous generation is screen time. So being on devices in the evening, being on devices in bed has been found to be the single biggest sex inhibitor. We've kind of taken away all of that interstitial time

Starting point is 01:51:32 where you might be like a little bored and reach for your partner and be like, hey. Totally. And so thinking about that is really important and, you know, carving out no screen time evenings where you're just, you know, like do old fashioned stuff. Take a shower together. Take a bath together. Play cards or like strip poker or something. Like do the fun stuff.

Starting point is 01:51:56 Make like a spicy, you know, chocolate something and watch a scary movie. together. These are weird things that actually have been found to boost libido. And, you know, just kind of like reconnect, create that time and that intimacy. If you have kids, it's going to be more, you know, you're going to have to be more creative about it, but then get creative about it. And the other thing is relationship. And this can be different at different times in our life cycle. So for example, women who are in their perimenopausal years, the way the hormones shift, it may be that sex drive goes down a little bit in terms of your desire to stimulate, right? Your incentive, your desire to initiate sexual encounters, but your receptive drive is just as high.

Starting point is 01:52:53 So informing, and this may be also like if you're a number. new mom. You know, you may feel touched out all day. And so you might not feel like initiating it, but you'd be really, really happy if somebody gave you a foot rub and then that went in an intimate sexual direction or for people who have been in long-term relationships. We know that women's initiative sexual interest goes down, but interestingly small gifts like even some chocolate or some flowers or something special on a regular basis has actually been really found to be helpful in helping people's sex drive go up. So talking with your partner about what you need, having your partner read a book like Emily Nagoski's book. Another book is Sherry Winston's

Starting point is 01:53:44 Anatomy of Desire. It's a really excellent book. Sherry's Nurse Midwife, who became a sexual health educator. Her books won a lot of awards. And that's a great book about the nitty-gritty anatomy stuff, and that's a great book to have your partner read. Is there a relationship tension? Are you, for some reason, not feeling it with your partner? Like, look, right now, you know, it's kind of weird. I think the way, particularly, you know, I'm kind of talking in a little bit of a gender binary way, but bear with me in terms of how our culture is set up. For women, particularly, we have been fed a lot of different messages from we're supposed to be the independent, badass entrepreneur to the waiting for the guy in Shining Armour to be the

Starting point is 01:54:33 hero and rescue us. And right now, if your partners lost their job, you know, your home together all the time and kind of like around each other's business all the time, that can really affect your attraction to someone else. And then yes, as you mentioned, I mean, hormonal issues are real. So if you're taking a hormonal contraceptive, that can take your sex drive. If you're not getting enough sleep and your cortisol is too high, or your stress level is triggering your cortisol to be too high, that can definitely affect your sex drive. And low thyroid function is a huge trigger of low sex drive. So, you know, of course, making sure you're addressing all those things we talked about earlier.

Starting point is 01:55:18 The one about the idea that women are down to have sex, but maybe aren't going to feel that like you look at your partner and just want to jump his bones at that moment is really resonant with me. And I've actually feel like I have more sex when I almost like when he initiates it, even if I'm not quite in the mood, I'm just like, okay, I'm just going to go with this for a second. And I would obviously stop if nothing happened. I'm not just going to have sex to please my husband, or maybe I will. I don't even know my thoughts on that in a long-term relationship. But I do find that after a few minutes of like kissing or touching or anything like that, I usually do want it. And I almost like letting myself do it even when I don't want it has been the most helpful thing

Starting point is 01:56:06 for my sex life. And so to hear you articulate that almost scientifically is really helpful. Yeah, we have in our brain. brains, if you think about it like, and Emily articulates this really, really well in her book, but we have, if you think about it as like an accelerator in the car and a brake in the car, like your gas pedal and your brake. And if you kind of have your foot on the brake, but not consciously, but your brain has like the sex drive part tamped down because you're going about your work and you're like functioning as a human being in your day job, if your foot is kind of

Starting point is 01:56:46 stuck on the break and then someone else starts to kind of gently put their foot on the accelerator, it might help you to just lessen your foot off the break. And so if you can go with it and relax into it, it really can be a game changer. And, you know, then that gets to, you know, the conversation with your partner, are they willing to? And that leads to other challenges like, Does your partner have a medical problem? Does like diabetes, diabetes medications, blood pressure medications, depression, antidepressants. Antidepressants are a huge cabosh on sex drive. So there are, there is one antidepressant, for example, that can be added in that can help. Like if you're, if you're on an antidepressant and it's really helping your life, but it's affecting your sex

Starting point is 01:57:35 drive. There are some workarounds for that. But looking at what medications people are on. And if your partner's on those medications or your partner is struggling with anxiety or depression, they might not initiate. And then you're kind of at a stalemate, no, you know, pun intended sort of. Okay. The last thing I wanted to get your opinion on is exercise. Are there types of exercise that are particularly good for hormones and are there types of

Starting point is 01:58:02 exercise that are particularly bad for hormones? I would say any exercise that you love that makes your body feel good, that makes you feel good, is phenomenal for your hormones. The only thing, and getting exercise is really beneficial for your hormones. There are some studies that look at women just getting more exercise and exercise in and of itself reversing PCOS, for example. So critically important, like super important finding what you love and doing that. The only thing that I would say is a problem for your hormones is either not exercising at all, but even more importantly, over-exercising. So that overexercising gets back to what I was talking about earlier about being too low body fat and too low body weight. There's something called the athletic triad, which is where you are like, you know, you're training too hard or it might not be too hard.

Starting point is 01:59:00 you're training for a marathon, you're a cross-country runner, you're a super-thin dancer or super-thin yoga practitioner, and you suppress your ovulation and you don't get your period. That's where it's a problem. But other than that, no, anything you love is great. And that doesn't, I've heard things like in the moment having very intense exercise, so not just sort of overarchingly too much, but in the moment really high intensity things can be harder on cortisol level specifically. Is that not true? Yeah, it is true. And so any high intensity, but if you do high intensity, like, let's say you go out for a really intense, you know, six mile hike with your friends and half of it's like, you know, on a 50 degree incline or whatever, like that one time is not going, that could be taxing,

Starting point is 01:59:52 but it's not going to make your period stop. But what if you do like hit workouts? every morning or you're doing a really hard spin class regularly. It can be. It depends if you're balancing out your calorie intake. So let's say you do like 30 minutes of a hit workout every day. And then you eat nothing for breakfast. You eat like you have a cup of coffee and a half a granola bar at 11 o'clock. And then you have a salad for dinner.

Starting point is 02:00:19 Like you're probably going to run into problems. But if you're balancing your energy output with your energy intake, it shouldn't be a problem for your hormones. Okay. Do you have time for one more question? Yeah. Okay. What about weight and hormones?

Starting point is 02:00:35 Like, I have heard the idea that cortisol can affect your weight gain, even if your calorie intake is consistent with not gaining weight. How, if somebody feels like they're gaining weight due to hormones, are there balances that they can do to have a happier weight in their life, a healthier weight? Yeah. So the two hormones that we think about that are most likely to contribute to weight problems are thyroid and cortisol. There are other things that happen at an even more subtle level with things

Starting point is 02:01:07 like ghrelin or leptin. Leptin is different than lectin. Leptin and grelin are hormones that control whether you're full or hungry and some situations can make those get confused. Stress can actually make those get confused, which is why you'll have people say, I haven't changed my diet or I don't eat that much, but I've gained 10 pounds and I can't seem to stop my cravings. You know, like, that's when you know there's a hormone imbalance. So with thyroid, it's back to what we talked about earlier, either finding ways to naturally support your thyroid back to health or if needed, then getting on a thyroid medication, either short term or long term to get your weight back down. For cortisol, then the two options, well, three options are, and they all need to go hand in hand, stress reduction and getting sleep back on target, using adaptogens, which are herbs that help to regulate cortisol levels and help to regulate the stress response. And then considering using some supplements that also support the adrenals and the stress response.

Starting point is 02:02:13 So B complex, vitamin C, magnesium, and then if you want to go in next level, something called phosphatidyl serine. The adaptogens are herbs like aschwaganda, holy basal, which is also called Tulsi, Rhodiola, rishi mushroom, and then the other medicinal mushrooms, cortisps, mitaki, et cetera. And then there are other adaptogens additionally. And that combination of stress reduction, nutrients and herbs can really make a difference. And keep in mind having your blood sugar be really imbalanced, like skipping a lot of meals and having really low blood sugar, that's a stressor. So we tend to think about stress. We think about like relationship or money or job or a living situation, but we want to think about some of those more subtle things like low blood sugar or not

Starting point is 02:03:03 sleeping well as part of it. One of the things that is really important to keep in mind to, and you know, I have to remind myself this because like any other woman, you know, and especially if you're in wellness and you appear socially, like it's hard not to equate weight and how we look with body image and persona. And for some of us, that can even be wrapped up in our professional lives. And I think for most women, the weight that we think we should be is probably about five or so, you know, five to eight pounds lower than the weight we probably actually needs to be. And there's no accident that we think to that. I mean, the diet industry is one of the biggest multi-billion dollar industries in our country when it comes to health and wellness. And the

Starting point is 02:03:53 entire fashion industry historically has been predicated on thin women. And those women are statistically underweight. And even the inclusion of more variety of women's beautiful body sizes, it's still like you get the sense that there's inclusion, but that really the ideal is still the other thing. And so when we think about gaining five pounds during COVID, I think we have to really also, it's another area that we have to be gentle with ourselves. It's normal to want to eat a little bit more carbs right now. It's normal to want to eat a little bit more sweets right now because that's part of the way that our brain actually calms down the stress response. There's a reason they're called comfort foods. And so the real trick is to find the

Starting point is 02:04:49 healthiest ones, which Liz, I mean, you do a beautiful job of including those, you know, in what you share and including them in the diet and a healthful way that gives ourselves permission to nurture and relax and enjoy. And then, of course, in moderating. right? It's okay. I think the COVID-5 or eight is one thing. We don't want the COVID-50, right? Right. I do think there's also something to be said for like almost this repression of women where I think about all of the things that women could do if they weren't spending their time thinking about this last five to 10 pounds, which might not impact their health in any way whatsoever and might even be better for their health to have. And I'm just like, if we got simply that time back, What would we do with it? Yeah, it's amazing. I mean, that five or ten pounds takes up way more than five or ten pounds worth of mental space and time.

Starting point is 02:05:45 And, you know, we're constantly hard on ourselves about it. And I think about it too in terms of like this idea of women being as small as possible and taking up as little space as possible or how fixated. Like I can't even tell you. I couldn't even count on fingers and toes in a six-month period. How many women would come into my practice as a new patient? feeling that they're bloated because they have like their belly isn't flat as a wall or a board. Like this idea that our bellies have to have to always be sucked in and all this tension

Starting point is 02:06:18 we put into our bellies. It's incredible. I love, I love, I would like love to end with that question though. Like if we could all ask ourselves, what would we do with that time and energy that we spent thinking about the last five or 10 pounds? I mean, we'd take over the world. think. It's a fear, right? Yes. I mean, I, when I was working with a book agent some years ago, he's one of the top book agents in the country for wellness books, who I actually left as a book agent because when I was talking with him about the next book I wanted to write, he said that it should really be a diet book. And I'm like, well, I'm not really about the diet book. I'm really about healthy eating. And he said, yeah, but Aviva, what women don't want to lose five or 10 pounds?

Starting point is 02:07:09 Even thin women want to lose five or 10 pounds. And you should capitalize on that. And I'm like, like we have such a huge industry, including the wellness industry that's built to deprive, not to nourish. And how do we shift that? Which I know you're doing, which is a beautiful. Trying. I'm trying. Well, I came into this conversation. with incredibly high expectations and you somehow surpass them. And I so appreciate you being the human that you are and sharing yourself with all of us. This was phenomenal. Thank you, Liz. Thank you so much for having me on your show. I hope you loved this episode with Viva. I think she is so brilliant. You could tell it. It was like fawning over her. But I think just the way she views women and

Starting point is 02:08:00 medicine and the world is not only smart and kind and compassionate, but important. It's important that we think about things these ways. And I hope that she helped maybe answer your health questions, but also maybe reframe some of the ways you were thinking about your body or your health in general. I know that she certainly did for me. We would of course love to hear your reactions, your thoughts, your feelings, your feedback on this episode. So please screenshot it and tag us on Instagram. She is at Aviva Rom with two M's. I'm, at Liz Moody. Also, if you have any follow-up questions, put them on Instagram and tag us, and maybe we can do an IG live and answer some follow-up questions. I think that would be really

Starting point is 02:08:37 fun. Also, if you love this episode or if you love Ask the Doctor type episodes in general, I would love a rating or review on iTunes that just kind of said, like, I love the Ask the Doctor episodes. It helps me know that I should put more of those in the queue. Also, if there's a topic you'd love for Ask the Doctor, we have hormones, we have anxiety and we have gut health. But if there's like a big topic you'd want me to cover, definitely let me know. I am here to serve. I want to create episodes that help you and help you feel amazing about yourself and amazing about your health. So for sure, let me know. And thank you so much for listening. I hope you love the episode and I will see you on the next episode of the Healthyer Together podcast.

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The Liz Moody Podcast - Ask The Doctor: Hormone Edition—Everything You Need To Know About Balancing Hormones Naturally with Aviva Romm, MD

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