The Liz Moody Podcast - Hormone Q&A—Solutions for Belly Fat, Acne, Hair Loss, Migraines, PMS, Insomnia, Low Energy, and More with Dr. Aviva Romm

Episode Date: June 16, 2021

I know you all love our Ask the Doctor episodes—we’ve got ones on longevity, happiness, anxiety, gut health, and more—so this is sort of in that vein, but a bit different.  I’ve invited back Dr. Aviva Romm, who was on the Ask the Doctor: Hormone Edition, to do a hormone Q&A. Aviva is my absolute favorite resource for hormone expertise—she’s a Yale-trained MD AND a midwife and herbalist, plus she’s the best-selling author of many books, including her most recent, Hormone Intelligence, which we discuss in this episode. For the Ask the Doctor episode, we covered a larger overview of hormones, so for this Q&A, I decided to go SUPER pragmatic and actionable, and basically used it as an opportunity to have her solve all of your hormonally-based problems. We talk about: Why being hormonal is actually your superpower The hormonal causes of and solutions for belly fat, insomnia, hair loss, low energy, acne, migraines, PMS, and more Her thoughts on the best way to “detox” your body How snacking impacts our hormone health What causes PCOS, how to know if you have it, and how she approaches treating it What causes endometriosis, how to know if you have it, and how she approaches treating it How our guts impact our hormones, our hormones impact our guts—and how to balance both Her easy formula for optimal hormone health We’d both love to hear from you as you’re listening, so screenshot and tag me—I’m @lizmoody—and @dr.avivaromm and tell us what you’re learning or thinking about. And if you want more hormone info, don’t forget to check out the Ask the Doctor: Hormone edition, which will give you even more background and information on your hormones . PS: Have you snagged my Foodie preset pack? You can get all 8 presets, designed to make your food pics look as good as they taste, at lizmoody.com/presets.  PPS: Healthier Together is officially a number one best-seller! You can get your copy on Amazon or at lizmoody.com/cookbook. Please keep sending me your creations on Instagram—they make me so happy! This episode is sponsored by Organifi, the makers of my favorite caffeine-free energy drink, Red Juice. You can go to www.organifi.com/healthiertogether and use the code “healthiertogether” for 20% off your order. This episode is sponsored by Seed, the makers of one of my all-time favorite supplements. Their Seed Daily Synbiotic is a game changer—it contains both pre- and probiotics, survives INTACT all the way into your gut, AND contains the most studied and powerful strains of probiotics out there. You can get 15% off of your first month’s supply of Seed’s Daily Synbiotic by going to seed.com and using the code LIZMOODY. Healthier Together cover art by Zack. Healthier Together music by Alex Ruimy. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends, and welcome back to the Healthier Together podcast. I'm your host, Liz Moody, and I'm a cookbook author and longtime journalist. I know you all love our Ask the Doctor episodes. We've got ones on longevity, happiness, anxiety, gut health, and more. So this is sort of in that vein, but a bit different. I've invited back on Dr. Aviva Rom, who was on the Ask the Doctor hormone edition to do a hormone Q&A. Aviva is my absolute favorite resource for hormone expertise.

She is a Yale-trained MD and a midwife and an herbalist. plus she is the best-selling author of many books, including her most recent hormone intelligence, which we discuss in this episode. For the Ask the Doctor episode, we covered a larger overview of hormones. So for this Q&A, I decided to go super pragmatic, super actionable, and I basically used it as an opportunity to have her solve all of your hormonally based problems. She shares the hormonal causes and exactly how to fix things like acne, belly fat, insomnia, hair loss, low energy, migraines, cramps, and more. By popular request, we also got into

PCOS and endometriosis, plus her thoughts on detoxification, the interplay between gut health and hormones, and much, much more. I hope you come away from this episode with lots of solutions that you can begin implementing today. As you can hear in the episode, Aviva and I are both passionate about empowering women to work with their hormones to feel their absolute best. So we would really appreciate if you'd share this episode with all of the women in your life who might be dealing with hair loss or acne or cramps or any of the other things we discuss. It just breaks my heart to think about women still dealing with these issues and not having this information. We would also both love to hear from you as you're listening. So screenshot and tag me.

I'm at Liz Moody and she is at Dr.daviram and tell us what you're learning or thinking about. And if you want more hormone info, don't forget to check out the appellate. Ask the Doctor hormone addition, which will give you even more background and information on your hormones. And if you're new here, if somebody shared the episode with you or you swiped up on Instagram, welcome. I am so glad to have you here. Don't forget to subscribe so that you don't miss out on any future episodes. I have so many good ones coming up, including a series on how a bunch of amazing women learn to love their beautiful bodies, a cortisol Q&A, an Asth the Doctor Dental Health Edition, and more. All right. Without further.

ado. Let's talk about hormones. All right, Dr. Rom, Aviva. I feel like I should call you Viva because you always tell me to call you Aviva, but I also feel like you're just such a notable, incredible, credentialed woman that it feels weird to call you Aviva. But welcome back to the podcast. Yes. Thank you. But we're friends. Please call me Aviva. No, I even tell my patients to call me Aviva. A lot of them won't. They say the same thing. It's a hard adjustment to bake. But welcome back to the podcast. I'm so excited to have you back. I do not like. to do two-time guests usually, but I think if there's ever somebody I'm going to do a two-time guest with, it is a master herbalist, Yale and Tufts-educated MD. And I think just one of the

most notable change-making voices in women's hormones. So I'm honored to have you back in the podcast today. Oh my gosh. Thank you so much. Well, we can two-time together. I love it. Well, on our last episode, if anybody hasn't listened to that, it's the Ask the Doctor hormone edition. We kind of dove into a lot of the science behind the various hormones in our body, how they work. If you really just kind of want a overview of primer of hormones, also we did a lot of information on testing for different hormones. So this time I thought, since we have all of that background covered, we could get more into actions. Like these are my symptoms. How do I fix them? And I think that goes really well with your new book, which I think is the ultimate primer for women's

hormones. Could you start us off just by telling us a little bit about the new book? Yes. It is called hormone intelligence and it is available anywhere you love buying books. And it's really a comprehensive book, but it starts out with how do we create a new conversation with our hormones and about our bodies? And first, that means understanding what is normal and what isn't normal because a lot of us grow up in the dark about that. And it's very confusing. We don't know how to get the information. And then another part of it is about if something is going on, how do you figure out what it is? What is the hormone imbalance or what is the condition? Do I have PCOS or is it not PCOS?

Do I have endometriosis or is it not? So it's really helping to find yourself in that kind of world of what's going on with our hormones. It's about understanding the subtleties of how our hormones influence our lives, our moods, even things like our mate selection and our spending habits and how we see ourselves in the mirror. It's really, there's some interesting stuff going on there with our hormones and how to work with that. And then there is a deep, a whole part of the book, six chapters dedicated to understanding the forces that are happening in the world we live in, because our hormones and our hormone health doesn't happen in a vacuum. there are ecological, and when I see ecological, I mean not just the environment, but our food, our stress, our gut, our endocrine disruptors that universally are affecting all of us.

And then within that, those universal impacts show up differently in each of us individually. So in some of us, our hormones are just cruising along and we're feeling pretty good. But in some of us, it may show up as period problems or polycystic ovary syndrome or endometriosis, fibroids, fertility challenges, miserable perimenopausal symptoms, chronic vaginal infections, low libido, pain with sex. And so all of those root causes help to address those universal factors, but then I wanted to make sure that readers had a way to also individualize and create targeted programs that specifically address the symptoms of those conditions, because nobody should have to live uncomfortable.

And also there are targeted dietary strategies, herbal strategies, nutritional strategies that are specific to those conditions. So the book does all of that and a bag of chips too, not actually a bag of chips, but five weeks of meal plans because I think that sometimes figuring out what to eat is a challenge and can be overwhelming. So there's five weeks of meal plans and about a bazillion wonderful recipe. right from my own kitchen. I love that.

And I hope this is a book that reaches across generations, reaches women. I mean, really, you could use this book if you have teenage daughters and you want to give it to someone in their teenagers and you can use it all the way through all your life cycles into when you finally reach menopause. Oh my gosh. I wish I'd had this book as a teenager. The only book I got as a teenager was that like my body myself and I remember it had like pictures of vaginas.

I'd never seen a picture of a vagina before. And I read that book over and over and over again. Oh my gosh. I gave that book to my nephew for his bar mitzvah. And my sister-in-law, she called me up one day. She's like, what is that book you gave Adam? Because he keeps going into the bathroom with it. And it's a little creepy.

And it's like, he's just learning stuff. He's just learning about his body. Yeah. And I think especially at the time when I was a kid, people weren't having these conversations and open at all. It was kind of like, people secretly handed you that book under the table and we're like, good luck, let's, you know, go enjoy being a woman. And it was, it's really, it's just heartening to think that people might have access to a book like yours now. Oh, thank you. I mean, I hope it dispels

a lot of myths. I can't tell you how many women I hear from, for example, who thought that there are horrible, painful periods and miserable heavy bleeding was normal because their mother went through that. And their mother thought it was normal. And so not only are we missing an opportunity to feel more comfortable in our bodies, but when we don't talk about these things, we're potentially missing an opportunity to identify actual medical conditions that when we don't treat can cause problems later. Absolutely. Well, we're going to get into light periods, heavy periods, migraines, PCOS, all of that in this episode. But I want to start at the beginning, the very beginning, in fact, the dedication of your book where you say you open your book by saying that being too sensitive,

too outspoken, too emotional or too hormonal is your superpower and that you should own it. Can you elaborate on what you meant by that? Yes. So, you know, so many of us kind of hearkening back to my daughter's boyfriend who said, are you on your period when my daughter was a little grouchy one morning? I think most of us in female bodies at some point, if we've been outspoken or irritable or expressing our need for some space, in some way or another have been told, you're hormonal. Or are you on your period? Or are you, is it that time of the month? Or other words that. start with a B, that kind of mean the same thing, right? And I want us to reframe understanding that our hormones, yes, they can make us feel all kinds of ways, and they do. And some of those

ways are fabulous. And some of those ways when our hormones are off kilter can feel really awful. But rather than blaming our hormones, understanding that our hormones are a powerful sixth sense, that they are a, and I don't mean in an ESP kind of psychic way, although there may be some truth to that too, but in a really powerful way that give us a lot of information about what's going in our personal internal ecosystems and also in our external ecosystems. The other thing about this that's really important to me is that as women, historically, we have been taught to be small, to be silent, to stuff it, to deny it, to gaslight ourselves told that it's all in our heads. And I want us to allow ourselves to be bolder, to be more in our truth, to not shrink, to not

apologize, and to really own who we are. And sometimes when that filter is down, especially in that premenstrual time, and also, again, for women in perimenopause, also for teenagers. You know, some of the things that we say we may say with a little bit more force and a little bit more fury than we may want to at times, especially if it hurts someone else. But I think often the things that we're saying reflect a deeper truth that we are actually noticing or experiencing. So I really love for us to just start owning that. And then the last thing is this piece about it being an inner guidance system.

And this comes to something we talked about at length in our IG Live together. talk about in the book is this concept that, and it's a very real. It's a medically ratified concept that our menstrual cycles are a sixth vital sign. So just like our temperature, our heart rate, our blood pressure, our pulse and pain, when we are experiencing challenges or changes or discomforts in our menstrual cycle or our gynecologic health, it's not enough to just say this is normal because I'm a woman or this is normal because everyone's experiencing it, it's really important to look deeper and say, what is going on in my body? My hormones are chemical messengers. What is the message that they're giving me to try to get me to pay attention to, whether that is something

feeling disharmonious in my life, in a relationship, in my job, and it's showing up in my body. you know, Martha Graham said the famous dancer, choreographer, she said, the body never lies. And listening to our body's truth is also a really powerful guidance system. And that's, that's really, to me, the deepest part of that superpower. Well, and you said in the live, and I thought this was so powerful, that it's kind of a gift in some ways that, like, a man could just, you know, have a heart attack out of the blue and wouldn't have had all of these precursor symptoms, but as a woman, we're given more information via our periods, via our cycles, via all of these hormonal signals. Yes, I mean, I'm sure that nobody who is struggling

to get pregnant or nobody who is suffering with endometriosis in any way feels that that's a gift. And I don't want to imply that I'm saying that that's a gift. However, understanding our cycles throughout our lives and also even understanding what's going on underneath the hood of some of these gynecologic challenges, even more serious ones, can provide us with deeper clues about imbalances that are going on in our gut, in our blood sugar, in our inflammatory or immune systems, or in our environment externally. And we may be being exposed to something as an endocrine disruptor. We may be being exposed to an undue amount of stress or a traumatic situation that is interfering with our health and well-being.

in that each month, you know, as women, we menstruate, we have about 400 menstrual cycles in the course of our life. If you figure on average, let's say five days, that's 2,000 days of our lives that we are getting a very visible, very measurable external, I mean, it's internal, I mean, it's internal, but we can see it, we can feel it. It's a measurable objective indicator. And it's not just our periods. It's whether we're ovulating. It's how we feel at different times. of our cycle. So it becomes, if we can see it that way, without being in denial about, you know, whatever feels bad and may actually really suck. I'm not saying deny that, but to look deeper at it and embrace it and welcome it, I jokingly say that because when hormones are the chemical messenger,

if we're blaming the hormones, we're shooting the messenger instead of actually reading the message. Yeah, I view it as like there's that arcade game where the alligators pop out and you bop them on the head. And I view that as like we can, a lot of us are doing that with our hormones when in fact, we should be sort of more in conversation, more inviting, why is this happening? What does this mean? How can I get to the bottom of this? Which I think your book does really beautifully. I want to get into some of those symptoms that we talk about. So I'm going to give you a bunch of symptoms that my audience wrote in and said that they were struggling with. And I would love to know like what they signify, how they're hormonally related and how people can treat them.

Sounds good. All right. Let's start with hair loss. Hair loss was a really big one. We talk, I've heard about like postpartum hair loss. I think that's a more common conversation, but a lot of women feel that they're experiencing hair loss beyond postpartum or they have postpartum and they don't know what to do about it. So is that hormonally related? Is it a symptom? Is it a cause? What, what's the deal there? This is a really interesting one to bring up particularly right now, Liz, because if you would ask me 18 months ago, I would have said 95% of the time it is hormonal. That hormone may be testosterone, that hormone may be cortisol due to stress. I do want to emphasize that right now

we are unquestionably seeing that people who have had COVID and maybe didn't even have serious symptoms, but maybe had mild COVID, we know that there is a significant amount of hair loss that's happening as a result of COVID infection and long haul symptoms. So I want to just, you know, highlight that. It does seem to be something that resolves, but it's extremely distressing. And it may have something to do with the viral infection. It may have something to do with the stress of the viral infection. Not all viral infections cause that. Most don't, in fact. So, you know, I just want to emphasize that it could be your hormones, but if you've had COVID, you know, knowing that may give you some not peace of mind.

but an answer, or if you suspect you've had COVID, that may be an answer. But otherwise, yes, most of the time it is hormonal. And the big picture things that typically lead to hair loss are low thyroid function, so hypothyroidism, which can be Hashimoto's or non-automune hypothyroidism, stress because cortisol itself can lead to hair loss. As your body is trying to protect itself at the core, hair becomes an expendable vanity that your body, body doesn't want to put energy into, and the same with thyroid function. Something called polycystic ovary syndrome, which I think we're going to talk more about, which is fundamentally a metabolic disruption, but that metabolic, so it's happening at the

blood sugar level, for example, but that causes the body to produce extra testosterone. And so women who have polycystic ovary syndrome, who have that increased testosterone, like men who start to lose their hair can experience what's called female pattern hair loss, but it's similar to that hair loss on the crown. It may be at the hairline, and that is a typical symptom of polycystic ovary syndrome. You mentioned postpartum. That's called telogen effluvium, and it's a stress response, and it doesn't mean that having a baby necessarily stressed you out.

You could have had a wonderful home birth with all the bells and whistles or, you know, chanting and crystals and still be experiencing hair loss three months later because it's a stress oar on the body. And that typically does start somewhere around three to five months postpartum. It's self-limiting. It stops. Yes.

You know, I think about this, and this is not the origin of the word distress, but tresses is an old word for hair. And distress is literally the state of being emotionally distressed, but it also would mean to lose hair. So I always think about that with stressful situations. Perimenopause, there is a thinning of the hair that happens in quite a number of women. Again, I think it's about 30% of women who go through perimenopause experience some hair thinning, which, again, is distressing and is related to hormones.

But some autoimmune conditions can cause it. There can be a genetic predisposition. So if a lot of the men in your family are bald, if there are other women who have had early, hair loss or thinning. There may be a genetic predisposition. So all those factors. And then another one is not hormonal, but iron deficiency anemia, which is really common, especially if women have had heavy periods over a long period of time or fibroids and a lot

of bleeding or heavy uterine bleeding. So those are the big ones that I think about. So I imagine that the best thing to do would be to kind of look at your other symptoms, maybe using one of the checklist in your book and try to isolate, is this a cortisol issue, is this a thyroid issue, et cetera? Would that be right? Absolutely. Symptoms can tell you a lot. Again, back to the body as a sixth vital sign. If you feel chills and you feel achy, you take your temperature and you kind of think, what kind of symptoms do I have? Does this seem like the cold? Does this seem like a flu? We can differentiate if we actually know what the symptoms are.

So much the same way, you don't necessarily need to run. and get a lab test when something can be, you know, you can check it off and say, yeah, it's definitely checking all these boxes. That said, with certain symptoms and hair loss being one of them, if you can't put your finger on it, that is one of those times that it could be worth getting some labs done because you may differentiate between high testosterone or low iron, something that might not be as fully obvious if you don't get tested. So run through the checklists, you know, kind of run through the checklist of the conditions that are,

if you know you have really heavy periods, you're tired all the time, you're pale, running to the doctor to get your hormones check, might not be the answer, but it would still be a good idea to know if you're anemic so that you can know what to do about it. Is there anything that you recommend? Obviously, I think the goal is to address all of the root causes and, you know, balance your thyroid and balance your cortisol and all of that. But is there anything you'd recommend specifically for? healthy thick hair or addressing hair loss. Like I know a lot of people take prenatals when they're not

pregnant. Yeah, I actually do recommend a prenatal whether or not you're pregnant or planning to get pregnant just because it has a higher level of some of the micronutrients that can really support hair growth. I recommend taking green tea extract that can be helpful for hair growth and making sure that you're getting a multivitamin. I'm sorry, getting fish oil. There have actually have been a couple of studies looking at two grams of an EPA, DHA fish oil combination. I don't remember what the ratio was, but they're pretty typical ratio. So whatever good quality fish oil you get at that dose should have it for six months, that can help with hair loss.

So those are the big things. And I'm a big fan of adaptogens. There's no scientific data that says adaptogens help with hair regrowth, but they can definitely help with stress reduction in cortisol and blood sugar, sort of rebalancing, if you will, for a simple way to put it, that can, I think can be really beneficial. Do you have favorite adaptogens for that? I, for women, I really like Ashwaganda, Holy Basil, and Rishi Mushroom. Those are probably my three favorites because they're so gentle that even someone who's

pretty crispy, you know, burnt out, exhausted is just getting sort of gentle nourishing support without pushing the body into any kind of more stimulated state. Like rodeola, ginseng, American ginseng, they're great, but they're a little bit more stimulating. Do you have a favorite prenatal and a favorite fish oil brand-wise? You know, I just did a full review of prenatals over on my website. And so rather than naming any particular brands, because I have a couple of different students and colleagues and friends who have prenatal brands. So just to stay in everyone's favor, there's not one that's necessarily better than the other,

but we did a comprehensive myself and the registered dietitian who works in my practice, who incidentally used to be at the Cleveland Clinic Functional Medicine Center. She's really well trained. She and I did a comprehensive review. We picked the top nine prenatals that met the criteria for the highest inclusion of the most important nutrients for healthy fertility. If it's good for free utility, it's good for your hair. And also that met the best ecological and ethos values that we put out to do our review as well. And then we also include price point and everything. So just go to Avivaram.com. It's on the homepage of my website. And there's

actually an ebook that you can download that has the whole chart in it of the prenatals and comparison of how many you have to take it. I mean, some people like, I don't tolerate taking personally, like eight prenatals a day. It's a lot of pills for me. I'm just not a pill person. We do have a couple of powders in there. But if you don't mind, you know, you can take that one or there's some that have two pills a day. So you can compare and you can price compare as well. For fish oil, I actually like Nordic naturals. And Carlson is another really excellent company. Both of them have been around for decades now. I first learned about those companies from a colleague of mine who is a psychoneuroimmunologist who actually is a fish oil researcher.

And then I have another colleague who is probably one of the world's leading fish oil researchers, Tom Brenna, and both have said they feel like they're very high quality, reliable companies. I'm not putting words into their amount. I'm just saying that, you know, in my discussions with them, and that they're reliable for testing for heavy metals. And I like the Nordic a lot because they have, and I have no financial relationship with any of these companies, just to say.

But they have a prenatal, they have a children's one, they have liquids, you know, for people who don't like those giant pills. They have one that's combined with vitamin D. So you're kind of getting two of your nutrients in one. They have a higher dose one. So because official, you know, you have to take, it's pretty pretty big pills. So the concentrated one, I really like a day. And you can get that in a liquid as well. And you get it in lemon and strawberry. So it kind of meets everyone's needs. What about acne? Is acne always hormonally related? I'm trying to think if there's a time that acne, I mean, acne can be a result of topical things that are causing skin irritation or skin reaction. So I can tell you, look, I've never struggled with acne my life. And for my 50th birthday, I decided to invest in, as a birthday gift to myself, $400 of this very beautiful organic skincare line. and I got it and it was so full of essential oils that within a couple of days of using it, I was having these horrible breakouts. And I was like, what the? 50 years old, I'm getting acne.

And I realized it was actually just the product. So I completely stopped using the part. Oh my gosh. I think I know which line it is, but I'm not going to make you call them out on the podcast. Okay, you can just give initials. Tell me the initials and I'll tell you if it's right. Is it TH? Yes.

Oh my gosh. It is. Yeah. I've heard that happen to a number of people. I think the essential oil concentration is just a lot for a lot of skin. Yeah, this was too much. Okay, so we have topicals, but other than sort of distressing your barrier layer. Yes, so other than that, I'm trying to think if there's anything else, it's pretty much always hormonal.

Well, and you can have gut disruption. You can have food reactions. So some people get acne when they eat dairy, for example. But that is, I think that's still hormonal. You know, it's the hormones in the dairy that are probably activating your own. But yeah, it's pretty much always hormonal. The cystic acne that we typically see around the chin and jaw line, that is almost endemic to me of like almost like pathonomonic, if you will, for PCOS.

And the reason I say that is PCOS acne is a result of increased androgens like testosterone. And if you think of where a man has a beard and the fact that a beard hair is stimulated by testosterone at the follicles, It's exactly where men have their beards. So if you have cystic acne, it's really been troubling you, you know, especially for a long time or you're a teen and you're first having it. It doesn't always mean it's PCOS, but I would put PCOS high up on the list of what's causing it. Cortisol, stress can cause acne. And we forget that cortisol is a hormone too.

Stress can absolutely cause an acne breakout. And then premenstrually, what happens premencerally is interesting. One, we have a natural little burst in those androgens. We also have a natural little burst in inflammation. And I don't know why, because nature's design is always pretty perfect to me. But we get a little, like a constriction in the follicles of the skin of the face premenstrually. So not only are you producing more sebum because of that testosterone, but it may be more likely to get trapped in there. So if you have, you can have more testosterone and more inflammation and not have people.

P-C-OS at all. So when we see that cyclic acne that's premenstrual, that's often what that is due to. So what do we do about acne, other than not buying the $400 essential? Yeah, not buying the $400. It was four products, not one, so it wasn't just one $400 product. But yeah, none of the TH. So first things first, pay attention to your acne and when is it happening? Is there something that's a trigger for you. Is there something that you can identify when this happens, my acne gets worse? And whether that is, you know, when I go home for the holidays or when I eat this or that, you know, when I eat the dairy, when I eat that ice cream, when I eat the muffin with sugar, whatever, pay attention. And then paying attention to where in your cycle is it happening?

If it's premenstrual, that's one thing. If it's all the time, you know, that's another thing. Where on your face is it happening? Is it happening at your jaw? is it happening more along your forehead? Because you can have acne along your forehead from having oily hair too, really, you know, cut the bangs, pull the hair back, do a different product if you have oily skin that, you know, helps to shift that. I do really believe in healing our acne from the inside out. So that all said, there are some nutrients that can really help. One, again, getting a multivitamin or prenatal because those little micronutrients may really make a difference. Zinc may really help with acne quite a bit, so 15 milligrams of zinc citrate every day.

And then I like the herb Vitex because it does help to regulate hormones. It helps to regulate estrogen levels. It helps to regulate progesterone, and it also helps to make sure you're ovulating. So it can help make sure that your testosterone levels are also staying in a reasonable range. If you have PCOS, you may want to start out with a low dose, but for everyone else with just kind of cyclic menstrual acne, that's where I would start. I'm a big fan of taking out all processed foods and dairy. Dairy, even though I don't think it's an unhealthy food per se, I think you can get great

organic sheep feta or sheep yogurt or goat cheese and whatnot. But even in the cleanest of environments, when animals are producing breast milk, which is what we're drinking, they are producing it with, they're making it and has hormones in it. And often animals are kept pregnant and lactating at the same time and used for their milk. So then they have higher levels of, for example, estrogen in their milk. And then certainly any environmental chemical, any commercial dairy, which has growth hormone and antibiotics and all of that. The other thing that may be less obvious is looking to the health of the gut. but our skin, well, and the health of the digestive system in general, and that includes the liver.

You know, we tend to think of the liver as part of detoxification, and it is, but it is technically a part of the digestive system. So looking at the health of the microbiome and looking at the health of the liver in general, our skin is our largest organ of elimination. Secondarily, our liver is our next largest organ of elimination, and it's so important for that liver to be breaking down our hormones that we're producing, the endocrine disruptors that we're getting exposed to, and so many other things. In fact, traditionally in herbal medicine, the skin is always treated through the gut and through the liver. So we use bitters, herbs that actually have a bitter taste, although you don't have to get the bitter taste for them to be effective. Interestingly, you can take them in capsules and still get the effect because we have

bitter receptors in our gut. But combination bitters, companies like Urban Moonshine, herb farm, Gaia herbs make wonderful bitter. I love the Urban Moonshine ones because you can put them right into some sparkling water and take them as aperitif. They're delicious that way. They really can feel them getting your digestion going. That can help. Bitters in general, I think they're such a good, like, soda alternative because they come in so many flavors. And they have, like, the world's tiniest amount of alcohol. So if you are completely sober, maybe that's something to avoid, but it's, I mean, we're talking about drops. And they come in so many delicious flavors. And they really quench that, that soda craving for me.

They do. And they also, you can get them in glycerin forms. So you're not getting the alcohol. But yes. And you can also just get capsules if you, you know, if you just can't take the alcohol, I totally respect that. And then we forget, but leafy greens, kale, collards, and dive, if anyone's ever eaten radicchio, ridiculously bitter. So those are great ways to get bitters in your diet, too. And then making sure that you're eliminating. So your liver detoxifies stuff, and then it pumps it out through your gallbladder into your

intestines so that you poop out whatever you broke down. And so making sure that you're having a good bowel movement, ideally once a day. twice a day, but even, you know, if it's not every single day, that's still okay, but aiming for every day to have one good, healthy bowel movement because then you're getting all that stuff out. And that comes down to plenty of fiber in the diet, drinking enough water, getting enough movement, exercise, possibly a probiotic if that helps you. And again, those bitters aren't just working at the liver and the gallbladder. They help you eliminate because they're helping your body to get more bile production. So that's my, that's my big one on, my whole lowdown on

acne. There's more stuff, but that's the big stuff. I interviewed Gigi Hedeed's skin doctor once, and he said that like the secret to Gigi's and like he works with all these other models. He has them eat like a cup of dandelion greens a day because of the bitter green quality and just to support their liver. So it's Gigi Hididid's secret to apparently. You're listening. You're listening. to the Healthier Together podcast. Look, I'm never going to make everything that I wear organic. But your sheets, your pillows, your comforter are literally touching your skin for eight hours every single night.

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Liz Moody for 15% off your first month supply of seeds daily symbiotic. Again, that's code Liz Moody on seed.com. Now, let's get back to the episode. I was going to talk about later the sort of environmental and detoxification part of your book. But since we mentioned it, let's get into that. And then I'll bring you back into the symptom thing. Can we talk about like there's the age old debate of like your body detoxifies itself or like you need to help your body do a detox. What's your stance on that? So your body does detoxify itself. All of these things are happening as we live and breathe.

We don't have to do anything to make those things happen. Here's how I think about this. We are living in a time where we are overloaded with environmental endocrine disruptors. They're in our food. They're in our water. They're in our air. They're in our furnishings. You know, if they've got flame retardant, they're just kind of everywhere now.

And you can't escape them even if you're a polar bear in the North Pole or a penguin in Antarctica. They're going to be in your fat. They're going to be in your blood. It's just the way it is. So on the one hand, we've got this old. overload. And on the other hand, most of us, us, you and me and like some of our listeners being exceptions to that, of course, but most of us as Americans are not getting nearly the amount of fruits, vegetables, and fibers that our ancestors got. So we know from studies done by the Centers

for Disease Control, they do these studies every couple of years called the N. Haynes studies, and they look at nutrition amongst other things around the country. And they, the last one they did a couple of few years ago, they found that in every single state in the United States, people were getting 14% of their vegetables and 16% of their fruits that are recommended. And those recommendations are like the paltry lowest level recommendations for survival that the FDA recommends. So we're not even talking optimal. So we're mostly not getting enough fruits and vegetables.

We're not getting the variety of colored, abundant, you know, greens and reds and blues and purples and all of those that contain these chemicals called phytochemicals that support those detoxification processes. They contain things with big fancy names like proanthosyanodins that actually support those processes. And we are not getting the fiber that our ancestors got. So our paleo ancestors, and this is not a shout for the paleo diet, I'm actually talking about paleo people, got about 100 grams of fiber a day from fruits and vegetables.

roots, things that they foraged. The American Cancer Society or the American Society of gastroenterologists, I forget which one it is now, but they say we need 30 grams of fiber minimum a day just to prevent colon cancer, average American getting 15 grams of fiber a day. So we're overloaded and we're undersupported. And that is called an evolutionary mismatch. So there's actually a biological thing happening. So our bodies know exactly how to detoxify, but we've gotten away from the natural things that support that, and at the same time, we're overburdening the system. And so that's where it comes to doing everything we can within our power to reduce our body burden and reduce our exposure. And that may sound really hard and complicated, but once you make it a

lifestyle, it just becomes, I promise you, as easy as breathing to make the choices and nowhere to shop. But changing our cosmetics so that they are truly clean and green, better for us, better for the planet. Our household cleaners, going organic wherever we can, especially meat and dairy, but also our produce. And it means making sure that we are really bumping up our fiber, eight to ten servings of fruits and veggies a day, going to the bathroom, getting those bitters. Our Our ancestors got tons of bitters. The only bitter most of us get in our diet these days is coffee, and people add sugar and cream to that, so it's not even really bitter anymore.

But a lot of people use coffee to go to bathroom in the morning, right? Because it's a bitter. It does that. So, yes, we do know that our bodies do this every day, and yes, we do want to support our bodies by reducing the stress of that burden and supporting, adding in all the nutrients that we need. Do you have to do detoxes? No, you do not have to do detoxes to make this happen at all. In fact, doing aggressive detoxes

can liberate these stored toxins really fast. And I've had more patients than I can count who have come in not usually after a first detox, but they had some good benefits with a first detox and then they did another one or they did it more aggressively. And now they're really not well. Sometimes they've thrown themselves into some significant imbalance. So historically, people have always done fasting, Right. So if you think about Judaism, there's Yom Kippur. If you think about Catholicism and Christianity, there's Lent. My best friend's husband is Ethiopian. He has three days a week where he doesn't eat meat and dairy. He's just three vegan days a week. It's part of what they do in Ethiopia. And then they have three months of the year where they don't eat meat. In Islam, there's Ramadan where people fast all day and then they eat in the evening. And every culture. We look at First Nations culture. probably the list goes on and on where fasting or sweating was part of the culture. And historically people ate less than we do in this country, too. They just ate healthier. So, you know, keeping our eating to daylight hours, some people call it intermittent fasting

or time-restricted eating. I'm not calling it either of those. I'm just saying not eating too late at night, you know, within three or four hours of bedtime, maybe having one day or two days a week where you do go plant-based or primarily plant-based. So are you okay with longer periods of fasting for women? Because I feel like I've heard, and I might have heard from you, that like, intermittent fasting or that women should sort of cap it at 12 to 14 hours and not go much longer than that because of our hormones. Yeah, I think that intermittent fasting for women after menopause may be fine because we're in a more metabolic and hormonal state that doesn't, isn't so energy-intensive. Ovulating every month is a really energy-intensive process. In fact, Sarah Hill,

who is an evolutionary psychologist who wrote a book about, oh, it's called Your Brain on Birth Control. She talks about really how much energy it takes to ovulate and how much energy it takes to menstruate. In fact, we're one of the only mammals that doesn't reabsorb our menstrual blood. It's really interesting. Not all mammals menstruate externally. And so we lose iron each month. You know, it takes a lot of nutrients to create an egg and then to ovulate it. So I think that when we restrict during those years that we are in that, you know,

those kind of what people call childbearing years while we're menstruating, it can actually become restrictive and can interfere with your hormones. So I don't typically recommend extended fasting. If you want to go a day and eat lighter, because that feels right to you or you're on a retreat, you know, something like that. Sure, a day. But I really don't recommend longer fasting. Intermittent fasting, it depends on your metabolism, your needs, your exercise habits, and what's going on. I usually only recommend intermittent fasting for women who are really struggling with metabolic syndrome, insulin resistance or diabetes or

pre-diabetes or, again, women post-menopausal. But I do love that eating window, you know, having breakfast, you know, let's say breakfast is seven or eight in the morning and then don't eat after seven or eight at night. That can be great unless, again, you're pregnant or breastfeeding and then you need those extra nutrients. While we're on the topic, you also talk about sort of recommending against snacking or against this notion of being constantly eating that we've developed in this society. Can you talk a little bit about snacking and its effect on your hormones? Yeah, so I don't think snacking is inherently problematic for everyone, but two things. One, our body likes to go into a rest and digest mode. And that is the whole point actually of the

overnight fasting. You know, we're just not eating after seven or eight o'clock or that's the point of intermittent fasting. You're letting your body go into a different mode that has very specific actions on your body that reduce inflammation, that help to reset your blood sugar. And that's why it's so important. So if we're eating all day long, we don't really get that break. Our digestive system doesn't get that break, but also our insulin. We're constantly pumping out those systems that are helping us to break down and metabolize that food. I think more importantly is looking at why are we snacking. And I know from my own experience, but also from, you know, many, many women I work with that when we eat in a way that sates us, that really gives us what we need, we often aren't hungry again two or three or four hours later. So some women, I find, do need to snack.

Often women who are burning up a lot of energy, you know, they're very high intensity athletes. They do a lot of physical labor. or they're engaged in an intense amount of cognitive labor. So they're in medical school or studying something or, you know, they're like a rocket scientist kind of job. But outside, and that tends to be those people need a lot more protein, interestingly. Outside of that, I think if we can really experiment with, first of all, I just want to step back and say, it's super important to trust your own body.

You know, everything I'm saying is general, but it's important to trust your own body. and to the extent you can, and to the extent that you are aligned with a sort of natural blueprint, trust your intuitive eating. Intuitive eating only goes so far, though, if your brain and your hormonal chemicals that regulate when you're hungry and full are working. And a lot of Americans, and also interestingly, women with polycystic ovary syndrome, if you have gut dysbiosis, that can all upset that hunger and fullness, those signals. So intuitive eating may not work if you're experiencing those. Stress can upset our hunger and fullness signals as well because cortisol does that.

So I do want to encourage people to pay attention to their bodies, find what's right for you. But observationally and experientially and also research-wise, if we eat a good breakfast that has protein and fat, So that could be something like an egg fried in olive oil and avocado on whatever kind of toast your body, you know, tolerates and maybe some of those dandelion greens on the side or arugula. I love it with arugula. For breakfast is very unlikely. And even according to the research, it's pretty much proven that you're going to be hungry again for four hours or so. So if we're not getting that, you know, if we're eating. something that is more sweet. And that can even be like a yogurt with fruit in it. That could have 30 grams of sugar. It could be if we make oatmeal and then we put fruit in it and dried fruit in it and maple syrup or honey in it, we can really be loading it with sugar. And then a couple of hours later, our blood sugar is crashing and then we're hungry. So learning to eat in a way that balances blood sugar gives your body a rest. It gives your digestion a rest. But then you're actually

also getting typically healthier meals. And so that's what I do encourage. encourage that in the book to learn how to eat to balance your blood sugar because it's so important for so many things. But I also do give healthy snacks because I get it. Some people need them. Some people just want them. We may be under a lot of stress and I think it's okay to eat something healthy if you need to calm that stress response as long as it's something, you know, healthful and supportive of you. So I have some phenomenal snacks in my book. Going back to the environmental exposure element, are there any sort of low-hanging fruits that you feel like, like I love set it and forget it, environmental exposure things that people don't

necessarily think of. Like I filter all my drinking water, which a lot of people do. But I also got a shower filter, which I think is great because it has the vanity benefits of making your skin and hair look really good. But it's also a one time and done. You have to change a filter like every six months environmental exposure that you can reduce. Do you have any sort of like quick tips like that? Yeah, I would say look at what you're putting. So anything that's scented, unless that's that scent, you're sure, is like some natural essential oil and a very little amount of it, as we've been talking about with those skincare products. If it's scented, it's probably got phthalates in it. And so anything that you can get in your household cleaners, your laundry

detergent, your shampoo, your body products, you know, natural scent, low scent or no scent. And if it's synthetic scent, forget it. You know, you breathe those scents right in and they act almost immediately as endocrine disruptors through your very sensitive nasal passages. I'm really big on changing out your cosmetics and your household cleaners because those are two huge exposures. So, I mean, with cosmetics, how often do we change those out? So I think that's a really good set it and forget it. And you can pick which ones.

I mean, I don't think we absorb a crazy amount of environmental chemicals through our eyelashes and our mascara. But our lipstick, our foundation, our shampoo, our soap, those things that you're putting all over your body or that you're getting into your mouth, like your lipstick. those would be a couple of big places that I would start. I think the unscented trick is so good because a lot of time, I'm all about like the supernatural really clean ingredient cleaning products, but sometimes those can be hard to find particularly in stores that are everywhere. And I love the idea that if you can't find

those just going for the unsented option will already save you like a huge chemical burden. Totally. And here's the crazy thing. You might think your products are unscended because if you're using them. People who use these scents actually get blunted. They adjust to them. Yeah, you adjust to it. So like the guy in the Uber and you're in there just going, oh my God, I'm dying. I got to roll up in every window and he's rolling the windows back up or she. And they don't even smell it. Or the people who work at the Home Depot or the Target in the like detergent section or the chemicals, they don't even smell it. And that's scary. But I think there should be a rule against those things in Uber's. They just are, it's terrible when you get in one. And then I feel bad for me because I'm smelling it. But then I

I just feel terrible for the driver who's inhaling it all day. I know. And then you feel like you're being judgy because you're opening the window because you can't breathe in there. Yeah, so that, I would say that is a huge one. And there are places now. I mean, honestly, not to shout out the big box Amazon, but you can get pretty much everything there

that you can get anywhere else. Grove Market has, it's like a market online for cleaner, greener products. And a lot of these companies now are very kind of like, I guess you call it like horizontal. They have something for every part of your house. You know, it's like if they've got window, if they've got counter cleaner or dish soap, they've also got the toilet paper or whatever. And let's not forget some of the basics. Like my grandma, she cleaned everything with vinegar. She cleaned the windows with vinegar and newsprint. I mean, maybe you don't like vinegar smells. So you go for some lemon juice.

But there are also, you know, books out there and resources online to use cleaner household cleaners. The other thing you mentioned in regards to acne and hormones in general is the gut. So we'll go back to my list of symptoms I want you to address shortly. But can we talk about the gut and how that impacts hormones for a second? And I'd also love to know how hormones impact our gut. Like I feel like it's a two-way street. Oh, yeah. Well, anyone who's ever had loose poops before their period or bloating definitely knows that it's a two-way street.

I'm raising my hand. Yeah, it's so common. And certainly women with endometriosis because a lot of women, with endometriosis also have irritable bowel syndrome. They can go hand in hand. So we kind of all, as women know, in a way, the impact of our hormones on our gut. And stress, we know the impact of those hormones on our gut, too. I used to jokingly say that my medical school exams were like the fast diet for me because I would have, I get so nervous over exams. I used to have to poop like four times before I would take a test. I'm like, I know I'm going to lose like four pounds over

my boards. But, you know, we just know that experientially. And what's happening is our hormones are changing things like these chemicals called prostaglandins that can create inflammation. Progesterone makes our bowels move more. So there are real things happening at a hormonal level that are affecting our gut. Our gut has a huge impact on our hormones. First of all, we know that gut disruption, dysbiosis, where and there's trouble in the microbiome, which is usually either an overgrowth of unhelpful or even harmful organisms or lack of a variety of the organisms we need or an undergrowth of the good organisms. It can happen one in three ways or usually all of that. That can lead to a number of issues. One of those is that it is our gut microbiome

that is largely responsible for breaking down and eliminating or reabsorbing the right amount and the right kind of estrogen that we're producing in our blood. We know that when there's problems with the gut microbiome, that can cause insulin resistance. So insulin resistance, I'll just explain it really quickly since I've mentioned it a few times, is when your cells no longer properly respond to insulin. And what happens then is that the insulin itself can trigger the ovaries to make more testosterone, but also the insulin's job is to swoop up blood sugar and bring it into the cells so it's not circulating all over your body causing inflammation and harm. And so when the cells get insulin

resistant, they're not swooping up that sugar. So you end up with high blood sugar and in of itself that causes more inflammation and more increased testosterone. So that's one way. If your gut is disrupted and you're getting that insulin resistance, you can get more testosterone. And there are just a bunch of ways that the gut is involved with sleep. Sleep has an impact on our hormones. It's involved with stress and cortisol. So those all have indirect impacts as well. So probably about I mean probably 50 different ways that we already know and then a bazillion that we don't, that the gut has an impact on our hormones. So having a healthy gut, getting that good fiber. The thing is, you know, Liz, all these things, I mean, they sound so complex and can feel overwhelming.

But when you actually dial it back in, it's like eat more fiber, eat more plants, eat greens, eat a variety, keep your dairy to a minimum or no, no processed foods, keep the sugar out, alcohol, not so much for most women because it can really affect hormones, and eat plenty of fish or good quality vegan protein, red meat occasionally. It's really, and good fats. Good fats are so important. Avocado, olive oil, ghee is really great for the gut lines. managing. Manage your stress, you know, get seven to nine hours of sleep a night and avoid those

big burdensome endocrine disruptors. And then if you're eating the right food and getting the right fiber, your body's already taking care of that detoxification support. So for most of us, that is the ticket right there. It's, it takes a minute to learn it. But once you learn it, it really, it's just life changing. And you can pick one area, right? You can start with, your food, because that's kind of low-hanging fruit, no pun intended. You know, you can just change some of your foods and change your cosmetics and give it time. You know, whatever is going on in your body usually didn't happen overnight. It may have been going on for years. So give yourself three months, six months, you know, to see how it goes for you. Take that multivitamin, the fish oil,

magnesium, get lactofermented foods in your diet. And usually you're kind of getting the foundation of what you need. And then if you have additional specific concerns or conditions, you can add in those extra nutrients or herbs that kind of push you to the next level, if you will, of healing. Okay, well, that brings me back to my list of symptoms. The next one I wanted to talk about was belly fat. And a lot of women who wrote in and said that they struggled with belly fat felt that they had already sort of done all of these positive lifestyle changes. Like one woman was like, I eat as well as I possibly could eat, and I still really struggle with this belly fat. So can you explain if or how that's hormonally related and what we can do about that?

Yeah, so there are two common hormonal reasons that we get belly fat. One is menopause, and menopause tends to put on weight not just on the belly, but around the waist in general. So you go from having nice, like, curvy hips to being a little bit more kind of like, like straight in there in a way. So that's the switch from one form of estrogen called estradial to another form of estrogen that dominates menopause called esterone that unfortunately just doesn't have as much metabolic fire. And so it's nature's way of putting on a little weight because that extra weight is how our fat cells take over producing estrogen from what was

previously being done in our ovaries that doesn't happen anymore or happens minimally after menopause. So it's kind of a natural change, one that most of us don't relish, one that you can keep on top of with good sleep, stress reduction, which I'm going to talk about in just a minute, because that's the other big hormonal reason. Increasing your burn with your exercise, interestingly, cold showers can increase brown fat that increases metabolism even when you're resting. So those are some of the things that you can do if that weight has crept on around your waist and in your belly and your menopausal years. Wait, can I ask super fast? This is like a super side note, but I'm personally interested in you said cold showers. I've been doing cold showers

because Zach like read something about it and was like, we should try cold showers. So we've been doing a minute of cold shower at the end of our showers. Do you think that's like generally hormonally a good idea? I think it's great actually. So Wimhoff is. I think got really popular, this gentleman, I want to say he's in Sweden or Switzerland. We were debating his accent. I think he's Dutch, but Zach thinks he's Swedish. He may be Dutch, actually. You may be right. We should really look that up. We're very much lumping those accents together and they're very different places. But he's from there and he promoted, kind of has like made this very popular.

People who are the polar bear club, you know, those older people on the coast of Maine and Massachusetts who do this intense cold dunking, actually it does really appear to be beneficial for their metabolism. What we know from the research, and I actually talk about this in the book, it's kind of one of the novel things that I think I may be the only one that has talked about in hormone book, and it's kind of exciting to me, is this idea of brown fat. So white fat is what most of us have when we put on weight, and it's very low metabolic. It's not burning calories while you rest.

It's more just inflammatory or more just fat. But brown fat, like muscle, not as much as muscle, but still like muscle, burns energy at rest. And we can actually build our brown fat. We can convert white fat to brown fat and get more burn. Exercising is, of course, an important way to do that. But two other ways that we do that are sleep and cold showers. So one of the things that I recommend in the book is starting out with 15. seconds at the end of your shower, building up to 30, 45, then a minute. So I think a minute is great.

I have not been able to push past a minute. And I'm not even at 100% cold in my shower. I'm such a wimp. I'm at like 85% cold. We live in Airbnb's. And so every shower has like a cold. It's been such a wake up call. We're in Colorado now. And our cold is so cold. And I thought I was so tough in our Santa Fe Airbnb. And now I'm like, oh my God, I'm such a wimp. I can't handle actual cold. That's so funny. When we lives in Vermont, a long time ago, our only hot water came from the wood stove. So we had a tank on the back of the wood stove and there's like you had to crank up the wood stove. I mean, sometimes those showers were just really cold, northern Vermont water out of the well. So I feel you on that. So yeah,

and so then the other thing is sleep. Getting seven to nine hours of sleep a night actually helps build your brown fat. So what I recommend in the book is actually taking your shower if you have the bandwidth and energy to do it at night. Just take a shower, even if it's not your like shampoo and conditioner shower and your shave. Just jump in the shower, do a nice warm shower for deep relaxation, then do your incrementally, you know, up to your minute of cold and then get in bed and read a book or meditate because then you're boosting your metabolism. And we all know, like remember when we were kids and we'd like jump in the freezing cold water at the pool or at the beach and we'd sleep so well that night.

That's so interesting. Like I sometimes just feel like when I come out of that cold water, because there's always that like second of like, I don't want to do this. I'm just going to skip it this time. And then you make yourself do it. And you're like, oh, that felt so good. And you feel better after. For sure.

You feel like really invigorated. And I was actually going to ask you about timing because because I feel invigorated, I wondered if it was something I should do in the morning. But I'm also switching my workouts to from morning to late afternoon. because of your book now. So I was like, I want to shower after my workout, which will be late afternoon, early evening. So is the cold shower benefit okay for night? I think it's great anytime you want, yeah, it's great anytime you want to do it. But if you do have trouble falling asleep, if you're perimenopausal and you just like need something different and you want to get that

brown fat going. And again, back to the third thing, you know, because we talked about it being what are the hormonal things that cause that belly weight. Yeah. Stress is a huge one. So the number one hormonal factor outside of menopause that causes us to put on weight around our middle is cortisol. Cortisol literally causes you to store weight there. And it's kind of an interesting evolutionary biology phenomenon in that one of the primitive ways that our body has learned to respond to periods of feasting and famine, right, as is common in many places.

there's an abundance of food certain times of year and not others, is to have this programming that when we're under stress, that stress, the brain doesn't know if that stress is like a saber-tooth tiger chasing you, you got your rent check and your rent bill and you don't have the money yet or a famine coming. And so your body causes you to store weight around your middle, almost like if you were like the pharaoh storing grain in the granary, but your body is storing weight around. And it's funny because actually I never thought about this before, but cortisol, I always describe it that way, and the adrenals are shaped like little triangles, like little pyramids.

So it's kind of funny. But, yeah, so, and it's not always obvious how we're under stress. Like, not getting seven hours of sleep a night, we know, getting for women, getting six hours of sleep a night rather than seven. And even having that happen once or twice a week causes you to have higher cortisol and store weight around your middle. So I think it's a little bit different when you're pregnant and breastfeeding because you have other shifts in your metabolism that kind of compensate for that. But outside of that,

you know, because babies wake us up when we're pregnant and they wake us up when we're breastfeeding. But outside of that, everything you can do to guard your sleep like a Faberge egg in a museum, don't let anything get in the way of that seven to nine hours can really do wonders. And then the last thing I would say is alcohol. And I know this doesn't make me anyone best friend. But if there's one thing that women kind of walk away from our podcast thinking about is just completely taking alcohol out for three months. And first of all, alcohol is the only substance that has been actually proven to food substance, I should say, it's the only food substance that's actually been proven to significantly increase estrogen enough to cause

breast cancer. Like, let's just put that like on the table. There is no safe or healthy amount of alcohol for women. The alcohol, the whole red wine thing was such an industry. It was an alcohol supported by the FDA industry-wide, revolving door of alcohol people running the FDA major campaign to convince us that it was a good idea to drink red wine. There is no actual health benefit of drinking red wine over eating blueberries. And I will tell you, when it comes to sleep, the biggest intervention that I find helps women get better sleep, whether they are having trouble falling asleep or staying asleep because they're waking up or they're waking up tired, is taking out the alcohol. It is probably the quickest thing you can do to lose that weight

around your middle, lose weight in general, and just not have the brain fog and the feeling crappy. So I would say experimentally, just go for it. Just take it out and see how you feel. You're listening to the Healthier Together podcast. When you think about strength and resilience, like your ability to feel energized, to recover well, to stay strong as you get older, what do you think that actually comes from? Most people say working out or good nutrition, and yes, of course that matters. But there is a biological foundation underneath all of that that most people are completely overlooking. I have been diving deep into this lately with the team at timeline and what I've learned has genuinely shifted how I think about my own. health. Every single movement that your body makes, every step, every workout, every muscle contraction

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As a non-cafine drinker, people are constantly asking me how I get my energy. So I'm going to tell you my secret trick, Organify Red Juice. It has absolutely no caffeine, only two grams of sugar, and it gives me boatloads of non-jittery energy. Organify is super particular about the ingredients that they use so you get exactly what you need and nothing extraneous. The red juice has 13 superfoods, including Rishi, Cordyceps, Siberian ginseng, and rodeola, all of which have been used as natural energy boosters for centuries. There's also a freeze-dried berry mix, which both makes it taste really good, even when it's only mixed with water, and it adds a ton of vitamin C, which I have been prioritizing, including in my diet ever since the skincare episode of the pod. If you listen to

that one, you will definitely know what I'm talking about. I will do a scoop in the morning if I am feeling sluggish, but I really love it around 2 p.m. One glassful fully gives me the energy that I need to enjoy and thrive for the rest of my day. Organify also makes a green juice that Zach's obsessed with. It can basically act as your daily multivitamin. That one has a little bit of caffeine for matcha or I would be all over it, but he says it tastes amazing and has gone through like five canisters of it already. So I will take that as a ringing endorsement. The ingredients are really why I love Organify so much. A lot of companies put like 45 different ingredients into a blend, but Organify picks the absolute best ones and puts enough in their blends for you to actually feel a

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I would do these interviews with these world famous doctors like yourself, and I'd kind of try to be like, well, what's the best type of alcohol for hormones, for longevity, for gut health? And every single doctor in my ass, the doctor's episode just kept saying over and over, like, really there's no good amount. You should just take it out. You should just take it out. I understand you're going to drink, but there's no amount that's like beneficial.

If you're doing it, you should always do it with the sort of acknowledgement that it's not the best thing you should be doing. And finally, absolutely. And it doesn't mean I never, ever, ever have a drink. It's like I don't, I actually don't drink red wine because I am just, I am not nice when I drink. And I'm very low substance tolerance anyway. So to me, like a quarter glass and I'm already buzzed, but I get very emotional. I feel depressed.

And I'm not, depression is not the direction I usually go in. If I'm going to go in a direction, it's more like. hyper-performing anxiety. And I will get depressed. I feel puffy the next day. My rings feel tight. I just feel bad. If I ever have anything to drink, which is once in a blue moon, I will have like a splash or two, literally, of vodka in sparkling water or I find tequila. And for most of my patients, I'm saying, look, if you're going to have a drink, and I talk to teenagers about all the time because it will call it, not teenage, but college students because they're going to drink. Like, here's how to do it. But I'm not saying it's good. I'm just saying that if you're going to do it,

those are probably the lightest, but it has to be a splash and it has to be infrequent, rare, like once every couple of blue moon, you know. Well, and I thought it would be so hard to cut it out. Like I tried to figure out ways to justify the inclusion of it in my diet for years and years and years and then finally in January I cut it out. I'd say not completely. I'm not sober, but I'd say 95%. And it's so much easier than I thought it would be. Like I do fun other types of beverages at night, like healthy soda or sparkling water with

bitters like we mentioned. Or if you literally just have sparkling water out at a restaurant, it's not like I think people are worried people are going to come up to them and be like. Oh my God, like, why aren't you drinking? But people aren't paying that much attention to you. Yeah, it's so rude that people do that, considering how many people actually are sober. Yeah.

And that's why I say, like, if you're going to have a drink, and let's say you're at a party and you're going to be there for hours, instead of having, like, all your vodka in one glass, stretch out a couple of splashes over the evening and sparkling water. If somebody asks you, it's like, oh, I'm having a vodka, you know, vodka and water, and you are and put a little lime in it. And in the book, I definitely give some mock tales because I know it's an issue. And I know, you know, I never actually had a drink of, this is crazy.

I never had a drink of alcohol until I was in my 30s in medical school. And medical students definitely drink. Probably don't want to hear that about your doctor, but medical students do. And not on the job. But, you know, it's very stressful. And what it did for me was it created this mental association where it was almost like an automatic thought. of at the end of a really stressful day, having that thought of like, oh, I'd really like a glass of wine.

And then if you don't have it, you feel like you're depriving yourself. And so there's a lot of that in our culture. Like, you know, we watch sitcoms and rom-coms. What are women doing? They're sitting around drinking red wine. It's so reinforced that that's what we do as women for sort of like rewarding ourselves. And so, you know, shifting that thought form, I think, is really helpful. because it is, it's not, it's not alcoholism or addiction if you're having that thought for him,

but it's sort of like a programmed response. And I think if we get past that program response with these other things, I love having tea at night. And I never feel bad if I have tea at night. Like I'll have chamomile and lavender. Well, and it goes to like your root cause thing, which is like I call myself an intentional drinker now, which is like if I'm having some other issue that I'm trying to correct with drinking, like I'm coming home every day so stressed that I feel like I need a drink to cap off the day. The root cause is that I'm having a whole day that's making me feel like I need a drink at the end of that.

And I feel like it's better to address that than to keep having a drink at the end of every day. You know what I mean? Someone told me there's a book which I haven't read yet, but called Sober Curious. Have you read it? It's about the pressure to drink in our culture. And even if you're not someone who has been an alcoholic, she'd basically apparently like our culture is kind of set up like either you've been an alcoholic and you're in,

A or you drink as opposed to people intentionally not drinking because there is so much. I mean, even my college students, I think a lot of them are drinking because it's a social thing. And it, and it is a social thing. But if it makes you feel bad, that's the problem. And I just want to say as like a PSA, you are fun without it and you can be silly and goofy without it. Like it's, it is not your permission slip. You are your permission slip. I love that. I love that. We've talked about being tired and like sleep being just. critical top, top, top. Two of my symptoms that I have, and I'm going to put them together because I feel like they're related, is the feeling tired all the time, even if you are sleeping.

And then we have on the flip side of that insomnia, like either can't fall asleep at the beginning of the night or waking up in the middle of the night. We're giving ourselves that time in bed. We've carved it out. We've guarded it with our lives, but we're still not using it. So is that hormonal? So let's start with that one, because that one is in some ways a little bit easier to unpack. and that can be hormonal. So if you're laying in bed at night and you're what is called tired and wired, you just can't settle down. You feel like even when you close your eyes, there's like a light still on. That is usually a problem where your cortisol is still high and your melatonin hasn't kicked in. And some simple ways to address that. I mean, not so simple because we're

so addicted to social media and TV and COVID made the whole Netflix thing, like basically like what we do in the evening. But being exposed to blue light, you know, we talked about not eating past a certain time, and that has to do with circadian rhythm and melatonin. And it's the same thing with light exposure. Our ancestors, when it got dark, they had candles and they had fires, and then, you know, they had a single light bulb or a kerosene lamp. Now we can not only keep all our lights on all day and all night, but we've got a blue light coming. We've got a, we've got literally a light that is blocking our melatonin coming out of our computers and our smartphones and our candles all day and all night. So giving yourself that hour before bed, if you can,

to just not be on, I was like, step away from the electronics, get a real book, not a Kindle, get a real book, and read in bed after that cold shower, you know, do some deep breathing. That over time, I mean, I'm talking even over a few weeks, can really, really reset your sleep. If you're, if you have Do you know the kids have gone to bed and you've just got to finish that work and you've got to teenagers and they didn't go to bed till 10 and now you're like, shoot, I got to do that thing every, you know, for the next day and that's happening every night. Think about are you doing too much or can you reset your day a little bit differently? But if you really have to be on electronics, blue blocker glasses and dimmers, you know,

using your computer or your iPad or phones dimmer is really important and blue blockers. So those are a couple of things you can do there. Ashwaganda can help to reset your sleep and your circadian rhythms, also really important. Does it matter? Would you want to take that at night or in the morning? Yeah, I take it at night. Rishi mushroom is another phenomenal one for sleep. Other ones are glycine, three milligrams of glycine before bed.

Melatonin can help. You can take even one milligram of melatonin. So there are different magnesium can help. So there are different things you can do. and then meditation, believe it or not, deep, just deep breathing before bed, listening to some music. Just make sure that your smartphone isn't next to you so that you don't, you know, if you're using it for music, so it's across the room, so you don't have to then go check your Instagram or remember the thing you need to do next day and start texting yourself. And then for the tired all the time, there's so many reasons, Liz. So, I mean, back to the iron deficiency anemia that we talked about.

it can be autoimmune, it can be chronic fatigue, polycystic ovary syndrome can create fatigue, chronic pain. But just also poor sleep. If we're not sleeping well at night, then we're going to wake up and be tired the next day, and then our blood sugar is wonky, and then we crave sugar. So it's a vicious cycle. But if you're tired all day long, there can be other reasons. Sleep apnea is one that we definitely need to get checked out.

So if you're having trouble going to sleep or you're waking up in the night, Oh, I meant to say with waking up during the night, that can be low progesterone also. So sometimes that happens premenstrually when our progesterone has naturally dropped. It can also happen for women in perimenopause and menopause due to low progesterone. So again, Vitex, flax seeds, those are some things that can help improve that progesterone. And if you're desperate, you know, if you're menopausal and your desperate, low-dose oral progesterone can work too. You see to know, you know, no side effects.

If you're tired all day, though, I definitely recommend that as a time to look at the common things. Like, is it your sleep? Is it stress? Is it depression? Is there something going on? And if you can't pinpoint it, then I would definitely get a workup because there could be something else going on. Is there any, like, healthy energy booster that you would recommend? I'm assuming you're not going to be like, have a shot of espresso when you're feeling laggy.

But is there something that you would recommend? You know, honestly, I think if you have time for it, even a 15-minute walk, a brisk walk, is probably the biggest energy booster that you can do. I think that. And then if you're hungry, you know, check in if you're hungry, eating some good protein snack like a handful of nuts. I'm not opposed to dark chocolate if it's afternoon and you're feeling a little energy lag. But those are some of the big things. And I'm not, I'm also not opposed to coffee. The only things with coffee are, if you're having a lot of breast tenderness or PMS every month, some women find that coffee's a trigger for that. I definitely talk about that in the book. And then if coffee's keeping you up at

night or you're depending on it to have energy during the day. So if you're, you know, if you're feeling like you want a cup of coffee, as long as you keep it to before like 10, 11 in the morning, keep it to one cup and you're still sleeping. It's great too. But in terms of like, I'm not a big one to say take this or that to just jumpstart your energy. I don't think that's generally beneficial, especially for women. It's usually what we need to do when we're tired is rest. Power naps. I'm a huge fan of a 15-minute power nap. It's something that we started when I was in med school, my best friend then, who's still my best friend and her kids are my God kids, we used to spot each other in the library. And we'd literally, we'd set an alarm very, very quietly with like a little chime or a

vibration, and we'd make sure the other one got up after a 15 or 20-minute power nap. And that can be huge. Yeah, it is crazy how like for some reason I had this block of like when I'm, I can't nap. I'm not a napping person or something like that. But it's so simple when you're tired sleep, even if it's briefly. And I've found recently if I just lay down and close my eyes and tell myself whether I nap or not, I'm going to have my eyes closed for 15 to 20 minutes. I almost always will fall asleep if I need it. And I wake up feeling so much better. So good. Jada Pinkett Smith. She has this quote. It's something like when I'm tired, I rest. I don't have to be a superwoman. And it's. It's so simple. Yeah. But what is it? We always push past the fatigue with something that stimulates. And I think the reason a walk is so great is because it gets your blood sugar. I mean, I'm sorry, it gets your blood circulation moving.

That's energizing. You know, it's getting oxygen to your brain. But it also, you know, gets you out in nature. It's relaxing. Oh, and here's another one. This is so bizarre. I actually learned this from the woman who cuts my hair. But it was like 4 o'clock.

It was a rainy day. I was getting my hair cut. I kept yawning. And I'm not usually like afternoon fatigue. And she said, have you been drinking enough water? And I said, no, I haven't hardly drank any water all day today, actually. Like, that is my thing. I have to remind myself to hydrate. My husband helps remember to hydrate. She's always like giving me water. But I drank a glass. Like I drank a full glass of water and I immediately stopped yawning. And it was such a lesson to me how dehydration it literally shrinks these like lakes in your brain that you can you can watch videos of these

that how dehydration affects your brain cells it literally shrinks your brain cells and it makes you more tired so hydrate like start with hydrating all right well everybody listening go get a glass of water pause podcast i've got one come back um okay next symptoms migraines is that hormonally related i know a lot of people get them around their period yeah so if it's a around your period or if it's menopausal, then it's almost always hormonal. There are lots of other reasons for migraines. You know, we talked a lot about endocrine disruptors and scent. For people who are susceptible to migraines, there's a whole list of triggers, those being one

of them, alcohol being another, interestingly, and aged cheeses, for example. But if it's happening premenstrually or after menopause, that is due to a drop in ester. And if you have excess estrogen and it really drops, you're more likely to get those migraines. So I have a whole section in the book on hormonal migrains. And if you haven't, you know, if you've preordered your book or don't want the book, I have a whole blog on my website about hormonal migrains to help you out and all the things that you can do to reverse those. Okay.

Amazing. So have the book or search Aviva Rob Migrains and that will come up. All right. Last one in my list of symptoms is PMS and cramps. Are they ever normal or is it always an indicator that something is out of balance? So we're talking about scale. If you have a little bit of fullness in your pelvis, if you notice a little bit of twingy, achy, premenstruly, but it's not distracting you or keeping you from doing anything or requiring you to take pain medication.

That's pretty normal. Like our uteruses get heavier before they let all that lining out as our period. If you notice that your mood is shifting into, you know, I kind of just want to be alone. I really don't want to go to that party or, yeah, no, I just don't feel like engaging. That desire, that tendency to want to turn inward more premenstrually is also normal. But if you are having emotions that feel out of control to you, meaning not just that you, you know, somebody pissed you off and you said it because your filter was lower, but they really did something that pissed you off.

That's not an out of control emotion. If you have a legit emotion, it's a legit emotion. But if the level of your emotion feels too much, or if you're having emotions that are troubling you because they're getting in the way of your life or you're ripping someone's head off or whatever, that's not normal. So the emotions are more like, I notice something's happening. I really kind of want to be alone. I want to watch a movie, read a book, whatever. I think that's fine. And then PMS isn't just mood either.

PMS is sugar craving. it's bloating, it's digestive, other digestive symptom changes, and it's water retention. So there are anxiety and depression. So there are different categories of PMS. And again, if you're craving a little chocolate or you're craving a little more grain or something like that or carbs pre-mention, that's pretty normal. But if things feel like a hormone monster has taken you over, then that's out of balance. It shouldn't make you suffer or miserable.

So what is it an indicator of if it feels extra, you know, if you're having really bad cramps or if you're feeling really out of balance hormonally or craving all the sugar? Like if those things are in excess, what does that indicate? Yeah, I love it. I'm just feeling extra. I'm pretty much not I'm feeling extra. Watch out. I'm feeling extra.

So it depends on what it is. So if it's cravings or depression or anxiety, that could mean, that you need to eat more healthy carbs in the week before your period or that you need more B vitamins, especially vitamin B6, because those help support the healthy, happy neurotransmitter called serotonin. So eat whole grains and take some B6 or B complex. I like the B6, especially 50 to 100 milligrams a day. If it is digestive system symptoms, that can be inflammation leading to more prostaglandins. And so that's where you lean into fish, vegetables, gut health, all the things that I talk about in the book plan. Which ones did I skip? Breast tenderness, that's also inflammation,

water retention. And we talked about that. Cramps. Crams is almost always a sign of one of two things, either heavier periods, and that's requiring your uterus to work harder because it's a muscle, It has to work harder to shed that lining or inflammation. Inflammation causes those prostaglandins to go up and that causes more painful periods. So if it's heavy periods, you want to figure out what's going on. Is it too much estrogen? Is it too long between cycles? If it is the inflammation, it's kind of all the things we talked about that reduce inflammation.

And again, in the book, I have extensive kind of root cause plans. protocols. And then, of course, while you're waiting for your book, you can head over to my website. I have a full blog on pretty kind of like, I write so much. There's one on heavy periods. There's one on migraines, and there's one on menstrual cramps. And then there's another one that's really fun and interesting on cannabis and CBD specifically for painful periods. There's two different painful periods articles. Oh, that's cool. Are you pro CBD in general? Yeah, I mean, not for everything. A lot of the claims are exaggerated. I'm not all about like drink your fizzy drink CBD, unless you just happen to love that. But for endometriosis pain and for menstrual pain and for anxiety, it can be, it can work wonders. Amazing. Okay, so I promise people that I would talk about PCOS. I can't even tell you how many questions I got from people about PCOS. I was unaware, I think, the level of people that it was affecting. So can you explain what's happening there and how. how we can know if we have it?

Yes. So it is a combination of different factors, one of those being primarily elevated testosterone or androgens. And that is what causes the acne, the hair loss, the unwanted hair in unwanted places, like chin hairs or nipple hairs. And just because you have some of that, doesn't mean you have PCOS, but if you have constellation of these things, plus irregular cycles, you frequently skip periods, that can all be indicative of PCOS. So there are some cardinal symptoms that we look for, irregular menstrual cycles,

all the androgen things that I just mentioned. But there can also be other things like binge eating, depression, anxiety, fatigue that are more subtle that a lot of doctors miss. Also, blood tests are not always accurate because, because high testosterone and insulin resistance aren't always seen, but they can be present because women with PCOS may be exquisitely sensitive. So the levels at which they're getting tripped off into these imbalances aren't the levels that we're looking for on labs. So really, if you have the symptoms, it's pretty indicative that you have it.

And that's when you want to think about making all the lifestyle changes that we've talked about, they're all relevant to PCOS. And it's really important because, you know, it may not be obvious to you that your anxiety or depression or binge eating has anything to do with something going on in your hormones in your body. And you may be giving yourself a really hard time or you may be on medications for anxiety and depression that you actually don't need because it's actually a symptom of the PCOS. So looking at the regularity of your cycle. your menstrual cycles should come every 26 to 34 days. If they don't, if they're coming farther apart than that or irregularly more than four days difference per month to month,

that can be an indication that something's going on. And then you pair it with these other things like the hair loss, the acne, etc. It starts to stack up. And so that's when you want to think, oh, and of course, you know, I've got a whole bunch of checklist in the book. And just information that helps you know what's normal and what's not. And then, of course, how to get a diagnosis if you're not sure or at least get confirmation that there's a good chance that that's happening if you're not sure. So we've mentioned a bunch of sort of like the lifestyle, you know, the foods, all of that. Is there special stuff you would layer on top of that, though, that's especially helpful for somebody who has PCOS? Yes. So definitely leaning into a more protein-based

diet, then I would otherwise generally recommend. I think it's, you know, with PCOS, we know that just increasing good quality protein in the diet, even if you hardly do anything else, but it has to be good quality protein. So ideally, plenty of fish. It's not too much to eat salmon or sardines two, three times a week. You know, three, four ounces of salmon is great. Poultry is fine. Eggs, I tend to lean away from red meat because it's more inflammatory and may actually increase estrogen, although I wouldn't say no to it ever, but maybe like once every week or a couple of weeks at the most. But leaning into making sure there's good quality protein at every meal. And while I've shared how important I think carbs are for women in general, especially for

PMS and fiber, having carbs be a smaller part of the daily diet. So us serving, you know, like a half a cup or a cup of cooked whole grain once a day and maybe one starchy vegetable, like a half a sweet potato or a piece of winter squash a day, but keeping carbs less. And then, of course, good quality fats are super important. Balancing blood sugar is just critical. And then from a supplement perspective, there are a few things. And I'd say the two biggest that I lean into in my practice are vitamin D. Vitamin D can help to reduce PCOS, help support blood sugar, et cetera.

and also a supplement, I think we mentioned it, or we may have mentioned it in the IG Live, I can't remember, but inositol, the myoinocetal. So products like sensitol and ovicital, again, I have no financial relationship to those. They're products I use in my practice, which have the inosatols that can help support healthy blood sugar. Can I ask a weird question? Sure. I always take my vitamin D in the morning because I feel like that's when I would see the sun. Does that matter at all? Or is that not true? Like, is that true in any way? I mean, we get, I mean, traditionally, if we were living kind of ancestrally, we would get

sun exposure all day and we'd be making vitamin D all day. So I don't know that from a, okay, from like a biological perspective. But I think it's really important if you feel that gives you that extra boost. You know, I think what we believe does translate into how things affect us. So yes, if you love it. That's your nice way of saying, like, no, there's no scientific basis. I really think it's important, you know. I will tell you, when I was practicing as an herbalist back in my 20s and I was formulating all my own products and I had a beautiful apothecary in my home, I used to hand paint my labels. I'm serious. I used to hand paint my labels and I would tie

every bottle of tincture or every bag of tea with a little raffia, you know, just to make it beautiful. because I really felt that when my client would hold that bottle in her hand or that package in her hand and go to make that tea, that ritual that we believe in, it's not, it's not, this is part of biology. Martin Samuels is one of the world's leading researchers on the placebo and nocebo effect. I mean, there's hard data that what we believe or don't believe about our healing and our medicines can actually make a huge, different. I know, but can I say that is so scary as somebody, like, I have hypochondria, so I'm always like, does it work in the negative? Like, are the things that I'm afraid are going to happen to my body, going to happen to my body because I'm placebo and myself in the negative direction?

No, not if you're a hypochondriac, that's different. That's just anxiety and worry. But if you're really like, every time you go to take something and you're like, this isn't going to work. This isn't going to work. It may work anyway over time. But I think that if you, if you feel good about doing something like doing it in the morning makes you feel better. And it sounds like it's when you remember to take it. It's like naturally, oh, sunlight, vitamin D, I'm going to take it. I think that's really powerful. I don't think that's something to dismiss. Okay, can you talk about endo for a quick second? Just sort of same thing as PCOS. Like what is happening there and how do we know if we have it and what some sort of low hanging fruit ways that we can add to our already

super healthy lifestyle to help mitigate the symptoms of it? Yeah. So endo is a comp, like PCOS, it's a complex condition in that it is hormonally triggered, each cycle when a woman has her hormonal shifts that would lead to menstruation, the abnormal tissue that is happening with endometriosis, which is outside of the uterus, it can be in the abdomen, it can be in many different parts of the body, also gets triggered to bleed. What's happening is that that tissue is abnormal because of immune dysregulation. That immune dysregulation, like with PCOS, could have started when someone was in their mom's womb. It could be a result of environmental triggers. We know that a lot of different environmental chemicals actually change the functioning and shape of immune cells that are

activated in endometriosis. And then also, if you add to that something like really high estrogen, that tissue is getting triggered even more. And then when that tissue is found, let's say the tissue is sitting in the abdomen, and now it's growing on the intestines, and then it's starting to extend over to the bladder. You can get what's called adhesions, and then when it bleeds, it causes pain and inflammation and can lead to scarring. So it can create an extreme amount of pain for women. And so, I mean, it's a really, it's a complex condition.

I have, you know, a very deep root cause plan in the book for it, and then a complete protocol for it. But the main things we want to think about are how do we achieve healthy hormone levels so that that tissue isn't being as triggered? And how do we support the reduction of inflammation while also doing strategic things that can help with pain? And, I mean, it can be really quite impactful on a woman's life in terms of her sex life, her bowel movements, her urinary symptoms. There's a higher level of fatigue, partly due to the inflammation and partly due to the chronic pain. Some women don't know they have it until they go into their years where they're trying to get pregnant and then they have trouble getting pregnant. But most women do have

just really difficult or even hellacious, heavy periods and pain, often starting in their teenage years, definitely into their 20s, that alerts them to the fact. So again, when we talked about earlier, you know, how much period pain is normal, how much heavy bleeding is. normal. Basically the answer is none of it. And it comes back to that sixth vital sign, not just assuming that because we're women, we have, again, being a woman is not a diagnosis. It's not enough to just say, oh, this is happening because she has periods. It is that sixth vital sign that needs to get us looking at what is really going on. Do you have add-ons that you like for inflammation? I do. For endometriosis, I love an acetyl cysteine. I love ginger. I love turmeric and curcumin. Those are just a few off the top that I love. And then I do also, again, vitamin D for immune regulation can be really helpful also. And then Oshuaganda, Rishi, these medicinal mushrooms and the adaptogens are known to support immune dysregulation to help revokelase,

immune dysregulation. And do you agree with some of the things that Western medicine is sort of doing for endometriosis right now? Like I know Lena Dunham got a hysterectomy. What are your thoughts on that as a MD in that side? So I think that it's any woman's choice, what she does. And I know, you know, in Lena Dunham's situation, well, at least I know from reading about it, you know, over the years.

I mean, she had had something like 15 surgeries by the time she was 30. And that's not uncommon. and she was comfortable making the choice to, I don't know if she froze her eggs or what she did around her fertility, but for her, the discomfort of the pain that she was living with was not worth it. It was, you know, from what she said, getting in the way of her life. And she really wanted a hysterectomy. And she felt like that was an empowered feminist thing to do. And I agree.

You know, but I feel it's sad and unfortunate that a woman would feel like she has to have a hysterectomy because there's no other answer. So from a medical perspective, I think excision surgery, if someone has extended, extensive endometriosis and scarring can be very effective in the hands of a skilled surgeon, you can have incredible recovery and incredible end to that chronic suffering. The ablation surgery and other forms of surgery, not so much. I think that having a hysterectomy should be an end choice because it's not just that you're losing your uterus, but there are increasingly known connections between the actual

organ in our body, our uterus and cognitive function as we age. So there may be more to the story than we know. Just having that organ out as if it's expendable may not be so wise. It's also major surgery. And a lot of women after hysterectomy experience changes in their physical comfort. There can be scarring that affects sex and all kinds of things. So anything that we can do to prevent that is what should be offered. And then ultimately, if a woman is, and there There's so many things. Back to the CBD and cannabis, there's great research coming out on cannabis and CBD specifically for endometriosis, pain control, pelvic floor, and our vigo types of physical

therapy to help with adhesion. So there's a lot that can be done for women who are having pain with sex. There's the O-Nut, which is a device that helps control penetration if it's penetrative sex, learning to do other things that aren't penetrative. So there's so many other things before that major surgery that I think are really important. And I'll tell you what, conventional medicine doesn't offer women any of them except pain medication, a few pretty big bang drugs, narcotics, and surgery. And it's not even always the optimal form of surgery. So yeah.

This was so incredibly helpful. I just feel like there's so much information in here. But it's crazy that it's just a teaser of the incredible amounts of information in your book. So can you just tell us quickly where you can find it, what is called all of the dates we need about the book? Yes, thank you for letting me talk about my book, baby. So it's called hormone intelligence, the complete guide to calming hormone chaos and restoring your body's blueprint for natural well-being.

And then it says heal your period, reverse PCOS, ease endometriosis, increase fertility, rekindle your sex drive, improve, improve sleep and digestion, and restore your body's balance naturally. And it's so much more than that. It's got, you know, what to do about the pill, what kind of birth control. We talk about adenomyosis. There's so much. It's so rich.

You can get it anywhere books are sold. So you can get it at your local bookstore, which I'm all about. If we can support our local bookstores, it's a wonderful thing. You can get it at the big box bookstores, which I've got no problem with if that's where you love getting books or the online big box places. And if you're just not sure where to go get your book, go to Avivaram.com forward slash book. because I've got some clickovers that you can get some ideas. And then also, if you go there after you've bought your book, you can register your proof of purchase for some phenomenal, actually really phenomenal free gifts that come with the book.

Amazing. Well, everybody definitely go do that. It's the definitive guide to hormones, in my opinion. And I've seen a lot of books on hormones. And thank you for so much for taking the time to share all of your wisdom with us today. Liz, thank you so much for all these amazing questions and taking so much time with me and just for all the love and support for me in my book, I'm so grateful. I hope you absolutely love this episode.

I hope you have lots of actionable tips, like things you can go try out today and start to feel better. And if you love this episode, if you love this, like kind of rapid fire Q&A style, let me know. Also, I would so appreciate a rating or review on whatever podcast app that you use. It really helps other people find the podcast, and it's massively appreciated on my end. And as I said at the beginning, if you know women in your life who are dealing with, with things like cramps or migraines or hair loss or insomnia, the things that we talk about in this episode, please, please, please, please, please share it with them. I think women having

this information is just so important, so empowering, and so vital for us living our best possible life. So I massively appreciate and send you all the thank yous for spreading the word about these important subjects. All right. Thank you so much for taking your time, spending it with me this way. I am very cognizant of the fact that there are limited hours in the day and every time you choose to spend your time this way with me, I am just so honored and grateful to get to share these conversations with you. I will see you on the next episode of the Healthier Together podcast. If you have headaches, allergies, brain fog, skin irritation, or you've been dealing with hormone issues, you are especially going to want to listen to this ad. Every single thing that

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