Lifestyle Choices & Your Hormones – with Dr. Anna Cabeca | The Empowering Neurologist EP. 81

Hello everyone, I'm Dr. David Perlmutter. Welcome again to The Empowering Neurologist. One of the great things that I get to experience is people send me their books prior to their publication. I get a chance to review them. And so I get really an early look at some really exciting books. And this one, The Hormone Fix by Dr. Anna Cabeca, is really very exciting. Dr. Cabeca looks at the effects of lifestyle choices on hormones and really does a deep dive, for example, into the role of the ketogenic diet, for example, in— and its relationship to balancing hormones. It's interesting because that's a question I've been asked actually quite often in various interactive forums that I'm involved in. Let me first tell you a little bit about Dr. Anna Cabeca. If you watch The Empowering Neurologist, we've had her as a guest before on the program. Her appearances have always been very, very well appreciated by our audience. She is a graduate of Emory University. She is a trained gynecologist, does obstetrics as well. a women's health expert, and she herself was diagnosed with menopause at an early age, at age 38 years. At that point, she was pretty— she uses the word devastated by that event and went around the world looking for answers and in fact found a lot of information. We've talked about her work before about how lifestyle choices play such an important role in terms of That event. She really then dedicated herself to becoming a menopause expert because that certainly can represent a challenging time for women. She has been involved as a physician in the care of thousands and thousands of women, helping them by giving them really powerful integrative information that they might not otherwise have been able to experience. She uses humor, honesty, and passion, and her outreach does include writing quite a bit, writing books like this. So let's jump right into our interview and, and hear what Dr. Kabeka can teach us today. Well, hello, Dr. Kabeka.

Hello, Dr. Perlmutter. It's great to be here with you.

I think we got to very quickly go to Anna and David, don't you think?

I think so. It's been a long time.

It has been, but I'm glad to have you back. I'm looking forward— we're going to see each other in a couple of— actually, next month it is, so looking forward to that. So as I was saying in the introduction, I have the great pleasure of getting to read some really exciting books ahead of time. This isn't out yet, but it looks like this is coming out probably in the next couple of days, so people can order this book right now. Let's talk about what are the fundamentals of the new book, The Hormone Fix. I mean, I know that it really does seem to emphasize the importance of lifestyle choices as they relate to hormones and more specifically menopause.

Yeah, so a big thing to realize as a gynecologist— now I'm triple boarded, right? So I'm boarded in gynecology, integrative medicine, and anti-aging and regenerative medicine. But the big thing to understand is that it takes more than hormones to fix our hormones. We have got to nail this down, and so the empowerment process of reclaiming our own power over our health is is critical. And that's what I really drove home in this book, and I created some really simple strategies and also understanding to help us figure out what works for us and what doesn't. So the lifestyle choices and the you know non-prescription ways that we can really. Well,

I was very intrigued early on, and you brought up a really, I think, powerful point that pretty much mainstream medicine focuses, as it relates to menopause, on estrogen, progesterone, and testosterone. And you really emphasize the importance of things like cortisol and insulin and oxytocin, which aren't typically part of the menopause narrative. So, can you talk about that? Maybe you could walk us through that a little bit.

Yeah, well, certainly. I always would love to say, as a gynecologist, that it's all about estrogen, progesterone, testosterone, and even DHEA, but it's more than that. The major drivers, as you well know, are insulin, cortisol, and I consider oxytocin the crowning hormone. I mean, that's our overarching hormone that really is our reason that we enjoy our life. That's our joy and pleasure and relational hormone, and it drives so many other hormones and is also dependent and interfered with by other hormones, especially cortisol. And so when we optimize our nutrition and our lifestyle to empower our cortisol, our circadian rhythm, and our cortisol balance and fluctuations, as well as insulin, and incorporate the practices that increase oxytocin, we have, you know, just that joie de vivre, that better connection with other people, and enjoyment throughout our life. And that's especially important in menopause as we're going through a tumultuous physical transformation and struggling often with relationships, not just with other people but with ourselves as well.

Well, for our viewers, I mean, the discussion with reference to insulin and cortisol is certainly not foreign. You know, we recognize that exactly what you're talking about plays a role in brain degeneration and even in moment-to-moment decline in brain functionality. And, you know, certainly that is something that menopause has been associated with, and that is mental clouding, brain fog, if you will. So I guess what you're saying then is this elevation of cortisol, which we know is not necessarily paving the way for good brain function, and insulin Elevation ultimately leading to insulin resistance might be an explanation for those cognitive and mood issues that are so common during menopause.

Absolutely, 100%. I think they're, they're more powerful. Certainly estrogen, progesterone, testosterone all have a part, but these are even more powerful. So powerful. So if we can keep our body in a hormonal balance through controlling these major hormones, we're going to, you know, have much better success and much better physical health, of course, and cognitive health. And that's, I think, one of the biggest fears that women express as they're going through menopause. Yeah, we don't want the weight gain. We hate it when, especially during the perimenopause and menopause, I mean, patients would always tell me, Dr. Anna, I'm gaining 5, 10, 20 pounds and I'm not doing anything different. Well, before I experienced it myself, David, I was like, oh yeah, sure. And then I experienced it myself and I'm like, shoot, I'm gaining 5, 10, 20 pounds and I'm not doing anything different. What the heck's going on? That really drove me because the hormones— I was able to manage the hormones, but I wasn't managing the cortisol and I certainly wasn't managing the stress. That became a big area of my research, why I dug down deep to see, okay, we want to manage the weight, but the brain fog, the inability to make concise decisions, feeling like I lost my edge, was terrifying. Like, what's down the road for me with increasing rates of dementia, increasing rates of Alzheimer's? And so really wanted to nip that in the bud right away. So, you know, 5 years ago now, and when I was 48, it was— that was like, that was 100% of my area of focus for me and for my patients in creating the solutions that I put together, the keto green solutions that I put together in The Hormone Fix.

I just want to say, this is really— it's breathtaking that we're having the same discussion right now with reference to menopause that others of our programs have talked about for such a long time, that a diet that's lower in sugar and simple carbohydrates, that welcomes healthful fat back to the table, i.e., pushes us into a low grade of ketosis, is exactly what you're talking about in terms of focusing on insulin sensitivity, lowering blood sugar, and therefore transitioning through menopause and not as likely to experience these detrimental or downside experiences.

Yeah, yeah, absolutely. And, you know, I'm just reflecting as you're saying this because prior to— I think it was maybe like 6 years ago or something— we were at a conference and we were having breakfast together, and your plate— I remember looking at your breakfast I mean, healthy fats. I mean, I think you had eggs. I don't remember if there were bacon on there, but you didn't have fruit on your plate. There were some other vegetables that you put on your plate, and I'm like, David, do you want some, like, fruit skewer? And you're like, nope. So

I remember, and that was somewhere out west. It might have been Arizona or even further west. I actually remember, and probably the bacon would not have been on the plate. I mean, you know, the chances of getting good You know, organic bacon at a hotel are probably pretty low. But that said, let me get back to some of the important points, and we were just mentioning oxytocin. You know, I think a lot of people may not be fully up to speed with the real beauty, and I think you called it your favorite hormone, of oxytocin. Why is it so important? What does it do? And what can we or women do to enhance levels of oxytocin?

Yeah, absolutely. It is my absolute favorite hormone, especially struggling from a time period where I didn't have enough of it and feeling the difference. So oxytocin is called the hormone of love, bonding, and connection. And most women understand, like, their first experience or introduction to oxytocin may be in pregnancy and labor when they're given an injection of Pitocin. Pitocin, to stimulate labor contractions, is oxytocin, is exactly that. And we've been using using it now for decades to help facilitate and speed up labor in childbirth. But it's naturally produced when we laugh, when we love, when we have sex and intimacy and orgasm, hugging and kissing and play, when we're— when we have a pet, and when we're generous and giving of ourselves. Those are all times that oxytocin really increases. And the benefits are, number one, we have to say the free benefits are it's a— it's It's number one, it's free. Our body produces naturally, and we can improve self-control for the most part, improve the way we're able to produce oxytocin. We can increase that ourselves. So we don't need to rely on a prescription, right? Our body's producing it naturally, and our thought processes, a positive mindset, an attitude of gratitude are huge ways to increase oxytocin. So the benefits are decrease in appetite. If anyone remembers, or is experiencing right now when they're just so in love, like they don't have an appetite. And decreases pain sensitivity. So we forget the pain of childbirth. And in so many other ways, if we can laugh off a fall, we don't remember the hurt. So that's the benefit of oxytocin, a natural analgesic. And then that connection, that bonding and intimacy. In one of my programs, I teach that, you know, it just takes the hormone oxytocin in women also responds differently in men, but in women it creates that wanting the connection and the— that actual intimacy in relationships. So we, we love to have sex and experience pleasure, but the connection after the fact, that feeling of bonding to our partner, our mate, our spouse— I mean, that is so critical to feel that love and, and heal some of the anger, angst, and resentment that can occur sometimes in relationships as well. So the most powerful hormone.

So, you know, it's interesting, we are living in a time of really disconnection disease— diseases related to disconnection. Our disconnection from our genome, our microbiome, disconnecting from our prefrontal cortex, our families and friends, neighbors, communities, other countries, and even disconnection from the planet. And you're right, you know, this oxytocin A hormone that we can increase, as you describe in the book, is related to connection, related to—I'd like to say reconnection. There were some other interesting relationships that you described. One of them was in correlating the functionality of certain neurotransmitters, for example dopamine, with testosterone, and I think that was. You know, it was very interesting. And GABA, I think you correlate with progesterone functionality. So how then do the imbalances and declining levels of hormones relate then to basics of neurotransmission and even mood regulation?

Yeah, well, and certainly with estrogen's connection to serotonin. So a few ways. Estrogen is really fascinating in and of itself because Glycolysis in the brain is an estrogen-dependent factor, and as we age and reducing levels of estrogen, the glycolytic pathways in the brain are somewhat damaged, delayed, right? That adds to the aging brain, and that's why ketones are an optimal brain source in menopause. Beyond that—

We have to stop right there because what you just said is just— It's really breathtaking because we know that the harbinger for Alzheimer's is a bioenergetic event, and that is to say that long before there are clinical manifestations of Alzheimer's, we can identify that the brain is less able to utilize sugar. You're talking about this in terms of glycolysis. That said, that can be overridden. We can power the brain with ketones What you're talking about, ketogenic diet. I want you to go through this again because this is incredibly important.

Yeah, that was a big aha moment for me because one of the things, in our profession, we rely on our memory, right? As a mom with 4 kids, you cannot risk brain fog. The children will manipulate you. I don't know. At least mine will, 4 daughters, right? When I was experiencing all that brain fog, too, going from really clear, 100% great memory to high levels of stress, PTSD, And that brain fog, like, whoa, I needed to understand what was happening in my body and figure out, you know, what beyond hormones could fix it. And so understanding that, wow, as estrogen's declining in our mid-forties, definitely post-menopause, we're declining levels of estrogen, that our brain is just not getting the fuel it needs. And if we're even— doesn't matter how much glucose is in our body, right? Because the receptor sites are less sensitive. So, so that was fascinating to me to really understand that. So when switching to that keto green, I call it my, you know, keto green approach, it was clarity. It was, I call it energized enlightenment. I really do feel like we're better able to communicate with spirit, with God, so much better. And, and certainly with our families, but that clarity was apparent to me. And now I've since run thousands of women through this process, this diet and nutritional lifestyle, to enhance getting into ketosis, but in a healthy way, too, with adding the grain component. That just does make a difference. Ketones are the optimal fuel for when we are aging, especially.

This may sound disparate, but I'll connect it afterwards. And that is, it's been estimated that as many as 20% of women in America may suffer at some level from what's called PCOS, polycystic ovarian syndrome, and ranked as probably the number one cause of infertility in America. The reason I'm mentioning it is a new study came out demonstrating that when you do FDG PET scans, fluorodeoxyglucose PET scans on these women, in other words, measure their brain's ability to utilize, as we talked about before, sugar as a fuel source, around, as an average, about, they have about a 17% reduction in terms of their brain's ability to utilize glucose in comparison to women who do not have PCOS. That typically the brain utilization of blood sugar of a PCOS young woman looks like the brain of a 70-year-old. And we do recognize that, you know, again, in PCOS, there is a strong representation of insulin resistance, higher blood sugar, and certainly the hormonal issues that accompany that situation as well. And the real fundamental of one of the studies that has talked about this is overriding This brain, this bioenergetic issue in the brain that we've been talking about, again by powering brain cells with a super fuel, and that is allowing the brain to have access to ketones by being on a ketogenic diet. But you talk about in your book, it's called the Keto Green Way, and so this is sounds like it's a little bit different, and as you describe it, it is. Walk us through what the Keto Green approaches as opposed to just what we've been hearing about being on a ketogenic diet.

Yeah, and I do want to just touch on your comment on PCOS because over 70% of women with PCOS are insulin resistant. It's so fascinating for that receptor resistance in the brain. One of the reasons I love talking with you, you weren't disparate at all in that conversation, is that just I've been a fan of yours since over a decade, at least over a decade and a half right now. The brain is just fascinating to me, and that's why I really— it's important for us as women to look good as we get older, but it's really important to feel good. If we don't have mental health, if we don't have our memory, if we're not able to relate and love and connect with other people, we don't have health. And there's an ancient saying that says, if you have your health, you have 100— you have a million wishes. If you don't have your health, you only have one wish, you know, to have our health.

Right.

And that's so true. So however we gain it, and that's why I was really passionate in my book and kind of creating a way that's so holistic. And first off, I was 90— the research shows 99% of diets fail, right? So, you know, it's a 4-letter word with the word die in it. I mean, that's never good, right? But it's also because it's only 25% about what we eat and 75% about how, how we live, maybe when we eat and, and so many other factors, what we're thinking about, how our relationships are and what we're exposed to as toxins. I mean, the list goes on and I go through that in the book. So in understanding the benefits and a fan of your work for so long and just thinking, okay, ketogenic diet, when I started pound, you know, packing on the extra pounds, And from being at a state where I was over 240 pounds at one time and losing it, anyone who's lost weight knows they never wanna regain it, right? And so to have that happen was devastating in so many ways. Plus I was the hormone expert and I was balancing this for so many women. So the Keto Green came about because understanding whenever I tried to go on a ketogenic diet or put my perimenopausal patients on a ketogenic diet, We would essentially go what I call keto crazy, irritability, agitation, mood swings. And again, you know, mom with 4 daughters, you don't want that. You have to have clarity, peace, calm. You have to respond, not react. And so, so that was a factor. I'm like, I can't go keto crazy. Why is that happening? And so I started revisiting all my functional medicine practices and principles and just started checking my urinary pH for alkalinity. And I was consistently acidic. I consistently had a very low urinary pH of 5. So first step was to work on getting alkaline and then getting into ketosis. And that combination just totally shifted everything for me, mental clarity. And then also, you know, lost 18 of those 20 pounds in 6 weeks. And that was profound because the energy, the memory, the focus, all of that came back. And of course the weight loss, I was thrilled. That's when I took it to so many of my most difficult clients, made them do it, and then took it to— now it's available around the world through my online programs, but now through The Hormone Fix. That was the revelation for me.

You bring up a very good point about just getting into ketosis and that many people do have issues in terms of tolerating it. Constipation, I think, is You know, on the top of the list because people, when they cut their carbs, they're cutting out their dietary fiber. But beyond that, I think that electrolytes are really hugely important, and I think inferentially you indicated it based upon alkalinity in terms of things like magnesium, which I think is so very important in terms of the irritability. And I think one of the primary reasons that people get so irritable and have brain fog when they're in ketosis. has to do with the balance of their electrolytes. And so how do we then look at getting out of this acidosis and into a more alkaline state based upon food choices?

Yeah, so based upon food, you really want to incorporate your greens, your low-carb dark leafy greens and alkalizing vegetables. And so I'm a big fan— one of my favorite recipes to prepare is sautéed beet greens. That will make me alkaline immediately. Love that. And it's a part of the vegetable we typically have thrown away, right? So sautéed beet greens are incredibly alkalinizing. And we're in the South— collards, kale, chard all are very great additions. And that really should encompass the majority of our plates. And again, organically grown, rich in minerals, because that is important. That cell membrane function relies on the minerals that we have to get from our nutrient sources. The second big realization is it's just not all about food because if we're in high stress, it doesn't matter how many greens we're eating. If we're not controlling our stress, we're very negative, we're anxious, dealing with inflammation and very hyperglycemic, it's very challenging to increase that urinary pH.

When you are looking not just for yourself but in working with patients, They're following their pH. What are they measuring?

They're totally measuring their urinary pH and urinary ketones. I have the urine pH ketone strips, Keto pH strips. I just want them to get to a pH of 7, slightly green on the pH scale for our strips, and just to get a pH of 7, especially when they wake up in the morning. Again, sleep is so important for cognitive health, memory health, brain health, all of those issues, and weight loss. But, and hormone balance, right? But also that restorative— those restorative hours are critical. So how is our body healing during that time? So waking up with a urinary pH of 7, perfect. And then check on it throughout the day and see what happens.

Mm-hmm.

And at night, work to get a nice alkaline urinary pH at night so that you can hopefully do more restorative work in your body. And that again, and accompany that with intermittent fasting overnight is very healing and very therapeutic. Our body should not be digesting or, you know, digesting our evening meal while we're sleeping. So really having an early dinner is part of our plan too in the lifestyle, in the Keto Green way.

So can you define intermittent fasting?

Yeah, well, for us, you know, again, because the key research that I looked at that was published in JAMA a couple years ago Was looking at women who have had breast cancer, and if they had a 12.5 fasting window between dinner and breakfast, they had significantly reduced breast cancer recurrence. And that's huge. So our window is 13 to 15 hours typically, and then sometimes we do extended fast and sometimes we're feasting. So, but typically a 13 to 15 hour window. For some women it's more and some it's less. It really just depends. Mm-hmm. But that's our goal for that intermittent fast between dinner and breakfast. Breaking fast, i.e.,

break fast. For our viewers, there's been a lot we've just talked about that's really very important as it relates to cancer. I would interject the idea of pulling up on our Empowering Neurologist channel on YouTube the interview that I did with Dr. Thomas Seyfried, who wrote a book called The Metabolic Basis of Cancer. And it's really very much about the idea of ketosis, ketones, and how they amplify the body's ability to deal with cancer cells, depriving cancer cells of the glucose that they basically require. And as we're hearing now from Dr. Cabeca, how research indicates that women who just engage a short fast, in other words, protracting the time until they break their fast in the morning, So that they're fasting from dinner the night before until breakfast the following day, have a reduced risk of recurrence of breast cancer. So, you know, getting back to our discussion, I'd say that it really has a lot to do with the individual in terms of how they first tolerate but ultimately learn to adapt. I think it takes a little while to the notion of being in ketosis. I For myself, I typically I do about at least a 17-18 hour fast every day. So I would have dinner the night before. Then I'll probably I will have my break fast between maybe noon until two or three o'clock in the afternoon. And I think you know it does take a little bit of getting used to. So what we're talking about here is keto adaptation, getting your body to be able to shift over to tapping into fat as a fuel source. And away from either blood glucose or breaking down glycogen, stored glucose, to utilize that as a fuel source. So how do you work that with individuals and allow them to become more keto-adapted?

Yeah, and it's exactly that— it's transition time period. So it's taking the time, it's initially going, you know, from 12, you know, working to get 12, 12.5 hours to go to 13, then to do some extended fasting and like choose a day to experience extended fasting. Even a full day of fasting eventually is what I encourage working up to, like a Sunday fast and how that feels. Maybe it's just one meal on Sunday. And so that we have that time, that we have that experience between, you know, our daily intermittent fasting and extended fasting. I think too, one of the problems that many women fear, or it's probably a fear more than a reality, is that they're going to have hypoglycemic or low blood sugar reactions. And in fact, when we're getting the healthy fats and healthy proteins and good greens and fibers to help maintain, you know, our healthy levels of blood sugar, it— they don't experience that. Even if they've struggled with hyperglycemia or hypoglycemia, you know, their entire lives, they will not experience that. So that's a big fear, like, how do I miss a meal. I'm supposed to, you know, eat, you know, before bed and 6 times a day. And I just think we destroyed a whole generation by that, you know, constant snacking and grazing philosophy, especially for women, especially as women are designed differently than men. And I do experience too, there are, there are a few women that do excellent with the extended fast, but most, you know, there's a sweet spot for women and for most women, and that's probably in the 13 to 16 hour range. It's a great balance.

I hate to call it the sweet spot, but it sure fits. But again, you know, this conversation relates back to, you know, your original comment about the— during menopause, the lack of brain cells' ability to use glycolysis, and therefore being able now to override that fuel deficit by being able to tap into this vast resource of calories that we all carry around. called body fat. And by being able to mobilize that body fat, yeah, it'll help you lose weight, that's for sure, but you have a backup source of fuel that your body now has activated the pathway to be able to utilize so that you don't crash and burn. And I, I like to use the metaphor of the oil lamp, the constant flame of the oil lamp burning fat oil, as contrasted to throwing gasoline on a fire, which is typically what you get With a, you know, the typical American breakfast of the glass of orange juice, that's 9 teaspoons of sugar, the croissant, maybe the bowl of Cocoa Puffs or whatever it is with some sugar on just to be sure. So yeah, your blood sugar is going to explode and then your body secretes insulin, your blood sugar crashes, and you're right. So you can feel a heck of a lot worse after having this really high carbohydrate breakfast In contrast to not eating breakfast whatsoever, which absolutely goes against what mom said years ago, you know, that's your most important meal. If you don't eat breakfast, you know, the world's going to come to an end, who knows. But, you know, for 2 million years, we didn't necessarily have access to 3 squares a day. Somebody along the way invented 3 meals a day. And the truth of the matter is that we have these wonderful adaptive mechanisms that have allowed us to survive for a couple million years and are based upon actually the salubrious experiences that we get by missing a meal, by having caloric scarcity. It actually turns on life-sustaining longevity genes. So, you know, whether it's protracting breakfast or even missing food for an entire day does a couple of things. I think it activates these gene pathways. Helps us get into ketosis, but it also amplifies our sense of gratitude. And I think, you know, that might well feed into the oxytocin discussion that we feel— we recognize gratitude, we recognize connection. And, and that's, you know, something I think that's so missing today when we have such access to immediate gratification, not only in terms of food, but in terms of everything that, that we might want. You talked in your book a little bit about gluten. I certainly think that is a topic we like to cover quite a bit on this program. Where might that fit in in the program, or

not? We're grain-free in the program, so pretty much grain-free. It's frustrating because we think, okay, well, if I'm gluten-free, well, I can have corn. Then I think guacamole, corn chips, and tequila. That's a great meal in and of itself. Then finding out the endocrine disruptors that are in our foods and our grain sources like zeaxanthin, and to know that's estrogen promoting and creating feminization in males, creating infertility, and is affecting our own natural hormone balance. So thinking about the the hormone disruptors that are actually in our grain sources, and and that is why you know that's one of the main reasons why we eliminate it in my program as well. I mean also you know again it's. you know, let's detox from as much as we can. And that, uh, to really get a leg up and to start being empowered with our willpower, because willpower is physiology. If we say, okay, I want you to go do an 18-hour fast tomorrow and you can't do it, you know, your body is like, you know, like you're crying about it and you cave to that first, um, you know, bagel or, you know, cookie or something that you see, you feel defeated. And I don't want women to feel defeated. I want them to feel empowered. So that step-by-step approach, empowering their physiology, getting hormonal balance, creates that willpower so we can do complete fasting days. In fact, I push clients in my online programs into— after a few weeks— into a 72-hour fast. And we do it sometimes with protein shakes or complete water fast. You know, I've extended dry fast. And so That just enhances our oxytocin, right? Because you're appreciating so much, you're forced to divert your mind to what you can do versus what you can't do. And those are important. Those are important experiences to have. And we have to continue to incorporate those into our lifestyle. We're full of abundance. So appreciating everything without, you know, you know, appreciating a fasting experience. really does enhance our appreciation of life in general.

I wrote something down a while ago that you had mentioned that I thought was really very important, and you said being able to respond as opposed to react. And I really love that because responding is, is, is thinking something through and coming up with a decision in terms of an action. And that is predicated on connecting to the prefrontal cortex, the front part of the brain that really defines us as being human, as opposed to simply reacting. Reacting is a more impulsive type of amygdala, primitive brain, reptilian brain sort of response that we don't think through. It's an automatic reaction. That is something that's good when you step on the brake before you think about it, when You know, you see a kid coming across the back of your car on the camera, that's great to be impulsive then and reactive, but to respond is exactly what you're talking about here in terms of dietary choices. To stop, though I want to eat the bagel, though I want something sweet, and really go through the cognitive part of this and go through the ideas of, is this good for me, is it not, and be in a place where you can make the right decision. And the more you do that, the more through neuroplasticity you connect to the prefrontal cortex and increase the likelihood that you're going to be able to respond as opposed to react. So, you know, our modern lives right now are all about react. It's all about instant gratification, ordering whatever you want on Amazon or whatever other platform. Buying whatever food we instantly need and getting instant gratification from the number of people who like our selfies or who give us a thumbs up. That's what our world is all about. It's about instantaneous satisfaction of these dopamine-driven needs that we have as opposed to the more oxytocin-driven prefrontal cortex empathetic, compassionate ideas and motivations and actions That are based upon thinking about the long-term consequences and responses to what our choices are. So in a very real way, what you're talking about is really playing upon this idea of neuroplasticity, rewiring our brains, reconnecting to that rationality part of the brain and getting away from the sudden— response, reactive type of brain that, you know, as soon as somebody does one thing, we do another. They say something, we tweet something, and, you know, and that's impulsive, and that doesn't allow us to really exercise this gift that we have, this prefrontal cortex, to take a step back and make the right decision, whether it has to do with how we're interacting with our children or how we choose to Put out the food for breakfast. So you're very right. And I think, you know, on the global scale, as we see the spread of the Western diet, which is very pro-inflammatory, we recognize that inflammation counters our ability to connect to the prefrontal cortex, inhibits the connecting anatomy, which is called the anterior cingulate. Mm-hmm. That allows us to bring this incredible computer on board to make a better decision. I guess it's a little bit away from what we were talking about, but the thought came to mind, and I've had some coffee, so what can I say?

There you go. I think that's so important, and then just the associations. One thing that's happening in the perimenopause-menopause time period, actually mid-30s on, is our progesterone levels are declining. Progesterone, a very active neuropeptide, a neuroprotective hormone, right? As progesterone declines, if we've had trauma, adverse childhood experiences, trauma at any age of our life, post-traumatic stress, let's say, which we want to convert to post-traumatic growth, we need to understand what's happening with our physiology. So as our protective hormones are declining, we're more disconnected from our prefrontal cortex, right, with PTSD. And so we have to incorporate the disciplines and the practices so that we can reconnect the two. And oxytocin is healing for that. I have a whole chapter in my book on this factor. We want to go from post-traumatic stress to post-traumatic growth, and I like to say postmenopausal growth, but women think we're growing this way. No, I want to grow this way, spiritually and enlightened. So in our postmenopausal growth, we've really got to understand to put the medicinal hormones into our lifestyle, the principles and practice to increase these medicinal hormones.

Well, here's your book, and I want to say, as always— Oh, there you go. Good. That's the way to do it. I always enjoy spending time with you, either virtually or in real life, and I know that this is going to be a very, very important book. I want our viewers to, again, remember the name Anna Cabeca, remember the name The Hormone Fix. But before we go, can you tell our viewers where they can learn more about all you're doing?

Yes, very simply at dranna.com, so dranna.com, my webpage.

That's terrific. We will talk soon. All the best, and thanks for joining us today.

Thank you for having me.

Okay. Well, that was interesting information as usual from Dr. Anna Cabeca. Again, the book, The Hormone Fix. I think by the time we publish this podcast, it will be available for you. Again, The Hormone Fix by Dr. Anna Cabeca. And really, what a new way of understanding the relationship between lifestyle choices and hormone balance, especially as it relates to menopause. I mean, we've been focusing— not we, but I think mainstream medicine has been focusing on the primary roles of Of estrogen predominantly, and to a lesser degree progesterone, and to a much lesser degree testosterone, and management of those hormones in terms of making menopause a less difficult event for women. But what a refreshing viewpoint we've heard today from Dr. Anna Cabeca. Thank you for joining us. I'm Dr. David Perlmutter, and we will talk soon. Bye for now. Bye.