2nd IAFM Meet 2025 | Dr. Priti Nanda Sibal | Functional Medicine Insights & Future Trends

Thank you everybody for being here. It's so heartwarming, such a nice moment to see so many people here. I think 4 years back when we were thinking about this, starting this community, this was what we had written in our dreams. So it's a dream come true for us, all of us today. I think the healthcare is changing, and with all of you here today, I am very confident that it will change at the fastest speed now the speed that it deserves to get into every household. Thank you very much. And my topic today for these hormones— so how many of you are on bioidentical hormones? Please raise your hands. Anybody here who is on bioidentical hormones? Hi! Only one of us. Two, three. Anybody else? Great. Anybody here Who said they should be on BHRT but still don't know where to get started? Please raise your hands. No. I would take this no as nobody has actually told you the facts why hormones are important, and I strongly feel it is criminal to live with hormones when they are in imbalance. So what did I say? Can you repeat it with me? I can't hear you guys, a little louder. Exactly, because I think quality of life is what brings all of us here, and hormones are a big, big, big change. And why hormones? So let's take you through this. So this is about me. I've written 4 books. What doctors should know about diabetes reversal, cyclic keto, 4-hour rapid fat loss mate, which is about hormones. You balance your hormones and your body has the intelligence to get you back to your right weight. When we talk about bio-individualization, personalization, somebody could be good at 49 kgs and somebody could be good at 65 kgs and somebody needs 68 kgs. Ages to feel optimum or to feel at their best. Do you agree with me or not? So this is one book, 4-Hour Rapid Fat Loss Method. Read it like a story. Has been written for patients, not for doctors, but I feel every doctor is a patient first. Anybody who agrees with me on this, right? So can we all say yes with our hands, right hand up? A little louder, please. Once more. Thank you. Of course, I have published 6 articles. One of the most prominent ones is Reversing Diabetes Through Functional Medicine in Indian Journal of Clinical Practice in the month of diabetes in 2019. The another very popular article because of which I get a lot of talk invites internationally is How sleep is the key behind managing insulin resistance. So when we say a patient comes to you and if you are in doubt where to start, start on the gut, right? And Dr. Arzu just spoke about that. Similarly, I say when a diabetic comes to you, don't start from his morning routine, start from the sleep. Because one night of irregular sleep has been found to increase insulin resistance or make 40%+ people insulin insulin resistance because of one night sleep loss. So that's so critical. And that, you know, that article really has gone places. I don't know where all, but yes, a lot of people refer to that article and send me an invite. Will you want to come on the medical syndrome conference? And I have written some more articles like elimination diet and getting your uric acid back. And why I'm sharing this is I took time to publish has come. Anybody who has good case studies, wants to write review articles, please speak to me. I will love to help you publish. The more publications we have, the more we will be able to show to our patients, and the more they will have trust on us, right? Of course, um, 30+ years of being into practice— 31 now, actually— and what I feel is hormones in your body are in delicate symphony. Like, you know, Amarjeet Jath said orchestra. Yes, the hormones are like an orchestra playing, and even if one hormone gets out of balance, the whole rhythm goes off. Your body screams, your body talks to you. But unfortunately, you know, your child is trying to pull your dupatta from the back, but you are so busy rushing to the office that you just tell the maid to hold the child back because you are getting late for the office. Anybody who can relate to this here? Right? And that is exactly what happens. Our hormones are screaming, talking to us, telling us, I am not at ease. But we are very busy doing what we want to do. So, kabhi thum jao, kabhi apne aap se baat karo, toh aapko kut samaj mein aayega where there is an imbalance. Right. And I think for me, hormones have been a game changer in my journey. I was telling somebody a few days back that if two things which I can pinpoint in my last 10 years of functional medicine journey, of my anti-aging journey— if you saw me when I was 42 and if you see me now 10 years later, that means I am 52. Anybody who is good at maths, I look much younger than what I was at 42. I was 88 kgs. Right? I used to call myself a batata bara. Okay, and from there to now, anybody who meets me from then asks me, Dr. Preeti, what have you done? And what changed me was balancing my hormones, and second was chelation. So coming to hormones, 10 years back I was obese, I had migraines, I had fibroids, I had Hashimoto's So a whole list of diseases, but one thing at the rock bottom was I was very, very low with DHEAS, DHEAS. Because of that, I was very low on cortisol because DHEAS was not supporting it. Because of that and cortisol steal, I was very low on progesterone, so I was estrogen dominant. When I started using hormones, it was a learning, it was a journey, but it taught me so much that I am a different person today. 10 years back, people outside used to think they won't see anybody more confident than Dr. Preeti. Whatever Dr. Preeti says, she makes sure that she does it. But at home, my husband can watch, I could be very angry I cry like this because I didn't have that, you know, thing in me to take care of things. My kids would say something, I would have tears here. My things would not go right, I would have tears here. And sometimes when sitting alone, I used to think, this is not the Preeti I was in college when I was— when kids were young. And finally, when I corrected my hormones, I think I'm back there. I am 30 years younger and I can say today whatever I say, I will make sure that I will do it. So I feel I found myself with hormones and that's the reason I say it is criminal not to know about your hormones and not to do something about them if we want to live the way we want to live, right? So what are bioidentical hormones? Biodentical hormones. So this is the old PPT. Can somebody help me change the PPT? Sorry, Dr. Ruhi. So till then, I will not, you know, stop here. If we can get the new PPT. But what are bioidentical hormones? Bioidentical hormones are hormones which are exactly similar to what your body makes. So tell me through common sense, if exactly same thing when your body is producing less or has stopped producing and you add it from outside, what does common sense tell you? Is it okay or it is not? Right? But what happened was, because bioidentical hormones cannot be patented, cannot be approved by FDA, so there is no money in it. Therefore, people tried changing bioidentical hormones to hormones which could be patented. So they changed a little structure here and a little structure there. So progesterone became progestin. Right, where we have to use cream of estrogen, they started giving oral estrogen which had side effects. And that is how HRT lost its name and fame. In 1942, more people were on hormone replacement than they are today. 1942, more people were on hormone replacement than they are today. So thank you, Dr. Ruhi. So if you look at this picture, you will see progesterone structure and you will see the FDA-approved forms of progesterone, which is medroxyprogesterone acetate and Megestrol. What do you see? There is separate bonds of C, CHO, and oxygen there in MPA, and in Megestrol also a similar structure, but instead of CHO, we have CH3. This little change has been done so that it can be patented and something can be earned through this. Whereas our body has progesterone, instead of giving OCs to girls, young girls, when they come to us because they are not having regular periods, If we give them bioidentical progesterone for a short while and we work on their lifestyle, that is much safer, much better. But unfortunately, as in other things, nobody is talking about this to us. Everybody is giving oral contraceptives, and then women of today are bearing the brunt of it years later. So bioidentical hormones also have better receptor binding. They have lower side effects if done well, and they are safe long-term use. There in US and all where BHRT is now becoming very popular, and in India very few women and men are doing it, the science says that you start it within 1 year of achieving menopause. The earlier you start it, the better results you have. But even if a woman comes to me at 75 and says, am I the right candidate for BHRT? My answer would be yes. Yes, of course, with more information telling them you might not get the same results which you would have got if you would have come to me just immediately after menopause, within 1 year, within 3 years. The earlier the better, but still you will benefit. And I will talk more about in my coming slides. It is plant-based, it is identical to human hormones, and it is naturally accepted if given right. So HRT in young postmenopausal women, extremely safe. I believe every woman and man must know about their hormones. There should be a class, not in school or college, but at least at the age of 30 they should start to know it. Why? Because your hormones start depleting at the age of 30. Now even at 18, 20, I get women and men with low levels of hormones, and so much can be done if you catch them early, if you catch them young. The beauty is hormones like DHEA, which is the uphill hormone, It does not have a negative feedback. If you give it to your patients for 4 weeks, 6 weeks, the release of that hormone increases in the body naturally. You stop it and the body functions much better. The day I came to know this, I was like, wow, this is amazing, right? If you, if you have something to give that kick to the body to come to its younger cells Why not? So it prevents a lot of degenerative diseases, from bone health to heart health to mental health. All are affected by hormones. Your memory, cardiovascular disease, diabetes mellitus. I get so many diabetics where I fail to help them through diet, through gut health, everything. And then when I check, they are low on DHEA. So they have a lot of cravings. They cannot do what they want to do. By the time evening comes, they can kill anybody around, but they want to have that thing of sugar so that they feel sane and in place. Anybody here who has seen such patients who say, sham ko craving hoti hai, control nahi hota, right? Check their DR, check their cortisol, check their progesterone. That could be it. If you have a woman saying, my decision-making is not that great, anymore. Check their testo. Who says testo is not important for women? You know, 3 times more testo women have in their body than estrogen and progesterone? I didn't know that till the time I started doing BHRT. And over the last 10 years, of the way I feel when I do my hormones, I honestly feel it is criminal if you are not checking your hormones, not balancing it. You can balance it through diet, through sleep, through relationships, or through BHRT. That's not the aim here. Aim is, do you make that decision that you will know your hormones, you will talk to your body and keep them in balance? If that is what you can take back today, I promise next time when I see you next year, you will be 3 or 5 years younger than what you are looking today, right? Natural progesterone, positive cognitive effects, better sleep. Cancer, you know, I'm going to talk about cancer a little later. And you will know. Now this is a simple cholesterol cascade. I will show it to you in a simpler version. Lot of people here, do you have patients who are on statins? Yeah? Have you seen patients whose cholesterol is 140, triglycerides at 70, and their doctor has said, "Good job, keep it up." Have you seen such reports? Right, and look at this diagram. Cholesterol gets converted to pregnenolone, pregnenolone to progesterone, cortisol and DHEA on the two sides. DHEA then converts to testosterone and estrogen, and testosterone to DHT. So all those patients where the doctor is saying, good job, well done, keep it up, they are being prepared to live a life where they don't know what are they doing living life. They will fall into memory loss, Alzheimer's, Parkinson's not very far away. If they are not diabetic, they will become diabetic sooner than otherwise they would have been, and so much more. So cholesterol has to be in balance. Everything is about balance, everything is about harmony. And please remember this simple algorithm, you will not go wrong. When you are in stress, there's a process called cortisol steal. To make that cortisol, body gets depleted into progesterone, because of which you can have PCOS, you can find it difficult to sleep, you can have osteopenia. and then osteoporosis. You can have high episodes of heart health and all of that. So quickly, let's play a small game. Are you guys ready? Great. So if you have oily skin, do you know which hormone could be causing it? Exactly. Clap for whosoever said that. And PCOD girls generally are high on DHEA, but today I see 30% of them low on DHEA also. So never judge, always test. In hormones, never trust, always test. Always test. Acne? DIA. I've written the answers there, so don't cheat. Hot flashes? Quickly! Estrogen but DIA. No libido? Estrogen, testosterone, but both of them, DIA is getting converted into that. Brain fog, dry skin, sugar cravings, fatigue, night sweats, bloating, depression, weight gain, irregular periods, increased irritability, insomnia, anxiety, deepening of voice, excess facial body hair, hair thinning on scalp. All these can be hormonal. You are trying to set their lifestyle right, they are doing their best. But please ask yourself, are you missing this one important piece in the puzzle of longevity or health? Are your patients being deprived of this one thing just because you have not ventured in it for your own self and you don't want to help your patients get the benefit of this? Very selfish. Must study this and must fit this piece of puzzle in place. Right, so quickly I will take 1, 1 minute on every hormone and say DHEA supports energy, mood, memory. When women come and DHEA— low DHEA is one of the big reasons for people having autoimmune conditions. All autoimmune patients, check DHEA and cortisol, set that right. You will see your gut health protocol will give you 2x benefit. Isn't it cool, right? Balances sex hormones, influences insulin sensitivity, supports adrenal resilience, and enhances immune function. So always test DR to evaluate. Start with low dose and monitor for acne, hirsutism, and estrogen-testosterone spikes, especially for women. So making this simple, you can take a picture of this. Low DR means adrenal fatigue, HPA axis dysregulation, aging-related hormone decline, chronic stress, burnout, autoimmunity, inflammation. It is very, very good anti-inflammatory. Poor mitochondrial function or cortisol steal. We keep talking about mitochondrial health, do everything, but I strongly feel put this piece of puzzle in between It will help you. So my prescriptions, the first prescription would definitely have BHRT element in it. Because one, patient will kulfidaao jaata hai. Because everything seems different to him or her. Their life changes the next morning. The results are very quick. They are able to do more for themselves. They feel the change. And when they come back next time, they are more motivated to do lot more things. Which in FM we want, just because we've put that puzzle first. High DIAH, oversupplementation of DIAH, first thing, very common. PCOS, insulin resistance, obesity, poor detoxification or hormone buildup could also lead to high DIAH. So check this up. Bioidentical progesterone, I give it to women 20 years plus, and of course all my postmenopausal women. But remember, progesterone is not safe for everybody. The biggest myth in the market is you can give progesterone to everybody, nothing will happen. Sorry, you must know whom to give, when to give, and what dose to give. Educate yourself, then only venture. It supports menstrual cycle balance. For young women, I generally only have to give for 2 months or 3 months, and then the body continues to work better. I don't have to give long-term. Perimenopausal, menopausal women, I tell them, this is your beauty medicine. Think of this as a cream which you apply like a moisturizer. Continue with this and live the life you want to live. Protects endometrium when used with estrogen. Calm effect on brain. It binds to GABA receptors. It helps produce more serotonin, so it keeps good moods. It doesn't make you feel sleepy, but if you take at night, it helps you have good sleep. And I can go on and on. Of course, in infertility, it makes a huge difference. Estrogen deficiency could be irregular or absent menses, breast tenderness, hot flashes, Do you know any postmenopausal, perimenopausal women suffering with hot flashes and not ready to do hormones because she's scared shit because of the trials and the information in the market? I'm sure all of you have seen such women, right? Such an irony. The Women Health Initiative is one of those studies which, if given an opportunity, I will want I will sue those people in court, right? Because the way they interpreted it is so unjustfully done. Over the next 30 days, so many women and men who were benefiting, especially women who were benefiting through BHRT, were told to stop BHRT because of wrongly interpreted results. And anybody who wants to know more, Dr. Musa and Vita One had done a Women's Day talk on hormones, and I had spoken in detail about the WHO initiative. If you have not watched that, go and watch that. You will feel as if you know you're looking women's health with a different perspective. Mood swings, depression, anxiety, frequent UTIs. I have seen women admitting to hospitals because nothing is working for the UTIs, and nobody is thinking about hormone balancing for them. Poor sleep, vaginal dryness, lack of sexual appeal, don't want to live life to their full, and all of that can happen. But on the contrary, estrogen— you know what estrogen gives? It is cardioprotective, it decreases the risk of type 2 diabetes, it does not increase risk of breast cancer if balanced properly with micronized progesterone. And second is If a test is done, Dutch Plus, to see how your estrogen is metabolizing. If your estrogen is metabolizing on the right side— wrong side, correct the metabolism. But don't think this, that your patient will live without this. It's okay if the patient doesn't have quality of life. Marmar ke bhi jiri hai toh jeet ho rahi hai. I don't think that should be the attitude, at least towards women's health. Prevents osteoporosis, cardiovascular disease, diabetes, and most importantly, cognitive impairment. Reduce risk mortality with heart failure and acute MI, and most importantly, neuroprotective. Anytime the time is over, just give me a thumbs up. Great. Now, testosterone. I have divided into two: benefits in men, benefits in women. Improved erectile ability, prostate protection. People say don't do it, prostate cancer. If done right, If it is in balance, if you know what are the estrogen levels in a male and what are the progesterone levels in a male, and then you are deciding the dose, you are safe. In men, estrogen is as important as in women, only we don't talk about it because this is one topic we are shy of. We don't want to share the right information. Cardiovascular protection, lower cholesterol, increases HDL, Increases energy, reduces body fat, builds muscle mass. If you have men 40-45+ in your practice and you know they are going to gym, they are doing everything right, but muscles to lose, you can see and make out 30 seconds by the time the patient sits on the chair in your OPD, you know what is happening. Check it first. Reducing anxiety, irritability, cognitive clarity. Men with low testosterone, there are studies to show that there is increased risk of Alzheimer's, cardiovascular disease, prostate cancer, diabetes, sarcopenia, increased abdominal fat, insulin resistance, higher CRP. Because I just told you in the beginning, hormones are anti-inflammatory if done right, right? Atherosclerosis, 41% increase in all-cause mortality. And this is allopathy saying this. So do you think we should do hormones? I'm sure you think that. In women, enhanced libido, heart protection, lower cholesterol, increased energy, enhanced sleep, feeling of overall well-being, reduced body fat, stronger bones, depression relief, and most importantly, reduced brain fog. So testo is equally important, as important as— how many minutes left? Wow, great. Breast cancer— does hormone increase breast cancer? If done right, maybe no. But everything you have to— with pros and cons, the benefits you get outnumber the minimum percentage of cases where we have had breast cancer in studies where we have given balanced bioidentical hormone therapy. So I'm again wanting to reiterate This is very, very powerful. But as you all know, the more power you have, more responsibility you need to own. Yes or no? In every household, you know, the one who has maximum power has the maximum responsibility. Yes or no? Therefore, if you want to balance hormones for yourself and for your patients, you have to be Responsible. You have to learn, you have to go in depth, and then you must do it. Don't shy away from it. Simple 2-3 things I want to tell you. Estrogen metabolism— when genetically you are not metabolizing correctly, you do a test, you find all the metabolism is happening on the wrong side, patient is going towards cancer. You get to know much early. Simple things like DIM, I3C can help you Simple antioxidants like vitamin C can help you bring the estrogen metabolism back and then start with hormones. With hormones, always remember, start low, go slow, and tell your patient— though in my practice I see next day they feel better— but tell your patient, give your body 3 months. If patient as it is you will love meeting the patient the next time when the patient walks in your OPD. Lack of time, I will quickly go through the slide though I have done this. Estradiol, majorly hot flashes, vaginal dryness, mood swings, bone loss. E3, vaginal atrophy, dryness, UTIs. Progesterone, anxiety, insomnia, irritability, heavy periods. Estrogen dominance. Progesterone, you must look into. Testo, low libido, fatigue, poor muscle tone. Diop, burnout, low libido, poor memory, immune suppression. Pregnalon, I'm not talking about it. Can somebody share— take a screenshot of this and share in the group? I've given you dosing for women in different age groups and then dosing for men in different age groups. Now this is something not which you can just Do it, but I wanted to give you an idea how it has to start.