5 Things That Are Silently Wrecking Your Fertility (Most People Do All of Them)

So if we take infertility not just as a disease or a problem and we treat it also as a symptom, that it's a representation of your underlying health, that really allows people the opportunity to change their life.

What you're saying really is important.

Fertility and the, the, your reproductive health, those are not just relevant for people who are looking to have a baby. Correct. They are relevant for everybody because they, they speak to this early warning signs, like an early flashing warning sign in your body that something's off.

For young women, it is that first glimpse into your cellular health. If we can get women to start paying attention to this younger in their 20s and 30s, we're gonna have a new generation of women.

Welcome Natalie. So good to have you on the podcast.

Thank you, Mark. I'm thrilled to be here.

What's interesting about your work in the fertility space is that you kind of reframe fertility and fertility issues in both men and women as sort of a biomarker of overall health.

Right.

And like you talk about it as a vital sign, the reproductive cycle as a vital sign, but you could also say sperm health is a vital sign.

Correct.

I think that, that most people don't think of it that way.

It is important that we zoom out on fertility, not just being the ability to get pregnant, because for many couples, especially younger couples, they don't have any medical problems. They've never had, you know, chronic illness care that they know about.

Yeah.

And when they first try to get pregnant, this is one of the first time they're challenging their body to do something else. And we get insight for underlying cellular and metabolic dysfunction. So if we take infertility not just as a disease or a problem and we treat it also as a symptom, that it's a representation of your underlying health, that really allows people the opportunity to change their life and get earlier testing, think about how they advocate for themselves and optimize things. And that could change their chronic disease risk as well.

And I love your reframe of like the fertility space and reproductive endocrinology from a disease-based, like infertility as a pathology to saying Oh, maybe we reframe this and say, how do we create healthy reproductive cycles and healthy sperm as a way of creating fertility as opposed to medicalizing fertility?

Right, right now the space is very reactive. And in fact, just the definition of infertility— let's try for a year, and then when you fail, only when you fail will we bring you in. And now we'll test your sperm and test ovarian reserve and find out if you have uterine birth defects. It doesn't make sense to me in today's day and age when infertility rates are rising that we're making people fail first before they they even get data about their body. And as a clinician, I know you and I feel similarly. I shouldn't be the gatekeeper for you to get data about your body. You should be able to access that information because we can't make decisions on data we don't know.

It's true. I remember I'm older than you, but I remember it was so patronizing when I was trained, you know, basically you do the test on the patient, you don't give them the results. You say your labs are fine. If they ask specific questions, you might go and tell them your blood sugar's okay, your cholesterol's okay, but not like any real detail. You certainly don't give them the paper that it's printed on.

No, in my early training, I would send patients, you know, notifications, and it was in the EMR at this time, but it would really just be, your labs are all good. No, not even attaching the results. No explanation about what good means or optimal means.

Well, that's all changed because I co-founded Function Health and people are flocking to find out what's going on in their body and they should have the ability to own their health and to check their health.

100%. I couldn't agree more.

Your work really came out of, and we're going to dive into not Exactly how to get pregnant and fertility exactly, but more in reproductive health as a biomarker of your overall health and what it tells you about what's going on in your body. It often is pre-disease, but it is really meaningful.

Exactly.

And if you catch things early, you're actually gonna have a better trajectory of your overall health for your life.

Right.

So that's kind of what I love about your work.

Okay. So let's, let's kind of get more specific.

Good.

And granular about this. 'Cause you know, you, you know, a lot of women just feel like something's off and they go to the doctor and they have their, their reproductive age, they get the pill, or if they're perimenopausal, they get hormone replacement therapy.

And it's kind of like a, like a catch-all, binary option.

Mm-hmm.

And nobody starts to look underneath the hood and see what's going on. So you talk about, about women feeling off and, and the, the menstrual cycle being like a vital sign. What does that actually mean?

The menstrual cycle is your body's way to tell you how your hormones are communicating. I wanna set the stage that your hormones come from different organs, and we'll talk about the reproductive system. We'll say brain and ovaries. Your brain doesn't know what's happening in the ovary, can't see the ovary. It's relying on the signals that the ovary makes to tell it what to do. Estrogen, progesterone, testosterone. So if we think about these as, you know, friends on a walkie-talkie, you know, the ovary's gonna walkie-talkie the brain, the brain's gonna hear it. One important factor is people say, well, how does inflammation impact this? One way is static interference on the radio. So if the brain can't hear the signals that are coming in because there's static on that radio, it's not going to respond appropriately. Same things happens at the ovary level. And then inflammation doubles down on this because it actually impacts your egg quality, the genetic normalcy, the mitochondrial function, and the ability of the ovary to respond to the brain signals. To put it really loosely though, because I don't think a lot of women always understand their menstrual cycle, I'd love to give you my 1-minute analogy overview. So women are born with all the eggs they're ever going to have. We like to think about them as kept in a vault inside the ovary. That's my favorite analogy. Every month, a group of these eggs comes out of that vault. From that group, one will be chosen to ovulate. So the brain sends out FSH, follicle stimulating hormone, well named, and one of the one times in medicine where things are named after women because each egg grows inside a follicle.

It also works for men too.

Yeah, it does, but it's named for women this time. That's true. So follicle stimulating hormone stimulates that follicle to grow. The egg matures and makes estrogen, and this is the first phase of the cycle called the follicular phase. This is by nature an estrogen dominant phase.

Mm-hmm.

And then when estrogen levels are high enough, and it's really specific, 200 picograms for 50 hours, now the brain gets a strong enough signal to say, Oh, I have a mature egg and sends out a signal of LH or luteinizing hormone. LH allows that follicle to rupture, the egg to be released, and then the follicle to reform. That's ovulation. And then after ovulation, that follicle that just reformed is now a corpus luteum, same structure. So the foundation was built from the follicle, but now it makes progesterone. So LH pulses from the brain stimulate progesterone pulses from the corpus luteum. Corpus luteum can only live about 2 weeks unless you get pregnant. If you get pregnant, hCG keeps it living. HCG and LH are similar in structure.

And HCG is the pregnancy hormone.

The pregnancy hormone. You take the pregnancy test.

Pregnancy test, right?

Exactly. And so if you don't get pregnant, which is often what happens most months, that corpus luteum will die, progesterone levels will drop, a woman will get a menstrual period, and this process will start over inside the ovaries. The reason why this is really important is that, well, you alluded to some of the reasons. Women are given hormonal contraceptives, so they're not ovulating or they're losing their cycle as a vital sign. But even if they are not and they're trying to track their cycle, many women are using apps where they simply put in cycle day 1. And these apps, if they don't leverage other markers of ovulation, are using an old-fashioned method called the calendar method, assuming that for every single person, the luteal phase is set at 14 days and giving you this day of ovulation. And it's only accurately predicting ovulation 20% of the time. 20%. So when somebody—

it's 80/20 in the wrong direction.

The wrong direction. So if somebody sits across from you, it's a doctor, and they say, are your cycles regular? And you say yes, and they move on to the next question, we're actually missing those little tire warning signs, the little red flags about what's going on. Ovulation is not a light switch, yes, no. That's how many physicians treat it, and that's how many patients think about it. Either I ovulate or I don't ovulate. If we step back and we think about this beautiful communication system and how intact everything has to be, there are stages of ovulatory dysfunction that can allow us to intervene earlier, get earlier testing, or make changes well before we're in the I'm not ovulating at all. So one of the first actual signs is what we call a short luteal phase. So if the luteal phase— again, the second half of the cycle— if it's less than 11 days in length, that means the brain hasn't been able to send out enough signals to keep this corpus luteum growing, or the follicle, the foundation that became the corpus luteum, wasn't strong enough. You know, build a house on a bad foundation, it's not gonna last as long as—

well, everything is going right, it'll be fine. But if, if things are going wrong, it kind of gets wacky.

It gets wacky.

So what are the symptoms of wackiness and what are the reasons it gets wacky?

So for a short luteal phase, some of the top symptoms can be thyroid dysfunction. We can have high prolactin, which is a pituitary gland hormone, or we can have inflammation impacting what we call hypothalamic dysfunction. So that's static interference on the radio. The brain can't interpret those signals quite well, so it's missing something.

So hormonal stuff like your thyroid's off or your thyroid —tumor, or you have this inflammation, chronic inflammation, insulin resistance, because of how they impact the brain.

The brain's lost that tight connection with the ovary. And so when we start to say, oh, well, if I'm not just relying on my app, if I'm actually tracking ovulation— and this can be with cervical mucus, body temperature, or urinary hormone measurements, which we can go over— but then I can pinpoint when I'm ovulating, and I can count how long is my luteal phase, and I can start to see Oh, this is a problem. It might make it harder for me to get pregnant, but regardless if I want to get pregnant or not, this is my body's red flag that something in my hormonal system is not connecting appropriately.

So you mentioned two things. I think the thyroid is understandable. People have thyroid issues and 1 in 5 women have these thyroid problems that most of them are undiagnosed. 100%. Two is, is pituitary tumors, which is pretty rare, although we're finding that a lot on function labs with high prolactin levels.

But also high prolactin, we should say, can come from other things, not just pituitary tumors. A lot of medications, especially psychiatric medications, so we see ADHD medications or medications for bipolar disease or depression, they actually can cause the pituitary gland to make more prolactin and they can throw off your cycle.

So drugs. Right. But then there's inflammation and then you mentioned insulin resistance.

I get it.

So insulin resistance really primarily comes from diet, sugar, processed foods, and I've talked a lot about that on podcasts. People I think understand that, but it's affecting like 93% of people at some level in this country with metabolic dysfunction. Oh, it's huge. And the inflammation can be caused by the insulin resistance, but there are other causes. And for you, it was gluten. It was gluten. But it can be environmental toxins. It can be the microbiome.

It can be 100%. Mark, here's how I like to think about this and how I explain to patients. I say, first of all, your inflammatory response system is needed and good, right? Like acute inflammation, the ability for your body to activate your immune system and heal is needed. And even for reproduction, you need to have it because many patients will say, can I just take a pill and get rid of inflammation?

Take aspirin or take Advil or whatever.

But the problem there is, right, inflammation's needed for ovulation. If you take anti-inflammatory medications at the time of ovulation, ovulation, you actually won't release the egg. The follicle will not burst and let the egg out. You'll go through hormonal changes of ovulation, but you will not release an egg. So important for people to know, we don't recommend NSAIDs— Motrin, Tylenol, Aleve, ibuprofen— any of those around ovulation because they do prevent egg release. So inflammation is important. So we like to think about— I say the inflammatory burden. So let's imagine how much inflammation you're exposed to on a day-to-day, and let's imagine it is a lever that can be moved up or down. For some of you might have factors causing you to have more inflammation that you don't have that much control over. Think about some patients with endometriosis or certain autoimmune disease. So although we know what the, those causes are of those diseases, we know what's causing it, but sometimes you can't get rid of it all, right? So everybody has a different, we'll say baseline starting value, but every single decision that we make, whether we want to accept it or we know it, can increase that total burden we have that day, or they can decrease it. So things like. If I got enough sleep or if I got too little sleep, too little sleep. Now I'm knocking it up. The foods that I eat can increase that burden, the toxins I'm exposed to, how I manage stress that day. And so I'm not sitting here trying to tell patients that you have to be perfect every single day or you're screwed. What we're saying is I want your body to have the resilience within it so that you can respond appropriately to the inflammatory things you obviously will be exposed to in your world. So we're looking at the things we can control. When you can't control everything, we want to make sure that in these 5 buckets that we go through that you mentioned earlier— food, toxins, stress, sleep, and exercise— we are making active decisions in line with our priorities that are going to actively decrease inflammation as much as we can, because that's going to set us up on a better track, yes, to get pregnant, but also to have better cycles, better hormonal health, and long-term health and longevity as well.

Yeah, so it's so important. And, and the things that you mentioned, environmental toxins are harder, but those are things that we have agency over.

We do. And so many of those decisions we make without thinking about it, right? I call sleep, stress, and exercise the foundation of your day. You've made a decision, you know, what time to go to get up, what time you go to bed, how you're going to cope with stress. We can't avoid all stress, but how you're going to cope with it, if you're going to build in ways for your day, if you're going to move, what type of movement you're going to do. And we should be lever— leveraging those choices in a way that's going to be beneficial for us.

Yeah. And people often don't even know, like I just talked to a friend who was at a friend's house And she poked a bunch of holes in a plastic bag full of broccoli and stuck it in the microwave. I was like, wow, microplastics in the ovaries are a real thing.

And they're microplastics. Yeah, microplastics are a huge problem. So are endocrine disruptors. And just because something is prevalent and difficult doesn't mean we don't need to start paying attention to it. And when it comes to toxins, thinking about in your world, what you're exposed to the most, the things in your home, how you cook, in your bathroom, those are easy places for us to make Good decisions that are going to change how you live most of the time so that you're able to adjust. You know, when we're in a hotel room right now, we don't have as much control over this environment. We control the things that we can.

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And what, what you're saying really is important cuz you're a fertility doctor, but you're saying that fertility and the, the, your reproductive health for both men and women, sperm quality and women's reproductive cycles and their, their ovulatory capacity, fecundity, you call it. Those are not just relevant for people who are looking to have a baby. Correct. They are relevant for everybody because they, they speak to this early warning signs, like an early flashing warning sign in your body that something's off.

Right. And specifically, let's say for women, women been dismissed in the healthcare system very often. I mean, I was dismissed as a patient, and when you do get dismissed, you start to dismiss yourself. So these little early warning signs, we really have to give that agency back to women to say, these are not normal, you deserve answers, and here's how we go about trying to get them. And paying attention to these things that are off, like our cycle, like our ability to get pregnant, because that's going to give us insight for our whole health, right? We want to live a long, healthy life. We don't want to just live long, we want to be healthy longer. And it really does, for women, start by paying attention to the ovary much earlier in life.

Natalie, you were, you were a doctor, you're working, I mean What were the early warning signs that you ignored?

For me, you know, fatigue, especially in the afternoon on days when I shouldn't be. I dismissed a lot because I was in medical training. Oh, I'm just a resident. I'm tired. But understanding that not everybody feels that afternoon fatigue, especially if you have gotten sleep at night. Mm-hmm. You know, I had really poor coping mechanisms. So thinking about, you know, I was definitely making choices that were more inflammatory, you drinking alcohol after a shift or stress eating or eating a lot of junk food while I'm on shift. So then a lot of the bloating—

What do you mean hospitals are just the— Oh, peanut butter crackers, right?

You only get help in a hospital, right? We had a McDonald's inside the hospital.

Tell me about it. I mean, where I did training, where I actually, where I was working as an ER doctor, the cafeterias were open 8 to 9, 12 to 1, and 6 to 7. And the rest of the time McDonald's was open from 6:00 AM to 2:00 AM. It was only closed from 2:00 AM to 6:00 AM.

And that was the only place you could eat in the hospital.

Overnight. And I would be on the ER shift. I'd have to go, I mean, like, I would have to go to get McDonald's and I was like, tried to get the chicken and not eat the bun.

And I visited that McDonald's like too many times to count. I even delivered a baby in there. But it's wild to think that this is how your hospital is structured with a McDonald's. So yes, those were not great decisions I was making, but I also then excused and dismissed some of these early signs of bloating, fatigue, headache, brain fog. Yeah. I'll tell you that. But fast forward later in life, I got my celiac diagnosis 'cause I started having peripheral neuropathy. So I started having numbness of my fingers, my toes. Of course, I'm a physician. I said, well, this is not good, right? I need to be able to use my hands to function. I ended up getting an MRI. They were afraid I could have multiple sclerosis or some neurologic problem. And I had a, luckily a good radiologist because it's not standard on MRI, but they said her bones look too thin for her age. Okay. Send that back to my primary doctor who then got a DEXA and I had osteopenia at age 41.

Yeah. Osteoporosis is a feature of celiac. Yeah.

Cuz you're not absorbing. Right. And I was, I would've told you I was healthy, right? I ate really plant-forward. I was a big runner. I was of normal weight. So from the outside, and if I were to sit across from a doctor, I'd say, oh, I'm really healthy. But then we got this DEXA and I had osteopenia. And luckily my doctor didn't just say, oh well, she said something's going on and dug deep. So something's absorbing. And she's the one who ended up getting me the celiac diagnosis as an, as an adult. And it was not classic, as we have already talked about, but also, you know, the fatigue, the headaches, the brain fog, some of those symptoms that were mild in my younger years became so much stronger right around this time of diagnosis. And then taking gluten outta my diet, I mean, it's changed my life, right? I mean, I don't have any of these symptoms anymore. And yes, for me it's one thing and not everybody has celiac, But it speaks to the impact I was able to make earlier by just listening to some of these inflammatory signs, right? Even if you can't get the answer yet or you're searching for it. Yeah. Like you said, being that, you know, individualized experience and believing your own body's warning signs. Yeah. You can make a meaningful difference in your own health. It's true.

Everybody's gotta be the CEO of their own health. Yes. I mean, they can't abdicate that to the healthcare system or to their doctor, even if they can work with their doctor, they can be allies, but you, you're not, being proactive about your health, you're, you're, you're likely going to have issues.

Nobody's going to care about your health like you will. So you need to, unfortunately, we put our own health last until it's really bad, especially doctors, especially physicians. Yeah. But speaking of that, female physicians have double the rate of infertility, right? That's not a coincidence. It's how we're structuring our life. The things we're exposed to, all of the increased inflammation we have because of lack of sleep, poor diet, poor stress, exposure to toxins, all the things we're talking about. In training, especially in your reproductive years, we're at higher risk.

But you came to this honestly. You were an OB-GYN resident, you were working like crazy, you were in the L&D, labor and delivery room, and you were struggling. You were having miscarriage after miscarriage. You said your, your current kids are your 5th and 6th attempt at having a kid. They are. You had also underlying issues that were immune issues that were affecting your fertility that, uh, often go undiagnosed for a decade or more, celiac disease. So I'd love you to sort of share your entry into this, cuz often when people like you and I get into this, kind of work and off the grid a little bit, it's usually because we had some story behind it.

Yeah. Our arc is definitely personal in origin very often. And mine is, I was already on the trajectory to be a fertility doctor because I loved the science and I loved the hormones. But I did start having recurrent pregnancy loss when my husband and I started trying in my last year of residency. And I remember being so clinical about it at first. Our first pregnancy loss, I sat across from him and I said, You know, Jason, 1 out of 4 pregnancies end in loss. It's okay. It's good that it didn't get further along. Those statements that I'd said to patients.

And that you learned in medical school.

That I learned in medical school. And then when I lost my second pregnancy, I was further along and I was working L&D actively and started bleeding while I was working. And it wasn't that time in medicine. I don't know how it is now, although I can hope it's better, but I was not gonna leave work. I was a resident, so I had to go to the bathroom, have your miscarriage, have my miscarriage and go back to work, go do a C-section. Yeah. Right. Deliver other people's babies while I was losing my arm. God, that's hard. But I remember pulling over the car on the way home and throwing up because the contractions from the miscarriage, the pain was so severe and feeling so emotionally, physically distraught, but also understanding that I took care of patients who'd been going through this and this was so much worse than I could have ever imagined. And I went to my doctor after that and said, I think something's wrong. And here's this litany of vague symptoms and here's these two pregnancy losses. And they sat across from me and said, well, you have to lose a third pregnancy before we'll do testing.

Aye yi yi.

And that, even though I, I quote, knew that, right? At that time, recurrent pregnancy loss is 3 pregnancy losses, zero blood work, zero testing was done.

Knew that, meaning that's how you were taught at Washington Medical School.

That's how I was taught.

That's how I was taught. So, I mean, I was a resident, right? So at the time I knew that was the party line. And when you are training, I do think it's important for people to know right? There is a lot you don't control and you learn what's taught to you because you have to, to take your boards, to pass the test. Right. So I knew that's what would be told to me, but to hear it was extremely disempowering. It was one of the worst things I could, I could hear. So I was told it was bad luck and keep trying. And I kept trying and I lost pregnancy 3 and I lost pregnancy 4. And along the way was told that everything was normal. I did get tested and I had unexplained recurrent pregnancy loss. Loss. And I was given the option to do IVF, so that would help what was going on. And I wasn't opposed to that. By this time, I was in fertility fellowship, and IVF is an incredible technology. We have to lay where it is. 17 million babies have been born because of IVF.

Incredible miracle of modern medicine. Absolutely right.

But I was the IVF fellow, so I was learning to do IVF, so I couldn't be the IVF patient at that time. I had to wait about 6 months until I could be the one to go through the process. Another pleasantries of medical training. But I said, okay, what should I do to prepare myself if I'm gonna do IVF? How are there things I can do that will make it better or worse? The outcome, I wanna have the highest chance of success. I'm a goal-oriented person here. And I was told none of it matters, just do IVF. Mm-hmm. And that really didn't make sense to me. Right. At the same time, we were starting—

doesn't matter what you eat or what you drink, right?

I said, what about the foods I eat? Am I running too much? Yeah. What about sleep? You know, I was a resident and I'm a fellow. None of that matters. IVF will take care of it. And we do a year and a half of research and fellowship is 3 years. So a year and a half clinical, a year and a half of research, and you start your projects early. And most people do IVF projects, more controlled environment. You can, you know, change one little thing and see what's happening. But I wanted to study fecundability. Like, why do some people get pregnant and others do not? That, that's my passion. That's a new word for people.

So that's fecundability. Pregnant. Again, pregnant.

Yeah. Pregnancy naturally without intervention. What's your pregnancy rate? I was permitted to do that luckily. And I got a master's in clinical research and started to look at vitamin levels, endocrine disrupting chemicals, luteal phase abnormalities in cohorts of people who were trying to get pregnant. Mm-hmm. And this is when I started to see that inflammation was in all the literature, but we weren't talking about it in medicine yet, unless it's the disease state, right? This disease causes inflammation, but in all of these different aspects of aspects. They were saying, well, this causes inflammation, or had higher inflammatory markers. And that same group of people had a harder time getting pregnant or more pregnancy losses. And I said, well, even though they told me there's nothing I can do, let's try to decrease inflammation. What does that mean? Let's try to decrease that. And so I remember my husband came home and I was cleaning out our kitchen, getting rid of the plastic and the Teflon. And this was like 12 years ago, trying to get rid of everything looking at how we ate, looking at sleep and exercise. And we ended up getting pregnant before we needed IVF and stayed pregnant with pregnancy number 5, my daughter. And one of the things we cut out during that time, I cut out gluten. I would've never told you that I had celiac disease. I got diagnosed with celiac or an allergy to gluten more than a decade later. I would never have known I had that. I didn't have classic GI symptoms. Which most people don't. Right. But I felt, you know, just a little more fatigued, bloated. And when I was really trying to listen to what is inflammation and how does it show up, when I cut it out, I felt better. So I kept it out of my diet for both my daughter and then got pregnant with my son pretty quickly postpartum, not eating gluten. And so when I got—

You hadn't done your celiac antibodies or anything?

No, I mean, I was told all the testing was done that could have been done, but there was no celiac testing at that time.

There was, they just didn't do it.

Correct. There was no celiac testing done on me. Right.

I wanna just double-click on that because you, you, you kind of threw it out a little earlier. And, and they said, you know, they, they did all the testing and everything was normal. Right. And so that's often what you'll have from doctors. Oh, we did all the tests and everything's normal. What it means is they did the test that they knew to do, not all the tests that need to be done. And, and doctors, you know, when they say that, they should be a little more humble because there's only one of two answers to the question of what's going on. Either you're crazy and you're making stuff up about your health, or two, the doctor's missing something. Missing something and it's not necessarily their fault, but they're missing something 'cause they weren't trained in it. I certainly wasn't. Celiac disease happened to little kids. They got bloated, they got emaciated, they got malnutrition, they had diarrhea.

You're not going to get diagnosed at 41. No, no, of course not. There's a lot that we leave on the table and patients should understand that, right? For something, for a doctor to order a test doesn't mean that there aren't other tests. And I often tell people unexplained anything. So unexplained pregnancy loss, unexplained infertility means we just haven't found the answer yet.

We call it idiopathic, which means we have no idea what's causing it. But it doesn't mean that the cause is not there.

It doesn't mean that there's nothing there. And that is a big mistake sometimes in, you know, traditional medicine is we say, oh, well, all these things are normal, just keep trying. Or, oh, you can do this. Instead of what I say is, you know, none of the things that are easy to test have we been able to find. That doesn't mean something's not there, but sometimes it's difficult or we have to really hunt for it. We have to either spend more money, do more invasive diagnostics, and sometimes we just make decisions based on that idea of that we have an underlying underlying chronic inflammatory disorder, and that's how I treat unexplained. But to piggyback off your question, or just to double down on the importance of this even more, I have two sisters and one is 8 years younger than me. And so she— I got diagnosed at 41 and she had more miscarriages than I did. She's had 6 miscarriages and she now has 3 children. But when I got diagnosed, you know, who's the first person I called? I called her and I said, hey, We need to— I'm gonna get you tested. I'm ordering testing right now. You need to go in. And of course she has celiac as well. Of course, this is partly genetic. And right. And so she cut out gluten as well after she got her diagnosis. And then her, her last two children are close in age and she didn't have pregnancy loss between them. Mm-hmm. Because the difference of having these six losses on that earlier journey and then taking gluten out, and now she has her completed family. That's amazing. So it really just goes to speak that. Patients have to be advocates for their own health. The medical system right now is not patient-centric. It's not. It's disease-centric. It's disease-centric.

You can get really sick. Definitely not health-centric.

You can get really sick and we'll take good care of you. Yeah. Right? But if we think about things that are much earlier in spectrum, thinking about especially your hormonal health, trying to get pregnant, trying to have a normal menstrual cycle and what these things mean, many doctors are not trained to evaluate these problems. It's not their fault. It's the system. But that means you're going to have to come to the table the level of knowledge and literacy in a way to be able to adequately advocate for yourself in the system.

Yeah, it's so important. And I think what your work is doing is highlighting something really important. And I think your story's just an, you know, a personal example of what happens so often in medicine, which is that, you know, you're a highly educated doctor. You were like a specialist in the very topic you were supposed to answer.

I couldn't get an answer.

I mean, it's just kind of the irony of it's kind of like kind of bad. And it's led you to this path of really looking at what is it to create healthy biological reproductive system for men and for women. And what are those factors that play a role? Diet, exercise, stress, sleep, toxins, and things like habits like alcohol, pot. All these things play a role and we don't really know in medicine how to tell people what to do about these things, but they are the most important things and they result in metabolic dysfunction, in mitochondrial dysfunction, which is related to toxins. And nutrition. It's related to inflammatory triggers or the, for you is gluten. So all these things are things we can actually start to double down on and look at hormonal dysregulation, thyroid things. And these are, these are, these are things that actually, like, and you write about this is there are like very early warning signs, you know, like, like if, if your tire pressure starts going down by like 1 millimeter. Yeah. You get the little flag, the little flag. It might not look like it was a problem yet. It might not be in the, like, fill up your tires, but it's like, it's starting to go down and you can track that often years and years before we even pay attention, even if it's in the quote normal range. A hundred percent.

Because it, because it may not be normal for you.

And I think we're learning more about biomarkers and we see this in function that, you know, you have to be your own control. You, you know, if your liver function tests are like, let's say 25, one of the common ones, AST, but the next year it's 40, like that's abnormal.

It's still normal.

But that's abnormal for me. It's abnormal for you. We have to allow ourselves to be our own in-of-one experiment in a way. Yeah. And really learn that we, we're going to give generalized advice based on the data that we have out there, but we have to apply it to our own body and health. And I agree, we'd rather just put more air in the tire and fix the problem than have a blowout while we're on the road, which is the pathway so many people are on.

What, uh, in terms of the inflammatory lifestyle that we're talking about, what do you, what are you advising people to do to kind of reduce inflammation? Because it seems like inflammation is connected to insulin resistance, to toxins, to mitochondrial health, like all that. So how do you, how do you kind of advise people? What when you're like, someone's coming off, say, I'm having problems with my, my fertility or my reproductive cycle. Men and women.

First of all, let's double down because you've said it a couple of times. Mitochondrial health is extremely important in how the egg is going to function. And we know that the follicular fluid— so we think about a follicle has an egg and fluid inside of it. The follicular fluid can carry inflammatory markers in it. And women who have more inflammatory markers in their follicular fluid, so a higher inflammatory burden, have more abnormally shaped mitochondria. So inflammation is directly harming the mitochondria of your eggs. Mitochondria of the eggs impact egg function, response to hormones, but they get exclusively passed on to your child. So very important for us to connect the dots for people that inflammation is not just this buzzword, but that it's significantly impacting your life and you can make a difference.

So you just said something really important. I want to gloss over the mitochondria. Mitochondria in the egg are influenced by inflammation and the mitochondria from the mother is what's passed on to the child. They don't get the mitochondrial DNA from the father. They get it from the mother, which is unusual. And when you look at genetics, everything else is half, half. So are you saying that, that the quality of the egg and the mitochondria of the egg is passed on to the child and that influences their mitochondrial health?

It does. It influences their mitochondrial health. It influences their genetic expression. And I know everybody wants to be making decisions that are going to be beneficial for hopefully their future baby, their child's health. But we've got to really bring this conversation publicly and talk about how do we influence our mitochondrial health? Because many people are still told the party line of it doesn't matter what you do, it's just luck, right?

Oh, it doesn't matter what you eat.

You know, fertility is all luck. None of this matters. But luck by definition is something you have no control over. Even if we don't control everything, you are directly controlling most of the inflammation you're exposed to, and it's worth it if you care about your health to start to break it down. So I'd love to dive into these type 5 and what I recommend. Please go for it. So the first thing that I recommend to patients, and the number one thing people are not doing in my practice, is sleeping enough. So sleep is going to be number one on the list. I have so many— I live in— we live in Austin, so we have so many patients who are healthy from the kind of like I was, and they look fine and they go to yoga class. Yeah, they declare themselves as healthy. And we go down and I talk about sleep, they'll say, oh, I only need 5.5 hours of sleep per night, that's all I need. And so we'd have to say like, hey, that might be what you think you need, that's not what your cells need, that's not enough to function optimally. So we're not just trying to get up and get through the day, we really are trying to reprogram our body when it comes to a fertility or reproductive lens. For every hour less of sleep that a woman gets, she's going to get fewer eggs in an IVF cycle. For every hour less sleep a man gets, he'll have a lower testosterone level and have less sperm. And then if either person gets poor sleep, it takes us longer to get pregnant and lower success with IVF. So this isn't just a good thing we should do, it really is foundational in how our body is set to deal with the inflammatory burden of the day. So when you sleep, inflammation levels can drop. You can obviously become more insulin sensitive in your cells because you're not eating during that timeframe. But again, for reproduction, FSH and LH are released from the brain in the early morning hours. If you are not sleeping long enough, your body's not getting to the stage where your brain is able to interpret and respond appropriately. So it's really important. Ideally, we get at minimum 7 hours. 7 and a half is probably better for women, especially in the luteal phase. Progesterone is a really energetically expensive process for women to make progesterone. So we want to make sure that we're prioritizing sleep and setting a good sleep environment. Both men and women, dark room, cool room, think sleep mask, sound machine. But also, if we have a partner, we've got to be on the same sleep schedule. So many couples have somebody they share a bed with, and they say, oh, one person goes to bed early, the other person goes to bed late. But that's really disrupting our sleep pattern when somebody's not coming to bed at the same time and getting up at the same time. And in the perfect world, this is similar. And in your circadian rhythm matters as well, right? So when it's dark outside, you're sleeping. So sleep, sleep number one. Number two is going to be stress. So we already talked about stress a little bit. There was a study called the LIFE Study, which is looking at a preconception cohort. So people who want to get pregnant, who don't have infertility, and people who had higher salivary amylase levels, a stress marker. That took them longer to get pregnant. And this was whether the man had it or the woman had it.

Salivary cortisol or amylase? Amylase. Amylase, that's a digestive enzyme.

It is, but it's also increased in stress.

Oh, interesting.

That's new for me, but that's good to know. It's interesting.

That's why I like doing podcasts. I talk to smart people like, I didn't know that.

So we want to think about how your body was made to function, which is obviously not in this world. Stress response had a very specific purpose. When your adrenal glands would make cortisol, right? Cortisol is inflammatory. But we'll use the old example of running from a bear. You know, your body wanted you to run from a bear, so it didn't need your survival from the bear to depend on when you ate your last meal because glucose coming from our food is the fuel for cells. So what happens when cortisol is released and you have stress, as you know, glucose gets broken down from the liver and goes into your bloodstream so that you can hopefully run from your bear, use up all that glucose and get back to normal. But bears are not what causes most of us to be stressed. Yeah. It's bad meetings, encounters with people, the internet, you know, bad medical news. And what we do is we internalize that stress. We don't leverage our physiology. And in fact, we do the worst thing, right? So leveraging your physiology would say, hey, I know that glucose has been released, so maybe I should do 10 squats right here, go for a very quick walk. I need to use up some of that glucose to get back to baseline. But what most people do is not that. And if we have extra glucose, our body will secrete more insulin from our pancreas. So insulin resistance is directly associated with chronic stress. If you have more chronic stress, it can cause insulin resistance. So not just from our food, but from our lifestyle or environment as well. And when we think about it this way, the fact that insulin levels being higher longer is so inflammatory, more visceral fat deposition impacts the hypothalamus or the brain's response But high insulin levels change the ovarian response specifically. So the ovaries are going to make more androgens, more male hormones, and less estrogen in the setting of higher insulin. And insulin is going to change mitochondrial function and shape when it's at high levels in the ovary. So it's not a benign hormone. It's an important one. So if we say, okay, right amount, not too much. Exactly. So we need to say, okay, if I'm stressed, I need to be in a place where hopefully I can manage that stress better, right? Go, go do something, activate your muscles so that you can use up that glucose. Glucose and not be on a treadmill. Seriously, I mean, a small walk, a few squats, a few push-ups, do something.

And jump up and down, scream.

But what do most Americans do, right? If you have a stressful day, what do most people come home and do?

Watch TV, eat food, eat food, drink alcohol.

We actually do things that are going to worsen our insulin resistance instead of improving it. And then to the last tenet here, especially for women, we, we need to build muscle, right? Muscle is really one of the keys for hormonal health because it can utilize glucose without needing insulin. It is one of the best ways to combat insulin resistance, which many, quote, healthy people are still insulin resistant. And you and I probably struggle with the fact that a lot of the lab tests to check for this have reference ranges that you and I also would not like most people to be in when it comes to are they optimal versus, quote, normal, because of population-based norms, right? So we see people who are more insulin resistant, and if they function and work on building more muscle One, they'll be able to use up more of that glucose in a better way, and that's gonna be more—

for most, it, it is such a prevalent problem. Like this insulin problem. It's, it's huge. I mean, I, I, we at Function Health, we've tested half a million people. Yes. And we've done 80 million lab tests. So, and we test insulin.

Yeah. Which I test fasting insulin in my patients.

Almost no doctors do except maybe you and me and a few others. I asked Quest, you know, how many tests that they receive are for include insulin? They said less than 1%. 65% of our members who we, we think would be health forward have high insulin levels at the Quest reference range, which is 18.

And so I want mine less than that.

And it should be, right? It should be, I think less, should be less than 5. So we're about the same ballpark. Yeah. But they're like far from 18.

So 65% are over 18.

That's wild. In fasting insulin at function, which is insane to me. That's severe insulin resistance in my book. And you know, I, I saw somebody recently, it was a woman. She had, she had like, you know, her insulin was like 70 or something, you know, like I think she had PCOS obviously. So these These are, these are things that we can modify 100%.

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It's so important because when I talk to patients and I bring up insulin resistance, the first response I always get is, well, nobody in my family has diabetes. Like, like this doesn't apply to me, or I'm really healthy. I go to yoga, I do these other things like that. This is not me. They have this idea that that's not gonna be them, or they had a hemoglobin A1C that fell into its reference range, so they think think that they are fine. But I'm like you, I check a fasting insulin and all my patients and say like, look, here's tangible proof that your body's not functioning as optimal as it could, and we can move the needle. And it's not just one thing that's going to do it, it's all of these things. And, you know, sleep, stress, and building muscle are really keys. And for young women specifically, a lot of them are not picking up weights and building muscle. We still see a lot of, you know, aerobic activity, which is not bad, but it shouldn't be all that you We see a lot of, you know, yoga, Pilates, also not bad, but we really need to build some more muscle so that we are able to combat the insulin resistance. That is how our world is really make— pushing our bodies into this insulin-resistant way. And then of course, food and toxins, which are the harder places for patients to make movement, but ultimately can make a lot of movement there. So I always say, start with the foundation: stress, sleep, and exercise. Master. And then let's talk about diet and let's talk about toxins so that you can be in the place where you are decreasing that inflammation to the degree you can.

And what does the diet look like? Diet's so—

such a hot topic for people, isn't it? An anti-inflammatory diet is one that's going to heal your gut health. It's going to improve your gut microbiome. You know, your gut microbiome is essential in estrogen metabolism. It's also that protective barrier for how much inflammation you're going to be exposed to. And we know if it is correlated with fertility rates. Your gut microbiome needs fiber, fruits, vegetables, which have lots of antioxidants, lots of fiber-rich food. Almost everybody I see needs to eat more of them. From fertility data and hormone data, yeah, more servings of fruits and vegetables is correlated with getting pregnant faster and better outcomes if you're doing fertility treatment. Core of the diet. We want to then leverage these whole foods. We want healthy fats, the olive oils, avocados, nuts, seeds. Fat is the backbone for hormones. You need cholesterol to make hormones. I still see specifically a lot of women who still go to the low-fat product just almost out of habit, or, you know, what the food industry has told people to do. So we don't want to be afraid of fats, and specifically those healthy fats. We want to leverage those. Most people need more plant-based protein. Doesn't mean you have to be completely plant-based, but plant-based protein is great because you're hitting multiple needs at once. You're going to get fiber and you're also going to get protein goals, vitamins, minerals. So a lot of people are not leveraging them at all.

And we say we're not talking about like Frankenfoods that are— no, we're not talking about processed foods, processed plant-based foods or vegan. Those are terrible for you. Those are actually worse than actually eating. 100%.

We really are limiting processed foods, including quote health foods that are processed. But we're talking about you know, beans, lentils, those legumes, soy, like things that can be really advantageous to hit on multiple markers of your health at once. And then when it comes to animal-based meat, because animal meat does not have fiber in it, we want to make sure that we're incorporating really high-quality meats. Then this is, of course, a limitation in nutritional data is that we look at certain different food groups and everything's grouped together, right? So your McDonald's hamburger is in the same food group as—

not even 50% meat, I think.

Well, so everything's kind of grouped grouped together, so we have to take it as it is. But what we know when we do look at different types of animal meat— eggs look beneficial, they're really high in choline, you know, healthy fats, so eggs are great. Fish, of course, with omega-3 fatty acids, look really lovely. People who consumed more servings of red meat had poor embryo quality, lower egg counts, and worse stage of endometriosis. Not all red meat's created equal. I tell patients you don't need to eat it every day though. There's healthier protein-based sources if we're looking at everything.

You're looking at a lot cow versus say regeneratively raised.

They're not all the same. We agree with that.

Near Austin, Texas.

But I was like, but we're in Texas. So we do have to tell people, you know, don't consume this food every single day because if you are, you're limiting exposure to the other foods in that protein category that you could get as well. But the biggest mover there is avoiding the ultra-processed foods. So no ultra-processed foods, the added refined sugars. We wanna make sure when it comes to carbohydrates, we have the complex carbs over the refined ones.

But I think people have to be careful with that cuz the complex carb thing is an older categorization. Like, you're right. White bread is a complex carb and that's just like sugar. So correct. It's more around the, you mean whole food carbs.

We want the whole food carbs and we want things that have ideally a lower glycemic index. Yeah. Meaning to eat the same food.

Sorry to pet you, but that's a pet peeve of mine.

No, that's great. We wanna be really clear for somebody who's listening what we mean by words. So having a food that doesn't cause as much glucose in your blood is going to help fight against insulin resistance. And then when it comes to thinking about dairy and gluten, more people have sensitivities to those than to other food categories. And that doesn't mean that everybody has to avoid them.

Praise the Lord. Hallelujah. Doctor's saying that. I can't believe it.

But it means that we— Wow. I recommend that if you, you know, have symptoms of inflammation or unexplained anything, or you're trying to optimize, be your own doctor. Own CEO of your health, you should give yourself the time to remove that food group from your diet. Mhm. You know, eat really, eat really anti-inflammatory, remove gluten and dairy, and then you do a trial of introducing it back in, and you'll notice the difference. That's great. If it causes inflammation in you, you will know, and then that's not a food that you should be consuming because it's not good for your individualized body.

Right. So the idea is like, if an elephant's been standing on your foot your whole life, you don't really know. You don't know. When the elephant gets off your foot, you're like, oh, I feel better. And then when it steps back on your foot, you go, oh, ouch. Exactly. And that's what happens. That's a great analogy.

Cause I don't eat gluten obviously now, but if I get exposed to it somewhere, like now I will have terrible stomach, all my inflammatory symptoms. Like I'm so aware of it because now I know how well my body can function without it. And I'm much more aware of what happens when I am. But you might've said, I've eaten gluten my whole life. How could I be allergic to it or be sensitive to it? It. It's really that you've been accustomed to such a high level of inflammation every single day. You're just not aware of it anymore.

And that's, you know, you know, I, I'm doing functional medicine for 30 years and I realized that there was a way to reset people by a short-term kind of reboot with a more extreme diet that removed all processed food, all the sugars, dairy, gluten, and just focus on whole foods. And I call it the 10-Day Detox diet. And it is unbelievable. Like, I, I, I, it's almost like a miracle.

I do a very similar thing in the book. I take everything down to whole foods. Then we do a little trial, couple weeks of add back in, remove it again. If you were sensitive to it, you know, try again and really helping give people— I agree, you will change your life. How many people though are sensitive? So many more than you think.

That long. That's why it's 10 days. You just remove it for 10 days. You know, we see a 70% reduction in all symptoms from all diseases in 10 Whether it's gut issues or mood issues or sleep issues or joint issues or skin issues or whatever it is. I had a guy come up to me at Cleveland Clinic and he said, Dr. Hyman, I did the 10-day detox that I have rheumatoid arthritis.

It went away. Is that possible?

I'm like, yeah, it's possible because you have it, you know, like, and another woman with like depression on psychiatric medications and not a psych hospital their whole life. She's like, I, I'm not depressed anymore.

Once you know how well your body can function, like it's a lifelong change for you.

Yeah. So it's important. I think what you're saying is important. And yes, stress, sleep, and muscle is key, but diet is—

you can move the needle the biggest on diet for most people, right? Even if they are quote healthy, when we start really looking at healthy, because we touched on it but didn't, processed foods can masquerade as health foods as well. You often get a double hit from them because a lot of the food wrappers do have some of those toxins in them. So you're getting inflammation from toxins, you're having how it's processed, it's directly causing inflammation.

So we didn't really, we didn't really hit on this, but I think, you know, I'm sure you talk about it, which is that the environmental toxins, it's not just toxins are bad, they are hormone disruptors. Correct. And they're, they mimic estrogen and they're combinatorial. In other words, it's not like 1 1 2. They might 1 1 1,000. And so they really screw up hormones in a, in a way and screw up fertility. So can you talk about that?

They do. And I have a whole chapter on toxins cuz I'm so passionate about it. When it comes to environmental toxins, there's different categories. We've got endocrine disrupting chemicals, heavy metals, plastics, behavioral toxins, and they are all impactful in different ways. The category we're most afraid of is the endocrine disrupting chemicals. Like you said, they actually— each chemical works differently. They can work at the thyroid, the brain, the ovaries, the adrenal glands. They can cause early puberty, early ovarian failure. They really can disrupt just from your day-to-day life, your ability to get pregnant. And more concerning is many of them live in your body forever and can get passed on, then get passed through the placenta, and they can impact your child as well. This And this isn't fearmongering, which is the narrative I get from colleagues sometimes, that toxins are everywhere, you can't control them, and you're just scaring people. I think people are brilliant and they can make good decisions if they have that data in front of them. So we want to really look at these endocrine disruptors, which some of the top categories come in plastics, in fragrance, and then in the PFCs can come in our water actually, and in some of our cookware exposures. So here's my recommendation.

And skincare. Oh, yep. So, and household cleaning products and our food.

When it comes to toxins, we wanna look at your home first and foremost because that's where you spend most of your time and you can move the needle the most. Let's look, let's just go through it very quickly. Your kitchen. So plastic doesn't deserve a place in your kitchen. You don't need any plastic.

Plastic cutting boards or Dara Wallach.

I was gonna say plastic cutting boards. Exactly. I was gonna say that's one of those things that a lot of people have just held onto it.

We really want plastic storage container, plastic storage.

I mean, think about a cutting board. You're cutting your food, getting on your knife and literally putting it back into your next food. The plastic storage containers and then kid products, plastics, cups, plates, bottles, To the degree you can, we'd rather see stainless steel and glass and then wooden for cutting boards being better options. Is silicone okay? Silicone's okay. For the data we have right now. For babies. For babies, it's going to be a much better choice than plastic is going to be. I prefer glass bottles and then stainless steel for plates. But, you know, we make the best—

I'm not having a grandson. I'm asking for a friend.

There's a great company that makes stainless steel kid, like, eating ware too. That could be amazing.

All right. Thank you.

I'll get that note on that after. But a good example is, you know, I remember getting really upset because my daughter water. I was actively doing research on the perfluorinated chemicals in fellowship, obsessed with how there's so much data how bad for us they are, how they are forever chemicals. The PFAS, remember? PFAS is one of them. And that we didn't know about them. Nobody was talking about them. And, you know, getting rid of the Teflon, not touching thermal paper for receipts.

Credit card receipts, gas station receipts. Oh, just don't take a receipt.

Don't— you don't need it. And yes, is one single touching a receipt going to make a difference? No. But we have these repeated exposures. And let's think about people who maybe are a cashier and you're touching a receipt all the time. Wear gloves. Yeah. Right. You're somebody who's has a higher risk. Yeah. We wanna really reduce that. But I remember being postpartum and really upset thinking we had glass bottles at home, but we had to take plastic bottles to daycare. And you know, this is where we say we control what we can cuz we can't control everything. Right. Yeah. So really the sneaky sources in our kitchen, plastics, and then especially when plastic gets hot. To-go food containers. So if you're ordering DoorDash and it comes to your house, that container is often going to be very toxic laden with some of these chemicals. And, you know, we're all going to order to-go food at times, and we can't control that exposure. But what we can do is put it on a plate immediately or put into glass storage if we need to keep it warm. And many people I know will eat it out of that container. They don't want to do dishes that night, but we need to be making the choices where can. You mentioned fragrance, and this is a big one and a pet peeve of mine. Consumers need to understand that here in America, we don't have protection or regulation against many chemicals like other countries do. And in fact, we have the opposite, where people love to make money and we have misleading marketing tactics as well. Fragrance often has phthalates in it, and this is why so many of us are talking about limiting fragrance where you can. But there's a big difference in product labeling and unscented and fragrance-free. Fragrance-free means that there is no fragrance in this, no added fragrance. It does not have fragrance. Unscented means it does not have a scent, but we can put a scent in to mask a scent to make it— I see.

So it's like it zeros it out, but it's—

Zeros it out, but it's toxic for you.

Wow, that's sneaky.

So that's sneaky and something we need to—

It's like gluten-free Lay's potato chips. Right.

Hairs is one of those things. I liken it to the gluten-free fries, but they're put in the fryer with all the other fried food, right? Labeled like it would be good for you, but in reality, if I ate that, it's causing a huge inflammatory burden in my body. So if you're trying to get laundry detergent or bath products, shampoo, conditioner, and it says unscented, instead we want to go to fragrance-free. That's where we want to choose instead. So there's little things, and I have some comparative charts in here so that you can look at your products and say Is this something that is going to be okay? Is this safe? Does this have hidden toxins? Because we don't have this language. We're not taught this yet.

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You can, you can put in your product and you can see its score, what's potentially in it, and you can search for other ones that can be better options. All right.

Well, I'd like to wrap up by talking about sort of the next cycle, which is aging and reproductive health and perimenopause and how, how you've made a connection between fertility fertility and aging? How, how are those linked?

Let's think back to my favorite analogy of the vault. So you're born with all the eggs you're ever going to have. Every single month you have a group of eggs coming out of that vault. We already talked through how one of them ovulates, the rest of the eggs die, and the next month you have another group. What's really fascinating is that when you have more eggs remaining, or generally you're younger, more come out of the vault every month. And as we start to get older, fewer eggs come out of the vault every month. In every woman, you will be out of eggs. That's menopause, right? Ovarian failure. You're out of eggs. The ovary now can no longer respond to the brain signals. But we also talk about, for fertility specifically, but also for female hormonal health, it's not just having eggs, it's the function of the ovary that is so important and its ability to respond to the brain signals. And this is where inflammation, fibrosis play a huge role. Chronic inflammation and insulin resistance can actually get into the vault and decrease the number of eggs you have, if you have an autoimmune disease, if you have a chronic inflammatory disorder, if you smoke cigarettes, these can get into the vault and decrease the number of eggs. You will go into menopause early. In the fertility lane, you'll go get a test diagnosed and you'll be diagnosed with a low egg count, which is good for women to know. They may make different decisions about this, but the next step of that that so often patients aren't told is if you have a low egg count now, you're going to go into ovarian failure early. And we know that ovarian failure the earlier you go into menopause, the higher the risk of these same health outcomes that are associated with if you have infertility. It's this underlying cellular health, how proper estrogen production is so crucial for fighting inflammation and for day-to-day function for women.

Because if you have premature menopause, you get more heart disease, more cancer—

heart disease, cancer, stroke, metabolic syndrome. Exactly the same things that we see higher rates rates of, even if you just have infertility. So there's such a tight correlation with chronic inflammation underlying what is going on and how protective female hormones are. So it's these same tenets of doing what you can do is, is one way that we can help our ovaries function longer, right? Thinking about ovarian health, not just going through menopause and perimenopause and making the experience better, although that's one piece of the puzzle, but also So how long can I get the ovary to last? How can I improve its function? And the ovary has a job that's not just ovulation. It still functions even when you're out of eggs and still makes hormones, just differently. And interfering with that process is impactful for your health, your life, and your inflammation. So these 5 lifestyle principles that we're talking about, that's so important to start looking at earlier. I'm a huge advocate for women checking their ovarian reserve, getting an AMH blood test, which function does—

part of our function panel.

I talk about it all the time. Because I mean, this is important.

Most doctors don't even know what that is.

Well, actually, Mark, the American College of OB-GYN, ACOG, recommends that you don't screen AMH in patients. I'm adamantly opposed to this. They say unless you have infertility, women don't need an AMH level. Their reason is that it's not associated, doesn't cause infertility, which maybe, maybe not true because if you have a low egg count that's due to endometriosis, for example, people that absolutely can contribute to infertility. But we'll say it for sake— two equal women, one has a low AMH, one has a normal. They say it's too difficult for a woman to find out she has a low AMH and too stressful when it's not known to cause infertility. But that woman who has a low AMH, one deserves an evaluation for why, might find something that's going to change her life. Maybe she'll take out gluten, get her Hashimoto's treated, get surgery for endometriosis but also she very well may make different decisions for her family planning. She might freeze eggs, embryos. She might try for a family sooner. You know, my husband and I were together for a very long time before we started trying for a family, and we could have started earlier. I was waiting for this perfect time in medical training that doesn't exist. She may do nothing, but then she's the one who makes the decision. Maybe she says, I'm not ready for kids, but I'm going to change how I eat, and I'm going to look I'm gonna look at all these lifestyle principles so that I can do what I can for my egg quality and my ovarian health outside of it. Yeah.

I had a, I had a friend who was a, did function and here she, she was about 32 and she had very low AMH and she's a vegan. I'm like, and she also had all these, all these other nutritional deficiencies that we found in her labs. And I'm like, hey, you know, probably not a good idea for you to eat that way.

You probably wanna, yeah, it's a, it's a biomarker for your ovarian health. And her AMH went up. It's not a perfect marker, right? A lot of our biomarkers aren't, but we've gotta leverage the data that's available to us. Yeah. And those are tools. It's a tool in the toolbox. And I think it's unfair for women to say, don't get it checked, because it can highlight decisions you might make now that are different, how you approach your family building, and then also how you think about perimenopause and menopause, because everybody will go into ovarian failure. Everybody will go through perimenopause or the years before ovarian failure where your hormones are becoming more dysfunctional. The brain-ovary communication is worse. Decreasing inflammation will be a big piece to manage that puzzle. But also, it's not normal to go into perimenopause in your 30s. It is possible because women do go into menopause early, but that's highlighting an underlying mechanism that needs to be explored. So just because something will happen to you, understanding what can influence it happening, how you can delay that to the degree you can, and then if it is happening and you're 35 and you say, I have all these symptoms of perimenopause, you need to get evaluated for a bigger picture. What, what I do dislike right now is this idea, well, that's just perimenopause and just deal with it, because that same person may actually be going through perimenopause, but maybe it's her Hashimoto's, her autoimmune thyroid disease that depleted her egg count, causing her to go into perimenopause early. And we need to treat that also.

That's so true. And everything you're saying is so important because the very things that, you know, affect the biomarkers biomarkers of fertility also affect the biomarkers of longevity.

Exactly the same thing. It, for young women, it is that first glimpse into your cellular health. And if we want to think about ovarian longevity as an important life goal for women who want to live long and healthy lives, if we can get women to start paying attention to this younger in their 20s and 30s, we're going to have a new generation of women. I agree.

And I would also just make a shout out there for guys, for men, because, because we did focus female here. Yeah, we could do a whole nother on men. The thing about sperm is that it also is a vital sign. It is increasingly becoming a problem for younger and younger men. I completely agree.

And we can look at it. And for men, even more so— I cut you off— but more so than women, takes 90 days to generate new sperm. You can actively see how making one change can completely change their sperm parameters and improve their overall health as well, because sperm and testosterone are made together. So often I'll have young men, you know, hear something I say and they're like, well, I don't want to get pregnant, so I'm okay if it hurts my sperm. Sperm count. Sperm and testosterone are made together. So surely you want to have normal testosterone because that's vital for men. And just like we talked about estrogen being made for women, chronic inflammation comes in and interferes with testosterone production in men. So all these same principles are really crucial for men to feel their best and have their longest, healthiest lives as well.

Absolutely. So this is such a great conversation. Your book, The Fertility Formula: Take Control of Your Reproductive Future, is for both men and women. Yes. I think it's important for guys to think about this too. I think, you know, you really have a lot of great resources out there. Um, tell us more about your practice, about your website.

Yeah, I practice in Austin, Texas, so I own Fora Fertility, which is a small— F-O-R-A— small physician-owned practice. There's two of us there, and we really try to have more personalized fertility care for patients, not just this reactive model but more proactive. And then you can learn more about me on Instagram at Natalie Crawford MD, or the website's nataliecrawfordmd.com. Thank you for what you're doing.

Thank you for seeing the forest for the trees. Thank you for discovering that all the things that I've been talking about for 30 years are actually a thing now. It's like, it makes me so happy cuz you know, for so many decades I was out there in the wilderness and no one was talking about mitochondrial health or inflammation or the microbiome or insulin resistance or any of these things that are so fundamental to everything, everything, every single day. So we could be talking about dementia, we keep talking about cancer, we could be talking about heart disease or diabetes.

We'd have the same conversation. Yeah, everybody's saying the same underlying factors across all body systems. And hopefully that helps, you know, make the message even more impactful.

Well, thank you so much. Thank you. Thank you.

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