EAT THESE FOODS To Improve Your Health & Balance Your HORMONES | Sara Gottfried & Mark Hyman

Why would we normalize it? It'd be okay for women to have.

All these hormonal dysfunction. Many of those symptoms are biomarkers of something much more serious.

You know, the thing is when I.

Think about my patients who have all.

These hormonal dysregulations, you know, the sex hormone in particular and insulin, it's even the stress hormones, you know, it's our diet that's super high in sugar and starch, you know, so carbohydrates are okay, but where are you getting them from? Are they whole grains? Are they beans? Are they vegetables? Are they fruit or is it flour and sugar? That matters. I think caffeine is another huge one that often adversely affects menstrual issues and hormonal problems. Alcohol is a huge one. I remember reading a study years ago that showed that if you were drinking alcohol and you were taking hormones, with Premarin for example, you would get toxic levels of hormones in your blood that cause cancer and other problems because of the alcohol. In fact, I think another study I read was women drank one glass of wine a day. which is not that much according to some people, it increases your risk of breast cancer by 40%. That's staggering and it has to do with how it affects estrogen and hormones. So you've got all that and then you've got all the crap in food, all the hormones and dairy. That's a big one. Dairy, I think, is a huge one for people. And I think a lot of women with hormonal dysregulation get off dairy and they feel better and there's 60 different hormones in milk including growth hormones and estrogens and progesterones. And as not to mention test, not to mention in antibiotics. So you've got all these things in our diets pretty typically that cause all these issues. And then, of course, there's all the hormone disruptors that you mentioned, the pesticides, the herbicides, all the Plastics, phthalates, PCBs, dioxin, Phenom, you know, those are all flame retardants. They're in everything and everywhere, and it's hard to get rid of them. So those are all collectively causing problems. And then the stress, obviously, of how stress affects the hormone Cascade, because stress is one of those hormones that connects everything together. And so you end up with this big kind of lifestyle environmental soup, not to mention the fact that only 8% get enough exercise and sleep is sleep deprivation is massive. You add all these things together and it's no wonder women have so many hormonal dysregulation issues.

Well, that I would say women are more vulnerable to them. So I think in some ways, especially for women who are still cycling, but also true for women in perimenopause and menopause, that our hormones get out of whack more easily than what we see with men. And we know that from looking at, you know, if you just look at estrogen, which is the master regulator in the female body, the primary regulator, the kind of changes that women experience during the menstrual cycle and then in perimenopause are really steep and they're quite sudden. They're much more abrupt than we see with men and testosterone as an example. And I'm so glad you raised alcohol because, you know, I read the same data and I think it's important to realize that the glass of wine that you're having every single night, you're treating something with it. You're treating stress, you're trying to, you know, kind of settle your nervous system. At least that was the case for me and for many of my patients. And we know that three servings a week is associated with an increased risk of breast cancer.

Yeah.

So as you described it, it creates more of what I think of as the Homer Simpson type of estrogen molecules, the ones that we don't want. you want the benevolent type of estrogen molecules and you're not going to get that from alcohol.

No, it's true. And I think, so when you begin to look at those things, that's the first place people start with their lifestyle and diet. And I think you talk a lot about it in the book. And there's also not just what not to eat, but there's what to eat, right? So can you talk a little bit about what are the hormone balancing foods.

That we should be eating? Well, they're the things that help you with your hormones. So that includes making sure that you're getting healthy fat. So my recommendation for four weeks is to increase your healthy fat so that it's about 60 to 70% of your calories.

And, you know, 60 to 70%.

60 to 70% of your calories per day. And this is for a few reasons. We know that fat is the backbone of hormones, the sex hormones, as we described. It also helps with decreasing gastric emptying, so it makes you feel fuller, it helps you with satiety, It's part of this process of nutritional ketosis where you make ketones, you feel more satisfied. But when you combine that with dialing in your carbohydrates. So what I really like for patients to do, for people who read this book to do, is to get your carbs so that it's less than 25 net carbs per day.

It's low.

It's low, but if you're really eating carbs that are from vegetables, and you've got that fiber that comes with the vegetables, especially the cruciferous vegetables, broccoli, cauliflower, radishes. And you've also got those methylating vegetables that help you to inactivate the Homer Simpson type of estrogens. You know, that's what really allows you to get into nutritional ketosis. And that's the protocol that's in the book. And then the remainder is protein, a moderate protein diet. about 20% of calories from protein.

Yeah, that's really quite different than the American diet, which is kind of the opposite, right? It's about 60 to 70% carbohydrates that are mostly starch, refined processed foods and about 20% protein or maybe 20% fat. So that's a big shift and I think it creates a lot of changes for people. Not only will they lose weight, but they have mental clarity, more energy, they'll build muscle, they lose body fat, They'll build bone density, they'll reduce inflammation, everything gets better, right? And it's-- yeah, I mean, the SAD.

Diet gave me prediabetes. It just-- it doesn't work in terms of metabolic health. And so, you know, the work I do is precision medicine. I think it's important for us to be thinking in terms of how to personalize diet. So nutritional ketosis is not for everyone. But for people to try it for four weeks to see how sated they feel when they're producing ketones where they've got that mental acuity from this particular set of macronutrients, and then to see the metabolic flexibility that it creates so that you can flip back and forth based on the type of fuel available between burning glucose or carbs and burning fat, depending on what you're eating, what's available. that's what really works for people.

Can you talk about this idea of metabolic flexibility? Because I think it's fascinating and I think it's something we really don't talk much about.

Yeah, metabolic flexibility, I think of like a hybrid car. So, you know, one of my first hybrids was a Prius and you could flip back and forth between burning gas or burning electricity. Yeah. And the body is very similar. You can either burn carbs, which I think of like gas, Yeah. Or you can use the electricity pathway, which is burning fat. And so, of course, the fat is more renewable. We've got more of it. And so, what's important for folks to realize is that you want to toggle the switch back and forth depending on the type of fuel that you have. So, you know, for me, this morning, as an example, I haven't had any food yet, and I'm burning fat. So I've got ketones. I feel satisfied. I don't feel hungry. I've got mental acuity. I'm able to focus. And that's hardwired into our DNA. Now, when I was eating more carbs, what I found was that I was hungry when I first woke up in the morning. I had more sugar cravings. My insulin was out of whack. It was too high. I was stuck in fat storage mode. It just didn't work very well in terms of trying to live the deep life that I want to live.

Sure.

Yeah.

So you get all out of balance. And, and, you know, the, what's interesting is that, you know, the, the sort of we talked about a little bit, but the cocktail of hormones that go awry in women's 40s and early 50s is, is really not well recognized. And that is the sort of the, this, this soup of hormones that get out of balance, including stress hormones, cortisol, the sex hormones like estrogen, progesterone and all the other hormones related to sex hormones, thyroid. and insulin. And so that, that is a, those are very subtle things to play with in the body. And, and yet they respond really well to lifestyle, to the right supplements, to fixing your microbiome, to just tweaking everything, reducing toxins, detoxifying. I, i think one of the things you talked about earlier was really important, which is there are certain foods which we know help with hormonal regulation and balance. One of them is the brassica family of cruciferous vegetables. You mentioned that, but I don't want to sort of gloss over it. It's really important. I think women should probably have a cup or two a day. of broccoli, collards, kale, cabbage, Brussels sprouts, that whole cocktail of vegetables because of the compounds, the phytochemicals they contain that help regulate estrogen metabolism and sort of de-risk your estrogen from being a carcinogenic type of estrogen to a more healing, beneficial type of estrogen. And, I think also the same thing is true around insulin and blood sugar. When you start to sort of get into the trouble with that, you've got to really do what you're saying is shift your diet towards more good fats and less starchy carbs. So we kind of know that if we kind of work on all these things that actually women can really, really get rid of these symptoms.

You can. And, you know, I think there's a few interesting areas related to this topic. One is that I was taught when I went through my training that the symptoms women start to experience after 40, you know, the difficulties sleeping, the night sweats, the hot flashes, those are these inconveniences that could be medicated with hormone therapy in the right candidates. But now what we're actually learning is that many of those symptoms are biomarkers of something much more serious, which is dysfunction of blood vessels, endothelial dysfunction. It's a biomarker associated with bone loss. And so it becomes much more important, I believe, to get these hormones back into balance, starting first with diet and lifestyle. Another piece that's really essential is that having large blood sugar excursions, which was my story until I figured this out in the book, that can trigger hot flashes, night sweats, mood swings, many panic attacks, many of the things that women are starting to experience in their 40s. So the more we can dial in that metabolic health piece, Along with balancing these sex hormones, the better off women are.

It's, yeah, it's so huge. And I think we really just come to understand that, that, these are not normal things. They shouldn't be normalized. That women aren't, aren't just sort of relegated to being called hysterical, which is the, I hate that word. It's like, it basically comes from his hysteria, which is the uterus, right? Hysterectomy and hysteria are not unrelated. I hate it too.

I mean, I love it.

Oh my God, it's terrible. Why we normalize it, it'd be okay for women to have all these hormonal dysfunction and not actually get to the root causes of it. So it's really not normal.

Like 75% of women have some time.

Of PMS and 85% women have some type of hormonal issues in their life. Why is this happening? Why has it been so normalized? And what are the root causes of all this hormonal dysfunction? And what is it?

Well, I would say the days of normalizing this need to be over because women are suffering unnecessarily, as you just described. There's a lot of different hormone issues at play here. One is cortisol related to toxic stress. It can be high, low, a combination of the two. Another hormone that gets out of whack is thyroid. So thyroid pause especially affects women about sevenfold more than it affects men. And that is a common cause of weight gain and hair loss and many of the things that women face. And then as you described, estrogen and progesterone often get out of whack. That can be related to just the cycling years, the reproductive years. It can also be related to being postpartum. And then perimenopause is when a lot of this becomes a perfect storm of many of these hormones out of whack. Insulin's another important one because so many women notice, especially after 35 or 40, that insulin's just not on their side the way that it once was. They become insulin resistant, which I think of as insulin.

It's not on their side, but it goes to their tummy.

That's right. It goes right to the side.

It's in the middle.

Exactly. Exactly. And, you know, I think there's a few issues at play. One is the way that our world is changing. It's related to stress. It's related to unrealistic expectations. It's related to over functioning and trauma, which we know affects women more than men. Men are still affected, but women more so. It's related to the food that we're eating, the way that our food has changed, which you talk to so brilliantly. And it's also related to the fact that physicians are not taught about this, right? Like I wasn't taught at Harvard Medical School about this. I imagine you weren't either.

No.

We were taught to hand over a prescription for a birth control pill or maybe hormone replacement therapy once a woman was peri-menopausal. and that is no solution because it addresses symptoms, it does not address the root cause.

That's right. And functional medicine and the perspective around functional medicine hormones is so rich and developed and allows us to understand one root causes, but also all the variables in our life that impact our hormones and how to regulate and change those to create balance, whether it's adrenal and stress hormones, thyroid hormones, sex hormones or insulin and And your book, Women, Food, and Hormones really helps us to map all that out in a way that gives women a toolkit for how to fix all these problems.

That's right. I mean, this was born of me struggling myself with almost every hormone imbalance that you can imagine, and also struggling with my weight. So unlike you, Mark, when I was sitting down and writing that first book, I gained about 25 pounds. I've never seen it fluctuate very much. I don't know. Is that true?

I go up and down. If I go off the reservation, like I was in Italy this summer and I was just eating bread and pasta and drinking lots of wine and I gain about five pounds in a week. So I can put it on if I go off the tracks and I actually lost weight from being sick. But my weight can go up and down, but mostly it's pretty stable.

Well, it sure seems stable. And we know that women have this asymmetric response to stressors to food, you know, so many of us will gain weight. And there's, you know, there's an evolutionary bias for women to gain weight rather than to lose weight because it helps us with fertility. It helps us with pregnancy.

Yes.

So, you know, for those of us who are trying to fit into the clothes in our closet, that can present some problems. So my own struggle with weight, my own struggle with hormones became really the basis of the books that I've written. So I'm a case study as well as someone who's really curious about how do we get these hormones into balance, especially with targeted lifestyle changes starting first with food. And then how do we, you know, how do we get out of that place of misery around hormone balance? Because the truth is, it's so much easier to get your hormones back into balance than to live with the discomfort, the misery of them being out of whack. Yeah, it's true. And I think the beautiful thing about.

It is that the solutions are relatively straightforward and yet you're not hearing about them. And I think that the suffering around hormones is quite extreme. I mean, it's irregular periods, it's heavy periods, it's PMS, which is a whole range of symptoms from breast tenderness and fluid retention to diarrhea, migraines, fatigue, mood changes, sleep issues, that can be quite debilitating. And they treat it now, they call it PMDD, which is premenstrual dysphoric disorder. They treat it with a version of Prozac. Essentially they change the name of Prozac to some other name and then they use it for PMS. That's not the solution. And even with postmenopausal symptoms and perimenopausal symptoms, those are often exacerbated by the things that are driving hormonal imbalance. So I'd love for you to talk about what are the things we know that drive hormonal imbalance. And then we'll get to what we do to fix those hormonal imbalances. Because I think we know a lot about whether it's food or lifestyle or environmental toxins. Talk about the things that really drive women's hormones out of whack.

Well, you got it. I mean, I would say food is one of the primary drivers. And that includes not just getting sufficient fat, which is the backbone of the sex hormones that you make. It's also getting the right dose of carbohydrates for you, which is so important when it comes to insulin and leptin and some of these other hormones that are involved in fat storage as well as satiety. Getting the carb dose right, also getting the protein dose right. Dialing in these macronutrients becomes incredibly important. A big part of what was behind this book was that I was struggling not just with weight gain, but with a loss of metabolic health. That's something that we know affects about 88% of Americans right now. 88% of us are metabolically unhealthy. Many of us don't know it. So it's not just about the bathroom scale. It's not about diet culture. It's about becoming metabolically healthy. And the hormones are such an essential part of that. So as you described, food, stressors, especially toxic stress, you know, I think a lot of us going through the pandemic had an experience of toxic stress. Some people had weight gain associated with that. There's the changes, there's environmental toxins that we get exposed to that are endocrine disruptors. The root causes are something that many of us encounter. The solutions are not what mainstream medicine is really taught to manage. You talk about how we don't want to normalize this. And what it reminds me of is that analogy of the frogs in the pot on the stove where you very slowly turn up the heat and the frog doesn't jump out because it's so slow and imperceptible. And so I don't want women to just sit back and say, oh, my doctor checked my labs and said, I'm just getting older. Like, don't settle for that. Don't be dismissed. There's so much misunderstanding about this. And so it takes us taking our health into our own hands and saying, okay, this is not how I want to live my life after 40. I want to change things.

Definitely not. And the things that we also talk about in terms of how to change things in terms of diet. So there's questions that people have about soy foods and I think about flaxseed. You know, a lot of people say soy is bad for you, it's going to cause hormonal dysfunction and it's an estrogen. What's your take on that? Because I think there's a lot of controversy about that.

There is a lot of controversy. I think the problem is with GMO soy. So I think that You know, you can go overboard with even whole foods. My general feeling is that some of the benefits associated with soy, with phytoestrogens like flax, outweigh the potential risks of them. I mean, you have to be cautious about getting the dose right. But for the most part, I think having whole soy in your diet once or twice a week, having whole flax in your diet a couple times a week is very healthy for you. It's not really the whole foods that we're having a problem with in the US. It's those processed foods, the ultra processed foods, the foods that are genetically modified. Those are the ones that are causing problems with hormones, not really the whole foods. Same thing with goitrogens. I always get asked about, well, what about the brassica family? Is that going to slow down my thyroid? So you lightly cook them. That reduces the goitrogenic effect. I've looked at the data. I've been underwhelmed. by the data really showing a significant impact on thyroid function, you get so many benefits from eating these foods that I think once again, the benefits outweigh the risks.

It's so true. I think people like, and what cracks me up is a lot of doctors who treat cancer patients, breast cancer patients will say essentially that they shouldn't eat soy food because they're worried about cancer. And yet they say, that it's okay to drink alcohol and to eat sugar and.

And to have some sure. If you're losing weight, having sure.

Oh, my God.

Yeah.

It's crazy. It's really crazy. So I think. I think what you're saying is important. I want to come back to the glucose thing because you mentioned the changes in blood sugar and glucose. They also affect hormones. And we know, for example, in men who eat a lot of sugar and starch, they tend to get more estrogens. They tend to get breast enlargement or, you know, man boobs. They get lose the hair on their body, they get big bellies, they get soft skin, and it's because the fat produces estrogen and the fat is laid down because of high insulin. And so you discovered a lot by using the continuous glucose monitor, which is really a kind of a new advance in actually personalizing medicine, what you call precision medicine. And, you know, you are an advisor to the level, so am I in terms of this company that is really driving the space around looking at our own blood sugars in real time and how different foods affect it and how we can modify our diet to actually keep our sugars in balance. So what did you learn from doing it yourself and why is it so important for for estrogen and hormone balance in general?

I'm a huge fan of continuous glucose monitoring. You know, the great thing is that you don't have to have a continuous glucose monitor to benefit from monitoring your glucose. You could also use just a $25 glucose meter to get some of the same data. It's not quite as dense or comprehensive. But I had a lot of surprises. I started wearing a continuous glucose monitor about four years At the time, I had pre-diabetes. My fasting glucose was about 105 to 110. And, what I discovered was that many of the foods that I thought were healthy were giving me these massive excursions with glucose, things like beans, chickpeas, legumes, sweet potatoes, apples. A lot of apples. We're just making me spike so high. Grapes. peaches. What I had to do to reclaim metabolic health was to really dial in my food plan and to avoid some of those foods that were spiking me to the diabetic range. And I found that that really helped. So a big part of what I learned as I dove into the literature for this book was that you've got a few choices for metabolic health. One is to go 100% plant-based. And there's a lot of evidence behind that. And what I discovered myself was that being 100% plant-based was not the best fit for me. I started to lose muscle mass. I'm someone, I'm Jewish, I'm hungry all the time. And so 100% plant-based just didn't work very well for me.

Wait a minute, wait a minute, wait a minute. When you're eating the way you're now, you're still Jewish and you're not hungry all the time. So I'm not sure that logic flows, Dr. Godfrey.

Well, I have to say, keto saved me. So going on a ketogenic diet, May my blood sugar go from severely spiky, which you don't want, to a lovely flat line where my mood is more stable. I don't have anxiety anymore. I've got this feeling of like, oh, like the angels are singing because I can focus. I don't have this jacked up glucose every day. So, you know, 100% plant-based or a ketogenic diet, that's what I found. in the literature to be the most evidence-based way to reclaim metabolic health.

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Check it out and the link below. But you know, often a vegan patient starts to change their hormonal pattern, they stop menstruating, they also... they do. issues. So how do you sort of explain that?

Well, what I see with a lot of folks who are vegan or 100 plant-based is that they don't often get sufficient fat. So fat is so important. We talked about how it's, it's making the backbone of your sex hormones. Your body goes from pregnenolone, cholesterol to pregnenolone, the mother hormone of all your sex hormones. That then goes on to make a few other hormones that are so important for your health. And so what I see with a lot of vegans is that they're not getting sufficient fat. They're not getting the extra virgin olive oil, the avocado oil, the nuts, the seeds that they really need. Sometimes they're eating too much processed food because we know there's a lot of vegan processed food that you think might be healthy, but it's not necessarily.

Oh boy.

Yeah.

So I think that's a really important piece to understand. And the great thing here is that you can personalize. you know, you can use devices, wearables like continuous glucose monitoring or using a glucose meter to see what sort of food is the best fit for you. You know, what I discovered was that nutritional ketosis or ketogenic diet adapted for women, so with sufficient carbohydrates to keep my thyroid working, to make enough serotonin, to avoid raising my reverse T3, to help me with not raising cortisol too excessively. That's what worked really well for me. And for hundreds of patients who followed after my protocol.

Now, you mentioned, you know, muscle mass as being key. Can you talk a little bit more about that in relation to hormones and particularly sex hormones for men and women and also cortisol and growth hormone, which insulin, which are all affected by your muscle? which people don't think of as important. I mean, people think, I'm gonna get my heart healthy, my brain healthy, and get my joints healthy, but no one's like muscle. But muscle is actually the currency of health.

Muscle is the currency of health. You know, I think I was taught a model that was very disease centered, not health centered. And, you know, the work that you and I do, I think, is turning the ship so that we can be more health centered. And a big part of being health centered is to make sure that you preserve your muscle mass as you get older. So we know that maintaining your muscle mass, maybe even growing it as you get older, is one of the most essential markers of health span, that period of time that you feel fantastic and relatively free of disease. So one of the things that I found when I was on 100% plant-based diet was that I was losing muscle. And, you know, yes, I had a high-stress life. I think cortisol was part of this story. So high cortisol can be associated with breakdown of muscle. But the other thing to think of with insulin and with blood glucose is that the math comes out to what are your inputs? So what are you eating? But also, how are you disposing of that glucose? And that's where the muscles become so important.

Yeah, right. I mean, it's interesting is a muscle is really where your metabolism is. It's all your mitochondria. And as muscle goes down, your insulin goes up, your blood sugar goes up, your blood pressure goes up, your cholesterol goes up, your, you know, sex hormones go down for, for, in terms of testosterone for men, growth hormone goes down, cortisol goes up.

So you got this whole soup of.

Hormonal change that is characteristic of rapid aging.

Yes.

Sarcopenia. Yeah, so I think it's, you know, I've come to really appreciate it more. And I always talked about exercise and strength training, but I was kind of lazy and I never did it. Well, I like things outside.

I started to put in the time, I have to say.

Well, even after, I mean, even after, I like yoga, I like tennis, I like biking, I do other stuff. And I was pretty good cardio, I might have them right. And yoga's good. But actually, it wasn't. And I actually started doing strength training.

About a year and a bit ago.

And my body has completely changed. I'm going to be 62 shortly. And I just, it's amazing to see what happens when you start to actually use your muscles as they were intended to be used. And unfortunately, we have to do strength training now because we're not living lives. We're actually active and carrying and moving stuff around and actually using our bodies. So we have to do it. But it's just amazing. It's made me feel better, more energy. It's helped my metabolism. It's helped my, my whole way of moving through space and life and the ability to do stuff and have fun, so. I don't find myself declining at all. I find the opposite is happening. I'm planning on going skiing, helicopter skiing, which is obviously a big luxury, but I've been dreaming about it my whole life and I'm always terrified. Well, can I do it? Am I strong enough?

And now I'm like, I can do anything. Which is pretty amazing. Well, that's such an inspiring message because the truth is it's never too late to change the way that you move. And what you've done with strength training You know, what I imagine is that you probably have increased your muscle mass, your lean body mass, and that's associated with slowing down the biological clock. So it's so good for you. It's, you know, I think of it in the service of that means you can like dance with your great grandchildren at their wedding. You know, that's one of the things I hope for myself.

There you go. There you go.

And to do those things that you've always sort of thought about doing, like the helicopter skiing, I mean, how fantastic to live your life in that way, not sort of signing up for the slow decline that we see in so many folks. We know after age 40 that most of us are gaining five pounds of fat and losing five pounds of muscle unless you're doing something active like strength training. So what I talk about in the book is to do about two-thirds of strength training, about one-third cardio. I think that combination is probably the most proven when it comes to cardiometabolic health. So true.

So, Sarah, your book is so important at this time because I think more than ever we're seeing this epidemic of hormonal dysfunction, including insulin, blood sugar, as well as sex hormones, cortisol, thyroid hormones. And you talk about it so well in your book.

Hey, YouTube, if you like this video.

You'Re gonna love the next one. Five to 10% of women are impacted by PCOS. Five to 10% of women, that's a lot of women.

I mean, listen, if half the population of America is 330 million, if that's the population, half of that's like 100, let's say 65 million. And 10% of that's like 16 million people. That's a lot of people. Yeah.

And you know, it is PCOS or polycystic ovarian syndrome is a syndrome that involves irregular periods or not having any periods and androgen excesser. changes in your hormone balance, but it is a syndrome. So that means that there's a continuum where some people have all aspects of PCOS and some people just have some aspects of PCOS. And we can talk more about that. But, but so, so there, there may even be, there may even be more than this, you know, that we don't, we're not even picking up. It's, it's quite common and it's definitely something we're thinking about all the time when somebody's coming in and complaining about irregular periods or not having had their period for a bunch of months. a young woman that should be having regular periods.

And then you get really heavy periods, they can miss periods, they can light periods. What are the other symptoms that are pretty common?

Yeah, so we see hirsutism, which is the growth of hair.

That sounds terrible.

The growth of hair where women don't want to have it, so on their lip, on their chin, on their abdomen, like in their belly area. So the hair is growing where they don't want to have it, and then they may have hair loss, where they want to have hair. So they may have some male pattern hair loss. They get acne and typically- Wait, wait.

So basically they're losing hair where they don't want to lose it and they're getting hair where they don't want it. And it's because of these high levels of male hormones like DHEA and testosterone that end up causing basically this male appearance almost.

Yeah, their hair growth shifts because their hormones shift.

And so you see the bearded women in the circus, that's what this is, right? Yes.

Well, some of them may have had some other things going on too to an extreme, right? But yes, in general, yeah, this is, you're starting to grow hair where you don't want it and not having good hair on the top of your head where you want it and all because there's been a real shift in your hormone balance in your body. And so when you check, when we actually check, we see high levels, like you mentioned, of that DHEA in the blood, we may see high testosterone levels or high free testosterone levels. And so those are some of the biomarkers that will show up when you look.

Yeah, and you also get acne, bad acne.

Bad acne.

Yeah.

A lot of times, like in the lower jaw area, acne, and sometimes cystic acne. So and then they'll they'll often gain weight. Now, not everybody with PCOS is overweight. We have There's a lot of women, and we can even talk more about that today, there was a lot of women who don't have the obesity part of it and they're just dealing with irregular periods. But for a good portion of women with PCOS, they gain weight because of the high levels of insulin that are going on. So, you know, if they have high levels of insulin floating around, so with PCOS, typically there is high levels of insulin. And we've talked about insulin so many times on this podcast, and you've talked about it many times, you know, but that insulin is that hormone that helps us balance our blood sugar. So you eat a meal, the body makes insulin, that insulin tells your body to take your food and get it into your muscles so it can be used for energy. And what happens when somebody has insulin resistance is their body's not listening to that insulin as well. and they've got high levels of insulin and that high level of insulin will cause people to gain weight around the belly. And so we often see with PCOS that waking around the belly, that belly weight.

Yeah, so this sounds like a miserable condition. You get pimples, you lose hair on your head, you grow a beard, you are infertile, your periods are all over the place. This just sounds terrible. And traditional medicine, has very kind of weird approach to it because the way I think about it is that it's called Polycystic Ovarian Syndrome, which makes people think it's a gynecological problem, but it's actually a dietary problem.

Right, right. It's often a dietary problem. And, you know, it's not, it's not always dietary, which is so interesting. Right. Because we're, you know, we're learning about how toxins from the environment, like BPA and plastics and. We were learning about the microbiome and how that can be a trigger. So there are, and there's so toxins and dysbiosis or imbalance in the microbiome are common.

But toxins can cause insulin resistance.

Absolutely.

And the microbiome imbalances can cause insulin resistance and prediabetes. So it's all connected.

It's all connected. And you're right. And a huge portion of people. It's dietary as well, you know, where they're... But I think it's important to remember it's not always that, right? But there's a huge portion of people where they're just eating too many carbohydrates, too many refined and processed carbohydrates for their body. So, you know, or for anybody's body. But those high levels of refined and processed carbohydrates really can be a trigger for this insulin resistance and weight gain. And then that insulin resistance shifts the hormone balance, and then you get this imbalance in hormones and you get the high androgens or testosterone and DHEA, and then the periods get irregular. So, but interestingly as a syndrome, it can be, it's important that we pay attention to that individual person because it's very different. You know, you may have 10 women in a room with PCOS and you may have 10 really different reasons for why they have PCOS.

No, that goes to the point.

They're really not all the same, yes. It's really an interesting aspect for functional medicine doctors to work with.

I mean, that just speaks to the whole approach of functional medicine, which is because you know the name of your disease, it doesn't mean you know what's wrong with you, right? Absolutely. It's just a description of the symptoms, but not the cause. And so functional medicine is about the cause. It's about why, not what, not what disease you have, PCOS, but why do you have that, right? And traditional medicine, the symptoms are treated symptomatically.

So what are the traditional treatments that you see regular doctors giving for PCOS? Yeah, so often women will be placed on birth control pills. because if they're having irregular periods or they're skipping their period, many times the physician will put them on birth control pills because it will regulate their cycle. They'll put them maybe on metformin because metformin improves insulin sensitivity.

It's a diabetes drug.

Yeah.

And then that can many times help with the weight gain. It sometimes helps with the acne and the hair growth or hair loss. And they'll often put him on spironolactone, which is another medication that helps with balancing the hormones and can help with some of the symptoms.

It's a diuretic and it just blocks the conversion of testosterone to the kind that really causes the hair loss called DHT. But it's really fascinating, but it really doesn't speak to addressing the root causes. So from a functional medicine perspective, what are the root causes for PCOS and.

How do we start to deal with these? Yeah, so as you mentioned already, diet is huge. Diet has a huge impact. In fact, when somebody's eating too many of the refined and processed carbs, too much sugar, too many of those coffee drinks with sugar in it, you know, juices, sodas, refined and processed oatmeals, you know, cereals and, you know, pastas and breads and muffins and, you know, those foods that we've been grabbing too much of for some people with some genetics that can really throw off this whole system in their body. Another big common area are toxins. I see this a lot. I see a lot of what I think is toxin related. We know genetics plays a huge role here. We also know that when what women are exposed to as a fetus, when what has happened to their mom is really when their mom's pregnant with them, that really impacts their hormone balance and their metabolism later in life.

So, what the mom's eating, she's at Dunkin' Donuts all day.

What's fascinating with the frappuccino mocha latte.

Wates, all day long with more sugar than three cans of Coke. I mean, yeah, people don't realize that.

Yeah, so when they're pregnant with their baby, it's really important that they're paying attention to what they're eating because if they're gaining too much weight or eating too many refined carbs or not gaining enough weight, which is kind of interesting. So if they're not gaining enough weight or they're gaining way too much weight or they're eating too many refined and processed carbs and sugars, that really throws off the fetus, that baby's metabolism. And so, you know, sometimes, you know, we tell our patients, you can just blame it on your mom.

That's called epigenetics, which in the genes get tagged and messages Jeff Bland's called the Book of Life. And where the bookmarks are in the Book of Life, you've got this whole genetic code, but not all of it gets read. But you can bookmark different aspects of it depending on what exposures you've had. And we know this from lots of research on epigenetics that what the mother does, what she eats, what she's exposed to, her thoughts, feelings, all those tag the baby's genes for what happens to them in the future and whether they get diabetes or heart disease or cancer or obesity. I mean, it's all programmed. But that doesn't mean it's not fixable. You can actually modify your gene expression. And that's what functional medicine is all about, is changing the environment, then the big picture of the environment, meaning your diet, lifestyle, toxins, et cetera, et cetera. How all of those inputs affect your gene expression is what functional medicine is about. It's about modifying your lifestyle and your environment to influence your genes, to change.

Your health in every aspect. Yeah, so for some people, it's harder. for them than others. Like some people come in and they're like, it's just not fair. I have to be so much more careful than my friend Susie, right? And it's true, you know, because there are some people, yes, there are some people that have to be so much more careful with their diet. I mean, we all should be eating a healthy diet, but some people have to be more careful with the carbohydrates than others.

Yeah, I would say, you know, there are a few people who are better adapted to higher carbohydrate diets. And there are a few. I know a few of them. And those are the ones who stay skinny eating anything. But when you look at the fact that 88% of Americans are metabolically unhealthy, almost nine out of ten of us have some degree of insulin resistance. That should get our attention. It's probably the majority of us who don't do well with a lot of starch and sugar. And there's a continuum. right? Some can do more, some can do less. Some are look at a bagel and they gain weight, literally, because they're think about it and their insulin goes up and they put all the fat on their bodies. I want to jump back to something you quickly talked about, which is toxins. And I want you to explain how environmental toxins and what toxins influence hormones and influence insulin resistance. Because both of those things are going on with PCOS, and I think it's something people don't understand.

Yeah.

You know, this was impacting more men more than women, but we realized in Agent Orange, right? So when men were exposed, there may have been a few women. I don't really know how many women went to Vietnam. Probably not very many, right?

Not too many.

Not too many. So when they were exposed to Agent Orange in Vietnam, they had a much higher rate. They have a much higher rate of getting diabetes. with less weight gain, right? So that's when we started to say, oh, this is interesting. There's a real interesting connection between toxins in the environment and our metabolism and our weight. And then we get diabetes.

And they get Agent Orange. Agent Orange exposure had lots more diabetes.

Lots more diabetes at less weight gain. So, you know, I'm just gonna make this up here, make up some numbers, but just so people understand, they may have only had to gain 10 pounds or 20 pounds to get type 2 diabetes, where a typical American maybe was gaining 50 pounds before they got type two diabetes.

Right.

You know, just for an example. So they were getting type two diabetes with less weight gain, meaning that there was more to it than just the weight gain, right? And that's when we realized that these toxins were damaging probably the mitochondria, right? So that powerhouse of your cells. We also know BPA, that plastic that's.

Been- BPA, that plastic.

Yeah, really well studied to show there's a connection with insulin resistance. Yes. You know, we know, we've known for a long time about the connection with breast cancer and BPA, but there's also this connection with insulin resistance and weight gain. So that hard plastic, they use BPA in the lining of cans or on receipts. Baby bottles. Baby, I know, right?

Yeah. When you get your credit card receipt, your gas station receipt, people say, join your receipt. I'm like, no thanks. No, you're taking because I don't want to constantly expose myself to get absorbed through the skin.

Yeah. So, you know, we realized that this toxin caused weight gain, insulin resistance, and I'm sure there's a lot of other toxins that we haven't even figured out yet that are really influencing it.

Well, pretty much all the petrochemical toxins, all the plastics and all the fossil fuel derived toxins, are endocrine disruptors. And I read way back when we were at Canyon Ranch, I read a book called Our Stolen Future by Theo Colborn, which was about the ways in which these environmental toxins were disrupting reproductive health of animals and humans. And I was like, oh my God. And so what's going on is that these are not just one exposure. So you're not just exposed to BPA. You're exposed to literally hundreds of these in our daily life through our modern living. And there are ways to reduce it. And I think the Environmental Working Group is a great resource for finding out what household products, skin care products, cleaning products, you know, are food products that you can eat that are not going to be full of these chemicals. And you just go to ewg.org. so that's important. Hey, everybody, it's Dr. Hyman. Thanks for tuning in to the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S. and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. So let's talk now about the gut because most people don't really think that your hormones are connected to your gut microbiome but it's incredibly connected.

Fascinating. It's so fascinating but they've been, they've shown that there's certain types of molecules from the gram-negative bacteria in our gut. So if the microbiome, if all of those trillions of bacteria are out of balance and there's an overgrowth of some unhealthy bacteria in our gut, that they have these gram-negative bacteria have something on them called LPS or lipopolysaccharides that these things can then these components can get into the body. And they've shown that this can trigger this insulin resistance in our body so that people, when they have higher levels of these abnormal bacteria, will have more insulin resistance.

That's absolutely right. So, you know, there's a name for this. We call it metabolic endotoxemia, which is a fancy way of saying that the poison crap in your gut leaks into your bloodstream and your immune system goes, ah, and starts creating an inflammatory response, which then affects your insulin sensitivity. So anything that causes inflammation, right? Anything, stress, bad food, toxins, infections, microbiome nastiness, all that can drive inflammation that can cause insulin resistance.

Yes.

So you don't even be eating sugar, right? But if your gut's a mess for various reasons, then you have to fix the and also there's a lot of effect on insulin resistance, but there's also other effects in the gut around the kind of bacteria that are there and how they affect your metabolic processing of estrogens and other hormones. So it's really important to eat the right kinds of fiber and the right kinds of foods and to feed your microbiome in your inner garden. So we've talked about a lot of things. We've talked about diet, we've talked about stress, we've talked about environmental toxins, we've talked about the gut microbiome. All these things play a role. And so the job of a functional medicine doctor is to dig down and figure these things out. So how do we begin to assess these? And I want to share a little bit about cases, but how do we assess? Because it seems like a lot of stuff that you go to the endocrinologist or the gynecologist, they're not looking at your poop, they're not measuring your toxin levels, they're not looking necessarily at insulin resistance very well. What do we look at that's so.

Different here at the UltraWellness Center and through the lens of functional medicine? I mean, I think that's what's critical about functional medicine and what we do is we get a really good detailed history and that gives us a lot of information. So when we take the time to get to know our patient and get all of the history of their life, their timeline of their life, what things have happened to them, what illnesses they've had, what disruptions they've had, what exposures they've had, what other things are going on in their body, that really impacts where we go and what we choose to look for. So you get a really good history first and foremost, and then that informs you what you'd want to test. You know, you could test everything, but you know, this ends up being a lot of tests. So what's important is to get a really good history so you know where to really focus. So for one person, it may be, I really got to look at their gut microbiome. I've got to figure they They've got this sort of history. I think that might be an area that we really have to focus on. I want to look at what the balance of the good and bad bacteria are. I want to see if they have maybe some of these lipopolysaccharide components that may be triggering inflammation and insulin resistance. Or maybe somebody else, you've got a sense based on their history and some of their other symptoms that it's more toxin related. Or somebody else, it may be, more lifestyle related. And you've got to just really focus more on breaking that cycle of craving those carbohydrates. Because what happens for a lot of people is it becomes a vicious cycle, right? They eat the carbohydrates, the real refined processed carbohydrates, their insulin goes up, but then they gain some weight, then they crave more and more of them and it becomes this vicious cycle that gets out of hand. And I think that's important. Yeah, it's so important.

And we really don't just look at the hormone levels, which a typical endocrinologist or GYN would look at those too, but because they're very helpful and informative to look at the testosterone levels, DHT and look at DHEAS and all kinds of things that we look at. But we also do looking at toxin load, we're looking at the microbiome, we're looking at nutrient levels, we're looking at insulin resistance in ways that may not be looked at. So, tell us about the first patient you had who was 20 and she had these really irregular periods and acne. bad digestive issues. How did that all get started for her?

Right, so she was 20 when she came to see me and she was frustrated with her, she was frustrated with her acne, she was frustrated with her digestion, and her periods were kind of all over the place. She had a lot of ear infections as a child, so she was put on antibiotics and then ended up getting a lot of recurrent ear infections, more antibiotics and more antibiotics. And so I think that really just set the stage for her microbiome to be out of balance. And then when she started having her period when she was 14, it never was regular. So from day one, she had an irregular cycle. So always, you know, one month it'd be six weeks and then two or three weeks, and then she'd skip a month and then, you know, she'd be eight weeks between periods. So always irregular. And, and then as a you know, I'm not really that surprised just having done this for so long, but she also then in puberty developed a lot of acne. So, you know, probably because of some of the shifts in the microbiome in her young, young years. And then, you know, just all of these things going on. And you see that a lot.

You see kids, you know, kids a lot of ear infections, maybe she's eating dairy, which commonly can cause a lot of congestion. They throw the antibiotics at the kids, and then they get a little older, then they start getting gut issues, and they start acne and other things. So it's all connected.

Yeah. So what we did is, you know, because of her digestive issues and her acne and her irregular periods, I said, you know, I'm really curious about her digestive system. I really wonder what's going on in there. And, you know, could this be the driver of her insulin resistance? And so we did a test that looks at, antibodies against different components in the digestive system. And one of the things it looks at are these lipopolysaccharides, which are on these gram-negative bacteria, which as we talked about has been shown to trigger inflammation.

These are bacterial toxins essentially.

The insulin resistance. And when we did that test on her, she had really high levels, which means that her levels were high enough to get into the body to trigger these antibody levels to occur. So we also did a stool test and the stool test we showed, it showed that she had an imbalance. She didn't have enough of the good bacteria. She had an overgrowth of some unwanted bacteria. So she had this dysbiosis. And so I said, you know what, this is where we've got to start. This is where we got to focus to help both your skin well, actually all your skin, your digestive system, and your cycles, your periods. We did see when we did hormone testing that she had signs of PCOS, she had some high level of DHEA and her testosterone was a little bit high and her LH/FSH ratio was off. So we did see some signs on hormone testing that she had some PCOS going on.

So, Liz, when you treated her, you also took her off dairy.

Yes.

And I want you to talk a.

Little bit about why dairy is bad, both for hormones and insulin resistance and acne, because she had all these problems. Yeah.

So, as you can imagine, dairy products, both milk and cheese and dairy products coming from a cow, are full of hormones. You know, that cow to make cow's milk has a lot of hormones floating around. Those hormones get into the milk, even if it's organic. Yeah.

And so- and there's more in ones that aren't organic.

Yes.

There's like 60 different hormones in milk.

Yeah. And so, and some people are very sensitive to those hormones and they will cause acne production, they will cause more acne, more, and then of course, a lot of people are sensitive to dairy. So it can cause a lot of digestive unrest and digestive issues.

And what's also interesting to me is that when you look, people consume dairy, dairy will spike insulin pretty high. A 300% increase in insulin consuming dairy, which I was sort of surprised at when I looked at the literature.

Especially the lower fat dairy. Right? Because that, you know, and so for so long we were going to the lower fat and then we were going maybe to the lower fat chocolate milk in school, right? You know, all those things that were spiking insulin.

And I would say for women with hormonal issues, I think dairy's gotta go for most of them to start at least to see how it affects them because, you know, whether it's irregular cycles or whether it's PCOS or whether it's acne, whatever is going on, I think it's an incredibly hormonally disruptive food for so many people. and a lot of people can tolerate it fine, but if you've got problems, you've got to start thinking about what you've got to cut out.

And I think what is really helpful a lot of times at the beginning when you're dealing with, when you have a lot of things going on and you're not sure how food's impacting you, sometimes to do a full elimination of a food or a group of foods is really helpful because it gives you a lot of feedback. So sometimes if you just sort of cut down, you don't really, you go, I'm not really eating much dairy. And, I get that all the time.

I just have cheese after dinner. I agree. It's hard for people to understand that a little bit can do a lot of damage. And, the way I explain it to people is think about a peanut allergy. Sometimes if you're just exposed to peanut dust, you can get an anaphylactic reaction. That's how powerful your immune system it responds to microscopic doses. Right, so I think that's important to remember. So what happened with her young woman, you treated her?

Yeah, so because we found this dysbiosis or imbalance in good and bad bacteria, we needed to get rid of the dysbiosis. So we used an herbal combination to treat that. We also gave her a lot of good probiotics and prebiotics, the things that feed the good probiotics. And we took her off a dairy. We also, we did more of a comprehensive elimination diet at the beginning, so we took her off a dairy, but we we also removed gluten and a lot of other inflammatory foods and really focused on a phytonutrient-rich diet. And I think sometimes we don't think about how powerful that can be, right? Those phytonutrients, those components from our plant foods that have amazing qualities in our health, from lowering inflammation to helping detoxification to helping the process of elimination of our hormones that we want to eliminate.

Yeah.

So they really are powerful. And so when you help people get those, eight to 12 servings of phytonutrients which come from your vegetables, some fruits, some seeds. -Yes, spices, teas. Really, that can be really powerful for the body.

-Yeah. So, it is not just about what you eliminate. It is what you add.

-That is very true.

-Yeah.

I want to change the name called the Addition Diet.

-Yeah, I like that. So, so that was very powerful for her. We also added in some inositol, a combination product that has some myo-inositol and D-chiro-inositol, which actually helps improve insulin sensitivity. So we did this for a while as well. It can help improve the cell signaling in the body and improve how the insulin works. We also really repleted some deficiency deficiencies she had. She was low in D, vitamin D, which we know is important for insulin sensitivity. And she was low in vitamin A, which is important for skin. She was low in omega-3 fats, which is really anti-inflammatory. So we replaced a lot of the deficiencies that we found as well.

That's amazing.

And then what happened?

Well, you know, it was great because her digestion improved. That was the first thing that got better. And then her skin, it got better. And then after a few months, her period just started to really get regular for her. Yeah, I mean, it's just so, and.

I get honestly, Liz, I get so angry because I've been doing functional medicine for so many years. People suffer so needlessly from problems that do have solutions. And it's not rocket science. It's not like we need to know some great new discovery in medicine. We, we understand biology enough now using the lens of functional medicine and systems biology. which is now gaining more traction and people are becoming more aware of it. But it's just so disheartening to me. It takes so long for people to get access. And I think I want to just sort of end with a case, a short case study that you had of a woman who had infertility.

Yes.

Because this is a problem that affects one in seven women. We've covered it before on the podcast. But I think I want to dig into this particular cause because it is one of the most common causes and also easily remedied. And I can't tell you how many women that I've treated personally. I know, sure you have. who had this problem and you fix it and then they get pregnant.

Yes, we see it all the time. It's phenomenal. So this woman was 34 and she came to see me because she was trying to get pregnant and she had been trying for three, four, four plus years, I think, and had not gotten pregnant yet and her periods were really irregular. And she was 34, so she was getting closer to that age where she was getting really concerned about the fact that she hadn't gotten pregnant yet. And she also noted that over the last few years she had gained some weight. She was about 20 pounds overweight. Most of that weight gain was around her belly, which was making her frustrated, you know? And she didn't really feel like she was doing much different anymore. She also had to get some laser therapy done to remove the hair on her chin. and on her belly. So she had had some laser therapy done and she was also struggling with acne. She was on birth control pills from the age of 17 to 29 to really regulate her period. But when...

I hate that. I hate that. When I hear that sentence, oh my doctor put me on the pill to regulate my period. I'm like, well, why is it irregular? And let's figure that out instead of just slapping you on the birth control pill, which is not side effect free.

Right.

No, it's not. No. And so, but when she went off of the birth control pills, her periods were irregular since then and she developed a bunch of acne. So, you know, she really came in to really for us to help her with her fertility. And so we did testing and we found that her testosterone level was high, her DHEA was high, her LH/FSH ratio was off, and her insulin, her fasting insulin was really high. so her fasting insulin was 13 and we really want that to be like five. So it was high. And to me that signaled, okay, this was an area that she's got insulin resistance, she's got PCOS, and that's really what's driving all of these things that she's dealing with. And so when I got her diet history, which she filled out when she came to see me, she said, You know, she was trying to eat healthy. She was having oatmeal for breakfast. You know, she was having that refined oatmeal that so many people are eating thinking it's healthy, right? Sandwich for lunch and at dinner she'd have some pasta with some chicken or vegetables on it. And so that's really where we focused. We really worked to lower that carbohydrate intake for her. We pulled away those extra refined and processed carbs. Oatmeal, you think it's healthy, she's having a breakfast.

Not so healthy for someone like that.

No, and especially a lot of the oatmeals out there, you know, and the way that we eat them. Like if we're eating a bowl of oatmeal with not a lot of other stuff in it, there's none of the, you know, good healthy fats and protein to balance that blood sugar, right? So, you know, you can have some, you can have some steel, a small amount of steel cut oats with a lot of, you know, nuts and maybe some coconut milk and and that can, you know, for some people that can be a healthy breakfast, but for her that's not how she was eating her oatmeal and it was spiking her blood sugar and it wasn't helping with her weight. It wasn't making her feel satiated and satisfied. You're hungry, yeah.

So what did you do?

So we really, you know, food first with her. We put her on the Pegan diet, right? You know, we pulled away the extra refined carbs. We said, when you're getting your carbohydrates, we want them to come from from vegetables. That's where you're going to be getting most of your carbohydrates from, from the.

Greens and the broccoli is a carbohydrate.

Yeah, exactly. It's a wonderful healthy carbohydrate and really rich in all those phytonutrients. We worked to balance her blood sugar so she had a good protein source and fat source at every meal. And we got her exercising. She had really kind of just she was really focusing more on the fertility and working had kind of like let that go. So we got her on a good exercise program, both that included some high intensity interval training and some good cardiovascular exercise and strength training. She was a healthy woman, so we just had to get her moving again more intensely.

And.

Within a few months, three months or so, she lost that extra 20 pounds, her periods regulated, and she got pregnant.

That's unbelievable. So basically, these are people who go to fertility doctors, spend tens of thousands of dollars. And what you're saying is all you do is take a good history and get all that starch and crap out of her diet and sugar, got her moving a little bit, she lost 20 pounds, her cycles regulated, and she got pregnant. I wish it was this easy for most people. Some people, it's a little more complicated, but you'd be surprised at how many people just following this simple approach can make a huge difference. There was a book by one of the top Harvard scientists of all time, Dr. Walter Willett called the Fertility Diet that really focuses in on this whole idea of why we have so much infertility and why is such a problem. So this is an area where I get nuts because from a functional medicine perspective, it's relatively straightforward to sort through this using a very detailed history, the right kinds of diagnostic tests that you wouldn't get at your regular doctor using a food first lifestyle approach, fixing the basic things need to get fixed, whether it's diet, toxins, you know, allergens, low grade gut issues, it all can drive problems. And we just see amazing results and it's so satisfying.

If you love that last video, you're.

Gonna love the next one.

Check it out here.

Why is there that imbalance in the hormones and, and what may be out of balance for that woman? You know, I think perimenopause is such interesting time where we get a lot of women who come in to the office at that time because they're just feeling so crummy.