How To Resolve Your Irregular Periods, Mood Swings, And Sleepless Nights

Coming up on this episode of the Doctor's Pharmacy.

It's important that we pay attention to that individual person with PCOS. Typically there is high levels of insulin.

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This week's episode of the Doctor's Pharmacy. Hi, this is Lauren F. Pheasant, one of the producers of the Doctor's Pharmacy podcast. So many women regularly experience hormonal imbalances, leading to symptoms like sleepless nights, irregular periods, mood swings, hair loss, and even issues with fertility. The good news is that the principles of functional medicine can help get to the root cause of your symptoms and bring your body back into balance. In today's episode, we feature three different conversations from the doctor's pharmacy about various root causes of hormonal imbalances. Dr. Hyman speaks with Dr. Elizabeth Boham about PCOS and later about the role that insulin resistance plays in hormonal imbalance. He also talks to Dr. Sarah Gottfried about how toxins affect hormones. Let's dive in.

PCOS or polycystic ovarian syndrome is a syndrome that involves irregular periods or not having any periods and androgen excess or 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, you know, a young woman that should be having regular periods.

And then you have 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. Yeah.

The growth of hair where women don't wanna 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 wanna 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.

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 know, 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. And a lot of times like in the lower jaw area, acne, and sometimes cystic acne. So, and then 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 weight gain 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. Right, it's often a dietary problem. And, you know, it's not always dietary, which is so interesting, right? 'Cause 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 is 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. But interestingly, as a syndrome, it's important that we pay attention to that individual person because it's very different. You may have 10 women in a room with PCOS and you may have 10 really different reasons for why they have PCOS.

Well, that goes to the functional.

It's 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.

The diabetes drug.

Yeah, so 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 them 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 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, juices, sodas, refined and processed oatmeals, cereals, and pasta's 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 and... What's fascinating with this... Eating 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 babies metabolism. And so, you know, sometimes, you know, we tell our patients, you can just blame it on your mom.

We call epigenetics, which in the genes get tagged and messages of, you know, 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, 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 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. Yeah. you know, 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 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, this was impacting men more than women, but we realized 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- so see diabetes.

Orange exposure had lots more diabetes.

Lots more diabetes at less weight gain. So, you know, 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 two diabetes where a typical American maybe was gaining 50 pounds before they got type two diabetes. 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. 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 really- BPA, CNL-A.

Yeah, really well studied to show there's a connection with insulin resistance. 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- BPA bottles. baby. I know, right?

Yeah. When you get your credit card receipt, your gas station receipt, the people say, join your receipt. I'm like, no, thanks. I'm like, you're taking it.

Because I, I don't want to constantly expose myself. Gets absorbed through the skin. Yeah.

Yeah.

So, you know, we realized that this toxin caused weight gain, insulin resistance, and, and I'm sure there's a lot of other toxins that we haven't even, you.

Know, figured out yet. Yeah. That are really influencing. Well, pretty much all the petrochemical toxins, all the plastics and. 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 Colburn, 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. 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 the, 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 have to be eating sugar, right? But if your gut's a mess for various reasons, then you have to fix the gut. 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 Ultra Wellness 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 wanna 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 gotta look at their gut microbiome. I've gotta figure, 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 end up, 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 to pay attention to.

Yeah, it's so important. And we really, you know, don't just look at the hormone levels, which a typical endocrinologist or GY, we 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. 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, that 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 just sort of relegated to being called hysterical, which is the, I hate that word. It's like, it basically comes from 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 to pay 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 type of PMS and 85 women have some type of hormonal issues in their life. Why is this happening? What, what, 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 talked 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 your weight fluctuate very much. I don't know.

It's not true.

I have, I go up and down. If I go off the reservation, like I was in Italy this summer and I was just eating like 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 I know my weight can go up and down, but mostly it's pretty stable.

Well, it sure seems stable. And, you know, 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. So getting the carb dose right, also getting the protein dose right. So dialing in these macronutrients becomes incredibly important. And 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. And that's something that we know affects about 88% of Americans right now. So 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. There's, you know, 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, you know, 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 in 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 flax seeds. And, 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. You know, 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 it cracks me up, there are 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, and you, you know, you are an advisor to 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 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, I had a lot of surprises. I started wearing a continuous glucose monitor about four years ago. 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 were 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.

See?

So going on a ketogenic diet made 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.

Perimenopause is the time frame between when your cycles are normal and you can easily get pregnant and menopause. So perimenopause are those years, you know, it can be like 10-13 years of perimenopause and it can occur anytime. You can go into menopause anytime between 45 and 55. That's typical. and that perimenopause can be 10, 6 to 10 to 13 years beforehand before you actually go into menopause is considered perimenopause.

What is that?

The perimenopause, yeah. I mean, the hormones are not as regular and consistent, right? So what happens a lot in perimenopause is during those years women will have what are called anovulatory cycles. So they ovulate every time they have a monthly cycle. Right, right. And so those anovulatory cycles, meaning no ovulation that month, results in less progesterone being produced in the body.

Because when you ovulate, that's when you make progesterone. And if you're sort of weaning down your years of reproductive life, you don't necessarily make progesterone, you don't ovulate every cycle. You get these high levels of estrogen. Right. And that causes a lot of these symptoms of slots and heavy bleeding and bad PMS and mood issues and sleep issues and migraines and all this stuff that women suffer from that is so unnecessary.

Right, you think of it as, you know, when you're having regular cycles with ovulation, you have estrogen and progesterone and they sort of balance each other out. And then when you're in those perimenopausal years, you're gonna have, so many women will have cycles where they they don't have that progesterone spike. So it feels like their body feels like it's higher in estrogen because they don't have that progesterone to balance it off. And so you feel like you have high estrogen and like you mentioned, you get more breast tenderness or more clotting or heavier bleeding and the low progesterone makes us often feel crummy. So you can be more irritable, so you can just, you know, cranky. Cranky, harder time sleeping because progesterone really is a calming hormone. It helps us, helps women, helps people sleep better. So when it's low, many times you don't sleep as well. You'll have irregular sleep patterns where you've never had that before.

And.

You just feel more irritable and cranky and, And it's no fun.

Out of balance. And you know, it's important to understand that we know a lot about what causes these imbalances and we know a lot about how to fix them except your traditional doctor is just not doing it. So what are the things that we know create hormone imbalance that make things worse for women? And by the way, you know, just to sort of a little aside, you know, it's not just sex hormones that get out of balance. And when you see this sort of period of life around perimenopause, there's like four different hormones that are all interacting that all kind of gets screwed up. One is insulin and blood sugar. Because you're off in the sandwich generation. You have kids and your parents are getting older and you're trying to have a career. And it's like, it's a lot going on at that time for women often. And then they have estrogen imbalances and progesterone. they have adrenal imbalances because their adrenal glands are their stress response and they're highly stressed in that time of life. So their adrenals interact with the sex hormones and screw that up. And then of course you got thyroid thrown in there in a lot of cases. So you got thyroid, adrenal, sex hormones, insulin.

And so it's like a big mishmash of hormone chaos.

Yep. And actually you can fix it.

Absolutely. I know. These are like so easy to fix with functional medicine. Yeah.

Yeah.

Yeah, and I'm so glad you brought that up because all of our hormones are interrelated. They're all playing off each other. They're all influencing each other. And so that's important to really understand because that's how we can really help women feel better. So when you really focus on the adrenal glands, for example, so you have two adrenal glands typically, they sit up on top of your kidneys, and those glands produce cortisol and they produce DHEA and they a bunch of other stress hormones. Dr. Yeah, so cortisol is one of your stress hormones. So when you're under a lot of stress, if you're under chronic stress for example, I mean, you know, your body is going to be producing a lot of cortisol all the time. And so what can happen, what can happen is then the body is spending all this time making cortisol to handle that chronic stress you're under, you're dealing with your kids and then your parents, as you talked about, you know, you're working all the time, your job, you're not giving your body enough time to rest, you're not getting enough sleep, you may not be eating right, you know, you might be just running from one thing to the other. You may not be taking the time to do your meditation or your exercise, right? You're just not doing that self-care, which is so important for your adrenal glands. And when that's happening, then your body's spending all this time producing cortisol that it can't do as good a job at producing progesterone. Yeah, right.

And so then you have- It's like a chicken-wired thing. It's all connected. It's not like they're all separate.

Right. And so then you have more of those signs of low progesterone, which we talked about before, which is irregular sleep, irritability, more crankiness, more PMS, right? So it's really important that we step back and say, okay, how can we support your adrenal glands. And that's really a lot of self-care, you know, by saying, okay, I need to give myself time to rest. I need to give myself enough time to sleep. Meditate maybe. I got to get my meditation in, right? And I think that makes a big difference. It can really help with balancing the hormones. We know, right, that even Simple meditation 15 minutes twice a day can cut back on, can significantly cut in half the amount of hot flashes a woman has during those perimenopause. We haven't even talked about hot flashes yet, right?

Well, I mean, let's talk about the things that screw up your hormones, right?

Yeah.

So sugar, yes. That causes insulin resistance, that causes more estrogen to be made and all the imbalances, right?

Right, right. We were talking about how when you when you get more insulin resistance, you gain more weight around the belly, right? And we know that when we gain more weight around the belly, that we have more of that aromatase enzyme, which makes more estrogen and again, throws us out of balance.

And what about alcohol?

Yeah, alcohol really is a concern because the way alcohol, there's multiple ways that alcohol can impact risk of breast cancer, for example, but it also seems to result in a higher level of free estrogen in the body. And so, you know, we know it disrupts sleep.

It's a liver toxin. And it literally impedes the body's ability to metabolize estrogen. And I've seen studies that were shocking to me where people were on hormone replacement and drinking and their liver just can't handle it and estrogen levels spike and their risk goes up. So we have enormous link there. I remember a study I read years ago which was if a woman had a glass of wine a day it increases her risk of breast cancer by 40%.

Yeah, unfortunately there's a linear relationship between alcohol and breast cancer risk. So for every drink a woman drinks per day, like every time she increases the amount that she drinks per day, her risk of breast cancer goes up even further. So what's considered moderation for women is is five or less drinks a week with a drink being, you know, five ounces of wine or, you know, an ounce of hard liquor. One ounce of hard liquor. Yeah, but not very much. No, it's not very much. And that's for a whole week. But what's interesting is you're right, there has been even studies showing that even one drink a day is linked with an increased risk of breast cancer. And it may be because it is impairing, well partly because it's impairing our liver and our ability to detoxify and it's shifting estrogen levels and it also depletes the body of B vitamins. So there's so many impacts that alcohol has there.

Yeah, and even the microbiome plays a role in your hormone balance, right?

Right, absolutely. That's something we're always measuring, right? We're looking at how the body is metabolizing hormones and we're looking at the microbiome. And I think that that's important when we're dealing with a woman in perimenopause. Sometimes there, they just don't even understand why am I feeling this way? Why am I all of a sudden more irritable? Why am I having a harder time with my periods? Why are they heavier? Why can't I sleep? Why am I getting hot flashes now? And so sometimes just educating them is a great first place to start. And a lot of times women just feel better when they start to understand, okay, this is gonna, my hormones are shifting, and then what can I do support them. And we were talking about how great meditation is, right? Because it's, oh yeah.

Yeah. And then the things you know, we see typically the women who have the worst problems have the worst diet, the most stress, they drink too much, they don't exercise, they don't, they have lots of stress, they don't meditate. It's not rocket science why hormones get screwed up. Right. And we know how to intervene using very specific diagnostic tests that we do at the UltraWellness Center to actually actually help map out what's happening with the hormones. We can look at estrogen metabolism. We can see how to really be sophisticated in manipulating those hormones so that actually they're better. We can fix the gut and the microbiome. We can look for environmental toxins which act like estrogens in the body and get rid of those or heavy metals. And we can actually have an impact through using various foods to help, whether it's flax seeds or other broccoli family help estrogen metabolism, certain soy products that are in our Whole Foods, soy products are good. and then we can kind of get people's hormones to kind of work better. We may want to even use nutrients. And you were talking about sulforaphane, which is a powerful broccoli chemical that you can take. And there's a whole cocktail of things we use to help estrogen metabolism.

We should probably talk about soy a little bit because honestly, this is probably the most common question I get. Because people are so confused about soy. Tell us, Dr. Baum.

Oh my goodness, sugar.

Do we eat soy or not eat soy? So soy, right, soy foods are in, they have these things called phytoestrogens in them. And this is what got everybody nervous, right? So they have these components, these phytonutrients, these components in them that can actually impact the estrogen receptor. And so for, you know, a bunch of years ago, oncologists used to say, oh no, it can impact the estrogen receptor, I don't want you to eat soy. But what we know actually is that they bind to the estrogen receptor, preventing your own estrogen from binding to the estrogen receptor. And as a result, you have a lower estrogen-like impact in the body. So multiple studies have shown that soy is actually associated with a lower rate of breast cancer and a lower rate of additional cancers. That's a good point.

Like tofu, Tempe, natto, miso, soy sauce.

Mame, right?

Right. Those are whole soy products that are not industrial food. And most soy we're eating today is industrial soy. Yes. Turned in all kinds of weird ingredients like soy burgers and soy hot dogs and texturized vegetable protein that gets inserted in all kinds of protein bars and isolated soy protein, which very different than regular whole soy and maybe linked to cancer in animal studies. So, I think it's important people realize that, you know, food is a modulator and it usually helps the body do what it does rather than interfere with it. And so, sometimes it's true with like if you eat too much broccoli or whatever, raw broccoli, you're gonna get back your thyroid. But, the phytoestrogens in soy actually help to act more like a thermos. They keep things balanced, right? and I think recommending those whole soy foods is great. And I think that's a really easy thing to do. Flax seeds also really help around flax seeds in the gut, broccoli, family vegetables, simple dietary things, and getting more fiber to help the prebiotics in the gut, getting rid of all the starch, the sugar, the processed food, all those ingredients, alcohol.

There's really simple things you can do. Yeah, like balancing your blood sugar, balancing your blood sugar by making sure that every meal has a good source of healthy healthy fat, has a good source of fiber, and has a good source of protein. So that prevents the spikes in blood sugar and the spikes in insulin. So you make sure your meals are balanced like that, then you won't get those ups and downs in your energy. And so you just feel better. And that helps with preventing that high insulin, which is-- and then you're going.

To be binging on carbs and sugar.

To get your energy up and all that. Right, right, right. So then that helps with the balance of all the hormones as you were mentioning earlier. And so, you know, when a woman is going through perimenopause, you know, the first place we look at is, okay, what are these personalized lifestyle factors? What can we really focus on with them? I mean, there might be times where we at the Ultra Wellness Center may use some hormones to help with- Dr. Hormones. Dr. Yeah, to help with their sleep if necessary. But many times just a woman understanding what's going on and then making some shifts in their lifestyle can make a huge impact and make them feel better.

Yeah. And so you had this patient who had struggled with sleep and she was 45 and she had never had problems before and woke up all the time at night sweats and she was terribly not well. And what did you find with her?

Right.

So, you know, we found so she was 45. So she was in perimenopause. we checked her hormones at day 20 in her cycle. So what we ended up finding was her progesterone was low, right? So she was in those anovulatory cycles like we had mentioned earlier, and her progesterone was low. So what we really worked on was supporting her progesterone production with supporting her adrenal gland, taking good self-care, getting good rest, doing her meditation, We also worked on metabolizing her estrogen. So she had some variations in her genetics and she ended up having some, we worked to really lower her estrogen levels with the cruciferous vegetables, folate-rich foods. We added in some supplements that actually on top of that were helpful. And she did much better. She really started to feel better and we Also, you know, we got her off of caffeine because we know that caffeine can impact sleep more. And it might not have bothered her in the past, but during this transition in her life, it was really impacting her sleep and her irritability. So we got her off of the caffeine and we also saw when we did that, her hot flashes significantly decreased and her sleep started to improve.

Yeah, and you just see so many of these patients who suffer with things like PMS or perimenopause or sleep issues or mood issues or depression or migraines, which are common when your hormones out of balance. Right. Or abnormal pap tests or we call it dysfunctional uterine bleeding, which you have clots and painful periods. And, you know, it makes me really angry when I see these patients because they're not getting the advice they need. They're not actually given a doorway into a way of thinking and diagnosis and treatment that actually fixes their problems.

Yep.

And they're either told they're, you know, you know, emotional or they're anxious or they give them an antidepressant or they give them a hormone treatment, which, you know, sometimes is okay, but a lot of times it's not the right hormones. It's, you know, giving them a birth control pill or giving them Premarin. And, and, and what we see in functional medicine is by working in this way, using the thyroid approach, the adrenal treatments and the insulin approach, you know, fixing the insulin resistance and fixing the estrogen metabolism and the gut and the toxins. You know, it's different for every woman, but you sort of look at what's for them the issue and you then personalize it and you can create an incredible roadmap for women to feel good and get rid of PMS and get rid of heavy bleeding and get rid of cramps and get rid of migraines and get rid of the sleep and high hot flash issues and so forth, right? So it's a pretty exciting model that I think is one of the best applications of functional medicine is helping women with all these hormone imbalances that are actually relatively easy to fix.

Yeah, I would agree. It's really fun. It's a fun place to be.

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