#130: How to Reverse PCOS

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies.

We're talking root cause resolution on this show.

So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome.

Hi, ladies.

Welcome back. I'm glad to be back. I had COVID again, so sorry about my voice. It sounds a little bit raspy. I'm still dealing with the aftereffects. You know, it's going around again, and luckily I didn't have it too bad this time, but it was a good reminder, uh, to take my own medicine, so to speak. You know, I was Overworking. I was overstressing about stuff and not fueling my body with what it needed, and that was what happened. So it was a good reminder to check myself, set— reset boundaries on my work and on my stress, to start journaling again, and to get out and be walking every day. And do my meditation. Like, everything kind of fell off the wagon over the past few weeks with traveling and taking on new responsibilities and different things that were going on, and that's what happened. So it's always a good reminder, do your self-care routines, right, ladies? So take it from me, it's so important to just Keep those daily self-care routines and not let them fall by the wayside because you'll end up sick like I was. So anyway, today I want to talk about what is PCOS, polycystic ovarian syndrome. I also want to talk about what PCOS isn't, why it's important to not ignore. And, you know, oftentimes we'll see Um, doctors put women on birth control pills telling them, oh, don't worry about it, this will stop PCOS. And then they try and go and get pregnant 5 or 10 years later, and then they have to deal with it. So I really want you to not go down that pathway. So we're going to talk about that, and we're going to talk about how to treat PCOS naturally. So PCOS stands for polycystic ovarian syndrome, and syndrome means that there are a constellation of symptoms that are often seen together in association and lead to a certain situation. And so it gets named a syndrome as opposed to a disease like diabetes, which is Definitely elevated blood sugar with your loss of ability to make enough insulin or respond to insulin appropriately. That's a disease with a cause. A syndrome— they're not sure exactly what the cause is, but they know that this constellation of symptoms goes together and certain effects are seen. And so You know, back in the '90s when PCOS really came out, it was thought, okay, women who have irregular periods, who have too many androgens, which are, are more male-type hormones of testosterone and DHEA, um, that they're seeing these symptoms occur with hirsutism, which is like chin hair, growth or hair on your abdomen or on your nipples, places it's not supposed to be essentially, and sometimes hair loss on your head in a male pattern baldness picture. And so they started seeing women with this constellation of symptoms and they decided that that was polycystic ovarian syndrome. And the name came from the fact that When they did ultrasounds on these women, they were seeing multiple cysts on the ovaries most of the time. And the key here is that these were very small cysts. They were follicles, so very tiny. In multiples, like 10 or 20 or 30 of these tiny little cysts, making the overall size of the ovary larger because of all these tiny cysts. Essentially, what we figured out was that women with this polycystic ovarian syndrome were not ovulating, and so their ovaries— every month when you're going to ovulate, you make a bunch of little follicles. Those are the tiny little cysts that have the egg inside of them that are potentially going to grow and be big enough to rupture open and release an egg. That's ovulation. And so every month you normally get different sized follicles. The big Biggest one is the winner, and it breaks open and releases the egg for the fallopian tube to grab and take in. And that resulting leftover area called the corpus luteum produces progesterone. And so you ovulated, you made progesterone. In polycystic ovarian syndrome, those follicles never get big enough to release an egg, so you don't ovulate. And then you actually don't make progesterone because there's no corpus luteum. And so what they saw was these ovaries had all these multiple cysts on them. Women weren't ovulating, so they weren't having their periods. They maybe had a period 3 or 4 times a year. That was the common presentation. And they had hirsutism and acne from these elevated androgens. So the Rotterdam criteria came out. Saying you had to have 2 of those 3 symptoms to diagnose PCOS. So say you're having your period every, you know, few months, more than 35 days apart. The average was like 9 times a year. You had elevated testosterone or DHEA, and you had these cysts on your ovaries. So if you had 2 to 3 of those, you had PCOS. The problem came that a lot of people didn't understand the mechanism behind what was happening with PCOS and what was driving these symptoms. So women were getting diagnosed incorrectly, and cysts on the ovary were probably the biggest one. And I still hear that today. Women will tell me, Oh, yes, I had a 4-centimeter cyst. I have polycystic ovarian syndrome and my doctor put me on a pill. That is not PCOS. We create cysts on our ovaries for other reasons. So I really wish they wouldn't have named it PCOS because it confuses people. It's not that you are making cysts on your ovaries that's driving the issue. That Those tiny little follicles are there because of hormone imbalances, which I'm going to explain. So if you have a bigger cyst, usually it's over 2 centimeters, or you get these repeated cysts, that's probably not PCOS. Those are termed functional cysts, corpus luteum cysts, hemorrhagic cysts. Dermoids, endometriomas, cystadenomas, and then there's obviously malignancy, which is a whole different ballgame. But you make cysts every month, like I said, when you do ovulate. And sometimes that leftover area can turn into a cyst and fill up with fluid. That's a corpus luteum cyst. You can get fluid-filled cysts on top of the ovaries. Those are adenomas. You can bleed into that corpus luteum area. That's called a hemorrhagic cyst. You can have endometriosis and get endometriomas, which are filled with a brown liquid substance. It looks like liquid chocolate. Those are endometriomas. So those are different cysts and they have nothing to do with PCOS. So— Please make sure that if you are getting the diagnosis, that it's actually the correct diagnosis. The second part of it, the androgens, so testosterone and DHEA, you don't always have to have grossly elevated hormone levels. So I'll often see women who seem to fit this picture of PCOS. They have acne, they have hirsutism, they're only having their period a couple of times a year. But because their total testosterone wasn't elevated, they get dismissed and they're told that's not an issue. But androgens are very complex. Not only are they made in the ovary, they're also made in the adrenal glands. And so you have DHEA, which comes from both the ovaries and the adrenal glands that can get converted into testosterone. Testosterone gets converted into DHT, which is a very potent androgenic form. And that's the kind that you really don't want because that usually causes acne and abnormal hair growth and scalp hair loss. It can deepen the voice, cause your clitoris to become enlarged, all these things. But it's not only about the total testosterone or the total DHEA because our hormones They get bound to proteins and they get carried around our body connected to these proteins. And as long as they're connected to those proteins, they're not available to bind to a receptor on a cell and send the signal. And so if you have a lot of sex hormone binding globulin around, or albumin, those hormones will bind to that and not be available to send the signal. So it's really important to know what your free available testosterone is because I've seen women with normal total testosterone, but because their sex hormone binding globulin is so low, they have a ton of free available testosterone to bind to receptors and cause all these symptoms. So there's definitely multiple pieces to the puzzle. You You need to know what is your sex hormone-binding globulin, what is your free available testosterone, what is your DHEAS, meaning sulfated version, level, all of those. So the missing piece of the puzzle is that the Rotterdam criteria does not address the metabolic issue of PCOS. At the core, PCOS is an issue with insulin resistance and blood sugar elevation. So what we see is this, you know, vicious cycle that women get stuck in, and we don't know what came first, the elevated androgens or the insulin resistance, but we know that the 2 drive this cycle to continue and to worsen. So in your brain, you have the hypothalamus, which secretes Gonadotropin-releasing hormone, GnRH, that talks to the pituitary gland and tells it to produce FSH or LH. Those hormones talk to the ovaries and tell it to produce estrogen or progesterone. And what we see is that in PCOS, you get too much gonadotropin-releasing hormone, which causes too much luteinizing hormone, which causes lower estrogen and no ovulation. So when you don't ovulate, then you don't get the progesterone, and that low progesterone continues that cycle. The other piece of it is that you make too many— too much testosterone in your ovary. So the low progesterone goes back and tells gonadotropin-releasing hormone to release some more, and you get stuck in this vicious cycle of anovulation, or no— not ovulating, not making progesterone. So you have a sex hormone imbalance of too much testosterone, not enough progesterone. And then you pull into the picture this insulin resistance issue. So insulin normally is Made in the pancreas and pushed out every time there's sugar in the bloodstream that needs to be taken up. So when you eat a meal of almost any kind, you're going to elevate your blood sugar. You need insulin to go out and get that and take it into the cells to be utilized as energy or stored as fat. What happens when you eat all of the time is that you are making insulin more and more and more, and your cells stop listening to the signal. They get really tired of insulin knocking on the door all the time asking them to take in the blood sugar. So you get this insulin resistance at the cellular level. So what happens is your pancreas has to make more insulin to send the same signal. It's like it's yelling. And so over time, if you keep eating frequent meals, even if they're small, healthy meals like almonds, you know, cheese sticks, whatever, you're still making more insulin than you should, and you develop this insulin resistance. Insulin resistance drives testosterone production and drives dihydrotestosterone production, which further suppresses The cycle of estrogen and progesterone. And so you are stuck in a cycle where you're making too many androgens, you're not ovulating, you're creating this insulin resistance, and that drives inflammation. And so all of this is happening at the level of the ovary. And the ovary is inflamed, it's— it can't function. And then your mitochondria, which are the little powerhouses inside your cells of your ovaries, they downregulate and they no longer want to produce energy. They go in defense mode. And so then your egg quality starts to diminish and your anti-Müllerian hormone level starts to diminish, and this all worsens your fertility issues. So it's really important to realize at the heart of PCOS is a metabolic issue. It's an insulin and blood sugar and inflammation issue more than anything. So at least 45% of women with PCOS have metabolic syndrome. There's another syndrome. So what they say is, if you have blood pressure that's greater than 130/85, or you have central obesity, meaning your waist circumference is over 35 inches, if you have elevated triglycerides above 150, or if you have low protective HDL less than 50, or fasting blood sugar over 100, So if that sounds like you, if you have 3 out of 5 of those I just listed, then you should be checked for PCOS. And if you already know you have PCOS, I'm glad you're listening to this episode because I have great recommendations for you to get control of it and reverse this metabolic syndrome and reverse your PCOS. Because if you have either of those, you have increased risk of fatty liver, infertility, miscarriage, diabetes, sleep apnea, depression, and uterine cancer. So they're kind of a big deal, right? So we want to get control of this. So you need to treat that insulin resistance. If you go to a conventional gynecologist or primary care doctor, They're going to focus on symptom relief. So they usually give you a birth control pill so that you, quote unquote, have regular periods again. That fixes your problem, right? Well, it doesn't actually. What, what's happening is you're taking synthetic hormones to override your brain and ovaries from making their own hormones. But what we are seeing is women who go on the birth control pill for PCOS, as soon as they come off, it's right back to where you were or 10 times worse. It really is just suppressing and masking the symptoms of what's going on, but it's not stopping the underlying root cause disease. And so it's really not helping you. The other piece of it is they try to get rid of your other symptoms like depression, acne, weight gain with spironolactone, antidepressants, Accutane. Sometimes they'll give you metformin for the insulin piece of it, or Clomid to get you pregnant without fixing the root cause of the issue. And unfortunately, those medications often cause new issues, right? So we now understand that Clomid and birth control pills have risks associated with them— long-term use, increase of cancers, and other issues like leaky gut, vitamin mineral deficiencies. Metformin is usually not very well tolerated. It causes a lot of loose stools or diarrhea. GI upset. And antidepressants usually cause weight gain, which is not helpful in PCOS. That actually causes you to make more testosterone and, and have greater insulin resistance. So that's not helpful. And the spironolactone can sometimes be helpful to block the production of dihydrotestosterone, that more androgenic form of testosterone. But it's not really fixing the problem with too much production and why that's happening. So these are very much Band-Aid approaches, and some women need those to feel better, look better, to make the changes necessary, but it's not really a long-term solution. It's not going to reverse your PCOS. you know, talk about is it's really important with what and when you're eating. So I— it's really common for women with PCOS to not actually have an appetite, um, and to not feel like eating full-size meals. They often are in a dysfunctional eating pattern because they not only develop insulin resistance, but they get this resulting hypoglycemia. So your blood sugar can drop lower than a lot of people because you have to make extra insulin because, like I said, those cells don't hear the insulin signals. So you make extra insulin. And then all that extra insulin floods your system and it can drop your blood sugar too low. So you go from these big, high, high levels of blood sugar to too low of levels, whereas someone without this polycystic ovarian syndrome, they don't have as big of, you know, elevations or drops. And so you're more on a roller coaster with your blood sugar. So it's more common for women to struggle with hypoglycemia and feel hangry, feel shaky, feel like they have to eat every couple hours to maintain their blood sugar. And for a long time, that— it's actually awful recommendations— that was told, that's what you should do, is to eat every couple hours to maintain your blood sugar. But that's not actually fixing the problem. It's actually making it much, much worse because you continue to drive that insulin resistance. So normally a fasting insulin level should be around 5 or less. And what we see is levels of 10, 15, 20, or even greater than that. And that is telling me that your cells aren't listening to the insulin and you're having to make too much to do the same job. So it's really important to figure out how can I get off of that vicious blood sugar cycle? The other piece of it is leptin. So leptin is our satiety hormone. It tells us to stop eating because we're full. But unfortunately, the more weight we carry, the more fat cells we have, The more leptin we end up making, and we can actually get leptin resistance, just like insulin resistance, and we stop feeling satisfied or full. So a lot of women will get stuck in this situation of never feeling full or satisfied, continuing to have cravings, and continuing to overeat because they're not feeling full. So if you're not eating healthy food, which is often the case with these cravings because you're craving immediate blood sugar relief— so simple carbohydrates, processed foods, things like that that are very high in carbohydrates to give you relief— that's driving the process and making it worse. And those don't actually have a lot of nutritional value. They don't have a lot of protein or healthy fats or vitamins or minerals. And so your body never feels satisfied, and that further drives the leptin resistance. So you're stuck in this vicious cycle. What do you do? You literally need to do time-restricted feeding, and that can start with just getting rid of your snacks, really focusing on eating 3 nutrient-dense meals a day. And that means getting 30 or 40 grams of protein in that meal, getting probably 34 or 40% of healthy fats like grass-fed butter or ghee, olives, olive oil, avocados, eggs, all these good healthy fats along with lean, clean proteins, you know, grass-fed be free-range chicken, that type of thing, and minimal carbohydrates. They should be actually from vegetables. You should have a lot of fiber in your carbohydrates because that causes your blood sugar to not be so elevated. It's the simple carbohydrates that elevate your blood sugar, like plain white rice, bread, Pasta, things like that. So stay away from the white foods. And if you can really figure out how to get 3 nutrient-dense meals a day and stop eating snacks during the day, that's step 1. Step 2 is to get into a time-restricted window. So stop eating at least 3 hours before bedtime. I would say most of us want to snack between Dinner and bedtime, and that drives major insulin resistance. And drinking, drinking alcohol, it all gets metabolized into sugar. So really refrain from drinking and eating after dinner. So if you can go from dinner until breakfast the next morning, you're on the right track. And intermittent fasting and time-restricted feeding is a practice that you need to learn how to do. You can't just wake up one day and do a 16-hour fast, necessarily, especially if you have metabolic issues like PCOS. So it's something you work at and you, you know, you get to that level by small incremental changes over time. So you get rid of the snacks, you eat the healthier meals, Then you shrink your eating window to 10 hours and then to 8 hours. And then you can eventually start to go for the longer fasts if that's the direction you want to go in. But that will improve the sensitivity at the cellular level. So it's super important. Moving your body also helps a ton. Oh my gosh, it helps so much with insulin resistance. So if you literally just go for a 20-minute walk after dinner or after lunch, that improves your cells' response to insulin and it helps keep your blood sugar balanced. So I would strongly encourage you, if you have PCOS, you should go for walks after every meal, without a doubt. And it doesn't have to be power walking. It's a Literally just going outside and walking for 20 or 30 minutes. And the other piece of it that I see often with PCOS is your circadian rhythms. So shift workers are more prone to having PCOS and shift working contributes and worsens it. So if your circadian rhythms are off, meaning you're not waking up with the sun and going to sleep with the sunset, Your circadian rhythms are going to be off. That is going to drive that insulin resistance. So it's really important to get on the regular healthy sleep cycle of, you know, humans as much as possible. So what you can do is first thing when you wake up, you get that sun to hit your retina. That triggers a cortisol awakening response that triggers the normal clocks in your body to pulsatile their hormone production out of your hypothalamus. Like I was talking about, your gonadotropin-releasing hormone, all these hormones, they get produced in a pulsatile fashion from the clocks in your body. And so you need to reset your clock. So get that sunlight hitting your retina. Stay outside for 10 or 15 minutes in the morning. Try to look at red light in the evenings. Go out and look at the sunset. That's why the sunset is actually red and pink and orange, because that is what drives your clocks to produce melatonin and your sleep hormones. So You need to really embrace your circadian rhythms and help prioritize good sleep habits. So stay away from blue light in the evening, get rid of the phones and the tablets, you know, at least an hour or 2 before bed, and that can really help. So lastly, there are 6 supplements that I absolutely love For not only calming down PCOS, but in a lot of times reversing it so that you get rid of that risk of diabetes and fatty liver and sleep apnea, and you are able to get pregnant again. You have return of your cycles and your fertility improves. So if I had PCOS, These are the 6 supplements that I would definitely be doing. Number 1, myo-inositol and D-chiro-inositol. So these have been studied with great results. Inositol's shown to reduce insulin resistance and elevated testosterone levels. So when they combine it with folate, they showed improved pregnancy rates and quality. egg quality, which looks like better AMH levels. So there was a study in the Gynecology Endocrinology journal that actually showed that it prevented gestational diabetes in some women as well. So it looked at women with PCOS who became pregnant. They had one group who took myo-inositol and one group who did not take it. And the women on myo-inositol developed gestational diabetes 17.4% of the time, whereas the control group developed gestational diabetes 54% of the time. That's huge. That's a big difference. And gestational diabetes not only affects you as a pregnant woman and increases your risk of type 2 diabetes later in life, but having gestational diabetes increases your baby's risk of being an obese child and having just— and having diabetes themselves. So if you do not want to set your brand-new baby up for, you know, all of those issues, it's imperative that you don't get gestational diabetes when you're pregnant. So I like using a combination of myo-inositol and D-chiro-inositol. My favorite is Sensitol from Designs for Health. You want to get at least 2 to 4 grams of that per day for great effects. Berberine is another amazing one. It's extracted from goldenseal. It's well known for its ability to improve blood sugar balance and cholesterol. But it's just as effective for insulin resistance and hormone imbalance in PCOS. So studies have shown that taking 400 milligrams 3 times a day causes significant improvement in your menstrual cycle regularity, ovulation, and insulin resistance. So it is important to know that berberine can alter the clearance of certain medications in your liver. So talk to your doctor if you're on medications like antidepressants, blood thinners, or beta blockers because berberine might decrease those levels. And I'll just make a side note, like, I am not your physician, right? Even though I am a physician, I'm not giving you specific medical advice for you. I have— I don't know you as my patient. So these are just general recommendations for women who struggle with PCOS. If you do want to work one-on-one with me, that is a possibility. But just know that you should always talk about these things with your doctor or provider and base it off what's best for you as an individual. So back to my general recommendations. Number 3 is omega-3 fatty acids. So These are a necessity when it comes to PCOS because PCOS causes inflammation in the ovaries. This prevents the mitochondria from doing their job. Omega-3s are anti-inflammatory, so they counteract the inflammatory process that is destroying your egg quality and the ovaries' ability to ovulate and make progesterone. Omega-3s also help regulate insulin and leptin levels, which decreases your resistance. So once your cells are no longer resistant, you can start to lose weight. This improvement in insulin and leptin sensitivity and resulting weight loss then lowers your testosterone production, which decreases your hirsutism and acne and often balances out your estrogen and progesterone. So then you ovulate and have regular periods. It's pretty awesome. So my Omega Lift is a great way to get your EPA, DHA. needs. I would say, in general, most people need about 1 capsule a day, but if you have PCOS, I recommend 2 capsules daily or even 2 capsules twice daily, depending on how much inflammation you have going on in your body and what else is going on with you particularly, right? And this is a really important thing to note. Like, you want to make sure you're taking a high-quality supplement that's been third party tested and make sure there's no contaminants, especially omega-3s. They can be contaminated with heavy metals like mercury from fish. So, so my Omega Lift is sourced from waters off the Chilean coast. As the world's least industrialized coastline, these cold fresh waters provide the cleanest, most sustainable source of fish in the world. So I'm confident recommending my Omega lift to you. And I can't say that about most of the omega-3 supplements. So I just want you to know that. So number 4 is vitamin D3. So many of us are deficient in vitamin D. Where I live in Michigan, it's super common to see blood levels as low as, you know, 15, 20, maybe 30. Optimal levels are like 60 to 80. So vitamin D deficiency Exacerbates many conditions, and PCOS is definitely one of them. Not only does it contribute to PCOS, but the lower your D level, the worse your symptoms seem to be. Vitamin D is needed for blood sugar control, which is the main driver of PCOS, like we've been talking about. So supplementing with vitamin D improves ovarian reserves seen with higher AMH levels. And overall better fertility. So even if you aren't deficient in vitamin D, these improvements in PCOS have been seen. So I would say get your levels tested. If you're above 50, then you probably only need 2,000 IUs a day to get this benefit for this PCOS. If your levels are between 30 and 50, you need at least 5,000 IUs daily. And if your level's less than 30, you probably could use up to 10,000 IUs a day. I would recommend rechecking your blood, your vitamin D level in your blood in 3 to 4 months just to see your response because you don't want your levels to get too high. But that would be my generalized recommendation. So you need to speak to your doctor specifically about what exact is a good dose for you. But in general, the studies show taking at least 2,000 IUs a day has been beneficial. And I love my D3 K2 Lift because it's a tasteless liquid. You just drop like 2 to 10 drops in your mouth and you're good to go because it gets absorbed right in your bloodstream. It's a full dose. You're not relying on your gut for absorption. So this is fabulous. Everybody needs vitamin D, and we've come to learn that through the pandemic, right? Okay, number 5, NAC. N-acetylcysteine is naturally made in our bodies and gets converted into glutathione, our major antioxidant that goes around and cleans house. It removes old and damaged cells and DNA so those cells don't go rogue and grow into tumors. Right? But you can take NAC. You can supplement this antioxidant in your body. And studies have shown that NAC improves insulin resistance, it reduces testosterone levels, and therefore causes less hirsutism in PCOS. So in one study, NAC was actually comparable to metformin, the diabetes drug that's often given for PCOS. So NAC was comparable to that in lowering insulin and androgens and improving your menstrual cycles. So that's pretty awesome because a lot of women don't tolerate metformin, like I mentioned, because of the GI upset, the loose stools, the gas, the bloating, the diarrhea, the nausea. So I recommend you take like 600 milligrams of NAC 3 times a day. Do this for at least 6 months and you're going to see some major improvements. And why not do that, right? That's a no-brainer as compared to taking metformin. And last but not least, number 6, saw palmetto. Saw palmetto is an herb with strong anti-androgen abilities, meaning it reduces testosterone levels. High testosterone is what causes the hirsutism and acne and PCOS. So with that in mind, I created Beauty Lift. It's an awesome supplement. It's got saw palmetto and stinging nettle to decrease your testosterone and dihydrotestosterone production, but it also has biotin and vitamin A, which are super necessary for healthy skin and hair. So I love Beauty Lift for combating the physical manifestations of PCOS. So that rounds out my 6 favorite supplements for tackling and reversing PCOS. If you start using these supplements, you get serious about what and when you're eating, and you move your body every day, you will break this vicious cycle that you're in. It's pretty amazing to see women's insulin resistance reverse. The cells start to become sensitive to insulin again. You start— You lower that androgen production, you start ovulating again, and you're supporting the mitochondrial health inside your ovary, decreasing the inflammation in your pelvis, and it all evens itself out. So the touch— the piece I didn't really touch on was gut health. It all comes back to gut health, right? But gut health drives what's going on in our pelvis because Literally, our bowels and our bladder and our uterus and our ovaries and our fallopian tubes—they all touch each other. They all live together in the same environment, and they affect each other. So what you're eating and when shifts your gut health. It decreases the inflammation. Just fasting alone will decrease inflammation in your gut. It will shift your microbiome. Bad bacteria will die off if they're not being. Fed simple carbohydrates all day long. So that's really important to understand. Like, if you can get control of your diet, if you can get control of your sleep patterns, if you can start moving your body and give your body everything that it's needing and lacking because of this vicious cycle you're in, you're going to break free. It's pretty amazing, but I see it all the time. So I hope this episode was helpful. PCOS is very complicated. At the heart of it, it's a metabolic syndrome with inflammation and hormone imbalance, but it can all be reversed and balanced out. And taking synthetic hormones and medications to cover up the symptoms does not actually fix the problem. So I hope that you've seen the light a little bit and feel encouraged that maybe you can try a few of these things and get on the right track. So if you feel like you want to work with me one-on-one to tackle this, you can always reach out to me at drtabatha.com. It's D-R-T-A-B-A-T-H-A. It's 3 A's, no I's. But like I said, Try this regimen and see how you do. I, I think you'll be very surprised. So if you found value in this, I hope that you'll hit the subscribe button so iTunes know that this is the kind of stuff you want to listen to, right? Shoot me a 5-star review, send me your feedback, tell me what else you want to listen to. And more importantly, like, if you thought of Of any woman in your life while you were listening to this that also needs to listen to this, please send it their way. Share that with them. If you share it and put it on Instagram, I'll send you a gift because it's a sisterhood. We need to support each other and lift each other up, right? So that is what it's all about. So I hope you got some great information from this. And And I will see you next week. Go have a kick-ass week, ladies.