Beyond Menopause: Reclaiming Health and Vitality with Functional Medicine

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Hey girlfriend, it's Dr. Anna Kabeca here. You know I love a good deal. If there's a sale, I'm already clicking add to cart. Look, I don't like to buy things full price, so if you're like me, this is your moment. The holidays are here and yes, chaos is knocking, but I've got your back. Sign up@dranna.com deals to get early access to my biggest celebration of the year and a little wellness gift from me to you.

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Welcome to the Girlfriend Doctor show where we empower women to thrive, mind, body and spirit. I'm Dr. Anna Kabeca, your host and guide. As a triple board certified OB GYN specializing in women's health, sexual health and menopause, I bring decades of experience to help you navigate the transformative stages of life with confidence and vitality. Each week we'll explore science backed strategies, expert insights and real life solutions to help you embrace your health journey. This is your safe space for honest conversation because here there's no such thing as tmi. Let's dive in.

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Do you feel like a stranger in your own body? Are you experiencing brain fog, hot flashes, weight gain, mood swings? You're not imagining it. On this week's episode on the Girlfriend Doctor Show, I am joined by Dr. Cheryl Burdett, a pioneer in functional medicine, testing and hormone health. We're unpacking how your hormones shift in midlife and what's happening well beyond what you can do in menopause and beyond to really help support you and what tests really tell you the truth and the simple strategies that help you reclaim your energy, your mood and yes, your libido. Also going to be talking about how you advocate for yourself. How do you show up at your office or clinic or self order tests that can really help you and this is such an important thing as our medical system needs to change. You have to stop practicing sick medicine. Really truly having healthcare and longevity care as part of our aging. Not just for us but for the generations to come. So you don't have to settle for just aging or this is just normal for your age. Tune in and learn how to bring your hormones back into harmony. I know you're gonna love this one. I love Dr. Cheryl Burdett. She has been incredibly influential in my career too. I had met her first when we were scientific advisors on the medical advisory board for a nutraceutical company that is absolutely excellent in creating great products and I was so impressed by her ability to teach, to digest and to bring such key knowledge and practical, really practical steps to understanding physiology, understanding nature as medicine, and so much more. You'll just going to be blown away because she always impresses me when I speak and this episode is no exception. So I'm excited for our one on one conversation. You're going to learn a lot. Dr. Cheryl Burdett is the co founder of Precision Point Diagnostics, a laboratory that focuses on gut based health and wellness. She designs clinical profiles and trains clinicians on their utilization. She has a rich history in the integrative medicine and laboratory space. She is co founder and educational director of Origins Incubator and she also has helped to launch many successful practitioners through her residency program in naturopathic medicine that she does at Progressive in Atlanta, Georgia. And she really has thrived in sharing her clinical experience with growing clinicians. She loves teaching. It is a passion, passion for her and she's very, very passionate about integrative medicine and naturopathic medicine. She says there's no other way. We have to integrate this into our care of our patients or we're not really helping them. So join me in welcoming Dr. Cheryl Burdette to the Girlfriend Doctor Show. Welcome Dr. Cheryl Burdette to The Girlfriend Doctor Podcast. How are you?

I am great. So glad to be here. Good to see you. You made it off of the back of a horse or out from a rodeo.

Well, today I've been busy teaching my hormone masterclass, but I'm going to go later. I'm going to go later and make sure I get some of that good loving in. It's been a long time coming, getting you on my podcast and every conversation I've ever had with you, it's always like, I'm blown away. And you're such an amazing teacher and clinician and, you know, scientist and you really just really are able to drive home points. I want to talk to you with your experience, I want to dive right in because I know we've got certain amount of time. There's so much I want to talk to you about. And our audience is ready and listening because I'm like, we are desperate for answers, right? Our audience is desperate for answers. How they can feel empowered, what's not working? And you are both functional medicine and naturopathic medicine and these are the areas that you dive into. What do you see, like what kind of patients are coming to you and where, like, what have they gone through by the time they get to you?

You know, I think like most of medicine, who we see, if we're going to break down just a Straight demographic tends to be more women. Right. And then it tends to be women as we get older, as we're transitioning, as we're moving towards menopause. And I think that there are a lot of failures out there, but this is a good, this is a good lens to look at a failure. And I bet this would sing to your heart as well. So do you remember back when we were pregnant and. Not exactly, but we almost got to go in as a, well, patient. I mean, there was still a lot of paperwork that indicated maybe pregnancy in and of itself was supposed to be a problem, but in general we got to be there for what was called a wellness check. You know, at least it had that name to it. And you weren't per se sick. You got. You were being checked on, it was being preventative, you were making sure it wasn't the case. And this is just not the experience as people transition to menopause, even though it is just a, as normal, maybe even more normal of a phenomenon, because if you get to make it to average age of 52, then you will become menopausal at some point. Not every person has a child, so we could even say it's more normal than childbirth. And there's no system around approaching it. But like a normal transition that people are supposed to go through, I mean, I get to exist in our community where I'm around beautiful minds like yours all the time, and then also highly scientific minds. I a lot of PhDs out there as well, and even just like one step over in the PhD world where they're looking at reproductive hormones. When somebody who's been studying it that much, but not clinical, but has been studying it that much, gets to that place in life, what they say is, I don't know what to do. There are no tools. Literally talking about people that undergraduate, graduate, postdoc after postdoc, and now they've made this their study. But when it came to them specifically, there was no map, there was no support, and they just felt lost. So I think that this is when people are really trying to achieve some type of optimal wellness and stay well. And menopause is a great example of that, of when you would be looking at it like that. This is really where the failure is.

Now. I love that I'm writing that down. No map, no support, just feel lost. And that is so true. That is definitely what happens. And even those who are trained in this area, OBGYN physicians that are supposed to be the experts, are lost. And honestly, if it wasn't you know, for my experience at 39 with early menopause and infertility, and then again at 48, full blown crazy. Let's just say, you know, I wouldn't know what I know and I wouldn't, you know, have gone down this route to essentially try to create a map. But when clients are coming in and like, you're so right, we don't look at it as that, you know, like wellness anymore. And menopause is being labeled as a disease, but is no more a disease than puberty is a disease. Right. So we want to empower. Like this is the stage of empowerment, the wise women, the, you know, the passionate, you know, the goddesses. I mean, really, like this is the time of life where we're able to do so much and we want to have the capacity, brain and body to do it. But what I see a lot of is definitely the issues with mood and memory and energy. Those are some of the big. And the weight gain without doing anything different for sure. And you know, in my practice, women have gone to many providers by the time they get to me. Right. Because I'm cash based and you know, it's a big jump. So curious in your clinic too, when they're seeking out a functional and naturopathic doctor. What have they tried by this time? What brings them to you?

Everything. And so they've gone to three to five doctors already. They've been searching online. They know they're not feeling like themselves. They maybe find some words out there that they can identify with. Maybe in this situation they read about bioidentical hormones and they say that sounds like a really good option because it's more natural and maybe it minimizes a cancer risk. But then when they go out there and ask for it is very difficult to find. It's even difficult to find a conversation about. To find a conversation about what you need to couple in terms of diet or lifestyle when you're doing that or other approaches that would be supportive, that's like impossible to find. And so people feel very non listened to, unheard for sure. They feel like nobody's telling them what's going on. What's the root cause of this? I mean, this is why I'm quoting you all the time. Because your approach to this transition is not that it always means a medication or a prescription. It might. And when we need those, there should not be a presumption against quality of life, which there almost seems to be. It's almost like if it prevents things and makes you feel good, there's A presumption against it. If it makes you feel pretty lousy, then let's hand that out like candy. I say that a little tongue in cheek.

Well, it'll make your lab numbers better, but you'll feel really sick.

Yeah, right, right. Whereas they could talk about diet and lifestyle, it might do the same thing and have the side benefit of making you have more energy and feel better. So it's those people that have been unheard and their problems are unaddressed and they want to be more involved than just either nothing or a script for depression. They know there's a reason for that. And so they're looking for how can they learn more about themselves, their body, how to be empowered.

Right. I think that's so important. And also, like menopause is mandatory and natural suffering is optional. But so many women are suffering and they say, oh, well, women just weren't talking about it 50 years ago, or can't say 30 years ago or whatever. They weren't talking about as much. I think that's part of it. But I think women are really hormonally imbalanced now. I think the inflammation, hormone disruption, autoimmune issues, I mean, it is exponentially more problematic now than it was 30 and 50. So the slap of the hormone is not the answer. It's not enough of the answer, let's say. What do you think?

I was just looking at tons of data today about how many of the major chemicals out there are known as what are called endocrine disruptors. And so disruptors, our hormonal systems. And so if they're, you know, strong enough to disrupt what we're making in our 20s, they're going to definitely be strong enough to disrupt what we're making in our 50s. And just replacing them doesn't necessarily mean they won't be disrupted in that environment. So all of this work around that, all of the detox and controlling inflammation and really working dietarily, like I've learned so much from you in terms of as we get older, our brain just doesn't do as well with sugar and glucose. And why low level ketones, tones can be so beneficial for clearing up the brain fog that's almost ubiquitous with hormonal changes. I mean, I talk about your book Menopause all the time. I tell men that they still need to have menopause on their shelf. I get that they're not going through menopause, but you have the best recipes for how to do a ketogenic diet in a healthy way. Everybody needs that book and maybe they can just stop on the men part if that makes them feel better somehow. But that is the way to do that. So if it helps your brain, probably on both sides, we're going to have some times we want our brain help. And in terms of dietarily, how to lay it out, it's easy, it's delicious. To me, that's a go to. I'm always keeping that around and sharing with people, telling them to go get it. So learning that transition or the help that you need again isn't just going to be wrapped up in some other package that some still looks like a pill, powder or potion. It's a journey and it is work, but it's satisfying work. Like I think most of us like when we're going into our exercise, sometimes we're like, yeah, I can't wait to do this. But there are plenty of.

There's really never. No, I'm like never that I'm always happy when I'm done.

Exactly when you do the work. And so I think that that's really the difference is that people want to know, well, what is the work I should do? There's no conversation about that. And so combining all of that together and you know, sometimes with pills, powders and potions, but not exclusively.

Yeah, no, that's so important. And so this, the hormonal transition that's happening, that's something that's really so fascinating because it's a neuroendocrine period of vulnerability. So it is this really neuroendocrine vulnerable time period. The mood swings, the memory loss, the anxiety, the depression, the forgetfulness, the increase in psychiatric diagnoses and disorders. And we look at that in relation to hormones and the gut. Gut. Right, like the gut, the neurotransmitters. And when you approach in perimenopause and early menopause, these symptoms and conditions, I'm curious, what's the testing? What are some of the basic and foundational tests that you recommend and what hormones are you specifically looking at as well.

Yeah, that I will sometimes look at different types of testing depending on what question I'm asking. So if I'm asking the question, what's a level of a hormone? And especially on someone who hasn't had, had a hormone, we can probably get by with a simpler test to start. Sometimes just a serum level or a salivary level. And there have been some developments in that area that are quite helpful. So serum estrogen, for example, is not what it used to be. There's now you can order sensitive estradiol. And that was developed to look at women menopausally, also on hormonal blockades. Because in the oncologic community they realized some people do better on hormonal blockades than others. They have better outcomes. What's the difference? And they said, well, it's shifting these very minute levels of estrogen, but we can't read them in a standard test. And this is problematic for women for many years because a serum test wasn't going to really show you where you were at. And they would have these bottom ranges of zero, which is not where a woman's supposed to be. What was the sensitivity of the test? Not what's in our body. It was just a test that was insensitive enough for what was in our body at that time. Well, that's changed. And with that it's allowed the conversation to change a bit as well. Because now we can say, hey, look, there is a postmenopausal range. Below a certain level is associated with more cognitive decline, more osteoporosis. It demonstrates that we're supposed to have circulating levels of estrogens even postmenopausally. It's just that that detection method couldn't pick it up. So it put us in a kind of odd direction. Then you added to it that most of what was being used was synthetic, which has a lot of problems. But a testing problem about that is when it doesn't look like your own stuff that the lab set up to measure, it can't measure those molecules, so you couldn't measure the synthetic ones either. So it added to this kind of mucked up knowledge that like, maybe we're not supposed to have any, which isn't the case at all. So that's.

Well, that testing was unreliable.

And that's still like I rely out that we should. And so then some clinicians would get scared doing things based on a clinical need or quality of life because of numbers on a test. And there always needs to be a balance there and probably weighted more on the clinical side and the quality of life. But add to that ways to make things safer. It was like that part of the conversation just got left out that we could do things to use hormones and make them safer, that we could do things to improve detox and improve gut health that we could look at we hormone metabolite. So now somebody's on some hormones. Now we might be asking a different question. Probably before you came in, you had all these symptoms. You probably just don't have enough. So now when we give you some are you metabol? And there's certain populations where you'd want to know all of that at the same time because they're more high risk or their symptoms dictate it. But now that you're on them, how do you clear them? Are you making the good guys from them? Are you making more the bad guys? Because this is going to sound odd to people. It's been about 20 years since Standard cancer community, oncology community said it's not estrogen that causes cancer. They said it's estrogen metabolites. And so that translation really didn't make it so much into clinical practice because not everybody, well, measuring these metabolites. So now that you're on them, okay, let's see how they move out of the body. Let's see the person that we're putting them in. What are you eating? Are we getting you on less inflammatory foods? Because the more inflamed you are, that blocks the hormones you have from binding yours or where they're coming from, from. And really surrounding a woman in a whole person approach, I think, you know, to not be like our experience when we were pregnant at that moment. I tried to build it up as this, well, this visit. But sometimes it could still feel like you were maybe a uterus and a blood pressure, a urine cup and a blood pressure. And so then on the flip side, even if you happen to find a patch of semestradiol or whatnot, it can still feel like hell. Now I'm just a replacement of what the uterus was doing. And so I think the difference is there are people are coming in looking to be a person. How do I eat, what exercise do I need, what do I need to do to my environment? Because I can optimize my own ability to make hormones to some degree. I might need to add some, I might need to add different ones than other people. And so really that individualization, I think.

It'S so important to talk about the nitty gritty with estrogen detoxification. I definitely want to get into it because back in the early 2000s when I was looking at this, you know, we had the 2 to 16 hydroxy estrogen ratio and then more and looking at urinary metabolites or blood. But now we're able to look at 2, 4, 16 hydroxy and methoxy estrogen metabolites and what those different pathways mean. I always say like the good, the bad and the ugly. Two the two pathways, the good, the 16 pathways, the bad and the four pathways. The ugly but like. And this methoxy piece, and this is again from so many years of testing. I'm curious what you found, but there's different ways we methylate down that piece, right? It's not just MTHFR, there are different ways we can drive methylation of 4 versus methylation of 2 versus methylation of 16. And I know you've geeked out on this. You know, can you explain this in a way and why, like why you and I both look at, you know, these hormone detoxification pathways and especially why it's so important as people are being you know, slapped on hormones at all kinds of levels and maybe really high levels, and then also why some people do well and some people do very poorly.

Yeah, absolutely. And so, I mean, first of all, I thank you for backing the conversation up even further and saying we've got to start with diet, you know, teaching people about how to get into low level ketosis, because that can clear a lot of the brain fog. And so if we start with diet and what we can do, okay, now do you even need those hormones or are you thinking more clearly and you're symptomatically feeling like yourself? I mean, that's not symptomatically. You are not symptomatic. You are feeling like yourself.

Yeah.

And so, but then from there, if you do need estrogen, then realizing that that can be done in a mindful way that lowers risk and can deal with people's various safety. So just like you said, it's a difficult world out there for a hormone these days. And so what we're talking about is someone is the hormones that we make or that they're given. And also just use estradiol because that's one of our strongest ones. And it's also one that is given, that's bioidentical. And so that hormone then has a fate, a pathway that it can go down, that it can either be broken down into metabolites that could be more of a cancer risk, or quite the opposite, protective, even less of a cancer risk. And that doesn't depend on the hormone that's given. It depends on all of those things that happen afterwards in terms of detox. And I'm sure, I would imagine that your clinical experience probably matches mine, that you see more infertility at earlier ages. And again, sometimes you're even looking at hormone levels and the hormones look fine. And it's all of these endocrine disrupting toxins that are in our environment. And certainly for our guys, we gotta think about that because we've just seen sperm counts tank to ridiculous levels, that they say if that curve keeps up in that direction, that men will be all be sterile in 10 years. And so this environmental detox piece is so important right from the start. Is it blocking your own hormones? And then when you have hormones, or even if you're taking them now, is it interfering with their ability to detox, to move out of your body? And we can measure this. So we're not guessing. We know. And so we have these ways of getting things moved through the body. And first of all, it's genetics. And maybe people think, yeah, I mean, just how my mom did it is how I'm going to do it. And there's some reality to that. But they compared people who had little broken genetics, not totally broken. They call them snips or polymorphisms in certain genes. One called one a one that helps to make a better estrogen metabolite. And they took that group with the injured gene and compared it to groups with normal 1A1, but that were under more oxidative stress. So oxidative stress would mean more toxins, less antioxidants in your diet, more free radicals, more inflammation. Thank you. They found the fate of that hormone was worse in the person with the environmental load than the genetic load. And I love that because it means that we're not just our moms, bless her heart, whoever she is, wherever she is, but that we're. That we have an ability to shift our genetics, to move them in a healthy direction, even if we were dealt a bit of an unfair hand. So that being said, that means we can surround somebody in good, healthy foods to make sure they're removing these metabolites. You mentioned that we can methylate, and that's true. We can use folates to methylate 5 methyltetrahydrofolate. It's a methylated folate. And we know when women are lower in that their risk of breast cancer goes up. We know women who drink too much where at risk of breast cancer goes up because they're using their methylators. We know if you restore those methylators, then the best way would be to not drink too much, not to take more folate. So if we're drawing that conclusion, I want to make sure we steer clear of that. But when we do restore methyl groups from folate, our risk of breast cancer goes almost back down to normal. But it's not the only way to get there. That oxidative stress interferes with our ability to methylate, to move it's like this last little exit hatch for this medium bad guy. Or. And maybe he's worse than. Or she's worse than a medium bad guy. And then if we dress it up in biochemistry, we're talking about our core hydroxy, estrones, estriol, estradiol. They can be methylated out. And if they don't get methylated out, they get jammed down into these things called quinones that directly damage your DNA. And we know that that sounds like and can be a mutation. So we have this escape hatch, and that's the methylation that Anna was talking about, the methylfolate. And that's one way. But we can also do things like more green tea that decreases oxidative stress. It's been shown to increase that enzyme as well. So there's all of these things that we have to layer a person to know where their deficiencies are, where they're really good. That happens, too, and they don't need to do extra work. So we can figure out who's a good candidate for hormones. And even if there's some parts that might be questionable about absolute best candidate, then we can manage that. We can improve the safety of it. We're not just left with, here's a patch, slap it on. Maybe we'll look at a level that's all we've got.

Yeah. And then the 4 and 16 pathways, like when you see abnormal 4 and 16 pathways and what are you doing to address those?

Yeah. So first of all, like, sometimes you'll see people get really upset about the fact that they're metabolizing to more of these bad metabolites when they have just almost no hormone in the first place. So I'm like, well, yeah, yeah, yeah. If you got a single drop, making a tenth of a drop of something bad might even be beneficial because some of the reason they can be called negative is because they're stronger in certain ways. And so of course, the body's going to do a little bit of that. It's going to make a kind of stronger, more aggressive metabolite when it doesn't have enough in the first place. So, first of all, taking it contextually. But then if you have a normal level of a hormone now, it does matter more if you're spilling out something like a 4 hydroxy. But you mentioned a 16 hydroxy. And that's interesting because we used to say 16 was the bad guy and 2 was the good guy. And so we would measure what's called a 2:16 ratio. And if your ratio so since two is good, if we're doing it that way, if you want a high ratio, if your ratio was low, then that meant you were more at risk for breast cancer. But then the original researcher who looked at all this, oops, I don't think it's this 16 metabolite. It's more this 4 hydroxy estrone, estriol, estradiol. That's actually the one that's more likely to go on to become this thing that can damage the DNA. And so then he said, and the way you shift that is a little bit different than shifting a 16. Your best bet is diindole methanes. They're a compound from broccoli that, you know, I've learned a lot about from you as well. From the cervix to the prostate, they really like to help reproductive tissue. And so we can combine these things with hormones to make sure people are moving in a favorable way. If we measure, if we know, if we realize. So nobody loves going to the doctor. We'd rather be at a rodeo, right? Or, you know, maybe even getting low carb ice cream somewhere that might be more fun. But what we do also know is that once a year, one visit really isn't going to be enough to get us to a state of health. And so we have to engage more. We have to think about going in, having a history, changing our diet, thinking about levels now, thinking about how we're metabolizing those levels, continuing to think about the person that they're going in. Are we detoxing? Are we supporting something called our adrenals, little glands that sit on top of the kidneys, that make our adrenaline, our get up and go hormones, but make these precursors that lifelong convert to reproductive hormones. All of this should be really talked about during this natural menopausal transition where there's so much that we can do just that way naturally, including bioidentical hormones, but not exclusively in terms of really continuing to feel well, because if I'm going to be shallow for a moment, in my opinion, I think the most beautiful, I think women really hit their beauty stride, I'm going to say at 36 or up, I don't think it's a 20s thing. And that is the number where you have your first big statistical drop off in hormones too. But in my opinion, I think that's about the place where women really come into their own. They have this confidence, they have this swagger going on, like they know what they're doing, where they're at, and it shows in terms of that outward glow. And yet at the same time, these more trivial things, if you will, in a way that are things that should not be getting in our way at this moment, like our hormone shifting start to kind of trip us up or in the peak of our beauty. So if we could just, you know, put that back in place, this is where we've gathered the wisdom and the strength and we're really pushing those things forward. So, yes, thinking about how to manage this natural transition in a way that continues to support us as we grow in our wisdom and our beauty, I think is imperative.

Yeah, I think we go like the stages. And when I think about it, it's like from the maiden to the mother to the magi, to bringing the magic in our life. That high intuition, that high, like enchantress stage. And hey, that's what I'm claiming right now. Yeah. And Cheryl, so we think about this, and you mentioned dim for estrogen detox. So di and omethane and glucophorin is another substance. And like broccoli sprouts. Right. So like handfuls of broccoli sprouts. You'll be proud of me. Before this call, I did eat some of my leftover spaghetti sauce, which was just organ meat, organ ground meat. So with some regular ground meat. So primal round, if you want to call it, with great fresh tomatoes and sauce that I put together last night with lots of herbs and spices. Because that's the sneaky medicine, right? That is our sneaky medicine. Herbs and spices were designed as medicinal. As medicinal. So that's why, like, say I create medicinal menus. I'm not just creating a diet, I'm creating medicinal menus. So I got all that, but I put in like a handful of broccoli sprouts. I'm like, I just gotta keep up with this. And also we can supplement. It is probably one of my favorite supplements for women because of all the things that we're seeing with brain health and certainly with estrogen metabolism and especially in this estrogen dominant or endocrine disruptors that are there now. This is something I've been curious about, you know, is that sometimes we see the symptoms, say, for example, hot flashes as a symptom. It is typically associated with estrogen deficiency. But people can have normal or healthy, optimal, even estrogen levels and still have significant unrelenting hot flashes. What have you found to be a reason for that? Because, you know, I've seen people on tons of, you know, they'll come in on higher and higher doses of estrogen. Like, well, I've been still having hot flashes. I'm like, okay, I've got. I've got my opinion, but I want to hear yours.

Yeah. And so I think in a world like that, and so we've ruled out, there's not estrogen there. We're looking at it. There's a level of estrogen. So what else could be going on? Is something blocking that estrogen from working like it should? So a lot of these environmental endocrine disruptors can do that. So getting somebody on a good detox. You mentioned those broccoli sprouts, that sulforaphane. And it does help us detox as well. So one of the magic pieces of magic about that is it too is an everybody knows broccoli decreases breast cancer. Like, that's something that we hear about. We know broccoli is good for us. Well, it keeps that estrogen in that healthy form. It helps us make some of those good metabolites. Maybe not quite as much as the dim that we mentioned, but it does do that to a smaller degree. But in addition to that, when it reduces oxidative stress with those free radicals, it keeps those pathways moving in a direction that it should as well. And it gets into the brain. Well, so, for example, if I gave a lot of broccoli sprouts to an animal and did an autopsy on them and look to see where it concentrates. It concentrates in the brain and in the reproductive tissue, like breast, ovaries, prostate. And so what we see with the brain is it gives us good focus and concentration. So if there's a brain fog component, but then it's protecting our reproductive tissue, our breasts and ovaries, and it's protecting the estrogen itself. So it's a nice little package to put there at the estrogen. It helps it to detox from the body. And so I think some of the hot flashes can be. Because there are things in their way. Endocrine disruptors, toxins. So your level looks good, but something is blocking it. Another piece is not just endocrine disruptors, but inflammation itself. So, for example, there is a marker that will go up when we are more inflamed. It's called F2 isoprostane, and it's associated with brain fog. It's associated with hot flashes. It's also associated with cardiovascular disease. The cardiovascular disease and the hot flashes aren't too surprising to see together, because a lot of the literature talks about a hot flash, not per se, being only a hormone deficiency, but how is your vessel working? Is it releasing heat and constricting like it should? Like, I saw this really cool study that talked about and I don't want anybody out there having self blame. So if you exercise regularly and you're still having a hot flash, this is not because you're not doing it right or. But it talked about how in general, when you have a population that exercises more compared to those who don't, they have less hot flashes because it's a thermoregulatory event. And so exercise helps us practice how to release heat. And so there was a connection between high intensity exercise and less of a hot flash because you are practicing vasodilation, vasoconstriction. So we've got to do things that help the vessel to practice when to release heat, when to constrict. It turns out exercise is very good at that. So creating a healthy vessel is another piece of that getting inflammation down. I started to hint at this, but there's a marker, that marker, F2 isoprostane. Not only does it tell us we're experiencing inflammation, but we make it in our body and it will sit where the estrogen's supposed to bind and block it from being able to bind. So if we're looking at a test and saying that the level is there, most people do fine at this level, what is it in that person that's keeping the estrogen from working like it should? A good next idea is, well, what's getting between it and the receptor? What's getting between the key and the key hole? And often that is inflammation, oxidative stress, or some toxin. And so as we clean people up, we see things get better. Like I think a lot of times in our younger population when they're not having periods or they're irregular, we really think about, you know, like a standard of care approach would be to put them on birth control pills. And I'm not saying that's out of the realm of possibility, but it's not looking at what the issue was, why they got there in the first place. And so a lot of times with just good detox, we can get people back to hormonal norm and then add to that detox and helping to figure out where inflammation is coming from. So we get rid of these things that are mucking up those works. That's really, to me, that is a whole person hormone type care and just whole person care.

Well, I think it's so important because like, I want people to be able to say, hey, I fixed myself right Like, I fixed myself. I'm not using medications. I'm like, my lifestyle's great. My nutrition's great. My mindset is, that's great because we have to put it all together, right? But I fixed myself because we can't, you know, like, yeah, it is not that. Here, take this. Here, prescribe them. And there's time and a place, but we want to be able to, you know, fix ourselves. And it takes more than hormones to fix our hormones. And I want to talk about this because this is something I'm seeing in the clinic, especially, you know, measuring total toxic burdens and mold toxins and things like that that we're seeing as huge hormone disruptors. When I find that challenging patient, or she comes in and she's had a cancer diagnosis or an autoimmune diagnosis of some sort, I'm like, okay, well, we've got to get to the bottom of this. First of all. Okay, tangent with you right here, Cheryl. First of all, you're getting these diagnosis, and the physician isn't even asking, how did you come to get this diagnosis? What caused. What's the underlying reasons you got this diagnosis? They're in treatment mode. God bless them. Right. But you as an individual, listening, have to ask for yourself, have to advocate, have to do, like, your Nancy Drew detective work and get to those reasons. So I'm seeing these challenging patients that have these issues and. And I wonder with, you know, with the hormone balancing, we're going to detox and stuff, but we're in that process, and I think, is there damage to the receptor sites? Can there be, you think? They're continually repairing Sutter, but sometimes I'm like, gosh, have we, you know, have these things permanently damage the receptor site?

I mean, we see it with insulin, right? And to your point, like, maybe someone who is having a hot flash, they got more estrogen, and now they're really on an upper level of that. And I'm sure you and I have both had moments where we're using upper levels, but we're thinking for a short period of time, and how are we going to get this back to where most people normally are? And so, yeah, when they get to those upper levels, you can have kind of more resistance and downregulation. And conversely, you see in the literature nutrients that help the receptor work better, like vitamin A, vitamin D and Omega 3. So people that could be more deficient in those for other reasons also not getting the same binding capacity. And then I'm sure those xenoestrogens are not really doing our receptor sites a huge favor. And when. And you can look at how some of those just bind so tightly for so much longer than estrogen. So I don't even think it's an educated guess. I think it is, you know, what you see in the science.

Yeah, yeah. And so then we really have to work on repairing them and regenerating and optimizing the ones that work. And so, you know, I'd say any of these symptoms that we experience are your body's cry for help. And then always look at, okay, what can I do? This is. I call this my lazy medicine approach, Cheryl. It's like, what can I do? What's the smallest thing I can do to make the biggest change, positive change?

Like, what are those that get you hired at Microsoft? Because a key part of their testing is who's gonna. Like when they bring you in for three days of putting you down to put things together. A key thing they look for is who comes up with the laziest solution, the easiest way to get from here to there. So if you need a next career.

There we go. There we go.

I'm ready.

I am well prepped. Now, you mentioned we were talking.

That's the one that everyone's gonna have the most compliance with, too. That's the one that's achievable day after day, you know. Yeah.

Well, I'm just going to call out some people too, here, because as a physician, I see people, you want it done for you. I don't want to work with you. I want you to do for yourself. I'm your partner in this. But, like, you know that go to standard medicine and they'll give you the prescriptions and they'll do whatever. And, you know, that's it. But, like, you have got to participate in your health. You are, in childhood, a teenager. I'm in charge of me, Mom. Right. And you are in charge of you. And it's so true. We are in charge. Like, we are responsible. If you want to stand up in this world and have health and be effective and make an influence and create peace and all those things you have to be responsible for you. Your choices are either leading you towards health or towards disease. And it's ultimately our choice. But my doctor told me. But what did you do? You know, what are you doing that works? And that's why we're always teaching. Okay.

We're not going to be able to be at the dinner table and decide what you eat or, you know, make sure that you're exercising and just Some of that's just non negotiable. It's hard and I should actually. I'm going to qualify that. It's harder as you're getting started. After that it becomes a habit, you know, like it's much harder the first time you go to the grocery store and you're trying to figure out what has the lower carbohydrates or. I was just looking at some research in terms of weight gain and they were showing controlled calories, same amount of calories, but this group has a whole bunch more junk in the food that they're eating. You know, a peanut butter with, let's say, two things, peanuts and maybe salt versus, you know, five, six, seven, eight things. And even myself, who's steeped in this, when I saw that, I was like, okay, yeah, go back, make sure, you know, that you're reading your labels. But yes, it's harder initially that first time, that second time, that third time when you're figuring all this out, when you're trying to sort through that, but then it becomes habit forming and it does get easier. But yes, you do have to do that work. And if you're not gonna do that work. Yeah, there's not a magic pill. Right, right. I realized I figured that out. That's why you're not looking for that anymore.

Yeah, right, right. You've been down that route. Okay, so I wanna talk about these high levels of hormones that sometimes people end up on by the time they come to see us. For example, testosterone pellets and estrogen pellets. So what are you seeing there? Do you have any red flags with that? Do you have any concerns long term for the HPA axis? Do you have any concerns about that?

Yeah, absolutely. Because just as I talked about when we barely have any hormone, worrying about metabolites is probably putting the cart before the horse. When you have a lot, even if you have great detox, you're probably going to make some more of those unfavorable hormones. And I think that while we all think hormones are valuable, we would also generally agree that the least amount that we can use to have a clinical outcome that's in a good, healthy, normal range is going to represent health the best. And so you see these people that just a pellet gets put in and their testosterone just shoots off the chart. And we know issues with that is that you can make more metabolites here, dihydroxy testosterone, make your hair fall out, make you break out. Not great for your prostate if you have one. So absolutely concerned. And it can compete with other hormones and in general you just get out of balance. Then the trick becomes, but it can for some feel pretty good to be kind of jacked up for a convenient term. And so now what do we do to get somebody back into normal range but keep that quality of life?

Before we go there, I want to talk about what I've seen like in people that have been on pellets for five years, let's say, and so they've been like for women continuously on doses, 200, 300, 400, on a serum level, when we see a total testosterone, we'll still look at the breakdown, but we see these higher levels of total testosterone and then they are like all of a sudden like, I feel terrible, I'm feeling depressed, I feel like it's not working. And this is where I have to question the hypo, pituitary, you know, the hypothalamic pituitary, adrenal, thyroid, gonadal access, the connection. Like we're down regulating other systems.

Yeah, so I just did a whole course in this area looking at interconnections between reproductive hormones, thyroid and adrenals, which are all a part of that axis. And yes, when something gets out of balance, it really pulls on another system. And there was a lot of this goes up, this goes down, this goes left, this goes right, sideways, back and forth. But really to me, the take home message was when one system gets really out of balance, it pulls on another. And so you're probably getting dysfunction elsewhere as well outside this pellet example. Kind of clinically, if you have been working, working, working, working, working in one area, like just working on your thyroid, can't get it right, back it up. Look at some reproductive hormones and look at some adrenal hormones too, because they all pull on one another different directions. And to your point, women on pellets, they're going to metabolize that into estrogen and then all those estrogen metabolites which can continue to not make them feel well. And we know maybe it's happened once or twice, but in general you are not going to have a woman sit in front of you who says, I do not have a good libido. And then you're going to slap her on testosterone and she's going to say, wow, that magically thickens. Fixed everything. That just isn't usually how it works.

It can, or it may be very short term, short term, it can work.

That way more often for men, I think, but for women we really have to be in balance. And so that's not just testosterone. That's estrogen, that's progesterone. When you shunt one, it floods some of these other pathways. It makes metabolites that compete. Then you know that it's not just even reproductive hormones. The thyroid part, if you get that beautifully balanced and someone has low functioning thyroid, which makes you fatigue, which makes you gain weight, which makes your hair flat, which makes your hand cold, your feet cold, that does not make you feel sexy when you go to bed. So really it's more of this complete balance. And when one pathway gets real tugged one direction, it inevitably messes up something in somewhere else in your system.

Yeah, yeah, definitely seen that. I've seen. And also abrupt stopping of those pellets because then you're in the mill if you abruptly stop depression and suicidal ideation. So it's definitely affecting something. Otherwise, why, when you go cold turkey, you're experiencing such severe symptoms, People step.

In with things like maca when they are coming down off too much testosterone. So they're doing something else to support their body's ability to feel good, but in a more balanced way. And so really, to me, yeah, that's integrative medicine. It's not saying, oh my gosh, somebody put you on too much testosterone, never do that again, right? It's like, how do we use it for you?

Yeah. And so coming off of it, right, like coming off slowly, just like with an SSRI or other, you know, antidepressant or anxiety, like, you come off slowly and support your body and start implementing another backup method or physiologic method that you're able to tighter easily. But also, I think the supplements definitely, for me, it's Mighty Maca plus, right? It's my superfood combination. So it's mighty Maca and then there's, you know, other combination. So a good detox support, liver detox support. And the gut, you have got to have a healthy gut. Now, you've done some of the most brilliant work in this area, Nick, talking about gut, but we say that gut is fundamental. It's ground zero. We have to address the gut. What is the gut? Hormonal connection?

It's fascinating and wild, and I think it's just there's so much there, like, I could say, like, simple things like they've done studies with lactobacillus, a probiotic, and seen good increases in serum thyroid hormone levels. Or we could talk about estrogen again. And there's even a part of the microbiome, the flora inside of us, that they call the estrobolome and it's not even a made up word, it's a real thing that there are certain bacteria that are better at helping us with favorable estrogen metabolites, with moving these out of our body, with decreasing cancer risk. Like even when we back up some of the things like in terms of like phytoestrogens, good or bad, it might not have ever been that question. Exactly. Really like when we look at something like soy and I'm gonna table soy chicken nuggets, soy burgers, soy processed food, I think that's a different thing than edamame and good clean sources. But there are anti cancer compounds from that phytoestrogen but you get more of those if you have a certain microbiome compared to people that don't. And so this gut based interconnection is really beautiful. And I think a real simple way to say it is like we'll sit down with a patient and we'll say okay, we want to make these dietary changes, I'm get some hormones on you and then you're going to come back in a couple weeks and they come back and they go, I already feel better, I'm already having less hot flashes, I'm sleeping better, even though they haven't started a hormone yet. And it's because we've worked on this gut connection through diet. We sent them home to try to see how any, you know, if these, they could embrace some of these changes. And when people are able to, you do see good results from that. And so even IVF studies that will combine certain flora probiotics because they know that those probiotic and sometimes used vaginally create a less inflammatory environment and less inflammatory environment allows an egg to attach better. And so how, I guess if I just put it in a nutshell, it is our strongest tool for making the gut less inflamed and then which makes the body less inflamed. And so hormones just work better in a less inflamed environment. So I could keep eating a whole bunch of processed food and junk and I'm going to need more and more estrogen to overcome all that junk I'm doing. And then if that junk causes me to gain weight, something goes up called leptin and that will be a feed forward into insulin resistance and gaining weight. And Nature, one of the highest impact factor journals out there, talks about how leptin flips the switch on estrogen to make it much more dangerous. And so again, what's the person, what's the environment, are we helping them in terms of bmi, in terms of inflammation? And those might be just saying the same thing from a different direction. But all of that, if I'm trying to just crystallize it, when I think about this gut based work, I think about the reason that we do that is because it's our strongest anti inflammatory. And our strongest anti inflammatory isn't a pill, it's not, not prednisone, it's not a biologic that shuts the immune system down. I guess it could be, but that comes with a lot of side effect too. But a strong anti inflammatory that doesn't shut our immune system down, but actually balances it. That's our gut based work. Our best way to build the immune system. That's not a mushroom or a vitamin C or a vitamin D. That's our gut based work. That's where the immune system is, that's where a lot of detox happens. And so when we're thinking about what's our strongest way of lowering inflammation, that's through changing the diet, that's through working on our microbiome. And so all of a sudden if we're asking you to collect stool and you're like, I'm just here cause I wanna know what my progesterone is, that's still an important part of it. Cause we want that progesterone to work better.

Yeah, no, absolutely. I'm so glad you said that so profoundly. Okay. And in the last few minutes I wanna just kind of rapid fire some questions at you really quick. Let's see. Okay, first, if a woman could do only one hormone test, which would you recommend and why?

One hormone test and why? All right, then I will go for a urine test because that's going to give me level and metabolites. That would be the most complete picture all at once.

Okay, and if you were to do other functional tests, what would be your second test that you would do to help her balance her hormones, improve longevity? What's a one functional test that you would absolutely recommend?

Probably looking at some type of gut based workup like a stool test would be the thing I'd want to look at next because that would give me a picture of the healthy microbiome. How's your estrobolome, how is something called beta glucuronidase that specifically is involved in some of those estrogen metabolites? And a whole bunch of other information that just tells me are you absorbing your nutrients, are you making things called short chain fatty acids that are anti Inflammatory. And if gut's going to govern whole person inflammation, and that's probably the thing that gives us the most information about the gut.

Yeah, no, I agree. Okay, so what's the most overlooked marker on lab work that can reveal hormone imbalance and or inflammation?

Okay, so I think oxidative stress markers.

I agree.

But I want to know that there is a healthy level of glutathione in the person that I'm looking at. Because if there's high levels of oxidative stress, you don't make your own hormones very well. We start from cholesterol to make a hormone. Oxidative stress blocks that enzyme from that becoming the backbone. Then when we finally get to an estrogen, it changes the metabolism of it, of where it goes. Then oxidative stress slows down the methylation of it. That last ditch effort to get it out. Then enough oxidative stress can even take some of those good guys and cork them and crunk them into a form that can eventually damage the DNA. So it can influence whether they're leaving the body or damaging the DNA. So, and all I'm really saying is are you putting hormones into a system that has lots of antioxidants and less inflammation? We all know that's going to work better, but just making sure we're looking at those at the same time.

So MPO myeloperoxidase.

Yeah, a lot of good research with 8 oh D G as well, which you may find many times on a urine hormone test. They're smart to put that there, called 8 hydroxy 2D iguanosine. If you want a long name. All it means is you've got too many free radicals. You've got so many free radicals that's damaging your DNA. And so we need to get that under check while we're putting more hormones in the body so they have the fate that we want them to.

So other blood markers, like are you looking at, you know, what other lipid peroxides are you looking at?

Or I love that F2 isoprophane too.

Is that some blood marker? I don't think I've ordered that except in especially.

It's a lipid. It is a marker of lipid peroxidation. But unlike T bars or mda, they're extractions in a lab. This we make internally and it does block the estrogen receptor.

So how effective is the oxidative LDL when we see that on a lab?

That's a great one too. To me it is the most predictive there's a lot of good cardio markers out there, but I think it's the most predictive for cardiovascular disease. You could try to argue and say apob, but we're really saying the same thing because they measure how oxidized the APOB is on the oxldl. So I think that's a great marker and it's a very predictive in terms of cardiovascular disease, but also goes up when there's more vascular disorder, which can drive a hot flash as well back to that healthy vessel.

So much, Cheryl, so much. Let's go into. Okay, what are some of your favorite supplements? Say we're already eating a very healthy, say keto green or keto alkaline diet. We're eating low carb, we're periodically intermittent fasting, and we're like, okay, we want longevity. The greatest research on which supplement, but I want the foundation.

So a mighty maca is an amazing step in for that. Because so often what people really say is they don't say. They do say all these things. They say fatigue and insomnia, et cetera. But what they really say is I just don't feel like myself. I don't feel well. And that covers so many bases in terms of how you'll feel well, from the hormones to the dopamine, the pleasure center of the brain, to supporting the adrenals, to making us more resilient to stress. So something that's just going to cover a lot of bases really quickly and adequately. I think that is amazing. Mentioned the broccoli sprouts. That's sulforaphane. That makes the hormone healthy, that makes the detox of it healthy, and it protects the brain and the breast. It really concentrates there. So really lowering our risk of cancer. In addition to that, I do like a phytoestrogen or two because we'll always have somebody who doesn't feel their best at a higher level of estrogen because it's not about a lab level, it's about quality of life. And you bump it up and they don't feel good for some other reason yet they're still having a hot flash. They're just sensitive in one way or another. So aprinyl nerogenine is a compound from hops. And it's just got such phenomenal research in terms of helping us with areas that estrogens would help with. It helps with cognitive decline, it decreases wrinkling, it helps with bone density, it helps with muscle mass. Bone. Did I say bone density? Yeah, it helps with some of the major things that we want an estrogen to help with. It shows up in all of those areas in the literature. And so it gives us another option when somebody is more sensitive in a particular direction.

I have to say I put hops in my night seas because I was like, okay, we gotta get restoration while we sleep. If we're not sleeping long, let's at least make it more efficient and productive.

Absolutely.

And then when like. Cause we worry now, like reading some of the scientific literature, when people are high oxidative stress, they shouldn't do omegas until we get down that like using the phytochemicals, et cetera, to bring down. Can you explain why that is?

Yeah, because they're not gonna be as effect. And they can get mucked up too. Kind of like how estrogen can get mucked up in a less healthy vessel. The same is true of your omega 3 fatty acid. So that same up 2 isoprostane tells that story. Well, for example, in studies where it is high and someone uses an Omega 3, they don't get the same benefit that oxidative stress is keeping that Omega 3 from doing what it should do. So many times it will convert into these other compounds called resolving mediators or lipoxins or resolvins, or in the brain, it moves to things called neuroprostains, particularly that DHA part of it. And neuroprostains help us think. But when F2 isoprostane is high, it blocks it from doing that. And so the system is too oxidized for it to work well, so it doesn't get incorporated where it should, like the brain, like the myelin sheath, the outside of the nerve. And so we've really got to improve the environment of the body to make that fish oil work better. And so when there's more oxidative stress or when we're measuring some of this oxidative stress, we'll be able to see who's a good candidate or not.

Yeah, I think that's important because I used to always say that's foundational. But now with more of the immune issues and inflammatory systemic inflammation, it's like, okay, we gotta come at this from different angles before pouring on the fatty acids. Thank you, Cheryl. Okay, so we've talked about hormones and hormone disruption. We've talked so much too about empowering. Like, we are powerful as individuals. We have our choices. We want well visits. We're not just going to wait for you to find something that we're sick about. Except we're sick about the healthcare system. In America, we talk about inflammation and the importance of gut health for hormonal health and how that's a piece of our evaluation and work in helping clients have healthy hormones and longevity, quality of life. So our health span equals our lifespan and all of these important pieces. And you know, we are always in it, right? And all like you can see it's complex, right? Our listeners, you know, after our conversation, like it's complex. But just listening to this, you start to pay attention more, you start to ask more questions, you start to be a critical, I mean having the information to be even more of a critical thinker. And so I think those are really powerful pieces. Cheryl, tell our audience where they can get a hold of you or your practitioners and even join your training programs and.

Yeah, absolutely. So Progressive Medical is the clinic that I am at in Atlanta, Georgia. And then I do some training programs for clinicians out there that's virtual, so that's Anywhere Origins Incubator and then also do some lab testing at Precision Point Diagnostics. So if you are looking for some of these lab markers, you can reach out to us and we'll tell you clinicians that do some of them where to go. And so also finally, I am the educational director for Zymogen as well, which does a lot of supplement work. So very happy to be there. They think they do good quality work and happy to get more of that kind of information out there. Just like I'm always happy to be talking about what you're doing because I'm always on the edge of my seat every time I get to listen to you. I know I'm going to learn something new. I know I'm going to learn something useful. I know I'm going to think about something in a different way, probably in a mind blowing way. So thank you for all the education that you do. So many women are deaf, desperate for what you're providing. How can I treat this like a normal event? How can I just get information about my body that's not painting me in a sickness corner? So yeah, I really appreciate what you do.

Right back at you, Cheryl. Right back at you. I'm always blown away. I feel like I'm drinking from a fire hose every time I listen to you. It's powerful. So really, thank you. This has been an enlightening conversation. You've helped us address and understand these issues, right, These key hormones issue. I want everyone listening to say, okay, I need to listen to this again. And you do and share this episode because we touched on topics that aren't going to be in our standard medical care conversations for probably, I don't know. What do you think, Cheryl? 10, 20 years.

That's what I used to say 20 years about this. And now here we are and they're still out there.

They're still right. Exactly. I started estrogen detox testing, I think in early 2000s, 20 years ago. Shoot. We're still not there. Okay, so there you go. Hopefully not another 10 to 20 years from now. But understanding that hormonal health isn't just about estrogen and progesterone. It's the orchestra of our hormones, our gut health, inflammation and lifestyle all working together. So to all my listeners, your hormones are not betraying you. They are your messengers calling you to deeper care, deeper investigation, deeper Nancy Drew where work and I'm really glad that all of you guys are here. Please leave a review and subscribe. Definitely subscribe on my YouTube channel at the Girlfriend Doctor your reviews and shares of this episode help me reach more people and help these messages get out and to as we become more educated, we force the change in our medical system. As we advocate for ourselves, we force the change in our economy and our healthcare dollars. So stay strong, stay sexy, stay empowered. I love being your girlfriend doctor. God bless y' all till next time. And before I forget, don't you forget to sign up@dranna.com forward/deals so you don't miss out on the best deals of the season. And as always, join me in sipping on Mighty Maca. Plus, it helps you keep your mind, your gut, your hormones in check. It is that clean energy and willpower that you need. I call it my healing journey in a jar. Drink it hot or cold. It is delicious. Wrap those hands around your mug and cheers my fellow friends. Here's to staying grounded, glowing and gorgeous us this holiday season.